Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RC OBGYN (CG) > OBS > Flashcards

OBS Flashcards

1
Q

What is the risk of placenta accreta in the presence of a previa and 0, 1, 2, 3, 4 CS

A

Previa and:

  • 0 prior CS: 3 %
  • 1 prior CS: 25 %
  • 2 prior CS: 40 %
  • 3 prior CS: 61 %
  • 4 prior CS: 67 %
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the risk of placenta accreta in the absence of placenta previa

A

Accreta without previa

  • 1 prior CS: 6.6 %
  • 2 prior CS: 17%
  • > 3 prior CS: 55%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the risk of accreta with 1 prior CS and with and without previa

A

One previous CS

  • No previa: 6.6%
  • Previa: 25%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the risk of accreta with 2 prior CS and with and without previa

A

Two (2) previous CS

  • No previa: 17%
  • Previa: 40%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the risk of accreta with 3 prior CS and with and without previa

A
  • No previa: 55%
  • Previa: 61%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the indications for aspirin in pregnancy (10)

A
  • AMA (Age > 40)
  • ART
  • BMI > 30
  • History of IUGR
  • History of PET
  • Chronic HTN or previous GHTN
  • Multiple pregnancy
  • DM 1 or DM2
  • History of placental abruption
  • History of placental infarct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When should ASA be started

A

12- 16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the mechanism of action of labetolol

A

Mixed alpha + beta adrenergic ANTAGONIST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mechanism of action of metyldopa

A

Alpha-2 adrenergic AGONIST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the mechanism of action of hydralazine

A

Vascular smooth muscle relaxant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the sources of progesterone in pregnancy (2)

A
  • Corpus luteum cyst (until 6-7 weeks)
  • Placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common congenital anomalies in patient with T1 or T2 DM

A

Neural tube defect (4.2 fold increase)

Congenital heart disease (3.4 fold increase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does BV in pregnancy predispose to?

A

PPROM

PTL

PTB

Post partum endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When are depression symptoms worse in adolescent pregnancy?

A

Between T2 and T3

1/2 have symptoms in early post partum period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What adverse outcomes are adolescent pregnancy linked to?

A

PTB

PPROM

LBW/ IUGR

NICU admissions

Stillbirth

Congenital anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What congenital anomalies are linked to adolescent pregnancies?

A

CNS

(anencephaly, spina bifida, hydrocephaly, microcephaly)

GI

(Gastroschesis, omphalocele)

MSK

(clift lip, cleft palate, polydactyliy, syndactaly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common lower genital tract disorder in women of reproductive age?

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some risk factors for BV (4?)

A

Black race

Smoking

Sexual activity

Use of vaginal douches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the two ways to establish a diagnosis of BV?

A

Amsel criteria

Nugent score (Gram stain, score > 7)

Amsel criteria:

Adherent and homogenous vaginal discharge

Vaginal pH > 4.5

Detection of clue cells

Positive wiff test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment + f/u of BV in pregnancy ?

A

Metronidazole (Flagyl) 500 mg PO BID x 7 days

Clinda 300 mg PO daily x 7 days

Repeat culture 1 month after treatment - high recurrence

Topical agents have similar cure rates but

  • Not effective to prevent PTL in high risk population
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the adverse pregnancy outcomes with BV (5)

A

Spontaneous abortion

PTL and PTB

PPROM

Chorioamionitis

PP infections (Endometritis + CS wound infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When should you screen for BV in pregnancy?

A

NO routine screening

Screen if bothersome and persistent discharge

Screen at 12-16 weeks in high risk women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is oral fluconazole in pregnancy associated to?

A

Tetralogy of Fallot

Safety in 2nd and 3rd trimester not investigated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is boric acid associated to in pregnancy?

A

2 fold increase in birth defects (during first 4 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define shock index

A

HR / sBP

< 0.7 → normal

> 0.7 → transfuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Absolute contraindications to neuraxial anesthesia

A

Maternal coagulopathy

Thrombocytopenia

LMWH within 12h

Sepsis

Skin infection at site of needle placement

Refractory maternal hypotension

Increased intracranial pressure caused by mass lesion

3 coags / 2 infection / 2 BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the following signs:

Goodell

Chadwick

Hegar

A

Goodell : Softening of LUS

Chadwick : Cyanosis / bluish discoloration

Hegar: Softening of cervix

(Hegar = cx dilator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What test should you order to r/o GDM in patient who underwent gastric bypass surgery?

(# 393)

A

Fasting glucose

1h post prandial blood glucose

HbA1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Who should you screen before 24-28 weeks for GDM ?

(#393)

A

Maternal age > 35 yo

Pre-pregnancy BMI > 30

PCOS

Acanthosis nigricans

Corticosteroid use

Ethnicity (Aboriginal, African, Asian, Hispanic, South Asian)

Family Hx of DM

Previous pregnancy with GDM

Previous macrosomic infant

30
Q

What are the benefits of optimal glucose control (5)?

(#393)

A

↓ PET

↓ Fetal macrosomia

↓ Shoulder dystocia

↓ CS

↓ IUFD

31
Q

What is the advantage of immediate breat feeding in diabetic mothers (1)?

(#393)

A

↓ neonatal hypoglycemia

32
Q

In GDM mothers, BF x 6 months has what advantages (2)?

(#393)

A

Reduce childhood obesity

Reduce maternal hyperglycemia

33
Q

What proportion of GDM mothers have DM at PP visit?

(#393)

A

1/3

34
Q

What proportion of GDM mothers will have DM later in life?

(#393)

A

15-50 %

35
Q

Describe the different levels of foreceps application (4)

(#381)

A

Outlet : Head visible at introitus without spreading the labias

Low: station > +2 **

Mid: Station between 0 and +2 **

High: Station above 0 (head not engaged)

** 2 subdivisions

  • Rotation < 45 ° from OA position
  • Rotation > 45 ° from OA position (including OP)
36
Q

When should you induce GDM patients ?

(#393)

A

Diet controlled: before 40 weeks

Insulin dependant: 39 weeks

37
Q

How and when do you test for post partum DM?

(#393)

A

2h 75g OGTT

Between 6 weeks and 6 mo post partum

When planning another pregnancy

38
Q

When and how to test for GDM in patients who received betamethasone?

(#393)

A

> 7 days post last dose of beta

2h 75 OGTT

39
Q

Describe antenatal testing for GDM

(#393)

A

US q 3-4 weeks starting at 28 weeks

  • EFW
  • Amniotic fluid volume

Weekly testing at 36 weeks

  • NST
  • NST + AFI
  • BPP
40
Q
A
41
Q

What dermatomes need to be blocked for vaginal delivery and CS?

A

Vaginal delivery: T10 - S5

CS: T4 - S1

(Williams OB p 513)

42
Q

What complication of DM1 in pregnancy leads to the highest number of PTB?

(Williams OB p 1131)

A

Pre-ecclampsia

43
Q

How do you follow a DM1 pregnancy ?

(Berghella)

A

Pre-conception

  • Normalization of HbA1c < 7 %
  • Eye exam
  • 24h urine protein
  • EKG

Antenatal

  • Viability scan
  • Early anatomy scan (14 -16 wks) if HbA1c > 8%
  • AFP screening 16-20 wks
  • Anatomy scan (18-20 wks)
  • Fetal echocardiography (20-22 weeks)
  • Serial growth US
  • 28 weeks: onset of antenatal testing if glucose poorly controlled
  • 32 - 36 weeks: NST and BPP weekly or twice weekly
  • 36 weeks to delivery : Twice weekly

Delivery:

  • 39 weeks
  • If CS, administer evening dose of long acting and hold morning short acting dose

Post partum

  • Decrease insulin dose by half and administer with onset of PO intake
44
Q

What are the neonatal effects of DM1 (5)?

(Berghella + Williams)

A

Hypoglycemia

Hypocalcemia

Hyperbilirubinemia + polycythemia

Cardiomyopathy

Mortality

45
Q

What is the impact of pregnancy on typical DM1 complications (7)?

(Berghella + Williams)

A

Pre-ecclampsia

Retinopathy → can significantly worsen

Nephropathy → if severe, can lead to end stage disease

Neuropathy → no effect, only if gastroparesis (high risk of complication + poor perinatal outcome)

Cardiovascular disease → no change in pregnancy

Ketacidosis → ↑ risk

Infection → ↑ risk of all infections

46
Q

What is a contraindication of pregnancy in pts with DM1?

(Berghella)

A

Symptomatic cardiovascular disease

47
Q

How do you prevent progression of retinopathy in DM1 patients?

A

Good glycemic control

Photocoagulation

48
Q

When does the fetal thyroid start functioning ?

What are thryroid hormone sources before and after that time?

A

10 - 12 weeks

  • Starts concentrating iodine
  • Start formning TSH
  • Small amount of thyroid hormones

18-20 weeks

  • Increased fetal secretion

Before 10-12 weeks → amternal T4 = only source

49
Q

Which Thyroid hormones cross the placenta?

A

T3

T4

TRH (small amount)

TSH receptor Antibody

Does not cross: TSH

50
Q

Describe the different periods of the development of a fetus and corresponding dates

(W OB p 128)

A

Weeks 1-2 : implantation

Weeks 3-8: Embryonic period = organogenesis

Weeks 9-38: fetal period = growth

51
Q

Inheritance pattern of G6PD disorder ?

What medication/ substance should be avoided ?

A

X-linked (recessive)

Methylene blue / Nitrofurantoin

+ long list but none are used in gyne

52
Q

Which stage of labour is affected by obesity?

A

First stage

53
Q

What maternal infections are associated with stillbirth?

(#394)

A

CMV

Parvo B19

Listeria

54
Q

What is the timeline of PP psychosis?

A

Within 2 weeks of birth

55
Q

What is often the first signe of PP psychosis?

(UpToDate)

A

Severe insomnia (more than to take care of infant)

56
Q

What is the most common cause of maternal death during the first year PP?

A

Suicide

(UpToDate: post partum psychosis)

57
Q

What is the risk of infanticide with PP psychosis?

(UpToDate: PP Psychosis)

A

4 %

58
Q

What medical condition is increased in PP psychosis?

(UpToDate PP Psychosis)

A

Autoimmune thyroid disease

Primary Hypoparathyroidism

59
Q

What are the RF for GDM ?

(Berghella p 60)

A

Hx of GDM

Family Hx of DM

Obesity

Age > 35

Non white etchnicity

Prior macrosomic infant

Chronic steroid use

Glycosuria

Know impaired glucose metabolism

Prior infant with congenital anomaly

Prior unexplained stillbirth

60
Q

What is the mechanism of GDM (2)?

Berghella p 61

A

Insulin resistance caused by:

  • ↑ human placental lactogen (maternal and placental production)
  • Progesterone
  • Growth hormone
  • Cortisol
  • Prolactin
  • ↑ BMI and caloric intake

↓ function of pancreatic islet cells

61
Q

What is the % of RhD - in the caucasian population?

A

15 %

In Basque : 30 %

In Asians : 1%

62
Q

If and RhD - patient does not get Rhogham, what is her chance of immunization?

(Berghella)

A

17 %

63
Q

What is the most common reason for izoimmunization ?

(Berghella)

A

Fetomaternal hemorrhage at delivery (>90%)

Third trimester (10%)

64
Q

Other than pregnancy, what are other causes of RBC alloimmunization?

Berghella

A

Amnio 7- 15 %

CVS: 14 %

Induced abortions : 4-5 %

ECV: 2-6 %

First trimester loss (1-2%)

65
Q

How long is Rogham effective for?

Berghella

A

12 weeks

Half life = 16- 24 days

66
Q

What is the incidence of Kell alloimmunization?

(Berghella)

A

0.1 - 0.3 %

67
Q

What is the risk of fetal demise with fetal blood transfusion?

(Berghella)

A

1-2 %

68
Q

What is the risk of error following fetal sex determination by US ?

(#192)

A

3 %

69
Q

Describe warfarin embryopathy ?

When administered in which trimester does it have the worse impact?

What are the other impacts of warfarin on pregnancy?

(#308)

A

Nasal and limb hypoplasia

Stippled bone epiphyses (pattern of focal bone calcification)

Worse in First Trimester (between 6-7 wks)

Effect is dose dependant

Pregnancy loss

Antigoagulation at time of delivery

70
Q

How do you manage an ovarian mass in pregnancy?

A
  • < 5 cm → no surveillance needed
  • 5- 10 cm, US surveillance.
    • Remove if grows, maliganant features, symptomatic
    • Surgery between 14 - 20 wks (most benign cyst will have resolved by then)
  • > 10 cm → Remove (↑ risk of malignancy)
  • NO EVIDENCE for tumor markers except Ca125
    • If 15 wks → delivery, Ca125 between 1000 and 10 000 → ABNORMAL
71
Q

What nerve roots and muscles are affected with Erb’s palsy ?

A

C5 - C6

Paralysis of deltoid, infraspinatus, flexor muscles of forearm

Arm is straight (elbow extended), internally rotated, wrist is flexed (fingers flexed or spared)

RC OBGYN (CG) (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions