OB

Question 1

Heavy blood loss during delivery (hypotension / blood transfusion)
Lactation failure, amenorrhea, weight loss, lethargy, hyponatremia, hypotension

Answer 1

Sheehan syndrome (postpartum pituitary infarction)
-> hypopituitarism (low prolactin, FSH/LH etc)

Question 2

Amniotic fluid embolism
Sx and tx?
Risk factors?

Answer 2

Cardiogenic shock, hypoxemic resp failure, DIC, seizures, coma

Tx: supportive care

Question 3

Woman in labor with active HSV… what to do?

Answer 3

C section!

Question 4

Ultrasound shows thin endometrial stripe

Makes what unlikely?

Answer 4

Suggests empty and normal uterine cavity

Retained placenta unlikely

Question 5

Most common cause of Postpartum hemorrhage

Soft (boggy) and enlarged uterus

Answer 5

Atony

Question 6

First line Treatment for uterine atony

Second line?

Answer 6

Oxytocin and bimanual massage

Second line is methylergonovine, but contraindicated for hypertension
Or carboprost but contraindicated for asthma

Question 7

Antihypertensives in pregnancy

Answer 7

Labetalol, hydralazine, methyldopa, nifedipine

Don’t use ace and arbs
Don’t volume deplete, so don’t use thiazides or loops

Question 8

Oxytocin overdose leads to

Answer 8

Hyponatremia (bc oxytocin similar to ADH)
Hypotension
Tachysystole

Question 9

What is HELLP

Answer 9

Preeclampsia with:
Hemolytic anemia
Elevated Liver enzymes
Low Platelets

Pathogenesis: hepatic and systemic inflammation, activation of coagulation, platelet consumption

Question 10

Treatment of HELLP

Answer 10

If >=34 weeks, OR abnormal fetal testing or severe/worsening maternal status, just DELIVER!

Mg for seizure prophylaxis
Antihypertensive drugs

Question 11

Fetal growth restriction, symmetric vs asymmetric

Answer 11

Early insult -> everything small

Late insult -> asymmetric (“head-sparing” growth lag because head grew first)

Question 12

When to give Rhogam

Answer 12

To D-negative woman with negative antibody screen

Give at 28-32 weeks gestation and again after delivery if baby is Rh+

Question 13

breastfeeding contraindications

Answer 13

active untreated TB
maternal HIV
herpetic breast lesions
active varicella infection
chemo/rad
active substance abuse (including marijuana)

Can still breastfeed with Hep B or C infection! :-O

Question 14

Definition of preeclampsia

Answer 14

New onset HTN (sBP>140 OR dBP>90) at 20 weeks

+ proteinuria (>300mg/24hr, Urine protein/creatinine ratio>0.3, or dipstick>1+)
and/or end-organ damage

Question 15

What is criteria for proteinuria in preeclampsia vs nephrotic syndrome?

Answer 15

preeclampsia >300mg/24hr

nephrotic syndrome >3g/24hr

Question 16

what are the features in “preeclampsia with severe features?”

Answer 16

ANY of:

sBP>160 OR dBP>110 (both 20 higher than HTN cut-off)
thrombocytopenia
increased Cr
increased transaminases
pulmonary edema
visual/cerebral symptoms

Question 17

tx for maternal hypertensive crisis

Answer 17

IV labetalol, IV hydralazine, or PO nifedipine

Note: labetolol is a b blocker, so don’t give if pt is bradycardic

Question 18

most common cause of neonatal sepsis

Answer 18

GBS

Question 19

treatment fof postpartum endometritis

Answer 19

polymicrobial, use clinda + gent

Question 20

treatment of syphilis in penicillin-allergic, pregnant vs. nonpregnant

Answer 20

pregnant: desensitize after skin test (if IgE+), then use penicillin

non-pregnant: can use doxy (can’t use in preg)

Question 21

Postop/postpartum
Persistent fever unresponsive to antibiotics
No uterine tenderness, no lochia

Answer 21

Septic pelvic thrombophlebitis (thrombosis of deep pelvic or ovarian veins)
Tx: anticoagulation and broad-spectrum antibiotics

Not endometritis

Question 22

1st trimester combined test

Answer 22

PAPP-A, nuchal transparency, HCG

Question 23

Quad screen

Answer 23

(At halfway mark)

AFP, estriol, HCG, inhibin A

All low for trisomy 18 (Edwards)
AFP, estriol low, HI (HCG, inhibin) high in Down’s
AFP high in neural tube defects, gastroschisis, omphalocele

Question 24

Umbilical artery Doppler in IUGR

Answer 24

Flow reverses!

Question 25

AFI cutoff for oligohydramnios

Answer 25

5

Question 26

Pre-eclampsia (+severe features)

Answer 26

140/90 + 300mg protein

Severe if:
160/110
Protein  > 5000mg
Headache
Scotomata/blurred vision
Hyperreflexia
RUQ pain, LFT elevation
low PLTs
hemolysis

(HELLP = hemolysis, elevated LFTs, low PLTs)

Question 27

Eclampsia

Answer 27

Pre-eclampsia + SEIZURES

Question 28

Side effects of Mg for seizure prevention in pre-eclampsia

Answer 28

Neuromuscular depression —> respiratory paralysis. Monitor DTRs!

If toxicity, give Ca gluconate