Flashcards
Describe the two categories of diabetes in pregnancy.
- Gestational diabetes occurring in late pregnancy. 2. Chronic diabetes.
What is the single-step testing method for diagnosing diabetes in pregnancy?
75g oral glucose tolerance test (OGTT) at 24-28 weeks.
How is diabetes in pregnancy treated in the mother?
Start with diet, then add insulin if needed; oral hypoglycemic drugs are contraindicated.
What fetal complications can arise from diabetes in pregnancy?
Cardiac and renal defects, neural tube defects, hypocalcemia, polycythemia, hyperbilirubinemia, hypoglycemia, respiratory distress syndrome, birth injury.
Define gestational hypertension and its risk.
Hypertension occurring after 20 weeks’ gestation, with a risk of progressing to preeclampsia.
What is the drug of choice for hypertension during pregnancy?
Methyldopa.
How is severe preeclampsia managed?
Control BP, prevent seizures with magnesium sulfate, then deliver by induction or C-section.
Describe the classic triad of ectopic pregnancy.
Abdominal pain, amenorrhea, vaginal bleeding.
What is the first step in diagnosing ectopic pregnancy?
Pregnancy test.
What are the most common causes of antepartum hemorrhage?
Placental abruption and placenta previa.
Define placenta previa and list some risk factors.
Placenta covering the cervical os; risk factors include prior C-sections, grand multiparity, multiple gestation, and prior placenta previa.
Describe the characteristics of placental abruption.
Painful, dark vaginal bleeding, abdominal pain, uterine tenderness, shock out of proportion to bleeding.
How is placenta previa diagnosed?
Mainly through ultrasound to detect a retroplacental clot.
Define vasa previa.
Fetal vessels crossing the internal os, leading to vaginal bleeding when rupture of membranes with marked fetal distress.
What are the risk factors for placental abruption?
Hypertension, cocaine use, smoking, and abdominal/pelvic trauma.
Do not perform what procedure in cases of placental abruption diagnosis?
Avoid vaginal exams.
Describe the management of umbilical cord prolapse.
Assess pulsation of umbilical cord, position patient knee-chest, push presenting part backward, consider cesarean section.
What is the initial step in managing umbilical cord prolapse?
Assess the pulsation of the umbilical cord to determine fetal viability.
What are the main complications of placental separation?
Hemorrhagic shock and coagulopathy, particularly DIC.
Describe the presentation of cholestasis of pregnancy.
Jaundice and itching, with elevated bilirubin and ALT levels.
How is asymptomatic bacteriuria treated in pregnant patients?
With nitrofurantoin as first-line and cephalexin as second-line antibiotics.
Define gestational trophoblastic disease.
Includes complete and incomplete moles, characterized by uterine bleeding, enlarged ovaries, and markedly elevated serum hCG levels.
What are the risk factors for gestational trophoblastic disease?
Extremes of age (<20 or >40 years).
Describe the diagnosis of gestational trophoblastic disease.
No fetal heartbeat, enlarged ovaries, ‘snowstorm’ appearance on ultrasound, and expulsion of grapelike molar clusters.
How is molar pregnancy treated?
By evacuating the uterus and monitoring with weekly beta-hCG levels, with chemotherapy for malignant disease if needed.
What complications can arise from molar pregnancy?
Progression to malignant GTD choriocarcinoma with pulmonary or CNS metastases.
Describe vesicular mole
Characterized by vesicles with bloody vaginal discharge and a snowstorm appearance.
What is the most common site for metastasis in vesicular mole?
Lung
Define polyhydramnios
Defined as an AFI > 20 on ultrasound.
How is oligohydramnios diagnosed?
An AFI < 5 cm on ultrasound.
What is the first step in managing shoulder dystocia?
Leg elevation (McRoberts’ maneuver).
Do you treat clavicle fractures associated with shoulder dystocia?
No specific treatment.
Describe Erb palsy
Root affected: C5 and C6, characterized by internally rotated arm, adduction (waiter tip) hand.
What is broad ligament hematoma characterized by?
Hypotension, contracted uterus, and deviated uterus.
Explain the diagnosis of rupture of membranes
First step: sterile speculum exam showing pooling of amniotic fluid in the vagina, followed by nitrazine paper test.
When is labor considered preterm?
Between 20 and 37 weeks’ gestation.
What are the contraindications to tocolysis in preterm labor?
Infection, nonreassuring fetal testing, placental abruption, fetus older than 34 weeks, fetus weighing less than 2500 grams, lethal abnormalities, cervical dilation > 4 cm, chorioamnionitis, other causes of fetal distress or death.
Describe the key word associated with preterm labor.
Uterine contraction and dilatation of cervix
What is the most important drug for premature rupture of membranes (PROM)?
Dexamethasone
Define tocolytics in the context of preterm labor.
Most important drug for preterm labor
What is the most absolute contraindication to tocolytics?
Chorioamnionitis
How is chorioamnionitis characterized?
Maternal fever
What are the treatment options once chorioamnionitis occurs?
Sampling and antibiotics
Do all presentations other than vertex in fetal malpresentation carry the same risk?
No, they have different risks
Describe the most common risk factor associated with fetal malpresentation.
Prematurity
Define the term ‘breech’ in the context of fetal malpresentation.
Most common malpresentation
What are the subtypes of breech presentations?
Frank breech, footling breech, complete breech
How can breech presentations be managed?
Up to 75% spontaneously change to vertex by week 38, external version after 36 weeks
Describe the most common indication for Cesarean Section.
Previous Cesarean Section (CS)
What is the most common cause of primary Cesarean Section?
Cephalopelvic disproportion
How should a transverse lie presentation be managed in terms of delivery?
Cesarean Section
What is the recommended approach for shoulder presentation during delivery?
Cesarean Section
How should face presentation during delivery be managed?
Cesarean Section
What is the management approach for a previous classical C-section?
Cesarean Section
Describe the management approach for cord compression during delivery.
Cesarean Section
What is the recommended delivery method for a mother with active Herpes on the genitalia?
Cesarean Section
How should HIV in the mother affect the delivery method?
Cesarean Section
Define the term ‘episiotomy’.
Surgical incision of the perineum during childbirth
What are the two types of episiotomy?
Median (midline) and mediolateral
Do all cases of inverted uterus occur more frequently in primigravidas?
Yes, more common in primigravidas
Describe the causes of uterine rupture.
Occurs in early labor or late pregnancy, associated with previous CS, grand multipara, myomectomy, labor augmentation
How is uterine atony diagnosed?
Palpation of a soft, enlarged, ‘boggy’ uterus
What are the risk factors for uterine atony?
Uterine overdistention, exhausted myometrium
What are the treatment steps for postpartum hemorrhage due to uterine atony?
Bimanual uterine massage, oxytocin infusion, Methergine, Prostaglandin, uterine/internal iliac artery ligation, hysterectomy
Describe the characteristics of postpartum infections (endometritis).
Temperature ≥ 38°C, uterine tenderness, malodorous lochia
What is the most common risk factor for postpartum infections (endometritis)?
C-section
How is Sheehan’s Syndrome characterized?
Anterior pituitary insufficiency due to massive obstetric hemorrhage and shock
What are the common symptoms of Sheehan’s Syndrome?
Failure to lactate, decreased TSH, FSH, LH
What is the recommended treatment for Sheehan’s Syndrome?
Replacement therapy with cortisone first, then thyroxine
Describe colostrum in the context of postpartum care.
Early breast milk rich in protein, fat, secretory IgA, and minerals
What are the 6 W’s of postpartum fever and their timings?
Wind (atelectasis) - first day, Water (UTI) - 2nd to 3rd day, Womb (endomyometritis) - 2nd to 3rd day, Walk (DVT, pulmonary embolism) - after 5 days, Wound (incision, episiotomy) - after one week, Weaning (breast engorgement, mastitis)
Describe the stages of childbirth.
Childbirth occurs in three stages: First stage involves the onset of true labor until the cervix is fully dilated to 10 cm. Second stage is from full dilation until the baby is delivered. Third stage involves the delivery of the placenta.
What are the signs of early labor phase?
Early labor lasts 8-12 hours, cervix effaces and dilates to 4 cm, contractions last 30-45 seconds with 5-30 minutes of rest in between.
Define the active labor phase.
Active labor lasts 3-5 hours, cervix dilates from 4 cm to 10 cm, contractions last 45-60 seconds with 3-5 minutes rest in between.
How is abnormal labor managed in case of prolonged latent phase?
If there is no cervical change in 14 hours with regular contractions and around 2 cm dilation, sedation and rest are recommended.
Describe the management of second stage arrest during childbirth.
If there are regular contractions, fully dilated cervix, and no descent in 3 hours, oxytocin is given for weak contractions. If the head is not engaged, a cesarean section is considered.
What is the significance of fetal heart rate variability during labor?
Fetal heart rate variability indicates the fluctuation in heart rate, normally occurring at 6-25 beats per minute. Absence of variability can signal fetal distress.
Explain the types of fetal deceleration during labor.
Early deceleration is due to fetal head compression, late deceleration indicates fetal hypoxia or acidosis, and variable deceleration is caused by cord compression.
How is variable deceleration managed during labor?
The first step is to give fluid and change maternal position. If there is no response, a cesarean section may be necessary.
When is labor considered normal during fetal heart rate monitoring?
Normal labor is indicated by a baseline heart rate of 110-160, presence of acceleration and variability, and absence of deceleration.
What criteria define abnormal labor during fetal heart rate monitoring?
Abnormal labor is characterized by a baseline heart rate less than 110 or more than 160, absence of acceleration and variability, and presence of late or variable deceleration.
Describe the management steps for abnormal fetal movements at 32-34 weeks of pregnancy.
History and examination, fetal heart Doppler, CTG if fetal heart rate detected, immediate ultrasound if not detected, reassurance if CTG is normal, immediate ultrasound if CTG is abnormal, refer to hospital if CTG is not available, induction of labor for recurrent abnormal fetal heart movements near term, continuous CTG away from term.
What is a Nonstress Test (NST) and how is it performed?
NST is performed with the mother resting in the lateral tilt position, monitoring fetal heart rate externally by Doppler, and using acoustic stimulation if needed.
Define a ‘Reactive’ Nonstress Test (NST) result.
Two accelerations of at least 15 bpm above baseline lasting for at least 15 seconds over a 20-minute period.
Describe the Biophysical Profile (BPP) and its parameters.
BPP assigns a score based on fetal tone, breathing, movement, amniotic fluid volume, and NST. Scores range from 0-10, with 8-10 being reassuring, 6 equivocal, and 0-4 indicating consideration for immediate delivery.
How does the cardiovascular system change during pregnancy?
Heart rate gradually increases by 20%, blood pressure decreases by 10%, stroke volume increases, and cardiac output increases especially in the left lateral position.
What are the changes in the pulmonary system during pregnancy?
Respiratory rate increases.
Describe the changes in the gastrointestinal system during pregnancy.
Sphincter tone decreases, gastric emptying increases.
Explain the endocrine changes in pregnancy related to the thyroid.
Total T3 and T4 levels increase, while free T3 and T4 levels remain normal.
Define abortion and its timing.
Abortion is the loss of products of conception before the 20th week of pregnancy, with over 80% occurring in the first trimester.
Describe the types of abortion and their characteristics.
Threatened (no POC expelled, bleeding, closed os, intact membranes, fetal cardiac motion), Complete (POC completely expelled, no pain or bleeding, closed os), Incomplete (some POC expelled, bleeding and pain, open os), Inevitable (no POC expelled, bleeding and pain, open os), Missed (no POC expelled, no fetal cardiac motion, closed os), Septic (endometritis leading to septicemia).
What is the main treatment for septic abortion?
Antibiotics followed by curettage, with a risk of uterine perforation.
How is fetal demise defined and what are the common causes?
Fetal death after 20 weeks of pregnancy, often due to idiopathic reasons with a risk of DIC.
Describe the initial steps in managing fetal demise.
Check hematology labs, wait for spontaneous delivery if no DIC, or induce labor if DIC is present.
Describe the management for incompetent cervix during pregnancy.
Management includes cerclage, to be done around 13-16 weeks and removed around 36-37 weeks.
What are the complications of hyperemesis gravidarum?
Complications include acute starvation, large ketonuria, weight loss, and electrolyte disturbances.
Define Rh Isoimmunization in pregnancy.
It occurs when fetal RBCs leak into the maternal circulation, leading to the formation of anti-Rh IgG antibodies that can cause hemolysis of fetal Rh-positive RBCs.
How is hyperemesis gravidarum diagnosed and managed?
Diagnosis involves ruling out molar pregnancy with B-hCG levels and ultrasound. Management includes hospitalization, IV fluids, TPN in severe cases, Vitamin B6, and antiemetics like metoclopramide.
Describe the effects of opioids during pregnancy.
Opioids can cause neonatal depression, which can be treated with naloxone.
What are the drugs to be avoided during pregnancy and their associated risks?
Drugs to avoid include alcohol (fetal alcohol syndrome), cocaine (congenital abnormalities), phenytoin (fetal hydantoin syndrome), carbamazepine (neural tube defects), tetracycline (teeth discoloration), isotretinoin, warfarin (facial abnormalities), ACE inhibitors, diethylstilbestrol (vaginal adenosis, T-shaped uterus), lithium (Ebstein’s anomaly), methotrexate, radiation, streptomycin (hearing loss), valproic acid (neural tube defects), and high doses of vitamin A.
How is gestational thrombocytopenia managed during pregnancy?
Usually, no treatment is needed, but if bleeding occurs, cortisone and IVIG can be used.
Describe the guidelines for post-term labor.
Normal delivery timing is 37-40 weeks. If labor hasn’t started by 42 weeks, induction is recommended. Between 40-42 weeks, CTG monitoring is the first step, followed by induction if distress is noted.
What is the most common congenital abnormality associated with SLE in pregnancy?
The most common congenital abnormality is heart block (anti-RO and anti-La antibodies).
Define Rh Isoimmunization and its implications in pregnancy.
Rh Isoimmunization occurs when fetal RBCs enter the maternal circulation, leading to the formation of antibodies that can cause hemolysis of fetal RBCs. This can result in erythroblastosis fetalis.
How is anesthesia and analgesia managed during pregnancy?
Options include opioids (with naloxone for neonatal depression), epidural (with vasopressors for hypotension), general anesthesia (with risk of maternal aspiration), and local blocks like lidocaine.
Describe the causes and investigations for incompetent cervix during pregnancy.
Causes include history of conization, LEEP, and diethylstilbestrol exposure. Investigations involve ultrasound showing shortening of the cervix and herniation of fetal membranes.
What are the risks and timing associated with SLE in pregnancy?
Risks include recurrent abortion, occurring mostly in the second trimester. Antibodies involved are antiphospholipid and anticardiolipin. The most common congenital abnormality is heart block.
Describe the best way to assess fetal severity in pregnancy
Fetal blood sampling
What is the treatment for severe cases in pregnancy when fetal lungs are mature?
Preterm delivery
What procedure can be done in severe cases of pregnancy involving intrauterine blood transfusions?
Intrauterine blood transfusions
What are the complications associated with Toxoplasmosis during pregnancy?
Hydrocephalus, Intracranial calcifications
How can Rubella be prevented during pregnancy?
Vaccination
When is the recommended timing to give the Rubella vaccine for pregnant women?
Before pregnancy or after delivery
What are the clinical manifestations of Syphilis in pregnancy?
Maculopapular skin rash, lymphadenopathy, hepatomegaly
What is the most common congenital infection in pregnancy?
CMV (Cytomegalovirus)
How is Herpes transmitted to the newborn during delivery prevented?
By performing a Cesarean section (CS)
How can HIV be transmitted to the baby during pregnancy?
In utero, at the time of delivery, or via breastfeeding
What are examples of primary prevention methods in Obstetrics/Gynecology?
Vaccination
What are examples of secondary prevention methods in Obstetrics/Gynecology?
Screening (colonoscopy, mammography, pap smear)
What are the guidelines for nutritional supplementation prior to pregnancy?
Folic acid, Iron, Calcium, Vitamin D, Vitamin B12, Iodine
What vitamin supplements are not recommended for use in pregnancy as they may cause harm?
Vitamin A, C, E
How can Down syndrome be prevented during pregnancy?
Screening in the first and second trimesters or using diagnostic tools like Chorionic villus sampling or Amniocentesis
What is the normal weight gain range during pregnancy?
10-12 kgs
How can Neural tube defects be prevented during pregnancy?
Folate supplementation
What is the recurrence rate of Neural tube defects in subsequent pregnancies?
1-5%
What diagnostic tool can be used to screen for Neural tube defects in pregnancy?
Amniocentesis
Describe how to prevent toxoplasmosis during pregnancy
Avoid cat litter, raw/undercooked meat, and unpasteurized milk products
Define the treatment for toxoplasmosis during pregnancy
Spiramycin and pyrimethamine
How can rubella infection be prevented during pregnancy?
Through vaccination 1-3 months before pregnancy, after delivery, but never during pregnancy
What is the recommended timing for Hepatitis B vaccination for a newborn?
Once the baby is delivered
Describe the management of genital herpes during vaginal delivery
Acyclovir should be given to the neonate if vaginal delivery is done
How should a baby born to an HIV-positive mother be treated to reduce transmission risk?
Give zidovudine for the first 6 weeks
What is the treatment of choice for syphilis during pregnancy?
Single dose IM benzathine penicillin
Define the preferred treatment for Candida infection during pregnancy
Vaginal clotrimazole is considered the best option
How can CMV infection be screened during pregnancy?
Anti-CMV IgM is an appropriate screening antibody
Describe the prevention of isoimmunization during pregnancy
Routine screening at 24-28 weeks and administer RhoGAM if mother is Rh- and father is Rh+ or unknown
What are the indications for RhoGAM administration during pregnancy?
Normal pregnancy at 24-28 weeks, after delivery within 72 hours, Rh- baby, abortion, ectopic pregnancy, amniocentesis, chorionic villus sampling, vaginal bleeding, placenta previa, or placental abruption
