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First AId 2CK > Obstetrics > Flashcards

Obstetrics Flashcards

0
Q

Parity

A

of pregnancies that led to a birth beyond 20 weeks’ gestational age or an infant weighing > 500 g

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1
Q

Gravidity

A

of times a woman has been pregnant

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2
Q

Developmental age

A

of weeks and days since fertilization

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3
Q

Gestational age

A

of weeks and days measured from the 1st day of the LMP

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4
Q

Determinants of gestational age

A
  1. Fundal height
  2. Fetal heart tones (Doppler)
  3. Quickening
  4. Ultrasound
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5
Q

Fundal height measurement

A

Umbilicus - 20 weeks + 2-3 cm/weeks thereafter

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6
Q

Fetal heart tones (Doppler)

A

Typically 10 - 12 weeks

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7
Q

Quickening - appreciation of fetal movement

A

Usually heard 17 - 18 weeks

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8
Q

Ultrasound

A
  1. Measures fetal crown-rup length: 6 - 12 weeks

2. Measures biparietal diameter, femure length, and abdominal circumference: 13 weeks

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9
Q

Most reliable measurement of GA

A

Ultrasound

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10
Q

Quantitative B-hCG

A
  1. Diagnose and follow ectopic pregnancy
  2. Monitor trophoblastic disease
  3. Screen for fetal aneuploidy
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11
Q

B-hCG

A
  • standard for diagnosing pregnancy

- produced by placenta

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12
Q

Rate of B-hCG production

A
  • reaches peak, 100,000mIU/ml by 10 weeks’ GA

- decreases throughout 2nd trimester and levels off by 3rd trimester

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13
Q

Ultrasound

A
  • used to confirm intrauterine prenancy
  • gestational sac visible by 5 weeks GA
  • B-hCG in range of 1000 - 1500 IU/ml
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14
Q

Renal changes during pregnancy

A
  • Renal flow increases 25-50%

- GFR increases early then plateaus

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15
Q

Weight changes during normal pregnancy

A
  • uterine weight increases from ~ 60 - 70 g to ~ 900 g - 1200g
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16
Q

Weight gain recommendations during pregnancy

A
  • 1.0 - 1.5kg/mo
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17
Q

Weight gain guidelines by BMI

A
  • undeweight: 12 - 18 kg
  • acceptable: 11- 16 kg
  • overweight: 7 - 11kg
  • severely overweight: 7kg
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18
Q

Folic acid supplementation

A

decreases neural tube defects for ALL reproductive age woman

  • 0.4mg/day
  • 4 mg/day for women w/ hx of neural tube defets in prior pregnancies
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19
Q

CV changes during normal pregnancy

A
  • HR gradually increases 20%
  • BP gradually decreases by 10% by 34 wks, then increases to prepregnancy values
    SV increases to maximum at 19 weeks then plateaus
    CO rises rapidly by 20% then increases to addl 10% by 28 wk
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20
Q

Pulm changes during pregnancy

A
  • RR remains unchanged
  • TV increases by 30 - 40%
  • Expiratory reserve gradually decreases
  • Vital capacity unchanged
  • Resp minute volume increases by 40%
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21
Q

Blood changes during normal pregnancy

A
  • Blood volume increases by 50% in 2nd trimester
  • Hct decreases slightly
  • Fibrinogen increases
  • Electrolytes remains unchanged
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22
Q

GI changes during normal pregnancy

A
  • sphincter tone decreases

- gastric emptying time increases

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23
Q

Immunoglobulins that cross placenta

A

IgG

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24
Q

Organisms that can cross placenta (9)

A
  1. Toxoplasmosis
  2. Rubella
  3. HIV
  4. Parvovirus
  5. CMV
  6. Enterovirus
  7. Treponema pallidum
  8. Listeria monocytogenes
  9. Parvovirus B19
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25
Q

Prenatal Visits

A

Wks 0 - 28: every 4 wks
Wks 29 - 35: every 2 wks
Wks 36 - birth: every wk

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26
Q

Heme Prenatal Dx Testing: initial visit

A
  • CBC, Rh factor, type and screen
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27
Q

Infectious Dz prenatal testing: initial visit

A
  • UA and cx
  • Rubella Ab titer
  • HBsg
  • RPR/VRDL
  • Cervical gonorrhea and chlamydia
  • PPD
  • HIV
  • Pap smear (to check for dysplasia)
  • Consider HCV and varicella based on hx
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28
Q

Genetic testing during initial visist

A
  • HbA1c
  • Sickle cell screening
  • Tay-Sachs disease
  • Cystic fibrosis
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29
Q

Prenatal Dx Testing: 9-14 wks

A
  • PAPP-A + nuchal transparency

- free B-hCG +/- chorionic villus sampling

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30
Q

Prenatal Dx Testing: 15 - 22 wks

A
  • Maternal serum alpha fetoprotein (MSAFP) or
  • Quad screen

+/- amniocentesis

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31
Q

Prenatal Dx Testing: 18-20 wks

A

Ultrasound for full anatomic screen

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32
Q

Prenatal Dx Testing: 24- 28 wks

A

1 hr glucose challenge test for gestational diabetes screen

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33
Q

Prenatal Dx Testing: 28 - 30 wks

A

RhoGAM for Rh- women (after antibody screen)

34
Q

Prenatal Dx Testing: 35- 40 wks

A

Group B Strep cx (GBS)

- repeat CBC

35
Q

Prenatal Dx Testing: 34 - 40 wks

A
  • Cervical chlamydia and gonorrhea cx
  • HIV
  • RPR in high risk pts
36
Q

Quad screening

A
  1. MSAFP
  2. Inhibin A
  3. Estriol
  4. B-hCG
37
Q

Maternal serum alpha fetoprotein (MSAFP)

A
  • produced by fetus and enters maternal circulation
  • reported multiples of median (MoMs)
  • measurement results depend on accurate gestational testing
  • rarely tested alone, quad screening incr. sensitivity for chromosal abnormalities
38
Q

Elevated MSAFP (> 2.5 MoMs) associated w/

A
  • open neural tube defects (anencephaly, spina bifida)
  • abdominal wall defects (gastrochisis, omphacele)
  • multiple gestation
  • incorrect gestational dating
  • fetal death
39
Q

Reduced MSAFP (< 0.5 MoM) is associated w/

A
  • Trisomy 21 and 18
  • Fetal demise
  • Inaccurate gestational testing
40
Q

Trisomy 18 via quad screening

A
    • Still UNDERage at 18**
  • decreased AFP
  • decreased estriol
  • decreased B-hCG
  • decreased inhibin A
41
Q

Trisomy 21 via quad screening

A
    • 2 up and 2 down**
  • decreased AFP, estrol
  • increased B-hCG, inhibin A
42
Q

Pregnancy-associated Plasma Protein A (PAPP-A)

A
  • recommended at 9 - 14 wks
  • PAPP-A + nuchal transparency + free B-hCG can detect 91% of Down’s syndrome and 95% of cases of trisomy 18
  • screen of low risk pregnant women (< 35 y/o)
  • available earlier than CVS and less invasive than CVS
43
Q

CVS

A
  • done at 10 - 12 wks
  • transcervical or transabdominal aspiration of placenta
  • geneticall diagnostic/ available at earlier GA
44
Q

Diasadvantages of CVS

A
  • Risk of fetal loss is 1%
  • Cannot detect open neural tube defects
  • Limb defects are associated w/ CVS < 9 wks
45
Q

Amniocentesis

A
  • done at 15 - 20 wks
  • transabdominal aspiration of aminiotic fluid using U/S needle
  • genetically diagnostic
46
Q

Disadvantages of CVS

A

At risk for:

  • premature of membranes (PROM)
  • chorioamniocentesis
  • fetal maternal hemorrhage
47
Q

Indications for amniocentesis

A
  • in women > 35 yrs of age at time of delivery
  • conjuction with abnormal quad screen
  • in Rh-sensitized pregnancy to obtain fetal blood type or detect fetal hemolysis
  • to eval lung maturity via lecithin to sphingomyelin ratio > 2.5
  • detect presence of phosphatidylglycerol (during 3rd trimester)
48
Q

ToRCHES pathogens

A
  • organisms that can cross placenta
  • Taxoplasmosis
  • Other (Parvovirus, Varicella, Listeria, TB, malaria)
  • Rubella
  • CMV
  • Herpes Simplex Virus
  • Syphillis
49
Q

Spontaneous abortion (SAB)

A
  • loss of product of conception (POC) prior to 20 wk of pregnancy
  • more than 80% occur in 1st trimester
50
Q

Major factors that contribute to SAB

A
  1. Chromosomal abnormalities
  2. Maternal factors
  3. Environmental factors
  4. Fetal factors
51
Q

Chromosomal abnormalities in SAB

A
  • factor in 50% of SABs in 1st trimester
52
Q

Maternal factors in SAB

A

Dx of Spontaneous Abortions

53
Q

Dx of spontaneous abortions

A
  • decreased levels of B-hCG
  • U/S can identify:
    • gestational sac 5-6 wks from LMP
      • fetal pole at 6 wks
      • fetal cardiac activity at 6-7 wks
54
Q

Fetal defects: ACEis

A
  • fetal renal tubular dysplasia and neonatal renal failure
  • oligohydramnios
  • intrauterine growth restriction (IUGR)
  • lack of cranial ossification
55
Q

Alcohol: fetal defects

A
  • Fetal alcohol syndrome (growth restriction before and after birth)
  • Mental retardation
  • Midfacial hypoplasia
  • Renal and cardiac defects
  • Consumption of > 6 wks per day is associated w/ 40% risk of FAS
56
Q

Androgens: fetal defect

A
  • virilization of females

- advanced genital development in males

57
Q

Carbamazepine

A
  • neural tube defects
  • fingernail hypoplasia
  • microcephaly
  • developmental delay
  • IUGR
58
Q

Cocaine: fetal defects

A
  • Bowel atresias
  • Congenital malformations of the heart, limbs, face, and GU tract
  • Microcephaly
  • IUGR
  • Cerebral infarctions
59
Q

Diethylstilbestrol (DES): fetal defects

A
  • Clear cell adenoma of vagina or cervix
  • Vaginal adenosis
  • Abnormalities of cervix and uterus or testes
  • Possible infertility
60
Q

Lead: fetal defects

A
  • increased risk of SAB

- stillbirths

61
Q

Lithium: fetal defects

A

Congenital heart disease (Ebstein’s anomaly)

62
Q

Methotrexate: fetal defects

A

increased SAB rate

63
Q

Organic mercury: fetal defects

A 
Cerebral atrophy
Microcephaly
Mental retardation
Spasticity
Seizures
Blindness
64
Q

Phenytoin: fetal defects

A
  • IUGR
  • Mental retardation
  • Microcephaly
  • Dysmorphic craniofacial features
  • Cardiac defects
  • Fingernail hypoplasia
65
Q

Radiation: fetal defects

A
  • Microcephaly
  • Mental retardation
  • Medical diagnostic radiation delivering < 0.05 Gy to the fetus has no diagnostic risk
66
Q

Streptomycin and kanamycin: fetal defects

A
  • Hearing loss

- CN VIII damage

67
Q

Tetracycline: fetal defects

A
  • Permanent yellow-brown discoloration of deciduous teeth

- Hypoplasia of tooth enamel

68
Q

Thalidomide: fetal defects

A
  • Bilateral limb deficiencies
  • Anotia and microtia
  • Cardiac and GI abnormalities
69
Q

Trimethadone and paramethadone: fetal defects

A
  • Cleft lip palate
  • Cardiac defects
  • Microcephaly
  • Mental retardation
70
Q

Valproic acid: fetal defects

A
  • Neural tube defects (spina bifida)

- Minor craniofacial defects

71
Q

Vitamin A derivatives: fetal defects

A
  • increased SAB rate
  • Microtia
  • Thymic agenesis
  • CV defects
  • Craniofacial dysmorphism
  • Microphthalmia
  • Cleft lip or cleft palate
  • Mental retardation
72
Q

Warfarin: fetal defects

** wages WAR on the fetus**

A
  • Natal hypoplasia and stippled bone epiphyses
  • Developmental delay
  • IUGR
  • Ophthalmologic abnormalities
73
Q

Toxoplasmosis: transmission

A
  • transplacental

- primary infxn via consumption of raw meat or contact w/ cat feces

74
Q

Toxplasmosis: Sx and Dx

A 
Sx:
- hydrocephalus
- intracranial calcifications
- chorioretinitis
- ring enhancing lesions on MRI
Dx:
- serum testing
75
Q

Toxoplasmosis: Dx and Tx

A

Dx: serologic testing
Tx: pyrimethamine + sulfadiazine

76
Q

Toxoplasmosis: Prevention

A
  • Avoid exposure to cat feces during pregnancy

- Spiramycin prophylaxis for 3rd trimester

77
Q

Rubella: Transmission

A
  • transplacental in the 1st trimester
78
Q

Rubella: Sx

A
  • purpuric “blueberry muffin”rash
  • cataracts
  • mental retardation
  • hearing loss
  • patent ductus arteriosus (PDA)
79
Q

Rubella: Dx and Tx

A

Dx: serologic testing
Tx: symptomatic

80
Q

Rubella: prevention

A
  • immunize before pregnancy

- vaccinate the mother after delivery if serologic titers remain negative

81
Q

CMV: transmission

A
  • primarily transplacental
82
Q

CMV: Sx

A
  • petechial rash

- periventricular calcifications

First AId 2CK (22 decks)

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