Boards Review Flashcards
Choroid plexus cyst
Associated with T18 but usually incidental
Gastroschisis
Right of midline, not assoc with genetic abnormalities
Omphalocele
Midline, associated with genetic abnormalities
Myelomeningocele
Check genetics after birth, Though usually are isolated
First Trimester screening
One: HCG
Two: PAPP-A
Three: nuchal translucency
Nuchal translucency
Measured between weeks 11 and 14, should be less than 3 mm
dandy walker
characterized by hypoplasia of the cerebellar vermis and a retrocerebellar cyst
Hydros
Classic: skin edema and abdominal ascites. Hydrops fetalis is defined as a fluid collection in two or more fetal cavities. Characteristic findings include: ascites, pericardial effusion, pleural effusion, skin edema, and polyhydramnios
Relative infant dose of opioids
Lipophilic nature of the drug
Degree to which the drug binds to protein
pKa and milk pH
Drug’s molecular weight
Amount of breast milk consumed
Timing of medication administration relative to breastfeeding episodes
Incidence of shoulder dystocia
1.4%. With diabetes is 9.4 to 24%. If diabetes and greater than 4500 g, approaches 50% risk.
Markers for Down syndrome
Soft markers for Down syndrome on ultrasonography include echogenic cardiac foci, echogenic bowel, a short humerus and/or femur, and absent nasal bone.
Maternal hypothyroidism
IUFD, IUGR, spontaneous abortion, and medically indicated preterm delivery
Cholestasis of pregnancy
eficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD)
Dexamethasone in HELLP syndrome
Raise platelets for regional anesthesia
Neural tube defect
Increased risk in Latina women, decreased risk in African American women
Increased with diabetes and obesity
Increased with Valproic Acid
Carbamazepine
Methotrexate
In the first 28 days: fever, amniotic bands, Sauna/hot tub
Maternal graves disease
Low birth weight, medically indicated preterm delivery, fetal hypothyroidism, fetal hyperthyroidism
Most common cause of first trimester maternal death
Ectopic pregnancy
Placenta accreta
Increased lacunae, irregularly shaped Lacunae, Placenta previa, increased vascularity to bladder
Low molecular weight heparin in pregnancy versus unfractionated heparin
Low-molecular weight heparin has a longer half-life, a more predictable therapeutic response, less bone mineral density loss, and a lower risk of heparin-induced thrombocytopenia.
Benefit of unfractionated: does not cross the placenta
300 µg of RhoGAM
which covers 30 mL of fetal blood or 15 mL of fetal red blood cells after a fetomaternal hemorrhage.
Group Prenatal care
Decreased rate of preterm birth in African-American women
Bromocriptine
Suppresses milk production
Clozapine
Life-threatening agranulocytosis in infants
ACE inhibitor
Not safe in pregnancy, fine in
breast-feeding
Decreased blood pressure from epidural?
Related to sympathetic nerve blockade
methimazole
Aplasia Cutis in the first trimester, Fine from second trimester onward
propylthiouracil
Caries risk of hepatoxicity, Should be avoided after first trimester, inhibits conversion of T4 to T3
Preterm delivery is associated with:
Delayed post natal growth
Combined use of vacuum and forceps
higher rates of subdural or cerebral hemorrhage, anal sphincter tear, subarachnoid hemorrhage, facial nerve injury, and brachial plexus injury
No increased risk of urinary incontinence compared with when used alone
Neural tube defect
If one parent affected, risk for fetus is 4.5%. If one parent and one sibling affected, risk for fetus is 12%
Hypercoagulability in pregnancy
increase in factor VIII, factor X, and fibrinogen
No change in factor V
Ultrasound indicated cerclage
Cervical length less than 25 mm in patient with history of preterm delivery prior to 34 weeks, Must currently be between 16 and 24 weeks pregnant
Note: if no history of preterm birth but short cervix, use vaginal progesterone. If cervical dilation may be a candidate for rescue cerclage
300 µg RhoGAM
May neutralize 15 mL of fetal blood cells and 30 mL Of whole blood
Mentum anterior presentation ( chin on the maternal pelvis )
Usually can deliver vaginally
ITP
Prednisone is first line at 1-2 mg/kg/day
I VIG can also be used, particularly if more urgent intervention needed
Monochorionic twin pregnancy
If death of one twin, 18% risk of neurologic injury to the surviving twin, 15% risk of death to the surviving twin
Pancreatitis and pregnancy
Most common cause is gallstones
Uncontrolled hyperthyroidism in pregnancy
severe preeclampsia, maternal heart failure, preterm delivery, and low birth weight
Thyroid storm In pregnancy
Treatment should begin with propylthiouracil, which blocks the release of T3 and T4 and also blocks the conversion of T4 to the more active metabolite T3. Sodium iodide will also help block the release of T3 and T4. Glucocorticoids help block the conversion of T4 to T3. Beta-blockers can be used to control heart rate.
Nuchal translucency
3 mm is the cut off for 95th percentile and usually when testing is offered
Prolonged latent phase
defined as >20 hours in nulliparous women and >14 hours in multiparous women
Active third stage management:
1) oxytocin administration, 2) uterine massage, and 3) umbilical cord traction.
Glyburide is a sulfonylurea that binds to beta-islet cells of the pancreas to stimulate secretion of insulin
Associated with neonatal hypoglycemia
Neural tube defect’s
Five in 10,000 births
Congenital Varicella
hydrops, hyperechogenic foci in the liver and bowel, cardiac malformations, fetal growth restriction, microcephaly, and limb deformities.
Alloimmune thrombocytopenia
Neonatal alloimmune thrombocytopenia is the MOST common cause of severe thrombocytopenia among term newborns. The cause is maternal alloimmunization to paternal inherited platelet antigens. The mother’s platelet count is normal, and unlike Rh-D alloimmunization, the first pregnancy is at risk.
TB treatment in pregnancy
Beginning after first trimester for nine months
Thrombotic thrombocytopenic Purpera, TTP
characterized by thrombocytopenia, fragmentation of red blood cells, renal disease, and neurologic symptoms such as headache, seizures, altered mental status, and stroke. TTP is related to a deficiency of or antibody against ADAMTS13. This protease is lowered in normal pregnancy and thus is thought why TTP is more common in pregnancy. The gold standard treatment is plasmapheresis to remove antibodies to ADAMTS13
Cardinal movements of labor
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
Magnesium therapy for pre-eclampsia
Immediate administration of a 6-g loading dose of magnesium sulfate intravenously followed by 2 g per hour should be initiated for cessation of a current seizure and prevention of another seizure. An alternative option if intravenous access is not available is intramuscular injection of 5 g of magnesium sulfate in each buttock (total of 10 g).
Best source for chromosome all studies in IUFD
Amniocentesis
Parvo virus infection during pregnancy
Serial ultrasonography to assess for hydrops and to measure the middle cerebral artery peak systolic velocity (to assess for fetal anemia) should be performed every 1–2 weeks for 8–12 weeks after exposure.
CMV
Primary infection rates are:
first trimester 30%
Second trimester 34%–38%
Third trimester 40%–72%
Ultrasonographic findings: Intracranial calcification Fetal hydrocephalus Microcephaly Fetal intrahepatic calcification Fetal hepatomegaly Evidence of intrauterine growth restriction (IUGR) Echogenic bowel Intracranial calcification Fetal hydrocephalus Hydrops fetalis
H pylori
treatment: proton pump inhibitor given along with an antibiotic regimen, which includes amoxicillin and clarithromycin
Preterm birth rate
12%
Low molecular weight heparin
Hold for 24 hours prior to epidural for therapeutic dose, Hold for 12 hours if prophylactic dose
Rh Allo immunization
ritical value dependent on the laboratory, but usually ranges 1:8 to 1:32. In the case that paternity is certain and the father of the baby is available, paternal blood typing should be performed to avoid unnecessary fetal testing and procedures. If the father is Rh+, then red cell antigen genotyping should be performed to determine zygosity. If the father is homozygous, there should be no further work-up as the fetus must be Rh+ by serology and should be monitored closely. If the father is heterozygous, then amniocentesis should be performed for red cell genotyping.
History indicated cerclage
history of ≥ 1 pregnancy loss in the 2nd trimester related to painless cervical dilation without placental abruption or labor
prior cerclage due to painless cervical dilation in the 2nd trimester
Hypothyroidism In pregnancy
Increase levothyroxine by 25%
Herpes
Double-stranded DNA
Changes in clotting factors during pregnancy
Procoagulants such as fibrinogen, factor VII, factor VIII, factor X, von Willebrand factor, plasminogen activator inhibitor-1, and plasminogen activator inhibitor-2 are increased, whereas the anticoagulant protein S is decreased.
Antiphospholipid syndrome Criteria for testing
1) Vascular thrombosis
2) Pregnancy morbidity
a) One or more deaths of a normal fetus
after 10 weeks
b) One or more premature births of a normal
neonate before 34 weeks due to severe preeclampsia,
eclampsia, or placental insufficiency
c) Three or more unexplained consecutive spontaneous
pregnancy losses before 10 weeks
Antiphospholipid syndrome Treatment in pregnancy
Low molecular weight heparin and aspirin
Warfarin in pregnancy
abnormalities of the bone and cartilage, which result in hypoplasia of mid-facial bones and the nasal bridge and stippling of vertebral and femoral epiphyses. Warfarin embryopathy occurs most commonly when the drug is taken between 6 and 12 weeks of gestation
Retinoic acid
spontaneous abortion and with microtia and anotia
Thalidomide
Limb abnormalities
Lithium
Ebstein anomaly, which is a downward displacement of the tricuspid valve.
mature cystic teratoma
Most common neoplasm in pregnancy
Antithrombin III
Most thrombophilic
Risk in pregnancy is 11 to 40%
Factor VIs the most common, risk in pregnancy for a homozygote is about 25% and heterozygote is 7%
Post maturity syndrome
decreased subcutaneous fat, lack of vernix and lanugo, and meconium staining of the amniotic fluid, skin, and membranes
Risk is 10 to 20% in post term pregnancies
Twin to twin transfusion syndrome stages
Quintero stage 1 twin-to-twin transfusion. Stage 2 is diagnosed when criteria for stage 1 are met and the bladder of the donor twin is not visualized. Stage 3 is diagnosed when criteria for the previous stages are met and Doppler studies (i.e., umbilical artery, ductus venosus, and/or umbilical vein) are abnormal for either twin. Stage 4 signifies hydrops fetalis is present in one or both of the fetuses, and stage 5 is diagnosed when one or both of the twins have died
Vacuum assisted vaginal delivery
Contra indicated prior to 34 weeks
Anti Lewis antibodies
type M immunoglobulins (IgM) that do not readily cross the placenta. As a result, this antibody is not associated with erythroblastosis fetalis
Amstel criteria
The first is a thin, gray-white vaginal wall discharge. The second is a vaginal pH greater than 4.5. The third is a positive whiff amine test, which is a fishy odor noted when a drop of 10% potassium hydroxide is added to a sample of vaginal discharge. The fourth is clue cells (>20% of the vaginal epithelial cells) noted in microscopy of the vaginal smear
Neural tube defect
If prior child with neural tube defect, 70% risk reduction with appropriate folic acid supplementation
Post placental IUD insertion
10 to 25% risk of expulsion
Rate of preterm birth
12%
Fetal red blood cells
Form at 42 days
Congenital vericella
echogenic foci in the fetal liver, limb anomalies, intrauterine growth restriction, microcephaly, and ventriculomegaly
Primary HSV outbreak during labor
60% chance of vertical transmission
Algorithm for IV hydralazine
5 mg or 10 mg, then repeat blood pressure check in 20 minutes if still severe then
10 mg, then repeat blood pressure check in 20 minutes if still severe then
20 mg of IV labetalol, then recheck blood pressure in 10 minutes if still severe then
40 mg of IV labetalol, then recheck blood pressure in 10 minutes if still severe, then consult maternal-fetal medicine or critical care
17 OHP
First to test for adult onset congenital adrenal hyperplasia. Should be done fasting and during the follicular phase
Marfan syndrome
Autosomal Dominant
Adult onset congenital Adrenal hyperplasia
Autosomal recessive
Increase in pregnancy
Fibrinogen D dimer sed rate, alk phos, aldosterone cortisol triglycerides LDL HDL insulin WBC, factors 178 910, vWB, plasminogen activator one and two
No anticoagulants go up in pregnancy
Decrease in pregnancy
13, 11-
Protein S
Same in pregnancy
2, 5, 9
Protein C and antithrombin III
Orlistat
Could be deficient in vitamins ADE or K
Endometriosis
Risk for clear-cell carcinoma
Methotrexate
Inhibits dihydrofolate reductase
Salmonella
Chicken eggs, bloody diarrhea
Rotavirus
Child day care
Norovirus
Cruise ship watery diarrhea
Beta agonists
Risk of pulmonary edema, tachycardia, inc BP
Metabolic syndrome
AC 88 cm or greater BG greater than 100 TG 150 HDL less than 50 BP 130/85
Stages of arousal
Desire, arousal, orgasm, resolution
Lubrication is transudative from vaginal epithelium
Androgen insensitivity syndrome
X linked recessive disorder
No pubic hair, yes breasts
Inguinal hernias
Mullarian agenesis
Scoliosis hearing issues kidney issues, Normal FSH, normal Karyotype, Multi factorial cause, have breasts and pubic hair
Pneumonia
Usually strep pneumonia— use Azithromycin.
Most deadly pneumonia and pregnancy is Varicella.
Anorexia
Low FSH, high leptin
Symptomatic urethral prolapse in a child
Estrogen cream, don’t treat unless symptomatic
Transgender females
Estrogen for breasts,
Spironolactone to decrease hair
Cowden syndrome
PTEN
associated with hamartomas breast cancer colorectal cancer endometrial cancer, Kidney cancer, melanoma
Ductile ectasia
Breast discharge, can be yellow or green
Intraductal papilloma
Bloody discharge
FRAX
Age, sex, BMI, previous fragility fracture, History of hip fracture, smoking status, Corticosteroid use greater than 5 mg per day, alcoholic intake greater than three drinks per day,Secondary causes of asked your process such as rheumatoid arthritis
Crohn’s disease
Mouth to anus fistulas
Ulcerative colitis
Bloody diarrhea
Von Willebrand’s disease
Type one: Autosomal Dominant, type two and type III: autosomal recessive, Most common is type one, most difficult is type three
Causes of primary amenorrhea
Most common is TUrner’s, second most common is Mullarian agenesis
Unicornate uterus
Arrested development of the Mullarian ducts, Increased incidence of infertility endometriosis and dysmenorrhea ,50% of pregnancies last in the first two trimesters
Uterine didelphys
Failed fusion of paired Mullarian ducts, Two endometrial cavity is each with a cervix,
Bicornuate uterus
Incomplete lateral fusion of the Mullarian and ducts
Uterine septum
Most common cause of early pregnancy loss with uterine anomaly
Inferior epigastric
Comes from the external iliac artery
Colon cancer screening
Begin screening 10 years younger than an immediate family member diagnosis time
Dantrolene
Treats malignant hyperthermia, this is a AutoSomal dominant disease
Causes of osteonecrosis: alcohol, steroids, trauma, Gout, sickle cell disease
Proximal and distal Femoral head, shoulder, Ankle, elbow
Cushing’s and PCOS
Both have obesity, menstrual disorders, androgen excess, cardiovascular disease,
Cushing’s has hypercortisolism and osteoporosis
Pregnancy and thyroid
1st trimester: TSH goes down
T4 and T3 go up in all trimester
Resin T3 uptake goes down
Same thing happens on OCPs
Free T3 and T4 stay the same
Pyuria in a sterile urine culture
Chlamydia, mycoplasma, Ureaplasma
Mucinous ovarian cancer
Resembles cervical glands, goblet cells, CEA
Granulosa cell tumor
Coffee bean nuclei, inhibin, call Exner bodies, engorged breasts
Kallman’s syndrome
Infantile development, ataxia, unilateral agensis, cleft palate, can’t smell
Most common structural defect
Heart
NTD
Most common midline defect
AFP
Most common endo disorder of reproductive age women
PCOS
Toxoplasmosis
Treat with Spiromycin
Fetal infection: add Pyrimethamine, sulfonamide, and folinic acid —treat x1 year after birth
Parvo
Most lethal, hydrops
Rate of loss 8 to 17%
Most common fetal infection
CMV
Rubella
Most Teratogenic fetal infection
VAVD
Worst: sub Galeal hematoma 3%
Cephalohematima- doesn’t not cross suture lines
Post pituitary
ADH, oxytocin
Mag syndrome
: Ascites hydrothorax
Oh Varian fibroma, Brenner tumor (transitional cell epithelium), keukenberg tumor
Perineorrhaphy
Bulbocavernosus and superficial transverse Perineal
Tamoxifen
VTE, endometrial cancer, vasomotor symptoms, fluid retention are all risks
Aromatase inhibitor
Letrozole- increases risk for osteoporosis
Mentum ant- SVD
Mentum post - CS
Brow- observe
Vaginal Cancer
Usually spreads lymphatically
Dumping syndrome
Related to ingestion of high glycemic carbohydrate foods
Statins
Myalgias, treat with coenzyme q
Turner
Cystic hygroma
Warm compress
Decreased rate 3rd and 4th degree
Maternal perineal massage
Prevents overall decreased lacerations
Yasmin
Drospirenone— synthetic progesterone for PMDD
Fetal macrosomia
4000 g
Carcinosarcoma
Most common type
Of uterine sarcoma
Femoral nerve retractor injury
Loss of hip flexion adduction and knee extension
Granulosa cell tumor
Inhibin B
Embryonal cell carcinoma
Alpha fetal protein
Beta hCG
Ovarian choriocarcinoma, mixed germ cells, and Embryonal cell carcinoma
AFP
Yolk sac tumor
Lactate dehydrogenase
Dysgerminoma
BRCA one
Risk of breast cancer 55 to 65%, risk of ovarian cancer 84%
BRCA2
Risk of breast cancer 45%, risk of ovarian cancer 39%
Post operative fever
Day 1 to 2: wind Day 3 to 5: water Day 4 to 6: walking Day 5 to 7: wound Day seven or more: wonder drugs
Electrolyte free: hypotonic equals sorbitol and glycine. Iso tonic equals mannitol
Can use monopolar but fluid deficit for hypotonic solutions is 1 L.
500 mL for high viscosity such as 32% dextran 70 (HYSKON)
PDS suture
POLYDIOXANONE
Monocryl
PLOL I GLECAPRONE 25
Victim
POLYGLECTIN 910
Prophylactic BSO
Age 40 or when done with child Bearing
Risk of GTN after complete Mole
15%
3% sorbitol for hysteroscopy
Can only allow 500 mL deficit
Dysgerminoma
Most common ovarian malignancy and found in pregnancy
