OB Flashcards
1
Q
Name 9 conditions all associated with breech presentation
A
1) prematurity; 2) multip gest; 3) genetic disorders; 4) polyhydramnios; 5) hydrocephaly; 6) anencephaly; 7) placenta previa; 8) uterine anomalies; 9) uterine fibroids
2
Q
Name 6 conditions associated with increased incidence of shoulder dystocia
A
1) fetal macrosomia; 2) maternal obesity; 3) DM; 4) postterm pregnancy; 5) prior should dystocia delivery; 6) prolonged second stage of labor
3
Q
What qualifies as prolonged 2nd stage?
A
gt 3 hours (nulli)
gt 2 hours (multi)
4
Q
What qualifies as prolonged latent phase?
A
gt 20 hrs (nulli)
gt 14 hrs (multi)
5
Q
What qualifies as prolonged active phase?
A
slower than 1.5 cm/hr (nulli)
slower than 1.2 cm/hr (multi)
6
Q
What qualifies as arrest of active phase
A
4 hrs of adequate ctx (200 mV in 10 mins)
or
6 hrs of all type
7
Q
What is the most common type of breech (and the next two?)
A
Frank breech then footling, then complete
8
Q
When is the fetus at greatest teratogenic risk?
A
Weeks 3-8
9
Q
There is no increase seen in fetal anomalies or pregnancy losses with ionizing radiation exposure less than ___. Fetus is at greatest risk of exposure brown __ and __ weeks
A
5 rads; 8-15 weeks
10
Q
Smoking increases the risk of these 5 serious complications
A
1) placental abruption; 2) placenta previa; 3) fetal growth; 4) preeclampsia; 5) infxn
11
Q
Name 5 tocolytics
A
1) nifedipine; 2) terbutaline; 3) ritodrine; 4) magnesium sulfate; 5) indomethacin
12
Q
Which two tocolytics are contraindicated in diabetic pts? Which one in myasthenia gravis?
A
terbutaline and ritodrine (terbutaline is no longer used to stop preterm labor in anyone); magnesium sulfate
13
Q
___ (a tocolytic) is contraindicated at 33 weeks due to risk of premature __ closure.
A
Indomethacin; ductus arteriosus (also associated with oligohydramnios)
14
Q
How does magnesium sulfate work as a tocolytic? Beta adrenergic agents? CCB? NSAIDs?
A
by competing with calcium entry into cells; increasing cAMP thereby decreasing free calcium; CCBs prevent calcium entry into muscle cells by inhibiting ca transport; NSAIDs block PG production
15
Q
Name 3 side effects of magnesium sulfate and the order in which they appear. What is the antidote?
A
1) loss of DTR; 2) respiratory depression (12-15mg/dl); 3) cardiac depression (gt 15mg/dl)
calcium
16
Q
Name 2 bad side effect associated with nifedipine.
A
fetal hypoxia and decreased uteroplacental blood flow
17
Q
In addition to increasing pulmonary maturity and reducing the incidence of RDS in the newborn, betamethasone from 24-34 wks has been associated with a decrease in __ and __.
A
intracerebral hemorrhage; necrotizing enterocolitis
18
Q
___ is an extracellular matrix protein that acts as an adhesive btwn the fetal membranes and the underlying decidua. Its presence in the cervical mucus btwn __ and __ weeks is thought to indicate a disruption to the __. It has a strong positive/negative predictive value only
A
fibronectin; 22-34 (it is normally found in cervical secretions in first half of preg); maternal-fetal interface; negative (if you have negative you have a 99/100 chance of not delivering in the next 14 days)
19
Q
During delivery a fibrinogen is checked; what do you expect to see
A
fibrinogen should go up
20
Q
if a pregnant woman is hypotensive, what is the first thing you do?
A
turn her on her left side (ivc compression)
21
Q
what happens to a pregnant woman in regard to clotting?
A
clotting increases
22
Q
what pulmonary function test gets worse (decreases) in pregnancy?
A
FRC
23
Q
what is the expected change in hemoglobin in pregnancy?
A
blood volume increases but hgb (concentration) falls; normal is to nadir at 10
24
Q
what happens to the tidal volume in pregnancy?
A
increases
25
what is the expected change in creatinine in pregnancy?
goes down
26
How do you treat GERD in a pregnant woman?
PPI
27
prior to pregnancy what vaccines should mom receive? What vaccine can mom NOT get once pregnant?
influenza, hep B, MMRV; MMRV
28
What vitamin should a woman who wants to get pregnant be on?
folic acid
29
Mom has HTN and wants to get pregnant. What do you put her on?
alpha methyl dopa (hydralazine, labetalol, nifedipine)
30
Mom is Rh-antigen positive, what do you put her on?
nothing
31
Pt has diabetes and wants to get pregnant, what do you do?
switch to insulin
32
What are the followup periods for pregnancy?
q4w until 28 wks, q2w until 36 wks, q1w until delivery
33
What is the quad screen for down syndrome?
increased: bHCG, inhibin
decreased: AFP, estriol
34
What is sequential screening?
1st then 2nd trimester screens - more unnecessary testing, more abortion advantage
35
What is combine screening?
1st and 2nd trimester screens at once - less unnecessary testing, less room for intervention
36
Nuchal translucency screen - when and for what?
1st tri screening for aneuploidy and spina bifida
37
What age is considered increased risk for aneuploidy? (AMA age)
35
38
Rh ? mom, Rh+ baby, Rh Ab-, what do you do?
Rhogam at 28 wks and w/in 72 hrs from delivery
39
How do you screen for gestational diabetes?
1 hr glucose tolerance test - 50g, sugar should be less than 140
40
For 3hr glucose tolerance test, what are the four glucose levels to look for?
```
give 100g; fasting gt 95
1 hr gt 180
2hr gt 155
3hr gt 140
(need 2/4 to be positive)
```
41
What constitutes anemia in a pregnant woman?
hgb lt 10; hct lt 30
42
Rh ? mom, Rh + baby, what do you do?
check mom for antibodies
43
How do you test to confirm a pregnancy?
ultrasound
44
How do you treat fetal anemia?
PUBS and transfuse (PUBS = percutaneous umbilical cord sampling)
45
When do you get an amniocentesis? What can it show? What is the risk of loss?
16-20 wks; AFP, genetics, fetal lung maturity, assess for infxn; 0.5%
46
How do you screen for fetal anemia? How do you confirm?
transcranial doppler (highly sensitive); PUBS
47
When do you perform chorionic villous sampling? What can it show? What is the risk of loss?
10-13 wks; genetics, karyotyping; 1-3%
48
Which is more invasive, CVS or amniocentesis?
CVS
49
What medication can you use in pregnancy for hyperthyroid?
PTU
50
A pregnant woman has n/v so bad that she has electrolyte abnormalities, next step?
IV hydration (THEN work it up)
51
A woman gets pregnant and has hypothyroid, what do you do with her synthroid?
increase it (thyroid binding proteins are increasing) - trend TSH q4wks (instead of q12)
52
Who do you tx when you find a positive UTI without symptoms?
pregnant women only
53
Cystitis in pregnant woman, what do you give?
amoxicillin (nitrofurantoin if penicillin allergic) x 7d (complicated UTI!)
54
How do you diagnose diabetes BEFORE she gets pregnant?
A1c or 2 hr glucose tolerance test
55
Who do you screen with urinalysis?
pregnant women!
56
The thyroid has to come out. When is it safe for thyroidectomy?
2nd trimester
57
How do you tx pyelonephritis in a pregnant woman?
ceftriaxone - if no improvement after 3 days, U/S looking for abscess
58
Pregnant pt with epilepsy - what can you give to prevent seizures? What can you give to abort seizures?
levetiracetam or lamotrigine; phenobarbital or benzos (ok in late pregnancy)
folate for all women on AEDs looking to get pregnant!
59
Latent phase of pregnancy is __ to __ and should take no longer than __ (nulli) or __ (multi)
0cm to 6cm; 20 hrs; 14 hrs
60
Active phase of pregnancy is __ to __ and should take no longer than __ (nulli) or __ (multi), __ (max)
6cm to 10cm; 1.2cm/hr; 1.5 cm/hr; 5hrs
61
What is the beginning and end of stage 1 of labor
0cm w/contractions to 10 cm max dilation
62
What defines stage II of labor? How long should it take?
delivery of fetus - from max dilation 10 cm to fetus out; 3 hrs (nulli) or 2hrs (multi); add one hour for epidural
63
Breech birth + external version fails, whats next?
C section
64
Define stage III of labor. How long should it take?
delivery of placenta, from fetus out to placenta out; less than 30 minutes
65
Fetal station is the number of centimeters from the __
ischial spine
66
We can simulate head engagement with?
cervical ripening balloon (CRB)
67
If prolonged latent phase, how can you tx?
augmentation of labor (balloon, oxytocin, misoprostol, amniotomy)
68
Mom has been pushing for 3 hrs since maximum dilation, baby is still at station -1, next step?
assess for progress/descent of fetal head - if not progressing offer cesarean (this is how to tx prolonged 2nd stage with negative station)
69
Baby's head can be seen just at the vaginal opening, but it's been going for 4 hours (maternal exhaustion). Next step?
vacuum or forceps (this is how to tx prolonged 2nd stage with positive station)
70
Define arrest of active phase. How do you tx?
4hrs of adequate ctx (gt 200 mV) or 6 hrs all comer. If decreased frequency or adequacy, oxytocin; everything else: C/S
71
What is considered adequate frequency of contractions in labor?
3 ctx in 10 mins = good; less than 3 in 30 mins is bad (this tells you nothing about the power of the ctx)
72
What are the 3 ways to tx prolonged stage 3 of labor?
1st: uterine massage; 2nd: oxytocin; 3rd: manual extraction
73
Mom has a fever after delivering baby 6 hrs ago, placenta out came 5.5 hours ago, diagnosis and next step?
endometritis - antibiotics (gentamicin + ampicillin)
74
Mom has had ROM and she's been laboring for 20 hours. She's progressing, just slowly - diagnosis and next step?
prolonged ROM (gt 18 hrs!); give GBS ppx (ampicillin) - watch out for endometritis and chorioamnionitis
75
A woman at 20 gestational weeks has a rush of fluid, her membranes are ruptures, diagnosis and next step?
previable PPROM - counsel on expectant mgmt vs delivery; counsel on risk of infxn
76
Mom has a rush of fluid, she is at 38 wks, but not contracting, diagnosis and next step?
PROM (premature rupture of membranes); GBS ppx if indicated; induce labor
77
A woman at 30 wks has a rush of fluid, her membranes are ruptured. Diagnosis and next step?
PPROM (preterm premature ROM); steroids for fetal lung maturity (betamethasone) and antibiotics for latency
Infxn is usually cause for PPROM
78
How do you treat PPROM?
gt 34 weeks = deliver
24-34 wks = cortiocosteroids
lt 24 wks = nonviable
79
What does premature in PROM mean?
absent contractions
80
Name 4 ways to confirm ROM
1) speculum shows pooling of fluid; 2) nitrazine test turns blue; 3) fern sign on a glass slide; 4) can also do U/S for AFI (shows oligo)
81
A woman at 38 wks has a rush of fluid, her membranes are ruptured, next step?
Deliver!
82
Mom has contractions at 28 wks, but there is no cervical change, and then they stop, diagnosis?
Braxton hicks (ctx, but not labor)
83
At 42 wks mom still hasn't delivered; what do you do? What is called when baby is gt 42 wks? Name 5 fetal risks
induction of labor, if that fails C/S; post dates; 1) macrosomia; 2) shoulder dystocia; 3) meconium aspiration; 4) fetal demise; 5) oligohydramnios
84
Mom has ct. at 28 wks. There are cervical changes, diagnosis and next step?
Preterm labor; give mag sulfate (for neuroprotection); give steroids (for lung maturation) and can also give tocolytics (just really to get mom to a tertiary center)
85
Name 6 causes of preterm labor
1) idiopathic; 2) smoking; 3) young maternal age; 4) preterm mom; 5) anatomical (short cervical length); 6) multiple gestations (twins)
86
Proteinuria in pregnancy + HTN, diagnosis?
pre-eclampsia (look for severe features)
87
Pregnant woman seizing who does not have epilepsy, next step?
Mag, benzos, and deliver (eclampsia)
88
BP gt 160/110 in pregnancy, no HTN at baseline, diagnosis?
gestational HTN vs preeclampsia - look for proteinuria
89
Name 7 alarm sxs that earn you preeclampsia with severe features
1) decreased plts; 2) increased LFTs; 3) RUQ abdominal pain; 4) increase creatinine (gt 1.1 or 2x baseline); 5) pulmonary edema; 6) HA/vision changes; 7) BP gt 160/110
90
Why might you get RUQ abd pain and increased LFTs with preeclampsia?
There is a stretch of glisson's capsule leading to decreased blood flow to the liver, leading to increased LFTs; pain is due to inflammation and stretching of the capsule around the liver
91
HA, vision change, HTN in pregnancy, diagnosis and next step?
pre eclampsia with severe features; tx with Mag and deliver
92
RUQ pain and HTN in a pregnant woman, diagnosis?
Pre-E
93
How do you tx Pre-E without severe features? With severe features? Eclampsia?
antenatal testing, deliver at 37 wks if stable; Mag + BP monitor + deliver urgently (induce); Mag + deliver emergently (section)
94
You get a lab question about a delivery: INR is elevated, plts are low, fibrinogen is low/normal and hub is low. Likely dx?
DIC
95
How do you tx Pre-E without severe features and gt 37 wks
deliver
96
You get a lab question about a pregnant woman, AST and ALT are up, the plts are down, the hgb is low, dx and next step?
HELLP; Mag and deliver emergently (section)
97
What is the primary risk factor for preterm ROM? Name 3 other risk factors
genital tract infxn (especially assoc w/bacterial vaginosis); smoking, previous premature ROM, shortened cervical length
98
Variable decelerations are a result of ___, which is frequently caused by a lack of ___.
cord compression; lack of amniotic fluid (can be seen with oligohydramnios or PPROM)
99
In some cases of preterm ROM, amniocentesis may be performed to detect intra-amniotic infxn. A low __ is an indication of infxn. The presence of __ has the lowest predictive value for the dx of chorioamnionitis
amniotic fluid glucose; amniotic leukocytes
100
What can be administered weekly (starting btwn 16-20 wks to 36 wks) to reduce the risk of premature labor?
17-alpha-hydroxyprogesterone
101
Prostaglandins are used for cervical ripening and are contraindicated in pts with previous hx of __ b/c of increased risk of uterine rupture
cesarean delivery
102
Name 5 initial measures to tx fetal hypo perfusion (late decels)
1) change in maternal position to left lateral position (which increases perfusion to uterus); 2) maternal supplemental oxygenation; 3) tx of maternal hypotension; 4) discontinuation of oxytocin; 5) intrauterine resuscitation w/tocolytics and IV fluids
103
Amnioinfusion may be used in pts with __
variable decelerations
104
What is the most common cause of post partum hemorrhage?
uterine atony
105
Name 4 of 9 risk factors of uterine atony
1) precipitous labor; 2) multiparity; 3) general anesthesia; 4) oxytocin use in labor; 5) prolonged labor; 6) macrosomia; 7) hydramnios; 8) twins; 9) chorioamnionitis
106
Factors that lead to a __ are risk factors for uterine inversion. Name 4. But what is the most common risk factor?
over distended uterus; 1) grand multiparity; 2) multiple gestation; 3) polyhydramnios; 4) macrosomia;
excessive (iatrogenic) traction on the umbilical cord
107
Name 3 risk factors for genital tract lacerations
1) precipitous labor; 2) macrosomia; 3) instrument assisted delivery or manipulative delivery (i.e. breech extraction)
108
Name 4 uterotonics (used to increase contractions and decrease uterine bleeding).
1) methergine (methylergonovine); 2) prostaglandins (cervidil = dinoprostone = PGE2; hemabate = carboprost = prostaglandin F2alpha); 3) misoprostol (PGE1); 4) oxytocin
109
Which uterotonic should be withheld in pts with HTN and/or preeclampsia? Asthma?
methergine; hemabate (carboprost, PGF2alpha)
110
A risk factor for placenta accreta is ___.
multiple prior c sections
111
Name 4 risk factors associated with retained placenta
1) prior cesarean delivery; 2) uterine leiomyomas; 3) prior uterine curettage; 4) succenturiate lobe of placenta (smaller accessory placental lobe separate from the main disc of the placenta)
112
When is a B lynch suture used?
it is a uterine compression suture used in mgmt of unresponsive uterine atony (requires laparoscopic surgery)
113
What is the risk for mono/mono twins?
cord entanglement/accident
114
For conjoined twins, when did the eggs split?
greater than day 12
115
Name 4 risks of ALL multiple gestations
1) preterm; 2) malpresentation; 3) C/S; 4) PPH
116
Identical twins, 2 placentas, 2 sacs - when did the egg split?
Day 0-3
| monochorion diamnion split 4-8
117
What added risk does monozygotic, mono-chor, and di-amniotic have?
twin-twin transfusion
118
Which baby does better in twin-twin transfusion?
the transfuser (the little one) - the acceptor has polycythemia which can result in bilirubinemia
119
What added risk does mono-zy, mono-chor, mono-amnio have?
coinjoined twins, cord entanglement
120
Post partum hemorrhage and nonpalpable uterus, dx?
uterine inversion
121
PPH that cannot be controlled with meds, next step?
surgery - ligate arteries
122
When do you do a hysterectomy in the setting of PPH?
severe instability or failure of all other options
123
How do you tx uterine inversion?
replace funds with pressure - may need to relax uterus (tocolytics)
124
Placenta has vessels to the edge, next step?
suspected retained placenta - U/S
125
PPH and a firm uterus, next step?
U/S for retained placenta
126
PPH and a boggy uterus, dx?
uterine atony
127
What is the goal accelerations you are looking for?
15x15, 2 in 20 (before wk 32 its 10x10)
128
Mom can't feel baby kicking, no accelerations on NST, next step?
vibroacoustic stim test
129
Biophysical profile lt 4, next step?
deliver
130
Variable decels, what's the likely dx? Early decels? Late decels?
cord compression; head compressions; uteroplacental insufficiency
131
Mom can't feel baby kicking, next step?
NST - accelerations are good
132
Vessels run to the edge of placenta surface over cervical os, dx?
vasa previa
133
What do you do for a uterine rupture?
Emergent c/section
134
How do you diagnose an abruption?
clinically and u/s
135
Baby is in a transverse lie, question about bleeding, dx?
placenta previa
136
MVA and 3rd tri bleeding, dx?
placental abruption
137
Cocaine, HTN, and 3rd tri bleeding, dx?
placental abruption
138
Painless 3rd tri bleeding, dx?
placenta previa
139
Contractions, lots of pain, contractions stop, uterus is no longer firm, dx?
Uterine rupture (also look for detail about loss of fetal station in stem)
140
Rh-Ag-Neg mom, Rh-Ag-Neg dad, what's risk to baby?
None
141
Rh-Ag-Neg mom, Rh-Ag-Pos daad, what's the risk?
Mom will prime against the NEXT baby
142
Rh-Ag-Pos mom, Rh-Ag-Pos dad, what's the risk?
None (mom is Ag+ so she can never develop Ab)
143
Rh-Ag-Neg mom, Rh-Ag-Pos dad, mom's first pregnancy, what do you do?
Rh-immune globulin (Rhogam) at week 28 and within 72 hours of delivery
144
When do you deliver a fetus with fetal anemia?
Transcranial doppler screen is positive and GA is gt 32 wks
145
When do you PUBS and transfuse fetal anemia
transcranial doppler screen is positive and GA is lt 32 wks
146
List the tx for group B strep
Ampicillin, cefazolin (if pen allergic), clinda (if pen anaphylaxis), vanco (if can't tolerate any of above)
147
Who gets intrapartum antibiotics for group B strep (3 groups)?
If GBS positive ever. Prolonged ROM, intrapartum fever
148
Hep B core ANTIBODY means what?
They've been exposed (unsure if active infxn or immune - look for Hep B surface antibody)
149
Hep B positive mom, what do you do for baby?
IVIG and vaccine at birth (no evidence C/S reduces vertical transmission)
150
Mom giving birth, HIV positive, next step?
AZT during birth
151
Tx for late latent syphilis? Tertiary syphilis? Secondary syphilis? Primary syphilis? Early latent syphilis?
penicillin IM qwk x 3; penicillin IV x 7-10 days; penicillin IM x 1; penicillin IM x 1; penicillin IM x 1
152
When it's not clinical, make the diagnosis of HSV using ___.
PCR (never the tzanck prep)
153
What test do you use to diagnose primary syphilis? Tertiary syphilis? secondary syphilis?
Darkfield microscopy (pick "gram stain"); CSF VDRL; RPR to FTL-antibodies
154
Painful prodrome, vesicles on an erythematous base suggests?
HSV
155
Tx of tertiary syphilis in a pregnant woman allergic to penicillin?
Penicillin IV x 7-10 days (give it anyways! desensitize)
156
Tx for herpes simplex virus in a pregnant woman?
(Val)-acyclovir
157
What is a risk of vacuum suction delivery?
fetal: cephalohematoma
maternal: catching vagina in suction can cause vaginal trauma
158
What's wrong with opiates for pain control in labor?
They go to baby
159
Cephalohematoma = ?
Complication of vacuum delivery, hemorrhage beneath periosteum (will not cross suture line)
160
Why/when do you cerclage?
Dx of cervical insufficiency; usually placed in second tri
161
Station +2, fetal distress, what do you use?
forceps or vacuum
162
When do you undo the cerclage?
by 36 wks, or if labor begins
163
What do you need if you do epidural?
tocodynamometer (she can't feel ctx anymore)
164
What is female surgical contraception? Male?
tubal ligation; vasectomy
165
What are two major contraindications to OCPs?
gt 35 yo and smoking (increased risk of DVTs!)
166
What is the emergency contraception for condom failure/rape?
Plan B = levonorgestrel, or ella = ulipristal, or copper IUD
167
Postpartum fever day 0, 1-2, 2-3, 4-5, 5-6, 7-21
0: atelectasis
1-2: UTI
2-3: endometritis (risk factors c/s after prolonged ROM and prolonged labor)
4-5: wound infxn
5-6: septic thrombophlebitis or pelvic abscess (pelvic mass)
7-21: infectious mastitis
168
How do you manage a pt with septic thrombophlebitis?
IV heparin for 7-10 days, keeping PTT values at 1.5-2x baseline
169
Postterm pregnancies are associated with these 4 things
1) placental sulfatase deficiency; 2) fetal adrenal hypoplasia; 3) anencephaly; 4) inaccurate or unknown dates
170
Define postterm pregnancy; define late term
postterm: gt/= 42 0/7
| late-term: 41 0/7 to 41 6/7
171
Fetus is born and is withered, meconium stained, long nailed, fragile, and has an associated small placenta. What is this called and who do you see it in?
Dysmaturity; postterm pregnancies
172
The systolic/diastolic (S/D) ratio of the umbilical artery is determined by __. An increase in the S/D ratio reflects increased __. It is a common finding in __ fetuses.
doppler u/s; vascular resistance; IUGR
| increased S/D associated with increased rate of perinatal morbidity and mortality
173
IUGR is a significant risk factor for the subsequent development of diseases as an adult such as these 6
1) CV disease; 2) chronic HTN; 3) stroke; 4) chronic obstructive lung disease; 5) type 2 DM; 6) obesity
(asthma, cardiomyopathy, and type 1 DM are not associated with IUGR)
174
Macrosomia is defined as a fetus greater than ___. A fetus with biparietal diameter greater than __, could benefit from a C/S
4000 grams; 12 cm
175
What complication is less likely to occur with a vacuum then with forceps delivery?
maternal laceration
176
External cephalic versions and internal versions are contraindicated in ___. Instead, if baby is breech, do a __.
active labor; c/s
177
What are the four signs of placental separation?
1) gush of blood; 2) lengthening of the cord; 3) globular-shaped uterus; 4) uterus rising to the anterior abdominal wall
178
Hyperemesis gravidarum is a severe persistent form of n/v of pregnancy that results in __, __, and __. Name 3 risk factors.
weight loss of gt 5% pre pregnancy weight; electrolyte abnormalities; ketonuria
1) multiple gestation; 2) hydatidiform mole; 3) hx of esophageal reflux
(HG is typically unresponsive to anti-emetics
179
Name 7 contraindications to external cephalic version
1) indications for C/S delivery regardless of fetal lie; 2) placental abnormalities (prevue or abrupt); 3) oligo; 4) ROM; 5) hyperextended fetal head; 6) fetal or uterine anomaly; 7) multiple gestation
180
Name 5 risk factors of postpartum endometritis. What's the tx?
1) C/S; 2) chorioamnionitis; 3) group B strep colonization; 4) prolonged ROM; 5) operative vaginal delivery;
clinda + gentamicin
181
Which antibiotic is given for lactation mastitis?
dicloxacillin
182
To dx proteinuria for preeclampsia, you need a __ or __.
urine protein to cretatinine ratio of gt/= 0.3 or a 24-hr urine collection for total protein of gt 300mg
183
Name 6 contraindications to breast feeding
1) active untreated TB; 2) maternal HIV infxn; 3) herpetic breast lesions; 4) active varicella infxn; 5) chemo or RT; 6) active substance abuse
