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GK F3E5 > OB 4 > Flashcards

OB 4 Flashcards

1
Q
  • What is the MC type of multiple gestation?
  • What 5 things increase the likelihood of multiple gestation?
A
  • Dizygotic Twins (Fraternal) (70%)
  1. Fertility tx
  2. Advanced maternal age
  3. Increasing parity
  4. Fam hx (either parent)
  5. Obese (BMI >30) + Tall (>5’4”)
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2
Q

Describe Dizygotic “Fraternal Twins”

  • How many oocytes are ovulated & fertilized?
  • How many chorions & amniotic sacs?
A
  • 2 oocytes are fertilized
  • 2 chorions / 2 amniotic sacs
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3
Q

Describe Monozygotic “Identical Twins”

  • Ovulation & fertilization of how many oocytes?
  • What determines “placentation?”
  • How many chorions & amniotic sacs?
A
  • A single oocyte is ovulated/fertilized
  • Timing of egg division determines placentation
  • 1 chorion, 1 amniotic sac = monoamniotic
  • 1 chorion, 2 amniotic sacs = diamniotic
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4
Q
  • What is the ONLY method for DEFINITIVE dx of multiple gestation?
  • What are the 2 different “signs” you can see?
A
  • Ultrasound
    • Gives accurate gestational age
    • Determines chorionicity/amnionicity
    • Best if done in 1st trimester >7 weeks
  • “Lamda Sign” = Dichorionic twins
  • “T Sign” = Monochorionic twins
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5
Q

What is this?

A

Multiple Gestation

  • US of intertwin membrane showing “Lambda Sign” = Dichorionic twins
  • Fraternal Twins (Dizygotic)
  • Diamniotic = 2 amniotic sacs
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6
Q

What is this?

A

Multiple Gestation

  • US of intertwin membrane showing “T Sign” = Monochorionic twins
  • Identical Twins (Monozygotic)
  • Diamniotic (2 amniotic sacs)
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7
Q

Multiple Gestation

  • What are the 7 complications?
  • Which 2 complications are MC?
A
  1. Preterm delivery** (60% before 37 weeks)
  2. Low BW** (57% are <5.5 lbs)
  3. Gestational diabetes
  4. Pregnancy induced HTN
  5. Pre-eclampsia
  6. Post-partum hemorrhage
  7. Higher C-section rate

“PL - HHCG”

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8
Q

What is the MOST SERIOUS complication of multiple gestation?** (probably on exam)

Describe it…

A

Twin-Twin Transfusion Syndrome

  • Only occurs w/ monochorionic gestation (fetuses share 1 placenta & blood supply is unevenly distributed)
  • One fetus is small w/ little amniotic fluid
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9
Q

Definition of what? Dx criteria?

  • Cervical shortening which can lead to preterm spontaneous delivery
A

Cervical Incompetence

  • US to see cervical length in 2nd trimester
  • 20mm or less in women w/ NO prior pre-term delivery
  • 25mm or less in women WITH a prior pre-term delivery
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10
Q

What is the tx for cervical incompetence?

A
  • Placement of cervical cerclage
  • Removed at 37 weeks gestation or onset of rupture of membranes
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11
Q

Which type of HTN?

  • >140/90 PRIOR to 20 weeks gestation
A

Chronic HTN

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12
Q

Which type of HTN?

  • New HTN (>140/90) presenting AFTER 20 weeks gestation w/ NO proteinuria
A

Pregnancy-Induced HTN

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13
Q

Which type of HTN?

  • New onset HTN & Proteinuria AFTER 20 weeks
  • BP reading criteria for dx?
A

Pre-Eclampsia

  • BP readings elevated on at least 2 occasions, at least 6 hours apart
  • Systolic 140+ or Diastolic 90+
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14
Q

Which type of HTN?

  • HTN, Proteinuria, & seizures in woman w/ pre-eclampsia
A

Eclampsia

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15
Q

What are some RFs for Pre-Eclampsia?

A
  • Nulliparity
  • Pre-eclampsia in prev pregnancy
  • Advanced maternal age
  • Multiple gestation
  • Diabetes
  • Chronic HTN
  • Chronic renal dz
  • Family hx of pre-eclampsia
  • Obesity
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16
Q
  • HTN
  • Epigastric pain
  • HA
  • Visual sxs: blurred vision, flashing lights, sparks
  • Edema
  • Hyper-reflexia
  • Oliguria

Dx?

A

Pre-eclampsia

17
Q

Describe criteria for Mild Pre-eclampsia

A
  • Systolic BP 140+ OR diastolic 90+
  • AND proteinuria of 0.3g+ in 24-h urine specimen
18
Q

Describe criteria for severe pre-eclampsia

A
  • Systolic 160+ or Diastolic 110+
  • Oliguria <500cc in 24 hrs
  • 3+ proteinuria (5+ grams on 24 h urine)
  • End organ damage
  • Fetal compromise
19
Q
  • SBP 160+ or DBP 110+
  • Severe HA “worse ever had”
  • Pulmonary Edema
  • AMS
  • Photopsia, scotomata, retinal vasospasm

Dx?

A

Severe features/Complications of Pre-eclampsia

20
Q

What are 3 possible findings in Pre-Eclampsia or Eclampsia?

A

HELLP

  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelet count
21
Q
  • What labs/imaging should be done for Pre-Eclampsia?
  • How often?
A
  • CBC, Creatinine, Liver enzymes
  • 24hr urine & Urine dipstick
  • Fetal NST
  • US (amniotic fluid volume / fetal weight)

Repeat weekly IF NO SIGNS of severe features

22
Q
  • Obese pregnant women 36 y/o w/ DM and HTN presents w/ blurred vision, flashing lights, HTN, epigastric pain, oliguria, proteinuria 5g, and “worse HA she’s ever had.”
  • BP is 162/112

Dx & Tx?

A

Severe Pre-Eclampsia

  • Tx is ALWAYS indicated if severe (to ↓ maternal stroke)
  • Use Beta Blockers (IV Labetalol)
  • AVOID: ACE, ARB, diuretics
23
Q

T/F

  • All antihypertensive meds cross the placenta
A

True!

Use Beta Blockers (=

DO NOT USE: ACE, ARB, diuretics )=

24
Q

What are the 3 causes of mortality for the mother w/ pre-eclampsia?

A
  • Acute MI
  • Stroke
  • Cardiac failure
25
Q

What are the 6 causes of mortality in newborn when mom has pre-eclampsia?

A
  • Poor oxygen transfer
  • Fetal growth restriction
  • Pre-term birth
  • Placental abruption
  • Stillbirth
  • Neonatal death
26
Q

G1P0 37 y/o pregnant female at 19 weeks gestation w/ hx of chronic renal dz presents w/ BP of 162/110.

Dx and Tx?

A

Chronic HTN / Severe Pre-eclampsia

Chronic bc: <20 weeks, nulliparity

Tx bc/ above 160/105!!

1st line: Labetalol

(Do not tx if below 160/105 w/ no evidence of end organ damage)

27
Q

New HTN (162/112) in a 37 y/o female at 21 weeks gestation. She has no proteinuria.

Dx and Tx?

A

Pregnancy Induced HTN - Severe Pre-eclampsia

Preg-induced bc: >20 weeks w/ no proteinuria

Tx bc/ SBP 160+ or DBP 110+

1st line: Labetalol

28
Q

37 y/o female w/ new onset HTN (140/90) w/ proteinuria of 0.3g in a 24 hr urine, at 24 weeks gestation. BP measured on 2 occasions 6 hours apart.

Dx and Tx?

A

Mild Pre-Eclampsia

  • Antihypertensives ARE NOT indicated if BP is consistently <150/100.
  • Tx: Expectant management / ambulatory BP measurements
29
Q

40 y/o pregnant woman at 25 weeks gestation, w/ BP (162/112), oliguria <500cc, 5g proteinuria on 24 hr urine, signs of end organ damage.

Dx and tx? (3)

A

Severe Pre-eclampsia

  • Admit for BP monitoring
  • IV labetalol or hydralazine
  • Prompt delivery for failed medical management
30
Q

40 y/o pregnant woman at 25 weeks gestation, w/ BP (162/112), oliguria <500cc, 5g proteinuria on 24 hr urine, signs of end organ damage. Patient was admitted and tx w/ IV labetalol which failed.

What is dx and next steps (3) in therapy?

A

Severe Pre-Eclampsia

  • Add Betamethasone bc/ under 34 weeks gestation (used to enhance fetal lung capacity)
  • Add MgSO4 (magnesium sulfate) (6g, then 2g/hour)
  • AND a PROMPT delivery
31
Q

What 2 things does pregnancy cause which leads to Gestational Diabetes?

A
  • Hyperinsulinemia
  • Insulin resistance
32
Q

6 RF of GDM (Gestational Diabetes Mellitus)

A
  1. Obesity
  2. +FH of DM
  3. >25 y/o
  4. Glucosuria
  5. Prev hx of GDM
  6. Hx of macrosomia (BW of 8lb 13oz = large baby)
33
Q

What is the #1 “medical complication” in pregnancy?

A

GDM

34
Q

How is GDM diagnosed?

A
  1. 50g 1 hour glucose challenge test administered at 24-28 w gestation. Positive/Failed test = >130
  2. 100g 3 hour OGTT, blood glucose measured at fasting, 1hr, 2hr, 3hr. (2/4 + values = GDM dx)
35
Q

What are 2 major complications of GDM?

A
  • Congenital anomalies (3-4 fold ↑)
  • Pregnancy induced HTN (2 fold ↑)
  • Others: macrosomia, placental abruption, prematurity, fetal demise, delayed fetal lung maturity, pre-eclampsia)
36
Q

Patient has blood glucose of 140 at 1 hour and 3 hour post 100mg OGTT.

What is dx and tx?

Blood monitoring goals?

A

GDM

  • 1st line: Insulin
  • Monitor capillary blood glucose at fasting & 2 hours post meal (4x/day)
  • Goal of fasting is <95-105
  • Goal of 2hr postprandial is <120
37
Q

Patient has blood glucose of 120 w/ 3 hour OGTT at fasting and 3 hour.

What is dx?

A

None. Patient does not have GDM bc/ glucose is not >130…

38
Q

Besides insulin and monitoring blood gucose, what is the treatment for GDM? (5)

A
  • ADA diet (diabetic diet)
  • Moderate exercise program
  • Nutrition cosult (usually has poor diet)
  • Fetal monitoring w/ NST and BPP (US)
  • Perform 2-hour glucose tolerance test at 6 weeks postpartum*** (this visit is to make sure GDM has resolved, incase pt entered pregnancy w/ undiagnosed DM2)

GK F3E5 (19 decks)

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