Obstetrics

Question 1

threatened vs inevitebale abortion

Answer 1

threatened: bleeding in early pregnancy
inevitable: patient presents with bleeding, cramping and open cerivcal OS.
patient presents after passing tissue, bleeding slowed, cramping slowed, closed os= suspect complete abotion

Question 2

diagnosing miscarriage

Answer 2

size of mean sac diameter: >25mm with no fetal pol
CRL >7mm with NO fetal cardiac activity or falling beta HCG.

if MSD <25mm or CRL <7mm= pregnancy of undetermined viability.

Question 3

management of missed abortion

Answer 3

often expectant management
medical; misoprostol 800micrograms vaginally.
surgical :DandC: often if incomplete abortion or missed or unstable patient.

Question 4

definition of infertility

Answer 4

inability to conceive after 1 year of regular unprotexted intercourse.

Question 5

in someone with a 36 day cycle, when does ovulation occur?

Answer 5

22 days. the follicular phase is day 1 -ovulation and variable in length. luteal phase is ovulation to onset of menses, fixed at 14 days for most women.

Question 6

fertile window:

Answer 6

highest chance of success from 5 days before to day of ovulation

Question 7

how do you evaluate fertility including ovulation, sperm, fallopian tubes and uterus?

Answer 7

Hysterosalpinogram
pelvic US
sperm analysis
day 21 progesterone
menstrual history: progesterone, bbt, LH surge(urine testing)

Question 8

Note:

Answer 8

luteal phase progesterone (21)
basal body temperature (after ovulation your temperature goes up .5 degrees
estradiol (ovarian reserve– if its low, then really early in cycle)

Question 9

first line fertility treatment for a woman with PCOS

Answer 9

1. weight loss and cycle regulation via birth control
2. ovulation induction with clomid/clomiphene citrate (SERM, risk of twins), or aromatase inhibitors like letrozole.

Question 10

if you have bilateral tube obstructions, what therapy is best for fertility

Answer 10

IVF
IUI would put the sperm in the uterus but it would not allow them to fertilize the egg in the tube since its still blocked. You need to fertilize the egg prior to insertion, and then implant it in the uterus wihtout going through the tube. aka IVF.

Question 11

definition of labour

Answer 11

regular cramping and cervical change through time.

Question 12

BPP

Answer 12

The BPP checks your baby’s heart rate, muscle tone, movement, and breathing. It also measures the amount of amniotic fluid around your baby. Looking at these five areas helps your doctor know how well your baby is doing

Question 13

6cm dilated, 100% efface, station is -1. what stage is she in?

Answer 13

first stage.

early- cramping to 4-5cm
active- 5cm to pushing to delivery
3- placental delivery

Question 14

prior to starting oxytocin, what should you make sure you do?

Answer 14

amniotomy prior to starting labour.

Question 15

ALARMER

Answer 15

alert
leg and hip hyper extension McRoberts
anterior shoulder rotation through suprapubic pressure
rotational maneuvers
manual delivery of posterior arm
evaluate for episiotomy
roll on all fours
potentially can break the clavicle.

Question 16

differential for PPH

Answer 16

Tone: things that prevent uterine contraction–fibroids, infection, retained products of conception
tissue: placenta
trauma: tears, cervix, uterine rupture
thrombin: coagulopathy, being on anticoagulation, DIC.

Question 17

meds for pph

Answer 17

hemabate (no asthma)
TXA
misoprostol
oxytocin
methylmergovine /ergot (not for those with hypertension because it causes vasoconstriction)
uterine compression

Question 18

acute drop in consciousness and blood pressure after delivery– what to consider?

Answer 18

amniotic fluid embolism:

Shortness of breath or difficulty breathing.
Sudden drop in blood pressure.
Pulmonary edema (fluid in your lungs).
Abnormal heart rate.
Bleeding from your uterus, C-section incision or IV (intravenous) sites.
Fetal distress.
Agitation, confusion or sudden anxiety.
Chills.

Question 19

when do you give rH- patient rhogam

Answer 19

15 weeks, 28 week, 35 week, post partum.

Question 20

tocolysis

Answer 20

nifedipine or indomethacin to slow down premature delivery to allow transfer. usually done at 24-34 weeks in labour.

Question 21

what type of twin is at risk of twin-twin transfusion

Answer 21

mono/di twin: 1 placenta, 2 sacs– one gets more nutrition than the other. therefore one is growth restricted+ oligohydramnios and the other is macro+polyhydramnios.

Question 22

twins at risk for cord entanglement

Answer 22

mono/mono twins: two cords in the same sac and placenta.