Pregnancy Flashcards
1
Q
Establishing gestational age
A
Uterine size, amenorrhea, positive pregnancy test, fetal heart sounds, ultrasound
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
3
Q
11-13 weeks
A
U/S for nuchal translucency, if positive, amniocentesis at 16 weeks
4
Q
16 weeks
A
Quad screen: HCG, estriols, AFP, DHT
5
Q
18-21 week
A
Anatomy scan
6
Q
24 weeks
A
50g glucose challenge, CBC, Rh repeat if G1
7
Q
35 weeks
A
GBS swab
8
Q
0-28 weeks measure SF height
A
Every 4 weeks
9
Q
28-delivery measure SF height
A
Every 2 weeks
10
Q
35 YO DS risk
A
1/350
11
Q
Prenatal record components
A
ID, OB, family, PMHx, pregnancy dating, symptoms, social history, genetics screen
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
13
Q
SIGECAPS
A
Sleep issues, interest, guilt, energy, concentration, appetite, psychomotor, suicidality
14
Q
Mania screen
A
Periods of extreme emotional highs, less sleep, very impulsive
15
Q
GABA
A
General appearance, behaviour, attitude
16
Q
Insight
A
The ability to make decisions, knowing sitatuional and available options
17
Q
Pregnancy and uterine leiomyoma on ultrasound shows
A
well-circumscribed masses in the myometrium and a fetus
18
Q
Characteristic ultrasound finding of a complete hydatidiform mole
A
Endometrium with a Swiss cheese or snowstorm appearance
19
Q
Treating a complete hydatidiform mole
A
Suction curettage due to risk of malignant transformation (choriocarcinoma)
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
21
Q
Complete hydatidiform moles have a 2-4% risk of developing into
A
Choriocarcinoma
22
Q
HcG levels during a molar pregnancy
A
Very high
23
Q
Components of complete mole
A
2 sperm, empty egg
24
Q
Partial mole components
A
2 sperm plus one egg
25
How much weight should the average pregnant lady gain?
25-35 lbs
26
Fish-eating guidelines for pregnancy
Consume only cooked seafood, and avoid fish with high mercury levels like swordfish and big eye tuna
27
24 the urine protein collection in a pregnancy evaluates for
Preeclampsia
28
Serum ceruloplasmin is used to evaluate for
Wilsons disease
29
Oligohydramnois is considered an amniotic fluid index
Less than 5cm
30
Most common cause of oligohydramnois at term gestation is
Spontaneous rupture of the membranes
31
Strongest risk factor for rectal prolapse is
Multiple childbirths
32
Unsafe activities during pregnancy include
Contact sports, high fall risk, scuba diving, hot yoga
33
A type of conductive hearing loss that presents in young women and may progress during pregnancy is
Otosclerosis
34
Second stage of labour is
Full dilation to delivery of infant
35
Three ways to measure contraction
Palpation, toco, intrauterine pressure catheter
36
A fetal scalp electrode
Measures RR intervals of babies ECG
37
What degree of perineal laceration involves rectal sphincter
3rd
38
Only Pharmacologic analgesic with no effects on baby during labour
Epidural
39
Premature labour occurs during weeks
20-37
40
Fetal fibeonectin is used during
24-34 weeks to predict that mom will not go into labour in the next 2 weeks
41
Initial step when assessing for false labour
Hydrate the mom and see if it stops
42
Side effects of indomethicin to a developing fetus
Closure of the ductus arteriosus
43
Main idea behind tocolysis is
To allow time to give glucocorticoids which will increase fetal lung compliance
44
Premature rupture of membranes confirmed by
Pooling in vaginal fornix, nitrazine, ferning on slide
45
When would you choose to induce a mom with premature rupture of membranes `
35-36 weeks, risk of infection outweigh that of prematurity
46
Post dates induction is started at
41+3 to ensure delivery by 42 weeks
47
Monozygotic twins are induced at
37 weeks
48
Placenta previa
Placenta over cervix
49
Placenta accreta
Placenta too deep in endometrium
50
Baby head position for the least resistance
Vertex - back of the head, flexed, chin tucked
51
Frank breech
Baby is coming out bum first, ankles by ears
52
Complete breech
Bum first, knees flexed
53
Footling breech
Feet first, too small to dilate the cervix adequately
54
Cardinal delivery rule for breech
If baby doesnt come out within an hour of pushing go for c section, dont touch it, no pulling
55
What US fetal measurement is best indication of fetal nutrition?
Abdominal circumference
56
Normal baseline heart rate fetus
120-160
57
Variable decelerations are due to
Cord compression causing sharp drop in FHR, mediated by the vagal nerve
58
Late decelerations
Uteroplacental insufficiency mediated by CNS chemoreceptors
59
Fetal risks of shoulder dystocia
Erbs palsy, clavicular fracture, asphyxia, death
60
McRoberts maneuver
Suprapubic pressure with hands locked like CPR, just above the pubic bone
61
Woods/Rubins corkscrew maneuver
Hand behind babies scapula and rotate the baby
62
Gestational hypertension is a BP of
>140/90
63
HELLP in pregnancy
Hemolysis, elevated liver enzymes, low platelets (a variant of preeclampsia)
64
Preeclampsia is gestational hypertension and
Proteinuria >0.3G/day
65
Cure for gestational diabetes
Delivery of the baby
66
What kind of antihypertensives are contraindicated in pregnancy
Ace inhibitors (bad for fetal kidneys)
67
Treating eclamptic seizures
MgSO4, short acting benzo
68
The primary purpose of antihypertensive medications in preeclampsia is
Prevention of maternal stroke
69
Thyroid hormones in pregnancy
Total T4 and TBG increase, so that free T4 and TSH remain the same
70
Most common cause of hyperthyroid in pregnancy is
Graves’ disease
71
Treating Graves’ disease in pregnancy
Methamizole or PTU
72
Thyroid storm presents as
Hyperthermia, tachycardia, severe dehydration
73
Management of thyroid storm
Beta blockers, iodine, PTU bolus, dexamethasone
74
Treating hypothyroidism
Start L thyroxine and monitor TSH and T4 once per trimester
75
Prerenal AKI reason in pregnancy
Blood loss, hypotension
76
Renal AKI reason in pregnancy
Usually a preexisting condition
77
Post renal AKI in pregnancy
Renal stones or iatrogenic (post op)
78
If FENa <1 in AKI, the cause is
Prerenal, hypovolemic
79
Pruritis with no rash, elevated LFT and total bile acids
Cholestasis
80
Treating DVT during pregnancy
Heparin
81
Treating PE in pregnancy
Heparin
82
Cystic fibrosis and pregnancy
Should not get pregnant, pulmonary hypertension and malabsorption leading to IUGR
83
Pregnancy and asymptomatic bacteruria
Treated with antibiotics
84
Lab for pancreatitis shows
Increased lipase +/- high LFTs
85
Greatest risk to fetus of Graves’ disease is
Neonatal thyrotoxicosis
86
Appendicitis diagnosis in pregnancy
Clinical, if it ruptures 50% of women will labour
87
Bowel obstruction in pregnancy presentation
Abdominal pain with air fluid levels on abdominal xray
88
Exclusive breastfeeding is recommended for
6m
89
Treating sore cracked nipples from breastfeeding
Lanolin based cream
90
Most common bug causing mastitis
S aureaus
91
Treating mastitis
Cloxacillin 10 days, keep breastfeeding unless an abscess develops
92
Complete return of uterus to non pregnant size takes
6-8 weeks
93
On average lochia persists for
1 month
94
First ovulation in postpartum non lactating mothers
45-90 days pp
95
1st line medication for postpartum depression
Sertraline
96
Vasa previa
Vessels running through the fetal membranes cross the cervix
97
Placenta increta
Placenta invading through myometrium, may result in hysterectomy
98
Placenta percreta
Placenta through uterine serosa, can invade bladder, planned c section and hysterectomy with bladder reconstruction
99
Placental abruption
Part of the placenta sheers of uterine wall prematurely, maternal bleeding
100
Complete placental abruption results in
Fetal death within minutes
101
Maternal risks of placental abruption
Hemorrhage, DIC
102
Causes of post partum hemorrhage
Uterine atony (not contracting), genital tract trauma, retained placental tissues
103
Treating uterine atony
Fundal massage, oxytocin
104
Uterine inversion leads to rapid loss of conciousness due to
Vasovagal response and hemorrhage
105
Early decels
Fetal head compression
106
Late decels
Uteroplacental insufficiency
107
Variable decels
Cord compression, oligohydramnios, cord prolapse
108
First line management of recurrent variable decelerations is
Intrauterine resuscitation with maternal repositioning which may improve blood flow to fetus
109
Inducing ovulation in PCOS
Letrozole
110
Presence of Acanthosis nigiricans indicates
Insulin resistance (diabetes, PCOS)
111
Letrozole is
An Aromatase inhibitor
112
Bromocriptine a dopamine agonist can be used to treat
Hyperprolactinemia
113
Laparoscopic fulguration improves fertility in patients with
Endometriosis
114
Pregnant patients with abnormal serological results (+VDRL, prolonged activated PTT) plus spontaneous abortions may have what disease?
Antiphospholipid antibody syndrome
115
Prothrombotic autoimmune disorder that can produce false positive tests and mild thrombocytopenia
Antiphospholipid antibody syndrome
116
First step in the management of antiphospholipid antibody syndrome
Anticoagulate the patient (typically with heparin)
117
What anticoagulant is safe in pregnancy?
Heparin
118
If a pregnant patient has +VDRL and +FTA-ABS they should be treated with what?
Benzathine penicillin G
