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CK OB > Obstetric Complications > Flashcards

Obstetric Complications Flashcards

1
Q

The terms ________ have been used to describe the

inability of the uterine cervix to retain a pregnancy to viability in the absence of contractions or labor.

A

“cervical insufficiency” and “cervical incompetency”

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2
Q

Etiology of cervical insufficiency

A

rapid forceful cervical dilation associated with
second trimester abortion procedures, cervical laceration from rapid delivery, injury from deep cervical conization, or congenital weakness from diethylstilbestrol (DES) exposure

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3
Q

Studies show the benefit of _____ with a history of 1 or more unexplained second-trimester pregnancy losses.

A

elective cervical cerclage

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4
Q

Elective cerclage placement at ______’ gestation is appropriate after sonographic demonstration for fetal normality.

A

13–14 weeks

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5
Q

Emergency or urgent cerclage may be considered with sonographic evidence of cervical insufficiency after ________

A

ruling out labor and chorioamnionitis.

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6
Q

Cerclage should be considered if cervical length is ______by vaginal sonography
prior to 24 weeks and prior preterm birth at_______gestation.

A

<25 mm

<34 weeks

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7
Q

_______ places a removable suture in the cervix. The benefit is that vaginal delivery can be allowed to take place, avoiding a cesarean.

A

McDonald cerclage

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8
Q

Cerclage removal should take place at _____, after fetal lung maturity has taken place but before the usual onset of spontaneous labor that could result in avulsion of
the suture.

A

36–37 weeks

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9
Q

______utilizes a submucosal placement of the suture that is buried beneath the mucosa and left in place. Cesarean delivery is performed at term.

A

Shirodkar cerclage

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10
Q

______twins are most common. Identifiable risk factors include by race, geography, family history, or ovulation induction

A

Dizygotic twins

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11
Q

Risk of twinning is up to 10% with ____ and up to 30% with ______

A

clomiphene citrate

human menopausal gonadotropin.

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12
Q

Cx of Twin pregnancy

A 
nutritional anemias (iron and folate), preeclampsia,
preterm labor (50%), malpresentation (50%), cesarean delivery (50%), and postpartum
hemorrhage.
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13
Q

Dizygotic twins arise from multiple ovulation with 2 zygotes. They are always _______

A

dichorionic,

diamnionic.

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14
Q

Monozygotic twins arise from one zygote. Chorionicity and amnionicity vary according to the ________

A

duration of time from fertilization to cleavage

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15
Q

Up to 72 hours (separation up to the morula stage), the twins are _______This is the lowest risk of all monozygotic twins.

A

dichorionic, diamnionic. There are 2 placentas and 2 sacs.

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16
Q

Between 4 and 8 days (separation at the blastocyst stage), the twins are___________

A

monochorionic, diamnionic. There is 1 placenta and 2 sacs

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17
Q

A specific additional complication is

________ which develops in 15% of mono-di twins

A

twin–twin transfusion,

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18
Q

Between 9 and 12 days (splitting of the embryonic disk), the twins are _______

A

monochorionic, monoamnionic. There is only 1 placenta and 1 sac

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19
Q

After 12 days,_______ result. Most often this condition is lethal.

A

conjoined twins

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20
Q

In twin gestation,

Route of delivery is based on presentation in labor—

______if both are cephalic presentation (50%); ________if first twin in noncephalic presentation;

A

vaginal delivery

cesarean delivery

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21
Q

route of delivery is controversial if ________

A

first twin is cephalic and second twin is noncephalic.

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22
Q

A pregnant woman has developed antibodies to foreign red blood cells (RBCs), most commonly against those of her current or previous fetus(es), but also caused by transfusion of mismatched blood

A

ALLOIMMUNIZATION

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23
Q

Hemolytic disease of the newborn (HDN) is a continuum ranging from _________

A

hyperbilirubinemia to erythroblastosis fetalis

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24
Q

______ is caused by maternal antibodies crossing

into the fetal circulation and targeting antigen-positive fetal RBCs, resulting in hemolysis.

A

HDN

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25
Q

RF for Alloimmunization

A

Other pregnancy-related risk factors are amniocentesis, ectopic pregnancy, D&C, abruptio placenta, and placenta previa

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26
Q

______ decreases the risk of maternal alloimmunization
from foreign RBCs. Naturally occurring anti-A and anti-B antibodies rapidly lyse foreign RBCs before maternal lymphocytes are stimulated to produce active antibodies

A

ABO incompatibility

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27
Q

Reqts for dx of alloimmunization

1
2
3
4
5
A

• Mother must be antigen negative.
• Fetus must be antigen positive, which means the father of the pregnancy must also be
antigen positive.
• Adequate fetal RBCs must cross over into the maternal circulation to stimulate her
lymphocytes to produce antibodies to the fetal RBC antigens.
• Antibodies must be associated with HDN.
• A significant titer of maternal antibodies must be present to cross over into the fetal
circulation and lead to fetal RBC hemolysi

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28
Q

In alloimmunization, Fetal risk is present only if

1
2
3
4

A

(1) atypical antibodies are detected in the mother’s circulation,
(2) antibodies are associated with HDN,
(3) antibodies are present at a significant
titer (>1:8), and
(4) the father of the baby (FOB) is RBC antigen positive

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29
Q 
In alloimmunization,No fetal risk is present if 
1
2
3
4
A

(1) the AAT is negative, (2) antibodies are present but are
NOT associated with HDN, (3) antibody titer is <1:8, or (4) the FOB is RBC antigen
negative

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30
Q

Assess the degree of fetal risk if the fetus is RBC antigen positive or if fetal blood typing is impossible. This can be done by

1
2
3
4

A

serial amniocentesis, PUBS, or ultrasound Doppler

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31
Q

Amniotic fluid bilirubin indirectly indicates fetal hemolysis because bilirubin accumulates as a byproduct of RBC lysis. The bilirubin is plotted on a_______

A

Liley graph

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32
Q

______ directly measures fetal hematocrit and degree of anemia.

A

PUBS

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33
Q

Alloimmunization:

_____is the procedure of choice since it is non-invasive and has a high correlation with fetal anemia

A

Doppler MCA ultrasound

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34
Q

When to intervene in Alloimmunization:

A

Intervene if there is severe anemia. This is diagnosed when amniotic fluid bilirubin is in Liley zone III or PUBS shows fetal hematocrit to be ≤25% or MCA flow is elevated

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35
Q

Tx of Alloimmunization:

  • _______ is performed if gestational age is <34 weeks.
  • _______is performed if gestational age is >34 weeks
A

Intrauterine intravascular transfusion

Delivery

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36
Q

______ is pooled anti-D IgG passive antibodies that are given IM to a pregnant woman when there is significant risk of fetal RBCs passing into her circulation

A

RhoGAM

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37
Q 
RhoGAM is routinely given to 
1
2
3
4
A

Rh(D)-negative mothers at 28 weeks, and within 72 h of chorionic villus sampling (CVS), amniocentesis, or D&C.

38
Q

300 mcg of RhoGAM will neutralize_______

A

15 ml of fetal RBCs or 30 mL of fetal whole blood

39
Q

________ is a qualitative screening test for detecting significant feto-maternal hemorrhage
(>10 mL).

A

Rosette test

40
Q

______ quantitates the volume of fetal RBCs in the maternal circulation by differential staining of fetal and maternal RBCs on a peripheral smear.

A

Kleihauer-Betke test

41
Q

______ is the most common cause of perinatal morbidity and mortality

A

Preterm delivery

42
Q

Criteria for PTL

A

• Gestational age—pregnancy duration >20 weeks, but <37 weeks
• Uterine contractions—at least 3 contractions in 30 min
• Cervical change—serial examinations show a change in dilation or effacement, or a
single examination shows cervical dilation of >2 cm

43
Q

RF for PTL

A

prior preterm birth (PTB), short transvaginal (TV) cervical length (<25 mm), PROM, multiple gestation, uterine anomaly

44
Q

Other RF for PTL

A

low maternal pre-pregnancy weight, smoking, substance abuse, and short
inter-pregnancy interval (<18 months)

45
Q

All gravidas should be screened:
• History: _______
• Sonographic cervical length: ______

A

previous PTB

prior to 24 weeks

46
Q

Mx of PTL

–________ if cervical length >25 mm with prior spontaneous PTB
–_________ if cervical length <25 mm before 24 weeks with prior PTB
– ________ if cervical length <20 mm before 24 weeks but no prior PTB

A

Weekly IM 17-hydroxy progesterone caproate (17-0H-P)

Weekly IM 17 -OH-P plus cervical cerclage placement

Daily vaginal progesterone

47
Q

_______is a protein matrix produced by fetal cells that acts as a biological glue binding the trophoblast
to the maternal decidua.

A

Fetal Fibronectin (fFN):

48
Q

Importance of FFN

A

It “leaks” into the vagina if PTB is likely and can be measured with a rapid test using a vaginal swab

49
Q

Pre-req for FFN Tests

A

Prerequisites for testing: gestation 22-35 weeks, cervical dilation <3 cm, and membranes intact

50
Q

How to interpret FFN tests

A

main value of the test is a negative, since the chance of PTB in the next 2 weeks is <1%. With a positive result, the likelihood of PTB is 50%

51
Q

_________may reduce the severity and risk of cerebral palsy in surviving very preterm neonates

A

Matemal IV MgSo4

52
Q

______ is recommended for pregnant women with gestational age 23–34 weeks of gestation who are at risk of preterm delivery within 7 days

A

A single course of corticosteroids

53
Q

Advanatges of pts with PTL given CS

A

lower severity, frequency, or both of respiratory distress syndrome, intracranial hemorrhage,
necrotizing enterocolitis and death

54
Q

These are conditions under which stopping labor is either dangerous for mother and baby or futile:

Obstetric

A

severe abruptio placenta, ruptured membranes, chorioamnionitis.

55
Q

These are conditions under which stopping labor is either dangerous for mother and baby or futile:

Fetal conditions—

A

lethal anomaly (anencephaly, renal agenesis), fetal demise or jeopardy (repetitive late decelerations).

56
Q

These are conditions under which stopping labor is either dangerous for mother and baby or futile:

Maternal conditions—

A

eclampsia, severe preeclampsia, advanced cervical dilation

57
Q

Importance of tocolytic agents for PTL

A

(1) administration of maternal IM betamethasone to
enhance fetal pulmonary surfactant and
(2) transportation of mother and fetus in utero to a
facility with neonatal intensive care

58
Q

Oral tocolytic agents are no more effective than placebo

A

Magnesium sulfate
b-Adrenergic agonists include terbutaline
Calcium-channel blockers
Prostaglandin synthetase inhibitors

59
Q

What tocolytic

______is a competitive inhibitor of calcium. Clinical monitoring is based on decreasing but maintaining detectable deep tendon reflexes

A

MgSO4

60
Q

SE of MgSO4

A

Side effects include muscle weakness, respiratory depression, and pulmonary edema

61
Q

SE of MgSO4 Tx

A

Magnesium overdose is treated with IV calcium gluconate.

62
Q

Contraindications of MgSO4

A

Contraindications include renal insufficiency and myasthenia gravis.

63
Q

______ Tocolytic effect depends on the b2-adrenergic

receptor myometrial activity

A

b-Adrenergic agonists include terbutaline.

64
Q

_____decrease smooth muscle contractility by decreasing prostaglandin production (e.g., indomethacin).

A

Prostaglandin synthetase inhibitors

65
Q

Prostaglandin synthetase inhibitors SE

A

Side effects include oligohydramnios, in utero ductus arteriosus closure, and neonatal necrotizing enterocolitis

66
Q

Contraindications Prostaglandin synthetase inhibitors SE _________

A

include gestational age >32 weeks.

67
Q

Mx of PTL

  • Confirm labor using the 3 criteria listed earlier.
  • Rule out contraindications to tocolysis using criteria listed above.
  • Initiate IV hydration with _______
  • Start IV MgSo4 for ______
A

isotonic fluids.

fetal neuroprotection (if <32 weeks) at least 4 hours before anticipated birth

68
Q

Mx of PTL

  • Start tocolytic therapy with ______, _______, ____for no longer than 48 hours to allow for antenatal steroid effect.
  • Obtain cervical and urine cultures before giving IV penicillin G (or erythromycin) for ______
  • Administer maternal IM betamethasone to stimulate ________
A

terbutaline, nifedipine or indomethacin (if <32 weeks)

group B b Streptococcus sepsis prophylaxis.

fetal type II pneumocyte surfactant production if gestational age is <34 weeks.

69
Q

Rupture of the fetal membranes before the onset of labor, whether at term or preterm

A

PROM

70
Q

PROM RF

A

Ascending infection from the lower genital tract is the most common risk factor for PROM. Other risk factors are local membrane defects and cigarette smoking

71
Q

PROM UTZ

A

Oligohydramnios is seen on ultrasound examination.

72
Q

Dx of PROM

PROM is diagnosed by sterile speculum examination meeting the following criteria:

  • __________—clear, watery amniotic fluid is seen in the posterior vaginal fornix
  • _______—the fluid turns pH-sensitive paper blue
  • ________—the fluid displays a ferning pattern when allowed to air dry on a microscope glass slide
A

Pooling positive

Nitrazine positive

Fern positive

73
Q

Chorioamnionitis is diagnosed clinically with all the following criteria needed:
1
2
3

A

• Maternal fever and uterine tenderness in the presence of confirmed PROM in the
absence of a URI or UTI

74
Q

Mx of PROM

  • If uterine contractions occur, __________
  • If chorioamnionitis is present, _________
A

tocolysis is contraindicated.

obtain cervical cultures, start broad-spectrum therapeutic IV antibiotics, and initiate prompt delivery.

75
Q

PROM

If no infection is present, management will be based on gestational age as follows:

– Before viability (<23 weeks), outcome is dismal. Either induce labor or manage patient with bed rest at home. Risk of __________ is high.

A

fetal pulmonary hypoplasia

76
Q

PROM

If no infection is present, management will be based on gestational age as follows:

With preterm viability (23 0/7–33 6/7 weeks), conservative management.

A

Hospitalize the patient at bed rest, administer IM betamethasone to enhance fetal lung maturity if <34 weeks, obtain cervical cultures, and start a 7-day course of
prophylactic ampicillin and erythromycin

77
Q

PROM

If no infection is present, management will be based on gestational age as follows:

At term (≥34 weeks), initiate prompt delivery. If vaginal delivery is expected, ________

A

use oxytocin or prostaglandins as indicated. Otherwise, perform cesarean delivery

78
Q

The most precise definition is a pregnancy that continues for ≥40 weeks or ≥280 days postconception. This includes 6% of all pregnancies

A

POSTTERM PREGNANCY

79
Q

Generally, _____of patients deliver by 40 weeks, ______ by 41 weeks, and ______ by 42 weeks.

A

50%

75%

90%

80
Q

The most common cause of true postdates cases are _______

A

idiopathic

81
Q

Post term:

It does occur more commonly in _______ with ______

A

young primigravidas and rarely with placental sulfatase deficiency

82
Q

Pregnancies with ______ are the longest pregnancies reported.

A

anencephalic fetuses

83
Q

Post term

What syndrome

In a minority of patients, placental function declines as
infarction and aging lead to placental scarring and loss of subcutaneous tissue.

This reduction of metabolic and respiratory support to the fetus can lead to the asphyxia that is responsible for the increased perinatal morbidity and mortality

A

Dysmaturity syndrome

84
Q

Mx of Post term pregnancy is based on:

A

Confidence in dates.

Favorableness of the cervix

85
Q

Favorableness of the cervix is assessed by?

A

The Bishop score is a numerical expression of how favorable the cervix is and the likelihood of
successful labia induction.

86
Q

How to interpret the BISHOP score

– Favorable cervix is dilated, effaced, soft, and anterior to mid position. Bishop score______

– Unfavorable cervix is closed, not effaced, long, firm, and posterior. Bishop score is________

A

is >8.

<5.

87
Q

Mx of postterm pregnancy:

Dates sure, favorable cervix.

A

Induce labor with IV oxytocin and artificial

rupture of membranes.

88
Q

Mx of postterm pregnancy:

Dates sure, unfavorable cervix

A

Management could be aggressive, with cervical ripening initiated with vaginal or cervical prostaglandin E2
followed by IV oxytocin.

Or management could be conservative with twice weekly
NSTs and AFIs awaiting spontaneous labor.

89
Q

Mx of postterm pregnancy:

Dates unsure,

A

Dates unsure. Management is conservative. Perform twice weekly NSTs and AFIs to
ensure fetal well-being and await spontaneous labor. If fetal jeopardy is identified,
delivery should be expedited

90
Q

Mx of Post term pregnancy

______ may be helpful to prevent umbilical cord compression; okay to perform it.

________ makes no difference in preventing MAS; do not
routinely perform.

________ is only indicated if the neonate is
depressed; perform selectively.

A

Amnioinfusion

Suctioning of fetal nose and pharynx

Laryngoscopic visualization of vocal cords

CK OB (15 decks)

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