Repro 2 mixup Flashcards
What labs do you order when a pt presents with new pregnancy?
Hbg/hct, UA, Glu, Lipids, Rh, Ab screen, PPD, A1C, HIV, Hep B/C, Rubella
How often do you perform risk assessments?
Up to 30 wks - every 4 weeks
30-36 weeks: every 2 weeks
36 to delivery is every week
What is chadwick’s sign?
bluish tint to vagina due to increased estrogen.
Sx of Pregnancy?
amenorrhea, urinary frequency, breast engorgement, nausea, fatigue.
hCG should be over what levels to confirm pregnancy?
typicall is above 25
What do you fear when you dx a missed abortion? how do you dx a missed abortion?
you worry about DIC. typically the fetus is dead for 6 weeks. You want to monitor fibrinogen levels. Fetus is retained, dead. Cervical os is closed. Tx with D&C.
What are the top 3 conditions associated with spontaneous abortion?
1: DM
2: Hypothyroidism
3: SLE
MC acquired abnormality of the uterus that can affect fecundity
Uterine submucous fibroids
tx of:
1: Threatened abortion
2: Incomplete/Inevitable abortion
3: Missed
4: recurrent
1: ultrasound, then reassure
2: stabilize, products evacuated
3: evacuate products surgically or D&C
4: R/o systemic dz. Genetic testing. R/O infxn.
Down’s syndrome is 95% due to?
meiotic nondisjunction
What does the MSTMS measure? When do you do it?
Measures AFP, hCG, and UE3. Do it at 16-18 weeks gestation
What marker can detect 80-85% of open neural tube defects? What protein is increased?
AFP. Acetylcholinesterase is increased
low AFP, Estriol, and hCG
Edwards syndrome.
low AFP, estriol. High hCG
Down’s syndrome
ACE Is cause what in fetus?
fetal nephropathy
Which anticoagulant would you want to use in a prego pt?
heparin because of the placental barrier.
When do you do the anatomical survey sono? What about the 50 gm glu?
18-20 wks, 24-28 wks
When do you perform the group B strep test?
34-37 wks
What is the plane of least diameter?
arrest of descent occurs most frequently here. Lower edge of pubis anteriorly, ischial spines and sacrospinous ligaments laterally, lower sacrum posteriorly
2 phases in the first stage of labor. What are they?
latent phase: cervical effacement and early dilatation occur. up to 4ish cm
Active phase: more rapid cervical dilatation. 4ish to complete.
How often should the fetal HR be evaluated in no risk factor situations?
Every 30 min in active phase of first stage, and every 15 min in second stage. W/risk factors: 15/5
What are the 6 movements performed in the second stage?
Descent, Flexion, Internal rotation, extension, external rotation, expulsion
What is the third stage consist of?
placental delivery by 30 min or manual removal if > 30 min.
What are the 4 degree lacerations?
First: vaginal mucosa
Second: 1 + subcutaneous tissues
Third: 1+2+ anal sphincter
Fourth: Rectal mucosa
What is the only drug approved for induction and augmentation of labor? What is the MC contraindication?
oxytocin. prior uterine surgery
What are the post partum changes that occur?
Involution of the uterus (breast feeding speeds this process).
Lochia: post partum vaginal discharge
Vagina regains tone (Kegal helpful)
CV: initial increase in peripheral resistance. 2 wks to normalize
What is the MC bacteria found in mastitis?
s. aureus. Tx with dicloxacillin and keep pumping.
What type of fetal decelerations are there?
late: bad. Uteroplacental insufficiency.
early: ok. head compression
variable: usually ok. Cord compression. Abrupt slope.
What constitutes as fetal distress? How do you perform intrauterine resuscitation?
Prolonged deceleration. Position on the left, check cervix for dilatation.
What are the three MC causes of maternal death?
1: hemorrhage
2: infxn
3: HTN dz
What is considered pre-term labor? What are some risk factors? How do you use the fetal fibronectin test to determine likelyhood of delivery?
< 37 weeks is preterm. some risk factors are cervitis, BV, Hx, multiples. If the fFN is neg - 98% chance no labor in next 2 wks. If positive, 50/50 shot.
Prior to 34 weeks preterm labor what do you give?
steriods to promote lung maturity (dexamethasone). You also want to tocolyze (MgSO4) to allow for steriods to work.
What are some alternatives to MgSO4?
CCB (nifedipine), Indomethacin (PG inhibitor)
How do you dx premature rupture of membranes? (PROM)
pooling - fluid in vault
ferning
nitrazine paper
Amnisure - detects placental alpha microglobulin 1
What is the mechanism of action of MgSO4?
Competes with Ca. mom may feel like she has the flu. Neuroprotection for remote from term fetuses.
what is a possible side effect of indomethacin/toradol at high doses?
can cause PDA in fetus
What is chorioamnionitis?
inflammation of the fetal membranes d/t a bacterial infection.
How would you diagnose placenta previa? What are the different types of placenta previa?
Complete: totally covering the os. partial: partially covering. Marginal: edge extends to the internal cervical os.
Dx: painless bleeding. do transabdominal ultrasonography. You want to obtain fetal maturation w/o compromising mom
What are the types of placenta accreta, and what do patients typically have a hx of?
Accreta: superficial.
Increta: invades part of myometrium
Percreta: extends to serosa.
Hx of prior uterine surgery.
What is the predisposing factor for placental abruption? How would you make this dx? how is separation initiated?
maternal htn predisposing factor. Dx based on painful bleeding + uterine tenderness. separation initiated by hemorrhage into the deciduas basalis.
MCC of DIC in pregnancy.
How do you make the diagnosis of uterine rupture?
sudden onset of intense ab pain and some vaginal bleeding.
abnormal fetal HR.
Tx: take it all out!!!
What is vasa previa?
unprotected vessels pass over the cervical os. Not surrounded by Wharton’s jelly.
must do immediate abdominal delivery
what is the MCC of postpartum hemorrhage?
Uterine atony
5 minutes after delivery the placenta is delivered. there is a purple mass at the introitus and the fundus is not palpable. What happened?
uterine inversion. improper management.
What is the 50 gram oral GCT?
screening only. Greater than 140 -> 3 hr GTT
Greater than 200 tx as diabetic
What about the 100 gram 3 hr GTT?
fasting > 105 --> tx as diabetic. 1 hr > 180 2 hr >155 3 hr >140 Screen everyone at 24-28 wks
what are 2 main complications of gestational diabetes?
shoulder dystocia, macrosomia.
What is preeclampsia? Eclampsia?
new onset HTN + proteinuria = preeclampsia.
eclampsia = seizures!
What meds to use in HTN of pregnancy?
a-methyldopa
Nifedipine
Labetalol.
What is the pathophys of HTN in pregnancy?
uteroplacental ischemia may be central to development of dz. release of toxins enter circulation -> vasospasm.
renal BF, GFR lower.
