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Notes
Hypertension in Pregnancy
Chronic Hypertension Diagnosis BP > 140/90 before 20w Treatment Methyldopa Labetalol Hydralazine Nifedipine ACEi and Diuretics ⇒ Uterine ischemia Gestational Hypertension Diagnosis BP > 140/90 after 20w No edema No proteinuria Treatment Metyldopa Labetalol Hydralazine Nifedipine Preeclampsia Risk Factors Chronic HTN Renal disease Mild Diagnosis BP > 140/90 Proteinuria...
Read moreRh Incompatibility
Hemolytic Disease of Newborn Fetal anemia Extramedullary hematopoiesis Billirubin neurotoxicity High output CHF Erythroblastosis fetalis Screening Algorithm Initial prenatal visit → Antibody screening Mother Rh Positive → No further workup Mother Rh Negative Dad Rh Negative → No further workup Dad UNKNOWN and high-risk pregnancy → Amniocentesis PCR for fetal blood type (16-20w) Fetus...
Read moreRupture of Membranes
Spontaneous ROM → After or at the labor onset Premature ROM → >1h before labor onset Preterm Premature ROM (PPROM) → <37w gestation Prolonged Premature ROM (Prolonged ROM) → >24h prior to delivery Premature ROM Presentation Gush of fluid Diagnosis Sterile speculum exam Fluid in posterior fornix Nitrazine paper → blue Ferning...
Read morePreterm Labor
Risk Factors Previous episode Multiple gestations Cervical surgery PROM Placental abruption Uterine abnormality Chorioamnionitis Preeclampsia Abdominal surgery Polyhydramnios Poor maternal nutrition Low SES Presentation Contraction Cervix dilation 20-37w Complications RDS Intraventricular hemorrhage PDA Necrotizing enterocolitis Retinopathy of prematurity Bronchopulmonary dysplasia Death Treatment High risk for preterm labor → Vaginal/IM progesterone during...
Read moreMultiple Gestations
Etiology Fertility drugs Presentation Exponential uterus growth Rapid wight gain ↑ hCG ↑ MSAFP Diagnosis Ultrasound Monozygotic (identical) Dizygotic (fraternal) Complications General Preterm delivery Placenta previa Breech presentation Post-partum hemorrhage Spontaneous abortion Anemia Monochorionic (one placenta) Twin-twin transfusion Monoamniotic (one amniotic sac) Conjoined twins Cord entanglement
Read moreAbortion
Pregnancy that ends Before 20w gestation Fetus <500g Etiology Chromosomal abnormality (60-80%) Anatomical abnormality STDs Antiphospholipid syndrome Hyperthyroidism Diabetes Malnutrition Trauma Rh isoimmunization Symptoms Cramping abdominal pain Vaginal bleeding Hypotension Diagnosis CBC Blood type Ultrasound Treatment Type Findings Cervix Treatment Complete abortion No products found Closed Follow up Incomplete...
Read moreEctopic Pregnancy
70-80% in ampulla Risk Factors PID IUD Previous EP Symptoms Pelvic pain Vaginal bleeding Hypotension if ruptures Diagnosis hCG If hCH >2000 then pregnancy should be seen with U/S Ultrasound Laparoscopy Treatment Methotrexate Contraindications Immunodeficiency Non-compliance Liver disease EP > 3.5 cm hCG >5000 Fetal heart beat Surgery Salpingostomy...
Read morePrenatal Care
First Trimester Visit every 4 weeks First visit Blood tests CBC Rh/Blood type Rubella Ab HBsAb VDRL/RPR HIV ± HCV Varicella HbA1c Sickle cell U/A and UC PPD Pap smear → Dysplasia Cervical Gonorrhea/Chlamydia Discuss genetic screening Tay-Sachs CF 9-14 weeks First trimester genetic screening Ultrasound Confirm gestational age...
Read moreNormal Pregnancy
Definitions Embryo → Fertilization – 8w Fetus → 8w – Birth Infant → Birth – 1y Gravidity/Parity G-TPAL G (# of pregnancies) P (full term; preterm; abortion; living children) Dating Methods Developmental Age (DA): since fertilization Gestational Age (GA): since LMP Nagele rule: Estimated deilvery = LMP...
Read moreNuclear Scan
HIDA scan Functional test for cholecystitis Bone scan Sensitive for occult metastases in bone Gallium scan Fever of unknown origin Follows iron metabolism, transports on ferritin Indium scan Fever of unknown origin Superior for abdomen Tags WBCs V/Q scan Normal V/Q scan excludes PE No longer the standard of...
Read moreUltrasonography
US is answer in: Gallbladder Renal disease Except for kidney stone in which CT is most accurate Gynecology Prostate Endoscopic US is most accurate in: Pancreas (head) Pancreatic and biliary ducts Gastrinoma (Zollinger-Ellison)
Read moreMRI
Most accurate for Any CNS disease except for hemorrhages Demyelinating (MS) Posterior fossa (cerebellum) Brainstem Pituitary lesions Spinal cord and vertebral lesions Facial structures (orbits, sinuses) Bone lesions (osteomyelitis) With cancer and infection, most accurate test in always biopsy Brain MRI Modes T1 and T2 All about FAT...
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