Biggio Bible
What are the PPROM antibiotics
Day 1: 1g azithro
Day 1-2: Ampicillin 2g q6
Day 3-10: Amoxicillin 500 q8
Day 5: 1g azithro
ERAS meaning
Enhanced Recovery After Surgery
Is B-type natriuretic protein useful for diagnosing heart failure in pregnant patients?
Yes.
The estimated optimal B-type natriuretic peptide cutoff was 111 (95% CI 78–291) pg/mL. Using this threshold, 45 (75%) women had an elevated B-type natriuretic peptide, which yielded a 95% sensitivity (95% CI 83–99), 62% specificity (95% CI 38–82), a positive likelihood ratio of 2.5 (95% CI 1.4–4.3), and a negative likelihood ratio of 0.1 (95% CI 0.0–0.3) for heart failure
- >140 mg/dL go to step 2
Second step: 3 hour 100g load
- 2 abnormal values
- fasting >95, 1 hr >180, 2 hr >155, 3 hr> 140
The stages of Twin-Twin Transfusion
Stage I: poly/oli
Stage II: absent bladder in donor
Stage III: Doppler abnormalities
Stage IV: Hydrops (non immune)
Stage V: death
Are all of these True, or False:
- Delivery cord clamping for at least 1 minute for term babies
- Routine suctioning of neonate airway should be avoided
- Room air is recommended over inspired air with oxygen
What is True
What side is DVT more likely to occur in and why?
Left lower extremity because compression of left iliac vein by right iliac artery
Does ERAS decease inpatient and outpatient opioid use
Yes.
inpatient opioid exposure (average daily morphine equivalents) decreased from 10.7 equivalents
the average number of dispensed pills decreased from 38 to 26
Blood sugar goal at time of delivery
What is <120 mg/dL
High level risk factors for developing Pre Eclampsia
History of Pre Eclampsia
Multifetal gestation
Chronic HTN
Pregestational Diabetes
Renal Disease
Autoimmune disease
True or false: heparin should be used routinely for VTE prophylaxis after cesarean delivery
False
(but evidence level is low and recommendation grade is weak)
This anticoagulant is decreased in pregnancy
Protein S
(Bonus Question: why does warfarin increase your chance of clot when first started?)
True or False: Endometriosis is associated with increased risk of HTN disorders in pregnancy?
True
Endometriosis was associated with a greater risk of pregnancy loss (spontaneous abortion: RR 1.40, 95% CI 1.31–1.49; ectopic pregnancy: RR 1.46, 95% CI 1.19–1.80). Endometriosis was also associated with a greater risk of GDM (RR 1.35, 95% CI 1.11–1.63) and hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.16–1.45).
Percentage of patients with GDM who develop frank diabetes at 6 weeks post partum
15-20%
Criteria for diagnosis of Chorioamnionitis
Maternal fever T>102.2 (39 C) OR
T>100.4 (38C) PLUS
at least 1 of the following:
fetal tachycardia, maternal leukocytosis (>15k), foul odor or purulent discharge
What percentage of patients develop surgical site infections and what percentage of those develop outside of the hospital
10%
80%
Use of depo significantly increases risk of fracture when used >2 years
False-ish
Use of DMPA beyond 2 years should not be considered an absolute contraindication. Although DMPA use was associated with slightly increased fracture risk compared with other methods, the absolute risk of fracture was small and was not observed after discontinuation.
Recommended first line agent for GDM:
insulin or oral hypoglycemics
Criteria for cesarean delivery in HIV positive patient and what gestational age
HIV viral load >1000 copies and by 38 weeks
True or False:
Urinary catheter use is associated with higher rates of urinary tract infections, AND
increased mean time to patient ambulation, voiding, oral rehydration, and LOS
TRUE
Does a patient with Factor V Leiden heterozygosity without prior VTE need antepartum or post partum anticoagulation?
No
True or false:
Universal aspirin use is associated with decreased cost relative to USPTF guidelines of aspirin use in pregnancy
True
Over a broad range of assumptions, universal aspirin administration is associated with fewer cases of preeclampsia and fewer costs relative to no aspirin administration
Second generation sulfonyurea
Stimulates pancreas to release insulin via beta cells