Obstetrics

Question 1

What GI changes occur during pregnancy?

Answer 1

• decreased motility
• decreased esophageal sphincter competency
• overall increased risk of aspiration

Question 2

What respiratory changes occur during pregnancy?

Answer 2

• increased tidal volume
• decreased FRC
• chronic compensatory respiratory alkalosis

Question 3

Are gravid woman in a state of hyper or hypocoagulability?

Answer 3

hyper

Question 4

What is the leading cause of pregnancy related mortality in the first trimester?

Answer 4

ectopic pregnancy

Question 5

How are ectopic pregnancies managed?

Answer 5

• non-operative (methotrexate) if B-hCG is less than 5000 and there is no cardiac activity
• then need to trend B-hCG until undetectable
• otherwise need an operation

Question 6

What operations are considered for ectopic pregnancy?

Answer 6

• salphingectomy for patients with rupture, tubal damage, uncontrolled bleeding, or if gestation is > 3cm
• otherwise can consider salphingostomy to leave tube intact

Question 7

What are the risks to the fetus of CT during pregnancy?

Answer 7

• typically results in 2.5 rad exposure
• <5 rad exposure has not been associated with pregnancy loss or increased risk of congenital anomalies

Question 8

What are the risks of anesthesia during pregnancy?

Answer 8

• no currently used anesthetic agents are associated with teratogenicity
• no evidence that in utero exposure impacts fetal brain development
• some elevated risk of preterm delivery depending on the procedure (consider pre-operative steroids for a pre-term but viable pregnancy in case of delivery)

Question 9

During which trimesters can laparoscopy be performed?

Answer 9

all

Question 10

What fetal monitoring and support is appropriate during surgery?

Answer 10

• less than 24 weeks: confirm fetal heartbeat before and after
• more than 24 weeks: continuous monitoring with external fetal heart monitor or transvaginal ultrasound
• consider pre-operative steroids for a pre-term but viable pregnancy in case of delivery

Question 11

Where should first port placement be in laparoscopy on a pregnant woman? And with what technique?

Answer 11

• Hasson technique
• start 6cm above the most cranial portion of the uterus

Question 12

Where can you expect the fundus of the uterus during pregnancy?

Answer 12

• at the umbilicus at 20 weeks
• 1cm higher for every additional week

Question 13

What is the standard management for endometriosis?

Answer 13

• oral contraceptives
• excision/ablation if unable to tolerate medial therapy, bowel/urinary obstruction, suspected malignancy

Question 14

What is the most common site of ureteral injury during hysterectomy?

Answer 14

distal ureter at the level of the uterine arteries

Question 15

What is the most common extracolonic tumor in Lynch syndrome?

Answer 15

endometrial