Maternal/Newborn/Repro

Question 1

Hyperemesis Gravidarum

Answer 1

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**

Question 2

Thiamine

Answer 2

important to take for pregnant pts with Hyperemesis Gravidarum (electrolyte imbalance)

Thiamine is important for fetal conversion of carbohydrate into energy.

Question 3

Ectopic pregnancy
- Emergency?

Answer 3

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)

Question 4

What to always do when assessing ABDOMEN PAIN in women?

Answer 4

Always rule out pregnancy first!!!

Question 5

Preeclampsia
- Fetal harm?

Answer 5

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

Question 6

Gestational DM
- when does screening happen?
- What are the risks/complications of GDM?

Answer 6

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

Question 7

Trimesters

Answer 7

FIRST = first day of last period - 13 wks
SECOND = 14 wks - 27 wks
THIRD = 27 wks to 40 wks

Question 8

Newborn vitals

Answer 8

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)

Question 9

Lactation Mastitis

Answer 9

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

Question 10

Normal presentations/interventions of healthy newborn?

Answer 10

• 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

Question 11

Circumcision
- Contraindications?

Answer 11

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

Question 12

Similarities/Differences between Infant Botulism and Gullain Barre Syndrome

Answer 12

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)

Question 13

Risks for Cleft lip & palate

Answer 13

POOR FEEDING
= Burp frequently
= Aspiration precautions (upright, nipple to side/back of mouth)

RECURRENT EAR INFECTIONS

SPEECH/LANGUAGE DELAYS

Question 14

Hirschsprung Disease

Answer 14

No specialized cells in distal LI = megacolon
= Bilious vomit
= Poor weight gain
= Delayed meconium
= Ribbon-like stools

Tx = SURGERY
= Enema (to prep for biopsy)

Question 15

Down Syndrome

Answer 15

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

Question 16

Neonatal Abstinence Syndrome

Answer 16

Withdrawal from substance received in-utero (opioids)
= Hypersensitivity
= Hypertonia, tremors
= Sneezing, Yawning**

Tx = opioid agonists (titrate down slowly)
- Self-soothe techniques,

Question 17

Fetal Alcohol Syndrome

Answer 17

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

Question 18

Hyperbilirubinemia

Answer 18

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

Question 19

Kernicterus

Answer 19

Bilirubin-induced neuro-dysfunction (brain cell necrosis)
= no startle reflex
= Apnea

Early intervention = Phototherapy

Question 20

Knee to chest position

Answer 20

Umbilical cord prolapse

Question 21

Lower HOB, McRoberts maneuver, applying Suprapubic pressure

Answer 21

Shoulder dystocia of fetus @ birth

Question 22

When is an epidural anesthesia contraindicated?

Answer 22

Pts with
= Hypotension
= Coagulation problems (thrombocytopenia, HELLP syndrome)
= Infection @site

Question 23

When to give Magnesium sulfate?

Toxicity = signs? Antidote?

Answer 23

• 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

Question 24

s/e of Oxytocin x2
- Interventions?

Answer 24

1. Uterine tachysystole (>5 contractions in 10 mins; tachy fetal HR)
2. 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)

Question 25

Normal findings with Stage 1 labour?
- Cervical dilation
- Vaginal fluid
- Contractions
- Uterine tone
- Patient somatic Sxs

Answer 25

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)

Question 26

Terbutaline

Answer 26

Tocolytic med = uterine relaxation

Question 27

Purpose of Oxytocin in labor stages

Answer 27

Stage 1 - induces labor, promotes contractions for birth
Stage 2 - promotes contraction for placenta
Stage 3 - Helps with PPH

Question 28

Ruptured ectopic pregnancy

Answer 28

EMERGENCY
= Hypotension
= Severe pain in ab, pelvic, lower back
= Pain radiates to shoulders

Question 29

Methrotrexate

Answer 29

A chemo drug used to treat ectopic pregnancy
= URINE IS TOXIC FOR 72 HRS POST-ADMIN
= ONLY TYLENOL for pain

Question 30

Signs of Pregnancy
- Positive
- Probable (in order)

Answer 30

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)

Question 31

Ideal weight gain during pregnancy trick

Answer 31

Ideal weight gain = Week - 9

Question 32

When to give a narcotic in pregnancy?

Answer 32

When contraction hits its peak to minimize fetal absorption

Question 33

Risks of Pregestational DM?

Answer 33

Congenital heart + neuro defects

Question 34

Placental previa

Answer 34

Placenta is over the cervical os
- PAINLESS vaginal bleed

Question 35

Cervical cerclage

Answer 35

For cervical insufficiency
= Bad if pt starts to feel preterm labour pains

Question 36

When is placenta abruption a complication?

Answer 36

Preeclampsia or HELLP syndrome
- Vaginal bleeding?

Question 37

Expected findings of neonate?

Answer 37

= Normal VS
= Normal blood glucose (2.2-3.3 mmol)
= Milia (white papules on nose bridge - plugged sebaceous glands)