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Antepartum > Week 7 > Flashcards

Week 7 Flashcards

1
Q

Formal definition of Gestational Diabetic

A

GCM characterized as carb intolerance that begins or is first noticied in pregnancy.

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2
Q

glucose metablism in pregnancy is considered a ________ _______

A

diabetogenic state

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3
Q

Does insulin cross the placenta?

A

no

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4
Q

Why is GD not usually an issue in the first half of pregnancy?

A

Bc estorgen and progesterone casues a decrease in maternal glucose levels

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5
Q

How does estorgen and progesterone decrease maternal glucose levels?

A

the cause hyperplasia of pancreatic beta cells which increases maternal insulin levels.

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6
Q

In the second half of pregnancy you have insulin _______

A

resistance

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7
Q

In the second half of pregnancy you have increased hepatic production of ____

A

glucagon

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8
Q

INsulin requirements may ____ in second half of pregnancy

A

triple

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9
Q

_______ is responsible for two insulin degrading enzymes

A

placenta

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10
Q

what is somogyi response?

A

hypoglycemic response at night with rebound hyperglycemia

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11
Q

what is dawn phenomenon?

A

increase in nighttime hypergycemia

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12
Q

when is ist appropriate to do first trimester screening for GD?

A

GDM in previous pregnancy, macrosomic infant in previous pregnancy, maternal obesity, hx of stillbirth

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13
Q

acceptable range for 1 hr GTT

A

<140

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14
Q

rule of thumb for 3 hr GTT

A
  1. in the am after an overnight fast
  2. no smoking before the test
  3. follow unrestricted diet consuming at least 150g carb/day for three days
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15
Q

fetal survaillence with GD at 16-20 weeks

A

genetic testing, amnio, level II US

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16
Q

fetal surveillence with GD at 20-22 weeks

A

level II or serial U/S

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17
Q

fetal surveillence with GD at 28-32 weeks

A

kick counts, weekly NST, serial US

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18
Q

fetal lung maturaty test in GD to be doe routinly at

A

37-40 weeks

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19
Q

What will the amnio show if fetal lung maturaty is established?

A

PG preset and LS ration 2

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20
Q

When should a person with GD have postpartum GTT?

A

6-8wks

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21
Q

What is the leading global cuase of maternal and infant illness and death?

A

preeclampsia

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22
Q

definition of gestational hypertension

A

HTn ONLY in pregnancy

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23
Q

definition of preeclampsia

A

HTN state prior to eclampsia

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24
Q

definition of superimposed preeclampsia

A

high readiness of preeclampsia on top of chronic HTN

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25
definition of chronic HTN
HTN either before pregnancy or dx before 20 weeks gestation and presistant after 12 weeks postpartum
26
HTN is diagnosed by waht reading?
140/90
27
What is NOT criteria for hypertensive disorder?
edema
28
Criteria for gestational hypertension
1. detected for the first time after mid pregnancy 2. NO protenuria 3. Bp returns to normal after 12 weeks pp 4. May have other s/s such as thrombocytopenia na depigastric discomfort
29
Criteria for preeclampsia
1. minimum BP 140/90 after 20 weeks 2. proteniuria >300mg/24 hours or greater >1+ dipstick 3. increased LDH 4. elevated ALT and AST 5. persistant epigastric pain from swollen liver
30
What does HELLP syndrome stand for?
Hemolysis, elevated liver enzymes, low platalets.
31
What are the renal effects of preeclampsia?
- decreased GFR | - decreased clearance of protein, uric acid, and sodium
32
If diastolic is <100 and +1 protein...what condition?
mild preeclampsia
33
With preeclampsia serum creatianine and uric acid are _______
elevated
34
vulvar mass at 5 or 7 o clock is what?
bartholins gland cyst or abscess
35
what is the course of action with a positive RPR?
requires confirmation with treponemal test (MHATP or FTA-ABS)
36
When hcg levels above threshold and no IUP seen on transvag US, most likely _____
ectopic
37
hcg should double every _____hours
48
38
If a pt is hpyotensive or has severe adenexal pain...what is happening?
they are most likely bleeding internally from ruptured ectopic and require surgery immediatly
39
open cervical os, cramping, hx of passing tissue =
incomplete ab
40
closed cerival os, completion of bleeding and cramping follwing passage of tissue, with small firm uterus =
complete ab
41
what is the most common cause of first trimester miscarriage?
fetal karyotype abnormality
42
How do you treat an incompetant cervix with painless cervical dilation?
cerclage
43
painless antepartum bleeding =
placenta previa
44
painful antepartum bleeding =
abruption
45
major risk factors for placental abruption are (3)
HTN, cocaine, trauma
46
what is the most common cause of antepartum bleeding with coagulopathies?
abruption
47
What is the KB test for?
used to measure the amt of fetal hgb trasnferred to mothers blood stream- usually done in rh negative moms
48
What is the most common cause of generalized pruritis in pregnancy in the absence of actual lesions?
cholestatsis
49
Where are the lesions of PUPPS usually noted?
abd spreading to thighs and buttocks and arms
50
you cant see a PE on ______
chest xray
51
what is the most common symptom of PE?
dyspnea
52
PE is confirmed with a ______
CT scan
53
What is the best tx of DVT or PE?
anticoagulation therapy
54
______ is NOT diagnostic of preeclampsia
edema ( both dependent or non dependent)
55
When is chronic HTN diagnosed?
When the pt has HTN prior to 20 weeks gestation or past 12 weeks pp
56
How will an ovarian torsion present?
acute onset of colicky abd pain
57
How with someone with an appendicitis present?
n/v, fever, anorexia, increased WBC, positive mcverneys (right lower abd)
58
How so you determine between ectopic and corpus luteum cyst from products of conception?
ectopic will float in normal saline
59
low TSH
hyperthyroidism (graves)
60
high TSH
hypothyroidism (hashimotos)
61
how does pregnancy effect thyroid hormones normally?
- total thyroxine and thyroid binding globulin increase | - free t4 and TSH unchanged
62
prime culprits for fifths diseae (parvo)
school teachers
63
what can parvo (fifths disease) cause for baby's
fetal anemia and fetal hydrops
64
what is one of the earliest signs of fetal hydrops?
hydramnios
65
children with parvo (fifths disease) usually present with....
high fever, lacy rash, "slapped cheeks" | **Adults typically dont have the fever or red cheeks
66
Which trimester is parvo particularlly bad?
second and third
67
If you have had _____ you are immune and will never get it again
Parvo (fifths disease)
68
elevated afp suggests
NTD
69
What will the enzymes do in a triple screening that is positive for downs?
- high hcg | - low afp and estriol
70
when is a nucal cord translucency test performed?
11-14 weeks
71
what does the quad screen add to the triple screen?
inhibin a
72
After a completed abortion is determined, what is the next step?
- weekly hcg levels to ensure that they decrease to <5 (usually takes 2-3 weeks). - blood typing - maybe hgb
73
How is a molar pregnancy characterized?
- spotting - EXTREMELY high hcg - no FHT - uterus larger then dates
74
how ia a molar preg dx?
us
75
If a woman has been exposed to fifths disease (parvo) what is the first step in treatment?
test for immunity: igg and igm
76
Why does getal hydrops occur?
because of fetal anemia.
77
Parvo virus inhibits __________
bone marrow erythrocyte production
78
How will parvo present in an adult?
myalgia, malaise, mild rash
79
What is the first step when a pt complains of calf pain?
doppler sonography
80
When is bedrest appropriate?
never
81
What are the normal value for one hour GTT (acog and ada)
ACOG 130 | ADA 140
82
When is rhogam given
28 weeks
83
How long is rhogam good for?
12 weeks
84
when is macrobid contraindicated?
after 36 weeks bc it has been linked with fetal jaundice
85
which antibodies cause problems in pregnancy?
kell kills
86
Which trimester is rubella the most harmful?
first
87
Which trimester is fifths disease the most harmful?
second
88
which trimester is varicella the most harmful?
third
89
which trimester is CMV the most dangerous?
especially in first
90
what test do you perfomr to see how much rhogam to administer?
KB

Antepartum (6 decks)

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