OB Flashcards
what are the criteria for preeclampsia?
-after 20th week
-140/90 on 2 occasions at least 8 hours apart
-one of more of the following: proteinuria, new onset headaches/visual disturbances, thrombocytopenia, impaired liver or kidney function, or pulmonary edema
what is the cure for preeclampsia?
delivery is the only cure
what is eclampsia?
severe preeclampsia in which seizures occur
what are the effects of preeclampsia and eclampsia on fetus?
-long-standing HTN leads to placental insufficiency which impairs the nutrient and 02 to fetus which results in IUGR.
-placental abruption is also more frequent
HELLP syndrome stands for?
- H = hemolysis
- EL = elevated liver enzymes
- LP = low platelet count
when does HELLP syndrome occur?
-4-12% of all those with preeclampsia, most often in 27-37 weeks but also may develop postpartum
how does the mother present with HELLP syndrome?
- often present with flu like symptoms including headache, nausea, vomiting, and visual disturbances
- pain in the upper right quadrant is related to liver dysfunction, but may be misdiagnosed as GI or gallbladder disease
what is the treatment of HELLP syndrome?
platelet transfusions are given immediately before birth - 20,000/mm3 before vaginal delivery or 50,000/mm3 before C-section.
HELLP syndrome treatment?
Immediate delivery of the fetus and platelet transfusion ideally prior to delivery
does insulin cross the placenta?
No
explain the effects of diabetes on a fetus/newborn
The fetus is exposed to elevated blood glucose levels which restrict fetal growth. at 20 weeks, the pancreas of the fetus be insipidus insulin the combination of elevated blood glucose from the mother, combined with elevated insulin from the newborn triggers rapid fetal growth increasing fat, and glucagon store at birth, sudden withdrawal of maternal glucose, combined with continued insulin production of the newborn results in hypoglycemia
around how many weeks does the fetus start producing insulin?
20 weeks
does glucose cross the placenta?
Yes
what is sickle cell?
Recessive genetic disorder of chromosome 11, causing hemoglobin to be defective, so that red blood cells are sickle shaped and inflexible, as result accumulation in small vessels creates blockages and causes pain
effects of sickle cell anemia on a pregnant woman
- Increase risk urinary and pulmonary infections, congestive heart failure, acute renal failure (all of which at any time can trigger crisis that puts the fetus at risk)
- Fetal mortality rates are about 18% due to sickling in the placenta
Effects of sickle cell anemia on the fetus
- fetal death rates are about 18% due to the sickling of the placenta
- neonates are at increased risk for prematurity and IGUR
cardiac disease in the mother puts baby at what risk? what is recommended?
5-10% of babies will have cardiac anomalies, fetal echocardiogram is recommended
what is the recommended iron dosing for anemia?
60-120mg daily, avoid caffeine and dairy, take with a source of vitamin C
foods high in folate
green leafy vegetables, liver, citrus fruits, legumes, nuts, and grains
recommended supplementation of folate/folic acid
folate 600-1000mcg daily, folic acid 1-5mg daily
naegele’s rule
first day of LMP minus 3 months plus 7 days = gestation age
vasa previa
one or more of the fetal blood vessel lie across the cervical OS
chorionic villus sampling
CVS; inserting a catheter into the ulterior to obtain placental villi for testing; preformed at 10-13 weeks gestation; chromosomal, DNA and enzymatic analysis is done to the tissue
amniocentesis
15-20 week; US guided, needled is inserted into amniotic pocket; 15-20ml if amniotic fluid needed
name the 5 parameters of a BPP
fetal respiration, fetal movement, fetal tone, amniotic fluid volume, fetal HR (NST) (NST can be omitted)
cat I
normal; FHR baseline 110-160 bpm, moderate variability only, may have early decels but no late of variable decels
cat II
indeterminate (anything that isn’t cat I or III); variability may be minimal or marked; accelerations may be absent; decelerations may be prolonged, variability, or recurrent late with moderate variability.
cat III
no variability with recurrent late decelerations, recurrent variable decelerations; bradycardia; sinusoids pattern
early deceleration
caused by head compression; onset just before the start of the contractions, lowest level at the midpoint of the contraction (mirrors the contraction)
late deceleration
caused by compression of vessels and uteroplacental insufficiency; onset is late in the contraction and the lowest point is after the midpoint of the contraction
variable deceleration
caused by umbilical cord compression; maybe abrupt and not related to the contraction; maybe be variable and occur once or receptively; repetitively may indicate fetal distress
uterine hypertonus? what can cause it?
- uterus fails to relax between contractions
- hormonal imbalance, immature genitals, infections, cervical failure, fibroid tumors
uterine tachsystole
6 or more contractions in 10 mins or a series of 2 min or longer contractions; averaged over 30 mins
explain the hormonal changes that cause labor onset
progesterone inhibits contractions; progesterone levels fall and estrogen levels increase; this allow the uterine to contact in response to the pituitary gland’s release of oxytocin
fetal factors that initiate labor (4)
- prostaglandin levels rise; arachidonic acid is release from amniotic fluid, the cord placenta bed; arachidonic acid is converted into prostaglandin
- as the placenta ages, this tiggers contractions
- fetal cortisol from the fetal adrenal glands reduces progesterone formation
- the fetus secrets oxytocin equal to an infusion of 3mU/min
maternal factors in initiate labor (4)
- stretching of uterine muscles causes release of prostaglandin; prostaglandin prepares uterine tissue to respond to oxytocin
- decreased progesterone levels allows estrogen to excite the uterine muscle response
- cervical pressure stimulates nerve plexus; resulting in signals to the posterior pituitary gland to release oxytocin
- oxytocin release in the circulation raises dramatically all throughout labor; along with prostaglandin, oxytocin keeps muscles from binding calcium, this raises the calcium in the blood causing the contractions to be begin
first stage of labor
0 - 10cm; latent is 0-3cm; active is 3-7cm; transition is 7 - complete
2nd stage of labor
10 cm to birth
pushing
3rd stage of labor
birth of baby to birth of placenta
4th stage of labor
birth of placenta to women is stabilized
1st degree tear
perineal skin + mucous membranes of the vagina are torn
2nd degree tear
perineal skin plus vaginal mucous membranes as well as the fascia and muscles of the perineum
3rd degree tear
perineal skin, vaginal mucous membranes, and fascia and muscle of the perineum are torn and extends to the rectal sphincter
4th degree tear
tear extends into the rectal sphincter
vacuum assisted birth rules
- suction 50-60mmHg
-traction is applied with contraction
-traction should be limited to 20-30mins - only 3 “pop offs” allowed
-increased risk for mother and newborn
marginal placenta previa
comes within 3cm of the cervix - is type is the most likely to resolve, this is because as the pregnancy grows the uterine grows and where the placenta implants moves upwards away from the cervix
partial placenta previa
within 3c of the cervical
the most irregular fetal heart rhythm is…
premature atrial contraction (PAC); usually resolve without interventions
most common effect of COVID on a fetus, and what is the recommendations from the CDC
preterm birth; there is a risk of stillborn; pregnant women are at a greater risk of being hospitalized and ventilation; CDC recommends women receive COVID vaccinations, including boosters
describe how sickle cell disease (SCD) is passed down
SCD is autosomal recessive disorder; in order to develop the disease, the child has to inherit the treat from both parents. if both parents have SCD 25% will have the disease, 50% will be a carrier; and 25% will have neither.
what medications is safe for women that have influenza
oseltamivir (tamiflu)
what is the difference between physiologic and pathological jaundice?
- pathological jaundice appears within the first 24 hours of life; physiologic appears after 24 hours (24-28 but may be later)
blue / black cohosh herb and pregnancy
not considered safe; stimulates contractions; also associated with maternal cardiovascular abnormalities and fetal hypoxia
when should a pregnant woman start antiviral?
only zanamivir or oseltamivir; within 48 hours of symtpoms
what is the difference between open and closed glottis pushing; which is recommended and why?
- closed-glottis pushing = holding breathe and bearing down hard without the urge to push
- open glottis pushing = women is advise to hold her breath for no more then 5-6 seconds when feeling the urge to push and take several breathes between pushes
- closed glottis pushing is no longer recommended because of the risk of fetal hypoxia
treatment for suspected necrotizing entercolitis in order of importance
- stop feeding; place NG to decompress stomach/intestines, IV fluid resuscitation and TPN to prevent dehydration and malnutrition; abx as indicated; surgical intervention if perforation as occured
- preterm infants that are formula fed are at highest risk for necrotizing enterocolitis
uterus descend post delivery
- by day 2 after delivery the uterus should normal descend by 1cm per day; usually the fondus can no longer by palpated by day 14
- post delivery the uterus is approx 1000g/2.2lbs and by 6 weeks PP it is 60g/2oz
during a ctx, the usual response to maternal cardiovascular system is…and why?
- increase BP, decrease HR
- because during a ctx the blood flow to the placenta slows temporarily causing maternal blood volume to increase 10-25%, this causes the BP to increase and the HR to decrease
what weeks should an amniocentesis be done and why?
- amniocentesis should be done at 16-20 weeks when adequate amniotic fluid volumes and fetal cells in the fluid are present
- earlier then 13-14 weeks is associated with increase fetal foot deformities; done between 15-16 weeks have a increased risk of resp problems
what are the 3 phases of a contraction?
increment, peak/acme, decrement
what is the increment phase of the contraction?
the contraction begins at the fundus and spreads downwards towards the uterus
what is the peak/acme of the contraction?
the point in which the contraction is the strongest and most intense
what is the decrement of the contraction?
the uterus begins to relax and the contraction decreases in intensity
BH contractions begin at h how many weeks?
16 weeks
what is the proteinuria level for preclampsia?
greater the 0.3g (300mg) in 24 urine; +1 dipstick
lochia rubia
- days 1 - 3 PP
- dark red with small clots
- abnormal: large clots; foul odor
lochia serosa
- 4 - 10 days PP
- serosanguinous drainage
- abnormal: persistent red drainage; excessive drainage; clots; foul odor
lochia alba
- 10 days to 6 weeks PP
- light yellow to white discharge, decreasing in volume
- abnormal: return to red or serosanguineous drainage; clots; foul smelling
3 primary causes of thromboembolic disorders in PP
- venous stasis; compression of vessels, prolong standing or inactivity, blood vessel dilate promoting thrombus formation
- hypercoagulation; coagulation factors increased; this is thought to help protect women from hemorrhage
- blood vessel trauma; may occur during c-section resulting in pelvic vein thrombosis
how long after miso can you start oxytocin?
3-4 hours after last dose of miso
how long after cervidil can you start oxytocin?
30-60 mins post removal of cervidil
how long after deinoprostone gel can you start oxytocin?
6-12 hours
contraindications of external cephalic version (ECV); what about Rh-negative?
- 37 weeks or more, anything that doesn’t allow for vaginal delivery (placenta previa, active gential herpes), non reactive NST, multiple gestation, amniotic fluid abnormality, pervious uterine surgery/ c-section.
- Rh negative is not a contraindication but RhoGAM should be given after the procedure
what is nocturia and why is normal is 2nd and 3rd trimester?
- nocturia = voiding at night
- when a patient is reclining in bed the pressure on the pelvic vessels lessens and the blood flow to the kidneys increases
what hormone is primarily responsible for maintaining the pregnancy? which hormone is primarily responsible for fetal growth?
- progesterone maintains the pregnancy; estrogen is primarily responsible for growth
- estrogen and progestestrone are are produced by the placenta at about 12 weeks
why do you monitor urine output when patient is on magnesium?
magnesium should be held if urine output is less then 30ml/hr because urine output must be adequate for magnesium to clear the system; to avoid magnesium toxicity which can result in resp depression.
what medication do you use to treat magnesium toxicity?
calcium gluconate
evaporative heat loss
heat loss that occurs when fluid is on newborns skin (amniotic fluid) is converted to vapor
convection heat loss
heat is lost to cool air passing over the infants skin, such as a draft or cold hair in room; cloth newborn and keep room warm
convection heat loss
heat is loss via radiation; when you place a infant by a nearby cool surface such as windows or isolette walls (NOT direct contact)
conduction heat loss
heat is loss through direct contact with cool surface, such as cool hands, stethoscope, cold blankets; skin to skin contact helps prevent conductive heat loss
reassuring fetal movements
4 fetal movements in 1 hour; or 10 movements in 2 hours
untreated hypothyroidism in pregnancy is more likely to cause what abnormalities in fetus:
significantly associated with brain development and can lead to fetal death
what is the selling maneuver and why is used in emergent C sections
gentle cricoid pressure against the trachea to effectively block the esophagus, reducing GI reflex and risk for aspiration. This is used in C-sections because the patient may not be NPO
what is a uterine artery embolization? what is used for?
-a procedure done by a interventional radiologist where tiny particles (about the size of grains of sand) are injected into the blood vessels that lead the uterus, decreasing the blood flow to the uterus, resulting in decreased blood loss
- used to avoid hysterectomy or to treat uterine fibroids
contraindications for uterine artery embolization?
infection of urinary or vaginal tract, hemodynamically unstable, cancer, rental failure, hyperthyroidism, and hx of radiation to pelvis
massive transfusion protocols: ratio to PRBCs, FFP, and platelets is….
1:1:1 = approximately makes whole blood
HIV exposed infants should receive what antiviral after delivery
- if mother took antiretroviral during pregnancy: zidovudine; as soon as possible following delivery (within 6-12 hours) and continue for usually 6 weeks; dose is determined by weight and gestation age at birth
- if mother didn’t take antiretrovirals, neonate should receive both zidovudine and nevirapine
what is considered anemia in a term infant
hematocrit below 45%
during birth, at what stage does the mother frequently experience chills?
stage 4; 1- 4 hours post delivery; unknown why but thought to be the result of circulatory changes post delivery
why do you give a tocolytic prior to external cephalic version?
tocolytic is administered to relax the uterus during the procedure
why does diarrhea pose a greater risk of dehydration for a neonate then an older child?
the intestines are relatively longer and have more surface area; this normal increases the absorption but with diarrhea it also increases the rate of fluid loss
when is the fundus palatable at the umbilicus?
20 weeks
when is the fundus palatable at the mid point between the symphysis pubis and the umbilicus?
16 weeks
where is the fundus at 12 weeks?
level with the symphysis pubis
how to measure fundal height after 22-24 weeks
gestational age is approx to centimeters; example 26 cm = 26 weeks
what is chloasma?
dark blotchy pigmentation of the face that occurs with pregnancy; melasma gravidarum
one of the most common pregnancy complications with patient with systemic lupus erthematosus?
preeclampsia; risk being 16-30%; also SGA is common, occurring in 10-30% of lupus pregnancies
TXA dosing and timeline
- 1g in 100ml IV min over 10 mins, a 2nd dose 30 mins after 1st if bleeding persists
- must be given within 3 hours of onset of bleeding/birth; shown no effectiveness if given later
maternal hyperthyroidism may cause __(4)_____ in fetus?
fetal tachycardia, preterm birth, stillborn, and SGA
frank breech
legs are completely extended towards the shoulders/head and the buttocks is the presenting part
full/complete breech
the fetus is in a flexed position with legs flexed against the abd/chest, head is in the superior position
footling breech
one or both legs are extended and presenting
what is polycythemia?
- hematocrit greater the 65%; results from fetal hypoxia or intrauterine transfusion = placental insufficiency, poorly controlled GDM, delayed cord clamping, twin to twin transfusion, maternal tobacco use, and certain chromosomal disorders
- treatment is partial exchange transfusion
what is a safe platelet count that a women can deliver at?
must be a over 50,000; gestational thrombocytopenia is common and characterized by platelet counts of 130,000-150,000.
the drug most commonly associated with abruptio placenta?
cocaine; cocaine is rapidly absorbed in the fetus, placenta and mother; all experience vasoconstriction which may be the direct cause of the abruption
cocaine use is associated with…..(5)
abruptio placentae, placenta previa, IUGR, precipitous delivery and preterm labor
during the uterine ctx, the contraction force is in the ________ section of the uterus
upper two thirds of the uterus
how many extra calories should a pregnant women eat?
300 calories per day