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Step 2 > OBG 2 > Flashcards

OBG 2 Flashcards

1
Q

magnesium should be monitored for signs of toxicity (somnolence, areflexia, respiratory suppression).
What pts are at increased risk for toxicity?

A

renal insufficiency

(bc magnesium is excreted by the kidneys)
Hypocalcemia is a potential adverse effect

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2
Q

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid unilateral ovarian mass

A

Sertoli-Leydig Tumor

Surgery required (2nd trimester or postpartum)
*High fetal virilization risk

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3
Q

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Cystic, bilateral ovarian masses

A

Theca lutein cyst

Spontaneous regression of masses after delivery (observe)
*Low fetal virilization risk

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4
Q

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid, unilateral/bilateral ovarian masses

A

Luteoma

Spontaneous regression of masses after delivery (observe)
*High fetal virilization risk

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5
Q

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
No ovarian mass on exam

A

Placental Aromatase Deficiency

Resolution of maternal symptoms after delivery (observe)
*High fetal virilization risk

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6
Q

Used to monitor fetal status in pregnancies complicated by maternal hypertension or fetal growth restriction.

A

Umbilical artery Doppler ultrasound

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7
Q

Low/↓ Maternal serum α-fetoprotein on quad screen indicates what?

A

Aneuploidies (eg, trisomy 18 & 21)

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8
Q

High/↑ Maternal serum α-fetoprotein on quad screen indicates what(3)?

A

Neural tube defects (anencephaly, open spina bifida)
Ventral wall defects (omphalocele, gastroschisis)
Multiple gestation
(these pts require fetal ultrasound)

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9
Q

Anti-D immune globulin (RhoGAM) is indicated in unsensitized, Rh-negative women at __ weeks gestation or within 72 hours of any procedure or incident in which there is any possibility of feto-maternal blood mixing.

A

28

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10
Q

Pruritus that is most severe on the palms with no associated rash occuring in the third trimester is consistent with what diagnosis?

A

Intrahepatic cholestasis of pregnancy (ICP)
s/t ↑ estrogen & progesterone levels causing hepatobiliary tract stasis and decreased bile excretion HENCE elevated total bile acids (≥10 µmol/L) which is diagnostic.

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11
Q

Management of Intrahepatic cholestasis of pregnancy (ICP) includes:

Antihistamines
Delivery at 37 weeks gestation
and what medication?

A

Ursodeoxycholic acid

cx: IUFD, Preterm delivery, Meconium-stained amniotic fluid, NRDS

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12
Q

Significant postpartum hemorrhage can cause _____.
Typically presents with bleeding and/or thrombosis (acute pulmonary embolus), thrombocytopenia, & prolonged PT & PTT

A

disseminated intravascular coagulation (DIC)

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13
Q

Prophylactic latency antibiotics (erythromycin, ampicillin) are indicated in patients at __ weeks gestation with preterm prelabor rupture of membranes to prevent fetal infection

A

<34

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14
Q

magnesium sulfate is administered for fetal neural protection to patients at __ weeks gestation

A

<32

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15
Q

A rare obstetrical emergency causing rapid hemodynamic instability and pulmonary edema.

A

Amniotic fluid embolism

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16
Q

A rare obstetrical emergency that can present with a vaginal mass, massive hemorrhage, and hemodynamic instability. Uterus is not palpable post-partum.

A

Uterine Inversion

17
Q

A rare obstetrical emergency that can present with a vaginal mass, Rectal or vaginal pressure, massive hemorrhage (can be concealed bleeding), ± hemodynamic instability.

Risk factors include: Operative vaginal delivery (obstetric trauma), Infant ≥ 4kg (8.8 lb)

A

Vaginal hematoma

Nonexpanding: observation
Expanding: embolization, surgery

18
Q

Preeclampsia can present up to __ weeks postpartum with headache and hypertension.

A

6
(if pt has a focal neurologic deficits a CT head is indicated)

19
Q

Patients with ___ in their current pregnancy or those who delivered a prior infant with early-onset GBS infection are high risk and require intrapartum antibiotic prophylaxis.

A

GBS bacteriuria

20
Q

Digital Cervical Exam may be insufficient for determining fetal presentation in patients with a bulging bag (which may be a normal finding s/t contractions tensing the sac).
If fetal presentation is indeterminate (no palpable presenting fetal part) on cervical exam, what is performed to confirm presentation and help determine route of delivery?

A

transabdominal ultrasound

Cephalic fetal presentation → managed expectantly
Non-cephalic (breech, transverse, funic/cord first) fetal presentations → cesarean delivery

21
Q

Presents with acute abdominal pain; a rigid, tender uterus; and high-frequency contractions.
Risk factors include cocaine and tobacco use, which cause placental vasoconstriction.

A

Placental Abruption

(20% have a concealed abruption w/ no visible bleeding. Usually have severe focal pain at the location of the placenta that progresses to diffuse uterine tenderness)

22
Q

Uncomplicated perineal lacerations (no fever or purulence) are managed how?

A

conservatively
(NSAIDs, sitz baths)

23
Q

Management of Placenta Accreta refractory to uterine massage, uterotonic meds, and manual extraction/ sharp uterine curettage of retained placenta.

A

Cesarean hysterectomy with placenta in situ

24
Q

Management of uterine inversion

A
  1. manual replacement (stop uterotonics)
  2. If refractory, uterine relaxants and laparotomy
25
Q

Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction.
Management is with what three interventions?

A

Left lateral patient positioning
IVF bolus
vasopressors (phenylephrine, vasopressin)

25
Q

Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction.
Management is with what three interventions?

A

Left lateral patient positioning
IVF bolus
vasopressors (phenylephrine, vasopressin)

26
Q

Presents with severe abdominal pain; uterine tenderness; a palpable, firm & tender mass; and signs of inflammation (eg, leukocytosis).

A

Uterine fibroid degeneration

(Leiomyomata uteri become an infarcted, degenerating uterine fibroid during pregnancy)

27
Q

Category 3 FHT (very bad) are defined by
1. Sinusoidal pattern
or
2. Absent variability PLUS one of what 3 FHT findings?

A

recurrent late decelerations (slow after every contraction)
recurrent variable decelerations (fast not always after every contraction)
bradycardia (Less than 100 bpm baseline)

28
Q

Management of Category 3 FHTs

A

Initial management is with intrauterine resuscitative interventions (maternal repositioning, Oxygen, IVFs)

If no improvement with initial management and are far from delivery require immediate cesarean delivery.

29
Q

Inevitable abortion presents with heavy vaginal bleeding, cramping, and a dilated cervix without passage of gestational tissue. ____ management is indicated for patients whose condition is hemodynamically unstable or has signs of infection?

A

suction curettage (surgical management)

30
Q

In Inevitable abortion where the pt is hemodynamically stable with minimal bleeding what 2 types of management are appropriate?

A

Medical induction (Misoprostol) or expectant management

31
Q

Persistently absent or minimal variability on fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, certain ___ can also cause decreased variability (fetal CNS depression).

A

medications (opioids/narcotics)

32
Q

Indomethacin tocolysis (inhibit contractions) is indicated in patients with preterm labor at __ weeks gestation.
*can cause oligohydramnios and premature closure of the fetal ductus arteriosus (benefits > risks)

A

<32

33
Q

Pregnancy complicated by chronic hypertension confers an elevated risk of ___ & ___ due to uteroplacental insufficiency.

A

fetal growth restriction (<10th percentile)
oligohydramnios (amniotic fluid index [AFI] ≤5 cm)

34
Q

Obesity in pregnancy (prepregnancy BMI ≥30 kg/m²) increases risks of ___ & ___

A

Intrauterine fetal demise
fetal macrosomia (>90th percentile)

35
Q

Diabetes mellitus in pregnancy increases the risk for ___ & ___

A

macrosomia (>90th percentile)
polyhydramnios (AFI ≥24 cm)

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