OBGYN #5

Question 1

Fundal Height Measurement and time frame

Answer 1

• 12 weeks: above pubic symphysis
• 16 weeks: between pubis and umbilicus
• 20 weeks: at umbilicus
• 38 weeks: 2-3 cm below xiphoid process

Question 2

What is Ladin’s Sign

Answer 2

Uterus softening after 6 weeks

Question 3

What is Hegar’s Sign?

Answer 3

uterine isthmus softening after 6-8 weeks gestation

Question 4

What is Goodell’s Sign?

Answer 4

Cervical softening due to increased vascularization at 4-5 weeks gestation

Question 5

What is Chadwick’s Sign?

Answer 5

Bluish coloration of the cervix and vulva at 8-12 weeks

Question 6

Fetal heart tones are heard at about _____ and the normal rate is ______

Answer 6

10-12 weeks

120-160 bpm

Question 7

Serum B-hCG can detect pregnancy as early as ____ days after conception

Urine B-hCG can detect pregnancy as early as _____ days after conception

Answer 7

5

14

Question 8

What is Naegele’s Rule?

Answer 8

First day of LMP + 7 days - 3 months

Question 9

Risk factors for gestational diabetes

Answer 9

• Family HX of gestational diabetes
• Spontaneous abortion
• History of infant > 4,000g at birth (8.8 pounds)
• Multiple gestations
• AA

Question 10

What is the pathophysiology of gestational diabetes

Answer 10

-Maternal insulin resistance in women with undiagnosed beta cell dysfunction exacerbated by placental release diabetogenic hormones (human placental lactogen), growth hormone, and corticotropin-releasing hormone

Question 11

Fetal complications of gestational diabetes

Answer 11

• Macrosomia (excessive birth weight)
• Shoulder dystocia
• Preterm labor
• neonatal hypoglycemia
• Congenital malformations

Question 12

What is the chance that the mother develops type 2 Diabetes mellitus after pregnancy if she has gestational diabetes?

Answer 12

50%

Question 13

What is the 2 step approach to screening for gestational diabetes?

Answer 13

• Step 1: 50 gram 1 hour glucose challenge test at 24-28 weeks gestation. If positive (>130-140), patients go on to 3h glucose tolerance test
• Step 2: 100 gram 3 hour oral glucose tolerance test (GOLD STANDARD). Threshold for glucose levels are 2 of the 4: fasting > 95, 1 hour > 180, 2 hour > 155, 3 hour > 140.

Question 14

Lifestyle modifications for gestational diabetes

Answer 14

Diabetic diet and exercise (walking) is the initial treatment of choice

-Pregnant patients are NOT told to lose weight. Daily finger sticks overnight and after each meal.

Question 15

What is the first-line medical treatment of choice and why? What is the goal of treatment?

Answer 15

Insulin (doesn’t cross the placenta)

-Goal of treatment is fasting glucose < 95

Question 16

If the patient refuses insulin therapy or won’t comply with insulin, what are safe medication alternatives?

Answer 16

Glyburide or Metformin

Question 17

What Vitamin should be supplemented to a baby if he/she is breastfeeding?

Answer 17

Vitamin D

Question 18

What is morning sickness and when does it occur?

Answer 18

Nausea and vomiting up until 16 weeks (most common in first trimester)

Question 19

What is hyperemesis gravidarum?

Answer 19

Severe, excessive form of morning sickness (nausea, vomiting) associated with weight loss and electrolyte imbalance. Develops during 1st or 2nd trimester and lasts > 16 weeks gestation

Question 20

What labs are shown with hyperemesis gravidarum?

Answer 20

• Hypokalemia

- Metabolic alkalosis from vomiting

Question 21

Management of morning sickness and Hyperemesis Gravidarum

Answer 21

• Lifestyle modifications: initial management of choice. Ginger, fluids, avoid spicy foods
• Pyridoxine (B6) + Doxylamine is first line medical management
• If no relief, use antihistamines
• IV rehydration, electrolyte repletion