OBGYN 4 Flashcards
(42 cards)
Describe intrahepatic cholestasis of pregnancy (ICP)
o Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash
Describe Pruritic urticarial papules and plaques of pregnancy
o A common skin condition of unknown etiology unique to pregnancy characterized by intense pruritic and erythematous papules on the abdomen that spread extremities and often the buttocks
Treatment of intrahepatic cholestasis of pregnancy
♣ Ursodeoxycholic acid (UDCA) – decreases total serum bile acid levels and helps to relieve the itching
♣ Fetal testing with plan for early deliver (37-18 weeks) due to increased risk of stillbirth
What is considered a reactive NST
> /= 2 accelerations in a 20 min period
What are the components of a biophysical profile
- NST
- Fetal breathing
- Fetal tone
- Fetal movement
- Amniotic fluid volume
What adverse pregnancy outcomes are associated with pruritic urticarial papules and plaques of pregnancy (PUPP)
None
What lung volume changes during pregnancy
Functional residual capacity decreases due to baby compressing the lungs
Ddx of acute onset severe dyspnea in a pregnant woman
- Reactive airway disease
- Pneumonia
- Pulmonary edema
- Pulmonary embolism
How do you diagnose pulmonary embolism
Spiral computed tomography or ventilation/perfusion (V/Q) imaging
Tx of PE in pregnant woman
- Full IV anticoagulation therapy for 5-7 days
- Then therapy is switched to subcutaneous therapy to maintain the aPTT at 1.5-2.5 times control for at least 3 months after the acute event
What anticoagulation meds are safe to use in pregnancy
Heparin and LMWH
Describe the two main factors of pregnancy that increase the risk of DVT
- Hypercoagulable state due to increased clotting factors
- Venous stasis due to uterus pressing on the vena cava
Tx of DVT in pregnant woman
Same as tx of PE:
- Full IV anticoagulation therapy for 5-7 days
- Then therapy is switched to subcutaneous therapy to maintain the aPTT at 1.5-2.5 times control for at least 3 months after the acute event
When is an amniotic fluid embolism most likely to occur
During labor or immediately postpartum
Tx of amniotic fluid embolism
Mostly supportive with immediate delivery if there is rapid maternal or fetal decompensation
What is the most common cause of maternal mortality in pregnancy
Embolism of all types (thrombotic or amniotic)
Followed by cardiovascular conditions and infection
What is the purpose of Bishop scoring
o Cervical assessment system used for predicting labor outcome (vaginal vs. C-section)
♣ Basically, high score means the cervix is more ripe and baby is more ready for delivery
What are the 5 components of bishop scoring
- Station of presenting part
- Cervical dilation
- Cervical effacement
- Consistency of cervix
- Position of cervix
What does a high Bishop score indicate (>/=8)
• Similar likelihood of vaginal delivery whether labor begins spontaneously or is induced
What does a low Bishop score indicate (= 6)
• Induction is less likely to be successful than spontaneous labor and associated with a higher rate of cesarean section
Diagnose: urinary incontinence in a patient with irregularly enlarged and anteverted/anteflexed uterus
Fibroids - diagnose via US
What are the guidelines for pap testing
• First Pap test age 21
• Test every three years until age 30
• Age > 30, HPV test with Pap test every 5 years
o Almost all young women are infected with HPV, but only transiently
o Usually clear HPV around 30 y/o
o This is why we test at 30 – because if they haven’t cleared virus by then, then we start to worry
When is it okay to stop getting pap tests
• No more testing after hysterectomy or age 65 (with negative Pap history)
What antihypertensives are okay to use in pregnancy
Labetalol, Nifedipine, Hydralazine
