Pregnancy Complications - Hill Flashcards
What vaccines do you not give during pregnancy?
1) Live vaccines!
a) rubella
b) varicella
c) flu nasal mist
When is it best to give folic acid?
3 months before getting pregnant
When is the flu vaccine ok to give?
Flu is ok to give IM during any trimester and if breastfeeding
What diseases are all pregnant women screened for?
1) gestational DM
2) gonorrhea
3) chlamydia
4) syphilis
5) HIV
6) Hep B
What can happen if the mom (who is Rh-) makes antibodies to the babies Rh+ blood?
1) hemolysis of fetal blood
2) release of bilirubin and fetal anemia
3) fetal cardiac failure
4) fluid accumulation
5) hydrops fetalis
Which baby is most affected by Rh antibodies?
THE SECOND!!! - moms first response is IgM and that is too big to cross the placenta
What antibody and blood typing do all women get at their first PNV?
1) Rh typing
2) antibody screening
What test is done if mom is positive for antibodies?
Indirect Coombs test - detects antibody titer
What are the steps in an indirect coombs test?
1) patients serum incubated with reagent RBC
2) IgG will bind to RBC if they are +
3) incuated with antibodies to human IgG
4) you will get agglutination of RBCs if they bound the original IgG
What is the definitions of hydrops?
Fluid in 2 of the following:
a) hert
b) lungs
c) abdomen
d) skin
What is RhoGAM?
IgG towards Rh antigen - prevents isoimmunization to Rh
What is the treatment for hydrops if the titer is < 32?
1) repeat titer every 4 weeks
2) at 24 weeks check every 2 weeks
3) if remains < 32 deliver at term
What is the treatment for hydrops if the titer is > 32?
1) test fathers antigen and genotype
a) homozygous - MCA dopler *****
b) heterozygous - perform amniocentesis
for fetal DNA, if Rh+ proceed with A
c) Rh - deliver fetus at term, no further test
What is there is an abnormal MCS test?
test fetal HCT - transfuse
What is required to have preeclampsia/eclampsia?
new HTN and proteinuria > 20 wga
What is gestational HTN?
elevated BP > 20 wga without proteinuria
What is mild preeclampsia?
1) systolic BP > 140 or diastolic > 90 (after 20 weeks gestational age)
2) proteinuria > 300mg on 24 hour urine (or +1 on urine drip)
What is severe preeclampsia?
1) systolic BP > 160, diastolic BP > 110 (on 2 occasions, 6 hours apart)
2) >5g of protein on 24 hr urine (3+ urine dip)
3) oliguria
4) HA, visual changes, Pulmonary edema, RUQ pain
5) bad liver function tests
6) low platelets
When they say zygote, you think?
Egg
When they say chorion, you think?
placenta
When they say amnionic, you think?
sac
A dizygote is always what?
dichorionic/diamnionic
Is a dichorinoic/diamnionic pregnancy always Dizygotic?
NO - it can also be monozygotic
What is a fraternal twin?
1) Dizygotic
a) dichorionic/diamnionic
What are identical twins?
Monozygotic
When do MZ di/di twins split and how many chorions are there?
1) split at 1-3 days
2) 2 chorions
When do MZ mo/di split and how many chorions?
1) 3-8 days
2) 1 chorion
When do MZ mo/mo twins split?
8-11 days
When do conjoined, monoamnionic twins split?
> 13 days
What are the most common twins?
MZ mo/di
Monozygotic: monochorionic, diamnionic
What are risk factors for a big baby?
1) History
2) weight gain/obesity
3) > 40 weeks gestation
4) diabetes
What are risk factors for a small baby?
1) HTN/vascular disease (uterine artery)
2) smoking/alcohol
3) genetics
4) infections
5) renal disease
How many vessels are in the umbilical cord?
1 artery
2 veins
When do most abnormalities occur in the fetus?
1-13 weeks
How much is in 1 vial of standard RoGAM?
30cc
