Complications with pregnancy

Question 1

What is the beta-hCG level at which an intrauterine pregnancy should be seen on ultrasound?

Answer 1

2000 mlU/ml

beta-hCG over this with empty uterus = ectopic

Question 2

What progesterone level suggests healthy pregnancy?

Answer 2

> 25 ng/ml

Question 3

In a normal pregnancy, the beta-hCG should rise by 50% every ___ hours for the first ___ days of the pregnancy.

Answer 3

48

42 days

Question 4

What conditions must be met prior to methotrexate administration for tx of ectopic pregnancy?

Answer 4

hemodynamic stability, non-ruptured ectopic, size <4cm without fetal HR OR <3.5 cm with fetal HR, nl liver enzymes and renal function, nl white cell count

Question 5

What is the most common chromosomal abnormality in spontaneous abortions?

Answer 5

autosomal trisomy

Question 6

Which systemic diseases are associated with early pregnancy loss?

Answer 6

Diabetes Type 1, chronic renal disease, lupus

Question 7

For a woman with an incompetent cervix, when should a cervical cerclage be placed?

Answer 7

14 weeks

Question 8

Use of misoprostol has been shown to (shorten/lengthen) time to expulsion.

Answer 8

shorten

Question 9

What are appropriate treatments for thyroid storm in pregnancy?

Answer 9

PTU, propanolol, sodium iodide, dexamethason

vs - radioactive iodine (I-131) can concentrate in the fetal thyroid

Question 10

Women without risk factors for type2 or gestational diabetes should be screened (when?)

Answer 10

24-28 weeks

Question 11

Women with risk factors for type 2 or gestational diabetes should be screened when?

Answer 11

At their first visit:
50-g oral glucose challenge
+ 100-g oral glucose tolerance test (OGTT)

Question 12

What is the biggest concern for a pregnant woman with pulmonary hypertension?

Answer 12

25-50% risk of death

Mostly from diminished venous return and R ventricular filling

Question 13

Magnesium toxicity can lead to what complication during labor?

Answer 13

Respiratory depression, muscle weakness, loss of DTR, nausea

Question 14

How do you reverse magnesium toxicity?

Answer 14

Calcium gluconate

Question 15

What 24 hour urine protein value indicates preeclampsia?

Answer 15

300 mg

Question 16

What 24 hour urine protein value indicates severe preeclampsia?

Answer 16

5000 mg or 5 g

Question 17

What is the hallmark of eclampsia syndrome?

Answer 17

seizures

Question 18

What are contraindications for expectant management of severe preeclampsia <32 weeks?

Answer 18

thrombocytopenia <100,000, BP not controlled with 2 antihypertensives, non-reassuring fetal surveillance, LFTs elevated >2x normal, eclampsia, persistent CNS symptoms, oliguria

Question 19

What on tocometer indicates placental abruption

Answer 19

tachycardia and sinusoidal HR pattern = fetal anemia

Question 20

When reducing blood pressure with medications, what is the target diastolic blood pressure?

Answer 20

90-100 mg, NOT normal blood pressure

Question 21

Uncontrolled diabetes can lead to birth defects in which main areas?

Answer 21

spine and heart

Question 22

Why do fetuses in utero to moms with gestational diabetes experience polyhydramnios?

Answer 22

high levels of glucose –> polyuria

Question 23

What medication is indicated for a pt with PPROM but no contractions?

Answer 23

ampicillin and erythromycin prolongs latency period by 5-7 days

Question 24

What medication has been shown to decrease the risk of PPROM?

Answer 24

17 alpha-hydroxyprogesterone

Question 25

When is delivery recommended for pts with PPROM?

Answer 25

34 weeks

Question 26

What is the pH of amniotic fluid?

Answer 26

7.1-7.3

Question 27

What body fluids can cause a falsely positive nitrazine test?

Answer 27

semen or blood

Question 28

What is a common finding in IUGR fetuses determined by doppler ultrasound?

Answer 28

systolic/diastolic (S/D) ratio increased

Question 29

Fetal growth restriction is a risk factor for development of what diseases?

Answer 29

Hypertension, stroke, COPD, DMT2, obesity

Question 30

What defines a threatened abortion?

Answer 30

vaginal bleeding and positive preg tests but closed cervix

Question 31

Medical abortion is associated with (higher/lower) blood loss than surgical.

Answer 31

higher

Question 32

Manual vacuum aspiration is effective for termination of pregnancy of what gestational age?

Answer 32

less than 8 weeks

Question 33

What antibiotic is given during/after surgical abortion?

Answer 33

doxycycline

Question 34

What are risk factors for molar pregnancy?

Answer 34

Asian race (1/800 vs 1/1500-2000) less than 20 yo decreased consumption of beta-carotene and folic acid

Question 35

What is the standard management for molar pregnancies?

Answer 35

suction curettage

Question 36

How many chromosomes are found in a complete mole?

Answer 36

46 (empty egg + single or two sperm)

Question 37

How many chromosomes are found in a partial mole?

Answer 37

69 (egg + 2 sperm)

Question 38

Partial moles have a (higher/lower) chance of developing into post-molar GTD.

Answer 38

lower

Question 39

What is the risk that molar pregnancy progresses to malignant GTD?

Answer 39

20%

Question 40

Molar pregnancies are associated with what other condition?

Answer 40

ovarian cysts and increase thyroid hormone

Question 41

What is the mechanism for increase in ovarian cysts and TSH suppression?

Answer 41

hCG has an alpha subunit similar to LH and TSH

Question 42

What is the most common malformation in babies born to diabetic mothers?

Answer 42

cardiac (38%), then MSK, then CNS

Question 43

What is the one diabetic complication that pregnancy worsens?

Answer 43

proliferative retinopathy

Question 44

What thyroid medications cross the placenta?

Answer 44

thionamides (PTU and methimazole) --> can lead to goiter and hypothyroid in fetus

Question 45

How does acute fatty liver of pregnancy present?

Answer 45

late in pregnancy, more in nulliparous, several days of malaise, anorexia, nausea, emesis, jaundice elevated PT/PTT, bilirubin, ammonia hypoglycemia

Question 46

How is acute fatty liver in pregnancy treated?

Answer 46

delivery - resolves spontaneously | Important to deliver quickly! without delivery --> coma, death from hepatic failure, hemorrhage or renal failure

Question 47

ITP is associated with platelet counts

Answer 47

100,000 | absence of splenomegaly

Question 48

What platelet count needs to be maintained in pregnant women with ITP to decrease risk of hemorrhagic episode?

Answer 48

above 20,000

Question 49

What are the fetal affects of maternal syphilis infection?

Answer 49

hepatosplenomegaly, edema, ascites, hyrops, petechiae/purpuric skin lesions, osteochondritis, lymphadenopathy, rhinitis, pneumonia, myocarditis, nephrosis, enlarged placenta

Question 50

What are complications for the fetus of maternal parvovirus infection?

Answer 50

hydrops, still birth, fetal anemia | remember the red baby balloon in sketchy

Question 51

Risk factors for placenta previa...

Answer 51

prior placenta previa multiple gestation advanced maternal age (>35) prior cesarean delivery

Question 52

Intrahepatic microvesicular fatty infiltration of hepatocytes secondary to abnormal maternal-fetal fatty acid metabolism =

Answer 52

AFLP = acute fatty liver of pregnancy

Question 53

Lab findings of AFLP

Answer 53

``` increased aminotransferases increased bili thrombocytopenia hypoglycemia DIC ```

Question 54

Treatment for AFLP

Answer 54

immediate delivery

Question 55

What defines a "threatened" abortion?

Answer 55

closed cervix, viable fetus on u/s, vaginal bleeding

Question 56

Amphetamine use during pregnancy is associated with what complication?

Answer 56

``` fetal growth restriction preeclampsia abruptio placentae preterm delivery fetal demise ```

Question 57

Complications of asymptomatic bacteriuria:

Answer 57

acute pyelonephritis preterm labor low birth weight

Question 58

Pathophys of asymptomatic bacteriuria in pregnancy?

Answer 58

increased progesterone --> smooth muscle relaxation --> ureteral dilation

Question 59

What is the amniotic fluid volume you are looking for in a biophysical profile?

Answer 59

single fluid pocket >2 cm x 1 cm less than that = oligo

Question 60

A biophysical profile score of 0-4/10 indicates...

Answer 60

fetal hypoxia --> from placental dysfunction

Question 61

What are the 5 components of the biophysical profile?

Answer 61

``` nonstress test Amniotic fluid volume fetal movements fetal tone fetal breathing movements ```

Question 62

What is fetal tachycardia defined as?

Answer 62

>160 bpm

Question 63

What are contraindications for a trial of labor?

Answer 63

vertical incision cesarean delivery | Abdominal myomectomy with uterine cavity entry

Question 64

Patients with active HSV infection should...

Answer 64

undergo C-section

Question 65

What is the next step in a patient at >34 weeks gestation with PPROM?

Answer 65

delivery +/- antibiotics if no GBS swab done

Question 66

What is the feared complication of PPROM?

Answer 66

chorioamnionitis

Question 67

How do you diagnose intra-amniotic infection?

Answer 67

maternal fever + one of the following: fetal tachy (>160), maternal leukocytosis, maternal tachy, purulent amniotic fluid

Question 68

What is the most appropriate management for pregnant patients with prior HSV infection?

Answer 68

begin antiviral suppression at 36 weeks - if lesions during labor then C-section

Question 69

SBP >140 and/or DBP >90 prior to 20 weeks gestation...

Answer 69

Chronic hypertension

Question 70

New onset elevation of BP at >20 weeks gestation withOUT proteinuria

Answer 70

gestational HTN

Question 71

Fetal risks to pregnancy from hypertension...

Answer 71

fetal growth restriction, perinatal mortality, oligo, preterm delivery

Question 72

Congenital heart defects are associated with what maternal conditions?

Answer 72

maternal diabetes | Family history of CHD

Question 73

What is magnesium used for during labor?

Answer 73

seizure prophylaxis

Question 74

What is oxytocin used for during labor?

Answer 74

induction, hemorrhage

Question 75

What are adverse effects of oxytocin?

Answer 75

hyponatremia, hypotension, tachysystole

Question 76

Oxytocin is similar to ___ (other hormone) --> water retention and hyponatremia

Answer 76

ADH | both from posterior pituitary