Dr. Sacklord lectures

Question 1

After a contraction, it is normal for the fetal HR to _____.

Answer 1

Increase

Question 2

What is a late decel? Is it normal or bad?

Answer 2

When the fetal HR decreases after contraction. It is bad.

Question 3

What is an early decel? Is it normal?

Answer 3

When fetal HR decreases before before contraction.

This can be normal due to increase in intrauterine pressure.

Question 4

What is more predictive of fetal outcome? NST or BPP?

Answer 4

BPP. It takes into account NST plus fetal breathing, axial skeleton movements, motor tone, and amniotic fluid assessment.

Question 5

What is a normal score for a BPP?

Answer 5

8-10 indicates no fetal asphyxia.

Question 6

What should you do with a BPP score of 6?

Answer 6

Deliver if >36 weeks, if < 36 weeks repeat in 4-6 hours.

Question 7

What should you do with a BPP score < 6?

Answer 7

Deliver if >36 weeks, if <26 weeks repeat in 4-6 hours for 120 minutes. If score remains <5, deliver.

Question 8

What does doppler evaluation of umbilical arteries and middle cerebral arteries measure?

Answer 8

Velocity of blood during systole and diastole.

Question 9

An increased S/D ration in doppler evaluation indicates?

Answer 9

Placenta is not working well.

Question 10

What is macrosomia?

Answer 10

big ass baby

Question 11

Causes for fetal macrosomia?

Answer 11

Constitutional (big parents)
Diabetes
Excessive maternal weight gain

Question 12

What is the major concern of macrosomia?

Answer 12

Shoulder dystocia

Question 13

What fetal weight is concerning for shoulder dystocia in diabetics? Non-diabetics?

Answer 13

DM - 4500g

No DM - 5000g

Question 14

What are some causes for fetal growth restriction?

Answer 14

Trisomy 21 (downs syndrome)
Monosomy XO (turners syndrome)
Placental insufficiency
Infections

Question 15

What measurements indicate oligohydramnios?

Answer 15

amniotic fluid index (AFI) < 5cm

Single deepest pocket <2cm

Question 16

What measurements indicate polyhydramnios?

Answer 16

AFI >24

SDP >8

Question 17

Causes of oligohydramnios?

Answer 17

Placental insufficiency
Renal and collecting system abnormalities
Preterm ROM

Question 18

Causes of polyhydramnios?

Answer 18

Diabetes
GI tract/esophageal abnormalities
Fetal anemia
genetic syndromes

Question 19

At how many weeks should a baby be delivered if there is polyhydramnios?

Answer 19

37-39 weeks

Question 20

How is fetal growth delay or excess measured?

Answer 20

Abnormal fundal height measurements. Confirmed with fetal biometry

Question 21

A fully dilated cervix is?

Answer 21

10cm dilation

Question 22

What is labor protraction?

Answer 22

Rate of dilation lags from expected

Question 23

What is labor arrest?

Answer 23

Rate of dilation has stopped or reversed.

Question 24

What is the normal rate of dilation in active labor?

Answer 24

1cm/hour

Question 25

When does stage 1 of labor start and end?

Answer 25

Onset of contractions to start of active labor

Question 26

When does stage 2 of labor start and end?

Answer 26

Starts at max dilation of cervix, ends at birth of baby.

Question 27

What medication can be used for induction of labor?

Answer 27

OXytocin

Question 28

What procedure can be done for induction of labor?

Answer 28

Artificial ROM

Question 29

What is the normal/ideal fetal presentation for vaginal birth?

Answer 29

Vertex/cephalic - head down

Question 30

``` Describe the following malpresentations: Breech Transverse Compound Face or brow ```

Answer 30

Breech - butt first Transverse - sideways Compound - head +arm/leg Face or brow - face or brow first

Question 31

Can you vaginally deliver a face/brow presentation?

Answer 31

If chin(mentum) is ANTERIOR, you can deliver.

Question 32

What malpresentation is amenable to external cephalic version?

Answer 32

Transverse back down

Question 33

A patient presents at 40 weeks with SROM 30 minutes ago. The baby is found to be in transverse back down malpresentation. Can you preform a external cephalic version?

Answer 33

No. External cephalic version is only indicated if membranes intact.

Question 34

Risks of external cephalic version?

Answer 34

Fetal trauma Abruption Cord compression Chance for emergency C section

Question 35

What is a VBAC?

Answer 35

Vaginal birth after caesarian

Question 36

Biggest risk of VBAC?

Answer 36

Uterine rupture

Question 37

Candidates for VBAC can only have how many previous caesarians?

Answer 37

1 or 2

Question 38

What type of uterine scar is a contraindication to a VBAC?

Answer 38

Vertical

Question 39

What are the first two maneuvers to preform for shoulder dystocia?

Answer 39

McRoberts and Suprapubic pressure

Question 40

What are the two types of operative vaginal delivery?

Answer 40

Forceps and vaccum

Question 41

When should operative vaginal delivery be used?

Answer 41

Maternal exhaustion

Question 42

What are the two types of episiotomy's. What are the downsides to each?

Answer 42

Midline -tear more | Mediolateral - bleed more

Question 43

Obstetric lacerations are graded on a scale from _ to _.

Answer 43

1-4

Question 44

Which grade obstetric lacerations tear into the anal sphincter?

Answer 44

3 and 4

Question 45

List 3 causes of pregnancy related first trimester bleeding.

Answer 45

Ectopic Spontaneous AB sub chorionic bleed

Question 46

How often should HCG be doubling in the first trimester?

Answer 46

every 48 hours

Question 47

You should be able to see a fetus on transvag US at HCG > _____

Answer 47

1500-2000

Question 48

You should be able to see getus on transabdominal US at HCG> ____

Answer 48

5000

Question 49

Most common cause of spontaneous AB?

Answer 49

genetic

Question 50

What are the 5 types of ABs?

Answer 50

``` Missed AB Threatened AB Inevitable AB Completed AB Incomplete AB ```

Question 51

3 ways of managing AB?

Answer 51

Expectant (wait) Medical (misoprostal) Surgical

Question 52

Risks of AB?

Answer 52

Bleeding Infection (septic abortion) Rarely DIC

Question 53

What are some obstetric causes of 2nd and 3rd trimester bleeding?

Answer 53

Labor Abruption Placenta/Vasa previa

Question 54

Painless 2nd/3rd trimester bleeding should make you think of?

Answer 54

Placenta previa

Question 55

Painful 2nd/3rd trimester bleeding should make you think of?

Answer 55

Placental abruption

Question 56

T/F? You can do a vaginal delivery during placental abruption.

Answer 56

True

Question 57

Can you do a vaginal delivery during placenta previa?

Answer 57

No

Question 58

Most common cause of postpartum hemorrhage?

Answer 58

ATONY!!!

Question 59

What tool can be used to control postpartum hemorrhage?

Answer 59

Bakri balloon

Question 60

What medication is used for DVT/PE in pregnancy?

Answer 60

Lovenox

Question 61

What is the rule of thirds for autoimmune diseases in pregnancy?

Answer 61

1/3 get better 1/3 remain unchanged 1/3 get worse

Question 62

What risks does pregnancy have for patients with cardiovascular disease?

Answer 62

Increased risk of morbidity and morality with stage 3 and 4 heart disease

Question 63

What patients are at risk for alloimmunization?

Answer 63

Pregnant women with previous pregnancy or transfusion

Question 64

When should antibody screening be done for pregnant women?

Answer 64

at first visit

Question 65

If fetus is determined to be at risk, how often should antibody titers be done?

Answer 65

Every month