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62 Cards in this Set
- Front
- Back
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folate supplement during pregnancy?
If prior NTD? |
1mg/day
if prior neural tube defect--> 4mg/day |
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Fe during pregnancy?
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30mg/day
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Ca during pregnancy?
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1500 mg /day
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Initial visit labs during pregnancy?
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CBC, Rh, (sickle cell in AA's), UA and culture, Pap smear/GC/Cl, Rubella, HBV Surface antigen, syphilis, PPD, HIV
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Best time for gestational age ultrasound?
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6-11 weeks
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Triple screen (done weeks 15-20) results for NTD?
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MSAFP increased
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Triple screen (done weeks 15-20) results for Trisomy 18
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all (MSAFP, estriol, and b-HCG) decreased
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Triple screen (done weeks 15-20) results for Trisomy 21?
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MSAFP dec, estriol dec, b-HCG inc
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What test can evaluate after...
abnormal triple screen, women>35 years, Rh-sensitized pregnancy, or determine fetal lung maturity in 3rd trimester? |
amniocentesis
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When is chorionic villus sampling done?
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10-12 weeks, higher risks of fetal loss (1-5%) than amnnio and may have distal limb defects
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Three items for 28 week check up
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one-hour glucose challenge (want <140)
Hb/hct (RhoGam in negative patients) fetal kick counting (10/hr) |
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4 things for 36 week check up?
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group B strep
Hb/Hct GC/Cl in at risk Leopold and ultrasound |
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When is a non-stress test normal?
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reactive-
acceleration of HR >15 bpm for 15 seconds twice in 20 minutes |
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What do you need if there is a non-reactive NST?
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biophysical profile
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Four reasons for non-reactive NST?
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fetal sleep cycle
GA <30 weeks CNS anomaly Maternal sedatives or narcotics |
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When is a contraction stress test abnormal?
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late decels after half of contractions (minimum of three) within 10 minutes
(assess uteroplacental dysfunction) |
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BPP parameters and scoring?
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tests The Baby MAN
fetal Tone fetal Breathing fetal Movements Amniotic fluid Nonstress test (0-2 points for each, >8 is good, <6 is bad) |
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what's happening during early decel?
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begins and ends at same time as contractions, --> fetal head compression --> no distress!
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what's happening during variable decels?
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abrupt onset and return --> umbilical cord compression
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what's happening in late decels?
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begin after onset of contractions and persist until contraction finished --> fetal hypoxia/distress!!
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Most common medical complication during pregnancy>
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diabetes
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HbA1C > ? before conception or during first trimester will result in higher rate of fetal malformations
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>8.5
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How is gestational DM diagnosed?
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28 week oral glucose challenge > 140, then two elevated levels during three hour glucose test
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Mild preeclampsia- BP and protein?
Severe preeclampsia? |
SBP > 140 or DBP >90 on 2 occasions
1+ proteinuria (0.3g/day) SBP>160 or DBP >110 on two occasions Proteinuria 3+ (>5g/day) (may also have HELLP sndrome, oliguria, pulmonary edema) |
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treatment for mild preeclampsia?
for severe? |
delivery
MgSO4 (through 24 hours post delivery), hydralazine/labetalol, delivery |
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HELLP syndrome?
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hemolysis
elevated liver enzymes low platelets |
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labs for preeclampsia?
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UA, 24 hour urine protein and creatinine, CBC, BMP, LFTs, coag, fibrin split product and pibrinogen, toxicology screen
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most common cause of maternal hyperthyroidism
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graves' disease
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treatment of maternal hyperthyroidism?
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propylthiouracil until euthyroid then dec dose, check TCTs every month, subtotal thyroidectomy if refractory
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treatment of thyrotoxicosis
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loading dose of propylthiouracil,
potassium iodide propranolol iv fluids |
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hyperemesis gravidarum labs and indication for hospitalization?
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BMP, TSH, LFTs, ultrasound, and UA
hospitalize if weight loss, dehydration, or altered electrolytes (low Na, K and cl, metabolic acidosis) |
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Define post partum hemorrhage?
What is major risk? |
>500 ml or 1000ml if c/section
Sheehan's syndrome |
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Three causes of PPH?
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uterine atony (massage, oxytocin)
gential tract trauma retained placental tissue (from placenta accreta/increta/percreta/previa) |
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treatment of mastitis?
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dicloxacillin PO QID x 10d
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chorioamnionitis vs endometritis?
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chorioamnionitis is infected chorion/amnion/amniotic fluid, diagnosed during labor, has hfever with tachycardia, abdominal tenderness, leukocytosis or foul smelling amniotic fluid, treatment is delivery and 24 hr antibiotics
endometritis is infection of uterus after delivery, diagnosed by 2 fevers >38.6 first day postpartum, treat with antibiotics until afebrile x 48 hours |
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7w's of post-partum fever
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walking- DVT, PE
wind- atelectasis, pneumonia water- UTI wound- incision wonder- drugs womb- endomyometritis weaning- engorgement, mastitis, abscess |
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most common presenting syndrome of Sheehan's
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failure to lactate (postpartum blood loss and hypotension--> ant pituitary ischemia --> dec prolactin)
years later may have lethargy, anorexia, weight loss, ammenorrhea, loss of sexual hair |
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risk of cxr during pregnancy?
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none!
0.1 mrad, need >5000 mrads during pregnancy to increase risk of teratogenicity |
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antibiotics good during pregnancy?
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penicillins
cephalosporin macrolides |
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IUGR is fetal weight <10% for GA, what are the most common maternal causes (4) and fetal causes (4)?
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maternal- hypertension, drugs (cigarettes, cocaine), malnutrition, genetics
fetal- trisomy 21 (then 18, then 13), infection (CMV and toxo), placental abnormalities, multiple gestation |
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when to suspect IUGR?
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when fundal height more than 4 cm off from GA
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most common causes of third trimester (>20 weeks) bleeding?
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placental abruption and placental previa
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risk of placental abruption?
painful? bleeding cease spontaneously? fetal distress? diagnosis? treatment? |
htn, trauma, cigarettes and cocaine are risk factors,
painfull bleeding doesn't stop spontaneously fetal distress! diganosis is clinical treatment is hospitalize, type and cross, bed rest if mild, and delivery of severe |
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placenta previa risk factors?
painful? bleeding stops spontaneously? fetal distress? diagnosis? treatment? |
prior c/s, grand multiparity or gestation are risks
painless bleeding that stops on its own no fetal distress diagnosis by u/s (no pelvic exams!) tx stabilize, serial ultrasounds, c/section if in distress or total previa |
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risk for uterine rupture?
painful? fetal distress? diagnosis? tretament? |
prior uterine scar, trauma or anomalies are risks?
severe pain during labor associated with fetal distress diagnosis is clinical treatment is c-section and repair of rupture |
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Most common getational trphoblastic disease?
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hydatidiform mole 80%
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first trimester bleeding with preeclampsia
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suspect GTD
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b-hCG in GTD?
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>100,000
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treatment of GTD?
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D&C
monitor b-HCG prevention of pregnancy |
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treat of malignant GTD?
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(choriocarcinoma) chemotherapy
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define oligohydramnios?
causes? diagnosis? treatment? complications? |
amniotic fluid index <5cm
causes- fetal urinary tract abnormalities, uteroplacental insufficiency, ROM dx- u/s, rule out ROM with ferning or nitrazine test tx- amnioinfusion during labor complication- cord compression, m/s abnormalities, pulponary hypoplasia, IUGR |
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Define polyhdramnios?
causes? dx? tx? complications? |
AFI>25
GDM, multiple gestations, pulmonary abnormalities, duodenal atresia, Tracheoesophageal fistual dx- u/s and glucose tx- depends on cause complications- preterm labor, malpresentation, cord collapse |
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what is erythroblastosis fetalis?
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when anti-Rh IgG antibodies from mom cross placenta to attack fetal RBCs
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treatment of PROM...
with infection? with no infection, 24-32 weeks? with no infection, >33 weeks? |
ampicillin, induce labor
ampicillin, steroids, tocolytics wait and watch |
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GBS prophylaxis
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ampicillin IV q4hours
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treatment of preterm labor (regular contractions with cervical change)
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ultrasound to verify GA, presentation and AFI
hydration and bed rest tocolytic and steroids ampicillin |
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threatened abortion-
are products of conception (POC) expelled? symptoms? os and u/s? tx? |
no POC expelled
minimal bleeding/cramping closed os, normal u/s avoid activity, rest |
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inevitable abortion-
(POC) expelled? symptoms? os and u/s? tx? |
POC not expelled
cramping and bleeding open os, normal u/s D&C |
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incomplete abortion-
(POC) expelled? symptoms? os and u/s? tx? |
some POC expelled
severe cramping and bleeding open os, normal u/s D&C |
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complete abortion-
(POC) expelled? symptoms? os and u/s? tx? |
all POC expelled
slight bleeding closed os, empty uterus on u/s no tx |
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missed abortion-
(POC) expelled? symptoms? os and u/s? tx? |
no POC expelled
no sx closed os no fetal cardiac activity on u/s can allow 4 weeks to pass POC, offer misoprostol or D&C |
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septic abortion-
symptoms? os and u/s? tx? |
recent abortion followed by constitutional symptoms, cervical motion tenderness, monitor ABCs, D&C, IV antibiotics
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