USTEP3 ob

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  1. 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
  2. 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
  3. high afp, next step
    get amniotic afp and acetylcholinesterase activity if high it is NTD
  4. 3rd trimester test
    • cbc
    • dm
    • rh ab
    • gbs
  5. rupture of memebranes, painless vaginal bleeding, fetal bradycardia
    vasa previa
  6. caues of  3rd trimetsr bleeding
    • vasa previa
    • abruptio placenta
    • uterine rupture
    • placenta previa
  7. 2 causes of painfull 3rd trimester bleeding
    • abruptio placenta
    • uterine rupture
  8. complication of abruptio placenta
    DIC due to fetal thromboplastin release
  9. when are peripartum abx not given
    • culture + but c-section is planned w/o rom
    • culture + in previus pregnancy but not currently
  10. what must pregnant women avoid in preg
    • raw goat milk
    • undercooked milk
    • cat feces
  11. rx for toxo
    pyrimethamine and sulfadaizine
  12. rash limb hypoplasia microcephaly, microopthalmia, chorioretinitis
    varicella
  13. rubella is what type virus
    rna, togavirus
  14. rx for treatment for varicella
    vzig within 10 days of exposure
  15. rx for maternal varicella infection
    acyclovir and ig
  16. most common cause of deafness in kids due to infection in pregnancy
    cmv
  17. perventricular calcifications, chorioretinitis, pneumonitis
    cmv
  18. rx for CMV
    • gancyclovir
    • ig
  19. can you give acyclovir to pregnant woman
    yes
  20. who gets ziduvidine monotherapy
    no one
  21. hiv is what type of virus
    single stranded enveloped rna virus
  22. when is vaginal delivery not indicated for HIV woman thats pregnant
    if VL >1000
  23. infant gets treated after delivery to HIV woman
    yes, 6 weeks of ZDV
  24. primary syphilis in the first trimester can give what
    hydrops fetalis
  25. VDRL is +, next step
    FTA
  26. can you breast feed baby if you have hep B but baby received IVIG and hep B vaccine
    yes
  27. mild vs severe pre-ecclampsia
    severe -BP>160/110, >5g protein , warning signs
  28. suspecting pre-ecclampsia in a pregnant woman, next step
    ua
  29. ecclampsia is
    pre-ecclampsia + seizures
  30. when do you treat BP in pre=ecclampsia
    if BP >160/110
  31. ppx and rx for seizure in ecclampsia
    magsulfuate
  32. 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
  33. HELLP can occur when
    before or after delivery
  34. rx for HEELP
    • steroids
    • mag sulfate
    • deliviry
    • plt transfusion?
  35. complications of HELLP
    • DIC
    • abruption placenta
  36. meds used for peripartum cardiomyopathy
    • bb
    • nitrates
    • loops
  37. what valvular problems are problematic in pregnancy
    stenotic, valvular are ok
  38. when do you anticoagulate in pregnancy
    • apl
    • eisenmenger
    • severe heart failure
  39. thyroid drugs in pregnancy
    ptu then methimazole
  40. fasting glucose and post prandial glucose targets in pregnancy
    • fasting <90
    • postprandial<120
  41. cuadal regression syndome is seen when
    bc of DM
  42. aic of >8.5 in 1st trimester is strongly associated with
    NTD
  43. what routine test are done with DM in pregnancy
    monthly us to look for structural problems and echocardiogram, triple marker, NST and AFI
  44. is gestational dm associated with congenital anomalies
    no
  45. what ratio of L/S is reassuring
    2.5
  46. wha weight do you induce vs c.section in dm
    • <4.5g induce
    • >4.5 c.section
  47. intrahepatic cholestasis of pregnancy rx
    ursodeoxycholic acid
  48. oral mifepristone or misoprostol is used for
    medical abortion
  49. spontaneous abortion
    feta demise  
    how many weeks both
    • <20
    • >20
  50. complete abortion, follow up
    beta hcg
  51. rx for threatened abortion
    bed rest
  52. mcc of spontaneous abortion i.e <20 weeks
    chromosomal abnormalities
  53. fetal demise common cause i.e >20 weeks
    hypercoagualbel
  54. what must be done with a presentaion of fetal demise
    rule out coagulopahty/DIC
  55. when is pregnancy seen on vaginal us
    at 5 weeks with bhcg of 1500
  56. rx for ectopic pregnancy
    • surgery if ruptured otherwise
    • MTX if 
    • sac <3.5cm
    • betahcg<6000
    • absence of fetal heart
    • no folic acid supplementation
  57. what needs to be rule out when cervical insufficiency is present
    labor and chorioamniotis
  58. IUGR definition
    <2.5kg or <10 percentile for gestational weight
  59. causes of symmetric IUGR

    assymetric
    • infection
    • chromosomal probelms
    • aneuploidy

    assymetric- mothers factors/womb factors
  60. macrosomia
    indication for c.section
    • >4-4.5kg or >90% percentile 
    • >4.5kg in diabetic
    • >5kg in non-diabetic
  61. when is gestational age determined
    at 10 weeks
  62. CVS is performed when
    Amniocenteiss when
    • 1o weeks
    • 15 weeks
  63. when is AF-AFP and acetylcholinesterase done
    in amniocentesis
  64. percutaneous umbilical  blood sample used for
    performed when
    • transfusion
    • igM
    • karyotype
    • blood gass
    • performed after 20 weeks
  65. findings in premature ruptures of membranes
    • ferning
    • nitrazine +
    • posterior fornix pooling of clear amniotic fluid
  66. if chorioamniotics
    • get cerivcal cultures
    • iv abx
    • delivery
  67. if no infection but ROM
    • <24 weeks-bed rest
    • 24-33 hospitalize betamethasone, iv abx
  68. adequate uterine contraction is what
    every 3 mintus,lasts 1 minute, 50mmhg pressure
  69. stages of labor
    3
  70. stage 1 has how many parts
    • 2
    • latent
    • active
  71. dilation of cervix present in active part of stage 1
    4 cm ends with 10 centemiter
  72. stage 2 is defined by
    10 cm cervical dilation and ends with delivry of baby
  73. prolonged latent phase
    no change for 14-20 hours
  74. arrest of active stage
    no dilation for 2 hours
  75. 2nd stage arrest, causes
    • failure to deliver in 2 hours
    • power, passenger, pelvis
  76. common cause of prolonged latent phase
    analgesia
  77. management of umbilical cord prolapse
    • terbutaline
    • c-section
  78. clues to umbilical cord prolapse
    • bradycardia
    • severe variable accelesations
  79. 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
  80. early decelerations are due to
    fetal head compression
  81. variable decelerations are due to
    umbilical cord compressions
  82. late decelerations are due to
    uteroplacental insuffiency
  83. when are vacum or forcepts delivery indicated
    • 2nd stage prolonged
    • nonreassuring efm
    • mother has medical conditions and cannot push
  84. indication for c-section
    • arrest of labor
    • hiv
    • hsv
    • cephalopelvic dispoportion
    • fetal malpresentation
    • nonreassuring efm strip
    • placenta previa
    • uterine scar
  85. when is external cephalic version done
    breech or transverse lie at 37 weeks
  86. mcc of postpartum hemorrhage
    uterine atony
  87. 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
  88. which medicaitons can be given in a pregnant patient with HTN to stop postpartum hemorrhage
    misoprostol
  89. are ocp given in post partum women who are lactating
    no bc it decreases lactation
  90. the only contraception pill that can be used with breast feeding
    progestin
  91. can you continue with breast feeding with mastitis
    yes
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320965
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USTEP3 ob
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USTEP3 ob
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