Obstetrics Flashcards
Contraindications to TOLAC/VBAC
Prior classical or T-incision, transfundal surgery, prior rupture, history of >2 prior c-sections
*undocumented scar not a contraindication
How do you treat hyperthyroidism in pregnancy? Thyroid storm?
PTU 1st tri, methimazole 2nd/3rd tri
Storm: PTU, iodine, propanolol, steroids
Which conditions are managed w/ prophylactic lovenox during pregnancy?
Factor V homozygous, prothrombin homozygous, ATIII mutation, compound heterozygouse factor V/prothrombin, APLS, hx of prior VTE on OCPs, any prior unexplained VTE
Mneumonic/differential dx for recurrent pregnancy loss
AGE IS IT - anatomic (septate/bicorunate uterus), Genetics (aneuploidy/balanced translocation), Endocrine (hypothyroid, diabetic), Infectious (Toxo, CMV, Listeria), Social hx (smoking/alcohol/caffeine), Immunologic, Thrombophilia (APLS)
AEDs during pregnancy & management considerations
- Pregnancy increases the frequency of seizures by 30-50%
- Increased risk of IUGR, stillbirth, cleft palate, cardiac defects, neural tube defects
- Switch to single agent monotherapy (Keppra)
- Increase folate (4mg) and vitamin D supplementation
What comprises different genetic testing options and what are the sensitivity rates?
- First trimester alone (Nuchal translucency, PAPP-A, HCG) - 80% detection
- Second trimester QUAD screen (HCG, estriol, AFP, inhibin) - 80% detection
- Ultrasound alone (50%)
- Cell free DNA (98%)
- Integrated screen (96%), sequential (>90%)
Compare and contrast omphalocele and gastroschisis
Gastroschisis - R abdominal defect, sporadic inheritance, bowel contents exposed
Omphalocele - midline defect, associated w/ aneuploidy, bowel contents covered w/ sac, associated w/ other abnormalities
Varicella in pregnancy - how do you treat if exposed
When is risk of transmission to baby the highest?
Determine immunity status. If susceptible then - If asymptomatic but positive exposure, can give VZIG as prevention. If symptomatic, high risk of varicella pneumonia and mortality - admit and start IV acyclovir. Greatest risk of transmission to newborn is 5 days before and 2 days after delivery
When do you treat for GBS? How do you treat?
How do you treat if PCN allergic?
- Hx of GBS+ UTI, +GBS culture, Hx of prior infant w/ GBS sepsis or infection
- GBS unknown plus PTL, >18hr ROM, intrapartum fever
- Treat w/ PCN 5mil units, followed by 2.4mil q4hr
- Cefazolin if PCN allergic and mild risk of anaphylaxis
- Clinda if BOTH clinda and erythromycin sensitive
- Vancomycin if clinda or erythro resistant
How do you treat mastitis? What if PCN allergic OR resistant to antibiotics? MRSA positive?
Dicloxacillin 500mg four times daily x 7 days
Erythromycin if PCN allergic
Augmentin if resistant to antibiotics
Bactrim if MRSA positive but then pump and dump
Who meets the criteria for offering cell free DNA?
- Maternal age >=35yo at delivery
- Prior pregnancy with trisomy
- Abnormal maternal serum screening (1st or 2nd tri screening)
- Fetal US findings suggesting of aneuploidy risk
- Maternal or paternal balanced robertsonian translocations involving chromosome 21 or 13
What is the mechanism of action for glyburide and metformin?
Glyburide - increases insulin release from pancreatic beta cells and decreases hepatic glucose production
Metformin - increases peripheral glucose uptake by improving insulin sensitivity, decreases hepatic glucose production
What are the cut offs for the 75g 2-hour glucose tolerance test
Fasting: 100-125 impaired; >126 diabetes
2hr value: 130-199 impaired; >200 diabetes
When do you perform early 1-hr glucose test and when is it performed?
What is an alternative to performing glucose testing if patient cannot handle possible dumping syndrome?
Early testing perform if: prior hx of GDM, impaired glucose tolerance, elevated A1C, hx of prior macrosomic baby, maternal obesity, PCOS, metabolic syndrome, excessive maternal weight gain, 1st deg family hx of diabetes
-Alternative: fasting/post prandial blood sugar levels for 1-2 weeks
Which vitamin/nutrition deficiencies should be screened for in patients with hx of gastric bypass/Roux-en-Y (malabsorptive)
Vitamin D, E, A, K
Folic acid, thiamine, B12*
calcium, iron
What are the weight gain considerations for women who are underweight, normal weight, overweight, obese, and morbidly obese?
Underweight (BMI < 18.5) - 28-40lb Normal (BMI 18.5-24.9) - 25-35lb Overweight (BMI 25-29.9) - 15-25lb Obese (>30) - 11-20lb Morbidly obese (>40) - 15lb
Which fetal anomalies are associated with obesity? (list in order from high to low risk)
NTDs, cardiac defects, cleft defects, anorectal atresia, limb reduction