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OBCE OB/Gyn Review > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Which hormone triggers a surge in LH?

A

Estrogen during the follicular phase

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2
Q

What does a surge in LH lead to

A

ovulation

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3
Q

Which medications have placental transmission?

A
  • Acutane
  • Antidepressant (sodium valproate)
  • Anticonvulsants
  • Anticoagulants
  • Vitamins ADEC in excess
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4
Q

When would you refer for genetic counseling?

A
  • advanced maternal age
  • suspected carriers for gene
  • family condition/trait
  • recurrent SAB
  • unexplained fetal death
  • SIDS hx
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5
Q

Carrier tests are available for which conditions?

A
  • Sickle Cell
  • Tay Sachs
  • Thalassemias
  • Cystic Fibrosis
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6
Q

T/F: Tay sachs screening is offered if both parents are Jews

A

True

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7
Q

What percentage of pregnancies are unplanned?

A

50%

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8
Q

Define infertility

A

inability to conceive after 1yr of trying

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9
Q

When should you intervene with an eval and workup for infertility?

A

If <35yo, wait 1yr;

If >35yo, wait only 6mo

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10
Q

What are the 3 primary causes of infertility?

A

1- Pelvic factors (PID, adhesions, inflam)
2- Semen defect (amount, motility, morph)
3- Ovulatory defect (progesterone, cycle, luteal phase defect)

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11
Q

What is labs are performed on an infertility workup?

A
  • Fertility awareness edu.
  • TSH
  • FSH
  • Progesterone
  • Prolactin
  • Semen analysis
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12
Q

When would you perform a hysterosalpingogram w/ infertility?

A

Checking for potency of tubes or anatomical obstructions

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13
Q

When would you perform laparoscopy w/ infertility?

A

checking for adhesions and fibroids or cysts

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14
Q

Which are 3 requirements for successful conception?

A

Egg, sperm, good environment

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15
Q

Where does conception occur?

A

FIMBRIA OR AMPULLA

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16
Q

How long is the egg viable for, once released?

A

24hrs

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17
Q

When is hCG produced?

A

When egg burrows into endometrium

- hCG triggers corpus lute to secrete prog past its normal 14 days

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18
Q

Once implantation occurs, how long does the corpus lute secrete prog for?

A

12-16th week, until placenta takes over

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19
Q

Why might there be increased hCG on pregnancy test?

A
  • Pregnancy (normal or complicated)
  • Ovarian tumor
  • Testicular cancer
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20
Q

What is the pattern of hCG increase with pregnancy?

A
  • doubles every 48-72hrs

- peaks at 50-75 days

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21
Q

What timeframe is considered for spontaneous abortion?

A

loss of fetus before 20 weeks gestation

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22
Q

Describe threatened abortion

A

spotting/bleeding w/ NO significant cramps/clots

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23
Q

Describe inevitable abortion

A
  • Heavy bleeding, cramps, cervix dilated, ROM, no FHTs
  • decrease in hCG
  • before wk 10 - natural course
  • after wk 10 = D&C
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24
Q

Describe incomplete abortion

A

Part or all of POC (products of conception) remained in uterus

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25
Q

What are s/sx of incomplete abortion? Next steps?

A
  • bleeding and pain

- monitor for infection/hemorrhage and refer for D&C

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26
Q

Describe complete abortion

A

all POC expelled

- 2-3wk follow up with provider

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27
Q

Describe missed abortion

A

Death of embryo or fetus with retained POC

- requires D&C

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28
Q

What is habitual abortion?

A

3 successive pregnancy losses

- requires referral

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29
Q

What is a septic abortion?

A

POC infected, may lead to systemic infection

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30
Q

What are s/sx of septic abortion?

A
  • increased bleeding
  • malodorous vaginal d/c
  • pain
  • fever/chills
  • leukocytosis
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31
Q

What is a blighted ovum?

A
  • Egg gets fertilized and implants- but does NOT develop
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32
Q

What is the usual cause for an anembryonic pregnancy/blighted ovum?

A

chromosomal abnormality

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33
Q

What is the presentation of ectopic pregnancy?

A

bleeding, pain, s/s of pregnancy

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34
Q

How do you dx ectopic pregnancy?

A

decreasing or low hCG levels and ultrasound

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35
Q

What are the risk of ectopic pregnancy?

A
  • hemorrhage and death
  • future infertility
  • increased risk of future complications
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36
Q

what occurs when there is an overproduction of placental cells with an abnormally high hCG level?

A

hydatidiform mole

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37
Q

What is the typical presentation for a molar pregnancy?

A
  • Large for gestational age
  • bleeding and pain
  • no fetal mvmt.
  • more nausea than normal (hCG)
  • no FHTs
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38
Q

Presence of a hydatidiform mole increases the risk for developing ________.

A

Choriocarcinoma

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39
Q

what are the common causes for first trimester SAB?

A

chromosomal abnorm, reproductive hazards and unknown

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40
Q

What are the common causes for second trimester SAB?

A

incompetent cervix, uterine septum, trauma

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41
Q

Which criteria help form a “Presumptive” pregnancy dx?

A
  • Amennorhea
  • N/V
  • Mastodynia
  • Quickening (baby moving)
  • Urinary freq.
  • Wt gain
  • Fatigue
  • Increase BBT
  • Chloasma/linea nigra/darkened areola
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42
Q

Which criteria help form a “Probable” pregnancy dx?

A
  • OTC pregnancy test (pos @ 12-14 days)
  • Blood test (pos @ 9-11 days)
  • Uterine changes (hegar’s & goodell’s)
  • Ballotable mass
  • Braxton-Hicks contractions
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43
Q

What is a ddx for probable pregnancy?

A
  • choriocarcinoma, hydatidiform mole, ectopic pregnancy.
  • obesity or neoplasm
  • muscle spasm
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44
Q

Which findings suggest a definitive “POSITIVE” pregnancy?

A

FHTs, Ultrasound and X-Ray

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45
Q

What is the role of “relaxin”?

A

softens tissues and joints, secreted through breastfeeding

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46
Q

What is role of prostaglandins in pregnancy?

A

Present in amniotic fluid, menstrual blood and semen; ripens cervix and induces contractions

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47
Q

What is the role of progesterone in pregnancy?

A
  • Secreted by CL then placenta
  • promotes breast gland growth
  • maintains pregnancy
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48
Q

Which form of estrogen is dominant through pregnancy?

A

E3 - Estriol, 1000x higher while prego

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49
Q

What is the role of prolactin in pregnancy?

A

Develops alveolar and glandular cells to help promote lactation and produces lactose and lipids

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50
Q

What is the role of oxytocin in pregnancy?

A

“Contractor hormone”

  • secreted from post. pit. to express milk and stimulate the uterus
  • induces labor and controls PP hemmorhage
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51
Q

What is piskacek’s sign?

A

asymmetric enlargement of the body of the pregnant uterus, an indication of pregnancy

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52
Q

What is goodell’s sign?

A

cervical softening, an indication of pregnancy

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53
Q

What is hegar’s sign?

A

Uterine isthmus softens. indication of pregnancy

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54
Q

What is chadwick’s sign?

A

bluish discoloration- increased vascularization of vaginal walls, indicating prengnancy

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55
Q

Which hormone inhibits egg maturation?

A

Progestin

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56
Q

Which hormone preserves corpus lute?

A

hCG

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57
Q

How does estrogen influence chloasma + similar conditions?

A

Estrogen stimulates melanocytes

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58
Q

Why and how is GI tract affected during pregnancy?

A

Relaxin from placenta causes GI relaxation, slowing food and water digestion

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59
Q

What are montgomery’s tubercles?

A

small glands around the nipples that secrete oils which lubricate and protect against infection

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60
Q

At what times do breasts become more enlarged w/ modularity and when do they express colostrum?

A
  • nodularity/enlargement by 8wks

- colostrum (rich in Ab/PRO, low in lipids) by 12wks

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61
Q

What are the normal cardiovascular changes with pregnancy?

A
  • CO increases, peaks @ 20-24wks
  • BP decreases in 2nd tri
  • HR increases by 10-15bpm
  • LE edema/neous congestion
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62
Q

Why will pregnant women appear anemic on lab tests?

A
  • Plasma increases more than RBC mass increases;
  • Will appear anemic on labwork as there is a RELATIVE decrease in hematocrit and hemoglobin. “Macrocytic anemia” d/t hemodilution
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63
Q

Which respiratory changes are important with pregnancy?

A

increase in tidal volume and O2 uptake

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64
Q

Which GI condition is common in pregnancy?

A

cholestasis

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65
Q

Which skin conditions are very common w/ pregnancy?

A
  • spider angiomas and varicosities

- hyperpigmentation

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66
Q

What is the difference between gravid and gravida?

A

one has an “a”;

  • gravid = currently pregnant
  • gravida = has been pregnant
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67
Q

Define nulligravida

A

never been pregnant

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68
Q

Define primigravida

A

pregnant for the first time

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69
Q

Define para

A

carried fetus to viability

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70
Q

Define primipara and multipara

A

carried one fetus and multiple fetuses to viability

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71
Q

Define parturient

A

woman IN labor

72
Q

What is post-partum

A

post-parturient = after labor

73
Q

What is puerpera?

A

woman who has just given birth

74
Q

What is GPA

A

Gravida-Para-Aborta

75
Q

What is Naegle’s rule?

A

due date calculation:

  • subtract 3mo from LNMP
  • Add 7 days to day of LNMP
  • Add year, if appropriate
76
Q

How much do caloric needs increase/day for a pregnant woman?

A

200-300kcal

77
Q

Which are the prenatal vitamins?

A

Folic acid, Iron, Calcium citrate and Mg malate

78
Q

Can you have caffeine while pregnant?

A

Yes, limit to 200mg per day

79
Q

What are the pregnancy risk factors?

A
  • High BP
  • Heart, lung, liver, kidney dz
  • STI or UTI
  • Diabetes (type 1)
  • asthma
  • seizure or psychiatric disorders
  • hypothyroidism
80
Q

What is the proposed frequency of visits throughout pregnancy?

A

1/mo until 28wks
2/mo from 28-36wks
1/wk from 36-40wks

81
Q

What procedures are performed on an initial prenatal visit?

A
  • Blood and Rh type
  • CBC
  • Rubella titer
  • Syphilis screen (VDRL/RPR)
  • Hep/HIV
  • Urinalysis
  • PAP smear and infection
  • Toxoplasmosis
82
Q

What is the QUAD screen?

A

Maternal serum screen at 16-18wks:

  • AFP
  • HCG
  • Estriol
  • Inhibit A
83
Q

When is the diabetes screen performed?

A

24-28wks

84
Q

When does the uterus become an abdominal organ during pregnancy?

A

First day of 2nd trimester

85
Q

What tests are performed on prenatal visits?

A
  • Gestational age
  • Wt
  • BP
  • Urine
  • FHR (120-160bpm)
  • Fetal presentation
86
Q

When can you hear FHTs via stethoscope ?

A

20wks

87
Q

When can you hear FHTs via doppler?

A

12wks

88
Q

At what rate does the uterine fundal height grow?

A

@ 12/14wks = above pubic bone;

@ 20wks = at umbilicus +1cm for each week

89
Q

What infection do you test for at 36wks?

A

Group B strep (GBS)

90
Q

What are the safest weeks for a pregnant woman to travel?

A

18-32wks

91
Q

What is the MC cause of mental disabilities in the US?

A

Fetal Alcohol Syndrome (FAS)

92
Q

Which facial features are characterized by FAS?

A

short eye opening, wide-set eyes, short nose, flat mid face, thin upper lip and small chin

93
Q

What are the 3 primary characteristics of FAS?

A
  • Characteristic facies
  • Growth retardation
  • CNS anomalies
94
Q

Which minerals are important to supplement in pregnancy?

A

Zinc and Calcium

95
Q

Which vitamins are important to supplement in pregnancy?

A

A (only in B-carotene form d/t teratogenic risk), B6 and B12

96
Q

When would you perform amniocentesis and CVS?

A

Amnio - ONLY after 16wks

CVS - btw wks 9-12

97
Q

What is oxytocin challenge aka stress test?

A

sees how baby reacts to oxytocin via HR monitor

98
Q

How is biophysical profile test performed and evaluated?

A
  • Uses U/S and Non-stress test to evaluate many parameters

- Scores up to 10, with 4pts or less being ominous

99
Q

What is MC onset of pre-eclampsia/eclampsia?

A

3rd Trimester (may be 20wks to 6wks PP)

100
Q

T/F: Progression of pre/eclampsia may be rapid

A

True

101
Q

What is the presentation for pre/eclampsia?

A

HTN, proteinuria, wt gain, edema, HA, URQ or Epigastric pain

102
Q

What is anasarca?

A

Generalized edema (pitting)

103
Q

What s/sx would signify severe preeclampsia?

A

anasarca, oliguria, acute retinal hemorrhages, HA, CNS irritability

104
Q

What is a major complication of preeclampsia?

A

HELLP

Hemolysis, Elevated Liver enzymes and Low Platelets

105
Q

What is the most common complication of pregnancy?

A

gestational diabetes

106
Q

What are s/sx of GD?

A

excessive thirst, hunger, fatigue or “not feeling right”

SCREEN @ 24-28wks

107
Q

What are complications of GD?

A

SAB, polyhydraminos, preterm, HTN, dystocia, resp. distress, macrosomia

108
Q

Which type of zygotic twins are riskier?

A

monozygotic

109
Q

What are s/sx of preterm labor?

A
  • back pain/pressure
  • contractions >4x/hr
  • mucoid d/c or ROM
110
Q

When is “term”?

A

38wks

111
Q

What is Franks breech position?

A

bum is facing outlet in pike position

112
Q

What are complications of postterm birth?

A

placental insuff., asphyxia, aspiration of mecon., dystocia

113
Q

What are red flags with post-date pregnancy?

A
  • less mvmt
  • bleeding
  • severe HA/visual disturbance
  • sudden wt gain
  • abd. pain
114
Q

Which drug while ingested during pregnancy will cause withdrawal s/sx

A

heroin

115
Q

which organism is commonly found in soft cheeses, lunch meat and unpasteurized milk?

A

listeria monocytogenes

116
Q

Which s/sx occur with toxoplasmosis?

A

fatigue, muscle pain and lymphadenopathy

117
Q

Which prominent STIs are communicable in utero?

A
  • Syphilis
  • Herpes (HSV)
  • CMV (salivary transmission too)
  • Mycoplasma
  • Hep B
  • HIV
118
Q

Which prominent STIs are communicable via birth canal?

A
  • NG/CT
  • GBS
  • Herpes (HSV)
  • CMV (salivary transmission too)
  • HPV
119
Q

When is HIV communicable?

A

in utero, delivery and via breastfeeding

120
Q

What is trademark sign of CMV?

A

hepatosplenomegaly

121
Q

Rubella is typically mild, however the congenital form may cause which problems?

A

deafness, heart dz, dev’t delays

122
Q

what is lightening?

A

when the baby drops lower into mother’s pelvis

123
Q

what is quickening?

A

first sign of fetal movement

124
Q

What is “lie” fetopelvic relationship?

A

relationship of long axis of fetus to long axis of mother (long/transverse/oblique)

125
Q

What is “presentation” fetopelvic relationship?

A

part of fetus presenting to pelvic inlet - usually vertex

126
Q

What is “attitude” fetopelvic relationship?

A

relationship of fetal parts to each other (flex/ext of head on trunk)

127
Q

What is “denominator” fetopelvic relationship?

A

point on PRESENTING part to describe position (i.e. Occiput, mentum or sacrum)

128
Q

What is most common denominator? Why?

A

Left occiput anterior d/t liver

129
Q

What is “position” fetopelvic relationship?

A

relationship of denominator to the front, back or side of maternal pelvis

130
Q

What is the order of cardinal movements?

A
  • EDIERAP*
  • engagement
  • descent, flexion
  • internal rotation
  • extension
  • restitution (90 deg rot.)
  • anterior shoulder
  • posterior shoulder
131
Q

How many cm is the cervix dilated in each stage of labor?

A

Stage 1 = 0-10cm

Stage 2 = 10cm to birth

132
Q

What are the 3 phases of stage 1 of labor?

A

Latent
Active
Transition

133
Q

How are CXNs timed?

A

start of CXN to start of the next CXN

134
Q

What is station?

A

“Zero station” means that the head is at the middle of the pelvis at the line of the sacroiliac spine, increasing numbers indicates head further below pelvis

135
Q

What is effacement?

A

thinning of cervical wall

136
Q

What is the frequency of contractions along all three phases of stage 1 labor?

A

Latent - 5-20min
Active - 2-4min
Transition - 2-3min

137
Q

What is the frequency of contractions in stage 2 labor?

A

2-5min

138
Q

T/F: Early decels in FHTs are ok, while only late decels are bad.

A

correct

139
Q

What is crowning?

A

“ring of fire” = widest part of fetal head at vulvar ring w/out retraction

140
Q

With a gush ROM, what should you be wary of?

A

check for prolapsed cord and monitor FHTs

141
Q

What is the concern with preterm or prolonged ROM?

A

increasing risk of infection after 24hr

142
Q

What is back labor?

A

baby is in occiput posterior position, fix with counter pressure on sacrum in quadruped position

143
Q

What is turtle’s sign?

A

shoulder gets stuck on pubic bone, causes dystocia

144
Q

What condition may corkscrew procedure cause?

A

Erb’s palsy

145
Q

What occurs in stage 3 of labor?

A

separation and expulsion of placenta

146
Q

What occurs with separation of placenta?

A

lengthening of cord, gush of blood and contractions

147
Q

How do you examine placenta after delivery?

A

for completeness

  • amniotic side is Shiny, Smooth and “Shultz”
  • meaty side is dull “Duncan”
148
Q

what is amniotomy?

A

artificial rupture of membranes

149
Q

What is placental abruption?

A

Subchorionic hematoma displacing placenta from uterine wall, there will be decrease in FHTs, painful

150
Q

What is placenta previa?

A

Placenta covers cervical os

S/sx = painless bright red bleeding late in pregnancy, requires c-section

151
Q

What are the labor laceration classification?

A

1st- vaginal mucosa/labial skin
2nd- bulbocavernosal muscle
3rd- external anal sphincter
4th- anterior anal wall

152
Q

What is lochia?

A

vaginal d/c post partum

153
Q

What are the types of lochia?

A

Rubra - active bleeding, red, lasts few days
Serosa - pink w/ serum and WBCs, 5-10days
Alba - whitish brown, RBCs, mucous and tissue debris for up to 6wks

154
Q

Pt has low back pain, CVA tenderness, fever and nausea post partum. What is their Dx?

A

UTI

155
Q

What are 3 depressive states following pregnancy?

A

I. Baby Blues
II. Depression
III. Psychosis

156
Q

Describe post partum depression

A

Mood has effect on ADLs, obsessive thoughts of harming baby or inability to care for baby

157
Q

Describe post partum psychosis

A

Manic and severe depressive state, sleep deprives and volatile
- requires management

158
Q

When should you screen for anemia post partum

A

4-6wks

159
Q

What is diastasis recti?

A

separation of rectus abdomens 2.7cm or greater

160
Q

What is APGAR?

A
  • Appearance (color)
  • Pulse (>100bpm)
  • Grimace (flex irritability)
  • Activity (mm. tone)
  • Respiration

score below 6 suggests neurologic sequelae

161
Q

What does Ballard assess?

A

determines actual age using physical assessment

162
Q

Vernix caseosa and lanugo suggest baby is younger or older?

A

younger

163
Q

Foot creases in baby suggest they are ______

A

older

164
Q

What are s/sx of perinatal oxygen deprivation?

A
  • decreased LOC/mvmt, poor tone, apnea spells and seizures
    + jittery/weak after 12hrs
    + brain stem/feedingw signs after 24hrs
165
Q

What is newborn molding?

A

sutures fold in on each other, CONE HEADS

166
Q

What is cephalohematoma?

A

blood btw periosteum and skull; DOES NOT CROSS SUTURE LINES

167
Q

What is caput succedeneum?

A

edema of scalp, more diffuse and crosses suture lines; lasts 1-2 days

168
Q

Why is baby jaundice important to manage?

A

potential for neuro defecits

169
Q

When is it normal for babies to get jaundice?

A

2-4 days after delivery; within 24hrs signifies hemolytic condition (kernicterus)

170
Q

What precautions should you take with sore nipples while breast feeding?

A
  • avoid soapy water & drying agents
  • air dry after feeding
  • limit time on that nip
  • avoid plastic lined breast pads
171
Q

What is the causative agent of mastitis?

A

S. aureus

172
Q

When is mastitis MC?

A

within 3 months

173
Q

What are s/sx of mastitis?

A

unilateral redness, tenderness, warmth and fever

->Tx with Ab and regular expression

174
Q

What is TORCH?

A

refers to a group of maternally acquired communicable diseases

175
Q

What does TORCH stand for?

A 
Toxoplasmosis 
Other:
 • Varicella
• Venezuelan equine encephalitis
• Mumps
• Coxsackie
• Parvovirus
• HIV
Rubella 
Cytomegalovirus 
Herpes

OBCE OB/Gyn Review (2 decks)

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