Obstetrics from Step 2 Secrets

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A pt on birth control has amenorrhea, what is the most common cause?: Pregnancy, no contraception is 100%
Si/sx of pregnancy: amenorrhea, morning sickness, weight gain, linea nigra, melasma, fetal heart tones,
Hegar's sign: softening and compressibility of the lower uterine segment
Chadwick's sign: dark discoloration of the vulva and vaginal walls
Define macrosomia: a newborn that weighs more than 4 kg (9 lbs), usually because of maternal diabetes
It's the first prenatal visit. What do you order?: Pap smear, UA, CBC, type and screen, syphilis, rubella, glucose if risk factors present, GC and chlamydia for every teenager and pt with risk factors
When do you screen for maternal diabetes?: At the first visit if risk factors present. If not, screen at 24-28 weeks.
How do you screen for maternal diabetes?: Get a fasting serum glucose and glucose levels 1-2 hours after an oral glucose load.
When do you do a triple screen?: 16-20 weeks
How does Down Syndrome present on triple screen?: low AFP, low estriol, high hCG
When can fetal heart tones be picked up by doppler?: 10-12 weeks
When can fetal heart tones be picked up by stethescope?: 16-20 weeks
When does the uterus reach the umbilicus?: 20 weeks
When is ultrasound the most accurate in estimating the fetal age?: At 16-20 weeks
What is a hydatiform mole?: It's when the products of conception basically become a tumor.
Sx of a hydatiform mole?: Preeclampsia before third trimester, hCG that does not return to zero after delivery (or abortion or miscarriage) or one that rises rapidly during pregnancy, 1st or 2nd trimester bleeding with possible expulsion of "grapes," excessive nausea/vomiting, uterine size/date discrepancy, "snow storm" appearance on ultrasound
Define complete mole: comes "completely" from the father, karyotype is 46XX, no fetal tissue
Define incomplete mole: karyotype 69XXY, fetal tissue present
Tx of hydatiform moles: dilation and curettage, hollow with serial measurements of hCG until they go to zero,
What if a pt is treated for hydatiform mole, and their hCG doesn't go to zero?: They have an invasive mole or choriocarcinoma. They need chemotherapy.
What is a choriocarcinoma?: An aggressive form of mole
What chemo agents are used for moles?: Methotrexate and actinomycin D
Define IUGR: fetal size below the tenth percentile for age.
Three type of causes of IUGR: Maternal (smoking, alcohol, drugs, lupus), Fetal (TORCH infections, congenital anomalies), and Placental (HTN, preeclampsia)
When do you order a fetal ultrasound?: size/date discrepancy, risk factors for IUGR, problems with previous pregnancies, fetal death, distress, suspected abortion
What is a non-stress test?: Done while mother is at rest, tracing of fetal heart tones is obtained for 20 minutes
What is a normal non-stress test?: A normal strip has at least 2 accelerations of fetal heart rate, each at 15 beats above baseline, lasting at least 15 seconds.
How do you do a biophysical profile?: it includes a non-stress test, and ultrasound measurement of amniotic fluid, fetal breathing movements, and general fetal movements
What do you do if a fetus scores poorly on BPP?: The next test is the contraction stress test
What is a contraction stress test?: It measures uteroplacental dysfunction. oxytocin is given and a fetal heart strip is monitored. If late decelerations are seen with each contraction, a c-section is usually performed
Would you do a BPP in a high risk pregnancy without obvious problems?: yes, if worried, do a BPP once-twice a week at the start of the third trimester
Do you use aspirin in pregnancy?: no, use tylenol, but there is an important exception--in pts with antiphospholipid syndrome, in whom aspirin may improve pregnancy outcome.
Define post-term pregnancy: more than 42 weeks gestation
Why is morbidity and mortality increased in post-term pregnancies?: Shoulder dystocia and difficult deliveries are increased
What do you do for post-term pts?: Induce labor if cervix is favorable. If it's not favorable, do biweekly BPPs until 43 weeks, then induce.
What disorders are associated with prolonged gestation?: anencephaly and placental sulfatase deficiency
Describe some normal changes in pregnant pts: Nausea, vomiting, heavy painful breasts, increased pigment in nipples, backache, linea nigra, melasma, striae gravidarum, ankle edema, heartburn, increasing urination frequency
Causes of low AFP: Down syndrome, fetal demise, inaccurate dates
Causes of high AFP: neural tube defects, ventral wall defects, multiple gestation, inaccurate dates
What do you do with an abnormal AFP or triple screen?: First, do ultrasound, then amniocentesis is needed for definitive diagnosis.
When do you offer chorionic villous sampling?: at 9-12 weeks
Why is chorionic villous sampling done?: Because it offers the chance for first trimester abortion.
Can chorionic villous sampling detect neural tube defects?: Nope, only genetic or chromosomal defects
What kind of birth defects are caused by thalidomide?: Phocomelia--limbs are missing with hands and feet attached directly to torso
What kind of birth defects are caused by tetracycline?: yellow or brown teeth
What kind of birth defects are caused by aminoglycosides?: deafness
What kind of birth defects are caused by valproic acid?: spina bifida, hypospadias
What kind of birth defects are caused by progesterone?: masculinization of female fetus
What kind of birth defects are caused by cigarettes?: IUGR, low birth weight, prematurity
What kind of birth defects are caused by OCPs?: VACTERL syndrome
What is VACTERL syndrome?: Vertebral, Anal, Cardiac, TracheoEsophaeal, Renal, and Limb malformations
What kind of birth defects are caused by Lithium?: Ebstein's cardiac anomaly
What kind of birth defects are caused by radiation?: IUGR, CNS defects, eye defects, leukemia
What kind of birth defects are caused by alcohol?: Fetal alcohol syndrome
What kind of birth defects are caused by phenytoin?: craniofacial, limb, and cerebrovascular defects, mental retardation
What kind of birth defects are caused by warfarin?: craniofacial defects, IUGR, CNS malformations, stillbirth
What kind of birth defects are caused by carbamazepine?: fingernail hypoplasia, craniofacial defects
What kind of birth defects are caused by isotretinoin?: CNS, craniofacial, ear, and cardiovascular defects
What kind of birth defects are caused by iodine?: Goiter, cretinism
What kind of birth defects are caused by cocaine?: cerebral infarcts, mental retardation
What kind of birth defects are caused by diazepam?: cleft lip and/or palate
What kind of birth defects are caused by diethylstilbestrol?: clear cell vaginal cancer, adenosis, cervical incompetence
What kind of birth defects are caused by maternal diabetes?: cardiovascular malformations, cleft lip and/or palate, caudal regression, neural tube defects, left colon hypoplasia/immaturity, macrosomia, microsomia (if mother has long-standing DM),
What kinds of problems do infants born to diabetic mothers have after birth?: increased risk of respiratory distress syndrome, postdelivery hypoglycemia,
How do you treat diabetes during pregnancy?: insulin (after diet and exercise), DON'T use oral hypoglycemics because they cross the placenta and cause fetal hypoglycemia
What drugs are safe during pregnancy?: acetaminophen, penicillin, cephalosporins, erythromycin, nitrofurantoin, H2 blockers, antacids, heparin, hydralazine, methyldopa, labetolol, insulin, docusate
What does TORCH stand for?: Toxoplasma, Other, Rubella, Cytomegalovirus, Herpes
risk factors for toxoplasma?: exposure to cats
What kind of birth defects are caused by toxoplasma?: intracranial calcifications, chorioretinitis
What kind of birth defects are caused by varicella-zoster?: limb hypoplasia, scarring of the skin
What kind of birth defects are caused by syphilis?: rhinitis, saber shins, Hutchinson's teeth, interstitial keratitis, skin lesions
What kind of birth defects are caused by rubella?: effects are worse in the first trimester, cardiovascular defects, deafness, cataracts, microphthalmia
What kind of birth defects are caused by cytomegalovirus?: deafness, cerebral calcifications, microphthalmia
What kind of birth defects are caused by herpes?: vesicular lesions, encephalitis, early fusion of cranial bones, sz's
What percent of fetuses are infected with HIV from their mothers if the mothers do not receive treatment?: 25%
How do you treat HIV in pregnant women?: zidovudine (AZT) is given to the mother prenatally, and it's given to the infant for 6 weeks afer birth
What percent of fetuses are infected with HIV from their mothers if the mothers receive treatment?: 8%
When do you test an infant for HIV antibodies?: between 6-18 months of age; Abs tests will be positive at birth because maternal antibodies cross the placenta
How do you test newborns for HIV?: HIV PCR, with follow up at 18 months with antibody test
can breastmilk transmit HIV?: yes
What do you do if a woman has active visible genital herpes lesions during labor?: do a c-section
What do you do if a woman has a hx of genital herpes and goes into labor, and there's no visible lesions?: proceed with vaginal birth
What do you do if a laboring mother has chronic hepatitis B?: give infant the first hep B vaccine and hepB immunoglobulin at birth.
What do you do if a mother contracts chickenpox late in pregnancy?: give the infant varicella-zoster immunoglobulin
How do you treat GC/chlamydia during pregnancy?: ceftriaxone and erythromycin or azithromycin
How do you treat TB during pregnancy?: same as in non-pregnant women. BUT don't use streptomycin (it's rarely use anyway). Make sure to give vitamin B6 with isoniazid.
How do you know if the placenta has separated during the third phase of delivery?: there is a fresh gush of blood, lengthening of the umbilical cord, and a rising fundus that is firm and globular
If a pt has had a c-section, can they have a vaginal delivery during the next pregnancies?: Maybe. If they have a vertical uterine incision, they have to have a repeat c-section. If they have a horizontal incision, they may deliver vaginally with only a slightly increased risk of uterine rupture.

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