Ob-Gyn Brainscape Flashcards - uWise Abnl Obstetrics

Question 1

MTX tx pre-reqs for (suspected) ectopic?

Answer 1

stable, not ruptured, mass <3.5 w/ FHR), nl LFTs, nl BUN/Cr, nl white count, able to f/u

Question 2

define: recurrent abortion

Answer 2

refers to three successive spontaneous abortions

Question 3

define: missed abortion

Answer 3

fetal demise without cervical dilatation or passage of products of conception

Question 4

define: incomplete abortion

Answer 4

passed some, but not all, of the products of conception

Question 5

When should a cerclage be placed in a woman w/ a h/o cervical insufficiency?

Answer 5

14 weeks GWA

Question 6

Use of ACE inhibitors during pregnancy causes?

Answer 6

oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death

Question 7

Timing of glucose challenge?

Answer 7

patients of average risk screening is performed at 24 – 28 weeks while those at high risk (severe obesity and strong family history) screening should be done as soon as feasible.

Question 8

SSRI contraindicated in preg?

Answer 8

paroxetine

Question 9

First line imaging for suspected appendicitis in preg?

Answer 9

graded compression u/s

Question 10

Percentage of women w/ gHTN who will go on to develop Pre-E?

Answer 10

25%

Question 11

protein cut-offs for Pre-E and E?

Answer 11

> 300mg/day = mild; 5000mg/day (i.e. 5g/d) = severe

Question 12

What is a therapeutic mag level for tx of pre-eclampsia?

Answer 12

between 4-7 mEq/L.

Question 13

Contraindications to expectant mgmt for severe Pre-E remote from term?

Answer 13

thrombocytopenia, maxed out on 2 BP agents w/o ctrl, non-reassuring fetal surveillance, LFTs > 2X nl, eclampsia, persistent CNS sx and oliguria

Question 14

HELLP stands for?

Answer 14

hemolysis, elevated liver enzymes & low plts

Question 15

When to start anti-HTNive in preg?

Answer 15

pressures persistently greater than 160 systolic and 105 diastolic

Question 16

Goal diastolic in anti-HTNive tx in preg?

Answer 16

90-100 mmHg

Question 17

First line agents and dosing for HTN in preg?

Answer 17

hydralazine (a direct vasodilator) 5 mg IV followed by 5-10 mg doses IV at q20-min (maximum dose = 40 mg); or labetalol (combined alpha & beta antagonist) 10-20 mg IV followed by 20 mg, then 40 mg, then 80 mg IV q10-min (maximum dose = 220 mg)

Question 18

Non-invasive test of fetal anemia?

Answer 18

Middle cerebral artery peak systolic velocity

Question 19

What is the ratio of RhoGAM to # of cc’s of fetal blood neutralize?

Answer 19

10mcg : 1 cc

Question 20

Current recommendation for RhoGAM prophylaxis?

Answer 20

Rh- women w/o evidence of Rh immunization is prophylactically at 28-wks (after an indirect Coombs’ test) and w/in 72hrs of: delivering an Rh+ baby, OR following spontaneous OR induced abortion, following antepartum hemorrhage and following amniocentesis or chorionic villus sampling

Question 21

Test to determine amount of fetal blood that entered mother’s bloodstream s/p abruption?

Answer 21

Kleihauer-Betke test

Question 22

What is seen in the amniotic fluid of a fetus w/ erythroblastosis fetalis?

Answer 22

bilirubin, can do OD test to determine [bili] and thus severity of crisis

Question 23

Placentation and amniotic sacs in monozygotic twins

Answer 23

If division occurs on post-conception days 1-3 (pre-morula) –> monochorionic monoamniotic; days 4-8 –> monochorionic diamniotic; days 9+ dichorionic diamniotic

Question 24

Placentation and amniotic sacs in dizygotic twins

Answer 24

Always dichorionic diamniotic

Question 25

TTTS usually occurs in ___chorionic ___amniotic twins

Answer 25

monochorionic, diamniotic

Question 26

Stages of grief

Answer 26

Denial, Anger, Bargaining, Depression, Acceptance

Question 27

W/u for a woman who has had fetal demise of one fetus in a multiple gestation?

Answer 27

Check maternal serum fibrinogen level, maybe low –> coagulopathy (ask about nose bleeds, etc.)

Question 28

Risk factors for breech presentation?

Answer 28

fibroids and other uterine anomalies, polyhydramnios, prematurity, multiples, anencephaly, hydrocephaly, previa, genetic d/o

Question 29

Fetal fibronectin PPV vs NPV

Answer 29

Higher NPV: “negative fetal fibronectin test gives a more than 95% likelihood of remaining undelivered for the next 2 weeks” [Wiki]

Question 30

S/Sx of mag tox by mag level

Answer 30

High levels of magnesium sulfate may cause respiratory depression (12-15 mg/dl) or cardiac depression (>15 mg/dl). Prior to developing respiratory depression the patient should have diminished or absent deep tendon reflexes (areflexia).

Question 31

It is especially important not to use indomethacin as a tocolytic after ___ weeks gestation

Answer 31

32

Question 32

Benefits of betamethasone treatment in pre-term fetuses

Answer 32

incr pulm maturity and decr RDS incidence/severity. also assoc’d w/ decr intracerebral hemorrhage and necrotizing enterocolitis

Question 33

When is tx w/ betamethasone appropriate?

Answer 33

24-34 weeks gestation

Question 34

The presence of fFN in the cervical mucus between __ and __ weeks is thought to
indicate a disruption or injury to the maternal-fetal interface.

Answer 34

22 and 34

Question 35

Prostaglandin F2-alpha is contrindicated in?

Answer 35

(a.k.a. hemabate) contraindicated in asthma pts b/c in addition to SMM constriction it bronchoconstricts

Question 36

Methergine (Methylergonovine) is contraindicated in who?

Answer 36

women w/ PIH or Pre-E/Ecc b/c in addition to uterotonic it’s also a vasoconstrictor

Question 37

Risks of antepartum SSRI use to fetus?

Answer 37

SRIs has been associated with persistent pulmonary hypertension of the newborn and a self-limiting neonatal behavioral syndrome. SSRI use in late pregnancy may be associated with clinical manifestations in as many as 30% of neonates. The clinical manifestations may include respiratory, neurobehavioral, somatic and gastrointestinal symptoms. Neonates may experience hyperirritability, hypertonus and jitteriness.

Question 38

Appropriateness criteria for an operative delivery

Answer 38

complete cervical dilation, head engagement, vertex presentation, clinical assessment of fetal size and maternal pelvis, known position of the fetal head, adequate maternal pain control and rupture of membranes

Question 39

When is CVS done?

Answer 39

between 10 and 12 weeks gestation