Pregnancy Facts Flashcards
What are chemo agents that increase risk of ovarian dysfunction?
Alkylating: Busulfan, carmustine, chlorambucil, cyclophosphamide, ifosfamide, lomustine, mechlorethamine, melphalan, procarbazine, thiotepa
non-classical alkylators: Dacarbazine, temozolomide
Metals: Carboplatin, cisplatin
What are cytotoxic effect of ovarian radiation doses?
Dose 0.6 -> no effect
Dose 1.5 -> No effect if <40 y/o
Dose 2.5 -5.0 -> permanent ovarian insufficiency in 60% females aged 15-40 yrs, can cause transient amenorrhea
What is treatment for headache in pregnancy?
Tylenol, caffeine, CCB (amlodipine, nifedipine, verapamil)
AVOID: triptans (SGA, cardiac anomalies), ergot alkaloids, beta blocker (heart anomalies, cleft lip, neural tube defects, FGR), clonidine (hypotension)
What are etiologies of fetal growth restriction?
Maternal medical conditions
pre gestational DM
renal insufficiency
autoimmune dz
cyanotic cardiac dz
PIH
antiphospholipid Ab syndrome
Substanse use
Multiple gestation
Infectious diseases (malaria, CMV, rubella, oxo, syphilis)
Genetic/structural disorders (Trisomy 13/18, gastroschisis)
Placental disorders/umbilical cord abnormalities
How many mL (cc) of blood does a super plus tampon hold?
15-18cc
What are the different pelvic shapes?
Gynecoid: Round, good
AnthrOPoid: anterior-posterior egg shape, increased OP delivery (blacks, blunted ischial spines, medium pubic arch)
Android: transverse-limited, BAD delivery shape
Platypelloid: flat oval shape, persistent transverse (Koreans)
When do di-di twins split?
0-3 days
Twin peak/lambda sign (triangle shape btw placentas
When do mono-di twins split?
4-8 days
(T sign on US)
When do mono-mono twins split?
9-12 days
When do conjoined twins split?
13+ days (thoracovagus most common)
Fetal heart completes morphological development at what gestational age?
8 wks
What are cranial neural tube defects?
Anencephaly: failure of fusion of cephalic portion neural folds
Exencephaly: failure of scalp/skull formation, exteriorization of abnormally formed brain
Encephalocele: failure of complete skull formation, brain tissue extrudes
Iniencephaly: defect of cervical/thoracic vertebrae: abnormally formed brain tissue and retroflexed upper spine
What are spinal neural tube defects?
Spina bifida: failure of fusion of caudal neural tube (vertebrae, spinal cord or meninges) exposued to amniotic fluid
Meningocele: failure of fusion of caudal portion of neural tube, meninges exposed
Myelomeningocele: meninges and neural tissue exposed
Myeloschisis: flattened mass of neural tissue exposed
Holoraschisis: failure of fusion of vertebral arches, entire spinal cord exposed
Craniorachischisis: coexisting anencephaly and open neural tube defect, in cervical-thoracic region
How do you close 1cm tear on bladder dome?
Polyglactin (vicryl) 910 first layer running, second layer imbricating
What is cervical cancer staging?
Stage 1A1: stromal invasion, <3mm depth. Can tx w/ cervical conization to preserve fertility or simple hyst (extra-fascial) if done w/ childbearing.
Stage 1A2: stromal infasion, 3-5mm depth. Tx=modified radical hyst w/ LAD, bc incr risk parametrial involvement so can’t just do simple hyst.
Stage 1B1: grossly visible tumor confined to cervix, < 4cm in diameter.
Stage 1B2: > 4cm in diameter
Stage IIA: spread to upper vagina, no parametrium
Stage IIB: parametrium included but not pelvic side wall
Stage IIIA: extension into lower ⅓ vagina, no pelvic side wall
Stage IIIB: extension into pelvic side wall and/or ureter
Stage IV: tx=chemotherapy
What is a gene mutation associated with cardiomyopathy in pregnancy?
MYH7
Does metformin cross the placenta?
Yes
What are facts about Glyburide in pregnancy?
sulfonylurea increases insulin secretion and sensitivity of peripheral tissues.
- avoid in sulfa allergy
- incr risk hypoglycemia in infants
In what phase of cell division are oocytes arrested between birth and ovulation?
Prophase 1
When does the placenta take over progesterone production?
10 weeks
When does Warfarin embryopathy occur?
If used between 6-12 wks. Causes nasal/facial hypoplasia, stipping/rings of vertebral/femoral epiphyses on US
What is the most common DVT in pregnancy?
proximal L leg (iliac/iliofemoral) 2/2 incr venous stasis from compression of L iliac vein by R iliac artery and IVC compression
What are the stages of twin twin transfusion syndrome?
Stage 1: mono-di twins w/ oligo and poly
Stage 2: absent bladder in donor twin
Stage 3: abnormal dopplers
Stage 4: hydrops
Stage 5: death of one or both twins.
What is Rhogam dosing?
300 mcg dose, covers 30ml fetal whole blood or 15ml fetal RBC.
- test indirect Coombs test of mom before giving Rhogam.
Rhogam works by Blocking D antigenic determinants on the erythrocyte membrane
What is first trimester screening?
NT (>3mm=bad) + b-hcg, PAPP-A, AFP
What is second trimester screening?
Screens for open neural tube defects + T18/21.
HCG, AFP, inhibin A, estradiol
What are environmental factors associated with neural tube defects?
antiepileptic carbamazepine (spina bidifda), valproic acid, fungal toxin fumonisin, maternal hyperthermia, pregestational diabetes, obesity, Chinese race
- neural tube defects: high risk of latex allergy!!
What is the role of AFP in screening for neural tube defects?
screen in 15-18wks, can detect NTD if MSAFP > 2.5 multiples of the mean.
What are facts about FGR?
Drugs associated w/ FGR: cyclophosphamide, valproic acid, warfarin
Malaria=most common cause infection-related FGR
Incr risk stillbirth. If <10%, risk of death is 1.5%, if <5%, risk is 2.5%.
What are group 1 conditions associated with pregnancy mortality?
<1% mortality:
ASD, VSD, PDA, pulmonic/tricuspid disease, corrected tetralogy of fallout, porcine valve, mitral stenosis (class 1 and 2)
What are group 2 conditions associated with pregnancy mortality?
5-15% mortality
Mitral stenosis w/ fib, artificial valve, mitral stenosis (class 3 and 4), aortic stenosis, coarctation of aorta, uncorrected tetralogy of allot, previous MI, Marfan syndrome
What are group 3 conditions associated with pregnancy mortality?
25-50% mortality
pHTN, complicated aortic coarctation, Eisenmenger syndrome, Marfan syndrome with aortic involvement (>4cm)
What are causes of maternal death
Cardiovascular (14%)
Infection (13.6%)
Cardiomyopathy (12%)
Hemorrhage (10%)
Preeclampsia (9.4%)
Thromboembolism (9.3%)
What are infectious causes of maternal death
KEEPS killing
Klebsiella
E. Coli
Enterobacter
Enterococcus
Peptostreptococcus
Proteus
Streptopeptococcus
What are iron requirements in pregnancy?
4mg/day of iron
1000 mg of additional iron throughout entire pregnancy
What is peripartum cardiomyopathy?
diagnosis of exclusion
- LV systolic dysfunction
- most common cause=myocarditis
Finding: CARDIOMYOPATHY
- BUZZ WORDS: soluble FMS-like tyrosine kinase, oxidative stress, impaired VEGF signaling
- mortality rate 10% within 2 years of diagnosis
EF <45%
What is treatment for peripartum cardiomyopathy?
Diuretics to decrease preload
Hydralazine to decrease after load
Digoxin for inotropic effects
Heparin for anticoagulation
Worse prognosis: blacks, >35 y/o, EF <25%
What are the most common causes of mastitis?
Staphylococcus.
- Tx: Reflex or Dicloxacillin (Dynapen) or Augmentin. Erythromycin if PCN allergy.
- If suspect MRSA, give bactrim or clinda.
What are findings DIAGNOSTIC of pregnancy failure?
CRL >7mm with no heartbeat
MSD >25 with no embryo
absence of embryo w/ heart beat 2 weeks after scan with GS w/o YS
absence of embryo owtih heartbeat 11 d after scan w/ GS + YS
What are findings SUSPICIOUS for pregnancy failure?
CRL <7 and no heartbeat
MSD 16-24mm and no embryo
Absence of embryo w/ HB 7-13d after gS w/o YS
absence of embryo for 6wks after LMP
Empty amnion
Enlarged yolk sac (>7mm)
small GS in relation to embryo size
What percent of all pregnancy loss occurs in 1st trimester?
80%
How does multiple sclerosis change during pregnancy?
no change
If flare, Tx: IV methylpred then pO prednisone. Prevent postpartum relapse with IVIG
What are risks associated with assisted reproductive technology?
Placenta previa, pre-eclampsia, placental abruption, SGA, prematurity, birth defects, imprinting disorders
When is head circumference equal to abdominal circumference?
32 weeks
How many grams is fetus at 20 weeks?
300 grams
How many grams is fetus at 28 wks?
1000g
How many grams is fetus at 32 and 34 weeks?
1600, 2000g
How many grams is fetus at 36,38,40 wks?
36=2500g
38=3000g
40=3500g
What are the cardinal movements of labor?
- Engagement
- Descent
- Flexion
- INTERNAL rotation
- Extension
- EXTERNAL rotation
- Expulsion
What are oocyte numbers by age?
20 wks gestation=6-7 million
term birth =1-2 million
puberty=500K
after 50=1000
What are factors that go into bishop score?
Dilation, effacement, station, consistency, position
Low score <5, high score >9
- all categories have max of 3 exception consistency/position have max of 2
What are components of apgar score?
Activity (Tone)
Pulse (HR)
Grimace (reflex irritability)
Appearance (color)
Respirations
What is Erb’s Palsy?
Duchenne/Erb’s Palsy=most common
“Waiter’s HIGH tip” =upper arm palsy
-Injury to C5-6 nerve roots
paralysis: deltoid, infraspinatus, flexor muscle (forearm)
What is Klumpke’s Palsy?
“Klaw hand”=lower arm palsy
Injury to C8-T1 nerve roots
paralysis: hand muscle
15% infants with brachial plexus injury left with significant residual, otherwise resolves
What is a chorioangioma?
Placental tumor.
- 1/5000 pregnancies.
- can cause fetal anemia, thrombocytopenia, fetal heart failure, hydrops, placentomegaly, AV shunting, polyhydramnios, pre-eclampsia
What is safest amount radiation in pregnancy?
below 50 mGy is considered safe
- Xray=safest. US and MRI have no radiation.
How do you diagnose Zika?
NAAT PCR (urine or blood) and Plaque reduction neutralization test (PRNT) - tests for neutralizing antibody
What is the perinatal period?
20 wks gestation to 28 days postpartum
Where is hemoglobin F produced?
Liver
In a normal pregnancy HCG levels increase in a curvilinear pattern and then plateau of 100,000 mIU /mL at
how many weeks?
10 WEEKS
What are risk factors for transverse lie?
Polyhydramnios
Uterine abnormality.
Placenta previa
Prematurity
Fibroids
Narrow or contracted pelvis.
multiple gestation
What are effects of ARB use in pregnancy?
renal failure, lung dysplasia, cranial hypoplasia, limb contractures, and fetal or neonatal death.
How do you calculate mean arterial pressure?
(2 x Diastolic + Systolic)/3
What is the indigo carmine PPROM test?
inject indigo carmine via amnioinfusion and see if it comes out through vagina (via tampon) in 20-30 min.
What percent of pregnancies are breech?
3-4%
What is neonatal alloimmune thrombocytopenia?
2/2 maternal alloimmunization to fetal platelet antigens, can cause severe thrombocytopenia in fetus (<20,000) and intracranial hemorrhage
- most common antigen is HPA-1a
- maternal platelets not affected
- sx: petechiae/ecchmyosis, bleeding after circumcision
- 100% future pregnancies affected
- IVIG w/ prednisone=treatment!
What is amount of folic acid recommended?
400 mcg daily starting 1 month prior to pregnancy and continue until at least 12wks GA.
- if high risk, then take 4000 mcg daily and start 3 months before.
- folate resistant NTD: poor glucose control,, obesity, aneuploidy. Anti-epileptics
What is the Gaskin maneuver?
attempt to deliver the fetal shoulder with mom on hands and knees
