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Flashcards in Clinical Aspects of Pregnancy Deck (26):
1


When is screening done for gestational diabetes?

What screens are done?
 

Screen Asx'c women: 24-28 weeks

  • 50-g one-hour glucose challenge = >130 mg/dL test is (+) screening test
    • To Dx/Confirm 100-g three-hour oral glucose tolerance test (NORMS are Fasting = 90,  1 hour = 165, 2 hour = 145, 3 hour = 125);
      • Two or more abnormal values are Dx'c for GD

2

What is the physiology behind gestational diabetes?

What is the major consequence of GD?

  • After 12 weeks gestation, maternal glucose crosses the placenta and fetal beta cells can produce insulin
  • If maternal glucose level is elevated after 12 weeks gestation, fetal insulin production increases-->
    • ​^^growth hormone effects of this insulin lead to fetal macrosomia [big baby>8lbs. 14oz] causing:
      • shoulder dystocia, brachial plexus injuries, hypoglycemia, clavical fractures
         

3

What are the consequences of GD on the mom?


Approximately 50% of women with gestational diabetes will develop type 2 diabetes within five to 10 years.

Recommend screening with oral glucose tolerance test at three year intervals.
 

4

What puts a mom at ^^risk of GD?

  • >35 yo
  • BMI >25
  • family Hx of DM
  • Hx of previous GD
  • macrosomia in previous pregnancies
  • high-risk ethnicities [Hispanic, Asian, Native Am]

5

What are signs of pre-term labor?

What is pre-term labor?

 

preterm labor= cervical change associated w/ uterine contrxns b4 37 wks


IN nulliparous woman,  uterine contractions with 2 cm dilation and 80% or greater effacement
 

6

What q's need to be answered in the assessment of pts w/ preterm labor?


What is the gestational age? 
Are the membranes ruptured? 
Is the patient in labor? 
Is there an infection? 
What is the likelihood that the patient will deliver prematurely?  
 

7

What are the risks of these infections during pregnancy:

VZV

parvo

CMV

Rubella
 

VZV: 1stTri ^^risk of spontaneous abortion, possible teratogenic threat

  • (Varicella zoster immune globulin is available –if exposed receive VZIG within 72 hours)

Parvovirus: fetal hydrops [fetal hemolytic anemia), follow infant w/ serial US & transfusion

Cytomegalovirus – may cause infant abnormalities- no treatment

Rubella: CRS (congenital rubella syndrome) deaf, cardiac abnorm's, cataracts, mental retardation

8

What can these infxns cause during pregnancy?

HIV

N. Gonorrhea

Chlamydia

Syphilis

Toxoplasmosis

HepB

HIV: C-section has been shown to lower transmission rates ..mom stays on triple therapy in pregnancy to keep their HIV viral load down

N. Gonorrhea: eye, oropharynx, external ear and anorectal mucosa

Chlamydia: conjunctivitis and Chlamydia pneumonia

Syphilis: vertical transmission- late abortion, stillborn infant , congenitally infected infant

Toxo: severe if transmitted to fetus in first trimester-seizures, hydro- or microcephaly, hepatosplenomegaly, jaundice, chorioretinitis

**Hep B causes things too but idk what

9

What is the differential diagnoses of antepartum bleeding?
 

What are your first 2 steps in eval?

Do ultrasound 1st!! [abd before transvaginal]

Then could do speculum exam

Differential!!
Placenta Previa (painless bleeding)
Placenta Abruption (painful contractions

10

When does vaginal bleeding occur with placental previas?

starts after 20 wks gest.

11

What is...

Complete placental previa [PP]?

Partial PP?

Marginal PP?

Low lying placenta?

placental abruption?

vasa previa?

 

Complete placenta previa: placenta completely covers the internal cervical os
Partial placenta previa: placenta partially covers the internal cervical os
Marginal placenta previa: placenta abuts against the internal cervical os
Low lying placenta: edge of placenta is within 2-3 cm of the internal cervical os
Placental abuption: Premature separation of a normally implanted placenta
Vasa previa: Umbilical cord vessels that insert in the membranes with the vessels overlying the internal cervical os, vulnerable to fetal exsanguination upon rupture of the membranes
 

12

Do we want babies facing up or down?

describe suture lines and how baby is presenting?

We want babies looking down!

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13

Abnormal presentations of baby that [most] require C sxn probably

breech= ^^ risk of hip dysplasia [esp in females] later

Vertex is probably able to have a vaginal birth

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14

What are consequences of HTN in pregnancy?
 


}Pregnancy Induced Hypertension: HTN w/o proteinuria @ >20 wks gest.

  • Pre-eclampsia: BPs >140/90 @>20wks w/ proteinuria & edema [strange criteria]
  • Eclampsia: all of above + grand mal seizures 
  • HELLP: hemolysis, elevated liver enzymes, low platelets

 

**hemmorrhage should be another concern
 

15

What would make us start to assess fetal well-being?


}Problem is suspected after 32 weeks
}Determine if the baby can survive if delivered early
}Severity of the mother’s condition
}Concern regarding the risk of stillbirth
 

16

What special tests can help us determine fetal well-being in utero [esp w/ complications of pregnancy]?

  • Fetal movements- DONT DO THIS ONE: ask moms to count this--> raises anxiety!!!
  • Non-stress testing
  • Oxytocin stress testing
  • Ultrasound- assess fetal growth
  • Biophysical Profile
  • Amniocentesis
     

17

What is nonstress testing?

pt is connected to monitor to measure baby's HR [should ^ when moving]

18

What is Oxytocin stress testing?

when do we do this test?

OxST

  • IV OT to induce contrxns
  • assess fetal heart tones [FHT]
    • should show variability w/o decelerations during contrxn

 

***DO this when NONSTRESS TEST RESULTS are NONREASSURING

19

What is biophysical profile?

BPP

Five categories with score 0-2 for each (F the BATH-->babies don't like baths)

  • Amniotic Fluid Volume
  • Fetal Tone
  • Fetal Activity
  • Fetal Breathing Movements
  • Fetal Heart Rate Reactivity (Nonstress test)

**Score of 8-10 normal
 

20

What can amniocentesis tell us?

 

WHY DONT WE DO THIS RIGHT AWAY?

lots of stuff but in concern for fetal well being we care about:

1) fetal lung maturity

2) Amniotic fluid index

 

DONT DO RIGHT AWAY: cuz there can be complications such as indxn of labor

21

WHat is Bishops scale/criteria?

What is it used for?

Used to evaluate if indxn should happen or not:

-score= 5 would be unfavorable for indxn

-gray area

-score>/= 8 would be favorable for indxn [cervix is probably ripe and indxn successful]

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22

How do we Tx depression in pregnancy? [general]

Tx is ESSENTIAL

Psychotherapy (preferably CBT or interpersonal psychotherapy) is recommended for treatment of mild-to-moderate depression during pregnancy.

  • Clinicians & pts should make decisions about pharmacotherapy collaboratively.

Electroconvulsive therapy is an option in severe depression.

  • Patients with severe depression, acute suicidality, psychosis, or bipolar disorder should receive psychiatric referrals.

23

Define post-partum depression?

How is it different from "Baby Blues"?

PPD: Major depressive episodes with post-partum onset, within 4 weeks after childbirth

baby blues: start @ 3rd-4th day postpartum & last < 1 wk

24

What antidepressant medications can be used in pregnancy?

TCA's

SSRIs

Bupropion-also smoking cessation

25

What is the criteria for major depressive depisode?

5 or more Sx's in 2 wks:

  • mood
  • interests
  • eating/w8
  • sleep
  • psychomotor activity
  • fatuigue
  • self-worth
  • concentration
  • thoughts of death or suicide

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