Obstetrics Flashcards
When is the embryo most sensitive to teratogens
embroyonic period in first trimester
When does fetus get in head down position?
weeks 32-35
What are breast changes in pregnancy
mastodynia, breast engorgement, colostrum secretion
Naegel’s rule
EDD= first LNMP + 1 year - 3 M + 7 days
Pelvic organ changes in pregnancy
Chadwick’s sign, Hegar sign, Goodell sign, Ballottement, leucorrhea, pelvic ligament relaxation, abdominal enlargement, uterine contractions
Diagnosis of pregnancy
Fetal heart tones, uterine size/fetal palpation, sonography, serum or urine pregnancy test
Best time to estimate gestational age via ultrasound
13-20 weeks is most accurate parameter
Fundal height used to measure
uterine size
Gold standard for diagnosis of early pregnancy failure
cardiac activity absence on ultrasound. lab findings also show lack of increase of serial B hCG levels
complications of pregnancy failure
DIC
aminopterin effect on child while pregnant
blocks folic acid= neural tube defects causing cleft lip and cleft palate
anti epileptics effect on child while pregnant (phenytoin, valproic acid)
CV abnormalities, cleft palate, microcephaly
effect of isotretinoin in pregnancy
neural tube defects, cleft palate, heart defects, abnormalities of outer ears, micronathia
anti-anxiety meds (lithium, phenothiazine, diazepam) in pregnancy
cleft lip/palate
androgens and progestins effect in pregnancy
female fetuses more masculine, clitoris larger than normal, fused labia, scrotum, and penis
DES effect in pregnancy
abrnormalities of uterus, vagina, and cervix
SSRI effect in pregnancy
irritability, tremor, increased RR, nasal congestion, diarrhea
invasive genetic diagnostic testing
chorionic villus sampling done in first trimester and amniocentesis, done after 15 week
Quad marker screen done between 15-20 weeks pregnancy to detect the following:
alpha fetoprotein, hCG, unconjugated estriol, and inhibin-A
Which hormones are produced by placenta, seen 15-20 weeks of pregnancy?
hCG and Inhibin-A
Unconjugated estriol
protein produced by placenta and baby’s liver
prognosis of edwards and patau syndrome
edwards- usually die in fetal stage. Patau- usually die within days
trisomy 13
patau syndrome
trisomy 18
edwards syndrome
which vaccines are contraindicated in pregnancy
HPV, influenza in live attenuated form, MMR, varicella
standard visits when pregnant
every month at 0-32 weeks, 32-36 every 2 weeks, after 36 weeks every week visit
types of gestational trophoblastic diseases
hydatidiform mole and gestational trophoblastic neoplasia
types of gestational trophoblastic neoplasia
persistent/invasive mole, choriocarcinoma, and placental-site trophoblastic tumor
Most common form of GTD
hydatidiform mole
GTD characterized by
beta subunit of hCG
Patient presents with abnormal uterine bleeding at 8 weeks gestation, has excessive amounts of N/V, larger uterus than expected, and enlarged cystic ovaries that are palpable. She has not had any previous pregnancies, Diet deficient in folic acid, poor, and is 18 years old. Dx and tests?
Hydatidiform mole. Serum hCG beta subunit greater than 40,000 mU/mL and urinary hCG greater than 100,000 units/24 hours. Imaging- US and CXR to r/o pulmonary metastases of trophoblast
“snow storm” image on ultrasound, amenorrhea, irregular uterine bleeding
gestational trophoblastic disease
F/U with GTD
effective contraception. quantitative hCG levels- goal is below 5 mU/mL. First 2 weeks, check weekly. after 2 negative weekly tests, check monthly for 6 months. then every 2 months for a year
neonatal defined as
birth to 28 days
perinatal defined as
28 weeks gestation to 7 days after birth
corrected age=
chronological age - # weeks born prematurely
primiparous
pregnant for first time
how early might colostrum secretion occur
as early as 11 weeks
braxton hick’s contractions usually begin around…
28 weeks
cardiac activity detected when in fetus?
at about 5-6 weeks viz transvaginal sonogram
when can you detect hCG
serum- 7 days after conception or 21-22 days after LNMP. Urine- first voided morning urine sample
half life of hCG
1.5 days
when does hCG go back down to normal levels?
21-24 days after delivery/fetal loss
when is gestational age usually determined and how?
by crown rump length between 6-13 weeks gestation. by ultrasound, most accurate parameter is between 13-20 weeks
smoking effect on mothers
difficulty getting pregnant, water breaks too early, placenta separates from womb too early causing bleeding, and placenta covers cervix causing complications. may also cause pregnancy to occur outside of womb
smoking effect on babies
born too small, too early, sudden infant death syndrome, fetal or infant death. May also cause miscarriage or certain birth defects
drinking during pregnancy
can cause growth issues and CNS or behavioral problems. if during first trimester, can cause abnormal facial features
incresed alpha fetoprotein associated with
increased risk of spina bifida, twins
increased hCG level
increased risk of downs syndrome, or might be gestational trophoblastic tumor
ptyalism
excessive salivation
when do drugs, nicotine, and alcohol have their greatest effect during pregnancy?
during organogenesis- embryonic stage, which is 2-10 weeks gestation
nutriotional requirements in pregnancy
1 g/kg/day + 20 g/day in second half of pregnancy protein, 1200mg calcium, 30 g Iron, 0.4 mg folic acid, inc caloric requirement- about 400 kcal/day in second and third trimesters
tx options for GTD
suction dilation and curettage, methotrexate or dactinomycin, multi-agent chemotherapy, hysterectomy, oral contraceptives
complication of GTD
thyrotoxicosis
if maternal T4 is low, what is consequence?
Maternal t4 converted to T3 which is needed for fetal dev. of brain. if less maternal T4, this results in low fetal T3 in brain
antithyroid meds not to be used in pregnancy
methimazole. but can use PTU
when is peripartum cardiomyopathy diagnosed?
late pregnancy or about 5 months after delivery
left ventricular systolic dysfunction less than 45% in woman in last month of pregnancy with no previous hx of heart disease. suspect..
peripartum cardiomyopathy
tx of peripartum cardiomyopathy
supportive care, diuretics, vasodilators, digitalis, maybe BB. If EF less than 34%, prophylactic anticoagulation during pregnancy and full anticoagulation for 7-10 days after delivery to avoid thromboembolism
NEW murmur during systole in woman that is 7 months pregnant who is very tired and appears swollen, has SOB, racing heart. how to diagnose?
EKG, BNP to check for stretching of myocardium, chest Xray may see cardiomegaly, Hgb and TSHrT4 to check for other fatigue causes, BMP or CMP for electrolytes
anatomic disorders of placenta
twin twin transfusion syndrome, placental infarction, chorioangioma, amniotic bands
abnormalities in placental implantation
placenta previa and accreta
amputation of limbs or digits can be a consequence of this placental disorder
amniotic bands
painless, bright red vaginal bleeding
placenta previa (in 2nd or third trimester), placenta accreta (after 24 weeks)
types of placenta previa
complete, partial, marginal, or low-lying
placenta increta
invasion into myometrium
placenta percreta
goes all the way through myometrium, associated with postpartum hemorrhage, increased need for immediate hysterectomy
invasion into myometrium ranges
a little bit- accreta, halfway- increta. all the way through- percreta
reasons for spontaneous births
pre term labor, PPROM (pretermed premature rupture of membranes), cervical incompetence
maternal complications from multiple gestation
pre-eclampsia, gestation diabetes, pre term labor, post partum hemorrhage, UTI’s, placenta previa
fetal complications from multiple gestation
spontaneous abortion, stillbirth, structural anomalies, fetal growth restriction, twin twin transfusion, malpresentation
painless, third trimester bright red bleeding
placenta previa
which types of placenta previa can you deliver vaginally vs. c-section
vaginally- marginal, low lying, and incomplete. c-section= complete (completely over cervix)
NO DIGITAL VAGINAL EXAMS if this condition
placenta previa
separation of placenta from uterine wall
abruptio placentae
abruptio placenta risk factors
trauma, smoking, HTN, drug use, pre term rupture of membranes, multiparity
PAINFUL vaginal bleeding could be in any trimester, contracting like crazy
abruptio placentae
post partum hemorrhage blood lost
vaginal delivery more than 500 cc. if c-section, more than 1,000-1,100 cc
management of post partum hemorrhage
PITOCIN, cytatec, methergine, hemabate
