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PLE SEPTEMBER 2018 > OB-Gyne > Flashcards

OB-Gyne Flashcards

1
Q

Weight of non-pregnant uterus

A

~70 grams

60 grams (williams)

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2
Q

Total volume if uterus at term

A

5L-20L
(500-1000x its capacity)

Normal (10 mL)

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3
Q

Weight of term uterus

A

1100 grams

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4
Q

Original shape of uterus

A

Pear shaped/piriform

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5
Q

Shape of uterus after 12 weeks

A

Spherical

Piriform-> globular -> spherical

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6
Q

How many weeks AOG will you expect the fundic height to be at the level of umbilicus

A

20

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7
Q

Dextrorotation of uterus upon ascent >12 weeks AOG is caused by

A

Rectosigmoid on the left side of the pelvis

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8
Q

Uterine blood flow near term

A

450-650 mL/minute

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9
Q

Substances that regulates uteroplacental blood flow in pregnancy

A

Constricts
Cathecolamines
Angiotensin 2

Dilates
Nitric oxide

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10
Q

Beading or crystallization is caused by what hormone

A

Progesterone

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11
Q

Ferning, observed in amniotic leaking is caused by what hormone

A

Estrogen

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12
Q

Increased vascularity of vagina resulting a violet color

A

Chadwick’s sign

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13
Q

Increased production of lactic acid from glycogen in the vaginal epitheliumby action of ____

A

Lactobacillus acidophilus

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14
Q

pH of vagina

A

3.5-6

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15
Q

Irregular brownish patches on face and neck.

Mask if pregnancy

A

Chloasma

“Melasma gravidarum”

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16
Q

Risk factors for striae gravidarum/stretch marks

A

Weight gain
Younger maternal age
Family history

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17
Q

Hormones that enhances Melanocyte stimulating hormone in pregnancy

A

Estrogen

Progesterone

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18
Q

Average weight gain during pregnancy

A

12.5 kg

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19
Q

Dilutional anemia is observed in pregnancy. The average hemoglobin level at term is ___

A

12.5 g/dL

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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)
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21
Q

Blood loss for delivery

A

Singleton NSD: 500-600 mL

Twins or CS: 1000 mL

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22
Q

In pregnancy is a hypercoagulable state, all clotting factors increases except

A

XI and XIII

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23
Q

In supine position, this structure is compressed by the enlarged uterus

A

IVC

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24
Q

Compression of the IVC by the enlarged uterus in supine position causes what syndrome

A

Supine Hypotensive Syndrome (IVC syndrome)

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25
Q

What is responsible for hyperemesis gravidarum

A

Beta-hcg

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26
Q

Only FDA approved treatment for hyperemesis

A

Doxylamine + Pyridoxine

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27
Q

Pregnancy is diabetogenic

What is the action of the ff

HPL:
ESTROGEN/PROGESTERONE/CORTISOL:
PLACENTAL INSULINASE:

A

HPL: anti insulin
ESTROGEN/PROGESTERONE/CORTISOL: promites insulin resistance
PLACENTAL INSULINASE: insulin degradation

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28
Q

Oral hypoglycemic used in pregnancy

A

Glyburide

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29
Q

Crown Rump Length

A

6-12 weeks AOG

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30
Q

BPD, Femur length, Abdominal circumference

A

13 weeks

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31
Q

Fundic height

A

20 weeks

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32
Q

FHT

A

10-12 weeks

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33
Q

Quickening

A

17-18 weeks

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34
Q

Standard for diagnosing pregnancy

A

Beta-hCG

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35
Q

Gestational sac is visible on TVS by

A

5 weeks AOG

Accompanied with hcg of 1000-1500 mIU/mL

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36
Q

Folic acid

A

0.4 mg/day for all women
400 mcg/ day can prevent NTD
4mg/day if with history of NTDs

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37
Q

Iron

A

30 mg/day of elemental iron or 150 mg Iron Sulfate

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38
Q

Calcium

A

1300 mg/day if <19 yo

1000 mg/day if >19 yo

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39
Q

Vitamin D

A

400 IU/day

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40
Q

Vitamin B12

A

2ug/day

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41
Q

CVS change in pregnancy

A

⬆ HR, BP, SV, CO

⬇ PVR

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42
Q

Factors that crosses the placenta

A

IgG

TORCHES

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43
Q

Quad Screening

A

MSFAP
Inhibin A
Estriol
Beta-hCG

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44
Q

Elevated MSAFP >2.5 is associated with

A 
Open NTD (anencephaly, spina bifida)
Abdominal wall defects
Multiple gestation
Incorrect gestational dating
Fetal death
Placental abnormalities
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45
Q

Reduced MSAFP <0.5

A

Trisomy 21
Trisomy 18
Fetal demise
Incorrect gestational dating

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46
Q

⬇ AFP, ⬇ estriol, ⬇ beta-hCG, ⬇ inhibin A

A

Trisomy 18

Still UNDERage at 18

47
Q

⬇ AFP, ⬇ estriol

⬆ beta hCG, ⬆ inhibin A

A 
Trisomy 21
(2 down, 2 up)
48
Q

Torches

A 
Toxoplasmosis
Others (parvovirus, varicella, listeria, tb, malaria, fungi)
Rubella
CMV
HSV
HIV
Syphilis
49
Q

Loss of products of conception prior to 20th week of pregnancy

A

Spontaneous abortion

50
Q

Bleeding and cramping stopped. POC expelled. Closed os.

A

Complete abortion

51
Q

Uterine bleeding ± abdominal pain (often painless). No POC expulsion.Closed os + intact membranes + fetal cardiac motion on ultrasonography.

A

Threatened abortion

52
Q

Partial POC expulsion; bleeding/ mild cramping.

Visible tissue on exam. Open os.

A

Incomplete abortion

53
Q

Uterine bleeding and cramps. No POC expulsion. Open os ± ROM.

A

Inevitable abortion

54
Q

Cramping, loss of early pregnancy symptoms. No bleeding. Closed os. No fetal cardiac activity; POC present on ultrasonography.

A

Missed abortion

55
Q

Foul-smelling discharge, abdominal pain, fever, and cervical motion tenderness; ± POC expulsion. Maternal mortality is 10–15%.

A

Septic abortion

56
Q

Absence of fetal cardiac activity > 20 weeks GA.

A

Intrauterine fetal demise

57
Q

.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?

A

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
Q

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?

A

I the patient has any active lesions at the time o delivery, per orm a C-section.

59
Q

Early decelerations

A

Head compression from the uterine contraction (normal).

60
Q

Late decelerations

A

Uteroplacental insufficiency and fetal hypoxemia.

61
Q

Variable decelerations

A

Umbilical cord compression.

62
Q

Absolute contraindications to regional anesthesia (epidural, spinal, or combination) include the following:

A

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
Q

Treatment for hyperemesis gravidarum

A

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
Q

Cardinal movement that is prerequisite for birth

65
Q

Cardinal movement that is essential for completion of labor

A

Internal Rotation

66
Q

Fetal movement: primigravida

A

18-20 weeks

67
Q

Fetal movement: multigravida

A

16-18 weeks

68
Q

Sonographic recognition

Gestational sac

69
Q

Sonographic recognition

Yolk sac

70
Q

Sonographic recognition

Cardiac motion

71
Q

Sonographic recognition

Crown-Rump Length

A

6 weeks

Up to 12 weeks

72
Q

Most accurate tool for GA in the 1st trimester

73
Q

Fundal height correlates with AOG in cm

A

20-34 weeks AOG

74
Q

Fetal heart sounds
Doppler:
Stethoscope:

A

Doppler: 10 weeks
Stethoscope: 16 weeks

75
Q

Calories

A

100-300 kcal/day

76
Q

Protein

A

5-6 g/day

Milk and dairy products are ideal sources

77
Q

Iodine

A

220 ug/day

78
Q

Vitamin C

A

80-85 mg/day

79
Q

Vaccines contraindicated in pregnancy

A 
Measles
Mumos
Rubella
Varicella
HPV
80
Q 
Before implantation to near end of pregnancy
Prelude to Parturition
  ✔ contractile unresponsiveness
  ✔ cervical softening
  ✔ Braxton-Hicks Contraction
A

Phase 1: Uterine Quiescence

81
Q 
Myometrial changes
Preparation for Labor
  ✔ ⬆ responsiveness to uterotonins
  ✔ lightening: formation of lower uterine 
      segment
  ✔ cervical ripening
A

💠 Phase 2: Activation

82
Q 
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
A

💠Phase 3: Stimulation

83
Q

✔ uterine involution
✔ cervical repair
✔ breastfeeding

A

Phase 4 of Parturition

84
Q

Change of shape of the uterus from discoid to ovoid

A

Calkin’s sign

85
Q

Signs of Placental separation

A

Calkin’s sign
Gush of blood
Uterus rises in the abdomen
Lengthening of the cord

86
Q

Central, shiny part out first - fetal membranes

A

Schultze’s

87
Q

Dirty side, maternal side out first- cotelydons of placenta

A

Duncan’s

88
Q

Episiotomy heals in

89
Q

Arrest or retardarion of involution; prolongation of lochial discharge or bleeding

A

Subinvolution

90
Q

Arrest or retardarion of involution; prolongation of lochial discharge or bleeding

A

Subinvolution

91
Q

Most common manifestation of postabortal infection

A

Endomyometritis

92
Q

Snow storm pattern

A

Complete mole

93
Q

Cannon ball exudates

A

Complete mole

94
Q

Lower limit of contraction pressure required to dilate the cervix

95
Q

Epidural anesthesia prolongs what stage of labor

A

1st and 2nd stage of labor

96
Q

Delivery of aftercoming head. Assistant should apply suprapubic pressure to fabor flexion and engagement of fetal head

A

Mauriceau-Smellie-Veit-Maneuver

97
Q

Delivery of aftercoming head. Assistant should apply suprapubic pressure to fabor flexion and engagement of fetal head

A

Mauriceau-Smellie-Veit-Maneuver

98
Q

rotation of the trunk of the fetus during a breech birth to facilitate delivery of the arms and the shoulders

A

Lovset maneuver

99
Q

Replacement of fetus higher into the vagina and uterus, followed by cesarean delivery

A

Zavanelli maneuver

100
Q

Maneuver to convert frank breech into a footling breech

A

Pinard maneuver

Breech decomposition

101
Q

Shoulder dystocia:

involves hyperflexing the mother’s legs tightly to her abdomen.
Lift the legs

A

McRobert’s Maneuver

102
Q

Shoulder dystocia

Suprapubic pressure over posterior aspect of anterior shoulder

A

Mazzanti maneuver

103
Q

Shoulder dystocia

Two fingers vaginally pushing the posterior aspect of anterior shoulder towards the chest

A

Rubin maneuver

104
Q

Shoulder dystocia

Two fingers on the anterior aspect of posterior shoulder to rotate obliquely

A

Wood’s corkscrew maneuver

105
Q

Patient in all 4’s. Grasp the posterior arm, sweep against chest and deliver

A

Gaskin’s maneuver

106
Q

Most frequent medical condition associated with abruptio placenta

A

Hypertension

107
Q

Painful uterin bleeding in pregnancy

A

Abruptio placenta

108
Q

is a life-threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into theuterinemyometrium forcing its way into the peritoneal cavity.

A

Couvelaire uterus

109
Q

Painless bleeding usually near the end of the 2nd trimester or later

A

Placenta previa

110
Q

Most imoortant criterion for diagnosis postpartum metritis

111
Q

Application of atraumatic clamps to each round ligament followed by upward traction

A

Huntington procedure

112
Q

Longitudinal surgical cut is made posteriorly throught the ring to expose the fundud and permit reinversion

A

Haultain incision

113
Q

Longitudinal surgical cut is made posteriorly throught the ring to expose the fundud and permit reinversion

A

Haultain incision

PLE SEPTEMBER 2018 (26 decks)

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