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Continuum > OBGYN > Flashcards

OBGYN Flashcards

1
Q

the fetus is most vulnerable to teratogens at what point in pregnancy?

A

3-6 week embryo (5-8 weeks post LMP)

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2
Q

folic acid antagonists

A

(e.g., valproate, carbamazepine).

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3
Q

criteria for anemia in pregnancy

A

Hb < 11 mg/dL is anemia in pregnancy

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4
Q

what is preterm labor

A

Defined as labor <37 weeks with regular contractions and cervical change

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5
Q

management of delivery of baby <34 weeks

A

i.e. very preterm

Corticosteroids – lung maturation
Tocolytic drugs – delay delivery at least 48 hours for max steroid impacts
Group B strep prophylaxis/antibiotics if (+)
Magnesium sulfate – up to 32 weeks for neuroprotection
Wait for natural labor progression unless complication arise

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6
Q

at what point is it indicated to induce labor and how?

A

Labor induction using prostaglandins (as early as 41 weeks and 6 days)

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7
Q

what abx are indicated for management of chorioamnionitis

A

Ampicillin + gentamicin

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8
Q

what medication is indicated for management of primary HSV infection in pregnant mother

A

acyclovir followed by suppressive therapy from 36 weeks onward. cesarean delivery for active lesions

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9
Q

risk factors for postpartum hemorrhage

A

hx of prior bleeds, augmented labor, chorioamnionitis, macrosomia, obesity, multiple gestation pregnancy (twins), preeclampsia, prolonged labor

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10
Q

what is the #1 reason for maternal morbidity and death worldwide

A

postpartum hemorrhage

defined as losing >500ml after vaginal delivery or >1000ml after C-section

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11
Q

what is the microbial profile and virulence factors of group B strep (streptococcus agalactiae)

A

Gram positive, non-motile, non-spore forming, facultative anaerobe, cat negative, beta hemolysis
Virulence factors: capsule, pilli, sialic acid, beta hemolysin

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12
Q

normal range for amniotic fluid index

A

5-24cm

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13
Q

what cervical dilation size is c/w active labor

A

> 3cm dilation

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14
Q

commonest drug used to induce labor

A

misoprostol (PGE analog)

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15
Q

what labs confirm DIC

A

low platelets, elevated d-dimer, elevated PT/PTT, decreased fibrinogen

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16
Q

what is the time range for normal delivery in weeks

A

37-42
if <37 it’s preterm but we don’t intervene unless <34
if >40 it’s late but not considered post-term pregnancy unless >42 weeks

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17
Q

oxytocin is synthesized where?

A

hypothalamus – then goes to post. pit. for storage

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18
Q

what is your differential list for vaginal bleeding in early pregnancy

A
  1. spontaneous abortion
  2. ectopic pregnancy
  3. torsion (less likely to p/w bleeding)
19
Q

risk factors for ectopic pregnancy

A 
History of PID (e.g., salpingitis)
Previous ectopic pregnancy
Endometriosis
Kartagener syndrome
Exposure to diethylstilbestrol (DES) in utero
Bicornuate uterus 
Smoking
Advanced maternal age
Intrauterine device
In vitro fertilization
Hormone therapy
20
Q

On US, compared to the endometrium, the myometrium is _____-echoic

A

Hypoechoic (darker)

21
Q

what medication is safe to use during pregnancy for treatment of DVT

A

Heparin is the most appropriate pharmacotherapy in this pregnant patient with a deep vein thrombosis (DVT). During pregnancy, levels of clotting factors increase (fibrinogen, thrombin), while levels of anticoagulants (protein S) decrease, resulting in a hypercoagulable state. Pregnancy is also associated with decreased physical activity, a general risk factor for DVT. Moreover, the pressure of the gravid uterus on the inferior vena cava can impede venous return and predispose to DVT. Heparin is safe during pregnancy, as it does not cross the placental barrier.

22
Q

what is the classic presentation and etiology of Potter’s sequence

A

low-set ears, flat nose, micrognathia, foot clubbing, and respiratory distress
etiology: oligohydramnios

23
Q

Pulmonary retention of amniotic fluid - is it associated with oligo or polyhydramnios

A

no, neither
Pulmonary retention of amniotic fluid is the cause of transient tachypnea of the newborn and results in neonate respiratory distress in the first 1–2 days of life. It is typically seen in mature newborns delivered by cesarean section and is not associated with bilateral renal agenesis. Moreover, transient tachypnea of the newborn usually resolves within 24–48 hours.

24
Q

target blood glucose levels (fasting and postprandial)

A

fasting: 70-95
postprandial: 140 or less

25
Q

congenital torticollis

A

muscular or skeletal injury during delivery with subsequent fibrosis and contracture of the sternocleidomastoid muscle

Associated with:
Intrauterine constraint, which causes unilateral shortening of the sternocleidomastoid muscle
Oligohydramnios
Multiple gestation
Macrosomia

Clinical features:
Head noticeably tilted to one side with the chin rotated towards the opposite side

26
Q

most normal position of the baby for childbirth

A

Fetal vertex presentation (a type of cephalic presentation)

27
Q

neonatal conditions associated with premature birth

A 
from top down:
intracranial hemorrhage
retinopathy of prematurity
neonatal respiratory distress syndrome
persistent fetal circulation
necrotizing enterocolitis
sepsis
28
Q

what are the possible causes of DIC in pregnancy?

A

Placental abruption, retained fetal products, amniotic fluid embolism, and pre-eclampsia.

29
Q

elevated α-fetoprotein (AFP) can indicate

A

Elevated AFP levels in the amniotic fluid and maternal serum can be a sign of neural tube closure defects (2nd trimester), placenta accreta (1st trimester), or abdominal wall defect (omphalocele or gastroschisis)

30
Q

what is the Quad screen profile for Down Syndrome

A

Down syndrome causes a decrease in AFP and estriol and an increase in β-HCG and inhibin (the other trisomies have all these levels normal or low)

31
Q

what is the 1st semester lab profile for placenta accreta

A

elevated maternal AFP and elevated PAPP-A

32
Q

what is the quad screen profile for multiple gestation

A

increased MSAFP, estriol, and β-hCG levels

33
Q

define low birth weight, very low birthweight

A

<2500g, <1500
*this does not take into consideration gestational age, so you could have a low birthweight infant who is not small for gestational age

34
Q

most common cause of abnormal AFP levels

A

the most common cause of abnormal AFP levels is incorrect dating of gestational age.

35
Q

what is the immediate management of a pregnant patient with preeclampsia with severe features?

A 
Pregnant women
 with severe-range
 blood pressures require anti-hypertensive
 therapy with intravenous
 hydralazine
 and/or labetalol
, as well as seizure
 prophylaxis with magesium sulfate.

Mnemonic: The idea is to go from High to Lower BP (Hydralazine
and Labetalol
).

methyldopa is indicated for less severe cases

36
Q

what hematologic disease is a/w down syndrome

A

acute lymphoblastic leukemia

37
Q

CHD7 gene deletion causes what syndrome?

A

CHARGE syndrome
coloboma, heart malformation, atresia of choanae, retardation of growth/development, genital hypoplasia, Ear abnormality including deafness

38
Q

microdeletion on chromosome 7 causes what syndrome

A

Williams syndrome

elvin facies, hypercalcemia, mental retardation, aortic stenosis

39
Q

what heart defect is a/w williams syndrome

A

aortic stenosis

“obstruction of left ventricular outflow”

40
Q

what are the three microdeletion syndromes

A

Cri-du-chat, Williams, GiGeorge

41
Q

which two genetic diseases are due to epigenetic mechanisms

A

Russel-silver (small child) and Beckwith-wideman (large child)

mn: Beckwith Wiedmann –> Big width and W-I-de. I =IGF problem

42
Q

which genetic diseases are due to epigenetic mechanisms

A

Russel-silver (small child) and Beckwith-wideman (large child)

mn: Beckwith Wiedmann –> Big width and W-I-de. I =IGF problem

Fragile X

Rett Syndrome

43
Q

maternal age related risk factors for abdominal wall defects

A

both extremes of age - risk factor for omphalocele
<20 yo -risk factor for gastroschisis (no protective membrane)
mn: think about a teenage mother being totally shocked at delivery
*polyhydramnios is a risk factor for both

44
Q

when is an infant born to diabetic mother at risk of IIUGR instead of macrosomia

A

Infants born to mothers with pregestational diabetes, not gestational diabetes, are at risk for intrauterine growth restriction

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