Obstetrics Flashcards
1
Q
Maternal cardiac output is _____ in pregnancy:
A. Increased
B. Decreased
C. Unchanged
A
A. Increased
2
Q
At what AOG does maternal cardiac output increase during pregnancy?
A
5th week AOG
3
Q
At what AOG does plasma expansion in the mother occur?
A
10-20 weeks AOG
4
Q
Increase in cardiac output during pregnancy is attributed to ______.
A
decrease in systemic resistance
5
Q
In pregnancy, the mother’s heart is displaced to ____ and ____ and rotated somewhat on its axis.
A
displaced left and upward
6
Q
The cardiac silhouette appears _____ on chest radiograph:
A. Smaller
B. Larger
C. Unchanged
A
B. Larger
7
Q
Some degree of benign pericardial effusion may increase the cardiac silhouette. T/F
A
T
8
Q
Characteristic ECG change/s expected in a pregnant woman
A
No characteristic ECG changes other than slight Left-Axis Deviation (due to altered heart position)
9
Q
Expected cardiac sounds (2) in a pregnant woman
A
- Exaggerated splitting of 1st heart sound
2. Systolic murmur (90% patients)
10
Q
Arterial pressure usually decreased to a nadir at _____ weeks AOG
A
24-36 weeks AOGd
11
Q
Components of rennin-angiotensin-aldosterone axis are ___ in normal pregnancy:
A. Unchanged
B. Increased
C. Decreased
A
B. Increased
12
Q
Principal prostaglandin of endothelium
A
Prostacyclin (PG12)
13
Q
Potent vasoconstrictor in endothelial and vascular smooth muscle cells that regulates local vasomotor tone.
A
Endothelin
14
Q
Potent vasodilator released by endothelial cells; for modifying vascular resistance during pregnancy.
A
Nitric Oxide (NO)
15
Q
Maternal blood expands most rapidly during which trimester?
A
2nd trimester
16
Q
Remission of some autoimmune disorders during pregnancy is due to which physiological change?
A
Suppressed Th1 response
17
Q
Cervical mucus plug acts as a barrier against infection for the fetus because there is an increase of this agent in the mucus.
A
IgA
18
Q
Effect of pregnancy on maternal hemoglobin?
A. Increase
B. Decrease
C. Unchanged
A
B. Decrease
19
Q
Effect of pregnancy on maternal hematocrit?
A. Increase
B. Decrease
C. Unchanged
A
B. Decrease
20
Q
Effect of pregnancy on maternal whole blood viscosity?
A. Increase
B. Decrease
C. Unchanged
A
B. Decrease
21
Q
Approximately ____ of iron is required for normal pregnancy.
A
1000mg or 1 g of iron
22
Q
How much iron is actively transferred to the fetus and placenta?
A
300 mg iron
23
Q
Estimated blood loss in singelton NSVD?
A
500-600 ml
24
Q
Estimated blood loss in twin NSVD?
A
1000 ml (same as in CS)
25
Failure of Th1 suppression in pregnancy may be related to development of preeclampsia. T/F
T
26
In pregnancy, which is upregulated and which is suppressed?
Th1 response: _____
Th2 response: ____
Th1 - suppressed
| Th2 - upregulated
27
Which coagulation/fibrinolysis factors are increased in pregnancy>
4Fs:
Fibrinogen
Factor 7
Factor 10
Plasminogen
28
The diaphragm rises by about __ cm during the 2nd half of pregnancy.
4 cm
29
The transverse diameter of the thoracic cage increases by __ cm during the 2nd half of pregnancy.
2 cm
30
The thoracic circumference increase by about __ cm during the 2nd half of pregnancy.
6 cm
31
Which lung volumes are increased in pregnancy?
Increased: (IT)
Tidal Volume
Inspiratory capacity
32
Which lung volumes are decreased in pregnancy?
Decreased: (REF)
Residual Volume
Expiratory reserve volume
Functional residual capacity
33
What causes physiologic dyspnea during pregnancy?
Progesterone
Progesterone lowers the threshold and increases sensitivity of the chemoreflex to CO2. Maternal hyperventilation reduces CO2, which aids CO2 transfer from fetus to mother while facilitating O2 release to fetus.
*increased CO2 lowers blood pH --> shifts O2 dissociation curve to left (inc O2 affinity) --> stimulates increase in 23-BPG --> shifts curve back to right (dec O2 affinity) --> easier O2 release to fetal tissues
34
Increase in 2,3-BPG in maternal blood shifts the O2 dissociation curve to:
A. Right
B. Left
A. Right - less affinity to O2
35
Uterine hypertrophy early in pregnancy is probably stimulated by _____.
Estrogen and Progesterone
36
Uterine enlargement is most marked in which part of the uterus?
Fundus
37
Softening of the uterine isthmus
Hegar's sign
38
The uterus undergoes rotation to the right because of the rectosigmoid on the left side of the pelvis. What do you call this process?
Dextrorotation
39
Softening and cyanosis of the cervix due to increased vascularity and edema
Goodell's sign
40
Benign hyperplasia and hypersecretory appearance of the endocervical gland
Arias-Stella Reaction
41
Violet discoloration of the vagina which is due to increased vascularity
Chadwick sign
42
Elevated patches of tissue which bleed easily. Represents cellular detritus from the endometrium that has passed through the fallopian tubes.
Decidual Reaction
43
Protein hormone secreted by corpus luteum, deciduas, and placenta, which functions in the remodelling of the reproductive tract for birth.
Relaxin
44
When is colostrum usually expressed?
2 days after delivery
45
When does the maternal basal metabolic rate increase by 10-20%?
3rd trimester
46
Pitting edema of the ankles and legs during pregnancy is best explained by:
increased venous pressure below the level of the uterus due to partial vena cava occlusion
47
Bladder trigone is elevated by __ weeks AOG
>12 weeks AOG
48
How is the appendix displaced in the abdomen as the uterus enlarges?
the appendix is displaced upward and laterally (may reach the flank)
49
In pregnancy, gastric emptying time is:
A. Increased
B. Decreased
C. Unchanged
C. Unchanged
50
Pyrosis (heartburn) in pregnancy is due to:
Progesterone, which causes relaxation of the LES (lower esophageal sphincter)
51
Focal, highly vascular swelling of the gums that regresses spontaneously after delivery
Epulis of pregnancy
52
In pregnancy liver size is:
A. Increased
B. Decreased
C. Unchanged
C. Unchanged
53
Why are pregnant patients more prone to gallbladder stone formation?
Progesterone inhibits CCK-mediated smooth muscle stimulation which impairs gallbladder contraction.
54
Intrahepatic cholestasis in pregnancy has been linked to high circulating levels of __, which inhibits intraductal transport of bile acids.
Estrogen
55
Pruritis gravidarum is explained by:
retained bile salts
56
Which organ enlarges by 135% during pregnancy?
Pituitary gland
57
The placenta is the principal source of growth hormone secretion at __ weeks AOG
17 weeks AOG
58
Prolactin in the amniotic fluid is produced by:
uterine decidua
59
Total serum thyroxine plateaus at __ weeks AOG
18 weeks AOG
60
Which pregnancy hormone has intrinsic thyrotropic activity and may cause thyroid stimulation?
hCG
hCG and TSH have identical a-subunits
61
Adult remnant of Ductus Venosus
Ligamentum Venosum/ Falciform Ligament
62
Adult remnant of Umbilical Artery
Umbilical ligament
63
Adult remnant of Umbilical Vein
Umbilical Ligament
64
Functional closure of Ductus Venosus
10-96 hours
65
Anatomic closure of Ductus Venosus
2-3 weeks
66
Functional closure of Ductus Arteriosus
10-12 hours
67
Anatomic closure of Ductus Arteriosus
2-3 weeks
68
Functional closure of Foramen Ovale
Several mins
69
Anatomic closure of Foramen Ovale
1 year
70
Closure of umbilical artery
3-4 days
71
Closure of umbilical vein
3-4 days
72
3 shunts of the fetal circulation
1. ductus venosus
2. foramen ovale
3. ductus arteriosus
73
At what age does bronchial branching of lung development?
16-26 weeks AOG
74
At what age does terminal sac stage of lung development occur?
26 weeks
75
Presence of pullmonary surfactant in amniotic fluid after ___ weeks AOG is evidence of fetal lung maturity.
after 34 weeks
76
Pulmonary surfactant is produced by which cells?
type II pneumocytes
77
Pulmonary surfactant starts appearing in amniotic fluid at ___ weeks AOG
28-32 weeks AOG
78
Most active component of pulmonary surfactant
Dipalmitoylphosphatidylcholine (DPPC)
79
Alveolar development begins just before birth until __ years old
8 years old
80
In early pregnancy, amniotic fluid is composed of ___.
Ultrafiltrate of maternal plasma
81
In the 2nd trimester, amniotic fluid is composed of ___.
extracellular fluid (ECF) diffused through fetal skin
82
At what AOG does the fetal kidney start producing urine?
12 weeks AOG
83
Fetal urine becomes the main source of amniotic fluid at what AOG?
> 20 weeks (2nd-3rd trimester)
84
Normal amniotic fluid volume by term
840 ml
85
Normal amniotic fluid by 12 weeks AOG
60 ml
86
Increased rates of which complication have been linked to binge drinking during pregnancy?
Stillbirth
87
Which antimicrobial drug is associated with nephrotoxicity and ototoxicity in preterm infants?
Aminoglycosides (Gentamicin or Streptomycin)
88
Which antimicrobial drug is associated with gray baby syndrome in neonates?
Chloramphenicol (not teratogenic)
89
Exposure to which antimicrobial drug during the 1st trimester may cause the ff birth defects: hypoplastic heart syndrome, ASD, microphthalmia/anophthalmia, and clefts?
Nitrofurantoin
90
Exposure to which antimicrobial drug during the 1st trimester may cause the ff birth defects: anencephaly, choanal atresia, left ventricular outflow tract obstruction,, and diaphragmatic hernia?
Sulfonamides
91
Which antimicrobial drug is associated with yellowish discoloration of deciduous teeth (fetus) when used >25 weeks AOG?
Tetracyclines
92
Exposure to this drug is associated with miscarriage and ear defects
Mycophenolic acid (immunosuppresant)
93
Exposure to this drug is associated with hypoplastic, T-shaped uterine cavity, cervical collars, and breast cancer in females
Diethylstilbestrol (sex hormone)
94
Exposure to this drug is associated with epididymal cysts, hypospadia, cryptorchidism
Diethylstilbestrol (sex hormone)
95
Exposure to this drug is associated with embryopathy (6th-9th week), stippling of vertebrae, nasal hypoplasia, and choanal atresia
Warfarin
| Fetal Warfarin Syndrome
96
Drug associated with "clover leaf" skull, wide nasal bridge, low set ears, micronathia, limb abnormalities
Methotrexate
97
Drug associated with irreversible hypothyroidism
Radioiodine
98
Drug associated with disturbances in neuronal cell division and migration, developmental delay, microcephaly, and severe brain damage
Mercury
*Avoid: shark, swordfish, king mackerel, tilefish,, albacore tuna
99
Most potent teratogen; causes cranial-neural defects
Retinoids (isotretinoin)
100
level of Retinol that causes defects
> 10,000 mIU/day
101
Drug associated with Neonatal behavioral syndrome
SSRI/SNRI (Fluoxetine, sertraline, citalopram)
102
Drug associated with ASD & VSD
Paroxetine (SSRI)
103
Drug associated with Ebstein Anomaly (apical displacement of tricuspid valve)
Lithium
104
Drug associated with abnormal extrapyramidal muscle movements and withdrawal symptoms
Anti-psychotics (Haloperidol, chlorpromazine, fluphenazine, clopazine, olanzapine, risperidone)
105
Most common non-lethal trisomy
Trisomy 21 (Down Syndrome)
106
Which genetic abnormality presents with "strawberry-shaped" cranium?
Trisomy 18 (Edward Syndrome)
107
Which genetic abnormality presents with holoprosencephaly?
Trisomy 13 (Patau Syndrome)
108
The only monosomy compatible with life
Turner Syndrome (45 XO)
109
The most common sex chromosome abnormality
Klinefelter Syndrome (47 XXY)
110
Which genetic abnormality presents with abnormal laryngeal development with "cat-like" cry
Cru du chat Syndrome
111
In a Primigravida, when is fetal movement felt by the mother?
18-20 weeks AOG
112
In a Multigravida, when is fetal movement felt by the mother?
16-18 weeks AOG
113
Earliest time that hCG is detectable in maternal serum or urine
8-9 days after ovulation
114
Most accurate tool for gestational age assessment
Crown-rump length, at 8-12 weeks AOG
115
Give the gestational age based on the sonographic finding:
(+) gestational sac
4-5 weeks AOG
116
Give the gestational age based on the sonographic finding:
(+) yolk sac
5-6 weeks AOG (confirms intrauterine location)
117
Give the gestational age based on the sonographic finding:
Embryonic pole with cardiac motion
6 weeks AOG
118
At what age does fundal height correlate with AOG?
20-34 weeks AOG
119
FHT is detectable by Doppler ultrasound at what age?
10 weeks AOG
120
FHT is detectable by stethoscope at what age?
16 weeks AOG
121
What is the recommended pregnancy weight gain in a patient with normal BMI?
25-35 lbs
Normal BMI: 18.5-24.9
122
What is the recommended pregnancy weight gain in a patient who is overweight?
15-25 lbs
Overweight: 25-29.9
123
What is the recommended pregnancy weight gain in a patient who is underweight?
28-40 lbs
Underweight BMI: <18.5
124
What is the recommended pregnancy weight gain in a patient who is obese?
11-20 lbs
Obese BMI: >30
125
Recommended daily allowance of calories in a pregnant woman
100-300 kcal/day
126
Recommended daily allowance of protein in a pregnant woman
5-6 g/day
127
Recommended daily allowance of elemental iron in a pregnant woman
27 mg/day (low risk)
| 60-100 mg/day (high risk)
128
Recommended daily allowance of iodine in a pregnant woman
220 ug/day
129
Recommended daily allowance of calcium in a pregnant woman
900-1000 mg/day
130
Recommended daily allowance of folate in a pregnant woman
0.4 mg/day (can prevent neural tube defects)
| or 400 mcg/day
131
Recommended daily allowance of folate in a pregnant woman with previous neural tube defect baby
4 mg/day
132
Recommended daily allowance of folate for all women
0.4-0.8 mg/day
133
Recommended daily allowance of vitamin C in a pregnant woman
80-85 mg/day
134
How is Tetanus-diphtheria-acellular pertusis (Tdap) given?
IM (3 doses): 0, 1, 6-12 mos
Booster every 10 years or once every pregnancy
Preferably between 27-36 weeks
135
How is Influenza vaccine administered?
IM (1 dose): once a year (during appropriate season)
136
How is HepB vaccine given?
IM (3 doses): 0, 1, 6 mos
137
What is the criteria for normal fetal activity?
10 fetal movements within 2 hours
138
Which fetal assessment test is done to check ureteroplacental function?
CST (contraction stress test)
139
What is a satisfactory CST result?
3 or more contractions
40 seconds or more
10 min period
(+): abnormal - late decelerations following 50% or more of contractions (even if contraction frequency is fewer than 3 in 10 mins)
(-): normal - no late or significant variable decelerations
140
Which fetal assessment test depends on fetal heart rate acceleration in response to fetal movement as a sign of fetal health?
Non-stress test (NST)
141
What are the components (5) of the Biophysical Score?
```
NST
Fetal breathing
Fetal movement
Fetal tone
Amniotic Fluid volume
```
142
Give the chronological order in which BPS parameters are affected by hypoxia?
1st affected: Fetal heart reactivity
2nd affected: Fetal breathing
3rd affected: Fetal movement
4th affected: Fetal tone
143
Normal baseline FHR
110-160 bpm
144
Normal baseline variability of FHR (moderate)
6-25 bpm
145
Normal acceleration in NST
>/= 32 weeks AOG: >15bpm from baseline, lasts >15s, but <2mins from onset to return
<32 weeks AOG: >/= 10bpm from baseline, lasts 10s, but 2 mins from onset to return
146
In NST, which type of deceleration is due to fetal head compression?
Early deceleration
uterine contraction --> fetal head compression --> increased ICP --> stimulation of vagal nerve --> decreased FHR
147
In NST, which type of deceleration is due to uteroplacental insufficiency?
Late deceleration
uterine contraction --> decreased U-P O2 transfer --> chemoreceptor stimulus --> stimulation of vagal nerve --> decreased FHR
148
In NST, which type of deceleration is due to umbilical cord occlusion?
Variable deceleration
decrease in FHR >/= 15 bpm, lasts >/= 15 s, but <2 mins
149
What do you call the thinning of the lower uterine segment with concomitant thickening of the upper segment during labor?
Physiologic retraction ring
150
What is the pathological retraction ring formed when the thinning of the lower uterine segment during labor becomes extreme?
Bandl Ring
151
Defined as the spontaneous release of a small amount of blood-tinged mucus from the vagina at the clinical onset of labor
"Bloody show"
152
This is the leading portion of fluid and amniotic sac located in front of the presenting part; formed during the process of cervical effacement and dilatation.
Forebag
153
In many nulliparas, engagement of the head is accomplished BEFORE labor begins. T/F.
T
154
Pattern of cervical dilatation during preparatory and dilatational divisions of labor
Sigmoid curve
155
Pattern formed when the station of the fetal head is plotted as a function of labor duration.
Hyperbolic curve
156
Most important pelvic floor structure during labor
Levator ani muscle
157
Components (3) of levator ani muscle
Pubovisceral
Puborectalis
Iliococcygeous
158
Mechanism of placental expulsion wherein placenta separates from its center; fetal surface of placenta exposed
Schultze mechanism ("shiny")
159
Mechanism of placental expulsion wherein placenta separates first at the periphery; maternal surface exposed
Duncan mechanism ("dirty")
160
What are the criteria for diagnosis of labor?
1. Uterine contractions (1 in 10 mins; 4 in 20 mins) at least 200 MVU
2. Cervical effacement > 70-80%
3. Cervical dilatation > 3cm
161
Parameters (5) used to calculate Bishop Score
1. Position (cervix)
2. Consistency (cervix)
3. Effacement
4. Dilation
5. Station
162
Signs (3) of oxytocin hyperstimulation
1. 5 contractions in 10 mins or > 10 contractions in 20 mins
2. hypertonus - contractions lasting more than 120s
3. excessive uterine activity with an atypical or abnormal FHR
163
Defined as the relation of the long axis of the fetus to that of the mother
Fetal lie
164
Defined as the posture or position of fetal body parts in relation to each other
Fetal attitude/posture
165
Defined as the relationship of an arbitrarily chosen presenting part to the right or left side of the maternal birth canal
Fetal position
166
Stage of labor from onset to 3-5 cm dilatation
Latent phase
167
Prolonged latent phase in nullipara lasts for how long?
>20 hours
168
Prolonged latent phase in multipara lasts for how long?
>14 hours
169
Stage of labor from 3-5cm dilatation up to full dilatation
Active Phase
170
Normal rate of cervical dilatation in nullipara
1.2 cm/hr
171
Normal rate of cervical dilatation in multipara
1.5 cm/hr
172
Sedation has no effect on which stage of labor?
A. Latent phase
B. Acceleration phase
C. Phase of maximum slope
D. Deceleration phase
C. Phase of maximum slope/ dilatational division
173
Provided that a patient is in active phase of labor with the ff rate of cervical dilatation,
In nulliparas: dilatation rate <1 cm/hr
In multiparas: dilatation rate <2 cm/hr
What is the abnormal labor pattern?
Protracted descent
174
Provided that a patient is in active phase of labor with the ff rate of cervical dilatation,
In nulliparas: dilatation rate <1.2 cm/hr
In multiparas: dilatation rate <1.5 cm/hr
What is the abnormal labor pattern?
Protracted active-phase dilatation
175
In nulliparas: fully dilated, no change in descent for > 3hrs
In multiparas: fully dilated, no change in descent for > 1hr
What is the abnormal labor pattern?
Prolonged deceleration phase
176
In nulliparas: in active-phase dilation but no change > 2 hrs
In multiparas: in active-phase dilation but no change > 2 hrs
What is the abnormal labor pattern?
Secondary arrest of dilatation
177
Provided that a patient is in active phase of labor, station 1+ onwards, with the ff,
In nulliparas: no progression of descent >1 hr
In multiparas: no progression of descent >1 hr
What is the abnormal labor pattern?
Arrest of descent
178
Enumerate theerior cardinal movements of labor
EDFIREEE
1. engagement
2. descent
3. flexion
4. internal rotation
5. extension
6. external rotation
7. expulsion
179
Defined as lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis
Asynclitism
180
Fetal sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers
Anterior asynclitism
181
Fetal sagittal suture lies close to the symphysis, more of the posterior parietal bone will present
Posterior asynclitism
182
What structure delineates the true pelvis from the false pelvis?
Linea terminalis
anything above = false pelvis
anything below = true pelvis
183
What is an adequate diagonal conjugate?
>11.5 cm
184
What is an adequate obstetrical conjugate?
>10 cm
185
Greatest diameter between linea terminalis
Transverse diameter
186
First requisite for birth of the newborn
Fetal descent
187
At what cervical dilatation does descent start in nulliparas?
7-8 cm
188
Occurs as the fetal occiput gradually moves toward the sympysis pubis anteriorly from its anterior position
internal rotation
189
Corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet
external rotation
190
Goals (3) of 3rd stage of labor
Delivery of intact placenta
Avoidance of uterine inversion
Avoidance of post-partum hemorrhage
191
Signs (4) of placental separation
Sudden gush of blood
Glober and firmer uterus
Lengthening of the cord
Rise of uterus into the abdomen
B.U.C.A. (blood-uterus-cord-abdomen)
192
Unang Yakap components (4)
Immediate and thorough drying
Early skin-to-skin contact
Properly timed cord clamping
Non-separation for early breastfeeding
193
Perineal laceration involving:
| fourchette, perineal skin, vaginal mucous membrane
1st degree
194
Perineal laceration involving:
| skin, mucous membrane, fascia and muscles of perineal body
2nd degree
195
Perineal laceration involving:
| skin, mucous membrane, perineal body, anal sphincter
3rd degree
196
Perineal laceration involving:
| skin, mucous membrane, perineal body, anal sphincter, rectal mucosa
4th degree
197
1st line prophylactic uterotonic drug
oxytocin
198
Criteria for outlet forceps delivery
Scalp is visible at introitus without separating labia.
Fetal skull has reached pelvic floor.
Sagittal suture is in AP diameter or ROA/LOA or ROP/LOP.
Fetal head is at or on perineum.
Rotation does not exceed 45 degrees.
199
Manipulation done during breech delivery to bring fetal feet within reach
Breech Decomposition (using Pinard Maneuver)
200
Breech delivery that begins with both fetal feet grasped through the vagina, followed by gentle traction.
Complete breech extraction
201
Breech delivery wherein breech is spontaneously delivered to the umbilicus and the remaining body is delivered with operator traction
Partial breech extraction
202
Delivery of the entrapped aftercoming head by dividing symphyseal cartilage to widen symphysis pubis up to 2.5 cm
Symphysiotomy
203
Delivery of the entrapped aftercoming head by using maxillary pressure to maintain head flexion as upward and outward traction is exerted
Mauriceau maneuver
204
Delivery of the entrapped aftercoming head by incision on the cervix at 2 o'clock and 10 o'clock position (add'l at 6 o'clock)
Duhrssen Incision
205
Which anesthetic is associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels?
Bupivacaine
206
What is the most common complication encountered during epidural anesthesia?
Hypotension
207
What is the most common complication encountered during spinal anesthesia?
Pruritus (with added opioid only)
2nd most common: hypotension
208
What interval following delivery is required for the typical uterus to complete involution?
4 weeks
209
Lochia, in its various forms, typically resolves after how many weeks postpartum?
5 weeks
210
Defined as the period of time between 4-6 weeks post-delivery wherein maternal anatomic and physiologic changes occur to return to its non-pregnant state
Puerperium
211
How long after delivery does the uterus involute into pelvic organ size?
within 2 weeks
212
When does postpartum reappearance of vaginal rugae occu?
4-6 weeks postpartum
213
How long after delivery does the cervix become parous?
7 days postpartum
214
When will the endometrium be fully restored postpartum?
16th day onwards
215
When will ovulation resume after delivery?
beginning 2nd to 18th month postpartum
216
Which organism has been implicated in late postpartum hemorrhage?
Chlamydia trachomatis
217
Bleeding 24 hrs to 12 weeks after delivery is called ___.
Late postpartum hemorrhage
218
Concentrations of which 2 vitamis are reduced or absent from mature breast milk and require supplementation?
Vitamin D and K
219
Method of family planning wherein unprotected intercourse is avoided during cycle days 8-19
Standard days
220
Method of family planning wherein the number of days in the shortest and longest menstrual cycle is counted during a 6- to 12-month span
Calendar rhythm
221
How do you compute for fertile days using Calendar Rhythm method?
1st fertile day = shortest cycle (days) - 18
| last fertile day = longest cycle (days) - 11
222
Method of family planning wherein the woman must abstain from intercourse from the 1st day of menses through the 3rd day after the increase in temperature
Temperature Rhythm
sustained 0.2-0.5 C (occurs after ovulation)
223
Method of family planning using abstinence from the beginning of menses until 4 days after slippery mucus is identified
Cervical Mucus Method
224
Method of family planning that combines the use of changes in cervical mucus (onset of fertile period) and changes in basal body temperature (end of fertile period)
Symptothermal Method
225
Etonorgestrel implants provide contraception for how many years?
3 years
226
How does Progestin work as a contraceptive?
prevents ovulation by suppressing LH
- thickens cervical mucus, retarding sperm passage
- renders endometrium unfavorable for implantation
227
How does Estrogen work as a contraceptive?
prevents ovulation by suppressing FSH release
- stabilizes endometrium, which prevents intermenstrual bleeding (breakthrough bleeding)
228
How will you advise a patient who is about to start taking oral contraception?
Start 1st pill on Day 1 of menses, same time each day.
Start 1st pill regardless of day of cycle, but will need a back-up contraception for 7 days
Back up: abstinence, withdrawal, condoms, spermicide
229
How will you advise a patient currently on OCP who missed taking 1-2 pills (1 or 2 days late)?
Take pill as soon as possible
230
How will you advise a patient currently on OCP who missed taking >3 pills in 1st or 2nd weeks?
Take pill as soon as possible.
Use back up for the next 7 days.
Use ECP if with sex the past 5 days.
231
How will you advise a patient currently on OCP who missed taking >3 pills in the 3rd week?
```
Take pill as soon as possible.
Finish remaining hormonal pills.
Throw away the 7 non-hormonal pills.
Start a new pack the next day.
Use back up for 7 days.
Use ECP if with sex the past 5 days.
```
232
How will you advise a patient currently on OCP who missed taking any non-hormonal pill?
Discard the missed nonhormonal pill/s.
Keep taking remaining pills.
Start new pack as usual.
233
When to start emergency contraceptive pill (ECP)?
ASAP
| Within 5 days after unprotected sex
234
How to give Levonorgestrel pill as emergency contraception?
single dose
235
How to give Estrogen-Progestin pill as emergency contraception?
2 doses, 12 hrs apart
236
How to give Progestin-only pill as emergency contraception?
single dose
237
How to give Injectable progestin (DMPA)?
IM on deltoid or gluteus without massage, given every 3 mos
Initial injection should begin within first 5 days of menses
If given >7 days of menses, use back for first 7 days.
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Etonogestrel implant provides contraception for how long?
3 years
Ideally inserted within 5 days of menses or after delivery
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Defined as 6 uterine contractions in 10 mins
tachysystole
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What are the criteria for adequate labor?
>6cm dilated with (-) BOW and
>4 hours of adequate contractions, OR
>6 hours if inadequate contractions and no cervical change
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Inappropriate leg positioning in stirrups in prolonged 2nd stage of labor can lead to which complication?
compression of common fibular (peroneal) nerve
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What is the initial step in performing a Zavanelli maneuver?
Restore the fetal head to an occiput anterior or posterior position
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When the anterior shoulder of the fetal becomes wedged behind the symphysis pubis during delivery, leading to failure of delivery using normally exerted downward traction and maternal pushing
Shoulder dystocia
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Shoulder dystocia maneuver wherein suprapubic pressure is applied over the posterior aspect of the fetal anterior shoulder
Mazzanti maneuver
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Shoulder dystocia maneuver wherein 2 fingers are vaginally pushing the posterior aspect of anterior shoulder toward chest
Rubin maneuver
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Shoulder dystocia maneuver wherein 2 fingers are used on the anterior space of posterior shoulder to rotate fetus obliquely
Wood's corkscrew
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Shoulder dystocia maneuver wherein mother is asked to roll over on all fours
Gaskin maneuver
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Which maneuver is applied to reduce the nuchal arm in breech delivery?
Lovset maneuver
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Intervals shorter than how many months between pregnancies have been associated with an increased risk for preterm birth?
18 months
<18 months or >59 months interval between pregnancies is associated with risk for preterm labor
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Most common causes of preterm birth
placenta previa or placenta abruptio
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Single most powerful predictor of preterm birth
transvaginal ultrasound
best time to screen: 22-25 weeks AOG
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Sonographic signs (4) predictive of preterm birth
- shortening of cervix = 25 mm at 16-24 weeks AOG (no contractions)
- dilatation of internal os: >5mm at 30 weeks
- prolapse of membranes into cervix (Guzman test)
- funneling: T, Y V, U
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1st line management for preterm labor
Beta-adrenergic agents
- Ritodrine
- Terbutaline
- Salbutamol
- Isoxsuprine
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What reversible complication can be seen when Indomethacin is used for tocolysis longer than 24-48 hours?
Oligohydramnios
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Standard antibiotic therapy for preterm labor
Ampicillin + Gentamicin
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Primary or prophylactic cerclage is done at which AOG?
10-12 weeks AOG
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What is the only reliable indicator of clinical chorioamnionitis in women with preterm rupture of the fetal membranes?
Fever
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Which antibiotic has been associated with increased risk of necrotizing enterocolitis in the newborn?
Co-Amoxiclav
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Criteria for chorioamnionitis
Maternal fever (>38C) plus one of the ff:
- fetal tachycardia
- uterine tenderness
- purulent or foul-smelling discharge
- leukocytosis
- elevated ESR
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What is the 7 day regimen for management of chorioamnionitis?
1st 48 hours: Ampicillin and Erythromycin
| After 48 hours: Oral Amoxicillin, Erythromycin
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What is the 3 day regimen for management of chorioamnionitis?
- Ampicillin or Ampcillin-Sulbactam
- Ampicillin and Gentamicin until delivery
- Clindamycin or Metronidazole
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Intrapartum administration of magnesium sulfate to women who deliver preterm has been demonstrated to reduce rates of which neonatal outcome?
A. Cerebral palsy
B. Necrotizing enterocolitis
C. Neonatal seizure
D. Bronchopulmonary dysplasia
A. Cerebral palsy
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Corticosteriods administered to women at risk for preterm birth have been demonstrated to decrease rates of respiratory distress if the birth is delayed for at least what amount of time after the initiation of therapy?
24 hours
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Type of H. mole composed of paternal chromosome only + empty ovum
Complete H. mole (diploid)
| 46XX
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Type of H. mole composed of 1 maternal and 2 paternal chromosomes
Partial H. mole (triploid)
| 69 XXY
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How frequent should you monitor hCG after evacuation of H. mole?
1 week after suction curettage
Every 2 weeks until hCG becomes normal for 3 consecutive tests
Every 1 month for 6 mos
Every 2 months for next 6 months
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What chemotherapeutic regimen is given to high risk patients with Gestational Trophoblastic Neoplasia?
EMACO
```
Etoposide
Methotrexate
Actinomycin D
Cyclophosphamide
Vincristine
```
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Gold standard for diagnosis of ectopic pregnancy?
Laparoscopy
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Indications for Methotrexate use in Tubal Pregnancy
pregnancy <6 weeks
tubal mass <3.5cm
no cardiac activity
serum BhCG <10-15,000 mIU/ml
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Defined as the premature separation of a normally implanted placenta
Abruptio Placenta
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What is the Virchow's triad of abruptio placenta
vaginal bleeding after 20 weeks AOG
increased uterine tone (woody uterus)
abdominal pain, uterine tenderness or back pain
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Defined as a placenta implanted in the lower uterine segment, presenting ahead of the leading pole of the fetus
Placenta previa
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What is a low-lying placenta?
placental edge within 2 cm from the internal os
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Classic clinical presentation of placenta previa
painless vaginal bleeding
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Defined as abnormally firm adherence of placenta to myometrium due to partial or total absence of decidua basalis and imperfect development of the fibrinoid or Nitabuch layer
Placenta accrete
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Based on depth of invasion, which type of placenta accrete has villi attached to the myometrium?
Placenta accreta
"attached"
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Based on depth of invasion, which type of placenta accrete has villi that invade the myometrium?
Placenta increta
"invaded"
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Based on depth of invasion, which type of placenta accrete has villi that penetrate through the myometrium and serosa?
Placenta percreta
"penetrated"
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What are the 2 most important risk factors for Placenta Accrete?
Previa
| Prior cesarean delivery
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Managment of placenta accreta typically requires which procedures?
Classical cesarean; hysterectomy
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Hypertension without proteinuria occurring after 20 weeks gestation and BP levels return to normal 12 weeks postpartum
Gestational Hypertension
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BP >/= 140/90 beyond 20 weeks AOG associated with any of the ff: (end-organ dysfunction)
- with or without proteinuria
- platelet <100,000/ml
- liver transaminase 2x above normal
- serum crea >1.1 mg/dl in absence of renal disease
- pulmo edema
- cerebral/visual disturbance
Mild Preeclampsia
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BP >/= 160/110 beyond 20 weeks AOG associated with any of the ff: (end-organ dysfunction)
- RUQ or epigastric pain
- platelet <100,000/ml
- liver transaminase 2x above normal
- serum crea >1.1 mg/dl in absence of renal disease
- oliguria <400ml/day
- pulmo edema
- cerebral/visual disturbance
Severe Preeclampsia
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Occurrence of convulsions, not caused by coincidental neurologic disease, in a woman with preeclampsia
Eclampsia
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BP >/= 140/90 prior to pregnancy or before 20 weeks AOG and persists after 12 weeks postpartum
Chronic Hypertension
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Pre-existing chronic hypertension with new-onset proteinuria and signs/symptoms of various end-organ dysfunction
Chronic hypertension with superimposed preeclampsia
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What is the underlying etiology of proteinuria seen with preeclampsia?
Increased capillary permeability
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What management is given for prevention of preeclampsia?
high dose calcium
| low dose aspirin
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Drug of choice for urgent control of severe hypertension in pregnancy
Hydralazine
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Drug of choice (1st line drug) as maintenance for gestational or chronic hypertension in pregnancy
Methyldopa
291
Neonatal thrombocytopenia is a known side effect of which antihypertensive agent?
Hydralazine
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What is the target magnesium sulphate level used for eclampsia prophylaxis?
4.8-8.4 mg/dl
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What clinical sign/test can be used to detect hyper-magnesemia prior to development of respiratory depression?
Patellar reflex
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Antidote for MgSO4 overdose
Calcium gluconate IV
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For patients with congenital heart disease, what is the most common adverse cardiovascular event encountered in pregnancy?
Arrhythmia
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Most frequent complication of maternal pneumonia during pregnancy
PROM
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Initial monotherapy for pregnant patients with pneumonia
Macrolide
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What are the criteria for diagnosing bacterial vaginosis?
Amsel's Criteria (3/4):
- vaginal pH > 4.7
- presence of clue cells
- homogenous, miky-white discharge
- release of fishy odor when KOH is added to discharge
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How would you advise a breastfeeding mother who is prescribed Metronidazole?
Breastfeeding must be withheld up to 12-24 hrs after the last dose of Metronidazole
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Which antifungal is contraindicated for use during pregnancy?
Fluconazole
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Drug of choice Chlamydia during pregnancy
Azithromycin 1 g PO single dose
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Gold standard for diagnosing gonorrhea
Thayer-Martin Culture: (+) intracellular gram negative diplococci
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Recommended treatment for early syphilis
Benzathine penicillin G IM single dose
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Management of herpes simplex during pregnancy
Acyclovir
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Universal vaginal and rectal GBS screening culture is done at what AOG?
35-37 weeks AOG
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What is the Toxoplasmosis Triad?
chorioretinitis
intracranial calcifications
hydrocephalus (*convulsions)
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Management for Acute Toxoplasmosis in Pregnancy
Spiramycin (reduces risk of congenital infection)
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Management for suspected toxoplasmosis infection in fetus
Pyrimethamine, sulfonamides, folinic acid
| eradicates parasites in placenta and fetus
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Gold standard for diagnosis of Malaria
Blood smear
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Treatment of choice for sensitive Plasmodium species
Chloroquine or hydroxychlorquine
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Treatment of choice for Chlorquine-resistant malaria
Mefloquine
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Which antimalarial drugs are contraindicated in pregnancy?
primaquine & doxycycline
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Which developmental stage of E. histolytica is the target of antimicrobial treatment?
trophozoite stage
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What FBS level is used as the threshold to diagnose overt diabetes?
126 mg/dl
315
What are the criteria for diagnosing GDM?
Any one of the ff:
- FBS >92 mg/dl
- 1 hr OGTT >180 mg/dl
- 2 hr OGTT >/= 153 mg/dl or >/= 140 mg/dl
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How do you screen for GDM in a pregnant patient?
If with risk factors, do 2-hr 75g OGTT at first consult
If without risk factors, do FBS/HbA1c/RBS at first visit; if normal, do 75g OGTT at 24-28 weeks AOG
If normal result at 24-28 weeks, retest at 32 weeks using 2hr 75g OGTT or earlier if with symptoms of hyperglycemia
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Women with thyroid peroxidase antibodies have an associated increased risk of which of the following:
A. Placenta previa
B. Placenta accreta
C. Placenta abruption
D. PROM
C. Placental abruption
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Which anti-hyperthyroid drug is associated with hepatotoxicity when used throughout pregnancy?
Propylthiouracil
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How to diagnose overt hypothyroidism in pregnancy?
1st trimester TSH >10 mIU/L
320
How to diagnose subclinical hypothyroidism in pregnancy?
1st trimester TSH >2.5-10 mIU/L
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How to diagnose hyperthyroidism in pregnancy?
1st reimester TSH <0.1 mIU/L
322
Preferred treatment for overt hyperthyroidism in the 1st trimester
Propylthiouracil
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Which anti-hyperthyroid drug is associated with embryopathy in the 1st trimester?
Methimazole
