Ob/gyn - Step Up To Step 2 Part 1

Front 1

Gestational age calculation

Back 1

two weeks older than embryonic age:
LMP + 7 days - 3 months

Front 2

Physiological changes in pregnancy
1) cardio
2) resp
3) renal
4) endocrine
5) hematologic
6) GI

Back 2

1) increase in CO 40%, increase in SV and HR
Systolic murmur common
decrease in BP

2) Decreased RV
TV increase 40% increase min ventilation
Pco2 decrease
dyspnea

3) increased GFR
decreased BUN/Cr-

4) nondiabetic hyperinsulinemia from hPlacental lactogen
increase TBF and total T4, decreased TSH

5) heme: hypercoag state, increased RBCs, decreased hematocrit

6) decreased motility

Front 3

How much wt gain in pregnancy

Back 3

BMI < 19 gain 28 - 40lb
BMI 19.8 gain 26 - 25 to 35 lb
BMI > 26 gain 15 - 25 lb

Front 4

Levels needed in pregnancy
folate
calcium
iron
protein

Back 4

folate: .8 - 1 mg/day
calcium 1000-1300 mg/day
iron 30 mg/day
protein 60 g day

Front 5

Trisomy 21 quad results

Back 5

hCG ↑
inhibin A ↑
AFP ↓
Estriol ↓

(↑NT
↓ PAPPA)

Front 6

Trisomy 18 quad results

Back 6

↓ AFP, estriol, hCG

Front 7

Trisomy 13 full integrated test results

Back 7

PAPPA & HCG↓

↑NT (in 13, 18, 21)

Front 8

when is alpha fetoprotein valid test

Back 8

16-18 weeks
high: NTD
low: trisomy

Front 9

Indication for amniocentesis

Back 9

abnormal quad
>35 yo
risk of Rh sensitization
(check alphaFP and karyotype)

Front 10

Indication for chorionic villus sampling

Back 10

early detection of chromosomal abnormalities in high risk patients (9 -12 weeks)

Front 11

Indications for percutaneous umbilical blood sampling

Back 11

late detection of genetic d/o
pregnancies high risk Rh sensitization
(>18 w)

Front 12

Gestational DM
1) diagnosed after how many weeks?
2) RFs
3) caused by increased what hormone?
4) Increases risk of what conditions?

Back 12

1) 24 w
2) FHx of DM, >25, obesity, prior polyhydramnios, recurrent abortion, prior stillbirth, macrosomia, HTN, african or paific islander, PCOS
3) human placental lactogen
4) macrosomia
birth injuries
hypoglycemia
hypocalcemia
hyperbilirubinemia
polyhydramnios
IUGR

Front 13

Gestational DM diagnosis

Back 13

1 hr GTT: > 130-140

3 hr GTT, at least 2 abnormal values
0, 1, 2, 3 hrs: levels 95, 180, 150, 140

Front 14

Screen for gest DM when

Back 14

24-28

Front 15

Whites classification

Back 15

A1 gest , diet
A2 gest, insulin
B - onset > 20 y duration < 10 y
C - onset 10-19 y, duration 10-19
D - onset < 10 duration > 20
F - nephropathy (Cr > 1.5)
R - proliferative retinopathy
RF - both
H - ischemic heart disease
T - renal transplant

Front 16

Preeclampsia

define
RFs
Labs

Back 16

HTN > 20 weeks, proteinuria >300 mg/24 hr

RFs: HTN, nullip, prior hx, <15 or > 35, multiple gestation, DM, obese, african american

plt, creatinine (>1.2), ast/alt, GFR, LDH, UA/UC

Front 17

Tx preeclampsia

Back 17

near term: deliver
mild and far from term: restrict activity, freq exams, NST/twice per week
severe and far from term: inpatient, maintain BP <155/105, using labetalol or other
give iv mag

Front 18

cx preeclampsia

Back 18

eclampsia
seizure
stroke
IUGR
pulm edema
oligo
preterm delivery
HELLP
abruptio placentae
renal insufficiency
encephalopathy
DIC

Front 19

Controlling eclamptic seizure

Back 19

diazepam to break seizure
mag sulfate to control
continue 48 hrs after delivery

Front 20

severe maternal asthma assoc w

Back 20

preeclampsia
spont abortion
IUFD IUGR

Front 21

Tx DVT in pregnancy

Back 21

IV heparin to maintain PTT 2x normal
or LMWH

sc lmwh at d/c

d/c 24-36 hrs prior to delivery

use 6 weeks after delivery

WARFARIN TERATOGENIC