Obstetrics

Fetal and Amniotic Size

Fetus IUGR Fetus weight in bottom 10% for GA Symmetric Before 20w Brain in proportion to body Asymmetric After 20w Brain bigger that body Etiology First trimester Chromosomal abnormality Uterine Infection 2/3 trimester Maternal HTN → Asymmetric Maternal smoking → Asymmetric Maternal substance abuse Maternal malnutrition Maternal anemia Placenta...

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Diabetes in Pregnancy

Pregestational Diabetes Diagnosis DM type 1/2 before pregnancy Complications Mother Preterm labor 4x preeclampsia 2x spontaneous abortion ↑ infection ↑ postpartum hemorrhage Fetus ↑ congenital anomalies Heart Neural tube Macrosomia Shoulder dystocia Additional evaluations needed Mother EKG 24h urine Cr clearance Protein HbA1c Ophthalmologic exam Fetus 22-24w → Fetal...

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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...

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Rh 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...

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Rupture 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...

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Preterm 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...

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Multiple 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

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Abortion

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...

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Ectopic 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...

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Prenatal 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...

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Normal 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...

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