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

Westra: Clinical Aspects of Pregnancy I Flashcards

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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
infection that increases risk for PROM and preterm delivery
bacterial vaginosis tx metronidazole
26
major pathogen for neonatal sepsis
GBS
27
when do you screen for GBS
36-37 weeks
28
mom w/ positive GBS
give IV penicillin G when in labor or if prolonged rupture of membranes
29
infection causing maternal fever, elevated maternal WBC, uterine tenderness and fetal tachycardia
chorioamnionitis
30
Pt at 22 weeks gestation has positive Chlamydia test.
oral erythromycin, azithryomycin or amoxicillin
31
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
32
is breast feeding recommended for HIV+ mothers?
NO
33
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
34
management for placenta previa
expectant observation as long as bleeding isn't excessive | planned C section at 36-37 weeks
35
umbilical cord vessels that INSERT IN THE MEMBRANES w/ the vessels overlying the internal cervical os
vasa previa
36
attachment of placenta to lower uterine segment
placenta previa
37
placenta that completely covers int os
complete PP
38
placenta that partially covers int os
partial PP
39
placenta that lies NEAR int os
MARGINAL
40
RF for placenta previa
``` multiparity prior c section prior uterine curettage previous cc multiple gestations ```
41
placenta attaches to MYOMETERIUM w/ OUT penetrating it
placenta accrete
42
placenta penetrates INTO myometrium
placenta INcreta
43
placenta PENETRATES through the myometrium into the uterine serosa (can attach to rectum or bladder)
placenta PErcreta
44
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
45
Abrupt painful bleeding in the third trimester
placental abruption
46
premature separation of a normally implanted placenta
placental abruption
47
RF for placental abruption
``` trauma smoking HTN cocain abuse older women delivery of first twin ```
48
DIC, maternal shock and fetal distress can all be caused by
placental abruption
49
how do you determine abnormal fetal presentations
leopold maneuver
50
prolapsed umbilical cord
serious concern w/ breech presentations
51
what should a infant be monitored for who had a breech presentation
hip dysplalsia
52
leading cause of maternal and prenatal morbidity/mortality in europe/n. america
Hypertensive disorders of pregnancy
53
BP 140/90 BEFORE pregnancy or LESS than 20 weeks gestation
chronic HTN
54
What should you NOT used to tx a pregnant woman w/ chronic HTN?
ACE inhibitors
55
HTN w/o proteinuria + 20 weeks gestation
pregnancy induced HTN
56
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
57
RF for pre-eclampsia
Pre-e in previous pregnancies chronic HTN low Ca
58
meds to reduce risk for pre-eclampsia
``` Ca supplementation (if diet ca <700) Low dose aspirin from 12-36 wks (vasospasm) ```
59
why do we tx pre-eclampsia
to prevent eclampsia (seizure!)
60
Tx for pre-eclampsia
DELIVERY BP: hydralazine or labetolol Mag to prevent seizures
61
preeclampsia w/ new onset grand mal seizures
eclampsia
62
tx for eclampsia
mag *excreted by kidneys so need to monitor for urine output
63
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)
64
``` BP> 160/110 proteinuria oliguria edema imapired liver fxn pain in epigastric area ```
severe pre-eclampsia
65
Pt w/ severe pre-eclampsia. After delivery has severe abdomianl pain and syncopal episode.
hepatic rupture **emergent exploratory laparotomy and blood product replacement
66
non stress testing
pt is connected to monitor to measure babys HR (should increase when baby moves)
67
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
68
biophysical profile
1. amniotic fluid volume 2. fetal tone 3. fetal activity 4. fetal breathing movements 5. fetal HR
69
used to assess fetal lung maturity and amniotic fluid index
amniocentesis
70
What is bishop's score for induction?
``` position of cervix consistency effacement dilation fetal station ```
71
bishop's score < 5
unfavorable
72
bishops score >8
cervix is ripe and induction has high probability for success
73
what is used to augment cervical ripening
mechanical balloon catheter> cervix> indcues PG Oxytocin PGs
74
should counting fetal movements be recommended to pregnant women?
NO
75
first line antidepressant tx during pregnancy
SSRIs *bupropion if woman hasn't responded to other meds and wants to quit somking
76
criteria for major depressive episode
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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