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IPAP > OB Block 2 Cram > Flashcards

OB Block 2 Cram Flashcards

1
Q

When is the first pregnancy visit needed and when are f/us needed?

How is the obstetric conjugate estimated?

A

Fist: 10-12wks EGA
Until 27wks: q4wks
28-36wks: q2wks
+36wks: q2wk

Inferior pubic symphisis to sacral promontory:
Diagonal conjugate - 2.5cm= +10cm

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2
Q

Preferred pelvis types for vaginal delivery?

Midpelvis is measured at ? and during labor are called ?

A

Gynecoid*
Anthropoid

Ischial spine
Stations

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3
Q

Mid pelvis and ischial spine make up ? labor start point?

Why is the interspinous diameter important?

A

Station 0
Above= neg numbers
Below= pos numbers

Obstructed/arrested labor point

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4
Q

When would GA be adjusted to an US date?

What are the two layers of the Double Decidua Sign and the importance?

A

<9wks old w/ >5d difference
9-14wk old w/ >1wk difference

D Parietalis
D Capsularis
First/earliest sign of intrauterine pregnancy

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5
Q

What is TORCH

What are the Others?

A

Toxoplasmosis Other Rubella
CMV HSV

Coxsackie Chicken C/G
HIV HTV HBV
GBS TB Bacteriuria Zika Syphilis

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6
Q

What are the RNA viruses in this block?

What are the DNA viruses?

A

Rubella HIV (retrovirus)

CMV HSV Varicella HBV

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7
Q

Toxoplasmosis infection can lead to ? in the baby

How is this type of infection Tx

A

Microcephaly

Spiramycin- PT only
Pyrimethamin Sulfa w/ FA- PT and baby

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8
Q

When does a CMV infection become a possibility?

How is a Dx made but w/ ? cautious info?

A

Mono-like
Hydrops IUGR CNS abnormality on US

Serology- IgM x 2yrs

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9
Q

When are pregnant PTs not screened for GBS?

What are the risk-factor strategies?

A

GBS bacteriuria this pregnancy
Previously infected infant

FBIRD
Fever 
Bacteriuria
Infected infant
Ruptured +18hrs
Delivered <37wks
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10
Q

When is intrapartum prophylaxis indicated for GBS

A 
BUIC
Bacturemia
Unknown (DRNF)
Infected infant
Culture pos
DRNF
Delivered <37wks
Ruptured >18hrs
NAAT Pos
Fever >100.4
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11
Q

When is intrapartum GBS prophylaxis not needed?

A

Previous pregnancy w/ +culture
Planned c-section
Neg vag/rectal cultures during this pregnancy

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12
Q

When are pregnant PTs screened for bacteriuria?

What ABX are used for empiric Tx?

What can this progress into and how is it Tx?

A

All PTs at new OB appt w/ UA and culture

Nitro Amox Amp w/ Test of Cure after completion of ABX

Leading cause of septic shock during pregnancy:
Pyelonephritis Tx InPt w/ IV ABX

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13
Q

Pregnant PTs need to be cautious and not exceed daily limits of ? vitamins?

Why is it recommended to be on folic acid prior to conception?

How much is recommended?

A

Iron Zinc Selenium
A B6 C D

NT closes on day 28

400-800mcg/day ideally 12wks prior

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14
Q

When would PTs be recommended to increase daily folate to 4mg?

What meds are c/i during pregnancy?

A

Valproate/Carbamazepine
Hx of NTD
T1DM
BMI >35

100 IS CAT
>100mg/day ASA Isotretinoin Sulfonamides Coumadin ACEIs Tetracyclines

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15
Q

What is the leading cause of preventable developmental disabilities?

What are the discriminating features of FAS?

A

FAS

Flat midface
Indistinct philtrum
Thin upper lip
Short fissures/nose

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16
Q

When/why would sex need to be avoided during pregnancy?

What dental issue is linked to increased risk of preterm labor?

A

Miscarriage risk/hx
Placenta previa
Premature labor

Peridontal dz

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17
Q

When are domestic violence screenings conducted?

When to screen for depression or behavioral health w/ ? questionnaire?

A

First prenatal visit
One/trimester
Post-partum visits

Once during perinatal period
Edinburgh post-natal depression

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18
Q

When is breast feeding c/i?

What are the emergent return criteria for PTs >20wks EGA?

A

HIV Lithium Dependence Active TB

Contractions q3-5min
Membrane rupture
Vaginal bleeding

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19
Q

What criteria need to be met for an elective delivery to be considered?

What may be the first test ordered at the first prenatal appointment?

A

FHTs in past 30wks
US dating supports
HCG at 36wks prior
Not before 39wks

hCG confirmation test

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20
Q

What is the quick time frame milestones for prenatal care by week?

A 
FQAFGRO
10: Doppler FHT
18: quickening
18-20: anatomy scan
20: fundal height at umbilicus
24-28: GTT
28: Rhogam if M-/F+
36: GBS
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21
Q

How quickly does hCG increase during pregnancy

What is seen on TVUS to correlate to hCGs for viability

What would be seen and indicative of demise?

A

Doubles every 2.2 days

Sac- 5wks, 1500
Pol- 5wks, 5200
Cardiac- 7wks, 17,500

Gestational sac w/out yolk
No FCM
CRL >5mm

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22
Q

What are the 6 types of abortions and the criteria of each

A

Threat: <20wks w/ bleeding and closed os

Inevitable: bleeding w/ dilated os, non-viable

InComp: Bleeding, dilated and passage of tissue

Comp: Os closed after passage of tissue

Missed: demise yet retained

Recurrent: +3 SpAbs in succession

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23
Q

Fetus feels mother’s stress until ? age

How are EPL’s managed?

A

22wks

Threat: reassure
InComp: Type/Cross, evacuate
Missed: US, manage w/ Misoprostol

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24
Q

What are 5 things conducted at routine prenatal visits?

How far should the fundus advance above umbilicus after 20wks and what indicates need for US?

A

BP/Weight
Fundal height
Fetal cardiac activity
Fetal movements

1cm per week
>3cm discrepancy

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25
Q

How much weight gain is expected?

When/how many calorie increases are needed?

How many calories are needed when breast feeding?

A

1st-T: 3-6lbs
After 20wks: 1lb/wk
Total: 25-35lbs for PTs w/ BMI 18.5-24.9
Avg: 27.5lbs/12.5kgs

3-400kcal/day= 1lb/wk during 2-3rd-T
500kcal/day

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26
Q

How much weight gain is normal for PTs w/ BMI <18.5

How much is normal if BMI is >30?

A

28-40lbs

11-20lbs

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27
Q

Pregnancy criteria for edema

When/how are fetal kick counts conducted

A

> +1 after 12hrs bed rest
5lb inc in 1wk

After 28wks in LLR:
>10/hr, norm >10 in 30min
If less, drink glucose, reassess x 1hr
<10 after 2hrs, LnD w/ Dec Fetal Movement

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28
Q

Define Rh Alloimmunization

What is the name of this response

A

Rh- mother carries Rh+ baby
Delivery= Rh+ mother, now dangerous to second Rh+ baby, IgGs cross and destroy fetal RBCs= hemolysis/hydrop

Anamnestic

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29
Q

How is fetal-maternal hemorrhage qualitative/screened and quantified?

When is quant test used?

A

Qual/Screen: RBC rossette screen
Quant: Kleihauer Betke test-
citric acid dissolves maternal cells, Eosin stain remaining fetal cells

Need for higher dose of Rhogam, >30cc blood loss

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30
Q

What is a “dose” of Rhogam

When/what prenatal genetic screening is conducted?

A

300mg IM to cover 30cc of fetal-maternal hemorrhage

20wk US and serum markers for all PTs

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31
Q

What d/o is the primary target for fetal aneuploidy screening?

Define Triple and Quad Screening done in 2nd-T

A

Tri-21

Triple at 13-16wks: AFp hCG Uncon Estradiol

Quad at 15-20wks: triple + Inhibin A

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32
Q

What fetal aneuploidy screening is done during 1st-T

Tri-13= ?
Tri-18= ?

All pregnant PTs in US are screened for ?

A

Age NT bhCG PAPP-A

Patau
Edwards

Cystic Fibrosis

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33
Q

What is the earliest screening option avail for detecting Tri-21

Being able to identify ? structure dec risk/likelihood?

A

US w/ marker

Nasal bone

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34
Q

Triple screening for Tri-21 has better positive predictive value in ? PTs

What would MSAFP, Estriol, bhCG, Inhibin results look like for Tri 13, 18 or 21

A

Older PTs

13: all depends
18: all dec
21: dec M/E, inc b/i

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35
Q

What are the indications to do a cffDNA test?

A

+35y/o at delivery
Prior 13 18 21 issues
Robertsonian translocation carrier
Any abnormal aneuploidy result

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36
Q

What are the indications for PTs to have amniocentesis of CVS procedures?

Pros/Cons of amnio or CVS

A

> 35y/o at delivery (>32 w/ twins)
Pos serum marker
Abnormal US
Carrier/chrome abnormality

Amnio: 16-20wks test w/ 2wk culture
CVS: Earlier/faster dx but no NTD info
<9wks risk jaw/limb abnormalities

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37
Q

When does antenatal testing begin?

What is the use and normal response for Electronic Fetal Monitorin

A

32-34wks q7days
High risk- 26-28wks

Assess fetal well being in high risk pregnancy w/ external monitors- inc of HR w/ movement

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38
Q

What is the first line tool for fetal surveillance and how is it performed?

A

Non-stress test

20min w/ PT in LLSupine- measures fetal HR as indicator of well being

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39
Q

What is a ‘normal’ NST result

What NST results are categorized as ‘moderate’ reassuring

Fetal heart rate monitoring with NST is essentially ? monitoring?

A

Reactive

Inc 10bpm x 10sec <31wks
Inc 15bpm x 15sec >32wks
Low risk of fetal acidosis

Fetal brain monitoring

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40
Q

When are NSTs most predictive?

What could be 4 causes of a non-reactive NST test?

A

Normal, high false-+ rate

Hypoxemia
Maternal sedative/opioid
Cardiac/neuro abnormality
Sleep-wake cycles

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41
Q

What is done during NSTs if fetal sleep cycle is occurring?

Define Contraction Stress test and the value of it’s results

A

Artificial larynx applied max of 3x to reduce testing time to 15min

Nipple/oxytocin release stimulates contractions;
High negative predictive value
+ test= high fetal death risk

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42
Q

Amniotic fluid is similar to ? fluid and starts production at ?

By __wks, fetal kidneys are the main contributor to amniotic fluid production

A

Extra cellular fluid
8-11wks

18wks- renal anomaly would present as oligohydramnios early in pregnancy

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43
Q

Define AFI and it’s value

What results are high, norm or low

What are the the two methods to measure the AFI

A

Amniotic fluid index- assesses volume and used to assess fetal health

High: >24cm
Norm: 5-24cm
Low: <5cm

Sum of 4 quadrants
Deepest pocket of 2x2cm

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44
Q

Define BPP

How is is measured and what does it include

A

Biophysical Profile- NST + US

Score of 0 if:
NST- 0-1 acceleration
Breathing- <30sec
Movement- < 3 movements
Tone- 0 exten/flexion
AFI- 2cm or less at deepest pockets
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45
Q

What is the modified method to acquire BPP that is equivocal to traditional BPP

What are the BPP scores indicative of

A

AFI + acoustic NST

10: rpt weekly; PT is DM/Post-partum repeat biweekly
8: dec AFT- deliver
6: repeat, still 6 or less- deliver
4: repeat same day, 6 or less- deliver
2: near certain asphyxia- deliver

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46
Q

How do BPP scores correlate to fetal pH?

What form of surveillance is utilized if suspected IUGR is present?

A

8-10: normal and reassuring
6: retest or deliver
4 or less: not reassuring, eval and consider delivery

Doppler of UA

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47
Q

What is considered normal or unfavorable Doppler UA US results

What unique situation can arise from these results?

A

Norm: dec vascular resistance as GA inc

Quantified w/ S:D ratio, if increased- possible steroids for pre-labor prep if 23-34wks

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48
Q

When is Quad screening used?

When are NT defects screened for?

A

If Triple Screen was abnormal, screening only, not Dx

1st-T w/ US
2nd-T w/ Triple/Quad screen

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49
Q

Where is MSAFP produced?

How/why does it become detectable and what does it signify

A

Yolk sac/Fetal GI and liver

Defected fetal skin allows MSAFP to leak into amniotic fluid and become detectable in serum
Anencephaly
Spina Bifida

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50
Q

What is the next step if higher than normal levels of MSAFP are detected?

This follow up step is preferred because ?

A

Eval w/ Sonography/US

DxToC for NTDs

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51
Q

When are pregnant PTs screened for Tri-21

Where is the genetic error leading to CF?

A

All screened during prenatal care prior to 20wks

Auto recessive mutation on CFTR within Chrom-7

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52
Q

What are the screening recommendations for Tay Sachs?

What screening tests are done for high or low risk ethnicity groups?

A

If both have risks/Hx
One is high risk or both are carriers

Molecular test (DNA base mutation analysis)- high
Hexosaminidase A serum levels- low
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53
Q

How does Tay Sachs cause damage to baby

How are amniocentesis procedures conducted if more than one fetus is present?

A

Undigested milk builds and damages Brain Liver Eyes Kidney

Indigo carmine dye injected to guarantee two samples from two different sacs

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54
Q

Indications to do amniocentesis

Indications to do CMV

Indications to do Cordocentesis

A

Alloimmunization Dx
Fetal lung assessment
Infections
Genetic d/o

Karyotype
Genetic anaylsis

MC fetal anemia assessment
Assess/Tx platelet alloimmunization
Karytotype results earlier than CMV/Amnio

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55
Q

What S/Sx for Dx pregnancy is not reliable until after 10 days

Define Chadwick sign
Define Hegar sign
Define Goodell’s

A

Amneorrhea

Red/blue cervix
Softening of isthmus
Softening of cervix

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56
Q

Define Cholasma

Uterus is too big for pelvis by ? wk and shifts ?

A

Mask of pregnancy

13wks, to R

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57
Q

Define Braxton Hicks contractions

Vasodilation allows for inc maternal/fetal flow is due to ?

A

Non-rhythmic contraction between 5-25mmHg w/out cervical changes

Estradiol

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58
Q

What causes cervical ripening near the end of pregnancy?

What is the purpose and contents of the mucus plug?

A

Inc water content

IgA/IgG, cytokines to prevent infections

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59
Q

What causes cervical mucus to get thicker farther into pregnancy?

What prevents further ovulation during pregnancy?

A

Progesterone- inc thickness, dec ferning

Corpus luteum secretes Progesterone x 7wks

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60
Q

Define Theca Lutein Cysts

Where does Relaxin get made and what for

A

Exagerated follicle stimulation due to inc hCG and:
Trophoblastic dz
Eclampsia/Hyperthyroid
Placentomegaly

Luteum Decidua Placenta for CT remodeling

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61
Q

Candidiasis infection increase during 2nd/3rd-T due to?

What effects do Estrogen and Progesterone have on breasts during pregnancy

A

Inc lactic acid- pH 3.5-6
Inc glycogen stores

E stims fat deposition, ductal growth
P stims ampullary hypertrophy, secretory maturation

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62
Q

Endocrine changes during pregnancy inc changes to :

Pituitary

Thyroid

ParaThyroid

Pancreas

Adrenals

A

Pit: inc size d/t estrogen

Thy: hCG has similar affect as thyroid hormones

PT: hyperplasis d/t PTH production and inc Ca needs

Pan: hyperplasia= inc insulin resistance

Ad: Inc cortisol d/t estrogen resulting in striae

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63
Q

What part of endocrine system is not needed to maintain pregnancy?

What is progesterones role in pregnancy?

A

Pituitary

Dec smooth muscle tone, naturally produced tocolytic

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64
Q

Define Linea Nigra

Chloasma is AKA and defined as ?

A

Dark brown pigmentation

Melasma gravidarum- irregular brown patches on face/neck

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65
Q

Define Angiomas

Define Palmar Erythema

A

Telangiectasias- vascular spiders on face/neck/upper chest/arms

Inc estrogen/cutaneous blood flow due to inc metabolism

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66
Q

Why do pregnant PTs have pitting edema in LEs?

In a normal pregnancy, what is a normal metabolic state due to carbs?

A

Inc venous pressure secondary to partial VC occlusion
Dec interstitial colloid osmotic pressures

Fasting hypo/post-prandial hyperglycemia w/ hyperinsulinemia

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67
Q

Why does placenta express ghrelin?

Why do maternal T4 levels inc?

When is fetal thyroid development begin and what demand is created?

A

Role in fetal growth and cell proliferation

Maintain maternal euthryoid and transfer to fetus

2nd half of pregnancy, inc iodide

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68
Q

Why does maternal levels of Vit D3 increase?

Why does maternal Hct/Hgb decrease during pregnancy?

A

Facilitates Ca absorption from diet to fetal bone development

Induced hypervolemia- plasma and RBC expansion

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69
Q

What blood work results can be used as a marker of bacterial infection?

Why do overall levels of WBCs increase during pregnancy?

A

Inc procalcitonin during 3rd-T/early post-partum

Estrogen/Cortisol

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70
Q

What happens to CO during pregnancy?

What would be seen on EKG?

What would be seen on CXR?

A

Inc CO= Dec SVR + Inc HR

LAD w/ inc Preload

Larger silhouette

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71
Q

What would be heard on cardiac exam in pregnant PTs

When/why would PTs experience Sx HOTN when laying down?

A

Exaggerated S1 split
Louder S1/S2

Compression of aorta/dec preload
LLR recommended, also reduces IVC occlusion

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72
Q

What are the roles of prostaglandins in pregnancy?

What CV lab result may be useful in pre/eclampsia pathogenesis?

A

Vascular tone
BP
Na balance

Ratio of PGI2:thromboxane
Inc endothelin (constrictor)
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73
Q

How is morning sickness Tx

How is hyperemesis gravidarum present and Tx

A

Small meals w/ B6 and Doxylamine/Phenothiazine

> 5% Weight loss E+ imbalance Ketosis
Admit fluids/nutrition

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74
Q

What can be used for N/V during pregnancy

What antiemetics can be used in pregnancy?

A

Ginger B6
Doxlamine Meclizine Diphenhydramine Metoclopramide

Cat B: Serotonin antagonists-
Ondansetron (long Qt, Serotonin syndrome)

Cat C: Promethazine Prochlorperazine
Chlorpromazine

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75
Q

Define Epulis Gravidarum and its AKA

Define Intrahepatic Cholestasis

A

AKA- pyogenic granuloma
Inc vascularity/swelling of gums

Dec emptying/inc saturation leading to retained bile salts

76
Q

How much proteinuria should be expected?

What type of memory issues may present?

A

> 150mg/day

3rd-T dec verbal recall and processing speeds

77
Q

What type of optic shifts occur?

What is the first and second MC form of Pica seen during pregnancy

What is believe to be the cause of Pica

A

Krukenberg spindles- brown/red opacities on posterior cornea

Amylophagia- MC
Pagophagia

Fe deficiency

78
Q

Pregnancy induced GERD is due to relaxing of LES, how is it Tx

Why is constipation common in pregnancy and how is it Tx

A

1st- small meals, raise bed, avoid fatty/tomato/coffee
1st meds: tums
Persistent- endoscopy

Progestone slows GI motility
Colace

79
Q

Round ligament pain usually occurs ? and is on ? side

What meds can be used for back pain during pregnancy?

A

2nd trimester
R>L

Tylenol
Cyclobenzaprine
Baclofen

80
Q

Define IUFD

Define PTL

Define Macrosomia

A

Death >20wks

Labor prior to 37wks

> 4kg

81
Q

Define LBW

Define VLBW

Define ELBW

A

1.5-2.5kg

1-1.49kg

0.5-0.99kg

82
Q

Criteria for IUGR

AMA is ? age

Adolsecent age is ?

A

<10th percentile due to genetic/environmental restraints

35 or older at delivery

<20 at delivery

83
Q

What is the MC 1st-T procedure done while PTs are pregnant?

What needs to be monitored if surgery is needed?

A

Laparoscopy

FHTs before and after surgery

84
Q

Obesity in pregnancy can produce ? trifecta of a syndrome?

How is asthma during pregnancy managed?

How does this factor into delivery?

A

DM2 Dyslipidemia HTN

SABA and CCS

If used >3wks, stress dose during delivery

85
Q

What is the leading cause of pregnancy related deaths?

What DVT screening test is not reliable during pregnancy?

What anti-thrombic meds are used?

A

PEs

D-dimer

LMWH- Lovenox
No coumdin

86
Q

When is gestational diabetes screened for?

How is this Dx

A

24-28wks

Step 1: GCT; 50g w/out fasting, draw in 1hr
140 or higher= OGTT

Step 2: Fasting gluose, 100g, if two or more are at/over= Dx
Fast: 95mg
1hr: 180mg
2hr; 155mg

87
Q

Glucose levels at ? during any gestational age is Dx and over ? is overt

When is follow up needed after delivery?

A

92-126
>126- overt

6-12wks
Q3yrs

88
Q

What is the goal for diabetes in pregnancy?

What meds can be given to help control gestatational diabetes````

Insulin is only used if ?

A

Euglycemia during organogenesis

Glyburide
Metformin

Fasting glucose persistently >95

89
Q

Why is gestational diabetes so dangerous?

What endocrine hormone at high levels may increase risk of multiple gestations?

A

Maternal progressing to Overt Diabetes w/in 20yrs

FSH

90
Q

Define Superfetation

Define Superfecuntation

A

Second conception in woman already pregnant

Second ovum fertilized during same cycle but different coitus/male

91
Q

What happens during TTT

80% of EPLs occur ?

A

Donor: Oligo Anemic Restricted
Recipient: Polycythemia Overloaded Polyhydra

First 12wks

92
Q

If PT has SpAb, exam must be done and what are indications?

What is the preferred method to visually assess PT?

What is the next step if this preferred method is unclear?

A

CRL +7mm w/out heart
Sac +25mm w/out embryo

TVUS w/ M-mode

Serial b-hCG:
Inc: ectopic
Dec: complete SpAb

93
Q

Ectopic means implantation ?

What is the MC site of ectopic implantation

What are the two biggest RFs for ectopic?

A

Anywhere but endometrial lining

Ampulla 6-8wks post LMP

Prior ectopic
SurgHx on fallopian tube

94
Q

Ectopic Triad

What is the next step once an extra-uterine pregnancy is Dx

A

Amenorrhea Ab pain Vaginal bleeding

Immediate laparotomy

95
Q

Define Heterotopic pregnancy

How are ectopic pregnancies Tx non-surgically and when does the Tx work best

A

IUP and ectopic at same time

Methotrexate- best if ASx, motivated and compliant

96
Q

Define GTD

What are the two types

When is this more common

A

Gestational Trophoblastic Dz

Hydatidiform- + villi
Malignant neoplasm- - villi

Hx
Extremes of age

97
Q

Define GTD- Complete Molar

A

Empty ovum- only paternal, no maternal chromosomes

Grape clusters w/ hCG >100K

Associated w/ Theca-Lutein cysts and risk of GTNeoplasia

1st-T bleeding
Hyperemesis gravidum
Preeclampsia

98
Q

Define GTD- Partial Molar

A

Normal ovum w/ extra paternal haploid set: 69XXX/69XXY

Non-viable fetus

Lower risk of GTN than complete molar

99
Q

What are the 4 types of GTN

A

Invasive- MC after hydatidiform

Choriocarcinoma- MC after SpAb/pregnancy; metastatic, associated w/ theca-lutein cysts

Placenta site trophoblast- chemo resistant

Epitheloid trophoblast- low hCG, chemo resistant and commonly metastatic

100
Q

What is the MC presentation of GTN

What is pathognomonic for molar pregnancy?

A

Irregular uterine bleeding w/ failure of uterine returning to regular size (subinvolution)

Pre-eclampsia w/out chronic HTN

101
Q

Other than GTDz, where else did we see Theca Lutein cysts?

How are hydatidiform moles Tx

A

Hyperthecosis

D and C
Serial hCG until non-detectable
Monthly x 6mon

102
Q

How are GTNs Tx

What is the MC cause and other causes of fetal anemia?

A

Chemo
Hysterectomy if chemo resistant

MC- alloimmunization
B19 Thalassemia Fetal/Maternal hemorrhage

103
Q

How is fetal anemia detected?

What is the whole goal of Rhogam?

A

Fetal blood sample
Doppler eval of cerebral artery

Prevent maternal sensitization

104
Q

How is maternal/fetal hemorrhage tested for?

Define Hydrops fetalis

A

Quant- KB test: detects fetal blood cells in maternal circulation

Edema overload of fetus from serous fluids

105
Q

How is Hydrops Dx

What usually accompanies this Dx

A

Two of:
Pericardial Pleural or Ascites
or
One effusion and anasarca

Placentamegoly and polydydraminos

106
Q

Non-immune hydrops usually occurs in ? PTs

What is the MC infectious cause?

A

45XO Turners

ParvoB19

107
Q

Criteria for mild/sev Polyhydramnios

Criteria for Oligohydramnios

A

Mild: AFI 25-29.9
Sev: AFI 35cm or more

AFT <5cm or deepest pcoket <2cm

108
Q

When would an aminioinfusion be conducted to Tx Oligo?

What are the 3 phases of fetal growth?

A

For FHR Dcells, suggest cord compressions

1: Wk 1-16, 5g/day , hyperplasia
2: Wk 17-32wks, 15-20g/day hyperplasia/trophy
3: 33+wks, fat/glycogen accumulation, hypertrophy

109
Q

Define Barker Hypothesis of IUGR

What are the two types of IUGR

A

Fetal adversity impacts adult-ness

Symetric: proportionate
Asymmetric: abdominal growth lags behind head

110
Q

What can cause a symmetric growth restriction

What causes Asymmetric growth restriction

A

Early pregnancy dec cell number/size: chemical viral mal-development

Later pregnancy w/ placental insufficiency from maternal HTN- dec glucose dec cell size, N number
AKA Brain sparing

111
Q

Placental abnormalities can cause ? part of fetal development to accelerate?

How is IUGR managed

A

Inc stress= inc adrenal GCS release, advanced lung maturation

Suspect: fundal growth lag >3cm
ID: serial US
Modify: improve nutrition/stressors
Preempt: deliver if lung mature

112
Q

What is the ACOG criteria for macrosomia

hCG resembles ? endocrine hormone

Placenta produces TSH and ?

A

Born 4500g or more

TSH

hCT

113
Q

MC form of pregnancy hyperthyroid and how is it Tx?

MC form of pregnancy hypothyroid and how is it Tx?

A

Graves- dec TSH, Inc FT4
Tx: PTU (1st-T) or Methimazole (2nd-T)

Hashimotos- Inc TSH, Dec FT4
Tx: Levothyroxine

114
Q

What is added to seizure d/o Tx w/ lowest possible dose of anti-seizure med?

If PT has seizure, ? PE finding is indicative of poor fetal outcome?

A

Vit K, Folic acid

Hyperthermia

115
Q

What is a normal LFT change during pregnancy

What is HELLP Syndrome for?

A

Inc ALPs

Hemolysis
Elevated Liver enzyme
Low Platelets

116
Q

How does intrahepatic cholestasis present

What would be seen on lab results

How is it Tx

What sequelae can occur?

A

Pruritis, Jaundice

Inc Bile acid, Bilirubin, ALP

Tx: Antihistamine, emollient
Ursodeoxycholic acid

Inc reoccurrence in future pregnancy/OCP use

117
Q

How does AFLP present?

What is seen on labs?

How is it Tx?

A

Pain HTN N/V Jaundice
Proteinuria Hypoglycemia

Inc Bili Ammonia Uric acid Transaminase
Dec Glucose Coags
Delivery and maternal support

118
Q

What is SIGECAPS

A

Sleep Interest Guilt Energy Concentration Appetite Psychmotor Suicide

119
Q

Define PUPPP

How does it present

How is it Tx

A

AKA Polymorphic Eruption of Pregnancy

Urticarial plaques in white striae on abdomen/thighs but sparing the umbilicus

Tx: PO antihistamines, emollients and topical CCS

120
Q

Define Pemphigoid Gestationis

How is this one different?

A

Erythematous, pruritic papules/vesicles on abdomen and extremities

Involves umbilicus and endangers fetus

121
Q

What are cardiac indications a PT needs to have C-section

A 
Dilated AA/root >4cm
Recent MI
Acute sev CHF
Warfarin in past 2wks
Severe Sx aortic stenosis
Emergency valve replacement after delivery
122
Q

Criteria for Chronic HTN Dx

What can we not give these PTs?

A

Pre-pregnancy HTN Dx
>140/90 prior to 20wks or,
After 12wks post-partum

ACEI/ARBs

123
Q

How is mild HTN <160/<105 Tx

Criteria for Chronic HTN w/ Superimposed Proteinuria

A

No meds

CHTN w/ new preoteinuria >300mg prior to 20wks
Tx as pre-eclampsia

124
Q

Criteria for Gestational HTN

Preeclampsia can be Dx if HTN and ? other exists

A

> 140/>90 after 20wks w/out proteinuria and,
Resolves <12wks postpartum

Proteinuria 300 or more
Renal insufficiency Cr>1.1
Thrombocytopenia <100K
Pulmonary edema
Cerebral Sxs- HA Vision Convulsion
Liver involvement- 2x transaminase
125
Q

What is the name of a visual disturbance that can precede eclampsia

What is the definitive Tx for pre-eclampsia

A

HA or Scotomata

Delivery, preferred vaginal

126
Q

What is used for first seizure prophylaxis for PTs w/ severe pre-eclampsia

What meds can be used to Tx BP

Fetal lungs need to mature until ? and ? can be used to help them mature

A

MgSulfate

Hydralazine
Labetalol

34wks w/ CCS

127
Q

Criteria for Eclampsia

How is it Tx

A

Pre-eclampsia w/ seizure, tonic clonic

ABCs IVFs
MgSlft and diazepam
Hydralazine and Labetalol
Definitive- delivery

128
Q

Define Preterm labor

What PE finding would be a reassuring finding for these PTs

A

Regular uterine contractions w/ cervical changes 20-37wks

No cervical changes in 2hrs

129
Q

What can be used to Dx preterm labor

What cervical lengths are used for preterm Dx

A

Fetal fibronectin and Cervical length
High neg value in Sx PTs
+= preterm delivery

> 30mm- low risk
20-30mm- check FFN
<20mm- big preterm birth risk

130
Q

How is preterm labor managed if PT is <34wks

A

Bed rest/hydrate

Betamethason IM

24-32wks- Indomethacin, MgSO4
32-34wks- Nife/Terbutaline

17-OHP- prevent preterm birth

131
Q

What PT populations would benefit from receiving progestogens to prevent preterm birth

Don’t use tocolytics if pregnancy is older than ? and offer benefits for how long?

A

Singletons + prior SPTB
Singletons - prior SPTB but cervical length <20mm or less at 24wks or less

> 34wks
48hrs

132
Q

What are the tocolytics available for use?

A

MgSO4
Indomethacin- prostaglandin inhibitors
Nifedipine- CCBs
Terbutaline- B-agonist to relax uterus (not for DM/respiratory conditions)

133
Q

What needs to be monitored in PTs receiving MgSulfate?

This needs to be avoided in PTs w/ ?

NSAIDs use= no ? production
ASA use= no ? production?

A

Dec DTRs, precedes respiratory depression
Tx w/ Ca Gluconate

M Gravis

N: arachadonic acid
A: cyclooxygenase

134
Q

What is the potential s/e of using NSAIDs during labor?

When does ACOG recommend CCS for lung maturity

What two are avail for use

A

Monitor amniotic fluid w/ US for possible Oligohydramnios

23-34 wks if delivery <7days
Rpt at 34wks if previous dose was 7 or more days ago

Betameth 12mg IM q24hrs
Dexameth 6mg IM q12hrs

135
Q

What triggers the start of labor?

What is the only FDA approved drug to prevent recurrent preterm birth

A

Progesterone withdrawal

17 OHP-C

136
Q

Define Cervical insufficiency

How can this be Tx/managed

A

Incompetent cervix dilates and prolapses during 2nd-T
Loss of fetus

Cerclage- sutures to strengthen
Recommended if prior preterm delivery <34wks, cervix is <25mm long and prior to
<24wks EGA

137
Q

Measurement indications to cerclage

What Tx/prevention is growing in favor of cerclage procedure?

What is the single most identifiable factor of preterm labor?

A

<15mm
<25mm and <24wks

Progesterone if short cervix w/out Hx of preterm delivery

PROM- premature rupture of membranes, rupture prior to onset of labor

138
Q

Define PPROM

What can occur if this happens prior to week 24?

A

Preterm Premature Rupture of Membranes
Ruptured membrane before labor and <37wks

Lung hypoplasia

139
Q

What tests can be done in attempt to Dx SROM?

During PPROM, what considerations are taken during Dx

A

Ferning- arborization of d/c
Amnisure- proteins in fluid
Nitrazine- alkalinity of fluid

No fingers
Sterile speculum
Dec of AFI

140
Q

What can lead to false-pos of ferning test?

What can cause false-pos on Nitrazine test?

A

Mucus/blood presence

+ test= blue
BV Soap
Blood Urine Mucus Semen

141
Q

How are PTs w/ PROM and >37wks managed?

How are PTs w/ PPROM managed?

A

Pitocin
FHR

Steroids if 23-34wks
Empiric ABX
Tocolytics if ABX/Steroids

142
Q

What can be done for post-term pregnancy’s to induce labor starting at 41wks

What is done at 42wks?

A

PgE
Membrane stripping
Surveillance- Movement AFI NST

Induction

143
Q

Algorithm for post-term pregnancy management

A

41 0/7wks-
UnComp- Surveillance Stripping Induction

Complication- HTN, Oligo- induce

42 0/7-42 6/7- induce

144
Q

Baby being born forehead first is called ?

If the top of their head is leading the way, what is it called?

A

Sinciput

Vertex

145
Q

What are the two fontanelle shapes and names

Leopolds are only assessments, what is the name of manually repositioning a baby?

A

Triangle- occiput, posterior
Diamond- bregma, anterior

Extracephalic version

146
Q

Define Engaged

What is the textbook definition

A

Fetal presenting part passes through pelvic inlet
Can be before/during labor

Mechanism of biparietal dameter- transverse diamter of occiput presentation- passes pelvic inlet

147
Q

What is the MC birthing presentation

What does it mean if during birth the occiput posterior (diamond ant, triangle post) is seen first?

A

Left occiput anterior- triangle top right, diamond bottom left, face down/left

Arrest of descent

148
Q

What are the 3 types of breech presentation

Preferred imaging modality for pelvimetry?

A

Frank- hip flex, knee ext
Complete: hip flex, 1+ knee flex
Incomplete- 1+ hip unflexed

CT

149
Q

What AP, Inlet Transverse of Midpelvic diameters are needed for vaginal delivery

External cephalic version is not attempted prior to ? and can try w/ epidural if at ?

A

A: 10.5cm
I: 12cm
M: 10cm

36wks
39wks

150
Q

What are the 3 types of breech births

A

Spontaneous- whole fetus expelled w/out aid

Partial- expelled to umbilucs, remainder delivered w/ outside efforts

Total- entire fetus removed by OB

151
Q

What are the 4 phases of labor

A

Quiescence- cervical softening
Activation- cervical ripening
Stimulation- 3 stages: contractions dilation expulsion
Involution- repair, feeding

Conception 1 Initiation 2 Onset 3 Delivery 4 Fertility

152
Q

Events of Phase 1

Events of Phase 2

A

36wks, prodrom of Braxton Hicks w/ cervical softening

Uterus awakens, baby drops to inlet- lightening, cervical ripens

153
Q

What are the 3 stages of Phase 3?

What is Phase 4 AKA and what med can be given to augment it

A

1: cervical effacement/dilation
2: descent of fetus
3: placenta delivery

Puerperium- Oxytocin

154
Q

How long after delivery does it take for ovulation to resume but what does this depend on?

What events mark the onset of labor

A

4-6wks, breast feeding

Sudden onset contractions or,
Bloody show

155
Q

What is the criteria of labor to be admitted to LnD?

What is the sequence of labor transition?

A

Dilated 3cm or more w/ uterine regular contraction
Exception- SROM

Prodromal Latent Active

156
Q

? is a severe form of pre-eclampsia

What is the best predictor of low risk for a preterm delivery?

A

HELLP

  • FFN test
157
Q

What indicates fetal lung maturity?

Four types of head flexion

A

Lecithin>Sphingomyelin

Poor Moderate Advanced Complete*

158
Q

What is the timing of contractions during different phases of labor

What is criteria for normal

A

Latent- 10min
Active- q3-5min x 30-90sec

5 contractions or less in 10min, averaged over 30min

159
Q

Why is labor painful

How much does the cervix dilate during Phase 3 stages?

A

Hypoxia to endometrium
Compression of nerve ganglia
Cervical/peritoneum stretching

1: 0-3cm
2: 3-5cm (delivery 4-6hrs)

160
Q

What are the 3 stages of Phase 3

When are mothers at highest risk for post-partum hemorrhage

A

Onset
Descent
Afterbirth

6hrs after stage 3

161
Q

What is the difference in cervical dilation between Primi and Multiparis

No admitting to labor unit unless

A

Primi- 1.2cm/hr
Multi- 1.5cm/hr

Clear Dx of labor-
Dilation
Contraction quality- regular, painful w/ one of:
complete effacement, membrane rupture, bloody show

162
Q

Why would Oxytocin be given during active labor?

How often are vaginal exams conducted for cervical changes?

A

Dilation <1cm/hr in 1st stage
No descent x 1hr in 2nd stage

q1hr for first 2-3hrs
Then q2hrs

163
Q

What are the 4 components of a cervical check

When do these no longer need to be done?

A

Dilation Effacement Station Position- 4cm/80%/-1/vertex

Once infant is vertex

164
Q

Infant head is ‘crowing’ at station ?

Define Precipitous Labor and when is this seen?

A

Station 5

Delivery <3hrs
Cocaine use

165
Q

Define Labor Dystocia

What is a common and correctable cause

What are the 4 potential components

A

Dysfunctional labor

Insufficient uterine activity

4 Ps:
Power: Abnormal forces
Passage: Abnormal pelvis
Passenger: Fetal abnormality
Psyche: stage 2 w/ pushing
166
Q

What is the MC cause of dystocia and subsequent need for c-sections?

Most of these causes arise from ?

A

Cephalopelvic disproportion

Malposition

167
Q

Latent phase is considered prolonged if it lasts ? in Primi or Multi

Define Protraction criteria of Nulli, Multi

A

Null/Primi- >20hrs
Multi- >14hrs

Null: <1.2cm/hr, <1cm descent/hr
Multi: <1.5cm/hr, <2descent/hr

168
Q

Define protraction arrest

When is dystocia suspected

What is the next step?

A

Dilation: 2hrs of no cervical changes
Descent: 1hr w/ no descent

Inadequate/absent cervical changes w/in 2hrs of admission

Amniotomy, recheck in 2hrs
Little/no change- IU monitor

169
Q

Uterine contractions are measured in ? units

If these contractions are too weak during a prolonged active phase, what is added

A

Mentevideo: Sum of contraction amplitudes in 10min
Adequate= 200-250

Oxytocin if <200 in 10min

170
Q

Montevideo units are measured w/ ? device

Installing this device also allows for ?

A

Trancervical Intrauterine Pressure Catheter (TIPC), must have ruptured membrane

Route for amnio infusion

171
Q

Define Labor Induction

Define Labor Augmentation

A

Stimulation of contraction before spontaneous onset of labor/ROM including ripening

Enhancement of spontaneous but inadequate contractions due to failed cervical dilation/fetal descent

172
Q

What items are considered when inducing labor

What scoring system is used to measure cervical remodeling?

A 
Fetal maturity
Quickening US (1st-T) EGA LMP Size

Bishop- 4 or less, not favorable and indication for ripening
9- high likelihood for successful induction

173
Q

When is the method of induction ‘stripping’ started

What are mechanical methods of dilation?

What meds can be used?

A

Weekly starting at 37wks

Laminaria Foley Balloon

E1- Misoprostol
E2- Vervidil

174
Q

What med is the only FDA approved drug for induction/augmentation of labor?

Define Amniotomy

A

Oxytocin

Active Labor augmentation, allows rush of fluid
Keep hand to assess for cord entrapment
No walking x 30min

175
Q

Maternal indication for induction

Fetoplacental indications for induction

Maternal indications for augmentation

A

Preeclampsia HDz DM

Prolonged
Abnormal fetal test
IUGR
Rh incompatible
PROM
Fetal abnormality
Chorioamnionitis

Abnormal labor
Prolonged latent/active phases

176
Q

What are maternal c/is to induction or augmentation

A

Maternal-
Absolute: contracted pelvis

Relative:
Classic c-section Oversdistended uterus
Prior uterine surgery

177
Q

What are fetoplacental c/is to induction/augmentation

A

Premature w/out lung maturity
Acute distress
Abnormal presentation

178
Q

When are prostglandins the initial agent of choice for labor initiation?

Where is Oxytocin released from and what stimulates the release

A

Low Bishops

PostPit, distended birth canal, mammary stimulation

179
Q

S/e of Pitocin use

How can you tell if the fetus is tolerating the drug?

A

Tachysystole- >5 cxn in 10min
W/in 1min of each other
Any lasting longer than 2min

+ Accel and - Dcell

180
Q

If PTs develops Tachysystole, how is it managed

Moderate variability in fetal HR is defined as ?

A

D/c med
Put PT on L side, do cervical exam to r/o cord entrapment
O2, 250mcg Terbutaline

Amplitude 6-25bpm

181
Q

Define fetal acceleration

When is is defined as prolonged acceleration

What if it is prolonged past the time frame for ‘prolonged’

A

+32wks: +15bpm x 15sec, less than 2min
-32wks: +10bpm x 10sec, less than 2min

Lasts 2min-10min

Baseline change

182
Q

What is the name of the electronic fetal heart rate monitor allowing for internal or external monitoring

What does it NOT assess?

A

Tocodynamometer

Contraction strength from external monitoring

183
Q

Acronym for fetal A-cell/D-cell

Which ones require intervention

A 
VEAL CHOP
Variable  Cord compression
Early decl   Head compression
Accel   Okay
Late decell  Placental insuff.

Variable/Late

184
Q

What will be seen on baby EKG that is OK and no intervention

Late Decell looks like

What does cord compression produce on baby ekg

A

Early Dcell: Mom and baby HR mirror each other

Not mirror image

Shoulders

185
Q

What are reassuring patterns on baby EKG

Preferred head flexion position for delivery

A

HR 110-160
No late/variable D-cells
Moderate 6-25 bpm
A-cell >32: 15x15 <32 10x10

Suboccipitobregmatic diameter, shortest of fetal head, w/ complete flexion

IPAP (212 decks)

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