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Flashcards in Day 14 - Ob2 Deck (14):

Hyperemesis gravidarum distinguished from normal morning sickness

Weight loss exceeding 5% of pre-pregnancy body weight, Detection of ketone urea due to starvation


W/u Hyperemesis gravidarum

Wt., Orthostatic bp, Serum free T4, electrolytes, urine ketones; Expected lab abnormalities w/ vomiting (including elevations of AST & ALT, not more than 1000, Lipase, Amylase, not more than 5x normal, Bili); US to detect gestation trophoblastic disease (molar pregnancy - HTN & hyperemesis in first trimester, multiple gestations - hyperemesis)


Tx Hyperemesis gravidarum

Conservative mgt; Choice: Vitamin B6; Doxylamine (sleep aid); Ginger; May use ry to avoid i can have something safer works: Promethazine, Ondansatron, Metoclopramide; IVF w/ multivitamins & thiamine, if necessary; If refractory & losing weight, NG tube feeds as last resort


Adverse effects w/ maternal marijuana use

Smoking at least 6 joints per wk, then small head circumference for age at all ages; No prematurity or congenital anomalies; Increases risk of using alcohol and cigarettes; Later in life - increased incidence of psychiatric problems (ADHD, depression, substance abuse) & certain cancers (Non-lymphoblastic leukemia, Rhabdomyosarcoma, Astrocytoma)


Teratogenic effects seen w/ ACEi/ARBs

Renal tubular dysplasia, Renal failure, Oligohydramnios, IUGR, Limb contactures, Pulmonary hyperplasia, Lack of cranial ossification (facial malformations), in utero death


Doses of radiation considered safe in pregnancy


Congenital findings assoc w/ new varicella infx during pregnancy

Skin dermatomal scarring, Chorioretinis, Cataracts, microopthalmopathy?, nystagmus (EYES), microcephaly, cortical atrophy, mental retardation, dysplasia of hands/feet, low birthweight, early death


Congenital defects assoc w/ maternal zoster reactivation



When to provide intrapartum GBS ppx

Vaginal rectal screening (swab culture) at 35-37 wks; If GBS bacteruria during current pregnancy, then calls for intrapartum GBS ppx; History of early onset GBS infx in prior infant, intrapartum fever, preterm labor, prolonged ROM (regardless of GBS screening results)


Antibx used for intrapartum GBS ppx

Penicillin G (preferred); Ampicillin; If pen allergic, only rash - Cephalexin; airway compromise - GBS cultx to determine sensitivity (Clindamycin, Erythromycin); If not know sensitivity, then use Vancomycin; Tx last 4 wks


Exposure to rubella in utero - findings

IUGR, radiolucent bone, hepatosplenomegaly, thrombocytopenia, purpuric skin lesions (blueberry muffin rash), hyperbili; sensorineural deafness, cataracts/glaucoma, cardiac (PDA, pulmonary artery stenosis); Neuro (meningeal encephalitis, behavioral disorders)


Congenital defects assoc w/ in utero CMV infx

90% asymptomatic at birth - 15% of these develop progressive hearing loss (usually unilateral); Defects at birth - SGA, hepatosplenomegaly, petechiae/purpura, jaundice (similar to Rubella); Neuro (microcephaly, seizure, intracranial calcifications/chororetinitis/hydrocephalus - like Toxo); Thrombocytopenia, hemolytic anemia


Feat. of congenital syphilis

Early - hepatosplenomegaly, elevated LFTs, hemolytic anemia, jaundice, rash (followed by desquamation of hands and feet), snuffles (blood tingled nasal secretions), Radiographic changes at birth (metaphyseal dystrophy, periostitis); Late (if not tx) - Hutchinson's teeth, Saddle nose, Frontal bossing, Saber shins (anterior bowing of tibia)


Indications for MTX for ectopic pregnancy (rather than surgical excision)

Hemodynamically stable, Reliably compliant pt w/ posttx monitoring, pre-treatment serum B-HCG

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