Obs Flashcards
1
Q
Name diseases, RF, diagnostics and tx of : painless bleeding in third trimester
A
2
Q
Name diseases, RF, diagnostics and tx of : PAINFUL bleeding in third trimester
A
3
Q
Describe : Prélèvement des villosités choriales
(6)
A
- Invasive test
- Reserved for those who are high risk or desire a diagnosis early : (1) Advanced maternal age (age > 35 years) who have increased risk of Trisomyand (2) those who have suffered from infants with birth defects, fetal demise, and intellectual disability.
- The idea is if the fetus can be assessed early enough and significant disease is detected, we can abort it and try again.
- Can be done as early as 10-13 weeks but it’s invasive and carries a risk of fetal demise.
- The advantage over amniocentesis is that CVS can be performed earlier in pregnancy and has a faster turnaround time
- There are now less invasive ways to test for many of the things that CVS and amnio are used for. Cell-free fetal DNA is found in the maternal blood, so many things can be evaluated with a simple blood draw (this is still considered a screening test, not diagnostic).
4
Q
Name definitive means of diagnosing and treating fetal anemia.
A
Prélèvement de sang ombilical percutané (PUBS)/Cordocentèse
* It can be performed at > 20 weeks, and typically isn’t done after 32 weeks (just deliver then).
5
Q
How to screen for fetal anemia?
A
Doppler de l’artère cérébrale moyenne fœtale
- Screening tool. It doesn’t provide access (can’t give blood or take a hemoglobin), but it’s safe and noninvasive.
- The concept is that an increased flow (water flows faster than ketchup - if the blood is thinner from anemia, dopplers will be higher) is indicative of some physiologic derangement, and, given the extensive thought process above it’s likely to be from fetal anemia.
- The metric is 1.5 times the median for gestational age.
6
Q
Describe : Confirmation and treatment of fetal anemia
A
- If gestational age < 32 weeks do Percutaneous umbilical cord sampling (PUBS, Cordocentesis) and transfuse.
- If gestational age > 32 weeks just deliver.
7
Q
Describe : Non-Stress Test (7)
A
- A non-stress test assesses the fetal heart rate for accelerations and variability.
- An acceleration is defined by “15x15, 2 in 20” (for younger GA, < 32, its 10x10, 2 in 20). The goal is an increased heart rate of 15 bpm sustained for 15 seconds and occurring twice in 20 minutes.
- If we see a good non-stress test it’s called a reactive NST (baby is doing well).
- If it was a test for decreased fetal movement, no further testing is required. If it was for a high-risk patient (DM, preeclampsia, over 41 weeks, etc), then it may be indicated weekly or twice weekly until delivery, depending on the individual scenario.
- Now, if the “15x15, 2 in 20” isn’t seen it’s called a nonreactive NST and we typically give an additional 20 minutes for accels to occur (baby may just be asleep/resting). If the NST is still nonreactive after 20 minutes, a vibroacoustic stimulation can be tried.
- Baby may be non-reactive because they’re sleeping. If, “15x15, 2 in 20,” with vibroacoustic stimulation, then it’s counted as though the NST was reassuring.
- If it still isn’t, “15x15, 2 in 20,” with stimulation, then it’s on to the Biophysical Profile, or BPP.
8
Q
Describe : Biophysical Profile
A
- This is similar to APGAR, but in utero.
- It’s performed using information from the NST and an Ultrasound.
- There are 5 factors that go into a BPP: NST, Breathing, Body Movement, Tone, and Amniotic Fluid. Each is worth 2 points.
- 0-2 : If baby is in trouble (basically dead) it needs to be delivered; that’s a score of 0-2.
- 8-10 : If baby is doing great (basically, normal), treat it just like a normal NST- a score of 8-10.
- 4-6 : If it’s in between, a decision needs to be made: does the benefit of further development outweigh the risk of fetal death? If the gestational age > 36 weeks, deliver; the risk of fetal loss outweighs the benefit of further development. If the baby is premature (gestational age < 36 weeks), a contraction stress test makes sense, talked about next.
9
Q
What’s the difference between preeclampsie with and without severe features?
A
10
Q
Describe tx Eclampsia Spectrum
A
11
Q
Describe : Treatment based on Severity (BP, Mg, Delivery) for PEC, sPEC and EC
A
12
Q
Describe : Screening for aneuploidy in 1st trimester and markers
A
13
Q
Describe : Screening for aneuploidy in second trimester and markers
A
14
Q
Describe epilepsy tx in pregnancy
A
- Valproate is the worst (pregnancy risk category) due to teratogenicity (cardiac abnormalities, neural tube defects, and craniofacial abnormalities).
- Two others should also be avoided: phenytoin and carbamazepine (both are pregnancy risk category D). They’re associated with cleft palate/craniofacial abnormalities, cardiac abnormalities, and developmental delay.
- Small studies to suggest that levetiracetam is a reasonable choice in pregnancy.
- The goal is to have the mom on the lowest therapeutic dose of whatever medication controls her seizures.
- If possible her epilepsy should be under good control prior to conception.
- Women on anticonvulsants should receive supplemental folate to prevent neural tube defects.
- This is hard; essentially every anticonvulsant is a teratogen.
- The key here is to recognize that it’s a risk-benefit analysis. Prenatal screening should be offered to women on anticonvulsants, with counseling and the option to terminate or plan for a baby with malformations.
15
Q
Name teratogen rx
A
18
Q
Describe : Dizygotic Dichorionic Diamniotic
A
- Two normal pregnancies that happened to occur at the same time.
- Two eggs were released during ovulation the month the mother got pregnant.
- Two eggs, two fertilizations, two sacs, two placentas.
- This is the only set that can have different genders (they don’t have to though - the two eggs have an equal chance of getting fertilized by an x or y carrying sperm). So, if different genders are identified the diagnosis is done.
- These have the** lowest pregnancy risk.**
- Beware of the vanishing twin where the second twin disappears by the end of the 1st trimester – it’s where one pregnancy dies and gets resorbed.
19
Q
Describe : Monozygotic Dichorionic Diamniotic
A
- These twins are a product of the** same fertilization** (monozygotic - only 1 egg was released); they have the same genetic material.
- These twins separate early, days 0-3.
- They’ll be identical twins and will share only the complications of the Dizygotic Dichorionic Diamniotic twins.
- They have two sacs, two placentas, but come from one egg so they must be the same gender.
20
Q
Describe : Monozygotic Monochorionic Diamniotic
A
- These twins are a product of the same fertilization (monozygotic); they have the same genetic material.
- They separate on days 4-8. Because they separate later, they now share a placenta (monochorionic).
- Since they share a placenta, they also share a blood supply.
- These twins have all the same characteristics of a Monozygotic-Dichorionic-Diamniotic, but are also at risk for twin-twin transfusion.
- This is where one twin (the smaller one) will donate its blood supply to the other (the larger baby).
- The small twin does better because of the reduced bilirubin load, despite the low birth weight.
21
Q
Describe : Monozygotic-Monochorionic-Monoamniotic
A
- These twins are a product of the same fertilization (monozygotic); they have the same genetic material.
- They either separate late (day 9-12) for nonconjoined twins or fail to separate (splitting >12 days) for conjoined twins.
- There’s only one placenta (monochorionic).
- In addition to all complications of the twins listed above, now they** share the same sac**.
- There are two cords within one sac (monoamniotic) that can become entangled, called cord entanglement, which puts both fetuses at risk for fetal demise.
- If conjoined, they can sometimes be separated in staged surgeries after birth.
