Gestational onset

Question 0

Threatened abortion?

Answer 0

Unexplained bleeding ( sometimes days)
Without cervical dilation
BACK ACHE

Question 1

During 1st and 2nd trimester what is the main cause of bleeding?

Answer 1

Abortion

Question 2

Imminent abortion?

Answer 2

Ruptured membranes
Cervical dilation
Increased bleeding

Question 3

Incomplete abortion?

Answer 3

Embryo passes 
Placenta retained ( May require D&C)

Question 4

Compete abortion?

Answer 4

All products of conception expelled

Question 5

Missed abortion?

Answer 5

Fetus dies in utero, but not expelled
Brownish discharge
Decreased HCG levels
Confirmed by ultra sound

Question 6

Ectopic pregnancy treatment?

Answer 6

Methotrexate (IM)

Monitor outp for pain, hCG titers

Question 7

Gestational trophoblastic disease?

Treatment?

Answer 7

Placenta characterized by Hydropic (fluid filled) grape like clusters

Treatment: suction evacuation and curettage of uterusn

Question 8

Hydatiform mole “Molar pregnancy”?

Answer 8

Less of pregnancy cause risk of developing choriocarcinoma from trophoblastic tissue.

• follow up for CA
• monitor hCG and for metastasis
• curable if treated early

Question 9

Gestational trophoblastic disease s/s?

Answer 9

Brown red bleeding
Anemia
Hyperemesis gravidarum **
Preeclampsia 
Absent FHR
Elevated hCG levels 
Low serum alpha-fetoprotein
(Diagnosis buy US)

Question 10

Hyperemsis Gravidarum diagnosis?

Answer 10

Intractable vomiting
Dehydration
Ketonuria
Weight loss of 5% of pregnancy weight

Question 11

Preeclampsia?

Eclampsia?

Answer 11

Increased BP after 20 weeks gestation accompanied by proteinuria ( encourage high protein diet)

Seizures

Question 12

HELLP Syndrome?

associated with, sx, tx?

Answer 12

Hemolysis, Elevated Liver enzymes, Low Platelet count
-associated with preeclampsia
-Sx: (before 36wks) n/v, mailaise, flulike symptoms, epigastric pain
Tx: DELIVERY

Question 13

Mild preeclampsia classifications?

Answer 13

BP of 140/90 on two occasions 6 hours apart @20 wks
Proteinuria (3oomg/L)
Edema ( weight gain >1.5 kg/mth) in 2nd trimester

Question 14

Sever preeclampsia manifestations?

Answer 14

BP > 160/110 @ 20 wks
Proteinuria ( 3+ or higher)
Oliguria
Visual disturbance
EPIGASTRIC PAIN or RUQ
Elevated liver enzymes

Question 15

When is childbirth considered in pt with preeclampsia?

Answer 15

After 34 weeks

Question 16

What is eclampsia and treatment?

Answer 16

Seizure or com associated with pregnancy

Magnesium Sulfate - bolus of 6g over 20-30 min

Question 17

Fetal reaction to seizure d/t eclampsia?

Answer 17

Bradycardia
Late decels
Decreased variability
Compensatory tachycardia

(Non-reassuring after 10-15 min consider birth)

Question 18

What can uncontrolled HTN in pregnant women cause?

Answer 18

Cerebral hemorrhage

Question 19

What is the intrapartum management of preeclampsia?

Postpartum?

Answer 19

Oxytocin and Mg Sulfate simultaneously
Narcotics for pain
Sims or lithotomy with wedge under R

POST: continue Mg sulfate for 24hrs
Anti hypertensives for BP 150/100
Usually improves rapidly

Question 20

Check deep tendon reflexes in women with eclampsia/ pre for what?

Answer 20

Clonus

Hyperreflexia (1+ and 2+ normal)

Question 21

What is considered chronic HTN?

Answer 21

BP 140/90 before pregnancy, before 20 wks, or persist 42 days following childbirth

Question 22

What is medication treatment for chronic HTN in pregnancy?

Answer 22

Methyldopa
Labetlol
( ACE Inhibitors contraindicated 2nd and 3rd trimester)
LIMIT SODIUM TO 2.4g

Question 23

What is considered a Gestational HTN?

Answer 23

Transient elevation without proteinuria, preeclampsia

Question 24

What is Kell (anti-K1) antibody in Rh alloimmunization?

Answer 24

Non RhD antibody which has an increasing incidences of alloimmunization

Question 25

What is Rh immune globulin?

Answer 25

Marks decrease in the presence of alloimmunization to the RhD antigen in pregnancy

Question 26

What is erythroblastosis fetalis?

Answer 26

Rh alloimmunization

Increased RBC production- presence of uncleared RBC s (erythroblast)

Question 27

What are fetal risk to Rh alloimmunization?

Answer 27

Fetal anemia : caused by hemolysis of maternal IgG antibodies

Hydrops fetalis- untreated anemia that leads to edema

Hyperbilirybinemia/ jaundice (neurological damage) due to RBC destruction

Question 28

When is Rhogam given?

Answer 28

At 28wks and sometimes after birth

Question 29

What does the Kleihauer-Betke (rosette) test determine?

Answer 29

The amount of RhD pos blood present in maternal circulation

Needed to determine how much Rh immune globulin to administer
-Up to 5 dowse can be given in 24hrs

Question 30

How do you achieve temporary passive immunity in mother with no titer who gave birth to Rh + fetus?

Answer 30

Rh immune globulin injection within 72hrs

Question 31

ABO Incompatibility?

Answer 31

Type O mother, with type A or B fetus
Causes hemolysis of RBC in fetus
Results in mild anemia in fetus
NOT TREATED ANTEPARTALLY

Question 32

Toxoplasmosis?

Answer 32

A whited through ingestion of undercooked meat, feline feces, and rarely through infected organ transplant.

1st trimester high rate of spontaneous abortion
Last monoth- Highest rate of fetal infection can cause retinochoroiditis if mild or convulsions and death of severe, survivors usually blind or deaf

Question 33

Rubella?

Answer 33

Immunize live virus prior to pregnancy/ postpartum

Fetal risks: IDD, cataracts, deafness, congenital heart defects

Elevated IgM antibody titer at birth

Question 34

CMV?

Answer 34

Most common infection in fetus

Found in urine, saliva, cervical mucus, breast milf, semen- ON ISOLATION

Dx by seroconversion

No tx : If mom is positive and no abx need C/S

Question 35

Herpes simplex Virus tx?

Answer 35

Antiviral therapy after 36wks gestation
Acyclovir
C/S

Question 36

Group B Strep (GBS)?

Answer 36

Found in lower GI and GU tract
Cause neonatal stillbirth
All women screened at 35/37 wks

Question 37

Human B19 Parovirus ?

Answer 37

Causes erythemia infectiosum 5th disease symptoms