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MCCEE > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

How often to bHCG levels double?

A

48 hours

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2
Q

At what bHCG value is gestational sac seen and at what week?

A

5 weeks

1000-1500

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3
Q

What are the nutritional supplements recommended for pregnant women?

A

Folic acid: 0.4 or 4 if woman has hx of NTD
Iron 30 mg
Calcium
Complete vegetarians: vitamin D, vitamin B12

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4
Q

Which disease should be detected at first visit?

A 
rubella 
HbSAg
Syphillis 
HIV 
Pap smear
Hep B 
Hep C
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5
Q

At what week does FTCS happen?

What is in the FTCS

A

9-14 weeks

PAPP-A, NT, free bHCG

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6
Q

When is second trimester combined screening happen?

What is in it?

A 
15-22 weeks 
Alpha feto protein 
AFP
Estrodiol
bHCG 
inhibin A
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7
Q

When does U/S happen for anatomic screening?

A

18-20 weeks

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8
Q

When does the glucose challenge happen?

A

24-23 weeks

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9
Q

What is elevated alpha AFP associated with?

A

Open neural tube defects (anencephaly, spina bifida)
Abdominal wall defects
Multiple gestation
Incorrect gestational dating

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10
Q

What is associated with low alpha AFP?

A

Trisomy 18
Trisomy 21
Fetal demise
Incorrect gestational dating

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11
Q

What is high/low in the quad screen for trisomy 21?

A

AFP low
Estriol low
Inhibin high
bHCG high

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12
Q

When can CVS be done?

A

10-12 weeks

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13
Q

When can Amniocentesis be done?

A

15-20 weeks

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14
Q

What are the risks of CVS?

A

Risk of fetal loss high

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15
Q

What are the risks of amniocentesis?

A

PROM
Chorioamnionitis
Fetal maternal hemorrhage

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16
Q

When can free cell DNA be done?

A

10 weeks

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17
Q

What is the management of termination of pregnancy in the first trimester?

A

up to 49 days: mifepristone + oral misoprostol OR IM methotrexate + oral/vaginal miso

surgical up to 13 weeks

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18
Q

What is the management of termination of pregnancy in the second trimester?

A

D&E

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19
Q

How long is First stage of labour?

A

6-18

2-10

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20
Q

How long is the second stage of labour?

A

0.5-3 hours

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21
Q

How long is the 3rd stage of labour?

A

0-0.5

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22
Q

Late deceleration causes

A

Uteroplacental insufficiency

Fetal hypoxemia

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23
Q

Early deceleration causes?

A

Head compression from uterine contraction

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24
Q

Causes of variable deceleration?

A

Umbilical cord compression

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25
Q

Treatment of hyperemesis gravidum?

A

Vitamin B6
Doxylamine PO
Promethazine or dimenhydrinate PO or rectal administration

If severe: metoclopramide, ondansetron
If dehydrated: IV fluids, IV nutritional supplementation…

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26
Q

What are the complications of pregestational diabetes for mom?

A 
PE 
Macrosomia leading to need for C-section 
Preterm labour 
Infection 
Polyhydramnios 
PPH 
Maternal mortality
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27
Q

What are the complications of pregestational diabetes for bb?

A 
Macrosomia or IUGR 
Cardiac and renal defects 
NTD 
Hypocalcemia 
Polycythemia 
Hyperbilirubinaemia 
Hyperglycaemia 
RBS 
Birth injury
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28
Q

What is contraindicated for treatment of gestational or chronic HTN?

A

ACE

Diuretic

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29
Q

What is the classic triad of Pre-eclampsia?

A

HTN (140/90)
Proteinuria
Edema
occurring at > 20 weeks gestation

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30
Q

What is HELLP syndrome?

A

Hemolysis
Elevated LFT
Low Platelet

31
Q

What are the symptoms of severe PE?

A 
Headache 
Blurred vision 
Hyperactive reflexes 
Clonus 
RUQ pain
32
Q

What are the symptoms of Magnesium toxicity?

A

Respiratory paralysis
Coma
Loss of deep tendon reflex

33
Q

How to control BP of severe PE?

A

Labetalol
Hydralazine
Continuous Mag sulfate
Delivery

34
Q

What is the treatment of asymptomatic bacteriuria in pregnancy?

A

3-7 days nitrofurantoin

35
Q

What is the treatment of asymptomatic bacteriuria in pregnancy?

A

IV fluids
Hospital admonition
IV 3rd generation cephalosporin

36
Q

Is placental Abruption painful or painless?

A

Painful

37
Q

In what kind of APH do you never perform a VE?

A

Placental previa

38
Q

Definition of IUGR?

A

EFW less 10th percentile for gestational age

39
Q

Causes of polyhydramnios?

A 
Maternal DM 
Multiple gestation 
Isoimmunization 
Pulmonary abnormality 
Fetal anomaly
40
Q

What is the definition of polyhydramnios?

A

AFI > 25

41
Q

What is the definition of oligohydramnions

A

AFI < 5

42
Q

Causes of oligohydramnios?

A

Fetal urinary tract abnormality
Uteroplacental insufficiency
Rupture of membranes

43
Q

What is the titre that suggest monitoring for mom for Rh -ve status?

A

1:16

44
Q

How to prevent RH isoimmmunisation?

A

28 weeks give RhoGAM

45
Q

What is the karyotype of a complete mole?

A

46 XX

46
Q

What is the karyotype of an incomplete mole?

A

69 XXY

47
Q

Definition complete mole

A

Sperm enters an egg that has no ovum

48
Q

Definition incompletely mole

A

Normal ovum touched by 2 sperm

49
Q

What is the presentation of molar pregnancy?

A

Uterine bleeding
Hyperemesis
PE < 4 weeks
Large uterine size

50
Q

What is diagnosis of molar pregnancy?

A

Very high betaHCG > 100000
D&C shows cluster of grapes
Snowstorm appearance on U/S

51
Q

Treatment molar pregnancy

A

Evacuate

Monitor bHCG

52
Q

What are the complications of multiple pregnancy?

A

Placenta praaevia

….

53
Q

What are the complications of twin pregnancy for bb?

A

TTT
IUGR
Preterm labour
Congenital malforamtion

54
Q

What are the risk factors of shoulder dystocia?

A

Macrosomia
Obese mom
Diabetes
Hx previous shoulder dystocia

55
Q

Treatment of shoulder dystocia?

A 
Help reposition 
Episiotomy 
Leg elevation
Pressure suprapubic 
Enter the vagina and help rotate 
Reach fetal arm
56
Q

What are the hours for failure to progress in first stage?

A

Latent

  • Prima > 20
  • Multi > 14

Active

  • Prima > 2
  • Multi > 2 after reaching 3-4 cm
57
Q

What are the hours for failure to progress in second stage?

A

Primary > 2, > 3 with epidural

Multi > 1, > 2 with epidural

58
Q

What is premature ROM?

A

> 1 hour before onset of labour

59
Q

What is preterm premature ROM?

A

ROM < 37 weeks gestation

60
Q

What is prolonged ROM?

A

> 18s prior to delivery

61
Q

How is ROM diagnosed?

A

Nitrazine paper test turns blue

Fern test +ve

62
Q

Treatment of preterm premature ROM?

A 
Abx 
CSC is < 32 w 
Term: check GBS and observe labour 
34-36 w: Induce labour 
< 32 w: bed and pelvic rest
63
Q

Treatment of preterm labour?

A

Steroids
Tocolysis : Beta-mimetic, MgSO4, CCB, PGI
Abx : penicillin or ampicillin for GBS prophylaxis
Transfer and admit
Intrapartum Care
Neuroprotection if < 30 w

64
Q

Definition of preterm labour?

A

Onset of labour between 20-37 w

65
Q

How do you diagnose preterm labour?

A

Regular uterine contractions

Concurrent cervical changes

66
Q

Complications of preterm labour

A

PDA
NEC
RDS…

67
Q

Definition PPH

A

Loss of blood > 500 mL

68
Q

Causes of PPH

A

Tone (commonest )
Tissue
Trauma
Thrombin

69
Q

6 W’s of postpartum delivery

A 
Womb (endometritis)
Wind 
Water (UTI
Walk (DVT)
Wound (incision infection )
Weaning (mastitis)
70
Q

What is Sheehan’s syndrome?

A

Pituitary ischemia secondary to obstetric hemorrhageand shock

71
Q

What is the presentation of Sheehan’s Syndrome?

A

Failure to lactate

72
Q

What does colostrum contain?

A

Protein
Fat
Secretory IgA
Minerals

73
Q

What is the treatment of mastitis?

A 
dicloxacillin 
cephalexin 
amoxycillin 
azythromycin 
clyndamycin

MCCEE (16 decks)

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