MTB 1 Flashcards
What causes morning sickness
Increase in b-HCG produced by placenta
- up to 12-14 weeks
One of first signs seen in pregnancy on PE
Goodell sign
- Softening of cervix at 4 weks
What is Chadwick sign and when do we see it
Bluish discoloration of the vagina and cervix
6-8 wks
What is Chloasma and when do we see it?
Hyperpigmentation of face, forehad, nose, cheeks
16 wks
What is linea nigra and when do we see it?
Hyperpigmentation line from xiphoid to pubic symphysis
Second trimester
B-HCG production
By placenta Doubles every 48 hrs for first 4 weeks Peaks at 10 weeks Drops in second trimester Increase again in 3rd trimester to 20,000-30,000
When is a gestational sac seen on US?
5 weeks
1000-15000 B-HCG
What Cardio changes take place in pregnancy
Increased CO, HR, SV, Plasma volume
Slightly decreased BP
GI changes take place in pregnancy
Increase in estrogen and progesterone - morning sickness
Reflux esophagitis
Cholelithiasis
Constipation - decreased motility in LI, decrease smooth m wall tone, Increase emptying time
LES - decreased tone
Renal changes take place in pregnancy
Increased kidney size and ureters - increase risk of pyelonephritis
Increase GFR (Increase plasma volume
Decrease in BUN/Cr - increase renal plasma flow, increase Cr clearance
Decrease serum uric acid
Heme changes take place in pregnancy
Anemia = Plasma Volume increase
Hypercoaguable state- Increase fibrinogen, Virchow triad
Increase in RBC mass, WBC count, ESR
Decrease in Hg/Hct
Respiratory changes take place in pregnancy
Increased TV, Minute ventilation, increased pH
Decreased pCO2, HCO3
Skin changes take place in pregnancy
Striae gravidum
Spider angiomata, palmer erythema, chadwick sign = increase vascularity
When are fetal heart sounds heard?
End of first trimester
Thickened or enlarged nuchal translucency
Down Syndrome
Endocrine changes take place in pregnancy
Cortisol increased 2-3X
Thyroid size increased
TBG, T4, T3 increased
NO change in TSH, TRH, Free T3, T4
Most accurate way to check GA at 11-14 wks
US
When is triple or quad screen performed?
15 - 20 wks
What is Quad screen
MSAFP
Estriol
b-HCG
Inhibin A (not in triple screen)
Increased MSAFP is what
Dating error
NTD
Abdominal wall defect
Decreased MSAFP is what
Down syndrome
What testing is done at 27 weeks
CBC
if Hb < 11 = replace iron
When is glucose load test done?
24 - 28 weeks
If glucose > 140 at one hour, do oral glucose tolerance test
Which tests are done at 36 wks
Cervical culture for chlamydia and gonnorrhea
Rectovaginal culture for GBS
TX if positive
When are PPX Abx given for GBS + mothers
IV Pen G during labor
If allergic, Clindamycin, Vancomycin
What is the glucose load test and tolerance test?
What is a positive result?
Load: fasting/non-fasting ingestion of 50 g glucose, check in 1 hour
Tolerance test: fasting serum glucose, ingest 100 glucose, serum glucose checks at 1,2,3 hours
Elevated during any 2 is gestational diabetes
When is chorionic villus sampling done?
9-12 weeks in advanced maternal age
When is amniocentesis done?
14-18 weeks (after 15)
Why is CVS done?
To obtain fetal karyotype
Why is amniocentesis done?
To obtain fetal karyotype
What is fetal blood sampling used for
PUBS
Done in RH isoimmunized pts when fetal CBC needed
What are complications of CVS
Fetal loss Limb reduction Infxn Bleeding Ob complication - preterm, placenta previa/abruptio
How does hyperemesis gravidum present
When?
Tx?
Severe vomiting Wt loss Ketonuria Weeks 4-10 Resolves on own
What are risk factors for ectopic pregnancy?
PID
IUD
Previous ectopic pregnancies
Congenital DES
What is the workup for ectopic pregnancy?
- B-HCG
If < 1500 = repeat in 2-3 days
If >1500 = TV US
Tx for ectopic pregnancy - Not ruptured
- MTX if b-HCG < 6,000
- Surgery w/laparoscopy if b-HCG >6,000
Tx for ectopic pregnancy - ruptured
Stable?
Unstable?
Stable -> Laparotomy
Unstable -> IVF, blood products, dopamine -> Laparotomy
If treating w MTX for ectopic, how to monitor
1. First dose given. Check b-HCG 4-7 days later IF > 15% drop in b-HCG = Observe IF < 15% drop in b-HCG = 2nd dose of MTX - if persistently high b-HCG - > Surgery - if > 15% drop = observe
MTX is CI in whom?
Pts that have completed families Immunodeficient Non-compliant Liver dz Ectopic is 3.5 cm or larger
Which Abortions present w dilated cervix
Inevitable
What is an abortion
Pregnancy that ends before 20 wks
Presentation of abortion
Cramping abdominal pain
Vaginal bleeding
D&C is tx for which abortions
Incomplete
Inevitable
Missed
Septic + Abx (Levofloxacin and metronidazole)
Abortion with internal os closed?
Incomplete
Threatened
Tx for threatened abortion
Bed rest
Pelvic rest
What is the difference b/t incomplete, inevitable and threatened abortion?
Incomplete - Some POC
Inevitable - POC in tact, IU bleeding, Dilated cervix
Threatened - POC in tact, IU bleeding, NO dilation of cervix
What is a missed abortion
Death of fetus
ALL POC in uterus
How does cervical incompetence present
Painless Dilatation of cervix
No hx of CTX
Risk factors for preterm labor
PROM Multiple gestations Previous hx of preterm Placental abruption Maternal factors - chorioamnionitis, preeclampsia
Who do we see intraventricular hemorrhage (IVH) in
Premies
Low birth weight infants
How does IVH present
Pallor Cyanosis HypoTN Seizures Focal neuro sx's Bulging, tense fontanelle Apnea Bradycardia Bleeding in germinal matrix
When do we deliver preterm babies
Maternal severe HTN (preeclampsia, eclampsia)
Maternal cardiac dz
Maternal cervical dilation > 4 cm
Maternal Hemorrhage - abruptio placenta, DIC
Fetal Death
Chorioamnionitis
What should be given w/corticosteroids in preterm
Tocolytics - decrease uterine CTX and slow cervical dilation progression, allowing time for steroids to work
