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IPAP > OB Block 2 > Flashcards

OB Block 2 Flashcards

1
Q

Define Embryo

Define Fetus

Define Fetal Viability

A

Fertilization to 8wks (10wks gestation)

> 8wks until birth (>10wks gestation)

20-24wks of gestation

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2
Q

Define Previable

Define Previable Birth

Why is gestational age two weeks older than fertilization age?

A

Infant delivered <24wks

Delivery from 20 +0/7-25+6/7 weeks of gestation

Gestational age calculated from date of LMP

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3
Q

Criteria for Preterm

Criteria for Term

Define Post-Term

A

Delivered 24-36w 6/7d,
Born <259 days

Delivered 37-41+7/7, 259-293

Delivery +42wks, 294 days

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4
Q

Define Placenta Previa

What are the 3 types and associated MC Sx

A

Placenta near/on cervical os

MC: 3rd trimester painless hemorrhage (8th mon):
Marginalis: at os margin
Partialis: covers part of os
Centralis: covers os

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5
Q

Define Abruptio Placentae

What are two RFs of Abruptio Placentae

What is the difference in presenting bleeds of an abruption?

A

Painful, premature detachment of placenta

Pre-Eclampsia
Chronic HTN

Marginal: external
Central: hemorrhage hidden

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6
Q

What layer is defected if a placenta Accreta/Increta/Percreta occurs?

Define Vasa Previa

A

A: placenta adheres to wall, deficient Nitabuch/decidua basalis
I: myometrium invasion
P: myometrium/structures penetrated

Umbilical vessels between head and cervical os; easily torn, fetal death d/t exsanguination
Common w/ multiple gestations

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7
Q

Define Velamentous Placenta

PTs presenting w/ Vasa Previa need to delivery baby via ?

A

Cord/vessels entering placenta separately

C-section at 35-37wks

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8
Q

Define Gravida

Define Parity

A

Number of pregnancy (regardless of multiples), including current (regardless of outcome)

Number of births after 20w gestation, twins= 1

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9
Q

Define Nulligravada

Define Primigravida

Define Multigravida

A

No prior pregnancy

Current first pregnancy

2 or more pregnancies including current

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10
Q

Define Nullipara

Define Primipara

Define Multipara

Define Grand Multipara

A

No births after 20wks

One birth after 20wks

+2 births after 20wks

Five+ births after 20wks

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11
Q

What’s the acronym for describing OB Hx

A 
GTPAL
Gravida- total number of pregnancy
Term: 37-40+ wks
Preterm: 20-36wks
Abortions: before 20wks
Living
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12
Q

How is Gestational Age calculated

Pregnancy trimesters are divided into equal ?

A

1st day LMP to birth
280 days, 40wks

Epochs: each 14wks

1: conception-14wks
2: 15-28wks
3: 29-42wks

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13
Q

When is a new OB appointment needed**

How long after are appointments needed?

A

10-12wks gestation

Every 4wks until 28wks
28-36wks: q2wks
+36wks: weekly

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14
Q

What screenings are checked during the first OB visit?

Which ones are done at the 15-20wk appointment

A

Cystic fibrosis
HIV
Aneuplody screen
Gonococcal

Cystic fibrosis
Aneuploidy
Neural tube defect

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15
Q

What screening is done at the 24-28wk appointment?

What screenings are done at the 29-41 wk appointments?

A

Ab screening

HepB
HIV
GBS culture
Gonococcal/Chlamydia
Syphilis
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16
Q

Clinical pelvimetry is not reliable to predict ? in labor

How is the obstetric conjugate measured

A

Cephalopelvic disproportion

Anteroposterior/Diagonal conjugate - 1.5-2cm= +10cm

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17
Q

Pelvimetry measures pelvic capacity w/ ? three measurements

What are the two pelvic shapes preferred for vaginal delivery

A

Diagonal conjugate
Interspinous diameter mid-pelvis
Intertuberous distance of pelvic outlet

Gynecoid*, Anthropoid

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18
Q

Where is the midpelvis measured at and what are they called during labor

The ? diameter is important when discussing obstructed/arrested labor

A

Ishial spine
Midpelvis + ischial= 0 station

Interspinous: 10cm

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19
Q

What is the name of the desired baby position during birth

Where is the sacrospinous ligament located

A

Occiput anterior

3 fingers between ischial spine and midline sacrum

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20
Q

The pelvic outlet is important if ? has occurred

What is the name of the device used figuring EDD and Gestational Age

A

Arrested labor

Naegles Rule:
1st day LMP - 3mon + 7 days

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21
Q

Early US is used in lieu of Naegles Rule if ?

What is the most accurate biometric predictor of gestational age

A

Uncertain LMP
Irregular periods
OCPs

Crown Rump length, greatest accuracy during 1st trimester

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22
Q

What adjustments are made if US and LMP don’t match up

Define Double Decidual Sign

What are the TORCH microbes

A

Correspond w/ US if:
<9wks GA: >5 day difference
9-<14wks GA: >1wk difference

D Parietalis outer layer
D Capsularis inner layer

Toxoplasmosis Other Rubella CMV HSV

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23
Q

When are HIV screening conducted during pregnancy

How is this RNA Retrovirus managed

A

New OB appointments
Repeat 3rd Tri if high risk

Load <1000- vaginal delivery
Load >1000= C-section
No breast feeding

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24
Q

What two TORCH microbes can cause blueberry muffin babies?

Which trimesters are Toxoplasmosis infections dangerous?

How are Toxo infections Dx?

A

Rubella
CMV

1st: low infection, high fatality
3rd: high infection, low fatality

IgM/Placenta culture

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25
Q

How are Toxo infections Tx

When is Syphilis screened for

A

Mother: Spiramycin
Mother and Baby: Pyrimethamine-sulfa w/ Folinic acid

RPR/VDRL for all
Repeat 3rd if high risk

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26
Q

How is congenital syphilis Tx

How is the following Jarisch Herxheimer reaction Tx

A

Pen G 2.4M unit x 1, rpt 1wk later

Fluid Antipyretic O2

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27
Q

When is Rubella infection dangerous

How is this infection avoided?

A

1st trimester

Avoid/Vaccine once post-partum, not c/i for breast feeding

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28
Q

What is the MC congenital viral infection

Why is this Dx difficult

When is acyclovir started for HSV positive mothers

A

CMV

IgM present x 2yrs

36wks

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29
Q

Can mothers get Varicella vaccine during pregnancy?

How is Varicella tx

When is Hep B screened for

DNA viruses
RNA viruses

A

No, wait 28 days

Infant: VZIG 96hrs and isolate
Exposed mom: VZIG <6days

HBsAg in all women
Rescreen high risk at 3rd trimester

DNA: CMV HSV Varicella HBV
RNA: HIV Rubella

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30
Q

How is Hep B Tx

How is Chlamydia or Gonorrhea Tx during pregnancy

A

Infant of +HBsAg PTs: HBIG + HBV vaccine <12hrs of birth
Mothers may breast feed

C: Amoxicillin 500mg TID x 7d or Azith 1000mg x 1d
G: Ceftriax 250mg IM or
Cefixime 400mg PO

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31
Q

What is the MC Cause of neonatal sepsis

If women tests + for this, how is it Tx

A

GBS- Strep Agalactiae

IV PCN G
PCN allergy= Clindamycin

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32
Q

What is the “Screening Strategy” for GBS

A

Results prior to labor
Screen at 35-37wks except**

Tx PTs w/ + cultures
Tx GBS bacteriuria this pregnancy**
Tx Pts w/ previously infected infants**

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33
Q

What is the Risk Factor strategy for GBS

A

Tx Pts w/ risk factors for colonization

Tx w/ GBS bacteriuria
Tx w/ previously infected infant
Intrapartum fevers +38*C
18+hrs ruptured membranes

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34
Q

When is intrapartum prophylaxis indicated

A

Previous infant w/ invasive GBS Dz

GBS bacteriuria during current pregnancy

+ GBS screening culture during current pregnancy

Unknown GBS status and delivery <37wks or membrane rupture +18hrs

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35
Q

When is intrapartum prophylaxis not indicated

A

Previous pregnancy w/ + GBS culture

Planned c-section w/out labor/membrane rupture

Neg vag/rectal culture in late gestation during current pregnancy

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36
Q

What is recommended for GBS Tx

What is the alternative

What is used for PCN allergies

A

Pen G 5M units IV
3M units IV q4hrs to delivery

Ampicillin 2g IV
1g IV q4hrs/2g q6hrs until delivery

Low anaphylaxis risk: Cefazolin 2g IV, 1g q8hrs
High risk anaphylaxis- Clindamycin 900mg IV q8hrs
High risk anaphylaxis and Clinda resistant- Vanc 1g IV q12hrs

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37
Q

How is bacteriuria Tx

What test is required for all PTs post-ABX

How are these PTs Tx if they develop pyelonephritis

A

Nitro Amox Ampicillin

Test of cure

Admit for IV therapy
Prophylaxis for remainder of therapy

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38
Q

When are pregnant PTs screened for TB

Conduct PPD and ? measurement is considered positive

A

High risk- HIV+
Lower socio-economics
Minorities
Immigrants from Africa Asia Cental/S America

5mm or bigger

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39
Q

What are the risks of TB to pregnant PTs and babies

How are latent infections Tx

How are active infections Tx

A

Preterm delivery
Low birth weight
IUGR
Perinatal mortality

INH 300mg PO daily w/ Pyridoxine x 9 mon

RIPE w/ B6 x 2mon
RI x 4mon

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40
Q

What are the Zika Sxs that may trigger need for testing

What is the risk babies can be born with

A

Fever Rash Arthralgia Conjunctivitis HA

Microcephaly
Lissencephaly- no brain grooves

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41
Q

What immunizations are in a Tdap vaccine

When can it be given

A

Tetanus Diphtheria Acellular Pertussis

27-36wks to maximize passive Abs to fetus

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42
Q

When can influenza vaccine be given?

When is MMR given and is breast feeding a c/i?

A

Any gestational age

Post-partum
Safe for breast feeding

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43
Q

Air travel is safe for pregnant PTs up to ? wk

Why is pregnancy itself a prothrombic/VTE risk phase

A

36wks

High estrogen

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44
Q

How much exercise should pregnant Pts get and what should be avoided

What recreation activity needs to be avoided

A

150min/wk
Falling/abdomen trauma
Extreme weather
Prolonged supine

No scuba: fetal decompression sickness

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45
Q

What supplement excess need to be avoided

What regular diet piece needs to be avoided

A

Iodine- congenital goiter

Raw eggs- Salmonella

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46
Q

What is a homeopathic remedy used to induce labor

What types of seafood need to be avoided

A

Raspberry leaf tea

Shark Tilefish Mackerel Swordfish

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47
Q

Pregnant PTs need to limit omega-3 fats/proteins to how much?

Ingestion of white/albacore tuna should be limited to /

A

8-12oz/wk

6oz/wk

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48
Q

Why do pregnant PTs need to avoided unpasteurized dairy/cheeses

What artificial sweetener needs to be avoided

A

Listeria
Toxoplasma

Saccharin (sweet n low)- crosses placenta

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49
Q

Avoidance of raw/under cooked seafood is exercised to prevent ? infection

PTs need to be careful and not exceed ? amount of prenatal vitamins

A

Parasites
Norovirus

Selenium Iron Zinc
Vit A B6 C D

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50
Q

What prenatal vitamin is best pre-conception

How much is recommended

A

Folic acid- neural tubes close by day 28

0.4-0.8mg PO daily 12wks prior 9400-800mcg)

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51
Q

When are PTs folic acid amounts increased to 4.0mg

What element is a form of Omega 3s key for brain/NS development

A

BMI >35
Anticonvulsants- Valproate Carbamazepine
T1DM
Hx/FamHx neural tube defects

DHA

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52
Q

What meds are c/i for pregnancy

A 
Tetracyclines
ACEIs
Coumadin
High ASA, 100mg or less ok
Isotretinoin- including topicals
Sulfonamides- not in late pregnancy
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53
Q

How much caffeine is considered a risk

How much is ok?

A

5 cups or 500mg

<300mg/day

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54
Q

Nicotine exposure leads to ? adverse fetal development

What is the leading cause of preventable developmental disabilities worldwide

A

Low birth weight

Alcohol intake

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55
Q

What are the discriminating features of FAS

What are the associated features

A 
Flat midface
Indistinct philtrum
Short nose
Thin upper lip
Short palpebral fissure

Epicanthal fold
Low nasal bridge
Ear abnormalities
Micrognathia

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56
Q

When does sex need to be avoided during pregnancy

Since dental care is recommended, how much x-ray exposure is ok?

A

Hx/Risk of miscarriage
Placenta previa
Preterm labor

<5 rads not associated w/ fetal malformations

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57
Q

Why is iodinated contrast avoided in pregnancy

When are domestic violence screenings conducted

A

Neonatal hypothyroidism

1st prenatal visit
Once per trimester
Post-partum visit

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58
Q

When do depression/behavioral health screenings needs to be conducted

What are c/is to breast feeding?

A

Once during perinatal period

HIV
Chemical dependency
Lithium
Active TB

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59
Q

What are the emergent indications for pregnant PTs to return

All PTs should be given ?

A

Contractions q3-5min
Membrane rupture
Vaginal bleeding

24hr phone number

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60
Q

How many weeks of leave are authorized?

What are the neonatal interventions done during 2nd/3rd trimester education

A

12wks

Circumcision
Hep B Imm
Vit K
Conjunctival eye care

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61
Q

Why would an US be warranted during a placental abruption?

When is Bacteriuria screenings conducted

A

Differentiate from placenta previa but aburption is clinical Dx

All PTs new OB- UA and culture

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62
Q

What may be the first lab ordered during the first prenatal appointment?

What labs may also be ordered during this appointment?

A

hCG

HIV Hep Rubella
G/C
TSH Rh UA FT4

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63
Q

Why does prenatal care need to begin prior to pregnancy

First prenatal visit is often too late to address ? risks

A

Organogenesis/placental development start 7d post-conception

Low birth weight
Obesity
Birth defects- neural tube

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64
Q 
What is the "Quick Run Down" for:
10w
18w
18-20wk
20wk
24-28wk
28w
36wk
A

10: FHTs by Doppler
18: quickening
18-20: anatomy scan
20: fundal height at umbilicus
24-28: glucose tolerance
28: Rhogam Rh- mom/Rh+ dad
36: GBS screen

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65
Q

How fast does hCG increase during the 1st mon of pregnancy

How is TVUS for viability determined

A

Doubles q2.2days

Gestational sac: 5w, 1500hCG
Fetal pole: 6w, 5200 hCG
Cardiac: 7w, 17500 hCG

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66
Q

All female PTs of reproductive age that present w/ abnormal vaginal bleeding need to have ? test?

What are TVUS indications of demise?

A

hCG

Gestational sac w/out yolk
Absent Fetal Cardiac Motion
Crown Rump Length >5mm

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67
Q

Define Threatened abortion

Define Inevitable abortion

Define Incomplete abortion

A

Th: bleeding <20wks, os closed, <50% loss

Inev: bleeding w/ dilated os, non-viable

Incom: bleeding w/ dilated os and passage of tissue

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68
Q

Define Complete abortion

Define Missed abortion

Define Recurrent abortion

A

Comp: passage of products, os closed, US to verify uterus

Miss: Fetal demise retained in uterus

Recurr: 3+ successive spot aborts

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69
Q

What is the MC cause of early pregnancy loss

Fetus are at risk to feel mothers stresses until ? wks

A

Genetic abnormalities

Cortisol- 22wks

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70
Q

How are threatened abortions managed?

How are incomplete abortions managed?

How are missed abortions managed?

A

Th: US and reassure

Incom: Type/Cross and evacuate immediately

Miss: US, reduce blood loss/pain (Misoprostol), possible D/C

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71
Q

Rhogam is given to ? PTs

Where is the uterus at by wks 12, 14-16, 20, 20-38 and 38-40

A

Rh- PT

12: palpable above pubic symphisis
14-16: midway pubic/umbilicus
20: at umbilicus
20-38: corresponds +/-2cm w/ wk of gestation
38-40: gravid uterus 3cm below xyphoid
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72
Q

Primigravida PTs may not feel fetal movement until ? while multigravida may feel at ?

What monitoring items are started and monitored during 3rd trimester

A

Primi: 18-20wks
Multi: 16-18wks

Fetal kick counts
Leopolds- fetal lie, weight, presentation at 28wks

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73
Q

What are the landmarks for measuring fundal height

Between weeks 20-36, how much growth is expected?

If there is a discrepancy of __ or more an US is needed

A

Top of symphysis pubis to top of fundus in cm

Weeks=height (cms)
1cm/wk

> 3cm

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74
Q

How much maternal weight gain is expected

If mother has excessive weight gain, what are the risks?

A

1st timester: 3-6lbs
20wks: 1lb/wk
25-35lbs total for women w/ normal BMI 18.5-24.9

Post-partum weight retention
C-section
Macrosomia: >4kg

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75
Q

How much of a calorie increase is needed for 2nd, 3rd trimester and breast feeding

How does maternal BP change during pregnancy and when would the lowest measurements be expected?

A

2/3: 300-400/day, 1lb/wk
500kcal/day while feeding

Dec 2nd trimester, returns during 3rd
Lowest at 26wks

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76
Q

What is the dangerous BP for pregnancy

What is normal range for fetal heart tones

A

140/90

Doptone at 110-160bpm

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77
Q

How is edema defined in pregnancy and how much of a weight gain is a concern

Why does edema occur so often in pregnancy

A

> +1 pitting after 12hrs bed rest
5lb gain <7days= concern

Uterine compression of IVC

78
Q

What is the purpose of counting fetal kicks after 28wks?

How many is expected and what happens if it’s low?

A

Assess fetal well being

10 kicks/hr (>10 in 30min)
<10: drink sugar, re-eval
<10 after 2hrs- LnD for dec fetal movement

79
Q

How long does fetal sleep cycle last

How is Rh alloimmunization screening done

A

20-75min, avg 23min

Blood type
Ab screen w/ Indirect Coombs

80
Q

Why are Rh- pregnancies dangerous

What are the end results of this issue

A

Rh Ag exposure causes IgM/IgG reaction
IgG cross placenta, attack fetal RBCs

Fetal hemolysis
Anemia
Hydrops fetalis

81
Q

What agglutination result is low enough for fetal survivability

When is Rhogam given?

A

Dilution titer below 1:16

28wks Rh-M/Rh+ or unknown Dad
72hrs post-partum Rh+ baby

82
Q

What is the name of the quantitative test to assess if Rh- mother has had blood mixing/possible sensitization

A

Kleihauer Betke test- citric acid w/ pH of 3.2 dissolves maternal Hgb

Eosin stains remaining HgF creating maternal ghost cells

83
Q

How much Rhogam is given

How much maternal blood does this cover

A

300mcg IM

30cc

84
Q

When is prenatal genetic counseling done?

Screening for fetal aneuploidy is primarily aimed at ? since it’s the MC

A

Serum markers and 20wk US for all PTs

Downs

85
Q

What are the RFs for each trimester for the occurrence of Down’s?

A

1: PAPP-A Age NT bhHCG

2: 
Triple screen (AFP, hCG, unconj estriol)

Quad screen (better for ID, lower false +: MSAFP, Total hCG Unconjugated estriol, Inhibin A**

86
Q

What are examples of single gene d/os

Trisomy 21
Trisomy 18
Trisomy 13

A

CF Sickle Hgbopathies Tay-Sachs

Downs
Edwards
Patau

87
Q

What single gene d/o screening is offered to ALL women in US?

How is Down’s screened for in 1st trimester w/ the earliest screening avail?

What finding indicates lower probability of Down’s risk?

A

CF

Serum marker added to US, look for nuchal translucency

Visualization of nasal bone

88
Q

When is Triple Screen for Down’s conducted

A

2nd Trimester, optimal at 16-18wks:
Total Hcg
Unconjugated estriol
MSAFP: inc +90% of NT defects

89
Q

What genetic screening test result is a better positive predictive value in older PTs

What are the results of the Quadruple Screening seen in 13, 18 and 21

A

MSAFP

13: depends x 4
18: all dec
21: dec MSAFP/Estriol, inc hCG, Inhibin

90
Q

What are the indications to do cffDNA screening for chromosomal abnormalities

A

> 35y/o at delivery

US results of fetal aneuploidy

Prior pregnancy w/ 13/18/21

Robertsonian translocation carriers (inc risk for 13 or 21)

Abnormal 1st/2nd screening

91
Q

When are amniocentesis or CVS genetic testing done?

A

All abnormal chromosome number

> 35y/o at delivery
32y/o w/ twins

Abnormal US

Previous affected pregnancy

Couples w/ known translocation/abnormalities

Women w/ + serum markers

92
Q

What is the difference of procedure techniques and pro/cons between amniocentesis and CVS?

A

Amnio- 16-20wks; US guided through abdomen
2wk culture
Chrom specific trisomy probes
PCR for other genetic d/os

CVS- 10-12wks; through cervix
Earlier/quicker Dx results
Less precise than amnio 
No amniotic fluid AFPs
Procedure <9wks- jaw/limg abnormalities
93
Q

Define Antenatal Unit

When does antenatal testing start

A

Pregnancy eval for risks
ER for OB +20wks gestation
‘OB Triage’

32-34wks gestation q7 days
High risk PTs: 26-28wks

94
Q

How is electronic fetal monitoring interpreted

What test is the first line tool for fetal surveillance

A

HR accelerations in response to fetal movement w/ NO deceleration
“Reactive HR=norm”

Non-Stress Test

95
Q

Fetal HR monitoring is essentially ? monitoring

What is a reassuring test result

What is a moderate/reassuring result?

A

Fetal brain monitoring

Norm HR110-160

Two HR accelerations in 20min, reassuring if:
Inc 10bpmx10sec <32wks
Inc 15bpmx15sex>32wks

96
Q

NST is most predictive when?

What can cause a non-reactive results

A

Normal

Fetal sleep cycle
Maternal sedative/opioids
Cardiac/neuro abnormality
Fetal hypoxemia

97
Q

If fetus is suspected to be sleeping during NST, how are they awakened?

What is the benefit to conduct a contraction stress test, although rarely ever done

How is it done?

A

Acoustic stim NST

High negative predictive value

Nipple stim to release oxytocin

98
Q

What does a + Contraction Stress test mean?

Amniotic fluid is similar to ? fluid

When does fetal urine production begin

A

High risk for fetal death, consider operative delivery

Extracellular fluids

8-11wks

99
Q

Fetal kidneys become major contributor to amniotic fluid generation by ?

? assesses amniotic fluid volume

A

18wks

Amniotic Fluid Index- measured at deepest vertical pocket in each of 4 abdominal quadrants;
Norm 2-8cm/quad w/ norm of 5-24cm
Poly= >24cm
Oligo= <5cm

100
Q

What is the desired result if Single Deepest Pocket” method is used for AFI

What are the 5 parts of a Biophysical Profile

A

2x2cm pocket

NST + US:
NST- HR inc
Breathing, movement, tone
AFI

101
Q

What is a modified BPP that is adequately predictive

A

AFI + vibroacoustic NST, takes 10min (Norm BPP takes 60min)

102
Q

What do BPP scores correlate to?

A

10: norm, repeat qWeek (DM, rpt twice/wk)
8 w/ normal AFI: repeat per protocol
8 w/ dec AFI: chronic asphyxia, deliver
6 w/ dec AFI- deliver
6 w/ norm AFI >36wks and favorable cervix- deliver
4, repeat same day, 6 or less= delivery
0-2: deliver, almost certain asphyxia

8-10: normal pH, reassuring unless + oligo
6: poor predictor
4 or less: not reassuring, consider delivery

103
Q

When are Doppler US of umbilical artery done?

What is considered normal?

A

IUGRestrictions

Dec resistance as gestational age inc

104
Q

What lab result is used as an indicator for giving steroids in preterm situations to prep for delivery?

What are the 1st Trimester precautions

A

Syst/Diastolic ratio from umbilical artery Doppler

Bleeding
Abdominal pain
UTI Sxs

105
Q

Folic acid supplementation is how much?

When are neural tube defects screened for?

A

400-800ug/day

1st: nuchal translucent US
2nd: MSAFP during Triple/Quad screening

106
Q

Where is MSAFP synthesized?

How is this protein linked to NT defects?

A

Yolk sac
Fetal GI tract/liver

Defected fetal integument allows AFP to leak into amnionic fluids

107
Q

MSAFP can help detect what two issues occurring during development?

What is the Dx test of choice for NTDs?

A

Anencephaly
Spina bifida

MSAFP w/ Sonography/US

108
Q

When are women screened for Trisomy 21

What type of genetic defect is Cystic Fibrosis

A

Prenatal care <20wks EGA

1st: Fetal NT
2nd: Triple/Quad screens

Auto Recessive on CFTR Chrom 7, defected Cl channel protein

109
Q

What type of genetic defect is Tay-Scahs

How are high risk ethnicity tested?

How are low risk ethnicity tested?

A

Auto Recessive, progressive neurodegeneration/early death

High: molecular DNA base mutation
Low: Hexosaminidase A serum level

110
Q

What happens if a baby w/ Tay-Sachs is given milk

What do babies present w/?

A

Unmetabolized sugars build up, damage liver, eyes, kidneys and brain

Brain/kidney damage
Cataracts
Jaundice
Large liver

111
Q

Amniocentesis is used to detect fetal genetic d/os and ?

What test is done to analyze getal karyotype?

A

Fetal lung maturity assessment

CVS

112
Q

Fetal blood sampling is AKA

What is the MC and other indications to do this test

A

Cordocentesis
Percutaneous UBS

MC: Fetal anemia assessment
Other: platelet alloimmunization, fetal karyotype

113
Q

Amenorrhea is not a reliable S/Sx of pregnancy until ?

During 1st month of pregnancy, uterine bleeding can be from ?

A

+10 days after expected menses

Blastocyst implantation

114
Q

Define Goodells

Define Hegars

Define Chadwicks

A

a

b

c

115
Q

What is the ‘mask of pregnancy’?

What is a common early sign?

A

Chloasma

Fatigue

116
Q

What is the purpose of the hcG during early pregnancy

When do these levels peak and plateau

A

Prevents involution of corpus luteum

60-70 days

117
Q

What is the qualitative and quantitative method to test for pregnancy

What are 3 rare but possible causes of false-pos tests?

A

Qual: urine
Quant: blood

Exogenous/tumor making hCG
Renal failure

118
Q

When will gestational sac, fetal pole and heart beat be detectable by TVUS?

What is the difference between a non and pregnant uterus

A

Sac: 21 days post-fertilization
Pole: 6wks
HR: 6-7wks

Non: 70gm
Preg: 1100gm, 1000x greater capacity by delivery

119
Q

What is the total volume of contents in a pregnant uterus

By __wk, uterus is too big to fit in pelvis and as it ascends it rotates ?

A

Avg 5L
Can be +20L

13wks
Right

120
Q

What supports a pregnant uterus when Pt is standing or laying

Define Braxton Hicks contractions

A

Up: Ant pressure on muscle wall, midline CT
Supine: vertebral columns, adjacent great vessels

Non-rhythmic, 5-25mmHg contraction w/out cervical changes

121
Q

Uterine contractions do ? to uterine flow?

Maternal placental blood flow ? during gestation by means of ?

A

Dec

Inc, vasodilation due to estradiol

122
Q

What is the difference between preg and non-preg cervix

What are the contents of the mucus plug and it’s function

A

Preg has inc water content

ImmGlobulins/Cytokines to prevent infections

123
Q

Progesterone causes cervical mucus to ?

Define Theca-Lutein Cysts

A

Thicken, no ferning/poor crystalization

Inc hCG due to:
Gestational trophoblastic dz
Pre-eclampsia
Hyperthryoid
Placentomegaly- multi fetal pregnancy + DM
124
Q

Where is relaxin released from

What changes does it cause in the body

A

Corpus luteum
Decidua
Placenta

CT remodeling, not peripheral joint laxity
Renal hemodynamics
Dec serum osmolality
Inc arterial compliance

125
Q

Why are pregnant PTs more vulnerable to vaginal candidiasis

What do estrogen and progesterone stimulate on the breasts during pregnancy

A

Inc lactic acid= pH 3.5-6, inc glycogen stores

E: adipose deposition, duct growth
P: ampullary hypertrophy, secretory maturation

126
Q

What part of the maternal endocrine system is not needed for pregnancy maintenance?

When does the part of the system reach peak size

A

Pituitary- serum Prl parallel pituitary size

First few days post-partum, possible chiasm compression
Normal by 6mon

127
Q

? part of the thyroid correlates to expanding blood volume

What does progesterone do to the body during pregnancy

A

Thyroxine binding globulin

Dec smooth muscle tone
Relaxes uterus= inc tocolytic

128
Q

Define Diastasis Recti

Define Striae gravidarum and the RFs for them

A

Seperated rectus muscles at midline

Stretch marks: weight gain, younger age, FamHx

129
Q

Define Linea Nigra

Define Chloasma

Skin changes during pregnancy can be mimicked it PTs is on ?

A

Pigmented dark brown skin

Melasma gravidarum- irregular brown patches on face/neck

OCPs

130
Q

Define Angiomas

What causes palmar erythema

A

Vascular spiders

Inc estrogen and cutaneous blood flow from heat released by inc metabolism

131
Q

Basal metabolic rate inc by ?? by 3rd trimester

What is average weight gain for a pregnancy

A

20%

27.5lbs/12/5kgs

132
Q

What is water retention normal during pregnancy

What can predispose PTs to late pregnancy edema

A

Dec plasma osmolality

Dec interstitial colloid osmotic pressure

133
Q

Protein metabolism increases by ? during pregnancy

What are normal carbohydrate metabolism findings during pregnancy

A

1000g

Mild fasting hypoglycemia
Postprandial hyperglycemia
Hyperinsulinemia

134
Q

Pregnant PTs who fast for prolonged periods will develop ? metabolic state

Leptin holds a key role in body fat/energy expenditure regulation so a deficiency can be associated w/?

A

Ketonemia

Anovulation
Infertility

135
Q

During pregnancy, inc insulin resistance and estrogen stimulation causes maternal ?

When do leptin levels peak?

A

Hyperlipidemia

2nd trimester

136
Q

What happens to thyroid hormones during pregnancy

What vitamin facilitates Ca absorption by the mother for fetal use?

A

Inc maternal T4 to maintain euthyroid
Fetal thyroid production in 2nd half req’s inc iodide

Vit D3

137
Q

What happens to blood volume and Hgb/Hct during pregnancy

How much blood loss is expected during pregnancy?

A

Inc volume, dec Hgb/Hct

Vaginal; 500-600mL
C-Section: 1L

138
Q

Metabolic increases during pregnancy

Early pregnancy is a ___inflammation state while mid pregnancy is a ___ inflammation state

A

Fe
WBC- d/t Estorgen/cortisol
Thromboembolism risk
IgA/IgG

Early: pro-inflammatory
Mid: anti-inflammatory, improvement of autoimmune dzs

139
Q

? much Fe is needed during pregnancy

? WBC is elevated during pregnancy

Inflammatory markers are useless during pregnancy, what is used for indicators?

A

1000mg, 1mL RBC= 1.1mg Fe

Leukocyte

Procalcitonin

140
Q

What are the cardiovascular changes during pregnancy by each week?

A 
5w: inc CO= Dec SVR + Inc HR
6-7w: dec BPs, inc HR
10-20: inc pre-load
LAD on EKG
Exaggerated S1 split w/ inc loudness
141
Q

What is the best position for pregnant PTs to lay down?

What is the change and significance of prostaglandins during pregnancy

A

LLR

Inc during, control vascular tone, BP and Na balance

142
Q

What ratio has been considered an important pre-eclampsia pathogenesis

What other CV finding in high levels have a role in eclampsia?

A

PGI2:thromboxane ratio

Endothelin

143
Q

When does morning sickness arise and disappear?

How can it be managed/Tx?

A

4-8wks, gone by 16wks

Small meals
Pyridoxine w/ Doxylamine or Phenothiazine

144
Q

What meds are used w/ B6 or Ginger to help manage N/V during pregnancy

What Cat B or Cat C anti-emetics may be considered?

A

Doxlamine
Meclizine
Diphenhydramine
Metoclopramide

B: Ondansetron; long QT, serotonin syndrome
C: Promethazine, Prochlorperazine, Chlorpromazine

145
Q

Define Pyogenic Granuloma

Stomach and intestines are displaced ? by enlarging uterus

A

Epulis gravidarum, highly vascular swelling of gums

Cephalad

146
Q

Gastric emptying is not changed during pregnancy except for ?

Why do PTs need to urinate more during pregnancy?

A

Labor

Hypervolemia induced hemodilution: dec protein/oncotic pressure increases renal blood flow

147
Q

What neuro decline is noted during the 3rd trimester?

Define Krukenberg spindles

A

Memory, dec verbal recall/processing speeds

Brown/red opacities on posterior cornea surgace due to hormone changes

148
Q

What is the MC form of Pica and other forms seen in pregnant PTs

This condition is usually triggered by ?

A

*Amylophagia- starch
Pagophagia- ice
Geophagia- clay

Fe deficient

149
Q

What is the first line medication for pregnancy GERD?

What can be used for constipation?

A

TUMS

Colace

150
Q

What causes varicosities to develop?

How are vulvar varicosities Tx

A

Uterus inc LE venous pressure

Special hose/belt

151
Q

Define Round Ligament pain and when/where is it seen

How is this Tx

A

Sharp groin pain early 2nd semester, R>L

Reassurance, modified activities

152
Q

How is pregnancy induced back pain managed?

What is the best way to manage?

A

Acetaminophen
No NSAIDs
Cyclobenzaprine/Baclofen

Education Exercise PT/Chiropractor

153
Q

Criteria for Low Birth Weight

Criteria for Very Low Birth Weight

Criteria for Extremely Low Birth Weight

A

1.5-2.5kg

1-1.49kg

0.5-0.99

154
Q

What is the criteria for advanced maternal age?

Criteria for adolescent pregnancy

A

> 35y/o at delivery

<20y/o at delivery

155
Q

What is the MC 1st trimester surgical procedure?

What monitoring is done for procedures?

A

Laparascopy for Dx/management

FHT before and after

156
Q

What pregnancy change leads to inc insulin risks

What is the trifecta of metabolic syndrome during pregnancy

A

Adipokines

DM2 Dyslipidemia HTN

157
Q

How much weight gain is recommended for PTs that are overweight?

How much gain is recommended for PTs that are obese?

A

BMI 25-29.9: 15-25lbs

BMI 30 or higher: 11-20lbs

158
Q

How is asthma managed?

Steroid stress does is considered if PTs have been using steroids for longer than ?

A

SABAs and inhaled CCS

> 3wks

159
Q

What is the leading cause of pregnancy related deaths?

What scoring method is not validated during pregnancy?

A

PEs

Wells, inc D-Dimer are not rliable

160
Q

What anticoagulants are used in pregnant PTs

What is not used due to it’s ability to cross placenta

A

Lovenox, LMWH

Coumadin

161
Q

What is the leading cause of septic shock during pregnancy

How are pregnancy related UTis Tx

A

Pyelonephritis

Empirically

162
Q

What is the goal of diabetes control during pregnancy

When is screening conducted?

A

Euglycemia during organogenesis

24-28wks EGA

163
Q

What are the two steps of screening for gestational diabetes

A

1: 50g glucose challenge-
Plasma glucose 1hr after
+ = 140mg or higher, order tolerance test

2: 100g glucose tolerance, overnight fast then drink 100g
Two or more levels at/above threshold= dx

164
Q

Ranges for Gestational Diabetes D

When is f/u/repeat testing done

A

Fasting 92-126 at any gestational age
>126= overt diabetes

6-12wks post-partum
Q3yrs

165
Q

How is GDM managed

What is the maternal risk for developing GDM

A

Insulin if fasting levels >95
PO sulfonylureas: Glyburide; Metformin= 1st line

50% chance of developing over DM in next 20yrs

166
Q

Define Superfetation

Define Superfecundation

A

Two embryos at different ages in same uterus

Fertilization of two ova w/in same menstrual cycle, not same coitus/same male

167
Q

Define TTT

A

Twin Twin Transfusion
Donor twin transfuses blood to recipient
Donor= polyhydra, anemic, restricted growth
Recipient: oligohydra, polycythemic, overloaded

168
Q

Majority of early pregnancy losses occur w/in ?

Spontaneous abortions will have what possible 4 findings on sonogram

A

12wks

CRL +7mm, no HR
MSD >25mm, no embryo
11 days w/ gestational sac w/ yold, no embryo/heart beat
14 days w/ gestational sac w/out yolk, no embryo/heart beat

169
Q

How are spontaneous abortions evaluated if VUS is unclear

MC site of ectopic pregnancy

A

Serial hCG:
Inc, no sac/embryo= ectopic
Dec, no sac/emryo= complete SAB

Ampulla d/t abnormal anatomy

170
Q

What is the classic triad of ectopic pregnancy

How are ectopic pregnancies Dx when hCG is above threshold?

A

Amenorrhea
Abdominal pain
Vaginal bleeding

TVUS

171
Q

As soon as an unruptured ectopic pregnancy is identified, what is the immediate/urgent next step

Define Heterotopic Pregnancy

A

Laparotomy removal

Coexisting intra-uterine and ectopic pregnancy

172
Q

What drug is used to remove ectopic pregnancies in healthy PTs

Difference salpingostomy and salpinectomy

A

Methotrexate

Removal of unruptured tubal pregnancy
Excision of tube for un/ruptured pregnancy

173
Q

What are the two types of Gestational Trophoblastic Dz

Define GTD complete molar pregnancy

What will be seen on lab work if this is present

A

Hydatidiform: + villi
Nonmolar malignant neoplasm; - villi

Empty ovum- all chromosomes are paternal

> 100K hCG, hyperemesis gravidum

174
Q

Define GTD Partial Molar

A

Fertilized ovum w/ extra paternal haploid set: 69XXX or 69XXY

Non viable fetus developing w/ cluster of grapes

175
Q

Define Grestational Trophoblastic Neoplasia types and risks

A

Invasive: MC GTN following hydatidiform moles

Choriocarcinoma: MC following SAB/pregnancy, most malignant

Placental site trophoblastic tumor: rare, chemo resistant

Epitheloid trophoblastic tumor: low hCG, chemo resistant, common metastatic Dz

176
Q

What is the MC presentation of Gestational Trophoblastic Neoplasia

What clinical presentation is pathognemonic for molar pregnancy

A

Irregular bleeding w/ uterine subinvolution (failure to return to normal size)

Pre/eclampsia w/out chronic HTN/occurring prior to 20wks gestation

177
Q

How are hydatidiform moles Tx

How are GTN Tx

A

D/C
Serial hCG q2wks until not detected (complete 9wks, partial 7wks)
qMon surveillance x 6mon

Chemo alone
Hysterectomy if Dz is chemo resistant

178
Q

Complete hydatidiform mole fact

MC cause of fetal hematologic anemia

A

Snowstorm appearance on US w/ extremely high hCG, empty ovum
9 week serial hCG monitoring

RBC alloimmunization- maternal Abs cross placenta, destroy fetal RBCs

179
Q

How is fetal anemia detected

Hydrops fetalis is defined as ?

A

Fetal blood sample
Doppler eval of middle cerebral artery during systole

Two or more effusion: pleural, pericardial, ascites or
One effusion and anasarca
Along w/ enlarged placenta

180
Q

Nearly half of non-immune hydrops occurs in ? population

What is the most common infection cause

A

45XO

Parvovirus B19

181
Q

How is Hydrops Fetalis evaluated for?

A

Indirect Coombs- alloimmunization

Sonograph: anatomy, MCA doppler, fetal echo

Amniocentesis- keryotype

Kleihauer Betke

A-thalassemia/inborn erros

182
Q

AFI criteria for mild/mod/sev polyhydramnios

This can indicate an issue ? in the fetus

A

Mild: 25-29.9cm
Mod: 30-34.9cm
Sev: 35 or more

Tracheo/Esphageal fistula

183
Q

Dx criteria for oligohydramnios

Presentation after midpregnancy can be associated with ?

A

AFI <5cm or
Deepest pocket <2cm

Growth restriction
Pre-eclampsia
Vascular dz

184
Q

How are cases of oligohydramnios Tx

What are the 3 phases of fetal growth

A

Maternal hydration
Intrapartum amnioinfusion if FHR decelerations are present

1: 5g/day x 16wks
2: 15-20g/day (wk 17-32)
3: fetal fat/glyogen accumulation

185
Q

Difference between Fetal Growth Restriction and Intrauterine Growth Restriction

If IUGR occurs early in pregnancy what will be seen?

What will be seen if it occurs later in pregnancy?

A

IUGR- pathological cause preventing growth

Symmetric- dec cell size and number from chemicals, viral or cellular agenesis

Asymmetric- placental insufficiency from maternal HTN; leads to brain sparing development

186
Q

What affect does IUGR have on lung development

What is the criteria for macrosomia

A

Accelerated maturation

+4500g at birth

187
Q

What is the most common sub-unit of hCG?

What is the MC form of pregnancy induced hyperthyroidism

How is it Dx

A

TSH

HyperThyroid: Graves

Dec TSH, Inc FT4 thyroxine

188
Q

How is pregnancy induced hyperthyroid Tx

What is the MC form of pregnancy induced hypothyroidism

A

Propylthiouracil in 1st Trimester
Methimazole- 2nd trimester

Hashimotos
High TSH, Dec FT$
Tx w/ Levothyroxine

189
Q

How are PTs w/ seizure d/os Tx

PTs w/ ? Sx signal a poor fetal outcome

A

Lowest dose of monotherapy
Folic Acid
Vit K

Hyperthermia

190
Q

How is an acute seizure managed in a PTs w/ no seizure Hx?

A

MgSulfate

191
Q

Stopped Vid 5

A

1 05 30

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