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13 Cards in this Set

  • Front
  • Back
Evalution of 1st tri bleed
Hx and PE
Pelvic exam
EGBUS
Vagina
Cervix
uterus
adnexa
RUQ
DDx for Sab
Threatened, US-in uterus, but bleed
Missed-not in the uterus, US
Incomplete-miscarried in cervix open, wait, med, DIC
Complete-out
Molar Preg
placental tissue gone bad
US for threated Sab vis Missed Sab
Threatened-HB
Missed-no HB
Risk Factors for recurrent preg loss (2/3 or more before 20 wks)
Endocrine factors; hypo,thy,ovar,intrinsic
Anatomic factors; incomplete cephalic/caudal differentation,
Infectious;
genetics, trisomy 22, 21, 13, 14, 15, 18. Mono X,
Immunologic factors; antiPhosphlipid, thrombosis, thrombocytopenia, anti-cardolipin.
Alloimmune; Th1 cells
Male factors: recurrent preg loss, largely unknown
evalutation of recurrent loss
H and P. detailed menstral history, presence of galactorrhea, pelvic inflammation, vitals, body habitus, hirsutism and hyperandrogenism.

Labs: TSH, Prolactin, cervical cultures for mycoplasma, ureaplasma, chlamydia, group B strep.
Lupus anticoag, apl Igm IgG
ectopic pregnancy; evalution and treatment plan
BhCG; decreased, 2000 at 5wk nl
abnormal pregnancies, decreased

Transvaginal US-assess HB, visualize interuterin preg.

Uterine curettage: visualization of villi-interuterine ab, no villi-complete ab

treatment: methotraxe if less the 4cm and below 15000 hCG, cardiac activity

surgical treatment, laparoscopy, salpingectomy, 100% cure, excises only pregnancy tissue.
preconceptional counsiling
teratogenic meds and drugs avoid
folic acid supplementation
diabetes, get it under control.
EGA and EDC
naegals rule, add 7, sub 3mo + one year

add 2 weeks to LMP
1st, 2nd, 3rd, trimester visits
1st: labs-anemia, isoimmunization risk, treatmable ID, infections for OB management, neoplasia, sickle cells management

2nd: screening for genetic and chromosomal abnomalities, triple screen, MSAFP, B-hCG, estradiol 15-18wks; anmiocentesis; US placental location, fluid, and fetal growth. Glucose challenge test 24-28 wks, Physical exam, fetal heart tones, RhoGAM

3rd visit-screen for materinal and fetal complications. preeclampsia, blood pressures checked at every visit, RF for preterm, drugs, indopathic, infection, preeclampsia

fetal presentation, GBS culture, readiness for baby.
Risk factors for Post partum depression
previous hx of depression after preg, increase risk of personal and FH of affective disease, severe PMS, dissatisfaction with relationship, poor social supports, stress at time of delievery
PP blues vs PP depression
PPB PPD
4wks to 1yr first 3days
insiduous onset
RF see prev card none
despondency fatigue
emotional rxn crying
obsession/comp irritable
suicideal restlessness
resolve 4-6wk tx reso 2wk pp
suicide none
meds/psychother educ/support
treatment of PP depression to a lactating mother
SSRIs and TCA (metabolites are passed minimally)

pyschotherapy