Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 CK > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

developmental age

A

of weeks and days since fertilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

gestational age

A

weeks and days since LMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when can you start hearing fetal heart tones

A

10-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

quickening (appreciation of fetal movement) begins around

A

17-18 weeks at the earliest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

US measurement of GA is most reliable during?

A

1st trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

standard method to diagnose pregnancy?

A

B-hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

B-hCG is produced by the ______ and peaks at ______ by ______ weeks gestation

A

placenta ; 100,000 ; 10 weeks Gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When does BhCG level off

A

decreases during 2nd trimester and levels off in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

BhCG levels double every _____ during early preg

A

48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When doubling is abnormal, BhCG can be used to diagnose ________

A

ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A gestational sac is visible on transvag US by ______

A

five weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

renal flow increases by _____ %

GFR ______ early and then ______

A

25-50%

increases ; plateus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Average body weight gain in preg?

A

11- kg or 25lb increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Excessive weight gain in preg is ____/month

Inadequate weight gain in preg is ____/month

A

> 1.5 kg

< 1 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Eat an additional _____- _____ kcal /day during preg and _____ kcal/day during breastfeeding

A

100-300 during preg

500 during breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

folic acid supplementation for all repro age women?

folic acid supplementation for women with a history of neural tube defects in prior pregnancies?

A

.4mg/day

4mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complete vegetarians should consume what vitamins during preg?

A

Vit D: 10ug or 400 IU/day

and Vit B12 2ug/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q 
Say whether increases or decreases in pregnancy?
HR 
BP
SV
CO
PVD
PVR
RR
Blood volume
Hcrit
Fibrinogen
Electrolytes
GI sphincter tone
GI emptying time
A 
HR: increases gradually by 20%
BP: decreases gradually by 34 weeks then increases to prepreg values
SV: increases to max at 19 weeks
CO: rises rapidly by 20% then gradual increase
PVD: increases to term
PVR: decreases to term
RR: unchanged
Blood volume: 50% increase by 2nd trimester
Hcrit: decrease slightly
Fibrinogen: increase
Electrolytes: no change
GI sphincter tone: decrease
GI emptying time: increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prenatal visit timeline
Weeks 0-28:
Weeks: 29-35:
Weeks 36-birth:

A

0-28: q 4 weeks
29-35: q 2 weeks
36-birth: q 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prenatal testing at first visit?

A

CBC, Rh factor, type and screen.
UA /culture, rubella antibody titer, HbsAg, RPR/VDRL, cervical gonorrhea, chlamydia, PPD, HIV, Pap smear, HCV, varicella
Hba1c/sickle- if indicated
Discuss: tay-sachs, CF screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

9-14 week screens?

A

offer PAPP-A and nuchal transparency and free B-hCG- CVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

15-22 week screens?

A

offer maternal serum AFP or Quad screen (AFP, estriol, B-hCG, inhibin A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

18-20 week screen?

A

US and full anatomic screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

24-28 week screen?

A

1 hour glucose challenge test for GDM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

28-30 week screen?

A

RhoGAM for Rh (-) women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

35-37 week screen?

A

GBS culture. repeat CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

34-40 week screen?

A

chlamydia, gonorrhea, HIV, RPR in high risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Elevated maternal serum AFP is associated with?

A

open neural tube defects (spina bifida, anencephaly)
abdominal wall defects (gastroschisis, omphalocele)
multiple gestation
incorrect GA
fetal death
placental abnml (abruption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Low MSAFP is ass with?

A

Trisomy 21 and 18
Fetal demise
Incorrect gest dating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What will Quad screen show for Trisomy 18?

A

“Still UNDER age at 18”

low AFP, low estriol, low B-hCG, low Inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What will Quad screen show for Trisomy 21?

A

low AFP, high B-hCG, low estriol, high inhibin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pregnancy associated plasma protein A. PAPP-A and nuchal transparency and B-hCG are recommended when?

A

week 9-14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

PAPP-A, nuchal transparency, B-hCG can detect ____ % cases DS and ____ cases T 18

A

91% DS

95% T18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Chorionic villus sampling

A

transcervical or abdominal aspiration of placental tissue offered at 10-12 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

advantages/disadvantages of CVS?

A

Adv: genetically diagnostic, available at early GA

Dis: 1% risk of fetal loss. cant detect open neural tube defects. CVS at < 9 weeks ass with limb defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Amniocentesis

A

transabdominal aspiration of amniotic fluid using US guided needle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

adv/disadv of amniocentesis

A

adv: genetically diagnostic
disadv: PROM, chorioamionitis, fetal maternal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

cell free DNA test. when is screening? how? adv/dis?

A

10 week test. Isolation of fetal DNA obtained from blood sample from mom.

adv: non-invasive
dis: limited due to low concentration of fetal DNA in maternal circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When is amniocentesis indicated?

A

Women > 35 at time of delivery
Conjunction with abnormal quad screen
Rh-sensitized pregnancy to detect fetal blood type or fetal hemolysis
Evaluate fetal lung maturity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How do you evaluate fetal lung maturity with amniocentesis?

A

Lecithin to Sphingomyelin ratio > 2.5 or presence of phosphatidylglycerol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

TORCHeS infections

A 
Toxo 
Other (parvo, varicella, listeria, TB, malaria, fungi)
Rubella 
CMV
HSV, HIV
Syphilis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Common sequelae that occur with maternal-fetal infections?

A

Premature delivery, CNS abnormalities, Anemia, Jaundice, Hepatosplenomegaly, Growth retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Teratogenic effects: ACE-Inh

A

renal tubular dysplasia, neonatal renal failure, oligohydramnios, IUGR, lack of cranial ossification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Teratogenic effects: Alcohol

A

FAS (> 6 drink/day = 40% risk). growth restriction, mental retardation, midfacial hypoplasia, renal and cardiac defects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Teratogenic effects: androgens

A

virilization in females. advanced genital development in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Teratogenic effects: carbamazepine

A

neural tube defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Teratogenic effects: cocaine

A

bowel atresia, congen heart, limb, face, GU malformations, microcephaly, IUGR, cerebral infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Teratogenic effects: DES (old birth control)

A

clear cell adenocarcinoma of vagina/cervix, vaginal adenosis, abnml cervix, uterus, testes, possibly infertile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Teratogenic effects: Lead

A

increase SAB, stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Teratogenic effects: Lithium

A

Ebstein anomaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Teratogenic effects: Methotrexate

A

SAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Teratogenic effects: Organic mercury

A

cerebral atrophy, microcephaly, mental retardation, spasticity, seizures, blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Teratogenic effects: Phenytoin

A

IUGR, mental retardation, cardiac, fingernail hypoplasia, dysmorphic cranial features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Teratogenic effects: Radiation

A

< .05 no risk. microcephaly/retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Teratogenic effects: Streptomycin, kanamycin

A

hearing loss, CN VIII damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Teratogenic effects: tetracycline

A

permanent yellow-brown teeth discoloration. hypoplasia of teeth enamal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Teratogenic effects: thalidomide

A

bilateral limb issue, cardiac, GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Teratogenic effects: Trimethadione, paramethadione (anticonvulsants)

A

cleft lip/palate, cardiac, microcephaly, MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Teratogenic effects: valproic acid

A

spina bifida, neural tube, craniofacial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Teratogenic effects: vit A derivative

A

SAB, thymic agenesis, micropthalmia, cleft lip/palate, MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Teratogenic effects: warfarin

A

nasal hypoplasia, stippled bone epiphyses, developmental delay, IUGR, ophthalmologic abnml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SAB

A

loss of products of conception before 20 weeks. > 80% in first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

risk factors for SAB

A

chromosome abnml
Maternal factors: inherited thrombophilias (Factor V leiden, prothrombin, antithrombin, proteins C/S, methylene tetrahydrofolate reductase)
Immune: antiphospholipid antibodies
Anatomic: uterine/cervix, incompetent cervix, cervical conization or LEEP, DES exposure
Endocrine: DM, hypothyroid, progesterone deficient
Env: tobacco, alcohol, caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

recurrent SAB

A

2 or more consecutive SABs or 3 SABs in 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

how to determine possible cause for recurrent SAB?

A

karyotype both parents, hypercoag work up for mom, evaluate uterine anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

likely cause for recurrent SAB < 12 weeks

A

chromosome abnml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

likely cause for recurrent SAB 12-20 week?

A

hypercoag (SLE, factor V, protein S deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

7 types of SAB?

A 
Complete
Threatened 
Incomplete
Inevitable
Missed 
Septic
Intrauterine fetal demise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Sign/symp, diagnosis, treatment: complete SAB

A

S/S: bleeding and cramping stopped. POC expelled
Dx: US w/o POC, closed OS
tx: none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Sign/symp, diagnosis, treatment: threatened

A

SS: uterine bleeding +/- abd pain (often painless). No expelled POC
Dx: Closed os, intact membranes, +fetal cardiac motion
Tx: pelvic rest for 24-48 hrs, follow up US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Sign/symp, diagnosis, treatment: Incomplete

A

SS: Partial POC expulsion. bleeding, cramping, visible tissue on exam
Dx: open OS, POC on US
Tx: Manual uterine aspiration (if < 12 weeks D+C or misoprostol or expectant management in inevitable and missed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Sign/symp, diagnosis, treatment: Inevitable

A

SS: uterine bleeding and cramps. no POC expulsion.
Dx: open os +/- RM. POC on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Sign/symp, diagnosis, treatment: Missed

A

SS: crampy, no bleeding. loss of early preg symptoms
Dx: closed os. no fetal cardiac activity. POC on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Sign/symp, diagnosis, treatment: Septic

A

SS: foul smelling discharge, abd pain, fever, cerv motion tenderness +/- POC expulsion
Dx: hypotension, hypothermia, elevated WBC, blood cultures
Tx: MUA, D+C, IV abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Sign/symp, diagnosis, treatment: Intrauterine fetal demise

A

SS: absence of fetal cardiac activity > 20 weeks GA
Dx: uterus small for GA, no fetal heart tone or movement on US
Tx: Induce labor, evacute uterus (D+E) to prevent DIC at GA > 16 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Maternal mortality with septic SAB?

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Diagnosing SAB in general?

A

Gestational sac > 25 mm without a fetal pole or absence of fetal heart activity when CRL > 7 on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

fetal pole should be seen at?

A

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

fetal cardiac activity at?

A

6-7 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

For SAB, administer RhoGAM if mom is Rh

A

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

First term abortion options (>90% of TAB)

A
  1. oral mifepristone (progesterone antag) + oral/vaginal misoprostol (PGE2 analogue) (49 days)
  2. IM/oral methotrexate + oral/vag misoprostol (49 days)
  3. Vaginal or sublingual or buccal misoprostol (high dose) repeated up to 3 times (59 days GA)
  4. Surgical management (MUA, D+C with vaccum) (13 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

2nd term abortion (10% TAB)

A

Induction of labor (prostaglandins, amniotomy, oxytocin)

surgery (D+E)

13-24 weeks depending on state law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

If ROM is suspected what should you do?

A

Conduct a sterile speculum exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

negative station?

A

fetal head superior to ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

positive station?

A

fetal head inferior to ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

stages of labor?

A
  1. First Stage
    a. latent: onset of labor to 3-4 cm dilation. (6-11 for primiparous) (4-8 for multiparous) (prolonged if sedated or hypotonic uterine contractions)
    b. active: 4 cm to complete cervical dilation -10cm (4-6 hr primiparouos) (2-3 hour multiparous) (prolonged if cephalopelvic disproportion)
  2. Second: complete cervical dilation to delivery of infant
    (.5-3 hr primiparous) ; (5-30 min multiparous) (all cardinal movements of delivery!)
  3. third: delivery of infant to delivery of placenta (0-.5 hour) (uterus contracts and placenta separates to establish homeostasis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

For patients with complications review FHR tracing every _____ min in first stage of labor and every ____ min in 2nd stage

A

15 min- 1st stage

5 min- 2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

For patients without complications- review FHR tracings q _____ min for first stage and q _____ min for 2nd stage

A

30 min- 1st stage

15 min - 2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Fetal accelerations and decelerations

VEAL CHOP

A

Variable decel: Cord compression
Early decel: head compression
Acceleration: Okay!
Late accel: placental insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Normal FHR?

A

110-160 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Causes of FHR < 110 bradycardia

A

congenital heart malformations, severe hypoxia (2ndary to uterine hyperstimulation, cord prolapse, rapid fetal descent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

FHR > 160 causes

A

hypoxia, maternal fever, fetal anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Absent variability indicates

A

severe fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

minimal variability (<6 bpm) indicates

A

fetal hypoxia, opioid effects, magnesium, sleeping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

normal variability is?

A

6-25 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

marked variability is? and can indicate?

A

> 25 bpm. fetal hypoxia, can occur before a decrease in variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

sinusoidal variability?

A

serious fetal anemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

pseudosinusoidal pattern can occur with maternal use of what drug?

A

meperidine (demerol) opioid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Accelerations are defined as?

A

onset of FHR >15 beats above baseline to a peak in less than 30 seconds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

why are accelerations reassuring?

A

indicate fetal ability to respond to environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

If patient has active HSV-2 lesions and is in labor what is appropriate action to take?

A

c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What does early decel look like on FHR tracing?

A

it begins before uterine conraction but nadir occurs around same time as uterine contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Early and late decels onset to nadir is > ____ seconds while variable decels onset to nadir is

A

30, 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Variable decels last between ____ seconds and ____ mins

A

15 sec, 2 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

non-stress test

A

mother is in lateral tilt position. FHR and uterine contractions monitored.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is a reactive NST?

A

normal response: 2 accerlerations >15bpm above baseline (if >32 weeks); 10bpm above baseline (if < 32 weeks). lasting for 15 seconds. Over a 20 min period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Non-reactive NST

A

insufficient accels over a 40 min period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what do you do if non-reactive NST?

A

perform BPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Contraction stress test

A

FHR is monitored via spontaneous or induced (nipple stimulation of oxytocin) contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is a positive CST?

A

BAD. Late decels following 50% or more of contractions in 10 min window. Delivery usually warranted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Negative CST?

A

Good. no late or significant variable decels and at least 3 contractions. in conjunction with normal NST- highly predictive of fetal well-being

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Equivocal CST

A

intermittent late decels OR significant variable decels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

BPP measures?
Test the
Baby
MAN

A

Tone, breathing, movements, amniotic fluid volume, nonstress test.

Uses real time US to score (2) or (0) to the 5 parameters listed above.

8-10: reassuring
6: equivocal
0-4: very worrisome (asphyxia concern. consider delivery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

AFI

A

amniotic fluid index. sum of measures of deepest cord free amniotic fluid measured in each abdominal quadrant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

modified BPP is?

A

NST + AFI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

normal modified BPP is?

A

reactive NST and AFI > 5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

When is umbilical artery doppler velocimetry used? why?

A

IUGR suspected. Because there can be a reduction or even reversal of umbilical artery diastolic flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

AFI < 5 =

A

oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Uterine contractions and cervix dilation result in visceral pain from

A

T10-L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Descent of fetal head and pressure on vagina and perineum result in

A

somatic pain (pudendal nerve) S2-S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Absolute contraindications to regional anesthesia (epidural, spinal, or combo)

A 
Refractory maternal hypotension
maternal coagulopathy
maternal useof LMWH w/in 12 hours
untreated maternal bacteremia
skin infection over needle site
increased ICP caused by mass lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

If morning sickness persists after 1st trimester, think?

A

hyperemesis gravidarum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Hyperemesis gravidarum presentation

A

persistent vomit, acute starvation ( large ketonuria) and weight loss- usually at least 5% from preg weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Hyperemesis gravidarum is more common when? What hormones/markers are elevated/implicated in its cause?

A

First pregnancies, multiple gestations, molar pregnancies

B-hCG and estradiol are implicated in pathophysiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

morning sickness usually starts when?

A

weeks 4-7 and resolves prior to week 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

first step in diagnosis of hyperemesis gravidarum is to rule out?

A

molar pregnancy with US +/- B-hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What other labs should you get in eval of hyperemesis gravidarum

A

ketonemia, ketonuria, hyponatremia, hypokalemia, hypochloremic metabolic alkalosis, liver enzymes, serum bili, serum amylast/lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Treatment for hyperemesis gravidarum

A 
Vit B6
Doxylamine (antihistamine) PO
Promethazine or dimenhydrinate PO or rectal
If severe: metoclopramide, ondansetron 
If dehydrated: IV fluids, IV nutrition,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

GDM is usually diagnosed in which trimester?

A

3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

GDM will present?

A

usually asymp. possible edema, polyhydramnios, or a large for GA infant (>90th %)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Diagnosis of GDM

A

screen with 1 hour 50g glucose challenge at 24-28 weeks.

glucose > 140 is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

How to confirm 1 hour 50g glucose challenge?

A

3 hour 100g glucose tolerance test showing any of the following:

Fasting: >95
1 hour: >180
2 hour: > 155
3 hour: >140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

4 keys to the management of GDM

A
  1. ADA diet
  2. insulin if needed
  3. US for fetal growth
  4. NST at 34 weeks if requiring insulin or oral hypoglycemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Define tight maternal glucose control

A

fasting < 95
1 hour postprandial <140
2 hour postprandial < 120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

how to maintain tight control during delivery?

A

intrapartum insulin and dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

how to monitor fetus when mom has GDM

A

periodic US and NST to assess growth. Might need to induce labor at 39-40 in patients poorly controlled on insulin or oral hypoglycemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

complications of GDM

A

> 50% patients go on to develop glucose intolerance and/or typeII DM later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

When to screen for DM after delivery?

A

6-12 weeks with a 75g 2 hour GTT and repeat every 3 years if normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

For pregestational diabetes, insulin requirements may increase by?

A

3X

140
Q

poorly controlled DM is associated with increased risk of?

A

congenital malformations

141
Q

If HbA1c is > _____ investigate for ______

A

8, congenital abnormalities

142
Q

If UA before 20 weeks GA shows glycosuria, should you think GDM or pregestational DM?

A

pregestational DM

143
Q

Hyperglycemia in 1st trimester suggests?

A

pre-existing diabetes and should be managed that way

144
Q

C/s should be considered when EFW is > ____

A

4500

145
Q

Gestational htn

A

idiopathic htn without significant proteinuria < 300mg/L

Develops at > 20 weeks GA

146
Q

how many patients with gestational htn develop preeclampsia?

A

25%

147
Q

chronic htn

A

present before conception and <20 weeks GA. can persist for >12 week postpartum. 1/3 of patients develop preeclampsia

148
Q

Classic triad of preeclampsi

A

hypertension
proteinuria
edema

149
Q

Appropriate anti-htn for pregnancy?

A

methyldopa, labetolol, nifedipine

150
Q

What blood pressure meds are absolutely contraindicated in preg? why?

A

ACE-Inh: lead to uterine ischemia

Diuretics: aggrevate low plasma volume to point of uterine ischemia

151
Q

HELLP syndrome

A

hemolysis
elevated LFTs
low plateletes

152
Q

Pre-eclampsia

A

new onset htn with systolic > 140 and diastolic >90 and proteinuria > 300 mg/24 hour occuring at > 20 week GA

153
Q

eclampsia

A

new onset grand mal seizure in women with pre-eclampsia

154
Q

HELLP syndrome

A

variant of pre-eclampsia with a poor prognosis.

cause is unknown.

155
Q

risk factors for HELLP syndrome

A

nulliparity, black, extremes of age (<20, >35), multiple gestation, molar preg, renal disease (SLE or type I DM), family history of preeclampsia or chronic HTN

156
Q

how does severe pre-eclampsia present and differ from mild preeclampsia?

A

Mild BP: >140/90 on 2 occasions 6 hours apart
Protein: >300mg/24 hours or 1-2 + urine dips
edema

Severe
BP: > 160/110 on 2 occasions 6 hours apart
Protein >5g/24hours or 3-4 + urine dips or oliguria < 500ml/24 hours
Cerebral changes: HA, somnolence
Visual changes: blurred vision, scotomata (partial loss of vision or blind spot)
Hyperactive reflexes/clonus; RUQ pain; hemolysis; elevated liver enzyme, thrombocytopenia (HELLP)

157
Q

most common symptoms preceding eclampsia attack?

A

HA, vision changes, RUQ/epigastric pain

158
Q

Only cure for eclampsia/preeclampsia is?

A

delivery of fetus

159
Q

If patient is close to term with worsening preeclampsia what do you do?

A

Induce delivery with IV oxytocin, prostaglandin or amniotomy

160
Q

If progressing preeclampsia and far from term what do you do?

A

modified bed rest and expectant management

161
Q

Prevent intrapartum seizures with a continuous _____ drip?

A

magnesium

162
Q

What are signs of mag toxicity?

A

loss of DTRs, respiratory paralysis, coma

163
Q

how long should you continue magnesium seizure prophylaxis?

A

24 hours postpartum

164
Q

Treat magnesium toxicity with?

A

IV calcium gluconate

165
Q

What is blood pressure goal for severe preeclampsia? how can you control the BP?

A

goal <160 systolic

between 90-100 diastolic to maintain fetal blood flow

control with labetolol and/or hydralazine

166
Q

Treatment for eclampsia

A

ABCs with supplemental O2
Seizure control with mag
If seizures occur give IV diazepam
Limit fluids (foley catheter for strict Is and Os)

167
Q

Asymptomatic bacteriuria

A

+ urine culture on 1st trimester screen (>10^5) colonies

168
Q

Diagnosis of UTI/Pyelonephritis ?

A

positive urine culture

169
Q

treatment for asymptomatic bacteriuria and UTI

A

3-7 days nitrofurantoin, cephalexin or amox-clavulonate. follow up cuture at 1 week for test of cure

170
Q

Treatment for pyelo in preg?

A

admit to hospital, IV fluids, IV 3rd gen cephalosporin, follow up culture

171
Q

Antepartum hemorrhage

A

any bleeding that occurs after 20 weeks gestation

172
Q

most common causes of antepartum hemorrhage?

A

placental abruption and placenta previa

173
Q

With third trimester bleeding think anatomically:

A

vagina: bloody show, trauma
cervix: cancer, cervical or vaginal lesion
placenta: abruption, previa, accreta
fetus: fetal bleeding

174
Q

Ectopic pregnancies are most common where? can also occur?

A

tubal.

can also occur abdomen, ovarian, cervical

175
Q

presentation of ectopic preg

A

abd pain, vaginal spotting, bleeding. can be asymptomatic

176
Q

ectopic preg is associated with?

A

PID, pelvic surg, DES use, endometriosis

177
Q

differential for ectopic preg

A

surgical abdomen, abortion, ovarian torsion, PID, ruptured ovarian cyst

178
Q

Approach women of repro age with abdominal pain as having ______ until proven otherwise

A

ectopic preg

179
Q

diagnosis of ectopic preg?

A

+ pregnancy test, transvaginal US showing empty uterus

confirm with serial B-hCG without appropriate B-hCG doubling

180
Q

Medical treatment for ectopic preg

A

methotrexate (sufficient for small, unruptured tubal pregnancies)

181
Q

Surgical treatments for ectopic preg?

A

salpingectomy or salpingostomy with evacuation (laparoscopic vs laparotomy)

182
Q

IUGR defined as

A

estimated fetal weight less than 10th percentile for GA

183
Q

Risk factors for IUGR

A

maternal systemic disease-> uteroplacental insuficiency
intrauterine infection, hypertension, anemia
maternal substance abuse
placenta previa
multiple gestation

184
Q

diagnosis of IUGR

A

serial fundal height measurements with US

perfrom US for EFW (estimated fetal weight)

185
Q

If patient is near due date with IUGR, what medical therapy is indicated?

A

betamethasone to accelerate fetal lung maturity (need 48 hours prior to delivery)

186
Q

Fetal macrosomia

A

Birth weight > 95th %

187
Q

Tx/management for fetal macrosomia

A

planned c/s for EFW > 4500g in women with GDM and > 5000g in women w/o GDM

188
Q

There is an increased risk of _________ leading to brachial plexus injiry as birth weight increases

A

shoulder dystocia

189
Q

AFI > 25 on US =

A

polyhydramnios (can be present in normal pregnancies but also need to consider pathology)

190
Q

Causes of polyhydramnios include?

A 
Maternal DM
Multiple gestation
Isoimmunization
Pulm abnml (cystic lung malformations)
fetal anomaly (duodenal atresia, T-E fistula, anencephaly)
twin-twin transfusion
191
Q

dx and work up for polyhydramnios:

A

fundal height > than expected on US.

Eval includes US for fetal anomaly, DM screen, Rh screen

192
Q

Common causes of oligohydramnios

A

renal agenesis. GU obstruction

193
Q

oligohydramnios is associated with a ____ X increase in fetal mortality

A

40 fold

194
Q

other complications associated with oligohydramnios include:

A

club foot, facial distortion, pulm hypoplasia, umbilical cord compression, IUGR

195
Q

Rh isoimmunization

A

fetal RBCs leak into maternal circulation and maternal anti-Rh IgG antibodies form that can then cross the placenta, leading to hemolysis of fetal Rh RBCs and erythroblastosis fetalis. Occurs only in Rh (-) women

196
Q

Who is at greatest risk for Rh isoimmunization?

A

increased risk with previous SAB, TAB or a delivery where RhoGAM wasnt given

197
Q

Tx for Rh isoimmunization

A

initiate preterm delivery when fetal lungs are mature (if severe)

prior to delivery- intrauterine blood transfusions canbe given to correct low fetal hcrit

198
Q

Prevention for Rh isoimmunization

A

If mom is Rh (-) at 28 weeks and father is Rh (+) or unknown then give RhoGAM (Rh Immune globulin)

199
Q

If baby is Rh (+) give mom Rhogam when?

A

postpartum

200
Q

For women who have abortion, ectopic preg, amniocentesis, vaginal bleeding, placenta previa/placental abruption and are Rh -, you should

A

give RhoGAM
Type and screen
follow B-hCG and prevent pregnancy for 1 year

201
Q

Complication of Rh isoimmunization when Hgb is < 7?

A

hydrops fetalis

202
Q

What are the 2 types of malignant gestational trophoblastic disease?

A

invasive moles

choriocarcinoma

203
Q

complications of malignant gestational trophoblastic disease?

A

pulmonary or CNS metastases and trophoblastic pulmonary emboli

204
Q

2 types of benign gestational trophoblastic disease?

A

Incomplete and Complete molar pregnancies

205
Q

Compare and contrast incomplete vs complete molar pregnancies according to

Mechanism of fertilization, karyotype and presence of fetal tissue

A

Complete:
MOF- sperm fertilizes empty ovum
Karyotype- 46, XX
fetal tissue - none

Incomplete:
MOF- 2 sperm fertilize normal ovum
Karyotype- 69, XXY
Fetal Tissue- yes

206
Q

Presentation of GTD

A

first trimester uterine bleeding, hyperemesis gravidarum, preeclapsia, eclampsia at < 24 weeks and uterine size greater than dates

207
Q

Risk factors for GTD

A

extremes of age < 20, >40. Diet deficient in folate or B-carotene

208
Q

Physical exam findings in GTD?

A

no fetal heartbeat
pelvic exam may reveal large ovaries (bilateral theca-lutein cysts)
May be grape-like molar clusters expelling into vaginal canal

209
Q

What will labs, US, CXR possibly show in women with GTD?

A

labs: markedly elevated B-hCG (usually > 100,000)
Pelvic US: snowstorm appearance w/o gestational sac
CXR: can show lung mets

210
Q

Treatment for GTD

A

evacuate uterus and follow up with weekly B-hCG
Treat malignant diseases with chemo
Treat residual uterine disease with hysterectomy

211
Q

Diagnosis of shoulder dystocia?

A

prolonged 2nd stage of labor, recoil of perineum “turtle sign”, lack of spontaneous restitution (turning head to align with shoulders)

212
Q

Treatment for shoulder dystocia

“HELPER”

A 
Help reposition into lateral position
Episiotomy
Leg elevated (McRoberts maneuvar)
Pressure (suprapubic)
Enter vagina and attempt rotation (Woods screw maneuvar)
Reach for fetal arm
213
Q

causes for failure to progress in labor?

A

chorioamnionitis, occiput posterior, nulliparity, elevated birth weight

214
Q

Premature ROM definition

A

Occurs > 1 hour before onset of labor

215
Q

Premature ROM can be precipitated by?

A

vaginal or cervical infections, abnormal membrane physiology, cervical incompetence

216
Q

Preterm premature rupture of membranes (PPROM) definition

A

ROM occuring before 37 weeks

217
Q

Prolonged ROM defined as

A

> 18 hours prior to delivery.

218
Q

To minimize risk of infection do not perform _______ on women with PROM

A

digital vaginal exams

219
Q

Diagnosis of ROM

A

Sterile speculum exam- pooling of amniotic fluid in vaginal vault

Nitrazine paper test: (+) paper turns blue due to alkaline pH of amniotic fluid

Fern test: (+) - ferning under microscope with dried amniotic fluid

220
Q

Treatment for PROM in term women?

A

Check GBS status and fetal presentation. Induce labor or observe for 6 hours and then induce

221
Q

Treatment for PROM in >34-36 week?

A

Consider labor induction

222
Q

Treatment for PROM in <32 weeks?

A

Expectant management with bed rest. Give abx and antenatal corticocteroids for 48 hours to promote fetal lung maturity

223
Q

If signs of infection/fetal distress develop with PROM, give?

A

antibiotics (ampicillin and gentamicin) AND induce labor

224
Q

Risk factors for preterm labor (20-37 weeks)

A

multiple gestation, infection, PROM, uterine anomalies, previous preterm labor, polyhydramnios, placental abruption, poor nutrition, low SES

225
Q

Most patients with preterm labor have/do not have risk factors?

A

Do not have!

226
Q

tocolytics

A

meds used to suppress preterm labor

227
Q

Diagnosis of preterm labor requires

A

regular uterine contractions
concurrent cervical change
sterile speculum exam to rule out PROM
US- rule out fetal anomalies, verify GA, assess presentation and amniotic fluid volume

228
Q

Contraindications to tocolytics

A

infection, nonreassuring fetal testing, placental abruption

229
Q

Tocolytic therapy meds include?

A

B-mimetics, MgSO4, CCBs, prostaglandin inhibitors

230
Q

Some common complications for neonates born prematurely?

A

RDS, inttraventricular hemorrhage, PDA, necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, death

231
Q

Why is sodium citrate given to mothers for both elective and indicated c/s delivery?

A

Decrease gastric acidity and prevent acid aspiration syndrome

232
Q

Post-partum endometritis is characterized by what signs/symptoms?

A

Fever > 38 within 36 hours
Uterine tenderness
Malodorous lochia

233
Q

Postpartum hemorrhage is defined as?

A

> 500 ml for vag delivery

> 1000 ml for c/s

234
Q

3 of the most common causes for postpartum hemorrhage are?

A

Uterine atony- most common
Genital tract trauma
Retained placental tissue

235
Q

Soft enlarged “boggy” uterus indicates?

A

uterine atony (most common cause of post-partum hemorrhage- 90%)

236
Q

How to treat uterine atony?

A

bimanual uterine massage, oxytocin infusion methergine (if patient is NOT HTN) or PGF2

237
Q

For all post-partum hemorrhage, when bleeding persists after conventional therapy what can be done?

A

uterine/iliac artery ligation, uterine artery embolization, or hysterectomy

238
Q

Treatment for suspected postpartum infection- endometritis?

A

broad spectrum antibiotics (clindamycin, gentamicin) until patients have been afebrile for 48 hour. (add ampicilin if complicated)

239
Q

Complications of post-partum endometritis?

A

Septic thrombophlebitis

240
Q

How does septic thrombophlebitis present?

A

“picket-fence” fever curve -> hectic fevers with wide swings from normal to as high as 41 C (105.8)

241
Q

The most common presenting syndrome for Sheehan syndrome is?

A

Failure to lactate due to decreased prolactin levels

242
Q

What are the 7W’s of postpartum fever (10 days post-delivery)

A 
Womb (endometritis)
Wind (atelectasis, pneumonia)
Water (UTI)
Walk (DVT, PE)
Wound (Incision, episiotomy)
Weaning (breast engorgement, abscess, mastitis) 
Wonder drugs (drug fever)
243
Q

Colostrum contains ?

A

protein, fat, ** secretory IgA and minerals

244
Q

What is the benefit of high IgA levels in Colostrum?

A

provide passive immunity for infant and protect against enteric bacteria

245
Q

Symptoms of placental abruption

A

PAINFUL, dark vaginal bleeding that does not spontaneously cease. Abdominal pain. Uterine hypertonicity. Fetal distress

246
Q

How to diagnose placental abruption? Is US helpful?

A

Mostly clinical. US is only 50% sensitive

247
Q

Management of abruption

A

expectent management if you can with starting IV, fetal monitoring, type and cross blood, bed rest

If severe- need to deliver

248
Q

Complications of abruption

A

hemorrhagic shock. DIC in 10% of patients. fetal hypoxia

249
Q

risk factors for abruption

A

htn, cocaine use, tobacco use, trauma, excessive uterine stimulation

250
Q

risk factors for previa

A

c-section hx, grand multip, advanced maternal age, multiple gestation, prior hx previa

251
Q

presentation of placenta previa

A

PAINLESS, bright red bleeding that often stops in 1-2 hours. usually no fetal distress

252
Q

diagnosis previa?

A

US is 95% sensitive.

253
Q

What should you not do to manage or diagnose previa?

A

NEVER perform vaginal exam!

254
Q

How/when should you deliver a baby with placenta previa present?

A

C/S! Indicated if term baby, lungs are mature, or if life-threatening bleeding or fetal distress

255
Q

Vasa previa

A

Fetal vessels cross over cervical os (due to biloped placenta or strangely inserted umbilical vessel in placenta)

256
Q

Presentation of vasa previa

A

PAINLESS bleeding at time of ROM and fetal bradycardia

257
Q

Diagnosis of vasa previa?

A

Transvaginal US with color doppler showing vessels passing over the interal os

258
Q

If patient presents with acute bleeding of vasa previa you should?

A

Deliver by emergency c-section

259
Q

If patient is diagnosed with vasa previa prior to bleeding what are steps you should take?

A

Steroids at 28-32 weeks. Hospitalization at 30-32 weeks for close monitoring. Scheduled c-section at 35 weeks.

260
Q

With intrauterine fetal demise (fetal death > 20 weeks) how do you manage (20-23 weeks) or (>24 weeks)

A

20-23 weeks: Dilation and evacuation OR vaginal delivery

> 24 weeks: vaginal delivery

261
Q

A Kleihauer-Betke test can confirm or exclude?

A

fetomaternal hemorrhage

262
Q

How do you evaluate fetal demise? (FETAL things)

A

Fetal: autopsy, exam of placenta, membranes and cord

Karyotype/genetic studies

263
Q

How do you evaluate for fetal demise (MATERNAL things)

A
  1. Kleihauer-Btke test for feto-maternal hemorrhage
  2. anti-phospholipid antibodies
  3. coag studies
264
Q

Particular complication for IUFD that is retained in utero for several weeks?

A

coagulopathy

265
Q

Progesterone supplementation is used to prevent recurrence of _____

A

preterm labor

266
Q

Contraindicated vaccines in pregnancy

A

HPV, MMR, Live influenza, Varicella

267
Q

Recommended vaccines in pregnancy

A

Tdap
Inactivated influenza
Rho (D) immunoglobulin

268
Q

pregnant women are at increased risk of what virus during preg? how to manage this?

A

Influenza. all preg women should get vaccine. they are more likely to get influenza pneumonia.

269
Q

If a pregnant women was exposed to varicella but did not show immunity (IgG response to it) how do you manage this?

A

post-exposure prophylaxis with varicella zoster immunoglobulin administration

270
Q

Diagnosis of chorioamnionitis is based on?

A

maternal fever and 1 or more of following (uterine tendernesss, maternal/fetal tachy, malodorous amniotic fluid, purulent vaginal discharge , WBC >15,000

271
Q

Treatment for chorioamnionitis

A

broad spectrum antibiotics (amp, gent, clinda)

delivery

272
Q

What should a patient with chorioamnionitis receive to accelerate labor?

A

oxytocin

273
Q

Corticosteroids are administered to all patients likely to deliver a preterm infant before ____ weeks

A

34

274
Q

Definition of preeclampsia

A

new onset htn (> 140 or > 90) at > 20 weeks. plus proteinuria and/or end organ damage

275
Q

What are severe features of pre-eclampsia

A 
> 160, >110 (2X 4 hours apart)
thrombocytopenia
elevated creatinine
elevated transaminases
pulmonary edema
visual/cerebral symptoms
276
Q

Management for preeclampsia
without severe features:
with severe features:

A

without: delivery >37 weeks
with: delivery > 34 weeks

Give mag (seizure prophylaxis) and anti-htn

277
Q

proteinuria is defined as?

A

> 300mg/24 hour

protein/creatinine ratio > .3

dipstick > or equal to 1+

278
Q

Patients with acute fatty liver of pregnancy present with?

A

nausea, vomit, abd pain, jaundice

279
Q

What are the anti-htn treatments of choice for pre-eclampsia?

A

Hydralazine (IV), Labetalol (IV), Nifedipine (PO)

280
Q

What is a contraindication for giving labetalol?

A

bradycardia

281
Q

Reason not to give nifedipine?

A

emesis

282
Q

Medication used to treat chonic htn in pregnancy?

A

methyldopa (limited by its slow onset)

283
Q

For an SAD, when do you have to treat with suction curettage?

A

If infection or hemodynamic instability

284
Q

Can you use oxytocin to stimulate uterine contractions or expel retained products of conception in 1st/2nd trimester?

A

NO- few oxytocin receptors in uterus during early pregnancy

285
Q

Largest risk factor for preterm delivery is?

A

Previous preterm delivery

286
Q

What should you do starting in 2nd trimester to help prevent preterm delivery?

A

progesterone

serial cervical length measurements by transvag ultrasound

287
Q

When do you consider cerclage?

A

short cervix.

288
Q

management of PPROM 34-37 weeks?

A

Antibiotics
+/- steroids
Delivery

289
Q

Management of PPROM < 34 weeks if signs of infection and fetal compromise are present

A

Antibiotics
steroids
mag if < 32 weeks
delivery

290
Q

Management of PPROM < 34 weeks if signs of infection and fetal compromise are NOT present

A

antibiotics
steroids
fetal surveilance

291
Q

Purpose of amnioinfusion??

A

instillation of saline into uterine cavity for treatment of recurrent variable decels for cord compression during labor

292
Q

Wernicke encephalopathy (thiamine deficiency) is a major complication of?

A

Hyperemesis gravidarum

293
Q

Classic presentation of Wernicke encephalopathy?

A

Encephalopathy
Oculomotor dysfunciton
Gait ataxia

294
Q

Fetal anemia is associated with what type of fetal heart rate tracing?

A

Sinusoidal!

295
Q

What is the first line intervention for reducing cord compression and improve blood flow to placenta?

A

Maternal repositioning

296
Q

2nd line intervention for reducing cord compression?

A

amnioinfusion

297
Q

Intermittent variable decels occuring with < 50% of contractions are/are not well tolerated by fetus

A

ARE

298
Q

Transverse lie invants typically correct before delivery. True/false?

A

True

299
Q

When is internal podalic version used?

A

to facilitate the breech extraction of a malpresenting 2nd twin

300
Q

Prognosis for erb-Duchenne palsy (waiter tip posture) after brachial plexus injury in setting of shoulder dystocia?

A

80% of patients have spontaneous recovery within 3 months

301
Q

Hyperemesis gravidarum can be associated with transient?

A

hyperthyroidism (thyrotoxicosis of hyperemesis) due to stimulation of the thyroid by elevated hCG levels

302
Q

Clinical features of mild, mod, severe mag toxicity

A

Mild: nausea, flushing, HA, hyporeflexia

Mod: areflexia, hypocalcemia, somnolence

Severe: resp paralysis, cardiac arrest

303
Q

Mag sulfate decreases the risk for ____ in preterm infants

A

cerebral palsy

304
Q

Oxytosin can enhance ____ hormone and cause SIADH

A

ADH

305
Q

Two major types of fetal growth restriction?

A

symmetric and asymmetric

306
Q

Symmetric FGR

A

is global, proportionate growth lag that includes the head and starts in 1st trimester. most likely to be congenital/chromosomal or 1st trimester TORCH infxn

307
Q

Asymmetric FGR

A

Head sparing growth lag that often begins in 2nd/3rd trimester due to placental insufficiency or maternal malnutrition

308
Q

Reactive NST?

A

2 or more accels greater thean 15 bpm and > 15 seconds long in 20 min period

309
Q

Non-reactive NST?

A

<2 accels or recurrent variable or late decels

310
Q

Loss of fetal station or retraction of fetal part is pathognomonic for?

A

Uterine rupture

311
Q

management for suspected uterine rupture?

A

Emergency laparotomy

312
Q

BPP and CST are equivalent/non-equivalent?

A

equivalent

313
Q

Women who miss GBS screening at 35-37 weeks ang go into labor should be treated if: (3 things)

A

< 37 weeks
intrapartum fever
rupture of membranes > 18 hours

314
Q

Do women who are GBS negative need prophylaxis if they have rupture of membrane > 18 hours?

A

NO

315
Q

when should penicillin prophylaxis be given for GBS?

A

4 hours before delivery

316
Q

most common cause of an arrested 2nd stage of labor is?

A

fetal malposition

317
Q

malpresentation refers to any?

A

non-vertex presentation (breech)

318
Q

malposition refers to?

A

(non-occiput anterior): relationship of presenting fetal part to maternal pelvis (occiput posterior, occiput transverse)

319
Q

Most common cause of protracted 1st stage of labor?

A

inadequate contractions

320
Q

molding of fetal head is suggestive of?

A

cephalopelvic disproportion

321
Q

Describe pathophysiology of pulmonary edema in pre-eclampsia/ eclampsia

A

generalized arterial vasospasm -> increased afterload -> increased pulm cap wedge pressure -> pulm edema

Also decreased albumin, renal function and increased vasc permeability -> pulm edema

322
Q

amniotic fluid embolism presentation and etiology

A

sudden hypoxemic resp failure and hypotensive shock. Amniotic fluid enters maternal citculation during delivery.

323
Q

When should you have suspicion of septic thrombophlebitis

A

post partum or post pelvic surgery in patient with bilateral low quad tenderness (thrombosis in deep pelvic or ovarian veins). these patients have persistent fever unresponsive to broad spectrum abx and negative blood, urine, urinalysis

324
Q

Treatment for septic pelvic thrombophlebitis

A

anticoagulation and broad spec abx

325
Q

adverse affects of oxytocin

A 
hyponatremia (similar in structure to ADH)
hypotension
uterine tachysystole (abnml frequent contractions)
326
Q

Patients with positive syphilis serology should be treated with?

A

Intramuscular benzathine Penicillin G

327
Q

An intrauterine fetal demise associated with growth restriction, multiple limb fractures, hypoplastic thoracic cavity is consistent with?

A

Type II osteogenesis imperfecta (lethal)

autosomal dominant

328
Q

non-lethal autosomal dominant bone dysplasia that presents with macrocephaly, frontal bossing, midface hypoplasia, genu varum and limb shortening

A

Achondroplasia

329
Q

symptomatic pubic symphisis presents as?

A

suprapubic pain that spreads to the back and hips. exacerbated by weight-bearing, walking, position changes, waddling gait, point tenderness over pubic symphisis

330
Q

Who should have cerclage

A

hx of 2nd trimester delivery or short <2.5cm cervical length

331
Q

DIC is a complication of?

A

placental abruption

332
Q

adhesions, powder-burn lesions, flesh colored or dark nodules and chocolate cysts indicate?

A

endometriosis

333
Q

Tocolysis is not indicated after _____ weeks because?

A

risk of therapies exceed those of preterm delivery

334
Q

In a patient with breech IUFD > 24 weeks, what is the best mode of delivery? why?

A

Vaginal induction of labor. Do not need c/s for breech IUFD because benefits are typically to protect the fetus. Vag delivery is a more safe option for Mom

335
Q

What types of fibroids can cause recurrent pregnancy loss?

A

submucosal and intracavitary

336
Q

What treatment is required for early decels? why?

A

NONE. Early = head compression. does not indicate fetal hypoxia.

337
Q

bladder atony should be suspected when?

A

patients unable to void by 6 hours after vaginal delivery or 6 hours after removal of indwelling catheter after cesarean delivery

338
Q

Symptoms of sheehan syndrome

A

fatigue, weight loss, hypotension, inability to breastfeed

339
Q

Tocolytic meds include?

A

nifedipine (CCB) and indomethicin

340
Q

Nifedipine and Mag together can cause

A

resp depression and suppressed muscular contractility

341
Q

A positive fetal fibronectin test is associated with?

A

preterm delivery

342
Q

Arrest of active labor occurs when?

A

no cervical change for >4 hours with adequate contraction or no cervical change >6 hours with inaequate contraction

343
Q

contractions generating > ______ MVUs in a 10 min interval are considered adequate

A

200

344
Q

When is oxytocin indicated for protracted labor?

A

inadequate contraction strength

345
Q

When can operative vag delivery be used to manage a protracted second stage of labor?

A

cervix is completely dilated (10cm)

Step 2 CK (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions