OB/GYN 4

Question 1

What is Gestation Thrombocytopenia?

What is the management?

Answer 1

BENIGN condition in pregnancy where PLT (70k-150k)

Management = resolves after deliver, follow with serial CBC to ensure it does.

Question 2

What are the two platelet associated C/Is for epidural?

Answer 2

1. Plt < 70K

2. Rapidly decreasing Plt due to HELLP.

Question 3

What are the three general indications for Plt transfusions?

Answer 3

1. Plt < 10,000
2. Plt < 50,000 + symptomatic
3. Plt < 50,000 + planned surgery

Question 4

What is the definition of Pre-Eclampsia?

What six features define Pre-Eclampsia with “severe features.” ? (If you have any ONE of these management changes.)

Answer 4

1. New onset HTN (>140/90) @ 20 weeks gestation
   (+)
2. Proteinuria OR end organ damage (HA, visual symp, and pain)

SEVERE FEATURES:

1. BP >160/110 (2x four hours apart)
2. Thrombocytopenia
3. Increased LFTs
4. Increased Cr
5. Pulmonary Edema
6. Blurred vision

Question 5

How do you manage PRE-E without severe features?

Answer 5

PRE-E without Severe Features:
- Deliver at >37 weeks

PRE -E WITH Severe Features:

• Stabilize mom with Mgsulfate
• IV Hydralazine or Labetalol if BP > 160/110
• DELIVER >34 weeks

Question 6

Cervical Insufficiency is caused by structural weakness of cervix causing repeated 2nd trimester spontaneous abortions…

What is the diagnostic criteria?

What is the management of cervical insufficiency during pregnancy?

Answer 6

DX = 2 or more prior 2nd trimester spontaneous abortions due to painless cervical dilation.

TRX = cervical cerclage placement at 12-14 weeks gestation.

Question 7

Maternal serum Alpha-fetoprotein screen can be done at what gestational age?

What is associated with increased AFP?

What is associated with decreased AFP?

Answer 7

15-20 weeks.

Increased AFP:

• Neural Tube defects
• Ventral wall defects (gastroschisis, omphalocele)

Decreased AFP:
- Trisomy (21 and 18)

Question 8

IF you have increase maternal AFP…what is the next step in management?

Answer 8

REPEAT maternal AFP…if remains elevated do US to look for structural abnormalities.

Can do amniocentesis and measure amniotic AFP and acetylcholinesterase if US is negative. (this has high PPV for NT defects)

Question 9

What is the TRX of Bacterial Vaginosis during pregnancy?

Answer 9

Metronidazole or Clindamycin

Question 10

What is the “turtle sign” and what does it signify?

Answer 10

Baby’s head retracts after deliver, suggest SHOULDER DYSTOCIA.

Question 11

What is the first line management of Shoulder Dystocia?

If first line fails…what following interventions can you do in ORDER?

Answer 11

First –> McRobert’s Position = hyper flex maternal hips + suprapubic pressure.

1. Episiotomy of vaginal opening
2. Deliver posterior arm first
3. Rotate 180
4. Collapse ant shoulder
5. Push back in and C-section (if all above fails)

Question 12

Some women should not get pregnant. What are the four absolute Cardiac CONTRAINDICATIONS TO PREGNANCY?

Answer 12

1. LVEF < 40%
2. NYHA class 3 or 4
3. Sever Pulmonary HTN (unrepaired Eisenmanger syndrome, unrepaired VSD causing L –> R shunting and causes Pulm HTN)
4. Aortic Dilation > 40 mm

Question 13

What should you do if you have active genital warts during labor?

Answer 13

GO ahead with vaginal birth.

C-section does NOT decrease transmission.

Question 14

All women should supplement with how much of folic acid 1 month before becoming pregnant though the first trimester?

What dose should you take if you are at high risk of neural tube defect (Prior baby with NT defect or AED)

Answer 14

0.4 mg Folic Acid daily

HIGH RISK = 4 mg daily.

Question 15

What is the definition of preterm labor?

Answer 15

Contractions that result in cervical change <37 weeks.