other in pregnancy Flashcards
Sheehan syndrome - clinical features
- Lactation failure
- amenorrhea, hor flashes, vaginal atrophy (low FSH, LH)
Fatique, bradycardia (Low TSH)
Anorexia, weight loss, hypotension (low ACTH)
decreased lean body mass (Low GH)
uterus examination if pospartum hemorrhage and retained placental tissue
enlarged and atonic uterus
postpartum period - normal findings
- transient rigors/chills
- peripheral edema
- lochia rubra
- uterine contraction + involution
- breast engorgement
postpartum period - routine care
- rooming in/lactation support
- serial examination for uterine atony/bleeding
- perianal care
- voiding trial
- pain management
Cerclage is a procedure involving a suture or synthetic tape to reinforce the cervix in
patietns with history of 2nd trimester deliveries or short (less than 2.5 cm) cervical length
renal colicky in pregnant - next step
U/S
pregnancy and exercise - contraindications
- amniotic fluid leak
- cervical incompetence
- multiple gesation
- placenta abruption or previa
- premature labor
- preeclampsia/gestational hypertension
- severe heart or lung disease
pregnancy and exercise - unsafe activies
- contact sports
- high fall risk
- scuba diving
- hot yoga
amniotic fluid embolism - RF
- preeclampsia
- placenta previa or abruption
- 5 or more pregnancies
- cesarean or instrumental
- advanced maternal age
amniotic fluid embolism - complications
- cardiogenic shock
- hypoxemic resp failure
- DIC
- coma or seizures
amniotic fluid embolism - treatment
resp + hemodynamic support
+/- transfusion
3rd trimester - acute appnedcitisis - what is unique
pain is RUQ due to enlare uterus
Postpartum urinary retention - RF
- regional anesthesia
- operative vaginal delivary
- primiparity
- perineal injury
- cesarea
Postpartum urinary retention - clinical featrues
inability to void
incomplete emptuing
dribbling
postpartum urinary retention - management
self limited
intermitent urethral catheterization
the most appropriate 1st step in suspected appendicitis during pregnancy
U/S –> noncompression + dilation are diagnostic –> if not diagnostic –> MRI
peripartum cardiomyopathy - onset
after 36 wks
intrahepatic cholestasis of pregnancy
- intense prurtus
- elevated bile acids
- elevated levels of liver aminotransferases
- diagnosis of exclusion
acute fatty liver of pregnancy
malaise, RUQ pain, nausea, vomiting, sequelae of liver failure
- hypoglycemia
- mildly elevated liver enzymes
- elevated bilirubin
- possible DIC
Low back pain during pregnancy - etiology
enlarged uterus - exaggerated lordosis
joint ligament laxity due to high progesterone and relaxin
weak abdominal muscles –> decreased lumbar support
Low back pain during pregnancy - RF
- excessive weight gain
- chronic back pain
- back pain in prior pregnancy
- multiparty
Low back pain during pregnancy - imaging
not indicated
Low back pain during pregnancy - management
- behavioural modification
- heating pads
- analgesics
multiple gestation - presentation
- exponential growth of uterus
- rapid weight gain by mother
- elevated β-HCG and MSAFP (levels higher than expected for estimated gestational age is the first clue to multiple gestation
…… increase the possibility for multiple gestation
fertility drugs
diagnostic tests for multiple gestation
US is done to visualize fetuses
multiple gestation - complications
- spontaneous abortion of one fetus
- premature labor + delivery
- placenta previa
- anemia
nonclassic congenital adrenal hyperplasia - pathophys
AR, low 21-hydroxylase activity, Normal gluco-mineralocoticoids, high androgens
nonclassic congenital adrenal hyperplasia - clinical features
- early pubic/axilary hair growth
- severe acne
- hirsutism, oligomenorrhea in girls
- high growth velocity + bone age
- elevated 17 hydrxyprogesterone
nonclassic congenital adrenal hyperplasia - treatment
hydrocortisone
anterior vs posterior dislocation (appearance)
anterior: abducted and externally rotated
posterior: adducted and internally rotated
osteoporosis nonmodifiable RFs
- age
- postmenopausal
- low body weight
- white or asian
- malabsorption
- hypercortisolism, hyperthyroidism, hyperparathyroidism
- inflam disorders
- chronic liver or renal disease
+ PRIOR HISTORY OF FRAGILITY FRACTURE (STRONGEST)
osteoporosis modifiable RF
- smoking
- excessive alcohol intake
- sedentary lifestyle 4. medications
- low vit D or Ca2+
- estrogen def
nitropruside during pregnancy
never
TSH in pregnancy
decreased
short cervix menas
less than 2 cm without history of preterm labor)
- less than 2,5 cm wih history of preterm labor)
shoulder dystocia - RF
- fetal macrosomia
- maternal obesity
- excessive pregancy wight gain
- Gestational DM
- post-term pregnancy
treatment of asymptomatic endometriosis
no treatment, just observation
an abnormal biophysic profile is consistent with
fetal hypoxia
amphetamines in pregnancy are associated with
- preterm delivery
- preeclampsia
- abruptio placentae
- fetal growth restriction
- intrauterine fetal demise
gastroschisis - RF
1st trimester NSAID use
labetolol - route of administration
IV
plugged duct
FOCAL (vs engorgement) tenderness + firmness or erythema, no fever (vs mastitis)
the most likely cause of the lack of accelerations in fetus
fetal sleep (last for 40 mins)
hypoxic brain injury - causes
acute uteroplacental insufficiency: labor stress or abruptuio placentae
postpartum bleeding after operative vaginal delivery - management
inspect genital tract injury
magnesium toxicity - treatment
- stop Mg
- start IV calcium gluconate bolus
diagnosis of chronic or preexisting HTN
more than 140 / 90 before 20 wks during 2 seperate measurements taken at least 4 hours apart
pregnant with not appropriate weight gain - Risks for
- preterm
2. fetal growth restriction
shoulder dystocia - complications
- fractured clavicle
- fractured humerus
- Erb-Duchenne palsy
- Klumpke palsy
- perinatal asphyxia
perinatal asphyxia - manifestations
variable presentation dependingon duration of hypoxia
2. altered mental status (eg. irritability, lethargy) resp or feeding difficulties, poor tone, seizure
leakage of the spinal fluid may occur if the dura is inadvertently punctured during epidural placement - this results in
leakage of spinal fluid (aka wet tap) –> postural headaches that are worse with sitting and improved with lying down after delivery
history of classic C-section or myomectomy with uterus entry - how to deliver
laparotomy + delivery
Mg - therapeutic levels
5-8
toxic if more than 8.5
Mg toxicity - seizures?
NO
trichomonas vaginalis - screening in pregnancy
only in HIV (+)
intrahepatic cholestasis of pregnancy - jundice
uncommon
further evaluation
intrahepatic cholestasis of pregnancy - management
- symptom relief, pruritus resolves in wkees after delivery. - Ursodeoxycholic acid is commonly used
- early delivery is recommended to avoid fetal complications
abruptio placenta - uterine size
increased
history of classic C-section or myomectomy with entrance - how to delivery
C-section, but if present in labor –> urgent laparotomy and delivery –> if the labor is ruptured, delivery through the rupture site, if it is not –> make c-section
intrahepatic cholestasis of pregnancy - obstetric risks
- fetal demise
- preterm delivery
- meconium stain amniotic fluid
- RDS
how to differentiate PCOS from CAH
elevated 17 hydroxyprogesterone in CAH
cervical mucous plug
barrier to ascending infections during pregnancy
- brown red or yellow thick
obesity mediated anovulation
normal LH + FSH (no production of progesterone)
malposition vs malpresentation
malpresentation is for ex breech
malposition is nonocciput anterior
