Mini-ALSO: Hypertensive Disorders of Pregnancy and Postpartum Care

Slide set from PGY-1 orientation "Mini-ALSO" by Dr Paul Simmons.  Delivered 6/26/17. Mini-ALSO- Pre-Eclampsia, Eclampsia, Post-Partum Hemorrhage and Post-Partum Care

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Antibiotics in Pregnancy

OK penicillins cephalosporins clindamycin erythromycin azithromycin SMX/TMP in SECOND TRIMESTER ONLY Avoid TMP in 1st trimester (folate antagonist) Avoid SMX in 3rd trimester (kernicterus risk) nitrofurantoin  Avoid in last month (risk of hemolytic anemia) CAUTION nitrofurantoin  small risk, but short courses (e.g., BV, trich) likely OK doxycycline likely OK in short courses NO fluoroquinolones tetracyclines… Continue reading Antibiotics in Pregnancy

Metformin as Effective as Insulin for GDM

Metformin appears to be at least as effective as insulin for treatment of gestational diabetes mellitusClinical Question:What are the short-term and long-term risks and benefits of metformin therapy compared with insulin therapy for glucose disorders in pregnancy?Bottom Line:The results of this systematic review and meta-analysis show that metformin is at least as effective as insulin… Continue reading Metformin as Effective as Insulin for GDM

Normal Weight Gain in Newborns Lower Than Traditionally Expected

Traditional teaching:  newborns regain birth weight by 10 days of life, then 0.5 - 2.0 oz per day thereafter for the first two months. n = 140,000 healthy newborns born >36 weeks of gestation in California between 2009-2013. 76% vaginal births, 24% C-section. 40% white, 25% Asian, 25% Hispanic. "Results were as follows: Early weight… Continue reading Normal Weight Gain in Newborns Lower Than Traditionally Expected

Antenatal Steroids in Preterm Deliveries Prevent Neonatal RDS and Shortens NICU Stay

Steroids at 34-36 weeks' and before term cesarean decrease respiratory distress syndromeClinical Question:Should antenatal corticosteroid treatment be used for women at risk of late premature delivery or women undergoing planned cesarean delivery?Bottom Line:For women admitted for imminent premature delivery at 34 to 36 weeks of gestation, 1 or 2 doses of betamethasone or dexamathasone (8-12… Continue reading Antenatal Steroids in Preterm Deliveries Prevent Neonatal RDS and Shortens NICU Stay

Maternal Resuscitation and Post-Partum Hemorrhage – ALSO

Physiological Changes with Pregnancy -  Cardiovascular     -  Uterus gets 20-30% of cardiac output.     -  Volume and RBC expansion begins about 4 wks, peaks at 28-34 weeks, declines to delivery.     -  Larger relative increase in plasma volume vs RBCs --> decrease in HCT to nadir 24-26 weeks.     -… Continue reading Maternal Resuscitation and Post-Partum Hemorrhage – ALSO