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What are the criteria for medical treatment (i.e. methotrexate) for ectopic pregnancy?
- hemodynamic stability,
- non-ruptured ectopic pregnancy,
- size of ectopic mass <4 cm without a fetal heart rate or <3.5 cm in the presence of a fetal heart rate,
- normal liver enzymes and renal function,
- normal white cell count,
- ability of the patient to follow up rapidly if her condition changes (reliable transportation, etc.).
What are some Bishop score modifiers?
- add 1 point:
- each prior vaginal delivery
- subtract 1 point:
- postdate pregnancy
What is peripartum cardiomyopathy?
idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic function towards the end of pregnancy or in the several months following delivery
What happens with PFT's during pregnancy?
- Inspiratory Capacity (IC)increased
- Tidal volume (TV)increased
- Functional reserve capacity (FRC)decreased
- Expiratory reserve capacity (ERC)decreased
- Residual volume (RV)decreased
- Total lung capacity (TLC)decreased
Besides PFT changes, what other respiratory changes occur?
- Diaphragmatic excursion is increased during pregnancy and it is not limited by the enlarging uterus.
- The upper displacement by the uterus causes a 4 cm elevation of the diaphragm
- total lung capacity decreases only slightly because of the compensatory widening of the chest.(increasing of subcostal angle)
- The minute ventilation is the product of the respiratory rate and the tidal volume (TV.)
- The respiratory rate does not change during pregnancy,
- TV is increased which increases the minute ventilation,
- --> respiratory alkalosis.
Associated with valproic acid during pregnancy
- neural tube defects (1-2%)
- craniofacial malformations
Folic acid recommendations
previous baby with NTD: 4mg daily
no previous baby with NTD: 0.4mg daily
Protein recs for preg
- 70g daily
- mostly from meat sources
What conditions are increased with gestational diabetes?
- fetal macrosomia
- fetal hypoglycemia
- fetal polycythemia
- fetal RDS
- fetal hyperbilirubinemia
- shoulder dystocia
- metabolic disturbances
- (caudal regression syndrome)
What are normal values for 3-hr glucose tolerance test?
- Fasting blood sugar less than or equal to 95
- 1-hour less than or equal to 180
- 2-hour less than or equal to 155
- 3-hour less than or equal to 140
Meds associated with fetal abnormalities
- valproic acid
- retinoic acid
- NSAIDs in 3rd trimester
What's in a BPP?
- amniotic fluid index
- fetal breathing
- fetal tone
- fetal movement
What physical features are associated with Downs syndrome?
- flattened nasal bridge,
- small size and small rotated, cup-shaped ears
- sandal gap toes,
- protruding tongue,
- short broad hands,
- Simian creases,
- epicanthic folds
- oblique palpebral fissures.
What is related to fetal RDS?
- gestational diabetes
- preterm delivery
- magnesium sulfat treatment for preeclampsia
What is the risk to baby from chorioamnionitis?
- high temp
What are risk factors for placental abruption?
- cocaine use,
- chronic hypertension,
- trauma and
- prolonged premature rupture of membranes,
- history of prior abruption
What are common presenting signs of placental abruption?
- abdominal pain,
- uterine hypertonus
- fetal distress
Risks for smoking during pregnancy
- placental abruption
- placenta previa
- growth restriction/LBW
Risks for placenta accreta
- previous C-sections
- (low) anterior placenta
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