OB 3

Question 1

chronic hypertension

Answer 1

BP >140/90 before the patient became pregnant

Question 2

what rx to treat maternal HTN

Answer 2

methydopa, labetalol, nifedipine

Question 3

gestational HTN

Answer 3

BP >140/90 that starts after 20 weeks gestation; no proteinuria and no edema; only tx patient during pregnancy

Question 4

preeclampsia risk factors

Answer 4

chronic HTN. Renal dz

Question 5

what are some antihypertensives contraindicated in pregnancy

Answer 5

ACE inhibitors and ARBs because they cause fetal malformations

Question 6

presentation of mild preeclampsia

Answer 6

BP >140/90; proteinuria (dipstick = 1-2+; 24 hr urine >300mg); edema of hands, feet, face

Question 7

presentation of severe preeclampsia

Answer 7

BP >160/110; proteinuria (dipstick = 3-4+; 24 hr urine >5 gms); generalized edema, mental status and vision changes, impaired liver fn

Question 8

eclampsia

Answer 8

tonic-clonic seizure in patient with h/o preeclampsia

Question 9

treatment of eclampsia

Answer 9

stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine

Question 10

HELLP syndrome

Answer 10

hemolysis, elevated liver enzymes, low platelets

Question 11

treatment of HELLP

Answer 11

stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine

Question 12

pregestational diabetes

Answer 12

woman had diabetes before becoming pregnant

Question 13

maternal complications of pregestational diabetes

Answer 13

4x more likely to have preeclampsia, 2x more likely to have a spontaneous abortion, increased infxn rate, increased PPH

Question 14

fetal complications of pregestational diabetes

Answer 14

increase in congenital abnormalities, macrosomia, preterm labor

Question 15

evaluation of patient with pregestational diabetes

Answer 15

EKG, 24-hour urine (CrCl, protein), HbA1C, ophtho exam

Question 16

treatment of diabetes during pregnancy; type 1

Answer 16

insulin pump with NPH

Question 17

treatment of diabetes during pregnancy; type 2

Answer 17

subQ insulin with NPH and lispro

Question 18

complications of gestational diabetes

Answer 18

preterm birth, fetal macrosomia, birth injuries, neonatal hypoglycemia, mothers are 4-10x more likely to develop DM2

Question 19

neonatal hypoglycemia

Answer 19

increase in fetal insulin secondary to living in hyperglycemic environment

Question 20

when to screen for gestational diabetes

Answer 20

between 24 and 28 weeks

Question 21

how to screen for gestational diabetes

Answer 21

glucose load test then if positive glucose tolerance test

Question 22

glucose load test

Answer 22

non-fasting ingestion of 50g of glucose, measurement of serum glucose 1 hour later; >140mg/dL is postive

Question 23

glucose tolerance test

Answer 23

fasting ingestion of 100mg of glucose then 3 measurments of serum glucose at 1, 2 and 3 hours. If any are elevated = gestation diabetes

Question 24

first line treatment of gestational diabetes

Answer 24

diabetic diet and exercise (walking)

Question 25

treatment of gestation diabetes is 1st line treament fails

Answer 25

treat with insulin (NPH before bed and Aspart before meals) or metformin and glyburide

Question 26

intrauterine growth restriction (IUGR)

Answer 26

fetuses weigh in bottom 10% for gestational age

Question 27

symmetric IUGR

Answer 27

brain is proportionate with rest of body, occurs before 20 weeks gestation

Question 28

asymmetric IUGR

Answer 28

brain weight is not decreased, abdomen is smaller than head, occurs after 20 weeks gestation

Question 29

etiologies of IUGR

Answer 29

chromosomal abnormalities, neural tube defects, infxn, multiple gestations, maternal htn or renal dz, maternal malnutrition and substance abuse

Question 30

complications of IUGR

Answer 30

premature labor, stillbirth, fetal hypoxia, low IQ, seizures, mental retardation

Question 31

what is the treatment of IUGR

Answer 31

no treatment just prevention -- quit smokig and prevent maternal infxn with immunizations

Question 32

macrosomia

Answer 32

fetuses with an estimated birth weight over 4500g

Question 33

risk factors for macrosomia

Answer 33

maternal diabetes or obesity, advanced maternal age, postterm pregnancy

Question 34

diagnosis of macrosomia

Answer 34

fundal height >3cm greater than gestational age; US to confirm

Question 35

what to look for on US to confirm macrosomia

Answer 35

femur length, abdominal circumference, head diameter

Question 36

complications of macrosomia

Answer 36

shoulder dystocia, birth injuries, low APGAR scores, hypoglycemia

Question 37

what should be done for macrosomic babies?

Answer 37

induction of labor if lungs are mature before the fetus is 4500g; cesarean is indicated if fetus is >4500g

Question 38

nonstress test (NST)

Answer 38

checks for fetal well-being while still in the uterus; measures fetal movements and fetal heart rate

Question 39

reactive NST

Answer 39

detection of two fetal movements, acceleration of fetal HR >15bpm lasting 15-20 seconds over a 20-minute period; fetus is doing well

Question 40

biophysical profile (BPP)

Answer 40

NST, fetal chest expansions, fetal movement, fetal muscle tone, amniotic fluid index; each worth 2 pts, 8-10 is nl, below 4 is abnormal

Question 41

fetal chest expansions

Answer 41

count episodes of fetal chest expansions; normal is 1 or more in 30 minutes

Question 42

fetal movement

Answer 42

count fetal movements; normal is >3 in 30 minutes

Question 43

fetal muscle tone

Answer 43

fetus flexes an extremity

Question 44

amniotic fluid index

Answer 44

volume of amniotic fluid based on sonogram