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endorepro remediation > Obstetrical Complications (Wootton) > Flashcards

Obstetrical Complications (Wootton) Flashcards

1
Q

Preterm birth is defined as a birth that occurs after __1__ weeks but before __2__ completed weeks of gestation.

A

1) 20 weeks

2) 36 6/7 weeks

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2
Q

Diagnosis of preterm labor is __1__ accompanied with cervical change or cervical dilation of __2__ and/or __3__ effaced.

A

1) Uterine contractions
2) 2 cm
3) 80%

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3
Q

What race is twice as more likely for preterm labor?

A

African American

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4
Q

The prevention of preterm labor is aimed at what four main pathways?

A

1) Infection (cervical)
2) Placental-vascular
3) Psychosocial stress and work strain
4) Uterine stretch

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5
Q

In the infection-cervical pathway what is associated with preterm delivery?

A

Bacterial Vaginosis

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6
Q

In the treatment of women in preterm labor with antibiotics what infections do you want to make sure you treat for as they are a known risk factor for preterm labor?

A

Group B strep

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7
Q

Bacterial vaginosis can increase the risk of cervical infections such as?

A

Gonorrhea and chlamydia

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8
Q

What are screening tools of cervical length to assess risk of preterm labor?

A

1) Ultrasound

2) Fetal fibronectin

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9
Q

Alteration of what components in the placental-vascular pathway may result in poor fetal growth which is a risk factor for preterm labor?

A

1) Immunologic component
2) Vascular component
3) Low resistance connection of spiral arteries

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10
Q

In the stress-strain pathway, mental and physical stress are thought to induce a stress response that increases the release of __1__ and __2__.

A

1) Cortisol

2) Catecholamines

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11
Q

Increased cortisol which is released from the adrenal glands can play a role in preterm labor because it stimulates increased __1__ levels which are known to assist in labor at term.

Catecholamines which affect blood flow can also play a role in preterm labor because they can cause __2__.

A

1) Corticotropin-releasing hormone (CRH)

2) Uterine contractions

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12
Q

In the uterine stretch pathway, uterine stretch is secondary to ____ increasing?

What are risk factors?

A

1) Volume

2) Polyhydramnios and multiple gestations

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13
Q

In the evaluation of preterm labor, what will resolve contractions in about 20% of patients?

A

Hydration and rest

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14
Q

In the evaluation of preterm labor, cultures should be taken for?

A

1) Group B strep
2) Gardnerella
3) Gonorrhea and chlamydia

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15
Q

Antibiotics are given, typically ____, to empirically treat for Group B strep and usually discontinued if culture negative.

A

Penicillin

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16
Q

If diagnosed 2 cm and/or 80% effaced or made cervical change then begin tocolysis (if gestational age is less than 34 weeks and no contraindication). What are the options for tocolytic drugs?

A

1) Magnesium sulfate
2) Nifedipine
3) Prostaglandin Synthetase Inhibitors (indomethacin)

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17
Q

__1__ is the tocolytic drug of choice in the U.S.

It acts on the cellular level and competes with __2__ for entry into the cell at the time of depolarization.

Typically a 6 gm loading dose is given __3__ and then a 3 gm/hour continuous maintenance.

A

1) Magnesium sulfate
2) Calcium
3) Intravenously

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18
Q

Some recent studies have shown magnesium sulfate may be more important in the role of __1__.

It may offer prevention against __2__.

A

1) Neuroprotection

2) Cerebral palsy

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19
Q

What maternal side effect may be seen with magnesium sulfate serum levels of 12-15 mg/dL?

What may be seen at high serum levels >30 mg/dL?

A

1) Respiratory depression

2) Cardiac conduction defects

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20
Q

Nifedipine is an __1__ agent effective in suppressing preterm labor.

It inhibits slow, inward current of __2__ during the second phase of the action potential.

A

1) Oral

2) Calcium

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21
Q

Prostaglandin Synthetase Inhibitors inhibit prostaglandin production that induce __1__ contractions.

It is indicated for __2__ prematurity.

__3__ is the most commonly used agent.

A

1) Myometrial contractions
2) Extreme
3) Indomethacin

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22
Q

Indomethacin can decrease fetal renal function which can lead to __1__.

It can cause premature closure of fetal ductus arteriosus and result in __2__.

A

1) Oligohydramnios

2) Pulmonary HTN and heart failure

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23
Q

__1__ are used to mature the premature fetal lung.

It is given between __2__ and __2__ weeks gestation.

Either 2 doses of 12mg __3__ given 24 hours apart or 4 doses of __5__ given every 12 hours.

A

1) Glucocorticoids
2) 24 and 34 weeks
3) Betamethasone
4) Dexamethasone

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24
Q

A single course of ____ is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids.

A

Betamethasone

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25
Q

In the prevention of preterm labor, what is used in women with previous history of spontaneous preterm labor or Preterm premature rupture of the membranes?

A

Progesterone

26
Q

In the prevention of preterm labor, what is used in women with shortened cervix?

A

1) Progesterone

2) Arabin pessary

27
Q

Should you check the cervix of a presumed ruptured preterm patient?

Why/Why not?

A

1) No

2) It increases risk of infection especially with the prolonged latency before delivery

28
Q

PPROM should be confirmed using a?

A

Sterile speculum

29
Q

When confirming PPROM diagnosis, nitrazine paper should turn __1__.

May also use ultrasound to evaluate __2__ to aid in diagnosis.

A

1) Blue

2) Amniotic fluid volume

30
Q

Along with fetal and maternal status, the management of PPROM depends on gestational age at time of rupture and amniotic fluid index. If the gestational age at time of rupture is less than 24 weeks it may lead to __1__.

Any value less than 5 cm is considered __2__.

A

1) Pulmonary hypoplasia

2) Oligohydramnios

31
Q

In the management of PPROM, the goal is to continue the pregnancy until?

Most will deliver at how many weeks regardless of the above happening?

Must monitor for signs/symptoms of?

A

1) Lungs mature
2) 34 weeks
3) Chorioamnionitis

32
Q

In the management of PPROM with antibiotic usage, the ACOG recommends a 48 hour course of IV __1__ and __1__ followed by 5 days of __2__ and __2__.

A

1) Ampicillin and Erythromycin/ Azithromycin

2) Amoxil and Erythromycin

33
Q

In the management of PPROM with tocolytic usage, the ACOG states that it may be used if there is no evidence of?

A

Chorioamnionitis

34
Q

In the management of PPROM with steroid usage, the ACOG recommends to use up to 34 weeks of gestation to reduce the risk of?

A

Respiratory distress syndrome

35
Q

Beginning at 24 weeks the __1__ pneumocytes in the respiratory bronchioles produce __2__.

It is necessary for lung function by decreasing __3__ and keeping the alveoli open.

A

1) type 2
2) surfactant
3) alveolar surface tension

36
Q

The substances phosphatidylcholine (lecithin), phosphatidylinositol (PI) and phosphatidylglycerol (PG) are important for ____.

A

Fetal lung maturity

37
Q

Measurement of the following substance are obtained by amniocentesis in order to test for fetal lung maturity. __1__ levels increase rapidly after 35 weeks gestation and __2__ levels remain stable (known as the L/S ratio).

L/S ratio is a measure of fetal lung maturity; ratio greater than __3__ is classified as mature.

Because these substances are affected by blood or meconium, the presence of __4__ is diagnostic of mature lungs because it is not affected by presence of blood or meconium.

A

1) Lecithin
2) Sphingomyelin
3) Two
4) Phosphatidylglycerol (PG)

38
Q

A ____ number density assessment can be used as a rapid test for fetal lung maturity.

A

Lamellar Body Number Density assessment (LBND)

39
Q

__1__ is when the birth weight of a newborn is below the 10% for a given gestational age.

__2__ is birth weight at the lower extreme of normal birth weight distribution.

A

1) Intrauterine Growth Restriction (IUGR)

2) SGA (small for gestational age)

40
Q

Maternal causes of Intrauterine Growth Restriction can be due to what nutritional factors?

What substance uses are maternal causes of IUGR?

What syndrome is a maternal cause of IUGR?

A

1) Poor nutritional intake/ Low maternal body weight
2) Smoking and alcohol
3) Antiphospholipid syndrome

41
Q

Insufficient substrate transfer through __1__ can cause IUGR.

Defective __2__ invasion can cause IUGR.

A

1) Placenta

2) Trophoblast

42
Q

What infections diseases are fetal causes of IUGR?

A

1) Listeriosis

2) TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes)

43
Q

Serial ____ measurement is primary screening tool for IUGR.

A

Fundal height (Pubic bone to top of uterus)

44
Q

If fundal height lags more than 3 cm behind the gestational age then what should be ordered?

A

Ultrasound

45
Q

In the management of IUGR, optimizing disease processes such as blood sugar control in diabetes and control of hypertension should be done at what time?

A

Pre-pregnancy

46
Q

The goal of antepartum management of IUGR is?

A

Deliver before fetal compromise but after fetal lung maturity

47
Q

With the patient in the lateral tilt position, the fetal heart rate is monitored with an external transducer. The tracing is observed for fetal heart rate accelerations that peak at least __1__ beats per minute above the baseline and last __2__ seconds from baseline to baseline. It may be necessary to continue the tracing for 40 minutes or longer to take into account the variations of the fetal sleep-wake cycle.

A

1) 15 bpm

2) 15 seconds

48
Q

The ____ consists of a nonstress test combined with four observations made by real-time ultrasonography.

A

Biophysical Profile

49
Q

Fetal breathing movements are a component of the Biophysical Profile which accounts for one or more episodes of rhythmic fetal breathing movements of ____ seconds or more within 30 minutes.

A

30 seconds

50
Q

Fetal movement is a component of the Biophysical Profile which accounts for ____ or more discrete body or limb movements within 30 minutes.

A

Three

51
Q

Fetal tone is a component of the Biophysical Profile which accounts for one or more episodes of __1__ of a fetal extremity with return to __2__, or another option is __3__ and __3__ of a hand.

A

1) Extension
2) Flexion
3) Opening or closing

52
Q

Determination of the amniotic fluid volume is a component of the Biophysical Profile which accounts for a single vertical pocket of amniotic fluid exceeding ____ cm is considered evidence of adequate amniotic fluid.

A

2 cm

53
Q

Doppler ultrasonography is a noninvasive technique used to assess the hemodynamic components of __1__.

__2__ Doppler flow velocimetry has been adapted for use as a technique of fetal surveillance, based on the observation that flow velocity waveforms in the __2__ of normally growing fetuses differ from those of growth restricted fetuses.

A

1) Vascular impedance

2) Umbilical artery

54
Q

With Umbilical artery Doppler flow velocimetry, the umbilical flow velocity waveform of normally growing fetuses is characterized by __1__ diastolic flow.

Whereas with intrauterine growth restriction, there is __2__ of umbilical artery diastolic flow.

A

1) High velocity

2) Reduction

55
Q

If ultrasound shows IUGR between 3rd and 10th percentile with normal dopplers than deliver between __1__ weeks.

If ultrasound shows IUGR less than 3rd percentile it is recommended to deliver at __2__ weeks.

A

1) 38-39 weeks

2) 37 weeks

56
Q

After delivery with IUGR, you want to monitor neonatal blood glucose because these neonates have less ____.

A

Hepatic glycogen stores

57
Q

Post-term pregnancy is a pregnancy that continues past ____ weeks.

A

42 weeks

58
Q

Post-term pregnancy may be associated with what rare congenital kidney condition?

It may be associated with what condition characterized by neural tube defect missing part of brain, skull and scalp?

It may be associated with what what x-linked disease that prevents conversion of estrogen precursors?

A

1) Fetal adrenal hypoplasia
2) Anencephalic fetuses
3) Placental sulfatase deficiency

59
Q

In the management of postterm pregnancy, if there is abnormal testing or oligohydramnios in the ___ week you want to induce labor.

A

41st week

60
Q

Intrauterine Fetal Demise is characterized by fetal death after __1__ weeks gestation but before __2__.

A

1) 20 weeks

2) Onset of labor

61
Q

Patients with Intrauterine Fetal Demise are at risk of?

A

Disseminated intravascular coagulopathy

62
Q

When searching for the cause of Intrauterine Fetal Demise, you want to order __1__ titers, __2__ studies, __3__ cultures, __4__ antibodies.

A

1) TORCH titers
2) Parvovirus studies
3) Listeria cultures
4) Anticardiolipin antibodies

endorepro remediation (21 decks)

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