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General OB Flashcards

1
Q

Incidence of macrosomia?

A

1.5%

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2
Q

Risk of shoulder dystocia

  1. W/o macrosomia
  2. W/ macrosomia
  3. W/ macrosomia & DM
A
  1. 1.5%
  2. 15%
  3. 25%
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3
Q

Risk of brachial plexus injury

  1. W/o macrosomia
  2. W/ macrosomia
A
  1. 0.1%

2. 5%

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4
Q

Risk factors for macrosomia (6)

A
  1. h/o macrosomia
  2. excessive weight gain
  3. maternal obesity
  4. gest age > 40 wks
  5. pos 1hr GTT and neg 3 hr GTT
  6. DM
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5
Q

When is fetal macrosomia an indication for IOL

A

> 5000g, 4500g if diabetic

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6
Q

Medication to consider for shoulder dystocia

  • onset
  • duration
  • SE
A

Nitroglycerine (50-100mcg)
onset- 30-90 sec
lasts 2-3 mins
SE: mild hypotension

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7
Q

Maneuvers to reduce shoulder dystocia

A
  1. Suprapubic pressure
  2. McRoberts maneuver
  3. Deliver Posterior arm
  4. Rubin Maneuver
  5. Woods corkscrew maneuver
  6. Episiotomy (only to make room for hand)
  7. Intentional clavicular fracture
  8. Zavanelli maneuver
  9. Symphysiotomy
  10. Laparotomy
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8
Q

Rubin Maneuver

A
  • pressure on posterior of the most accessible shoulder
  • rotate fetus <180 to dis-impact the shoulder from the symphysis
  • decreases the bis-acromial diameter
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9
Q

Woods Corkscew maneuver

A
  • pressure on the front of the posterior shoulder
  • rotate fetus <180
  • increases the bis-acromial diameter
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10
Q

Zavaneli Maneuver

A 
cephalic replacement
reverse cardinal movements of labor
do c-section
(consider tocolytic)
LAST RESORT
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11
Q

Intentional Clavicular Fracture

A

Anterior fracture

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12
Q

Risks of Clavicular Fracture

A

Penumothrox
Hemothorax
Subclavian vessel injury
Brachial plexus injury

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13
Q

Erb’s Palsy

A 
C5-C6
Arm hangs at side medially rotated
Forearm extended &amp; pronated
Wrist flexed
Grasp reflex intact (waiter's tip)
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14
Q

Klumpke’s Palsy

A 
Flaccid Arm
C8-T1
Hand &amp; wrist paralysis
arm hangs flaccidly at side
Grasp reflex lost
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15
Q

Cardinal movements

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
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16
Q

NPV for NST, CST, BPP, modified BPP, umbilical artery doppler

A

> 99.8%

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17
Q

PPV for NST

A

10%

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18
Q

Contraindications for ECV

A
  1. Multiple gestation
  2. IUGR
  3. Indication for elective c/s
  4. Placenta previa
  5. Maternal cardiac disease
  6. Gestational Hypertension
  7. Previous classical c/s
  8. Utero-placental insufficiency
  9. Congenital uterine malformations
  10. Oligohydramnios
  11. Major fetal anomaly
  12. NRFHT
  13. PROM
  14. Unexplained uterine bleeding
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19
Q

Ideal time for ECV

A

37 weeks

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20
Q

Vaginal Breech Delivery Prerequisites

A
  • Call for help (extra OB, pediatrician, nurse and anethesiologist)
  • Have Piper forceps in delivery room
  • Empty bladder & rectum
  • Functional IV line
  • Oxygen for mother
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21
Q

Vaginal Breech Delivery Motions

A
  1. Hands off, only apply rotational force to achieve backup position
  2. Deliver legs with Pinaud’s maneuver (pressure on popliteal fossa)
  3. Wrap body in towel
  4. Lovset’s maneuver for delivery of arms
    (slide hand from back over shoulder, onto anterior surface of humerus, place pressure in cubital fossa & sweep arm over over chest to the side and out of the vagina
  5. Wrap arms in body in towel
  6. Make sure the back rotates anteriorly (persistent back down=disaster for trapped head)
  7. Delivery of head
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22
Q

Delivery of Head in Vaginal Breech Delivery

A
  1. Suprapubic pressure (promote flexion)
  2. Bracht Maneuver (only after back of neck firmly tucked under symphysis pubis)-baby’s body is held against pubic symphysis
  3. Mauriceau-Smellie-Veit Maneuver
  4. Piper forceps for after-coming head
  5. Consider possible need for Duhrssen incision (2,6, and 10 o’clock)
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23
Q

Max amount of lidocaine w/ and w/o epinepherine

A

w/ epi: 7mg/kg 0.5% (max 60cc)

w/o epi: 4mg/kg 0.5% w/o epi (max 30cc)

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24
Q

Side Effects of Epinepherine in order of increasing toxicity

A 
Metallic taste in mouth
Perioral numbness
Tinnitis
Slurred speech &amp; blurred vision
Altered consciousness
Convulsions
Cardiac arrhythmias
Cardiac arrest
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25
Q

During an emergency c/s which layers must be infiltrated with local anesthesia?

A

Skin
Parietal peritoneum
Visceral peritoneum

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26
Q

Signs of Uterine Rupture

A
  • Most consistent (70%)- abrupt FHR abnormality
  • Abrupt change in uterine ctx pattern
  • loss of station
  • vaginal bleeding (not consistent)
  • pelvic/abdominal pain (not consistent)
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27
Q

Peri-mortem C/S

  • within what time period
  • relationship to CPR
A
  1. within 4 minutes, (survival diminishes after 5 min)
  2. CPR should not be initiated in lieu of immediate delivery
    (not sufficiently effective in maintaining CO, delays optimal window for delivery, compressions less effective w/ lg ut)
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28
Q

Contraindications to TOLAC

A
  1. Previous uterine rupture
  2. previous classical or T-incision
  3. Extensive transfundal surgery
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29
Q

Candidates for TOLAC

A
  1. 1 or 2 previous LTCD
  2. Previous low vertical CD
  3. Previous CD w/ unknown scar unless there is strong suspicion of a classical CD
  4. Twin gestation
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30
Q

Requirements for TOLAC

A
  1. Adequate pelvis
  2. Continuous EFM recommended
  3. Appropriately trained MD available throughout labor
  4. Hospital/facility support for emergency c/d
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31
Q

Rupture risk during TOLAC for

  1. Background risk
  2. Undocumented scar
  3. Twins
  4. Previous lower segment rupture
  5. Previous upper segment rupture
  6. Classical CD
  7. Induction w/ PGE1
  8. PG induction for 2nd TM loss
A

Rupture risk during TOLAC for

  1. Background risk (1%)
  2. Undocumented scar (1%)
  3. Twins (1%)
  4. Previous lower segment rupture (6%)
  5. Previous upper segment rupture (32%)
  6. Classical CD (10%)
  7. Induction w/ PGE1 (15%)
  8. PG induction for 2nd TM loss (1%)
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32
Q

VBAC success rates

  1. previous CD for CPD
  2. previous CD not for CPD
A
  1. previous CD for CPD (66%)

2. previous CD not for CPD (75%)

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33
Q

Risks to infant from Parvovirus

A

1st TM-Spontaneous Abortion

2nd TM- Hydrops, anemia, heart failure, IUFD

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34
Q

How do you diagnose B19?

A

ELISA for IgG & IgM or

PCR (more sensitive)

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35
Q

Mother tests positive for Parvovirus. How do you follow?

A

Serial weekly u/s for fetal well-being and to r/o hydrops for 2 moths after exposure/infection
-PUBS looking for fetal anemia, transfusion if hydrops is present

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36
Q

Maternal effects from Varicella

A
  • pneumonia (20%), more common in 3rd TM, mortality 5%, tx w/ Acyclovir IV, ICU admit
  • Encephalitis-rare
  • Shingles
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37
Q

Fetal effects from Varicella

A
  • Spontaneous abortion
  • IUFD
  • Varicella embryopathy (risk 13-20 wks–> 2%)
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38
Q

Neonatal effect of Varicella

A

increased mortality if maternal infection is <5 days from delivery (no passive maternal IgG)

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39
Q

Varicella Post-exposure prophylaxis

A

VariZIG - 60-80% effective in preventing infx

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40
Q

Varicella vaccine

A

2 doses SQ 4-8 wks apart
Live attenuated, contraindicated in pregnancy
Not teratogenic, not indicated for termination
Defer pregnancy for 3 months post vaccination

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41
Q

Incidence of Listeria in pregnant patients

A

13x greater for pregnant women

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42
Q

Symptoms of Listeria

A

mild GI /flu-like sx (mayalgia, N&V, diairrhea)

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43
Q

Listeria: Fetal effects

A

fetal loss

PTL

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44
Q

Listeria: Neonatal effects

A

sepsis
meningitis
death

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45
Q

Listeria: dx

A

Blood cultures (not stool)

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46
Q

Management of pregnant pt who consumes recalled or implicated food product

A
  • Asymptomatic- no testing, no tx, observe for sx for 2 months
  • Mildly symptomatic- no fever
    • manage as for asymptomatic
    • send blood cx, only tx if cx+
  • Febrile-w/ or w/o symptoms-test and tx simultaneously
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47
Q

Tx of Listeria

A

-high dose IV ampicillin (at least 6gm/day) for 14d, may add gentamicin
(Bactrim w/ PCN allergy)

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48
Q

Hepatitis B in pregnancy

  1. Incidence
  2. Risk of vertical transmission
  3. Breast feeding recommendations?
  4. Prevention
A

Hepatitis B in pregnancy

  1. Incidence-40%
  2. Risk of vertical transmission- HBsAg+ (20%), HBsAg & HBeAg+ (90%)
  3. Breast feeding recommendations? Ok in preg but needs vaccine 0, 1 , 6 m)
  4. Prevention- Vaccine and HBIG w/in 24 hrs of exposure
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49
Q

Significance of HBcAg and HBeAg

A

HBcAg-found in hepatocyts, positive w/ natural but not vaccine based immunity

HBeAg- High infectivity, active replication, cirrhosis and liver cancer association

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50
Q

Risk of Vertical Transmission of Hepatitis B:

  1. 1st TM vs. 2nd TM
  2. How do majority of transmission occur?
  3. Risk of transmission during amniocentesis? Hi/Lo?
  4. Which method of delivery has lower risk of transmission?
A

Risk of Vertical Transmission:

  1. 1st TM-10% vs. 2nd TM-90%
  2. How do majority of transmission occur? during delivery
  3. Risk of transmission during amniocentesis? Hi/Lo?
  4. Which method of delivery has lower risk of transmission? Transmission rate not affected by mode of delivery.
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51
Q

C-section Abx prophylaxis for c-section

A

Cefazolin (Ancef) 1gm
Cefazolin 2gm IV if BMI>30 or >100kg
Clindamycin 900mg w/ aminoglycoside (eg. gentamycin)

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52
Q

Latency Abx

A 
Ampicillin 2gm q6 hr x 48 hr
Erythromycin 250 mg q6 x 48 hr
    then
Amoxicillin 250mg q 8 hr x 5 d
Erythromycin 333g q8 hr x 5 d
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53
Q

Incidence of GBS pos cx in population

A

20%

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54
Q
  1. How long is GBS cx valid for?

2. When should routine cx be taken?

A
  1. 5 wks

2. 35-37 wks

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55
Q

What affect does GBS prophylaxis have on early GBS infx?

A

80% reduction in early onset GBS

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56
Q

GBS prophylaxis

A

-Pen G 5 mil u, then 2.5 mil u q4 hr until delivery or
-Amp 2gm bolus then 1gm IV q4 hr to delivery
PCN Allergy:
Low risk: Cefazolin 2gm iv then 1gm q8 hr
High risk: Clindamycin 900 mg Q8 hr (if susceptible to both clinda and erythromycin) or
Vancomycin 1gm IV q12 hr (if no sus testing/ resistant to erythro)

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57
Q

Clinical features of CMV

A
  • Chorioretinitis
  • Hepatosplenomegaly
  • IUGR
  • Fetal hydrops
  • Echogenic bowel
  • Congenital deafness
  • Microcephaly
  • Ventriculomegaly
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58
Q

CMV Vertical Transmission

A

More common in 3rd TM but more severe in 1TM

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59
Q

Causes of Recurrent Pregnancy Loss

A 
Uterine anomalies
Genetic
Luteal phase deficiency
Infection (TORCH, B19, Syphilis)
Immune d/o (APLA, alloimmune)
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60
Q

Which congenital uterine abnormality carries the worse prognosis?

A

Septate

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61
Q

W/up for recurrent preg loss

A
  1. Hx- family, PMH, exposure
  2. Examination (placenta, autopsy, HSG/SHG)
  3. Tests: CBC, Utox, TORCH, RPR, AclAb, Lupus anticoag, KB, Karyotype, TSH, HBA1c
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62
Q

Incidence of recurrent preg loss?

A

1-2%

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63
Q

Definition of recurrent pregnancy loss?

A

3 or more spontaneous pregnancy losses

testing should begin after 2, risk of another is just as high as after 3rd

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64
Q

Baseline incidence of SAB?

A

20% (40% of these are genetically abnormal)

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65
Q

Isoimmunization w/up

A

-If ab screen positive-> titer =/> 16-Doppler MCA to assess anemia (replaces amnio to measure delta OD 450)

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66
Q

Prevention of isoimmunization

A
  • 50 micrograms for 1TM bleeding/loss
  • 300 micrograms
    • covers up to 15 ml fetal blood cell transfusion (30ml whole blood)
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67
Q

How much blood does normal dose of Rho GAM cover?

A

-up to 15 ml of fetal blood cell transfusion (30ml or whole blood)

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68
Q

How long is regular dose of Rho GAM effective?

A

10-12 weeks

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69
Q

What is the name of the test used to determine dose of RhoGAM necessary postpartum?

A

Kleihauer-Betke

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70
Q

Minor Antigens and effects

A

Kell =Kills (IgG)
Duffy = Dies (IgG)
Lewis = Lives (IgM)

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71
Q

Weak Rh+ treatment

A

treat as Rh +

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72
Q
  1. Sickle Cell Heredity

2. Sickle Cell Trait Heredity

A
  1. Autosomal Recessive, Homozygous (Hb AS)

2. Heterozygous (Hb AS)

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73
Q

Incidence of Sickle Cell Gene in African Americans

A

1:12 (AS)

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74
Q

Pathophysiology of Sickle Cell

A

Decreased pO2-> sickling -> microvascular obstruction-> decreased perfusion & organ damage (eg. auto splenectomy-> inc infx risk & acute chest syndrome)

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75
Q

Sx of Acute Chest Syndrome

A
  1. Pulmonary infiltrate (vaso-occulsive dz)
  2. Fever
  3. Hypoxemia
  4. Acidosis
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76
Q

Dx of Sickle Cell Disease on Hgb Electrophoresis

A

SS Dz: virtually all Hb is HbS w/ minimal HbA2/HbF

SS Tr: Higher % if HbA & asymptomatic

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77
Q

Maternal Risks of SS Dz

A
  1. Inc frequency of crises
  2. Gest HTN
  3. Infx
78
Q

Fetal Risks of SS Dz

A
  1. SAB
  2. IUGR
  3. IUFD
79
Q

Management of SS Dz in pregnancy

A
  1. Increased folic acid supplementation (4mg/day)
  2. Transfusion (aim for HbS fraction <40%, Total Hb >10), controversial, some say transfuse if Hgb <6/7 w/ frequent crises
  3. Increased fetal testing (US and FH monitoring)
80
Q

Sickle Cell Crisis Managment

A
  1. Pain management
  2. Oxygen (if O2 Sat <95%)
  3. Tx infx if there is one
81
Q

Thalassemias-most common populations

A
  1. Southeast Asian (a-thal cis form w/ elevated HbH)
  2. Mediterranean
  3. W. Indies
  4. Hispanic
82
Q

a-Thalassemia Types

Heredity of a-thal?

A
  1. If 1 gene absent-clinically insignificant
  2. If 2 genes absent- a-thal minor=carrier (trait)- Mild Anemia
  3. If 3 genes absent Hb H Disease: Mod hemolytic anemia
  4. If 4 genes absent- Bart’s Disease (a-thal major)-Hydrops

Autosomal Recessive

83
Q

a-Thal Minor Subsets

A
  1. cis form- same chromosome, common in SE Asians more likely to have offspring w/ HbH
  2. trans form-opposing chromosomes- less likely to have offspring w/ Hb H
84
Q

b-Thalassemia

Heredity

A
  • Decreased ability to make b-chains thus adult Hb (HbA)

- Autosomal Recessive

85
Q

b-thal minor

A
  • heterozygous

- asymptomatic mild anemia

86
Q

b-thal major

A
  • homozygous
  • Cooley’s anemia
  • Severe anemia
  • Death usually w/in 10 years
  • Pregnancy extremely rare, pts need extensive MFM care
87
Q

Composition of Adult Hgb

A

2 a chains +
2 b chains (Hb A) or
2 d chains (Hb A2) or
2 g chains ( Hb F- predominates in fetus at 12-24 w)

88
Q

Effects of obesity antepartum?

A
  1. GDM
  2. VTE
  3. pre-E
  4. fatty liver dz
  5. cardiac dysfxn
  6. proteinuria
  7. excess gestational wt gain
  8. SAB
  9. Recurrent AB
  10. IUFD
  11. macrosomia
  12. congenital anomalies (cardiac, orofacial, limb)
89
Q

Effects of obesity intrapartum?

A
  1. Inc risk of CD
  2. Failed 1st stage of labor
  3. VTE
  4. Blood loss
90
Q

Effects of obesity postpartum

A
  1. Inc risk of surg site infx
  2. VTE
  3. excess PP wt retention
91
Q

Effects of obesity postpartum

A
  1. Inc risk of surg site infx
  2. VTE
  3. excess PP wt retention
92
Q

Target weight gain by BMI

A

Underweight BMI <18.5 30-40 lbs
Normal weight BMI 18.5-24.9 25-35 lbs
Over weight BMI 25-29.9 15-25 lbs
Obese BMI 30 10-20 lb

93
Q

When do you perform early GDM screening?

A
  1. BMI >30
  2. prev GDM
  3. Known glucose intolerance
94
Q

Roux-en-Y can cause malabosorption of what?

A 
folate
iron
Vit D
B12
protein
calcium
95
Q

Special considerations about Roux-en-Y and 2TM testing.

A

Best to avoid gtt at 24 weeks secondary to concerns for Dumping Syndrom (perform fasting & postprandial home glucose tests x 1 week instead)

96
Q

Differential Dx of Fetal Hydrops

A

Immune-Rh Dz
Non-Immune
Infectious- B19, CMV
Congenital- Congenital Heart Defect, supra-
ventricular tachycardia
Placental- AV malformations (chorioangioma),
fetomaternal bleed

97
Q

Teratogenicity of Tetracyclines

A

Dental discoloration

98
Q

Teratogenicity of Chloramphenicol

A

Gray baby sydrome

99
Q

Teratogenicity of Quinolones

A

Affects cartilage

100
Q

Teratogenicity of Erythromycin estolate

A

Maternal hepatic toxicity

101
Q

Teratogenicity of Retinoic Acid

A

CNS, craniofacial abnormalities

102
Q

Teratogenicity of ACE inhibitors

A

Possible heart defects (1TM), Oliguria, renal failure (2nd/3rd)

103
Q

Teratogenicity of MTX

A

Multiple anomalies, IUFD

104
Q

Teratogenicity of Coumadin

A

Multiple anomalies, IUFD

105
Q

Teratogenicity of Valproate

106
Q

Fetal blood volume

107
Q

When does corpus luteal/placental shift take place?

108
Q

Effects of smoking in OB

A 
Increased:
spontaneous abortion
IUGR
placental abruption
SIDS
infertility
PTD
stillbirth
ectopic pregnancy
109
Q

NTD prohylaxis

A

Routine 0.4 mg/day

History of NTD 4 mg/day ( also if on phenytoin, carbamazepine, valproate)

110
Q

Acceptable Vaccines in Pregnancy

A

Tdap (27-36 weeks)
Hepatitis A & B
Pneumococcus
Influenza

111
Q

Vaccines that are Contraindicated in Pregnancy

A 
Measles (Rubeola)
Mumps (Paramyxovirus)
Chickenpox (Varicella)
Rubella (pregnancy should be delayed at least 3 m)
HPV
Intranasal Flu Vaccine
112
Q

Causes of Oligohydramnios

A 
ROM
IUGR
SGA
Idiopathic
TORCH ifx
Renal Agenesis
113
Q

Causes of Polyhydramnios

A 
Idiopathic
Maternal DM
Esophageal atresia
genetic anomalies
Infx: syphilis, TORCH
Hydrops fetalis
114
Q

Definition of Polyhydramnios

A

> 25/>8cm
Mild <30/12cm
Mod <35/16
SVR >35/>16

115
Q

W/up for polyhydramnios

A
  1. U/S: look for anomalies & hydrops
  2. DM
  3. Ab Screen
  4. RPR
  5. TORCH
116
Q

Polyhydramnios increases the risk of what?

A
  1. PTL
  2. PPROM
  3. macrosomia
  4. malpresentation
  5. cord prolapse
  6. abruption
  7. atony
  8. PPH
117
Q

Target Delivery w/ Polyhydramnios

A

Deliver at 39-40 weeks

118
Q

Utility of Amnio-Reduction

A
  • Alleviate maternal discomfort, difficulty breathing or sleeping
  • only works temporarily
119
Q

How should amnio-reduction be performed?

A

Remove 500cc/hr to a total of 1500cc: repeat every 1-2 weeks

120
Q

Up until when does the corpus luteum of pregnancy persist?

121
Q

Management of adnexal mass in pregnancy

A

Expectant Management: (Rationale)
Risk of acute complications <2%
Risk of malignancy low

122
Q

Contraindications to breast feeding

A
  1. Substance abuse
  2. HIV pos
  3. Untreated TB or varicella
  4. HSV on breast
123
Q

Management of nursing mother with Mastitis

A
  1. Continue to breast feed

2. Dicloxacillin 500mg Q6 hrs x 10 days

124
Q

Consideration for mother with von Willebrand Dz during delivery

A

Do not perform VAVD (baby may have dz) as this may cause a severe hematoma

125
Q

Preconception counseling: when do you begin PNV?

A

1 month before conception

126
Q

Fragile X:

  1. Gene mutation?
  2. Incidence?
  3. Genetic Transmission?
  4. Dx Testing?
  5. Indications for screening?
A

Fragile X:
1. Gene mutation? FMR1 gene
2. Incidence? 1/4000
3. Genetic Transmission? X-linked Recessive
4. Dx Testing? PCR or southern blot
5. Indications for screening?
Fam hx of Fragile X, MR, Developmental delay, autism or Personal H/o Premature ovarian failure or patient request

127
Q

Testing recommended by ACOG for Eastern European Jewish descent?

A
  1. Tay-Sachs (1:30)
  2. CF (1:30)
  3. Familial dysautonomia (1:30)
  4. Canavan Dz (1:40)
128
Q

What intervertebral space would one aim for in order to place an epidural?

A

L2/3 or L3/4

129
Q

Contraindications for Epidural?

A
  1. Infx on overlying skin
  2. Coagulopathy
  3. Inc intracranial pressure
  4. Local spinal anomaly
  5. Uncooperative patient
  6. Maternal hypovolemia
130
Q

How would you treat Maternal hypotension caused by epidural?

A

Ephedrine 5mg and IV fluids

131
Q

How long would you wait before placement of epidural if pt received prophylactic dose of LMWH?

132
Q

How long would you wait before placement of epidural if pt received therapeutic dose of LMWH?

133
Q

Which dermatome is associated with Nipple level?

134
Q

Which dermatome is associated with Xiphisternum?

135
Q

Which dermatome is associated with Umbilicus?

136
Q

Which dermatome is associated with Pubis?

137
Q

Classical female pelvic sup-type

138
Q

Male Type, heart shaped inlet w/ funnel shaped cavity

139
Q

Stretched inlet in AP diameter

A

Anthropoid

140
Q

Stretched inlet in transverse diameter w/ shallow cavity

A

Platypelloid (“platty” pelloid is “flatty” pelloid)

141
Q

Anatomy of the Ureter- Abdominal

A

15 cm long
commences at renal pelvis and descends over psoas from lat to med
Enters pelvic brim at bifurcation of common iliac vessels

142
Q

Anatomy of the Ureter-Pelvic

A

15 cm
Descends pelvic side wall post to ov fossa
Corsses under cardinal lig from post-lat to antero-med
Crosses under uterine art (water under bridge) 1-2 cm from cervix
Continues anteriomedially to insert into bladder tangentially

143
Q

Common locations of ureteral injury

A
  1. Ligating ut art (under cardinal ligaments)
  2. Ligating uterosacral ligaments (under uterosacral lig)
  3. Ligating infundibular ligaments
  4. Closing/over sewing the vault
144
Q

Muscles cut in episiotomy

A
  1. Bulbocavernosous muscle
  2. transverse perineal muscle
  3. deep transverse perineal muscle
145
Q

Progress of dilation & descent for multip?

A

1.5cm/hr dilation & 1 cm/hr descent

146
Q

Progress of dilation & descent for nulip?

A

1.2cm/hr dilation & 2 cm/hr descent

147
Q

Failed IOL?

A

Failure to generate regular Q3 min ctx & cvx change after at least 24 hrs of oxytocin w/ AROM if possible

148
Q

Arrest of dilation (first stage of labor)

A

Dilation =/>6 cm w/ AROM and no cervical change for =/>4 hrs of adequate contractions (MVU>200) or =/>6 hr of inadequate contractions

149
Q

Arrest of descent (second stage of labor) for Multip

A

w/o epidural 2 hrs

w/ epidural 3 hrs

150
Q

Arrest of descent (second stage of labor) for Nulip

A

w/o epidural 3 hrs

2/ epidural 4 hrs

151
Q

Indication for IUPC

A

Obesity (if ext monitor not effective)
Absence of 1:1 nursing care
Inadequate response to oxytocin

152
Q

Indications for CD because safe vag delivery is problematic?

A

Face, mentum posterior
Breech, back down (back must rotate anteriorly: too late for CD if back rotates posteriorly)
Brow
Transverse lie, back down-requires classical CD not transverse lower segment)

153
Q

Definition of Category III tracing

A

Sinusoidal pattern alone or absent variability plus any of the following:

  • recurrent late decels
  • recurrent variable decels
  • bradycardia
154
Q

Definition of tachysystole

A

> 5 ctx in 10 min averaged over 30 mins

155
Q

Management of BPP 6

A

Term-Deliver

Preterm-Repeat in 24 hrs

156
Q

Management of BPP of 4 or less

157
Q

Utility of Bishop score

A

=/>8- probability of vag del is same as pat in spont labor

=/<6 unfavorable cervix (unripe) should not be done unless for medical reason

158
Q

Dx of chronic HTN

A

HTN <20 wks, prior to preg or persists >12 wks PP w/ systolic >140/Diastolic >90 mmHg, BP should be measured on 2 occasions at least 4 hrs apart

159
Q

Differential Dx of Primary (w/in 24 hrs) PPH

A 
Atony
Retained POC
Lacerations
Uterine Inversion
Coagulopathy
Uterine Rupture
160
Q

Differential Dx of Secondary (24hr-6wks) PPH

A

Infection
Placental site sub-involution
Retained placental fragments
Repair breakdown

161
Q

Definition of GHTN

A

HTN >20 wks
BP normal at 12 wk PP
No proteinuria

162
Q

Definition of Preeclampsia

A 
GHTN + proteinuria
Proteinuria:
24 hr urine >300 mg
P:C =/>0.3
Random urine >30 mg/dL (1+or greater)
163
Q 
Protein Dipstick Indicators
\+
\++
\+++
\++++
A 
Protein Dipstick Indicators
\+ 30
\++ 100
\+++ 300
\++++ >2000
164
Q

Preeclampsia w/ severe features

A 
Proteinuria not required.
PreE + any:
Vascular- BP>160/110 mmHG
               - Pulmonary edema
Renal- Serum creatinine >1.1 mg/dL
          -doubling of Cr w/o renal dz
Cerebral- HA &amp; vis disturbances
Hematologic- Hemolysis/thrombocytopenia (HELLP)
Hepatic- elevated enzymes (twice normal)
    -RUQ or epigastric pain
    - Fatty liver of pregnancy
             -Low glucose
             -Liver Dysfunction
             -Prolonged PTT
             *High maternal and fetal mortality
165
Q

MgSO4 dilution solution

A

40 gm in 1000ml which provides 4gm/100ml

166
Q

Dose of MgSO4

A

2-4gm bolus over 20 minutes then 2gm/hr

167
Q

Therapeutic range of MgSO4

168
Q

MgSO4 Level of 10

A

Loss of Reflexes

169
Q

MgSO4 Level of 16

A

Respiratory Arrest

170
Q

MgSO4 Level of 22

A

Cardiac Arrest

171
Q

Antidote of Magnesium sulfate Toxicity

A

Calcium gluconate 1gm IV over 2 minutes

172
Q

What condition is contraindicated w/ use of MgSO4? What medication can you use instead for seizure prophylaxis?

A

Myasthenia Gravis
Phenytoin (monitor w/ EKG)
Diazepam (be able to intubate)

173
Q

HTN emergency protocol?

A

160/110
Labetalol 20 mg, 40 mg, 80 mg (Q10 min) ->Hydralazine 10 mg

Hydralazine 5mg, 10mg, 20mg (Q20 min)
->Labetalol 40 mg

Nifedipine oral 10mg, 20mg, 20mg (Q20m)
->Labetalol 40 mg

174
Q

3 Hr GTT cutoff

A

105/190/165/145

Carpenter Coustan: 95/180/155/140

175
Q

Early 1 hr GTT (Indications)

A 
Obesity
Fam H/o DM
Previous macrosomic infant
Previous GDM
Previous macrosomic stillbirth
176
Q

White Classification for DM

A 
A1-GDM-diet controlled
A2-GDM- drug tx
B- Onset >age 20, Duration <10 yrs
C- Onset 10-20, Duration 10-20
D- Onset <10, Duration >20
F- Ne "F" ropathy
H- Heart involvement
R- Retinopathy
177
Q

Effects of DM on pregnancy 1st TM

A

1TM- SAB
Congenital malformations 2-6 fold
Cardiac (ASD, VSD, transposition) 38%
Skeletal
CNS (NTD, holoporcencephaly)
Caudal regression-rare but nearly all 2/2
DM

CONGENITAL ANOMALIES & SAB NOT ASSOCIATED W/ GESTATIONAL DM SINCE BLOOD SUGARS BECOME ELEVATED LONG AFTER ORGANOGENESIS

178
Q

Effects of DM of pregnancy 3rd TM

A

LGA/macrosomia
IUGR
IUFD

179
Q

Effects of DM on neonatal period

A

Low- glucose, calcium, temperature, mg

High- bilirubin, RBC, +RDS

180
Q

Dietary requirements w/ DM

A

30kcal/kg/day (typically 2200-2400) using prepregnant weight

20 kcal/kg/day if BMI >30

181
Q

Critical antibody titer

A

16 or greater, Doppler the MCA to access level of anemia, this replaces amnio to measure DeltaOD450

182
Q

80% of new HSV cases are of which subtype? Which subtype recurs less frequently?

183
Q

Dx of HSV?

A

Serology w/ PCR (cultures have false + rate of 20%

184
Q

Vertical Transmission Rate of HSV Primary Infection? Serology results?

A

50%, Ab neg

185
Q

Vertical Transmission Rate of Non-primary, 1st episode? Serology results?

A

33%, Ab+ but Ab & clinical type don’t match

186
Q

Vertical transmission of Recurrent infection? Serology results?

A

3%, Ab +: Ab and clinical type do match.

187
Q

MOA of Acyclovir?

A

Inhibits viral thymidine kinase and thus viral replication.

188
Q

MOA of Famiclovir?

A

Converted to pencyclovir in liver (>bioavailability than acyclovir)

189
Q

MOA of Valacyclovir?

A

Converted to acyclovir in the liver (>bioavailability than acyclovir)

190
Q

How would you treat primary or non-primary 1st herpes episode?

A

Valacyclovir 1000mg BID x 10 days

191
Q

How would you treat recurrent herpes episode?

A

Valacyclovir 500mg BID x 5 days

192
Q

Suppression of Herpes?

A

Valacyclovir 1000mg daily

OB (5 decks)

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