At what hCG level can you do a transvag US?
18,000
At what hCG level can you do a transabdominal US
35,000
Naegele’s rule for gestational age
+7day to LMP
- 3 months
When is the quad screen done? What does it assess?
15-20 weeks
MSAFP, Estriol, hCG, Inhibin A
Eval for neural tube defects, spina bifida, ancephaly, and Ter of Fallot, trisomy 21, and other chromosomal
What is “quickening”?
When does it start?
maternal awareness of fetal movement
16-20weeks
dystocia
failure to progress
3Ps: power (uterine contractions)
passenger (baby too big/ wrong angle)
passage (canal too small)
What changes are NOT normal during pregnancy
diastolic murmur
increased BP (after 20wks)
proteinuria
fetal viability=
20 weeks/ 500gms
term gestation
38-42 weeks
Preterm =
<37 weeks
early decelerations due to
head compression
variable decelerations due to
cord compression
late decelerations due to
uterine placental insufficiency
Rhogam in rh negative prego w/o sensitivity given at
28 weeks
Quad screen with decreased MSAFP & estriol
+ increased hCG and inhibin A
Trisomy 21 or 28 (or other chromosomal abnl)
Increased MSAFP (maternal serum alpha fetal protein) seen in
neural tube defects: spina bifida, ancephaly, etc
How much folic acid should prenatal provide
0.4 mg folic acid
Nausea tx
1st gen antihistamine first choice
Esp in 1st trimester
what happens during the 2nd stage of labor
“pushing stage”
from full cervical dilation to delivery of baby
what happened during 3rd stage of labor
delivery of placenta
Mean time of 1st stage of labor
nulliparous: 12 hr with 8hr of latent
multiparous: 6.5 hr with 5 hr of latent
Movements of labor
Engagement- 0 station Flexion Descent Internal rotation Extension (of fetal head) External rotation/restitution Expulsion
14 weeks gestation presents with vaginal bleeding and abdominal pain
next step
US to confirm IUP
must r/o ectopic
16 weeks gestation
hyperemesis
US can not demonstrate fetal structure or HR
hCG is very elevated
Trophoblastic Disease
Hydatidoform Mole
US shows focal cystic changes in the placenta and a “snow storm”
Hydatidoform Mole
late vaginal bleeding in postpartum period with enlarged uterus and enlarged ovaries
r/o choriocarcinoma
bleeding through a closed cervcical os
threatened abortion
when do prego women get glucose screening
24-28 weeks
SOC for gestational diabetes
insulin
more frequent office visits q2-3 weeks
meal planning
HTN only during pregnancy and immed post partum
gestational HTN
TOC HTN in pregnancy
Methyldopa or labetalol
What HTN drugs contraindicated in prego
ACEI/ARB
Post partum hemorrhage causes
4 'T's: Tissue (retained placenta) Tone (uterine atony) Trauma (traumatic delivery, episiotomy) Thrombin (coagulation disorders, DIC)
Dx for preeclampsia
BP >140/90
+proteinuria (>0.3g in 24hrs)
Definitive tx for preeclampsia/eclampsia
Delivery
Severe preeclampsia tx
magnesium sulfate
hospitalized modified bedrest
<34weeks- corticosteroids
plan delivery
epigastric or RUQ pain and >20wks gestation
~HTN
r/o HELLP
hemolysis
elevated liver enzymes
low platelets
Tx HELLP syndrome
magnesium sulfate
BP control
Stabilize mother
Definitive- delivery of fetus
placenta previa vs abruption placentae
previa is PAINLESS
sudden gush of fluid >20 weeks
next step
sterile speculum exam to r/o PROM
how to dx PROM
sterile speculum exam: pooling of fluid in posterior fornix nitrazine paper test pH 7.0-7.25 ferning leak with valsalva
PROM with chorioamniotis
delivery regardless of age
PROM at 34 weeks gestation
Induce labor
PROM 24-34 weeks gestation
abx
corticosteroids for lungs
magnesium sulfate for fetal neural protection
deliver once lungs mature
PROM at 22-24 weeks gestation
terminate pregnancy vs abx and educate on risk
Prego women hx premature labor and PROM
IM or intravag progesterone from week 16-36
MCC postpartum hemorrhage
uterine atony
post-partum fever
soft-tender uterus
leukocytosis
postpartum endometritis
abx- cefoxitin
