OBGYN 2 Flashcards
Although quite effective in treating UTI, this drug class should be avoided during the last few weeks of pregnancy because they competitively inhibit the binding of bilirubin to albumin, which increases the risk of neonatal hyperbilirubinemia. Which drug class is this?
Sulfonamides.
This drug that is commonly used to treat UTI in pregnancy may cause severe nausea and thus not be tolerated. It should also be avoided in late pregnancy because of the risk of hemolysis caused by deficiency of erythrocyte phosphate dehydrogenase in the newborn. What drug is this?
Nitrofurantoin.
What are the two drugs of choice for treatment of UTI in pregnancy?
Ampicillin and the Cephalosporins.
By how much does the heart rate increase in pregnancy?
10 to 15 beats per minute.
True or False: an S3, a 2/6 systolic ejection murmur greater during inspiration, and a soft diastolic murmur can all be normal findings in a pregnant woman?
TRUE!!!
This is the most common dermatologic condition of pregnancy. It is more common in nulliparous women and occurs most often in the second and third trimesters of pregnancy. It is characterized by erythematous papules and plaques that are intensely pruritic and appear first on the abdomen. The lesions then commonly spread to the buttocks, thighs, and extremities with sparing of the face. Diagnosis?
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP).
This is a blistering skin eruption that occurs more commonly in multiparous patients in the second or third trimester of pregnancy. The presence of vesicles and bullae help differentiate this skin condition from PUPPP. Diagnosis?
Herpes gestationis.
This is a very rare dermatosis of pregnancy that is characterized by small, pruritic excoriated lesions that occur between 25 and 30 weeks. The lesions first appear on the trunk and forearms and can spread throughout the body as well. Diagnosis?
Prurigo gestationis.
This is a rare pustular eruption that forms along the margins of erythematous patches. This skin condition usually occurs in late pregnancy. The skin lesions usually begin at points of flexure and extend peripherally; mucous membranes are commonly involved. Patients with this condition usually do not have intense pruritis, but more commonly have systemic symptoms of nausea, vomiting, diarrhea, chills, and fever. Diagnosis?
Impetigo herpetiformis.
What is the incidence of major malformations in women with diabetes?
5-10%; it is believed that they are a consequence of poorly controlled diabetes in the preconception and early pregnancy period.
A hemoglobin A1c level greater than 10.6 has what % risk of fetal malformations?
25%.
Cardiac (38%), Musculoskeletal (15%), and CNS (10%) are the most common single organ system anomalies seen in pregnant women with what chronic disease?
DIABETES!!!
Sacral agenesis is a rare malformation seen commonly in pregnant women with what severe chronic disease?
Diabetes.
Pregnancy has not been found to exacerbate or modify diabetic nephropathy. Diabetic neuropathy and gastroparesis may complicate some pregnancies, but pregnancy does not affect the overall disease process. What is the one diabetic complication that pregnancy is thought to worsen?
Diabetic proliferative retinopathy.
Pregnant women who remain hyperthyroid despite therapy have a higher incidence of what two medical conditions?
Preeclampsia and Heart Failure.
This is a rare condition that affects the liver during pregnancy. This disorder is usually fatal for both mother and baby. It manifests itself late in pregnancy and is more common in nulliparous women. Typically a woman will present with a several-day or -week history of general malaise, anorexia, nausea, emesis, and jaundice. Liver enzymes are usually not elevated above 500. Indicators of liver failure are present, manifested by elevated PT/PTT, bilirubin, and ammonia levels. In addition there is marked hypoglycemia. Low fibrinogen and platelets occur secondary to a consumptive coagulopathy. Diagnosis?
Acute fatty liver of pregnancy; recently it has been suggested that recessively inherited mitochondrial abnormalities of fatty acid oxidation predispose women to fatty liver in pregnancy.
This condition occurs in up to 8% of pregnancies. Affected women are usually asymptomatic, have no prior history of bleeding and usually maintain platelet counts above 70,000. With this disorder, platelet count usually return to normal in about three months. Diagnosis?
Gestational Thrombocytopenia.
In this condition there is maternal alloimmunization to fetal platelet antigens. The mother is healthy and has a normal platelet count, but produces antibodies that cross the placenta and destroy fetal/neonatal platelets. Diagnosis?
Neonatal alloimmune thrombocytopenia.
Asymptomatic pregnant women with a platelet count over 50,000 do not need to be treated, because this count is sufficient to prevent bleeding complications. For severely low platelet counts, what therapies should be considered?
Prednisone, IVIg, splenectomy.
Maternal infection with this virus in the first half of pregnancy can cause malformations such as cutaneous and bony defects, chorioretinitis, cerebral cortical atrophy, and hydronephrosis. Adults with this infection fare much worse than children; about 10% will develop a pneumonitis, and some of these will require ventilatory support. Diagnosis?
Varicella-zoster infection.
Fetal manifestations of this infection correlate with time of maternal infection and fetal organ development. If infection occurs within the first 12 weeks, 80% of fetuses manifest the associated congenital syndrome, while only 25% manifest the syndrome if it occurs at the end of 24 weeks. The congenital syndrome cause by this virus includes one or more of the following: eye lesions, cardiac disease, sensorineural deafness, CNS defects, growth restriction, thrombocytopenia, anemia, liver dysfunction, interstitial pneumonitis, and osseous changes. Diagnosis?
Rubella syndrome.
In the past this infection accounted for about 1/3 of all stillbirths. Transplacental infection can occur with any stage of this disease, but the highest incidence is with the primary and secondary stages. The fetal and neonatal effects include hepatosplenomegaly, edema, ascites, hydrops, petechiae or purpuric skin lesions, osteochondritis, lymphadenopathy, rhinitis, penumonia, myocarditis, and nephrosis. The placenta is enlarged, sometimes weighing as much as the fetus. Diagnosis?
SYPHILIS!!!
This bacterial infection during pregnancy can be asymptomatic or cause a febrile illness that is confused with influenza, pyelonephritis, or meningitis. Fetal infection is characterized by granulomatous lesions with microabscesses. Early onset neonatal sepsis is a common manifestation of this infection during pregnancy, and late onset disease occurs after 3 to 4 weeks as meningitis, which is similar to Group B Strep. This, however, is a much less common infection. Diagnosis???
Listeria monocytogenes infection.
This type of forceps delivery requires a visible scalp, the fetal skull on the pelvic floor, the sagittal suture essentially in the OA position, and the fetal head on the perineum. A rotation can occur but only up to 45 degrees. What kind of forceps are these?
Outlet forceps.
This type of forceps delivery requires a station of at least +2, but not on the pelvic floor. Rotation can be more than 45 degrees. What type of forceps delivery is this?
Low forceps delivery.
This type of forceps delivery is from a station above 2+, but with an engaged head. What type of forceps delivery is this?
Midforceps delivery.
What percentage of women are colonized with GBS in the vagina or rectum?
10-30%.
Routine screening for GBS in pregnant women occurs between what range of gestational weeks?
35-37 weeks.
What is the preferred method of treatment for GBS colonization of the pregnant woman?
Penicillin; ampicilin is an acceptable alternative treatment, but penicillin is preferred. If penicillin allergic, but not at high risk for anaphylaxis, cefazolin is recommended. If penicillin allergic and high risk for anaphylaxis, use clindamycin or erythromycin if the isolate is susceptible to both. If penicillin allergic and high risk for anaphylaxis and the GBS is resistant to clindamycin or erythromycin, or susceptibilities are not available, use vancomycin.
The preferred method of treatment for pregnant women colonized with this bacteria is penicillin; ampicilin is an acceptable alternative treatment, but penicillin is preferred. If penicillin allergic, but not at high risk for anaphylaxis, cefazolin is recommended. If penicillin allergic and high risk for anaphylaxis, use clindamycin or erythromycin if the isolate is susceptible to both. If penicillin allergic and high risk for anaphylaxis and the isolate of this bacteria is resistant to clindamycin or erythromycin, or susceptibilities are not available, use vancomycin. What is the bacteria treatment with this protocol?
Group B strep.
Prolongation of the latent phase in the multiparous patient is considered at how many hours?
20 hours; the diagnosis of this category of uterine dysfunction is difficult and is made, in many cases, only in retrospect. Only rarely is there a need to resort to oxytocic agents or to cesarean section. The recommended management is meperidine (Demerol) 100mg intramuscularly; this will allow most patients to rest and wake up in active labor.
Prolongation of the latent phase in the nulliparous patient is considered at how many hours?
14 hours; he diagnosis of this category of uterine dysfunction is difficult and is made, in many cases, only in retrospect. Only rarely is there a need to resort to oxytocic agents or to cesarean section. The recommended management is meperidine (Demerol) 100mg intramuscularly; this will allow most patients to rest and wake up in active labor.
Early decelerations occur before the onset of contractions and represent what type of nervous system response to increased intracranial pressure form the uterine pressure on the fetal head?
A Vagal response.
This is perhaps the most common form of anesthesia used for vaginal delivery. It provides adequate pain relief for episiotomy, spontaneous delivery, forceps delivery, or vacuum extraction. What type of anesthesia is this?
Pudendal nerve block.
This type of labor anesthesia was a popular form of anesthesia for the first stage of labor until it was implicated in several fetal deaths. It has been shown that this technique was associated with fetal bradycardia in 25-35% of cases, probably due to the response to rapid uptake of the drug from the highly vascular surrounding tissue with a resultant reduction of uteroplacental blood flow. Death in some cases was related to direct injection of the local anesthetic into the fetus. What type of anesthesia is this?
Paracervical block.
This type of anesthesia bock provides prompt and adequate relief for spontaneous and instrument-assisted delivery. The local anesthetic is injected at the level of the L4-L5 interspace with the patient sitting. Hypotension and a decrease in uteroplacental perfusion are common results of the profound sympathetic blockade caused by spinal anesthesia. What type of block is this?
Low spinal anesthesia (saddle block).
This form of labor anesthesia provides effective pain relief for the first and second stages of labor and for delivery. It may be associated with late decelerations suggestive of uteroplacental insufficiency in as many as 20% of cases, but the frequency of this complication may be reduced by prehydration of the mother and by avoiding the supine position. This type of block appears to lengthen the second stage of labor and is associated with an increased need for augmentation of labor with oxytocin and for instrument-assisted delivery. In experienced hands, however, this mode of anesthesia has an excellent safety record. What type of anesthesia is this?
Epidural block.
What type of labor is characterized by contractions that are irregular in timing and duration and do not result in any cervical dilation. The intensity of this type of labor does not change and the discomfort is mainly felt in the lower abdomen and is usually relieved by sedation. What type of labor is this?
False labor, or Braxton-Hicks contractions.
In the case of this type of labor, the uterine contractions occur at regular intervals and tend to become increasingly more intense with time. In this labor, the contractions tend to be felt in the patients back and abdomen, and cervical change occurs over time. Sedation does not stop the discomfort. What type of labor is this?
True labor.
What is the major complication of general anesthesia when performing C-sections?
Maternal aspiration, which can result in fatal aspiration pneumonitis.
