OB complications

Question 1

Suspected ectopic bHCG magic number?

Answer 1

1500, If lower, repeat in 2 days. If higher, TVUS should show IUP so it is bad if you can’t see baby

B hCG should double every 2 days if normal

Question 2

What if bHCG goes up but not as much as you hope on subsequent measurements in suspected ectopic?

Answer 2

Do D&C to treat failed pregnancy or further suggest ectopic

Question 3

When can you treat ectopic with methotrexate?

Answer 3

Stable patient

MUST FOLLOW TO zero bHCG

Question 4

Tx of Inevetable abortion?

Answer 4

D&C or misoprostol or expectant

Question 5

Missed abortion tx?

Answer 5

D&C misoprostol or expectant

Question 6

Male baby can cause oligohydramnios by what?

Answer 6

Posterior urethral valves

Question 7

Concern with zygotes splitting 8-12 days?

Answer 7

Mono mono babies can wrap each other’s cords

Question 8

What is the issue with twin steal syndrome?

Answer 8

Monochorionic

VAcular anastomosises and they gdont share

days 4 or later sw itching

Question 9

Med needed to decreases complications in PCOS?

Answer 9

DEFINITELY OCP b/c unopposed estrogen with nonovulation

Question 10

dONT DO DIGITAL EXAM FOR BLEEDING! Duh

Answer 10

Do ultrasound for dx of placenta previa

Question 11

Accrete usually treated how?

Answer 11

C section followed by hysterectomy

Question 12

Bleeding after rupture of membranes suspect what?

Answer 12

VASA PREVIA. Dx with ultrasound

Question 13

DIC can happen with abruption

Answer 13

makes sense

Question 14

Placental abruption tx?

Answer 14

EMERGEMCY C SECTION

Question 15

PROM is what?

Answer 15

premature rupture of membrane, before membranes

Water broken before contractions

Question 16

Complication of PROM?

Answer 16

Infection
Cord prolapse
Placental abruption
Preterm labor

Question 17

PROM management?

Answer 17

More than 34 weeks? labor induced

Less than 34 weeks: admission with steroids for fetal lung maturity
Antibiotics with gent
Expectant labor

Question 18

Fetal fibronectin is what?

Answer 18

done to see if in labor

Question 19

Why do you give mag sulfate at less than 32 weeks for preterm labor?

Answer 19

Neuro protection: less cerebral palsy

doubles as tocolytic

Question 20

Types of tocolytic classes?

Answer 20

beta 2 agonists
CCB’s nifedipine
Magnesium sulfate
Indomethacin not used often

Question 21

Gestational trophoblast disease associated with what lab?

Answer 21

Increased HCG

Question 22

Complete mole is from what?

Answer 22

COMPLETELY dad. One sperm duplicated. So can be XX or YY

Question 23

Which moles are worse? (meaning bigger, more hCG, more invasive mole, more risk of choriocarcinoma?

Answer 23

COMPLETE MOLES are completely worse

Question 24

Preggers with hyperemesis gravidum and signs of hyperthyroidism?

Also could have early preeclampsia

Answer 24

Think MOLE b/c common alpha subunit

Question 25

Tx of moles?

Answer 25

D&C
Follow hCG levels
Methotrexate fi they don’t get to zero

ask to wait at least 6 months to preggers again to make sure it is not a mole

Question 26

Problems with invasive moles?

Answer 26

invade through uterine wall and can cause uterine rupture and hemorrhage

Question 27

Choriocarcinoma mets to where?

Answer 27

lung

Question 28

Persistent bleeding after delivery with vaginal bleeding is possibly from what?

Answer 28

Choriocarcionma

Question 29

Pulm symptoms after pregnancy remember to consider what?

Answer 29

Choriocarcinoma

Question 30

Suspect choriocarcinoma after preggers, how do you check?

Answer 30

hCG
Pelvic exam for vaginal mets
US for masses of utrine with necrosis and hemorrhage
CXR FOR METS TO LUNG

Needs chemo: methotrexate
Surgery