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Obstetrics Flashcards

1
Q

Random fingerstick diagnostic of diabetes

A

200+

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2
Q

Misoprostol dose

A

800 mcg buccal for pph

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3
Q

Local anesthesia C-section

A

Lidocaine 0.5% with epinephrine 7 mg/k2 for 60 mL max

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4
Q

Indigo carmine dosing for rom confirmation

A

1 mL in 9 mL sterile saline

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5
Q

Timing of luteal-placental shift

A

Starts at 6-7 weeks, mostly done by 10 weeks, supplement to 14 weeks

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6
Q

Arrest of dilation

A

6+ cm

  • no change over 4 hours with adequate Montevideo units (200)
  • no change over 6 hours with inadequate contractions and pitocin
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7
Q

Arrest of descent

A

No descent at 2 hours for multitip, 3 hours for nullip

- add 1 hour for epidural

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8
Q

Degrees of uterine inversion

A

1st: fundus within endometrial cavity
2nd: fundus through cervical os
3rd: fundus to or beyond intriotus
4th: uterus and vagina inverted

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9
Q

Huntington procedure for uterine inversion

A

Clamps on round ligament to correct inversion

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10
Q

Nitroglycerin dosing

A

50 mg IV every minute for 5 max doses

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11
Q

Terbutaline dosing

A

0.25 or 0.5 mg IV or subcutaneous

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12
Q

Transfusion reaction rate

A

20%

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13
Q

Failure rate of operative delivery

A

Forceps: 9%
Vacuum: 14%

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14
Q

4th degree vaginal laceration

A

Involvement of rectal mucosa in addition to external and internal anal sphincters
- Repair with subcutaneous 4-0 Vicryl

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15
Q

Components of 2nd degree laceration

A

Fascia and perineal body musculature (deep and superficial transverse perineal, bulbocaverous muscles)

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16
Q

Rhogam dosing

A

<12 weeks: 50 mcg
Later: 300 mcg
- Redose every 3 weeks

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17
Q

TTP

A

Thrombotic thrombocytopenic purpura

- Defined by severe deficiency of ADAMTS13 (activity <10 percent)

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18
Q

ITP diagnosis

A

Idiopathic thrombocytopenia purpura

  • autoimmune attack on platelets
  • diagnosis based on exclusion of other causes (peripheral smear, HIV, HCV, coag studies)
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19
Q

Platelet transfusion timing

A 
1 pack (6 units) > 30,000 units within 10 minutes
- 5-10,000 units per unit
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20
Q

Causes of sinusoidal fetal heart pattern

A

Medications, especially narcotics
Fetal acidemia
Fetal infection
Fetal cardiac anomalies

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21
Q

Contraindications to magnesium

A 
Myasthenia gravis
Allergy
Heart block
Myocarditis 
Several renal dysfunction
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22
Q

Diazepam dosing for seizure

A

5-10 mg

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23
Q

Antidote to magnesium

A

Calcium gluconate 10% (1 gram)

Add furosemide to increase magnesium excretion

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24
Q

Magnesium toxicity levels

A

Loss of reflexes: 7 mEq/L
Respiratory depression: 10 mEq/L
Cardiac arrest: 25 mEq/L

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25
Q

Differential for thrombocytopenia

A 
Preeclampsia, help
ITP, TTP, gestational 
Medications 
Liver dysfunction 
Type 2 von willebrand’s disease
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26
Q

Poor candidates for VBAC

A

Prior classical or t-uterine incision
Prior uterine rupture
Non-vertex presentation
Medical or obstetrical complications precluding vaginal delivery
> 2 c-sections
Inability to perform emergency Caesearan delivery

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27
Q

Clinical signs of uterine rupture

A 
Fetal bradycardia
Recurrent decelerations
Abrupt change in contraction pattern
Loss of station of presenting part
Significant abdominal pain
Vaginal bleeding
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28
Q

Risks of congenital varicella syndrome

A 
Greatest between 13-20 weeks
- Musculoskeletal: Skin scarring, limb hypo plasma, digital malformation 
- Brain: Microcephaly
- Ocular: chorioretinitis, cataracts
Delay delivery by one week if possible!
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29
Q

Coverage of triple antibiotics

A

Ampicillin: gram positive cocci
Gentamicin: gram negative rods
Clindamycin: anaerobes

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30
Q

Reasons for elevated MS-AFP

A

False positive
Maternal tumor (endodermal sinus tumor, liver cancer)
Anatomical anomalies (abdominal wall defects)
Renal or liver anomies
IUGR

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31
Q

Risk of elevated MS-AFP with no anatomic anomalies

A

Stillbirth
IUGR
Preterm delivery
SIDS

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32
Q

Sensitivity of prenatal genetic screening other than cell-free

A

80-90%

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33
Q

Methergine dosing

A

0.2 mg, every 2-4 hours

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34
Q

Hemabate dosing

A

0.25 mg, every 15 minutes up to max of 2 mg (8 doses)

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35
Q

Risk of accreta with placenta previa

A

No prior c-section: 5%
1: 15%
2: 25-30%
3+: 50-60%

Compared to <5% risk with 5 c-sections and no previa

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36
Q

Length GBS valid

A

5 weeks

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37
Q

Abnormal for GTT

A

1-hour: >=140

3-hour: 105/190/165/145

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38
Q

Normal values for gestational diabetes

A

Fasting 95
1-hour postprandial: 140
2-hour postprandial: 120

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39
Q

Daily suppression for UTIs

A

After pyelonephritis or 2 UTIs

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40
Q

Cardiac changes in pregnancy

A

Increased heart rate
Increased plasma volume
Increased cardiac output

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41
Q

Cardiac conditions that decompensate in pregnancy

A 
Mitral stenosis
Aortic stenosis
Eisenmenger syndrome (VSD+)
Pulmonary hypertension 
Congestive heart disease
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42
Q

Timing of ocp restart postpartum

A

No one <21 days

Can start 21-45 days if no other risk factors

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43
Q

Why is OP position more difficult delivery than OA position?

A

With OA delivery, head extends under pubic symphysis

With OP, fetus has to descend lower before head extension or deliver without head extension.

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44
Q

Which type of transverse lie requires classical or low-vertical C-section?

A

Back down (unable to access fetal parts otherwise)

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45
Q

Management of category 3 tracing

A 
Halt uterotonics
Intrauterine resuscitation
- lateral position
- IV fluid bolus
- maternal oxygen
Tocolytic
Move toward delivery if no resolution
46
Q

Posterior division of hypogastric artery

A

Lateral sacral
Iliolumbar
Superior gluteal

47
Q

Anterior division of hypogastric artery

A 
Umbilical/Superior vesicle 
Obturator
Uterine
Vaginal 
Internal pudendal
Inferior gluteal
48
Q

HSV treatment in pregnancy

A

Episodic: Valacyclovir 1000 mg BID 5 days
Suppression: Valacyclovir 1000 mg daily

49
Q

Twining by post-conception day

A

<4: di-di
4-8: di-amniotic, mono-chorionic
8-12: Mono-amniotic, mono-chorionic
>12: conjoined

50
Q

Delivery for placenta previa

A

Bleeding after 34 weeks

Otherwise 36-37 weeks

51
Q

Delivery for absent end-diastolic flow

A

34 weeks

52
Q

Delivery for reversed end-diastolic flow

A

32 weeks

53
Q

How do rotational maneuvers help shoulder dystocia?

A

Pushing posteriorly on fetal shoulder to rotate shoulder under pubic symphysis > decreased A/P diameter

54
Q

Risk of recurrent shoulder dystocia

A

10-20%

55
Q

Time benefit of magnesium for fetal neuroprotection

A

> 2 hours from presentation to deliver

Re-evaluate after 12 hours

56
Q

Syphillis treatment monitoring

A
  • 4-fold decline in RPR consistent with response
    Repeat titers every 4 weeks
    Fluorescent treponemal antibody absorption (FTA-ABS) will stay positive forever
57
Q

Folic acid supplementation with seizure disorder

A

4 mg folic acid

58
Q

Bile acid threshold for 36 week delivery

A

Total bile acids > 100 umol/L

59
Q

Hepatitis screening in pregnancy

A

Anti-HCV antibody

Hepatitis B surface antigen

60
Q

Positive after Hepatitis B vaccination

A

Anti-HBs positive (hepatitis B surface antibody)

61
Q

Risk of perinatal Hepatitis B and C transmission

A

Hepatitis B 20-50%
- 90% if hepatitis b envelope antigen positive
Hepatitis C 5%
- 20% if HIV positive
HIV 2% if controlled, 25% if not and no c-section

62
Q

Abdominal wall defects

A

Gastroschisis: no genetic abnormalities, not midline
Omphalocele: midline, chromosomal abnormalities

63
Q

2nd trimester genetic screening

A

Triple: HCG, AFP, estriol
Quadruple: plus inhibin A

Only 1st trimester screening has PAPP-A.

64
Q

Components of 1st trimester screening

A

US: Nuchal thickness testing
Lab: HCG, PAPP A

Does not detect open neural tube defects

65
Q

Insulin dosing

A
  1. 7-1.0 IU/kg
    - 2/3 AM and 1/3 PM
    - AM: 2/3 immediate acting and 1/3 long acting
    - PM: 1/2 immediate, 1/2 long acting
66
Q

Face presentation that requires c-section

A

Mentum posterior

67
Q

Prerequisites for operative vaginal delivery

A 
Fully dilated, ruptured membranes
Engaged fetal head (2+)
Known position 
Adequate pelvis 
Adequate analgesia
Empty bladder and rectum
Facilities to perform emergency c-section
Gestational age <34 weeks
No evidence of fetal bleeding disorder or bone demineralization
68
Q

Maylard incision

A

2-3 cm above pubic symphysis
Ligate inferior epigastric vessels
Split rectus muscles

69
Q

How to reduce nuchal arm

A

Rotate fetus toward impacted arm

70
Q

Pregnancy weight gain recommendations

A

Underweight: 28-40 pounds
Normal weight: 25-35 pounds
Overweight: 15-25 pounds
Obese: 11-20 pounds

71
Q

Category 3 tracing

A 
Sinusoidal pattern
Absent FHR variability with:
- Recurrent late decelerations
- Recurrent variable decelerations 
- Bradycardia
72
Q

Bishop score

A

Dilation, cervix position, effacement, station and consistency

0: closed cervix, posterior cervix, 0-30% effacement, -3 station, firm cervix
1: 1-2 cm cervix, mid position cervix, 40-50% effacement, -2 station, medium consistency
2: 3-4 cm cervix, anterior position, 60-70% effacement, -1 to 0 position, soft cervix
3: 5-6 cm cervix, 80% effaced, +1-+2

73
Q

Tachysystole

A

More than 5 contractions in 10 minutes averaged over a 30 minute period

74
Q

Confirmation of term gestation

A

Ultrasound less than 20 weeks
36 weeks since positive pregnancy test
Fetal heart tones present for 30 weeks

75
Q

Moderate fetal heart rate variability

A

6-25 beats per minute

76
Q

Normal fetal heart rate baseline

A

110-160 bpm

77
Q

Indications for cerclage

A

History
- Prior Exam or US indicated cerclage
- 1 or more second trimester losses from painless cervical dilation (no labor or abruption)
Physical exam
- Painless cervical dilation in second trimester
Ultrasound
- Cervical length < 25 mm before 24 weeks and history of prior preterm birth
- Cervical length < 10 mm with no previous preterm births

78
Q

Ultrasound redating criteria

A

1st trimester: 5-7 day discrepancy
2nd trimester: 7-14 day discrepancy
3rd trimester: 21+ day discrepancy

79
Q

Oxytocin dosing for PPH

A

IM: 10 units
IV: 40 units per 1000 mL as continuous infusion

80
Q

How much to fill a Bakri balloon

A

300-500 mL normal saline

81
Q

Diclegis dosing

A

Max vitamin B6 (pyridoxine): 40 mg
Max doxylamine: 40 mg
- Add antihistamines, prochlorperazine, or promethazine next

82
Q

Typical starting dose of insulin

A

0.7-1 units/kg

83
Q

Postpartum diabetes diagnosis

A

Fasting glucose >125 mg/dL

2-hour glucose > 199 mg/dL

84
Q

Coagulation changes in pregnancy

A

Increased: Fibrinogen, factor VII, factor VIII, factor X, von willebrand factor
Deceased: Free protein S
Others no change

This means you can test for factor V Leiden, prothrombin mutation, protein c deficiency and antithrombin deficiency in pregnancy.

85
Q

Anemia definitions

A

Hb < 11 g/dL in 1st and 3rd trimester

Hb < 10.5 g/dL in 2nd trimester

86
Q

Placement of vacuum

A

2 cm anterior to posterior fontanelle

87
Q

NPH pharmokinetics

A

Onset of action: 1-3 hours
Peak of action: 5-7 hours
Duration of action: 13-18 hours

88
Q

Oral nifedipine dosing and timing

A

10 mg > repeat BP in 20 minutes > 20 mg > repeat BP in 20 minutes > 20 mg > repeat BP in 20 minutes > switch to labetalol 20 mg

89
Q

IV hydralazine severe hypertension regiment

A

5-10 mg > repeat BP in 20 minutes > 10 mg > repeat BP in 20 minutes > switch to labetalol 20 mg

90
Q

IV labetalol severe hypertension guidelines

A

Labetalol 20 mg > repeat BP in 10 minutes > 40 mg > repeat BP in 10 minutes > 80 mg > repeat BP in 10 minutes > switch to hydralazine 10 mg

91
Q

Valacyclovir dosing

A

Treatment: 1 gram daily or twice daily for 5-10 days
Suppression: 500 mg BID from 36 weeks

92
Q

Severe preeclampsia criteria

A 
BP 160/110 4 hours apart or requiring treatment
Platelets <100
Twice normal LFTs
RUQ or epigastric pain unresponsive to medication 
Cr > 1.1 or doubling baseline
Pulmonary edema
Headache unresponsive to medications
Visual disturbances
93
Q

Chronic hypertension treatment options

A

Labetalol 200-2400 daily divided into 2-3 doses (100 mg BID to 800 mg TID)
Nifedipine 30-120 mg daily
Methyldopa 500-3000 mg daily divided into 2-3 doses

94
Q

Thyroid testing in pregnancy

A

Estrogen increases thryoid binding globulin > increased total T3 and T4

  • no change in free T3 or free T4
  • TSH varies by trimester
95
Q

Mechanism of heparin

A

Binds to antithrombin 3 > inhibits thrombin

96
Q

Mechanism of low-molecular heparin

A

Inhibits factor Xa

97
Q

Placental causes of IUGR

A 
Cirmcumvallate placenta
Velamentous cord insertion
Marginal cord insertion
Chronic abruption
Single umbilical artery
- Start antenatal surveillance at 36 weeks
98
Q

Biophysical profile

A

Fetal breathing: 1 or more episodes of 30+ seconds
Fetal movement: 3 or more discrete body or limb movements
Fetal tone: 1 or more extension/flexion or opening or closing of a hand
Amniotic fluid volume: MVP 2+ cm

NPV for stillbirth within 1 week: 99.9%

99
Q

Twin peak sign (lambda or delta sign)

A

Triangular projection of tissue that extends beyond the placenta > di-di pregnancy
- Visible after 9-10 weeks

100
Q

Apgar score

A 
Heart rate
Respiratory rate
Muscle tone
Reflex irritability (grimace, cry)
Color
101
Q

Clinical pelvimetry

A 
Inlet = diagonal conjugate
- symphysis to sacral promontory
- obstetrical conjugate = above - 2 cm
Mid-pelvis
- sacral promontory to sacral hollow
Interspinous diameter

Goal: 10+ cm for each

102
Q

Branchial nerve palsy

A

Erb’s palsy = C5-C6
- waiters tip (arm medially rotated)
Klumpke’s palsy = C8-T1
- hand and wrist paralysis, arm hangs at side

103
Q

Proteinuria criteria for pre-eclampsia

A

2+ urine dip
P/c ratio >= 0.3
Proteinuria > 300 mg/24 hours

104
Q

TORCH fetal consequences

A 
Chorioretinitis
Intracranial calcifications
Hydrocephalus 
Hearing loss
Mental retardation
Hepatosplenomegaly
105
Q

Low vs outlet

A

Outlet: vertex evident at intriotus between contractions
Low: fetal skull at +2 station or lower

106
Q

Cardinal movements of labor

A 
Engagement
Descent
Flexion
Internal rotation 
Extension
External rotation
Expulsion
107
Q

Findings of ARRIVE trial

A

Decreased c-section rate with 39 week induction
Lower hypertension rates
No difference in perinatal outcomes

108
Q

HELLP criteria

A

LDH > 600
LFTs 2X normal
Platelets < 100

109
Q

MOM cutoffs for second trimester screening (hCG, estriol, inhibin, afp)

A

0.5-2.5 MOM

110
Q

Delivery timing for isolated oligohydramnios

A

36-37 weeks

- if IUGR, 34-37 weeks

111
Q

Chlymadia treatment in pregnancy

A

Azithromycin 1 gram once

Amoxicillin 500 mg tid for 7 days

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