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Foundations III-Women's Health > OB part 2 > Flashcards

OB part 2 Flashcards

1
Q

multiple gestation is increased by the following factors:

A 
Fertility tx,
Advanced maternal age
Increasing parity
Family history: either parent
Obese (BMI > 30) and tall (> 5’4”) women
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2
Q

what is dizygotic twin gestation?

A

“fraternal” twins

Ovulation and fertilization of two oocytes, dichorionic/diamniotic (2 chorions, 2 amnio sacs)

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3
Q

what is monozygotic twin gestation?

A

“identical twins”

ovulation and fertilization of a single oocyte (1 chorion and 1-2 amnio sacs)

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4
Q

U/S for multiple gestation

A

for definitive dx

determines chorionicity and amnionicity

“lambda sign” = dichorionic twins

“t sign” = monochorionic twins

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5
Q

complications for multiple gestation?

A

preterm delivery (60%), LBW, gestational DM, pregnancy induced HTN, pre-eclampsia, post-partum hemorrhage, higher C-sect rate

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6
Q

what is twin-twin transfusion syndrome?

A

most serious complication w/mult. gestation

only occurs w/monochorionic gestation

one fetus demonstrates small size and amnt of amniotic fluid

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7
Q

cervical incompetence

A

Cervical shortening which can lead to preterm spontaneous delivery

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8
Q

tx for cervical incompetence?

A

Placement of cervical cerclage

Removed at 37w gestation or onset of rupture of membranes

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9
Q

chronic HTN presentation?

A

> 140/90 presenting PRIOR to 20w gestation

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10
Q

new onset HTN > 140/90 with proteinuria is called? w/out proteinuria?

A

w/: pre-eclampsia (BP elevated at least 2 occasions, minimum 6hrs apart)

w/out: pregnancy-induced hypertension (after 20w gest)

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11
Q

what is eclampsia?

A

Onset of seizures in a woman with pre-eclampsia

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12
Q

clinical presentation for pre-eclampsia?

A

HTN, epigastric pain, HA, visual sxs (blurry, flashing lights/sparks), edema, hyperreflexia, oliguria

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13
Q

criteria for severe pre-eclampsia

A

Sys. BP > 160 or Dia. BP > 110

Oliguria < 500cc in 24h
3+ proteinuria (5+ grams on 24h urine)

End organ damage

Fetal compromise

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14
Q

complications for pre-eclampsia

A

HELLP: Hemolysis, Elevated Liver enzymes, Low Platelet count

also “worst HA ever”

> 160/110

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15
Q

labs/imaging for pre-eclampsia?

A

CBC, Cr, liver enzymes, 24h urine/dipstick, fetal non-stress test, U/S

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16
Q

Tx for HTN in pregnancy

A

all antihypertensive meds cross placenta

always indicated w/severe HTN (SBP>160)

avoid ACE, ARB, and diuretic

17
Q

HTN in pregnancy: complications w/ fetus

A 
Poor oxygen transfer
Fetal growth restriction
Pre-term birth
Placental abruption
Stillbirth
Neonatal death
18
Q

Tx for chronic HTN

A

ACOG guidelines
Initiate if SBP >160 or DBP >105

1st line = Labetalol, Nifedipine or methyldopa

encourage ambulatory BP measurements

19
Q

Tx for mild pre-eclamsia

A

Antihypertensives not indicated if BP consistently < 150/100

Expectant management / ambulatory BP measurement

20
Q

Tx for severe pre-eclampsia

A

SBP > 160 or DBP > 110

Admission for blood pressure monitoring

IV labetalol or hydralazine

Prompt delivery for failed medical management

21
Q

Tx if failed management of severe pre-eclampsia or eclampsia

A

IV labetalol or hydralazine, betamethasone < 34 weeks gestation to enhance fetal lung maturity, MgSO4

PROMPT DELIVERY

22
Q

how does pregnancy cause gestational DM:

A

Pregnancy causes hyperinsulinemia and insulin resistance

23
Q

what is the #1 MEDICAL complication in pregnancy?

A

Gestational Dia-beet-us

24
Q

Dx for GDM?

A

50g 1hr glucose challenge test at 24 – 28w gestation: failed test = >130

100g 3-hour OGTT
FBG 1h, 2h and 3h
– 2 or more values on 3h test are elevated

25
Q

complications during GDM?

A

induced HTN (2x incr)

macrosomia, placental abruption, congenital anomalies, fetal demise, pre-eclampsia

26
Q

Tx for GDM?

A

monitoring of cap blood glucose levels (fasting and 2hr PP)

1st line = insulin

goal: FBG 95-105, 2hr PP <120

ADA diet, exercise, nutrition, fetal monitoring

*perform 2hr glucose tolerance test at 6wks postpartum

27
Q

what antigen is part of the Rh antigens?

A

D antigen

present if (+) Rh
absent if (-) Rh
28
Q

Rh incompatibility refers to…

A

alloimmunization - develops as result of maternal immune system being exposed to Rh+ RBC’s

29
Q

causes of Rh incompatibility

A

Rh- mother is exposed to Rh+ fetal blood, mom exposed during norm pregnancy/miscarriage/elective abortion/surg, Rh antigens can cross the placenta freely,
Rh- mother develops antibodies to the Rh+ antigens, maternal antibodies cross the placenta and fetal RBC hemolysis occurs

can cause fetal morbidity or death

30
Q

Prevention for Rh incompatibility?

A

RhoGAM is Rh immunoglobulin

31
Q

when is Rh indicated?

A

Administered only to mothers who are NOT alloimmunized

1st dose –> 28w gestation for prophylaxis

Foundations III-Women's Health (13 decks)

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