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NM 717 Comps > Module 4 Antepartum Flash Cards > Flashcards

Module 4 Antepartum Flash Cards

1
Q

The _________ a screening test is (sensitivity and specificity) the greater the ________ in unnecessary procedures

A

The “better” a screening test is (sensitivity and specificity) the greater the reduction in unnecessary procedures

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2
Q

What types of “tests” are the following?
NIPT/NIPS
1st tri- 2nd tri
Integrated, sequential
Non-treponemal (RPR, VDRL)
Mammogram
1 hour 50 gm load glucose
Pap smear
PHQ-2
TORCH antibody screen

A

Screening

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3
Q

What types of “tests” are the following?
CVS
amnio
Treponemal
Mammogram (actually a biopsy)
3 hour 100 gm load glucose
Biopsy
Colposcopy
PHQ-9
More specific tests

A

Diagnostic

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4
Q

What are the features of the inlet?

A

The sacral promontory and diagonal conjugate

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5
Q

What are the features of the midplane?

A

The ischial spines (interspinous diameter)

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6
Q

What are the features of the outlet?

A

The sacrococcygeal joint, ischial tuberosities and pubic arch

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7
Q

What are the significant diameters of the inlet?

A

11.5+cmx13.5+cmx12.75+cm

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8
Q

What are the significant diameters of the midplane?

A

10cmx11.5+cm

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9
Q

What are the significant diameters of the outlet?

A

11.5+cmx10cm

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10
Q

What is the expected fundal height at 8 weeks?

A

Below the symphysis pubis

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11
Q

What is the expected fundal height at 12 weeks?

A

At the symphysis pubis

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12
Q

What is the expected fundal height at 15/16 weeks?

A

Midway between the symphysis pubis and the umbilicus

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13
Q

What is the expected fundal height at 20 weeks?

A

At the Umbilicus

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14
Q

What is the expected fundal height after 20 weeks?

A

Within 2cm of gestational age from the pubic bone

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15
Q

At what gestation does the uterus become an abdominal organ?

A

After the 12 week

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16
Q

When is HCG detectable?

A

-8-10 days after ovulation
-Just before the missed period
-With implantation of the ovum

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17
Q

What is the expected rise of Hcg with early pregnancy?

A

Should double every 48-72 hours

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18
Q

At what gestation and level does HCG peak. What level is expected after the peak?

A

-Peaks at 8-11 weeks at 100,000 mIU/mL
-Then decreases and levels out at 20,000mIU/mL

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19
Q

What produces HCG and what is its role?

A

It is first produces by the blastocyst and then the placenta.

Its role is to keep the corpus luteum going until the placenta takes over.

Key Functions:
-Stimulates production of progesterone from the corpus luteum
-Stimulates thyroid production of thyroxine
-Suppresses myometrial contractions

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20
Q

What is the source of hPL and what is its role?

A

Produces by the placenta

Role:
-Increases insulin resistance
-Stimulates production of growth hormones

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21
Q

What is the source of progesterone and what is its role?

A

Source: Corpus luteum then the placenta

Role:
-Systemic vasodilation
-Prevents myometrial contractility
-Withdrawal leads to uterine contractions
-Inhibits uterine production of prostaglandins
-Supports mammary growth for lactation

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22
Q

What is the source of estrogen and what is its role?

A

Source: Ovaries, Corpus luteum, Placenta, fetus

Role:
Increases uterine blood flow
Promotes growth of the uterus and breast
Increases production of growth factors
Enhances myometrial contractility

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23
Q

Which estrogen is dominant in pregnancy?

A

E3 “Estriol”

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24
Q

Discuss the steps of fertilization and implantation:

A

Ovum (oocyte) ->zygote ->Blastocyst ->Trophoblast (placenta) ->embryo ->fetus

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25
Q

Define Oligohydramnios

A

AFI or 5.0 cm or less

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26
Q

Define Polyhydramnios

A

AFI of 24cm or more

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27
Q

How many arteries and veins are expected in the umbilical cord?

A

2 arteries and 1 vein

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28
Q

At what gestation is limb movement expected?

A

9weeks

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29
Q

At what gestation is leg movement expected?

A

14 weeks

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30
Q

At what gestation is hand to face movement expected?

A

12-13 weeks

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31
Q

At what gestation is limb head and torso movement expected?

A

12-16 weeks

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32
Q

At what gestation is finger sucking expected?

A

15 weeks

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33
Q

At what gestation is respiratory movement expected?

A

24 weeks

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34
Q

At what gestation are sleep-wake cycles, FHR pattern, eye movements, quiet states and active states expected?

A

32 weeks

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35
Q

What hematological changes are expected in pregnancy? When do they occur and why?

A

Increase in clotting factors I, II, VII, VIII, IX and decrease in protein S and C (which inhibit coagulation.

These occur primarily in the 2nd and 3rd trimesters

Purpose: to prevent PPH!

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36
Q

What are the expected thyroid changes in pregnancy?

A

hCG stimulated the thyroid and causes a decrease in TSH and increase in T4 and T3. This results in subclinical hyperthyroidism in first trimester.

In third trimester, the levels stabilize.

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37
Q

What is the first endocrine gland to appear in the fetus?

A

the Thyroid!!

Note: it does not produce thyroid hormones until 18-20weeks

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38
Q

What is T4 critical for during pregnancy?

A

brain and bone growth

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39
Q

What is the recommended daily intake of iodine in pregnancy?

A

220 mcg/day

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40
Q

What TSH level is expected in normal pregnancy?

A

0.1-4.0

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41
Q

What TSH level is expected in overt hyperthyroidism in pregnancy?

A

Undetectable TSH

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42
Q

What TSH level is expected in overt hypothyroidism in pregnancy?

A

> 4.0

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43
Q

Why is the fetus an allograft?

A

So the pregnant persons immune system doesnt attack it!

-trophoblastic tissue does NOT express cell membrane proteins!
-downregulation of maternal adaptive immunity

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44
Q

Define fetal lie.

A

Long axis of the fetus to the long axis of the pregnant person

Longitudinal, Transverse or Oblique

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45
Q

Define fetal position

A

Position (3 letter notation)

Left or Right: references the pregnant person’s pelvis
Denominator: Occiput, Sacrum, or Mentum

Where in the pelvis does the denominator lie?
Anterior, transverse or posterior

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46
Q

Define Presentation

A

Presentation (vertex, breech or shoulder)

Subdivided: vertex, sinciput, brow or face

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47
Q

Define attitude

A

Attitude (flexed, face, brow)

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48
Q

How are these conditions genetically passed down?
-Neurofibromatosis
-Marfan’s Syndrome
-Huntington Disease
-Achondroplasia (dwarfism)

A

Autosomal Dominant

Key: There is no carrier state

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49
Q

How are these conditions genetically passed down?
-Sickle Cell Disease
-Cystic Fibrosis
-Alpha-thalassemia
-Tay-Sachs
-Beta-thalassemia

A

Autosomal recessive

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50
Q

How are these conditions genetically passed down?
-Duchenne muscular dystrophy
-Hemophilia A

A

Sex-linked

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51
Q

How are these conditions passed down?
-Neural Tube Defects (spina bifida, anencephaly)
-Heart Defects
-Pyloric stenosis
-Cleft lip
-Club foot

A

Multifactoral Inheritence

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52
Q

What is an aneuploidy?

A
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53
Q

What is a moosomy?

A
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54
Q

What is a trisomy?

A
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55
Q

How can we test for chromosomal disorders?

A

cell free DNA

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56
Q

What are the different sex chromosome abnormalities?

A

-Turner Syndrome (x) F: weblike neck
-Klinefelter syndrome (XXY) M: tall, feminine
-Trisomy X (XXX) F: epicanthal folds, wide-spaced eyes, curved pinky

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57
Q

What can the maternal condition-CMV cause in the fetus?

A

cognitive deficit, microcephaly

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58
Q

What can the maternal condition-rubella cause in the fetus?

A

Deafness, cataracts, heart defects, cognitive deficit

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59
Q

What can the maternal condition-syphillis cause in the fetus?

A

Abnormal teeth and bones, cognitive deficits

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60
Q

What can the maternal condition-toxoplasmosis cause in the fetus?

A

Hydrocephaly, blindness, cognitive deficit

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61
Q

What can the maternal condition-varicella cause in the fetus?

A

Limb reduction, skin scarring, muscle atrophy, chorioretinitis

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62
Q

What can the maternal condition-zika cause in the fetus?

A

Microcephaly, decreased brain tissue, dec ROM in joints, eye damage

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63
Q

What can the maternal condition-alcoholism cause in the fetus?

A

Miscarriage, fetal alcohol syndrome, FGR, developmental delay

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64
Q

What can the maternal condition-DM cause in the fetus?

A

heart Defects, microcephaly, NTDs, skeletal defects, GU, GI & reproductive system defects

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65
Q

What can the maternal condition-fever cause in the fetus?

A

NTD’s, heart & abdominal wall defects, oral cleft

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66
Q

What can the maternal condition-seizure disorder cause in the fetus?

A

Cleft lip, cleft palate, heart defects

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67
Q

What can the maternal condition-lupus disorder cause in the fetus?

A

MAB, stillbirth, congenital heart block, FGR, prematurity

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68
Q

Currently, it is recommended that both screening & dx testing be offered to ___________ pregnant people ___________ age or risk factors present.

A

Currently, it is recommended that both screening & dx testing be offered to all pregnant people regardless of age or risk factors present

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69
Q

When can the NIPT/NIPS/cell free DNA be done, what does it test for an how accurate is it?

A

After 10weeks until delivery

99% accurate!

blood test: Karyotyping-checks for chormosomal aneuploidies only

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70
Q

When can the 1st trimester screen be done, what does it test for an how accurate is it?

A

10-14wks

90% accurate

blood test + NT U/S to check for chromosomal aneuploidies

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71
Q

When can the 2nd trimester screen be done, what does it test for an how accurate is it?

A

15-18weeks

83% accurate

Blood test + anatomy U/S: checks for chromosomal aneuploidies and NTDs

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72
Q

What is the integrated screen, what does it test for an how accurate is it?

A

Combines the first and 2nd trimester screen to increase accuracy to 95%

73
Q

What is the only test/screen that can check for neural tube defects?

A

The 2nd trimester screen/AFP!!

Note: this can only be done from week 15-18

74
Q

What can cause a falsely abnormal AFP?

A

-Dates are off (VERY common)- -AFP is measured by the week
-Multiples ( 1 in 42)
-False Positives (5%) (5 in 100)
-Actual NTD (1 in 200-1,000-ish)

75
Q

How is AFP produced in the fetus? Why cant it be checked until 15 weeks?

A

In the liver, this is when the liver is developed enough for an accurate result

76
Q

explain multiple marker tests slide 42

A
77
Q

How often will patients be recommended to be seen during pregnancy?

A

Every 4 weeks until 28w
Every 2w until 36w
Weekly until birth

78
Q

What gestational ages fall under each of the trimesters?

A

1st: 0-12w
2nd: 13-27w
3rd: 28-40w

79
Q

What are the presumptive signs of pregnancy?

A

The least accurate and the patient may assume they are pregnant.

-Amenorrhea
-Breast or nipple changes
-Fatigue
-N & V
-Quickening
-Pigmentation changes
-Elevated BBT
-Urinary frequency

80
Q

What are the probable signs of pregnancy?

A

Providers can also see these signs!

-Breast changes- colostrum, enlarged breasts
-Abdomen enlarged
-Uterus enlarged
-Ballottement
-Chadwick’s sign -blue
-Goodell’s sign- cervical softening
-Hegar’s sign- lower uterine segment softening
-Piskacek’s sign-asymmetric lateral bulge in the uterus
-Palpable fetal outline or fetal movement
-Palpation of uterine contractions
-Positive pregnancy test

81
Q

What are the positive signs of pregnancy?

A

The baby is visualized or heard!

-Sonographic evidence of pregnancy
-Audible fetal heart tones

82
Q

What is chadwick’s sign?

A

Blueish discoloration of cervix, vagina, and labia d/t vascularization

83
Q

What is Hegar’s sign?

A

softening of the lower uterine segment

84
Q

What is goodell’s sign?

A

Softening of the cervix “Goodell’s is GOOEY”

85
Q

What is Piskacek’s sign?

A

asymmetrical lateral bulge in the uterus

86
Q

What is the most accurate method for dating a pregnancy?

A

An U/S done before 13w6d

87
Q

At what BhCG level is a intrauterine sac visible on TVUS?

A

1000-1500

88
Q

At what BhCG level is the gestational sac visible on an abdominal U/S?

A

6,000-6,5000

89
Q

What GA is expected with a BhCG of up to 7200?

A

5-6w

Yolk sac present when gestational sac is > 10 mm
Embryo present when gestational sac is > 18 mm
Cardiac activity present when CRL is > 5 mm

90
Q

What GA is expected with a BhCG of up to 10,800?

A

6-7wks

CRL is 4-9 mm

91
Q

Describe Nagel’s rule.

A

-assumes a 28 day cycle
e-stimated that a pregnancy would end at 40 weeks (280) days after LMP
-add 7 days to LMP.
-subtract 3 months
-= EDD
-LMP+7 days - 3 mo = EDD

92
Q

What STI screening is recommended during pregnancy?

A

1st Trimester: HIV, Syphilis, HepB, G/C, HepC

Repeat in 3rd trimester and at delivery: Syphillis

High Risk Only:
-Repeat in 3rd trimester: HIV, G/C
-Repeat at delivery: Hep B

93
Q

Who is considered high risk for STI?

A

IV drug use
Have STI during pregnancy
Have multiple sex partners
Have new sex partner during pregnancy
Have partners with HIV
Those receiving care in facilities in settings with HIV incidence of > or equal to 1 per 1,000 women
People who are incarcerated
Those who live in areas with high rates of HIV
Whose with S/S of acute HIV

94
Q

For a patient that is HepB negative but high risk, what should be considered?

A

Consider vaccination during pregnancy. Repeat HBsAg during labor. Offer vaccine PP if not vaccinated during pregnancy

95
Q

How should we respond to a HepB + patient in pregnancy?

A

Report to Perinatal HBV Prevention Program
Recommend screening for all household & sexual contacts. Order HBeAg, HBV DNA concentration, ALT. Obtain physician consult for consideration of co-management or referral.

96
Q

What are the anemic lab values in each trimester?

A

1st: <11/33
2nd: <10.5/32
3rd: <11/33

97
Q

What are the risk factors for DM that would indicate need for early GDM screen?

A

BMI ≥ 25
Clinical condition with insulin resistance
1st degree relative with diabetes
GDM in a previous pregnancy
HbA1C ≥ 5.7%
Impaired glucose tolerance or impaired fasting glucose on previous testing
HDL <35
Triglycerides >250
High risk race/ethnicity
Hx of cardiovascular disease
Hypertension ≥ 140/90 or on therapy for HTN
Physical inactivity
PCOS

98
Q

Per ACOG, what blood glucose level of a 1hr screen is a positive and warrants further testing?

A

140 or greater

99
Q

On the 3 hour glucose test, how many draws need to be elevated to be considered a positive test=fail?

A

2 or more abnormal levels are diagnostic for GDM/DM

100
Q

What is the Carpenter and Coustan criteria levels?

A

95+
180+
155+
140+

Carpenter story: You were driving down I-95, you realized you were going the wrong way and did a 180, then you got a ticket for doing 155 in a 140 zone!

101
Q

Who should get rhogam and when?

A

All Rh negative moms should get it at 28 weeks, within 72 hours-28d of birth if baby is Rh+ and during episodes of bleeding or a first trimester loss

102
Q

What is the dosing of RhoGAM by trimester?

A

up to 12 weeks gestation 50mcg
in 2nd/3rd trimester 300 mcg
-repeat PP if baby rh+

103
Q

Who should recieve the HepB immune globulin?

A

-To someone exposed to Hep B
-Someone with a + HBsAg
-Immediately PP to newborns of a HepB+ birthing person

104
Q

Who should receive the varicella-zoster immune globulin?

A

Given after presumed exposure to varicella zoster to someone non-immune

Chicken pox or shingles
Can be given in pregnancy

105
Q

What is the leading cause of early-onset newborn sepsis in the U.S.?

A

GBS

106
Q

Who should be screened for GBS and how?

A

All patients at 35-37w gestation
Vaginal/rectal swab

Excluding those with + GBS in urine during pregnancy

107
Q

What total weight gain is recommended for an underweight patient? What is the expected weight gain per week in 2nd/3rd trimester?

A

Underweight= <18.5 BMI

Total: 28-40lb

1-1.3 lb/wk

108
Q

What total weight gain is recommended for an “normal” weight patient? What is the expected weight gain per week in 2nd/3rd trimester?

A

Normal=18.5-24.9 BMI

Total: 25-25lb

0.8-1lb/wk

109
Q

What total weight gain is recommended for an overweight patient? What is the expected weight gain per week in 2nd/3rd trimester?

A

Overweight: 25-29.9 BMI

Total: 15-25lb

0.6 lb/wk

110
Q

What total weight gain is recommended for an obese patient? What is the expected weight gain per week in 2nd/3rd trimester?

A

Obese: >30 BMI

Total: 11-20lb

0.5lb/wk

111
Q

What is the minimum and maximum recommended weight gain for all pregestational BMIs?

A

11 minimum
40 maximum

112
Q

What is the minimum and maximum recommended 2nd and 3rd trimester weight gain for all pregestational BMIs?

A

0.5 minimum
1.3 maximum

113
Q

What is considered a level IV care for an OB patient?

A

Care of most complex medical conditions and critically ill pregnant people

On-site OB ICU, med surg ICU, med surg subspecialist available 24/7 including cardiac surgery and advanced neurosurgery. OB onsite, MFM on site, anesthesia with special training in OB onsite 24/7

114
Q

What is considered a level III care for an OB patient?

A

Care of more complex maternal medical, OB and fetal conditions

Medical and surgical ICU with ability to collaborate with MFM. Subspecialties available for consult

115
Q

What is considered a level II care for an OB patient?

A

Complications that do not require subspecialty care

Medical & surgical consultants available to stabilize women prior to transfer. Anesthesia 24/7

116
Q

What is considered a level I care for an OB patient?

A

Ability to manage unanticipated complications until transfer to a higher level of care

Ability to provide emergency cesarean birth on a 24/7 basis

117
Q

What is the lowest level of care for an inpatient OB patient?

A

Birth Center

Low risk, uncomplicated

Low risk, uncomplicated, midwives

118
Q

What PUQ score indicated mild nausea and vomiting? What are the recommended treatments?

A

PUQ: <6

Treatment: Ginger, acupressure bands, Vitamin B6

119
Q

What PUQ score indicated moderate nausea and vomiting? What are the recommended treatments?

A

PUQ: 7-12

Treatment: Unisom&B6, Reglan, Zofran, Phenergan, Compazine

120
Q

What PUQ score indicated severe nausea and vomiting? What are the recommended treatments?

A

PUQ: >13

Treatment: Inpatient admission for IVF and IV antiemetics

121
Q

What signs on a first trimester ultrasound may indicate a threatened early pregnancy loss?

A

CRL ≥7 mm without FHR
TVUS shows gestational sac without yolk sac…
There should be an embryo with a heart beat in 2 more weeks.
TVUS shows gestational sac with yolk sac, but no heartbeat…
Within 11 days, there should be a heartbeat
Mean sac diameter ≥ 25 mm without an embryo
Subchorionic bleeding
Embryo > 5 mm w/o a heartbeat
Bradycardia after 8 weeks gestation.
Serum progesterone <5 ng/mL (20 or more is consistent with viable pregnancy)

122
Q

What should you do for a pregnancy of unknown viability?

A

For uncertain viability, repeat ultrasound in 1 week.
TVUS is preferable for dx.

123
Q

At what gestation should we typically be able to see a heart beat but it still may be to early?

A

6wks

Heartbeat 110-130 with CRL of 1-5mm

124
Q

At what gestation should we DEFINITELY be able to see a heart beat?

A

7wks

125
Q

How do we manage an ectopic pregnancy?

A

REFER/CONSULT: Depends on hemodynamic stability.

Can be surgical or medication (methotrexate)

Follow up with serial BhCGs

126
Q

Which type of growth restriction holds less risk to the fetus? Why?

A

Asymmetric because it is brain sparing

127
Q

Describe asymmetric fetal growth restriction.

A

Head is larger than 10th%, occurs after 30 wks.

Can be caused by: any condition that causes decreased placental blood flow (HTN, renal dx, heart, dx, etc.)

128
Q

Describe symmetric fetal growth restriction.

A

Both the head and body are equally small. Occurs in early pregnancy and gets more severe.

Causes: Maternal malnutrition, Low PREpregnancy wt, No wt gain, Mulifetal gestation, Chromosomal abnormalities, Perinatal infection, Exposure to drugs, Environmental teratogens

Prognosis is poor

129
Q

What is the most high-risk vs. ideal type of twin pregnancy? What is the most common twin type?

A

High risk: Mono/Mono
Ideal: Di/Di

Most common: Monochorionic/diamniotic

130
Q

What is a succenturiate lobe and what adverse condition is it associated with?

A

Refers to a smaller accessory placental lobe that is separate to the main disc

Associated with retained placenta

131
Q

What is a circumvallate placenta and what adverse condition is it associated with?

A

Placenta abnormality where the membranes of the placenta to fold back around its edges.

Associated with: 2nd tri bleeding, PTB, PPROM

132
Q

What is a marginal cord insertion (battledore) and what adverse outcomes is it associated with?

A

When the umbilical cord is within two centimeters or less from the edge of the placenta.

No adverse outcomes!

133
Q

What is a velamentous cord insertion and what adverse outcomes is it associated with?

A

When the umbilical cord is implanted into the fetal membranes.

Associated with Increased risk of rupture or compression of the cord, PTB, FGR, Perinatal morbidity & mortality

134
Q

What cervical length requires no intervention in a patient WITHOUT a history of preterm birth?

A

> 20mm

135
Q

What cervical length requires no intervention in a patient WITH a history of preterm birth?

A

> 25mm

136
Q

What gestation is considered late term vs. post term?

A

Late term: 41.0-41.6
Post-term: 42+

137
Q

Which dermatosis of pregnancy are benign?

A

Atopic eruption of pregnancy and polymorphic eruption of pregnancy

138
Q

Which dermatosis of pregnancy are associated with maternal or fetal risks?

A

ICP
Pemphigoid Gestationis (PG)
Pustular Psoriasis of Pregnancy

139
Q

What is the next step if a patient has a positive antibody?

A

Determine the titer. Pt may need a referral to high risk!

140
Q

What blood types are ABO incompatibility most likely?

A

More likely with birthing person O blood and fetus A or B blood.

141
Q

What is a CST and how do you interpret the results?

A

Give patient oxytocin and cause 3 contractions in 10m. If the FHR in WNL and without decels, it is a negative result. If recurrent lates occur, it is a positive result.

142
Q

What outcome is a reactive NST?

A

2 or more accels within 20m

143
Q

What is a normal BPP result?

A

8/8 if NST not done. 6/10 is equivocal

144
Q

What is included in a modified BPP and what is a normal result?

A

NST and AFI

Normal: Reactive NST and AFI 5-23.9

145
Q

Which fetoscope should not be used intrapartum?

A

A pinnard

146
Q

What are the components of a BPP?

A

Fetal Movement (3+movements)
Fetal Tone (1+ episode extension and flexion)
Fetal Breathing (1+ episode of breathing for 30+s)
AFI (5-23.9)

With or without NST (Reactive)

2 pts or no pts for each

147
Q

How many movement should a patient expect over what period of time for fetal kick counts?

A

10 movements in 2 hours

148
Q

What is GDM A1 vs A2?

A

A1=diet controlled
A2=medication controlled

149
Q

What are the target BG levels in pregnancy?

A

Fasting: 95
1H PP: 140
2H PP: 120
HgA1c: <6.0%

150
Q

What is the recommended timing of delivery for a GDM A1 patient? What is the recommendation for fetal surveillance?

A

39-40.6

Surveillance: None

151
Q

What is the recommended timing of delivery for a GDM A2 patient? What is the recommendation for fetal surveillance?

A

Delivery: 39-39.6 for well controlled

Surveillance: 2xweekly NST and AFI start at 32w

152
Q

What is murphy’s sign and what does it indicate?

A

**Acute cholecystitis

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

153
Q

What pharm management options do we have for pregnant patients with GERD?

A

Tums->H2anatgonist (ex. Zantac/pepcid)-> PPI (ex. protonix)

154
Q

What are the microcytic anemias?

A

IDA
Thalassemias (A or B)
Chronic blood loss (ex. GI bleed)

155
Q

What are the normocytic anemias?

A

Acute blood loss anemia
Sickle cell
Anemia of chronic disease
Hbg C disease
G6PD deficiency

156
Q

What are the macrocytic anemias?

A

Folate Deficiency
B12 Deficiency
Medication Side effects
Liver Disease

157
Q

Why is it important to run hemoglobinopathies when a patient has a microcytic anemia?

A

Iron will not fix a thalassemia because it is a genetic condition!!

158
Q

What medications/foods are contraindicated with G6PD deficiency?

A

Sulfa, Macrobid, NSAIDs, methylene blue

Fava beans and legumes

Note: If a birthing person has this, notify peds as the newborn may have it as well.

159
Q

How are coagulation disorders managed during pregnancy? What type of pt is very high risk?

A

-anticoagulant tx w/ low-molecular weight heparin

High risk: BMI >30

160
Q

What is the diagnostic criteria for GHTN?

A

> 140/>90 on two separate occasions at least 4 hours apart

WITHOUT proteinuria or pre-E symptoms

161
Q

What is the diagnostic criteria for pre-eclampsia?

A

HTN and proteinuria

->300 mg/24 hour urine
-OR >1+ on dipstick
-OR PCR >0.3 mg/DL

If no proteinuria:
-Thrombocytopenia
-Impaired LFTs
-Renal insufficiency cr >1.1
-Pulmonary edema
-Visual disturbances

162
Q

What is the diagnostic criteria for pre-eclampsia with severe features?

A

HTN and proteinuria plus at least one of the following:

-BPs >160/>110 twice 15m apart
-Thrombocytopenia
-Impaired LFTs
-Renal insufficiency cr >1.1
-Pulmonary edema
-Visual disturbances

163
Q

What is HELLP?

A

-Hemolysis (low hemoglobin due to destruction of RBCs)
-Elevated Liver enzymes (greater than 40…probably quite higher)
-Low Platelets (less than 100,000)

Note: 20% dont have HTN or proteinuria

164
Q

How is toxoplasmosis transmitted and what are the fetal risks?

A

Transmission: cat feces, water, fruit, veggies, gardening, undercooked meat

Risks: Most asymptomatic at birth, 90% develop vision/hearing loss. developmental delay, SAB, PTB, FGR

165
Q

How is toxoplasmosis treated?

A

Spiramycin until 18wks then pyrimethamine, sulfadiazine, leucovorin

166
Q

How is Parvovirus transmitted and what are the fetal risks? How is it treated?

A

Transmission: young children (5ths disease)

Fetal risk: 1st trim=death, 2nd=severe anemia, hydrops, cardiac failure, liver damage, still birth

Treatment: NSAIDs and APAP

167
Q

How is varicella transmitted and what are the fetal risks?

A

Transmission: exposure to chicken pox for 5m

Risks: FGR, LBW, microcephaly, hydrocephaly, cognitive impairment, congenital varicella syndrome if infected <20w

Treatment: VZIG to mom and infant

168
Q

When is the biggest concern for transmission of syphillis and what are the fetal risks? What is the treatment?

A

Transmission: 16-28w

Risks: 40% miscarry, 80% of babys have congenital syphilis (deafness, congenital malformations, hepatomegaly, bone abnormalities, hydrops, jaundice, cholestasis, skin rash, pseudoparalysis), PTB, LBW, IUFD

Tx: Pen G

169
Q

Explain the quantitative titers used to monitor syphilis.

A

Titers should decline at least fourfold after treatment but this can take months to years. Someone with a titer or 1:32 that decreases to 1:8 indicates response to treatment. A four fold increase indicates a new infection.

Ex. 1:4 increases to 1:32

170
Q

How is rubella transmitted and what are the fetal risks?

A

Transmission: droplet

Fetal risk: deafness, cataracts, cardiac defects, SAB, FGR, stillbirth

Note: Extremely rare!!

171
Q

Explain the titers for rubella and what level indicated immunity

A

10 IU/mL or higher = immune (IgG antibody detected) = positive= seroprotected

8-9 IU/mL = equivocal

7 IU/mL or lower = non-immune = negative= non-seroprotected

172
Q

How is the cytomegalovirus transmitted and what are the fetal risks?

A

Transmission: Sex, body fluids, Toddlers -most common

Risk: Congenital anomalies, FGR, Microcephaly Hepatosplenomegaly, Thrombocytopenia, Hearing loss, Vision impairment, Learning disabilities
30% of infant mortality

173
Q

How is herpes transmitted and what are the risks to the fetus?

A

Transmission: highest risk during a primary outbreak and vaginal birth with active lesions

Risk: skin lesion, malformation of eyes, CNS dysfunction

174
Q

What medications are considered most safe in pregnancy for epilepsy?

A

Lamotrigine (Lamictal)
Levetiracetam (Keppra)

175
Q

What supplemental recommendations should be given to someone on medication for epilepsy?

A

Folic acid supplement of 4mg daily

176
Q

What are the S/S of a thyroid storm?

A

**HYPERthyroidism

Abrupt onset of N/V, diarrhea, FEVER (105.8 F), tachycardia, and tremor

Often precipitated by birth, trauma, or sx

177
Q

Why should asymptomatic bacteruria be treated in pregnancy?

A

Because it can cause pyelo or PTL

Treat 100,000+ colonies with no more than 2 microorganisms

Treat with macrobid for 7 days

178
Q

How should pyelo be managed?

A

Inpatient for pregnant people with IV abx until afebrile for 24-28hrs, then start on PO meds and d/c home

179
Q

List teratogenic medications

A

Androgens & Testosterone
Danocrine (Danazol)

Tetracyclines
doxycycline

Sulfonamides
Bactrim/ Septra

Aminoglycosides
Gentamycin
Streptomycin
Kanamycin

Anticonvulsants:
Tegretol
Dilantin
Tridione
Depakene- valporic acid

ACE inhibitors
Captopril
Enalapril
Lisinopril

Antidepressants
Paroxetine (Paxil)

Antineoplastics
Methotrexate

Anti-thyroid drugs
PTU
Methimazole (Tapazole)

Aspirin (& NSAIDS)
> 150 mg daily

Benzodiazepines
Alprazolam (Xanax)
Diazepam (Valium)

Corticosteroids: -Medrol

Coumarin (Warfarin)

Ergotamine (Cafergot)

Folic Acid antagonists
Tegretol
Dilantin

Misoprostol (Cytotec)

Accutane

Statins: Lipitor

NM 717 Comps (31 decks)

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