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NNP I > Maternal Hx WK1 > Flashcards

Maternal Hx WK1 Flashcards

1
Q

DM - Types

A
  • DMI
  • DMII
  • GDM
    • Diet VS
    • Insulin controlled
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2
Q

DM - Incidence

A
  • DM 6-8% preg
  • GDM 90% DM preg
  • DMII 10% DM preg
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3
Q

GDM: when dx

A

24-28wk

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4
Q

DM - WNL Preg and Patho

A
  • Decrease insulin sensitivity
    • Wnl - increase insulin secretion
    • DM - insufficient insulin –> hyperglycemia
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5
Q

DM - Risk Factors

A
  • AMA
  • Multiple gestation
  • >BMI
  • Family hx
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6
Q

DM: Complications

A
  • Stillbirth (esp DMI)
  • Congenital malformations (esp DMI/II)
  • Hypoglycemia
  • Hypocalcemia
  • Hypomag
  • Macrosomia
  • IUGR
  • Asphyxia
  • RDS (up to 38wk)
  • TTN
  • Hyperbili
  • Polycythemia
  • Larger organs - except kidney and brain
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7
Q

DM: Congenital Malformations

A
  • Congenital malformations (esp DMI/II)
    • CV (most common) - VSD, Tet, TGV, ASD, coarc, hypoplastic L heart, double outlet RV, truncus arteriosus, cardiomegaly
    • CNS - spina bifida, anencephaly, hydrocephalus
    • GI - intestinal atresia, anal atresia
    • GU - renal agenesis, ureteral duplication, hypospadias
    • MSK - skeletal dysplasia, caudal regression sx (fixed flexed legs, absent sacral/lumbar vert, sacral agenesis, urinary incontinence, renal dx, heart dx)
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8
Q

DM: CHTN and Severe Vasculopathy Complications

A
  • Uteroplacental insufficiency
  • IUGR
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9
Q

DM: Fetal Hyperglycemia Complicaitons

A
  • Hyperinsulinemia
  • Hypoglycemia
  • Hypocalcemia
  • Cardiomyopathy
  • RDS
  • Demise
  • Polyhydramnios (rt osmotic diuresis)
  • Child obesity
  • Child insulin resistance
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10
Q

HTN: Types and Definitions

A
  • CHTN - <20wk
  • GHTN - >20wk
  • PE - >20wk w proteinuria
    • <32-34wk severe
    • CHTN + PE - <20wk w proteinuria
  • Eclampsia - seizures
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11
Q

HTN: Incidence

A
  • 10% preg HTN
  • 5-8% preg PE
  • 1% preg PE w severe features
  • 0.1% preg eclampsia
  • 15-20% maternal mortality rt HTN
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12
Q

HTN: Risk Factors PE

A
  • >40yr
  • hx PE/CHTN
  • DM
  • multiple gestation
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13
Q

HTN: Complications

A
  • IUGR
  • PT
  • abruption
  • demise
  • fetal acidemia
  • thormobocytopenia (esp IUGR)
  • neutropenia (esp IUGR, multiple gestation, association sepsis)
  • hypermag
  • NEC (esp abnormal end diastolic flow)
  • RDS (esp <32wk)
  • BPD

NOT IVH/PVL, NOT CP

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14
Q

ID: Required to chart mom positive in baby chart

A
  • HIV
  • HEP B
  • GBS
  • Syphilis
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15
Q

HIV: Transmission Incidence

A

<1% w <1,000 copies/ml viral load

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16
Q

GBS: Transmission Route

A
  • L/D most common
  • in utero –> stillbirth
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17
Q

HIV: Risk Factors

A
  • STI <12m
  • IV drug use or partner
  • new sex partner, >1 partner preg
  • partner HIV or high risk
  • care in hospital high incidence HIV
  • location high incidence HIV
  • Incarceration
  • s/s HIV infection
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18
Q

HIV: Screening

A
  • PNC - opt out antigen/antibody test T1, repeat T3 <36wk high risk
  • Unknown prepartum - rapid HIV (confirm test, asap ART)
  • Unknown postpartum or positive maternal - infant DNA
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19
Q

HIV: Delivery Implications

A
  • >1,000 copies/ml or unknown w/o labor AND w/o ROM - c/s 38wk, IV zidovudine 3hr preop
  • >1,000 copies/ml or unknown w labor OR ROM - no consensus
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20
Q

HIV: Transmission Route

A

L/D

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21
Q

HEP B: Transmission Incidence

A
  • <1% transmission HBsAg positive w tx
  • 30% transmission HBsAg positive w/o tx
  • 85% transmission HBeAg positive w/o tx
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22
Q

HEP B: Risk Factors

A
  • STI >12m
  • IV drug use or partner
  • new sex partner, >1 partner preg
  • partner HIV or high risk
  • care hospital high incidence HEP B
  • location high incidence HEP B
  • incarceration
  • s/s HIV infection
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23
Q

HEP B: Screening

A
  • T1 - HBsAg screen
    • if positive - screen HBeAg, Hep B virus DNA, alanine aminotransferase, refer GI, repeat T3
  • T3 or L/D repeat positive or high risk
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24
Q

HEP B: Vaccine

A
  • HBsAg positive
    • HBIG (HEP B immunoglobulin), HEP B <12hr
  • HBsAg unknown
    • HBIG <12hr
    • <2,000g - HEP B <12hr
    • >2,000g - HEP B <7d or d/c
  • HBsAg negative
    • <2,000g - HEP B 1m or d/c
    • >2,000g - HEP B <24hr
  • admin separate sites
  • HEP B vaccine x3-4 dose w serologic testing 1-2m s/p final dose
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25
Q

HSV: Incidence

A
  • Most common STI world
  • 40-80% mortality
  • 60-80% HSV transmission w/o s/s
  • 3-5% transmission w recurrent infection
  • increase risk transmission w 1ary infection
  • 66% HSV infant onset illness <1wk
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26
Q

HSV: Stages of Infection

A
  • 1ary
  • 2ary
  • Latent
  • 3ary
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27
Q

HSV: Risk Factors Intrapartum Transmission

A
  • 1ary infection
  • cervical lesions
  • PT
  • prolonged ROM
  • instrumented delivery
  • fetal scalp electrodes
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28
Q

HSV: Transmission Route and Incidence

A
  • 85% perinatal/peripartum
  • 10% postnatal
  • 5% intrauterine
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29
Q

HSV: Complications 1ary Infection

A
  • highest risk transmission
  • demise
  • PT
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30
Q

HSV: Complications T1 Recurrent Infection

A
  • skin vesicles
  • chorioretinitis
  • microcephaly
  • microopthalmia
  • intracranial calcifications
  • seizures
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31
Q

Syphilis - Incidence

A
  • 1mil w preg
  • 40% fetal/perinatal death syphilis preg
  • 40-50% congenital syphilis fatal
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32
Q

Syphilis: Types

A
  • 1ary infection - after incubation 10-90d s/p exposure
  • 2ary infection - 4-10wk s/p 1ary w/o tx
  • latency
  • 3ary infection
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33
Q

Syphilis: Transmission Routes

A
  • transplacental
  • L/D - contact active lesions
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34
Q

Syphilis: Risk Factors

A
  • poor PNC
  • illicit drugs
  • high risk sex
  • hx STI
  • underserved location
  • teen preg
35
Q

Syphilis: Complications Congenital Syphilis w/o tx

A
  • non immune hydrops
  • IUGR
  • hemolytic anemia
  • hepatospleomegaly
  • maculopapular rash
  • condyloma rata
  • CNS involvement\
  • bone abnormalities
36
Q

Syphilis: Screening

A
  • PNC
    • 1st PNC
    • 28-32wk repeat high risk
    • L/D admission high risk
  • Nontreponemal test
    • VDRL
    • RPR
    • if positive, confirm w treponemal
  • Treponemal test
    • FTA-ABS
    • TP-PA
37
Q

GBS: Incidence

A
  • most common cause early onset sepsis
  • 20-25% women colonized GBS
  • 90% decrease transmission w tx PCN G or amp
38
Q

GBS: Screening

A
  • 36-<37wk - vaginal rectal culture
  • PT labor or PROM - vaginal rectal culture
  • >37wk w unknown - rapid NAAT test
  • GBS test >5wk onset labor - repeat vaginal rectal culture
  • exceptions
    • GBS bacteriuria any time preg
    • hx GBS
39
Q

GBS: ABX Indications

A
  • GBS positive w labor or ROM
    • NO IAP if c/s w/o labor AND w/o ROM
  • GBS unknown w
    • <37wk
    • >100.5 (38C)
    • ROM >18hr
    • NAAT positive GBS
    • hx GBS
40
Q

GBS: ABX Types

A
  • only appropriate tx - PCN G or amp
  • PCN allergy NOT effective infant
    • Cefazolin
    • Clindamycin
    • Vancomycin
41
Q

HIV: Infant MGMT, Screening, Tx

A
  • NO breastmilk
  • Screen: HIV RNA or DNA (NOT antibody)
  • ART <12hr postpartum
    • tx stable <1,000 copies/ml - zidovudine 4-6wk
    • tx and >1,000 copies/ml - multidrug ART
42
Q

DM: Prenatal MGMT

A
  • A1C<7%
  • 400 microg folic acid - decrease risk neural tube defect
  • 18wk early level II US (major anomalies)
  • 22wk - fetal echo
43
Q

GDM: Screening

A
  • 16wk - w risk factors
  • 24-28wk - universal
44
Q

DM: Delivery MGMT

A
  • well controlled insulin dependent - expectant mgmt until 39wk
  • poorly controlled - LPT, early FT delivery
45
Q

Multiple Gestation: Incidence

A
  • twins 3% preg - decreasing
46
Q

Multiple Gestation: Zygosity Types

A
  • Monozygotic - 1 ova splits, identical
  • Dizygotic - 2 ova, fraternal
47
Q

Chorionicity: Definition

A
  • # outer membranes and placenta
48
Q

Amnionicity: Defintion

A
  • # inner membranes, amniotic fluid sacs
49
Q

Monozygotic: Types and Timing

A
  • DCDA - cleavage 1-4d s/p fertilization
  • MCDA - cleavage 3-8d s/p fertilization
  • MCMA - cleavage 8-12d s/p fertilization
  • Conjoined - cleavage >13d s/p fertilization
50
Q

Dizygotic: Types

A
  • DCDA
    • fused
    • separate
51
Q

Monozygotic: Risk Factors

A
  • Family hx
  • IVH
  • higher parity (esp AA, NOT Asian)
52
Q

Monozygotic: Incidence

A
  • 20% twin preg
53
Q

DIzygotic: Risk Factors

A
  • Yoruba (Nigerian)
  • IVH
  • Ovulation inducing agents
  • AMA
  • Family hx
  • Higher parity (esp AA, NOT Asian)
54
Q

Multiple Gestation: Screening

A
  • T1 - cell free DNA aneuploidy screen w single nucleotide polymorphism
  • Postnatal
55
Q

Multiple Gestation: Complications

A
  • PT
    • 36-36wk twin
    • 32wk triplet
  • Demise
  • Congenital anomalies
  • IUGR
  • Aneuploidy (esp dizygotic)
  • CP
  • c/s
  • maternal HTN/PE (earlier and more severe vs singleton)
56
Q

Multiple Gestation: MC Complications

A
  • PT
  • Growth discordance - 20% MC preg
  • TTTS - 15% MC preg
    • donor - IUGR, hypovolemia, hypotension, anemia, thrombocytopenia, oligohydramnios, compression anomalies, hypoxia → heart failure and hydrops
    • recipient - polycythemia, polyhydramnios, LGA, cardiomegaly, congestive heart failure, pulmonary edema
  • TAPS twin anemia polycythemia sequence - 3-5% MC preg, hgb 5+g/dL difference
  • TRAP twin reversed arterial perfusion sequence - 1% MC preg
  • Unexpected fetal death
  • Congenital anomalies (esp CCHD) - 5-10% MC preg
  • c/s
  • Cord enlargement
  • Skeletal anomalies
57
Q

Multiple Gestation: MA Complications

A
  • Similar MCDA congenital anomalies vs MCDA
  • > demise vs MCDA
  • Always c/s
58
Q

Multiple Gestation: MGMT

A
  • MPR multifetal preg reduction - ppx PT DC
  • Selective termination - DC, MC w cord occlusion
  • Low dose aspirin <16wk - ppx PE, PT
59
Q

Multiple Gestation: Delivery MGMT

A
  • DCDA twin - 38-<39wk
  • MCDA twin - 34-<38wk
  • MCMA twin - 32-<34wk
  • >multiples - individualized
60
Q

SLE: Incidence

A
  • 4,500 preg/yr US
61
Q

SLE: Complications

A
  • PT 47%
  • demise 40%
  • PE 25%
  • IUGR 15%
62
Q

SLE: Risk Factors Poor Preg Outcomes

A
  • proteinuria
  • renal insufficiency
  • antiphospholipid antibody sx
  • thrombocytopenia
  • active matern dx at conception
  • nephritis
  • anti SSA (Ro) antibodies (risk fetal congenital heart block)
63
Q

SLE: Contraindicated Meds

A
  • methotrexate
  • mycophenolate mofeitl
64
Q

SLE: Safer Meds

A
  • prednisone
  • axathioprine
  • hydroxychloroquine
65
Q

AAS: s/s

A
  • antiphospholipid antibodies aPL
  • venous thrombosis
  • hx preg loss
  • thrombocytopenia
66
Q

AAS: Prevalence

A

50:100,000

67
Q

Neonatal Lupus: Preg MGMT

A
  • screen fetal congenital heart block
68
Q

Neonatal Lupus: Complicaitons

A
  • 16-24wk AV node injury common
  • congenital heart block
69
Q

Neonatal Lupus: MGMT

A
  • congenital heart block
    • pacemaker VS transplant
    • fluorinated steroid 2nd degree heart block
70
Q

ITP: Incidence

A
  • 7-10% preg thrombocytopenia (rt gestational common, PE, ITP)
  • 1:1,000 preg ITP
71
Q

ITP: Complications

A
  • neonatal thrombocytopenia
  • hemorrhage

VS gestational thrombocytopenia - benign

72
Q

ITP: Delivery MGMT

A
  • do NOT alter delivery mode
73
Q

Fetal Hydantonin Sx: Defintion

A
  • pattern mental and physical birth defects rt anticonvulsant drugs
74
Q

Fetal Hydantoin Sx: s/s

A
  • craniofacial
    • broad nasal bridge
    • wide fontanel
    • low set hairline
    • broad alveolar ridge
    • metopic riding
    • short neck
    • ocular hypertelorism
    • microcephaly
    • cleft lip w or w/o palate
    • abnormal or low set ears
    • epicanthal folds
    • ptosis
    • coloboma
    • coarse scalp hair
  • limb
    • small or absent nails
    • hypoplasia distal phalanges
    • altered palmar crease
    • digital thumb
    • dislocated hip
  • NDI
75
Q

Chorio: Incidence

A
  • 1-5% preg
  • e. coli most common PT (NOT GBS)
76
Q

Chorio: Types

A
  • Acute
  • Subclinical - histologic, w/o s/s, chronic
77
Q

Chorio: Dx

A
  • Fever 39C+ OR x2 30min apart 38C+
    • w/o cear source
    • 1 below
      • FHR >160 rest 10+min
      • Maternal WBC >15,000 (esp L shift), NOT on corticosteroids
      • Purulent fluid cervical os via speculum
  • histologic chorio - placenta pathology
78
Q

Chorio: Patho

A
  • wnl - cervical mucus plug (physical barrier, abx peptides), fetal membranes, placenta protect fetus from bacteria
  • organisms (common polymicrobial) invade intrauterine space via cervix
  • in utero inflammation -→ fetal IL production -→ increase surfactant production -→ lung maturation
79
Q

Chorio: Risk Factors

A
  • ROM >18hr
  • prenatal testing - amniocentesis, chorionic villus sampling
  • frequent UTI
  • maternal fever
80
Q

Chorio: Complications

A
  • PT
  • Demise
  • Asphyxia
  • Early Onset Sepsis 40%
  • Septic Shock
  • PNA
  • Meningitis
  • IVH
  • Cerebral white matter damage
  • BPD (rt alteration lung maturation)
  • NDI (esp CP)
81
Q

Chorio: MGMT

A
  • early onset sepsis risk calculator (kaiser tool)
    • tx vs NO tx
    • NOT valid <34wk, NOT late onset sepsis
82
Q

Viral Infection: Transmission

A
  • in utero
  • postnatal
83
Q

Viral Infection: Complications

A
  • IUGR
  • Hydrops
  • Hepatomegaly
  • Splenomegaly
  • Pneumonitis
  • Bone lesions
  • Rashes
  • Hematologic abnormalities
84
Q

Viral Infection: MGMT

A
  • early detection
  • time of exposure important

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