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Pregnancy Flashcards

1
Q

Amniotic fluid index (AFI)
Normal range: _ cm
Oligohydramnios: <
Polyhydraminos: >

A

8–18 cm
5
25

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2
Q

3 causes of oligohydraminos

A
  • post-term pregnancies (> 42w)
  • Placenta lnsufficiency
  • PROM

PIPsqueak

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3
Q

Complications of oligohydraminos (3)

A
  • Cord compression
  • IU Growth Restriction
  • Potter sequence

only enough AF for a CIP

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4
Q

5 maternal/pregnancy causes of polyhydraminos

A
  • Diabetes mellitus (Maternal)
  • Rh incompatibility (Maternal)
  • Anencephaly
  • GI atresias/ stenosis
  • Cystic lungs
  • Twin-to-twin transfusion syndrome
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5
Q

Complications of polyhydraminos (3)

A
  • Premature birth
  • Umbilical cord prolapse
  • Fetal malposition

(PUFM)

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6
Q

Complications of multiple gestations:
- Preeclampsia
- PROM
- Cervical incompetence
- Gestational DM

(4)

A
  • Preterm birth (MCCx) –> dulce maria
  • HyperEmesis gravidarum
  • Atony uterine
  • Placental Insufficiency

DIEPAP
(DM,Insuff/Incomp,Emesis,Preterm,Atony,PROM/Pre-eclampsia)

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7
Q

Risk Factors for

Ectopic pregnancy:
* h/o ectopic pregnancy

(5)

A
  • Ligated tubes
  • IUD
  • Tubal scarring (s/t PID)
  • Endometriosis
  • Smoking

(LITES)

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8
Q

Sxs of Tubal Rupture in Ectopic pregnancy

3

A

Acute severe lower abdominal pain
Tachycardia
Hypotension

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9
Q

Uncomplicated ectopic pregnancies
Hemodynamically stable
Treatment:

A
  1. Methotrexate (MTX)
  2. Indications for non-urgent surgery:
    - Unsuccessful MTX

salpingostomy (removal of EP w/o removing affected fallopian tube)

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10
Q

What surgery is emergently indicated in (impending) rupture tubal ectopic pregnancy which presents as ACUTE, severe abdominal pain and Hemodynamic instability?

A

Salpingectomy

complete removal of the affected fallopian tube

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11
Q

Prenatal screening for GBS performed between___ weeks of gestation bc colonization by this bacteria may cause ___

A

36 - 38 weeks

chorioamnionitis

vaginal and rectal swab for culture and gram staining

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12
Q

50g, one-hour oral glucose challenge test (initial screening) at ___ weeks gestation

100g, three-hour oral glucose tolerance test (oGTT) to confirm diagnosis

A

24–28

If glucose challenge is + but tolerance is normal → Hyperglycemia of pregnancy

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13
Q

first-line antibiotic agent for asymptomatic bacteriuria during pregnancy

A

Amoxicillin/clavulanate

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14
Q

Chronic hypertension during pregnancy is associated with an increased risk of fetal complications (5)

Diagnosed prior to pregnancy or to 20 weeks gestation

A
  • small for gestational age
  • abruptio placentae
  • premature delivery
  • IUGR
  • IUFD (Placental insufficiency)

SAPII

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15
Q

First-line treatment for the acute management of severe migraine in pregnant patients

A

Acetaminophen

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16
Q

A short cervix is defined as being less than __ mm in length at less than __ weeks.

A

25 mm (2.5 cm)
24 weeks

By 3rd trimester, normal to have a cervical length <3 cm (bc it thins out)

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17
Q

Spontaneous expulsion of a dead fetus (s/t intrauterine fetal demise) occur within 2 weeks.
If not, offer induction of labor by
- vaginal [med]
- IV [med]

A
  • misoprostol
  • oxytocin

Risk factors for IUFD:
≥ 35 yo
nulliparity
DM/obesity/HTN

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18
Q

Retention of a dead fetus for >2 w leads to

↑ maternal absorption of fetal ____ → DIC

A

Thromboplastin

DIC can lead to AKI

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19
Q

Amniotic fluid embolism can occur antepartum, postpartum, and with IUFD.

Clinical features include (4):

Treatment:

s/t entry of fetal debris into maternal circulation

A

hypotension; dyspnea; cardiac arrest; DIC

Tx: Emergency cesarean delivery/supportive care

20
Q

Neonatal thyrotoxicosis is most often self-limiting, but severe disease can result in tachycardia, diaphoresis, and (3)

A

poor weight gain (Failure to thrive) w/ hyperphagia
stridor
microcephaly

21
Q

Increased levels of ____ during pregnancy result in ureteral smooth muscle relaxation and ureteral dilation → urinary stasis & uv-reflux → ascending UTI

A

progesterone

22
Q

In pregnant women, listeriosis can cause these complications:
- maternal fever
- preterm birth
- PPROM
- 2 other complications

Transmission occurs trans-placentally or via ____

A
  • chorioamnionitis
  • IUFD

infected vaginal secretions/blood during delivery

23
Q

Neonatal listeriosis (granulomatosis infantiseptica) manifests in newborns up to 3 weeks with:
severe systemic infection
dissemination to organs (3).

Both mother and newborn should be treated with IV ___

A

liver → hepatomegaly
lungs → respiratory distress
Meningitis (brain) → fever, seizures, hypotonia, abnormal cerebral u/s

ampicillin and gentamicin

24
Q

Delivery of the placenta causes a rapid decline in what hormone?

A

progesterone

25
Antithyroid meds In pregnancy: 1st trimester: ___ is recommended. 2nd/3rd trimester: __ or __
Propylthiouracil (PTU → Primary Trimester Uterus) carbimazole or methimazole
26
**Amniocentesis** is the method of choice to confirm fetal aneuploidy in patients at ≥ _ weeks gestation Offered to patients with: - 35+ yo - abnormal quad screen - h/o child with chrm anomaly
15 ## Footnote Complications: PROM, Miscarriage, Hemorrhage, Infection
27
Risk factors for Breech presentation: - Premature delivery (no time to move) - Maternal reproductive tract anomalies (2)
Oligohydraminos (no space to move) | small for gestational age (not strong enough)
28
Pregnant patient presents with dull abdominal pain, vomiting, fever, leukocytosis, and mild pyuria. No uterine tenderness.
Appendy
29
Pregnant patient with: abdominal pain, N/V, anorexia, +/-fever → Jaundice → Hyper-bilirubin & AST/ALT > 1000!!!!!!!!
Viral hepatitis A infection (Travel to Latin America increases risk) *hemolysis and thrombocytopenia rarely are seen
30
In patients with PPH and suspected uterine atony, the first-line therapy is to administer __ & bimanual uterine massage, followed by other _____ and ____. If all that fails to stop the bleeding, surgical interventions, such as placement of ____ or ___, are necessary if conservative therapy shows no effect within 30 minutes.
IV oxytocin Uterotonic agents (methylergonovine/misoprostol/Carboprost) Tranexamic acid uterine compression sutures (B-lynch) hysterectomy
31
Pregnant pt with intense pruritus (usually hands & feet) and labs show: ↑ bile acid ↑ direct bilirubin Dx and Tx?
Dx: Intrahepatic cholestasis Tx: Ursodeoxycholic acid to increase bile flow ↑ bile acid (sensitive/specific) for dx
32
Pregnant pt with abdominal pain, nausea, vomiting, and hypertension with proteinuria: ↑ T bilirubin ≥ 1.2 mg/dL platelet count < 100k AST > 80+ dx/tx:
HELLP syndrome Tx: magnesium sulfate (prevents seizures), Antihypertensives, and prompt delivery.
33
# Diagnosis & Treatment Pregnant pt with nausea, vomiting, RUQ pain & jaundice Labs show: ↑ WBCs ↓ Platelets (+/-) ↑ AST ↑ Direct bilirubin ↑ Prothrombin **HYPOGLYCEMIA** ## Footnote may rapidly lead to AMS, AKI & acute hepatic failure
Acute fatty liver of pregnancy Tx: Prompt delivery | **NO HYPERTENSION**
34
During pregnancy, preexisting mild __ symptoms can worsen due to increased turnover of antidiuretic hormone.
Diabetes Insipidus
35
pt with h/o of multiple pregnancy losses < 10w with livedo reticularis (purple rash/net like coloration), prolonged PTT, low plts, and a + antiphospholipid antibody (anti-β2-glycoprotein 1 antibody) dx/tx
antiphospholipid syndrome (APS) TX: LMWH (enoxaparin) + low-dose Aspirin ## Footnote recommended for the prevention of thrombosis and preeclampsia, respectively, in all pregnant patients with APS
36
___ is a common complication of third-degree perineal lacerations
Fecal incontinence
37
How to evaluate suspected IUGR?
transabdominal or transvaginal fetal ultrasonography Dx confirmed by estimated fetal weight or abdominal circumference < 10th %
38
Hypogonadotropic Hypogonadism can cause Functional Hypothalamic Amennorhea (FHA) Typically seen in pts with a hx of stress or excessive exercise + low to normal BMI Treatment consists of diet and exercise to increase BMI and what medication?
pulsatile GnRH injections | to increase FSH/LH levels & stimulate ovulation ## Footnote FHA is due to a dysfunction in the pulsatile secretion of GnRH
39
# Dianosis New-onset **hypertension** (≥ 140/90 mm Hg on ≥ 2 occasions after >20w EGA) & **Proteinuria** OR **End-organ dysfunction** (cerebral or visual disturbances, hemolysis, thrombocytopenia, pulmonary edema, hepatic or renal dysfunction).
Pre-eclampsia with severe features
40
# Diagnosis Presents with slow progression of hirsutism, normal menstruation, normal gonadotropins, and normal testosterone and DHEA-S
idiopathic hirsutism | s/t Increased activity of 5-alpha reductase ## Footnote resulting in elevated dihydrotestosterone (DHT)
41
21-hydroxylase deficiency, which typically affects adolescents, is characterized by (5) laboratory studies would show increased levels of __ & __ | Labs show elevated levels of 2 products
hirsutism virilization acne infertility or irregular menses | 17-hydroxyprogesterone DHEA-S
42
Postterm (42+w) pregnancy increases the risk for __ amniotic fluid.
meconium-stained | can be aspirated by baby
43
Intermittent ___ are not associated with worse perinatal outcomes, and therefore intervention is not always required
variable decelerations | (some early some late in less than 50% contractions)
44
# Therapy Can reduce umbilical cord compression by increasing the volume of amniotic fluid, and is one option for recurrent variable decelerations
Amnioinfusion
45
recurrent variable decelerations are defined as | Treatment consists of what?
some early some late decels in greater than 50% contractions | 1st line: Maternal resuscitation/repositioning 2nd line: Amnioinfusion
46
Postpartum hemorrhage (PPH) with a soft, boggy uterus on examination is suggestive of uterine atony. Uterine massage and oxytocin are not helping. What do next?
Give additional uterotonic agents* (methylergonovine/misoprostol) and tranexamic acid (TXA). * carbetocin, ergometrine, carboprost, injectable prostaglandins

OBG (8 decks)

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