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PLE TN Mastery > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Maternal cardiac output is _____ in pregnancy:
A. Increased
B. Decreased
C. Unchanged

A

A. Increased

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2
Q

At what AOG does maternal cardiac output increase during pregnancy?

A

5th week AOG

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3
Q

At what AOG does plasma expansion in the mother occur?

A

10-20 weeks AOG

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4
Q

Increase in cardiac output during pregnancy is attributed to ______.

A

decrease in systemic resistance

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5
Q

In pregnancy, the mother’s heart is displaced to ____ and ____ and rotated somewhat on its axis.

A

displaced left and upward

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6
Q

The cardiac silhouette appears _____ on chest radiograph:

A. Smaller
B. Larger
C. Unchanged

A

B. Larger

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7
Q

Some degree of benign pericardial effusion may increase the cardiac silhouette. T/F

A

T

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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)

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9
Q

Expected cardiac sounds (2) in a pregnant woman

A
  1. Exaggerated splitting of 1st heart sound

2. Systolic murmur (90% patients)

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10
Q

Arterial pressure usually decreased to a nadir at _____ weeks AOG

A

24-36 weeks AOGd

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11
Q

Components of rennin-angiotensin-aldosterone axis are ___ in normal pregnancy:

A. Unchanged
B. Increased
C. Decreased

A

B. Increased

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12
Q

Principal prostaglandin of endothelium

A

Prostacyclin (PG12)

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13
Q

Potent vasoconstrictor in endothelial and vascular smooth muscle cells that regulates local vasomotor tone.

A

Endothelin

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14
Q

Potent vasodilator released by endothelial cells; for modifying vascular resistance during pregnancy.

A

Nitric Oxide (NO)

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15
Q

Maternal blood expands most rapidly during which trimester?

A

2nd trimester

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16
Q

Remission of some autoimmune disorders during pregnancy is due to which physiological change?

A

Suppressed Th1 response

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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

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18
Q

Effect of pregnancy on maternal hemoglobin?

A. Increase
B. Decrease
C. Unchanged

A

B. Decrease

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19
Q

Effect of pregnancy on maternal hematocrit?

A. Increase
B. Decrease
C. Unchanged

A

B. Decrease

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20
Q

Effect of pregnancy on maternal whole blood viscosity?

A. Increase
B. Decrease
C. Unchanged

A

B. Decrease

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21
Q

Approximately ____ of iron is required for normal pregnancy.

A

1000mg or 1 g of iron

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22
Q

How much iron is actively transferred to the fetus and placenta?

A

300 mg iron

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23
Q

Estimated blood loss in singelton NSVD?

A

500-600 ml

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24
Q

Estimated blood loss in twin NSVD?

A

1000 ml (same as in CS)

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25
Q

Failure of Th1 suppression in pregnancy may be related to development of preeclampsia. T/F

A

T

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26
Q

In pregnancy, which is upregulated and which is suppressed?

Th1 response: _____
Th2 response: ____

A

Th1 - suppressed

Th2 - upregulated

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27
Q

Which coagulation/fibrinolysis factors are increased in pregnancy>

A

4Fs:

Fibrinogen
Factor 7
Factor 10
Plasminogen

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28
Q

The diaphragm rises by about __ cm during the 2nd half of pregnancy.

A

4 cm

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29
Q

The transverse diameter of the thoracic cage increases by __ cm during the 2nd half of pregnancy.

A

2 cm

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30
Q

The thoracic circumference increase by about __ cm during the 2nd half of pregnancy.

A

6 cm

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31
Q

Which lung volumes are increased in pregnancy?

A

Increased: (IT)

Tidal Volume
Inspiratory capacity

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32
Q

Which lung volumes are decreased in pregnancy?

A

Decreased: (REF)

Residual Volume
Expiratory reserve volume
Functional residual capacity

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33
Q

What causes physiologic dyspnea during pregnancy?

A

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

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34
Q

Increase in 2,3-BPG in maternal blood shifts the O2 dissociation curve to:

A. Right
B. Left

A

A. Right - less affinity to O2

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35
Q

Uterine hypertrophy early in pregnancy is probably stimulated by _____.

A

Estrogen and Progesterone

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36
Q

Uterine enlargement is most marked in which part of the uterus?

A

Fundus

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37
Q

Softening of the uterine isthmus

A

Hegar’s sign

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38
Q

The uterus undergoes rotation to the right because of the rectosigmoid on the left side of the pelvis. What do you call this process?

A

Dextrorotation

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39
Q

Softening and cyanosis of the cervix due to increased vascularity and edema

A

Goodell’s sign

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40
Q

Benign hyperplasia and hypersecretory appearance of the endocervical gland

A

Arias-Stella Reaction

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41
Q

Violet discoloration of the vagina which is due to increased vascularity

A

Chadwick sign

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42
Q

Elevated patches of tissue which bleed easily. Represents cellular detritus from the endometrium that has passed through the fallopian tubes.

A

Decidual Reaction

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43
Q

Protein hormone secreted by corpus luteum, deciduas, and placenta, which functions in the remodelling of the reproductive tract for birth.

A

Relaxin

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44
Q

When is colostrum usually expressed?

A

2 days after delivery

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45
Q

When does the maternal basal metabolic rate increase by 10-20%?

A

3rd trimester

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46
Q

Pitting edema of the ankles and legs during pregnancy is best explained by:

A

increased venous pressure below the level of the uterus due to partial vena cava occlusion

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47
Q

Bladder trigone is elevated by __ weeks AOG

A

> 12 weeks AOG

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48
Q

How is the appendix displaced in the abdomen as the uterus enlarges?

A

the appendix is displaced upward and laterally (may reach the flank)

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49
Q

In pregnancy, gastric emptying time is:

A. Increased
B. Decreased
C. Unchanged

A

C. Unchanged

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50
Q

Pyrosis (heartburn) in pregnancy is due to:

A

Progesterone, which causes relaxation of the LES (lower esophageal sphincter)

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51
Q

Focal, highly vascular swelling of the gums that regresses spontaneously after delivery

A

Epulis of pregnancy

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52
Q

In pregnancy liver size is:

A. Increased
B. Decreased
C. Unchanged

A

C. Unchanged

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53
Q

Why are pregnant patients more prone to gallbladder stone formation?

A

Progesterone inhibits CCK-mediated smooth muscle stimulation which impairs gallbladder contraction.

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54
Q

Intrahepatic cholestasis in pregnancy has been linked to high circulating levels of __, which inhibits intraductal transport of bile acids.

A

Estrogen

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55
Q

Pruritis gravidarum is explained by:

A

retained bile salts

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56
Q

Which organ enlarges by 135% during pregnancy?

A

Pituitary gland

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57
Q

The placenta is the principal source of growth hormone secretion at __ weeks AOG

A

17 weeks AOG

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58
Q

Prolactin in the amniotic fluid is produced by:

A

uterine decidua

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59
Q

Total serum thyroxine plateaus at __ weeks AOG

A

18 weeks AOG

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60
Q

Which pregnancy hormone has intrinsic thyrotropic activity and may cause thyroid stimulation?

A

hCG

hCG and TSH have identical a-subunits

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61
Q

Adult remnant of Ductus Venosus

A

Ligamentum Venosum/ Falciform Ligament

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62
Q

Adult remnant of Umbilical Artery

A

Umbilical ligament

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63
Q

Adult remnant of Umbilical Vein

A

Umbilical Ligament

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64
Q

Functional closure of Ductus Venosus

A

10-96 hours

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65
Q

Anatomic closure of Ductus Venosus

A

2-3 weeks

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66
Q

Functional closure of Ductus Arteriosus

A

10-12 hours

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67
Q

Anatomic closure of Ductus Arteriosus

A

2-3 weeks

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68
Q

Functional closure of Foramen Ovale

A

Several mins

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69
Q

Anatomic closure of Foramen Ovale

A

1 year

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70
Q

Closure of umbilical artery

A

3-4 days

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71
Q

Closure of umbilical vein

A

3-4 days

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72
Q

3 shunts of the fetal circulation

A
  1. ductus venosus
  2. foramen ovale
  3. ductus arteriosus
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73
Q

At what age does bronchial branching of lung development?

A

16-26 weeks AOG

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74
Q

At what age does terminal sac stage of lung development occur?

A

26 weeks

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75
Q

Presence of pullmonary surfactant in amniotic fluid after ___ weeks AOG is evidence of fetal lung maturity.

A

after 34 weeks

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76
Q

Pulmonary surfactant is produced by which cells?

A

type II pneumocytes

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77
Q

Pulmonary surfactant starts appearing in amniotic fluid at ___ weeks AOG

A

28-32 weeks AOG

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78
Q

Most active component of pulmonary surfactant

A

Dipalmitoylphosphatidylcholine (DPPC)

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79
Q

Alveolar development begins just before birth until __ years old

A

8 years old

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80
Q

In early pregnancy, amniotic fluid is composed of ___.

A

Ultrafiltrate of maternal plasma

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81
Q

In the 2nd trimester, amniotic fluid is composed of ___.

A

extracellular fluid (ECF) diffused through fetal skin

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82
Q

At what AOG does the fetal kidney start producing urine?

A

12 weeks AOG

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83
Q

Fetal urine becomes the main source of amniotic fluid at what AOG?

A

> 20 weeks (2nd-3rd trimester)

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84
Q

Normal amniotic fluid volume by term

A

840 ml

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85
Q

Normal amniotic fluid by 12 weeks AOG

A

60 ml

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86
Q

Increased rates of which complication have been linked to binge drinking during pregnancy?

A

Stillbirth

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87
Q

Which antimicrobial drug is associated with nephrotoxicity and ototoxicity in preterm infants?

A

Aminoglycosides (Gentamicin or Streptomycin)

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88
Q

Which antimicrobial drug is associated with gray baby syndrome in neonates?

A

Chloramphenicol (not teratogenic)

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89
Q

Exposure to which antimicrobial drug during the 1st trimester may cause the ff birth defects: hypoplastic heart syndrome, ASD, microphthalmia/anophthalmia, and clefts?

A

Nitrofurantoin

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90
Q

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?

A

Sulfonamides

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91
Q

Which antimicrobial drug is associated with yellowish discoloration of deciduous teeth (fetus) when used >25 weeks AOG?

A

Tetracyclines

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92
Q

Exposure to this drug is associated with miscarriage and ear defects

A

Mycophenolic acid (immunosuppresant)

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93
Q

Exposure to this drug is associated with hypoplastic, T-shaped uterine cavity, cervical collars, and breast cancer in females

A

Diethylstilbestrol (sex hormone)

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94
Q

Exposure to this drug is associated with epididymal cysts, hypospadia, cryptorchidism

A

Diethylstilbestrol (sex hormone)

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95
Q

Exposure to this drug is associated with embryopathy (6th-9th week), stippling of vertebrae, nasal hypoplasia, and choanal atresia

A

Warfarin

Fetal Warfarin Syndrome

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96
Q

Drug associated with “clover leaf” skull, wide nasal bridge, low set ears, micronathia, limb abnormalities

A

Methotrexate

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97
Q

Drug associated with irreversible hypothyroidism

A

Radioiodine

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98
Q

Drug associated with disturbances in neuronal cell division and migration, developmental delay, microcephaly, and severe brain damage

A

Mercury

*Avoid: shark, swordfish, king mackerel, tilefish,, albacore tuna

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99
Q

Most potent teratogen; causes cranial-neural defects

A

Retinoids (isotretinoin)

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100
Q

level of Retinol that causes defects

A

> 10,000 mIU/day

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101
Q

Drug associated with Neonatal behavioral syndrome

A

SSRI/SNRI (Fluoxetine, sertraline, citalopram)

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102
Q

Drug associated with ASD & VSD

A

Paroxetine (SSRI)

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103
Q

Drug associated with Ebstein Anomaly (apical displacement of tricuspid valve)

A

Lithium

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104
Q

Drug associated with abnormal extrapyramidal muscle movements and withdrawal symptoms

A

Anti-psychotics (Haloperidol, chlorpromazine, fluphenazine, clopazine, olanzapine, risperidone)

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105
Q

Most common non-lethal trisomy

A

Trisomy 21 (Down Syndrome)

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106
Q

Which genetic abnormality presents with “strawberry-shaped” cranium?

A

Trisomy 18 (Edward Syndrome)

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107
Q

Which genetic abnormality presents with holoprosencephaly?

A

Trisomy 13 (Patau Syndrome)

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108
Q

The only monosomy compatible with life

A

Turner Syndrome (45 XO)

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109
Q

The most common sex chromosome abnormality

A

Klinefelter Syndrome (47 XXY)

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110
Q

Which genetic abnormality presents with abnormal laryngeal development with “cat-like” cry

A

Cru du chat Syndrome

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111
Q

In a Primigravida, when is fetal movement felt by the mother?

A

18-20 weeks AOG

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112
Q

In a Multigravida, when is fetal movement felt by the mother?

A

16-18 weeks AOG

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113
Q

Earliest time that hCG is detectable in maternal serum or urine

A

8-9 days after ovulation

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114
Q

Most accurate tool for gestational age assessment

A

Crown-rump length, at 8-12 weeks AOG

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115
Q

Give the gestational age based on the sonographic finding:

(+) gestational sac

A

4-5 weeks AOG

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116
Q

Give the gestational age based on the sonographic finding:

(+) yolk sac

A

5-6 weeks AOG (confirms intrauterine location)

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117
Q

Give the gestational age based on the sonographic finding:

Embryonic pole with cardiac motion

A

6 weeks AOG

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118
Q

At what age does fundal height correlate with AOG?

A

20-34 weeks AOG

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119
Q

FHT is detectable by Doppler ultrasound at what age?

A

10 weeks AOG

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120
Q

FHT is detectable by stethoscope at what age?

A

16 weeks AOG

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121
Q

What is the recommended pregnancy weight gain in a patient with normal BMI?

A

25-35 lbs

Normal BMI: 18.5-24.9

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122
Q

What is the recommended pregnancy weight gain in a patient who is overweight?

A

15-25 lbs

Overweight: 25-29.9

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123
Q

What is the recommended pregnancy weight gain in a patient who is underweight?

A

28-40 lbs

Underweight BMI: <18.5

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124
Q

What is the recommended pregnancy weight gain in a patient who is obese?

A

11-20 lbs

Obese BMI: >30

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125
Q

Recommended daily allowance of calories in a pregnant woman

A

100-300 kcal/day

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126
Q

Recommended daily allowance of protein in a pregnant woman

A

5-6 g/day

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127
Q

Recommended daily allowance of elemental iron in a pregnant woman

A

27 mg/day (low risk)

60-100 mg/day (high risk)

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128
Q

Recommended daily allowance of iodine in a pregnant woman

A

220 ug/day

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129
Q

Recommended daily allowance of calcium in a pregnant woman

A

900-1000 mg/day

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130
Q

Recommended daily allowance of folate in a pregnant woman

A

0.4 mg/day (can prevent neural tube defects)

or 400 mcg/day

131
Q

Recommended daily allowance of folate in a pregnant woman with previous neural tube defect baby

A

4 mg/day

132
Q

Recommended daily allowance of folate for all women

A

0.4-0.8 mg/day

133
Q

Recommended daily allowance of vitamin C in a pregnant woman

A

80-85 mg/day

134
Q

How is Tetanus-diphtheria-acellular pertusis (Tdap) given?

A

IM (3 doses): 0, 1, 6-12 mos
Booster every 10 years or once every pregnancy
Preferably between 27-36 weeks

135
Q

How is Influenza vaccine administered?

A

IM (1 dose): once a year (during appropriate season)

136
Q

How is HepB vaccine given?

A

IM (3 doses): 0, 1, 6 mos

137
Q

What is the criteria for normal fetal activity?

A

10 fetal movements within 2 hours

138
Q

Which fetal assessment test is done to check ureteroplacental function?

A

CST (contraction stress test)

139
Q

What is a satisfactory CST result?

A

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
Q

Which fetal assessment test depends on fetal heart rate acceleration in response to fetal movement as a sign of fetal health?

A

Non-stress test (NST)

141
Q

What are the components (5) of the Biophysical Score?

A 
NST
Fetal breathing
Fetal movement
Fetal tone
Amniotic Fluid volume
142
Q

Give the chronological order in which BPS parameters are affected by hypoxia?

A

1st affected: Fetal heart reactivity
2nd affected: Fetal breathing
3rd affected: Fetal movement
4th affected: Fetal tone

143
Q

Normal baseline FHR

A

110-160 bpm

144
Q

Normal baseline variability of FHR (moderate)

A

6-25 bpm

145
Q

Normal acceleration in NST

A

> /= 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
Q

In NST, which type of deceleration is due to fetal head compression?

A

Early deceleration

uterine contraction –> fetal head compression –> increased ICP –> stimulation of vagal nerve –> decreased FHR

147
Q

In NST, which type of deceleration is due to uteroplacental insufficiency?

A

Late deceleration

uterine contraction –> decreased U-P O2 transfer –> chemoreceptor stimulus –> stimulation of vagal nerve –> decreased FHR

148
Q

In NST, which type of deceleration is due to umbilical cord occlusion?

A

Variable deceleration

decrease in FHR >/= 15 bpm, lasts >/= 15 s, but <2 mins

149
Q

What do you call the thinning of the lower uterine segment with concomitant thickening of the upper segment during labor?

A

Physiologic retraction ring

150
Q

What is the pathological retraction ring formed when the thinning of the lower uterine segment during labor becomes extreme?

A

Bandl Ring

151
Q

Defined as the spontaneous release of a small amount of blood-tinged mucus from the vagina at the clinical onset of labor

A

“Bloody show”

152
Q

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.

A

Forebag

153
Q

In many nulliparas, engagement of the head is accomplished BEFORE labor begins. T/F.

A

T

154
Q

Pattern of cervical dilatation during preparatory and dilatational divisions of labor

A

Sigmoid curve

155
Q

Pattern formed when the station of the fetal head is plotted as a function of labor duration.

A

Hyperbolic curve

156
Q

Most important pelvic floor structure during labor

A

Levator ani muscle

157
Q

Components (3) of levator ani muscle

A

Pubovisceral
Puborectalis
Iliococcygeous

158
Q

Mechanism of placental expulsion wherein placenta separates from its center; fetal surface of placenta exposed

A

Schultze mechanism (“shiny”)

159
Q

Mechanism of placental expulsion wherein placenta separates first at the periphery; maternal surface exposed

A

Duncan mechanism (“dirty”)

160
Q

What are the criteria for diagnosis of labor?

A
  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
Q

Parameters (5) used to calculate Bishop Score

A
  1. Position (cervix)
  2. Consistency (cervix)
  3. Effacement
  4. Dilation
  5. Station
162
Q

Signs (3) of oxytocin hyperstimulation

A
  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
Q

Defined as the relation of the long axis of the fetus to that of the mother

A

Fetal lie

164
Q

Defined as the posture or position of fetal body parts in relation to each other

A

Fetal attitude/posture

165
Q

Defined as the relationship of an arbitrarily chosen presenting part to the right or left side of the maternal birth canal

A

Fetal position

166
Q

Stage of labor from onset to 3-5 cm dilatation

A

Latent phase

167
Q

Prolonged latent phase in nullipara lasts for how long?

A

> 20 hours

168
Q

Prolonged latent phase in multipara lasts for how long?

A

> 14 hours

169
Q

Stage of labor from 3-5cm dilatation up to full dilatation

A

Active Phase

170
Q

Normal rate of cervical dilatation in nullipara

A

1.2 cm/hr

171
Q

Normal rate of cervical dilatation in multipara

A

1.5 cm/hr

172
Q

Sedation has no effect on which stage of labor?

A. Latent phase
B. Acceleration phase
C. Phase of maximum slope
D. Deceleration phase

A

C. Phase of maximum slope/ dilatational division

173
Q

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?

A

Protracted descent

174
Q

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?

A

Protracted active-phase dilatation

175
Q

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?

A

Prolonged deceleration phase

176
Q

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?

A

Secondary arrest of dilatation

177
Q

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?

A

Arrest of descent

178
Q

Enumerate theerior cardinal movements of labor

A

EDFIREEE

  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation
  7. expulsion
179
Q

Defined as lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis

A

Asynclitism

180
Q

Fetal sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers

A

Anterior asynclitism

181
Q

Fetal sagittal suture lies close to the symphysis, more of the posterior parietal bone will present

A

Posterior asynclitism

182
Q

What structure delineates the true pelvis from the false pelvis?

A

Linea terminalis

anything above = false pelvis
anything below = true pelvis

183
Q

What is an adequate diagonal conjugate?

A

> 11.5 cm

184
Q

What is an adequate obstetrical conjugate?

A

> 10 cm

185
Q

Greatest diameter between linea terminalis

A

Transverse diameter

186
Q

First requisite for birth of the newborn

A

Fetal descent

187
Q

At what cervical dilatation does descent start in nulliparas?

A

7-8 cm

188
Q

Occurs as the fetal occiput gradually moves toward the sympysis pubis anteriorly from its anterior position

A

internal rotation

189
Q

Corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet

A

external rotation

190
Q

Goals (3) of 3rd stage of labor

A

Delivery of intact placenta
Avoidance of uterine inversion
Avoidance of post-partum hemorrhage

191
Q

Signs (4) of placental separation

A

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
Q

Unang Yakap components (4)

A

Immediate and thorough drying
Early skin-to-skin contact
Properly timed cord clamping
Non-separation for early breastfeeding

193
Q

Perineal laceration involving:

fourchette, perineal skin, vaginal mucous membrane

A

1st degree

194
Q

Perineal laceration involving:

skin, mucous membrane, fascia and muscles of perineal body

A

2nd degree

195
Q

Perineal laceration involving:

skin, mucous membrane, perineal body, anal sphincter

A

3rd degree

196
Q

Perineal laceration involving:

skin, mucous membrane, perineal body, anal sphincter, rectal mucosa

A

4th degree

197
Q

1st line prophylactic uterotonic drug

A

oxytocin

198
Q

Criteria for outlet forceps delivery

A

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
Q

Manipulation done during breech delivery to bring fetal feet within reach

A

Breech Decomposition (using Pinard Maneuver)

200
Q

Breech delivery that begins with both fetal feet grasped through the vagina, followed by gentle traction.

A

Complete breech extraction

201
Q

Breech delivery wherein breech is spontaneously delivered to the umbilicus and the remaining body is delivered with operator traction

A

Partial breech extraction

202
Q

Delivery of the entrapped aftercoming head by dividing symphyseal cartilage to widen symphysis pubis up to 2.5 cm

A

Symphysiotomy

203
Q

Delivery of the entrapped aftercoming head by using maxillary pressure to maintain head flexion as upward and outward traction is exerted

A

Mauriceau maneuver

204
Q

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)

A

Duhrssen Incision

205
Q

Which anesthetic is associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels?

A

Bupivacaine

206
Q

What is the most common complication encountered during epidural anesthesia?

A

Hypotension

207
Q

What is the most common complication encountered during spinal anesthesia?

A

Pruritus (with added opioid only)

2nd most common: hypotension

208
Q

What interval following delivery is required for the typical uterus to complete involution?

A

4 weeks

209
Q

Lochia, in its various forms, typically resolves after how many weeks postpartum?

A

5 weeks

210
Q

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

A

Puerperium

211
Q

How long after delivery does the uterus involute into pelvic organ size?

A

within 2 weeks

212
Q

When does postpartum reappearance of vaginal rugae occu?

A

4-6 weeks postpartum

213
Q

How long after delivery does the cervix become parous?

A

7 days postpartum

214
Q

When will the endometrium be fully restored postpartum?

A

16th day onwards

215
Q

When will ovulation resume after delivery?

A

beginning 2nd to 18th month postpartum

216
Q

Which organism has been implicated in late postpartum hemorrhage?

A

Chlamydia trachomatis

217
Q

Bleeding 24 hrs to 12 weeks after delivery is called ___.

A

Late postpartum hemorrhage

218
Q

Concentrations of which 2 vitamis are reduced or absent from mature breast milk and require supplementation?

A

Vitamin D and K

219
Q

Method of family planning wherein unprotected intercourse is avoided during cycle days 8-19

A

Standard days

220
Q

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

A

Calendar rhythm

221
Q

How do you compute for fertile days using Calendar Rhythm method?

A

1st fertile day = shortest cycle (days) - 18

last fertile day = longest cycle (days) - 11

222
Q

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

A

Temperature Rhythm

sustained 0.2-0.5 C (occurs after ovulation)

223
Q

Method of family planning using abstinence from the beginning of menses until 4 days after slippery mucus is identified

A

Cervical Mucus Method

224
Q

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)

A

Symptothermal Method

225
Q

Etonorgestrel implants provide contraception for how many years?

A

3 years

226
Q

How does Progestin work as a contraceptive?

A

prevents ovulation by suppressing LH

  • thickens cervical mucus, retarding sperm passage
  • renders endometrium unfavorable for implantation
227
Q

How does Estrogen work as a contraceptive?

A

prevents ovulation by suppressing FSH release

  • stabilizes endometrium, which prevents intermenstrual bleeding (breakthrough bleeding)
228
Q

How will you advise a patient who is about to start taking oral contraception?

A

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
Q

How will you advise a patient currently on OCP who missed taking 1-2 pills (1 or 2 days late)?

A

Take pill as soon as possible

230
Q

How will you advise a patient currently on OCP who missed taking >3 pills in 1st or 2nd weeks?

A

Take pill as soon as possible.
Use back up for the next 7 days.
Use ECP if with sex the past 5 days.

231
Q

How will you advise a patient currently on OCP who missed taking >3 pills in the 3rd week?

A 
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
Q

How will you advise a patient currently on OCP who missed taking any non-hormonal pill?

A

Discard the missed nonhormonal pill/s.
Keep taking remaining pills.
Start new pack as usual.

233
Q

When to start emergency contraceptive pill (ECP)?

A

ASAP

Within 5 days after unprotected sex

234
Q

How to give Levonorgestrel pill as emergency contraception?

A

single dose

235
Q

How to give Estrogen-Progestin pill as emergency contraception?

A

2 doses, 12 hrs apart

236
Q

How to give Progestin-only pill as emergency contraception?

A

single dose

237
Q

How to give Injectable progestin (DMPA)?

A

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.

238
Q

Etonogestrel implant provides contraception for how long?

A

3 years

Ideally inserted within 5 days of menses or after delivery

239
Q

Defined as 6 uterine contractions in 10 mins

A

tachysystole

240
Q

What are the criteria for adequate labor?

A

> 6cm dilated with (-) BOW and
4 hours of adequate contractions, OR
6 hours if inadequate contractions and no cervical change

241
Q

Inappropriate leg positioning in stirrups in prolonged 2nd stage of labor can lead to which complication?

A

compression of common fibular (peroneal) nerve

242
Q

What is the initial step in performing a Zavanelli maneuver?

A

Restore the fetal head to an occiput anterior or posterior position

243
Q

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

A

Shoulder dystocia

244
Q

Shoulder dystocia maneuver wherein suprapubic pressure is applied over the posterior aspect of the fetal anterior shoulder

A

Mazzanti maneuver

245
Q

Shoulder dystocia maneuver wherein 2 fingers are vaginally pushing the posterior aspect of anterior shoulder toward chest

A

Rubin maneuver

246
Q

Shoulder dystocia maneuver wherein 2 fingers are used on the anterior space of posterior shoulder to rotate fetus obliquely

A

Wood’s corkscrew

247
Q

Shoulder dystocia maneuver wherein mother is asked to roll over on all fours

A

Gaskin maneuver

248
Q

Which maneuver is applied to reduce the nuchal arm in breech delivery?

A

Lovset maneuver

249
Q

Intervals shorter than how many months between pregnancies have been associated with an increased risk for preterm birth?

A

18 months

<18 months or >59 months interval between pregnancies is associated with risk for preterm labor

250
Q

Most common causes of preterm birth

A

placenta previa or placenta abruptio

251
Q

Single most powerful predictor of preterm birth

A

transvaginal ultrasound

best time to screen: 22-25 weeks AOG

252
Q

Sonographic signs (4) predictive of preterm birth

A
  • 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
253
Q

1st line management for preterm labor

A

Beta-adrenergic agents

  • Ritodrine
  • Terbutaline
  • Salbutamol
  • Isoxsuprine
254
Q

What reversible complication can be seen when Indomethacin is used for tocolysis longer than 24-48 hours?

A

Oligohydramnios

255
Q

Standard antibiotic therapy for preterm labor

A

Ampicillin + Gentamicin

256
Q

Primary or prophylactic cerclage is done at which AOG?

A

10-12 weeks AOG

257
Q

What is the only reliable indicator of clinical chorioamnionitis in women with preterm rupture of the fetal membranes?

A

Fever

258
Q

Which antibiotic has been associated with increased risk of necrotizing enterocolitis in the newborn?

A

Co-Amoxiclav

259
Q

Criteria for chorioamnionitis

A

Maternal fever (>38C) plus one of the ff:

  • fetal tachycardia
  • uterine tenderness
  • purulent or foul-smelling discharge
  • leukocytosis
  • elevated ESR
260
Q

What is the 7 day regimen for management of chorioamnionitis?

A

1st 48 hours: Ampicillin and Erythromycin

After 48 hours: Oral Amoxicillin, Erythromycin

261
Q

What is the 3 day regimen for management of chorioamnionitis?

A
  • Ampicillin or Ampcillin-Sulbactam
  • Ampicillin and Gentamicin until delivery
  • Clindamycin or Metronidazole
262
Q

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

A. Cerebral palsy

263
Q

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?

A

24 hours

264
Q

Type of H. mole composed of paternal chromosome only + empty ovum

A

Complete H. mole (diploid)

46XX

265
Q

Type of H. mole composed of 1 maternal and 2 paternal chromosomes

A

Partial H. mole (triploid)

69 XXY

266
Q

How frequent should you monitor hCG after evacuation of H. mole?

A

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

267
Q

What chemotherapeutic regimen is given to high risk patients with Gestational Trophoblastic Neoplasia?

A

EMACO

Etoposide
Methotrexate
Actinomycin D
Cyclophosphamide
Vincristine
268
Q

Gold standard for diagnosis of ectopic pregnancy?

A

Laparoscopy

269
Q

Indications for Methotrexate use in Tubal Pregnancy

A

pregnancy <6 weeks
tubal mass <3.5cm
no cardiac activity
serum BhCG <10-15,000 mIU/ml

270
Q

Defined as the premature separation of a normally implanted placenta

A

Abruptio Placenta

271
Q

What is the Virchow’s triad of abruptio placenta

A

vaginal bleeding after 20 weeks AOG
increased uterine tone (woody uterus)
abdominal pain, uterine tenderness or back pain

272
Q

Defined as a placenta implanted in the lower uterine segment, presenting ahead of the leading pole of the fetus

A

Placenta previa

273
Q

What is a low-lying placenta?

A

placental edge within 2 cm from the internal os

274
Q

Classic clinical presentation of placenta previa

A

painless vaginal bleeding

275
Q

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

A

Placenta accrete

276
Q

Based on depth of invasion, which type of placenta accrete has villi attached to the myometrium?

A

Placenta accreta

“attached”

277
Q

Based on depth of invasion, which type of placenta accrete has villi that invade the myometrium?

A

Placenta increta

“invaded”

278
Q

Based on depth of invasion, which type of placenta accrete has villi that penetrate through the myometrium and serosa?

A

Placenta percreta

“penetrated”

279
Q

What are the 2 most important risk factors for Placenta Accrete?

A

Previa

Prior cesarean delivery

280
Q

Managment of placenta accreta typically requires which procedures?

A

Classical cesarean; hysterectomy

281
Q

Hypertension without proteinuria occurring after 20 weeks gestation and BP levels return to normal 12 weeks postpartum

A

Gestational Hypertension

282
Q

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
A

Mild Preeclampsia

283
Q

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
A

Severe Preeclampsia

284
Q

Occurrence of convulsions, not caused by coincidental neurologic disease, in a woman with preeclampsia

A

Eclampsia

285
Q

BP >/= 140/90 prior to pregnancy or before 20 weeks AOG and persists after 12 weeks postpartum

A

Chronic Hypertension

286
Q

Pre-existing chronic hypertension with new-onset proteinuria and signs/symptoms of various end-organ dysfunction

A

Chronic hypertension with superimposed preeclampsia

287
Q

What is the underlying etiology of proteinuria seen with preeclampsia?

A

Increased capillary permeability

288
Q

What management is given for prevention of preeclampsia?

A

high dose calcium

low dose aspirin

289
Q

Drug of choice for urgent control of severe hypertension in pregnancy

A

Hydralazine

290
Q

Drug of choice (1st line drug) as maintenance for gestational or chronic hypertension in pregnancy

A

Methyldopa

291
Q

Neonatal thrombocytopenia is a known side effect of which antihypertensive agent?

A

Hydralazine

292
Q

What is the target magnesium sulphate level used for eclampsia prophylaxis?

A

4.8-8.4 mg/dl

293
Q

What clinical sign/test can be used to detect hyper-magnesemia prior to development of respiratory depression?

A

Patellar reflex

294
Q

Antidote for MgSO4 overdose

A

Calcium gluconate IV

295
Q

For patients with congenital heart disease, what is the most common adverse cardiovascular event encountered in pregnancy?

A

Arrhythmia

296
Q

Most frequent complication of maternal pneumonia during pregnancy

A

PROM

297
Q

Initial monotherapy for pregnant patients with pneumonia

A

Macrolide

298
Q

What are the criteria for diagnosing bacterial vaginosis?

A

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
299
Q

How would you advise a breastfeeding mother who is prescribed Metronidazole?

A

Breastfeeding must be withheld up to 12-24 hrs after the last dose of Metronidazole

300
Q

Which antifungal is contraindicated for use during pregnancy?

A

Fluconazole

301
Q

Drug of choice Chlamydia during pregnancy

A

Azithromycin 1 g PO single dose

302
Q

Gold standard for diagnosing gonorrhea

A

Thayer-Martin Culture: (+) intracellular gram negative diplococci

303
Q

Recommended treatment for early syphilis

A

Benzathine penicillin G IM single dose

304
Q

Management of herpes simplex during pregnancy

A

Acyclovir

305
Q

Universal vaginal and rectal GBS screening culture is done at what AOG?

A

35-37 weeks AOG

306
Q

What is the Toxoplasmosis Triad?

A

chorioretinitis
intracranial calcifications
hydrocephalus (*convulsions)

307
Q

Management for Acute Toxoplasmosis in Pregnancy

A

Spiramycin (reduces risk of congenital infection)

308
Q

Management for suspected toxoplasmosis infection in fetus

A

Pyrimethamine, sulfonamides, folinic acid

eradicates parasites in placenta and fetus

309
Q

Gold standard for diagnosis of Malaria

A

Blood smear

310
Q

Treatment of choice for sensitive Plasmodium species

A

Chloroquine or hydroxychlorquine

311
Q

Treatment of choice for Chlorquine-resistant malaria

A

Mefloquine

312
Q

Which antimalarial drugs are contraindicated in pregnancy?

A

primaquine & doxycycline

313
Q

Which developmental stage of E. histolytica is the target of antimicrobial treatment?

A

trophozoite stage

314
Q

What FBS level is used as the threshold to diagnose overt diabetes?

A

126 mg/dl

315
Q

What are the criteria for diagnosing GDM?

A

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
316
Q

How do you screen for GDM in a pregnant patient?

A

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

317
Q

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

A

C. Placental abruption

318
Q

Which anti-hyperthyroid drug is associated with hepatotoxicity when used throughout pregnancy?

A

Propylthiouracil

319
Q

How to diagnose overt hypothyroidism in pregnancy?

A

1st trimester TSH >10 mIU/L

320
Q

How to diagnose subclinical hypothyroidism in pregnancy?

A

1st trimester TSH >2.5-10 mIU/L

321
Q

How to diagnose hyperthyroidism in pregnancy?

A

1st reimester TSH <0.1 mIU/L

322
Q

Preferred treatment for overt hyperthyroidism in the 1st trimester

A

Propylthiouracil

323
Q

Which anti-hyperthyroid drug is associated with embryopathy in the 1st trimester?

A

Methimazole

PLE TN Mastery (6 decks)

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