Pregnancy Flashcards
Pregnancy is
a time sensitive endeavor
not a disease
needs little intervention
Most important assessment with pregnancy
constant vigilance
First trimester
0-12 weeks
Second trimester
13-28 weeks
Third trimester
29-40 weeks
Qualitative lab value for pregnancy
yes/no are you pregnant?
Quantitative lab value for pregnancy
an actual value that should double in 48 hours
Early vaginal bleeding
do you need to draw quants
what is their blood type (Rhogam)
progesterone
First trimester screening
Nuchal Translucency (PAPP-A Blood
HCG
chorionic villus sampling
(these are optional and look at folds on back of the neck)
Second trimester screening
gender ultrasound (18-22 weeks)
GDM (24-28wks)
Anemia (24-28 wks)
RhoGam for RH neg moms
Third trimester screening
GBS 36-37 weeks
Monitor those overdue
NSTs
BPPs
Calculate EDD
subtract 3 months + 7 days
Goal during preconception
optimize health
minimize risk
folic acid
Advanced maternal age
35 years and older
Pregnancy visits
Q4 weeks until 28 weeks
Q2 weeks until 36
Q week until delivery
components of pregnancy visits
Wt UA BP fetal movment fundal ht cervical exam
Fundal height at 20 weeks
at umbilicus from symphysis pubis to fundus
New OB labs
G/C UA Pap HIV RPR/VDRL Type & screen Hep B CBC
Antidepressant Drug of choice PP
Zoloft
Postpartum visit
at 6 weeks and 3 months
High risk screen for GDM
at 1st prenatal visit if family hx, prev preg with GDM, PCOS
1 hour glucose challenge
50g glucose oral solution
Indication of need for 3 hour GTT
1 hour glucose >135
Diagnose GDM
2 out of 4 values abnormal in 3 hour
Goal of GDM tx
FBS <140
reduce macrosomia
reduction of stillbirth
Risks with GDM
Spont AB IUFD Congenital malformations (VSD) neural tube defects sacral agenesis
Fetal surveillance with GDM
weekly NSTs starting at 28-32 weeks
serial ultrasounds
Chronic HTN in pregnancy
elevated BP < 20 weeks
BP >140 systolic and presists >12 weeks PP
Pregnancy induced HTN
elevated BP after 20 weeks
Edema in pregnancy
considered normal
Risk factors for preeclampsia or eclampsia
paternal mother daughters of preeclmaptic mothers sister nulliparity pregnancy with new father less than 20 yo greater than 35 yo
When is final diagnosis made for gestational hypertension
12 weeks PP if BP returns to normal
Mild Preeclampsia
diastolic BP <100 trace to 1+ protein No HA No epigastric pain Neg thrombocytopenia normal creatinine mild elevation in lfts
Severe Preeclampsia
SBP >160, DBP >110 2+ protein HA epigastric pain creatinine >1 hyperbilirubinemia thrombocytopenia pulmonary edema oligouria <500ml/24 hours
Gold standard for protein eval
24 hour urine (>300mg/24 hours)
Superimposed Preeclampsia on chronic HTN
new onset proteinuria
sudden increase in BP, LFTs
decreased plts
Acute urethritis caused by
E. coli
N. gonorrhea
C. trachomatis
If there is a hx of recurrent UTIs
test for a cure
every trimester screening with culture
suppression therapy with macrobid
Tx of UTI in pregnancy
Amox 500 TID x 7 days
Cephalosporin 250 QID x 7 days
Macrobid (Nitrofurantion) 100 BID x 7 days
Pyelo in pregnancy
bacterial infection of upper urinary tract
unilater usually
more common in 2nd and 3rd trimesters
Pyelo s/s
fever/chills
flank pain
hematuria
CBC left shift
Spont AB
unintended termination before 20 weeks
most occur before 12 weeks
If more than 3 SAB
recommend genetic counseling and reproductive endocrine
Preterm labor
any time 20weeks to 37 weeks
cervical length 30 mm, no risk
Predictors of preterm birth
previous PT del
cerv length
BV
cervicovaginal fibronectin
If size > dates
inaccurate dates fibroids multiple gestation poly DM Breech presentation LGA
If size < dates
inaccurate dates small mom maternal HTN smoking IUGR abnormal cord insertion fetal anomalies
