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ABOG written boards > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Normal umbilical artery gas values

A

pH 7.28 (+- 0.05)
pCO2 49 +- 8.4
pO2 18.0 +- 6.2
HCO3 22.3 +- 2.5
Base deficit 4 +- 3

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2
Q

Neonatal metabolic acidosis labs

A

pH <7.0, base deficit 12 or greater

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3
Q

Effects of radiation exposure by gestational age

A

0-4w all or nothing
4-11w multi-organ systems
12-15w CNS

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4
Q

Antiphospholipid syndrome diagnostic criteria

A

Meets one clinical and one lab criteria
Clinical:
- vascular thrombosis
- pregnancy morbidity (unexplained fetal death after 10w, preterm birth before 34w b/c of preE/eclampsia/placental insufficiency, 3+ consecutive SAB before 10w without other cause)
Lab: +Ab on 2 occasions 12+ weeks apart
- lupus AC, anticardiolipin med-high titer, anti-beta2 glycoprotein >99%ile)

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5
Q

CMV in pregnancy

A
  • most severe fetal effects in first trimester, but most commonly transmitted in third trimester (40-72% vs. 30%)
  • up to 25% of babies with sequelae
  • HSM, jaundice, petechiae, thrombocytopenia, hearing loss
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6
Q

Congenital varicella US findings

A

Hydrops
Hyperechogenic foci in liver/bowel
Cardiac malformations
Limb deformities
Microcephaly
FGR
- most likely transmitted in 2nd tri, least likely in 3rd, overall unlikely (0.4-2%)

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7
Q

TTTS Quintero staging

A

I: oli-poly (>8 and <2 cm in donor)
II: bladder absent in donor
III: abnormal dopplers (AEDF or reversal)
IV: hydrops
V: demise

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8
Q

Diseases with highest risk of stillbirth

A

out of 1000 pregnancies
SLE (40-150)
Renal disease (15-200)
Cholestasis (12-30)
Prior stillbirth (9-20)
Late term pregnancy (14-40)
Multiple gestation (12-34)
FGR (10-47)
Diabetes (6-35), worse when on meds
Overall stillbirth rate 6.4/1000

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9
Q

Di-di twin timing, diagnosis

A

Cleavage in days 1-3 (morula stage)
Can be mono or dizygotic
Twin peak/lambda sign

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10
Q

Monochorionic timing, diagnosis

A

Cleavage in days 4-8 (dichorionic, blastocyst) or 8-13 (implanted blastocyst, monochorionic)
Thin dividing membrane (max 2mm)
Right angle between membrane and placenta
Fetal echo needed (risk of CHD)
Growth/fluid every 4 weeks
Antenatal testing at 32w
TTTS screening q2w starting at 16w

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11
Q

Recommended weight gain in pregnancy

A

BMI <18.5 28-40
18.5-24.9 25-35
25-29.9 15-25
>30 11-20

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12
Q

Obesity risks in pregnancy

A

Maternal: C-section, VTE, wound complications, endometritis, PPD, preE, GDM, OSA
Fetal: SAB, stillbirth, congenital anomalies (NTD, cardiac, orofacial/limb), indicated PTD, macrosomia, childhood morbidities (metabolic syndrome/obesity)

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13
Q

Congenital rubella findings (US and postnatal)

A

US: cataracts, pulmonary a. stenosis, microcephaly, radiolucent bone disease
After birth: PDA, intellectual disabilities, sensorineural deafness

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14
Q

Tetracycline fetal effects

A

Teeth staining

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15
Q

Cerebral palsy imaging findings

A

Periventricular leukomalacia

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16
Q

Erb palsy

A

C5-6
Waiters tip

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17
Q

Klumpke palsy

A

C8-T11
Claw hand

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18
Q

Congenital varicella findings

A

Skin scarring
Limb hypoplasia
Chorioretinitis
Microcephaly

High neonatal death rate when transmitted within 5d before to 48h after delivery

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19
Q

Congenital CMV findings

A

Jaundice
Petechiae
Thrombocytopenia
HSM
FGR
Myocarditis
Nonimmune hydrops
Congenital hearing loss

30% of severely infected infants die, 65-80% of survivors have neurologic morbidity

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20
Q

Parvovirus B19

A

aka Fifth disease
Fetus most vulnerable in second trimester
SAB, hydrops (aplastic anemia), stillbirth, FGR

21
Q

Toxoplasmosis

A

Transmission more likely in later gestation (10% first tri to 60% third tri)
Chorioretinitis, visual impairment, hearing loss, neurodevelopmental delay, HSM, ascites, periventricular calcifications, ventriculomegaly, seizures

22
Q

FRAX score

A

Used for patients with osteopenia or other high risk of fracture (T score -1.5 to -2.49)
10y risk major osteoporotic fracture 20% or greater, or hip fracture risk 3% or greater&raquo_space; treat

23
Q

Patients who do not require stress dose steroids

A
  • Glucocorticoids <3 weeks (any dose)
  • AM doses of prednisone <5mg/d (any length of time)
  • <10mg of prednisone or its equivalent every other day

Regimen: hydrocortisone 25mg IV q6h, at delivery hydrocortisone 100mg IV
- taper to baseline regimen/3d

24
Q

Effects of isotretinoin

A

External ear malformations
Cleft palate
Micrognathia
Conotruncal heart defects/VSDs
Aortic arch malformations
Brain malformations

25
Q

Risk of neurologic injury and death with loss of one twin

A

Monochorionic: 18/15%
Dichorionic: 1/3%

26
Q

Anthropoid pelvis associations

A

OP fetal position

27
Q

Platypelloid pelvis associations

A

Transverse arrest

28
Q

Risk of accreta with # prior C-sections, with/without previa

A

With previa:
1: 3%
2: 11%
3: 40%
4: 61%
5: 67%

without previa (uptodate)
0.03> 0.2> 0.1> 0.8> 4.7%

29
Q

IUFD eval

A

CBC, syphilis, glucose/A1C, UDS, KB
- offer karyotype/autopsy, amniocentesis/microarray

30
Q

Varicella US findings

A

FGR
Limb hypoplasia
Microcephaly
Microphthalmia

31
Q

Toxoplasmosis US findings

A

Microcephaly
Hydrocephalus
Intracranial calcifications

32
Q

HSV US findings

A

FGR
Microphthalmia
Microcephaly
Hydranencephaly
HSM

33
Q

Rubella US findings

A

FGR
Cardiac malformations (PDA, septal)
Microphthalmia
HSM

34
Q

CMV US findings

A

FGR
Cerebral ventriculomegaly
Microcephaly
Hydrops
Chorioretinitis
Intracranial calcifications

35
Q

History indicated cerclage

A
  • hx 1+ 2nd trimester loss due to painless cervical dilation (not labor or abruption)
  • prior cerclage due to painless dilation in 2nd trimester
36
Q

Exam-indicated cerclage

A

Painless cervical dilation in 2nd trimester

37
Q

Ultrasound-indicated cerclage

A
  • Singleton
  • Prior spontaneous PTD <34 weeks
  • AND short cervix <25mm before 24w
38
Q

Most common benign neoplasm in pregnancy

A

Mature teratoma

39
Q

Most common malignant neoplasm in pregnancy

A

Dysgerminoma

40
Q

Vaginal progesterone indication

A

Incidentally found short cervix <20 mm
No history of PTD <34w

41
Q

Criteria for failed induction

A
  1. attempting induction for 24+ hours
  2. Ruptured membranes
  3. 12-18h of pitocin after ROM
42
Q

Down syndrome quad screen

A

elevated hCG, inhibin A
Low AFP, estriol
16-18 weeks

43
Q

Contraction stress test

A

Satisfactory if:
- at least 3 ctx in 10 mins
- Each ctx 40s or more

Negative: no late or variables
Positive: lates after 50% or more of ctx (even if fewer than 3 in 10 mins)
Equivocal if decels with contractions that are too frequent or last >90s

44
Q

ACE-I fetal exposure

A

Oligohydramnios
Calvarium maldevelopment

45
Q

Danazol fetal effects

A

Androgenic/virilization of female fetus

46
Q

Isotretinoin fetal effects

A

Early pregnancy loss
Cardiac abnormalities
CNS anomalies

47
Q

Lithium fetal effects

A

Ebstein anomaly (apical displacement of tricuspid valve)

48
Q

Thalidomide fetal effects

A

Phocomelia (proximal aspect of extremity is absent)

49
Q

Rhogam coverage

A

300 mcg covers 30 mL of fetal whole blood or 15 mL fetal RBC
- KB quantifies percent of fetal cells in maternal circulation, can be used to calculate # vials, assume 5L maternal blood
- Give enough vials to cover, plus one additional vial for safety

ABOG written boards (5 decks)

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