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ObsGyn > Hacker and Moore Part 2 - Obs > Flashcards

Hacker and Moore Part 2 - Obs Flashcards

1
Q

Provide the source, function, and signal for the peptide hormone hCG.

A

1) source: placenta (trophoblastic cells) 2) function: maintains pregnancy 3) signal: none

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2
Q

What does an hCG concentration at times other than pregnancy indicate (3)?

A

1) hydatidiform mole 2) choricarcinoma 3) embryonal carcinoma (germ cell tumor)

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3
Q

When does hCG rise to detectable levels in pregnancy? When does it peak? What role does hCG serve in the first 8 weeks of pregnancy? What does a below normal hCG level indicate (2)?

A

1) Day 8 after ovulation 2) hCG peaks at day 60-90 of pregnancy 3) role in maintaining corpus luteum (progesterone secretion) 4) low hCG: threatened abortion, ectopic pregnancy

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4
Q

Provide the source, function, and signal for the peptide hormone hPL (human placental lactogen).

A

1) source: placenta 2) function: antagonizes insulin, increasing glucose available to fetus 3) signal: none

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5
Q

What does a low hPL hormone suggest (2)?

A

1) threatened abortion 2) intrauterine growth restriction

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6
Q

Provide the source, function, and signal for the peptide hormone CRH (corticotropin-releasing hormone).

A

1) source: placenta 2) function: stimulate fetal ACTH - results in DHEA-S secretion from fetal adrenal (converted to estrogen in placenta) 3) signal: fetal cortisol

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7
Q

Provide the source, function, and signal for the peptide hormone Prolactin.

A

1) source: anterior pituitary (maternal) 2) function: stimulates post-partum milk production 3) signal: maternal estrogen

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8
Q

Which steroid hormone maintains uterine quiescence in pregnancy?

A

Progesterone inhibits uterine contractions

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9
Q

DHEA-S is secreted from the fetal adrenals and converted by what structure into estradiol?

A

The placenta

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10
Q

A decline of maternal estradiol may indicate what condition of the fetus (2)?

A

1) fetal compromise if fetus neurologically intact 2) Anencephaly of the fetus

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11
Q

What role does cortisol play in the fetus near term?

A

1) promotes lung maturation - alveolar cell differentiation and surfactant production 2) increases release of labour hormones - CRH and prostaglandins

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12
Q

What is the primary function of ocytocin in pregnancy?

A

Causes uterine contractions

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13
Q

What is the impact of Prostaglandins E and F (2)?

A

1) Cause uterine contractions 2) PGE causes cervical ripening

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14
Q

What drugs can be used to prolong gestation? What do they inhibit? What is a risk of their use?

A

1) NSAIDs and Aspirin block the production of prostaglandins thus preventing uterine contractions 2) Prostaglandin E and F 3) Closure of the ductus arteriosus, this is kept patent by PGE

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15
Q

What are three events that occur during the onset of labour when the estrogen-to-progesterone ration increases?

A

1) PG secretion increases 2) gap junctions form in the myometrium 3) cervix ripening

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16
Q

What type of contractions occur during the quiescence phase of parturition? What hormone maintains the quiescence phase?

A

1) Braxton-Hicks contractions 2) Progesterone

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17
Q

Phase 2 (stimulation) of parturition begins with placental production of CRH, what are the outcomes of this (2)?

A

1) Increased cortisol and DHEA-S 2) Resultant estrogen increase

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18
Q

Describe physiological anemia of pregnancy

A

RBCs and Plasma increase total blood volume by 40% i pregnancy. The plasma increase dominates and thus produces a net hemodilution

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19
Q

In what direction do the following CV parameters change in pregnancy - SBP, DBP, HR, SV, CO?

A

SBP and DBP fall HR, SV, CO rise

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20
Q

What are potential outcomes caused by low venous flow due to compression by the gravid uterus in a pregnant woman (3)?

A

1) Varicose veins in the lower extremities and vulva 2) Hemorrhoids 3) thrombosis (DVT)

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21
Q

What impact does pregnancy have on the following RS parameters - IRC, FRC, minute vent, tidal volume, resp rate, vital capacity

A

1) IRC, minute vent, tidal volume increase 2) FRC drops (ERV and RV decrease) 3) resp rate and vital capacity unchanged

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22
Q

Why does a respiratory alkalosis exist in pregnancy?

A

Hyperventilation due to increased minute ventilation leads to drop in PCO2.

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23
Q

What impact does pregnancy have on renal physiology in terms of flow and buffering capacity?

A

1) Flow increases up to 40% - drops serum creatinine 2) Resp alkalosis causes bicarb excretion thus reducing buffering capacity of kidney

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24
Q

Contrast insulin sensitivity in early and late pregnancy. What hormone causes the change? What is the primary source of fuel for the mother, and for the fetus? What is a potential risk to the mother due to this change?

A

1) Early - increased insulin sensitivity, high glycogen synthesis, low gluconeogenesis (anabolic phase). Late - increased insulin resistance, increase lipolysis 2) hPL 3) mother - lipids. Fetus - glucose and AAs 4) Risk of ketoacidosis in the mother

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25
Q

What 3 structures ensure fetal circulation is a parallel system?

A

Ductus arteriosus, foramen ovale, ductus venosus

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26
Q

Which immunoglobulins cross the placenta? Provide an example where this is deleterious.

A

1) IgG 2) Rh sensitization in first pregnancy in Rh- mother.

27
Q

What immunizations should be ensured to be up to date in the preterm period (6)?

A

1) Hep B 2) Rubela 3) Varicella 4) Tdap 5) HPV 6) influenza

28
Q

What is meant by torch infection?

A

Toxoplasmosis, Orther, Rubella, Cytomegalovirus, Herpes

29
Q

When should WinRho be provided to women (4)

A

1) Rh negative
2) 28 weeks
3) Gestation if baby Rh positive
4) Rh negative mother with bleed (ie threatened abortion)

30
Q

When is hCG first detectable? At what level? What level will urine pregnancy tests pick it up?

A

1) 6-8 days post ovulation
2) 25 IU/L is a positive test and will be picked up on urine testing

31
Q

What is the doubling time of hCG in early pregnancy? When should a gestational sack be seen on U/S?

A

1) Expect doubling every 2.2 days
2) 5 weeks GA or hCG of 1500

32
Q

Provide 3 instances of U/S findings suggestive probable embryonic demise

A

1) gestational sac of 8mm with no yolk sac
2) gestational sac of 16mm with no embryo
3) No cardiac motion in embryo with crown-rump length greater than 5mm

33
Q

What is the rate of spontaneous abortion? What is the rate if the embryo is present beyond 8 weeks GA?

A

1) 10-15% for clinically recognized pregnancies
2) 3% after 8 weeks

34
Q

Define the terms threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion.

A

1) threatened: PVB before 20 weeks, cervix closed. 25-50% result in loss
2) Inevitable: PVB, cramping, cervix dilated
3) Incomplete: PVB, cramping, cervix dilated, passing of some tissue
4) Complete: passage of all products of conception, pregnancy test becomes negative
5) Missed: dead fetus retained by uterus (more than 6 weeks)
6) Recurrent: 3 or more SA

35
Q

Discuss the management of Threatened, Incomplete, Missed, and Recurrent abortions.

A

1) Threatened: U/S to determine if live fetus present, if so, 94% chance of producing live baby. Reassurance.
2) Incomplete: Ensure patient is stable. Remove products
3) Missed: confirm with U/S. Evacuate surgically.
4) Recurrent: r/o DM, hypoT, SLE. Test pat/mat chromosomes. hysteroscopy. Test for infectious agents.

36
Q

Discuss tests offered in the first trimester of pregnancy (3). What are the findings that suggest Down’s?

A

1) Nuchal translucency
2) b-hCG
3) Pregnancy associated plasma protein A (PAPPA)
4) Downs - high NT, high b-hCG, low PAPPA

37
Q

What are the serum markers used in second-trimester testing? When are they done? What can be expected in a neural tube defect and how is this confirmed? What can be expected in Downs and what additional test can be added to confirm?

A

1) alphafetoprotein (AFP), b-hCG, unconjugated estriol (UE3)
2) Done at 16-20 wks
3) Neural tube defect: high AFP. Do amnio, Acetylcholinesterase presence in amniotic fluid confirms NT defect
4) Downs: low AFP, high b-hCG, low UE3. Add inhibin A (quad test)

38
Q

Teratogens:

1) What is the safest antianxiety drug in pregnancy?
2) What are the effects of Warfarin and Heparin in pregnancy?
3) What is the risk of valproic acid and carbamazepine use during pregnancy?
4) What is the effect of Diethylstilbestrol (DES) on female offspring?

A

1) Fluoxetine (B)
2) Warfarin (D): crosses placenta, risk of SA, risk of fetal warfarin syndrome. Excreted in breast milke. Heparin (B): does not cross placenta, associated with prematurity and fetal demise
3) risk of spina bifida
4) cervical and uterine malformation

39
Q

What are the warning signs of pre-eclampsia (4)?

A

Vision change, frontal headache, hand or face swelling, RUQ pain

40
Q

Describe the four Leopold maneuvers

A

1) palpate fundus to detemine lie
2) palpate sides to find back
3) Grasp above pubis to determine presenting part
4) Palpate for brow or occiput when vertex to determine if flexed or extended

41
Q

Describe the tests of fetal-wellbeing (4)

A

1) Maternal test: count fetal movements in 1hr, should be 10+
2) NST: fetal heart doppler. 2 accels in 20 mins
3) U/S: assess amniotic fluid level and fetal movement
4) contraction stress test: oxytocin given to enduce contraction, if late decels present, indicates uteroplacental dysfunction

42
Q

What 5 metrics are included in a biophysical profile test?

A

1) reactive nonstress test
2) adequate amniotic fluid
3) adequate fetal movement
4) adequate fetal breathing
5) adequate tone

43
Q

Define labour

A

Something unions ruin.

Jk. It’s progressive cervical effacement and dilation due to contractions of less than 5 min intervals, lasting 30-60 seconds

44
Q

What are the two smallest diameters for presentation? What is the largest?

A

1) suboccipitobregmatic and submentobregmatic
2) Supraoccipitomental

45
Q

What make up the borders of the plane of least diameter in the pelvis (4)?

A

1) inferior edge of pubis
2) Ischial spines
3) Sacrospinous ligaments
4) Anterior surface of the sacrum

46
Q

What does synclitic mean?

A

Sagital suture is equidistant from the ischial spines when head is engaged

47
Q

What are the characteristics of Braxton Hicks contractions (3)?

A

1) irregular
2) Painless
3) Do not cause cerival dilation and effacement (false labour)

48
Q

What does a “bloody-show” refer to?

A

Passage of cervical mucous plug and onset of labour

49
Q

Discuss the phases of the first stage of labour, their length, their rate, and important investigations

A

1) Latent: Effacement and cervical dilation to 3-4cm.
2) Active: 3-4cm to full dilation of cervix. Rate of 1-1.2cm/hr. PV exam every 2hrs.
3) First stage: 6-18 hrs in prime, 2-10 hrs in multi. Check fetal heart rate every 30 mins or every 15 mins if obs risk factors. Monitor continuously with uterine contractions if high risk pregnancy.

50
Q

What is involved in the second stage of labour. What are the 6 movements that characterize this stage.

A

1) Full cervical dilation to delivery of fetus
2) Descent, flexion, internal rotation, extension, external rotation, expulsion

51
Q

What is the typical length of the second stage of labour? How oftern should the fetal heart rate be checked? How often should PV exams be done?

A

1) prime: 30min-3hrs. multi: 5min-30min
2) Assess heart rate every 15 mins, every 5 if obs RF, continuously if high risk pregnancy
3) every 30 mins

52
Q

What are the signs of placental separation in the third stage of labour (4)? How long does this typically take?

A

1) fresh show of blood PV, umbilical cord lengthens, fundus rises in abdomen, uterus becomes firm
2) 2-10 mins.

53
Q

What are some indication for induction of labour (5)? for augmentation (2)?

A

1) pre-eclampsia, DM, heart disease, post-dates, IUGR
2) Inadequate uterine activity, prolonged first stage

54
Q

What are some contraindications for induction and augmentation (5)?

A

1) contracted pelvis, prior uterine surgery (past c-s, past transection), poor fetal lung maturity, fetal distress, abnormal presentation

55
Q

What are the 5 components of a Bishop score?

A

Position, consistency, effacement, dilation, station

56
Q

What are 3 complications of oxytocin use?

A

1) hyperstimulation and uterine rupture
2) ADH effect and water intoxication
3) uterine fatigue and post delivery atony (PPH)

57
Q

How does lochia change in the post-partum period and what are the timelines? What does a foul smell indicate?

A

1) Lochia rubra - red, first 3 days
2) Lochia serosa - pale, day 4-10
3) Lochia alba - white or yellow, day 10+
4) foul smell suggests endometritis

58
Q

What impact does breast feeding have on the maternal uterus and fetal immunity? Which hormones are important in breastfeeding (3)?

A

1) BF stimulate oxytocin release which aids in uterine contraction, IgA is secreted in breast milk
2) Estrogen - drops after pregnancy. It inhibits prolactin action
3) Prolactin - stimulated by suckling, involved in milk production
4) Oxytocin - stimulated by suckling, involved in milk ejection

59
Q

Give two examples of labour pains negative impact on the fetus from a physiologic standpoint

A

1) hyperventilation of mother -> resp alkalosis -> left shift oxy curve -> less O2 to fetus
2) Catecholamines -> decrease blood flow to uterus and impair contractility (relax smooth muscle)

60
Q

Provide 4 anesthesia risks specific to pregnant patients

A

1) difficult intubation (8x)
2) increase O2 demand
3) decreased FRC
4) higher aspiration risk

61
Q

Provide 3 physiologic changes that prepare the fetus for life on the outside and their coresponding hormones

A

1) hyperthyroidism - caused by cortisol, high TSH, and T3. Allows thermoregulation
2) Decrease in fetal breathing during labour - allows retention of surfactant
3) Catecholamines released in response to stress - promotes lung fluid absorption, mobilizes glc.

62
Q

What are the 5 components of the APGAR score?

A

Appearance, Pulse, Grimace, Activity (tone), Respiration

63
Q
A

ObsGyn (5 decks)

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