Westra: Clinical Aspects of Pregnancy I Flashcards
MC reported health conditions among pregnant women
diabetes and HTN
what happens if maternal glucose level is elevated after 12 weeks gestation
fetal insulin production increases>
increased GH effects>
fetal meacrosomia (large for gestational age)
when do we do screening for gestational DM
24-28 weeks
How do we screen for gestational DM
Drink a 50 g glucose solution and test blood 1 hr later
If greater than 130 test is POSITIVE screening
what validates a positive 50g 1hr glucose challange?
100 g 3 hr oral glucose tolerance test
2+ abnormal values are diagnostic!
who’s at increased risk for GDM?
35+
BMI >25
Minority
Macrosomia in previous pregnancy
tx goal for a pt with GDM?
130 mg/dL
may control w/ diet, glyburide, glucophage or intensive insulin therapy
what type of fetal surveillance should be done for a GDM pt on insulin who has POORLY controlled glucose
2x weekly non-stress testing w/ AF determinations beggining in the 3rd trimester
why do many physicians want to deliver woman w/ GDM before 39 weeks?
decreases risk of macrosomia
how should you monitor a postpartum F w/ had GDM?
check blood sugars before discharge and continue to do an ovral glucose screen every 3 years b/c 50% of women develop T2D
Do you test a 27y/o F G1P0000 at your clinic for prenatal care for GDM?
YES
Consider testing between 24-28 weeks if she’s ASYMPTOMATIC
Cervical changes and uterine contractions BEFORE 37 weeks
preterm labor
Nulliparous women, uterine contractions, 2 cm dilation and 80% effacement
preterm labor
how do you rule out PROM in a woman w/ preterm labor
Speculum exam
Cultures, fetal fibronectin, US and digital exam should all be done to evaluate for…
preterm labor
cervix <16 mm
cervical cerclage
cervix 16-20
bed rest and remeasure in 1 week
cervix 21-25
decrease physical activity and re measure in 2 weeks
a large glycoprotein thought to act as adhesive of fetal membranes to decidua
fetal fibronectin
What biochemical marker has a better predictive value than cervical dilation or uterine activity in predicting imminent delivery?
Fetal fibronectin
what does a negative FN tell you
the pt likely won’t deliver
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?
betamethasone/dexamethasone
antenatal corticosteroids
@ 24-34 weeks
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?
Preterm labor
Prescribe bed rest
tocolytic
US to check cervical thickness
cervix cerclage
ToRCHE infections (maternal fetal transmission)
Toxoplasmosis Rubella CMV HIV HSV-2 Syphillis
infection that increases risk for PROM and preterm delivery
bacterial vaginosis
tx metronidazole
major pathogen for neonatal sepsis
GBS
when do you screen for GBS
36-37 weeks
mom w/ positive GBS
give IV penicillin G when in labor or if prolonged rupture of membranes
infection causing maternal fever, elevated maternal WBC, uterine tenderness and fetal tachycardia
chorioamnionitis
Pt at 22 weeks gestation has positive Chlamydia test.
oral erythromycin, azithryomycin or amoxicillin
what is the optimal tx for a pregnant woman who has an HIV infection?
Initiate HAART
offer C section near term
Oral Zidovucine to neonate
Maintain viral load of less than 1000 RNA copies/mL
is breast feeding recommended for HIV+ mothers?
NO
30 y/o F
bright red vaginal bleeding
vaginal spotting after intercourse
Next step?
Dx?
US
NO bimanual
Gentle speculum exam (tear/trauma)
Placenta previa
management for placenta previa
expectant observation as long as bleeding isn’t excessive
planned C section at 36-37 weeks
umbilical cord vessels that INSERT IN THE MEMBRANES w/ the vessels overlying the internal cervical os
vasa previa
attachment of placenta to lower uterine segment
placenta previa
placenta that completely covers int os
complete PP
placenta that partially covers int os
partial PP
placenta that lies NEAR int os
MARGINAL
RF for placenta previa
multiparity prior c section prior uterine curettage previous cc multiple gestations
placenta attaches to MYOMETERIUM w/ OUT penetrating it
placenta accrete
placenta penetrates INTO myometrium
placenta INcreta
placenta PENETRATES through the myometrium into the uterine serosa (can attach to rectum or bladder)
placenta PErcreta
what could cause a massive bleed after delivery that is life threatening to the mother
Placenta acreta/increta/percreta
because placenta is abnormally attached it doesn’t separate after delivery
Abrupt painful bleeding in the third trimester
placental abruption
premature separation of a normally implanted placenta
placental abruption
RF for placental abruption
trauma smoking HTN cocain abuse older women delivery of first twin
DIC, maternal shock and fetal distress can all be caused by
placental abruption
how do you determine abnormal fetal presentations
leopold maneuver
prolapsed umbilical cord
serious concern w/ breech presentations
what should a infant be monitored for who had a breech presentation
hip dysplalsia
leading cause of maternal and prenatal morbidity/mortality in europe/n. america
Hypertensive disorders of pregnancy
BP 140/90 BEFORE pregnancy or LESS than 20 weeks gestation
chronic HTN
What should you NOT used to tx a pregnant woman w/ chronic HTN?
ACE inhibitors
HTN w/o proteinuria + 20 weeks gestation
pregnancy induced HTN
systolic BP > 140/90 after 20 weeks in woman who’s BP has been normal
Proteinuria
non-dependent edema
pre-eclampsia
*generally a disorder of first pregnancies
RF for pre-eclampsia
Pre-e in previous pregnancies
chronic HTN
low Ca
meds to reduce risk for pre-eclampsia
Ca supplementation (if diet ca <700) Low dose aspirin from 12-36 wks (vasospasm)
why do we tx pre-eclampsia
to prevent eclampsia (seizure!)
Tx for pre-eclampsia
DELIVERY
BP: hydralazine or labetolol
Mag to prevent seizures
preeclampsia w/ new onset grand mal seizures
eclampsia
tx for eclampsia
mag
*excreted by kidneys so need to monitor for urine output
HELLP syndrome
Hemolysis Elevated Liver enzymes Low Platelet count
**pts can monitor DIC
Liver capsule distension> epigastric pain (worsening N/V can progress to hepatic rupture)
BP> 160/110 proteinuria oliguria edema imapired liver fxn pain in epigastric area
severe pre-eclampsia
Pt w/ severe pre-eclampsia. After delivery has severe abdomianl pain and syncopal episode.
hepatic rupture
**emergent exploratory laparotomy and blood product replacement
non stress testing
pt is connected to monitor to measure babys HR (should increase when baby moves)
completed when non-stress testing is non-reassuring
oxytocin stress testing
IV oxytocin to induce contractions> assess FHT w/ contraction> FHT should show VARIABILITY w/out decels w/ contractions
biophysical profile
- amniotic fluid volume
- fetal tone
- fetal activity
- fetal breathing movements
- fetal HR
used to assess fetal lung maturity and amniotic fluid index
amniocentesis
What is bishop’s score for induction?
position of cervix consistency effacement dilation fetal station
bishop’s score < 5
unfavorable
bishops score >8
cervix is ripe and induction has high probability for success
what is used to augment cervical ripening
mechanical balloon catheter> cervix> indcues PG
Oxytocin
PGs
should counting fetal movements be recommended to pregnant women?
NO
first line antidepressant tx during pregnancy
SSRIs
*bupropion if woman hasn’t responded to other meds and wants to quit somking
criteria for major depressive episode
5+ sx in same 2 weeks
Mood, interests, eating/wght, sleep, fatigue, self worht, ocnentration, thoughts of death/suicide
