OB Lecture- Keppler 2

Question 1

What is a good rule to live by in pregnancy?

Answer 1

“If it happened before, it is more likely to happen again”

Question 2

True or false: Clinical pelvimetry can accurately predict a woman’s likelihood of delivering vaginally?

Answer 2

B. False ← The best predictor is a trial of labor

Question 3

True or false: Most tests done in pregnancy are diagnostic tests?

Answer 3

B. False ← Most tests are screening tests

Question 4

Which of the following complications from prior pregnancies do not predict an increased risk of recurrence in the current pregnancy?
A. Preeclampsia
B. Gestational diabetes
C. Labor dystocia
D. Postpartum hemorrhage
E. None of the above

Answer 4

E. None of the above ← I challenge you to think of a complication in pregnancy that does not increase the risk of the same complication
in future pregnancies

Question 5

What are two things that are NOT normal in pregnancy?

Answer 5

○ Vaginal bleeding

○ Severe pain

Question 6

What are three things to put on the ddx for first trimester bleeding?

Answer 6

○ Ectopic pregnancy
○ Spontaneous abortion (miscarriage)
○ Gestational trophoblastic disease

Question 7

What are three things to put on the ddx for 2nd and 3rd trimester bleeding?

Answer 7

○ Preterm labor / labor
○ Placental abruption
○ Placenta previa / vasa previa

Question 8

WHat amount of weight gain is normal in pregnnat women?

Answer 8

25-35 lbs

Question 9

Is exercising when pregnant ok?

Answer 9

Yes! Recommend 30 min daily

Benefits: 
○ Less weight gain
○ Better conditioning
○ Decreases morbidity
○ Improved sleep
○ Risk of GDM decreased?

Question 10

What are three important supplements to take in pregnancy?

Answer 10

● Iron: 30 mg (60-120 if anemic)
● Calcium: 1200 mg
● Folate: 400 mcg
○ 4 mg if has a history of neural tube defects (NTD), or using anticonvulsants

Question 11

Is sex ok in pregnancy?

Answer 11

● Does not increase risk to uncomplicated pregnancies

Question 12

Is travel ok in pregnancy?

Answer 12

● No consensus on what restrictions are appropriate
● Some airlines may require MD note
● Red flag for high risk pregnancy

DVT, separation from primary provider and Zika/Covid are all risks though

Question 13

Which of the following is not a common complaint of pregnant patients?
A. Breast tenderness
B. Dysuria
C. Nausea
D. GERD

Answer 13

B. Dysuria ← Usually suggests underlying pathology like UTI or vaginitis

Question 14

True or False: Bleeding is always considered abnormal in pregnancy?

Answer 14

A. True ← But is actually quite common and most causes are fairly benign

Question 15

For which class of drugs should you increase the Folate micronutrient supplementation in pregnancy?
A. Anticholinergics
B. Antihypertensives
C. Anticonvulsants 
D. Antidepressants

Answer 15

C. Anticonvulsants ← Primarily to decrease risk of neural tube defects

Question 16

What is the highest teratogenic risk for pregnant women?

Answer 16

During organogenesis (2-10 weeks)

Question 17

What are some common and safe meds used in pregnancy?

Answer 17

○ Acetaminophen
○ Antihistamines
○ H2 blockers
○ Topical treatments like inhaled corticosteroids for asthma
○ Some BP medications - labetalol, nifedipine (other’s contraindicated)

Question 18

What meds are contraindicated in pregnancy?

Answer 18

○ Many anticonvulsants
○ Renal medications (e.g. ACE inhibitors, ARBs, diuretics)
○ NSAIDs (premature closure of ductus arteriosis)
○ Retinoids
○ Certain antibiotics (e.g. doxycycline)

Question 19

What is bad about taking opoids in pregnancy?

Answer 19

Do not seem to increase risk of fetal malformation. However, maternal and fetal withdrawl risk

Question 20

True or False: Opiates in pregnancy increase risk of teratogenesis if given in during embryogenesis?

Answer 20

B. False ← Evidence does not support this

Question 21

Which of the following medication classes is not generally contraindicated in pregnancy?
A. Antihistamines
B. Retinoids
C. Antihypertensives acting on the kidneys (ACE / ARB, diuretics)
D. NSAIDs

Answer 21

A. Antihistamines ← Used commonly for allergies, nausea

Question 22

Which of the following is a risk of tobacco use in pregnancy?
A. Preeclampsia
B. Preterm labor 
C. Gestational diabetes
D. Large for gestational age fetus

Answer 22

B. Preterm labor ← Others include miscarriage, placental abruption, SGA fetus, fetal demise

Question 23

How frequent are prenatal visits recommended?

Answer 23

Monthly through 32 weeks after establishes care
● Then, every 2 weeks until reaches term
● Then, weekly through delivery

Question 24

What post-term visits are recommended?

Answer 24

● If post-term, usually starting 41 weeks, may recommend twice weekly
surveillance visits until delivery
○ Most practices recommend delivery at / after 41 weeks if hasn’t labored spontaneously

Question 25

True or False: The frequency of prenatal visits remains relatively constant throughout the pregnancy?

Answer 25

B. False ← Duh! A Softball

Question 26

What routine labs are indicated at onset of pregnancy care?

Answer 26

Routine labs at onset of care include CBC, STI and infectious disease screening,
Rubella immune status, and blood type and antibody screen.