OB1
Terms
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- Chadwick sign
- congestion & bluish discoloration of the vagina
- Hegar sign
- softening of the cervix
- Nagele's Rule
- Due date: LMP + 7 - 3 months
- Lochia
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postpartum vaginal bleeding resulting from sloughing of the decisua
- normally heavy for 2-3 days, but can last for 6-8 weeks - Pica
- consumption of non-nutrient substances like clay, starch, dirt during pregnancy
- Ashkenazi Jewish - 4 screening tests offered
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1. Tay-sachs
2. CF
3. Canavan
4. Familial Dysautonomia
"Tay is familiar with his (cys)ter's cans" - Chorionic Villus Sampling
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10-12 weeks
- chromosome analysis, molecular genetic testing, mosaicism screen (like PUBS) to see if placental cells match fetal cells - Amniocentesis
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15-22 weeks
- chomosome analysis, molecular genetic testing
- open neural tube defects!!! - Structural abnormalities like anencephaly, hypoplastic L heart, etc.
- 18-22 weeks via US
- Thalidomide
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Antinausea/antiemetic.. now currently used for TNFalpha-antagonist properties
**A teratogen!**
Oxidative DNA damage
- Causes phocomelia (shortened limbs) - Isotretinoin
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Accutane - acne medication
**A teratogen!**
Contains Vitamin A
- Spontaneous abortions
-Microtia/anotia: small or absent ears
- Rentina/optic nerve defects
- Decrease thymus so decrease immune - Phenytoin/Carbamazepine
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Used for seizures
**A teratogen!**
Valproate acid is VERY BAD - causes neural tube defects
Deficient in epoxide hydrolase.. thus can't make Arene Oxide into an inactive/nontoxic compound
- Causes Fetal Hydantoin Syndrome - Tetracyclines
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Antimicrobial
**A teratogen!**
Wait until 2nd trimester if u need to use it
- Baby: causes yellow-brown teeth
- Mom: fatty degeneration of liver, pancreatitis, GI intolerance, Photosensitivity - Methotrexate
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Folic acid antagonist
Used to abort ECTOPIC PREGNANCIES - Hyperviscosity syndrome
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*Due to Intrauterine Growth Restriction*
- polycythemia, multiorgan thrombosis, heart failure, hyperbilirubinemia - Kleihauer-Betke Test
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Determines if there are fetal erythrocytes in the maternal circulation
(isoimmunization) - 4 drugs to delay preterm labor to increase maturity of the fetus..
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1. Mg Sulfate - most often used, decreases contractions, safe (flushing, HA, nausea)
2. Indomethacin - 2nd line, increase side effects (an NSAID)
3. Nifedipine - Ca2+ channel blocker, for chorinoic contractions (hypotensive and HAs)
4. Terbutaline - beta adrenergic - Erb-Duchenne Palsy
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Brachial plexus injury
#1 reason OB docs get sued
Postterm pregnancy (>42 weeks) - associated with macrosomia --> shoulder dystocia - Dysmaturity Syndrome
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in Postterm pregnancies
- umbilicial cord compression - oligiohydraminos (AFI < 5cm) - Hypoglycemia - Seizures - Tocodynamometer
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Measures uterine contraction frequency and duration (but strength can't be quanified)
an external tool along with doppler and real-time US
Strength of contraction measured by Intrauterine Pressure Catheter - Cardiff Method
- Minimum of 10 fetal movements in a 12 hour period
- NST (non-stress test) resulting in a "reactive" test
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Good/reassuring
2 FHR accelerations, 15 bpm above baseline lasting 15 seconds in a 20 minute period (> 32 weeks) - Friedmans Curve
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Rate of cervical dilation
- 1.5 cm/hr (multiparous
- 1.2 cm/hr (nulliparous)
- Bishop Score
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*Helps determine if induction will be needed*
Based on: 1. cervical position 2. cervical effacement 3. cervical dilation 4. cervical consistency 5. fetal station .. - Nitrazine test
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ph > 7.1
.. a test used on the amniotic fluid in the vagina to see if it is amniotic fluid or not - Homans Test
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Positive in DVT - pain at squeezing of achille's tendon
DVT also associated with pain, edema, and redness! - Caudal regression
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Degeneration of the cauda equina and portions of the sacrum
**Seen only in babies of DM mothers**! - Glyburide and Metformin
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Oral hypoglycemic agents used to decrease blood glucose (instead of gold standard insulin)
They do not cross the placenta like insulin - Magnesium sulfate
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used to prevent convulsions from HTN in pregnancy
**Antitdote = calcium gluconate - tx MgSO4 toxicity (if patient loses reflexes) - Tx for HTN in LABOR
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Administer if BP > 180/100
- Hydralazine: vasodilatory
- Labetalol: beta blocker
GOAL: 160/110 (too large of a decrease can affect placental perfusion) - Antepartum/Postpartum Outpatient Tx for HTN in pregnancy
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Tx chronic pre-existing as outpatient (not PIH)
GOAL: 160/90-110
Methyldopa
Clonidine
Prazosin (alpha 1 antagonist)
**Do not use Ace inhibitors or diuretics** - Fidelity
- Obligation to keep promises
- Veracity
- Right of patient to be provided complete and honest information
- Vasa previa
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when the umbilical cord vessels go over the cervical os
.. when someone checks to see dilation, there will be massive amounts of bleeding (from baby).. these vessels are predisposed to rupturing