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Pregnancy Flashcards

1
Q

Establishing gestational age

A

Uterine size, amenorrhea, positive pregnancy test, fetal heart sounds, ultrasound

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2
Q

1st pregnancy visit

A 
Blood work: CBC, rh, glucose 
Serology: VDRL, rubella, Hep BsAg, HIV, Varicella IgG
Cultures: G/C, pap 
Urinalysis 
Date by U/S if uncertain
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3
Q

11-13 weeks

A

U/S for nuchal translucency, if positive, amniocentesis at 16 weeks

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4
Q

16 weeks

A

Quad screen: HCG, estriols, AFP, DHT

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5
Q

18-21 week

A

Anatomy scan

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6
Q

24 weeks

A

50g glucose challenge, CBC, Rh repeat if G1

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7
Q

35 weeks

A

GBS swab

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8
Q

0-28 weeks measure SF height

A

Every 4 weeks

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9
Q

28-delivery measure SF height

A

Every 2 weeks

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10
Q

35 YO DS risk

A

1/350

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11
Q

Prenatal record components

A

ID, OB, family, PMHx, pregnancy dating, symptoms, social history, genetics screen

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12
Q

Questions for genetic screen

A

Age older than 35, consanguinity, ethnicity, neural tube defects, Down syndrome, hemophilia, muscular dystrophy, maternal PKU, cystic fibrosis, Huntington’s, developmental delay

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13
Q

SIGECAPS

A

Sleep issues, interest, guilt, energy, concentration, appetite, psychomotor, suicidality

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14
Q

Mania screen

A

Periods of extreme emotional highs, less sleep, very impulsive

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15
Q

GABA

A

General appearance, behaviour, attitude

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16
Q

Insight

A

The ability to make decisions, knowing sitatuional and available options

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17
Q

Pregnancy and uterine leiomyoma on ultrasound shows

A

well-circumscribed masses in the myometrium and a fetus

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18
Q

Characteristic ultrasound finding of a complete hydatidiform mole

A

Endometrium with a Swiss cheese or snowstorm appearance

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19
Q

Treating a complete hydatidiform mole

A

Suction curettage due to risk of malignant transformation (choriocarcinoma)

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20
Q

Complete hydatidiform mole pregnancies result from

A

An abnormal fertilization of an empty ovum by either 2 sperm or by 1 sperm which subsequently duplicates its genome

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21
Q

Complete hydatidiform moles have a 2-4% risk of developing into

A

Choriocarcinoma

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22
Q

HcG levels during a molar pregnancy

A

Very high

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23
Q

Components of complete mole

A

2 sperm, empty egg

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24
Q

Partial mole components

A

2 sperm plus one egg

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25
Q

How much weight should the average pregnant lady gain?

A

25-35 lbs

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26
Q

Fish-eating guidelines for pregnancy

A

Consume only cooked seafood, and avoid fish with high mercury levels like swordfish and big eye tuna

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27
Q

24 the urine protein collection in a pregnancy evaluates for

A

Preeclampsia

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28
Q

Serum ceruloplasmin is used to evaluate for

A

Wilsons disease

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29
Q

Oligohydramnois is considered an amniotic fluid index

A

Less than 5cm

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30
Q

Most common cause of oligohydramnois at term gestation is

A

Spontaneous rupture of the membranes

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31
Q

Strongest risk factor for rectal prolapse is

A

Multiple childbirths

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32
Q

Unsafe activities during pregnancy include

A

Contact sports, high fall risk, scuba diving, hot yoga

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33
Q

A type of conductive hearing loss that presents in young women and may progress during pregnancy is

A

Otosclerosis

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34
Q

Second stage of labour is

A

Full dilation to delivery of infant

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35
Q

Three ways to measure contraction

A

Palpation, toco, intrauterine pressure catheter

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36
Q

A fetal scalp electrode

A

Measures RR intervals of babies ECG

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37
Q

What degree of perineal laceration involves rectal sphincter

A

3rd

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38
Q

Only Pharmacologic analgesic with no effects on baby during labour

A

Epidural

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39
Q

Premature labour occurs during weeks

A

20-37

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40
Q

Fetal fibeonectin is used during

A

24-34 weeks to predict that mom will not go into labour in the next 2 weeks

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41
Q

Initial step when assessing for false labour

A

Hydrate the mom and see if it stops

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42
Q

Side effects of indomethicin to a developing fetus

A

Closure of the ductus arteriosus

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43
Q

Main idea behind tocolysis is

A

To allow time to give glucocorticoids which will increase fetal lung compliance

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44
Q

Premature rupture of membranes confirmed by

A

Pooling in vaginal fornix, nitrazine, ferning on slide

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45
Q

When would you choose to induce a mom with premature rupture of membranes `

A

35-36 weeks, risk of infection outweigh that of prematurity

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46
Q

Post dates induction is started at

A

41+3 to ensure delivery by 42 weeks

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47
Q

Monozygotic twins are induced at

A

37 weeks

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48
Q

Placenta previa

A

Placenta over cervix

49
Q

Placenta accreta

A

Placenta too deep in endometrium

50
Q

Baby head position for the least resistance

A

Vertex - back of the head, flexed, chin tucked

51
Q

Frank breech

A

Baby is coming out bum first, ankles by ears

52
Q

Complete breech

A

Bum first, knees flexed

53
Q

Footling breech

A

Feet first, too small to dilate the cervix adequately

54
Q

Cardinal delivery rule for breech

A

If baby doesnt come out within an hour of pushing go for c section, dont touch it, no pulling

55
Q

What US fetal measurement is best indication of fetal nutrition?

A

Abdominal circumference

56
Q

Normal baseline heart rate fetus

57
Q

Variable decelerations are due to

A

Cord compression causing sharp drop in FHR, mediated by the vagal nerve

58
Q

Late decelerations

A

Uteroplacental insufficiency mediated by CNS chemoreceptors

59
Q

Fetal risks of shoulder dystocia

A

Erbs palsy, clavicular fracture, asphyxia, death

60
Q

McRoberts maneuver

A

Suprapubic pressure with hands locked like CPR, just above the pubic bone

61
Q

Woods/Rubins corkscrew maneuver

A

Hand behind babies scapula and rotate the baby

62
Q

Gestational hypertension is a BP of

63
Q

HELLP in pregnancy

A

Hemolysis, elevated liver enzymes, low platelets (a variant of preeclampsia)

64
Q

Preeclampsia is gestational hypertension and

A

Proteinuria >0.3G/day

65
Q

Cure for gestational diabetes

A

Delivery of the baby

66
Q

What kind of antihypertensives are contraindicated in pregnancy

A

Ace inhibitors (bad for fetal kidneys)

67
Q

Treating eclamptic seizures

A

MgSO4, short acting benzo

68
Q

The primary purpose of antihypertensive medications in preeclampsia is

A

Prevention of maternal stroke

69
Q

Thyroid hormones in pregnancy

A

Total T4 and TBG increase, so that free T4 and TSH remain the same

70
Q

Most common cause of hyperthyroid in pregnancy is

A

Graves’ disease

71
Q

Treating Graves’ disease in pregnancy

A

Methamizole or PTU

72
Q

Thyroid storm presents as

A

Hyperthermia, tachycardia, severe dehydration

73
Q

Management of thyroid storm

A

Beta blockers, iodine, PTU bolus, dexamethasone

74
Q

Treating hypothyroidism

A

Start L thyroxine and monitor TSH and T4 once per trimester

75
Q

Prerenal AKI reason in pregnancy

A

Blood loss, hypotension

76
Q

Renal AKI reason in pregnancy

A

Usually a preexisting condition

77
Q

Post renal AKI in pregnancy

A

Renal stones or iatrogenic (post op)

78
Q

If FENa <1 in AKI, the cause is

A

Prerenal, hypovolemic

79
Q

Pruritis with no rash, elevated LFT and total bile acids

A

Cholestasis

80
Q

Treating DVT during pregnancy

81
Q

Treating PE in pregnancy

82
Q

Cystic fibrosis and pregnancy

A

Should not get pregnant, pulmonary hypertension and malabsorption leading to IUGR

83
Q

Pregnancy and asymptomatic bacteruria

A

Treated with antibiotics

84
Q

Lab for pancreatitis shows

A

Increased lipase +/- high LFTs

85
Q

Greatest risk to fetus of Graves’ disease is

A

Neonatal thyrotoxicosis

86
Q

Appendicitis diagnosis in pregnancy

A

Clinical, if it ruptures 50% of women will labour

87
Q

Bowel obstruction in pregnancy presentation

A

Abdominal pain with air fluid levels on abdominal xray

88
Q

Exclusive breastfeeding is recommended for

89
Q

Treating sore cracked nipples from breastfeeding

A

Lanolin based cream

90
Q

Most common bug causing mastitis

91
Q

Treating mastitis

A

Cloxacillin 10 days, keep breastfeeding unless an abscess develops

92
Q

Complete return of uterus to non pregnant size takes

93
Q

On average lochia persists for

94
Q

First ovulation in postpartum non lactating mothers

A

45-90 days pp

95
Q

1st line medication for postpartum depression

A

Sertraline

96
Q

Vasa previa

A

Vessels running through the fetal membranes cross the cervix

97
Q

Placenta increta

A

Placenta invading through myometrium, may result in hysterectomy

98
Q

Placenta percreta

A

Placenta through uterine serosa, can invade bladder, planned c section and hysterectomy with bladder reconstruction

99
Q

Placental abruption

A

Part of the placenta sheers of uterine wall prematurely, maternal bleeding

100
Q

Complete placental abruption results in

A

Fetal death within minutes

101
Q

Maternal risks of placental abruption

A

Hemorrhage, DIC

102
Q

Causes of post partum hemorrhage

A

Uterine atony (not contracting), genital tract trauma, retained placental tissues

103
Q

Treating uterine atony

A

Fundal massage, oxytocin

104
Q

Uterine inversion leads to rapid loss of conciousness due to

A

Vasovagal response and hemorrhage

105
Q

Early decels

A

Fetal head compression

106
Q

Late decels

A

Uteroplacental insufficiency

107
Q

Variable decels

A

Cord compression, oligohydramnios, cord prolapse

108
Q

First line management of recurrent variable decelerations is

A

Intrauterine resuscitation with maternal repositioning which may improve blood flow to fetus

109
Q

Inducing ovulation in PCOS

110
Q

Presence of Acanthosis nigiricans indicates

A

Insulin resistance (diabetes, PCOS)

111
Q

Letrozole is

A

An Aromatase inhibitor

112
Q

Bromocriptine a dopamine agonist can be used to treat

A

Hyperprolactinemia

113
Q

Laparoscopic fulguration improves fertility in patients with

A

Endometriosis

114
Q

Pregnant patients with abnormal serological results (+VDRL, prolonged activated PTT) plus spontaneous abortions may have what disease?

A

Antiphospholipid antibody syndrome

115
Q

Prothrombotic autoimmune disorder that can produce false positive tests and mild thrombocytopenia

A

Antiphospholipid antibody syndrome

116
Q

First step in the management of antiphospholipid antibody syndrome

A

Anticoagulate the patient (typically with heparin)

117
Q

What anticoagulant is safe in pregnancy?

118
Q

If a pregnant patient has +VDRL and +FTA-ABS they should be treated with what?

A

Benzathine penicillin G

Clerkship Prep (34 decks)

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