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OB > MTB 1 > Flashcards

MTB 1 Flashcards

1
Q

What causes morning sickness

A

Increase in b-HCG produced by placenta

- up to 12-14 weeks

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2
Q

One of first signs seen in pregnancy on PE

A

Goodell sign

- Softening of cervix at 4 weks

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3
Q

What is Chadwick sign and when do we see it

A

Bluish discoloration of the vagina and cervix

6-8 wks

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4
Q

What is Chloasma and when do we see it?

A

Hyperpigmentation of face, forehad, nose, cheeks

16 wks

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5
Q

What is linea nigra and when do we see it?

A

Hyperpigmentation line from xiphoid to pubic symphysis

Second trimester

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6
Q

B-HCG production

A 
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
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7
Q

When is a gestational sac seen on US?

A

5 weeks

1000-15000 B-HCG

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8
Q

What Cardio changes take place in pregnancy

A

Increased CO, HR, SV, Plasma volume

Slightly decreased BP

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9
Q

GI changes take place in pregnancy

A

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

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10
Q

Renal changes take place in pregnancy

A

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

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11
Q

Heme changes take place in pregnancy

A

Anemia = Plasma Volume increase
Hypercoaguable state- Increase fibrinogen, Virchow triad
Increase in RBC mass, WBC count, ESR
Decrease in Hg/Hct

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12
Q

Respiratory changes take place in pregnancy

A

Increased TV, Minute ventilation, increased pH

Decreased pCO2, HCO3

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13
Q

Skin changes take place in pregnancy

A

Striae gravidum

Spider angiomata, palmer erythema, chadwick sign = increase vascularity

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14
Q

When are fetal heart sounds heard?

A

End of first trimester

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15
Q

Thickened or enlarged nuchal translucency

A

Down Syndrome

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16
Q

Endocrine changes take place in pregnancy

A

Cortisol increased 2-3X
Thyroid size increased
TBG, T4, T3 increased
NO change in TSH, TRH, Free T3, T4

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17
Q

Most accurate way to check GA at 11-14 wks

A

US

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18
Q

When is triple or quad screen performed?

A

15 - 20 wks

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19
Q

What is Quad screen

A

MSAFP
Estriol
b-HCG
Inhibin A (not in triple screen)

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20
Q

Increased MSAFP is what

A

Dating error
NTD
Abdominal wall defect

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21
Q

Decreased MSAFP is what

A

Down syndrome

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22
Q

What testing is done at 27 weeks

A

CBC

if Hb < 11 = replace iron

23
Q

When is glucose load test done?

A

24 - 28 weeks

If glucose > 140 at one hour, do oral glucose tolerance test

24
Q

Which tests are done at 36 wks

A

Cervical culture for chlamydia and gonnorrhea
Rectovaginal culture for GBS

TX if positive

25
Q

When are PPX Abx given for GBS + mothers

A

IV Pen G during labor

If allergic, Clindamycin, Vancomycin

26
Q

What is the glucose load test and tolerance test?

What is a positive result?

A

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

27
Q

When is chorionic villus sampling done?

A

9-12 weeks in advanced maternal age

28
Q

When is amniocentesis done?

A

14-18 weeks (after 15)

29
Q

Why is CVS done?

A

To obtain fetal karyotype

30
Q

Why is amniocentesis done?

A

To obtain fetal karyotype

31
Q

What is fetal blood sampling used for

A

PUBS

Done in RH isoimmunized pts when fetal CBC needed

32
Q

What are complications of CVS

A 
Fetal loss
Limb reduction 
Infxn
Bleeding
Ob complication - preterm, placenta previa/abruptio
33
Q

How does hyperemesis gravidum present
When?
Tx?

A 
Severe vomiting
Wt loss
Ketonuria
Weeks 4-10
Resolves on own
34
Q

What are risk factors for ectopic pregnancy?

A

PID
IUD
Previous ectopic pregnancies
Congenital DES

35
Q

What is the workup for ectopic pregnancy?

A
  1. B-HCG
    If < 1500 = repeat in 2-3 days
    If >1500 = TV US
36
Q

Tx for ectopic pregnancy - Not ruptured

A
  • MTX if b-HCG < 6,000

- Surgery w/laparoscopy if b-HCG >6,000

37
Q

Tx for ectopic pregnancy - ruptured
Stable?
Unstable?

A

Stable -> Laparotomy

Unstable -> IVF, blood products, dopamine -> Laparotomy

38
Q

If treating w MTX for ectopic, how to monitor

A 
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
39
Q

MTX is CI in whom?

A 
Pts that have completed families
Immunodeficient
Non-compliant
Liver dz
Ectopic is 3.5 cm or larger
40
Q

Which Abortions present w dilated cervix

A

Inevitable

41
Q

What is an abortion

A

Pregnancy that ends before 20 wks

42
Q

Presentation of abortion

A

Cramping abdominal pain

Vaginal bleeding

43
Q

D&C is tx for which abortions

A

Incomplete
Inevitable
Missed
Septic + Abx (Levofloxacin and metronidazole)

44
Q

Abortion with internal os closed?

A

Incomplete

Threatened

45
Q

Tx for threatened abortion

A

Bed rest

Pelvic rest

46
Q

What is the difference b/t incomplete, inevitable and threatened abortion?

A

Incomplete - Some POC
Inevitable - POC in tact, IU bleeding, Dilated cervix
Threatened - POC in tact, IU bleeding, NO dilation of cervix

47
Q

What is a missed abortion

A

Death of fetus

ALL POC in uterus

48
Q

How does cervical incompetence present

A

Painless Dilatation of cervix

No hx of CTX

49
Q

Risk factors for preterm labor

A 
PROM
Multiple gestations 
Previous hx of preterm
Placental abruption 
Maternal factors - chorioamnionitis, preeclampsia
50
Q

Who do we see intraventricular hemorrhage (IVH) in

A

Premies

Low birth weight infants

51
Q

How does IVH present

A 
Pallor
Cyanosis
HypoTN
Seizures
Focal neuro sx's
Bulging, tense fontanelle
Apnea
Bradycardia
Bleeding in germinal matrix
52
Q

When do we deliver preterm babies

A

Maternal severe HTN (preeclampsia, eclampsia)
Maternal cardiac dz
Maternal cervical dilation > 4 cm
Maternal Hemorrhage - abruptio placenta, DIC
Fetal Death
Chorioamnionitis

53
Q

What should be given w/corticosteroids in preterm

A

Tocolytics - decrease uterine CTX and slow cervical dilation progression, allowing time for steroids to work

OB (4 decks)

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