Day 14 - Ob2 Flashcards Preview

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Flashcards in Day 14 - Ob2 Deck (14):
1

Hyperemesis gravidarum distinguished from normal morning sickness

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

2

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)

3

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

4

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)

5

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

6

Doses of radiation considered safe in pregnancy

7

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

8

Congenital defects assoc w/ maternal zoster reactivation

None

9

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)

10

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

11

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)

12

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

13

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)

14

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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