Medical Disease, Third Trimester Bleeding, Prenatal Infections, Contraception Flashcards
Why would a Ua or UCX be done to work up UTI
On asymptomatic screen, for frequency/dysuria/urgency, or for UFD with chills, fever, and CVA
What are the possible outcomes of UA and UCX
Positive UA, positive symptoms, positive casts
Positive UA, positive symptoms, no casts
Positive UA, no symptoms
What does Positive UA, positive symptoms, positive casts mean? How to work it up?
Pyelonephritis. If pregnant, admit and start zosyn.
Rescreen after dose. If pyelo is improved, it’s pyelo. If not improved then there’s an abscess. Diagnose with ultrasound and treat with I+D.
What does Positive UA, positive symptoms, positive casts
Positive UA, positive symptoms, no casts mean? How to work it up?
UTI. Treat with nitro, ceftriaxone
What does positive UA, no symptoms mean? How to work it up?
Asymptomatic bacteriuria. MUST treat in pregnancy with nitro or ceftriaxone. Then rescreen to make sure negative. If still positive, keep treating.
What drugs should and should not be used to treat chronic hypertension?
Use methyldopa, hydralazine, labetalol. DO NOT USE acei, arbs, diuretics.
What does fetal hyperthyroidism cause? Fetal hypothyroidism?
Demise
Cretinism
Can RAIU be done in pregnancY?
NO
How to treat maternal hyperthyroidism?
PTU is safe in pregnancy. Do surgery during second trimester. DO NOT iodine ablate.
How to treat maternal hypothyroidism?
Levothyroxine.
How to diagnose/treat lichen sclerosis?
Punch biopsy necessary, followed by treatment with steroids if positive
How to treat maternal seizures?
Tricky because all anti-seizure medications are teratogens. Best one to use is phenobarbital. The least bad.
How to supplement phenobarbital?
Give folate
Placenta previa pathogenesis
Placenta implants across the os. As os dilates the placenta tears.
How does patient with placenta previa present?
Presents with painless third trimester bleeding with signs of struggling baby.
How to diagnose placenta previa?
Ultrasound. Can show baby in transverse lie.
How to treat placenta previa?
Do a c/s
Risk factors for placenta previa?
Multiple gestations, multiparity.
Pathogenesis of placental abruption
Placenta tears off wall and bleeds (can be concealed too)
What types of things cause placental abruption?
Hypertension, cocaine use, huge trauma
How does a patient with placental abruption present?
With painful, sudden onset, heavy vaginal bleeding. Fetal distress
How to diagnose placental abruption?
With ultrasound showing a tear
How to treat placental abruption?
C/s
Uterine rupture pathogenesis
Uterus ruptures with big contraction along c/s scar, or after pitocin use. Baby is birthed into peritoneum
How does uterine rupture present?
HUGE pain, may or may not bleed. Fetal heart rate abnormalities
How to diagnose uterine rupture?
No need for diagnosis, move straight to crash section
How to treat uterine rupture
Crash C-section
Vasa previa pathogenesis
Accessory lobe across the oss, there are bridging blood vessels. Os dilates and vessels tear.
How does vasa previa present?
With painless fetal distress and third trimester bleeding.
How to treat vasa previa?
C section.
Pathogenesis of neonatal GBS infection
Benign colonization of vagina, exposure during delivery
Patient presentation with GBS
Found on ASX screen at week 35-38. Or found on normal delivery with fetal crash within 12 hours
How to treat GBS
Ampicillin. Also give penicillin for asx bacteriuria, gbs+ status, prolonged ROM, or third trimester delivery with GBS.
How does baby get hepatitis B
Vertical transmission, can become chronic carrier
How to treat to make sure baby doesn’t get hep B
C/section with hep B IVIG and hep B vaccine
How does maternal HSV infection affect baby?
Primary viremia definitely affects baby, secondary reactivation affects baby only if exposed during delivery
How to treat secondary reactivation of HSV in pregnancy?
Treat with acyclovir and c/s baby
How to prevent maternal chickenpox infection
Vaccinate before pregnancy or if pregnant already, isolate mom from children.
How does baby with neonatal chicken pox present?
Zig zag lesions with small eyes and small extremities.
Which method of contraception has highest risk of DVT/PE
Orthoevra patch, risk increases with increased age and smoking
Can you do ECV in active labor?
No.
