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DIT STEP 2 > OBSTETRICS > Flashcards

OBSTETRICS Flashcards

1
Q

Changes in thyroid hormone observed during pregnancy

A

Since TBG increases, total T4 will increase but free T4 remains unchanged. TSH will also decrease slightly during early pregnancy but remains within normal limits.

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2
Q

Why is metabolic alkalosis seen during pregnancy?

A

PCO2 decreases to about 30 mm Hg which makes sense because mom wants to release more oxygen to baby.

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3
Q

Tidal volume changes in pregnancy

A

Tidal volume increases 40% with associated increase in minute ventilation due to stimulation by progesterone.

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4
Q

Glucose-related changes during pregnancy

A

Non-diabetic hyperinsulinemia with associated mild glucose intolerance.
Production of human placental lactogen contributes to glucose intolerance by interfering with insulin activity

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5
Q

Treatment of GERD during pregnancy

A

CAlcium carbonate. H2 blockers and PPIs are also safe. The only thing that is NOT safe is milk of magnesia (recall magnesium induces tocolytic effects)

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6
Q

At what gestational age is physiologic anemia of pregnancy most apparent?

A

Second trimester due to greater increase in plasma volume as compared to BC mass.

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7
Q

When should anemia in pregnancy be treated with oral iron?

A

If Hb falls below 11 in first or third trimesters OR when less than 10.5 in second trimester.

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8
Q

What is Goodell’s sign?

A

Softening and cyanosis of cervix at 6 weeks gestation

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9
Q

What is Chadwicks sign

A

Bluish discoloration of the vagina due to vascular congestion at 8-12 weeks gestation

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10
Q

What is Hegars sign

A

Softening of the uterus at 6 weeks gestation

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11
Q

Folic acid requirement in all women of childbearing years

A

.4 mg daily

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12
Q

IF previous child wit neural tube defect, recommended folic acid intake?

A

Starting the mont prior to pregnancy, 4 mg daily.

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13
Q

When do you do Group B strep screening?

A

36 weeks gestation. Thats because its only good for 4 weeks.

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14
Q

Increased nuchal translucency

A

Down syndrome
Turner syndrome
Congenital heart defects

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15
Q

MCC of abnormal quad screen

A

Incorrect dating

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16
Q

Serum AFP is only valid if performed during what window

A

16-18 weeks gestation

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17
Q

High aFP

A

Increased risk of neural tube defects or multiple gestations

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18
Q

Low aFP

A

Increased risk of trisomies 21 and 18

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19
Q

Low PAPP-A
Elevated hCG
Elevated nuchal traslucency

A

Trisomy 21

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20
Q

Very low PAPP-A, very low hCG, increased nuchal translucency

A

Trisomy 18

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21
Q

Very low PAPP-A, low hCG, increased nuchal translucency

A

Trisomy 13

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22
Q

Low AFP, uE3

High hCG, Inh A

A

Trisomy 21

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23
Q

Low AFP

VERY LOW uE3, hCG

A

Trisomy 18

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24
Q

Which test has lowest false-positive rate for non-invasive tests in pregnancy

A

Full integrated test. US measurement of nuchal translucency, serum measurement of pregnancy-associated plasma protein A in first trimester and quad screen in second trimester

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25
What does the quad screen consist of
Maternal serum aFP Estriol (uncojugated) hCG Maternal serum inhibin A
26
Which screening test is performed in all pregnant women at 16-18 weeks gestation
Quad screen
27
Which screening can determine karyotype
Amniocentesis
28
When is chorionic villi sampling performed
Early detection of chromosomal abnormalities in higher risk patients (advanced age, hx of children wit genetic defects)
29
What are the indications for percutaneous umbilical blood sampling/cordocentesis
Second and third trimester when karyotype results are required within a few days Diagnosing fetal hyper- or hypothyroidism Diagnosing and managing fetal thrombocytopenia
30
Nagele's rule
LMP + 7 days - 3 months + 1 year = estimated delivery date.
31
Cardiac defect associated with gestational DM
Transposition of great vessels
32
BP i npre-eclampsia
>140/90
33
A rise in creatinine during pregnancy should make you consider?
Pre-eclampsia
34
BP meds used in pregnancy
``` Methyldopa Labetalol Hydralazine Nifedipine/amlodipine Thiazides (Avoid volume depletion!) ```
35
Why is mag sulfate used in pre-eclampsia
Prevent seizures (NOT FOR BP!!!)
36
What do we use to treat eclampsia?
Mag sulfate and IV diazepam and continue for 48 hours following delivery!!
37
What happens if your patient is on mag sulfate and starts having seizures?
Give more mag sulfate
38
How long do we continue mag sulfate in PRE eclampsia
24 hours post-delivery
39
Epilepsy tx in pregnancy
Keep them on their AED but also should be given supplemental vitamin K (only during last month of pregnancy to prevent PPH) and folate.
40
How is hyperemesis gravid arum distinguished from normal morning sickness
Weight loss exceeding 5% of pre pregnancy body weight and detection of ketonuria due to starvation
41
Workup in a patient wit hyperemiis gravidarum
WEight, orthostatic Serum free T4, serum electrolytes, urine ketones Ulrasound to detect gestational trophoblastic disease and multiple gestations
42
Expected non worrisome lab abnormalities associated with vomiting in prego
Elevated AST and ALT (but
43
Tx of UTI in pregnancy
Amoxicillin Nitrofurantoin Ceftriaxone
44
Which opioid is more likely to have increased teratogenic effects in neonate
Methadone
45
How do you treat migraines in pregnancy
Hydrocodone (opioids!) I HAD THIS Q ON COMLEX LEVEL 1
46
Radiation dose considered safe in pregnancy
Less than 0.05 (5 rads) | Risk of malformations increases after 0.10 gray
47
Which AED causes fingernail hypoplasia
Carbamazepine
48
Which rx drug associated with cleft palate
Diazepam (maybe also phenytoin)
49
Effect of sulfonamides during pregnancy
Kernicterus
50
Which rx drug associated with Dandy Walker malformation
Warfarin
51
Which rx drug associated with hypospadias
Valproic acid
52
Anti-viral contraindicated in prego
Ribavirin
53
Which congenital infection associated with high risk of neonatal death if disease transmission occurs?
Rubeola (measles)
54
When should you provide intrapartum antibiotic prophylaxis for GBS
GBS bacteriuria during current pregnancy History of early onset GBS in a previous infant Intraoartum fever Preterm labor (18 hrs)
55
When can methotrexate be used in the treatment of ectopic pregnancy rather than surgical removal?
Hemodynamicaly stable Reliably compliant with post-treatment monitoring Pretreatment serum hCG
56
At what hCG level should you be able to see an intrauterine pregnancy on transabdominal US
6500 mIU/mL
57
At what hCG level should you be able to see transvaginal US intrauterine preg
1500 mIU/mL
58
Which congenital infection is initially asymptomatic but later develops a unilateral hearing loss
CMV
59
Which congenital infection associated wit hhydrocephalus, intracranial calcifications and chorioretinitis
Toxo classically but also could be CMV
60
Which congenital infection associated with hearing loss, chorioretinitis, and intracranial calcifccations
CMV
61
Which congenital infection associated with PDA or pulmonary artery stenosis
Rubella
62
1st line tx for hyperemesis gravidarum
Vitamin B6 Docsalamine (unasom) Hydration
63
Which teratogen gives craniofacial defects, IUGR, CNS malformation and stillbirth
Warfarin
64
Which teratogen causes hydrocephalus, CNS defects, craniofacial, ear and cardiovascular defects
Isotretinoin
65
Which teratogen causes cerebral infarcts, mental retardation
cocaine
66
Initial US finding for IUGR
Abdominal circumference
67
Definition of oligohydramnios
AFI
68
Definition of polyhydramnios
AFI>25 cm on ultrasound
69
Oligohydramnios in 3rd trimester
premature rupture of membranes
70
Mag sulfate is contraindicated when?
In myasthenia gravis
71
Reversal agent for mag sulfate
Calcium gluconate
72
Early decels are a sign of
Head compression
73
LAte decals are a sign of
uteroplacental insufficiency | Fetal hypoxia
74
Variable decals are a sign of
Umbilical cord compression
75
What should you do if you see variable decels
Change moms position
76
What should you do if you see late decels
Test fetal blood from scalp sample to dx hypoxia or acidosis | Recurrent late decals or fetal hypoxia direct PROMPT DELIVERY
77
Nml fetal heart rate
120-160 bpm
78
Non-stress test -- what is moms position
Left lateral supine
79
Define a reactive nonstress test
two or more 15 bp accelerations of fetal heart rate lasting at least 15 seconds within 20 minutes
80
Non-reactive nonstress test prompts?
Biophysical profile
81
Components of biophysical profile
Nonstress test repeated Ultrasound to measure AFI Fetal breathing, movement, and tone (extension of fetal spine or limb with return to flexion)
82
Reassuring biophysical profile
8-10
83
Reassuring contraction stress test
Beat to beat variability of ~5 bp Long-term heart rate variability Occasional heart rate accelerations (2+ access of 15 bp lasting at least 15 seconds within a 20 minute period)
84
Abnormal 3 hour 100 g fasting glucose test
95 mg/dL
85
Abnormal 1 hour 50 g oral glucose test
140 mg/dL
86
Abnormal 3 hour 100 g oral glucose test at 1, 2, and 3 hours
180 mg/dL 155 mg/dL 140 mg/dL
87
Cervical dilation: bishop scoring
For 0 cm: 0 points For 1-2 cm: 1 point For 3-4 cm: 2 points For 5-6: 3 points
88
Effacement: bishop scoring
For 0-30%: 0 points For 40-50%: 1 point For 60-70%: 2 points For 80%: 3 points
89
Station: bishop scoring
For -3 station: 0 points For -2 station: 1 point For -1 and 0 station: 2 points For +1 and +2 station: 3 points
90
Consistency: bishop scoring
For firm: 0 points For medium: 1 point For soft: 2 points
91
Position: bishop scoring
Posterior: 0 points Mid: 1 point For anterior: 2 points
92
Normal cervical dilation for primp during active phase
1.2 cm per hour
93
Normal cervical dilation for multi during active phase
1.5 cm/hr
94
Normal latent phase length in primip
20 hours
95
Normal latent phase length for multip
14 hours.
96
What causes the changes in the cervix during labor
Breakage of disulfide bonds in collagen (mediated by prostaglandin E2, stimulated by engagement)
97
What is the station when the fetal head has engaged the cervix?
-2. This is engagement, when the fetal head contacts the cervix and tells it to start ripening.
98
Frank breech
Knees are extended, hips flexed
99
Adequate contractions
CTX 3 in 30 min | >40 mm Hg
100
A prolonged phase III in labor puts mom at higher risk for ?
PPH. If the uterus is too tired to push out a placenta, its probably too tired to calm down and prevent PPH.
101
Most common cause of premature ROM?
Ascending infection. Give her abx.
102
Most common cause of ppROM?
Ascending infection. If
103
Define prolonged ROM
>18 hours from ROM to delivery. Increased risk of GBS infection.
104
Abx used for prom/pprom + fever
Broad spec, usually pip-tazo
105
4 things that can delay delivery
Mag sulf B agonists (like terbutaline) CCB (like nifedipine) Prostaglandin inhibitors like ketorolac or indomethacin
106
Next step if you think baby might be post-date?
If you're unsure of dates, perform biophys profile.
107
In twin gestation, with 2 placentas, the twins are ?
Monozygotic Diamniotic Dichorionic
108
What if theres only 1 plant in twin gestation?
Check the septum which would separate the sacs.
109
If there is one placenta, and at least 1 septum in a twin gestation, the twins are?
MONO zygotic MONO chorionic DIamniotic
110
If there is 1 placenta and NO sept in a twin gestation, the twins are ?
Monozygotic Monochorionic MMonoamniotic
111
When did split occur for monozygotic, dichorionic, diamniotic twins?
0-3 days after fertilization, in the tubal phase.
112
When did split occur for monozygotic, monochorionic diamniotic twins?
4-8 days after fertilization, in blastocyst phase
113
Extra risk associated with monozygotic monochorionic diamniotic twins?
Twin twin transfusion, since they share a placenta.
114
When did split occur for mono mono mono twins?
9-12 days after fertilization. | If > day 12, most likely conjoined :(
115
Extra risk associated with mono mono mono twins?
Cord entanglement.
116
Tx of uterine inversion
Tack down fornices, give pitocin since its bleeding.
117
Next step after an in-between BPP and baby is
Contraction stress test using pitocin. Looking for LATE DECELS.

DIT STEP 2 (17 decks)

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