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NNP I > Maternal Hx WK1 > Flashcards

Maternal Hx WK1 Flashcards

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1
Q

DM - Types

A
  • DMI
  • DMII
  • GDM
    • Diet VS
    • Insulin controlled
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2
Q

DM - Incidence

A
  • DM 6-8% preg
  • GDM 90% DM preg
  • DMII 10% DM preg
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3
Q

GDM: when dx

A

24-28wk

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4
Q

DM - WNL Preg and Patho

A
  • Decrease insulin sensitivity
    • Wnl - increase insulin secretion
    • DM - insufficient insulin –> hyperglycemia
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5
Q

DM - Risk Factors

A
  • AMA
  • Multiple gestation
  • >BMI
  • Family hx
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6
Q

DM: Complications

A
  • Stillbirth (esp DMI)
  • Congenital malformations (esp DMI/II)
  • Hypoglycemia
  • Hypocalcemia
  • Hypomag
  • Macrosomia
  • IUGR
  • Asphyxia
  • RDS (up to 38wk)
  • TTN
  • Hyperbili
  • Polycythemia
  • Larger organs - except kidney and brain
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7
Q

DM: Congenital Malformations

A
  • Congenital malformations (esp DMI/II)
    • CV (most common) - VSD, Tet, TGV, ASD, coarc, hypoplastic L heart, double outlet RV, truncus arteriosus, cardiomegaly
    • CNS - spina bifida, anencephaly, hydrocephalus
    • GI - intestinal atresia, anal atresia
    • GU - renal agenesis, ureteral duplication, hypospadias
    • MSK - skeletal dysplasia, caudal regression sx (fixed flexed legs, absent sacral/lumbar vert, sacral agenesis, urinary incontinence, renal dx, heart dx)
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8
Q

DM: CHTN and Severe Vasculopathy Complications

A
  • Uteroplacental insufficiency
  • IUGR
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9
Q

DM: Fetal Hyperglycemia Complicaitons

A
  • Hyperinsulinemia
  • Hypoglycemia
  • Hypocalcemia
  • Cardiomyopathy
  • RDS
  • Demise
  • Polyhydramnios (rt osmotic diuresis)
  • Child obesity
  • Child insulin resistance
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10
Q

HTN: Types and Definitions

A
  • CHTN - <20wk
  • GHTN - >20wk
  • PE - >20wk w proteinuria
    • <32-34wk severe
    • CHTN + PE - <20wk w proteinuria
  • Eclampsia - seizures
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11
Q

HTN: Incidence

A
  • 10% preg HTN
  • 5-8% preg PE
  • 1% preg PE w severe features
  • 0.1% preg eclampsia
  • 15-20% maternal mortality rt HTN
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12
Q

HTN: Risk Factors PE

A
  • >40yr
  • hx PE/CHTN
  • DM
  • multiple gestation
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13
Q

HTN: Complications

A
  • IUGR
  • PT
  • abruption
  • demise
  • fetal acidemia
  • thormobocytopenia (esp IUGR)
  • neutropenia (esp IUGR, multiple gestation, association sepsis)
  • hypermag
  • NEC (esp abnormal end diastolic flow)
  • RDS (esp <32wk)
  • BPD

NOT IVH/PVL, NOT CP

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14
Q

ID: Required to chart mom positive in baby chart

A
  • HIV
  • HEP B
  • GBS
  • Syphilis
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15
Q

HIV: Transmission Incidence

A

<1% w <1,000 copies/ml viral load

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16
Q

GBS: Transmission Route

A
  • L/D most common
  • in utero –> stillbirth
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17
Q

HIV: Risk Factors

A
  • STI <12m
  • IV drug use or partner
  • new sex partner, >1 partner preg
  • partner HIV or high risk
  • care in hospital high incidence HIV
  • location high incidence HIV
  • Incarceration
  • s/s HIV infection
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18
Q

HIV: Screening

A
  • PNC - opt out antigen/antibody test T1, repeat T3 <36wk high risk
  • Unknown prepartum - rapid HIV (confirm test, asap ART)
  • Unknown postpartum or positive maternal - infant DNA
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19
Q

HIV: Delivery Implications

A
  • >1,000 copies/ml or unknown w/o labor AND w/o ROM - c/s 38wk, IV zidovudine 3hr preop
  • >1,000 copies/ml or unknown w labor OR ROM - no consensus
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20
Q

HIV: Transmission Route

A

L/D

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21
Q

HEP B: Transmission Incidence

A
  • <1% transmission HBsAg positive w tx
  • 30% transmission HBsAg positive w/o tx
  • 85% transmission HBeAg positive w/o tx
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22
Q

HEP B: Risk Factors

A
  • STI >12m
  • IV drug use or partner
  • new sex partner, >1 partner preg
  • partner HIV or high risk
  • care hospital high incidence HEP B
  • location high incidence HEP B
  • incarceration
  • s/s HIV infection
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23
Q

HEP B: Screening

A
  • T1 - HBsAg screen
    • if positive - screen HBeAg, Hep B virus DNA, alanine aminotransferase, refer GI, repeat T3
  • T3 or L/D repeat positive or high risk
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24
Q

HEP B: Vaccine

A
  • HBsAg positive
    • HBIG (HEP B immunoglobulin), HEP B <12hr
  • HBsAg unknown
    • HBIG <12hr
    • <2,000g - HEP B <12hr
    • >2,000g - HEP B <7d or d/c
  • HBsAg negative
    • <2,000g - HEP B 1m or d/c
    • >2,000g - HEP B <24hr
  • admin separate sites
  • HEP B vaccine x3-4 dose w serologic testing 1-2m s/p final dose
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25
HSV: Incidence
* Most common STI world * 40-80% mortality * 60-80% HSV transmission w/o s/s * 3-5% transmission w recurrent infection * increase risk transmission w 1ary infection * 66% HSV infant onset illness \<1wk
26
HSV: Stages of Infection
* 1ary * 2ary * Latent * 3ary
27
HSV: Risk Factors Intrapartum Transmission
* 1ary infection * cervical lesions * PT * prolonged ROM * instrumented delivery * fetal scalp electrodes
28
HSV: Transmission Route and Incidence
* 85% perinatal/peripartum * 10% postnatal * 5% intrauterine
29
HSV: Complications 1ary Infection
* highest risk transmission * demise * PT
30
HSV: Complications T1 Recurrent Infection
* skin vesicles * chorioretinitis * microcephaly * microopthalmia * intracranial calcifications * seizures
31
Syphilis - Incidence
* 1mil w preg * 40% fetal/perinatal death syphilis preg * 40-50% congenital syphilis fatal
32
Syphilis: Types
* 1ary infection - after incubation 10-90d s/p exposure * 2ary infection - 4-10wk s/p 1ary w/o tx * latency * 3ary infection
33
Syphilis: Transmission Routes
* transplacental * L/D - contact active lesions
34
Syphilis: Risk Factors
* poor PNC * illicit drugs * high risk sex * hx STI * underserved location * teen preg
35
Syphilis: Complications Congenital Syphilis w/o tx
* non immune hydrops * IUGR * hemolytic anemia * hepatospleomegaly * maculopapular rash * condyloma rata * CNS involvement\ * bone abnormalities
36
Syphilis: Screening
* PNC * 1st PNC * 28-32wk repeat high risk * L/D admission high risk * Nontreponemal test * VDRL * RPR * if positive, confirm w treponemal * Treponemal test * FTA-ABS * TP-PA
37
GBS: Incidence
* most common cause early onset sepsis * 20-25% women colonized GBS * 90% decrease transmission w tx PCN G or amp
38
GBS: Screening
* 36-\<37wk - vaginal rectal culture * PT labor or PROM - vaginal rectal culture * \>37wk w unknown - rapid NAAT test * GBS test \>5wk onset labor - repeat vaginal rectal culture * exceptions * GBS bacteriuria any time preg * hx GBS
39
GBS: ABX Indications
* GBS positive w labor or ROM * NO IAP if c/s w/o labor AND w/o ROM * GBS unknown w * \<37wk * \>100.5 (38C) * ROM \>18hr * NAAT positive GBS * hx GBS
40
GBS: ABX Types
* only appropriate tx - PCN G or amp * PCN allergy NOT effective infant * Cefazolin * Clindamycin * Vancomycin
41
HIV: Infant MGMT, Screening, Tx
* NO breastmilk * Screen: HIV RNA or DNA (NOT antibody) * ART \<12hr postpartum * tx stable \<1,000 copies/ml - zidovudine 4-6wk * tx and \>1,000 copies/ml - multidrug ART
42
DM: Prenatal MGMT
* A1C\<7% * 400 microg folic acid - decrease risk neural tube defect * 18wk early level II US (major anomalies) * 22wk - fetal echo
43
GDM: Screening
* 16wk - w risk factors * 24-28wk - universal
44
DM: Delivery MGMT
* well controlled insulin dependent - expectant mgmt until 39wk * poorly controlled - LPT, early FT delivery
45
Multiple Gestation: Incidence
* twins 3% preg - decreasing
46
Multiple Gestation: Zygosity Types
* Monozygotic - 1 ova splits, identical * Dizygotic - 2 ova, fraternal
47
Chorionicity: Definition
* # outer membranes and placenta
48
Amnionicity: Defintion
* # inner membranes, amniotic fluid sacs
49
Monozygotic: Types and Timing
* DCDA - cleavage 1-4d s/p fertilization * MCDA - cleavage 3-8d s/p fertilization * MCMA - cleavage 8-12d s/p fertilization * Conjoined - cleavage \>13d s/p fertilization
50
Dizygotic: Types
* DCDA * fused * separate
51
Monozygotic: Risk Factors
* Family hx * IVH * higher parity (esp AA, NOT Asian)
52
Monozygotic: Incidence
* 20% twin preg
53
DIzygotic: Risk Factors
* Yoruba (Nigerian) * IVH * Ovulation inducing agents * AMA * Family hx * Higher parity (esp AA, NOT Asian)
54
Multiple Gestation: Screening
* T1 - cell free DNA aneuploidy screen w single nucleotide polymorphism * Postnatal
55
Multiple Gestation: Complications
* PT * 36-36wk twin * 32wk triplet * Demise * Congenital anomalies * IUGR * Aneuploidy (esp dizygotic) * CP * c/s * maternal HTN/PE (earlier and more severe vs singleton)
56
Multiple Gestation: MC Complications
* PT * Growth discordance - 20% MC preg * TTTS - 15% MC preg * donor - IUGR, hypovolemia, hypotension, anemia, thrombocytopenia, oligohydramnios, compression anomalies, hypoxia → heart failure and hydrops * recipient - polycythemia, polyhydramnios, LGA, cardiomegaly, congestive heart failure, pulmonary edema * TAPS twin anemia polycythemia sequence - 3-5% MC preg, hgb 5+g/dL difference * TRAP twin reversed arterial perfusion sequence - 1% MC preg * Unexpected fetal death * Congenital anomalies (esp CCHD) - 5-10% MC preg * c/s * Cord enlargement * Skeletal anomalies
57
Multiple Gestation: MA Complications
* Similar MCDA congenital anomalies vs MCDA * \> demise vs MCDA * Always c/s
58
Multiple Gestation: MGMT
* MPR multifetal preg reduction - ppx PT DC * Selective termination - DC, MC w cord occlusion * Low dose aspirin \<16wk - ppx PE, PT
59
Multiple Gestation: Delivery MGMT
* DCDA twin - 38-\<39wk * MCDA twin - 34-\<38wk * MCMA twin - 32-\<34wk * \>multiples - individualized
60
SLE: Incidence
* 4,500 preg/yr US
61
SLE: Complications
* PT 47% * demise 40% * PE 25% * IUGR 15%
62
SLE: Risk Factors Poor Preg Outcomes
* proteinuria * renal insufficiency * antiphospholipid antibody sx * thrombocytopenia * active matern dx at conception * nephritis * anti SSA (Ro) antibodies (risk fetal congenital heart block)
63
SLE: Contraindicated Meds
* methotrexate * mycophenolate mofeitl
64
SLE: Safer Meds
* prednisone * axathioprine * hydroxychloroquine
65
AAS: s/s
* antiphospholipid antibodies aPL * venous thrombosis * hx preg loss * thrombocytopenia
66
AAS: Prevalence
50:100,000
67
Neonatal Lupus: Preg MGMT
* screen fetal congenital heart block
68
Neonatal Lupus: Complicaitons
* 16-24wk AV node injury common * congenital heart block
69
Neonatal Lupus: MGMT
* congenital heart block * pacemaker VS transplant * fluorinated steroid 2nd degree heart block
70
ITP: Incidence
* 7-10% preg thrombocytopenia (rt gestational common, PE, ITP) * 1:1,000 preg ITP
71
ITP: Complications
* neonatal thrombocytopenia * hemorrhage VS gestational thrombocytopenia - benign
72
ITP: Delivery MGMT
* do NOT alter delivery mode
73
Fetal Hydantonin Sx: Defintion
* pattern mental and physical birth defects rt anticonvulsant drugs
74
Fetal Hydantoin Sx: s/s
* craniofacial * broad nasal bridge * wide fontanel * low set hairline * broad alveolar ridge * metopic riding * short neck * ocular hypertelorism * microcephaly * cleft lip w or w/o palate * abnormal or low set ears * epicanthal folds * ptosis * coloboma * coarse scalp hair * limb * small or absent nails * hypoplasia distal phalanges * altered palmar crease * digital thumb * dislocated hip * NDI
75
Chorio: Incidence
* 1-5% preg * e. coli most common PT (NOT GBS)
76
Chorio: Types
* Acute * Subclinical - histologic, w/o s/s, chronic
77
Chorio: Dx
* Fever 39C+ OR x2 30min apart 38C+ * w/o cear source * + 1 below * FHR \>160 rest 10+min * Maternal WBC \>15,000 (esp L shift), NOT on corticosteroids * Purulent fluid cervical os via speculum * histologic chorio - placenta pathology
78
Chorio: Patho
* wnl - cervical mucus plug (physical barrier, abx peptides), fetal membranes, placenta protect fetus from bacteria * organisms (common polymicrobial) invade intrauterine space via cervix * in utero inflammation -→ fetal IL production -→ increase surfactant production -→ lung maturation
79
Chorio: Risk Factors
* ROM \>18hr * prenatal testing - amniocentesis, chorionic villus sampling * frequent UTI * maternal fever
80
Chorio: Complications
* PT * Demise * Asphyxia * Early Onset Sepsis 40% * Septic Shock * PNA * Meningitis * IVH * Cerebral white matter damage * BPD (rt alteration lung maturation) * NDI (esp CP)
81
Chorio: MGMT
* early onset sepsis risk calculator (kaiser tool) * tx vs NO tx * NOT valid \<34wk, NOT late onset sepsis
82
Viral Infection: Transmission
* in utero * postnatal
83
Viral Infection: Complications
* IUGR * Hydrops * Hepatomegaly * Splenomegaly * Pneumonitis * Bone lesions * Rashes * Hematologic abnormalities
84
Viral Infection: MGMT
* early detection * time of exposure important

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