What are the dietary recommendations for: Calories Protein Iron Calcium

Calories: 350 additional / day Protein: 1g/kg/day (50kg pt = 50g/day) Iron: 30 mg/day Calcium: 250mg/day

OB 2 Flashcards by Shea Green

What 4 prenatal labs are obtained during the 3rd trimester?

At what weeks?

Gestational Diabetes (24-28 w)

Repeat antibody screen in Rh neg women (26-28 w)

Hemoglobin & Hematocrit (35 w)

Perform GBS screen (35-37 w)

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Describe the Gestational Diabetes Screening

24-28 weeks gestation

50g 1 hour glucose challenge test
Normal = <130
If >130, do 3 hr glucose tolerance test
3 hr: 100g glucose, blood glucose obtained at:
- fasting, 1, 2, 3 hr
- 2 of these 4 values need to be abnormal for dx

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What is performed at 26-28 weeks gestation?

Antibody Screening

Repeat antibody screen in Rh neg women
If neg, administer RhoGAM at 28 weeks
RhoGAM attaches to Rh+ antigen, preventing mothers immune system from attacking fetal RBCs

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What is performed at 35-37 weeks gestation?

GBS screen

GBS + women planning a vag delivery require intrapartum IV abx
(Ampicillin 2g, then 1g ever 4 hrs till delivery)
If pcn allergy: Clindamycin
ALL WOMEN in labor PRIOR to GBS screen, require empiric abx therapy

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GBS causes what infections in infants?

Sepsis

PNA

Meningitis

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What are the dietary recommendations for:

Calories
Protein
Iron
Calcium

Calories: 350 additional / day
Protein: 1g/kg/day (50kg pt = 50g/day)
Iron: 30 mg/day
Calcium: 250mg/day

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How much Folic Acid is needed/day?

Why?

0.4mg/day (minimum)

↓ neural tube defects & spina bifida

Required for brain, skull, spinal cord development

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What 4 things might you need to supplement in a vegetarian/vegan diet?

Calcium
B12
Iron
Zinc

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What is the recommended caffeine consumption in pregnancy?

<200 mg /day

Otherwise there is an ↑ risk of spntneous abortion, low birth weight, pre-term delivery

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What 4 fishes should pregnant women avoid eating?

Shark
Swordfish
Marlin
Bigeye Tuna

Can eat: crab, salmon, lobster, tilapia, canned light tuna

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Why should pregnant women avoid undercooked meat?

Listeria monocytogenes / Toxoplasmosis

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Why should pregnant women avoid contaminated raw milk/cheese?

Brucellosis

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Women should avoid exercise while lying on back at how many weeks gestation?

>20 weeks bc/ ↑ fetal weight can compress IVC blood which will ↓ flow to fetus

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What are some signs a woman should stop exercising in pregnancy? f

Fatigue, uncomfortable, dehydrated, overheated

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2 vaccines to update during pregnancy?

Tdap & INACTIVE influenza

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What vaccines are avoided in pregnancy? (3)

ALL LIVE VACCINES:

MMR, Varicella, Influenza (live)

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Travel recommendations for pregnancy women?

Avoid travel to areas w/ Zika virus (basically everywhere)
Avoid travel in general >35 weeks

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What is the normal length of cervix?

2.5cm or greater

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What is the “station” in the process of labor?

Degree of descent of presenting part in birth canal in relation to ischial spines

(reported w/ + or - signs)

What are the 3 P’s?

Power: uterine contractions

Passenger: size, position, lie, attitude, presentation

Pelvis/Passage: bony & soft tissue structures of maternal pelvis

What does the 1st stage of labor consist of?

Interval between: onset of labor –> full cervical dilation & effacement

Latent phase: 1st contractions –> 3-4cm dilation (rate of dilation is SLOW 0.5cm/hr)

Active phase: Dilation rate increases 1cm/hr –> ends w/ COMPLETE dilation

What does the 2nd stage of labor consist of?

Complete dilation –> delivery

(pushing phase)

What does the 3rd stage of labor consist of?

Delivery of infant –> Delivery of placenta

(placenta is usually delivered <30 mins after delivery of infant)

Describe “Acceleration” of Fetal Monitoring

Normal/Good/Reassuring of fetal well-being

Increases 15 bpm above baseline and lasts 15 seconds

Describe "Deceleration" of Fetal Monitoring

BAD **Variable:** d/t cord compression (seen in respect w/ timing of contraction, shape, severity) **Late:** baby is in distress, fetal hypoxia, placental insufficiency, maternal hypotension, maternal hypoxia

What is hypocontractile uterine activity (power) Measured how? Solution?

* **Monitored by external tocometry** * \<3 contractions in 10 mins **or** contractions lasting \<50 seconds * **Measured by internal pressure catheter (IUPC)** * \<200-250 Montevideo units (MVUs) * **Solution:** augment w/ Pitocin

What is Cephalopelvic Disproportion?

non-gynecoid pelvis (looks like a mans pelvis) Can be d/t injury or illness causing contracted pelvis **Solution:** abdominal delivery

What is considered an abortion?

Pregnancy loss prior to 20 w gestation **Causes:** chromosomal (50%) & teratogens

What is the MC complication in early pregnancy?

Abortion (80% occur in 1st trimester) =pregnancy loss prior to 20 w gestation

**Which type of abortion?** Vaginal bleeding with a closed cervix

Threatened

**Which type of abortion?** Vaginal bleeding with an open cervix

Inevitable

**Which type of abortion?** Products of conception have partially passed

Incomplete

**Which type of abortion?** Passage of the entire conceptus

Complete

**Which type of abortion?** Pregnancy is retained despite death of the fetus

Missed

**Which type of abortion?** Recent spontaneous abortion complicated by intrauterine infection

Septic

What are 6 RF of abortion?

* Advanced maternal age * Prior spontaneous abortion * Multigravity * Alcohol * Ilicit drug use * Smoking

Clinical presentation of abortion? (3)

* Vaginal bleeding * Pelvic pain * Incidental finding on US

What 2 labs should be obtained for abortion?

* CBC * beta HCG quant

What is seen on transvaginal US w/ abortion?

* Absent fetal heart tones * Absent / failed growth of fetal pole, gestational sac/yolk sac

**T/F** Abortion does not require Rhogam

False, give Rhogam if Rh neg

3 treatment options for abortion

**Expectant:** get preg test 2w later **Surgical:** Dilation & Curettage (must ensure pathology contains chorionic villi) **Medical:** Misoprostol 800mg/vagina, repeat US 24hrs later, pregnancy test in office 2 w later

What should you warn patient about if any instruments are used? such as forceps?

Asherman's Syndrome (adhesions in uterus, can affect subsequent pregnancies)

**Dx? Tx?** Recent spontaneous abortion followed by fever, chills, malaise, abd pain, vaginal bleeding/hemorrhage, malodorous vag discharge

**Septic Abortion** **Tx:** hospitalization for IV abx: Cefoxitin + Doxycycline

**Elective Abortion** What is the "medical" option?

**Medical:** * **Day 1:** Mifepristone 200mg oral * **24-48 hrs later:** Misoprostol 800mcg bucally * Used ONLY for pregnancies up to **70 days** gestation

**Elective Abortion** What is the surgical option? (2)

**Suction curettage:** 1st trimester **Dilation & evacuation:** 2nd trimester, Laminaria (osmotic dilator) placed within endocervix 24-48 hrs prior to procedure

5 complications of Elective Abortions?

* Hemorrhage * Uterine perforation * Infection/retained products of conception * Death * Postabortal syndrome

**Dx? Tx?** Immediate abdominal pain within 1 hr of procedure, diaphoresis, nausea, tachycardia, large globular uterus on bimanual exam

* *_Postabortal Syndrome_** * *Tx:** Methergine 0.2 mg IM & Dilation and Curettage