OB 2 Flashcards
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)
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
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
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
GBS causes what infections in infants?
Sepsis
PNA
Meningitis
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
How much Folic Acid is needed/day?
Why?
0.4mg/day (minimum)
↓ neural tube defects & spina bifida
Required for brain, skull, spinal cord development
What 4 things might you need to supplement in a vegetarian/vegan diet?
- Calcium
- B12
- Iron
- Zinc
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
What 4 fishes should pregnant women avoid eating?
- Shark
- Swordfish
- Marlin
- Bigeye Tuna
Can eat: crab, salmon, lobster, tilapia, canned light tuna
Why should pregnant women avoid undercooked meat?
Listeria monocytogenes / Toxoplasmosis
Why should pregnant women avoid contaminated raw milk/cheese?
Brucellosis
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
What are some signs a woman should stop exercising in pregnancy? f
Fatigue, uncomfortable, dehydrated, overheated
2 vaccines to update during pregnancy?
Tdap & INACTIVE influenza
What vaccines are avoided in pregnancy? (3)
ALL LIVE VACCINES:
- MMR, Varicella, Influenza (live)
Travel recommendations for pregnancy women?
- Avoid travel to areas w/ Zika virus (basically everywhere)
- Avoid travel in general >35 weeks
What is the normal length of cervix?
2.5cm or greater
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
