OB 3 Flashcards

(44 cards)

1
Q

chronic hypertension

A

BP >140/90 before the patient became pregnant

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2
Q

what rx to treat maternal HTN

A

methydopa, labetalol, nifedipine

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3
Q

gestational HTN

A

BP >140/90 that starts after 20 weeks gestation; no proteinuria and no edema; only tx patient during pregnancy

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4
Q

preeclampsia risk factors

A

chronic HTN. Renal dz

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5
Q

what are some antihypertensives contraindicated in pregnancy

A

ACE inhibitors and ARBs because they cause fetal malformations

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6
Q

presentation of mild preeclampsia

A

BP >140/90; proteinuria (dipstick = 1-2+; 24 hr urine >300mg); edema of hands, feet, face

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7
Q

presentation of severe preeclampsia

A

BP >160/110; proteinuria (dipstick = 3-4+; 24 hr urine >5 gms); generalized edema, mental status and vision changes, impaired liver fn

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8
Q

eclampsia

A

tonic-clonic seizure in patient with h/o preeclampsia

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9
Q

treatment of eclampsia

A

stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine

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10
Q

HELLP syndrome

A

hemolysis, elevated liver enzymes, low platelets

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11
Q

treatment of HELLP

A

stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine

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12
Q

pregestational diabetes

A

woman had diabetes before becoming pregnant

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13
Q

maternal complications of pregestational diabetes

A

4x more likely to have preeclampsia, 2x more likely to have a spontaneous abortion, increased infxn rate, increased PPH

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14
Q

fetal complications of pregestational diabetes

A

increase in congenital abnormalities, macrosomia, preterm labor

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15
Q

evaluation of patient with pregestational diabetes

A

EKG, 24-hour urine (CrCl, protein), HbA1C, ophtho exam

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16
Q

treatment of diabetes during pregnancy; type 1

A

insulin pump with NPH

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17
Q

treatment of diabetes during pregnancy; type 2

A

subQ insulin with NPH and lispro

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18
Q

complications of gestational diabetes

A

preterm birth, fetal macrosomia, birth injuries, neonatal hypoglycemia, mothers are 4-10x more likely to develop DM2

19
Q

neonatal hypoglycemia

A

increase in fetal insulin secondary to living in hyperglycemic environment

20
Q

when to screen for gestational diabetes

A

between 24 and 28 weeks

21
Q

how to screen for gestational diabetes

A

glucose load test then if positive glucose tolerance test

22
Q

glucose load test

A

non-fasting ingestion of 50g of glucose, measurement of serum glucose 1 hour later; >140mg/dL is postive

23
Q

glucose tolerance test

A

fasting ingestion of 100mg of glucose then 3 measurments of serum glucose at 1, 2 and 3 hours. If any are elevated = gestation diabetes

24
Q

first line treatment of gestational diabetes

A

diabetic diet and exercise (walking)

25
treatment of gestation diabetes is 1st line treament fails
treat with insulin (NPH before bed and Aspart before meals) or metformin and glyburide
26
intrauterine growth restriction (IUGR)
fetuses weigh in bottom 10% for gestational age
27
symmetric IUGR
brain is proportionate with rest of body, occurs before 20 weeks gestation
28
asymmetric IUGR
brain weight is not decreased, abdomen is smaller than head, occurs after 20 weeks gestation
29
etiologies of IUGR
chromosomal abnormalities, neural tube defects, infxn, multiple gestations, maternal htn or renal dz, maternal malnutrition and substance abuse
30
complications of IUGR
premature labor, stillbirth, fetal hypoxia, low IQ, seizures, mental retardation
31
what is the treatment of IUGR
no treatment just prevention -- quit smokig and prevent maternal infxn with immunizations
32
macrosomia
fetuses with an estimated birth weight over 4500g
33
risk factors for macrosomia
maternal diabetes or obesity, advanced maternal age, postterm pregnancy
34
diagnosis of macrosomia
fundal height >3cm greater than gestational age; US to confirm
35
what to look for on US to confirm macrosomia
femur length, abdominal circumference, head diameter
36
complications of macrosomia
shoulder dystocia, birth injuries, low APGAR scores, hypoglycemia
37
what should be done for macrosomic babies?
induction of labor if lungs are mature before the fetus is 4500g; cesarean is indicated if fetus is >4500g
38
nonstress test (NST)
checks for fetal well-being while still in the uterus; measures fetal movements and fetal heart rate
39
reactive NST
detection of two fetal movements, acceleration of fetal HR >15bpm lasting 15-20 seconds over a 20-minute period; fetus is doing well
40
biophysical profile (BPP)
NST, fetal chest expansions, fetal movement, fetal muscle tone, amniotic fluid index; each worth 2 pts, 8-10 is nl, below 4 is abnormal
41
fetal chest expansions
count episodes of fetal chest expansions; normal is 1 or more in 30 minutes
42
fetal movement
count fetal movements; normal is >3 in 30 minutes
43
fetal muscle tone
fetus flexes an extremity
44
amniotic fluid index
volume of amniotic fluid based on sonogram