Obstetrics
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| Hormone levels in PG: | FSH/LH low; progesterone high
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| part of maternal serum quad test | Estriol (tests looking for trisomy/Down syndrome)
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| Current hCG test is what type test: | monoclonal Ab
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| Urine hCG tests may be negative even when: | serum test is positive
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| hCG high: | PG, ectopic, molar pregnancy, choriocarcinoma, germ cell tumors, hepatomas, lymphoma
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| hCG low: | threatened or incomplete abortion, fetal demise
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| Half life of hCG: | 3-7 days
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| Grp B Strep bacteruria indicates: | Heavy colonization
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| Seen in babies born to mothers on AZT for HIV: | Lower WBC counts & macrocytic anemia (will resolve over time)
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| If PG pt is pos for HBSAg: | check acute/chronic (HBcAb,LFT); test partner, if neg, vax
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| Hep E antigen: increased risk of: | infectivity (vertical trans in maternal chronic Hep B)
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| When do you screen with 1 hour glucose | At 24-28 weeks in patients >25 or family history of DM or Ethnic risk; if >130, do 3 hr GTT
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| HbA1C can predict the risk for __ when measured in the first trimester | Malformation; otherwise HbA1c not recommended to screen for GDM
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| optimal fasting glucose in pregnancy | 70-95
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| optimal 1-hr postprandial glucose value during pregnancy | Less than 140
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| optimal 2-hr postprandial glucose value during pregnancy | Less than 120
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| Proteinuria in preeclampsia = | Urinary excretion of >/= 0.3g protein in a 24 hr urine, usually correlates with 1+ or greater on dipstick
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| transvaginal scan: gestational sac visible at: | 4.5 - 5 wks
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| transvaginal scan: fetal pole w/cardiac activity visible at: | 5.5 - 6 wks
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| Spont Abortion: U/S dx | Absence cardiac activity when crown-rump length (CRL) >5 mm; absent fetal pole when sac >18 mm(TVS) or >25 (AbUS)
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| The fetal fibronectin test has a high __ value in predicting delivery within the next 14 days | Negative predictive
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| What is the best tool we have right now to determine patients not at risk for imminent delivery | Fetal fibronectin and cervical length
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| 1st tri: low PAPP-A (PG-assoc plasma pro A) & low free HCG may signify: | trisomy 21 or other genetic dz
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| amniocentesis indication | 10-13 wks if NTD risk
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| US for nuchal translucency & CVS: indications | performed at 10-13 wks if: mom >35, FH or prior PG w/chromo abnl, abnl quad screen; CVS/amnio if nuchal fold abnl
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| quad screen | in 2nd trimester for trisomy 21 & 13 & NTD; HCG, AFP, uE3 (unconjugated estriol), inhibin A (DIA)
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| normal (reactive) non stress test: | Done in 3rd trimester. 2 accelerations of FHT (of 15 bpm), lasting 15 sec, within 20 min
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| 3rd trimester: biophysical profile (BPP) components | NST, amniotic fluid level, gross fetal movements, fetal tone, fetal breathing; best score=10
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| ectopic PG studies | bHCG (s/b double q 48 hr; poss ectopic if less); TVUS should show intrauterine gestation if bHCG >1500
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| snowstorm pattern (or grapelike vesicles) on US = | complete hydatidiform mole
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| complete hydatidiform mole: HCG: | often >10,000 mU/mL
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| US & placental abruption vs placenta previa | Placenta previa: US is TOC; abruption: US not reliable (dx is clinical)
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| Kleihauer-Betke test | detects presence of fetal RBCs in maternal circulation
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| Tests for fetal anemia | High bili in amniotic fluid. US of middle cerebral artery for peak velocity: increase in flow 2/2 decreased viscosity in anemia. PUBS for HCT
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| Indirect Coombs that is associated with fetal hemolysis | titer of 1:8 to 1:32
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| Triple screen | at 15-18 weeks to assess risk for Down, trisomy 13 & 18
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| Prenatal diagnostic studies | Triple screen, AFP, HCG, PG-associated protein A, US, amniocentesis, chorionic villus sampling for DNA eval, PUBS, fetal blood sampling
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| Placental abruption dx studies | Pelvis US of fetus, placenta, uterus. FHM & tocometry (may show hypertonic contractions w/elevated baseline). Coag studies
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| Elevated AFP is associated with: | neural tube defects
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| Decreased AFP is associated with: | Down syndrome
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| Contraction stress test (CST) result interpretation | Reassuring: no late decelerations. Non-reassuring: late decelerations in >50% of contractions
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| When do US? | at 18-20 weeks
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| 3rd trimester mgmt | TdAP at 28 weeks (whole family). Rhogam at 28 weeks and 72h postpartum if Rh neg. Gest DM 24-28 wks. Rectal-vaginal cx for GBS 35 wks (IV PCN if pos).
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Created by:
Abarnard
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