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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.).
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What are some Bishop score modifiers?
- add 1 point:
- preeclampsia
- each prior vaginal delivery
- subtract 1 point:
- nulliparity
- PPROM
- postdate pregnancy
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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
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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
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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.
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Associated with valproic acid during pregnancy
- neural tube defects (1-2%)
- hydrocephalus
- craniofacial malformations
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Folic acid recommendations
previous baby with NTD: 4mg daily
no previous baby with NTD: 0.4mg daily
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Protein recs for preg
- 70g daily
- mostly from meat sources
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What conditions are increased with gestational diabetes?
- preeclampsia
- polyhydramnios
- fetal macrosomia
- fetal hypoglycemia
- fetal polycythemia
- fetal RDS
- fetal hyperbilirubinemia
- shoulder dystocia
- metabolic disturbances
- (caudal regression syndrome)
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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
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Meds associated with fetal abnormalities
- phenytoin
- warfarin
- valproic acid
- tetracycline
- retinoic acid
- enalapril
- NSAIDs in 3rd trimester
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What's in a BPP?
- NST
- amniotic fluid index
- fetal breathing
- fetal tone
- fetal movement
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What physical features are associated with Downs syndrome?
- flattened nasal bridge,
- small size and small rotated, cup-shaped ears
- sandal gap toes,
- hypotonia,
- protruding tongue,
- short broad hands,
- Simian creases,
- epicanthic folds
- oblique palpebral fissures.
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What is related to fetal RDS?
- gestational diabetes
- preterm delivery
- magnesium sulfat treatment for preeclampsia
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What is the risk to baby from chorioamnionitis?
- sepsis:
- lethargy
- pale
- high temp
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What are risk factors for placental abruption?
- smoking,
- cocaine use,
- chronic hypertension,
- trauma and
- prolonged premature rupture of membranes,
- history of prior abruption
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What are common presenting signs of placental abruption?
- abdominal pain,
- bleeding,
- uterine hypertonus
- fetal distress
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Risks for smoking during pregnancy
- placental abruption
- placenta previa
- preeclampsia
- growth restriction/LBW
- infection
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Risks for placenta accreta
- previous C-sections
- (low) anterior placenta
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