OB - 2 Flashcards by Krupa Harishankar

When are antibiotics recommended for ppx use for endocarditis?

No longer recommended!
May consider if hx endocarditis, unrepaired cyanotic disease, or prosthetic valve
Ampicillin 2g

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What factors convey Risk Of Heart Attack?

Race, Obesity, HTN, Age

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What are most common cardiac illnesses in pregnancy and postpartum?

Heart failure, MI, arrhythmia, aortic dissection

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NYHA Classification of Heart Disease

Class 1 - no compromise
Class 2 - mild fatigue with activity
Class 3 - fatigue with less than normal activity
Class 4 - fatigue at rest

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What is the most common rheumatic heart lesion?

Mitral stenosis

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What pathology does mitral stenosis have?

Fixed cardiac output d/t narrowed valve
Blood accumulates in L atrium, backs up into lungs, causes heart failure

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What is the treatment for mitral stenosis?

Prevent tachycardia with beta blockers

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What strategies are employed in laboring patient with cardiac disease?

Vaginal delivery preferred
- Except Marfan’s > CS!
Allow to labor down
Shorten 2nd stage with OVD

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What is the treatment of thyroid storm?

PTU followed by iodide
Steroids, beta blockers

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What are the risks of epilepsy in pregnancy?

IUGR, IUFD, PEC

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What are some of the adverse effects of anti-epileptics?

Decreased folate (give 4mg)
Decreased Vit K (give upon delivery)
Decreased Vit D

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What are the drugs of choice for epilepsy in pregnancy?

Lamotrigine (textbook)
Keppra (reality)

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What are the effects of valproate on pregnancy?

NTD

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What is fetal hydantoin syndrome?

Growth restriction
Microcephaly
Mental retardation
Phalangeal hypoplasia

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What are the clinical criteria for APLS?

Vascular
- Venous or arterial thrombosis
Pregnancy
- Loss > 10w
- SAB x3 < 10w
- Delivery at <34w for PEC/IUGR

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What are the lab criteria for APLS?

On 2 occasions >= 12w apart
- Beta-2 glycoprotein
- Anti-cardiolipin
- LA

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With APLS, what is the (percent) risk of: fetal loss?

50%

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With APLS, what is the (percent) risk of: PEC?

50%

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With APLS, what is the (percent) risk of: IUGR?

25%

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With APLS, what is the (percent) risk of: thrombosis?

10%

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What are antepartum considerations for APLS?

ASA + ppx AC
Surveillance for PEC and thrombosis
Growth US in 3rd tri for risk of IUGR
NST surveillance
Postpartum AC x6w

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What are some causes of symmetric IUGR?

Genetics, TORCH, malaria, syphilis, congenital anomalies

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What are some causes of asymmetric IUGR?

Placental insufficiency

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When to deliver: uncomplicated IUGR (3-10%ile)?

38-39w

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When to deliver: complicated IUGR (oligo, abn doppler, maternal conditions)?

34-38w

When to deliver: severe IUGR (<3%ile)?

37w

When to deliver: IUGR DCDA twins (uncomplicated)?

36-38w

When to deliver: IUGR DCDA twins (complicated)?

32-35w

What are some causes of TCP in pregnancy?

Gestational Immune (ITP, TTP) PEC Drugs (SQH, AZT) HIV

When do you treat TCP in pregnancy?

Plt < 50k or bleeding diathesis

What is the antigen implicated in NAIT?

HPA-1a, Plt antigen

When to deliver: DCDA twins (uncomplicated)?

38-39w

When to deliver: MCDA twins (uncomplicated)?

34-38w

When to deliver: MCMA twins (uncomplicated)?

32-34w

What are some maternal complications of twin gestation?

Hyperemesis Anemia DVT/PE Pyelo CS

What are some OB complications of twin gestation?

PPROM, PTL HTN/PEC/HELLP Acute fatty liver GDM Placenta previa PPH

What are some fetal complications of twin gestation?

IUGR, Congenital anomalies /Hydramnios, Cerebral palsy, cord accident (MCMA), TT Transfusion (MCDA, MCMA)

What are some complications of preterm labor? (RIPNS)

RDS, IVH, PDA, NEC, Sepsis

When is IM progesterone (17-OHP) recommended?

For women with hx PTD, give 16-26w

When is vaginal progesterone recommended?

Short cervix <= 20mm before 20w

What are the criteria for US indicated cerclage?

<25mm before 24w GA and hx PTD < 34/mid tri loss

What are the criteria for history indicated cerclage?

Hx one or more 2nd tri delivery (without labor)

What are the criteria for exam indicated cerclage?

Advanced cervical dilation without labor, abruption, or infection evident

Post term pregnancy is associated with:

Perinatal mortality, meconium aspiration, convulsions, low 5-min Apgars, low cord PH, oligo, dysmaturity syndrome, macrosomia

If you don't know the gestational age of a patient, how can you determine if they are term?

Early US suggesting EGA > 39w Positive HCG x 36w Fetal heart heard with Doppler x 30w device x 20w

How do you treat GBS if pt PCN allergic?

Normally: PCN 5mil u f/b 2.5mil u q4 hrs If not true allergy: ancef 2g q6 If susceptible to clinda + erythromycin: Clindamycin 900mg q8 hrs If not: Vancomycin 20mg/kg q8 hrs

When do you treat a pt who is GBS unk?

Preterm ROM => 18 hrs Fever => 100.4 Known GBS pos in prior pregnancy

What is the risk of transmission for and severity of toxoplasmosis in each trimester?

1 - 15% (severe) 2 - 30% (mod) 3 - 60% (mild)

What is the clinical presentation of fetal toxoplasmosis?

Intracranial calcifications, chorioretinitis, hearing loss, mental retardations, HSM

What is the prevalence of acute primary CMV and risk of vertical transmission, neonatal disease, death?

Prevalence 3% Vertical transmission 30% of these 3% Neonatal disease: 30% Death: 30%

What is the clinical presentation of fetal CMV?

Chorioretinitis, HSM, IUGR, Hydrops

What is the vertical transmission rate of Parvovirus, and what occurs in each trimester?

25% 1st tri - SAB 2nd/3rd tri - Hydrops, IUFD 2/2 anemia

What fetal surveillance is required once mom tests positive for Parvovirus?

Serials weekly US for 2 mo after maternal infection to evaluate fetal wellbeing and signs of hydrops.

What is the rate of survival with fetal Parvovirus?

With treatment - 80% Without treatment - 20%

What is this clinical presentation of maternal Parvovirus?

Rash, arthritis, flu-like illness, mostly asymptomatic

What is the clinical presentation of maternal Varicella?

Primary rash or shingles, PNA, Encephalitis

What is the clinical presentation of fetal Varicella?

SAB, Varicella embryopathy (eyes, limbs, skin, CNS effects), IUFD (high risk if <5d prior to delivery)

What is PEP for Varicella?

Varicella immunoglobulin and Acyclovir 800mg 5x daily x7d

What are the symptoms of Zika virus?

Fever, maculopapular rash, arthralgia, conjunctivitis, myalgias, pruritis, vomiting

How do you screen for Zika virus?

Potential exposure, travel to endemic area by patient or partner, symptoms

What testing is performed for Zika virus?

Test symptomatic pregnant people with possible exposure, up to 12w after symptoms onset, with concurrent IgM and NAT testing If ongoing exposure, testing 3 times during pregnancy with Zika NAT of serum and urine

If considering conception, how long must you wait after a Zika exposure?

Female partner - 8w Male partner - 6mo

What is the clinical presentation of maternal Listeria?

GI illness and flu-like symptoms (myalgia, N/V, diarrhea), fever

What are the fetal and neonatal effects of Listeria?

Fetal - IUFD, PTL Neonatal - Meningitis, Sepsis, Death

How do you manage a patient exposed to a recalled Listeria product?

Asymptomatic - nothing, observe Mild sx no fever - manage as asymptomatic or send blood cx, only treat if cx+ Fever +/- other sx - test and treat simultaneously (ampicillin or bactrim)

What is the definition of AIDS?

HIV+ and CD4< 200

What are the rates of vertical transmission of HSV with: - Primary infection - Non-primary 1st episode - Recurrent infection?

- Primary: 50% - Non-primary 1st: 33% - Recurrent: 3%

What is the dose of Valacyclovir for - Primary infection + non-primary 1st episode - Recurrent infection - Suppression?

- Primary + non-p 1st: 1000mg bid x10d - Recurrent 500mg bid x3d - Suppression 500mg bid from 36w

What the effects of obesity on pregnancy?

Increased risk of SAB and recurrent SAB, IUFD, PEC, macrosomia, congenital anomalies (cardiac, orofacial, limb, NTD), childhood obesity and asthma, ADHD, autism spectrum

What micronutrients should be monitored after bariatric surgery?

Folate, Fe, Vit D, B12, Ca

What is the different diagnosis of fetal hydrops?

Immune (Rh disease) Non-immune - Anemia - Parvo or CMV - Congenital heart defects - Placenta problems: AV malformations, fetal maternal hemorrhage

What vaccines are acceptable in pregnancy?

Tdap, Flu, Hep A + B, Pneumococcus

What vaccines are contraindicated in pregnancy?

MMR, Varicella, HPV, Intranasal Flu

What is the ddx of oligohydramnios?

ROM, IUGR, SGA, TORCH, renal agenesis, Idiopathic

What is the ddx of polyhydramnios?

Diabetes, esophageal atresia, duodenal atresia, TORCH, syphilis, hydrops, genetic anomalies, idiopathic

OB - 2 Flashcards

(75 cards)