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What test should be done at the initial pregnancy visit?
- CBC, Type and screen
- RPR or VDRL, Hep B, HIV
- Pap with chlam and GC and UA
What tests make up the quad screen? When should it be given?
- Tests: AFP, hCG, unconjugated estradiol, maternal serum inhibin A
- When: 16-18 weeks
When should U/S be done on normal pregnancy?
When should glucose test be done in normal pregnancy?
When should gonorrhea, chlam, and group B strep tests be done in pregnancy?
Tests for fetal lung maturity?
- lecithin-to-sphingomyelin ratio or
- phosphatidylglycerol concentration in diabetic
What results from a quad screen indicate Downs? Neural Tube defects?
- Downs: Low AFP and Estriol with High B-hCG and Inhibin A
- Neural Tube Defects: High AFP (but can also indicate ventral wall defects)
Pregnant female with preeclampsia signs before third trimester, hCG rapidly rising, first or second semester bleeding with expulsion of grapes or snow-storm on U/S. Dx? Treatment?
- Hydatidiform Mole
- Treat: D&C; watch hCG until zero, if doesn't fall then chemo (methotrexate or actinomycin)
Pregnant woman at 26 weeks gestation with anemia, high indirect billi, high AST and ALT, thrombocytopenia, with RUQ pain and epigastric pain.
Pre-eclampsia with HELLP syndrome
Patient receiving treatment for preecplampsia begins having shortness of breath, and loses consciousness; she has poor reflexes through out. What is the condition?
Mg toxicity from Mg SO4
When should mom get RhoGAM shot?
Woman in delivering and fetal heart monitoring shows decelerations that begin and end with uterine contractions. What is this a sign of and what do you do?
- Caused by head compression.
- Do nothing its normal
Woman is delivering and fetal heart rate decelerations begin after initiation of contractions and end after contraction has finished. What is this a sign of and what do you do?
- Sign of Uteroplacental insufficiency or any abnormality that prevents fetus from getting adequate blood or oxygen.
- Treat: Test with fetal scalp pH monitoring if they continue deliver
Woman is delivering baby and fetal heart rate decelerates before contrations then after and doesn't seem to coordinate with contractions. What is this a sign of and what do you do?
- Umbilical cord compression
- treat by moving mom to releive pressure on cord
- stop oxytocin and give mom oxygen
- if it continues fetal scalp pH
Mother is delivering and begins having bleeding but denies pain; fetal hr increases and then becomes bradycardic. What is this a sign of and what do you do?
- Sign of fetal bleeding
- Do an Apt test and if positive C-section
What score on non-stess test is acceptable?
What would you like to do?
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