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Endo/Repro: Week 5 > Westra: Clinical Aspects of Pregnancy I > Flashcards

Westra: Clinical Aspects of Pregnancy I Flashcards

1
Q

MC reported health conditions among pregnant women

A

diabetes and HTN

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2
Q

what happens if maternal glucose level is elevated after 12 weeks gestation

A

fetal insulin production increases>
increased GH effects>
fetal meacrosomia (large for gestational age)

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3
Q

when do we do screening for gestational DM

A

24-28 weeks

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4
Q

How do we screen for gestational DM

A

Drink a 50 g glucose solution and test blood 1 hr later

If greater than 130 test is POSITIVE screening

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5
Q

what validates a positive 50g 1hr glucose challange?

A

100 g 3 hr oral glucose tolerance test

2+ abnormal values are diagnostic!

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6
Q

who’s at increased risk for GDM?

A

35+
BMI >25
Minority
Macrosomia in previous pregnancy

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7
Q

tx goal for a pt with GDM?

A

130 mg/dL

may control w/ diet, glyburide, glucophage or intensive insulin therapy

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8
Q

what type of fetal surveillance should be done for a GDM pt on insulin who has POORLY controlled glucose

A

2x weekly non-stress testing w/ AF determinations beggining in the 3rd trimester

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9
Q

why do many physicians want to deliver woman w/ GDM before 39 weeks?

A

decreases risk of macrosomia

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10
Q

how should you monitor a postpartum F w/ had GDM?

A

check blood sugars before discharge and continue to do an ovral glucose screen every 3 years b/c 50% of women develop T2D

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11
Q

Do you test a 27y/o F G1P0000 at your clinic for prenatal care for GDM?

A

YES

Consider testing between 24-28 weeks if she’s ASYMPTOMATIC

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12
Q

Cervical changes and uterine contractions BEFORE 37 weeks

A

preterm labor

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13
Q

Nulliparous women, uterine contractions, 2 cm dilation and 80% effacement

A

preterm labor

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14
Q

how do you rule out PROM in a woman w/ preterm labor

A

Speculum exam

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15
Q

Cultures, fetal fibronectin, US and digital exam should all be done to evaluate for…

A

preterm labor

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16
Q

cervix <16 mm

A

cervical cerclage

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17
Q

cervix 16-20

A

bed rest and remeasure in 1 week

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18
Q

cervix 21-25

A

decrease physical activity and re measure in 2 weeks

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19
Q

a large glycoprotein thought to act as adhesive of fetal membranes to decidua

A

fetal fibronectin

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20
Q

What biochemical marker has a better predictive value than cervical dilation or uterine activity in predicting imminent delivery?

A

Fetal fibronectin

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21
Q

what does a negative FN tell you

A

the pt likely won’t deliver

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22
Q

what should be given to a woman in preterm labor to aid in fetal lung maturation if you don’t think you’ll be able to stop the delivery?

A

betamethasone/dexamethasone
antenatal corticosteroids

@ 24-34 weeks

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23
Q

A 19 y/o pt presents at 29 weeks w/ intermittent abdominal pain. She’s having uterine contractions every 3-5 mins. Cervix is 3 cm dilated, 90% effaced, -1 station cephalic. Dx? Tx?

A

Preterm labor

Prescribe bed rest
tocolytic
US to check cervical thickness
cervix cerclage

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24
Q

ToRCHE infections (maternal fetal transmission)

A 
Toxoplasmosis
Rubella
CMV
HIV
HSV-2
Syphillis
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25
Q

infection that increases risk for PROM and preterm delivery

A

bacterial vaginosis

tx metronidazole

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26
Q

major pathogen for neonatal sepsis

A

GBS

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27
Q

when do you screen for GBS

A

36-37 weeks

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28
Q

mom w/ positive GBS

A

give IV penicillin G when in labor or if prolonged rupture of membranes

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29
Q

infection causing maternal fever, elevated maternal WBC, uterine tenderness and fetal tachycardia

A

chorioamnionitis

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30
Q

Pt at 22 weeks gestation has positive Chlamydia test.

A

oral erythromycin, azithryomycin or amoxicillin

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31
Q

what is the optimal tx for a pregnant woman who has an HIV infection?

A

Initiate HAART
offer C section near term
Oral Zidovucine to neonate

Maintain viral load of less than 1000 RNA copies/mL

32
Q

is breast feeding recommended for HIV+ mothers?

A

NO

33
Q

30 y/o F
bright red vaginal bleeding
vaginal spotting after intercourse

Next step?
Dx?

A

US
NO bimanual
Gentle speculum exam (tear/trauma)

Placenta previa

34
Q

management for placenta previa

A

expectant observation as long as bleeding isn’t excessive

planned C section at 36-37 weeks

35
Q

umbilical cord vessels that INSERT IN THE MEMBRANES w/ the vessels overlying the internal cervical os

A

vasa previa

36
Q

attachment of placenta to lower uterine segment

A

placenta previa

37
Q

placenta that completely covers int os

A

complete PP

38
Q

placenta that partially covers int os

A

partial PP

39
Q

placenta that lies NEAR int os

A

MARGINAL

40
Q

RF for placenta previa

A 
multiparity
prior c section
prior uterine curettage
previous cc
multiple gestations
41
Q

placenta attaches to MYOMETERIUM w/ OUT penetrating it

A

placenta accrete

42
Q

placenta penetrates INTO myometrium

A

placenta INcreta

43
Q

placenta PENETRATES through the myometrium into the uterine serosa (can attach to rectum or bladder)

A

placenta PErcreta

44
Q

what could cause a massive bleed after delivery that is life threatening to the mother

A

Placenta acreta/increta/percreta

because placenta is abnormally attached it doesn’t separate after delivery

45
Q

Abrupt painful bleeding in the third trimester

A

placental abruption

46
Q

premature separation of a normally implanted placenta

A

placental abruption

47
Q

RF for placental abruption

A 
trauma
smoking
HTN
cocain abuse
older women
delivery of first twin
48
Q

DIC, maternal shock and fetal distress can all be caused by

A

placental abruption

49
Q

how do you determine abnormal fetal presentations

A

leopold maneuver

50
Q

prolapsed umbilical cord

A

serious concern w/ breech presentations

51
Q

what should a infant be monitored for who had a breech presentation

A

hip dysplalsia

52
Q

leading cause of maternal and prenatal morbidity/mortality in europe/n. america

A

Hypertensive disorders of pregnancy

53
Q

BP 140/90 BEFORE pregnancy or LESS than 20 weeks gestation

A

chronic HTN

54
Q

What should you NOT used to tx a pregnant woman w/ chronic HTN?

A

ACE inhibitors

55
Q

HTN w/o proteinuria + 20 weeks gestation

A

pregnancy induced HTN

56
Q

systolic BP > 140/90 after 20 weeks in woman who’s BP has been normal
Proteinuria
non-dependent edema

A

pre-eclampsia

*generally a disorder of first pregnancies

57
Q

RF for pre-eclampsia

A

Pre-e in previous pregnancies
chronic HTN
low Ca

58
Q

meds to reduce risk for pre-eclampsia

A 
Ca supplementation (if diet ca <700)
Low dose aspirin from 12-36 wks (vasospasm)
59
Q

why do we tx pre-eclampsia

A

to prevent eclampsia (seizure!)

60
Q

Tx for pre-eclampsia

A

DELIVERY
BP: hydralazine or labetolol
Mag to prevent seizures

61
Q

preeclampsia w/ new onset grand mal seizures

A

eclampsia

62
Q

tx for eclampsia

A

mag

*excreted by kidneys so need to monitor for urine output

63
Q

HELLP syndrome

A 
Hemolysis
Elevated
Liver enzymes
Low
Platelet count

**pts can monitor DIC
Liver capsule distension> epigastric pain (worsening N/V can progress to hepatic rupture)

64
Q 
BP> 160/110
proteinuria
oliguria
edema
imapired liver fxn
pain in epigastric area
A

severe pre-eclampsia

65
Q

Pt w/ severe pre-eclampsia. After delivery has severe abdomianl pain and syncopal episode.

A

hepatic rupture

**emergent exploratory laparotomy and blood product replacement

66
Q

non stress testing

A

pt is connected to monitor to measure babys HR (should increase when baby moves)

67
Q

completed when non-stress testing is non-reassuring

A

oxytocin stress testing

IV oxytocin to induce contractions> assess FHT w/ contraction> FHT should show VARIABILITY w/out decels w/ contractions

68
Q

biophysical profile

A
  1. amniotic fluid volume
  2. fetal tone
  3. fetal activity
  4. fetal breathing movements
  5. fetal HR
69
Q

used to assess fetal lung maturity and amniotic fluid index

A

amniocentesis

70
Q

What is bishop’s score for induction?

A 
position of cervix
consistency
effacement
dilation
fetal station
71
Q

bishop’s score < 5

A

unfavorable

72
Q

bishops score >8

A

cervix is ripe and induction has high probability for success

73
Q

what is used to augment cervical ripening

A

mechanical balloon catheter> cervix> indcues PG
Oxytocin
PGs

74
Q

should counting fetal movements be recommended to pregnant women?

A

NO

75
Q

first line antidepressant tx during pregnancy

A

SSRIs

*bupropion if woman hasn’t responded to other meds and wants to quit somking

76
Q

criteria for major depressive episode

A

5+ sx in same 2 weeks

Mood, interests, eating/wght, sleep, fatigue, self worht, ocnentration, thoughts of death/suicide

Endo/Repro: Week 5 (6 decks)

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