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pszurnicki
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when is a gestational sac seen on transvaginal ultrasound
5 weeks or 1500 units of beta hcg
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what is ordered at the first prenatal visit
- counseling +
- cbc
- type and screen
- rh
- pap
- urinalysis and culture
- rubella
- chlamydia
- gonorhea
- herpes
- hiv syphilis
- hep b serology
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low platelts on cbc of pregnancy, next step
rule out itp or HELP syndromes
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when is rhogam given to rh negative mothers
at 28 weeks
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negative rubella antibodies during pregnancy, next step
immunize after delivery
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+ hep b antigen, next step
order hep B e antigen
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+vdrl for a pregnant woman, next step
confirm with fta-abs and if positive give penicillin , if allergic desensitize and give penicillin
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+ screening test like high beta hcg, papp-a or nuchal translcency is confiremd how for downs
with CVS
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which markers are increased in downs? edwards
beta hcg and inhibin are high, alpha fetoprotein and estriol are low
all the 4 markers are low in edwards
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high alpha feto protein is seen whe
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next step for alpha feto protein that is high
low
high--amniocenteseis and acetylcholinesterase testing
low--amniocentesis and karyotypin
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4 tests in third trimester
- cbc
- glucose
- gbs
- antibodies for rh
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do you give rhogam to women who have anti-d antibodies
no
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+GBS NEXT step
intrapartum antibiotics
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which antiemetics can be used in pregnancy
all of them
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fasting blood glucose is 125, diagnosis
gestational diabetes
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when do you give rhogam
twice at 28 weeks and within 72 hours of delivery
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initial mnx of late trimester bleeding
- vitals
- fluids
- external fetal monitor
- cbc
- type and cross
- dic workup
- ultrasound to r/o placenta previa
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further management for late trimester bleeding
- foley
- transfuse
- vaginal exam
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feared complication of placenta abruption
DIC
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rupture of membranes and brady, dx
vasa previa
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rx for vasa previa, uterine rupture, placenta previa, placenta abruption
- c-section
- altough vaginal can be attempted if the placenta is 2 cm away from cervical os
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uterine rupture may sometimes require what if the bleeding is profuse
hysterectomy
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when do you give abx for gbs
- prior baby with sepsis
- culture + at any point
- rom>18 hours
- fever
- preterm
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planned c section and + culture, abx
no
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triad of toxo
- cranial calcifiations
- chorioretinitis
- hydrocephalus and resulting microcephaly
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rx for toxo to prevent transmision
steptomycin
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mnx of suspected toxo
- igG and igM. high IgG avidity, past infection
- low IgG avidity, recent infection
- rx is pyrimethamine and sulfadiazine
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post exposure to varicella prophylaxis for mother
rx for mother
neonate
ivig for up to 10 dyas
ivig to mother and neonate
ivig and acyclovir to neonate
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rx for post exposure prophylaxis for rubella
nothing
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rx for a woman with cmv infection
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rx for a woman thats pregnant and has hiv
triple therapy
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when do you do c section for hiv
if rna>100 and CD4<350
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a pregnant woman tests positive for std, next step
HIV test
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rx for mild preeclampsia
delivery above 36 weeks
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rx for hellp syndrome
- delivery
- steroids
- mg sulfate
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heart failure what class is associated with maternal and fetal death
class 3 and 4
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what htn mds can be continued
loops, nitrates, bb, digoxin
never aceI or aldosterone blockers
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how are arrhythmias controlled in pregnancy
as normally but dont give warfarin or amiodarone
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endocarditis prophylaxis in pregnancy
- same as non pregnany
- prophylax with rheumatic heart disease
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regurg or stenosis are not tolerated with pregnancy
stenosis
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when do you anticoagulate
- dvt/pe current or past pregnancy
- afib with undrlying disease, not afib alone
- hypercoagulable states
- severe heart failure
- eisenmenger syndrome
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hyperthyroid and hypo cause what effect on fetus
- growth restriction and stillbirth--hyperthyroid
- miscarriage and intellectual deficits-hypothyroid
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hypothyroid pregnant woman, next step
increase thyroxine
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drug given for hypothryoid in pregnanc
levothyroxine
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high hba1c in first trimester, next step
- get sono at 20 weeks to looks for structure anomalies
- 24 weeks fetal echo to look for defects
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monitoring for diabetics in pregnancy
- hba1c every trimesetr
- monthly sono
- monthly biophysical profiles
- nst at 32 weeks and amniotic fluid index
- triple marker screen to look at ntd
- caudal regression syndrome
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ntd and other congenital defects are seen when with what hba1c
first trimester and at 8.5 Hba1c
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women with gestational diabtes are followed how after delivery
6 weeks post partum 75gram oral glucose tolerance test
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complications of neonate from diabetic mother
- polycythemia
- high bilil
- low calcium
- low glucose
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rx for intrahepatic cholestasis of pregnancy
- ursodeoxycholic acid
- antihistamines
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how does acute fatty liver present
rx
- high LFT's
- coagulation abnormalities
- fluids and icu and delivery
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rx for acute cystitis and asymptomatic bacteruria in pregnancy
pyelo
- nitrofurantoin
- cephallosporin
iv cephalosporins
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1st trimester abortio options
- d and c up to 13 weeks
- medical wtih mifepristone and misoprostol
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2nd trimester abortion options
dialation and evacuation
intact dilation and evacuation--partial birth
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most common delayed complication of d and e for abortion
cervical trauma and cervical insufficiency
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spontaneoius abortion vs fetal demise
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what are the only 2 abortions that have open cervical os
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how does missed abortion presetn
- poc retained
- closed cervical os
- allow pasage of poc or use misoprostolr
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rx for threatened abortion
- expectant mangametn
- bed rest
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rx for incomplete and inevitable
d and c
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most common cause of spontaneous abortion <20 weeks
fetal demise>20 weeks
chromosomal abnormaolites
>20 weeks-maternal factors, antiphospholipid sydnrome, smoking, dm
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most serioius complication of prolonged fetal demise
dic from tissue thromboplastin
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with prolonged fetal demise next step
order coagulopathy studies
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presumed diagnosis of ectopic
Bta hcg>1500 and no intrauterine pregnancy
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4 indications for mtx rx for ectopic pregnancy
- fetus <3.5 cm
- beta hcg<6000
- no fetal heart beats
- no folic acid supplementaiton
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next step in mnx of a woman with cervical insufficiency
r/o chorioamnioti
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when is an elective cerclage placed?
urgent
- elective after 3 repeat abortions
- urgent after labor and chorioamniotis is ruled out
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woman with short cervix but no other symptoms, next step
monitor short cervix with sonogram
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iugr definition
estimated fetal weight is 10%< gestational age or <2500 grams
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work up for asymmetic iugr
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ultrasound determines age when
10 weeks
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percutaneous umbilical blood sample is taken when
after 20 weeks
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cvs or amnio tests for alpha feto protein and acetylcholinesterase
amniocenteisis
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management of chorioamniotics
- if infection present--iv abx, deliver
- if infection is absent and <24--bed rest
- 32 weeks --admit, steroids and deliver--abx prophylactically
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prolonged latent phase
mcc
- 20hrs no change in cervix
- analgesia
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prolonged active phase
mcc
- <1.2cm/hr for nulliparous
- <1.5 for multi
- no change for 2 hrs arrest
- 3 p/s
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how long does stage 2 last
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how long does stage 3 last
30 mins
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rx for umbilical cord prolapse
c section
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variable accelerations are due to what
umbilical cord compression---fetal hypoxia
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is variability normal?
yes 6-30 beats
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non reassuring fhr, next step
- stop med
- give fluids
- give oxygen
- change maternal position
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when is vacuum , forceps the answer
- non reasuringg fhr with no contraindications
- prolonged 2nd stage
- mother cant push bc of pulmonary or cardio causes
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when is c section indicated
- cephalopelvic disporotpohs
- arrest of labor
- infections
- breech presentations
- placenta previa
- non reassuring fhr
- uterine scar from myom
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when is vbac done
no indications for c sectio and prion c section ws a low c section
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what contraception can be started after delivery and not affect milk productions
progestin
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