Obstetric Hemorrhage, Cardio, Pulmo

Question 1

Happens when there is premature separation of a normally implanted placenta

Answer 1

Abruptio placenta

Question 2

Immediate event that can cause hemorrhage and subsequent abruptio placenta

Answer 2

Preeclampsia

Question 3

This dangerous drug can cause vasoconstriction with resultant placental separation

Answer 3

Cocaine

Question 4

Virchow’s triad in placental abruption

Answer 4

VIA Vaginal bleeding Increased uterine tone Abdominal pain

Question 5

Diagnostic test for abruptio placenta where you put a blood sample in a test tube and positive if a clot forms within 6 minutes or forms and lyses within 30 minutes

Answer 5

Clot observation test

Question 6

Most common obstetric cause of DIC

Answer 6

abruptio placenta

Question 7

This intervention can be diagnostic and therapeutic in abruptio placenta

Answer 7

Amniotomy

Question 8

What is the boundary threshold for a low lying placenta?

Answer 8

2cm

Question 9

Most common pathophysiology of placenta previa

Answer 9

Defective decidual vascularization

Question 10

Management of placenta accreta

Answer 10

Classical CS, hysterectomy

Question 11

Septic abortion and chorioamnionitis are associated with what coagulation pathway?

Answer 11

Intrinsic pathway (endothelial damage)

Question 12

Abruptio, amniotic fluid embolism, retained dead fetus and saline induced abortion is associated with what coagulation pathway?

Answer 12

Extrinsic

Question 13

Syndrome characterized by widespread systemic activation of coagulation

Answer 13

DIC

Question 14

The combination of nifedipine snd what other tocolytic agent can cause dangerous neuromuscular blockade?

Answer 14

Magnesium sulfate

Question 15

Only well accepted risk factor of gestational hypertension

Answer 15

Primiparity

Question 16

Classic presentation of placenta previa

Answer 16

Painless vaginal bleeding

Question 17

Management of placenta previa is the placental edge is >2cm from os

Answer 17

Trial of labor

Question 18

Management of placenta previa is the placental edge is <2cm from os

Answer 18

Vaginal delivery if possible

Question 19

Classification of placenta accreta if it invades the myometrium

Answer 19

Increta

Question 20

Classification of placenta accreta if it penetrates the myometrium and through the serosa

Answer 20

Percreta

Question 21

2 most important risk factors in placenta accreta

Answer 21

Placenta previa Prior CS

Question 22

Hypertension without proteinuria occurring after 20 weeks AOG and BP returns to normal levels 12 weeks postpartum

Answer 22

Gestational hypertension

Question 23

BP 140/90 prior to pregnancy or before 20 weeks AOG and persists 12 weeks postpartum

Answer 23

Chronic hypertension

Question 24

What is the underlying etiology of proteinuria is seen with preeclampsia?

Answer 24

Increased capillary permeability

Question 25

Renal change that occur in gestational hypertension

Answer 25

Glomerular endotheliosis

Question 26

Mechanism in preeclampsia is placental implantation with replacement of ________ endothelium with trophoblasts

Answer 26

Spiral arteriole

Question 27

Prevention of preeclampsia syndrome

Answer 27

High dose calcium Low dose aspirin

Question 28

Management of severe preeclampsia if **\<34 weeks**

Answer 28

* Expectant management \<34 weeks * Admit to hospital at maternal ICU * Maternal-fetal evaluation for 24 hours * Magnesium sulfate for 24 hours * Antihypertensives for BP \>160/110 or MAP \>125 * Sonological monitoring: * Assess fetal size by US every 2 weeks * BPS + AFI at least twice weekly * Umbilical artery Doppler – once a week * NST - daily

Question 29

Management of severe preeclampsia if \<23 weeks

Answer 29

Terminate pregnancy

Question 30

Management of severe preeclampsia if 23-32 weeks

Answer 30

* Steroids (24-34 weeks AOG) * Betamethasone 12 mg/IM q24 hours for 2 doses * Dexamethasone 6 mg/IM q12 hours for 4 doses * Antihypertensives if needed * daily evaluation of maternal-fetal condition * Delivery if with indications * Delivery at 32-34 weeks

Question 31

Known fetal side effect of hydralazine

Answer 31

Thrombocytopenia

Question 32

Drug of choice for severe hypertension in pregnancy

Answer 32

Hydralazine

Question 33

Drug of choice for gestational/chronic hypertension in pregnancy

Answer 33

Methyldopa

Question 34

Side effect of labetalol

Answer 34

Fetal growth restriction

Question 35

What is the target magnesium level in eclampsia prophylaxis?

Answer 35

4.8-8.4 mg/dl

Question 36

Drug of choice for prevention of convulsions in severe preeclampsia

Answer 36

Magnesium sulfate

Question 37

Preferred mode of delivery for cardiovascular disorders

Answer 37

Vaginal Epidural anesthesia

Question 38

For patients with congenital heart disease, what is the most common adverse event encountered in pregnancy?

Answer 38

Arrhythmia

Question 39

Most common etiology of CAP in pregnancy

Answer 39

Strep pneumoniae

Question 40

Most frequent complication of pneumonia in pregnancy

Answer 40

PROM

Question 41

Initial monotherapy for CAP

Answer 41

Macrolides

Question 42

Fetal response to maternal hypoxemia

Answer 42

Decreased CO

Question 43

Management of severe preeclampsia if **\>34 weeks**

Answer 43

stabilize mother and deliver * Mode of delivery * **\>34 weeks:** **vaginal delivery** if maternal, fetal and cervical conditions are **favorable** * **\<32 weeks**: consider **CS** due to reduced success in induction