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ob > OB > Flashcards

OB Flashcards

1
Q

Amnisure

A

identify placental α-microglobulin-1 via immunoassay

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2
Q

active labor cm?

A

6 cm

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3
Q

indication operative vaginal delivery

A

prolonged second stage,

maternal exhaustion, or the need to hasten delivery

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4
Q

Scalp is visible at the introitus without separating the labia
Fetal skull has reached pelvic floor
Sagittal suture is in anteroposterior diameter or right or left
occiput anterior or posterior position
Fetal head is at or on perineum
Rotation does not exceed 45 degrees

A

Outlet forceps

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5
Q

Leading point of fetal skull is at station 2 or greater, but not
on the pelvic floor
Rotation <45 degrees (left or right occiput anterior to occiput
anterior, or left or right occiput posterior to occiput
posterior)
Rotation >45 degrees

A

Low forceps

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6
Q

Station above +2 cm but head engaged

A

Midforceps

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7
Q

conditions necessary for safe application of forceps

A

full dilation of the cervix, ruptured membranes, engaged head and at least +2 station, absolute knowledge of fetal position, no evidence of CPD, adequate anesthesia, empty bladder, and—most important—an experienced operator.

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8
Q

Complications from forceps application

A

bruising on the face and
head, lacerations to the fetal head, cervix, vagina, and perineum, facial nerve
palsy, and, rarely, skull fracture and/or intracranial damage.

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9
Q

most common complications of use of the vacuum

A

scalp laceration and cephalohematoma.

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10
Q

rupture of the prior uterine scar percent

A

0.5% to 1.0%

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11
Q

Increased Success of TOLAC

A

Prior vaginal birth, Prior VBAC, Nonrecurring indication
for prior C/S (herpes,
previa, breech), Presentation in labor at:
>3 cm dilated, >75% effaced

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12
Q

Risk of Uterine Rupture

A

More than one prior cesarean delivery, Prior classical cesarean, Induction of labor
Use of prostaglandins
Use of high amounts of oxytocin, Time from last cesarean <18 mo

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13
Q

complication of both forms of anesthesia

A

maternal hypotension secondary
to decreased systemic vascular resistance, which can lead to decreased
placental perfusion and fetal bradycardia.

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14
Q

Circumvallate

placenta

A

Occurs when the membranes double back over the edge of the placenta, forming a dense ring around the periphery of the placenta.
Often considered a variant of placental abruption, it is a major cause of second-trimester hemorrhage

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15
Q

Succenturiate

placenta

A

An extra lobe of the placenta that is implanted at some distance away
from the rest of the placenta
Fetal vessels may course between the two lobes, possibly over the
cervix, leaving these blood vessels unprotected and at risk for rupture

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16
Q

percent placenta previa

A

20%

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17
Q

Predisposing Factors for Placenta Previa

A 
Prior cesarean section and uterine surgery (e.g., myomectomy)
Multiparity
Multiple gestation
Erythroblastosis
Smoking
History of placenta previa
Increasing maternal age
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18
Q

Findings on ultrasound suggestive of a placenta accreta

A

irregular
shaped placental lacunae, thinning of the myometrium over the placenta, loss
of the retroplacental space, protrusion of the placenta into the bladder,
increased vascularity of the uterine serosa–bladder interface, and turbulent
blood flow through the lacunae on ultrasound.

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19
Q

percent of abruptions occur
before labor and after 30 weeks of gestation/ occur during labor/ identified only on placental inspection after delivery

A

50%/15%/30%

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20
Q

Predisposing factors abruptio

A 
Hypertension
Previous placental abruption
Advanced maternal age
Multiparity
Uterine distension
Multiple pregnancy
Polyhydramnios
Vascular deficiency
Diabetes mellitus
Collagen vascular disease
Cocaine use
Methamphetamine use
Cigarette smoking
Alcohol use (>14 drinks/wk)
Circumvallate placenta
Short umbilical cord
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21
Q

Precipitating factors abruptio

A 
Trauma
External/internal version
Motor vehicle accident
Abdominal trauma
Sudden uterine volume loss
Delivery of first twin
Rupture of membranes with polyhydramnios
PPROM
PPROM, preterm premature rupture of membrane
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22
Q

risk of abruption in future pregnancy %?

A

10% after one abruption

and 25% after two prior abruptions

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23
Q

Presentation of Abruptio Placentae

A

Vaginal bleeding 80%
Uterine tenderness/abdominal or back pain 67
Abnormal contractions/increased uterine tone 34
Fetal distress 50
Fetal demise 15

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24
Q

Risk Factors for Uterine Rupture

A 
Prior uterine surgery/uterine scar
Injudicious use of oxytocin
Grand multiparity
Marked uterine distension
Abnormal fetal lie
Large fetus
External version
Trauma
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25
Q

Risk factors for fetal vessel rupture

A

abnormal placentation leading to
a succenturiate lobe as well as multiple gestations that increase the risk of
velamentous insertion

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26
Q

Apt test

A

examination of the blood for nucleated (fetal) RBCs. If the resulting mixture is pink, it indicates fetal
blood; a yellow-brown color is seen with maternal blood

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27
Q

RACE of infants were 50% more

likely to be born preterm compared with their Caucasian counterparts

A

African american

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28
Q

risk factors have been associated with PTL

A

(ROM);
chorioamnionitis; multiple gestations; uterine anomalies, such as a bicornuate
uterus; previous preterm delivery; maternal prepregnancy weight less than 50
kg; placental abruption; maternal disease, including preeclampsia, infections,
intra-abdominal disease or surgery; substance abuse; and low socioeconomic
status.

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29
Q

principal goal of tocolytic therapy

A

delay delivery by at least 48

hours.

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30
Q

principle that a dehydrated patient has

increased levels of this hormone? action on contraction?

A

ADH. ADH differs from oxytocin by only one amino acid, it may bind with
oxytocin receptors and lead to contractions

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31
Q

tocolytic contraindicated in women with
preload-dependent cardiac lesions and hypotension and should be used with
caution in women with left ventricular dysfunction.

A

Nifedipine

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32
Q

nifedipine and magnesium sulfate

A

potential synergistic effect that results in respiratory depression.

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33
Q

Maternal contraindications to

indomethacin

A

platelet dysfunction, hepatic dysfunction,

gastrointestinal ulcerative disease, renal dysfunction, and asthma

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34
Q

magnesium sulfate administration

A

loaded as a 6-g bolus over 20
minutes, and then maintained at a 2 g/hour continuous infusion. A slower
infusion should be used in the case of renal insufficiency because magnesium
is cleared via the kidneys.
β-Mimetics

35
Q

black box warning to the use of terbutaline IV beyond 24 to 48 hrs

A

cause maternal death and cardiac
events, including tachycardia, transient hyperglycemia, hypokalemia, cardiac
arrhythmias, pulmonary edema, and myocardial ischemia,

36
Q

tampon test

A

amniocentesis dye test can be performed by injecting
a dye via amniocentesis and observing whether or not the dye leaks into the
vagina

37
Q

PPROM <34 weeks, use of antibiotics

A

leads to a longer latency period before the

onset of labor

38
Q

Factors

associated with breech presentation

A

previous breech delivery, uterine
anomalies, polyhydramnios, oligohydramnios, multiple gestation, PPROM,
hydrocephaly, and anencephaly.

39
Q

Complications of breech

deliveries

A

cord prolapse, entrapment of the fetal head, and fetal

neurologic injury.

40
Q

criteria trial of labor of breech presentation

A 
favorable pelvis (by clinical examination, pelvic
radiograph, MRI, or CT pelvimetry), a flexed head, estimated fetal weight
between 2,000 and 3,800 g, and frank or complete breech
41
Q

only face presentation that will allow for a vaginal

delivery.

A

mentum anterior

42
Q

common complication of compound

presentation

A

umbilical cord prolapse

43
Q

cardinal movement of internal rotation usually converts the fetus to the ____ position

A

OA

44
Q

persistent OT position leading to arrest of labor is more common in
women with a ___ pelvis

A

platypelloid

45
Q

Risk factors for

shoulder dystocia

A 
fetal macrosomia (weight greater than 4,000 g),
preconceptional and gestational diabetes, previous shoulder dystocia,
maternal obesity, postterm pregnancy, prolonged second stage of labor, and
operative vaginal delivery.
46
Q

elective cesarean delivery fetal wt

A

fetus is suspected to weigh greater than 5,000 g in women without diabetes
and greater than 4,500 g in women with diabetes

47
Q

% of patients with preeclampsia

with severe features develop HELLP syndrome.

A

10%

48
Q

any patient who presents with RUQ pain,

epigastric pain, or nausea and vomiting in the third trimester

A

R/O HELLP syndrome

49
Q

smoking appears to be associated with an increased or decreased risk of preeclampsia?

A

decreased

50
Q

preeclampsia has an alloimmunogenic pathophysiology

A

A tolerance effect is seen in
women who cohabitate with the father of the baby longer than 1 year prior to
conceiving in comparison to women who conceive sooner.

51
Q

DX HELLP syndrome

A

Hemolytic anemia
Schistocytes on peripheral blood smear
Elevated lactate dehydrogenase
Elevated total bilirubin

Elevated liver enzymes
Increase in aspartate aminotransferase
Increase in alanine aminotransferase

Low platelets
Thrombocytopenia

52
Q

AFLP

A

exhibit evidence of liver failure, including an elevated

ammonia level, blood glucose less than 50 mg/dL, and markedly reduced fibrinogen and antithrombin III levels.

53
Q

recurrence rate in subsequent pregnancies pre eclampsia

A

25- 33%

54
Q

both chronic hypertension and preeclampsia, the risk of recurrence

A

70%

55
Q

eclampsia

A

breakdown in the autoregulatory
system of cerebral circulation due to hyperperfusion, endothelial dysfunction,
and brain edema.

56
Q

MgSO4 use for eclampsia

A

decrease hyperreflexia and

prevent further seizures by raising the seizure threshold

57
Q

eclampsia overdose

A

10 mL 10% calcium chloride or calcium gluconate should be

rapidly administered intravenously for cardiac protection

58
Q

mgso4 levels response

A 
4.8–8.4 Therapeutic seizure prophylaxis
8 CNS depression
10 Loss of deep tendon reflexes
15 Respiratory depression/paralysis
17 Coma
20–25 Cardiac arrest
59
Q

differentiate preeclampsia from exacerbation of

hypertension in patient with renal disease

A

elevated uric acid above 6.0 to 6.5

60
Q

calories per day is recommended for all patients with diabetes during pregnancy

A

2200

61
Q

g of carbohydrates per day

A

200 to 220 g

62
Q

target range values control gdm

A

(fasting values <90 mg/dL and 1-hour postprandial

values <140 mg/dL or 2-hour postprandial values <120 mg/dL),

63
Q

fetal monitoring gdm

A

(NST) or modified biophysical
profile (BPP) is typically begun between 32 and 36 weeks of gestation and
continued until delivery on a weekly or biweekly basis.

estimated fetal weight (EFW) between 34 and 37 weeks

64
Q 
Scheduled delivery (typically via induction of labor) at \_\_\_\_ wks of
gestation is common in patients on insulin or a hypoglycemic agent
A

39 weeks

65
Q

% will experience GDM in subsequent

pregnancies,

A

50%

66
Q

% will go on to develop overt diabetes within 5 years.

A

25% to 35%

67
Q

Obstetric complications pregestational dm

A 
Polyhydramnios
Preeclampsia
Miscarriage
Infection
Postpartum hemorrhage
Increased cesarean section
68
Q

HgbA1c greater than or equal to 12% are estimated to have a__% rate of congenital
anomalies.

A

25%

69
Q

effects of progesterone in GUT pregnancy

A

smooth muscle relaxation
effects of progesterone decrease bladder tone and cause ureteral and renal
pelvis dilation, as well as decrease ureteral peristalsis.

70
Q

gold standard for diagnosing a UTI

A

quantitative culture

containing at least 100,000 CFU/mL.

71
Q

routine urine culture is used to screen for ASB between____weeks of gestation.

A

12 and 16

72
Q

prophylaxis for 2 or more uti pregnancy

A

nitrofurantoin or

trimethoprim/sulfamethoxazole

73
Q

DX Chorioamnioniitis

A

fever ≥39°C or 102.2°F based on oral maternal
temperature with another clinical sign, including elevated maternal WBC count (>15,000/mL), purulent fluid from cervical os or fetal tachycardia
(>160 beats per minute), or evidence from an amniocentesis that is consistent
with microbial invasion

74
Q

gold standard for diagnosis

of chorioamnionitis

A

culture of the amniotic fluid

75
Q

causative organisms chorio

A

polymicrobial

76
Q

infection develops during the first 12 weeks of

gestation, the risk of hydrops is

A

5% to 10%

77
Q

detect evolving fetal anemia

A

Doppler velocimetry to

examine the peak systolic velocity of the middle cerebral artery (MCA).

78
Q

is the most

common severe sequela of secondary infection CMV

A

Congenital hearing loss

79
Q

diagnosis of maternal rubella infection

A

serology studies

80
Q

if woman is within the window of seroconversion and has a suspected acute
HIV infection, what test to do?

A

plasma HIV PCR

81
Q

Tx babies born to hiv mothers

A

within 12 hours should receive a course of

ZDV therapy, which should be continued for 4 to 6 weeks

82
Q

tx diff stages syphilis

A

primary syphilis, one dose of 2.4 million units benzathine penicillin G

secondary or latent syphilis, the patient will require weekly treatments of 2.4
million units of benzathine penicillin G for 3 consecutive weeks

neurosyphilis should be treated with high
doses of aqueous penicillin G.

83
Q

estrogen in seizures

A

increase the function of the P450 enzymes, which leads to more rapid hepatic metabolism of AEDs

84
Q

best predictor of seizure frequency in pregnancy

A

appears to

be the amount of seizures in the year prior to pregnancy

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