OB Clinical Flashcards by Denisse Tiangco

Vasospasm
Endothelial cell activation
Inc pressor response
Prostaglandin and NO
Endothelin
Angiogenic and antiangiogenic proteins

Preeclampsia

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Eclampsia =

Pre-Eclampsia + Convulsion/Coma

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Difference bet preeclampsia and HTN

Proteinuria

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Signs of impending Eclampsia

Headache
BOV
Epigastric pain
Pulmonary edema

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HELLP

Hemolysis
Elevated 
Liver enzyme
Low 
Platelet Count

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Vasospasm causes

Compromised uteroplacental perfusion

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Most common cause of CP

Perinatal asphyxia

Fetal hypoxia

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Drugs used for seizure in Eclampsia

Magnesium sulfate

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Anti hypertensive of choice for HTN in pregnancy

Hydralazine

Ca ch blocker

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Stable pre eclampsia medication

Methyldopa

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Methyldopa side effect

Positive coombs test

Hemolytic anemia

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Methyldopa
Procainamide
Hydralazine
Isoniazid

Positive

Drug induced lupus

anti-histone

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anti hypertensive CI in pregnancy bec of fetal renal agenesis

ACEI

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Magnesium toxicity

BP Decrease
UO decrease
Respiratory decrease
Patellar reflex absence

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Worst prognosis in mag sul toxicity

Dec respiratory rate

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Normal magnesium levels

4-7 meq/L

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Mg >10 meq/L

Patellar reflex absent

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Mg 12 meq/L

Respi paralysis and depression

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Mag sul toxicity antidote

Cal gluconate

Cal chloride

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Goal in eclampsia

Early termination of pregnancy

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Proliferative trophoblast abnormality

Both syncytio and cytotrophoblast

GTD

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Degeneration and partly hyperplastic changes in chorionic villi

Benign neoplasia of chorion with malig potential

H Mole

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Hydropic degeneration
Villous edema
Absent villous blood vessel
Proliferation of trophoblastic epithelium
Absence of embryonic elements (fetus, amnion)

H Mole

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1-2 mo amenorrhea
Nausea and vomiting
Uterine bleeding
Uterine growth

GTD

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UTZ finding H Mole

Snowstorm pattern | multiple echoes

Most common mets by GTN

Lung

On x ray GTN mets may present as

cannon ball appearance

Marker for GTN

HCG

HCG exerts

thyrotropin like effect leading to elevated thyroxine levels and dec TSH

A large mole may be assoc with

Early onset pre eclampsia

Elevation of BHCG beyond 48 h after evacuation and the succeeding weeks, there may be

persistent trophoblastic disease

More tendency to be malig | High index of suspicion

Complete H mole

H Mole Tx

Suction curettage Hysterectomy Prophylactic single agent chemo: large uterus poor follow up

Chemotherapeutic drug used

Methotrexate

Uterus volume at term

5L 20L | 1100g

Unpredictable Sporadic Nonrhythmic Intensity bet 5-25mmHg

Braxton Hick contraction

FH is related to AOG

18-20 to 34 w Monitors fetal growth and AFV Limitations in measurement when obese and uterine myoma

At symphysis pubis

22 weeks

When internal cervical os lining goes out to vagina during pregnancy

Ectropion

Cervica mucus in pregnant due to progesterone

Beading pattern

Cervical mucus ferning

Ammiotic fluid leakage

Softening of uterus

Hegar

Softening of cervix

Goodall

Surgical removal of ovary before 7 weeks | Fall of progesterone

Spontaneous abortion

When oophorectomy is needed but pregnancy, do surgery

After 14 weeks AOG

pH of vagina

3.5-6 by Lactobacillus acidophilus during metabolism of glycogen

Growth hair phase | Lengthens during pregnancy

Anagen

Involution phase | Inc postpartum

Catagen

Excessive hair loss in puerperium

Telogen effluvium

BMR inc in pregnancy by Wt

20% 12.5kg or 27.5lbs

Carb metab in pregnant

Mild fasting hypoglycemia Postprandial hyperglycemia for sustained fetal glucose supply Hyperinsulinemia due to progesterone PIGH prolactin cortisol

Hematologic change in preg

Pregnancy induced hypovolemia | 40-45% higher than nonpregnant after 32-34 w

Hemoglobin at term ave

12.5

IDA in pregnancy

11 g/dl

Dec slightly due to inc plasma | Whole blood viscosity dec

Hemoglobin

Iron req for normal pregnancy

1000mg 300 transfer to fetus 200 lost through excretion 500 for inc erythrocyte

Iron requirement is highest at

2nd half of pregnancy

Creates barrier to ascending infection

Ig rich cervical mucus plug

Transferred to developing fetus in 3rd tri as passive immunity

IgG

Vaccine should be given 27w onward bec antibodies formed is short lived

TdAP

WBC in pregnancy

Physiologic leukocytosis | 15,000 - 25,000

Clotting factors in pregnancy are inc except

XI | XIII

Fibrin activity in pregnancy

reduced

Neutralizes factor Va and VIIIa | Resistancr inc due to drop of

Protein C | Protein S

Platelet level in pregnancy

Decline slightly | Borderline normal due to hypersplenism and hemodilution

CO at pregnancy

inc at 5th week

Expands bet 10-20w AOG

Plasma

All CV functions inc except

Systemic vascular resistance (decreased)

Heart changes in pregnancy

Displaced to left Apex moved laterallt Larger cardiac silhouette on xray ECG: L axis deviation, Q waves, inverted T waves

Hypovolemia Gravid uterus compressing on aorta and cava lie

Supine hypotensive syndrome Lateral decubitus

All respi capacity increased except All respi volumes dec except

FRC TV

Kidneys GFR and renal blood flow

1cm increase Inc in early pregnancy

Hyperfiltration is inc in pregnancy bec of

Hypervolemia induced hemodilution | Renal plasma flow inc by 80%

Boosts renal NO production and inc vascular gelatinase

Relaxin

Renal vessels

Renal vasodilation dec artery resistance Inc filtration

Serum crea in pregnants

Dec (0.5-0.7 mg/dl)

Gallbladder in pregnancy

Contractility reduced Inc residual volume Impaired emptying

Gallbladder contraction by CCK is inhibited by

Progesterone

TSH level in first tri

80% in women decreased

Parathyroid gland activity in pregnancy

Favors skeletal formation at expense of mother | Pregnancy is vulnerable for osteoporosis

Pregnancy effect on androgens

Production rates of maternal testosterone and androstenedione are increased

T/F: Maternal Androgens cannot enter fetus during pregnancy

True

Memory in pregnancy

Decline limited to 3rd tri | Transient and quickly resolved

IOP during preg

Dec due to greater vitreous outflow | Corneal sensitivity dec

Brownish red opacity on posterior surface of cornea inc pigmentation due to hormone effect

Krukenberg spindle

Artery that courses round ligament

Sampson artery