High Risk Pregnancy Care Flashcards
Maternal complications from the effects of alcohol and nicotine use during pregnancy include what?
pre e, placental abruption, placenta previa, spontaneous abortion, ectopic pregnancy and PROM
What is the highest prevalence of women who smoke during pregnancy?
non-hispanic American Indian or Alaska native women
Up to how many days after birth can an infant show signs of NAS?
up to 14 days after birth
Birth defects, low birth weight, premature birth, small head circumference and SIDS are general effects of infants that were exposed to what in utero?
Opiods (prescription or heroin), barbs or benzos
What does TORCH stand for?
Toxoplasmosis, other (syphilis, varicella-zoster, parvo B19), rubella, cytomegalovirus and herpes
Fully cooking meat, avoiding unpasteurized milk/cheese, avoid handling kitty litter, avoid drinking untreated water and good handwashing following gardening are all prevention education that should be given in order to avoid which infection?
Toxoplasmosis
The greatest risk for congenital varicella syndrome occurs when the mother is infected in the first or last 20 weeks of pregnancy?
First
Maternal infection occurring from ____ days before to ____ days after delivery can be passed to newborn causing serious infection
6 days
2 days
A maculo-papular rash that becomes vesicles and then crusts by 1 week is c/w which virus?
Varicella
What antiviral agent can be given to mothers who have a severe varicella infection?
IV acyclovir
What do you give if a pregnant woman has been exposed and is susceptible to varicella?
varicella-zoster immunoglobulin (VZIG)
Disease transmission to fetus and likelihood of severe complications are highest in which trimester for parvovirus B19?
second trimester
What are 2 complications that can occur to the fetus if the mother has parvovirus B19?
Severe fetal anemia and hydrops fetalis
A discrete pinkish-red maculo-papular rash that appears first on the face then on the trunk and extremities with symptoms lasting 3 days is c/w which virus?
Rubella
What is the most common congenital infection?
cytomegalovirus (CMV)
Mononucleosis-like syndrome consisting of fever, chills, malaise, myalgia, leukocytosis and lymphadenopathy is c/w which virus?
CMV
Most cases worldwide are HIV 1 or HIV 2?
HIV 1
Which screening test is used for HIV?
enzyme immunoassay (EIA or ELISA)
Which cells are a type of white blood cell that plays a vital role in the immune system?
CD4
What is the strongest predictor for vertical transmission and at what point should you offer a cesarean?
Viral load
Consider a cesarean at 38 weeks if viral load is >1000 copies/mL
Which IV highly active antiretroviral therapy (HAART) is indicated during labor for the HIV positive woman?
zidovudine
What two things is an infant at risk for if their mother was infected with Zika during pregnancy?
Microcephaly and severe brain damage
A prenatal diagnosis that is based on u/s measurements used to describe impaired or restricted intrauterine growth and considered a pathologic process is what?
IUGR
A neonatal diagnosis that describes an infant who falls <10th %tile is what?
SGA
Occurs early in pregnancy and is likely caused by congenital infections, chromosomal abnormalities and maternal drug use (tobacco, alcohol, dilantin, cocaine, heroin) is which growth restriction (symmetric or asymmetric)?
Symmetric
Appears later in pregnancy and is r/t either reduced nutrition to fetus causing decreased abdominal circumference or abnormalities in utero-placental perfusion causing a head sparing appearance is which growth restriction (symmetric or asymmetric)?
Asymmetric
Newborns weighing over _____ or are > ____ %tile are considered LGA/macrosomic?
4000g (4500g in some studies) or 90th %tile
Which term refers to placentation of twins and is most reliable when assessed in the first trimester?
Chronicity
Use of fertility drugs increases the chance of which zygosity in twins?
Dizygotic (DZ) (fraternal)
What three things must happen for Rh isoimmunization to occur?
Fetus must be D+ and mother D-
Mother must be sensitized
Sufficient quantities of fetal cells must gain access to the mothers blood stream
How long is Rho (D) immunoglobulin (Rhogam) protective for?
12 weeks
What condition is the #1 reason for hospitalization in the first trimester?
Hyperemesis gravidarum (HG)
What are some of the typical criteria for HG?
severe/intractable vomiting with unknown etiology, weight loss of >5% pre pregnancy weight, ketouria, electrolyte imbalance, thyroid/liver lab abnormalities
What are four different medications that can aid with HG?
Pyridoxine, diclegis, metoclopramide and promethazine
Cough with minimal sputum production, low grade fever, hemoptysis and weight loss and c/w which infection?
Tuberculosis
What medication do you treat a woman with during pregnancy if she has latent TB infection?
Isoniazid (INH)
Serum hCG is positive ___ to ____ days after fertilization?
8-9 days
Appearance of signs and symptoms of possible loss of fetus (vaginal bleeding with or without intermittent pain) is which type of abortion?
Threatened
When the cervix is dilating, that is considered which type of abortion?
Inevitable
An abortion where part of the products of conception has been retained is considered what?
Incomplete abortion
You should be able to visualize an IUP trans-abdominally at an hCG level of ____ and trans-vaginally at an hCG level of ____.
6500
2000
A _____ abortion is when all the productions of conception have been expelled.
Complete
Hcg levels higher than _____ are highly suggestive of _____.
> 100,000
Hydatidiform mole
Three or more consecutive abortions is termed _____ pregnancy loss.
Recurrent
Severe abdominal pain (often unilateral), CMT and serum b-hCG usually <6500 is c/w which diagnosis?
Ectopic pregnancy
Hcg levels higher than _____ are highly suggestive of _____.
> 100,000
Hydatidiform mole
An abruption that occurs between the placenta and amniotic fluid is a _______ abruption.
Preplacental
Previous mid trimester loss, cervical surgery and DES are risk factors for what and what can you do?
Cervical insufficiency
Cervical cerclage after 12-14 weeks
A partial abruption that is between the placenta and membranes is called what?
Subchorionic
A partial abruption that is between the placenta and myometrium is called what?
Retro-placental and has a worse prognosis than sub-chorionic hemorrhage
Normal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall is called what?
Placenta accreta
Seizure frequency and severity is likely to increase or decrease during pregnancy with a diagnosis of epilepsy?
Increase
Which seizure medications should be avoided during pregnancy?
Valproate and Phynetoin
What is the safest anti-epileptic drug to take in pregnancy?
Carbamazepine (Tegretol)
What is the definition of thrombocytopenia in pregnancy?
<150,000 platelet count
What is the most common etiology of thrombocytopenia?
Gestational thrombocytopenia (GT)
Which ethnicity is affected the most by stillbirth?
Non-hispanic black women
Which medication can be used for treatment or prophylaxis of VTE in pregnancy because it does not cross the placenta?
Unfractionated/low-molecular weight (LMW) Heparin
Blood pressure >140/90 diagnosed before pregnancy, before 20 weeks gestation or after 12 weeks postpartum is which diagnosis?
Chronic hypertension
New onset blood pressure after 20 weeks gestation without proteinuria is which diagnosis?
Gestational hypertension
Two blood pressures > ___/___ on two occasions at least 4 hours apart after ____ weeks gestation is preeclampsia.
> 140/90
> 20 weeks gestation
What does HELLP stand for?
Hemolytic anemia, elevated liver enzymes and low platelet count that can occur AP or PP
What are 3 first line antihypertensives for women who require pharmacologic therapy for chronic hypertension?
Labetolol, nifedipine and methyldopa
What are the five severe features that, even when proteinuria is not present, can be paired with a new onset of HTN >20 weeks in pregnancy to warrant a diagnosis of preeclampsia?
Thrombocytopenia (platelets <100,000), renal insufficiency (serum creatinine >1.1mg/dL), impaired liver function, pulmonary edema, cerebral or visual symptoms
What is are three known insulin antagonist that contribute to GDM?
hPL, progesterone, and estrogen
In a two step appraoach to diagnose GDM, a BSG level of ______ on 1 hour screening warrants further testing with the 3hr gtt.
130 mg/dL
What are the abnormal values used to diagnose GDM in the 2hr gtt, or one step approach?
Fasting: 95mg/dL or greater
1 hour: 180mg/dL or greater
2 hour: 155mg/dL or greater
What is the first line therapy recommended for medical management of GDM and why?
Insulin
Does not cross the placenta
When should antenatal testing (NST, BPP) begin if poorly controlled GDM or requiring medication therapy without other comorbidities?
32 weeks
What screening should be performed and when in the PP period if a woman was diagnosed with GDM?
75g 2 hour OGTT at 6-12 weeks PP
A diagnosis of anemia can be made with hgb levels of
<11.0
<10.5
At what hCG level should you be able to see a FHR on u/s?
5,000-6,000
For a 3 hour gtt, what is the NDDG criteria?
Fasting: >105
1 hour PP: >190
2 hour PP: >165
3 hour PP >145
For a 3 hour gtt, what is the carpenter/coustan criteria?
Fasting: >95
1 hour PP: >180
2 hour PP: >155
3 hour PP >140
