Prenatal Care
At what gestation is a 1 hr ( 50 g) glucose test performed and what value constitutes a FAIL and need for 3 hr testing?
24 to 28 weeks and 130 mg/dL
32 y/o G4P3 comes in at 40 weeks 5 days in labor. She has a history of cesarean section due to failure to progress. She has a birth plan and wishes for VBAC. Patient is dilated to 10, cervix is 100% effaced, and at 1+ station. She is actively pushing with the OB when there is a gush of vaginal bleeding and she experiences severe abdominal pain. FHR drops from 155 to 50 bpm. What is the most likely diagnosis?
Uterine Rupture
Definitive treatment of pre-eclampsia
Delivery
Goal is at 37 weeks if severe features present
How does copper IUD work and how long does it last?
The IUD is a foreign object in the uterus that triggers an inflammatory response. White blood cells from the immune system destroy sperm, preventing embryos from forming or implanting
Copper ions released from the IUD into the uterus and fallopian tubes are toxic to sperm.
10 years
31 year old G2P1 comes in at 22 weeks with a blood pressure of 149/97. No history of high blood pressure. Only complaint today is headache. Routine UA shows 3+ protein. What is she showing signs of?
Pre-eclampsia
Diagnosed after 20 weeks gestations. If before, it is gestational hypertension. Proteinuria is classified as 24 hr urinary protein >300mg/24hr or protein:creatine >0.3. Can be diagnosed without proteinuria if there is signs of end organ damage.
22 year old patient comes in for vaginal bleeding. She is G1P0 at 9 weeks 3 days. On physical exam you see an closed cervical os, scant bleeding in the canal. TVUS shows no gestational sac and a thin endometrial lining. What is the most likely diagnosis.
Complete Abortion
_______ is the preferred agent to prevent eclampsia in patients with pre-eclampsia with severe features.
Magnesium Sulfate
Do they have migraine with aura and do they have hx of blood clots
What constitutes a fail of the 3 hr (100g) glucose challenge?
Need two of the 4 to be high OR one >200
Fasting >95
1 hr >180
2 hr >155
3 hr > 140
A 19 year old G2P1 at 11 weeks comes in the vaginal bleeding. Physical exam reveals
Missed Abortion
You have diagnosed an ectopic pregnancy. What shot can be given for treatment?
Methotrexate
Nexplanon and the hormonal IUD have what type of hormone(s)? And what is the major/most common side effect?
Progesterone only - Vaginal bleeding
(Progesterone thins out the lining of the uterus)
Patient has hx of HSV but no active lesions during this pregnancy - is she treated? If so, when?
No. There is no evidence that НSV seropositive persons without active genital lesions during рrеgոaոϲу benefit from suppressive therapy, and we do not offer it to such persons.
For all patients who present with a genital HЅV lesion anytime during рrеgոаncy, whether with a primary, nonprimary first-episode, or recurrent infection, we recommend initiating suppressive therapy at 36 weeks of gestation to continue until the onset of labor. We use acyclovir 400 mg three times daily
Offer ϲеѕarеаn delivery as soon as possible after the onset of labor/rupture of membranes to prеgոаnt persons with a history of genital HЅV and either of the following:
●Active genital lesions (including those that have crusted)
●Prodromal symptoms (genital pain or burning) that may be associated viral shedding
Name this pathology.
The placenta attaches near or over the cervix, which can block the baby's vaginal exit. Bleeding often occurs after 20 weeks of gestation and is usually painless.
Placenta Previa
Patient has hypothyroidism in pregnancy. Do you increase her dose of Synthroid or decrease it?
Bonus points if you can explain pathophys of thyroid in pregnancy
Increase
Estrogen increases TBG so more T3 and total T4. hCG stimulate thyroid which increases T3 and 4.
3 to 4 months
Which oral blood pressure medications are safe in pregnancy? (Looking for 3 out of the 4 drugs here)
Procardia/Nifedipine - CCB
Labetalol - alpha and beta blocker
Hydralazine - peripheral vasodilator
Methyldopa - central acting alpha agonist
Patient has a history of PID, smokes, and is on birth control. She has a history of positive home pregnancy test and is now having vaginal bleeding severe pain in her lower abdomen. Most likely diagnosis?
Ectopic Pregnancy
Patient is on post partum floor and has pulmonary edema. Echo shows dilated cardiomyopathy. How are you going to treat her?
Diuretics, B blocker, ACE I
Patients FDLMP was 14 days ago. She wants to start OCP. When should you tell her to start?
Within 5 days of start of next period