Eclampsia, Advanced Early Testing, Multiple Gestations, Antenatal Testing

Question 1

Transient hypertension?

Answer 1

Nonsustained bp over 140/90 before 20 weeks. No treatment, no symptoms

Question 2

Chronic hypertension?

Answer 2

Sustained BP over 140/90 before 20 weeks. No symptoms, no need for urinalysis, treat with hydralazine, metoprolol

Question 3

Mild preecplampsia

Answer 3

BP over 140/90 sustained after 20 weeks. Urinalysis over 300mg/dl. No symptoms

Question 4

How to treat mild preeclampsia?

Answer 4

If over 36 weeks, give mag and deliver.

If less than 36 weeks, give mag and steroids to develop baby

Question 5

Severe preeclampsia

Answer 5

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)

Question 6

Eclampsia

Answer 6

Seizures, give mag and deliver.

Question 7

When to do advanced early testing

Answer 7

For history of chromosomal abnormalities, spontaneous abortions, AMA (>35)

Question 8

How accurate is ultrasound to assess fetal age

Answer 8

+/- 1 week in first trimester
+/- 2 weeks in second trimester
+/- 3 weeks in third trimester

Question 9

When is transcranial doppler done and why?

Answer 9

Greater than 20 weeks to assess fetal anemia. Increased flow = anemia

Question 10

What week is amniocentesis done and why

Answer 10

over 16 weeks to looks for afp and genetic material. Also LS ratio

Question 11

When is chorionic villous sampling done and why?

Answer 11

8-12 weeks to look for genetics and karyotype

Question 12

Risk of Amnio?

Answer 12

Fetal loss is 1/200

Question 13

Risk of CVS?

Answer 13

Fetal loss is 1/150

Question 14

PUBS indication and week and risk

Answer 14

1:30 fetal loss, done over 20 weeks to assess fetal anemia and transfusion

Question 15

Algorithm for working up multiple gestations

Answer 15

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

Question 16

Risk of di di di twins?

Answer 16

Preterm labor, malpresentation, 50% c/s, post partum hemorrhage

Question 17

When does mono, di, di split occur?

Answer 17

At 0-3 days. There are two placentas and two sacs.

Question 18

When does mono, mono, di split occur

Answer 18

4-8 days in blastocyst stage.

Question 19

Risks of mono, mono, di

Answer 19

Twin twin transfusion. Transfusing twin does better even though they come out smaller. They don’t have to deal with a huge bili load

Question 20

Risks of mono mono mono

Answer 20

Cord entanglement, conjoinment

Question 21

Why do antenatal testing?

Answer 21

High risk pregnancy or decreased fetal movement.

Question 22

Algorithm for antenatal testing

Answer 22

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.

Question 23

NST reassuring signs

Answer 23

Moderate variability with accels that are 15 for 15, 2 in 20 minutes

Question 24

Biophysical profile components?

Answer 24

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.

Question 25

Contraction stress test looks for

Answer 25

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.