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First AId 2CK COPY > Obstetrics - MTB > Flashcards

Obstetrics - MTB Flashcards

1
Q

Pregnancy

A
  • suggest in patient w/ amenorrhea, enlargment of uterus and + urinary B-hCG
  • confirmed w/ gestational sac, fetal heart motion, fetal heart sounds, and fetal movement
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2
Q

Presence of gestational sac

A
  • seen by transvaginal U/S at 4-5 weeks

- corresponds to B-hCG level of 1500 mIU/mL

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3
Q

Fetal heart motion

A
  • seen by U/S at 5-6 weeks
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4
Q

Fetal heart sounds

A
  • seen by U/S at 8 - 10 weeks
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5
Q

Fetal movements

A
  • felt by examining physician after 20 wees
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6
Q

Gravidity

A

number of pregnancies

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7
Q

Parity

A

number of births with gestational age > 24 months

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8
Q

21 y/o primigravida, para 0 (G1P0) presents for her first prenatal visit at 11 weeks gestation, which is confirmed by OB sono. No risk factors. What screening tests will you perform?

A
  • CBC (to check for blood disorders)
  • Blood type, Rh and antibody (type and screen, Direct and indirect Coombs)
  • Cervical PAP smear
  • Urinalysis/ urine culture
  • Rubella anibody
  • Hep B surface antigen
  • RPR
  • HIV Elisa
  • Cervical culture
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9
Q

Anemia in pregnancy

A
  • look for Hb < 10
  • most common cause is Fe deficiency
  • WBC > 16K is abnormal
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10
Q

If CBC returns w/ decr Hgb and decreased MCV. Next step?

A
  • Give Fe

- Test for thalassemia is anemia doesn’t improve

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11
Q

If CBC returns w/ decr HgB and increased MCV. Next step?

A

Give folate to treat possible folate deficiency

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12
Q

If CBC returns w/ thrombocytopenia (< 150K)

A
  • correlate clinically for ITP or HELLP syndrome
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13
Q

Testing for Rh and antibody during pregnancy

A
  • Rh negative mothers may become sensitized (anti-D antibody) which increases risk of erythroblastosis fetalis
  • Indirect Coombs test for atypical antibody test
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14
Q

RhoGAM indication

A
  • give to Rh negative mothers at 28 weeks after first rescreening for absence of anti-D antibodies
  • given to Rh negative mothers after any procedure (CVS, amniocentesis) and after delivery
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15
Q

Cervical Pap smear during pregnancy

A
  • detects cervical dysplasia or malignancy
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16
Q

Urinalysis/ Urine Cc

A
  • screen for underlying renal disease and infeection
  • UCx screen for asymptomatic bacteruris
  • always treat ASB to prevent pyelonephritis
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17
Q

ASB: treatment

A
  • Nitrofurantoin (before 30 weeks), Cephalosporins, and Amoxicillin
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18
Q

Rubella antibody

A
  • test in 1st trimester
  • Negative rubella IgG ab means increased risk of primary rubell a infection
  • DO NOT GIVE RUBELLA IMMUNIZATION DURING PREGNANCY
  • Immunize seronegative patients after pregnancy
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19
Q

Hepatitis B surface antigen

A
  • tested in 1st trimester
  • Positive HBsAg indicates risk for vertical transmission of HBV
  • If (+) HBsAg, order HBVe to check for active infection
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20
Q

Syphillis testing

A
  • done in 1st trimester
  • confirm (+) VDRL or RPR with FTA or MHATB
  • If (+) confirmatory test, treat with IM penicillin
  • If penicllin allergic, desensitize and treat w/ penicillin
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21
Q

HIV ELISA

A
  • test in 1st trimester
  • confirm w/ Western blot test (presence of HIV core and envelope
  • all babies born to HIV (+) will have HIV antibody due to passive transport of maternal As
  • ARVs are not contraindicated in pregnancy`
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22
Q

Chlamydia/Gonorrhea

A
  • cervical culture in 1st trimester

- also treat trichomonas vaginalis

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23
Q

Chlamydia/Gonorrhea: treatment in pregnancy

A
  • PO azithromycin + IM ceftriaxone (treatment of choice)

- Alternative: PO amoxicillin

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24
Q

Bacterial vaginitis: treatment

A
  • PO metronidazole or clindamycin PO

-

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25
Q

Trichomonas vaginalis

A
  • PO metronidazole
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26
Q

Optional tests during 1st trimester

A

Tuberculosis

Trisomy 21: early testing with PAPP-A and fetal nuchal translucency

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27
Q

Tuberculosis testing in 1st trimester

A
  • optional test
  • test for exposure in high risk moms
  • (+) test is induration, not erythema
28
Q

TB management in pregnancy

A
  • If (+) PPD, order CXR to r/o active disease
29
Q

Treatment for (+) PPD

A

(+) PDD and (-) CXR: Isoniazide and B6 for 9 mths
(+) PPD and (+) CXR (+) sputum: triple therapy antiTB if sputum stain positive
** Avoid streptomycin in pregnancy for risk of ototoxicity

30
Q

Trisomy 21: Early testing

A
  • B-hCG
  • PAPPA
  • Fetal nuchal translucency
  • offered to high risk pregnancies (> age of 35 y.o at delivery or women w/ prior hx of Trisomy 21)
31
Q

Trisomy 21 (Early Testing): Management

A

(+) screening test is confirmed w/ CVS sampling in 1st trimester

32
Q

Maternal serum alpha fetoprotein (MS-AFP)

A
  • increases w/ gestational age and is expressed in MoM
  • > 2.2 MoM is considered elevated
  • < 2. 2 MoM is considered normal
33
Q

Inhibin A

A

made by placenta during pregnancy and normally remains constant during 15th - 18th week of pregnancy
- is increased in blood in mothers of fetuses w/ Downs Syndrome

34
Q

23 y.o F (G3P1 Abortion 1) is seen at 17 weeks gestation. She recently underwent triple marker screen w/ MS-AFP (normal

A

U/S

- most common cause of abnormal MS-AFP is gestational dating error

35
Q

Second Trimester Optional Tests

A
  1. MS-AFP
  2. B-hCG
  3. Add Inhibin A in high risk women (increased sensitivity to 80%)
36
Q

Increased MS-AFP

A
  • neural tube defect (NTD)
  • ventral wall defect
  • twin pregnancy
  • placental bleeding
  • renal disease
  • sacrococcygeal teratoma
37
Q

Decreased MS-AFP

A
  • Trisomy 21 (Down syndrome)

- Trisomy 18

38
Q

Trisomy 21

A
  • decreased MS-AFP
  • decreased estriol
  • increased B-hCG
39
Q

Trisomy 18 (Edward syndrome)

A
  • decreased MS-AFP
  • decreased estriol
  • decreased B-hCG
40
Q

Pt has abnormal MS-AFP. Next step?

A
  1. Perform U/S to confirm dates
  2. If dating error, repeat MS-AFP
    If normal, repeat MS-AFP is reassuring
41
Q

If patient has abnormally increased MS-AFP and dates have been confirmed by ultrasound. Next step?

A

For increased MS-AFP,

  • do aminiocentesis for amniotic fluid alpha fetoprotein level and acetylcholintersase activity
    • elevated amniotic fluid acetylcholinesterase activity are specific open to NTD
42
Q

If patient has abnormally decreased MS-AFP and dates have been confirmed by U/S. What’s next step?

A

For decreased MS-AFP

- amniocentesis for karyotyping

43
Q

38 y.o F (G2P1) is at 27 weeks gestation. She weighs 227 lbs. She has gained 30 lbs during her pregnancy but reports that most of it is fluid retention. She was diagnosed w/ gestational diabetes during her last pregnancy. Which of the following is the next step in management?

A

Obtain 1-hr 50 g OGTT (indicated in 24-28 weeks)

– if positive, then patient undergoes confirmatory 3 hr 100g OGTT

44
Q

What conditions do you test for during 3rd trimester of pregnancy

A
  • Diabetes
  • Anemia
  • Atypical antibodies
  • GBS Screening
45
Q

Diabetes during pregnancy

A
  • test during 24- 28 weeks of pregnancy
  • screening test: 1hr 50g OGTT
    • abnormal result is > 140mg/dL
    • if (+) screening test: perform 3hr 100g OGTT for glucose intolerance
46
Q

Anemia during pregnancy

A
  • Do CBC at 24-28 weeks
  • Hemoglobin < 10 g / dL = anemia
  • Most common cause is Fe deficiency
47
Q

Atypical antibody testing during pregnancy

A
  • Do Indirect Coombs test
  • performed on Rh-negative women to look after anti-D antibodies before giving RhoGAM
  • RhoGAM is not indicated in Rh negative women who have developed anti-D antibodies
48
Q

GBS Screening during pregnancy

A
  • test for vaginal and rectal cx for GBS (35-37 weeks)
  • (+) GBS is high risk for neonatal sepsis. Tx with intrapartum IV abx (IV penicillin G, IV clindamycin or erythromycin in penicillin allergic patient)
49
Q

Confirmatory testing for diabetes in pregnancy

A

3hr 100g OGTT

50
Q

Gestational diabetes: diagnosis

A

After taking 3hr 100 g OGTT

  • if plasma glucose > 125 mg/dL at beginning of test - DIABETES MELLITUS
  • abnormal plasma measurements > 140 mg/dL at 3 h, 155 mg/dL at 2h, and > 180 mg/dL at 1h
  • if > 2 of postglucose load measurements are abnormal, the diagnosis is GESTATIONAL DIABETES
51
Q

Impaired glucose tolerance after 3hr 100g OGTT

A
  • only 1 postglucose load measurement is abnormal
52
Q

Indications to give RhoGAM to Rh negative mothers

A

Give to Rh negative mothers:

  • at 28 weeks
  • within 72 hrs of delivery
  • after miscarriage or abortion
  • during amniocentesis or CVS
  • with heavy vaginal bleeding
53
Q

N/V Management during pregnancy

A
  • Doxylamine
  • Metoclopramide
  • Ondansetron
  • Promethazine
  • Pyroxidine
54
Q

Third Trimester Bleeding

A
  1. Perform initial management
    - Vitals, external fetal monitor, IV fluids
  2. Order lab tests
    - CBC, DC w/u, type and crossmatch, obstetric U/S
  3. Further steps in management
    - Blood xfusions, foley catheter, vaginal exam to r/o lacerations, scheule delivery if fetus is > 36 weeks
55
Q

When do you perform speculum exam or digital exam in pregnant patient w/ late trimester vaginal bleeding?

A
  • Digital rectal exam OR speculum exam

MUST DO VAGINAL U/S TO R/O PLACENTA PREVIA

56
Q

Abruptio Placenta

A
  • sudden onset vaginal bleeding
  • severe constant pelvic pain in patient w/ hx of HTN or trauma (e.g. MVA)
  • bleeding results from avulsion of anchoring placental villi from lower uterine segment
57
Q

Feared complication of abruptio placenta

A

Disseminated intravascular coagulation (DIC)

- release of thromboplastin into the circulation

58
Q

Placenta Previa

A
  • sudden onset painless bleeding occurs at rest or during activity w/o warning
  • includes hx of trauma, coitus, or pelvic examination before bleeding occurs
  • occurs when placenta is implanted in lower uterine segment
59
Q

Complete placenta previa

A
  • the placenta covers the entire os
60
Q

Incomplete placenta previa

A
  • the placenta partially covers the cervical os
61
Q

Placenta accreta

A
  • if placental implantation occurs over a previous uterine scare, the villi may invade into the deeper layers of decidua basalis and myometrium
  • intractable bleeding may require cesarian hysterectomy
62
Q

Vasa Previa

A
  • life-threatening for the fetus

- occurs when velamentous cord insertion results in umbilical vessels crossing the placental membranes over cervix

63
Q

Vasa Previa: Classic triad

A
  1. Rupture of membranes
  2. Painless vaginal bleeding
  3. Fetal bradycardia

** Emergency C-section is always 1st step management

64
Q

Uterine rupture

A
  • hx of uterine scar w/ sudden-onset abdominal pain and vaginal bleeding associated w/ loss of electronic fetal heart rate, uterine contractions, and recession of fetal head
65
Q

Abruptio placenta: risk factors

A
  • Previous abruption
  • Hypertension
  • Trauma
  • Cocaine abuse
66
Q

Abruptio placenta: diagnosis

A

Placenta in normal position +/- retroplacental hematoma

67
Q

Abruptio placenta: management

A
  1. Emergent C-section:
  2. Vaginal delivery > 36 weeks or continued bleeding.
  3. Admit and observe if bleeding has stopped, vital and fetal heart rate stable, or < 34 weeks

First AId 2CK COPY (22 decks)

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