OB-Gyne Flashcards
1
Q
Weight of non-pregnant uterus
A
~70 grams
60 grams (williams)
2
Q
Total volume if uterus at term
A
5L-20L
(500-1000x its capacity)
Normal (10 mL)
3
Q
Weight of term uterus
A
1100 grams
4
Q
Original shape of uterus
A
Pear shaped/piriform
5
Q
Shape of uterus after 12 weeks
A
Spherical
Piriform-> globular -> spherical
6
Q
How many weeks AOG will you expect the fundic height to be at the level of umbilicus
A
20
7
Q
Dextrorotation of uterus upon ascent >12 weeks AOG is caused by
A
Rectosigmoid on the left side of the pelvis
8
Q
Uterine blood flow near term
A
450-650 mL/minute
9
Q
Substances that regulates uteroplacental blood flow in pregnancy
A
Constricts
Cathecolamines
Angiotensin 2
Dilates
Nitric oxide
10
Q
Beading or crystallization is caused by what hormone
A
Progesterone
11
Q
Ferning, observed in amniotic leaking is caused by what hormone
A
Estrogen
12
Q
Increased vascularity of vagina resulting a violet color
A
Chadwick’s sign
13
Q
Increased production of lactic acid from glycogen in the vaginal epitheliumby action of ____
A
Lactobacillus acidophilus
14
Q
pH of vagina
A
3.5-6
15
Q
Irregular brownish patches on face and neck.
Mask if pregnancy
A
Chloasma
“Melasma gravidarum”
16
Q
Risk factors for striae gravidarum/stretch marks
A
Weight gain
Younger maternal age
Family history
17
Q
Hormones that enhances Melanocyte stimulating hormone in pregnancy
A
Estrogen
Progesterone
18
Q
Average weight gain during pregnancy
A
12.5 kg
19
Q
Dilutional anemia is observed in pregnancy. The average hemoglobin level at term is ___
A
12.5 g/dL
20
Q
Total Iron requirement for pregnacy
A
27 mg elemental iron per day
60-100 mg if large woman or multigestational pregnancy
Whole pregnancy breakdown: 1000 mg -300mg (fetus) -200 mg (fetus) -500 mg (rbc)
21
Q
Blood loss for delivery
A
Singleton NSD: 500-600 mL
Twins or CS: 1000 mL
22
Q
In pregnancy is a hypercoagulable state, all clotting factors increases except
A
XI and XIII
23
Q
In supine position, this structure is compressed by the enlarged uterus
A
IVC
24
Q
Compression of the IVC by the enlarged uterus in supine position causes what syndrome
A
Supine Hypotensive Syndrome (IVC syndrome)
25
What is responsible for hyperemesis gravidarum
Beta-hcg
26
Only FDA approved treatment for hyperemesis
Doxylamine + Pyridoxine
27
Pregnancy is diabetogenic
What is the action of the ff
HPL:
ESTROGEN/PROGESTERONE/CORTISOL:
PLACENTAL INSULINASE:
HPL: anti insulin
ESTROGEN/PROGESTERONE/CORTISOL: promites insulin resistance
PLACENTAL INSULINASE: insulin degradation
28
Oral hypoglycemic used in pregnancy
Glyburide
29
Crown Rump Length
6-12 weeks AOG
30
BPD, Femur length, Abdominal circumference
13 weeks
31
Fundic height
20 weeks
32
FHT
10-12 weeks
33
Quickening
17-18 weeks
34
Standard for diagnosing pregnancy
Beta-hCG
35
Gestational sac is visible on TVS by
5 weeks AOG
| Accompanied with hcg of 1000-1500 mIU/mL
36
Folic acid
0.4 mg/day for all women
400 mcg/ day can prevent NTD
4mg/day if with history of NTDs
37
Iron
30 mg/day of elemental iron or 150 mg Iron Sulfate
38
Calcium
1300 mg/day if <19 yo
| 1000 mg/day if >19 yo
39
Vitamin D
400 IU/day
40
Vitamin B12
2ug/day
41
CVS change in pregnancy
⬆ HR, BP, SV, CO
| ⬇ PVR
42
Factors that crosses the placenta
IgG
| TORCHES
43
Quad Screening
MSFAP
Inhibin A
Estriol
Beta-hCG
44
Elevated MSAFP >2.5 is associated with
```
Open NTD (anencephaly, spina bifida)
Abdominal wall defects
Multiple gestation
Incorrect gestational dating
Fetal death
Placental abnormalities
```
45
Reduced MSAFP <0.5
Trisomy 21
Trisomy 18
Fetal demise
Incorrect gestational dating
46
⬇ AFP, ⬇ estriol, ⬇ beta-hCG, ⬇ inhibin A
Trisomy 18
| Still UNDERage at 18
47
⬇ AFP, ⬇ estriol
| ⬆ beta hCG, ⬆ inhibin A
```
Trisomy 21
(2 down, 2 up)
```
48
Torches
```
Toxoplasmosis
Others (parvovirus, varicella, listeria, tb, malaria, fungi)
Rubella
CMV
HSV
HIV
Syphilis
```
49
Loss of products of conception prior to 20th week of pregnancy
Spontaneous abortion
50
Bleeding and cramping stopped. POC expelled. Closed os.
Complete abortion
51
Uterine bleeding ± abdominal pain (often painless). No POC expulsion.Closed os + intact membranes + fetal cardiac motion on ultrasonography.
Threatened abortion
52
Partial POC expulsion; bleeding/ mild cramping.
| Visible tissue on exam. Open os.
Incomplete abortion
53
Uterine bleeding and cramps. No POC expulsion. Open os ± ROM.
Inevitable abortion
54
Cramping, loss of early pregnancy symptoms. No bleeding. Closed os. No fetal cardiac activity; POC present on ultrasonography.
Missed abortion
55
Foul-smelling discharge, abdominal pain, fever, and cervical motion tenderness; ± POC expulsion. Maternal mortality is 10–15%.
Septic abortion
56
Absence of fetal cardiac activity > 20 weeks GA.
Intrauterine fetal demise
57
.A 23-year-old G1P0 woman at 15 weeks GA presents with abdominal pain and mild bleeding rom the cervix. On pelvic examination, some POC are ound to be present in the vaginal vault. What test is necessary to determine the next step in management?
Ultrasonography should be per ormed to determine i all the POC have been expelled (ie, i the uterus is empty). I so, it is a complete abortion and the POC should be sent to pathology to con rm etal tissue with no other treatment. I POC are retained, it is an incomplete abortion, and manual uterine aspiration or D&C is indicated. Medical management with misoprostol may also be appropriate.
58
A 17-year-old G1P0 girl with a history o genital HSV presents at 37 weeks in labor. What is the appropriate management o the patient at delivery?
I the patient has any active lesions at the time o delivery, per orm a C-section.
59
Early decelerations
Head compression from the uterine contraction (normal).
60
Late decelerations
Uteroplacental insufficiency and fetal hypoxemia.
61
Variable decelerations
Umbilical cord compression.
62
Absolute contraindications to regional anesthesia (epidural, spinal, or combination) include the following:
Refractory maternal hypotension.
Maternal coagulopathy.
Maternal use of a once-daily dose of low-molecular-weight heparin within 12 hours.
Untreated maternal bacteremia.
Skin infection over the site of needle placement.
↑ ICP caused by a mass lesion.
63
Treatment for hyperemesis gravidarum
Administer vitamin B6
.
Doxylamine (an antihistamine) PO. Promethazine or dimenhydrinate PO or rectal administration. If severe: Metoclopramide, ondansetron, prochlorperazine, or promethazine IM/PO. If dehydrated: IV uids, IV nutritional supplementation, and dimenhydrinate IV.
64
Cardinal movement that is prerequisite for birth
Descent
65
Cardinal movement that is essential for completion of labor
Internal Rotation
66
Fetal movement: primigravida
18-20 weeks
67
Fetal movement: multigravida
16-18 weeks
68
Sonographic recognition
Gestational sac
4-5 weeks
69
Sonographic recognition
Yolk sac
5-6 weeks
70
Sonographic recognition
Cardiac motion
6 weeks
71
Sonographic recognition
Crown-Rump Length
6 weeks
| Up to 12 weeks
72
Most accurate tool for GA in the 1st trimester
CRL
73
Fundal height correlates with AOG in cm
20-34 weeks AOG
74
Fetal heart sounds
Doppler:
Stethoscope:
Doppler: 10 weeks
Stethoscope: 16 weeks
75
Calories
100-300 kcal/day
76
Protein
5-6 g/day
| Milk and dairy products are ideal sources
77
Iodine
220 ug/day
78
Vitamin C
80-85 mg/day
79
Vaccines contraindicated in pregnancy
```
Measles
Mumos
Rubella
Varicella
HPV
```
80
```
Before implantation to near end of pregnancy
Prelude to Parturition
✔ contractile unresponsiveness
✔ cervical softening
✔ Braxton-Hicks Contraction
```
Phase 1: Uterine Quiescence
81
```
Myometrial changes
Preparation for Labor
✔ ⬆ responsiveness to uterotonins
✔ lightening: formation of lower uterine
segment
✔ cervical ripening
```
💠 Phase 2: Activation
82
```
Processes of labor
💠 Stage 1: Clinical onset of labor
✔ bloody show
✔uterine contractions
✔ cervical effacement
✔ cervical dilatation
💠 Stage 2: fetal descent
✔ cardinal movements of fetus
✔ expulsion of baby
💠 Stage 3 : delivery of placenta and membranes
```
💠Phase 3: Stimulation
83
✔ uterine involution
✔ cervical repair
✔ breastfeeding
Phase 4 of Parturition
84
Change of shape of the uterus from discoid to ovoid
Calkin's sign
85
Signs of Placental separation
Calkin's sign
Gush of blood
Uterus rises in the abdomen
Lengthening of the cord
86
Central, shiny part out first - fetal membranes
Schultze's
87
Dirty side, maternal side out first- cotelydons of placenta
Duncan's
88
Episiotomy heals in
1-2 weeks
89
Arrest or retardarion of involution; prolongation of lochial discharge or bleeding
Subinvolution
90
Arrest or retardarion of involution; prolongation of lochial discharge or bleeding
Subinvolution
91
Most common manifestation of postabortal infection
Endomyometritis
92
Snow storm pattern
Complete mole
93
Cannon ball exudates
Complete mole
94
Lower limit of contraction pressure required to dilate the cervix
15 mmHg
95
Epidural anesthesia prolongs what stage of labor
1st and 2nd stage of labor
96
Delivery of aftercoming head. Assistant should apply suprapubic pressure to fabor flexion and engagement of fetal head
Mauriceau-Smellie-Veit-Maneuver
97
Delivery of aftercoming head. Assistant should apply suprapubic pressure to fabor flexion and engagement of fetal head
Mauriceau-Smellie-Veit-Maneuver
98
rotation of the trunk of the fetus during a breech birth to facilitate delivery of the arms and the shoulders
Lovset maneuver
99
Replacement of fetus higher into the vagina and uterus, followed by cesarean delivery
Zavanelli maneuver
100
Maneuver to convert frank breech into a footling breech
Pinard maneuver
| Breech decomposition
101
Shoulder dystocia:
| involves hyperflexing the mother's legs tightly to her abdomen.
Lift the legs
McRobert's Maneuver
102
Shoulder dystocia
Suprapubic pressure over posterior aspect of anterior shoulder
Mazzanti maneuver
103
Shoulder dystocia
Two fingers vaginally pushing the posterior aspect of anterior shoulder towards the chest
Rubin maneuver
104
Shoulder dystocia
Two fingers on the anterior aspect of posterior shoulder to rotate obliquely
Wood's corkscrew maneuver
105
Patient in all 4's. Grasp the posterior arm, sweep against chest and deliver
Gaskin's maneuver
106
Most frequent medical condition associated with abruptio placenta
Hypertension
107
Painful uterin bleeding in pregnancy
Abruptio placenta
108
is a life-threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into the uterinemyometrium forcing its way into the peritoneal cavity.
Couvelaire uterus
109
Painless bleeding usually near the end of the 2nd trimester or later
Placenta previa
110
Most imoortant criterion for diagnosis postpartum metritis
Fever
111
Application of atraumatic clamps to each round ligament followed by upward traction
Huntington procedure
112
Longitudinal surgical cut is made posteriorly throught the ring to expose the fundud and permit reinversion
Haultain incision
113
Longitudinal surgical cut is made posteriorly throught the ring to expose the fundud and permit reinversion
Haultain incision
