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Obstetrics > High-Risk, Antepartum > Flashcards

High-Risk, Antepartum Flashcards

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1
Q

Cerclage Indications

A
  1. history
  2. physical exam
  3. ultrasound
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2
Q

Delivery Timing for PPROM

Mgmt

A

~34w0d

inpatient, steroids, latency abx, MgSO4

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3
Q

When to give MgSO4 for fetal neuroprotection (GA)

A

≤ 32w0d

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4
Q

History-Indicated Cerclage Reasons:

A
  1. hx painless cervical dilation in 2T
    or
  2. hx of prior cerclage
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5
Q

Physical Exam-Indicated Cerclage Reason:

A
  1. 1-4cm dilation (painless) in mid-second trimester

aka “rescue” cerclage (avg of 4wks GA gained!)

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6
Q

Sono-Indicated Cerclage Reason

A

CL <25mm
<24wks
hx PTB <34w

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7
Q

MCC fetal death in mono-mono twins

A

cord entanglement (rate as high 17%)

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8
Q

“TAPS” stands for

A

Twin Anemia Polycthemia Sequence

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9
Q

TAPS definition

MoA

A

form of TTTS

tiny AVS anastamoses (not large AVS like TAPS)

can occur after incomplete laser ablation for TTTS

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10
Q

TAPS vs TTTS differences

A

-AVS anastamoses size
-TAPS = normal amniotic fluid, polycthemia/anemia
-TTTS = different amniotic fluid levels, poly/oligo

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11
Q

TRAP sequence stands for…

A

Twin Reversed Arterial Perfusion sequence

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12
Q

TRAPS sequence findings

type of twinning

A

acardiac twin
pump twin (supplies blood to itself and acardiac twin)

monochorionic

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13
Q

Antenatal Surveillance for maternal anti-SSA/SSB+
(timing, GA)

Looking for what?

A

16-26wks GA: fetal echo qWeek
26-34wks GA: fetal echo q 2wks

neonatal lupus -> fetal heart block

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14
Q

Cervical Insufficiency risk factors

A
  1. cervical trauma / procedures (D&C, LEEP, CKC)
  2. congenital cervical defects / uterine anomalies
  3. collagen d/o
  4. DES exposure
  5. inc IL-8
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15
Q

Nifedipine as tocolytic can be used up to what GA?

A

<34w

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16
Q

indomethacin as tocolytic can be used up to what GA? (and why?)

A

<32w (premature closure of ductus arteriosus)

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17
Q

MgSO4 for neuroprotection

GA? timing (when do you stop?)

what does it protect against?

A

GA: <32w
Stop: if delivery not imminent (~4hrs away) after risk has passed(i.e. after 24hrs monitoring)

protects against: CP (does not reduce hypoxic-ischemic encephalopathy)

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18
Q

B2 agonist (tocolytic) adverse fx

A

maternal tachy
palpitations
pulmonary edema (MoA is sodium retention -> vol overload)

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19
Q

Nifedipine (CCB tocolytic) adverse fx

A

-maternal dizziness, flushing, hypotension
-decreased heart contractility -> maternal brady

MoA: less calcium ,less ctx

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20
Q

monochorionic twin demise ->
risk for surviving twin

neuro, death

A

neuro injury: 18%
death: 15%

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21
Q

dichorionic twin demise ->
risk for surviving twin

neuro, death

A

neuro injury: 1%
death: 3%

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22
Q

PPROM incidence in U.S.

A

2-3% pregnancies

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23
Q

AFLP: deficiency

Outocmes

A

LCHAD deficiency

increase in maternal fatty acid levels -> hepatic toxicity

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24
Q

TTP MoA

outcomes

A

reduces ADAMSTs13 activity (a vWF-cleaving metalloprotease)

uncleavesd VWF -> aggregation -> microangiopathy ->TTP

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25
fetal demise: best method to obtain fetal cells for karyotyping? | why?
amniocentesis | 80-100% viable cells (compare to tissue, placenta, skin s/p demise)
26
pancreatitis in pregnancy causes
gallstones (mcc) alcohol HLD AFLD (rare) ERCP complication
27
Effects of inadeq. maternal hyperthyroidism
-IUGR -tachy -> Fetal hydrops->demise -PTD -miscarriage
28
Preterm birth % in US
10%
29
SLE rx in pregnancy
-hydrocychloroquine (plaquinil) safe, reduces risk of neonatal luus | mycophenolate = teratogenicity, inc risk loss
30
Does hydroxychloroquine cross placenta?
yes but not assoc w/ fetal toxicity
31
thrombocytopenia incidence in pregnancy
7-12%
32
MC congenital cardiac malformation
VSD | account for 50% of cardiac malformations
33
Tetrology Fallot Anatomy Findings
1. VSD 2. Overriding aorta 3. pulm stenosis 4. RV hypertrophy
34
Tet Fallot sx
cyanosis
35
Tet fallot "self-mgmt" and MoA
squatting -> inc venous return to heart, inc SVR -> dec R to L shunt
36
Uterine rupture risk: 1. hx 1 transverse CS 2. hx 2 transverse CS 3. classical CS
1. hx 1 transverse CS: 0.5% 2. hx 2 transverse CS: 1-2% 3. classical CS: 10%
37
fetal fibronectin positive predictive value: -1wk -2wk | *if cervix dilated >1cm or ctx
1wk: ~12% 2wk: ~16% | low PPV, meaning positive = not good at ruling IN preterm delivery ## Footnote only 13%of pts with +ffn will deliver in next 7d, but almost half will deliver before 37wks
38
fetal fibronectin negative predictive value: -1wk -2wk
1wk: 99% 2wk: 99% | good at ruling out PTD within 1-2wks of test performed
39
what is fetal fibronectin
extracellular matrix protein at decidual-chorionic interface | FFN measures disruption of interface 2/2 infxn, abruption, ctx
40
FFN can be used at what GA?
22-34wk | *22-30w during routine prenatal visits (says the company that makes it..
41
hydrops cause
fluid accumulation in peritoneal cavity, pleura, skin edema
42
hydrops types
1. immune - RBC alloimmunization 2. nonimmune (cardiovascular > chromosomal, hematologic, infxn, TTTS,GI, etc)
43
most-common infxn cause of non-immune hydrops
parvo
44
hydrops pathophys
fetal anemia or increased central venous pressure -> fillign issues or inc CO -> fluid buildup
45
infective endocarditis ppx abx + timing
2g amoxicillin x1 30-60mins prior to procedure / delivery
46
high-risk individuals who need labor IE Abx ppx
1. prosthetic valve 2. hx IE 3. unrepaired cyanotic heart disease 4. repaired heart defect <6mo 5. repaired heart defect with residual defects 6. cardiac transplant recipient with valve regurg
47
IE abx ppx?for hx childhood (remote) repaired heart defect, no prosthetic material
no
48
IE abx ppx? for repaired heart defect with residual defects
yes
49
IE abx ppx?for hx childhood (remote) repaired heart defect, with prosthetic material
yes prosthetic cardiac valve)
50
IE abx ppx? cardiac transplant recipient
no | (unless has valve regurg due to structurally abnormal valve)
51
ffn PPV within 7d in sx women (ctx)
30%
52
delivery timing accreta
34-35w6d
53
retroplacental myometrial thickness finding in placenta accreta
<1mm
54
mgmt short cervix (20mm) w/o hx preterm birth
vaginal progesterone | IM not helpful
55
mgmt short cervix (24mm) w/o hx preterm birth
no intervention | (b/t 20-25mm)
56
why do insulin requirements inc in pregnancy?
human placental lactogen (hPL) and estrogen increase in pregnancy -> insulin sensitivity
57
IHCP Etiol / MoA
poorly understood
58
IHCP sx
pruritis (worse on palms, soles, at night)
59
IHCP tx
UDCA
60
IHCP delivery timing
36w0-39w0d | if bile acids >100, ~36w

Obstetrics (16 decks)

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