When can fetal heart tones be detected w/doppler?
10-12 weeks
When is fetal movement appreciated?
17-18 weeks
When should you get a
... [Show More] "quantitative" beta-hCG
-to diagnose & follow ectopic pregnancy
-monitor trophoblastic dz
-screen for fetal aneuploidy
What supplement is given in pregnancy to decrease neural tube defects for all reproductive-age women?
Folic acid supplements
What additional supplements are given for complete vegeterians
vitamin D & vitamin B12
What kind of immunoglobulins can cross the placenta?
IgG
Prenatal screening at the initial visit
Heme= CBC, Rh factor, Type & Screen
ID= UA & culture, rubella Ab titer, HBsAg, RPR/VDRL, cervical G/C, PPD, IV, Pap smear (to check for dysplasia).
If indicated: HbA1C, Sickle cell screening. Can also discuss genetic screening (Tay-Sachs dz, Cystic Fibrosis).
When are prenatal visits conducted?
Weeks 0-28= every 4 weeks (7*4=28)
Weeks 29-35= every 2 weeks
Weeks 36-birth= every week
When is a quad screen conducted?
15-22 weeks
When's an ultrasound for full anatomic screen done?
18-20 weeks
When is the 1 hr glucose challenge test for gestational DM done?
24-28 weeks
When is RhoGAM given to Rh- women?
28-30 weeks
When's GBS culture done?
(and cervical culture for N gonorrhoeae & Chlamydia in selected populations).
35-40 weeks or 32-37 weeks
when can a nuchal transparency test be ordered?
9-14 weeks
4 elements of the Quad Screen
maternal serum AFP
B-hCG
Estradiol
Inhibin A
What's associated with ELEVATED maternal serum AFP (MSAFP)?
(<2.5 MoMs)
Open neural tube defects (spina bifida, anencephaly)
Abdominal wall defects (gastroschisis, omphalocele)
Multiple gestation
Incorrect gestational dating
Fetal death
Placental abnormailities (like rupture)
What's associated with REDUCED maternal serufm AFP (MSAFP)
(<0.5 MoM)
Trisomy 21 & 18
Fetal demise
Inaccurate gestational dating
Quad screen in trisomy 18
all are decreased
(still "UNDERage" at age 18)
Quad screen in Trisomy 21
Decreased AFP
Increased B-hCG
Decreased Estradiol
Increased Inhibin A
earliest screening for down syndrome & trisomy 18?
PAPP-A + nuchal transparency +free B-hCG done at 9-14 weeks ("Full Integrated test")
Note-> nuchal transparency is increased.
(PAPP-A= pregnancy-associated plasma protein A)
At what time (weeks) is CVS vs amniocentesis done?
CVS= 10-12 weeks
Amniocentesis= 15-20 weeks
Which is indicated in women who will be >35 yo at time of delivery?
amniocentesis
What are the major infectious organisms that can cross the placenta?
TORCHeS:
Toxoplasmosis
Other (parvovirus, varicella, Listeria, TB, malaria, fungi)
Rubella
CMV
Herpes simplex virus
HIV
Syphilis
What's the definition of spontaneous abortion?
Loss of products of conception (POC) before 20th week of pregnancy.
Major birth defect caused by lithium
Congenital heart disease (Ebstein's anomaly)
Defects associated w/streptomycin & kanamycin
Aminoglycosides--> hearing loss & CN VIII damage
Birth defects caused by tetracyclines
Permanent yellow-brown discoloration of deciduous teeth; hypoplasia of tooth enamel.
Major defects associated w/valproic acid
Neural tube defects (spina bifida)
Minor craniofacial defects
Which drugs can cause thymic agenesis?
Vitamin A & derivatives.
Intracranial calcifications & ring-enhancing lesions on MRI of fetus/child is associated with...
Toxoplasmosis
Symptoms of Congenital Rubella infection
Purpuric "blueberry muffin" rash
Cataracts
Mental retardation, hearing loss, PDA
Periventricular calcifications & petechial rash can be seen with which congenital infection?
CMV
Treatment for congenital toxoplasmosis infection
Pyrimethamine & sulfadiazine
Treatment for syphilis
Penicillin
Diagnosis of CMV
Urine culture; PCR of amniotic fluid
Which TORCHeS infections can be diagnosed w/serologic testing?
Toxoplasmosis, Rubella, & HSV
Dark-field microscopy can be used to diagnose...
syphilis
Type of abortion: NO POC expelled; closed os. No fetal cardiac motion & no uterine bleeding.
Missed abortion
Type of abortion: No POC expelled, closed os; uterine bleeding +/- abdominal pain
Threatened abortion
Type of abortion: no POC expelled; open os
Inevitable
Type of abortion: some POC expelled; open os.
Incomplete
What's the definition of "recurrent" spontaneous abortions
2 or more consecutive SABs
or
A total of 3 SABs in 1 year.
Most likely cause of recurrent SAB's in pregnancy in early vs later pregnancy?
early= most often chromosomal abnormalities
late= most often hypercoagulable states (SLE, factor V leiden, Protein S deficiency)
what should you suspect in a hx of painless cervical dilation & delivery of normal fetus between weeks 18-32?
Incompetent cervix.
What's important in diagnosis of a woman w/recurrent SAB's?
Karyotype both parents.
Hypercoagulability workup of mother.
*Evaluate for uterine abnormalities.
What can be done in treating a woman with an incompetent cervix?
Surgical cerclage to suture the cervix closed until labor or ROM (hen remove it prior to delivery)
What should you do if ROM is suspected?
Sterile speculum exam.
What are the recommendations for FHR monitoring in pt's without complications?
First stage of labor= every 30 mins
Second stage of labor= every 15 mins
What are the recommendations for FHR monitoring in pt's WITH complications?
First stage of labor= every 15 mins
Second stage of labor= every 5 mins
What's normal variability for FHR?
5-25 bpm [Show Less]