Ob-Gyn Brainscape Flashcards - uWise Abnl Obstetrics
MTX tx pre-reqs for (suspected) ectopic?
stable, not ruptured, mass <3.5 w/ FHR), nl LFTs, nl BUN/Cr, nl white count, able to f/u
define: recurrent abortion
refers to three successive spontaneous abortions
define: missed abortion
fetal demise without cervical dilatation or passage of products of conception
define: incomplete abortion
passed some, but not all, of the products of conception
When should a cerclage be placed in a woman w/ a h/o cervical insufficiency?
14 weeks GWA
Use of ACE inhibitors during pregnancy causes?
oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death
Timing of glucose challenge?
patients of average risk screening is performed at 24 – 28 weeks while those at high risk (severe obesity and strong family history) screening should be done as soon as feasible.
SSRI contraindicated in preg?
paroxetine
First line imaging for suspected appendicitis in preg?
graded compression u/s
Percentage of women w/ gHTN who will go on to develop Pre-E?
25%
protein cut-offs for Pre-E and E?
> 300mg/day = mild; 5000mg/day (i.e. 5g/d) = severe
What is a therapeutic mag level for tx of pre-eclampsia?
between 4-7 mEq/L.
Contraindications to expectant mgmt for severe Pre-E remote from term?
thrombocytopenia, maxed out on 2 BP agents w/o ctrl, non-reassuring fetal surveillance, LFTs > 2X nl, eclampsia, persistent CNS sx and oliguria
HELLP stands for?
hemolysis, elevated liver enzymes & low plts
When to start anti-HTNive in preg?
pressures persistently greater than 160 systolic and 105 diastolic
Goal diastolic in anti-HTNive tx in preg?
90-100 mmHg
First line agents and dosing for HTN in preg?
hydralazine (a direct vasodilator) 5 mg IV followed by 5-10 mg doses IV at q20-min (maximum dose = 40 mg); or labetalol (combined alpha & beta antagonist) 10-20 mg IV followed by 20 mg, then 40 mg, then 80 mg IV q10-min (maximum dose = 220 mg)
Non-invasive test of fetal anemia?
Middle cerebral artery peak systolic velocity
What is the ratio of RhoGAM to # of cc’s of fetal blood neutralize?
10mcg : 1 cc
Current recommendation for RhoGAM prophylaxis?
Rh- women w/o evidence of Rh immunization is prophylactically at 28-wks (after an indirect Coombs’ test) and w/in 72hrs of: delivering an Rh+ baby, OR following spontaneous OR induced abortion, following antepartum hemorrhage and following amniocentesis or chorionic villus sampling
Test to determine amount of fetal blood that entered mother’s bloodstream s/p abruption?
Kleihauer-Betke test
What is seen in the amniotic fluid of a fetus w/ erythroblastosis fetalis?
bilirubin, can do OD test to determine [bili] and thus severity of crisis
Placentation and amniotic sacs in monozygotic twins
If division occurs on post-conception days 1-3 (pre-morula) –> monochorionic monoamniotic; days 4-8 –> monochorionic diamniotic; days 9+ dichorionic diamniotic
Placentation and amniotic sacs in dizygotic twins
Always dichorionic diamniotic
TTTS usually occurs in ___chorionic ___amniotic twins
monochorionic, diamniotic
Stages of grief
Denial, Anger, Bargaining, Depression, Acceptance
W/u for a woman who has had fetal demise of one fetus in a multiple gestation?
Check maternal serum fibrinogen level, maybe low –> coagulopathy (ask about nose bleeds, etc.)
Risk factors for breech presentation?
fibroids and other uterine anomalies, polyhydramnios, prematurity, multiples, anencephaly, hydrocephaly, previa, genetic d/o
Fetal fibronectin PPV vs NPV
Higher NPV: “negative fetal fibronectin test gives a more than 95% likelihood of remaining undelivered for the next 2 weeks” [Wiki]
S/Sx of mag tox by mag level
High levels of magnesium sulfate may cause respiratory depression (12-15 mg/dl) or cardiac depression (>15 mg/dl). Prior to developing respiratory depression the patient should have diminished or absent deep tendon reflexes (areflexia).
It is especially important not to use indomethacin as a tocolytic after ___ weeks gestation
32
Benefits of betamethasone treatment in pre-term fetuses
incr pulm maturity and decr RDS incidence/severity. also assoc’d w/ decr intracerebral hemorrhage and necrotizing enterocolitis
When is tx w/ betamethasone appropriate?
24-34 weeks gestation
The presence of fFN in the cervical mucus between __ and __ weeks is thought to
indicate a disruption or injury to the maternal-fetal interface.
22 and 34
Prostaglandin F2-alpha is contrindicated in?
(a.k.a. hemabate) contraindicated in asthma pts b/c in addition to SMM constriction it bronchoconstricts
Methergine (Methylergonovine) is contraindicated in who?
women w/ PIH or Pre-E/Ecc b/c in addition to uterotonic it’s also a vasoconstrictor
Risks of antepartum SSRI use to fetus?
SRIs has been associated with persistent pulmonary hypertension of the newborn and a self-limiting neonatal behavioral syndrome. SSRI use in late pregnancy may be associated with clinical manifestations in as many as 30% of neonates. The clinical manifestations may include respiratory, neurobehavioral, somatic and gastrointestinal symptoms. Neonates may experience hyperirritability, hypertonus and jitteriness.
Appropriateness criteria for an operative delivery
complete cervical dilation, head engagement, vertex presentation, clinical assessment of fetal size and maternal pelvis, known position of the fetal head, adequate maternal pain control and rupture of membranes
When is CVS done?
between 10 and 12 weeks gestation
