First AId 2CK > Obstetrics > Flashcards

Obstetrics Flashcards

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0
Q

Parity

A

of pregnancies that led to a birth beyond 20 weeks’ gestational age or an infant weighing > 500 g

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1
Q

Gravidity

A

of times a woman has been pregnant

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2
Q

Developmental age

A

of weeks and days since fertilization

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3
Q

Gestational age

A

of weeks and days measured from the 1st day of the LMP

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4
Q

Determinants of gestational age

A
  1. Fundal height
  2. Fetal heart tones (Doppler)
  3. Quickening
  4. Ultrasound
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5
Q

Fundal height measurement

A

Umbilicus - 20 weeks + 2-3 cm/weeks thereafter

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6
Q

Fetal heart tones (Doppler)

A

Typically 10 - 12 weeks

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7
Q

Quickening - appreciation of fetal movement

A

Usually heard 17 - 18 weeks

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8
Q

Ultrasound

A
  1. Measures fetal crown-rup length: 6 - 12 weeks

2. Measures biparietal diameter, femure length, and abdominal circumference: 13 weeks

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9
Q

Most reliable measurement of GA

A

Ultrasound

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10
Q

Quantitative B-hCG

A
  1. Diagnose and follow ectopic pregnancy
  2. Monitor trophoblastic disease
  3. Screen for fetal aneuploidy
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11
Q

B-hCG

A
  • standard for diagnosing pregnancy

- produced by placenta

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12
Q

Rate of B-hCG production

A
  • reaches peak, 100,000mIU/ml by 10 weeks’ GA

- decreases throughout 2nd trimester and levels off by 3rd trimester

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13
Q

Ultrasound

A
  • used to confirm intrauterine prenancy
  • gestational sac visible by 5 weeks GA
  • B-hCG in range of 1000 - 1500 IU/ml
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14
Q

Renal changes during pregnancy

A
  • Renal flow increases 25-50%

- GFR increases early then plateaus

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15
Q

Weight changes during normal pregnancy

A
  • uterine weight increases from ~ 60 - 70 g to ~ 900 g - 1200g
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16
Q

Weight gain recommendations during pregnancy

A
  • 1.0 - 1.5kg/mo
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17
Q

Weight gain guidelines by BMI

A
  • undeweight: 12 - 18 kg
  • acceptable: 11- 16 kg
  • overweight: 7 - 11kg
  • severely overweight: 7kg
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18
Q

Folic acid supplementation

A

decreases neural tube defects for ALL reproductive age woman

  • 0.4mg/day
  • 4 mg/day for women w/ hx of neural tube defets in prior pregnancies
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19
Q

CV changes during normal pregnancy

A
  • HR gradually increases 20%
  • BP gradually decreases by 10% by 34 wks, then increases to prepregnancy values
    SV increases to maximum at 19 weeks then plateaus
    CO rises rapidly by 20% then increases to addl 10% by 28 wk
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20
Q

Pulm changes during pregnancy

A
  • RR remains unchanged
  • TV increases by 30 - 40%
  • Expiratory reserve gradually decreases
  • Vital capacity unchanged
  • Resp minute volume increases by 40%
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21
Q

Blood changes during normal pregnancy

A
  • Blood volume increases by 50% in 2nd trimester
  • Hct decreases slightly
  • Fibrinogen increases
  • Electrolytes remains unchanged
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22
Q

GI changes during normal pregnancy

A
  • sphincter tone decreases

- gastric emptying time increases

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23
Q

Immunoglobulins that cross placenta

A

IgG

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24
Organisms that can cross placenta (9)
1. Toxoplasmosis 2. Rubella 3. HIV 4. Parvovirus 5. CMV 6. Enterovirus 7. Treponema pallidum 8. Listeria monocytogenes 9. Parvovirus B19
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Prenatal Visits
Wks 0 - 28: every 4 wks Wks 29 - 35: every 2 wks Wks 36 - birth: every wk
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Heme Prenatal Dx Testing: initial visit
- CBC, Rh factor, type and screen
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Infectious Dz prenatal testing: initial visit
- UA and cx - Rubella Ab titer - HBsg - RPR/VRDL - Cervical gonorrhea and chlamydia - PPD - HIV - Pap smear (to check for dysplasia) - Consider HCV and varicella based on hx
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Genetic testing during initial visist
- HbA1c - Sickle cell screening - Tay-Sachs disease - Cystic fibrosis
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Prenatal Dx Testing: 9-14 wks
- PAPP-A + nuchal transparency | - free B-hCG +/- chorionic villus sampling
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Prenatal Dx Testing: 15 - 22 wks
- Maternal serum alpha fetoprotein (MSAFP) or - Quad screen +/- amniocentesis
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Prenatal Dx Testing: 18-20 wks
Ultrasound for full anatomic screen
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Prenatal Dx Testing: 24- 28 wks
1 hr glucose challenge test for gestational diabetes screen
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Prenatal Dx Testing: 28 - 30 wks
RhoGAM for Rh- women (after antibody screen)
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Prenatal Dx Testing: 35- 40 wks
Group B Strep cx (GBS) | - repeat CBC
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Prenatal Dx Testing: 34 - 40 wks
- Cervical chlamydia and gonorrhea cx - HIV - RPR in high risk pts
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Quad screening
1. MSAFP 2. Inhibin A 3. Estriol 4. B-hCG
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Maternal serum alpha fetoprotein (MSAFP)
- produced by fetus and enters maternal circulation - reported multiples of median (MoMs) - measurement results depend on accurate gestational testing - rarely tested alone, quad screening incr. sensitivity for chromosal abnormalities
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Elevated MSAFP (> 2.5 MoMs) associated w/
- open neural tube defects (anencephaly, spina bifida) - abdominal wall defects (gastrochisis, omphacele) - multiple gestation - incorrect gestational dating - fetal death
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Reduced MSAFP (< 0.5 MoM) is associated w/
- Trisomy 21 and 18 - Fetal demise - Inaccurate gestational testing
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Trisomy 18 via quad screening
* * Still UNDERage at 18** - decreased AFP - decreased estriol - decreased B-hCG - decreased inhibin A
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Trisomy 21 via quad screening
* * 2 up and 2 down** - decreased AFP, estrol - increased B-hCG, inhibin A
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Pregnancy-associated Plasma Protein A (PAPP-A)
- recommended at 9 - 14 wks - PAPP-A + nuchal transparency + free B-hCG can detect 91% of Down's syndrome and 95% of cases of trisomy 18 - screen of low risk pregnant women (< 35 y/o) - available earlier than CVS and less invasive than CVS
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CVS
- done at 10 - 12 wks - transcervical or transabdominal aspiration of placenta - geneticall diagnostic/ available at earlier GA
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Diasadvantages of CVS
- Risk of fetal loss is 1% - Cannot detect open neural tube defects - Limb defects are associated w/ CVS < 9 wks
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Amniocentesis
- done at 15 - 20 wks - transabdominal aspiration of aminiotic fluid using U/S needle - genetically diagnostic
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Disadvantages of CVS
At risk for: - premature of membranes (PROM) - chorioamniocentesis - fetal maternal hemorrhage
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Indications for amniocentesis
- in women > 35 yrs of age at time of delivery - conjuction with abnormal quad screen - in Rh-sensitized pregnancy to obtain fetal blood type or detect fetal hemolysis - to eval lung maturity via lecithin to sphingomyelin ratio > 2.5 - detect presence of phosphatidylglycerol (during 3rd trimester)
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ToRCHES pathogens
* organisms that can cross placenta - Taxoplasmosis - Other (Parvovirus, Varicella, Listeria, TB, malaria) - Rubella - CMV - Herpes Simplex Virus - Syphillis
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Spontaneous abortion (SAB)
- loss of product of conception (POC) prior to 20 wk of pregnancy - more than 80% occur in 1st trimester
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Major factors that contribute to SAB
1. Chromosomal abnormalities 2. Maternal factors 3. Environmental factors 4. Fetal factors
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Chromosomal abnormalities in SAB
- factor in 50% of SABs in 1st trimester
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Maternal factors in SAB
Dx of Spontaneous Abortions
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Dx of spontaneous abortions
- decreased levels of B-hCG - U/S can identify: - gestational sac 5-6 wks from LMP - fetal pole at 6 wks - fetal cardiac activity at 6-7 wks
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Fetal defects: ACEis
- fetal renal tubular dysplasia and neonatal renal failure - oligohydramnios - intrauterine growth restriction (IUGR) - lack of cranial ossification
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Alcohol: fetal defects
- Fetal alcohol syndrome (growth restriction before and after birth) - Mental retardation - Midfacial hypoplasia - Renal and cardiac defects - Consumption of > 6 wks per day is associated w/ 40% risk of FAS
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Androgens: fetal defect
- virilization of females | - advanced genital development in males
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Carbamazepine
- neural tube defects - fingernail hypoplasia - microcephaly - developmental delay - IUGR
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Cocaine: fetal defects
- Bowel atresias - Congenital malformations of the heart, limbs, face, and GU tract - Microcephaly - IUGR - Cerebral infarctions
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Diethylstilbestrol (DES): fetal defects
- Clear cell adenoma of vagina or cervix - Vaginal adenosis - Abnormalities of cervix and uterus or testes - Possible infertility
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Lead: fetal defects
- increased risk of SAB | - stillbirths
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Lithium: fetal defects
Congenital heart disease (Ebstein's anomaly)
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Methotrexate: fetal defects
increased SAB rate
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Organic mercury: fetal defects
``` Cerebral atrophy Microcephaly Mental retardation Spasticity Seizures Blindness ```
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Phenytoin: fetal defects
- IUGR - Mental retardation - Microcephaly - Dysmorphic craniofacial features - Cardiac defects - Fingernail hypoplasia
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Radiation: fetal defects
- Microcephaly - Mental retardation - Medical diagnostic radiation delivering < 0.05 Gy to the fetus has no diagnostic risk
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Streptomycin and kanamycin: fetal defects
- Hearing loss | - CN VIII damage
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Tetracycline: fetal defects
- Permanent yellow-brown discoloration of deciduous teeth | - Hypoplasia of tooth enamel
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Thalidomide: fetal defects
- Bilateral limb deficiencies - Anotia and microtia - Cardiac and GI abnormalities
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Trimethadone and paramethadone: fetal defects
- Cleft lip palate - Cardiac defects - Microcephaly - Mental retardation
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Valproic acid: fetal defects
- Neural tube defects (spina bifida) | - Minor craniofacial defects
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Vitamin A derivatives: fetal defects
- increased SAB rate - Microtia - Thymic agenesis - CV defects - Craniofacial dysmorphism - Microphthalmia - Cleft lip or cleft palate - Mental retardation
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Warfarin: fetal defects | ** wages WAR on the fetus**
- Natal hypoplasia and stippled bone epiphyses - Developmental delay - IUGR - Ophthalmologic abnormalities
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Toxoplasmosis: transmission
- transplacental | - primary infxn via consumption of raw meat or contact w/ cat feces
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Toxplasmosis: Sx and Dx
``` Sx: - hydrocephalus - intracranial calcifications - chorioretinitis - ring enhancing lesions on MRI Dx: - serum testing ```
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Toxoplasmosis: Dx and Tx
Dx: serologic testing Tx: pyrimethamine + sulfadiazine
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Toxoplasmosis: Prevention
- Avoid exposure to cat feces during pregnancy | - Spiramycin prophylaxis for 3rd trimester
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Rubella: Transmission
- transplacental in the 1st trimester
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Rubella: Sx
- purpuric "blueberry muffin"rash - cataracts - mental retardation - hearing loss - patent ductus arteriosus (PDA)
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Rubella: Dx and Tx
Dx: serologic testing Tx: symptomatic
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Rubella: prevention
- immunize before pregnancy | - vaccinate the mother after delivery if serologic titers remain negative
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CMV: transmission
- primarily transplacental
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CMV: Sx
- petechial rash | - periventricular calcifications
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