women's health pregnancy and childbirth Flashcards
placenta abrutio
PAINFUL
SUDDEN onset of vaginal bleeding with hard (hypertonic) uterus. > risk with HTN, cocaine. if severe, baby must be delivered
placenta previa
PAINLESS vaginal bleeding
bright red, uterus SOFT
bed rest, no intercourse
magnesium sulfate if cramping
severe preeclampsia
only cure is delivery s/s lated 3rd trimester SEVERE sudden headache edema, weight gain >2lb/week HIGH blood pressure protein in urine
- IF seizure= eclampsia
HELLP syndrome (hemolysis, >liver enzymes, Low platelet)
complication of preeclampsia
RIGHT upper quadrant pain, n/v
?ALT
?AST
protein in urine during pregnancy
abnormal labs and what to do
check midstream urine
protein from 1+ to 4+ is abnormal
if >20 wks, r/o preeclampsia
ir protein present urder 24 hour urine (for protein and creatinine clearance)
which lab > during pregnancy as normal
Alkaline phosphate (ALP) (dt growth of fetal bones)
WBC (up to 16,000) “leukocytosis and neutrophilia” is normal, check s/s
H/H decrease
ESR increase
t3/t4 increase
What is a high neutrophil count?
What is a high neutrophil count?
Neutrophil are the primary white blood cells that respond to a bacterial infection, so the most common cause of neutrophilia is a bacterial infection, especially pyogenic infections. Neutrophils are also increased in any acute inflammation, so will be raised after a heart attack, other infarct or burns.
Leukocytosis
Leukocytosis is defined as a total WBC value of greater than 11,000/microL in adults
normal ANC
norm ANC: 2,500 and 6,000.
The ANC is found by multiplying the WBC count by the percent of neutrophils in the blood
Low AFP results and triple screen
risk for down’s dt maternal age >35yo
if APT Is low order triple screen; AFP, HCG, estriol, inhibit A
screen in jewish for which genetic disorder
tay-sachs (fatal neurological disease, no cure)
screen in whites for which genetic disorder
cystic fibrosis
doubling time
doubling of hcg, only good for 1st trimester ONLY
if values lower than normal, r/o ectopic or inevitable abortion
vaginal cultures during pregnancy and tx
group B; 35-37wks swab introits and rectum
is positive tx with PCN G IV, or clinda/erythro if allergic
which STD to screen in pregnancy
hiv hep b, hep c herpes 1 and 2 gonorrhea/chlamydia syphilis
titers to check during pregnancy
rubella
varicella
most drugs are CATegory B, animal studies show NO risk, no human data available.
cat B drugs
antacids (tums, maalox)
colace
analgesics (acetaminiphin)
antibiotics for pregnancy ok / contraindicated
cat B:
PCN,cephalosporin, macrobid
macrolides- except CLARITHROMCIN (Biaxin)- category C
nitrofurantoin (furandantin, macrobid)- don’t us in g6pd anemia dt hemolysis (anemia, jaundice, dark urine)
category C
septra
nsaids
adverse in animals, no human data
trimethroprim-sulfamethoxazole (bactrim/septra DS)
nsaids (blocks prostaglandins)
what category is ibuprofen/advil during pregnancy
category B (1st and 2nd tri) category D (3d trimester!)- evidence of fetal risk
category D
Acei/arb (ie: capoten/captopril, losartan/hyzaar)
fluroroquinolones (cipro, floxin, levaquin)
* achillis heal rupture/can’t use under 18!
tetracycline- teeth stain (minocycline)
NSAID- premature labor, blocks prostaglandin
SULFa- risk of hyperbilirunemia (neonatal jaundice, kernicterus).
category X
proven fetal risk
accutane
methotrexate- anti metabolite (tx for autoimmune; RA, psoriasis,cancers)
proscar (anti androgen)- BPH, prostate cancer
** misoprostol- drugs for abortions
evista (osteoporosis rx)
LIVE vaccines
LAIV flu mist (flu injection OK)
varicella
MMR
oral polio
- note: after LAIV, reproductive femals should use reliable birth control in the next 4 weeks (MMR) or 3 months (varicella)
teratogens - causes structural abnormalities in fetus
alcohol
aminoglycosides (“mycin”, gentamycin, neomycin, streptomycin)
lithium
chronic hyperglycemia ( poorly controlled DM) can cause neural tube defects/craniofacial defects
health education for pregnancy
folic acid 400mcg (start 3 months before conception)
avoid soft cheese (blue/brie)
no hot tubs
pregnancy weight gain for obese pt
11-20lb
when is fetal heart tones heard
10-12 weeks by doppler ( end of 1st tri)
20 by fetascope
“probable” pregnancy signs
goodell's- cervical softening@ 4 wks chadwicks- blue discoloration 6 wks hegar's- softening uterine isthmus 6 wks ballottement urine or blood (hct) test "quickening"- mother feels baby move starting at 16 wks
positive pregnancy sign (for sure)
palpation of fetus
ultrasound
fetal heart sounds
10-12 weeks by doppler ( end of 1st tri)
20 by fetascope
palpation of fetal mvt (quickening) is what kind of sign
“probable”, NOT positive (positive, is actual palpation of the fetus body)
hog blood test what kind of sign
probable. HcG also present in molar pregnancy, ovarian cancer
when is FHT heard by dopper
10-12 wk s
20 wks
fhb heard by stethoscope
fundus @ umbilicus
size and date discrepancy
if >2cm order ultrasound for further evaluation
heart position and heart changes during pregnancy
heart is displaced horizontal and rotate left (increases the transverse diameter)
cardio output, plasma volume, heart rate all INCREASE
BP may decrease ( mom can be off htn medication.
htn medication used during pregnancy
methylodopa (aldomet) alpha-adrenergic antagonist
labetolol ( normodyne) BB
heart sounds during pregnancy (later) dt > blood volume
systolic ejection murmur (SEM)
mammary souffle- bilateral murmur in mammary vesseles
vena cava during pregnancy
compression by uterus causes hypotension, lay on left
lung changes
uterus pushes UP the diaphragm, diameter of the thorax is increased
hemoglobin during pregnancy
decreases due to hemodilution ( more fluid in the body)
HH: ranges from 9.5-10 is NORMAL ( normal is 12-14)
thyroid during pregnancy
increase, 15% larger
free t3 mildly elevated
renal system during pregnancy
kidneys increase in size
GFR increases dt >cardio output/renal blood flow
normal GFR: >90
Naegele’s rule
used to estimate delivery date (EDD) during the first trimester with regular menstrual cycle
SUBTRACT 3 months from the month of the last menstrual period and ADD 7 days
placenta previa vc abruptio ( uterus)
previa: BRIGHT RED vaginal bleeding, PAINLESS, without a tender uterus
abruptio: Hypertonic, HARD uterus
who should be screened for tay sachs
askenazi (euro) jew
GPA for pregnancy
gravida: number of total pregnancies ( regardless of outcome)
para: number of BIRTHS >20 weeks ( no matter outcome). twins count as 1
abortions- lost more > 20 weeks (induced or spontaneous abortion)
when to give rhogam
to ALL rh- mothers regardless if they miscarriage, abortion, or ectopic pregnancy
aka; anti- D immune globulin (from igG)
if NOT given will cause fetal hemolysis/anemia in future pregnancies
coombs test (direct vs indirect)
direct- done on infancy
indirect- done on mom
detects Rh antibodies in the MOTHER
when is rhogam given
2 times!
300mcg IM @ 28 wks
2nd dose within 72 hours ( or sooner) AFTER delivery
what does rhogam do?
it decreases risk of isoimmunization of the maternal immune system by destroying fetal rh positive RBC that have crossed the placenta
doesn’t affect current baby, just FUTURE baby
risk factors for gestational DM mom
obesity, baby >albs, previous GDM.
screening fo GDM
28 wks
75g 2 hour glucose tolerance test (OGTT)
GDM treatment
LIFESTYLE first! diet and exercise
monitor 4-6x/day
insulin if can’t be controlled
NO ORAL medication
asymptomatic bacteriuria
tx
ALWAYS treat dt risk for pyelonephiritis.
tx: antibiotics, fluids, fre/post urine C&S
nitrofurantoin (Macrobid) or amoixcillin (augmentin)
** DO NOT USE MACROBID during 3rd trimester dt risk of bilirubinemenia
risk of macrobid and sulfa during pregnancy
nitrofurantoin ( macrobid) causes hemolysis if mom has g6pd anemia.
UTI during pregnancy
100,000 colony forming units (UTI) or 10 to the 5th power
1st line for UTI during pregnancy
nitrofurantoin ( macrobid). AVOID during 3rd trimester
spontaneous abortion
aka “miscarriage”, loss of fetus
threatened abortion
vaginal bleeding, bur cervical os is closed
incomplete abortion
vaginal bleeding with cramping, placental products remain. cervical os dilated, foul smelling ( BV)
tx: dilations with curettage (D&C) and antibiotics
eclampsia
dsg if SEIZURES
preelampsia ( pregnancy induced HTN)
can occur late 3rd trimester OR 4 wks postpartum
s/s: headache, blurry vision, right upper quadrant pain
triad for preeclampsia
1) hypertension
2) protein (>.3g in 24 hour specimen) proteinuria ranges from trace to sever (1+ to 4+. )
look at hands and face.
3) edema (gained 1 plus pound per week)
previous HTN during pregnancy
stop if on ace/arb
most moms can stop during first and 2nd trimester due to less peripheral vascular resistance
placenta abruptio
defintion, controllable risk factors, s/s
partial to complete separation of placenta from the uterine bed
controllable risk factors: smoking, cocaine, HTN, “seatbelt”
s/s: sudden vaginal bleeding, pain, uterus is “hypertonic/rigid and tender”!
placenta previa s/s and tx
uterus is SOFT and NON tender
refer to ED NO bimanual exam, Ultrasound only bed rest if contractions, give mgSO4 (mag sulfate) c section prn
how often will newborns nurse 24 hour period
10-12 ( every 2 hours)
medication for BF mastitis
dicloxacillin 500mg or cephalexin (keflex)
mrsa risk: bactrim (trimesthorpim-sulfamethoxazole) or clindaymycin
CONTINUE BF
chlamydia during pregnancy
treat to
