Pregnancy Flashcards
Screening to do pre conception (List three pieces of advise and five tests to do)
Folic acid 0.4 mg po daily Healthy exercise Target BMI 19-27 Domestic violence Finances Healthy sleep Quit smoking
Varicella titers Rubella titers HIV Hep B Ag G+C HGB electrophoresis in at risk ethnicities Hematopoietic stem cell screen for ashkenazi jewish populations CF and Tay Sachs if fmaily history
First trimester labs and screening
Hgb Blood type Rh status Antibody screen HIV Syphilis HBsAG Rubella Varicella MCV Hemoglobin C+G TSH Urine culture Hemoglobin electrophoresis Ferritin B12 Pap
Dating ultrasound at 11-14 weeks
Offer Early First trimester screening
2nd trimester tests
Anatomy ultrasound at 18-20 weeks
2 h glucose tolerace test at 24-26 weeks
3rd trimester tests
GBS at 35-37 weeks
Diagnose and treat gestational hypertension.
140/90 x2
Rue out pre eclampsia
Treat with Labetalol, nifedipine, or hydralazine
Consider delivery if severe
General advise for conception with a chronic disease
Review medications
Review control
Advise delay conception until good control is achieved
When does someone need more than 0.4 mg of folate per day
1 mg if mod risk: Family history of neural tube issues
Teratogenic medications like metformin, methotrexate, anticonvulsants
Liver disease
IBD.Celiac
On dialysis
ETOH use
5 mg if high risk
Person history of NTD
What to do at each routine visit
Ask about symptoms of cramping, bleeding, fluid and fetal movements
Take BP wt, SFH, FHR and Leopolds
Do not do routine urinalysis if normotensive
What genetic screening can we offer a patient
Enhanced first trimester screen which is blood work and nuchal translucency ultrasound to be done on the same day weeks 11-14
Checks for trisomy 18 and trisomy 21
NIPT if high risk or positive EFTS (can be done basically any time)
MSS (maternal serum screening) good if you miss the window for eFTS
Just a blood test
Definition of pre-eclamsia
Proteinuria, increased creat, symptoms
Ask questions about preeclapsia: Vision changes Nausea vomiting Headaches SOB Urine output
Tests to get for hypertension
Lfts Platelets Albumin LDH Haptaglobin Urine dip to check for protein
If you see Increased LFTS, decreased platlets, hemolysis=HELLP
What is HELLP
Hemolysis Elevated Liver enxymes Low Platlets
How to treat HELLP
Consider blood products If: Platlets <20 20-50 if going for c section or heavy bleeding >50 if heavy bleeding
How to treat eclampsia
Give fetal corticosteroids if <37 weeks
Treat with MgSo4 4 g IV ober 20 minutes and then 1 g per hour
Give also in pre eclampsia if severe
Diagnose and manage PROM
Sterile spec exam
Do Nitrazine blue, look for ferning, look for pooling
Check GBS
Antibiotics
Consider Steroids if <32 weeks
Diagnose and treat preterm labour
20-37
Check fetal fibronectin Do US for cervical length Consider bed rest or cerclage Give Nifedipine of mndomethacin as tocolytic Consider MgSo4 and steroids <32 weeks Steroids up to 37 weeks
Diagnose Gestational diabetes and the risks for it and risks of it
Between 24-28 weeks do 50 g OGCT
If <7.8 nothing futher
if 7.8-11.1 do a 75 g OGTT
Diagnose if fasting >5.3, 1 hr >10.6, or 2 hour >9
Risks: Previous GDM Family hisotyr Obese PCOS Steroids Hx of macrosomia
Complications: Preeclampsia
Shoulder dystocia
C section
Large for gestational age
Goal during pregnancy if preexisting diabetes
<6.5
What management and screening is needed post partum situations where mom has GDM
Breastfeed to avoid hypoglycemia and obesity in baby
Screen for DM 6 weeks to 6 months post delivery and then every 3 years
How to manage Nausea and vomiting
List lines 1-4 and then 3 non farm options
- Pyrodozine or Diclectin
- Add gravol
- Metaclopramide, chlorpromazine, Promethazine
- Ondansetron
Consider IV fluids if dehydration
Acupressure
Ginger
MBCT
Eat small meal
