NAGY OBS Flashcards
1
Q
Definition of gestational hypertension
A
BP over 140/90 measured two times four hours apart OR BP measured over 160/110 one time
After week 20
2
Q
Rh isoimmunization
A
When mixing of maternal and fetal blood occur, and they are not compatible: placental abruption, bleeding during pregnancy, during labor
3
Q
What to do with pregnant patients with type 1 DM?
A
- Don’t do OGTT, it can kill the patient
- Monitor blood glucose and HbA1c
- Offer an abortion if patient gets pregnatn and has poorly controlled diabetes
- Risk for the baby: congenital malformations, IUGR, hypoglycemia
4
Q
When do you diagnose IUGR in fetus? What do you look for?
A
- Week 30-32
- You have to compare with previous US
- Head circumference, abdominal circumference, limb length
5
Q
How do you do Leopold manouver?
A
- Fundal grip: feel the fundis, height of the fundus, breech or cephalic?
- Umbilical grip: localize fetal back
- Pelvic grip: fetal presenting part, breech or cephalic?
- Second pelvic grip: facing womans feet, attemt to locate brow with both hands, assess degree of flexion of fetal head
6
Q
What type of delivery in placenta previa?
A
C-section
7
Q
Which CV disease are of highest risk in pregnancy?
A
- Postpartum CMP
- Eisenmenger syndrome
8
Q
What medications to use in induction and augmentation of labor?
A
- Oxytocin
- Intravaginal prostaglandin E2
- Together with amniotomy, membrane sweep or balloon catheter
9
Q
Whats the difference between umbilical cord prolapse and umbilical cord presentation?
A
In umbilical cord prolapse, the membrane has ruptured
10
Q
What abnormal presentation and position of the fetus causes dystocia?
A
- Persistent occipitotransverse or occipitoposterior presentation
- Breech
- Sholder presentation
- Transverse lie
11
Q
What are the degrees of perineal tears and what anatomical structure is affected?// Can you mention a birth canal lesion?
A
1: Only perineal mucosa, no need to suture
2: Perineal mucosa and muscles (no sphincter), need to suture
3: External anal sphincter
4: Internal anal sphincter and rectal mucosa
Worst outcome: complete continuity between vaginal opening and opening to anal canal.
12
Q
What prophylaxis for PPROM?
A
- AB: 48 hr IV ampicillin+erythromycin, followed by po amoxicillin and erythromycin
- If before 34 wog., use corticosteroids (bethamethasone) to promoote lung maturity
- IV magnesium sulfate if before 32 weeks
- Tx of chorioamnionitis: amp+genta
13
Q
Fetal head movements during labor
A
- Flexion
- Internal rotation
- Extension
- External rotation
??
14
Q
How long does each of the 4 stages of labor last?
A
Stage 1: longest stage, around 20 hours
Latent: 0-3 cm
Active: 3-10 cm
Stage 2: 30-90 min
Propulsive stage (full dilation, descend to pelvic floor)
Expulsion stage (from pelvic floor to delivery of the baby)
Stage 3: shortest stage, 5-30 min
Expulsion of placenta and membranes
Stage 4: 2 hours
High risk of bleeding
Repair lacerations
RhoGAM: Rh D immune globulin is given to RhD negative mothers to prevent TTP
15
Q
What to do if placenta took longer than 30 minutes to deliver, but you are not in a hospital?
A
NO TOUCH TECHNIQUE
Do not do uterine massage unless in the hospital with OB/GYN specialists due to risk of placental retention and PPH
16
Q
What is the most common gastric malformation?
A
Ophalocele, gastroschisis, anal atresia
17
Q
Advice to give pregnants to avoid toxoplasmosis
A
If the female has a cat, avoid any contact with the cat, either the husband takes care of it or leave it someplace else. Advice to wash her hand everyday the cat is in the house.
Avoid raw meat and unpasturised milk
18
Q
How do you measure AFI? And what is the cutoff values?
A
4 quadrant measurement of amnitic fluid, take the deepest pockets and add them together.
< 6 oligo
> 24 poly
19
Q
What NYHA stage is contraindication to get pregnant?
A
Absolute CI: stage 4
Relative CI: stage 3
20
Q
Screening on cardiovascular patient that wants to get pregnant
A
NYHA
21
Q
Hormonal changes in pregnancy
A
- Increased production of TBG
- Increased total T hormone, but T3 and T4 is the same
- Increased BMR
- Increased blood flow to the pituitary
- Increased cortisol, ACTH
- Increased prolactin, hCG and oxytocin
22
Q
What UTIs do you not want in pregnancy?
A
Asymptomatic bacteruria can cause premature labor, PROM and low birth weight. Increased perinatal mortality
23
Q
Why can breech cause dystocia?
A
Breech position can cause complications like:
- Umbilical cord prolapse
- Decreased O2 supply to fetus
- Head entrapment
- Injury to fetal brain and skull
24
Q
What is the connection between intrauterine fetal death and postterm pregnancy?
A
Postterm pregnancy is associated with higher perinatal mortality
25
What are the signs that the placenta has detatched in the 3rd stage of delivery?
- Fresh blood from vagina
- Umbilical cord lengthens outside vagina
- Fundus rises up and uterus becomes firm and globular
26
What is to be said about smoking in pregnancy?
- Dont do it
- Causes hypoxia and vasoconstriction of vessels, can cause IUGR in fetus
27
How to treat 1-2 stage of labor?
- Externally: Leopold manuver
- Internal: CTG, BP, infections
28
Which antihypertensives are contraindicated in pregnancy?
Propanolol, ACEi, ARBs, diuretics
29
Why is cordocentesis done nowadays?
- Percutaneous umbilical blood sampling
- Just done in case you want to give blood transfusions
30
What maternal parameters help to determine potential cephalopelvic disproportion?
Maternal height/size -> short means higher chance of dystocia
But pelvic size and shape is also important
31
What fetal parameters help to determine potential cephalopelvic disproportion?
Biparietal diameter ca 10 cm
Head circumference
32
How to do respiratory resucitation on a newborn?
- Place newborn in warm environment, stimulate breathing by rubbing on chest
- Positive pressure ventilation should be started if the HR is less than 100 after 30 sec and there is no breathing or gasping
- If HR is still low after 60 sec, consider endotracheal intubation
- If HR remais low besides adequate ventilation for 30 sec, start chest compressions (3:1 ratio)
- If HR remains low despite adequate ventilation and chest compressions, give IV epinephrine
33
Common factor and difference between SGA and IUGR?
Both are in the lower 10th percentile of fetus size, but SGA is usually physiological while IUGR is always pathological.
34
Extragenital causes of pathological pueriperium?
- Mastitis
- UTI
- Thromboplebitis
- Atelectasia
35
Which patients can get IVF immediately?
When they have tubal ligation (strictures)
36
What is HEELP syndrome? How much thrombocytopenia do they have?
- Hemolysis, elevated liver enzymes, low platelets
- Missisippi classification of low platelets:
M3: Less than 150 G/L
M2: Less than 100 G/L
M1: Less than 50 G/L
37
Does chomosomal abnormality cause symmetrical or asymmetrical IUGR?
Symmetrical
38
What hormones are responsible for onset of labor?
Cortisol in fetus
39
First stages after conception and how many cells?
Zygote (-1)
Morula (16)
Blastocyst (+32)
40
When can we see thrombocytopenia in pregnancy?
TTP
HUS
HELLP
DIC
41
Differentiation between placental abruption and placenta previa
The emphasis is on the rock hard uterus in abruption, not the pain, because all women will be stressed and pain is not a proper indication.
Abruption: painful, hard uterus
Previa: painless, CTG normal
42
Drugs you can't give during pregnancy
Antiepileptics, ACEi, folic acid inhibitors, coumarin
43
Types of IUGR
Symmetric (fetal causes) and asymmetric (maternal and placental causes)
44
What fetal position enables vaginal delivery of twins?
Only if the first fetus is in the proper position and no breech at all!
45
What are some maternal causes of dystocia?
- Cephalopelvic disproportion; inlet, outlet and midpelvis contraction
- Pelvic shape: gynecoid, android, anthropoid, platypolloid
- Trauma
46
Cause of oligohydramnios
Decreased urine production of the fetus (renal agenesis)
47
Definition of eclampsia
Unexplained generalized seizures in a patient with preeclampsia (>140/90 BP, > 300 mg/day proteinuria)
48
Which classification do you use for pregnant women with cardiovascular disease?
New York Heart association (when do you feel short of breath?)
49
What manuver is used in malpresentation?
Leopold
50
In what stage of labor do the membrane rupture?
Late in the first stage, earliest 1 hour before labor starts.
51
Why is it important to repair the cervix after lesions of birth canal and uterine rupture?
For possible future pregnancies
52
What is important to determine with suspected IUGR?
Make sure you compare to the previous US to see if it might just be wrong estimation of gestational week or actual IUGR.
53
What does a normal CTG look like?
1) Base frequency 110-160
Bradycardia< 110 for more than 3 min
Tachycardia > 160 for more than 10 min
2) Oscilliation/Variability should be > 5 per minute.
If there is a line the baby dies within 24-48 hours.
3) Accelerations are compared to BF. Elevations of 10-30 mm in 10-30 min
4) No deccelerations (asynchronized deccelerations means hypoxia)
54
Drugs used in first and second stage of labor
??
55
Advices during pregnancy.
What advice would you give?
Would you recommend physical exercise during 1st and 2nd trimester?
- Exercise is recommended to continue as usual, rest when tired
- No drugs, smoking, drinking!!
- Folate supplement
- Eat protein, healthy diet, weight can influence birth weight of infant!!
- Avoid cats
- Take into consideration thromboembolic events when flying
- Proper use of seatbelt !!
( FROM YONI)
56
Different types of transverse lie
Left-right
Facing up-down
Backwards-forwards
57
Causes of macrosomia
Maternal diabetes
Maternal obesity
Genetic
Gestational age > 40 w
58
What is the problem of cervical implantation?
Ectopic pregnancy -> high chance of life threatening bleeding
59
What malpresentation requires c-section?
Transverse lie
60
Gestational week of GDM screening
24-28th week
61
Definition of abortion
Induced: Medical or surgical termination of pregnancy before 24th gestational week
Spontaneous: non-induced embryonic or fetal death or passage of products of conception before 24th gestational week
62
Types of placenta previa and complications
Types:
- Total
- Partial
- Marginal
- Low-lying
Complications:
- Fetal malpresentation
- Vasa previa
- PPROM
- IUGR
63
How often does a doctor or a nurse need to check on a woman in the 2nd stage of labor?
Continously
64
Neonatal death from what week?
24th week
65
Perinatal mortality rate
Number of late intrauterine deaths (from w24) + number of neonatal deaths (168h after) per 1000 live births
66
How long does physiological pueripurim period last?
6 weeks
67
What anesthesia do you use in C-section?
Spinal
68
How to diagnose CMV infection?
Amniocentesis and look for viral genome
69
What is the problem with PROM?
- Infections
- Abnormal presentation
- Placental abruption
70
What is the problem with UTI during pregnancy?
Ascending infection can lead to premature birth and PROM
71
What could be the cause of dystocia even though position and presentation is normal?
- Macrosomia
- Shoulder dystocia
- Maternal pelvic alterations
72
What is a worrying sign in prolonged labor?
- If the woman suddenly feels a sense of relief after straining a lot
- If the baby is unable to pass through the birth canal and the uterus ruptures
73
What is a sign of missed abortion?
See retained fetus in uterine cavity during routine prenatal care, absent fetal movements, risk of DIC
74
What do you do in a patient with asymptomatic gallstones?
Wait and do elective cholecystectomy after pregnancy
75
Causes of postpartum hemorrage
- Trauma: laceration
- Tone: atony
- Tissue: placental part left in uterus
- DIC: thrombin
76
Superimposed preeclampsia?
Has chronic HTN before week 20 and gets >300mg/day proteinuria after week 20
77
Consequences of hyperthyroidism in pregnancy
- IUGR
- Mental retardation
- Elevation of BP
- Abruption
78
Physiological changes of thyroid during pregnancy
- Increase in hCG may function as TSH
- Elevation of TBG
- Concentration of free thyroid hormone and TSH stays the same (but total T hormone increases)
79
What is PPROM and what are the causes?
- Preterm premature rupture of the membranes
- Cause: ascending vaginal and cervical infections
80
How would you diagnose interuterine death?
US
81
Which of the breech malpresentations can be delivered vaginally?
Frank breech
82
Who would you screen for DM?
Everyone should be screened w24-w28
83
What are some physiological changes of pregnancy and CV changes?
- Increase of HR, CO
- Increase in plasma volume
- Increase of RBF and GFR, decreased serum creatinine
84
How to diagnose placental abruption/ What examination should you do first?
Physical exam, feel the fetal hypertonic uterus.
85
How to diagnose uterine rupture?
- Loss of fetal station
- Nature of patient complain changes to diffuse abdominal pain in stead of contractions
86
What is difficult with GI disorder in pregnancy?
Pregnancy may imitate symptoms such as leukocytosis and constipation (appendicitis, ileus, gallstone) and nause and vomiting, making them difficult to diagnose.
87
What drugs do you give in preterm labor?
Bethametasone and AB prophylaxis
88
What BP-drugs can you give in pregnancy?
Labetalol
Nifedipine
alpha-methyldopa
89
Treatment of toxoplasmosis
- Affected women during pregnancy: spiramycin
- Infected fetus: pyrimethamine and sulfadiazine
90
How to check if a fetus is infected with toxoplasmosis?
Do amniocentesis and check viral DNA
91
Classification of C-section indications
ELECTIVE INDICATIONS
- Maternal: previous CS, underlying disease
- Fetal: threatened asphyxia
- Maternofetal: dystocia, prolonged labor, twin pregnancy
VITAL INDICATIONS
- Maternal: DIC, severe hemorrage
- Fetal: asphyxia, transverse lie, umbilical cord prolapse
- Maternofetal: eclampsia, uteroplacental insufficiency, placenta previa, placental abruption, uterine rupture
92
How can you get toxoplasma?
Household cats
93
How to differentiate dizygotic from monozygotic twins?
If the twins are of different sex they are for sure dizygotic
94
Why is appendicitis hard to diagnose in pregnancy?
Leukocytosis may occur in pregnancy
95
Cause of post partum hemorrage
Tissue : Retained placenta
Tony: Uterine atony
Trauma: Vaginal laceration, macrosomy
Thrombin: DIC
96
Spontaneous abortion symptoms and diagnosis
Hx: Pain and bleeding
DX: check cervix, US and hCG
97
Contraindication to tocolytics
Obstetric: severe abruption, ruptured membranes, chorioamnionitis
Fetal: lethal anomaly, fetus is dead already, fetal jeaopardy
Maternal: Eclampsia, advanced dilation
98
History taking
Surgical history
Allergy to medications
Obstetric history
Illnesses, drugs
Naegels rule
99
Signs of pregnancy
Presumptive: Chadwick
Probable: home urine pregnancy test, uterine enlargement and breast engorgement
Piskacek: prominence over implantation site
Goodell: softening of cervix
Hegar: softening of cervical isthmus
Positive sign: detection of fetal HR, recognition of fetal movement
100
Vitamin supplements in pregnancy
Preconception: folic acid 400 microgram per day for 6 weeks
2nd trimester: low dose iron and iodine 250 microgram per day
101
When does prenatal care start?
Before conception! Advice etc, change lifestyle
102
Techniques of C-section
Abdominal wall: Transverse (pfannenstiel) and Vertical (midline)
Uterus: Lower segment incision (Transverse), Classical (Vertical)
