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Flashcards in OB- FA Step 2 Deck (54):
1

When do you use quantitative Beta-HCG

- Diagnose/follow ectopic pregnancy
- Monitor trophoblastic disease
- Screen for fetal aneuploidy (elevated in Tri 21, low in tri 18)

- Increases to about 100,000 mIU/mL by 10 weeks and decreases throughout 2nd tri
- doubles every 48 hrs in early pregnancy

2

When do you use quantitative Beta-HCG

- Diagnose/follow ectopic pregnancy
- Monitor trophoblastic disease
- Screen for fetal aneuploidy (elevated in Tri 21, low in tri 18)

- Increases to about 100,000 mIU/mL by 10 weeks and decreases throughout 2nd tri
- doubles every 48 hrs in early pregnancy

3

When can you detect pregnancy on ultrasound

Gestational sac visible on transvaginal US at 5 weeks GA
- Beta - hcg 1000-1500

4

What is considered excessive weight gain in pregnancy

> 1.5 kg/month (about 3.3 pounds)

5

What is considered inappropriate weight gain in pregnancy

6

What is the appropriate weight gain in pregnancy?

- BMI 29: 5-9 kg (11-20 lbs)
-

7

Cardiovascular changes in pregnancy

- HR increases by 20%
- Stroke volume increases
- BP decreases by 10% by 34 weeks then back up to pre-prego values
- Peripheral venous distention: increases to term
- Peripheral vascular resistance: decreases to term

8

Pulmonary adaptations of pregnancy

- Tidal volume: increases
- Expiratory reserve volume: decreases
- Respiratory rate: unchanged
- Respiratory minute volume: increases by 40%

9

Blood changes in pregnancy

- increase in RBC and increase in plasma volume more than RBC, so hemodilution
- Hct: Decreases
- Fibrinogen: Increases
- Electrolytes: Unchanged

10

GI changes in pregnancy

decreased sphincter tone and increased gastric emptying time

11

Organisms that cross the placenta

Toxo gondii
Rubella
HIV
VZV
CMV
Enteroviruses
Treponema pallidum
Listeria
Parvovirus B19

12

How often do pregnant women get checkups

- 0-28 weeks: every 4 weeks
- 29-35: every 2 weeks
- 36- birth: every week

13

What labs do you check at initial prenatal visit

Heme: CBC, Rh factor, type and
screen
- Infectious: UA and culture, Rubella, HbsAg, RPR/VDRL, gono/chlamydia, PPD, HIV, Pap smear. Consider HCV and varicella based on hx

- IF INDICATED: Hb A1C, sickle cell
- Discuss genetic: Tay-Sachs, CF

14

When do you screen for gestational diabetes

- 24-26 weeks unless at risk for diabetes (obese, fam hx) then screen asap

15

When to administer RhoGam

28 weeks for Rh negative; after any procedures/bleeding events

16

When do you do GBS culture

35-37 weeks

17

What is the quad screen

Done ~15-22 weeks
- MSAFP
- Inhibin A
- Estradiol
- Beta HCG

18

Quad screen for Trisomy 18 and 21

Everything is low for 18
- Low MSAFP/Estriol with high inhibin A/betaHCG for 21

19

When is amniocentesis indicated

- Women > 35 at time of delivery
- Abnormal quad screen
- Rh-sensitized pregnancy for fetal blood type/assess hemolysis
- Evaluate lung maturity (L:S >/= 2.5 or presence of phosphatidylglycerol)

20

Risk factors for spontaneous abortions

- Chromosomal abnormality
- Maternal thrombophilia
- Maternal immune issue (antiphospholipid Ab)
- Maternal anatomic issue
- Endocrine (DM, hypothyroid, prog deficient)
- Other: trauma, elevated maternal age, infection, dietary deficiency
- Environment: smoking, EtOH, caffeine, toxins, drugs, radiation
-Fetal: anatomic malformation

21

Risk factors for spontaneous abortions

- Chromosomal abnormality
- Maternal thrombophilia
- Maternal immune issue (APL ab

22

When can you detect pregnancy on ultrasound

Gestational sac visible on transvaginal US at 5 weeks GA
- Beta - hcg 1000-1500

23

What is considered excessive weight gain in pregnancy

> 1.5 kg/month (about 3.3 pounds)

24

What is considered inappropriate weight gain in pregnancy

25

What is the appropriate weight gain in pregnancy?

- BMI 29: 5-9 kg (11-20 lbs)
-

26

Cardiovascular changes in pregnancy

- HR increases by 20%
- Stroke volume increases
- BP decreases by 10% by 34 weeks then back up to pre-prego values
- Peripheral venous distention: increases to term
- Peripheral vascular resistance: decreases to term

27

Inevitable abortion

- uterine bleeding/cramps but NO POC expulsion
- OPEN OS/POC on ultrasound
- Tx: Misoprostol or expectant management; manual uterine aspiration if

28

Missed abortion

- cramping, loss of early pregnancy sxs, NO BLEEDING
- Closed Os/no heart activity, POC on ultrasound
- Tx: Misoprostol/expectant management; manual Uterine evac if

29

Intrauterine fetal demise

Absence of fetal cardiac activity >20 weeks
- Tx: Induce labor, evacuate uterusto prevent DIC at GA >16 weeks

30

Organisms that cross the placenta

Toxo gondii
Rubella
HIV
VZV
CMV
Enteroviruses
Treponema pallidum
Listeria
Parvovirus B19

31

How often do pregnant women get checkups

- 0-28 weeks: every 4 weeks
- 29-35: every 2 weeks
- 36- birth: every week

32

2nd trimester elevtive termination of pregnancy

13-24 weeks GA depending on state laws
- OB mgmt: induce labor (prostaglandins, amniotomy, oxygocin)
- Surgical management: D&E

33

When do you screen for gestational diabetes

- 24-26 weeks unless at risk for diabetes (obese, fam hx) then screen asap

34

When to administer RhoGam

28 weeks for Rh negative; after any procedures/bleeding events

35

When do you do GBS culture

35-37 weeks

36

What is the quad screen

Done ~15-22 weeks
- MSAFP
- Inhibin A
- Estradiol
- Beta HCG

37

Quad screen for Trisomy 18 and 21

Everything is low for 18
- Low MSAFP/Estriol with high inhibin A/betaHCG for 21

38

When is amniocentesis indicated

- Women > 35 at time of delivery
- Abnormal quad screen
- Rh-sensitized pregnancy for fetal blood type/assess hemolysis
- Evaluate lung maturity (L:S >/= 2.5 or presence of phosphatidylglycerol)

39

TORCHES pathogens

- Toxoplasmosis
- Other (Parvo, varicella, Listeria, TB, malaria, fungi)
- Rubella
- CMV
- Herpes simplex
- HIV
- Syphillis

40

Risk factors for spontaneous abortions

- Chromosomal abnormality
- Maternal thrombophilia
- Maternal immune issue (APL ab

41

What is recurrent spontaneous abortions

Two or more consecutive SABs or 3 in 1 year

- workup: karyotype parents, hypercoag panel, uterine anatomy

42

Most likely cause of spontaneous abortions

- Early (

43

Types of spontaneous abortions

Complete, Threatened, incomplete, inevitable missed, septic, intrauterine fetal demise

44

Complete abortion

- see bleeding/cramping stopped with products of conception expelled
- Closed OS
- No treatment

45

Threatened abortion

- Uterine bleeding, maybe abdominal pain
- NO POC expulsion
- Closed OS
- Treat with pelvic rest for 24-48 h and follow up US to assess viability

46

Incomplete Abortion

- Partial POC expulsion, visible tissue on exam
- OPEN OS/POC on US
- Manual uterine aspiration if

47

Inevitable abortion

- uterine bleeding/cramps but NO POC expulsion
- OPEN OS/POC on ultrasound

48

Missed abortion

- cramping, loss of early pregnancy sxs, NO BLEEDING
- Closed Os/no heart activity, POC on ultrasound

49

Intrauterine fetal demise

Absence of fetal cardiac activity >20 weeks

50

Nonviable pregnancy

Gestational sac >25 mm without a fetal pole or absence of fetal cardiac activity when CRL >7 mm on transvaginal US

51

Elective termination management - first trimester

First Trimester:
- Oral mifepristone + oral/vag misoprostol OR IM/oral methotrexate ? oral/vag misoprostol up to 49 days
- Vaginal/sublingual/buccal misoprostol (high dose) up to 59 days

SURGICAL (up to 13 weeks)
- Manual Uterine aspiration or D&C with vacuum aspiration

52

2nd trimester elevtive termination of pregnancy

13-24 weeks GA depending on state laws
- OB mgmt: induce labor (prostaglandins, amniotomy, oxygocin)
- Surgical management: D&E

53

normal fetal HR and variability

110-160 bpm
- nl variability is 6-25 bpm

54

What does sinusoidal variability indicate

Serious fetal anemia;
- pseudosinusoidal pattern may also occur during maternal meperidine use