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Comp part 2 obgn > obgyn > Flashcards

obgyn Flashcards

1
Q
  • restrictive airway disease
  • 1/3 worsen, 1/3 improve, 1/3 remain the same
  • manage: maintain adequate oxygen, use of albuterol, steroids and nebs PRN
A

Asthma in pregnancy

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2
Q
  • increased risk to pneumonia
  • vaccine can be used during pregnancy
  • chemoprophylaxis for those who havent been exposed.
A

Influenza A or B in pregnancy

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3
Q
  • common
  • may cause subacute bacterial endocarditis, HF, pulm edema
  • 90% : mitral valve stenosis worsens with increased cardiac output needs d/t pregnancy
A

Rheumatic heart disease in pregnancy

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4
Q

Occasionally encountered w/ PAROXYSMAL ATRIAL TACH

A

Cardiac Dz in pregnancy

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5
Q
  • rare severe cardiac condition
  • last month of pregnancy through first 6 months PP
  • high mortality rate
  • Prognosis: better w/ return to normal heart size
  • Sterilization should be discussed with persistent cardiomyopathy
A

Peripartum Cardiomyopathy in pregnancy

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6
Q
  • Predominant change in preeclampsia and gestational HTN is MATERNAL VASOSPASM.
A

Patho phys of HTN in pregnancy

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7
Q

Mechanisms:

  1. vascular changes
  2. Hemostatic changes
  3. Changes in prostanoids
  4. Changes in endothelium-derived factors
  5. Lipid peroxide, free radical, antiox release
A

Mechanisms of HTN dz in pregnancy

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8
Q

Effects:
CV: elevated BP
Hematology: plasma volume contraction = increase Hct, risk of hypovolemic shock in event of hemorrhage
—> Risk of DIC, liver involvement, third spacing of fluid (increase BP , decrease plasma oncotic pressure
-

A

Effects of HTN in pregnancy

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9
Q

Decreased GFR and proteinuria d/t atherosclerotic-like changes in renal vessels; Decrease uric acid filtering and leads to increase maternal serum levels

A

HTN effect on Renal

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10
Q

Edema
Left heart failure
fluid overload

A

HTN effect on Pulmonary

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11
Q

decreased placental perfusion secondary to vasospasm leadst IUGR
- oligohydramnios, placental abruption, increased incidence of perinatal mortality
-

A

HTN dz on Fetals

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12
Q 
risk factors for? 
1. primipravity 
2. prior hx with IUP
3. chronic HTN, chronic renal dz or both
4, hx of thrombophilia
5. multi fetal gestation or invitro
6. FHx
7. DM 1 OR 2 ; OBESITY
8. SLE
A

Risk factors for HTN disease in pregnancy

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13
Q

Classifcation

- elevated BP that predates conception or before 20 weeks EGA

A

Chronic HTN in dz

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14
Q

New onset BP elevation > 20 weeks EGA before EKG /near term in absence of associated proteinuria

  • failure to normalize PP = diagnostic chronic HTN
  • progress mild to severe to preeclampsia
  • Chronic HTN w/ superimposed preeclampsia
A

Gestational HTN, on HTN dz of pregnancy

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15
Q
  • new onset HTN, new onset proteinuria > 20 weeks EGA
  • Other sx with HTN
  • Without severe sx progress to severe
A

Preeclampsia

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16
Q

Additional presence of seizures in patient w/ pre-eclampsia and w/out neuro hx

17
Q

complication = HELLP syndrome

  • Hemolysis, elevated liver enzyme, low platelet
  • sudden deterioration of maternal and fetal condition
  • REQUIRES: cardiovascular stabilization, correct coag abnml (platelet transfusion), and delivery
  • STAT delivery
A

Preeclampsia- eclampsia syndrome

18
Q

HTN WITH:

  1. proteinuria & edema >20 weeks of pregnancy
    - -> persistent SBP greater/= to 140-160, or DPB great/= 90-110
    - —> 2 occasions 4 hours apart in pt. w previously normal BP
    - —> proteinuria = 1+ dipstick or > 300 mg per 24 h urine or protein/creatine ratio = >.3 mg/dl
  2. TCP ( 20 weeks EGA
  3. elevated LFTs (transaminases 2x normal) > 20 weeks EGA
  4. serum creatinine > 1.1 mg/dl or double serum creat in absent of other renal dz >20 weeks EGA
  5. Pulmonary edema or cerebral-visual disturbances >20 weeks EGA
A

Pre-eclampsia WITHOUT severe features (htn dz of pregnancy)

19
Q

HTN WITH:
1. Proteinuria & edema > 20th week pregnancy
–> persistent SBP >160 , or DPB > 110
(2 occasions 4 hours apart pt on BED REST)
2. TCP platelets 1.1 mg/dl or double serum creat in absent other renal dz
6. Pulmonary edema or new onset cerebral-visual sx

A

Pre-eclampsia WITH severe features (htn dz of pregnancy)

20
Q

No single test yet to predict , not FDA approved and not available in US
- Angiogenesis proteins, PAPP-A, Placental protein 13, Uric Acid
Diagnosis - s/s w/ lab studies
Prevention - no unequivocal intervention

A

Pre-eclampsia (htn dz of pregnancy)

21
Q

What is not absolutely required to diagnose pre-eclampsia?

A

PROTEINURIA

22
Q

Rx/ Management
: No HA, visual change, SOB, RUQ/epigastric pain, dec FM, UC, abdl’pain, leaking fluid, vaginal spotting, sudden wt. gain

Signs: monitor maternal BP and fundal height

  • Another maternal BP w/ NST visit
  • Urine protein w/ each visit - gestational HTN PT
  • Abnormal FH NON-REACTIVE NST = BPP
A

Rx management for: Preeclampsia w/ No severe features or ONLY gestational HTN
(htn dz of pregnancy)

23
Q

Rx. management

  • Hospitalize state with changes suggestive of severe gestational HTN or severe preeclampsia
  • -> RX: MAGNESIUM SULFATE (prevent seizures)
  • -> antiHTN meds
A

Preeclampsia (htn dz of pregnancy)

24
Q

Hospitalize and deliver

  • greater than equal to 37 weeks EGA or suspect abruption
  • greater than equal to 34 wks EGA progressive labor/and or ROM,
    • – US fetal wt
A

Rx management of Preeclampsia (htn dz of pregnancy)

25
Types of opioids: heroin, opium, morphine, fentanyl, oxycodone HCL , hydrocodone, oxymorphone, meperide, propoxyphene
Opioid addiction
26
Screening tool example - CRAFFT (car, rest, alone, friends, family, trouble) 1. Begin asks if they had alcohol, pot/hashish, or anything else to get high in past 12 months - - If say yes to one, ask all from part B - - If say no to all, only ask the 1st part B question 2. Have you ever ridden in a CAR driven by someone who was high or had been using drugs or ethod? RAFFT
Opioid addiction screening told
27
H&P 1. Seek PN care late in pregnancy 2. High non-compliance with appointments 3. Poor wt gain 4. Seem intoxicated or sedated 5. Track marks, skin abscess -Withdrawal syndrome w/ physical dependence Fetus at risk for IUGR, preterm labor, placental abruption, death Labs: CBC, STD,HIV, Hep C w Hep B w/ IVDU or high risk exposure, urine drug screen
Opioid Addiction h&p
28
Psychosocial intervention Detox - highly motivated pt, special detox center - perinatal addiction Detox recommended during 2nd trimester to avoid risk of miscarriage OR after 32 weeks EGA to limit preterm labor risk
Opioid addiction rx management
29
Methadone maintenance - registered abuse tx specialist - substance abuse and mental health services admin - -> pn care, family counsel, rehab/dependency , nutrition, psychosocial services Buprenorphine maintenance - physicians office, w PN visits - S/L, implant
RX management for opioid addiction
30
Interdisciplinary team- all work together - Fetal monitoring : NSTs or BPP 4-6 hours after methadone dose - -> Methadone decreases baseline FHR, breathing movement and tone Post partum : refer patient back to treatment center for maintenance therapy counseling, breast feeding encouraged, methadone minimally excreted in breast milk
Rx management for opioid addiction
31
NAS: neonatal abstinence syndrome - cns/ans hyperactivity, poor feeding/uncoordinated sucking reflex, irritable, high pitch cry - sx within 72 hours delivery and may last days to week
opioid addiction rx management
32
Jaundice - most common cause is ACUTE VIRAL HEPATITIS DDX - jaundice = hepatic, obstructive gall bladder or bile duct dz, severe preeclampsia, HELLP syndrome Labs: urine bilirubin and urobilinogen, serum: total and direct bilirubin, LFTs, ALT AST , alkaline phosphatase CBC PTINR total protein and albumin +- ammonia
Hepatitis in pregnancy
33
Transmission: person to person via fecal oral route Rare: cross placenta 2ndary to travel within geographic locations when virus endemic - Infection = lifelong immunity - Lab: anti ___ IgM positive - Rx : supportive for outpt Inpatient- severe dz w/ coag, encephalopathy, extreme malaise, hepatic necrosis, Prevent: Travel precautions, IZ : inactive form ok for IUP Immunoglobulin Infection NOT c/i in breast feeding
Hep A in pregnancy
34
-most common form of chronic hep -> at risk for chronic insufficiency or hepatocellular CA - interfere with liver function - DOES NOT CROSS PLACENTA - Transmit during delivery LABs: CDC recommend testing for Hep C and D Manage - Maternal : ID carrier state Neonate : IZ, post exposure prophylaxis HBIG Prevention: IZ: not contraindicated in IUP or breastfeeding (infants must have BOTH vaccine and Ig w/in 12 hours of delivery)
Hep B in pregnancy
35
- Major cause of chronic hepatitis (50%) , cirrhosis, and HCC - Majority are asx and unaware - Transmit: IVDU/needles (60%) , coitus (20%) , transfuson (6%), needle sticks (3%) - -> Vertical are Perinatal transmission - depend on viral load and HIV status (higher with those) - 1% women have it, AA most at risk Risk factors: alcoholism, IVDU, HIV Lab: no definitive test, test those in 1945-1965 - HCV RNA , HCV antibodies, LFTs Rx/management - No guidelines BUT C-section NOT recommended for prevetion if NOT HIV co-infected Meds: interferon and Ribavirin not indicated No current pre or post exposure prophylaxis
Hep C
36
-Delta antigen, defective RNA virus -> only causes hepatitis in HBV infected - Transmit : percutaneous or sexual contact --> Uses HBsAG for transmission, co-infection or superinfection with Chronic Hep B - Diagnose: any pt. positive for HBsAG or recent HBV infection Lab: Anti-HDAg positive , HDV DNA - Rx: NO effective anti-vrial meds Prevent: HEP B IZ!!
Hep D
37
Water borne - -> RNA virus - rare industrialized countries - Transmit: fecal oral / contaminated water - US: rare, common: central and SE Asia, Africa, Mexico, Egypt - Mild to moderate illness IUP: CAN BE SEVERE W/ FULMINANT HEPATITIS = 20% MORTALITY W/ ACUTE INFXN 3RD TRIMESTER Labs: IgM antibodies Hep E (anti-HEV antibodies) Rx/manage: NO HEV immunoglobulin - IUP monitor: renal failure, fulminant hep, premature L&D, eclampsia Prevention : Travel education sanitation, hygiene IFXN NOT C/I IN BREASTFEEDING
Hep E
38
RNA virus - Transmit: parenteral, sex, intrapartum - Common in HEP C or HIV infected individuals - Replicate: monocyte, lymphocyte, bone marrow Labs: RNA-PCR amplification ; anti HGVE2 antibodies - Universal screening in all IUP = not suggested
HEP G

Comp part 2 obgn (1 decks)

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