OB Flashcards
What is the effect of teratogens?
First two weeks: either kill baby…or nothing
2-12 weeks: abnormal organ formation
Does blood pressure go up or down with pregnancy?
Both systolic and diastolic pressures go down
What causes increased tidal volume/minute ventilation during pregnancy?
Progesterone
What happens to the stomach with pregnancy?
Decreased motility
How many calories should a pregnant woman take in per day?
2500
How much weight should a pregnant woman gain?
BMI less than 19.8…28-40lbs
BMI less 19.8-26…25-35lbs
BMI greater than 26…15-25
How much folate is recommend for non-risk pregnancies?
0.8-1mg/day to prevent neural tube defects
How much calcium is recommended for pregnancies? What can happen with hypocalcemia?
1000-1300mg/day (50% increase)
Impaired maternal bone mineralization or HTN
Premature birth or low birth weight
How much iron is recommended for pregnancies?
30mg/day (100% increase)
How much protein is recommended for pregnancies?
60g/day (30% increase)
A Full Integrated Test is done during the first trimester for mothers who desire noninvasive testing with the lowest false-positive risk. What is all on it?
PAPP-A (Pregnancy-Associated Plasma Protein A)
hCG
NT (Nuchal Translucency)
A Full Integrated Test comes back with decreased PAPP-A, increased hCG, and increased NT. What is the likely defect?
Trisomy 21…only one with elevated hCG
How can trisomy 18 and 13 be told apart on Full Integrated Test?
Trisomy 18 has really low hCG
Trisomy 13 has only low hCG
When is a quadruple screen checked? What is all on it?
16-18wk appointment
AFP, hCG, unconjugated estriol, inhibin A
How can it be determined on quad screen that the baby has trisomy 21?
Increased hCG and Inhibin A
How can trisomy 18 and 13 be told apart on quad screen?
Trisomy 18 everything is low except inhibin A…which is normal
Trisomy 13 everything is normal
When is glucose challenge done?
24-28 weeks
When are N. gonorrhea, Chlamydia, and GBS screened for?
32-37 weeks
When can an amniocentesis be done? What does it check for? What is the risk?
16 weeks
Amniotic AFP and determine karyotype (detects neural tube defects and chromosome abnormalities)
1% increased risk of spontaneous abortion
When is chorionic villi sampling done?
9-12 weeks for early detection in higher risk patients
When is percutaneous umbilical blood sampling done?
After 18 weeks to identify chromosomal defects, fetal infection, and Rh sensitization
RECAP: Maternal serum AFP can be checked from weeks 16-18 to determine what?
Neural tube defects (if high)
Trisomy 18 or 21 (if low)
What is considered an abnormal 1hr glucose tolerance test? 3hr glucose tolerance test?
1 hr:
>130mg/dL
3hr: 2+ of the following Fasting: 95+mg/dL 1hr: 180+mg/dL 2hr: 150+mg/dL 3hr: 140+mg/dL
What are the goal glucose levels in pregnant women with gestational diabetes?
Fasting glucose less than 90
1 hour post-prandial less than 120
What are some fetal complications from gestational diabetes?
Macrosomia, polyhydramnios delayed pulmonary maturity, uteroplacental insufficiency –> IUGR or intrauterine fetal demise
What are some perinatal/postnatal complications from gestational diabetes?
Traumatic delivery, delayed neurologic maturity, RDS, hypoglycemia (secondary to therapy), hypocalcemia
What are maternal complications from normal diabetes?
Preeclampsia, renal insufficiency, retinopathy, DKA, hyperosmolar hyperglycemic nonketotic state
What are fetal complications from normal diabetes?
Cardiac defects (TGA and ToF), neural tube defects, sacral agenesis, renal agenesis, polyhdramnios, macrosomia, IUGR, intrauterine fetal demise
A pregnant woman has HTN, proteinuria, and edema. What does she have? What is seen on labs
Preeclampsia
Decreased platelets, normal/high Cr, increased ALT and AST, decreased GFR
What are some complications of preeclampsia? What is the cure for preeclampsia?
Eclampsia, stroke, IUGR, pulmonary edema, maternal organ dysfunction, HELLP…can cause abruptio placentae, renal insufficiency, encephalopathy, DIC
Deliver
What is done for preeclampsia if far from term?
If mild: restricted activity and frequent assessments
If severe: inpatient, BP less than 155/105 with diastolic >90, MgSO4 (prevent seizure)
A mother has preeclampsia and delivers the baby. Now what?
Continue anti-HTN meds and MgSO4 and continue to monitor
What is eclampsia?
Maternal seizures…usually preceded by headaches, visual disturbances (scotomata), and upper abdominal pain
How should eclampsia be treated?
MgSO4 and diazepam
Stabilize with oxygen and BP control
Continue BP med and MgSO4 for 48hrs post-delivery
What are complications of eclampsia?
2% maternal death; 6-12% fetal death
65% of preeclampsia and 2% of eclampsia in subsequent pregnancies
What should be done with pregnant epileptic patients?
Continue normal meds + supplement vitamin K and folate
What are the risks for a pregnant asthma patient?
Preeclampsia, spontaneous abortion, intrauterine fetal demise, and IUGR with untreated severe disease
A pregnant woman requires anticoagulation. What cannot be used? When should it be stopped/restarted?
Warfarin is teratogenic (skeletal abnormalities)
Stop 24-36hrs prior to delivery and restart 6 hours after
What can be used to treat maternal UTIs?
Amoxicillin, nitrofurantoin, or cephalexin for 3-7days
NOT fluoroquinolones
Risks for pot baby? Momma?
Fetal risks: IUGR, prematurity
Maternal risks: minimal
Risks for coke baby? Momma?
Fetal risks: abruptio placentae*, IUGR, prematurity, facial abnormalities, delayed intellectual development, fetal demise
Maternal risks: Arrhythmia, MI, subarachnoid hemorrhage, seizures, stroke, abruptio placentae
Risks for alcohol baby? Momma?
Fetal risks: FAS (metnal retardation, IUGR, sensory and motor neuropathy, facial abnormalities), spontaneous abortion, intrauterine demise
Maternal risks: minimal
Risks for opioid baby? momma?
Fetal risks: Prematurity, IUGR, meconium aspiration, neonatal infections, narcotic withdrawal…can be fatal
Maternal risks: infection (from needles), narcotic withdrawal, PROM