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Step 2 > Pregnancy, Childbirth and Puerperium > Flashcards

Pregnancy, Childbirth and Puerperium Flashcards

(50 cards)

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1
Q

High maternal alpha-fetoprotein screening (MSAFP)

A

Open neural tube defects: anencephaly, open spina bifida
Ventral wall defects: omphalocele, gastroschisis
Multiple Gestation

Warrants careful ultrasound of fetal anatomy.

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2
Q

Low maternal alpha-fetoprotein screening (MSAFP)

A

Aneuploidies: trisomy 18, 21

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3
Q

When do you measure alpha-fetoprotein during pregnancy?

A

15 to 20 weeks, optimally 16 - 18.

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4
Q

Down Syndrome Screening

A

LOW MSAFP
LOW Estriol
HIGH beta-HCG
HIGH Inhibin A

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5
Q

Preeclampisa definition

A

New onset HTN SBP > 140 / DBP > 90

plus

Proteinuria or end organ damage

AT LEAST 20 WEEKS GESTATION (if not, molar pregnancy)

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6
Q

Preeclampsia SEVERE FEATURES

A 
SBP > 160 / DBP > 110 (2 times more than 4 hours apart)
Thrombocytopenia
Elevated liven enzymes
Elevated Creatinine
Visual or neurologic disturbances
Pulmonary edema
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7
Q

Preeclampsia management

A

w/o severe features: delivery at 37

w/ severe features: delivery at 34

Magnesium sulfate

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8
Q

Maternal Hypertensive crisis treatment

SBP > 160 or DBP > 110, for > 15 minutes

A

IV: Hydralazine: vasodilator
IV: labetalol: beware of bradycardia
Oral: Nifedipine: beware of emesis

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9
Q

Chronic maternal hypertension treatment

A

Methyldopa

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10
Q

Cocaine use during pregnancy

A

Preterm delivery
Abruptio Placentae
Fetal growth Restriction

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11
Q

ACEI use in pregnancy

A 
Renal failure
Oligohydroamnios
Pulmonary hypoplasia
Growth restriction
Limb defects

NO CLEFT PALATE/LIP

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12
Q

Vaccines during pregnancy: recommended

A

Tdap
Inactivated influenza
Rho(D) IG (28 weeks)

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13
Q

Vaccines during pregnancy: indicated for high risk patients

A 
Hep B
Hep A
Pneumococcus
H.flu
Meningococcus
Varicella Zoster IG
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14
Q

Vaccines during pregnancy: contraindicated

A

HPV
MMR
Live attenuated influenza
Varicella

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15
Q

Congenital Rubella Syndrome (CRS)

A 
Deafness
Cataracts
Micrpocephaly
Blue Berry Muffin Rash
Hepatosplenomegaly
Patent Ductus Arteriousus
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16
Q

Routine prenatal laboratory tests: first visit

A 
Rh(D) type
Hb/Ht, MCV
HIV, VDRL/RPR, HBsAg
Rubella, Varicella
Pap test
Chlamydia PCR
Urine Culture
Protein Dipstick
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17
Q

Prenatal laboratory tests: 24-28 weeks

A

Hb/Ht
Antibody screen if Rh(D) negative
50 gr 1 hour GCT

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18
Q

Prenatal laboratory tests: 35-37 weeks

A

GBS culture

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19
Q

OCD risk in postpartum

A

New onset, recurrence or exacerbation

Tte: mild CBT, other serotoninergic antidepressant

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20
Q

Gestational Diabetes Mellitus physiopathology

A

Placenta secretes hormones that induce insulin resistance to promote fetal growthj

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21
Q

Risk of uterine rupture

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A

Vertical cesarean delivery

Prior myomectomy

22
Q

Routine Newborn Care

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A

Preventive: Vit K, Erythromycin eye ointment, HBV vaccine

Screening: Newborn screen, Hyperbili, Hearing screen, pre and post ductal pulse oximetry, hypoglycemia

23
Q

Pregnancy Management in patients with HSV

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A

Antiviral suppression beginning at 36 weeks

Lesion/prodromal symptoms during labor, cesarean delivery

24
Q

Higher risk of UTI in pregnancy

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A

Urinary stasis

25
Breastfeeding contraindications
``` HIV infection Herpetic lesions Active substance abuse Active varicella Chemo/Radiothepray Active TB ```
26
Preterm labor risk factors
``` PRIOR PRETERM DELIVERY Multiple gestation Short cervical length Cervical Surgery Smoking ```
27
Magnesium Toxicity features
Mild: nausea, flushing, headache, hyporeflexia moderate: areflexia, hypocalcemia, somnolence Severe: respiratory paralysis, cardiac arrest TTE: stop Mg, give calcium gluconate bolus
28
Magnesium Toxicity mechanism
Inhibition of presynaptic Acetylcholine release (neuromuscular inhibition), Decreased urine output increases risk for toxicity.
29
Disorders of active phase of labor: PROTRACTION
Cervical change lower than expected w/ or w/o inadequate contractions TTE: OXYTOCIN
30
Disorders of active phase of labor: ARREST
No cervical change in more than 4 hours, w/ adequate contractions No cervical changes in more than 6 houres, w/o adequate contractions TTE: CESAREAN DELIVERY
31
Active Phase of Labor
Cervix is at least 6 cm dilated | Expected to dilate 1 cm every 2 hours
32
Oxytocin drip
Increases contraction frequency and strength
33
Post delivery Soft uterus 4 cm above the umbilicus
Uterine ATONY
34
Cervix dilation < 1 cm after reaching the active phase < 1 cm in 2 hours
Protracted action phase :: cephalopelvic disproportion
35
First pre natal visit lab study
``` ABO + Rh CBC Rubella , varicella STI: hiv Urine protein Urine Culture PAP smear ```
36
First trimester screen
bhCG PAPP-a + NT cell free dna
37
2nd trimester screen
bhCG Inhibin A Estriol AFP
38
20 weeks screen
anatomy scan with uf
39
24-28 week screen
Gestational diabetes of the mother screen
40
contraindicated vaccines in pregnancy
MMR Varicella Any live vaccine
41
28 weeks
RhoGAM (anti D IG)
42
over 36 weeks
screen for GBS
43
Risk factors for ectopic pregnancy
h/o ectopic h/o PID tubal abnormalities in vitro fertilization intra uterine devices smoking
44
RF for early pregnancy loss
PB19 CMV Syphilis tobacco EtOH Pesticides
45
US criteria for Early pregnancy loss
CRL greater than 7 mm w/o hearbeat MSD greater than 25mm w/o embruo No embruo w/ hearbeat after 2 weeks of UF that showed gestional sac w/o yolk sac
46
uterine adhesions
asherman syndrome after curetage
47
most common cause of early pregnancy loss
chromosomal anomaly trysomy
48
Preeclampsia diagnosis criteria
HTN 140/90 Proteinuria >300mg/24hrs After 20w
49
Preeclampsia Severe features
``` SBP > 160 DBP > 110 Platelets < 100.000 Crea > 1,1 AST ALT > 2x upper limit ```
50
Magnesium toxicity
REspiratory depression cardiac arrest hyperexcitability

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