-
definition of embryo?
fetus?
infant?
- up to 8 weeks
- 8weeks to birth
- birth to one year old
-
how do you estimate the date of delivery?
LMP - 3 months +7 days
-
difference between developmental age and gestational age?
- developmental age is time since fertilization
- gestational age is time since LMP
-
how many weeks is a term fetus?
38-42
-
what is the first physical sign of pregnancy?
softening of cervix at 4 weeks
-
at how many weeks o what level of beta hcg, can ultrasound detect an intrauterine pregnancy?
5 weeks or 1000
-
enlarged nuchal transulency is seen in what ?
down syndrome
-
when are fetal heart sounds heard?
at the end of 1st trimester
-
what is hte most accurate way of establishing gestational age?
ultrasound
-
what is screened for in 1st trimester?
- nuchal translucency via ultrasound
- karyotype/genetic diseases via Chorionic v. sampling
-
when is chorionic villi sampling done?
amniocentesis?
amniocentesis
chorionic vi. sampling-12 weeks
amniocentesis---15 weeks
-
after how many weeks are visits to the ob every week?
after 36 weeks
-
what kind of contractions occur in 3rd trimester?
braxton hicks contractions
-
what should you do with continued braxton hicks contractions?
check the cervix
-
what needs to be given with iron supplements?
stool softeners--docusate
-
what 3 tests are done in 3rd trimester?
- 1-cbc--anemia if present give oral iron
- 2-glucose load if above 140 give glucose tolerance
- 3- cervical cultures for chlamydia and gbs
-
how is glucose load testing done and what is the management if the levels are high?
- glucose load--50 mg whether fasting or not, check at 1 hour if >140
- then give 100mg while fasting and check at 1, 2, 3 hrs
-
when is fetal blood sampling done
- need fetus' cbc
- rh isoimmunization
-
diagnostic tests for ectopic pregnancy?
- beta hcg
- ultrasound
- laparoscopy
-
how is ectopic pregnancy managed?
if pt is stable and ectopic intact-mtx--observe for 15% drop in beta hcg--if not present--give another dose of mtx..if it fails..surgery
- if ectopic is rupture--surgery
- if ectopic is ruptured and pt is unstable--stablizize pt and then surgery
-
exclusion criteria for mtx for ectopic?
- pt completed their families
- ectopic larger than 3.5
- liver disease
- pt is non compliant
- fetal heart beats
- immunodeficiency
-
what is the procedure called for surgery for an ectopic?
- salpingostomy--cut in the fallopian tube
- salpingectomy-- removal of fallopian tube
-
when do spontaneous abortions take place, how many weeks?
before 20 weeks
-
most common cause of spontaneous abortions?
chromosomal abnormalities
-
how does each of the following abortions present on ultrasound? rx?
1-complete
2-incomplete
3-inevitable
4-threatened abortion
5-missed abortion
6-septic abortion
- 1-no products of conception-follow up in office
- 2-some products of conception -d/c
- 3-products of conception present but dilated cervix with intrauterine bleeding-d/c
- 4- products of conception present, intrauterine bleeding but no dilated cervix- rest
- 5- death of fetus but all products of conception in the uterus - d/c
- 6-infection of uterus and the surrounding areas- d/c and antibiotics
-
during what procedures should mothers receive anti- D Rh ig?
salpigectomy and during d/c
-
how do multiple gestations present?
- rapid growth
- high beta hcg and maternal fetal protein than expected
-
how is preterm labor defined? during what time
premature rupture of membranes?
- combinations of contractions and cervical dilation
- between 20-37 weeks
- blood loss
-
diagnosis of multiple gestations?
multiple fetuses on on ultrasound
-
when should you deliver a preterm baby?
- pre ecclampsia, ecclampsia
- fetal death
- maternal hemorrhage
- maternal cardiac dz
- cervix dilation >4cm
- chorioamnionitis
-
what 2 conditions dictate stopping premature labor?
- weight <2500grams
- 24-33 EGA
-
how is preterm labor stopped?
-
how do you check for magnesium toxicity?
deep tendon reflexes
-
what is the most commonly used tocolytic?
magnesium
-
-
which tocolytics is not an answer?
indomethacin
-
management of premature rupture of of the membranes?
- if preterm and no chorioamniotitis--amp/gent with tocolytic, steroids
- if term and no chorioamniotis--wait 6 to 12 hours and deliver
- if term and chorioamnionitis--deliver now
-
4 complications of premature rupture of the membranes?
- cord prolapse
- premature labor
- chorioamnionitis
- placental abruption
-
placenta previa?
placenta over the internal cervical os
-
next step in management of painless vaginal bleeding in a 32 week ga?
transdominal ultrasound to rule out placenta previa
-
digital vaginal exam in not done in what trimester?
3rd
-
what allows for diagnosis of premature rupture of membrane
- gush of fluid
- amniotic fluid examination--ferning pattern
-
placental vasa previa is what?
fetal blood vessels lying over the internal cervical os
-
rx for placenta previa?
when do you do immediate cesearean section for it?
pelvic rest
- c section if cervix >4cm
- severe hemorrhage
- fetal distress
-
3 types of placental invasion?
- acreta--attaches to superficial uterine wall
- increta-uterine myometrium
- percreta--uterine serosa, bladder and rectum wall
-
causes of placental abruption?
- trauma
- hypertension
- cocaine use
- prior abruption
-
placenta previa vs placental abruption presentation?
- previa--painless bleeding
- abruption--painful bleeding
-
2 types of placental abruption?
concealed--placenta is most likely detached and complications are severe
extenal--placenta is semi detached and complications are minimal
-
risk factors or uterine rupture?
- previoius c sections--
- 1- longitudinal
- 2-low transverse
- trauma
- large baby
- polyhydramnios
- placenta percreta
-
rx for uterine rupture?
laparatomy and delivery..no c section
-
erythroblastosis fetalis is cuased by?
rh incompatibility
-
gestational hypertension vs preecclampsia?
- gestations htn is htn without proteinuria or edema
- it starts after 20 weeks of gestation
-
rx for chronic htn, gestational htn?
- labetalol
- alpha methyl dopa
- nifedipine
- hydralazine
-
rx for mild precclampsia in the following situation?
term?
preterm?
severe precclampsia?
- delivery
- betamethasone and mgso4 for prophylaxis
severe--mgso4 for prophylaxis, hydralazine
-
ecclampsia presents with what?
tonic-clonic seizures
-
what is HELLP syndrome?
rx?
- hemolysis
- elevated liver enzymes
- low platelets
mg and hydralazine
-
rx of pregestational diabetes mellitus?
- type 1--insulin pump
- type 2--subQ insulin
-
what other tests are done for diabetics who are pregnant?
- ekg
- 24 creatinine/protein
- HbA1c
- EYE exam
-
are mothers with gestational diabetes more likely to develop diabetes?
yes
-
when is gestational diabetes screened for?
- 3rd trimester--
- 24 weeks
- 28 weeks
-
rx for gestational diabetes?
diabetic diet and exercise
no weight loss
-
what kind of tests are done from 32 week to 38? if the patients are put on insulin
32-36 non stress tests and ultrasound weekly
- >36 twice a week non stress tests and biophysical profile
- 37 weeks L/S ratio
-
criteria for IUGR?
infants weigh in the bottom 10%
-
when does symmetric IUGR occur?
NOn symmetric?
- before 20 weeks
- after 20 weeks
-
rx for macrosomia?
- induce labor if lungs are mature and fetus is <4500grams
- if fetus is >4500 grams, c section
-
what is a reactive nonstress test?
- 2 fetal movements
- hr increased by 15bpm for 15mins
-
biophysical profile consists of?
- NST
- feta chest expansions
- fetal movement
- fetaml muscle tone
- amniotic fluid index
-
what is normal fetal heart rate during labor?
brady?
tachy?
- brady <110
- normal 110-160
- Tachy >160
-
what is the normal hr acceleration during labor?
hr increases by 15 beats for 15 seconds
-
how many Stages of Labor are there?
3 stages
-
what happens during the 3 stages of labor?
- 1st stage--onset of labor to full dilation of cervix
- 2nd stage--full dilation of cervix to delivery
- 3rd stage-delivery of baby to delivery of placenta
-
signs of placental separation
- umbilical cord lengthening
- fresh bleeding
- uterine fundus rising
- uterus becoming firm
-
how is induction of labor done?
- prostoglandin
- oxytoxin
- puncture of the amniotic sac
-
in what pts you shouldnt give prostaglandin to induce labor?
asthmatic patients
-
what is an arrest of cervical dilation?
when the cervix does not dilate for 2 hours
-
what is prolonged latent stage?
in stage one when the cervix takes more than 20 hours to dilate 4 cm
-
rx for prolonged latent stage?
rest and hydration..labor progresses spontaneously
-
what is protracted cervical dilation?
slow dilation of the active stage of stage 1
-
etiology of protracted cervical dilation?
-
rx for protracted cervical dilation?
-
what is arrest of cervical dilation?
- no dilation for 2 hours
- no fetal descent for 1 hour
-
rx for arrest of cervical dilation?
c section
-
how is a breech diagnosed?
ultrasound
-
-
what are the maneuvers in order to deliver a baby taht is at risk for shoulder dystocia?
- McRoberts maneuver
- Rubin
- woods
- Delivery of posterior arm
- deliberate fracture of fetal clavicle
- Zavanelli Maneuver
-
how much blood is lost in a post partum hemorrhage?
500mL
-
rx for postpartum hemorrgae?
- compression and massage
- oxytocin
-
what is the work up of rh incompatibility?
- screen at 15 weeks
- if no antibodies, repeat at 28 weeks and if still negative give anti-D Rh IV
if positive at 15 weeks, titer, if titer is bigger than 1:16, do amnio and see if fetal cells rh negative, if they are..normal pregnancy
if fetal cells rh positive, look at bilirubin, if low, repeat amnio, if high, take blood sample and see hct and if low transfuse
-
teratogens cause abnormalities when?
between 2 adn 12 weeks
-
Chadwick sign?
bluish discoloration of vagina
-
hegar sign
softening of the lower uterus
-
what causes glucose intolerance in pregnancy?
human placental lactogen
-
when should a woman not have sex in pregnancy?
- recurrent uti
- placenta previa
- history of spontaneous abortions
-
what seizure meds interrupt folate metabolism
-
what are the levels of afp, estriol, beta hcg and inhibin a?
in down syndrome
edwards
turners?
down--afp and estriol are down, beta hcg and inhibin are up
- edwards---everything is down except inhibin
- turner--just like down syndorm
-
low maternal papp-a is associated with what?
trisomy 21 and 18
-
when is percutaneous umbilical venous sampling done?
- thrombocytopenia
- thyroid disorder
- fetal anemia due to rh incompatibility
-
vaccines ok in pregnancy?
not ok in pregnancy?
- tetanus
- pneumococcal
- meningococcal
- influenza
- hep a and b
-
5 types of lacunar strokes?
- pure sensory
- pure motor
- ataxic hemiparesis
- dysarthia clumsy hand syndrome
- sensory motor
-
rx for cerebral palsy contractures?
- dantrolene
- baclofen
- botox
- benzos
-
brain tumors?
mgm studios
- metatasis
- glioblastoma
- meningioma
- shwannoma
-
brain tumors in kids?
- astrocytoma
- medulloblastoma
- epyndymoma
-
exploration of neck after trauma?
- zone one--ct angiogram
- zone two--surgical
- zone 3--angiogram
-
most sensitive and specific test for chronic pancreatitis?
low fecal elastase level
-
what is a reactive non stress test?
2 15bpm accelerations of the heart held for 15 seconds in 20 minutes
-
what makes up the biophysical profile?
- amniotic fluid index
- movement
- breathing
- tone
-
what is pathologic, early or late deceleration?
late deceleration due to placental insufficiency
-
acidosis in the baby will manifest itself as late or early deceleration?
late
-
sinusoidal heart rate means what?
anemia
-
cause of fetal tachy?
- maternal infection
- chorioamniotis
- anemia
- maternal thyrotoxicosis
- fetal arrythmia
- terbutaline
-
when does arrest of labor occur?
in the active phase >2 hours
-
what is uterine hyperstimulation?
5 contractions/10 minutes
-
when is breast feeding contraindicated?
- hiv
- tetracycline
- chloramphenicol
- galactoseemia
- topiramate
- amiodarone
- drugs
-
ocp for lactating woman?
progesterone
-
post partum bleeding for vaginal delivey?
c section?
-
rx for uterine atony/postpartum hemorrhage?
- uterine massage
- oxytocin
- prostaglandins
- ergots
-
rx for postpartum hemorrhage if hypertensive?
prostaglandin
-
reasons for vertical incision for c section?
- transverse lie
- adhesions or fibroids
- hysterectomy planned
- cervical cancer
- postmortem delivery
-
when is c section done? for mother
for infant
- placenta previa
- ecclampsia
- prior uterine surgery
- cardiac disease
- cervical death
- herpes
- maternal death
- for infant:
- acute fetal distress
- malpresentation
- cord prolapse
- macrosomia
- failel labor progression
- abruptio placenta
- cephalopelvic disproportion
-
adverse events after a vbac?
- uterine ruprue1/100
- baby or mother death 1/1000
-
rx for post partum endometritis?
amp and gent
-
mx of breech baby after 36 weeks?
extenral cephalic version
-
arrest of descent?
> hours in stage 2
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