What are the signs and symptoms of a placenta abruptio?
As early separation from uterus in 2-3 trimester
**Lots of pain & cramping suddenly- emergency C-section
Seperation of placenta from uterine wall
What are the signs and symptoms of placenta previa?
Placenta is in the lower uterine wall
Dx by ultrasound
***Painless vaginal bleeding
Hemmorrhage may happen even if the fundus is contracted firmly
What are the signs and symptoms of INFECTION?
UTI, abdominal or CP, chills fever, vomiting,
hyperemesis gravtium- unable to stop vomiting
↑ fluid from vagina, constant leaking maybe possible ruptured membranes
What is Nagele's Rule?
1st day of last menstrual period, go back 3 months and add 7 days.
Exp: LMP 11/7/10 Due : 8/14/11
What is gravida?
# of times pregnant
What is parity?
# of infants delivered after 20 weeks (whether they were alive or dead)
What does FPAL stand for?
F- Full term
L- living children
What is important when looking for past medical history?
Last Pap smear, STDs, more babies= ↑ risk of hemorrhage
What initial labs are done when pregnancy is confirmed?
H&H / WBC
Blood Type and Cross / RH
VDRL- syphilis and gonorrhea
GC - syphilis and gonorrhea
HBsAg (antibody titer for Rubella / Hep. B)
MSAFP (16-18 weeks)
o Maternal serum alpha protein- looks for genetic defects
Diabetes screen (24-28 weeks)
o 24-28 weeks
1st glucose test – 1hr test- if failed have to take the 3 hour test
o Sickle cell, Thalassemia- genetic blood disorder of misshaped RBCs
What does TORCH stand for?
O- other infections
C- Cytomegalovirus (CMV)
H- Herpes Simples
What is Toxoplasmosis caused by?
What can it cause?
Improperly cooked meats or cat feces
Cause fetal brain damage and high incident of abortions in 1st trimester
What are the "Other" infections?
Group B streptococcus- pregnancy can aggravate it and Mom will test positive Will do 2-3 rounds of ABX before birth of infant
Will cause pneumonia in neonate
If Strep B is unknown- will get 1 round of ABX and infant will go to NICU for observation
What does CYTOMEGALOVIRUS (CMV) cause in the fetus?
Mentally challenged, auditory impairment
What will happen if the Mom has active herpes?
Dr will only deliver vaginally if Mom doesn’t have active herpes, if there is a lesion Mom will have a C-section
How early can you do a ultrasound?
What does it confirm?
confirm pregnancy and gestational age
What is CVS -Chorionic Villus Sampling?
When do you do it?
Take a sample of the fetal part of the placenta, checks for Down syndrome, sickle cell, muscular dystrophy- (unable to get up at age 2 with all 4 limbs)
10-12 weeks gestation
1. What does Amniocentesis measure?
2. How is it done?
3. What is it checking for?
4. When is it usually done?
1. L/S ratio- 2:1 (lecithin/sphingomyelin)
2. Remove amniotic fluid by needle
3. Checking for fetal lung development, especially in large babies
4. 14-16 weeks gestation, >30 weeks gestation
1. What is MSAFP - Maternal Serum Alpha Fetal Protein testing for?
2. How many weeks?
1. Checking for Neural Tube Defects (NTD) & Down Syndrome
Blood draw from Mom
2. 16-18 weeks gestation
1. Why is PUBS - Percutaneous Umbilical Blood Sampling done?
2. Where is the blood drawn from?
1. Transfusion and Fetal blood sampling (looking for abnormalities such as inherited blood disorders, detecting fetal infection, acid-base balance of fetus' with IUGR)
2. Blood draw from the umbilical cord
1. When is a BPP - Biophysical Profile usually done and what is it looking for?
2. What are the categories?
3. What is normal? Equivocal? Abnormal?
1. Noninvasive assessment of the fetus and its environment using ultrasound and fetal
Fetal breathing movements
Gross body movements
Fetal tone (extension and flexion of arms, legs, and hands)
Reactive fetal heart rate
Qualitative amniotic fluid volume
3. Normal is 8-10
What does the CST - Contraction Stress Test look for?
o Test to stimulate uterine contractions for the purpose of assessing fetal response, a healthy fetus does not react to contractions, whereas a compromised fetus shows a late decelerations in the fetal heart rate that are indicative of uteroplacental insufficiency.