Maternal/Newborn/Repro Flashcards
Hyperemesis Gravidarum
Persistent N/V during pregnancy (more excessive than typical in 1st trimester)
= Greater than 5% weight loss from pre-pregnancy
= Ketouria (hypoglycemia)
= Hypokalemia
Tx = Fluids, Antimetics, THIAMINE**
Thiamine
important to take for pregnant pts with Hyperemesis Gravidarum (electrolyte imbalance)
Thiamine is important for fetal conversion of carbohydrate into energy.
Ectopic pregnancy
- Emergency?
Implantation is outside uterus (usually in FT)
= UNILAT ab/pelvic pain
= Vaginal bleeding/spotting
= Delayed menstrual period with (+) pregnancy test
RUPTURE = Hemiperitoneum EMERGENCY
= Severe pain (ab/pelvis/lower back; Referred in shoulders)
= Hypotensive (hemorrhagic)
Tx: Methotrexate (chemo drug) + SURGERY
DO NOT TAKE ANALGESICS STRONGER THAN TYLENOL (can mask Sxs)
What to always do when assessing ABDOMEN PAIN in women?
Always rule out pregnancy first!!!
Preeclampsia
- Fetal harm?
HTN in pregnancy over 20 wks
Non-severe (≥ 140/90)
= Proteinuria = Kidney failure
Severe (≥ 160/110)
= high stroke risk
= Hemolysis, elevated liver enzymes
= Thrombocytopenia (low platelets) = DIC
Tx: BIRTH resolves it all
Stroke prevention = Hypertensives + Deep tendon reflexes
FETAL HARM
= Placental abruption that causes restricted growth / preterm birth / death
Gestational DM
- when does screening happen?
- What are the risks/complications of GDM?
Pregestational/Preexisting DM
= Congenital heart + neural defects in FETUS
GESTATIONAL DM
= Pre-screening @ 24-28 wks via 1-hr GCT (no fasting)
= Dx via 3-hr GTT (fasting) if ≥2/4 BG checks are elevated
= FETAL MACROSOMIA (shoulder dystocia)
= Polyhydramnios
= Preeclampsia
= Neonatal Hypoglycemia
= Stillbirth
Trimesters
FIRST = first day of last period - 13 wks
SECOND = 14 wks - 27 wks
THIRD = 27 wks to 40 wks
Newborn vitals
TEmp = 36.5-37.5 (low temps are DANGEROUS)
BP >72/34
HR @ rest = 110-160
HR @ sleep = 90-110
RR = 30-60 (w/ perioidic breathing, only bad if Sx)
Lactation Mastitis
Clogged nipple pores that impair milk duct drainage + Breastfeeding due to STAPH BACTERIAL INFECTION
= Flu-like Sxs
= UNILATERAL breast pain, erythema, swelling
Tx = abx, analgesics, warm compress on breast
CONTINUE BREASTFEEDING with affected breast first!
BREAST ABSCESS = need U/S guided drainage
Normal presentations/interventions of healthy newborn?
- AGPAR score >7/10
- Periodic breathing (only bad if Sx)
FIRST 24 HRS
- At least 1 void + meconium
- Hep B vaccine
- Vitamin K (d/t immature liver + absent normal flora to synthesize)
- Erythromycin eye ointment (Abx to prevent Neonatal conjunctivitis, esp if maternal STI)
NORMAL >10% weight loss in first few days of life
Circumcision
- Contraindications?
removes foreskin @ 1-week old
= helps reduce UTIs + STIs
= give oral sucrose + topical numbing cream
Contraindications
- Sick newborn
- Hypospodias (urethral opening on penis underside), Epispadias
Similarities/Differences between Infant Botulism and Gullain Barre Syndrome
CAUSE
Botulism = bacterial infection (honey)
GBS = autoimmune, but triggered by GI/Resp infection
SXs
= symmetrical muscle paralysis (ascending/descending)
= Risk of respiratory failure (both!!)
= CVS instability - reflexive tachycardia/hypotension/dysrthymmias (GBS)
Tx = IVIG (both)
Risks for Cleft lip & palate
POOR FEEDING
= Burp frequently
= Aspiration precautions (upright, nipple to side/back of mouth)
RECURRENT EAR INFECTIONS
SPEECH/LANGUAGE DELAYS
Hirschsprung Disease
No specialized cells in distal LI = megacolon
= Bilious vomit
= Poor weight gain
= Delayed meconium
= Ribbon-like stools
Tx = SURGERY
= Enema (to prep for biopsy)
Down Syndrome
Chromosome 21 x3 copies
Brushfield spots, Low ears, Up-slant of outer eyes, Epicanthal fold in eyelid, Short neck, Single palm crease, Sandal toe, Congenital heart defects, Hearing/vision deficits, Intellectual disabilities, Lung/Language problems, Developmental delay, Decreased muscle tone
Neonatal Abstinence Syndrome
Withdrawal from substance received in-utero (opioids)
= Hypersensitivity
= Hypertonia, tremors
= Sneezing, Yawning**
Tx = opioid agonists (titrate down slowly)
- Self-soothe techniques,
Fetal Alcohol Syndrome
Hypersensitivity = SEIZURE RISK
= Hyper/Hypotonia + reflexes
= Poor feeding (weak suck reflex)
= Hypoglycemia
= Irritable, high pitched cry
= Microcephaly, small eyes
= Flat face, smooth philtrum, thin upper lip
Hyperbilirubinemia
Rapid hemolysis @birth + immature liver = JAUNDICE (head to toe)
Normally, excreted via stools + jaundice resolves in 2 weeks (toe to head)
= BLOOD INCOMPATIBILITY
= POLYCYTHEMIA
= POOR BREASTFEEDING (reduced stools in baby)
Tx w/ Phototherapy + increase feeding frequency (no supplements)
Bilirubin encephalopathy = seizure risk
Kernicterus
Bilirubin-induced neuro-dysfunction (brain cell necrosis)
= no startle reflex
= Apnea
Early intervention = Phototherapy
Knee to chest position
Umbilical cord prolapse
Lower HOB, McRoberts maneuver, applying Suprapubic pressure
Shoulder dystocia of fetus @ birth
When is an epidural anesthesia contraindicated?
Pts with
= Hypotension
= Coagulation problems (thrombocytopenia, HELLP syndrome)
= Infection @site
When to give Magnesium sulfate?
Toxicity = signs? Antidote?
- For pts with preeclampsia w/ severe features to prevent seizures (eclampsia)
- Premature babies (<32 wks) for neuro protection
Mg sulfate toxicity
= decreased urine output (impaired kidney to excrete)
= Neuromuscular + Respiratory depression
Antidote = IV calcium gluconate
s/e of Oxytocin x2
- Interventions?
- Uterine tachysystole (>5 contractions in 10 mins; tachy fetal HR)
- Fluid retention
ACTIONS
- D/C or Decrease oxytocin
- Reposition to LEFT side lying (increase BF + O2 to fetal)
- Give 8-10L/min O2 (increase BF + O2 to fetal)
Normal findings with Stage 1 labour?
- Cervical dilation
- Vaginal fluid
- Contractions
- Uterine tone
- Patient somatic Sxs
Cervical dilation of 6-10 cm
- Bloody vaginal fluid
- 2-5 Contractions every 10 mins, < 90 sec/each
- 25-50 mmHg intensity (contractions)
- <20 mmHg resting tone
- Urge to have a BM, N/V, trembling/shivers (transition stage)
Terbutaline
Tocolytic med = uterine relaxation
Purpose of Oxytocin in labor stages
Stage 1 - induces labor, promotes contractions for birth
Stage 2 - promotes contraction for placenta
Stage 3 - Helps with PPH
Ruptured ectopic pregnancy
EMERGENCY
= Hypotension
= Severe pain in ab, pelvic, lower back
= Pain radiates to shoulders
Methrotrexate
A chemo drug used to treat ectopic pregnancy
= URINE IS TOXIC FOR 72 HRS POST-ADMIN
= ONLY TYLENOL for pain
Signs of Pregnancy
- Positive
- Probable (in order)
Positive = all “fetal” tests done by HCP
Probable
= ALL urine/blood pregnancy tests
= Chadwick’s sign (cervical color change - blusish/cyanotic)
= Goodell’s sign (cervical softening)
= Hegar’s sign (uterine softening)
Ideal weight gain during pregnancy trick
Ideal weight gain = Week - 9
When to give a narcotic in pregnancy?
When contraction hits its peak to minimize fetal absorption
Risks of Pregestational DM?
Congenital heart + neuro defects
Placental previa
Placenta is over the cervical os
- PAINLESS vaginal bleed
Cervical cerclage
For cervical insufficiency
= Bad if pt starts to feel preterm labour pains
When is placenta abruption a complication?
Preeclampsia or HELLP syndrome
- Vaginal bleeding?
Expected findings of neonate?
= Normal VS
= Normal blood glucose (2.2-3.3 mmol)
= Milia (white papules on nose bridge - plugged sebaceous glands)
