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What test should be done at the initial pregnancy visit?
- CBC, Type and screen
- RPR or VDRL, Hep B, HIV
- Pap with chlam and GC and UA
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What tests make up the quad screen? When should it be given?
- Tests: AFP, hCG, unconjugated estradiol, maternal serum inhibin A
- When: 16-18 weeks
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When should U/S be done on normal pregnancy?
18-20 weeks
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When should glucose test be done in normal pregnancy?
24-28 weeks
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When should gonorrhea, chlam, and group B strep tests be done in pregnancy?
32-37 weeks
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Tests for fetal lung maturity?
- lecithin-to-sphingomyelin ratio or
- phosphatidylglycerol concentration in diabetic
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What results from a quad screen indicate Downs? Neural Tube defects?
- Downs: Low AFP and Estriol with High B-hCG and Inhibin A
- Neural Tube Defects: High AFP (but can also indicate ventral wall defects)
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Pregnant female with preeclampsia signs before third trimester, hCG rapidly rising, first or second semester bleeding with expulsion of grapes or snow-storm on U/S. Dx? Treatment?
- Hydatidiform Mole
- Treat: D&C; watch hCG until zero, if doesn't fall then chemo (methotrexate or actinomycin)
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Pregnant woman at 26 weeks gestation with anemia, high indirect billi, high AST and ALT, thrombocytopenia, with RUQ pain and epigastric pain.
Pre-eclampsia with HELLP syndrome
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Patient receiving treatment for preecplampsia begins having shortness of breath, and loses consciousness; she has poor reflexes through out. What is the condition?
Mg toxicity from Mg SO4
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When should mom get RhoGAM shot?
28 weeks
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Woman in delivering and fetal heart monitoring shows decelerations that begin and end with uterine contractions. What is this a sign of and what do you do?
- Caused by head compression.
- Do nothing its normal
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Woman is delivering and fetal heart rate decelerations begin after initiation of contractions and end after contraction has finished. What is this a sign of and what do you do?
- Sign of Uteroplacental insufficiency or any abnormality that prevents fetus from getting adequate blood or oxygen.
- Treat: Test with fetal scalp pH monitoring if they continue deliver
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Woman is delivering baby and fetal heart rate decelerates before contrations then after and doesn't seem to coordinate with contractions. What is this a sign of and what do you do?
- Umbilical cord compression
- treat by moving mom to releive pressure on cord
- stop oxytocin and give mom oxygen
- if it continues fetal scalp pH
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Mother is delivering and begins having bleeding but denies pain; fetal hr increases and then becomes bradycardic. What is this a sign of and what do you do?
- Sign of fetal bleeding
- Do an Apt test and if positive C-section
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What score on non-stess test is acceptable?
8-10
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