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OB Gyne > OB 1.1 > Flashcards

OB 1.1 Flashcards

1
Q

Persistent vomiting aggravated by inability to take in food leading to severe dehydration and ketonuria

A

Hyperemesis gravidarum

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2
Q

Disturbances in urination is most prominent during

A

2nd and 3rd months

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3
Q

Easy fatigability in normal pregnancy is due to

A

Increased BMR

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4
Q

First perception by mother of fetal movement

A

Quickening

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5
Q

Quickening: Primigravida

A

18-20 weeks

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6
Q

Quickening: Multigravida

A

16-18 weeks

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7
Q

T/F Quickening increases in intensity and frequency as pregnancy progresses

A

T

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8
Q

Hormone: Stimulate mammary DUCT system

A

Estrogen

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9
Q

Hormone: Stimulate ALVEOLAR components of breast

A

Progesterone

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10
Q

Earliest sign of pregnancy

A

Cessation of menstruation

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11
Q

Highly suspect pregnancy if ___ days have elapsed after expected onset of menses

A

10 or more

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12
Q

Expression of colostrum is appreciated at ___ week

A

16th

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13
Q

T/F There is no relation between pre-pregnant breast size and volume of milk production during lactation

A

T

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14
Q

Hormone: Thermal changes in pregnancy

A

Progesterone

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15
Q

Luteal vs follicular phase: Greater basal body temp

A

Luteal

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16
Q

Temp in luteal phase is ___ degrees higher than in follicular phase

A

0.3-0.5C

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17
Q

Hormone: Skin pigmentation changes

A

Estrogen and progesterone

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18
Q

T/F Skin pigmentation is more prominent in dark-skinned individuals

A

T

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19
Q

T/F Skin pigmentation in pregnancy is intensified by exposure to sunlight

A

T

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20
Q

Reddish, slightly depressed streaks commonly found in abdominal skin that may turn silvery white after delivery

A

Striae gravidarum

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21
Q

Striae gravidarum is due to

A

Separation of underlying collagen tissue

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22
Q

Hormone: Decreased peripheral vascular resistance

A

Estrogen

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23
Q

More rapid growth as uterus rises out of pelvis: Weeks

A

16-22 weeks

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24
Q

Time during which fundic height is equal to gestational age, i.e. x cm = x weeks AOG

A

16-32 weeks

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25
Q

T/F Abdominal enlargement is more pronounced in

multigravida than primigravida

A

T

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26
Q

T/F Uterine growth is limited to anteroposterior

diameter

A

T

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27
Q

Average diameter of uterus at 12 weeks AOG

A

8 cm

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28
Q

Hegar sign is appreciated at ___ weeks

A

6-8

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29
Q

T/F At about 4 weeks AOG external cervical os and cervical canal become patulous (open/distended) to allow insertion of fingertip

A

T

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30
Q

Hormone: Ferning of cervical mucus

A

Estrogen

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31
Q

In non-pregnant women, ferning of cervical mucus is appreciated at days ___ of cycle

A

7-18

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32
Q

In non-pregnant women, beading of cervical mucus is appreciated at day ___ of cycle

A

21

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33
Q

Predominant hormone in pregnancy

A

Progesterone

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34
Q

False labor pain

A

Braxton-Hicks contraction

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35
Q

Intensity of Braxton-Hicks contractions

A

5-25 mmHg

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36
Q

When are Braxton Hicks contractions felt most

A

28 weeks AOG

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37
Q

HCG in pregnancy is produced by

A

Fetal trophoblasts

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38
Q

Function of HCG in pregnancy

A

Maintains the corpus luteum which is the main site of progesterone production in early pregnancy

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39
Q

HCG: Doubling time

A

1.4-2 days

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40
Q

α subunit of HCG is similar to that of (3)

A

1) LH
2) FSH
3) TSH

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41
Q

False positive sandwich type immunoassay pregnancy test is due to

A

Heterophile antibodies

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42
Q

Detection limit of home pregnancy tests

A

12.5 mIU/mL

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43
Q

Normal FHT

A

110-160 bpm

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44
Q

Most accurate method of determining FHT

A

UTZ

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45
Q

Soft, blowing sound synchronous with maternal pulse

A

Uterine souffle

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46
Q

Sharp, whistling sound that is synchronous with fetal pulse

A

Funic souffle or umbilical cord souffle

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47
Q

Uterine souffle: Passage of blood through

A

Uterine vessels

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48
Q

Funic souffle or umbilical cord souffle: Passage of blood through

A

Umbilical arteries

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49
Q

Fetal movement can be perceived by the examiner at what week

A

20th

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50
Q

Week: Gestational sac

A

5

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51
Q

Week: Fetus w/in gestational sac & fetal heart beat detected

A

6

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52
Q

Week: CRL measurement is predictive of

gestational age

A

6-12

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53
Q

Imaginary or spurious pregnancy

A

Pseudocyesis

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54
Q

Pseudocyesis is usually seen in what population

A

Women nearing menopause or with strong desire to become pregnant

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55
Q

Most convincing method for women who have pesudocyesis

A

Ultrasound

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56
Q

T/F Pregnancy test kits are reliable means of identifying fetal death

A

F, trophoblasts continue to produce hcg for several days or weeks after fetal demise

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57
Q

Nonviability of a pregnancy is best confirmed by

A

Ultrasound

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58
Q

Usually the most noticeable symptom in fetal demise

A

Cessation of fetal movement

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59
Q

Overlapping of the fetal skull bones due to liquefaction of the brain

A

Spalding sign

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60
Q

Gas bubbles in the fetus

A

Robert sign

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61
Q

Phases of parturition

A

1) Quiescence
2) Preparation for labor
3) Process of stimulation or labor
4) Parturient recovery

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62
Q

Hormone: Dominant in phase 0 of parturition

A

Progesterone

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63
Q

Gap junction for interaction between uterine smooth muscle cells that is inhibited by progesterone

A

Connexin 43

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64
Q

Hormone: Promotes formation of connexin 43

A

Estrogen

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65
Q

Promoters of myometrial relaxation (7)

A

1) Beta adrenoreceptors
2) LH and HCG
3) Relaxin
4) CRH
5) PTH-rp
6) PGD2, E2, I2
7) ANP and BNP

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66
Q

Hormone: Cevical ripening

A

Relaxin

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67
Q

Hormone: Can induce both uterine relaxation and contraction

A

CRH

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68
Q

Phase 2 of parturition commences at

A

37 weeks AOG

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69
Q

Phase of parturition: Development of uterine sensitivity

A

Phase 2

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70
Q

Phase of parturition: T/F Phase 2 is the phase where most uterotonins are active

A

T

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71
Q

Phase of parturition: Progesterone withdrawal

A

Phase 2

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72
Q

Hormone: Upregulation of oxytocin receptors

A

Estrogen

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73
Q

Sensation that a pregnant woman feels that the baby has descended

A

Lightening

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74
Q

Important events at 37 weeks AOG (3)

A

1) Formation of LUS
2) Cervical softening
3) Lightening

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75
Q

Cervical softening in phase 2 of parturition is due to

A

Breakdown of collagen fibers

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76
Q

Placental source of CRH

A

Cytotrophoblast

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77
Q

Hormone: Goes to pituitary of fetus stimulating release of steroids that will act on lungs to promote pulmonary maturity

A

CRH

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78
Q

Major substrate for estrogen production

A

C19 steroids

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79
Q

Production of CRH from placenta stops when

A

After release of fetus

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80
Q

Hormone: Stimulates membranes to increase prostaglandin

synthesis, which is a potent uterotonin

A

CRH

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81
Q

Hormone: Stimulate fetal adrenals to produce C19 steroids

leading to increased substrate for placental aromatization

A

CRH

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82
Q

Fetal anomalies that may cause delayed parturition

A

1) Hypoestrogenism
2) Anencephaly
3) Adrenal hypoplasia
4) Placental sulfatase deficiency –> decreased CRH

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83
Q

Phase of parturition: Time when most events in labor and delivery happen

A

Phase 3

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84
Q

Most potent uterotonin

A

Oxytocin

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85
Q

3 important points at which oxytocin is increased

A

1) 2nd stage of labor
2) Early postpartum
3) Breastfeeding

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86
Q

Treatment of pregnant women with this agent in any gestation causes labor or abortion

A

PG

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87
Q

Substances that promote uterine contraction (4)

A

1) Platelet-activating factor
2) Endothelin-1
3) AT II
4) CRH, hCG, PTH-rp

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88
Q

Substance released with stripping of membranes

A

PGF-2α

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89
Q

Intrauterine tissue that provides tensile strength and resistance to tearing and rupture

A

Amnion

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90
Q

Intrauterine tissue that provides for immunological acceptance and is enriched with enzymes that inactivate uterotonins

A

Chorion laeve

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91
Q

Intrauterine tissue responsible for generation of uterotonins (paracrine) and responds to inflammatory reaction provoked by vaginal fluids

A

Decidua parietalis

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92
Q

Strict definition of labor

A

Uterine contractions that bring about demonstrable effacement and dilatation of the cervix

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93
Q

3 functional divisions of labor

A

1) Preparatory
2) Dilatational
3) Pelvic

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94
Q

Phase of labor: Latent phase

A

From perception of regular contractions to 3 cm dilation

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95
Q

Prolonged latent phase: Nullipara

A

> or = to 20 hours

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96
Q

Prolonged latent phase: Multipara

A

> or = 14 hours

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97
Q

Phase of labor: Affected by sedation or epidural analgesia

A

Latent phase

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98
Q

Phase of labor: Active phase

A

3 cm dilation to 10 cm dilation

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99
Q

Stages of labor

A

Stage I: Latent phase and active phase
Stage II
Stage III

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100
Q

Stage of labor: Stage II

A

10 cm dilation to delivery of neonate

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101
Q

Stage of labor: Stage III

A

Delivery of neonate to delivery of placenta

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102
Q

Normal duration: Active phase, multipara

A

Less than 4 hours

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103
Q

Normal duration: Active phase,nullipara

A

Less than 5 hours

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104
Q

Normal rate of cervical dilation during active phase: Multipara

A

> or = 1.5cm/hour

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105
Q

Normal rate of cervical dilation during active phase: Nullipara

A

> or = 1.2 cm/hour

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106
Q

Normal duration: Stage II, multipara

A

Less than 30 minutes

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107
Q

Normal duration: Stage II, nullipara

A

Less than 1 hour

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108
Q

Normal duration: Stage III (multipara and nullipara)

A

Less than 30 minutes

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109
Q

cm dilation wherein descent starts in nullipara

A

7-8 cm

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110
Q

True vs false labor: Contractions, regular

A

True

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111
Q

True vs false labor: Contractions, irregular

A

False

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112
Q

True vs false labor: Contractions, gradually shorten in duration

A

True

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113
Q

True vs false labor: Contractions gradually increase in intensity

A

True

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114
Q

True vs false labor: Pain/discomfort confined to lower abdomen

A

False

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115
Q

True vs false labor: Pain/discomfort at the abdomen and back

A

True

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116
Q

True vs false labor: Relieved by sedation

A

False

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117
Q

True vs false labor: Unaffected by sedation

A

True

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118
Q

Definition of “interval” between contraction

A

START of 1 contraction to the START of the next

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119
Q

Area of the abdomen where contraction starts

A

Fundus (not hypogastric)

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120
Q

Recpetors of oxytocin are more concentrated at which area of the uterus

A

Uterotubal junction

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121
Q

T/F Rest is ineffective in relieving true labor

A

T

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122
Q

Early vs late sign: Extrusion of mucus plug from the cervix, resulting in a bloody show

A

Early

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123
Q

Cervical effacement is expressed in terms of

A

Length of cervical canal compared to cervical canal of uneffaced cervix

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124
Q

Length of uneffaced cervix

A

2.5 to 3 cm

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125
Q

Cervical length is measured from

A

Lateral fornix to ectocervix

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126
Q

Normal biparietal diameter

A

9.5 cm, hence cervix should dilate 10 cm

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127
Q

Normal interspinous diameter

A

10 cm

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128
Q

Signals that the mother should START to push. (Do not ask to push before this happens)

A

1) Dilation at 10 cm 2) 2nd stage of labor 3) During contraction

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129
Q

Gestational age is ___ weeks before/after ovulation and fertilization

A

2 weeks before

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130
Q

Gestational age is ___ weeks before/after implantation

A

3 weeks before

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131
Q

Gestational age is aka

A

Menstrual age

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132
Q

Delivery may be more or less ___ weeks from EDD

A

+/- 2 weeks

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133
Q

Weeks from EDD at which pregnancy is considered postterm

A

> 2 weeks

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134
Q

Includes events in development from the time of ovulation (2 weeks after LMP)

A

Ovulation age or postconception age

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135
Q

Trimester: Spontaneous abortions

A

First

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136
Q

Trimester: BP is lower

A

Second

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137
Q

Period of organogenesis

A

Embryonic period

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138
Q

Emryonic period (week)

A

3rd week after ovulation

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139
Q

Event-week: Fetal blood vessels in chorionic villi appear

A

3

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140
Q

Event-week: Chorionic sac is 1 cm in diameter

A

3

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141
Q

Event-week: Chorionic sac is 2-3 cm in diameter

A

4

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142
Q

Event-week: Embryonic disc is formed

A

3

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143
Q

Event-week: Embryo is 4-5 mm in length

A

4

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144
Q

Event-week: Primitive heart

A

4-5

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145
Q

Event-week: Arm and leg buds

A

4-5

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146
Q

Event-week: Fingers and toes

A

6-8

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147
Q

Event-week: Arms bend at elbows

A

6-8

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148
Q

Event-week: Upper lip and external ears visible

A

6-8

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149
Q

Fetal period: AOG

A

10

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150
Q

T/F Fetal length is a more accurate criterion of gestational age than weight

A

T

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151
Q

Fetal weight increases linearly until ___ weeks

A

37

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152
Q

Weight gain of fetus in 3rd trimester

A

30g/day

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153
Q

Event-week: Centers of ossification appear

A

12 [CDB: 16]

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154
Q

Event-week: Gender can be determined by inspection of genitalia

A

14

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155
Q

Event-week: External genitalia – start to show evidence of gender

A

12

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156
Q

Event-week: Spontaneous fetal movements; responds to stimuli

A

12

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157
Q

Event-week: Downy lanugo hair surround skin

A

20

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158
Q

Event-week: Fetal breathing movements become regular

A

20

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159
Q

Event-week: Fat deposition begins

A

24

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160
Q

Event-week: Canalicular period of the lungs

A

24

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161
Q

Event-week: Fetal lung pneumocytes begin production of surfactant

A

24

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162
Q

Fetuses born at this time may survive w/ intensive neonatal care

A

24 weeks AOG

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163
Q

Event-week: Vernix caseosa

A

28

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164
Q

Event-week: Eyes partially open

A

28

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165
Q

Birth at this age: 90% survival w/ no physical or neuro impairment

A

28

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166
Q

Event-week: Testes start to descend

A

32

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167
Q

Sutures that can be palpated in vertex presentation

A

All except temporal

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168
Q

Junction of the lambdoid and temporal structures

A

Temporal/Caesarian fontanel

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169
Q

Occipitofrontal diameter

A

Most prominent part of occipital bone to root of nose

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170
Q

Widest transverse diameter of the fetal head

A

Biparietal diameter

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171
Q

Bitemporal diameter

A

Greatest distance between 2 temporal bones

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172
Q

Occipitomental diameter

A

Chin to most prominent portion of occiput

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173
Q

Suboccipitobregmatic diameter

A

Middle of anterior fontanel to undersurface of bone where it joins the neck

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174
Q

Shortest AP diameter that can pass through during normal cephalic delivery

A

Suboccipitobregmatic

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175
Q

Trachelobregmatic diameter

A

Bregma to undersurface of fetal mentum/mandible

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176
Q

Normal occipitofrontal diameter

A

11.5 cm

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177
Q

Normal bitemporal diameter

A

8 cm

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178
Q

Normal occipitomental diameter

A

12.5 cm

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179
Q

Normal suboccipitobregmatic diameter

A

9.5 cm

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180
Q

Normal trachelobregmatic diameter

A

9.5 cm

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181
Q

Greatest circumference of the head

A

Plane of the occipitofrontal diameter

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182
Q

Smallest circumference of the head

A

Plane of the suboccipitobregmatic diameter

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183
Q

Myelination of ventral roots of the cerebrospinal nerves and brainstem begins at

A

6th month

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184
Q

Major portion of myelination occurs

A

After birth

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185
Q

Fetal circulation

A

IMAGE

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186
Q

Medial vs lateral part of IVC: Well oxygenated blood

A

Medial

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187
Q

Medial vs lateral part of IVC: Less oxygenated blood

A

Lateral

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188
Q

Umbilical veins undergo atrophy and obliteration within ___ days

A

3-4

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189
Q

Ductus venosus constricts by

A

10-96 hours after birth

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190
Q

Ductus venosus anatomically closes at

A

2-3 weeks to become ligamentum venosum

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191
Q

Sites of EPO production in the fetus

A

Liver and kidneys

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192
Q

Hgb from yolk sac

A

Portland, Gower 1, Gower 2

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193
Q

Hgb from fetal liver

A

Hgb F

194
Q

Accounts for higher O2 binding by fetal Hgb

A

Decreased 2,3-DPG binding

195
Q

Hgb that persists in newborns of diabetic mothers

A

Hgb F

196
Q

Transplacental transport of IgG starts at

A

16 weeks

197
Q

Bulk of IgG is acquired by the fetus during

A

Last 4 weeks

198
Q

Adult values of IgG is achieved

A

3 y/o

199
Q

IgM levels are increased in

A

Newborns with congenital infections

200
Q

Ig helpful in preventing newborn diarrhea

A

IgA from colostrum

201
Q

GI peristalsis and glucose transport starts at

A

11 weeks

202
Q

Swallowing starts at

A

16 weeks

203
Q

T/F Swallowed amniotic fluid has little effect on amniotic fluid volume

A

T

204
Q

T/F If baby does not swallow, polyhydramnios may occur

A

T

205
Q

Stimulates pituitary gland to produce arginine vasopressin -> stimulate contraction of the smooth muscles of the colon = meconium passage / intraamniotic defecation

A

Hypoxia

206
Q

T/F Kidneys are not essential for survival in utero

A

T

207
Q

Urine production begins

A

12 weeks

208
Q

Amount of urine produced at term

A

650 mL/day

209
Q

Source of amniotic fluid: Early pregnancy

A

Amniotic membrane

210
Q

Source of amniotic fluid: Midpregnancy

A

Fetal urine

211
Q

Amniotic fluid: Peak volume

A

1L

212
Q

Amniotic fluid: Peak volume is attained at

A

36-38 weeks

213
Q

Amniotic fluid index measurement

A

Uterus is divided into 4 equal quadrants -> AF measured vertically in single deepest pocket of each quadrant -> add 4 values to get AFI

214
Q

AFI in oligohydramnios

A

Less than or equal to 5cm

215
Q

AFI in polyhydramnios

A

> 24cm

216
Q

3 essential stages of lung development

A

1) Pesudoglandular
2) Canalicular
3) Terminal sac

217
Q

Weeks: Pseudoglandular stage

A

5-17 weeks

218
Q

Weeks: Canalicular stage

A

16-25 weeks

219
Q

Weeks: Terminal sac stage

A

Beyond 25 weeks

220
Q

Stage of lung development: Production of surfactant begins

A

Terminal sac stage

221
Q

Stage of lung development: Bronchial cartilage extends peripherally (terminal bronchioles -> respiratory bronchioles -> saccular ducts)

A

Canalicular stage

222
Q

Stage of lung development: Growth of intrasegmental bronchial tree

A

Pseudoglandular stage

223
Q

Pulmonary hypoplasia results from insult before stage ___ of lung development

A

3

224
Q

Lung continues to grow with more alveoli up to ___ years

A

8

225
Q

Natural stimulus for lung maturation and augmented surfactant synthesis

A

Cortisol

226
Q

L/S ratio is 1:1 at

A

34 weeks

227
Q

L/S ratio is 2:1 at

A

36 weeks

228
Q

Test that indirectly measures phosphatidylglycerol

A

Foam shake test

229
Q

Counter used for lamellar body count

A

Coulter counter

230
Q

Lamellar body count that indicates fetal lung maturity

A

> 20,000

231
Q

Major component of surfactant

A

Lipid (90%)

232
Q

Major lipid component of surfactant

A

Phosphatidylcholines (lecithins) (80%)

233
Q

Principal active component of surfactant

A

DPPC

234
Q

Detection of respiratory movements

A

4th month

235
Q

Weight of uterus at term

A

1100g

236
Q

Mechanism by which the biparietal diameter passes through the inlet

A

Engagement

237
Q

At engagement, the lowermost portion of the head is at the level of

A

Ischial spines

238
Q

What station is the level of ischial spines

A

0

239
Q

When does engagement usually occur in nullipara

A

~2 weeks before EDC (Naegele’s rule)

240
Q

When does engagement usually occur in multipara

A

Onset of labor or with amniotomy

241
Q

What does engagement tell about the pelvic inlet

A

Pelvic inlet is adequate

242
Q

Deflection of the sagittal suture anteriorly towards the symphysis pubis or posteriorly toward the promontory

A

Asynclitism

243
Q

Anterior or posterior asynclitism is determined based on

A

The side of the parietal bone that presents to the examining finger (anterior parietal bone presents > anterior asynclitism; posterior parietal bone presents > posterior asynclitism)

244
Q

Significance of asynclitism

A

If severe, it is a common reason for CPD even with a normal-sized pelvis

245
Q

First requisite for the birth of the newborn

A

Descent

246
Q

At which stage of labor does descent occur

A

Stage II

247
Q

Descent is brought about by what forces

A

1) Hydrostatic pressure of amniotic fluid 2) Direct pressure of funds upon the breech with contractions 3) Bearing-down of maternal abdominal muscles 4) Straightening of the fetal back

248
Q

MC position

A

LOT, with fetal back at the left

249
Q

What is determined by LM 3

A

Presentation

250
Q

What is determined by LM 4

A

If engagement has already taken place

251
Q

What is LM 4 if engagement has already taken place

A

Negative (you cannot feel for the cephalic prominence anymore)

252
Q

Presenting landmark/reference point in cephalic/vertex position

A

Posterior fontanel

253
Q

Ideal attitude of the fetal head

A

Flexed

254
Q

Cardinal movement that results from resistance meeting the fetal head from the cervix and pelvic walls or floor

A

Flexion

255
Q

In LOT, what is the presenting diameter

A

Occipitofrontal

256
Q

How many cm is the occipitofrontal diameter

A

11.5

257
Q

In Flexion, what diameter replaces the occipitofrontal diameter so that the head can pass through the interspinous diameter (10 cm)

A

SOB diameter (9.5 cm)

258
Q

Turning of the head in such a way that the occiput gradually moves towards the symphysis pubis anteriorly from its original position or posteriorly (less common) toward hollow of the sacrum

A

Internal rotation (LOT > LOA)

259
Q

Cardinal movement that is essential for completion of labor

A

Internal rotation

260
Q

Cardinal movement wherein the sharply flexed head reaches vulva and follows the J-shaped contour of the vaginal canal in dorsal lithotomy

A

Extension

261
Q

Cardinal movement, the goal of which is to deliver the head out into the vulva

A

Extension

262
Q

2 forces that bring about extension

A

1) Uterus 2) Pelvic floor and symphysis pubis

263
Q

Swelling of baby’s head that can cross suture lines

A

Caput succedaneum

264
Q

Swelling of baby’s head that is confined to suture lines

A

Cephalhematoma

265
Q

How many cm of moulding is allowable

A

1 cm

266
Q

Cardinal movement that brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis

A

Extension

267
Q

Cardinal movement that corresponds to the rotation of the fetal body

A

External rotation

268
Q

Phases of cervical dilation (active phase)

A

1) Acceleration phase (increasing rate) 2) Phase of maximum slope (greatest rate) 3) Deceleration phase (slowing down)

269
Q

The gold standard for documentation of rates of cervical dilation and fetal descent during active labor

A

Friedman curve

270
Q

A composite graphical record of key data (maternal and fetal) during labor entered against time that helps in decision-making during labor

A

Partograph

271
Q

The latent phase of labor (regular uterine contractions to 3 cm) should not be longer than

A

8 hours

272
Q

During the active phase, the rate of cervical dilatation should not be slower than

A

1 cm/hour

273
Q

Phase of cervical dilation that is not always present

A

Acceleration phase

274
Q

Functional divisions of labor

A

1) Preparatory (latent phase) 2) Dilatational (active) 3) Pelvic (deceleration phase of cervical dilation/cardinal movements of labor)

275
Q

Protracted active phase is defined as

A

Less than 1.2 cm/hour in nulli; less than 1.5 cm/hour in multis

276
Q

Prolonged deceleration (stage II) in nullipara

A

3 hours or more if with anesthesia; 2 hours or more if without anesthesia

277
Q

Prolonged deceleration (stage II) in multipara

A

2 hours or more if with anesthesia; 1 hour or more without anesthesia

278
Q

Station: Pelvic inlet

A

-3, -5

279
Q

Station: Ischial spines

A

0

280
Q

Station: Perineum (crowning)

A

+3, +5

281
Q

Arrest in descent, nulli

A

No change in dilatation in an hour

282
Q

Arrest in descent, multi

A

No change in dilatation in 30 minutes

283
Q

Prolonged latent phase, nulli

A

> 20 hours

284
Q

Prolonged latent phase, multi

A

> 14 hours

285
Q

Arrest of dilation

A

No progress for 2 hours

286
Q

Protracted descent, nulli

A

Less than 1 cm/hour

287
Q

Protracted descent, multi

A

Less than 2 cm/hour

288
Q

Shoulder dystocia is disproportion between fetal bisacromial diameter and ___

A

AP diameter of pelvic inlet

289
Q

Indicator of shoulder dystocia described as retraction of feral head against maternal perineum

A

Turtle sign

290
Q

Turtle sign is due to failure of what cardinal movement

A

Internal rotation of bisacromial diameter at midpelvis > impaction of shoulder at sacral promontory

291
Q

MC fractured bone in shoulder dystocia

A

Clavicular fracture (2nd: Humeral fracture)

292
Q

Planned CS may be reasonable for a diabetic woman with EFW ___

A

> 4200-4500g

293
Q

ACOG guideline for application of fundal pressure

A

Don’t apply directly downward; lateral application from either sides of maternal abdomen at an angle towards the feral chest

294
Q

A maneuver that flattens the maternal sacrum hence increases the size of the posterior outlet and may unlock posterior shoulder; increases intraabdominal pressure

A

Mc Robert

295
Q

Progressive rotations of shoulder girdle in a corkscrew fashion by continuous pressure on anterior surface of the posterior shoulder together with downward thrust of the left hand on the buttocks of the baby

A

Woods maneuver

296
Q

Posterior arm delivery; pressure applied on the antecubital fossa in order to flex the fetal forearm and then pull across the chest and face until it is outside the vagina

A

Barum maneuver

297
Q

Pressure is applied to the posterior surface of the most accessible part of fetal shoulder (scapula; either the anterior or posterior shoulder) to effect shoulder abduction

A

Rubin maneuver (opposite Wood’s)

298
Q

Replacement of the head up to station 0 for subsequent abdominal rescue

A

Zavanelli maneuver

299
Q

Placing the patient on all fours

A

Gaskin maneuver

300
Q

During the active phase, the rate of cervical dilatation should not be slower than

A

1 cm/hour

301
Q

Phase of cervical dilation that is not always present

A

Acceleration phase

302
Q

Functional divisions of labor

A

1) Preparatory (latent phase) 2) Dilatational (active) 3) Pelvic (deceleration phase of cervical dilation/cardinal movements of labor)

303
Q

Protracted active phase is defined as

A

Less than 1.2 cm/hour in nulli; less than 1.5 cm/hour in multis

304
Q

Prolonged deceleration (stage II) in nullipara

A

3 hours or more

305
Q

Prolonged deceleration (stage II) in multipara

A

1 hour or more

306
Q

Station: Pelvic inlet

A

-3, -5

307
Q

Station: Ischial spines

A

0

308
Q

Station: Perineum (crowning)

A

+3, +5

309
Q

Arrest in descent, nulli

A

No change in dilatation in an hour

310
Q

Arrest in descent, multi

A

No change in dilatation in 30 minutes

311
Q

Prolonged latent phase, nulli

A

> 20 hours

312
Q

Prolonged latent phase, multi

A

> 14 hours

313
Q

Arrest of dilation

A

No progress for 2 hours

314
Q

Protracted descent, nulli

A

Less than 1 cm/hour

315
Q

Protracted descent, multi

A

Less than 2 cm/hour

316
Q

Shoulder dystocia is disproportion between fetal bisacromial diameter and ___

A

AP diameter of pelvic inlet

317
Q

Indicator of shoulder dystocia described as retraction of feral head against maternal perineum

A

Turtle sign

318
Q

Turtle sign is due to failure of what cardinal movement

A

Internal rotation of bisacromial diameter at midpelvis > impaction of shoulder at sacral promontory

319
Q

MC fractured bone in shoulder dystocia

A

Clavicular fracture (2nd: Humeral fracture)

320
Q

Planned CS may be reasonable for a diabetic woman with EFW ___

A

> 4200-4500g

321
Q

ACOG guideline for application of fundal pressure

A

Don’t apply directly downward; lateral application from either sides of maternal abdomen at an angle towards the feral chest

322
Q

A maneuver that flattens the maternal sacrum hence increases the size of the posterior outlet and may unlock posterior shoulder; increases intraabdominal pressure

A

Mc Robert

323
Q

Progressive rotations of shoulder girdle in a corkscrew fashion by continuous pressure on anterior surface of the posterior shoulder together with downward thrust of the left hand on the buttocks of the baby

A

Woods maneuver

324
Q

Posterior arm delivery; pressure applied on the antecubital fossa in order to flex the fetal forearm and then pull across the chest and face until it is outside the vagina

A

Barum maneuver

325
Q

The pressure is applied to the posterior surface of the most accessible part of fetal shoulder (either the anterior or posterior shoulder) to effect shoulder abduction

A

Rubin maneuver (opposite Wood’s)

326
Q

Replacement of the head up to station 0 for subsequent abdominal rescue

A

Zavanelli maneuver

327
Q

Placing the patient on all fours

A

Gaskin maneuver

328
Q

At station -2, the presenting part is at the level of

A

2 cm above ischial spine

329
Q

First degree laceration

A

Fourchette, perineal skin, vaginal mucosa; PERIURETHRAL

330
Q

At full effacement, cervix is described to be

A

“Paper thin”

331
Q

Absolute indication for CS

A

Contracted pelvis

332
Q

Cutting the cervix to make the opening bigger

A

Duhrseen

333
Q

Shoulder horn instrument w/ concave blade w/ long handle, is slipped b/w symphsis pubis and
impacted anterior shoulder

A

Chavis

334
Q

Pressure applied at infant’s jaw and neck in the

direction of the mom’s rectum, w/ strong fundal pressure applied by an assistant as the anterior shoulder is freed

A

Hibbard

335
Q

Best anaesthesia to alleviate pain during childbirth

A

Epidural anesthesia

336
Q

Incompetent cervix is defined as

A

Cervical dilatation in the absence of uterine contractions

337
Q

Interval and duration of contractions true labor

A

2-3 minutes, 40-60 seconds

338
Q

How often should pelvic exams be done

A

Every 4 hours in latent phase; every 2-3 hours during the active phase

339
Q

Test used to confirm whether bag of water has ruptured

A

Litmus paper test

340
Q

Patient in labor should be placed on NPO for

A

8 hours

341
Q

When to give analgesia in labor

A

Active phase

342
Q

Position and movement during labor

A

Position the patient is most comfortable in EXCEPT in ROM and sedated patients; IDEALLY, dorsal lithotomy (increases diameter of outlet

343
Q

Position if membranes have ruptured and patient is sedated

A

Left lateral decubitus (increases blood flow to fetus)

344
Q

Normal fetal response to movement and contractions

A

HR accelerates

345
Q

Most accurate measure of labor progress

A

Cervical dilation

346
Q

Sign that episiotomy may be done

A

Crowning, 3-4 cm of the head is visible

347
Q

Purpose of episiotomy

A

Prevent tears of perineal muscle

348
Q

What is the ONLY disadvantage of midline episiotomy compared to mediolateral episiotomy

A

Transection of rectum

349
Q

When is mediolateral episiotomy indicated

A

1) Very short perineum 2) Anticipated large baby

350
Q

Heel of clinician’s hand that is draped with a sterile towel is placed over posterior perineum overlying fetal chin

A

Modified Ritgen maneuver

351
Q

When to start Modified Ritgen maneuver

A

Vulvar ring is at 5 cm

352
Q

Purpose of Modified Ritgen maneuver

A

Allows control of delivery of fetal head so that the smallest diameter passes through introitus

353
Q

Where to place clamp during cord clamping

A

2-5 cm from baby’s umbilicus

354
Q

Earliest sign of placental separation

A

Change in uterine shape from discoid to globular (CALKIN SIGN)

355
Q

Signs of placental separation

A

1) Calkin sign 2) Gush of blood from vagina 3) Lengthening of the cord 4) Rise of uterus in abdomen as placenta descends to LUS or vagina

356
Q

A pathologic constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with absence of progress in labor with very good uterine contractions

A

Pathologic ring of Bandl

357
Q

First degree laceration

A

Fourchette, perineal skin, vaginal mucosa (sparing underlying fascia and muscle)

358
Q

Second degree laceration

A

Up to fascia and muscles of perineal body

359
Q

Third degree laceration

A

Up to anal sphincter

360
Q

Fourth degree laceration

A

Up to rectal mucosa

361
Q

If you are dealing with 4th degree lacerations, which mucosa should you repair first

A

Rectal mucosa FIRST before the vaginal mucosa

362
Q

CI from giving ergot alkaloids (methylergonovine malate)

A

Hypertension

363
Q

The Nitabuch’s layer separates the cotyledons from the

A

Decidua basalis

364
Q

Mean blood loss with vaginal delivery

A

500 mL

365
Q

Mean blood loss with CS

A

1000 mL

366
Q

Total blood loss in vaginal delivery that is considered hemorrhage

A

1000 mL

367
Q

Total blood loss in CS that is considered hemorrhage

A

1500 mL

368
Q

% blood loss in class 1 hemorrhage

A

15

369
Q

% blood loss in class 2 hemorrhage

A

20-25

370
Q

% blood loss in class 3 hemorrhage

A

30-35

371
Q

% blood loss in class 4 hemorrhage

A

40

372
Q

Prenatal risk factors for hemorrhage

A

1) Pre-eclampsia 2) Previous PPH 3) Multiple gestation 4) Previous CS 5) Multiparity

373
Q

Intrapartum risk factors for hemorrhage

A

1) Prolonged 3rd stage 2) Episiotomy, midline or mediolateral 3) Arrest of descent 4) Lacerations 5) Augmented labor 6) Forceps delivery

374
Q

4 T’s of postpartum hemorrhage

A

1) Tone 2) Tissue 3) Trauma 4) Thrombin

375
Q

PPH: Frank bleeding, blood loss proportionate with maternal VS, contracted uterus

A

Birth canal injuries

376
Q

MC risk factor for birth canal injuries

A

History of delivery of big babies

377
Q

Management for birth canal injuries

A

1) Suture if >2 cm laceration, 1st stitch 1 cm above apex of tear 2) Antimicrobials 3) Crystalloids while waiting for BT

378
Q

In complete uterine rupture, which layers of the uterine wall are separated

A

All

379
Q

In incomplete uterine rupture, which layers of the uterine wall are separated

A

Uterine muscle separated; visceral peritoneum intact (uterine dehiscence)

380
Q

MCC of uterine rupture

A

Previous classical CS scar (located at active segment)

381
Q

By ___, you expect most organs have returned to their normal non-pregnant condition

A

6 weeks

382
Q

MC location of myoma

A

Body of uterus

383
Q

Cerclage in women with weak cervix has to be removed at ___ weeks AOG to prevent the risk of uterine rupture during childbirth

A

36 weeks

384
Q

A pathologic constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with obstructed labor

A

Pathologic ring of Bandl

385
Q

Postpartum bleeding presenting as amount of bleeding disproportionate to maternal vital signs

A

Uterine rupture

386
Q

Management for uterine rupture

A

Laparotomy

387
Q

Management of choice for uncontrolled uterine bleeding from rupture

A

Hysterectomy

388
Q

Placental separation wherein blood escapes into the vagina due to separation from the periphery

A

Duncan

389
Q

Placental separation wherein blood is concealed behind the placenta due to separation from the center

A

Schultze

390
Q

In placenta accreta, abnormal attachment of the villi (trophoblasts) to the myometrium is due to the absence of

A

Nitabuch’s layer

391
Q

The Nitabuch’s layer separates the cotyledons from the

A

Decidua basalis

392
Q

MC risk factor for placenta accreta

A

Previous CS

393
Q

Preferred diagnostic modality for placenta accreta

A

Ultrasound with Doppler

394
Q

UTZ criteria that is diagnostic for placenta accreta

A

Intraplacental lacunae

395
Q

Management for placenta accreta

A

Cut umbilical cord, leave placenta to necrose, MTX + folinic acid

396
Q

MCC of postpartum hemorrhage

A

Hematomas secondary to inadequate repair of an episiotomy or vaginal laceration

397
Q

1st manifestation of bleeding in hematomas secondary to inadequate repair of an episiotomy or vaginal laceration

A

Pallor

398
Q

Complete uterine inversion

A

Uterus extends beyond cervix

399
Q

Incomplete uterine inversion

A

Does not extend beyond cervix

400
Q

Prolapsed uterus

A

Corpus is out of introitus

401
Q

Uterine atony is failure of the uterus to contract within ___ after delivery

A

1 hour

402
Q

Uterine atony can take place within ___ after placental delivery

A

6 weeks

403
Q

MCC of obstetrical haemorrhage and bleeding in the 4th stage

A

Uterine atony

404
Q

4th stage of labor

A

1-2 hours after placental delivery

405
Q

MCC of late obstetrical hemorrhage

A

Retained placental fragments

406
Q

Conservative management of uterine atony

A

1) Bimanual compression 2) Oxytocin 3) Ergot alakloids 4) PGF2

407
Q

Surgical management of uterine atony

A

1) Uterine artery ligation (90% of uterine blood flow) 2) Hypogastric/Internal iliac artery ligation (external iliac pulsation must be present after ligation) 3) B-lynch compression sutures (previous CS and LTCS) 4) TAH

408
Q

Puerperium

A

Delivery of placenta until 6 weeks postpartum

409
Q

Non-pregnant weight is normally attained at

A

6 months postpartum

410
Q

Time when most physiologic changes during pregnancy return to prepregnancy state

A

Puerperium

411
Q

Mechanism of uterine involution

A

Atrophy

412
Q

T/F Oxytoxic agents hasten uterine involution

A

F

413
Q

T/F Uterine involusion is faster in nulliparas than multiparas

A

T

414
Q

At ___ uterus is in pelvic cavity

A

10th – 12th postpartum day

415
Q

Weight of uterus after delivery

A

1000g

416
Q

Weight of uterus 1 week postpartum

A

500g

417
Q

Weight of uterus 2 weeks postpartum

A

300g

418
Q

Weight of uterus at the end of puerperium

A

70g

419
Q

Weight of non pregnant uterus

A

100g or less

420
Q

Prolonged lochial discharge is a sign of

A

Uterine subinvolution

421
Q

Placental site at the end of 2nd week postpartum

A

3-4 cm diameter

422
Q

Regeneration of the stroma and endometrial glands over the placental site

A

7th day postpartum

423
Q

Regeneration of the stroma and endometrial glands over the placental site begins at what area

A

Desidua basalis/periphery

424
Q

Restoration of entire endometrium postpartum completes at

A

3rd week

425
Q

T/F Inflammatory changes within 6 weeks postpartum reflect infection

A

F, histological endometritis and acute salpingitis are part of the normal reparative process

426
Q

Vascularity of cervix are located at

A

12, 3, 6, and 9

427
Q

Small elevations of the mucous membrane encircling the vaginal orifice after vaginal delivery

A

Myrtiform caruncles

428
Q

At which week are fully healed lacerations and episiotomy and return of fallopian tubes and ovaries to the pelvis expected

A

1-2 weeks

429
Q

Collecting duct system which is dilated during pregnancy returns to prepregnant measurement at ___ week postpartum

A

6th

430
Q

Lochia rubra lasts for

A

3-4 days postpartum

431
Q

Lochia serosa lasts for

A

6-9 days postaprtum

432
Q

Lochia alba is seen during

A

After 10 days postpartum

433
Q

Refers to intermittent, crampy lower abdominal pain that is experienced by some after delivery

A

After pain

434
Q

Duration and intensity of after pain are increased with

A

1) Parity 2) Breastfeeding

435
Q

Return of non-pregnant blood volume

A

1 week postpartum

436
Q

CO returns to normal at

A

2 weeks postapartum

437
Q

Non-pregnant weight is normally attained at

A

6 months postpartum

438
Q

Return of menses postpartum is delayed with lactation because

A

Prolactin inhibits GnRH

439
Q

Return of menstruation in non-lactating

A

7-8 weeks

440
Q

Puerperal infection is defined as

A

38C or higher, 2nd-10th day postpartum (exclusive of the first 24 hours)

441
Q

MCC of puerperal fever

A

Endometritis

442
Q

Early-onset postpartum infection occurs within

A

48 hours

443
Q

Late-onset postpartum infection occurs

A

After 48 hours up to 6 weeks postpartum

444
Q

Single most significant risk factor for the development of uterine infection

A

Route of delivery

445
Q

Most important criterion for diagnosis of postpartum metritis

A

Fever

446
Q

Chills in puerperal infection suggests

A

Bacteremia

447
Q

When to do antepartum fetal surveillance

A

28-32 weeks until 42 weeks

448
Q

Fetal viability begins at

A

28 weeks

449
Q

What patients will benefit from antepartum fetal surveillance

A

Those at risk for perinatal morbidity and/or mortality

450
Q

T/F Do antepartum fetal surveillance in the presence of fetal abnormalities that are incompatible with life

A

F

451
Q

Usual frequency of antepartum fetal surveillance

A

Once to 2x a week

452
Q

Antepartum fetal surveillance techniques

A

1) Fetal movement counting 2) Non-stress test 3) Contraction stress test 4) Biophysical profile 5) Fetal umbilical artery velocimetry

453
Q

Simplest and least expensive antepartum fetal surveillance

A

Fetal movement counting

454
Q

When to do fetal movement counting

A

2nd half of pregnancy

455
Q

Maximum period of awake stage when the baby makes a lot of movement

A

11pm-4am

456
Q

Number of fetal movements that indicate a well baby in utero

A

10/hour

457
Q

Maximal fetal activity when amniotic fluid volume is greater than the fetus

A

28-32 weeks

458
Q

T/F Sleep cycle of a fetus becomes longer as the baby matures

A

T

459
Q

Normal response of fetus to hypoxia

A

Reduction/cessation of movements to reduce O2 consumption and conserve energy

460
Q

In stillbirth, fetal movement stops ___ hours before death

A

12-24

461
Q

What is assessed in a non-stress test

A

FHR response to movement

462
Q

Normal response in a non-stress test

A

FHR will temporarily accelerate/increase in response to the

fetal movement

463
Q

Parameters measured in NST

A

1) Baseline FHR (110-160) 2) FHR variability (6-25/min) 3) Accelerations (normal response) 4) Decelerations (sign of fetal hypoxia)

464
Q

Causes of non-reactive NST

A

1) Prematurity 2) Fetal sleep cycle 3) Tramadol

465
Q

One dark line to another in an NST strip

A

1 minute

466
Q

Each small box horizontally in an NST strip corresponds to

A

10 seconds

467
Q

Define an acceleration in an NST

A

Increase in FHR of at least 15 beats lasting for at least 15 seconds

468
Q

Reactive NST

A

2 or more FHR accelerations that peak at least 15 bpm above the baseline lasting for 15 seconds within a 20-minute period

469
Q

Non-reactive NST

A

Does not meet the criteria over a period of 40 minutes

470
Q

T/F A contraction stress test may be done in a preterm baby

A

F, may induce preterm labor

471
Q

Intensity of contractions: 30-40 mmHg

A

Mild

472
Q

Intensity of contractions: 40-60 mmHg

A

Moderate

473
Q

Intensity of contractions: 60-80 mmHg

A

Strong

474
Q

Intrauterine resuscitative measures

A

1) Maternal O2 in left lateral recumbent position (4-5 L) 2) Change oxytocics to plain IV, preferably D5 glucose for the brain of the fetus

475
Q

Interpretation of NST: No late or significant variable deceleration

A

Negative; Assured that baby is okay

476
Q

Interpretation of NST: Late decelerations following 50% or more of contractions

A

Positive; Non-reassuring FHR pattern

477
Q

Interpretation of NST: Intermittent late decelerations

A

Suspicious

478
Q

Non-invasive mode of antepartum fetal surveillance that predicts the presence or absence of fetal asphyxia and predicts risk of fetal death in the antenatal period

A

BPS

479
Q

Redistribution of blood in a fetus will favour which organs

A

1) Brain 2) Heart 3) Adrenals

480
Q

5 parameters of BPS

A

[NR Ba Talaga Ako]

NST + 4 variables observed by ultrasound 1) fetal bReathing 2) fetal Body movements 3) fetal Tone 4) AFV

481
Q

BPS parameters of acute hypoxia

A

NST + RBT

482
Q

BPS parameters of chronic hypoxia

A

AFV

OB Gyne (7 decks)

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