ob test 3 Flashcards
TORCH
Infections affecting fetus T-toxoplasmosis O-Other- syphilis, gonorrhea, HIV R-rubella C-cytomegalovirus H-herpes simplex
three places toxoplasmosis is found
how does it pass to babe?
Cat poop, undercooked meat, unpasteurized milk
Transplacental
Toxoplasmosis maternal s/s
Most-1
4
Most asymptomatic
Flu like sympt, mild rash, splenomegaly, enlarged lymph nodes.
Toxo fetus risks 7
hepatosplenomegaly, jaundice, microcephaly, hydrocephalus, eye infections/blindness, Neuro- seizures, Intellectual disability
How to diagnose toxo 3
Blood test followed by amniocentesis then serial ultrasound
tx for toxoplasmosis
treat after 1st trimester
Do we test all women for toxo?
No
Rubella
What is it? also called?
what are maternal symptoms? 4
A virus, German measles. rash, enlarged nodes, flu like sympt, HA
Rubella is transmitted to mom?
To babe?
and one thing about transmission?
Droplets and contact with nasopharyngeal secretions.
transplacentally
Transmission worsens the earlier in pregnancy
neonatal risks for rubella 8
Cardiac defects, microcephaly, cerebral palsy, MR, Cataracts, glacoma, Deafness, blindness
Rubella and vaccine and preg 3
Immunize 28days before preg, check antibodies 1:8, immunize immediate postpartum.
What is rubeola? 2 plus one thing
A virus. Measles. Usually attacks respiratory system
rubeola fetal risks 4
SAB, premature labor, fetal demise, pneumonia
Immunize rubeola
Same as rubella
What is CMV? 1
and how is it transmitted? 2
Herpes virus, with any body fluid and transplacentally
Maternal symptoms of CMV 2
Asymptomatic or flu like
How does CMV appear in the child 2
They can have anything- may seem normal at birth
how to treat CMV 2 emphasis on? -1
NO vaccine, prevention ( especially child contact)
Do they test for CMV at prenatal visits?
NO
When is the most contagious time for an infant to contract herps
When mom gets a primary infection near birth
When do they recommend a c section with herps
Active lesions within 6 weeks of birth
When will an infant show signs of herps infection
If contracted through birth canal within 2-12 days
s/s of herps infection with kids 9
Fever, hypothermia, jaundice, skin lesions, conjunctivitis, cns issues, convulsions, encephalitis, high mortality rate.
antivirals for herps 2
Zovirax and valtrex
One thing to remember if vaginal birth with herps
Avoid anything that could rupture babes skin
Syphilis
what is it?
how does mom get it?
How does babe get it?
Spirochete, sexually, transplacentally
2 things on babe with syphilis infection
Rash on feet and hands and lesions all over body that are contagious.
Do we test for syphilis at prenatal visit
Yes, state law
Tx for syphilis
penecillin
What is gonorrhea
transmitted to mom?
to babe?
Spirochete,
sexually
transplacental
Three things that gonorrhea can cause in infant?
Opthalmia neontorum, blindness, sepsis
Do we test for Gonorrhea at prenatal visit
yes
Tx for mom- and babe-2 (one is same as mom) one thing to remember about one for babe
Rocephin for both
erythromycin ointment- all babes
How is chlamydia transmitted to babe 2
placental or direct contact
Maternal risks of chlamydia 3
infertility, ectopic preg, PID
2 fetal risks chlamydia
pneumonia and eye infection
Do we test for chlamydia at prenatal visit
yes
Tx for chlamydia mom-2 babe 2 (one to remember)
Erythromycin
Erythromycin eye drops routine
tx for UTI can cause 2 things with babe and onw thing to remember
AMpicillin abortion preterm labor and fetal death doubles if not treated
tx for UTI can cause 2 things with babe and onw thing to remember
AMpicillin abortion preterm labor and fetal death doubles if not treated
How do you get Hep b? 2 mom 1 babe
Blood, sexual contact, tranplacental
when is the baby most a t risk for getting hep b?
if mom gets it in the third trimester.
Maternal s/s of hep b 4
Fever, N/V, ab pain, jaundice
one thing to remember about neonates and hep b
They are at a greater risk for cirrhosis and liver cancer
Do we test for hep b at prenatal visit and one thing to remember
yes! Even if you are vaccinated!
3 things about hep b vaccine
Get prior to preg, can give to pregnant women, babes will get at within 12 hours of birth.
can you breastfeed with hep b
yes unless cracked nipples
HIV 3 ways to get it
Blood, transplacental, breast milk
What is the goal for a mom who is HIV positive
Reducing the viral load to undetectable.
One thing to remember about a titer in babes who were born to HIV moms
They may have antibodies from mom so they may not carry the disease this is an unreliable way to test.
How do we identify HIV in babes?
We look for
failure to thrive, enlarged liver or spleen, recurrent infections, neuro abnormalities and facial features
What are the facial features in HIV positive babes? 4
Small head, flat nose, prom forehead, wide eyes
Do we test HIV at prenatal visits
We do the opt out approach
tx for HIV durning preg-when and during labor
Zidovudine prenatal-usually after first trimester
IV during labor
How is group b transmitted to babe 2
Vaginal tract or ascending infection after ROM
How does group b present in women 3
Usually asymptomatic, may have UTI, may naturally reside.
Risks to mom with group b strep when preg 3
Endometritis, sepsis, wound infections
Group b risk to babe 2
Sepsis, meningitis
When do we screen women for Group b
35-37 weeks
If mom is positive for group b what do we do for mom? for babe? How long do they stay Breastfeeding?
Give penicillin or ampillin diuring labor or 4 hours before
give prophylactically for babes
stay for ex 48 hours
ok to breast feed
One thing to remember about influenza and pregnant women?
It is more severe in them
Brain risks for newborns from influenza 4
Autism, schzophrenia, bipolar, psychosis
tx for flu 2 and one thing to remember
Tamiflu or relenza start treatment right away if suspect.
2 things to support mom with flu
Acetaminophen! and avoid dehydration
How is Zika transmitted?
3
Mosquito bites, semen, vaginal secretions
When is Zika dangerous for fetus
All throughout pregnancy
How does zika present in mom 5
Often asympotmatic, maculopapular rash, conjunctivitis, sore mm, joint pain, gullain-barre
Screening for Zika 3
s/s At every visit
if s/s are there blood test and aminocentesis
if positive, serial fetal ultasounds
how long does nicotine withdrawal last?/
24-48 hours
2 thing to remember about alcohol in the neonate
Can cause respiratory depression
hearing loss
Fetal Alcohol spectrum disorder s/s 6
Sleeplessness, inconsolable cry, jitteriness, seizures, ab distension, hyperactive rooting
Facial features of child with fetal alcohol syndrome 10
Microcephaly, short palpebral fissures, epicanthal folds, flat midface, indistinct philtrum, thin upper lip, low nasal bridge, minor ear abnormalities, short nose, micrognathia
L and D with alcoholic mom 2 things to remember
Seizure precautions and fluids.
What is it called when infants are going through withdrawals
Neonatal abstinence syndrome
What to watch for with babes whos moms have been doing drugs?
Preterm delivery
precipitous delivery
placental abruption
assess for fetal growth and well being
Can we urine screen for drugs?
no, we need consent
Newborn responses with marijuana 5
exaggerated moro response, poor eating sucking coordination, small head size, slower brain growth, vision and motor development delays.
THC and breastmilk
THC is stored in fat so high levels in breastmilk
cocaine effects in babe 3
Lethargic but irritable, unable to focus on mom, small strokes.
opioids and babe
watch for
w/d time and two things about it
Respiratory depression
2-24 hours very dangerous, can take months
s/s of newborn heroin 3
Hyperactive, increased DTR, Increased moro reflex,
What happens when babe is not treated for heroin withdrawal 4
Fever, vomiting/d, apnea, seizures
care of the addicted newborn 3
need extra calories, swaddling, minimal stimulation
Cordstat/Mecstat
tests for exposure 20 plus weeks
What tests for neonatal abstinence syndrome?
Neonatal withdrawal inventory
When we suspect mom is using assess neonate for 4 and one thing to remember about one of them
SGA, IUGR, CVA, NEC (Normal in premes not full term)
3 risks about covid and preg
women are at a higher risk for complications, higher risk of still born or premature death
pregnancy and vaccine vs exposure
More antibodies for vaccine
When is preeclampsia diagnosed? 2
most commonly after 31 weeks but definitely after 20
What do you call it when someone has had hypertension before pregnancy and then has preE
Chronic hypertension with super-imposed preE
What is PreE
Hypertension associated with proteinurea or severe features.
What should happen to BP in all trimesters
1-slight increase 2-decrease 3-at baseline
What are the Pre E risk factors 6
African american, personal/family history, co-morbitities, Mulit-fetal, nulli-parity, AMA (35)
BP number for preE
140/90
Protein number in 24hr urine collection
300mg
Creatinine ratio number for preE
0.3mg/dl
Rule to remember about BP and preE
must have two measures at least 4 hrs apart
What are severe features Just BP
BP 160/110
abnormal platelet range
less than 100,000
Impaired liver function would 2
Increase AST and ACT
What cerebral/vision symptoms would happen with a severe feature? 4
Photophobia, hyperflexia, clonus, eye changes
What is DIC 2
Disseminated intravascular coagulation
can’t clot
one sign that liver function is not happening
Severe upper right epigastric pain that won’t go away
Respiratory change with preE
Edema in lungs
4 CNS changes
HA, Micro-capillary hem, ischemia, edema
Normal DTR
+1 +2
Normal urine output
30ml/hr
When do we treat with Mag 2 for preE
When BP is higher than 160/110 or there are severe features present
What med to avoid with HTN
NSAIDS
S/S of mag tox 6
Decreased BP, Decreased UO, Decreased DTR, Decreased RR, sedation, change in LOC
What do we treat Mag tox with?
Calcium gluconate 10%
Steps in seizure with preE 4
Call code, reposition,monitor fetus, O2 suction
One thing to remember if mom has a seizure
let her recover before surg
What does HELLP stand for and what is a complication of it?
Hemolysis, Elevated Liver enzymes, Low platelets
DIC
Risks for Gestational diabetes 7
Obesity, family, multiparity, hydramnios, AMA, hx of fetal loss, racial disparities
S/s of diabetes 3
Polydipsia, polyuria, weightloss
3 infections that can happen with hyperglycemia
Yeast, group B, UTI
Risks for diabetes 6
PreE, Hem, PROM, Preterm birth, preterm contractions,clots
What is a teratogen -gestational diabetes
hyperglycemia
Neonatal risks with GD 4
Hypoglycemia, polycememia, respiratory distress, jaundice
What happens to insulin need levels in pregnancy
1st half-decrease in insulin need, Second half- increase, labor decrease
S/S hyperglycemia 2 you did not say before
Drymouth, rapid breathing
Hypoglycemia 5
HA, tremors, cold, clammy, blurry vision.
normal glucose range and one number in preg
70-110
70
glucose levels 1 hr and 2hr
180
153
