Ob (Blueprints) Flashcards
Second trimester symptoms of vaginal discharge, infection, and hourglass membranes on ultrasound. Could be caused by what? U/s finding? Rx?
Incompetent cervix. More commonly presents in 2nd trimester
Hourglass membrane on u/s from amniotic sac bulging through cervix
Cervical cerclage (purse string suturing) can be Rx
Patients with history of any cervical surgery or instrumentation at risk for incompetent cervix.
Patients with anti-phospholipid antibody syndrome have increased risk for what obstetric abnormality? Rx?
Recurrent spontaneous abortions (often from placental thromboses)
Low-dose aspirin. Remember APA is a hypercoagulable state with paradoxical prolonged aPTT
1st trimester screening of trisomy 21, trisomy 18, trisomy 13?
21: nuchal translucency, pregnancy associated plasma protein A (PAPP-A) can be performed during the 1st trimester!
18: Edwards syndrome. More likely associated with physical defects visible on u/s: rocker bottom feet, overlapping digits, and cardiac defects
13: Patau syndrome. Serum studies are poor. Almost all have deformities visible on u/s
Fetal ultrasound reveals concavity of frontal bones, flattened and caudally displaced cerebellum, and elevated maternal alpha-fetoprotein. Diagnosis?
Spina bifida! Note that you don’t often directly see the spinal cord opening, but other associated signs
Utility of the nitrazine test? Fern test?
Nitrazine paper used to distinguish amniotic fluid from vaginal secretions
Nitrazine paper turns blue from alkaline amniotic fluid. Vaginal secretions are acidic
Fern test reveals “Fern-like” crystals from dried up amniotic fluid (crystallization of salts caused by estrogen in the fluid)
Contraindications for cervical ripening using prostaglandins in induction of labor?
Asthma, glaucoma, more than 1 previous cesarean section
3 classic signs of start readiness for placental delivery
Cord lengthening, gush of blood, fundal rebound (felt with external suprapubic pressure)
Woman of advanced maternal age, multiple previous pregnancies, prior myomectomy of uterine fundus, and a 20pack/year smoking history presents at 32 weeks with sudden, painless and quite profuse vaginal bleeding. What is likely Dx? Rx? What blood disorder increases risk for this disorder?
Placenta previa (low lying placenta at cervical os). Asymptomatic bleeding after 28wks most common
Rx: nothing by vagina!! Including examination fingers, and penises
Note all these are risk factors for previa…Erythroblastosis is another risk factor
Patient presenting with early (though irregular contractions) told to drink plenty of water. Why? Mechanism?
Hydration decreases secretion of vasopressin/ADH. Along with oxytocin, these are released from the posterior pituitary and have similar molecular structures and some cross reactivity
34week gestation preggie lady complains of a bolus of fluid that came out of her vagina 30 minutes ago. She is not having any contractions. Nitrazine and fern test are positive. Diagnosis? What pharmacotherapy should be initiated (other than labor induction)?
Preterm, premature rupture of membranes (
Diagnostic criteria for preeclampsia? Rx?
Third trimester, HTN > 140/90 x2 q6, proteinuria >300mg/24hrs (generally urine protein/creatinine ratio > 0.2 or 2+ on UA dipstick)
Non-dependent edema not part of criteria, though classically associated.
Rx: Magnesium bolus + continued infusion through induced deliver + 24hrs afterward
Patient presents with vaginal discharge. It is malodorous, thin, white discharge with pH >4.5. Gram stain reveals epithelial cells studded with small bacteria. Diagnosis? Rx? Organisms?
Bacterial vaginosis. Causes alkalinization of vaginal discharge and clue cells (epithelial cells studded with bacteria)
Rx: Metronidazole standard (maybe Clindamycin)
Organisms: Gardinella vaginosis, bacteroides, mycoplasma hominis.
Antiepileptic drugs associated most strongly with neural tube defects? Mechanism
Valproate and carbamazapine. Both act effectively as folate antagonists.
Patient presents to L&D floor in the midst of a seizure. Their med list shows they’ve been maintained on an antiepileptic drug during pregnancy. Rx? What blood abnormality is this patient at risk for?
Phenytoin is AED of choice in this setting. If it was eclampsia, Mg would be drug of choice.
AEDs increase Vitamin K metabolism in mother and fetus. Mothers should receive Vitamin K supplements toward end of pregnancy, & high suspicion for fetal Vitamin K insufficiency
Lupus flare (including lupus glomerulonephritis) during pregnancy and preeclampsia have very similar presentations! How can they be distinguished by labs? Rx for each?
Lupus: low complement (C3, C4 levels), normal in preeclampsia. Also look for malar rash on face
Lupus: high dose steroids, Preeclampsia: delivery
