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Flashcards in women's health pregnancy and childbirth Deck (69):
1

placenta abrutio

PAINFUL
SUDDEN onset of vaginal bleeding with hard (hypertonic) uterus. > risk with HTN, cocaine. if severe, baby must be delivered

2

placenta previa

PAINLESS vaginal bleeding
bright red, uterus SOFT
bed rest, no intercourse
magnesium sulfate if cramping

3

severe preeclampsia

only cure is delivery
s/s
lated 3rd trimester
SEVERE sudden headache
edema, weight gain >2lb/week
HIGH blood pressure
protein in urine

* IF seizure= eclampsia

4

HELLP syndrome (hemolysis, >liver enzymes, Low platelet)

complication of preeclampsia
RIGHT upper quadrant pain, n/v
?ALT
?AST

5

protein in urine during pregnancy
abnormal labs and what to do

check midstream urine
protein from 1+ to 4+ is abnormal
if >20 wks, r/o preeclampsia

ir protein present urder 24 hour urine (for protein and creatinine clearance)

6

which lab > during pregnancy as normal

Alkaline phosphate (ALP) (dt growth of fetal bones)
WBC (up to 16,000) "leukocytosis and neutrophilia" is normal, check s/s
H/H decrease
ESR increase
t3/t4 increase

7

What is a high neutrophil count?

What is a high neutrophil count?
Neutrophil are the primary white blood cells that respond to a bacterial infection, so the most common cause of neutrophilia is a bacterial infection, especially pyogenic infections. Neutrophils are also increased in any acute inflammation, so will be raised after a heart attack, other infarct or burns.

8

Leukocytosis

Leukocytosis is defined as a total WBC value of greater than 11,000/microL in adults

9

normal ANC

norm ANC: 2,500 and 6,000.
The ANC is found by multiplying the WBC count by the percent of neutrophils in the blood

10

Low AFP results and triple screen

risk for down's dt maternal age >35yo
if APT Is low order triple screen; AFP, HCG, estriol, inhibit A

11

screen in jewish for which genetic disorder

tay-sachs (fatal neurological disease, no cure)

12

screen in whites for which genetic disorder

cystic fibrosis

13

doubling time

doubling of hcg, only good for 1st trimester ONLY

if values lower than normal, r/o ectopic or inevitable abortion

14

vaginal cultures during pregnancy and tx

group B; 35-37wks swab introits and rectum
is positive tx with PCN G IV, or clinda/erythro if allergic

15

which STD to screen in pregnancy

hiv
hep b, hep c
herpes 1 and 2
gonorrhea/chlamydia
syphilis

16

titers to check during pregnancy

rubella
varicella

17

most drugs are CATegory B, animal studies show NO risk, no human data available.
cat B drugs

antacids (tums, maalox)
colace
analgesics (acetaminiphin)

18

antibiotics for pregnancy ok / contraindicated

cat B:
PCN,cephalosporin, macrobid
macrolides- except CLARITHROMCIN (Biaxin)- category C
nitrofurantoin (furandantin, macrobid)- don't us in g6pd anemia dt hemolysis (anemia, jaundice, dark urine)

19

category C

septra
nsaids


adverse in animals, no human data

trimethroprim-sulfamethoxazole (bactrim/septra DS)
nsaids (blocks prostaglandins)

20

what category is ibuprofen/advil during pregnancy

category B (1st and 2nd tri)
category D (3d trimester!)- evidence of fetal risk

21

category D

Acei/arb (ie: capoten/captopril, losartan/hyzaar)

fluroroquinolones (cipro, floxin, levaquin)
* achillis heal rupture/can't use under 18!

tetracycline- teeth stain (minocycline)

NSAID- premature labor, blocks prostaglandin

SULFa- risk of hyperbilirunemia (neonatal jaundice, kernicterus).

22

category X

proven fetal risk

accutane
methotrexate- anti metabolite (tx for autoimmune; RA, psoriasis,cancers)
proscar (anti androgen)- BPH, prostate cancer
** misoprostol- drugs for abortions
evista (osteoporosis rx)

23

LIVE vaccines

LAIV flu mist (flu injection OK)
varicella
MMR
oral polio

* note: after LAIV, reproductive femals should use reliable birth control in the next 4 weeks (MMR) or 3 months (varicella)

24

teratogens - causes structural abnormalities in fetus

alcohol
aminoglycosides ("mycin", gentamycin, neomycin, streptomycin)
lithium
chronic hyperglycemia ( poorly controlled DM) can cause neural tube defects/craniofacial defects

25

health education for pregnancy

folic acid 400mcg (start 3 months before conception)
avoid soft cheese (blue/brie)
no hot tubs

26

pregnancy weight gain for obese pt

11-20lb

27

when is fetal heart tones heard

10-12 weeks by doppler ( end of 1st tri)
20 by fetascope

28

"probable" pregnancy signs

goodell's- cervical softening@ 4 wks
chadwicks- blue discoloration 6 wks
hegar's- softening uterine isthmus 6 wks
ballottement
urine or blood (hct) test
"quickening"- mother feels baby move starting at 16 wks


29

positive pregnancy sign (for sure)

palpation of fetus
ultrasound
fetal heart sounds

10-12 weeks by doppler ( end of 1st tri)
20 by fetascope

30

palpation of fetal mvt (quickening) is what kind of sign

"probable", NOT positive (positive, is actual palpation of the fetus body)

31

hog blood test what kind of sign

probable. HcG also present in molar pregnancy, ovarian cancer

32

when is FHT heard by dopper

10-12 wk s

33

20 wks

fhb heard by stethoscope
fundus @ umbilicus

34

size and date discrepancy

if >2cm order ultrasound for further evaluation

35

heart position and heart changes during pregnancy

heart is displaced horizontal and rotate left (increases the transverse diameter)

cardio output, plasma volume, heart rate all INCREASE

BP may decrease ( mom can be off htn medication.

36

htn medication used during pregnancy

methylodopa (aldomet) alpha-adrenergic antagonist
labetolol ( normodyne) BB

37

heart sounds during pregnancy (later) dt > blood volume

systolic ejection murmur (SEM)
mammary souffle- bilateral murmur in mammary vesseles

38

vena cava during pregnancy

compression by uterus causes hypotension, lay on left

39

lung changes

uterus pushes UP the diaphragm, diameter of the thorax is increased

40

hemoglobin during pregnancy

decreases due to hemodilution ( more fluid in the body)
HH: ranges from 9.5-10 is NORMAL ( normal is 12-14)

41

thyroid during pregnancy

increase, 15% larger
free t3 mildly elevated

42

renal system during pregnancy

kidneys increase in size
GFR increases dt >cardio output/renal blood flow

normal GFR: >90

43

Naegele's rule

used to estimate delivery date (EDD) during the first trimester with regular menstrual cycle

SUBTRACT 3 months from the month of the last menstrual period and ADD 7 days

44

placenta previa vc abruptio ( uterus)

previa: BRIGHT RED vaginal bleeding, PAINLESS, without a tender uterus

abruptio: Hypertonic, HARD uterus

45

who should be screened for tay sachs

askenazi (euro) jew

46

GPA for pregnancy

gravida: number of total pregnancies ( regardless of outcome)

para: number of BIRTHS >20 weeks ( no matter outcome). twins count as 1

abortions- lost more > 20 weeks (induced or spontaneous abortion)

47

when to give rhogam

to ALL rh- mothers regardless if they miscarriage, abortion, or ectopic pregnancy
aka; anti- D immune globulin (from igG)
if NOT given will cause fetal hemolysis/anemia in future pregnancies

48

coombs test (direct vs indirect)

direct- done on infancy
indirect- done on mom

detects Rh antibodies in the MOTHER

49

when is rhogam given

2 times!

300mcg IM @ 28 wks
2nd dose within 72 hours ( or sooner) AFTER delivery

50

what does rhogam do?

it decreases risk of isoimmunization of the maternal immune system by destroying fetal rh positive RBC that have crossed the placenta

doesn't affect current baby, just FUTURE baby

51

risk factors for gestational DM mom

obesity, baby >albs, previous GDM.

52

screening fo GDM

28 wks
75g 2 hour glucose tolerance test (OGTT)

53

GDM treatment

LIFESTYLE first! diet and exercise
monitor 4-6x/day
insulin if can't be controlled
NO ORAL medication

54

asymptomatic bacteriuria
tx

ALWAYS treat dt risk for pyelonephiritis.

tx: antibiotics, fluids, fre/post urine C&S
nitrofurantoin (Macrobid) or amoixcillin (augmentin)

** DO NOT USE MACROBID during 3rd trimester dt risk of bilirubinemenia

55

risk of macrobid and sulfa during pregnancy

nitrofurantoin ( macrobid) causes hemolysis if mom has g6pd anemia.

56

UTI during pregnancy

100,000 colony forming units (UTI) or 10 to the 5th power

57

1st line for UTI during pregnancy

nitrofurantoin ( macrobid). AVOID during 3rd trimester

58

spontaneous abortion

aka "miscarriage", loss of fetus

59

threatened abortion

vaginal bleeding, bur cervical os is closed

60

incomplete abortion

vaginal bleeding with cramping, placental products remain. cervical os dilated, foul smelling ( BV)
tx: dilations with curettage (D&C) and antibiotics

61

eclampsia

dsg if SEIZURES

62

preelampsia ( pregnancy induced HTN)

can occur late 3rd trimester OR 4 wks postpartum

s/s: headache, blurry vision, right upper quadrant pain

63

triad for preeclampsia

1) hypertension
2) protein (>.3g in 24 hour specimen) proteinuria ranges from trace to sever (1+ to 4+. )
look at hands and face.
3) edema (gained 1 plus pound per week)

64

previous HTN during pregnancy

stop if on ace/arb
most moms can stop during first and 2nd trimester due to less peripheral vascular resistance

65

placenta abruptio

defintion, controllable risk factors, s/s

partial to complete separation of placenta from the uterine bed

controllable risk factors: smoking, cocaine, HTN, "seatbelt"

s/s: sudden vaginal bleeding, pain, uterus is "hypertonic/rigid and tender"!

66

placenta previa s/s and tx

uterus is SOFT and NON tender

refer to ED
NO bimanual exam, Ultrasound only
bed rest
if contractions, give mgSO4 (mag sulfate)
c section prn

67

how often will newborns nurse 24 hour period

10-12 ( every 2 hours)

68

medication for BF mastitis

dicloxacillin 500mg or cephalexin (keflex)

mrsa risk: bactrim (trimesthorpim-sulfamethoxazole) or clindaymycin

CONTINUE BF

69

chlamydia during pregnancy

treat to