Term
|
Definition
birth center - uncomplicated cephalic SVD, able to transfer to a hospital
1 - uncomplicated SVD, emergent CD available, anesthesia and US available
2- MFM and consult services alvailable, acute care, anesthesia 24/7
3 - MFM there, RNs need training for this, all consults readily available
4 - criticall ill |
|
|
Term
| progesterone - where does it come from, what is need to make it, what does it do |
|
Definition
corpus luteum -> placenta
maternal LDL
inhibits smooth muscle |
|
|
Term
| estrogen - where does it come from, what is needed to make it, what does it do |
|
Definition
corpus luteum --> placenta trophoblasts
maternal and fetal DHEAS
historically for monitoring fetal wellbeing since it contributes to making it |
|
|
Term
| cortison - changes in pregnancy, why, what does it do |
|
Definition
| placenta makes cortisol binding globulin increasing cortisol, myometrial contractions |
|
|
Term
| human placental lactogen - where does it come from, what does it do |
|
Definition
| placenta, lioplysis, insulin resistance (favors glucose to baby), increases GDM |
|
|
Term
| what does AMH do in pregnancy and why |
|
Definition
| decreases, ovaries are not being stimulated |
|
|
Term
|
Definition
|
|
Term
| rate of reproductive age female obesity |
|
Definition
|
|
Term
| rate of reproductive age female overweight |
|
Definition
|
|
Term
| suggested maternal weight gain |
|
Definition
<18.5 - 28-40lb
18.5-24.9 - 25-35lb
25-29.9 - 15-25lb
30+ - 11-20lb |
|
|
Term
|
Definition
underweight <18.5
normal 18.5-24.9
overweight 25-29.9
class 1 30-34.9
class 2 35-39.9
class 3 40-49.9
super 50-59.9
super suprt 60+ |
|
|
Term
| #1 fetal anomaly associated with obesity |
|
Definition
|
|
Term
| fetal anomalies associated with obesity |
|
Definition
| ONTD, cardiac, palate/lip, anorectal atresia, hydrocephaly, limb reduction |
|
|
Term
| labor abnormalities associated with obesity - 6 |
|
Definition
| increased CD, IOL, failed IOL, PPH, failed epidural, failed VBAC |
|
|
Term
| maternal medical pregnancy issues associated with obesity - 3 |
|
Definition
|
|
Term
| postpartum issues associated with obesity |
|
Definition
| baby weight retention, CVD, DM |
|
|
Term
| OSA in pregnancy increases the risk of - 4 |
|
Definition
| pre-e, mortality, cardiomyopathy, PE |
|
|
Term
| comparison of VBAC success to obese and non |
|
Definition
BMI <19.8 85% success
20-26 79%
26-29 69%
>29 68% |
|
|
Term
| fetal complications associated with obesity - 3 |
|
Definition
| increased risk of fetal death, LGA, hypoglycemia |
|
|
Term
| cancers associated with obesity |
|
Definition
| esophageal, pancreatic, colorectal, breast, endometrial, ovarian |
|
|
Term
| why is infertility associated with obesity |
|
Definition
| increased insulin resistance, increased androgens, increased leptin decreases follicle activity and steridogenesis |
|
|
Term
| effect of obesity on male fertility |
|
Definition
|
|
Term
| surgical risks associated with obesity - 5 |
|
Definition
| increased EBL, infection, pneumonia, OR time, anesthesia complications |
|
|
Term
| clinical/medical risks associated with obesity (general) - 7 |
|
Definition
| CVD, HTN, DM, OSA, DVT/PE, dementia, premature death |
|
|
Term
| risk of low fetal fraction in NIPT in obesity compared to normal |
|
Definition
60kkg 0.8%
100kg 7%
140kg 28% |
|
|
Term
| detection rate on US of anomalies of obesity compared to normal |
|
Definition
normal 66%
overweight 49%
class 1 48%
ckass 2 45%
class 3 22% |
|
|
Term
| recommended screening in obese patients (pregnant and not) - 5 |
|
Definition
LFTs
cardiac - if BMI >35 and comorbidities
OSA
APFT - not indicated, can consider BMI >40
IOL 39wk - not indicated, can consider BMI>40 |
|
|
Term
| initial lifestyle interventions and goals for obesity |
|
Definition
exercise - 150min/wk moderate or 75min/wk intense (200-300min/wk walking needed to loose weight)
goal 5-10% weight loss in 6mo |
|
|
Term
| chance that lifestyle modification will maintain after weight loss |
|
Definition
|
|
Term
|
Definition
| lovenox 40mg BID for 4-6wk PP |
|
|
Term
| most effective forms of weight loss - 1-4 |
|
Definition
1 - bariatric surgery
2 - diet very low calorie
3 - weight drug and lifestyle modifications
4 - lifestyle modifications |
|
|
Term
| 1-st line weight loss drug - name, MIA, SE 3, benefits 2 |
|
Definition
| orlistat, pancreatic lipase inhibitor, farts, diarrhea/leaking, decreased fat soluble vitamins, decreases LDL, decreases total cholesterol |
|
|
Term
| 2nd line weight loss drug - name, MOA, SE 3, contraindications 1 |
|
Definition
| locaserin, seratonin 2C receptor agonist, URI, dizziness, nausea, contraindication ergots |
|
|
Term
| 3rd line weight loss drug - name, MIA, contraindications 4, SE 8 |
|
Definition
phentramine-topomax, carbonic anhydrase inhibitor and symphathetic inhibitor
contraindications - HTN, DM, renal, liver
SE - dry mouth, constipation, parasthesias, depression, anxiety, tachycardia, metabolic acidosis, abuse potential |
|
|
Term
| when are weight loss drugs indicated |
|
Definition
| BMI >27 with comorbidities, or BMI >30 |
|
|
Term
| when should a weight loss drug be stopped and another method tried |
|
Definition
|
|
Term
| when is bariatric surgery indicated |
|
Definition
failed diet/lifestyle modifications plus
BMI >40 or BMI >35 with comorbidities |
|
|
Term
| NADIR of weight loss with bariatric surgery |
|
Definition
|
|
Term
| average time weight is started to gain back after bariatric surgery |
|
Definition
|
|
Term
| % who fail / insufficient weight loss after bariatric surgery |
|
Definition
|
|
Term
| % resolution of GDM, HLD, OSA after weight loss surgery |
|
Definition
77% DM cured
85% DM improved
79% HLD resolved
85% OSA resolved |
|
|
Term
|
Definition
| divide jujenum distal to ligament of treitz and recommect to 30mL pouch of stomach |
|
|
Term
| complications higher in rou-en-y then other methods - 5 |
|
Definition
| dumping syndrome, B12/folace/protein deficiency, obstruction |
|
|
Term
| where is a lap band placed |
|
Definition
|
|
Term
| complications associated with lap band > rou-en-y - 8 |
|
Definition
ulcers, GERD, erosions
slipping, stenosis
leaking
nausea, vomiting |
|
|
Term
| cause of dumping syndrome |
|
Definition
| refined / high glycemic glucose intake |
|
|
Term
| signs of dumping syndrome - |
|
Definition
| bloating, n/v/d, hyperinsulinemia, hypoglycemia, tachycardia, palpitations, anxiety, diaphoresis |
|
|
Term
| prevention of dumping syndrome - 2 |
|
Definition
| small frequent meals, increase fiber, avoid high glycemic or refined sugars |
|
|
Term
| prevalence of nutrition deficiencies after bariatric surgery - B12, folace, Fe |
|
Definition
| B12 70%, folate 20%, Fe 50-60% |
|
|
Term
| what are the best forms of IV Fe |
|
Definition
|
|
Term
| how is the amnount of IV Fe needed calculated, what does it normally come out to |
|
Definition
normally 1-2mg
Mg = (0.3xlbsx100) / ((14.8-hbg)/14.8) |
|
|
Term
| what are the risks of a pregnancy too close to bariatric surgery - 4 |
|
Definition
|
|
Term
| what is the increased rate of pregnancy after bariatric surgery |
|
Definition
|
|
Term
| what is the recommended weight gain in pregnancy if had bariatric surgery |
|
Definition
|
|
Term
| genetic screening recommended in patients with history of bariatric surgery |
|
Definition
|
|
Term
| percent of nausea in pregnancy |
|
Definition
|
|
Term
| percent nausea in pregnancy will progress to hypermesis |
|
Definition
|
|
Term
| definition of hyperemesis - 5 |
|
Definition
| >5% weight loss, dehydration, lyte abnormalities (esp low K), ketosis, acidosis |
|
|
Term
| conservative treatment nausea in pregnancy and their evidence - 5 |
|
Definition
ginger - good evidence
acupuncture - conflicting evidence
food avoidance - conflicting evidence
psychotherapy - no evidence
hyponosis - some evidence |
|
|
Term
| first line medications for nausea in pregnancy |
|
Definition
| pyrodoxine/B6/doxyalamine |
|
|
Term
| second line medications for nausea in pregnancy |
|
Definition
| reglan, chlorpromazine, dicyclomine, promethazine |
|
|
Term
| third line medications for nausea in pregnancy |
|
Definition
| add a second second line medication |
|
|
Term
| fourth line medications for nausea in pregnancy |
|
Definition
|
|
Term
| 5th line medications for nausea in pregnancy |
|
Definition
|
|
Term
| complications of steroids in pregnancy |
|
Definition
| cleft lip palate if <10wk |
|
|
Term
| #1 complication of PICC line in pregnancy |
|
Definition
|
|
Term
| complications of PICC line in pregnancy - 4 |
|
Definition
| bacteremia/infection, cellulitis, pain, thrombophlebitis, failure of line |
|
|
Term
| nutritions to be sure to replace in admission for n/v of pregnancy |
|
Definition
| B1/thiamine - avoid wereneckies |
|
|
Term
| incidence of carrying phenlyketonuria |
|
Definition
|
|
Term
| if mom has phenoketonuria and dad is unknown what is the chance of her baby having it |
|
Definition
|
|
Term
| what is the chance a baby of a mom with phenylketonuria will be a carrier |
|
Definition
|
|
Term
| physiology of phenylketonuria |
|
Definition
| AR, deficient phenylalanine hydroxylase in liver, phenylalanine builds up and is higher in fetal blood than maternal, toxic to fetal brain |
|
|
Term
| complications and incidence of untreated phenylketonuria in pregnancy - 5 |
|
Definition
| 92% developmental delays, 72% microcephaly, 12% cardiac defects, growth delay, seizure |
|
|
Term
| foods someone with phenylketonuria cant eat |
|
Definition
| meat, fish, egg, bread, dairy, nuts, seeds, aspartame, soy, non-wheat flour, beer, cream liquior |
|
|
Term
| safe phenylalanine levels in pregnancy |
|
Definition
| 2-6ng/dL <8wk decreases risk, <8 decreases microcephaly 73 to 8% |
|
|
Term
| prognosis of seizure disorders in pregnancy |
|
Definition
| 50% same, 25% improve, 25% worsen, 1-2% seizure risk PP |
|
|
Term
| complications of seizure disorders in pregnancy - 5 |
|
Definition
| ONTD x10, LBW, pre-e, IUFD, malformations x2 |
|
|
Term
| #1 fetal malformation in seizure disorders |
|
Definition
|
|
Term
| drug level monitoring seizure disorder |
|
Definition
| 5-6wk then qTrimester then 1-2wk PP |
|
|
Term
| which seizure meds cause increased fracture risk - 5 |
|
Definition
topomax, phenobarbitol, phenytoin, carbmazapine, valproate
- give bisphosphonates to decrease Fx and increased BMD if on long term |
|
|
Term
| physiology of myasthenia gravis |
|
Definition
| Ab to nicotinic Ach receptor at NMJ |
|
|
Term
|
Definition
| thymoma (15%), progressive weakness with use, pitosis/diplopia 50%, dysarthria/dysphagia 15% |
|
|
Term
| what percent of thymomas will have myasthenia |
|
Definition
|
|
Term
|
Definition
thymomectomy imp/resolves 85%
acetylcholinesterase drugs
steroids |
|
|
Term
| drugs to avoid in myasthenia - 11 |
|
Definition
| aminoglycosides, quinolones, clindamycin, vancomycin, BB, procanamide, anticonvulsants, succinylcholine, tetracaine, chlorprocane, magnesium |
|
|
Term
| drugs to caution in myasthenia - 9 |
|
Definition
| flagyl, macrobid, doxycycline, CCB, statins, macrolides, lithium, haldol, chlorpromazine |
|
|
Term
| pregnancy complications associated with myasthenia - 2 |
|
Definition
neonatal myasthenia - 15-20% resolves 6mo
PTL |
|
|
Term
| what do you use instead of Mg in myasthenia |
|
Definition
|
|
Term
| % pregnancy close interval |
|
Definition
|
|
Term
| define close interval pregnancy |
|
Definition
|
|
Term
| recommended inter-pregnancy interval |
|
Definition
|
|
Term
| risks of close interval pregnancy - 3 |
|
Definition
| PTD, LBW, congenital abnromalities |
|
|
Term
| #1 non OB surgery in pregnancy |
|
Definition
|
|
Term
| rate of appendicitis in pregnancy |
|
Definition
|
|
Term
| trimester most likley for appendicitis |
|
Definition
|
|
Term
| gold standard appendicitis diagnosis |
|
Definition
|
|
Term
| complications of appendicitis in pregnancy and % occurence - 4 |
|
Definition
| 1-4% loss, 30% rupture, 20% pyrea, 7% no appy in 3T, 26% no appy in 2T |
|
|
Term
| prognosis of RA in pregnancy |
|
Definition
60% improve (Esp if RF)
90% will flare PP (esp if G1) |
|
|
Term
| risks of RA in pregnancy - 1 |
|
Definition
|
|
Term
| RA medications NOT ok in pregnnacy - 2 |
|
Definition
|
|
Term
| when does MTX have to stop before conception |
|
Definition
|
|
Term
| when does lefutamide have to stop before conception |
|
Definition
|
|
Term
| RA medications safe in pregnancy - 6 |
|
Definition
depending on timing - NSAIDS, steroids, TNF inhibitors
always ok - hydroxychloroquinie, sulfasalazine, azathioprine |
|
|
Term
| when should you discontinue RA medications during pregnancy |
|
Definition
| no difference was seen in rates of fetal infection with discontinuation, do not discontinue, delay live vaccines 6mo for baby |
|
|
Term
| causes of amniotic band syndrome |
|
Definition
| #1 sporadic, ehlers dhanlos, epidermilysis bullosum |
|
|
Term
| #1 complication amniotic band syndrome |
|
Definition
|
|
Term
| rate of amniotic band syndrom |
|
Definition
|
|
Term
|
Definition
| amnion and chorion around uterine synchiae |
|
|
Term
| signs and risks placental cyst |
|
Definition
| comes from base of placenta into amniotic membranes, may have solid compoents at base, risk of bleeding |
|
|
Term
| signs cause risks of unfused amniotic sac |
|
Definition
no fusion at 12-13wk
blood between layers after amnio
PTL risk |
|
|
Term
| cause of subchorionic lucency |
|
Definition
| wortons jelly, placental lake |
|
|
Term
| changes in pregnancy - GFR, renal plasma flow, renal length, renal volume, renal pelvises, ureter, urine protein/albumin |
|
Definition
GFR up 50%
plasma flow up 80%
volume up 30%
length up 1-1.5cm
pelvis and ureters dilate R>L
increased urine protein/albumin at 20wk |
|
|
Term
| changes in pregnancy - CO, SV, HR |
|
Definition
|
|
Term
| cardiac disease is #__ COD in pregnancy |
|
Definition
|
|
Term
| low risk cardiac disease in pregnancy and % death - 7 |
|
Definition
| <1% death - ASD, VSD, MVP, PDA, bioprosthetic valve, corrected TOF, bicuspid aorta |
|
|
Term
| moderate risk cardiac disease in pregnancy and % death - 4 |
|
Definition
| 5-15% death - prosthetic valve, MS/AFib, AS, TOF uncorrected |
|
|
Term
| high risk cardiac disease in pregnancy and % death - 6 |
|
Definition
| >15% death - pulmonary HTN, dilated cardiomyopathy, coarctation of aorta, dilated aortic root, eismengers |
|
|
Term
| cardiac disease causing highest mortality in pregnancy |
|
Definition
|
|
Term
| rate of peripartum cardiomyopathy |
|
Definition
|
|
Term
| risks for peripartum cardiomyopathy - 5 |
|
Definition
| AA, AMA, multiples, tocolytics, HTN |
|
|
Term
| after someone has peripartum cardiomyopathy what meds are they on PP, how long, and how do you determine when to DC them |
|
Definition
| ACEI/BB 1y, dobutamine stress test |
|
|
Term
| % recovery to normal peripartum cardiomyopathy |
|
Definition
|
|
Term
| poor prognostic sign wont return to normal after peripartum cardiomyopathy |
|
Definition
|
|
Term
| risk of peripartum cardomyopathy in NEXT pregnancy - recurrence, mortality |
|
Definition
EF >50% - 27% recurrence, no inc mortality
EF <50% - 48% recurrence, 16% mortality |
|
|
Term
| % pregnant women with dental disease |
|
Definition
|
|
Term
| risk factors for dental disease - 3 |
|
Definition
|
|
Term
| bug causing dental disease |
|
Definition
|
|
Term
| complications in pregnancy of dental disease - 2 |
|
Definition
|
|
Term
| why is there increased tooth mobility in pregnancy |
|
Definition
| estrogen and progesterone loosens tooth ligaments |
|
|
Term
| pyogenic granuloma - what is it, why does it happen, what do you do |
|
Definition
| hyperplastic inflammatory repsonse to mouth bacteria in pregnancy causing a vascular lesion <2cm, nothing unless cant eat will resolve PP |
|
|
Term
| % pyogenic granuloma in pregnancy |
|
Definition
|
|
Term
| #1 cause of death of women of reproductive age |
|
Definition
|
|
Term
| causes of trauma in pregnancy and incidence |
|
Definition
| MVA 55%, assault 22%, fall 21%, burn 1% |
|
|
Term
| percent of pregnancy MVA wearing seat belt |
|
Definition
|
|
Term
| cause of fetal loss after trauma - 4 |
|
Definition
| maternal death, abruption, uterine rupture, direct fetal trauma |
|
|
Term
| monitoring after maternal trauma |
|
Definition
| NST 4h if contractions <1 q15m then ok, if greater then monitor 24h |
|
|
Term
| rate of abruption after trauma |
|
Definition
| 5% minor and 5-50% major traumas |
|
|
Term
|
Definition
|
|
Term
| rate and location of uterine rupture after trauma |
|
Definition
| 0.6% (75% fundal due to direct impact) |
|
|
Term
| rate of direct fetal trauma in a maternal traum |
|
Definition
|
|
Term
|
Definition
| within 4min of CPR start, baby out within 5m CPR, fetal death likley after 15-20m CPR |
|
|
Term
| recommendations for radiation exposure |
|
Definition
<5 rad ok
5-10 rad low risk
10-15 rad high risk, consider termination
15+ rad terminate |
|
|
Term
| rads associated with - CT pelvis, KUB, CT head, pelvic XR, CXR |
|
Definition
CT pelvis 1-2
KUB 0.24
CT head <0.001
CXR 0.001
pelvic XR 0.17 |
|
|
Term
| immune cell shift in pregnancy - 3 |
|
Definition
T1/cell mediated decreases
T2/humoral increases
IL4 increases - to stop fetal rejection |
|
|
Term
| diseases improved by improved T2 mediated immunity - 2 |
|
Definition
|
|
Term
| diseases worsened by decreased T1 mediated immunity - 1 |
|
Definition
|
|
Term
| pregnancy complications of lupus - 4 |
|
Definition
| PTL, IUGR, PROM, neonatal lupus |
|
|
Term
| signs of neonatal lupus - 2 |
|
Definition
| skin changes, congenital heart block |
|
|
Term
| risk factors and rate of neonatal lupus |
|
Definition
| 1/3 of babys of moms who have SSA/B Ab |
|
|
Term
| fibrinogen - normal, pregnancy |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| herpes/phemphgoid gestationalis - physiology |
|
Definition
| immune response to fetal antigen on placenta and cord (bullous phemphgoid antigen 2 / BP180) abnromally expressed DR3/DR4. mom makes IgG which attacks those things plus her basement membrane |
|
|
Term
| herpes/phemphgoid gestationalis - histology |
|
Definition
| superficial and deep perivascular lymphohistocytic eosinophil invasion, linear IgG/C3 on BM |
|
|
Term
| herpes/phemphgoid gestationalis - location |
|
Definition
| umbilicus to abdomen to thighs to palms and soles |
|
|
Term
| herpes/phemphgoid gestationalis - rash appearance |
|
Definition
| erythematous ring with central vessicle, bullae |
|
|
Term
| herpes/phemphgoid gestationalis - onset |
|
Definition
|
|
Term
| herpes/phemphgoid gestationalis - diagnosis |
|
Definition
| biopsy immunoflourescent assay for IgG |
|
|
Term
| herpes/phemphgoid gestationalis - management |
|
Definition
| topical/PO steroids, topical antihistamines, PP azathioprine or MTX |
|
|
Term
| herpes/phemphgoid gestationalis - resolution |
|
Definition
| slow postpartum over months |
|
|
Term
| herpes/phemphgoid gestationalis - prognosis |
|
Definition
| no long term, earlier presentation worse disease |
|
|
Term
|
Definition
| distention causes CT damage, combined with altered cortisol levels, there is an inflammatory response |
|
|
Term
|
Definition
| G1, atopy history, increased maternal weight gain, multiples |
|
|
Term
|
Definition
| dermal edema, superficial and mid dermal perivascular eosinophils, Th cells, macrophages |
|
|
Term
|
Definition
| spares umbilicus, spares palms and soles, goes from striae to thighs, butt, back |
|
|
Term
|
Definition
| erythematous uticaria, can progress to wheels/vesicles/eczema |
|
|
Term
|
Definition
|
|
Term
| PUPPS - fetal complications |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| topical/PO steroids, anithistamines |
|
|
Term
|
Definition
|
|
Term
| atopic errution of pregnancy - risk factors - 2 |
|
Definition
|
|
Term
| #1 cause of pruritis in pregnancy |
|
Definition
| atopic errution of pregnancy |
|
|
Term
| atopic errution of pregnancy - location |
|
Definition
66% extensor, 33% trunk/limbs - will be small pruritic papules only
spares palms and soles |
|
|
Term
| atopic errution of pregnancy - fetal complications |
|
Definition
|
|
Term
| atopic errution of pregnancy - management |
|
Definition
| topical/PO steroids, anto-histamines, UV, antibiotics for secondary infections |
|
|
Term
| atopic errution of pregnancy - appearance - 4 |
|
Definition
| red plaques, dry skin, excoriations, secondary infections |
|
|
Term
| pustular psoriasis of pregnancy - aka |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - onset |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - location |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - lesion appearance |
|
Definition
| sterile pustules, erythematous plques |
|
|
Term
| pustular psoriasis of pregnancy - fetal risks |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - maternal risks |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - resolution |
|
Definition
|
|
Term
| pustular psoriasis of pregnancy - management |
|
Definition
| admit, NST, GS, lytes, delivery early |
|
|
Term
|
Definition
| hormonal, genetic, seasonal, dietary |
|
|
Term
| IHCP - liver biopsy result |
|
Definition
| bile stained hepatocytes, central lobar cirrhosis without inflammation |
|
|
Term
|
Definition
| no rash, pruritis of palms and soles |
|
|
Term
|
Definition
| usually 3T, worse at night |
|
|
Term
|
Definition
| PTD, demise, RDS, meconium, low vitamin K/ coagulopathy |
|
|
Term
| IHCP - maternal risks - 4 |
|
Definition
| PPH, recurrence, PP cholelithiasis, coagulopathy |
|
|
Term
|
Definition
| ursadiol, UV for sx, APFT 28wk (BPP weekly, bi-weekly NST) |
|
|
Term
|
Definition
| BA >10 37wk, BA >40 36wk, BA >100 consider now |
|
|
Term
| benefits of ursadiol IHCP - 3 |
|
Definition
| decreased PTD, LFTs, NICU admits. does not decrease stillbirth or BA |
|
|
Term
|
Definition
| BA elevated, LFT elevated but <300, AP 4x |
|
|
