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Step 2 > Pregnancy, Childbirth and Puerperium > Flashcards

Pregnancy, Childbirth and Puerperium Flashcards

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

A

Vertical cesarean delivery

Prior myomectomy

22
Q

Routine Newborn Care

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

A

Antiviral suppression beginning at 36 weeks

Lesion/prodromal symptoms during labor, cesarean delivery

24
Q

Higher risk of UTI in pregnancy

A

Urinary stasis

25
Q

Breastfeeding contraindications

A 
HIV infection
Herpetic lesions
Active substance abuse
Active varicella
Chemo/Radiothepray
Active TB
26
Q

Preterm labor risk factors

A 
PRIOR PRETERM DELIVERY
Multiple gestation
Short cervical length
Cervical Surgery
Smoking
27
Q

Magnesium Toxicity features

A

Mild: nausea, flushing, headache, hyporeflexia

moderate: areflexia, hypocalcemia, somnolence

Severe: respiratory paralysis, cardiac arrest

TTE: stop Mg, give calcium gluconate bolus

28
Q

Magnesium Toxicity mechanism

A

Inhibition of presynaptic Acetylcholine release (neuromuscular inhibition),

Decreased urine output increases risk for toxicity.

29
Q

Disorders of active phase of labor: PROTRACTION

A

Cervical change lower than expected
w/ or w/o inadequate contractions

TTE: OXYTOCIN

30
Q

Disorders of active phase of labor: ARREST

A

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
Q

Active Phase of Labor

A

Cervix is at least 6 cm dilated

Expected to dilate 1 cm every 2 hours

32
Q

Oxytocin drip

A

Increases contraction frequency and strength

33
Q

Post delivery

Soft uterus

4 cm above the umbilicus

A

Uterine ATONY

34
Q

Cervix dilation < 1 cm after reaching the active phase

< 1 cm in 2 hours

A

Protracted action phase

:: cephalopelvic disproportion

35
Q

First pre natal visit lab study

A 
ABO + Rh
CBC
Rubella , varicella
STI: hiv
Urine protein
Urine Culture
PAP smear
36
Q

First trimester screen

A

bhCG
PAPP-a + NT
cell free dna

37
Q

2nd trimester screen

A

bhCG
Inhibin A
Estriol
AFP

38
Q

20 weeks screen

A

anatomy scan with uf

39
Q

24-28 week screen

A

Gestational diabetes of the mother screen

40
Q

contraindicated vaccines in pregnancy

A

MMR
Varicella

Any live vaccine

41
Q

28 weeks

A

RhoGAM (anti D IG)

42
Q

over 36 weeks

A

screen for GBS

43
Q

Risk factors for ectopic pregnancy

A

h/o ectopic

h/o PID

tubal abnormalities

in vitro fertilization

intra uterine devices

smoking

44
Q

RF for early pregnancy loss

A

PB19
CMV
Syphilis

tobacco
EtOH
Pesticides

45
Q

US criteria for Early pregnancy loss

A

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
Q

uterine adhesions

A

asherman syndrome

after curetage

47
Q

most common cause of early pregnancy loss

A

chromosomal anomaly

trysomy

48
Q

Preeclampsia diagnosis criteria

A

HTN 140/90

Proteinuria >300mg/24hrs

After 20w

49
Q

Preeclampsia Severe features

A 
SBP > 160
DBP > 110
Platelets < 100.000
Crea > 1,1
AST ALT > 2x upper limit
50
Q

Magnesium toxicity

A

REspiratory depression
cardiac arrest

hyperexcitability

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