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Ob/Gyn > Kaplan High Yield Ob > Flashcards

Kaplan High Yield Ob Flashcards

1
Q

pre-viable vs preterm vs term fetus

A

<24 weeks vs 25-37 weeks vs 38-42 weeks

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2
Q

Goodell sign
Ladin sign
Chadwick sign

A
  • softening of cervix; 4 weeks
  • softening of midline of uterus; 6 weeks
  • blue discoloration of cervix/ vagina; 6-8 weeks
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3
Q

what is the cause of morning sickness?

A

inc progesterone, estrogen, beta-HCG

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4
Q

physiologic changes during pregnancy

  • cardiac
  • GI
  • renal
  • hematology
A
  • cardiac: inc CO, dec BP (progesterone-mediated vasodilation)
  • GI: morning sickness, GERD, constipation
  • renal: inc GFR (from inc plasma volume); inc size of kidney/ ureter (= physiologic hydronephrosis from compression of ureters)
  • heme: anemia (from inc plasma volume); hyper-coagulable state
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5
Q

triple vs quad screen? when are they done? what is it used for?

A
  • MSAFP + beta-HCG + estriol
  • MSAFP + beta-HCG + estriol + inhibin A
  • performed during 2nd tri
  • used to screen for chromosomal abnormalities
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6
Q

Braxton-Hicks contractions vs preterm labor

A
  • B-H = sporadic contractions withOUT cervical changes

- preterm labor = regular contractions with cervical changes before 37 weeks

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7
Q

3rd tri tests?

A
  • CBC –> for anemia
  • glucose load test
  • cervical and rectovaginal cultures –> for chlamydia/ gonorrhea and GBS
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8
Q

chorionic villus sampling: when? what does it dx? how?

A
  • when: 10-13 weeks
  • dx: obtains fetal karyotype
  • how: aspirate chorionic villi from placenta via inserting a catheter to the intrauterine cavity (trans-abdominally vs -vaginally)
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9
Q

amniocentesis: when? what does it dx? how?

A
  • when: after 14 weeks
  • dx: obtains fetal karyotype
  • how: withdraws amniotic fluid via inserting a needle trans-abdominally
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10
Q

fetal blood sampling: when? what does it dx? how?

A
  • when: in mom’s with Rh isoimmunization or when fetal CBC is needed
  • dx: anemia of the fetus
  • how: withdraw blood from the umbilical cord via a needle trans-abdominally
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11
Q

risk factors for ectopic pregnancy?

A
  • PID
  • IUD
  • previous ectopic
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12
Q

ectopic pregnancy px

A

-px: unilateral lower abdominal or pelvic pain + vaginal bleeding + hypotensive (if ruptured)

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13
Q

ectopic pregnancy tx

A
  • medical: get CBC + type/screen + transaminases + beta-HCG –> administer methotrexate (heptotoxic) –> watch for changes in beta-HCG
  • proceed to surgery if ruptured* OR if no changes in beta-HCG
  • surgery: give fluids + blood products + pressers if unstable
  • salpingostomy or salpingectomy
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14
Q

contraindications to methotrexate?

A
  • immunodeficiency –> methotrexate = immunosuppresive
  • liver disease
  • noncompliant –> may need f/u for 2nd dose
  • ectopic > 3.5cm
  • fetal heart beat heard
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15
Q

abortion =

A

a pregnancy that ends before 20 weeks or a fetus <500g

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16
Q

types of abortion

  • complete
  • incomplete
  • inevitable
  • threatened
  • missed
  • septic
A
  • no products of conception left in uterus
  • some products of conception left in uterus
  • intact products of conception + intrauterine bleeding + cervical dilation
  • intact products of conception + intrauterine bleeding
  • death of fetus; no bleeding or cervical changes
  • infection of uterus
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17
Q

multiple gestation px

A
  • exponential growth of uterus
  • rapid weight gain by mother
  • elevated beta-HCG & MSAFP more than expected for GA
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18
Q

twin transfusion syndrome

A

anastomosis of vessels causing 1 twin to receive most of the supply –>

  • 1 twin becomes anemic –> hydrops fettles
  • 1 twin becomes fluid overloaded
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19
Q

preterm labor definition, risk factors

A

= contractions + cervical dilation before 37 weeks

-risk factors: PROM, multiple gestation, placental abruption, previous hx of preterm labor, chorioamnionitis, preeclampsia

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20
Q

preterm labor tx

  • stop delivery if:
  • deliver if:
A
  • stop if 24-33 GA or 600-2500g
  • given betamethasone + tocolytics so that lungs can mature

-deliver if 34-37 GA (lungs already matured)

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21
Q

tocolytics definition, list

A

-slow progression of cervical dilation by decreasing uterine contractions

  • magnesium sulfate
  • CCBs (nifedipine)
  • beta agonists (terbutaline)
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22
Q

premature rupture of membranes (PROM) definition, dx

A

=rupture of chorioamniotic membrane –> “gush of fluids” from vagina

-dx: sterile* speculum exam + fluid in posterior turns nitrazine paper blue + ferning on microscopy

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23
Q

PROM tx

  • chorioamnionitis
  • term infant, no infection
  • preterm infant
A
  • deliver now
  • wait for spontaneous delivery (induce after 12 hours of waiting)
  • betamethasone + tocolytic + ampicillin + azithromycin
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24
Q

placenta previa definition, px, dx, tx

A

=abnormal implantation of placenta over internal cervical os

  • px: painless* vaginal bleeding
  • dx: trans-abdominal US (vaginal exam contraindicated**)
  • tx: strict pelvic rest + c-section
25
Q

types of placenta pre via

A
  • complete – totally covering the os
  • partial
  • marginal – adjacent to os
  • vasa previa – fetal vessels over the os
  • low-lying placenta – doesn’t cover os
26
Q

placental invasion definition, types, risk

A

=abnormal attachment of placenta to uterus

  • accreta = attaches to superficial uterine wall
  • increta = attaches to myometrium
  • percreta = passes thru uterine serosa to bladder or rectum
  • risk of hemorrhage/shock if placenta cannot be delivered –> hysterectomy
  • normally implants to decidua
27
Q

placental abruption definition, px, types, dx, causes, risks

A

=premature separation of placenta from uterus –> bleeding

  • px: painful* vaginal bleeding + contractions + possible fetal distress
  • types: concealed vs external
  • dx: trans-abdominal US
  • causes: maternal HTN, cocaine use, trauma, smoking, prior hx
  • risks: uterine tetany, DIC, hypovolemic shock
28
Q

uterine rupture risk factors, px, tx

A
  • risk factors: previous c-section (classical incision), trauma, uterine overdistension (polyhydramnios, multiple gestation), placenta percreta
  • px: sudden extreme abdominal pain + no contractions + abnormal bump in abdomen (=fetus in abdominal cavity)

-tx: immediate laparatomy with delivery
-no c-section bc baby can be in abdominal cavity
+/- hysterectomy or uterus repair

29
Q

hemolytic disease of the newborn results in?

A
  • fetal anemia –> extramedullary RBC production (liver, spleen)
  • inc bilirubin –> kernicterus
  • erythroblastosis fetalis (high fetal cardiac output)
30
Q

instances where fetal blood can cross into maternal blood?

A
  • abortion
  • delivery
  • abruption
  • amniocentesis
  • vaginal bleeding
31
Q

when is prenatal antibody screening done for Rh(-) moms?

A

28 and 35 weeks

32
Q

what antibody level constitutes a sensitized Rh(-) mother?

  • sensitized = Rh(-) mom having anti-Rh antibodies against fetus
  • unsenzitized = no anti-Rh antibodies
A
  • initial titer >1:4
  • reaching 1:16 at any point during the pregnancy

*screen fetus with serial amniocentesis to monitor bilirubin levels

33
Q

chronic vs gestational HTN

A

BP >140/90 before vs after 20 weeks

34
Q

tx for preeclampsia/ eclamspia/ HELLP syndrome

A
  • stabilize pt (with hydralazine & magnesium sulfate)
  • deliver
  • give betamethasone if preterm
  • induce delivery if at term
35
Q

risks of pre-gestational DB

A
  • preeclampsia
  • spontaneous abortion
  • infection
  • postpartum hemorrhage
  • congenital anomalies of fetus
  • macrosomia/ shoulder dystocia
  • preterm labor
36
Q

when is screening of gestational DB done? how? glucose level to dx DB?

A
  • 24 to 28 weeks
  • glucose load test (nonfasting ingestion of 50g glucose –> measure 1 hour later)
  • glucose tolerance test (fasting ingestion of 100mg –> 3 measurements after)

-dx: >140mg/dL

37
Q

gestational DB tx

A
  • diabetic diet
  • exercise
  • insulin
  • glyburide, metformin
38
Q

symmetric vs asymmetric IUGR

A
  • occurs before vs after 20 weeks

- brain in proportion vs smaller than rest of body

39
Q

IUGR causes

A
  • chromosomal abnormalities
  • neural tube defect
  • infection (rubella, varicella, CMV, etc)
  • multiple gestation
  • maternal HTN
  • maternal renal disease
  • maternal malnutrition
  • maternal substance abuse (smoking, alcohol)
40
Q

if pt is 28 weeks gestation, the fundal heigh should be how many cm?

A

28 cm

fundal height ~ gestational age

41
Q

NST (non stress test) looks at?

A
  • fetal movements x2
  • accelerations x2 of >15bpm lasting 15-20s over a 20min period

-vibroacoustic stimulation to wake up baby

42
Q

BPP (biophysical profile) looks at?

A
  • NST
  • fetal tone
  • fetal movement
  • fetal chest expansions
  • amniotic fluid index (AFI)

-each category is worth 2 points; normal BPP: 8-10

43
Q

fetal heart rate parameters

  • bradycardia
  • normal
  • tachycardia
A
  • below 110 bpm
  • 110-160
  • over 160 bpm
44
Q

what do the different types of decelerations represent?

  • early
  • variable
  • late
A
  • head compression; occurs during contractions
  • umbilical cord compression; no relationship to contractions
  • fetal hypoxia & uretoplacental insufficiency
45
Q

what is bloody show?

A
  • release of bloody mucus plug from cervix

- occurs with cervical effacement

46
Q

what is fetal station?

A

where the fetus head is in relation to the pelvis

47
Q
  • stage 1: latent vs active
  • stage 2
  • stage 3
A 
stage 1:
-latent: onset of labor --> 4cm dilated
-active: 4cm --> full dilation
stage 2: delivery of neonate
stage 3: delivery of placenta
48
Q

medications/ means to induce labor

A
  • prostaglandin E2
  • oxytocin
  • amniotomy
49
Q

prostaglandins are contraindicated in what population?

A

asthmatics

50
Q

prolonged latent stage definition, tx

A
  • latent stage longer than 20 hours (primipara)
  • > 14 hours (multipara)

-tx: rest, hydration

51
Q

protracted cervical dilation

A

slow dilation during active phase

- <1.5cm (multipara)

52
Q

protracted cervical dilation causes, tx

A
  • Power: strength & frequency of contractions
  • Passenger: size & position of fetus
  • Passage: cephalopelvic disproportion

-tx: oxytocin (for power probs) or c-section (for passage probs)

53
Q

malpresentation tx

A
  • external cephalic version (after 36 weeks)

- c-section

54
Q

MCC of postpartum hemorrhage

A

uterine atony

-normally uterine contractions compress the blood vessels to stop the blood loss

55
Q

uterine atony causes

A
  • anesthesia
  • uterine overdistension (multiple gestation, polyhydramnios)
  • prolonged labor
  • laceration
  • retained placenta
  • coagulopathy
56
Q

uterine atony tx

A
  • bimanual compression and massage

- oxytocin

57
Q

Sheehan syndrome

A

ischemia of the pituitary after postpartum hemorrhage –> lactotrophs die –> inability to breast feed

58
Q

definitions

  • low birth weight
  • IUGR (small for gestational age)
  • macrosomia
  • large for gestational age
A
  • 4500g - >90th percentile

Ob/Gyn (3 decks)

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