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OB- FA Step 2 Flashcards

1
Q

When do you use quantitative Beta-HCG

A
  • Diagnose/follow ectopic pregnancy
  • Monitor trophoblastic disease
  • Screen for fetal aneuploidy (elevated in Tri 21, low in tri 18)
  • Increases to about 100,000 mIU/mL by 10 weeks and decreases throughout 2nd tri
  • doubles every 48 hrs in early pregnancy
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2
Q

When do you use quantitative Beta-HCG

A
  • Diagnose/follow ectopic pregnancy
  • Monitor trophoblastic disease
  • Screen for fetal aneuploidy (elevated in Tri 21, low in tri 18)
  • Increases to about 100,000 mIU/mL by 10 weeks and decreases throughout 2nd tri
  • doubles every 48 hrs in early pregnancy
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3
Q

When can you detect pregnancy on ultrasound

A

Gestational sac visible on transvaginal US at 5 weeks GA

- Beta - hcg 1000-1500

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4
Q

What is considered excessive weight gain in pregnancy

A

> 1.5 kg/month (about 3.3 pounds)

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5
Q

What is considered inappropriate weight gain in pregnancy

A
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6
Q

What is the appropriate weight gain in pregnancy?

A
  • BMI 29: 5-9 kg (11-20 lbs)

-

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7
Q

Cardiovascular changes in pregnancy

A
  • HR increases by 20%
  • Stroke volume increases
  • BP decreases by 10% by 34 weeks then back up to pre-prego values
  • Peripheral venous distention: increases to term
  • Peripheral vascular resistance: decreases to term
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8
Q

Pulmonary adaptations of pregnancy

A
  • Tidal volume: increases
  • Expiratory reserve volume: decreases
  • Respiratory rate: unchanged
  • Respiratory minute volume: increases by 40%
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9
Q

Blood changes in pregnancy

A
  • increase in RBC and increase in plasma volume more than RBC, so hemodilution
  • Hct: Decreases
  • Fibrinogen: Increases
  • Electrolytes: Unchanged
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10
Q

GI changes in pregnancy

A

decreased sphincter tone and increased gastric emptying time

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11
Q

Organisms that cross the placenta

A 
Toxo gondii
Rubella
HIV
VZV
CMV
Enteroviruses
Treponema pallidum
Listeria
Parvovirus B19
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12
Q

How often do pregnant women get checkups

A
  • 0-28 weeks: every 4 weeks
  • 29-35: every 2 weeks
  • 36- birth: every week
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13
Q

What labs do you check at initial prenatal visit

A

Heme: CBC, Rh factor, type and
screen
- Infectious: UA and culture, Rubella, HbsAg, RPR/VDRL, gono/chlamydia, PPD, HIV, Pap smear. Consider HCV and varicella based on hx

  • IF INDICATED: Hb A1C, sickle cell
  • Discuss genetic: Tay-Sachs, CF
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14
Q

When do you screen for gestational diabetes

A
  • 24-26 weeks unless at risk for diabetes (obese, fam hx) then screen asap
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15
Q

When to administer RhoGam

A

28 weeks for Rh negative; after any procedures/bleeding events

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16
Q

When do you do GBS culture

A

35-37 weeks

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17
Q

What is the quad screen

A

Done ~15-22 weeks

  • MSAFP
  • Inhibin A
  • Estradiol
  • Beta HCG
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18
Q

Quad screen for Trisomy 18 and 21

A

Everything is low for 18

- Low MSAFP/Estriol with high inhibin A/betaHCG for 21

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19
Q

When is amniocentesis indicated

A
  • Women > 35 at time of delivery
  • Abnormal quad screen
  • Rh-sensitized pregnancy for fetal blood type/assess hemolysis
  • Evaluate lung maturity (L:S >/= 2.5 or presence of phosphatidylglycerol)
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20
Q

Risk factors for spontaneous abortions

A
  • Chromosomal abnormality
  • Maternal thrombophilia
  • Maternal immune issue (antiphospholipid Ab)
  • Maternal anatomic issue
  • Endocrine (DM, hypothyroid, prog deficient)
  • Other: trauma, elevated maternal age, infection, dietary deficiency
  • Environment: smoking, EtOH, caffeine, toxins, drugs, radiation
  • Fetal: anatomic malformation
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21
Q

Risk factors for spontaneous abortions

A
  • Chromosomal abnormality
  • Maternal thrombophilia
  • Maternal immune issue (APL ab
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22
Q

When can you detect pregnancy on ultrasound

A

Gestational sac visible on transvaginal US at 5 weeks GA

- Beta - hcg 1000-1500

23
Q

What is considered excessive weight gain in pregnancy

A

> 1.5 kg/month (about 3.3 pounds)

24
Q

What is considered inappropriate weight gain in pregnancy

25
Q

What is the appropriate weight gain in pregnancy?

A
  • BMI 29: 5-9 kg (11-20 lbs)

-

26
Q

Cardiovascular changes in pregnancy

A
  • HR increases by 20%
  • Stroke volume increases
  • BP decreases by 10% by 34 weeks then back up to pre-prego values
  • Peripheral venous distention: increases to term
  • Peripheral vascular resistance: decreases to term
27
Q

Inevitable abortion

A
  • uterine bleeding/cramps but NO POC expulsion
  • OPEN OS/POC on ultrasound
  • Tx: Misoprostol or expectant management; manual uterine aspiration if
28
Q

Missed abortion

A
  • cramping, loss of early pregnancy sxs, NO BLEEDING
  • Closed Os/no heart activity, POC on ultrasound
  • Tx: Misoprostol/expectant management; manual Uterine evac if
29
Q

Intrauterine fetal demise

A

Absence of fetal cardiac activity >20 weeks

- Tx: Induce labor, evacuate uterusto prevent DIC at GA >16 weeks

30
Q

Organisms that cross the placenta

A 
Toxo gondii
Rubella
HIV
VZV
CMV
Enteroviruses
Treponema pallidum
Listeria
Parvovirus B19
31
Q

How often do pregnant women get checkups

A
  • 0-28 weeks: every 4 weeks
  • 29-35: every 2 weeks
  • 36- birth: every week
32
Q

2nd trimester elevtive termination of pregnancy

A

13-24 weeks GA depending on state laws

  • OB mgmt: induce labor (prostaglandins, amniotomy, oxygocin)
  • Surgical management: D&E
33
Q

When do you screen for gestational diabetes

A
  • 24-26 weeks unless at risk for diabetes (obese, fam hx) then screen asap
34
Q

When to administer RhoGam

A

28 weeks for Rh negative; after any procedures/bleeding events

35
Q

When do you do GBS culture

A

35-37 weeks

36
Q

What is the quad screen

A

Done ~15-22 weeks

  • MSAFP
  • Inhibin A
  • Estradiol
  • Beta HCG
37
Q

Quad screen for Trisomy 18 and 21

A

Everything is low for 18

- Low MSAFP/Estriol with high inhibin A/betaHCG for 21

38
Q

When is amniocentesis indicated

A
  • Women > 35 at time of delivery
  • Abnormal quad screen
  • Rh-sensitized pregnancy for fetal blood type/assess hemolysis
  • Evaluate lung maturity (L:S >/= 2.5 or presence of phosphatidylglycerol)
39
Q

TORCHES pathogens

A
  • Toxoplasmosis
  • Other (Parvo, varicella, Listeria, TB, malaria, fungi)
  • Rubella
  • CMV
  • Herpes simplex
  • HIV
  • Syphillis
40
Q

Risk factors for spontaneous abortions

A
  • Chromosomal abnormality
  • Maternal thrombophilia
  • Maternal immune issue (APL ab
41
Q

What is recurrent spontaneous abortions

A

Two or more consecutive SABs or 3 in 1 year

  • workup: karyotype parents, hypercoag panel, uterine anatomy
42
Q

Most likely cause of spontaneous abortions

43
Q

Types of spontaneous abortions

A

Complete, Threatened, incomplete, inevitable missed, septic, intrauterine fetal demise

44
Q

Complete abortion

A
  • see bleeding/cramping stopped with products of conception expelled
  • Closed OS
  • No treatment
45
Q

Threatened abortion

A
  • Uterine bleeding, maybe abdominal pain
  • NO POC expulsion
  • Closed OS
  • Treat with pelvic rest for 24-48 h and follow up US to assess viability
46
Q

Incomplete Abortion

A
  • Partial POC expulsion, visible tissue on exam
  • OPEN OS/POC on US
  • Manual uterine aspiration if
47
Q

Inevitable abortion

A
  • uterine bleeding/cramps but NO POC expulsion

- OPEN OS/POC on ultrasound

48
Q

Missed abortion

A
  • cramping, loss of early pregnancy sxs, NO BLEEDING

- Closed Os/no heart activity, POC on ultrasound

49
Q

Intrauterine fetal demise

A

Absence of fetal cardiac activity >20 weeks

50
Q

Nonviable pregnancy

A

Gestational sac >25 mm without a fetal pole or absence of fetal cardiac activity when CRL >7 mm on transvaginal US

51
Q

Elective termination management - first trimester

A

First Trimester:

  • Oral mifepristone + oral/vag misoprostol OR IM/oral methotrexate ? oral/vag misoprostol up to 49 days
  • Vaginal/sublingual/buccal misoprostol (high dose) up to 59 days

SURGICAL (up to 13 weeks)
- Manual Uterine aspiration or D&C with vacuum aspiration

52
Q

2nd trimester elevtive termination of pregnancy

A

13-24 weeks GA depending on state laws

  • OB mgmt: induce labor (prostaglandins, amniotomy, oxygocin)
  • Surgical management: D&E
53
Q

normal fetal HR and variability

A

110-160 bpm

- nl variability is 6-25 bpm

54
Q

What does sinusoidal variability indicate

A

Serious fetal anemia;

- pseudosinusoidal pattern may also occur during maternal meperidine use

Third year shit (12 decks)

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