OB/GYN Flashcards
At what gestational age can you see gestational sac with yolk sac
4-6 weeks
CCS: what should we order in newly diagnosed pregnant patients?
Pregnancy counseling… order icon, “counsel patient, pregnancy
what does parity mean?
of births with a gestational age >20wk
What are the first trimest routine tests?
CBC, type and screen, direct and indirect coombs, PAP, UA and UC, Rubella antibody, HepBs Ag, VDRL or RPR, ELISA for HIV, Cervical cx for chlamydia/gonorrhea, TB with Quant gold, Trisomy 21 testing
What do you confirm a + ELISA screen with?
Western blot: presence of HIV core and envelope Ag’s
What do you confirm +VDRL/RPR with?
FTA
How do you manage Anemia with low MCV in early preggo?
give iron, test for thalassemia if anemia does not improve
How do you manage anemia with high MCV in early preggo?
give folate
What does Trisomy 21 Early testing consist of?
B-hCG, Pregnancy associated plasma protein A (PAPP-A), Fetal nuchal translucency
What is a Trisomy 21 positive screening test confirmed with in 1st trimester?
Chorionic villus sampling or amniocentesis
What is Anemia in pregnancy caused by?
increased levels of hepcidin, which inhibits iron transport… preggo increases iron demand, but hepcidin prevents absorption
What are some unique features of Chlamydia and gonorrhea
Chlamydia is an obligate intracellular parsite that needs a host cell to survive
Neisseria is a gram-negative diplococcus that grows on chocolate agar… NAAT is the test of choice
If a mom has negative rubella antibody titer, what do you do?
DONT IMMUNIZE HER!, wait until after pregnancy to do that
How do we manage HIV positive moms
antiretrovirals are recommended in pregnancy, give zidovudine in labor
Tx for chlamydia/gonorrhea
PO azithromycin + IM ceftriaxone
Tx for bacterial vaginitis
PO or vaginal metronidazole or clindamycin
Tx for trichomonas vaginalis
PO metronidazole for mother and partner
What to do with Rh negative moms
give rhogam at 28 weeks AFTER first rescreening for absence of anti-D antibodies
-give it to Rh negative mothers after any procedure and after delivery (including CVS, amniocentesis)
why do we always treat asymptomatic bacteriuria in pregnancy?
30% risk of pyelonephritis
-use cephalosporins or amoxicillin
If there is increased levels of Inhibin A, what does the fetus have?
Down syndrome
What is the most common cause of an abnormal maternal serum alpha fetoprotein (MS-AFP)
gestational error
-so get an obstetric U/S to confirm getstational date
What does the second trimester Quad screen consist of? (btw, this is the only thing we do in 2nd trimester
- MS-AFP
- B-hCG
- Estriol
- add Inhibin A in high-risk women (otherwise it is a triple screen)
what does increased MS-AFP mean?
NTD, Ventral wall defect, twin preggo, placental bleeding, renal disease, sacrococcygeal teratoma
What is the quad screen look like for down syndrome?
decreased MS-AFP, Estriol
incrased B-hCG, Inhibin A
Quad screen results indicative of trisomy 18 (edwards)
everything is down
First thing we do in an abnormal MS-AFP
perform U/S to confirm dating
- (increased MS-AFP)amniocentesis for amniotic fluis AF-AFP (amniotic fluid) level and acetylcholinesterase activity
- (decrased MS-AFP) amniocentesis for karyotyping
What are elevated levels of amniotic fluid acetylcholinesterase activity specific for?
Neural tube defects
How do you work up gestational diabetes?
first step is 1 hr 50g OGTT at 24-28 wks
-then, if positive, do the 3hr 100g OGTT to confirm
What are all the screening things we do in 3rd trimester screening?
- 1 hr 50g OGTT 24-28 wks
- CBC at 24-28 wks
- Indirect coombs test
- Vaginal and rectal cx and GBS at 35-37 wks
Mom is GBS positive and in labor, what do you do?
IV penicillin G
- IV clinda or eryth if allergic AND we have sensitivities
- if no sensitivities: IV Vanc
what is a positive 1 hr OGTT?
blood glc >130-140
What is a positive 3 hr OGTT?
> 180 at 1 hr
155 at 2 hr
140 at 3 hr
How do you interpret a 3 hr OGTT?
if 1 postflc load measurement is abnormal, dx is impaired glc tolerance
-if 2 or more of the postglucose loads are abnormal, the dx is gestational diabetes
Why do we screen everyone for gestational diabetes?
because the symptoms are not always there, and if they are, they are usually not the “classic” diabetes symptoms
What is the threshold of radiation exposure that the infant will start to see adverse effects from it?
50mGy (milligrays)
What are the components of the Bishop score?
DESPC
- dilation
- effacement
- station
- postition
- consistency
What is a Bishop’s score?
tells us whether it’s a good idea to induce a mom!
- total score= 13
- threshold of being ok to induce: 6
When treating an ectopic pregnancy, when should you give another dose of methotrexate?
if the B-hCG has not decreased by 15% from days 4-7
-this is why it’s super important to follow their B-hCG!
