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Major Clinical Sciences (Big 4) > OB > Flashcards

OB Flashcards

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1
Q

ENUMERATE:

Essential prenatal labs

A 
CBC w/ PC
BT w/ RH
Urine CS
RPR/VDRL
ICC ELISA
HBsAg
Rubella IgG
75g OGTT
BPP/Biometry
Pap Smear
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2
Q

ENUMERATE:

High Risk Pregnancies

A 
Age < 17
Primigravid > 35 
Multiple Gestation
Poor Obstetric History
Maternal Medical Conditions
Psychiatric Conditions
Reproductive Tract Problems
Malignancy
Trophoblastic Disease
Unsure Fetal Size and Aging
Placenta Abruptio/Previa
Polyhydramnios/Oligohydramnios
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3
Q

Identify the required intake of the ff:

Protein
Folic Acid
Calcium Carbonate
Iron

A
  1. Protein
    5-6 g/day
  2. Folic Acid
    No NTD: 400 mcg/day
    w/ NTD: 4 g/day
  3. Calcium carbonate
    1000 mg/day
  4. Iron
    27 mg/day
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4
Q

ENUMERATE:

Indications for Operative Vaginal Delivery

A

Fetal Indications:

  1. Non-reassuring fetal status
  2. Premature placental separation

Maternal indications:

  1. Exhaustion
  2. Prolonged 2nd stage of labor
  3. Heart Disease
  4. Pulmonary Compromise
  5. Neurologic Conditions
  6. Infections
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5
Q

ENUMERATE:

Prerequisites for Forceps Delivery

A 
F - fully dilated 
O - occiput anterior 
R - ruptured BOW
C - cephalopelvic disproportion ruled out 
E - engaged
P - position known 
S - skilled operator
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6
Q

ENUMERATE:

Complications of Forceps Delivery

A

Cervical/vaginal lacerations
Pelvic floor disorders
Caput succedaneum
Cephalhematoma

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7
Q

ENUMERATE:

Factors that increase failure rate in Forceps Delivery

A

Absence of anesthesia
Persistent occiput posterior
Weight > 4000 g

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8
Q

ENUMERATE:

Types of multiple fetal gestation, with their respective times of separation

A
  1. Dichorionic, diamniotic: 0-3 days
  2. Monochorionic, diamniotic: 4-8 days
  3. Monochorionic, monoamniotic: 8-12 days
  4. Conjoined twins: >13 days
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9
Q

ENUMERATE:

Types of Breech Presentation

A
  1. Complete
  2. Incomplete
  3. Frank
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10
Q

ENUMERATE:

Risk factors for Breech Presentation

A 
Maternal: 
Uterine anomalies
Lax abdominal walls 
Pelvic tumors
Contracted pelvis
Abnormal placentation
Hydramnios (poly, oligo) 
Fetal: 
Fetal anomalies
Multiple fetal gestation
Fetal neurologic conditions
Short umbilical cord
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11
Q

ENUMERATE:

Types of forceps

A

Simpson
Tucker McLane
Kielland
Piper

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12
Q

DESCRIBE:

Mariceau maneuver

A
  • fetal body on examiner’s hand and forearm
  • index and middle finger flexing head down on chin
  • other hand supporting shoulders
  • gentle suprapubic pressure by assistant to keep head flexed
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13
Q

OUTLINE:

Diagnostic Criteria for Pre-eclampsia

A

BP > 140/90, on at least 2 measurements, 4 hours apart, at or beyond 20 wks AoG, with previously normotensive woman
BP > 160/110

+

Proteinuria
300 mg in 24 hour urine collection
Protein/creatinine ratio > 0.3
+1 on dipstick

OR

Thrombocytopenia
Renal insufficiency
Liver dysfunction 
Pulmonary edema 
Cerebral or visual symptoms
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14
Q

ENUMERATE:

Severe features of pre-eclampsia

A

Thrombocytopenia (<100,000)
Renal insufficiency (>1.1 mg /dL serum creatinine)
Elevated liver enzymes (2-3 times elevated)
Persistent RUQ pain
Pulmonary edema
Cerebral or visual symptoms

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15
Q

ENUMERATE/OUTLINE:

Mechanisms of Pre-eclampsia

A
  1. Abnormal trophoblastic invasion, leading to endothelial activation and vessel leakage, eventually leading to poor end-organ perfusion and damage
  2. Maternal hypersensitivity to paternal antigens
  3. Genetic predisposition
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16
Q

DEFINE:

Eclampsia

A

Development of generalized seizures
with no other attributable cause
in woman with pre-eclampsia

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17
Q

ENUMERATE:

Objectives of Eclampsia Management

A
  1. Control BP
  2. Control seizures
  3. Correct hypoxia and acidosis
  4. Delivery of fetus
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18
Q

DESCRIBE:

How to give MgSO4 for seizure prophylaxis/prevention

A

IV
Loading: 4-6 g IV in 100 mL, over 20 minutes
Maintenance: 2 g/hr in 100 mL solution

IM:
4g as 20% solution, at rate of 1g/min
10g of 50% solution, injected 5 g at each buttock (upper-outer)
Thereafter
5g of 50% solution on alternate buttocks, after every 4 hours

Discontinue MgSO4 24 hrs after delivery

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19
Q

ENUMERATE:

Maneuvers/Techniques for Breech Delivery

A 
Mariceau Maneuver
Modified Prague Maneuver
Bracht Maneuver
Duhrssen Incision
Piper Forceps for after-coming head
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20
Q

OUTLINE:

Criteria for diagnosis of Overt DM in pregnancy

A

FPG > 126 mg/dL
HbA1c > 6.5%
RBS > 200 mg/dL
75g OGTT 2nd hr > 200 mg/dL

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21
Q

OUTLINE:

Target control levels for FPG, 5g OGTT, and HbA1c

A

FPG: < 95 mg/dL

75g OGTT
1st hr < 140 mg/dL
2nd hr < 120 mg/dL

HbA1c < 6%

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22
Q

DEFINE:

GDM

A

Diabetes Mellitus diagnosed in the 2nd or 3rd trimester

In a woman with no overt DM or DM prior to gestation

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23
Q

OUTLINE:

Criteria for Diagnosis of GDM

A

FPG > 92 mg/dL
1st hr OGTT > 180 mg/dL
2nd hr OGTT > 153 mg/dL

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24
Q

ENUMERATE:

4 Cornerstones of Management of DM in Pregnancy

A
  1. Fetal Well-Being Studies
  2. Lifestyle modifications - diet & exercise
  3. Control of blood sugar
  4. Prevention of DM-related complications
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25
Q

OUTLINE:

Dosage and administration of insulin per trimester

A

1st trimester: 0.7-0.8 U/kg actual body weight
2nd trimester: 1 U/kg actual body weight
3rd trimester: 1.2 U/kg actual body weight

2/3 of insulin in the AM (2/3 NPH, 1/3 rapid)
1/3 of insulin in the PM (1/3 NPH, 2/3 rapid)

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26
Q

ENUMERATE:

Complications of GDM (Maternal, Fetal, Neonatal)

A 
MATERNAL: 
Retinopathy
Nephropathy
Neuropathy
Cardiovascular System Complications
Susceptibility to Infection
Ketoacidosis
Operative Delivery
FETAL: 
Congenital Anomalies
Altered Fetal Growth
Abortion
Unexplained Fetal Death
Preterm Delivery 
Hydramnios
NEONATAL:
RDS
Hypoglycemia
Hypocalcemia
Hypomagnesemia
Polycythemia
Hyperbilirubinemia
Renal thrombosis
Cardiac hypertrophy
Macrosomia 
IUGR
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27
Q

ENUMERATE:

Caldwell-Moloy Pelvic Types, with a brief description of each

A

Gynecoid - “female” pelvis
Android - “male” pelvis
Anthropoid - “ape-like” pelvis
Platypelloid - “flat” pelvis

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28
Q

ENUMERATE:

Diameters of the Pelvic Inlet and their normal measurements

A

ANTEROPOSTERIOR:
Diagonal Conjugate: 11.5 cm
Obstetric Conjugate: 10 cm
True Conjugate: 10.3 cm

TRANSVERSE: 13.5 cm

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29
Q

ENUMERATE:

Diameters of the Pelvic Midplane and their normal measurements

A

ANTEROPOSTERIOR: 11.5 cm

TRANSVERSE (Bispinous): >9.5-10 cm

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30
Q

ENUMERATE:

Diameters of the Pelvic Outlet and their normal measurements

A

ANTEROPOSTERIOR: 9.5-11.5 cm

TRANSVERSE (Bituberous): >8.5 cm

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31
Q

OUTLINE:

Complete pelvimetry with normal measurements/findings

A

INLET:
Diagonal conjugate: >11.5 cm

MIDPLANE:
Pelvic sidewalls: parallel
Ischial spines: blunt
Bispinous diameter: >9.5 cm
Sacral inclination: posterior
Sacral notch: wide
Sacral width: wide
Sacral curvature: hollow

OUTLET:
Coccyx - movable
Pubic arch - >90 degrees
Bituberous diameter: >8.5 cm

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32
Q

ENUMERATE:

Bones of the pelvis

A

Innominate bone - ilium, ischium, pubis
Sacrum
Coccyx

33
Q

ENUMERATE:

Factors to check before administering MgSO4

A

Urine output
Respiratory depression
Deep Tendon Reflexes

34
Q

Rupture rate of:

  1. single previous LSCS?
  2. multiple previous LSCS?
  3. Classical incision
A
  1. 0.2-0.9%
  2. 0.9-1.8%
  3. 2-9%
35
Q

ENUMERATE:

Indications for CS

A

Previous CS
Unreassuring fetal status
Dystocia
Breech delivery

36
Q

ENUMERATE:

Transverse Abdominal Incisions used in CS

A 
Pfannenstiel (most common)
Kutsner
Cherney
Maylard
Joel-Cohen
37
Q

OUTLINE:

Degrees of birth canal lacerations

A

1ST DEGREE - vaginal mucosa, fourchette, subcutaneous fat

2ND DEGREE - fascia and muscles (superficial transverse perineal, bulbocavernosus, deep transverse perineal, pubococcygeus)

3RD DEGREE

3a: <50% of External Anal Sphincter (EAS)
3b: >50% of EAS
3c: Involvement of IAS

4TH DEGREE:
Rectal mucosa

38
Q

ENUMERATE:

Advantages of Midline Episiotomy over Mediolateral

A
  1. Easier repair
  2. Excellent healing
  3. Minimal post-op pain
  4. Good anatomical result
  5. Less bleeding
  6. Less dyspareunia
39
Q

ENUMERATE:

Advantages of Mediolateral Episiotomy over Midline

A

Less risk of extension to 3rd and 4th degree lacerations

40
Q

ENUMERATE:

All natural family planning methods

A

Abstinence
Coitus interruptus

(CBC-STS-L)  
Cervical mucus method
Basal body temperature
Calendar rhythm method
Sympto-thermal method
Two days method
Standard days method
Lactation amenorrhea
41
Q

OUTLINE:

Requirements for successful Lactation Amenorrhea

A

Breastfeeding 4 hrs/day & 6 hrs/night, everyday
At least 6 months postpartum
Amenorrheic

42
Q

DESCRIBE:

How to determine fertile days using the Calendar Rhythm Method

A
  1. get shortest cycle duration and longest cycle duration
  2. # of days of shortest duration - 18 = FIRST FERTILE DAY
  3. # of days of longest duration - 11 = LAST FERTILE DAY
43
Q

DESCRIBE:

How to determine fertile days using Sympto-thermal method

A

1st day: first day of stringy cervical mucus

Last day: changes in BBT

44
Q

OUTLINE:

Mechanisms by which COCs prevent pregnancy

A
  1. Prevent ovulation
  2. Thickening of cervical mucus
  3. Creation of unfavorable endometrium for implantation
45
Q

OUTLINE:

Mechanisms by which POPs prevent pregnancy

A
  1. Prevent ovulation (less effective)
  2. Thickening of cervical mucus
  3. Creation of unfavorable endometrium for implantation
46
Q

ENUMERATE:

Contraindications to COC use

A 
Breastfeeding
Pregnant
Thrombotic disorders
Thrombogenic arrhythmias
Diabetes with vascular complications
Hypertension with poor control
Known or suspected Breast Ca
Known or suspected Endometrial Ca
Cholestatic jaundice
Hepatic masses
Liver disease
Cigarette smoking
47
Q

ENUMERATE:

Off-label benefits of COCs

A

IMPROVES:
Dysmenorrhea, Acne, RA symptoms

DECREASES:
Risk for Breast, Endometrial, and Ovarian Cancer

PREVENTS:
Hirsutism
Atheroformation
Abnormal bleeding

Good for Bones

48
Q

ENUMERATE:

Contraindications to POP use

A 
Breastfeeding
Pregnant
Breast Cancer
Unexplained uterine bleeding
Liver Disease
49
Q

IDENTIFY:

Active estrogen component of COCs

A

Ethinyl estradiol

50
Q

DESCRIBE:

  1. MPA
  2. How it works
  3. Side effects
A
  1. Methoxyprogesterone Acetate - injectable progestin-only contraceptive
  2. Prevents ovulation by suppression of LH
  3. Irregular bleeding, decreased bone density, weight gain
51
Q

DESCRIBE:

  1. Implanon
  2. How it works
  3. Side effects
A
  1. Levonorgestrel subdermal implant
  2. Prevents ovulation by suppression of LH. Slow, continuous release of progestin
  3. Irregular bleeding, decreased bone density, weight gain
52
Q

DESCRIBE:

How IUDs work

A
  • prevents fertilization via inflammatory reactions
  • prevents implantation by creating unfavorable endometrium
  • slow, continuous release of hormones (chemical IUDs)
53
Q

DEFINE:

Abortion

A
  1. Fetus < 500 g weight

2. Pregnancy terminated before 20 wks AoG

54
Q

ENUMERATE:

Factors noted in characterizing type of abortion

A
  1. Presence of bleeding/show
  2. Uterine contractions
  3. Cervix (dilated or not)
  4. BOW (ruptured or not)
  5. Uterine size (equal to AOG or not)
  6. FHT
55
Q

OUTLINE:

Management for the different types of abortion

A

Threatened - analgesia, rest, expectant management
Missed - medical/surgical management
Complete - observation
Imminent - await expulsion then curettage
Inevitable - await expulsion then curettage
Incomplete - curettage

56
Q

ENUMERATE:

Fetal and Maternal Etiologies of Abortion

A

FETAL

  1. Abnormal zygote development
  2. Aneuploidy
  3. Euploid/Idiopathic
MATERNAL: 
Trauma
Infection
Exposure
Thrombophilia
Immunologic
Endocrine pathology
Paternal Factor
Uterine Anomalies
Gametes are agng
Cervix incompetent

(Tie Tie the PUG Cer!)

57
Q

ENUMERATE:

Indications for Methotrexate Therapy in Ectopic Pregnancy

A

(How to know? - BRS BISHHH)

B HCG < 5000 mIU/mL
Renal pathology absent
Size < 3.5 cm

Breastfeeding not 
Immunocompromised not
Stable
Heart tones absent
Hepatic pathology absent 
Hypersensitivity ruled out 
Hemodynamically stable
58
Q

DESCRIBE:

Single dose Methotrexate Regimen for Ectopic Pregnancy

A

50 mg/m2 BSA IM on 1st day
Measure on 4th and 7th day

If >15% decrease in B HCG from 4th to 7th - repeat weekly until undetectable

59
Q

DESCRIBE:

Multiple dose Methotrexate regimen for Ectopic Pregnancy

A

Methotrexate 1 mg/kg IM Day 1 3 5 7
Leucovorin 0.1 mg/kg IM Day 2 4 6 8

Max 4 doses of Methotrexate

Continue alternate doses until >15% decrease in BHCG in 48 hours

Continue weekly until BHCG < 0.5 mIU/mL

60
Q

IDENTIFY:

Criteria for failed medical treatment of Ectopic Pregnancy

A
  1. Presence of FHT after 3 cycles of Methotrexate

2. No significant decrease in BHCG after 3 cycles of Methotrexate

61
Q

ENUMERATE:

Criteria for expectant management in Ectopic pregnancy

A

Hemodynamically stable
Falling serial B HCG levels
Absence of intraabdominal bleeding/rupture
Size < 3.5 cm

62
Q

ENUMERATE:

Classic triad of Ectopic Pregnancy

A

Amenorrhea
Vaginal bleeding
Lower abdominal pain

63
Q

ENUMERATE:

Risk factors for Ectopic Pregnancy

A 
Previous ectopic pregnancy
Pelvic surgery
Tubal pathology
Tubal sterilization
History of PID
IUD use
Smoking
64
Q

ENUMERATE:

Differentials for Ectopic Pregnancy

A 
Subchorionic Hemorrhage
Hydatidiform mole
Abortion
Acute appendicitis
PID
65
Q

ENUMERATE:
Tumor Markers for the following tumors

  1. Ovarian CA
  2. Choriocarcinoma
  3. Yolk Sac Tumor
  4. Colon Cancer
  5. Pancreatic Cancer
  6. Dysgerminoma
A
  1. CA 125
  2. B HCG
  3. AFP
  4. CA 19-9
  5. CA 19-9
  6. LDH
66
Q

ENUMERATE:

Mechanisms by which Myoma Uteri can cause AUB

A
  1. Mechanical increase in surface area of endometrium
  2. Increased production of bleeding factors
  3. Abnormal vascular growth of the endometrium
  4. Ulcerations and hemorrhage of the endometrium
  5. mechanical compression and dilation of venous plexuses
67
Q

ENUMERATE:

Risk factors for Cervical Cancer

A 
Early coitus
Multiple sexual partners
History of STDs
HPV Infection
Smoking
OCP use > 5 years 
Multiparity
Low socioeconomic status
68
Q

ENUMERATE:

Leopold’s Manuevers and their significance

A
  1. Fundal grip - Fetal Pole
  2. Umbilical grip - Fetal Orientation
  3. Pawlick’s grip - Fetal Presentation
  4. Pelvic grip - Engagement
69
Q

OUTLINE:

Johnson’s Formula for estimation of fetal weight

A

If station < 0
Fundal Height - 12 x 155

If station 0 and above
Fundal Height - 11 x 155

NOTE: for Vertex Cephalic Presentation only

70
Q 
OUTLINE: 
Criteria for:
1. Prolonged Latent Phase 
2. Prolonged Decceleration Phase
3. Prolonged 2nd Stage of Labor

in Nulliparas and Multiparas

A
  1. Prolonged Latent
    Nullipara: Latent Phase > 20 hrs
    Multipara: Latent Phase > 14 hrs
  2. Prolonged Decceleration
    Nullipara: > 3 hrs
    Multipara: > 1 hr
  3. Prolonged 2nd Stage
    Nullipara: >3 (with analgesia), >2 (w/o analgesia)
    Multipara: >2 (with analgesia), >1 (w/o analgesia)
71
Q

OUTLINE:
Criteria for:
1. Protracted active phase
2. Protracted descent

in Nulliparas and Multiparas

A
  1. Protracted active phase
    Nullipara: < 1.2 cm/hr
    Multipara: < 1.5 cm/hr
  2. Protracted descent
    Nullipara: < 1 cm/hr
    Multipara: <2 cm/hr
72
Q 
OUTLINE: 
Criteria for 
1. Arrest of Dilation
2. Arrest of Descent
3. Failure of Descent

in Nulliparas and Multiparas

A

For BOTH Nulliparas and Multiparas

  1. > 2 hrs with no change in dilation
  2. Not fully dilated + > 1 hr with no change in position
  3. Fully dilated + no change in position
73
Q

IDENTIFY:

Etiologies of each of the 3 types of deccelerations

A
  1. Early - head compression
  2. Late - uteroplacental insufficiency
  3. Variable - cord compression
74
Q

ENUMERATE:

4 peaks of Cardiac Load

A
  1. 28th weeks AoG
  2. Labor
  3. Upon Deliver
  4. 7-10 days postpartum
75
Q

ENUMERATE and DESCRIBE:

NYHA Heart Failure Classes

A

I - no limitation in activities
II - mild limitation, symptoms on ordinary activities, asymptomatic at rest
III - moderate limitation, symptoms on less than ordinary activities, asymptomatic at rest
IV - severe limitation, symptomatic at rest

76
Q

ENUMERATE:

4 conditions with that pose the highest mortality risk in Gravidocardiac patients

A
  1. Pulmonary Hypertension - primary & secondary
  2. Coarctation of the Aorta with Valve problems
  3. Marfan Syndrome with Aortic invovlement
  4. Peripartal Cardiomyopathy
77
Q

ENUMERATE:

Indications for providing IE prophylaxis to Gravidocardiac patients

A

Previous IE
Prosthetic Valve
Unrepaired cyanotic heart disease

78
Q

DESCRIBE:

Giving of IE prophylaxis to Gravidocardiac Patients

A 
(30-60 minutes prior to delivery) 
Ampicillin 2g IV 
Cefazolin 1g IV  
OR
Clindamycin 600 mg IV 
Vancomycin 1g IV (if with enterococcus, MRSA)

(While in Labor)
Ampicillin 1g IV q4-6

79
Q

ENUMERATE:

Non-obstetric indications for CS in Gravidocardiac patients

A
  1. Marfan Syndrome with Aortic Dissection
  2. Preterm Labor on Anti-coagulants
  3. Intractable Heart Failure

Major Clinical Sciences (Big 4) (3 decks)

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