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Obstetrics Flashcards

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1
Q

Alloimmunization

A

Maternal antibodies against fetal blood cells

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2
Q

Potentially sensitizing events in rh-d negative women

A 
Chorionic villi sampling, amniocentesis, cordocentesis
Threatened miscarriage
Ectopic pregnancy
Evacuation of molar pregnancy
Termination of pregnancy
Antepartum hemorrhage
Abdominal trauma
Intrauterine fetal death
External cephalic version
Delivery
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3
Q

Minimum volume of maternal-fetal hemorrhage that can lead to alloimmunization

A

0.1ml

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4
Q

Kleihauer-Betke test

A

Method for determining percentage of fetal blood in maternal circulation

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5
Q

At what gestational age should rhogam be given for threatened miscarriage

A

12 weeks

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6
Q

Rhogam for miscarriage?

A

50-120mcg before 12 weeks, especially after D&C

300 mcg after 12 weeks

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7
Q

Postpartum depression diagnostic criteria

A

5 out of 9 symptoms in the first four weeks after delivery

  1. Depressed mood
  2. Anhedonia
  3. Decreased energy
  4. Changes in sleep pattern
  5. Feelings of guilt or worthlessness
  6. Psychomotor slowing or agitation
  7. Suicidal ideation
  8. Decreased concentration
  9. Weight changes
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8
Q

Postpartum psychosis

A

Hallucinations, delusions, and profound thought disorganization that occurs in the first 2 weeks postpartum

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9
Q

Postpartum blues

A

Mild depressive symptoms, irritability, tearfulness, decreased concentration in the first 2-3 days postpartum and resolve by 10 days postpartum

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10
Q

Jarisch-Herxheimer reaction

A

Reaction to penicillin G with uterine contractions, fetal heart rate decelerations, and preterm labor, fever, myalgia
Usually resolves 24-48 hours

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11
Q

Ultrasound abnormalities associated with syphilis

A 
Nonimmune hydrops
Hepatomegaly
Placentomegaly
Polyhydramnios
Ascites
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12
Q

Ultrasound indicated cerclage

A

Performed if cervical length during cervical length screening is <2.5cm

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13
Q

3-6 months postpartum
Autoimmune thyroid dysfunction
Major risk factor is positive thyroid antibodies in the first trimester and GDM
Thyrotoxicosis –> transient hypothyroidism –> euthyroid at 12 months PP
Antithyroid treatments aren’t helpful, use beta blocker

A

Postpartum thyroiditis

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14
Q

Kidney changes during pregnancy

A

Kidney size increases 1-1.5cm, decreases in 6 months PP

Mild to moderate hydronephrosis and hydroureter, particularly on the right side

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15
Q

The IUD insertion approach in a breastfeeding woman that is considered category 1 (no restrictions) according to US Medical Eligibility Criteria is:

A

copper IUD within 10 minutes of placental separation

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16
Q

Preferred treatment for depression in pregnancy

A

CBT, psychotherapy

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17
Q

Edinburgh Postnatal Depresson Scale positive score

A

> 10

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18
Q

Division of embryo before day 4

A

Dichorionic twins (and diamniotic)

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19
Q

Embryo division days 4-8

A

Monochorionic diamniotic twins

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20
Q

Embryo division day 9-13

A

Monochorionic monoamniotic twins

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21
Q

Embryo division after 13 days

A

Conjoined twins

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22
Q

Risk of listeria in pregnancy

A

13 times more likely than nonpregnant patients

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23
Q

Type of cheese that should be avoided in pregnancy

A

queso fresco

soft unpasteurized

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24
Q

Type of tuna that should be limited in pregnancy (to one serving per week)

A

Canned albacore tuna
Fresh tuna
(canned light tuna is very low in methylmercury)

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25
Fish that should be avoided in pregnancy
``` Tilefish from Gulf of Mexico shark swordfish marlin orange roughy bigeye tuna king mackerel ```
26
Huntington procedure
For correcting uterine inversion | Serial clamping and upward traction on the round ligaments to restore uterine position
27
Haultain procedure
For correcting uterine inversion | Cervical ring is incised posteriorly to aid in repositioning of the uterus
28
Treatment of mastitis abscess
Drainage and culture (keep dicloxicillin going)
29
17 y/o with painless fluctuant, fluid filled 6cm mass on left lateral vagina, 4cm cephalad to hymenal ring
Mesonephric duct remnant
30
Major modifiable risk factors for obstetric anal sphincter injuries
Forceps-assisted delivery Vacuum extraction Prolonged second stage Midline episiotomy
31
Most likely fetal karyotype with Tetralogy of Fallot
46 XY
32
Tetralogy of Fallot
VSD Overriding aorta Pulmonic valve stenosis Right ventricular hypertrophy
33
Type of prenatal diagnostic test to perform if it's because you find congenital heart disease
Genomic microarray
34
Congenital heart defect associated with Down syndrome
ASD
35
What is the infectious disease for which prepregnancy interventions are most likely to improve perinatal outcome?
HIV
36
Low PAPP-A correlates with
Low birth weight
37
Advantages of delivering at higher level NICU
``` Lower mortality Decreased severe intracranial hemorrhage Decreased respiratory distress syndrome Decreased patent ductus arteriosis Decreased nosocomial infections ```
38
Contraindicated vaccines in pregnancy
Live influenza MMR Varicella Zoster
39
Most common nutrient abnormalities after Roux-en-Y gastric bypass
``` Protein Iron Vitamins B12 and D Folic acid Calcium ```
40
Highest risk for infection after needle stick
Hepatitis C
41
In history of alloimmunization in previous pregnancy, next step to address alloimmunization in this pregnancy if paternity is different
Determine rhesus type of the fetus
42
Treatment of moderate to severe persistent asthma
Inhaled corticosteroid + short acting beta-2 agonist | Add long-acting beta-2 agonist
43
Off label treatment that best increases milk supply
metoclopramide (Reglan)
44
Safest mood stabilizer for breastfeeding
valproic acid (L2)
45
HIV+ individual in pregnancy and hepatitis B anti-HB surface antigen is negative
Single booster dose of hepatitis B vaccine | retest anti-HB surface antigen in 1 month, and if <10 give other two doses of the vaccine on normal schedule
46
Women at high risk of aneuploidy
>35 y/o Ultrasound findings suggestive of aneuploidy History of prior pregnancy with trisomy Increased risk of aneuploidy on traditional serum screening Maternal or paternal balanced roberstonian translocation involving chromosome 21 or 13
47
Suspicious adnexal mass, do CA-125 or refer to gyn onc?
Refer to gyn onc | CA-125 can be normal in some malignancies
48
Best imaging modality for intracavitary lesions, intracavitary fibroids
Sonohysterography
49
Management of chronic bronchitis (besides smoking cessation)
Beta-2 agonist
50
The most appropriate way for pregnant patients to monitor her level of exercise intensity
Perceived exertion rate
51
Anomaly that is the highest attributable increased risk from obesity
Neural tube defects
52
Management of pregnant women with known influenza exposure
Chemoprophylaxis with oseltamivir
53
Only recommended intervention with previable premature rupture of membranes
Antibiotics | Mag and steroids not until 23 weeks
54
To reduce risk of fetal intellectual disability and birth defects, patients with PKU should ensure a diet
Low in protein
55
Preeclampsia signs but accompanied by hypoglycemia?
Acute fatty liver of pregnancy | test ammonia and look out for altered mental status
56
Prognosis for women who recover from peripartum cardiomyopathy with EF of 50%
Recurrence risk of 21% and no increased risk of mortality
57
Prognosis for patients who have persistent cardiac dysfunction after peripartum cardiomyopathy, EF <50%
Recurrence risk of 48% and maternal mortality risk of 16%
58
HIV viral load to warrant zidovudine prior to delivery
1000 copies
59
Best way to reduce vertical transmission in patients with undetectable viral load of HIV
Avoid breastfeeding
60
Contraindication to IR embolization for vulvar hematoma
Persistent coagulopathy
61
Most common cause of severe polyhydramnios (>35cm)
Fetal abnormality like tracheo-esophageal fistula
62
When to resume LMWH after vaginal delivery without epidural
4-6 hours
63
Next step after diagnosing IUGR with abnormal dopplers at 35 weeks
BPP
64
Activity restriction with short cervix
None
65
Measles infection during pregnancy is associated with
Spontanous abortion Still birth Low birth weight Risk of preterm delivery
66
What does binge drinking increase during pregnancy
Stillbirth
67
What perinatal infection accounts for the most cases of FGR worldwide
Malaria
68
SGA newborns are predisposed to
Hypoglycemia Hypothermia IVH RDS
69
What percent of pregnancy loss are due to fetal chromosomal abnormalities
50%
70
VBAC is associated with lower
VTE Hemorrhage Recovery time Infection
71
What % of diet should be obtained from protein when managing diabetes in pregnancy
15-30%
72
Signs and symptoms of Zika
Fever Rash Arthralgias Conjunctivitis
73
What risk factor carries the highest rate of stillbirth
SLE
74
Gestational age threshold for lung hypoplasia in women with ruptured membranes
23 weeks
75
Which trisomy is most associated with spontaneous abortions
Trisomy 18
76
Most maternal life-threatening complications of HSV
HSV hepatitis
77
What typically happens to umbilical artery resistance
Progressively decreases throughout pregnancy
78
Mother has BRCA1, what is patient's baseline risk of inheriting the gene?
50%
79
Amniocentesis test to provide the most rapid result in determining if fetus has down syndrome
FISH
80
Chorioangiomas associated with
Normal pregnancy Arterial venous shunting Fetal anemia FGR
81
Benefits of delayed cord clamping
Improved blood count Decreased need for transfusion Decreased sepsis Decreased intraventricular hemorrhage
82
Ratio of chest compressions to breaths per minute in a term neonate
90:30
83
Zika virus NAT negative and non-negative IgM, next step
Plaque reduction neutralization test
84
Mechanism of RhoD immunoglobulin
Blocks D antigenic determinants on the erythrocyte membrane
85
Leading cause of septic shock in pregnancy
Pyelonephritis
86
Perinatal period
20 weeks to 4 weeks postpartum
87
Kidd antibody that doesn’t require fetal assessment
JKa
88
How is iodide transported across the placenta
Carrier mediated
89
How to prevent pulmonary edema during evacuation of molar pregnancy in patient with hyperthyroidism
Beta blocker
90
Most likely source of PPH after FAVD
Genital tract laceration
91
Epidural analgesia prolongs the second stage of labor by how many minutes
5-10
92
How is water transferred across the placenta
Bulk flow
93
How many women develop DM in the next 25 years after GDM
70%
94
Sacral agenesis occurs when
3-7 weeks
95
VACTERL
Mullerian agenesis/uterine anomalies Cardiovascular anomalies TE fistula
96
Beta thalassemia electrophoresis
HBA 96%, HBA2 > 3.5%
97
Third leading cause of cancer among women
Colon
98
Heart sound heard during pregnancy
S1 split
99
Most common pelvic retroperitoneal mass related to urinary tract
Pelvic kidney
100
Largest diameter of the fetal head at term
Supra occipital mental
101
How to treat Donovan bodies
Azithromycin

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