Obstetrics Flashcards
Alloimmunization
Maternal antibodies against fetal blood cells
Potentially sensitizing events in rh-d negative women
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
Minimum volume of maternal-fetal hemorrhage that can lead to alloimmunization
0.1ml
Kleihauer-Betke test
Method for determining percentage of fetal blood in maternal circulation
At what gestational age should rhogam be given for threatened miscarriage
12 weeks
Rhogam for miscarriage?
50-120mcg before 12 weeks, especially after D&C
300 mcg after 12 weeks
Postpartum depression diagnostic criteria
5 out of 9 symptoms in the first four weeks after delivery
- Depressed mood
- Anhedonia
- Decreased energy
- Changes in sleep pattern
- Feelings of guilt or worthlessness
- Psychomotor slowing or agitation
- Suicidal ideation
- Decreased concentration
- Weight changes
Postpartum psychosis
Hallucinations, delusions, and profound thought disorganization that occurs in the first 2 weeks postpartum
Postpartum blues
Mild depressive symptoms, irritability, tearfulness, decreased concentration in the first 2-3 days postpartum and resolve by 10 days postpartum
Jarisch-Herxheimer reaction
Reaction to penicillin G with uterine contractions, fetal heart rate decelerations, and preterm labor, fever, myalgia
Usually resolves 24-48 hours
Ultrasound abnormalities associated with syphilis
Nonimmune hydrops Hepatomegaly Placentomegaly Polyhydramnios Ascites
Ultrasound indicated cerclage
Performed if cervical length during cervical length screening is <2.5cm
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
Postpartum thyroiditis
Kidney changes during pregnancy
Kidney size increases 1-1.5cm, decreases in 6 months PP
Mild to moderate hydronephrosis and hydroureter, particularly on the right side
The IUD insertion approach in a breastfeeding woman that is considered category 1 (no restrictions) according to US Medical Eligibility Criteria is:
copper IUD within 10 minutes of placental separation
Preferred treatment for depression in pregnancy
CBT, psychotherapy
Edinburgh Postnatal Depresson Scale positive score
> 10
Division of embryo before day 4
Dichorionic twins (and diamniotic)
Embryo division days 4-8
Monochorionic diamniotic twins
Embryo division day 9-13
Monochorionic monoamniotic twins
Embryo division after 13 days
Conjoined twins
Risk of listeria in pregnancy
13 times more likely than nonpregnant patients
Type of cheese that should be avoided in pregnancy
queso fresco
soft unpasteurized
Type of tuna that should be limited in pregnancy (to one serving per week)
Canned albacore tuna
Fresh tuna
(canned light tuna is very low in methylmercury)
Fish that should be avoided in pregnancy
Tilefish from Gulf of Mexico shark swordfish marlin orange roughy bigeye tuna king mackerel
Huntington procedure
For correcting uterine inversion
Serial clamping and upward traction on the round ligaments to restore uterine position
Haultain procedure
For correcting uterine inversion
Cervical ring is incised posteriorly to aid in repositioning of the uterus
Treatment of mastitis abscess
Drainage and culture (keep dicloxicillin going)
17 y/o with painless fluctuant, fluid filled 6cm mass on left lateral vagina, 4cm cephalad to hymenal ring
Mesonephric duct remnant
Major modifiable risk factors for obstetric anal sphincter injuries
Forceps-assisted delivery
Vacuum extraction
Prolonged second stage
Midline episiotomy
Most likely fetal karyotype with Tetralogy of Fallot
46 XY
Tetralogy of Fallot
VSD
Overriding aorta
Pulmonic valve stenosis
Right ventricular hypertrophy
Type of prenatal diagnostic test to perform if it’s because you find congenital heart disease
Genomic microarray
Congenital heart defect associated with Down syndrome
ASD
What is the infectious disease for which prepregnancy interventions are most likely to improve perinatal outcome?
HIV
Low PAPP-A correlates with
Low birth weight
Advantages of delivering at higher level NICU
Lower mortality Decreased severe intracranial hemorrhage Decreased respiratory distress syndrome Decreased patent ductus arteriosis Decreased nosocomial infections
Contraindicated vaccines in pregnancy
Live influenza
MMR
Varicella
Zoster
Most common nutrient abnormalities after Roux-en-Y gastric bypass
Protein Iron Vitamins B12 and D Folic acid Calcium
Highest risk for infection after needle stick
Hepatitis C
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
Treatment of moderate to severe persistent asthma
Inhaled corticosteroid + short acting beta-2 agonist
Add long-acting beta-2 agonist
Off label treatment that best increases milk supply
metoclopramide (Reglan)
Safest mood stabilizer for breastfeeding
valproic acid (L2)
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
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
Suspicious adnexal mass, do CA-125 or refer to gyn onc?
Refer to gyn onc
CA-125 can be normal in some malignancies
Best imaging modality for intracavitary lesions, intracavitary fibroids
Sonohysterography
Management of chronic bronchitis (besides smoking cessation)
Beta-2 agonist
The most appropriate way for pregnant patients to monitor her level of exercise intensity
Perceived exertion rate
Anomaly that is the highest attributable increased risk from obesity
Neural tube defects
Management of pregnant women with known influenza exposure
Chemoprophylaxis with oseltamivir
Only recommended intervention with previable premature rupture of membranes
Antibiotics
Mag and steroids not until 23 weeks
To reduce risk of fetal intellectual disability and birth defects, patients with PKU should ensure a diet
Low in protein
Preeclampsia signs but accompanied by hypoglycemia?
Acute fatty liver of pregnancy
test ammonia and look out for altered mental status
Prognosis for women who recover from peripartum cardiomyopathy with EF of 50%
Recurrence risk of 21% and no increased risk of mortality
Prognosis for patients who have persistent cardiac dysfunction after peripartum cardiomyopathy, EF <50%
Recurrence risk of 48% and maternal mortality risk of 16%
HIV viral load to warrant zidovudine prior to delivery
1000 copies
Best way to reduce vertical transmission in patients with undetectable viral load of HIV
Avoid breastfeeding
Contraindication to IR embolization for vulvar hematoma
Persistent coagulopathy
Most common cause of severe polyhydramnios (>35cm)
Fetal abnormality like tracheo-esophageal fistula
When to resume LMWH after vaginal delivery without epidural
4-6 hours
Next step after diagnosing IUGR with abnormal dopplers at 35 weeks
BPP
Activity restriction with short cervix
None
Measles infection during pregnancy is associated with
Spontanous abortion
Still birth
Low birth weight
Risk of preterm delivery
What does binge drinking increase during pregnancy
Stillbirth
What perinatal infection accounts for the most cases of FGR worldwide
Malaria
SGA newborns are predisposed to
Hypoglycemia
Hypothermia
IVH
RDS
What percent of pregnancy loss are due to fetal chromosomal abnormalities
50%
VBAC is associated with lower
VTE
Hemorrhage
Recovery time
Infection
What % of diet should be obtained from protein when managing diabetes in pregnancy
15-30%
Signs and symptoms of Zika
Fever
Rash
Arthralgias
Conjunctivitis
What risk factor carries the highest rate of stillbirth
SLE
Gestational age threshold for lung hypoplasia in women with ruptured membranes
23 weeks
Which trisomy is most associated with spontaneous abortions
Trisomy 18
Most maternal life-threatening complications of HSV
HSV hepatitis
What typically happens to umbilical artery resistance
Progressively decreases throughout pregnancy
Mother has BRCA1, what is patient’s baseline risk of inheriting the gene?
50%
Amniocentesis test to provide the most rapid result in determining if fetus has down syndrome
FISH
Chorioangiomas associated with
Normal pregnancy
Arterial venous shunting
Fetal anemia
FGR
Benefits of delayed cord clamping
Improved blood count
Decreased need for transfusion
Decreased sepsis
Decreased intraventricular hemorrhage
Ratio of chest compressions to breaths per minute in a term neonate
90:30
Zika virus NAT negative and non-negative IgM, next step
Plaque reduction neutralization test
Mechanism of RhoD immunoglobulin
Blocks D antigenic determinants on the erythrocyte membrane
Leading cause of septic shock in pregnancy
Pyelonephritis
Perinatal period
20 weeks to 4 weeks postpartum
Kidd antibody that doesn’t require fetal assessment
JKa
How is iodide transported across the placenta
Carrier mediated
How to prevent pulmonary edema during evacuation of molar pregnancy in patient with hyperthyroidism
Beta blocker
Most likely source of PPH after FAVD
Genital tract laceration
Epidural analgesia prolongs the second stage of labor by how many minutes
5-10
How is water transferred across the placenta
Bulk flow
How many women develop DM in the next 25 years after GDM
70%
Sacral agenesis occurs when
3-7 weeks
VACTERL
Mullerian agenesis/uterine anomalies
Cardiovascular anomalies
TE fistula
Beta thalassemia electrophoresis
HBA 96%, HBA2 > 3.5%
Third leading cause of cancer among women
Colon
Heart sound heard during pregnancy
S1 split
Most common pelvic retroperitoneal mass related to urinary tract
Pelvic kidney
Largest diameter of the fetal head at term
Supra occipital mental
How to treat Donovan bodies
Azithromycin