Eclampsia, Advanced Early Testing, Multiple Gestations, Antenatal Testing Flashcards
Transient hypertension?
Nonsustained bp over 140/90 before 20 weeks. No treatment, no symptoms
Chronic hypertension?
Sustained BP over 140/90 before 20 weeks. No symptoms, no need for urinalysis, treat with hydralazine, metoprolol
Mild preecplampsia
BP over 140/90 sustained after 20 weeks. Urinalysis over 300mg/dl. No symptoms
How to treat mild preeclampsia?
If over 36 weeks, give mag and deliver.
If less than 36 weeks, give mag and steroids to develop baby
Severe preeclampsia
Sustained BP over 160/110 and 5 g of protein on UA with symptoms like epigastric pain, headaches+vision changes. Treat with mag and deliver (C/s)
Eclampsia
Seizures, give mag and deliver.
When to do advanced early testing
For history of chromosomal abnormalities, spontaneous abortions, AMA (>35)
How accurate is ultrasound to assess fetal age
+/- 1 week in first trimester
+/- 2 weeks in second trimester
+/- 3 weeks in third trimester
When is transcranial doppler done and why?
Greater than 20 weeks to assess fetal anemia. Increased flow = anemia
What week is amniocentesis done and why
over 16 weeks to looks for afp and genetic material. Also LS ratio
When is chorionic villous sampling done and why?
8-12 weeks to look for genetics and karyotype
Risk of Amnio?
Fetal loss is 1/200
Risk of CVS?
Fetal loss is 1/150
PUBS indication and week and risk
1:30 fetal loss, done over 20 weeks to assess fetal anemia and transfusion
Algorithm for working up multiple gestations
Look at sex first. If different sex then its definitely dizygotic dichorionic diamniotic. If same sex then look to see how many placentas. If two, then monozygotic dichorionic diamniotic, if one, see if there’s a septum. If septum then monozygotic monochorionic diamniotic. If not, then monozygotic monochorionic monoamniotic
Risk of di di di twins?
Preterm labor, malpresentation, 50% c/s, post partum hemorrhage
When does mono, di, di split occur?
At 0-3 days. There are two placentas and two sacs.
When does mono, mono, di split occur
4-8 days in blastocyst stage.
Risks of mono, mono, di
Twin twin transfusion. Transfusing twin does better even though they come out smaller. They don’t have to deal with a huge bili load
Risks of mono mono mono
Cord entanglement, conjoinment
Why do antenatal testing?
High risk pregnancy or decreased fetal movement.
Algorithm for antenatal testing
NST, if reassuring see patient in a week if high risk, stop if decreased FM. If NST is not reactive, then do vibroacoustic stimulation. If that’s not reactive do a BPP (assess AFI, NST, Breathing, Tone, Movement) if 0-2 fetal demise is immanent (deliver via CS), if 8-10 then all is good. If bpp is 3-7, and gestational age is greater than 36, deliver. If less than 36, do a contraction stress test. If there are late decels or fetal bradycardia, then deliver baby via cs immediately. If there are no late decels, admit mom and give steroids to grow baby.
NST reassuring signs
Moderate variability with accels that are 15 for 15, 2 in 20 minutes
Biophysical profile components?
NST, AFI, Breathing, Tone, Movement. If less than 2 emergently deliver. If greater than 8 okay. If between 2 and 8 then look at age. If over 36 deliver baby. If under 36 do contraction stress test.
Contraction stress test looks for
Look for 3 contractions in 10 minutes or give pit. If there are late decels or fetal bradycardia deliver via cs. If no late decels then admit mom and give steroids.
