OB Flashcards
dx and mgmt of chorio
one 39F or 38.9F x2 fever, PLUS, fetal tachycardia, cervical purulence, maternal leukocytosis
- mgmt= amp, gent for SVD, add clinda for c/s, postpartum continue clinda but dc amp/gent
- remember that chorio neonates have increased risk of espsis and 4x higher risk of CP compared to similar aged infants
how much do GFR and RPF increase in pregnancy?
50 and 80 % respectively
at what level of meaternal anemia is there associated direct fetal morbidity?
<6 g/dl
rpt c/s timing after classical?
36-37 wk
mechanism of action for PTU and methimazole?
blocks peripheral conversion of T4 to T3
- graves MC cause hyperT in preg
- fetus makes own thyroid hormone @ 12 wk
MC cause of PPH? what percentage of all PPH is it responsible for?
atony, 80%
u/s definition of pregnancy loss
- CRL >7 w/o cardiac activity
- gestational sac >25 mm w/o embryo
- no cardiac activty 11 days after u/s shows gest sac w/ yolk sac
- no cardiac activity 14 days after u/s shows gest sac w/o yolk sac
what is the only MEC1 contraception for breastfeeding moms?
copper IUD
most sensitive finding for abruption?
uterine ctx. Coag changes is late change bc at that point 50% of products have been consumed
how often do you need to scan monochorionic twins?
q2wk for fluid (r/o TTTS)
q4wk for growth
contraindication for late preterm steroids?
chorio, diabetes(??), previous course (rescue), other conditions prompting del (don’t delay for steroids)
what are the #1 and #2 MC causes of thrombocytopenia in pregnancy?
- GTP (80%)
- PreE (15%)
- all others combined (5%)
what is PAPP-A an independent marker for?
FGR, IUFD
what is considered an abnormal nuchal translucency measurement? what are euploid fetuses at risk for w/ increased nuchal translucency?
> 3.0mm. increased risk for cardiac defect
what percentage of GDM pts will have impaired glucose control postpartum? when do you test them?
up to 33%. 2GTT 75 g between 6 and `12 wk
vaccines for pregnant HIV pts?
influenza, Tdap, pneumococcus, hep B
what medications are affected by changes in pregnancy metabolism?
anything metabolized by P450. These include synthroid, some antihypertensives (beta blockers), SSRIs, seizure meds. N/V can exacerbate these effects too. Pregnancy itself may also lower seizure threshold.
what do gastric bypass pts need supplementation of during pregnancy?
Fe, B12, protein, vit D, folic acid, Ca. Worst w/ roux en y but still possible w/ restrictive procedures
what is the greatest infection risk to physicians w/ needle stick (highest rate of transmission)
Hep C
Describe the mgmt of rhesus dz during pregnancy
W/ first affected pregnancy, perform titers q 2 wks until 24 wks, if 1:32 or worse, MCA doppler q 1-2 wk, if 1.5 MoM or greater, cordocentesis, if fetal hematocrit 30% or worse, intrauterine infusion, antenatal testing 32 wk, deliver 37-38 wk
W/ previously affect pregnancy, don’t do titers. At 18 wks, start 1-2 wk MCA dopplers, mgmt per above
what percentage of couples will experience recurrent pregnancy loss. What is mgmt for pts w/ antiphospholipid syndrome and how much does it improve pregnancy outcomes
1%. ASA 81 mg + heparin, reduces AB by 50%. Only 3-15% of couples w/ recurrent early pregnancy loss have antiphospholipid syndrome
what is the most common bug in chorio? what bug is transmitted via hemogenous spread? What categories of bugs do the tx for chorio cover?
“polymicrobial”. Listeria can be spread by hematogenous spread. Amp covers gram pos, gent gram neg.
findings of ICP. Recurrence rates in subsequent gestations. Delivery timing. Recommend tx and MOA. What bile acid level denotes higher risk?
Pruritis w/ transaminitis w/o derm findings. Recurrence = 40-60% subs pregnancies. Tx= ursodeoxycholic acid (ursodiol). Deliver @ 36-37 wks. Anything over 40 is higher risk for adverse outocme.
Triplets percentage of PreE? What should you do to minimize risk?
10%. Add ASA 81 mg qd fo multiples.
what findings are c/w neonatal encephalopathy? what neonatal tx should they receive and what is its benefit? what intrapartum finding also increases this risk
- apgars <5 @ 5 and 10 min, cord pH <7, base deficit >12, MRI c/w hypoxic changes, multisystemic failure
- tx= therapeutic cooling (hypothermia) reduces rates of mortality and severe disabilitiy @ 18-24 mo
- fever associated w/ neonatal encephalopathy when acidosis is present: OR 93.9!
in increasing severity, what are asthma rx
SABA -> inhaled CS -> LABA -> PO CS
define autonomy, beneficience, justice, nonmaleficience
- autonomy- patient’s self-determination
- beneficence- obligation to help, do good
- justice- obligation to consider fair distribution of resources/costs
- nonmaleficence- obligation to do no harm
What is mgmt of syphilis findings in pregnancy?
If RPR is pos, do VDRL. If VDRL is pos, do titers. If 1’ or 2’ dz, PCN G IM x1. If asx, presume latenet sx PCN G x3. If HIV pos/immunocompromised, PCN G qw x 3 IV.
Ddx postpartum fever?
UTI, breast engorgement, mastitis, wound infection, endometritis, sptic pelvic thrombophlebitis, epidural fever, PNA. Ddx narrowed w/ timing and sx.
peripartum cardiomyophathy dx and mgmt.
Dx- new onset cardiac failure w/in last month pregnancy or 5 mo postpartum, absence of another cause of dz, echo <45%
Mgmt- ace, diuretic, O2, then when stable, beta blocker
mgmt listeria exposure (gram pos bacteria)
If pt is sx, then tx only if febrile (ampicillin)
If pt is sx, expectant mgmt if afebrile
If no sx, no testing/tx
when can cesarean delivery be indicated in context of failed IOL?
24 hr pit or 12 hr pit after ruptured membranes.
pre-pregnancy PrEP for HIV couple? how long of tx is needed before risk is minimized?
emtricitabine/tenofovir. 20 days for vaginal sex. these are also safe during pregnancy
description of appendicitis on u/s. If inconclusive, best test?
“non-compressible tubular structure more than 6 mm in diameter” warrants surgical intervention. CT abd/pelvis is best if inconclusive. Consider MRI if immediately available.
which fetal structural abnormality is most highly attributable to obesity?
neural tube defect, spina bifida. anorectal atresia, cardiac anomaly, limb anomaly, orofacial clefting are also associated but not as directly.
when to report a patient w/ opiate use to state authorities?
only if mandated by the state
what interventions at what wk for periviability?
20-21 wk abx for PPROM, 22 wk NICU, 23 consider everything, 24 do everything except fetal c/s 25 do everything
dx of alpha, beta thal?
both are microcytic anemias w/ normal Fe labs. alpha thal requires DNA testing and will appear normal on hgb electrophoresis. Beta thal can be dx’d w/ electrophoresis (elevated A2 >3.5%)
at what age should steroids be avoided for NVP? if need nutrition, how to feed?
associated w/ clef palate before 10 wk gestation. if need nutrition, an NG tube should be used for feeding (not TPN)
what type of diet should PKU pts be on during pregnancy?
low protein diet. high rates of developmental delay, microcephaly, congenital heart defect. metabolic control later in pregnancy may not help cardiac defect as it develops so early.
breast ca tx during pregnancy? modality and timing
Chemotx is used in 2nd and 3rd TM. Should be d/c 3 wk prior to delivery if possible d/t possibility of neonatal immunosuppresion. IUGR and PTD have been reported sfx. Tamoxifen use contraindicated
mgmt of hep B during pregnancy
hep B greater than 6-8 log10 copies/mil should receive antiviral tx, usually tenofovir. amnio, breastfeeding are ok.
mgmt and delivery timing for HIV pts
if viral load is <1000 can undergo vaginal labor w/o antiviral tx. For these pts, amnio and prolonged ROM have not been associated w/ greater transmission. If viral load is >1000 should have cesarean delivery @ 38 wks to avoid vertical transmission and receive zidovudine before surgery. Even w/ undetectable viral load should not breastfeed in resource rich settings.
what is the most common cause of fetal bradycardia in a non-laboring pt?
heart block- consider quick u/s(?)
what is the definition of polyhydramnios and severe polyhydramnios?
25 and 35 AFI respectively. When greater than 35, congenital abnormalities are the most common cause.. Otherwise, nearly 50% of cases are idiopathic.
why is TDAP and flu vaccine so important during pregnancy
neonates depend on passive immunity from mom until 2 mo for pertussis vaccination.
timing of anticoag restarting for SVD and c/s
4-6 hr, 6-12 hr respectively
IUGR timing by doppler
REDF 32 wk
AEDF 34 wk
elevated 37 wk
what u/s finding is most strongly associated w/ down syndrome
thickened nuchal fold
selection of GBS abx w/o sensitivity known and mild PCN allergy?
ancef. if anaphylaxis hx, clinda or vanc depending on sensitivities
what baseline evaluation is always most helpful for IUFD?
placental histology, fetal autopsy, fetal karyotype
most important risk factor for postpartum infection?
c/s. Ppx abx decrease risk by 60-70%
