1
Q
When do you use quantitative Beta-HCG
A
- 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
Q
When do you use quantitative Beta-HCG
A
- 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
Q
When can you detect pregnancy on ultrasound
A
Gestational sac visible on transvaginal US at 5 weeks GA
- Beta - hcg 1000-1500
4
Q
What is considered excessive weight gain in pregnancy
A
> 1.5 kg/month (about 3.3 pounds)
5
Q
What is considered inappropriate weight gain in pregnancy
A
6
Q
What is the appropriate weight gain in pregnancy?
A
- BMI 29: 5-9 kg (11-20 lbs)
-
7
Q
Cardiovascular changes in pregnancy
A
- 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
Q
Pulmonary adaptations of pregnancy
A
- Tidal volume: increases
- Expiratory reserve volume: decreases
- Respiratory rate: unchanged
- Respiratory minute volume: increases by 40%
9
Q
Blood changes in pregnancy
A
- increase in RBC and increase in plasma volume more than RBC, so hemodilution
- Hct: Decreases
- Fibrinogen: Increases
- Electrolytes: Unchanged
10
Q
GI changes in pregnancy
A
decreased sphincter tone and increased gastric emptying time
11
Q
Organisms that cross the placenta
A
Toxo gondii Rubella HIV VZV CMV Enteroviruses Treponema pallidum Listeria Parvovirus B19
12
Q
How often do pregnant women get checkups
A
- 0-28 weeks: every 4 weeks
- 29-35: every 2 weeks
- 36- birth: every week
13
Q
What labs do you check at initial prenatal visit
A
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
Q
When do you screen for gestational diabetes
A
- 24-26 weeks unless at risk for diabetes (obese, fam hx) then screen asap
15
Q
When to administer RhoGam
A
28 weeks for Rh negative; after any procedures/bleeding events
16
Q
When do you do GBS culture
A
35-37 weeks
17
Q
What is the quad screen
A
Done ~15-22 weeks
- MSAFP
- Inhibin A
- Estradiol
- Beta HCG
18
Q
Quad screen for Trisomy 18 and 21
A
Everything is low for 18
- Low MSAFP/Estriol with high inhibin A/betaHCG for 21
19
Q
When is amniocentesis indicated
A
- 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
Q
Risk factors for spontaneous abortions
A
- 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
Q
Risk factors for spontaneous abortions
A
- Chromosomal abnormality
- Maternal thrombophilia
- Maternal immune issue (APL ab
22
Q
When can you detect pregnancy on ultrasound
A
Gestational sac visible on transvaginal US at 5 weeks GA
- Beta - hcg 1000-1500
23
Q
What is considered excessive weight gain in pregnancy
A
> 1.5 kg/month (about 3.3 pounds)
24
Q
What is considered inappropriate weight gain in pregnancy
A
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
