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