OB part 2 Flashcards
multiple gestation is increased by the following factors:
Fertility tx, Advanced maternal age Increasing parity Family history: either parent Obese (BMI > 30) and tall (> 5’4”) women
what is dizygotic twin gestation?
“fraternal” twins
Ovulation and fertilization of two oocytes, dichorionic/diamniotic (2 chorions, 2 amnio sacs)
what is monozygotic twin gestation?
“identical twins”
ovulation and fertilization of a single oocyte (1 chorion and 1-2 amnio sacs)
U/S for multiple gestation
for definitive dx
determines chorionicity and amnionicity
“lambda sign” = dichorionic twins
“t sign” = monochorionic twins
complications for multiple gestation?
preterm delivery (60%), LBW, gestational DM, pregnancy induced HTN, pre-eclampsia, post-partum hemorrhage, higher C-sect rate
what is twin-twin transfusion syndrome?
most serious complication w/mult. gestation
only occurs w/monochorionic gestation
one fetus demonstrates small size and amnt of amniotic fluid
cervical incompetence
Cervical shortening which can lead to preterm spontaneous delivery
tx for cervical incompetence?
Placement of cervical cerclage
Removed at 37w gestation or onset of rupture of membranes
chronic HTN presentation?
> 140/90 presenting PRIOR to 20w gestation
new onset HTN > 140/90 with proteinuria is called? w/out proteinuria?
w/: pre-eclampsia (BP elevated at least 2 occasions, minimum 6hrs apart)
w/out: pregnancy-induced hypertension (after 20w gest)
what is eclampsia?
Onset of seizures in a woman with pre-eclampsia
clinical presentation for pre-eclampsia?
HTN, epigastric pain, HA, visual sxs (blurry, flashing lights/sparks), edema, hyperreflexia, oliguria
criteria for severe pre-eclampsia
Sys. BP > 160 or Dia. BP > 110
Oliguria < 500cc in 24h
3+ proteinuria (5+ grams on 24h urine)
End organ damage
Fetal compromise
complications for pre-eclampsia
HELLP: Hemolysis, Elevated Liver enzymes, Low Platelet count
also “worst HA ever”
> 160/110
labs/imaging for pre-eclampsia?
CBC, Cr, liver enzymes, 24h urine/dipstick, fetal non-stress test, U/S
Tx for HTN in pregnancy
all antihypertensive meds cross placenta
always indicated w/severe HTN (SBP>160)
avoid ACE, ARB, and diuretic
HTN in pregnancy: complications w/ fetus
Poor oxygen transfer Fetal growth restriction Pre-term birth Placental abruption Stillbirth Neonatal death
Tx for chronic HTN
ACOG guidelines
Initiate if SBP >160 or DBP >105
1st line = Labetalol, Nifedipine or methyldopa
encourage ambulatory BP measurements
Tx for mild pre-eclamsia
Antihypertensives not indicated if BP consistently < 150/100
Expectant management / ambulatory BP measurement
Tx for severe pre-eclampsia
SBP > 160 or DBP > 110
Admission for blood pressure monitoring
IV labetalol or hydralazine
Prompt delivery for failed medical management
Tx if failed management of severe pre-eclampsia or eclampsia
IV labetalol or hydralazine, betamethasone < 34 weeks gestation to enhance fetal lung maturity, MgSO4
PROMPT DELIVERY
how does pregnancy cause gestational DM:
Pregnancy causes hyperinsulinemia and insulin resistance
what is the #1 MEDICAL complication in pregnancy?
Gestational Dia-beet-us
Dx for GDM?
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
complications during GDM?
induced HTN (2x incr)
macrosomia, placental abruption, congenital anomalies, fetal demise, pre-eclampsia
Tx for GDM?
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
what antigen is part of the Rh antigens?
D antigen
present if (+) Rh absent if (-) Rh
Rh incompatibility refers to…
alloimmunization - develops as result of maternal immune system being exposed to Rh+ RBC’s
causes of Rh incompatibility
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
Prevention for Rh incompatibility?
RhoGAM is Rh immunoglobulin
when is Rh indicated?
Administered only to mothers who are NOT alloimmunized
1st dose –> 28w gestation for prophylaxis
