Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step2CK > OB Stepup > Flashcards

OB Stepup Flashcards

1
Q

how is sgestational age calculated

A

first day of LMP + 7 days

minus 3 months+1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when can teratogens cause abnormal organ function

A

between 2 and 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when is surfactant produced

A

26 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CV changes in mom during pregnancy

A

CO increases 40%
systolic murmur from CO
inc O2 demand
dec BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Resp changes in mom during pregnancy

A

decreased in RV, FRC, and ERV
O2 consumption increases 20%
tidal volum einc 40%
pCO2 decreases because of increased minute ventilation stimulated by progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal changes in mom during pregnancy

A

increased RBF and GFR
dec DUN and Cr
Inc renal loss HCO3 to compensate for respiratory alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

endocrine changes in mom during pregnancy

A

nondiabetic hyperinsulinemia with assoc mild glucose intolerance
production human placental lactogen contributes to glucose intolerance
fasting TG increase
cortisol increases
TBG and total T4 increase
TSH decreases slightly during early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

heme changes during pregnnacy

A

hypercoagulable state
increased RBC production
Hct dec from inc blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

GI changes during pregnancy

A

increased salivation

decreased gastric motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ideal weight gain for pregnant women BMI

A

28-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ideal weight gain for pregnant women BMI

A

25-35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ideal weight gain for pregnant women BMI >26

A

15-25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

caffeine increases risk for what during pregnancy

A

increased risk spontaneous abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

why limit fish during pregnancy

A

methylmercury contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

daily caloric intake during pregnancy

A

2500 kcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

screening labs at first visit of pregnancy

A 
CBC
blood Ab and Rh testing
pap smear
Gon/chalmydia testing
UA
RPR or VDRL
rubella Ab
Hep BsAg
HIV screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when do you do the quad screen

A

16-18 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when do you do US dating for age and fetal anomalies

A

18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when is the gestational DM test

A

24-28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when do you do GBS sreening

A

32-37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why to do amniocentesis

A

abnormal quad screen
women >35 years
risk Rh sensitization
0.5% risk spont abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when do you perform amniocentesis (date)

A

16 weeks

measures amniotic AFP and can do karyotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

at what date do you do chorionic villus samlping

A

transabdominal or transcervical aspiration of tissue 9-12 weeks gestation
detects chromosomal abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

indications for chorionic villus sampling

A

early detection of chromosomal abnormalities in higher risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when is percutaneous umbilical blood sampling

A

blood sampling from umbilical vein after 18 weeks gestation to look for chromosomal defects, fetal infection and Rh sensitization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are leopold maneuvers

A

external abdominal exam to determine fetal presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what do you measure for full integrated test in 1st trimester

A

PAPP-A and NT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

labs in downs for full integrated test

A

dec PAPP-A and icnreased nucal translucency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

labs for downs in quad screen

A

dec AFP
dec estriol
inc hCG
inc Inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

labs for edwards in quad screen

A

dec AFP
very dec estriol
very dec hCG
normal inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

labs for patau trisomy 13 in quad screen

A

normal AFP
normal estriol
normal hCG
normal inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

labs for patau trisomy 13 on full integrated test

A

very dec PAPP-A and increased nuchal translucency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

labs for edwards on full integrated test

A

very dec PAPP-A and increased nuchal transluceny

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

high levels maternal AFP between 16-18 weeks assoc with

A

neural tube defects or multiple gestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

low levels maternal AFP between 16-18 weeks assoc with

A

trisomy 21 and 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

risk factors gestational DM

A 
>25 years old
obesity
prior polyhydramnios
recurrent abortions
prior stillbirth
prior macrosomia
HTN
african or pacific islander
corticosteroid use
PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what should fasting glucose be in pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

new onset DM in first trimester

A

nongestational!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

pregnant patient failing non pharmacologic methods to control gesttational DM

A

insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is normal 1 hr glucose tolerance test

A

give 50g glucose 1 hour later should be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

3 hr glucose tolerance test

A

carbo load 3 days
fasting glucose measured
100 g given then measure at 1 2 and 3 hours

abnormal is fasting >95
1 hr >180
2 hr >150
3 hr >140
Need 2 of the above values to be considered gestational DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

when to check gestational DM

A

24-28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

complications gestational DM

A 
macrosomia
polyhydramnios
delayed pulmonary maturity
uteroplacental insufficiency
IUGR
delayed neurologica maturity
fetal RDS
hypoglycemia
hypoCa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Dx for DM I

A

anti insulin and anti islet cell Ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

in mom with DM and is pregnant do what in third trimester

A

give corticosteroids for fetal lung maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

fetal cardiac anomalies associated with maternal DM

A 
transposition
tetralogy
neural tube defects
sacral agenesis
renal agenesis
polyhydramnios
macrosomia
IUGR
intrauterine fetal demise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is preeclampsia

A

pregnancy induced HTN with proteinuria and edema after 20 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

risk factors preeclampsia

A 
HTN
nulliparity
prior Hx preeclampsia
multiple gestation
vascular disease
chronici HTN or renal disease
DM
obesity
african american heritage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

signs Sx preeclampsia

A 
edema in hands and face
rapid weight gain
HA 
epigastric pain
visual disturbances
hyperreflexia
BP >140/90
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

UA in preeclampsia

A

2+ proteinuria on dipstick

>300 mg protein/24 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

CBC preeclampsia

A

dec platelets
normal or inc Cr
increased aLT AST
dec GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

cure for preeclampsia

A

delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

which BP meds do you not use in preeclampsia

A

ACEI or ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

want to maintain what BP in preeclampsia

A

90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what meds do you use in severe preeclampsia

A

labetalol
IV MgSO4 for seizure proph
continue postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Rx for preexisting HTN in pregnant women

A

lavetalol or methyldopa

long acting CCB as sexond agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Complications preeclampsia

A

eclampsia, seizure, stroke, IUGR, pulmonary edema, maternal organ dysfunction, oligohydramnios, preterm delivery, hemolysis, elevated liver enzymes, low platelets, abruptio placenta, renal insufficiency, encephalopathy, DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is eclampsia

A

maternal seizures that can be fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Signs Sx eclampsia

A

HA

scotoma visual disturbances, upper abdominal pain preceding seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Tx exlampsia

A

delivery
MgSO4 and IV diazepam for seizure
O2 and BP control with labetolol and hydralazine
continue MgSO4 for post 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

anticonvulsants with pregnancy

A

kept on meds but supplemented with folate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is associated with severe maternal asthma

A

preeclampsia, spontaneous abortion, intrauterine fetal demise and IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Tx mild persistent asthma in pregnangy

A

short acting Beta agonist and low dose inhaled corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Tx mod persistent asthma in pregnangy

A

med dos inhaled corticosteroid or low dose + long acting beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Tx severe persistent asthma

A

high dose inhaled corticosteroid plus long acting beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

complications maternal asthma

A

increased risk preeclampsia, spontaneous abortion, Intrauterine fetal death
IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Tx hyperemesis gravidarum

A

avoidance large meals
adequate hydration
pyridoxine and doxylamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what causes morning sickness

A

increase hCG or imbalance P and E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Dx DVT in pregnancy

A

doppler and US studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Tx DVT in pregnangy

A

IV heparin to maintain PTT 2x normal or LMWH to keep anti-factor Xa levels within 0.5-1.2 4 hours post infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

DVT in pregnancy, discharged on

A

LMWH

try to discontinue 24-36 hrs prior to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

why not use warfarin in pregnancy

A

teratogenic

but can use breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

how long are anticoagulants continued post partum if patient had DVT during pregnancy

A

6 weeks

and wait at least 6 hours since delivery to prevent severe hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Tx UTI in pregnancy

A

amox
nitrofurantoin
cephalexin x3-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

why not use fluoroquinolones in pregancy

A

teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

fetal effects from maternal marijuana

A

IUGR and prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

fetal risks of maternal cocaine use

A 
abruptio placentae
IUGR
prematurity
facial abnormalities
delayed intelectual development
fetal demise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

fetal risks of ethanol use during pregnancy

A

fetal alcohol syndrome- mental retardation, IUGR, sensory and motor neuropathy, facial abnormalities
psontaneous abortion
Intrauterine fetal demise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

fetal risks of maternal use of opioids

A

prematurity, IUGR meconium aspiration, neonatal infecitons, narcotic withdrawl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

fetal risks of maternal use of stimulants

A

IUGR congenital heart defects, cleft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

fetal risks of maternal use of tobaccco

A 
spont abortion
prematurity
IUGR
intrauterine fetal demise
impaired intellectual development
higher risk neonatal respiratory infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

maternal risk factors for using tobacco during pregnancy

A

abruptio placentae, placenta previa, PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

fetal risks of maternal use of hallucinogens

A

developmental delays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

ACEI teratogenic effects

A

renal abnormalities and decreased skull ossification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Aminoglycoside teratogenicity

A

CN VIII damage (hearing) skel abnormalities, renal defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

carbamazapine teratogenicity

A

facial abnrmalities, IUGR, mental retardation, CV abnormalities
neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

DES teratogenicity

A

vaginal and cervical cancer later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

fluoroquinolone teratogenicity

A

cartilage abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

phenobarbital teratogenicity

A

neonatal withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

phenytoin teratogenicity

A

facial abnormalities, IUGR, mental retardation, CV abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

retinoids teratogenicity

A

CNS abnormalities, CV abnormalities, facial abnormalities, spont abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

sulfonamides teratogenicity

A

kernicterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

tetracycline teratogenicity

A

skeletal abnormalities, limb abnormalities, teeth discoloration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

thalidomide teratogenicity

A

limb abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

valproic acid teratogenicity

A

neural tube defects
facial abnormalites
CV abnormalities
skeletal issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

warfarin is assoc with what teratogenic effect

A

dandy walker malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

TORCH

A 
toxo
other: varicella, parvo, GBS, Chlamydia, gonn
Rubella, rubeola, RPR
Cytomegalovirus
Herpes/hepatitisB, HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

congenital toxo signs

A

hydrocephalus, intracranial calcifications, chorioretinitis, microcephaly
seizures
spont abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Dx toxo in pregnancy

A

amniotic fluid PCR for toxo and srum Ab sscreening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Tx for toxo infection in mom

A

pyrimethamine, sulfadiazine, folinic acid

avoid gardening, raw meat, cat litter and unpasteurized milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

congenital rubella

A

blueberry muffin baby

IUGR, deafness, CV abrnomalities, vision isssues, CNS problems, hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

screeningmaternal rubella

A

early prenatal IgG screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

if mom contracts rubella during pregnancy

A

no Tx and no benefit from Ig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

fetal effects of rubeola (measles) infection

A

increased risk prematurity
IUGR
spont abortion
high risk neonatal death if transmission occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Dx rubeola or measles in pregnancy how

A

IgM or IgG Ab in mom after rash develops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Tx if mom has rubeola during pregnancy

A

Ig to mom

not vaccine because live attenuated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Fetal risks of maternal syphilis infection

A

neonatal anemia, deafness, HSM, pneumonia, hepatitis, osteodystophy, rash and hand foot desquamation
25% death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Dx maternal syphilis infection

A

early prenatal RPR or VDRL screen

confirm with FTA-ABS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Tx maternal syphilis infection

A

penicillin for mom and baby if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

effcts of CMV infection on fetus

A

IUGR, chorioretinits, CNS problems

mental retardation, vision issues, deafness, hydrocephalus, seizures, HSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Dx of CMS infection during pregnancy

A

mono like illness

IgM screening or PCR of baby in first few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Tx for CMV infection in pregnany

A

no Tx
gangciclovir after once baby is born
good hygiene reduces transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

fetal effects of maternal herpes infection

A

increased risk prematurity
IUGR and spont abortion
high risk death
CNS problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Tx for herpes maternal infection

A

delivery by C section to avoid transmission

acyclovir maybe in infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What happens with HIV during pregnancy

A

viral transmission, and rapid progression to AIDs

116
Q

Tx maternal HIv infection

A

AZT to reduce vertical transmission
continue antiretroviral regimen
no efavirenz, didanosine, stavudine or nevirapine

117
Q

risks with maternal hep B infection

A

inc risk prematuiry, IUGR and neonatal death if they get acute disease

118
Q

how to screen for hep B in pregnancy

A

prenatal surface Ag screening

119
Q

Tx maternal hep B infection during pregnancy

A

vaccination

neonate gets vaccine and Ig shortly after birth

120
Q

Tx gonorrhea or chlamydia in neonate from mom

A

erythromycin

can give to mom during pregnancy

121
Q

fetal risks of maternal varicella zoster infection

A

prematurity, encephalitis, pneumonia IUGR
CNS problems
limb problems, blindness
high risk neonatal death with transmission

122
Q

Dx maternal variceela zoster infection

A

IgG screening with no known Hx of disease prenatally

IgM and IgG in infants can confirm

123
Q

Tx for varicella zoster infection during pregnancy

A

varicella Ig to nonimmune mom
and to neonate if active infection
vaccine is contraindicated during pregnancy

124
Q

fetal risks of maternal GBS infection

A

respiratory distress, pneumonia, meningitis, sepsis

125
Q

when to screen for maternal GBS

A

after 34 weeks gestation

126
Q

Tx for GBS in mo during pregnancy

A

IV beta lactams or clinda during labor or in infected neonates

127
Q

fetal effects of maternal parvo virus

A

decreased RBC produciton
hemolytic anemia
hydrops fetalis

128
Q

screening parvo

A

IgM Av or PCR viral DNA in neonate

129
Q

Tx maternal parvo B 19 infection

A

monitor fetal Hb by PUBS and give transfusion if severe anemia

130
Q

where is most common place ectopic

A

ampulla of fallopian tube

131
Q

risk factors for ectopic

A 
PID or STDs
gyn surgery
prior ectopic
multiple partners
smoking
132
Q

sign ectopic

A

pain, nausea, amenorrhea, scant vaginal bleeding

peritoneal signs and tachy if ruptured

133
Q

how does bhCG increase in pregnanc

A

double every 48 hours

134
Q

bhCG that is not doubling in the right amount of time

A

suspicious for ectopic

135
Q

most common cause vaginal bleeding in early pregnancy

A

ectopic
spont abortion
physiologic bleeding
uterine-cervical pathology

136
Q

when to do transvaginal US to look for ecotpic

A

when bhCG>6500 and 1500

137
Q

Tx unruptured ectopic

A

MTX to abort pregnancy

138
Q

Tx ruptured ecoptic

A

IV hydration and surfical excision with attempts to preserve fallopian tube

139
Q

complications ectopic

A

fetal death,
severe maternal hemorrhage
increased risk for future ectopics, infertility, Rh sensitization, maternal death

140
Q

cause of first trimester spont abortion

A

chromosomal abnormalities, especially trisomies

141
Q

causes of second trimester spont abortions

A

infection, cervical incompetence, uterine abnormalities, hypercoagulable, poor maternal health or drug use

142
Q

risk factors for spont abortions

A 
increased maternal age
multiple prior births
prior spont abortion
uterine abnormalities
smoking
alcohol
NSAIDs
cocaine
excessive caffeine use
maternal inections
low folate
autoimmune- antiphospholipid!
143
Q

signs of threatened abortion

A

uterine bleedingin initial 20 weeks
closed cervical os, no uterine contents expelled
US show viable fetus
need bed rest

144
Q

signs of missed abortion

A

some uterine bleeding can be with pain
closed os
no expelled contents
US shows nonviable intrauterine fetus

145
Q

Tx of missed abortion

A

expectant
misoprostol or D&C
give Rhogam

146
Q

Signs inevitable abortion

A

uterine bleeding in inital 20 weeks with pain
open cervical os with no contents expelled
US shows viable fetus and cervix is dilated

147
Q

Tx of inevitable abortion

A

expectant
misoprostol or D&C
give rhogam

148
Q

Signs incomplete abortion

A

uterine bleeding in inital 20 weeks

open os and some uterine contents expelled

149
Q

Tx incomplete abortion

A

misoprostol or D&C

give rhogam

150
Q

what to give for complete abortion

A

rhogam

151
Q

when is intrauterine fetal demise

A

fetal death after 20 weeks and before onset labor

152
Q

what can cause intraunterine fetal demise

A 
placental or cord abnormalities from maternal CV or heme conditions
maternal HTN
infection
poor maternal health
fetal congenital abnormalities
153
Q

US of intrauterine fetal demise

A

nonviable intrauterine fetus with no heart activity

154
Q

Tx of intrauterine fetal demise

A

oxytocin, misoprostol (PGE1) or PGE2

dialtion and evactuation

155
Q

complications intrauterine fetal demise

A

DIC if retained for a while

156
Q

definition of IUGR

A

fetal growth that lags behind gestational age

157
Q

symmetric IUGR

A

overall decrease in size

likely from congenital infection, chromosomal abnormality or maternal drug use

158
Q

asymmetric IUGR

A

majority
decreased abdominal size with preserved head and extremities
happens late in pregnancy
caused from multiple gestation or poor maternal health or placental insufficiency

159
Q

fundal height in IUGR

A
160
Q

when does fundal height equal gestational age

A

20 weeks and on

161
Q

Tx IUGR

A

follow with US
nutritional supp and mom O2 therapy
maybe bedrest
delivery should be induced if fetal growth slows further
give corticosteroids to increase lung maturation

162
Q

some causes of oligohydramnios

A

IUGR, fetal stress, fetal renal abnormalities, poor fetal health

163
Q

second trimester oligohydramnios

A

renal problems
maternal cause like preeclampsia, renal disease, HTN
or placental thormbosis

164
Q

third trimester oligohydramnios

A

assoc with PROM, preeclampsia, abruptio placentae or idiopathic cause

165
Q

US of oligohydramnios Dx

A

amniotic fluid index

166
Q

Tx oligohydramnios

A

expectant. may need to induce

hydraiton and bed rest

167
Q

complications oligohydramnios

A

spon abortion
intrauterine fetal demise
abnomral limb, facies of lungs
abnormal abdominal development all from compression

168
Q

polyhydramnios Dx criteria

A

> 25 cm amniotic fluid index

169
Q

causes of polyhydramnios

A

insufficient swallowing of fluid(esophageal atresia)
infecreased fetal urination from maternal DM
multiple gestation
fetal anemia, chrom abnormalities

170
Q

Tx polyhydramnios

A

32 weeks amnioreduction only

171
Q

complications polyhydramnios

A

preterm labor
PROM
fetal malpresentation
maternal respiratory compromise

172
Q

what is PROM

A

spontaneous rupture of amniotic sac with spillage of fluid before onset of labor

173
Q

risk factors for PROM

A

vaginal or cervical infection, cervical incompetence, poor maternal nurtrion, prior PROM

174
Q

labs to Dx PROM

A

microscopic exam of vaginal fluid will show ferning
vaginal fluid will turn nitrazine paper blue
Need to send for culture to Dx possible infection

175
Q

imaging for PROM

A

US to assess volume and fetal position

176
Q

why not do bimanual if patient has PROM

A

risk of infection

177
Q

Tx for PROM

A
178
Q

Tx for PROM 32-34 weeks

A

amniotic analysis for lung maturation
if mature induce labor
corticosteroids and antibiotics if not mature yet

179
Q

Tx PROM >34 weeks

A

antibiotics and delivery is induced

180
Q

how to assess fetal lung maturity

A

Lecithin and sphingomyelin levels L:S should be >2 in presence of phophatidylglycerol which suggests maturation

181
Q

what is preterm labor

A

labor before 37 weeks

182
Q

risk factors preterm labor

A

multiple gestation, PROM, infection, placenta previa, abruptio placentae, previous preterm labor, polydydramnios, cervical imcompetence, poor nutrition, stressful environment, smoking, substance abuse, lower socioeconomic statu

183
Q

signs Sx preterm labor

A

constant low back pain and conractions

184
Q

what to order in preterm labor

A

UA vaginal and cervical cultures to check for infection

do US to assess amniotic fluid and fetal well being and confirm gestational age

185
Q

Tx preterm labor

A

hospitalization, hydration and acitivy restriction
tocolytics for 48 hours – with MgSO4, terbutaline, indomethacin or nifedipine
glucocorticoids for 48 hours
empiric ampicillin if delivery is immenent of suspect infection

186
Q

Tx preterm labor >34 weeks

A

active management if indication for delivery

empiric ampicillin

187
Q

what cervical length by US has greater risk preterm birth

A
188
Q

What is placenta previa

A

implantation of placenta near cervical os assoc with vaginal bleeding

189
Q

what is low implantation placenta previa

A

in lower uterus but does not affect cervical os until dilation

190
Q

what is partial placental previa

A

placenta partially covers os

191
Q

what is complete placental previa

A

placenta completely covers os

192
Q

risk factors placenta previa

A

muliparity, increased maternal age, prior previa, prior cesarean section!!!!
multiple gestation, fibroids, Hx ablation and smoking

193
Q

painless vaginal bleeding in third trimester

A

placenta previa

194
Q

Dx placenta previa

A

US

195
Q

Tx placenta previa

A

bed rest
rhogram for Rh- moms with any bleeding
tocolytics can be used
do C section

196
Q

most common causes of vaginal bleeding after 20 weeks gestation

A

placenta previa and placenta abruption

197
Q

complications plcaenta previa

A

severe hemorrhage, IUGR, malpresentation, PROM, vasa previa(fetal exsanguination)
maternal death in 1%

198
Q

painless vaginal bleeding in 3rd trimester

do NOT do what

A

steril vaginal examination

need to rule out placenta previa

199
Q

risk factors abruptio placentae

A 
HTN
prior abruption
trauma
tobacco use
cocaine
PROM
mutiple gestation
multiparity
200
Q

signs of abruptio placentae

A

painful vaginal bleeding in 3rd trimester, back pain, abdominal pain, pelvic tenderness, increased uterine tone, hypotension

201
Q

US of abruptio placentae

A

inconsistently shows separation of placenta from uterus

202
Q

Tx abruptio placentae

A

bed rest
C section for hemodynamic instability
transfusion usually required

203
Q

complications abruptio placentae

A

DIC, severe hemorrhage that increases risk maternal death, fetal demise and increased abruption in future pregnancies

204
Q

monozygotic twins

A

division zygote resulting in identical fetuses

may or maynot share same amnion or chorion

205
Q

dizygotic twins

A

fertilization of more than one egg by different sperm
fraternal twins
separate amnions

206
Q

twins create increased risk for what during pregnancy

A

HTN DM preeclampsia and preterm

fetal malpresenationa, previa, abruptiom PROM, IUGR, birth trauma, CO and RDS

207
Q

what is twin twin transfusion syndrome

A

umbilical cords are fused and one twin is inadequately perfused causing more complications

208
Q

average delivery time for twin

A

36 weeks

209
Q

pregnancy visits for twins

A

biweekly or weekly starting at 24 weeks

210
Q

when do you start fetal non stress tests for twins

A

36 weeks

211
Q

twins and having preterm labor

A

tocolytics

212
Q

when can you attempt vaginal delivery of twins

A

Vertex vertex

or vertex-breech sometimes

213
Q

normal fetal HR

A

120-160

214
Q

position for fetal non stress test

A

L lateral decubitus

215
Q

normal reactive NST for fetal wellbeing

A

2+ 15 bpm accelerations lasting at least 15 seconds each within 20 minutes

216
Q

what to do if nonreactive NST

A

biophysical profile

217
Q

what is a biophysical profile to assess fetal well being

A 
NST repeat with US
US measures amniotic fluid index
fetal breathing rate
fetal mvoement 
fetal tone
218
Q

total points for biophysical profile

A
  1. 8-10 is normal
219
Q

what is used to assess uteroplacental dysfunction

A

contractions tress test

fetal HR monitored with fetal scalp electrode

220
Q

reassuring signs of fetal HR

A

beat to beat variability
long term HR variability
occasional HR acclerations

221
Q

decelerations

A

fetal head compression, umbilical cord compression of fetal hypoxia

222
Q

when do you perform fetal scalp blood sampling

A

consistentlyabnormal fetal heart rate tracing

dec pH and hypoxemia and inc lactate indicate fetal distress

223
Q

braxton hicks contractions

A

false contractions

224
Q

early decelerations

A

begin and end with uterine contractions

head compression

225
Q

late decelerations

A

begin after initiation of uterine contraction and end after contraction finishes

226
Q

cause of late decelerations

A

uteroplacental insufficiency, maternal venous compression
maternal hypotension
abruptio placentae
fetal hypoxia

227
Q

Tx for late decelerations

A

test fetal blood for hypoxia or acidosis

recurrent late declerations promt delivery

228
Q

variable decelerations

A

inconsistent onset duration and degree

229
Q

cause of variable decelerations

A

umbilical cord compression

230
Q

Tx for variable decelerations

A

change in mother position

231
Q

Stage 1 labor begins and ends with what

A

latent is the start of uterine contractions until 6 cm dilated and complete effacement
active phase is 6 cm to 10 cm dilation
deceleration phase is transition into 2nd stage

232
Q

Stage 2 labor what happens

A

full dilation until delivery

233
Q

Stage 3 labor what happens

A

delivery of neonate until placental delivery

234
Q

Stage 4 labor is what

A

initial postpartum hour

235
Q

progression of cervical dilation in active phase 1 for nulliparous

A

1.2 cm/hr

236
Q

progression of cervical dilation in active phase 1 for multiparous

A

1.5cm/hr

237
Q

management stage 1 labor

A

monitor fetal heart rate and uterine contractions

assess progressions of cervical change periodically

238
Q

how long is stage 1 labor in nulliparous

A
239
Q

how long is stage 1 labor in multiparous

A
240
Q

management of stage 2 labor

A

monitor fetal heart rate and movenet through birth canal

241
Q

how long is stage 2 labor in nulliparous

A
242
Q

how long is stage 2 labor in multiparous

A
243
Q

management of stage 3 labor

A

uterine massage and examination of placenta to confirm no intrauterine remnatns

244
Q

how long is stage 3 labor for nulli and multiparous

A

0-30 minutes

245
Q

managemnet stage 4 labor

A

monitor maternal pulse and BP

look for signs of hemorrhage

246
Q

how long is stage 4 labor for nulliparous and multiparous

A

1 hr

247
Q

what can you induce labor with

A

oxytocin or misoprostol

248
Q

indicatoins to induce labor

A

maternal preeclampsia, DM, stalled stage of labor, chorioamnionitis
fetal: prolonged pregnancy, IUGR, PROM, congenital defects

249
Q

contraindications to induce labor

A

prior uterine surgery, fetal lung immaturity, malpresentation, acute fetal distress, active genital herpes, vasa previa

250
Q

what is bishop score measuring

A

likelihood of vaginal delivery following induction

251
Q

face presentation of fetus

A

full hyperextension of neck

252
Q

brow presentation of fetus

A

partial hyperextenion

253
Q

frank breech

A

hips flexed and knees extended- 75%

254
Q

complete breech

A

hips and knees flexed

255
Q

footling breech

A

one or both legs extended

256
Q

risk factors for malpresentation

A

prematurity, multiple gestation,polyhydramnios, uterine anomaly placenta previa

257
Q

complications malpresentation

A

cord prolapse, head entrapment, fetal hypoxia, abruptio placentae, birth trauma

258
Q

vertical C section

A

vertical incision through anterior muscle protion
“classic”
when fetus is in transverese position or adhesions and fibroids prevent acess
do it if hysterectomy after delivery
if cervical cancer
or if postmorten delivery

259
Q

low transverse C section

A

transverse incision in lower uterine segment
decreased risk uterine rupture, bleeding, bowel adhesions, and infection
more common

260
Q

when can you do VBAC, what type of C section did they have

A

transverse

cannot do with vertical

261
Q

what is colostrum

A

early breast milk rich in proteins, fat and minerals

has IgA

262
Q

components of apgar

A 
color
heart rate
response to stimulation
muscle tone
respirations
263
Q

when does the red lochia discharge after birth stop in mom

A

by 10th day

264
Q

when does mensturation return in non nursing moms

A

6-8 weeks

265
Q

what causes the most substantial volume of postpartum bleeding

A

retaiend placental tissue

266
Q

what blood loss in delivery is abnormal

A

> 500 mL in 24 hours if vaginal

>1000 in 24 hours if c sextion

267
Q

major cause of postpartume bleeding

A

uterine atony

268
Q

workup for postpartum bleeding

A

US to look for retained tissue

269
Q

Tx for postpartum bleeding

A 
uterine massage and oxytocin administration
dec hemorrhage
surgical repair of lacerations
D&C if retained tissue
hysterectomy for refractory cases
270
Q

What is hydatidiform mole

A

benign neoplasm of trophoblastic cells that become malignant

271
Q

complete mole

A

46 XX or 46 XY
derived from father
empty egg with 2 sperm

272
Q

what is incomplete mole

A

69 XXY or 69XYY
fertilization of egg by 2 sperm
assoc with abnormal fetus

273
Q

risk factors for hydatidiform mole

A

low socioeconomic status, extremes of age, Hx prior molar pregnancy, asian, smoking

274
Q

signs of molar pregnancy

A

heavy or irregular painless bleedingi n 1st and 2nd trimester
hyperemesis gravidarum
dizziness
anxiety
large fundal height for gestational age
grape like vesicles in vagina and no heart tones

275
Q

preeclampsia in first half of pregnancy

A

suspect molar pregnancy

276
Q

labs in molar pregnancy

A

bhCG is very high

277
Q

US in molar pregnancy

A

snowstorm pattern without presence of gestational sac

278
Q

Tx molar pregnancy

A

D&C to remove neoplasm
follow bchCG for 1 year
avoid pregnancy 6 mo-1 year

279
Q

complications molar pregnancy

A

malignant gestational trophoblastic neoplasm

choriocarcinoma

280
Q

choriocarcinoma

A

malignant trophoblastic neoplasm that arises from hydatidiform moles or following abortion, ectopic or normal pregnancy

281
Q

signs choriocarcinoma

A

vaginal bleeding, possible hemoptysis, dyspnea, HA, dizziness or rectal bleeding, enlarged uterus with bleeding from cervical os

282
Q

labs in choriocarcinoma

A

increase bhCG

283
Q

US in choriocarcinoma

A

uterine mass with mix hemorrhagic and necrotic areas, possible parametrial invasion
CT detects mets

284
Q

treatment choriocarcinoma

A 
hysterectomy if limited to uterus
chemo
if want to maintain fetility do chemo alone
follow bhCG
avoid pregnancy 1 year after therapy
285
Q

complications choriocarcinoma

A

mets to lungs, brain, liver, kidneys and GI tract

good prognosis unless brain or liver mets

Step2CK (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions