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Obstetrics PLE > OB PLE > Flashcards

OB PLE Flashcards

1
Q

Pelvis:
Anything below the linea terminalis

Bounded anteriorly by pubic bones, laterally by inner surface of ischial bones and posteriorly by sacral promontory

A

True Pelvis

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2
Q

Represents the shortest diameter of the pelvic cavity which is an important landmark in assessing level to which presenting part has descended

A

Ischial spines

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3
Q

Pelvis:
Anything above the linea terminalis

Bounded anteriorly by lower abdominal wall, laterally by iliac fossa
And posteriorly by lumbar vertebrae

A

False pelvis

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4
Q

2 important diameters in pregnancy

A

Obstetrical conjugate and diagonal conjugate

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5
Q

Shortest distance bet. Symphysis pubis and sacral promontory

Cannot be measured directly

Approximately 10cm

A

Obstetrical conjugate

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6
Q

Distance between midportion of sacral promontory to upper margin of symphysis pubis

A

True conjugate

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7
Q

Distance from lower margin of symphysis pubis to the sacral promontory

Can be assessed clinically

Approximately 11.5-12cm

A

Diagonal conjugate

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8
Q

Distance bet. the farthest two points of the pelvic brim over linea terminalis

A

Transverse Diameter

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9
Q

If the lowest part of occiput is at/below the level of the ischial spine

A

Engagement

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10
Q

Inadequate midpelvis/midpelvic contraction

A

Narrow sacrosciatic notch
prominent ischial spine
Convergent sidewalls

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11
Q

Pelvic outlet contraction

A

Bituberous diameter <8cm

Narrow suprapubic arch

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12
Q

Pelvis that is most suitable for normal delivery

Round shape

Sacral angle >90 inclined backwards

A

Gynecoid pelvis

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13
Q

Pelvic bones

A

Ischium
Pubis
Ilium
Sacrum

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14
Q

3 muscles of the pelvic floor

Covered by parietal layer of pelvic fascia

A

Levator Ani
Iliococcygeus
Pubococcygeus

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15
Q

Heart shaped pelvis, suprapubic arch <90,

More common in males

A

Android Pelvis

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16
Q

AP diameter > transverse diameter

Narrow sidewalls, wide inclination of sacrum, ischial spines not prominent

A

Anthropoid pelvis

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17
Q

Supports the pelvic organs

Controls the external anal sphicter through puborectalis

Stabilizes sacroiliac and sacrococcygeal joints through ischiococcygeus

A

Pelvic diaphragm

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18
Q

Most common type of malpresentation

A

Breech

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19
Q

Hips are flexed, knees extended over anterior surface of the body

Most common type

Ideal for vaginal delivery

A

Frank breech

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20
Q

Hips flexed and knees flexed

A

Complete breech

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21
Q

Hyperextension of fetal head

Occiput is at the same side

Mentum/chin is the presenting part

A

Face presentation

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22
Q

Military attitude

Head is partially flexed

A

Sinciput presentation

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23
Q

Neck is fully flexed, chin in contact with thorax

A

Vertex/Occiput presentation

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24
Q

Lateral deflection of the head in labor that the sagittal suture is not at midline

A

Asynclitism

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25
Q

Longitudinal axis of fetus to that of the mother

A

Fetal lie

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26
Q

Sagital suture approaches the sacral promontory

A

Anterior Asynclitism/Naegele’s Obliquity

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27
Q

Sagital suture approaches the symphysis Pubis

A

Posterior asynclitism

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28
Q

Irregular contractions with long intervals and same intensity

Does not radiate to lumbosacral area

Sedation stops contraction

A

False labor

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29
Q

Regular contractions with shortening intervals

Intensity increases

With cervical effacement and dilation

A

True labor

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30
Q

Most common injury associated with shoulder dystocia

A

Brachial plexus injury

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31
Q

Maneuver:
Remove legs from stirrups and sharply flexing them up onto the abdomen

Decreasing the angle of inclination
Flattens/straightens sacrum

A

McRobert’s Maneuver

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32
Q

Maneuver:
Cephalic relacement into pelvis followed by CS

Reversal of cardinal movements of labor

A

Zavanelli maneuver

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33
Q

Maneuver:

Insert hand under symphysis pubis, reach for the accessible shoulder and push towards anterior surface of chest

A

Rubin’s maneuver

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34
Q

Cardinal Movements of labor

A 
(E-D-F-IR-E-ER-E)
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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35
Q

Maneuver:
Hand is used to exert forward pressure on the chin of the fetus through the perineum just front of the coccyx and other hand exerts pressure posteriorly against the occiput

A

Ritgen maneuver

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36
Q

Stages of labor:
Onset of regular contraction and ends at 4cm dilation

Nullipara: <20hrs
Myltipara: <14hrs

A

Stage 1: Latent phase

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37
Q

Stages of labor:
Starts at 4cm until complete cervical dilation

Nullipara: >1.2cm/hr
Multipara: >1.5cm/hr

A

Stage 1: Active phase

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38
Q

Functional Phases of Labor

A

Preparatory
Dilational
Pelvic Division

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39
Q

Active Phase of labor:

Predictive of the outcome of labor

4-6cm

A

Acceleration Phase

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40
Q

Active Phase of labor:

Measures the overall efficiency of the machine

7-8cm

A

Maximum Slope

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41
Q

Active Phase of labor:

Reflective of the fetopelvic relationship

8-10cm

A

Deceleration Phase

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42
Q

Lacerations of birth canal:

Involves the fourchette, perineal skin, vaginal mucous membrane

A

First Degree

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43
Q

Lacerations of birth canal:

Extends to the external anal sphincter

A

Third degree

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44
Q

Lacerations of birth canal:

Extends into the rectal mucosa

A

Fourth degree

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45
Q

Lacerations of birth canal:

Involves the fascia and perineal muscles

A

Second degree

46
Q

Separation of placenta occurs at the periphery first

Blood collects between the membranes and uterine wall and escapes from vagina

A

Duncan

47
Q

Detachement of placenta starts from the central portion

Blood does not escape externally until extrusion of the placenta

A

Schultze

48
Q

Episiotomy:

Easier to repair
Heals better
Less postoperative pin
More likely to extend to rectum

A

Midline episiotomy

49
Q

Episiotomy:

More room for delivery
More blood loss
More difficult to repair
More dyspareunia

A

Mediolateral episiotomy

50
Q

Signs of placental separation

A

Calkin’s sign
Sudden gush of blood from vagina
Lengthening of the cord
Uterus rises to abdomen

51
Q

Active management of labor

A

Oxytocin 10U IM
(+) contractions, controlled traction on umbilical cord while other hand places counter suprapubic pressure
Start oxytocin drip

52
Q

Forceps delivery:
Most common type used

For delivery of fetus with molded head

A

Simpson forceps

53
Q

Forceps delivery:

For fetus with a rounded head (common in multipara)

A

Tucker McLane Forceps

54
Q

Forceps delivery:

Ideal for rotating head

Head is engaged but is not at the level of perineal floor

A

Kielland forceps

55
Q

Forceps delivery:

The double pelvic curve facilitates application to the after-coming head in BREECH presentation

A

Piper forceps

56
Q

Forceps delivery:

Leading point of head is at station +2 but not on the pelvic floor

Rotation - >45 degrees

A

Low Forceps delivery

57
Q

Forceps delivery:

Leading point of head is above +2 or head is engaged

Fetal and maternal risks are greater

A

Midforceps delivery

58
Q

Forceps delivery:

Fetal head or scalp is VISIBLE AT THE INTROITUS

Rotation - <45 degrees

A

Outlet forceps

59
Q

Indications for Forceps Delivery

A

Fetal:
Non-reassuring FHR pattern

Maternal:
Prolonged 2nd stage of labor
Exhaustion
Heart disease
Pulmonary disorders
60
Q

Most common indication for primary cesarean delivery

A

Dystocia

61
Q

Breech delivery:

Usually used for small babies

Breech is allowed to deliver spontaneously up to navel

Fetal body held against symphysis pubis

A

Bracht maneuver

62
Q

Breech delivery:

2 fingers are placed on malar areas of the fetus

Flexes fetal head in order to permit pelvic passage

Other arm acts as a splint for the nect to prevent hyperextension of neck and exerts downward traction

A

Mauriceau-Smellie-Viet Maneuver

63
Q

Breech delivery:

Shoulder’s back pressure

Pull baby posteriorly until chin is under symphysis pubis and will act as a fulcrum to allow delivery

A

Prague maneuver

64
Q

Abortion:

Sx: minimal bloody vaginal discharge, no pain or very minimal hypogastric pain
Cervix: closed
Bag of water: Intact
Uterus compatible with AOG

Management: complete bed rest and Pain relief

A

Threatened Abortion

65
Q

Abortion:

Sx: minimal to moderate bloody vaginal discharge, minimal hypogastric pain
Cervix: admits tip
Bag of water: Intact

A

Imminent Abortion

66
Q

Abortion:

Sx: moderate bloody vaginal discharge, moderate hypogastric pain
Cervix: open
Bag of water: Ruptured

A

Inevitable Abortion

67
Q

Abortion:

Sx: profuse bloody vaginal discharge, severe hypogastric pain
Cervix: open WITH PASSAGE OF MEATY TISSUE
Bag of water: Ruptured
Management: elective D&C

A

Incomplete abortion

68
Q

Abortion:

Sx: minimal or absent bloody vaginal discharge
Cervix: closed
Uterus: uterus INCOMPATIBLE with AOG
Management: elective D&C

A

Missed abortion

69
Q

Abortion:

Three or more consecutive spontaneous abortion

A

Recurrent Abortion

70
Q

Painless vaginal bleeding

Cervical dilation (2nd or early 3rd trimester)

Balooning of membranes

A

Incompetent Cervix

Do cerclage

71
Q

Most commonly involved site of ectopic pregnancy?

A

TUBAL

72
Q

Most commonly involved site of tubal ectopic pregnancy?

A

Ampulla

73
Q

Most commonly involved site of ruptured ectopic pregnancy?

A

Isthmus

74
Q

Gold standard in diagnosis and subsequent management of ectopic pregnancy

A

Laparoscopy

75
Q

Most frequent symptom of ectopic pregnancy

A

Abdominal pain

76
Q

Candidates for medical management with Methotrexate in Ectopic pregnancy

A

Pregnancy <6weeks
Tubal mass less 3.5cm
Absent fetal heart tone
Serum B-hcg <15000mIU/ml

77
Q

Increase in cardiac output is attributed to which physiologic change?

A

Decrease systemic vascular resistance and increase heart rate

78
Q

Principal prostaglandin of endothelium

Regulates BP and platelet function

Decrease in preeclampsia

A

Prostacyclin (PGI2)

79
Q

Potent VASOCONSTRICTOR in endothelial and vascular smooth muscle cells

Regulates local vasomotor tone

Stimulates secretion ANP, aldosterone and catecholamine

A

Endothelin

80
Q

Potent VASODILATOR released by endothelial cells

Modifies vascular resistance during pregnancy

A

Nitric Oxide

81
Q

Normal blood loss in normal singleton spontaneous vaginal delivery?

A

500ml

82
Q

Normal blood loss in normal cesarean delivery and twin delivery?

A

1000ml

83
Q

Maternal blood expands most rapidly during what trimester?

A

2nd trimester

84
Q

Pulmonary anatomic changes during 2nd half pregnancy

A

transverse diameter of the thoracic cage increases by 2cm
Diaphragm rises about 4cm
Thoracic circumference increases about 6cm
Greater diaphragmatic excursion

85
Q

Changes in the lung volume during pregnancy

A

Increased: TV and IC
Decreased: FRC, RV and ERV

86
Q

Softening of the uterine isthmus

A

Hegar’s sign

87
Q

Softening and cyanosis due to increased vascularity and edema of the entire cervix

A

Goodell’s sign

88
Q

Increased vascularity affecting vagina and results in violet discoloration

A

Chadwick’s sign

89
Q

Melasma gravidarum

“Mask of Pregnancy”

A

Chloasma

90
Q

Primarily secreted by adipose tissue

Plays a role in body fat and energy expenditure regulation

Help regulate fetal growth

Deficiency: anovulation and infertility
Abnormally Elevated: preeclampsia and GDM

A

Leptin

91
Q

Secreted by the stomach in response to hunger

Has a role in fetal growth and cell proliferation

A

Ghrelin

92
Q

Major determinant of maternal insulin resistance after midpregnancy

Secreted by syncitiotrophoblasts

A

Placental Growth Hormone

93
Q

Intraabdominal remnants of the umbilical vein

A

Ligamentum venosum and falciform ligament

94
Q

Presence in the amniotic fluid is evidence of fetal lung maturity (after 34 weeks)

A

Pulmonary surfactant

95
Q

Most active component of pulmonary surfactant

A

Dipalmitoylphosphatidylcholine

96
Q

Test for uteroplacental function

A

Contraction stress test

97
Q

Test for fetal condition

A

Non-stress test

98
Q

Components of Biophysical profile

A 
Non-stress test
Fetal breathing
Fetal tone
Fetal movement
Amniotic fluid volume
99
Q

Onset, nadir and recovery of deceleration are coincident with the beginning, peak and ending of a contraction, respectively

A

Early deceleration

100
Q

Onset, nadir and recovery of deceleration are after the beginning, peak and ending of a contraction, respectively

A

Late deceleration

101
Q

Most common deceleration pattern

Onset, nadir and recovery of decelerations vary with successive contractions

A

Variable deceleration

102
Q

Decrease in fetal heart rate >15bpm, lasting for more than 2mins but less than 10minutes

A

Prolonged deceleration

103
Q

Phases of Parturition:

Prelude to parturition

Uterine quiescence, cervical softening

A

Phase 1 quiescence

104
Q

Phases of Parturition:

Uterine preparedness for labor, cervical ripening

A

Phase 2 Activation

105
Q

Phases of Parturition:

Uterine contraction, cervical dilation

A

Phase 3 Stimulation

106
Q

Phases of Parturition:

Uterine involution, cervical repair, breastfeeding

A

Phase 4 Involution

107
Q

Shortening of the cervical canal

Causes expulsion of the mucus plug

A

Cervical effacement

108
Q

Quantifiable method used to predict labor induction

A

Bishop Score

109
Q

What is the direct cause of most maternal deaths involving regional anesthesia?

A

High spinal blockade

110
Q

What anesthetic is associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels?

A

Bupivacaine

111
Q

Most common complication encountered during epidural anesthesia

A

Hypotension

Obstetrics PLE (1 decks)

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