OB/GYN review Flashcards
Which vaccines are contraindicated in pregnancy?
Varicella, MMR
Prepregnancy plans should include?
- Prenatal vitamins (folic acid >400mg)
- healthy lifestyle counseling
- transitional birth control- condoms; let system bounce back from OCP
- vaccinations- get Varicella or MMR at least 3 months before
- referral
also cessation of smoking, alcohol, caffeine
What is associated with increased risk for ectopic pregnancy?
- history of chlamydia
- smoking
- history of PID
- prior ectopic pregnancy
- assisted reproduction- (hetertrophic pregnancy)
what level of HCG should you see tissue in the uterus?
- > 1500 HCG
- by 2000 you should see
Patient comes in with cramping, bleeding and on examination cervix is closed
threatened abortion
patient comes in cramping and bleeding and cervix is dilated
inevitable abortion
Patient comes in with moderate bleeding and cramping- cervix is obscured by dark blood and some tissue from the os
incomplete abortion
possible all tissue would be excreted from the fundus, pt may recall passing tissue
complete abortion
What is naegele’s rule?
- a ways of dating the pregnancy
- 9months and a week
what are ways to date a pregnancy?
- LMP
- Naegele’s rule
- fundal height
- fetal heart tones
- ultrasound
what is the most common reason for an abnormal fetal screen?
The dates are inaccurate, so the expectations
what are first trimester screenings for mom and baby?
- mom: entry panel
- fetal: 1st trimester screen (NT/ PAPP-A, b-hcg)
- these screening cover trisomy
what are second trimester screenings for mom and baby?
- mom: 1-hr glucola(roughly at 24-28 weeks), CBC, antibody screen
- fetal: Triple/Quad screen (AFP, b-hcg , estriol/inhibin A)
- If the first trimester screening was done, only check AFP in 2nd trimester
AFP- indicator for open neural tube defects (spina bifida)
What are third trimester screenings for mom and baby?
- mom: CBC (anemia) , Group B strep
- PRN: depression, STI
- Fetal: NST, BPP (keep an eye on fetal status, if the NST is not reactive—> complete BPP)
What is another screening test that can be perfomed on mom and baby? Considered “advanced”
“Advanced screening test (NIPT, cell-free fetal DNA)
- Maternal serum test
- 10-20 weeks (optimal 11-13)
- T21, 18, 13, and some sex chromosomes aneuploidies (limitations- T21 easier to detect than 13)
- “near-diagnostic” DNA test
- if multiples, can’t tell which twin is affected
If NIPT abnormal–> direct fetal tissue test
What fetal diagnostic test can be completed at 10-15 weeks?
- fetal: Chorionic Villi Sampling- can be done 1st trimester- sampling placenta
what fetal diagnostic test can be completed at 15-20 weeks?
- Fetal: Amniocentesis- abdominal or vaginally getting amniotic fluid (looking for sloughed cells w/in fluid)
- can’t do too early, so you can get enough fluid
in terms of fundus height, where do you expect the fundus to be at 12 weeks, 20 weeks, 36-38 weeks, 40 weeks?
- 12 weeks: fundal height just above pubic bone; fundus meets pelvic brim
- 20 weeks: fundal height is approximately at the level of her umbilicus
- 36-38: fundus usually right up under sternum
- 40 weeks: Fundus drops below 38 week level as presenting part drops down into pelvis
what heatlth maintence is recommended for pregnant patients?
- Influenza, COVID vacc
- Tdap, vaccine (recommended every third trimester of every pregnancy)
- PRN: RhoGAM, HSV prophylaxis
when is RhoGam given? What is it for?
- given at 28 weeks
- RhoGAM is given when there is an RH- mom and RH + baby
- can also be used for threatened abortions, trauma or potential for bleeding to help to stop body from making antibodies against RH+ blood
What is a postive kick count?
- At least 10 times in an hour = positive kick count
what is considered a positive non-stress test?
- Fetal HR response to fetal activity
- Seeing at least 2 heart rate responses is positive, non reactive can usually goes onto biophysical profile
what is the biophysical profile? How is it scored?
- BPP: NST + ultrasound to look for fetal movement, overall tone and amniotic fluid index
- scored 0-2 for each category: 8-10 =reassuring, 6= equivacal, 0,2,4= not reassuring, move toward delivery
- Preexisting
- mild: 140-159/ 90-109
- severe: 160/110
Chronic Hypertension
- After 20 weeks - no preexisting
- 5-10% weeks
- no proteinuria
Gestational Hypertension
- hypertension with proteinuria
- multisystem involvement possible (implicates problems w/placenta, can include heart and other systems
Pre-eclampsia (Toxemia)
elevated BP + proteinuria + seizures
Eclampsia
- Hemolysis (anemic), elevated LFT, lower platelets(bleeding, DIC, abnormal blood counts)
- can happen to patients with pre/eclampsia
HELLP syndrome
How do you workup patients with hypertensive disorders?
PE: BP, edema, heart, lungs, eyes (papilledema), abdomen(RUQ tenderness), Neuro (CNS instability), fetal status
labs: CBC, BUN/CR, LFTs, ua, 24-hr urine, coags
what are acceptable medications to treat hypertensive conditions in pregnancy?
- methyldopa, a/b-blockers (labetolol), hydralazine, CCB (nifedipine)
what are acceptable medications to treat hypertensive conditions in pregnancy?
- methyldopa, a/b-blockers (labetolol), hydralazine, CCB (nifedipine)
what are not acceptable medications to treat hypertensive conditions in pregnancy?
- ACE-I, ARBS
- Diuretics
can cause pregnancy loss
ex. of gestational diabetes complications
congenital anomalies
SAB and stillbirth
macrosomia
polyhydraminos (excess amniotic fluid)
placental abruption(big baby, big placenta)
neonatal hypoglycemia
what is associated with postpartum hemorrhage?
- prolonged labor
- precipitous labor (too fast and furious)
- pre-eclampsia
- multiple gestation
- retained placenta
- operative delivery
- uterine atony (uterine muscle doesn’t contract )
can treat uterine atony with massage or medication
what factors are associated with preterm labor?
- smoking (Causes vascular inflammation)
- short interpregnancy interval (uterus is not healed enough < 12-18 months)
- UTI/ genital tract infection (inflammatory response)
- periodontal disease (systemic inflammation)
what is associated with placental abruption?
- Gestation hypertension
- prior placental abruption
- multiparity
- smoking
- cocaine use
- trauma
- PT will present with: Bleeding, pain, “hard, board-like abdomen and tenderness”
What are primary factors to be considered to evaluate progression of labor?
- Cervical effacement & dilation
- contraction frequency & intensity
- fetal present part at the inlet
