OB NAGY FAVE Flashcards
Appendicitis in pregnancy, difficult to diagnose why?
Leukocytosis may occur in pregnancy
Physiologic changes in pregnancy, renal system, hormonal changes
◆ increased RBF and GFR, decreased serum Creatinine
◆ Increased Total thyroid hormone, increased basal metabolic rate
➔ Multiple gestation: How to differentiate dizygotic from monozygotic twins
◆ If the twins are of different sex, i.e. boy and girl = dizygotic
➔ What does HELLP stand for
◆ Hemolysis, elevated liver enzymes, low platelet count
➔ Toxoplasma - how can you get it?
◆ Household pets (cats)
➔ classification of C/S indications
◆ Elective indication
● Maternal: previous CS, underlying disease
● Fetal: threatened asphyxia
● Maternofetal: dystocia, prolonged labor, twin pregnancy
◆ Vital indication
● Maternal: DIC, severe hemorrhage
● Fetal: asphyxia, transverse lie, umbilical cord prolapse
● Maternofetal: Eclampsia, uteroplacental insufficiency, placenta previa,
placental abruption, uterine rupture
➔ how to check if a Fetus is infected with Toxoplasma
◆ do amniocentesis and check the viral dna
➔ Treatment of toxoplasmosis
◆ Of affected women during pregnancy is by spiramycin
◆ Of infected fetus: pyrimethamine and sulfadiazine
➔ Licit & illicit drug use
◆ mention the BP-drugs you CAN give in pregnancy: Labetalol, nifedipine,
a-methyldopa
➔ Preterm labour - what drugs do you give?
◆ Betamethasone and AB prophylaxis
➔ What is difficult with Gi disorders in pregnancy?
◆ Pregnancy may imitate symptoms such as leukocytosis and constipation making
them difficult to diagnos
➔ Uterine rupture how to diagnose on physica
◆ loss of fetal station, nature of patients pain changes to diffuse abdominal pain as
opposed to contractions
➔ How to diagnose placental abruption/What examination would you do first?
◆ physical exam, feel hypertonic uterus
➔ Polyhydramnios/Oligohydramnios—how to measure (AFI), what are the cutoff values
◆ <6 = oligo. >24 = poly
➔ Which patients would you send for genetic testing?
◆ Older patients, Diabetic patients (specifically mentioned Hba1c level here),
patients with previous pregnancy with aneuploidy or other abnormalities
➔ Physiological changes in pregnancy, CV changes
◆ literally mentioned HR CO CV increase and plasma volume increase and he
moved on
➔ Who should you screen for DM?
◆ Everyone should be screened (week 24-28)
➔ Malpresentation: Which of the breech malpresentations can be delivered vaginally?
◆ I answered Frank breech and complete breech, and he was happy with only
Frank breech
➔ How would you diagnose intrauterine death?
◆ US
➔ What is PPROM and what are the causes?
◆ Preterm premature rupture of membranes
◆ Causes: ascending vaginal and cervical infection
➔ Physiological changes of thyroid during pregnancy:
◆ Increase hCG may function as TSH, elevation of TBG, concentration of free
thyroid hormones and TSH stays the same (but total T hormone increases)
➔ Consequences of hyperthyroidism in pregnancy
◆ IUGR, mental retardation, elevation of BP → abruption
➔ Superimposed preeclampsia:
◆ chronic HT before <20th gestational week. After 20th week get >300mg
proteinuria /day.
➔ Postpartum hemorrhage:
◆ laceration (trauma), atony (tone), placental part left in uterus (tissue), DIC
(thrombin)
➔ What do you do in a patient with asymptomatic gallstones?
◆ wait and do elective cholecystectomy after pregnancy.
➔ What’s a sign of a missed abortion?
◆ See retained fetus in uterine cavity during routine prenatal care, risk of DIC
➔ Worrying sign in prolonged labour?
◆ If the woman suddenly feels a sense of relief after straining a lot - If the baby is
unable to pass through the birth canal and the uterus ruptures
➔ Dystocia w normal position and presentation causes?
◆ Macrosomia, shoulder dystocia, maternal pelvic alterations (think 3 Ps: power,
passage, passenger)
➔ Advice during pregnancy
◆ No alcohol, drugs, proper diet, seatbelt
➔ Problem with UTI during pregnancy
◆ ascending infection —> premature birth, PROM, etc
➔ Problem with PROM
◆ infections, abnormal presentation, placental abruption
➔ CMV infection - how to diagnose
◆for initial diagnosis: US the placenta, there will be cysts. Then check mother for TORCH w/ serology. then if mother positive–> Amniocentesis and look for viral genome.
➔ Anesthesia for a C-section
◆ spinal
➔ Physiologic puerperium duration
◆ 6 weeks
➔ Perinatal mortality rate
◆ Number of fetal (from week 24) deaths + number of neonatal (until 7th day after
birth) deaths/1000 total live births
➔ Neonatal death from what week?
◆ 24th week
➔ How often does a doctor or nurse have to check on a woman in 2nd stage of labor
◆ Continuously
➔ Placenta previa types and complications
◆ Total, partial, marginal, low-lying
◆ Complications: fetal malpresentation, vasa previa, PPROM, IUGR
➔ Definition of abortion
◆ Induced abortion: Medical or surgical termination of pregnancy before 24th
gestational week
◆ Spontanous abortion: non-induced emryonic or fetal death or passage of
products of conception before 24th gestational week
➔ Gestational week of GDM screening
◆ 24-28th gestational week
➔ What malpresentation requires c-section
◆ Transverse lie, ?
➔ What is the problem of cervical implantation
◆ Ectopic pregnancy?
➔ Causes of macrosomia
◆ Maternal diabetes, maternal obesity, genetic, gestational age >40 w
➔ Malpresentation: different types of transverse lie
◆ he explained that it can be left-right, facing up-down, backwards-forwards
➔ Advices during pregnancy: what advice would you give to a pregnant woman? Would
you recommend physical exercise, esp during 1st and 2nd trimester?
exercise, no alc, no cigi, proper seatbelt,… IDK dawg
➔ Main form of congenital malformation in GI
◆ Omphalocele, gastroschisis, anal atresia
➔ Birth Canal lesions:
◆ He wanted to know especially perineal tears and that I described the different
degrees, what is the worst possible outcome: that you have complete
continuity between then vaginal opening and the opening to the anal canal.
➔ What a normal ctg looks like
FHR=110-160, 2 fluctuations to high HR for 15s every 2 mins
➔ What is important to determine with suspected IUGR
◆ make sure you compare to the previous US to see if it might just be wrong
estimation of gestational week or actual IUGR
➔ Lesions of the birth canal and uterine rupture: Why is it important to repair the
cervix?
◆ For possible future pregnancies
➔ When (what stage of labor) do the membranes rupture? Early or late?
◆ First stage, Late. Or earliest 1 hour before labor starts.
➔ Drugs used in 1st and 2nd stage of labour
i guess Prostaglandin for dilation and oxytocin for contraction (or glucose but that aint no drug)
➔ Maneuver used in malpresentation (they wanted the authors name)
◆ Leopold
➔ Methods of contraceptives and she asked me about the name of statistically finding the
number of effective contraceptives
◆ Pearl index
➔ Which classification would you use for pregnant women with cardiovascular disease?
◆ New York heart association (NYHA)
➔ Definition of eclampsia
◆ Unexplained generalized seizures in patient with preeclampsia (which is
BP>140/90 + proteinuria >300mg/day
➔ Cause of oligohydramnios
◆ Decreased urine production of the fetus (renal agenesis)
➔ Dystocia - maternal causes?
◆ Cephalopelvic disproportion, pelvic shape (he also asked which type, and I
mentioned android & anthropoid, but not sure whether it was correct), he also
said trauma
➔ What fetal position enables vaginal delivery of twins?
◆ only if the first fetus is in the proper position, no breech! (also not frank)
➔ Types of IUGR
◆ Symmetric (fetal causes) and asymmetric (maternal and placental causes)
➔ name drugs you can’t give during the 1st trimester
◆ antiepileptic, ACEi, folic acid inhibitors, coumarin
➔ differentiation between placental abruption and previa:
◆ the emphasis is on a rock hard uterus in abruption, not the pain (b/c all women
would be stressed and pain is not a proper indicator)
➔ When can we see thrombocytopenia in pregnancy?
◆ Said HELLP Syndrome and DIC but he just kept saying “and..?”, when I
couldn’t think of more he asked me if I knew what TTP and HUS stood for
(Thrombotic Thrombocytopenia and Hemolytic Uremic Syndrome) and then
moved on to next Q so maybe that was the remaining ones..?
➔ First stages after conception and how many cells?:
◆ Zygote (1) -morula (16) -blastocyst (+32)
➔ What hormones is responsible for starting onset of labor:
◆ cortisol in fetus
➔ IUGR: Does chromosomal abnormality cause symmetrical or asymmetrical ?
◆ Symmetrical (fetal causes)
➔ HEELP: definiton, how much thrombocytopenia
◆ Hemolysis, elevated liver enzymes, low plt count
◆ Mississippi classification of low plt count:
● M3 less than 150 G/l
● M2 less than 100 G/l
● M1 less than 50 G/l
➔ IVF: in whom do we do it immediately:
◆ tubal ligation (strictures)
➔ Pathological puerperium extragenital causes:
◆ mastitis, UTI, thrombophlebitis, atelectasia
➔ Common factor and difference between SGA and IUGR
◆ Both are in the lower 10th percentile of fetus size, but SGA is usually
physiological while IUGR is always pathological.
➔ Respiratory resucitasion - whole cascade and how to give compressions
◆ Place newborn in warm environment, stimulate breathing by rubbing its chest.
◆ If after 30 secs HR is less than 100, there is gasping or no breathing, start
Positive pressure ventilation
◆ If HR is still low after 60 secs, consider endotracheal intubation
◆ If HR remains low despite adequate ventilation for 30 secs, start chest
compressions (3:1 ratio)
◆ If HR remains low despite adequate ventilation and chest compressions give
IV epinephrine
➔ What fetal parameters help to determine potential cephalopelvic disproportion?
◆ Biparietal diameter (~10cm) Head circumference.
➔ What maternal parameters help to determine potential cephalopelvic disproportion?
◆ I starting talking about pelvic size and shape and I think I got the mark for
that but he said it’s based more on maternal height now. (Short means
higher chance of dystocia)
➔ Why is cordocentesis done nowadays?
◆ To give transfusions
➔ Which antihypertensives are contraindicated in pregnancy?
◆ Propranolol, ACEi, ARBs, Diuretics
➔ How to treat 1-2 stage of labor:
◆ (external) Leopold, (internal) ctg, blood pressure (preeclampsia) and
infections eg gbs
➔ Advices: smoking, what would you advice, how does it affect and what can it cause?
◆ Don’t smoke, causes hypoxia and vasoconstriction of vessels, can cause
IUGR in fetus
➔ What is the connection between the topics intrauterine fetal death and postterm
pregnancy
◆ ?? postterm pregnancy is associated with increased perinatal mortality
➔ What are the signs that the placenta has detached in the 3rd stage of delivery
◆ Fresh blood from the vagina
◆ Umbilical cord lengthens outside the vagina
◆ Fundus rises up and uterus becomes firm and globular
➔ Why can breech position cause dystocia
◆ Breech position causes more complications: umbilical cord prolapse and
decreased O2 supply to fetus, head entrapment, injury to fetal brain and skull
(when in Breech and descending rapidly through the uterus, the head doesn’t
gradually mold to the pelvis as it does in cephalic position).
➔ Why is urinary tract infections not wanted in pregnancy and how does it ascend
◆ Asymptomatic bacteruria can cause premature labor and PROM, low birth
weight (thereby increased perinatal mortality)
➔ List hormonal changes in pregnancy
◆ Increased prod of TBG, increased total T hormone but free T3 and T4 and TSH remain unchanged. Increased BMR ◆ Increased blood flow to pituitary ◆ Increased cortisol, ACTH ◆ Increased prolactin, hCG, oxytocin
➔ Pregnancy and Cardiovascular disease - What type of sceening do you perform on a
pregnant female with cardiac def?
not really screening but file said NYHA
➔ Which NYHA stage is CI to get pregnant?
◆ Absolute CI: stage IV
◆ Relative CI: stage III
➔ Amniotic fluid and its disorders. Poly. Oligo - What is the cut of value for poly and
oligo
◆ He said 6 cm and 24 cm.
➔ How to you measure AFI?
◆ 4 quadrant measurement of AM and take the deepest pocket and add them
together
➔ Infectious diseases in pregnancy. Bacteria and parasite. - What advices would you
give to pregnant female to avoid toxoplasmos?
◆ IF the female has a cat, avoid any contact with the cat, either the husband
takes care of it or place it somewhere else. Advice to wash her hand
everyday if the cat is in the house. Avoid raw meat and unpast milk.
➔ Main form of congenital malformation: - What is the most common gastric
malformation?
◆ Omphalocele and gastroschisis
➔ 3rd stage of normal labor ‘placental delivery’: He asked what would be done outside
of the hospital setting if the placenta took longer than 30 minutes to deliver?
◆ NO TOUCH TECHNIQUE ( do not do uterine massage unless in the hospital
with OBGYN specialists due to the risk of placental retention and PPH.
➔ Timing of each of the stages
◆ Stage 1: longest stage
◆ Stage 2: 30-90 mins
◆ Stage 3: shortest stage, 5-30 mins
◆ Stage 4: recovery, 2 hours
➔ Fetal head movements
: flexion, internal rotation, extension, and external rotatio
➔ Prophylaxis meds in PPROM and for what
◆ Antibiotics: 48 hr IV ampicillin+erythromycin, followed by po amoxicillin and
erythromycin
◆ Corticosteroids if before 34th week of gestation to accelerate lung maturity
◆ IV magnesium sulfate if before 32 week
◆ Tx of chorioamnionitis: amp+genta
➔ Degrees of perineal tears and what anatomic structure is affected
◆ 1st degree: only perineal mucosa - no need to suture
◆ 2nd degree: perineal mucosa and muscles - need to suture
◆ 3rd degree: external anal sphincter
◆ 4th degree: internal anal sphincter and rectal mucosa
➔ Whats the difference in umbilical cord prolapse and and umbilical cord presentation
◆ Cord prolapse is when the membranes rupture
➔ Dystocia caused by abnormal presentation and position of the fetus
◆ Persistent occipitotransverse or occipitoposterior presentation? Breech
➔ Induction and augmentation of labor, what medications to use
◆ Oxytocin
◆ Intravaginal prostaglandin E2
◆ (artifical ROM aka amniotomy, membrane sweep and balloon catheter can
also be used)
➔ Which CV disease are of highest risk/is the most dangerous in pregnancy?
◆ Postpartum (dilative) CMP
➔ What type of delivery in P.previa?
◆ C-section
➔ How do you do Leopold manouver? Describe all types and what you can feel
◆ 1. Fundal grip - feel the fundus, height of the fundus, breech/cephalic
◆ 2. Umbilical grip - localize fetal back
◆ 3. Pelvic grip - fetal presenting part - breech/cephalic, engagement of
presenting part
◆ 4. Second pelvic grip, facing woman’s feet. Attempt to locate brow with both
hands. Assess degree of flexion of fetal head.
➔ Patient with type 1 diabetes
◆ Don’t do OGTT!! Can kill the patient
◆ Monitor blood glucose and HbA1c
◆ Offer an abortion if patient gets pregnant and has poorly controlled diabetes
◆ Risk for baby: congenital malformations, IUGR, hypoglycemia
◆ When do you diagnose IUGR in fetus: gestational week 30-32
◆ What do you look for during US: head circumference, abdominal
circumference, limb length, etc. Compare it to fetuses of the same gender
and gestational week.
➔ Rh isoimmunization
◆ When can mixing of maternal and fetal blood occur: placental abruption,
bleeding during pregnancy, during labor
➔ Definition of gestational hypertension
◆ BP over 140/90 measured two times with 4 hours apart
◆ Or BP over 160/110 measured one time
