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Gynecology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

HCG produced by?

A

Syncytio-trophoblast starting 8th day post fertilization
It is similar to LH*/FSH/TSH, it’s a glycoprotein hormone
Maintains corpus luteum in pregnancy (LH maintains without pregnancy)

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2
Q

HCG levels are high in which conditions?

A

Molar pregnancy (GT Disease)
Down syndrome (trisomy 21)
Multi-fetal pregnancy
Erythroblastosis fetalis (Hydrops)
Underestimated gestational age

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3
Q

HCG levels are low in which conditions?

A

Ectopic pregnancy
Abortion
Trisomy 18 Edwards
Blighted ovum/Anembryonic pregnancy
Overestimated gestational age

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4
Q

Progesterone is produced by ______ in pregnancy.

A

Corpus luteum upto 8 weeks

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5
Q

When does placenta take over function of Corpus luteum?

A

After 8 weeks, produces progesterone after 8 weeks

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6
Q

Progesterone decreases?

A

Myometrial contractions

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7
Q

What is used for prophylaxis of preterm labor?

A

Progesterone - but it can’t stop labor
(>32 weeks Tocolytics)

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8
Q

MC Tocolytic drug?

A

Nifedipine - Ca channel blocker

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9
Q

Morula enters uterine cavity on?

A

D4 - 16 cell stage

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10
Q

Morula -> Blastocyst formed on?

A

D5 - implantation - zona hatching

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11
Q

Implantation starting and ending days?

A

D6-D10

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12
Q

What prevents polyspermy?

A

Zone pellucida

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13
Q

Implantation sign?

A

Bleeding - Hartman’s sign

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14
Q

MC site of implantation

A

Upper post wall of the uterus MC
Eccentric - Piskaceks sign

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15
Q

Site of fertilization?

A

Ampulla

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16
Q

Placenta is made of?

A

Decidua basalis
Chorion frondosum

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17
Q

DES syndrome teratogenicity?

A

Clear cell adenocarcinoma of vagina
T-shaped uterine cavity

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18
Q

Lithium teratogenicity?

A

Ebstein anomaly - box shaped heart

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19
Q

Thalidomide teratogenicity?

A

Phocomelia

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20
Q

Valproic acid teratogenicity?

A

NTD - spina bifida, cleft lip

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21
Q

Warfarin teratogenicity?

A

Chondrodysplasia punctata - absent nasal bone

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22
Q

One condition that allows us to give Warfarin in pregnancy?

A

Prosthetic valves in patient

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23
Q

Parvovirus B19/syphilis teratogenicity?

A

Hydrops fetalis non-immune
(Immune caused by Rh incompatibility)

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24
Q

Viral infections that do not cause teratogenicity but are transmitted to the baby?

A

HIV and Herpes

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25
Q

Vaccines contraindicated in pregnancy?

A

MMR
Varicella
HPV
Yellow fever can be given but we don’t usually give

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26
Q

ACEI/Valproate/Methotrexate are?

A

Teratogenic

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27
Q

Y-chromosome induces gonadal secretion of?

A

MIS - causes mullerian duct involute
By Sertoli cells

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28
Q

What makes testis?

A

SRY region on short arm of Y-chromosome

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29
Q

What female parts are formed from Mullerian ducts/paramesonephric?

A

Uterus, cervix, FT and Upper 1/3rd of vagina
DOES NOT MAKE OVARIES

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30
Q

Mesonephric ducts/Wolffian duct require which stimulant to form male internal genitalia?

A

Testosterone that comes from Leydig cells

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31
Q

Wolffian duct (after stimulation from Testosterone) makes which male organs?

A

Vas deferens, seminal vesicles, Epididymis, and efferent ducts

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32
Q

What is required for the formation of male external genitalia?

A

DHT - makes Penis and scrotum
Testosterone –> 5-alpha reductase –> DHT

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33
Q

What happens to BP in pregnancy?

A

Arterial Systolic and diastolic both decrease - Peripheral vascular resistance increases
(everything else in CVS increases)

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34
Q

CO output is lowest in which position in pregnency?

A

Supine - because of compression of IVC
It’s called supine hypotension syndrome

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35
Q

Which murmur is MC in pregnancy?

A

Systolic murmur - physiological
(Diastolic murmur is physiological only in 20% cases)

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36
Q

Cardiac output is highest in which pregnancy phase?

A

Immediate post-partum - highest risk of heart failure > second labor stage

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37
Q

Which physiological heart sounds are heard during pregnancy?

A

Soft diastolic murmur and S3

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38
Q

Hematological changes during pregnancy?

A

RBC mass increases and Hb - hematocrit values decrease
Because of hemodilution

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39
Q

Define anemia in pregnancy?

A

less than 11 gm% Hb

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40
Q

ESR in pregnancy?

A

ESR Increases because of increase in fibrinogen

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41
Q

All coagulation factors increase in pregnancy except?

A

11&13 (they decrease)
Because of Estrogen

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42
Q

MC cause of thrombocytopenia in pregnancy?

A

Gestational thrombocytopenia

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43
Q

Which pulmonary parameters increase in pregnancy?

A

Tidal volume
Minute ventilation
(RR and VC no change and residual/reserve volume decreases)

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44
Q

Why are ureters dilated in pregnancy?

A

Progesterone
(right side ureter more dilated than left)

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45
Q

What happens to GFR in pregnancy?

A

Increases
Hence blood urea nitrogen (BUN), creatinine and uric acid decrease in blood

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46
Q

Effects of estrogen in pregnancy?

A

Increases liver-produced TBG thus increasing total T3 and T4
But free T3 and T4 remain normal
(TSH normal)
Causes skin pigmentation and water retention

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47
Q

DOC hyperthyroidism in pregnancy?

A

1st trimester = PTU
2/3rd trimester = Methimazole

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48
Q

Double bleb sign has which 2 blebs?

A

Yolk sac
Amniotic sac

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49
Q

Double decidual sac sign has which 2 rings?

A

Decidua capsularis and paritalis
their fusion will obliterate the uterine cavity at 16 weeks

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50
Q

1st sign that on TVS that tells Intrauterine pregnancy?

A

G-sac or Intra-decidual sign at 5 weeks

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51
Q

Cardiac activity in pregnancy is first seen at?

A

6 weeks

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52
Q

Define superfetation?

A

Double fertilization in different cycle

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53
Q

Define superfecundation?

A

Fertilization of 2 ova by different acts of coitus in same cycle

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54
Q

Softening of Isthmus is which sign?

A

Hegar’s sign - 6 weeks

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55
Q

Softening of cervix is which sign?

A

Goodle’s sign - 6 weeks

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56
Q

Chadwick/Jaqueimiers sign is?

A

Bluish discoloration of vagina in pregnancy

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57
Q

When does quickening happen?

A

18 weeks
(multi 16-18 or primi 18-20)
Presumptive sign only felt by patient

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58
Q

Which hormone causes linea nigra?

A

Estrogen

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59
Q

Melasma is a sign of?

A

Pregnancy - pigmentation of mallor bones

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60
Q

LMP is?

A

1st day of last menstrual period

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61
Q

Formula for EDD?

A

Naegeles formula
First day of the last menstrual period (LMP) + 1 year - 3 months + 7 days

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62
Q

Naegeles formula can’t be used if?

A

Irregular cycles
does not remember LMP
conceived on OCPs
(USG-CRL used for EDD)

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63
Q

What is term for post-term and pre-term pregnancy?

A

Pregnancy beyond 42 weeks port-term
Pregnancy ended before 37 weeks is pre-term

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64
Q

How many extra calories needed in pregnancy?

A

350 in 2 and 3rd trimester

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65
Q

Folic acid supplementation in pregnancy?

A

0.4 mg upto 12 weeks and IFA tab after that
IFA tab has 60 mg iron + 0.5 mg FA 1 tab per day, 180 days during pregnancy and 180 beyond pregnancy

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66
Q

Supplementation for pregnant woman with history of NTD and antiepileptics?

A

4 mg folic acid upto 12 weeks

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67
Q

SCA Supplementation for pregnant woman?

A

5 mg folic acid throughout pregnancy

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68
Q

Iron and Ca supplementation in pregnancy is done after?

A

12 weeks

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69
Q

Tab Albendazole dose?

A

1 tab 400 mg in second trimester to every pregnancy woman for deworming

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70
Q

When do we give infection Dt1?

A

1st ANC –> 4 weeks Dt2

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71
Q

Cause of hyperemesis gravidarum?

A

HCG (high risk in molar and multifetal)

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72
Q

Bleeding gums in pregnancy is called?

A

Pregnancy tumor - pyogenic granuloma - granuloma gravidarum
NOT A TUMOR

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73
Q

Test mandatory at first ANC?

A

Hb, VDRL, BgRh, HIV
2 hour OGTT done at first ANC (if normal repeat beyond 24 weeks)

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74
Q

Urine test done at first ANC?

A

Dipstick for protein and sugar

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75
Q

Screening for Down’s syndrome is done at?

A

First trimester 11-13 weeks > Second trimester

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76
Q

Which USG is mandatory in ANC?

A

Level 2 USG - done at 18/22 weeks

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77
Q

What is best parameter for gestational age assessment in first trimester?

A

CRL 7-9 weeks

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78
Q

What is best parameter for gestational age assessment in second trimester?

A

BPD

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79
Q

Indications for mandatory USG in first trimester?

A

Suspected ectopic (pain and bleeding)
Discrepancy between uterine size and pregnancy dating (molar or multifetal pregnancy)
Fetal Viability doubt - we look for cardiac activity
Chronicity in a twin pregnancy
Screening for Down’s - NT scan, CV sampling

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80
Q

DUAL test includes?

A

done in first trimester for Down’s syndrome
HCG high and PAPPA low

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81
Q

NT scan is done at?

A

11-13 weeks for Down’s syndrome

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82
Q

If NT is increased more than or equal to 3 mm, next step?

A

CV sampling done at 10-13 weeks

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83
Q

Combined test is a test of which trimester?

A

First, it includes DUAL and NT scan

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84
Q

Quadruple test is a test of which trimester?

A

Second, 15-22 weeks (HCG, UE3, AFP and Inhibin A)
same time triple test also done

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85
Q

Amniocentesis is done at which week?

A

16-18 weeks (anytime beyond 15 weeks)
Second trimester test

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86
Q

Cordo is done at which week?

A

Beyond 18 weeks

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87
Q

Early-amnio is done at?

A

11-14 weeks

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88
Q

Level 2 ultrasound is done for?

A

Congenital anomalies hence its called anomaly scan
TIFFA - Targeted imaging for fetal anomalies
18-22 weeks - MENDATORY

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89
Q

Diabetes screening in pregnancy?

A

2 hour OGTT
If normal at first ANC repeat again after 24-28 weeks

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90
Q

Plasma glucose level values in 2-hour OGTT?

A

more than 140 GDM
more than 200 overt diabetes

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91
Q

What do we suspect if NT is increased?

A

Down’s trisomy 21 > Turners syndrome monosomy X 45XO
If karyotyping normal, then heart disease

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92
Q

NT increased more than 4 mm, karyotyping after CVS normal. What’s the next step?

A

Anomaly scan + fetal echo to find cardiac issues
18-22 weeks

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93
Q

Reasons for AFP elevation in pregnancy after Quad test?

A

NTD and abdominal defects

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94
Q

MC NTD?
Anomaly that can be diagnosed using USG in first trimester?

A

Anencephaly - frog eye sign, mickey mouse sign
As early as 10-11 weeks
Has polyhydramnios because of absent swallowing

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95
Q

Define abortion?

A

Pregnancy lost before 20 weeks <500 gm

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96
Q

MC cause of early pregnancy loss?

A

First trimester abortions - chromosomal anomalies
MC trisomy > monosomy X

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97
Q

MC cause of pregnancy loss in 2nd trimester?

A

Uterine abnormalities

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98
Q

MC congenital and acquired anomaly to cause pregnancy loss in second trimester?

A

Congenital Septae
Cervical incompetence acquired

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99
Q

Cervical incompetence presentation?

A

RPL in 2nd trimester
Painless
<25mm

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100
Q

TOC Cervical incompetence?

A

Cervical cerclage - McDonalds + progesterone

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101
Q

CT for Cervical cerclage?

A

Ruptured membranes, Uterine contractions, Active infection, Gross congenital anomalies

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102
Q

Antiphospholipid antibody syndrome antibodies (APLA) are?

A

LAC, ACA, Anti beta-2 GP1

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103
Q

TOC APLA syndrome?

A

LMWH + Aspirin low dose
LMWH given only if there’s history of abortion or thrombosis

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104
Q

OS open + IU bleeding indicates?

A

Inevitable abor = no history of passage
Incomplete abor= History of passage of products

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105
Q

OS closed + IU bleeding indicates?

A

Threatened abor: Size of uterus same
Missed abor: size uterus smaller
Complete abor: history of passage of products present

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106
Q

As per new MTP act, MTP can be done up to?

A

24 weeks
up to 20 weeks if OCP failure
Beyond 24 weeks in GCA

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107
Q

Outpatient abortions is possible up to?

A

9 weeks - MMA
Mifepristone 200 mg (RU486 - Antiprogesterone) and Misoprostol (PGE1 tab) 800 mg
Vaginal + buccal + sublingual + oral

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108
Q

MTP method beyond 9 weeks up to 12 weeks?

A

Suction and evacuation
MVA - pressure 660 mmhg - 60 ml

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109
Q

MTP method in second trimester?

A

Drugs: PGs, Extra-amniotic ethacridine, Intra-amniotic saline, Oxytocin
D&E - Ovum forceps used

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110
Q

MC PG used in MTP?

A

MISO
400 mcg every 3-4 hours, 5 total doses
Other PGs: PGE2, PGF2 alfa - carboprost

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111
Q

Uses for Karman’s cannula?

A

Suction and evacuation
Molar pregnancy
Incomplete abortion
Endometrial sampling

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112
Q

Pressure generated by Karman’s cannula?

A

600 mmhg
spoon shaped tip without lock

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113
Q

Use of uterine sound?

A

UCL measurement
Direction of uterus
IUD insertion

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114
Q

Ideal time for McDonald’s/purse string cerclage?

A

14 weeks (up to 28 weeks)
Remove at 37 weeks/active labor/ruptured membranes

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115
Q

Sharp end of uterine curette is only used in?

A

Molar pregnancy

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116
Q

Sims speculum is used for?

A

Posterior vaginal wall retraction

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117
Q

Cusco’s speculum advantages?

A

Self-retracting
retracts both anterior and posterior walls of vagina

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118
Q

Ectopic pregnancy risk factors?

A

MC PID
Infertility/IVF
FT surgery
Previous ectopic
Tubal ligation > IUD > POP

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119
Q

MC site for Ectopic pregnancy?

A

Ampulla - ruptures at 8 weeks
(intramural/interstitial least common - rupture at 10-12 weeks)

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120
Q

Obs triad of Ectopic pregnancy?

A

Pain + amenorrhea + bleeding
If ruptured generalized abdominal pain, shoulder tip pain

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121
Q

IOC Ectopic pregnancy?

A

TVS

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122
Q

No uterine or extrauterine pregnancy with embryo or cardiac activity + complex adnexal mass + ring of fire sign, next step?

A

Beta-HCG test
If more than 2000 IU - Medical management of ectopic
If less than 2000 IU - repeat test in 48 hours

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123
Q

Most important finding in Ectopic pregnancy?

A

Adnexal mass

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124
Q

TOC Ectopic pregnancy?

A

Medical management best, only if:
Hemodynamically stable (SBP<90 mmhg)
Unruptured
Less than 4 cm
HCG less than 5000 IU
Absent CVS activity (surgical if present)

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125
Q

DOC Ectopic pregnancy?

A

Methotrexate 1 mg/kg IM (50 mg/m2)

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126
Q

Preferred Sx in Ectopic pregnancy?

A

Salpingostomy
(salpingectomy if ruptured or family complete or more than 5 cm size)

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127
Q

Cervical Ectopic pregnancy criteria?

A

Pallmann Rubins

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128
Q

Ovarian Ectopic pregnancy criteria?

A

Spiegelberg

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129
Q

Abdominal Ectopic pregnancy criteria?

A

Studdiford

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130
Q

Colpotomy is done for?

A

To drain pelvic abscess - open POD

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131
Q

Culdocentesis is done for?

A

Ruptured ectopic pregnancy

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132
Q

Define antepartum hemorrhage?

A

Bleeding beyond period of viability (28 weeks)

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133
Q

Key words for abruptio placentae?

A

Bleeding in 3rd trimester
Painful bleeding/dark color
Fundal height more than POG
Uterus tense and tender - well made out
Retroplacental clot on USG
Distress fetal HR
Fetal parts difficult to feel

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134
Q

Sign on USG for APH?

A

Retroplacental clot
clot between placenta and decidua basalis

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135
Q

Warning hemorrhage is seen in?

A

Placenta previa

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136
Q

Preeclampsia in APH is likely to be?

A

abruptio placentae

137
Q

Risk factors of abruptio placentae?

A

Preeclampsia
Polyhydramnios
Trauma
Advanced maternal age
Multiparity
PROM
Smoking
Fibroid uterus

138
Q

Smoking is protective for?

A

Preeclampsia

139
Q

Normal fetal HR?

140
Q

Key words for rupture placentae?

A

Abdomen tense and tender
Distress fetal HR
Fetal parts easy to feel superficially
Loss of uterine contour

141
Q

Why is Cervix dilated in abruptio placentae?

A

Cervix dilated because patient in labor - because of tissue thromboplastin (DIC MC cause abruptio placentae)

142
Q

Indication for CS in abruptio placentae?

A

Fetal distress
Mother hemodynamically unstable
(Vaginal delivery if none of the above or fetal HR absent)

143
Q

Special thing we do in Vaginal delivery in case of abruptio placentae?

144
Q

Indication for RARE conservative management in abruptio placentae?

A

Remote from term <34 weeks
No bleeding and contractions

145
Q

Blood between the myometrial fibers appearing like bruises is called?

A

Couvelaire Uterus
Accidental hemorrhage
Utero placental apoplexy

146
Q

Bleeding type in placenta previa?

A

Red/fresh bleeding in 3rd trimester
Painless and causeless

147
Q

USG finding in placenta previa?

A

Placenta over internal OS
(low lying placenta means it’s near the OS, around 2 cm)

148
Q

IOC placenta previa?

149
Q

Risk factors for placenta previa?

A

Multiparity
Smoking
Advanced maternal age
Twin pregnancy
History of CS, curettage or uterine anomalies
Transverse lie

150
Q

Features of placenta previa?

A

Fundal height POG (if less then means transverse lie)
Relaxed uterus non-tender
FHR/fetal parts normal

151
Q

Management of placenta previa?

A

LSCS - in all scenarios if delivery needed
(Johnson’s and McAfee’s regime for conservative management)

152
Q

Reason behind occurrence of PAS in placenta previa?

A

If placenta previa occurs over scar tissue
It enters myometrium layers causing PAS

153
Q

PAS doesn’t have?

A

D. Basalis and Nita Buch’s membrane

154
Q

IOC PAS?

A

USG - moth eaten placenta/heterogenous placenta/lakes
Other doppler and MRI

155
Q

Management of PAS?

A

Elective classical CS + Hysterectomy
Upper segment vertical incision

156
Q

Define Vasa previa

A

Fetal vessels over internal OS
vessels from Velamentous/succenturiata

157
Q

Diagnosis of Vasa previa?

A

USG + doppler

158
Q

Classic presentation of Vasa previa?

A

Fetal distress and bleeding right after membranes rupture

159
Q

Test which tells its fetal blood?

A

APT - alkali denaturation test

160
Q

Management of Vasa previa

A

Emergency CS or Elective CS

161
Q

Key words for Uterine rupture?

A

Previous CS and rupture
Patient in labor
Misoprostol
Myomectomy

162
Q

Drug that is contraindicated in induction for labor in previous CS?

A

Misoprostol

163
Q

Which CS has highest risk of uterine rupture?

A

Classical CS - vaginal delivery never allowed

164
Q

Uterine rupture presentation?

A

Uterine contour loss, no contractions
Teder abdomen
Severe FHR distress
Fetal parts superficial
Management: emergency laparotomy
Most specific finding: loss of station

165
Q

Gestational trophoblastic disease includes?

A

Molar pregnancy and GTN (invasive mole, chorio CA, PSTT, ETT)

166
Q

Complete molar pregnancy
46XX - diploid
Monospermic
Empty ovum
Absent fetus
Complete hydropic change
fundal height more than POG
HCG >10⁵
Theca leuein cyst present
USG snowstorm/honeycomb

A

Partial molar pregnancy
69XXY - triploid
Di-spermic
no ovum
present fetus dies early
Focal hydropic change
Fundal height less/same as POG
Higher HCG than expected
Theca leuein cyst absent
USG not seen snowstorm or honeycomb

167
Q

TOC for molar pregnancy?

A

S&E
Hysterectomy if >40 yo and family complete
OCP used IUD not used

168
Q

Period of surveillance for complete mole?

169
Q

Prophylactic chemo indications in molar pregnancy?

A

Age >40
HCG >100000
Bilateral theca leutein cyst
FH>POG
Post S&E chemo

170
Q

DOC molar pregnancy?

A

Methotrexate

171
Q

Diagnosis of GTN - Gestational trophoblastic neoplasia?

A

3 consecutive values of HCG showing rise - 2 weeks
4 consecutive values showing Plateau -3 weeks
Histopathological confirmation

172
Q

MC GTN?

A

Invasive mole

173
Q

Chorio Ca arises after?

A

Complete mole

174
Q

MC site of mets?

A

Lungs > Vagina
Canon ball 3 - blue sub-urethral nodule 2 stage

175
Q

Low risk GTN key words

A

Stage 1 GTN and >6 FIGO WHO score
Single agent multi dose chemo - methotrexate/leucovorin folinic acid

176
Q

High risk GTN key words

A

Stage 4 GTN and >7
Multi agent chemo EMACO - cyclophosphamide
FU - 12 months

177
Q

Preeclampsia definition?

A

140/90 mmhg on 2 occasions 4 hours apart
POG more than 20 weeks
proteinuria >+2
end organ damage
Pul edema

178
Q

Gestational HTN definition?

A

No proteinuria and no end organ damage

179
Q

Eclampsia is?

A

PE with seizures (GTCS)

180
Q

DOC HTN pregnancy?

A

Labetalol (not given in asthma and HF) > hydralazine > nifedipine

181
Q

CI in HTN pregnancy?

A

ACEI, ARB, Diuretics, beta-blockers

182
Q

Well controlled PE BP, pregnancy terminated at?

183
Q

Severe PE with controlled BP terminate pregnancy at?

184
Q

ECV is CT in?

185
Q

Impending eclampsia TOC?

A

symptoms: Epigastric pain, headache, visual changes
Next step: MgSO4 then anti-HTN then delivery
Preferred vaginal delivery

186
Q

Cause of tonic-clonic seizures?

A

Hypoxia and cerebral edema

187
Q

Therapeutic blood levels of MgSO4?

A

4-7 meq
First sign of toxicity is loss of knee jerk

188
Q

Loading dose MgSO4?

A

Loading dose - 4 gm IV over 10 minutes
10 g IM (5 gm in each buttock)

189
Q

What to check before giving MgSO4 loading dose?

A

Patellar reflex
RR>12
Urine output > 100ml or 30 ml per hour

190
Q

Antidote for MgSO4?

A

IV Ca-gluconate

191
Q

Indications for MgSO4?

A

Tocolytic
Neuroprotection for baby
Impending eclampsia

192
Q

HELLP syndrome criteria and full form?

A

Tennessee criteria
Hemolysis - raised indirect bilirubin
Elevated liver enzymes two times
Low platelet count less than 1 lac
Schistocytes - Helmel cells
High LDH and low haptoglobin

193
Q

Management HELLP?

A

PE with severe features = 34 weeks termination

194
Q

Acute fatty liver of pregnancy features?

A

Epigastric pain
Risk factor: PE/primigravida/multifetal/male baby (LCHAD)
hypoglycemia, high ammonia, disorientation, renal failure, coagulopathy
Third trimester

195
Q

Management Acute fatty liver of pregnancy?

A

TOP - vaginal anytime

196
Q

Intrahepatic cholestasis in pregnancy features?

A

Stimulated by Estrogen
3rd trimester
Important symptom is Pruritic
high direct bilirubin and liver enzymes

197
Q

Diagnostic findings in Acute fatty liver of pregnancy?

A

Serum bile acids

198
Q

DOC Acute fatty liver of pregnancy

A

Ursodeoxycholic acid
IOL at 37-38 weeks

199
Q

Effects of Acute fatty liver of pregnancy on baby?

A

Sudden IUD, prematurity, meconium aspiration syndrome

200
Q

MC heart disease in pregnant woman?

A

Mitral stenosis > RHD

201
Q

When to switch from warfarin to LMWH in pregnancy?

A

1st trimester - if dose is more than 5 mg/d then switch at 12 weeks
Switch back from warfarin to LMWH at 36 weeks
12-36 weeks - patient stays on warfarin

202
Q

Preferred analgesic/anesthesia in pregnant woman with heart disease?

203
Q

Preferred mode of delivery in woman with heart disease?

204
Q

Drug CI in pregnant woman with PPH and heart disease?

205
Q

Pregnant woman on warfarin, she’s in labor preterm management?

206
Q

Which heart disease is indication for CS?

A

Severe AS/Aortic dissection/Marfan’s with aortic root/coarctation with aortic valve

207
Q

A1 GDM is managed?

A

Diabetic diet only

208
Q

A2 GDM is managed?

A

Diet + drug

209
Q

Insulin resistance in pregnancy is because of?

210
Q

Insulin levels in pregnancy?

A

Increased
(Resistance also high)

211
Q

2 hour OGTT done at?

A

first ANC and 24-28 weeks
75 gm 300 ml within 10 min

212
Q

2 hour OGTT DIPSI value >140 then?
If more than 200?

A

Diabetic diet for 2 weeks - GDM
Initiate Insulin: Overt

213
Q

Target of 2 hour PP value?

A

<120 - start on insulin (and avg value 100)

214
Q

Anomalies are seen in which diabetes?

A

Overt - Sacral agenesis/caudal regression syndrome
Not seen in GDM

215
Q

MC anomaly in baby of a diabetic mother?

216
Q

USG done at which term to look for anomalies?

A

18-22 weeks

217
Q

USG findings in diabetic mother?

A

Polyhydramnios
Macrosomia >4kgs

218
Q

When do we induce labor in a diabetic pregnancy?

A

39-40 weeks

219
Q

CS for fetal weight?

220
Q

Insulin requirement during labor?

A

Decreased - that’s why night dose given but day dose not given on day of induction

221
Q

Shoulder Dystocia is seen in?

A

Macrosomia fetus

222
Q

First maneuver done in Shoulder Dystocia?

A

McRoberts then Suprapubic pressure
(Fundal pressure not given and ask not to push)

223
Q

Last maneuver done in Shoulder Dystocia?

A

Zavanelli
Cleidotomy or fracture of anterior clavicle can be done

224
Q

Maneuvers done in Shoulder Dystocia?

A

Woods corkscrew Maneuver and Rubin – internal rotational
Removal of post arm
Gaskin all 4s
Zavanelli
McRoberts then Suprapubic pressure

225
Q

Erb’s palsy MC cause in baby?

A

Shoulder Dystocia
C5-C6 brachial plexus

226
Q

Neonatal issues?

A

Hypoglycemia
Hyperbilirubinemia
Polycythemia
Hypocalcemia/hypomagnesemia
RDS
Hypertrophic cardiomyopathy

227
Q

MC anemia in preg?

A

Iron deficiency
Microcytic
Hypocromic

228
Q

DOC Iron deficiency anemia in pregnancy?

A

Iron sucrose IV
DO NOT GIVE PARANTRAL in first trimester

229
Q

Iron requirement in pregnancy?

A

1000 mg (300 for fetus)
If hb<8gm% 2 tabs per day

230
Q

MC type of twins?

A

Dizygotic - DCDA

231
Q

Up to 72 hours zygote separation?

A

Morula - DCDA

232
Q

Between 4-8 days zygote separation?

A

Blastocyst - MCDA

233
Q

Between 9-12 days zygote separation?

234
Q

After 12 days zygote separation?

A

Conjoint/Siamese = MC Paraphagus > Thoracovagus

235
Q

2 separate placenta means which twins?

A

DCDA
Opposite sex twin
Lamda sign - twin peak sign 10-14 weeks
4 layers in dividing membrane

236
Q

Sign in Monochorionic twins?

237
Q

Twin-twin transfusion syndrome is seen in?

A

MCDA
Recipient twin has polyhydramnios and polycythemia
Donor twin gets oligo and anemia

238
Q

Twin-twin transfusion syndrome staging?

A

Quintero
Stage 5 is worst - either or both babies dead
Stage 4 - Either one or both babies have hydrops
Stage 3 - oligo + poly doppler abnormal
Stage 2 - oligo + poly doppler normal bladder invisible
Stage 1 - oligo + poly doppler normal bladder visible

239
Q

TOC TTTS?

A

IU Sx - Fetoscopic laser ablation vascular anastomosis

240
Q

Mode of delivery in MA twins?

241
Q

Cord entanglement is a sign of?

242
Q

Max amniotic fluid is seen at?

A

32/34 weeks

243
Q

Dye used in chromotubation?

A

Methylene blue

244
Q

Drugs for medical abortion?

A

Mifepristone 200 mg and misoprostol 800 McG after 48 hours

245
Q

USG snowstorm appearance?

A

Hydatidiform mole

246
Q

Placenta developes by which gestational week?

247
Q

Vessel which disappears in placenta?

248
Q

Largest fetal heart diameter?

A

Mentovertical

249
Q

Lowest estrogen and progesterone seen at which phase?

A

Follicular phase

250
Q

True support for uterus?

A

Cardinal ligament

251
Q

Smallest transverse diameter of fetal heart?

252
Q

Best time to do self breast exam?

A

3 days after menstruation

253
Q

Size of graffican follicle at time of ovulation?

254
Q

Vertex fetal position means?

A

Left occiput anterior

255
Q

Pacemaker of uterine contractions located at?

A

Tubal ostia

256
Q

Pressure in the uterus during the second stage of labor?

A

100-120 mmHg

257
Q

Anti D is not given if?

A

ICT positive
DCT positive
baby or father negative

258
Q

Anti D dose?
RhoGAM

A

> 12 weeks = 300 mcg IM
<12 weeks = 50 mcg IM
Best time 28 weeks
Post delivery give at 72 hours 300 mcg

259
Q

Intrauterine transfusion is done if?

A

Hb is less than 8gm% or hematocrit less than 30%
(hydrops develops when hematocrit is less than 15% and hb less than 5 gm%)

260
Q

Non-immune hydrops fetalis causes?

A

MC CVS > anemia
Parvovirus/syphilis

261
Q

USG criteria hydrops fetalis?

A

fluid in two or more compartments
1. Pleural effusion
2. Pericardial effusion
3. Ascites
4. Subcutaneous edema
placento-megaly and polyhydramnios

262
Q

Next step in preterm labor?

A

Find out cervical length
If less than 25 mm = cerlage + progesterone
If more than 25 mm = only progesterone

263
Q

Diagnosis of pre-term labor?

A

more than or equal to 5 cm = labor = treatment of preterm
if less than 5 cm = USG find out cervical length

264
Q

MgSO4 given only before?

A

32 weeks POG
Increases risk of PPH

265
Q

Steroids dosage in pregnancy and preferred drug?

A

up to 36+6
Dexamethasone 6 mg 4 doses 12 hourly IM

266
Q

Tocolytic agents given in pregnancy?

A

Only if POG less than 34 weeks - Nifedipine
Increases risk of PPH

267
Q

Indomethacin to be used in pregnancy if POG is

A

<32 weeks as it causes premature closure of DA

268
Q

Causes of Polyhydramnios?

A

NTD
GID - cleft palette, duodenal atresia
Diabetes in pregnancy
Fetal anemia - MCA doppler done
TTTS
IU infections

269
Q

Polyhydramnios can cause?

A

Abruption
Cord prolapse
preterm labor
PPH
Malpresentation
Fetal barter syndrome

270
Q

Biophysical profile is also called?

A

Manning score - done on USG
Components: fetal breathing movements, gross body movements, fetal tone, AF and NST

271
Q

Biophysical profile BPP score 8-10 means?

A

Normal
6 = Equivocal
0-4 = hypoxia or fetal acidosis = CS immediate

272
Q

Modified BPP components?

A

NST and AFI

273
Q

PPH min blood loss criteria?

A

Vaginal 500 ml
CS 1000 ml

274
Q

Primary PPH if?

A

within 24 hours
Secondary if beyond 24 hours up to 12 weeks

275
Q

MC cause of PPH?

A

Retained placental tissue

276
Q

Prevention of PPH is done by?

A

Oxytocin - DOC - within 1 min - 10IU IM/IV infusion only
delayed clot clamping

277
Q

Why oxytocin is only given IV infusion and not IV bolus?

A

Because it causes severe hypotension = MI, cardiac arrest, arrythmias

278
Q

Dose of Methergin for Prevention of PPH?

A

0.2 mg
Side effect: HTN

279
Q

Dose of Carbetocin for Prevention of PPH?

A

100 mcg IV over 1 min

280
Q

Dose of Misoprostol for Prevention of PPH?

A

600 mcg oral
Side effect: fever with chills

281
Q

Dose of Tranexa for Prevention of PPH?

282
Q

Carboprost drug features?

A

Most potent drug
dose 0.25 mg IM (Max 2mg)
DO NOT use in AMTSL or IOL
CI asthma
Side effect: diarrhea

283
Q

Next step after balloon tamponade if vitals stable?

A

UAE
B-lynch - UT compression suture - only effect on atonic PPH
If still bleeding, then stepwise devascularization

284
Q

Next step after balloon tamponade if vitals unstable?

A

Stepwise pelvic devascularization
Uterine A. first - UT-Ovarian anastomosis

285
Q

Cause of PPH is uterus is well contracted?

286
Q

Precipitate labor is?

A

If entire labor finishes within 3 hours

287
Q

Sign of uterine inversion?

A

Red mass sticking out of vagina + shock (neurogenic)
Cause of death = hypovolemia
OS will not be visible
Management is manual re-positioning, stop oxytocin

288
Q

MC reason of post-partum shiviring?

A

Blood loss > misoprostol

289
Q

4th trimester/puerperium is how long?

290
Q

Uterus becomes pelvic organ how much longer after delivery?

A

2 weeks/10-12 days postpartum
Complete involution by 6 weeks

291
Q

MC postpartum neuropathy?

A

Lateral cutaneous nerve of thigh
or common peroneal nerve = foot drop

292
Q

HCG returns to normal after delivery by?

293
Q

Cardiac output returns to normal after delivery by?

294
Q

Ovulation can start after delivery by?

A

3 weeks in breastfeeding and 6-8 weeks in non-breastfeeding

295
Q

Reason of amenorrhea during breast feeding?

A

High level of prolactin – negative feedback suppression GnRH/LH/FSH

296
Q

Prolactin levels are highest in?

A

3rd T and decrease after delivery

297
Q

First stimulus for initiation of lactation is?

A

Decreased progesterone and Estrogen

298
Q

Failure of lactation + persistent amenorrhea + delivery complicated by severe PPH indicates?

A

Sheehan syndrome

299
Q

Colostrum (first breastmilk) has?

A

Has less lactose, K and Ca less fat and sugar
High NaCl, Mg are higher – for immunogenicity

300
Q

DOC breast milk supression?

A

Cabergoline

301
Q

CI breast feeding?

A

Best - Galactosemia
Active untreated pul TB
Active herpes on breast
Chemo/radio therapy
Recent varicella infection

302
Q

When to start contraception in breastfeeding and non-breastfeeding women?

A

3 weeks - Non breastfeeding
3 months - breastfeeding

303
Q

Contraception of choice in breast feeding?

A

POP, minipill
IUD

304
Q

Post-partum tubal ligation done upto which day? and method?

A

7 days
Mini laparotomy/Modified Pomeroy
DO NOT USE laparotomy and falope rings

305
Q

Smallest diameter of pelvic cavity?

A

IID - 10.5 (less than 8 when contracted)

306
Q

Direct of persistent OP which pelvis?

A

Anthropoid
face to pubes

307
Q

Face/brow position which pelvis?

A

Platypelvic

308
Q

Occipital-posterior which pelvis?

A

Android
Deep transverse arrest

309
Q

Hands superior to belly near diaphragm?

A

Leopold 1 - fundal grip

310
Q

Hands on lateral sides of belly?

A

Leopold 2 - umbilical - lateral grip

311
Q

First pelvic grip?

A

Leopold 3 - hands on inferior side below umbilicus

312
Q

Only grip in which fingers are directed downwards?

A

Leopold 4 - pelvic - 2nd pelvic

313
Q

MC position in labor?

A

LOT
LOA in late labor

314
Q

Indications of Occipito-post malposition?

A

Infraumbilical flattening
fetal limb in midline and back in the flank
Fetal HR in flanks
Ant shoulder away from midline
Delayed engagement head deflexed (ED = occipito frontal)
Ant-fontanel is felt easily

315
Q

Engaging diameter (ED) if head is flexed?

A

Suboccipito-bregmatic - 9.5

316
Q

If baby head is well flexed, what position is it?

A

Vertex
We feel post-fontanel on PV exam

317
Q

Management of Occipito-post malpresentation?

A

Wait and watch - longer labor

318
Q

Smallest diameter of baby head?

A

Bimastoid = 7.5
Bitemporal = 8

319
Q

Cardinal steps of labor?

A

Engagement
Descent
Flexion
Internal rotation
Extension
Est rotation
Expulsion

320
Q

Management of prolonged latent stage?

A

(>20 hours in primi and >14 hours in multi)
Augment the labor with oxytocin
and sedate for pain

321
Q

MC cause of arrest labor/labor dystocia/slow progress of labor?

322
Q

MCC of breech?

A

Prematurity
MC type Frank and least common type Complete/flexed breech

323
Q

Risk of cord prolapse?

A

Transverse lie
Footling - in breech high risk of cord prolapse

324
Q

Management of breech?

A

ECV 37 weeks
then CS only
(if vaginal baby weight less than 4 kg)

325
Q

Contraindications of ECV (External Cephalic Version)

A

Footling breech
Stargazer breech - hyperextension
Ruptured membranes
Contracted pelvis
Placenta previa

326
Q

Lonest forceps in obs?

A

Piper - after coming head of breech - bada pakadne wala handle
(Wrigley is shorter with cross lock short handle)

327
Q

CI to using vaccum?

A

Prematurity
Face presentation
Aftercoming head of breech
Big caput
USE ONLY FORECEPS

328
Q

MC Fetal injuries caused by forceps?

A

Facial N palsy
Brachial plexus
Cornea of the eye
Intraventricular hemorrhage

329
Q

SE of Ritodrine?

A

Hyperglycemia
Hypokalemia - Tremor

330
Q

Order of Lochia?

A

Lochia rubra - lochia serosa - lochia alba

331
Q

Oxytocin is CI during labor in?

A

Abnormal lie - transverse lie - CS

332
Q

If division of zygote occurs between 9-12 days after fertilization, outcome of twins is?

333
Q

Which anti-thyroid medication is safe in pregnency?

A

Propylthiouracil

334
Q

HTN DOC in pregnancy?

A

Methyldopa
(If HTN emergency Hydralazine)

335
Q

Lithium during pregnancy causes which anomaly?

A

Ebstein anomaly

336
Q

Angle in episiotomy?

A

60’ from midline

337
Q

Last to rupture tubal ectopic?

A

Interstitial

338
Q

Double decidual sign is seen in?

A

Intrauterine pregnancy
(pseudo sac is seen in ectopic)

Gynecology (2 decks)

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