-
what is ordered when patient is diagnosed with pregnancy
- cbc
- type and screen rh antibody, coombs
- ua, uc
- pap smear
- hiv, hep b
- rpr, rubella
- chlamydia
-
how is the level of bhcg, inhibin, estriol, afp in downs
edwards
- bhcg and inhibin are high
- estriol and afp are low
edwards-everything is low
-
high afp, next step
get amniotic afp and acetylcholinesterase activity if high it is NTD
-
-
rupture of memebranes, painless vaginal bleeding, fetal bradycardia
vasa previa
-
caues of 3rd trimetsr bleeding
- vasa previa
- abruptio placenta
- uterine rupture
- placenta previa
-
2 causes of painfull 3rd trimester bleeding
- abruptio placenta
- uterine rupture
-
complication of abruptio placenta
DIC due to fetal thromboplastin release
-
when are peripartum abx not given
- culture + but c-section is planned w/o rom
- culture + in previus pregnancy but not currently
-
what must pregnant women avoid in preg
- raw goat milk
- undercooked milk
- cat feces
-
rx for toxo
pyrimethamine and sulfadaizine
-
rash limb hypoplasia microcephaly, microopthalmia, chorioretinitis
varicella
-
rubella is what type virus
rna, togavirus
-
rx for treatment for varicella
vzig within 10 days of exposure
-
rx for maternal varicella infection
acyclovir and ig
-
most common cause of deafness in kids due to infection in pregnancy
cmv
-
perventricular calcifications, chorioretinitis, pneumonitis
cmv
-
-
can you give acyclovir to pregnant woman
yes
-
who gets ziduvidine monotherapy
no one
-
hiv is what type of virus
single stranded enveloped rna virus
-
when is vaginal delivery not indicated for HIV woman thats pregnant
if VL >1000
-
infant gets treated after delivery to HIV woman
yes, 6 weeks of ZDV
-
primary syphilis in the first trimester can give what
hydrops fetalis
-
-
can you breast feed baby if you have hep B but baby received IVIG and hep B vaccine
yes
-
mild vs severe pre-ecclampsia
severe -BP>160/110, >5g protein , warning signs
-
suspecting pre-ecclampsia in a pregnant woman, next step
ua
-
ecclampsia is
pre-ecclampsia + seizures
-
when do you treat BP in pre=ecclampsia
if BP >160/110
-
ppx and rx for seizure in ecclampsia
magsulfuate
-
rx for mild preeclampsia
severe or ecclampsia
induce labor if >36 weeks and mom and fetus stable
if unstable or ecclampsia, delivery at any time
-
HELLP can occur when
before or after delivery
-
rx for HEELP
- steroids
- mag sulfate
- deliviry
- plt transfusion?
-
-
meds used for peripartum cardiomyopathy
-
what valvular problems are problematic in pregnancy
stenotic, valvular are ok
-
when do you anticoagulate in pregnancy
- apl
- eisenmenger
- severe heart failure
-
thyroid drugs in pregnancy
ptu then methimazole
-
fasting glucose and post prandial glucose targets in pregnancy
- fasting <90
- postprandial<120
-
cuadal regression syndome is seen when
bc of DM
-
aic of >8.5 in 1st trimester is strongly associated with
NTD
-
what routine test are done with DM in pregnancy
monthly us to look for structural problems and echocardiogram, triple marker, NST and AFI
-
is gestational dm associated with congenital anomalies
no
-
what ratio of L/S is reassuring
2.5
-
wha weight do you induce vs c.section in dm
- <4.5g induce
- >4.5 c.section
-
intrahepatic cholestasis of pregnancy rx
ursodeoxycholic acid
-
oral mifepristone or misoprostol is used for
medical abortion
-
spontaneous abortion
feta demise
how many weeks both
-
complete abortion, follow up
beta hcg
-
rx for threatened abortion
bed rest
-
mcc of spontaneous abortion i.e <20 weeks
chromosomal abnormalities
-
fetal demise common cause i.e >20 weeks
hypercoagualbel
-
what must be done with a presentaion of fetal demise
rule out coagulopahty/DIC
-
when is pregnancy seen on vaginal us
at 5 weeks with bhcg of 1500
-
rx for ectopic pregnancy
- surgery if ruptured otherwise
- MTX if
- sac <3.5cm
- betahcg<6000
- absence of fetal heart
- no folic acid supplementation
-
what needs to be rule out when cervical insufficiency is present
labor and chorioamniotis
-
IUGR definition
<2.5kg or <10 percentile for gestational weight
-
causes of symmetric IUGR
assymetric
- infection
- chromosomal probelms
- aneuploidy
assymetric- mothers factors/womb factors
-
macrosomia
indication for c.section
- >4-4.5kg or >90% percentile
- >4.5kg in diabetic
- >5kg in non-diabetic
-
when is gestational age determined
at 10 weeks
-
CVS is performed when
Amniocenteiss when
-
when is AF-AFP and acetylcholinesterase done
in amniocentesis
-
percutaneous umbilical blood sample used for
performed when
- transfusion
- igM
- karyotype
- blood gass
- performed after 20 weeks
-
findings in premature ruptures of membranes
- ferning
- nitrazine +
- posterior fornix pooling of clear amniotic fluid
-
if chorioamniotics
- get cerivcal cultures
- iv abx
- delivery
-
if no infection but ROM
- <24 weeks-bed rest
- 24-33 hospitalize betamethasone, iv abx
-
adequate uterine contraction is what
every 3 mintus,lasts 1 minute, 50mmhg pressure
-
-
stage 1 has how many parts
-
dilation of cervix present in active part of stage 1
4 cm ends with 10 centemiter
-
stage 2 is defined by
10 cm cervical dilation and ends with delivry of baby
-
prolonged latent phase
no change for 14-20 hours
-
arrest of active stage
no dilation for 2 hours
-
2nd stage arrest, causes
- failure to deliver in 2 hours
- power, passenger, pelvis
-
common cause of prolonged latent phase
analgesia
-
management of umbilical cord prolapse
-
clues to umbilical cord prolapse
- bradycardia
- severe variable accelesations
-
reassuring FHR
non-reassuring FHR
- HR 110-160
- + beat to beat variability
- +accelerations
- -decelerations
- brady or tachycardia
- late or variable decelrations
- -accelerations
- -beat to beat variability
-
early decelerations are due to
fetal head compression
-
variable decelerations are due to
umbilical cord compressions
-
late decelerations are due to
uteroplacental insuffiency
-
when are vacum or forcepts delivery indicated
- 2nd stage prolonged
- nonreassuring efm
- mother has medical conditions and cannot push
-
indication for c-section
- arrest of labor
- hiv
- hsv
- cephalopelvic dispoportion
- fetal malpresentation
- nonreassuring efm strip
- placenta previa
- uterine scar
-
when is external cephalic version done
breech or transverse lie at 37 weeks
-
mcc of postpartum hemorrhage
uterine atony
-
active stage arrest
2nd stage arrest
- active stage arrest- no cervical change for 2 hr
- 2nd stage arrest- failure to deliver in 2 hours in primipara or 1 hours in multipara
-
which medicaitons can be given in a pregnant patient with HTN to stop postpartum hemorrhage
misoprostol
-
are ocp given in post partum women who are lactating
no bc it decreases lactation
-
the only contraception pill that can be used with breast feeding
progestin
-
can you continue with breast feeding with mastitis
yes
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