Obstetrics Flashcards
How is the EDD calculated?
Add 40 weeks from the 1st day of the patient’s LMP
beta HCG imitates which type of activity?
beta HCG has thyrotropin levels –> increase T4
What are some changes in the GI system that occur during pregnancy?
Progesterone causes smooth muscle relaxation leading to:
- GERD (decreased LES tone)
- Gallstones (decreased contractility)
- Constipation (decreased motility)
When does emesis improve during pregnancy?
14-16 weeks (as beta HCG declines)
What are some changes in the CV system that occur during pregnancy?
- Increased CO (30-50%)
- Decreased BP (progesterone causes vasodilation)
What are some changes in the respiratory system that occur during pregnancy?
- Increased MV
- Compensated respiratory alkalosis
- Subcostal angle widens
What are some changes in the hematologic system that occur during pregnancy?
- 45% increase in plasma blood volume
- 35% increase in RBC volume (leads to physiologic anemia)
- Increase in fibrinogen
- Decrease in Protein C and S
How many umbilical arteries and veins exist?
- Two umbilical arteries
- One umbilical vein
What are the 3 major shunts of pregnancy:
- Ductus venosus (shunts 50% of the blood going to the liver to the IVC)
- Foramen ovale (goes from RA to LA)
- Ductus arteriosus (shuts blood from pulmonary arteries to the aorta)
What are the BP classifications in pregnancy?
- Normal: <140/90
- Mild-to-moderate: 140-159/90-109
- Severe: > 160/110
Which anti-hypertensives are contra-indicated in pregnancy?
- ACE inhibitors
- ARBs
- Direct renin inhibitors
Which anti-hypertensives are safe and commonly used during pregnancy?
- Lebatalol and methyldopa
True or False:
Live vaccines can be administered during pregnancy?
False
What is the leading preventable cause of intellectual disability, developmental delay, and birth defects in the fetus?
Alcohol use during pregnancy
What is the antepartum visit schedule?
- 4 week intervals up to 28 weeks (7 months) GA
- 2 week intervals up to 36 weeks (two more months)
- 1 week intervals up to delivery
When does the OGTT occur?
24-28 weeks (at initial pre-natal visit in obese patients)
What is the last fetal system to mature completely?
Lungs
What is the appropriate folic acid dose for women during pregnancy?
0.4 mg daily
What is the appropriate folic acid dose for women during pregnancy who have previously had NTDs?
4 mg daily
Which two criteria are necessary for “true labor”
- Painful uterine contractions
- Cervical dilation
Which hormones are responsible for breast alveolar hypertrophy and lobule growth respectively?
PALE:
- Progesterone –> Alveolar hypertrophy
- Lobule growth –> Estrogen
What happens to the appearance of the areola during pregnancy and why?
The areola darkens such that the baby can see it better
When does breast milk production begin?
48-72 hours after delivery
What causes mastitis?
An impediment (galactocele or plugged duct) to forward flow of breast milk causing it to back up in the breast tissue
What is the treatment of mastitis?
Dicloxacilin
What are some contraindications to breastfeeding?
- Infections (HIV, Hep B, TB, Herpetic lesions)
- Infants born with galactosemia
Where are the majority of ectopic pregnancies found?
- 98% in the fallopian tube (most in the ampulla)
What are some risk factors for ectopic pregnancy?
- History of ectopic pregnancy
- History of tubal surgery
- History of chlamydial infection
- History of PID
- Smoking
What are signs of ectopic pregnancy?
- Amenorrhea
- Abdominal pain
- Vaginal bleeding
What is the pharmacologic treatment for ectopic pregnancy?
- Methotrexate
What are contraindications for using methotrexate in the treatment of ectopic pregnancy?
- Hemodynamic instability
- Lung disease
- Liver/kidney abnormalities
- Currently breastfeeding
What are the two main options for surgical management of ectopic pregnancy?
- Salpingectomy
- Salpingostomy (requires post-procedure HCG levels to make sure the ectopic pregnancy was completely removed)
What is the definition of spontaneous abortion?
Loss of pregnancy <20 weeks gestation
What change in beta HCG indicates that a pregnancy is not viable?
Decrease over a 48 hour period (normally we see a 50% increase)
What is the rule of 10’s for beta HCG levels?
- Peaks at 10 weeks EGA at 100,000
- Term HCG decreases to 10,000
What is a complete abortion?
All products have passed without need for intervention and the cervix is completely closed
What is an incomplete abortion?
Some but not all products have passed and the cervix is open
What is an inevitable abortion?
But the products have not passed and the cervix is open
What is a missed abortion?
There has usually been a fetal demise for many weeks, but the products have never been expelled
What is the most common cause of SAB in the 1st trimester?
Chromosomal abnormalities (esp. trisomies)
What is the most common cause of SAB in the 2nd trimester?
- Maternal systemic disease
- Abnormal placentation
What is pre-eclampsia?
New-onset HTN diagnosed > 20 weeks GA + proteinuria OR end-organ dysfunction
What is chronic hypertension?
HTN that pre-dates the pregnancy or is diagnosed <20 weeks GA
What is chronic hypertension with superimposed preeclampsia?
Signs/symptoms of preeclampsia along with chronic hypertension
What is gestational hypertension?
An elevated BP diagnosed > 20 weeks GA without the systemic findings of preeclampsia
What is the #1 risk factor for pre-eclampsia?
- Previous history of preeclampsia
Aside from a prior history of preeclampsia what are some other risk factors?
- Hx of preeclampsia in 1st-degree relative
- Primaparity
- Multiple gestation pregnancy
How is preeclampsia diagnosed?
- Elevated BP (>140/90)
AND - Proteinuria (>300mg/24 hr, or protein/Cr > 0.3)
OR - Systemic findings (Plt < 100k, Cr >1.1, LFTs 2x nml, Pulmonary edema, etc.)
When should antihypertensives be started in a patient with preeclampsia?
SBP >160 OR DBP>110
Which drug is provided for seizure prophylaxis in preeclampsia?
Magnesium sulfate
What are signs that an infant is receiving sufficient milk?
- 3-4 stools in 24 hours
- 6 wet diapers in 24 hours
- Weight gain
- Sounds of swallowing
What is the most common cause of inherited intellectual disability?
Fragile X syndrome
In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides within the first 3 days?
Diamniotic Dichorionic twins
- Two chorions
- Two amnions
- Two placentas
In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides between days 4-8?
Diamniotic Monochorionic twins
- One chorion
- Two amnions
- One placenta
In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides between days 9-12?
Monoamniotic Monochorionic
- One chorion
- One amnion
- One placenta
In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides after day 12?
Increased risk of conjoined twins
What are some increased risk factors for multiple gestation pregnancies?
- Increasing maternal age
- Increasing parity
- Moms with family history of twins
What is one of the most serious complications for di-mo twins?
Twin twin transfusion syndrome
What is the 1st-line therapy for twin twin transfusion syndrome?
Endoscopic intrauterine laser ablation
What is one of the most serious complications for mo-mo twins?
Cord entanglement and fetal death
What are some of the health complications that are more common in multiple gestational pregnancies?
- Hyperemesis gravidarum
- Gestational diabetes
- Post-partum depression
What rate of uterine contractions is sufficient for labor?
3 in a 10 min span
What device is used to measure the strength of contractions?
IUPC = intrauterine pressure catheter
What Montevideo Unit (MVU) is considered sufficient for the force of uterine contractions?
> 200 MVU
What fetal positioning is considered most ideal?
Occiput Anterior
- OA is OK
What is McRobert’s maneuver?
- Hyperflexion + Abduction of the hips
What is the classic presentation of placenta previa?
Painless vaginal bleeding
What is the classic presentation of placental abruption?
Vaginal bleeding with abdominal pain
What are some risk factors for placental abruption?
- Trauma (e.g. MVA)
- Cocaine use
- HTN
- Multiple gestations
What is the definition of massive transfusion protocol?
Delivery is > 10 units of PRBCs in 24 hours
How much would 1 unit of packed RBCs raise hematocrit?
3-4%
What are the leading causes of morbidity/mortality in pre-term infants?
- Respiratory distress
- Infection
- Intraventricular hemorrhage
What are the
- History of preterm birth
- Short cervical length (<25 mm)
- Cervical surgery
- Vaginal bleeding and genital tract infections
- Smoking/reduced maternal BMI
- Short interpregnancy intervals
What are the most common tocolytics?
Calcium channel blockers
What is the definition of premature rupture of membranes (PROM)?
Rupture of membranes prior to the onset of labor
What is the definition of preterm premature rupture of membranes (PPROM)?
Rupture of membranes prior to the onset of labor AND prior to full-term GA
What are risk factors for PROM?
Anything that weakens the strength of the chorio-amniotic membrane:
- Ascending infections
- Smoking
- Hx of prior PROM
- Polyhydramnios/mutliple gestations
What are the steps of interpreting the fetal heart tracing?
- Baseline (nml HR 110-160)
- Variability (beat to beat change in fetal heart rate)
- Accelerations
- Decelerations
What does moderate variability indicate on a fetal heart rate tracing represent?
Adequate fetal oxygenation
What do variable decelerations on the fetal heart tracing indicate?
Cord compression
What do early decelerations on the fetal heart tracing indicate?
Head compression
What do accelerations on the fetal heart tracing indicate?
Nothing, they’re okay!
What do late decelerations on the fetal heart tracing indicate?
Placental insufficiency/fetal hypoxia
Define the VEAL CHOP nemonic
- Variable decelerations = Cord compression
- Early decelerations = Head compression
- Accelerations = OK!
- Late decelerations = Placental insufficiency
What are features of a Category I fetal heart tracing?
- Baseline: 110-160
- Moderate variability
- No late or variable decelerations
- ± Early decelerations
- ± Accelerations
What are features of a Category III fetal heart tracing?
Absent baseline variability + at least one of the following:
- Recurrent late decelerations
- Recurrent variable decelerations
- Sinusoidal wave pattern
What are features of a Category II fetal heart tracing?
Everything between I and II
How is postpartum hemorrhage defined for a vaginal delivery?
Blood loss > 500 cc
How is postpartum hemorrhage defined for a Cesarean delivery?
Blood loss > 1000 cc
What are some risk factors of uterine atony?
- Polyhydramnios
- Multiple gestations
- Prolonged labor/augmented w/ oxytocin
- History of PPH
What are some pharmacologic therapies for the management of uterine atony?
- Methergine (CI in HTN)
- Hemabate (CI in asthmatics)
- IV oxytocin
- Misoprostol
What are the top four most likely types of postpartum infections?
- UTI
- Wound infection
- Mastitis or breast abscess
- Endometritis
What are the most common abx used for the treatment of postpartum UTI?
- Nitrofurantoin
- Cephalosporin
What is the first-line treatment for postpartum wound infection?
- Cephalosporin
What is the first-line treatment for mastitis?
- 7-10 day course of dicloxacilin
What are the first-line therapies for endometritis?
- Gentamicin
- Clindamycin
What features characterize postpartum blues?
- Tearfulness
- Fatigue
- Irritability
- Depressed affect
- Mild insomnia
- Usually self-limited
What is the definition of postpartum depression?
Major episode of depression that occurs within the first 4 weeks or 6 months postpartum
What features characterize postpartum psychosis?
- Confusion
- Clouded sensorium
- Distractibility
What is the definition of post-term pregnancy?
Reaching or extending beyond 42 weeks GA
What is the definition of late-term pregnancy?
GA between 41+0 days and 41+6 days
What are some maternal risks of post-term pregnancy?
- Vaginal trauma
- Cesarean delivery
What are some neonatal risks of post-term pregnancy?
- Macrosomia
- Postmaturity syndrome
- Meconium aspiration syndrome
- Oligohydramnios
What is the definition of macrosomia?
Fetus > 4000/4500 g
What are some maternal risk factors for fetal macrosomia?
- History of fetal macrosomia
- Glucose intolerance
- Pregnancy weight gain
What are the ACOG recommendations for delivering a macrosomic baby?
- Cesarean section if EFW > 5000g (4500 g if mom has DM)
What is the definition of FGR/IUGR?
Fetus less than 10%ile
What type of fetal growth characterizes early onset IUGR?
Cellular hyperPlasia
What type of fetal growth characterizes late onset IUGR?
Cellular hyperTrophy
What type of maternal factors contribute to early onset IUGR?
- Infection (e.g. rubella, varicella, CMV)
- Smoking
- Multiple pregnancies
- Chronic maternal illness
What type of maternal factors contribute to late onset IUGR?
Uteroplacental insufficiency
How does the progesterone IUD work?
- Thickens cervical mucus to prevent sperm from entering the uterus
How long does the progesterone IUD last?
3-5 years
What is a side effect of the progesterone IUD?
Lighter menstrual cycles or amenorrhea
How does the copper IUD work?
- Creates an unfavorable environment for the sperm to fertilize the egg
How long does the copper IUD last?
10 years
What is a side effect of the copper IUD?
Heavier and crampier menses
How does the implant work?
Etonogestrel inhibits ovulation
What is a side effect of the implant?
Irregular bleeding/spotting
How does the Depo-Provera injection work?
A progesterone shot that last 3 months
What is a side effect of the Depo-Provera shot?
Weight gain (10 lbs average)
How does emergency contraception work?
Prevents ovulation and fertilization
Which IUD can also be used for emergency contraception?
Copper IUD
Which three terms define unintended pregnancy?
- Mistimed
- Unwanted
- Unplanned
When can pregnancy termination be performed?
- 1st trimester (12 weeks GA)
- 2nd trimester (13-26 weeks GA)
How does Mifepristone work in terminating a pregnancy?
Mifepristone is a progesterone antagonist that works by stopping the growth of the pregnancy
How does Misoprostol work in terminating a pregnancy?
Misoprostol is a prostaglandin analog that works by induces uterine cramping and expulsion of the products of conception
What are some risk factors for amniotic fluid embolism?
- Advanced maternal age
- High gravida (≥5)
- Prior cesarean (more arterial access for embolism)
How is amniotic fluid embolism managed?
It usually presents with cardiorespiratory failure, so you’ll want to manage by supporting respiration
What is the definition of a short cervix during pregnancy and how is it managed?
- Cervix length ≤2.5cm
- Cerclage
What are components of the biophysical profile (BPP)?
- Non-stress test (NST)
- Amniotic fluid volume
- Fetal movements
- Fetal tone
- Fetal breathing
What is a normal amniotic fluid volume for the BPP?
Maximum vertical pocket ≥2cm or amniotic fluid index > 5
What defines normal fetal movements for the BPP?
≥3 in 30 minutes
What defines normal fetal tone for the BPP?
≥1 flexion/extension episode in 30 minutes
What defines normal fetal breathing during the BPP?
≥1 breathing episode lasting ≥30 second in 30 minutes
What are the features of Horner Syndrome?
- Ptosis
- Miosis (affected pupil is constricted relative to the other)
- Anhidrosis
What is Klumpke Paralysis?
Caused by shoulder dystocia, and presents with:
- “Claw hand” due to lack of grasp reflex
- Horner syndrome
What is a major risk factor for lactational mastitis?
- Inadequate milk drainage (e.g. pumping instead of direct breastfeeding or poor latch)
What happens to minute ventilation during pregnancy and what is the resultant acid-base status?
- Minute ventilation increases
- Results in a compensated respiratory alkalosis
What is the most common site of metastasis in the setting of molar pregnancy, and what test should be performed to rule out disease?
- Lungs
- Chest X-ray
What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI < 18.5?
28-40 pounds
What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI between 18.5-24.9?
25-35 pounds
What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI between 25-29.9?
15-25 pounds
What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI > 30?
11-20 pounds
What is the most effective screening test for Down Syndrome?
Cell-free DNA
What are the components of the pregnancy triple screen?
(Alphabetical)
- Alpha fetal protein (AFP)
- Beta-HCG
- Estriol
What are the components of the pregnancy quadruple screen?
(Alphabetical) = Triple Screen + Inhibin A
- Alpha fetal protein (AFP)
- Beta-HCG
- Estriol
- Inhibin A
When is screening for Gestational Diabetes performed and why at this time?
- Between 24-28 weeks GA
- This is when human Placental Lactogen (hPL) is at its peak and decreases maternal insulin sensitivity
How is screening for gestational diabetes performed?
- First with a 1-hour glucose load test
- Followed by a 3-hour glucose tolerance test
Describe the 1-hour glucose load test and what its results indicate
1-hour glucose load = give 50g of glucose with measurement of blood glucose one hour later
- if glucose is >130-140 mg/dL then do a glucose tolerance test
Describe the 3-hour glucose tolerance test and what its results indicate
3-hour glucose tolerance = take fasting BG then give 100g of glucose, then take measurements at 1, 2 and 3 hours. If two of the four measurements are abnormal the test is positive for gestational diabetes:
- Normal Fasting ≤ 95
- Normal 1-hour ≤ 180
- Normal 2-hour ≤ 155
- Normal 3-hour ≤ 140
Does fetal IUGR occur in the setting of gestational DM or pregestational DM?
Pre-gestational DM
How much folic acid should a woman who previously had a pregnancy complicated by NTDs be taking?
4.0mg
What pregnancy screening tests can be offered to women during the 1st trimester?
- Combined test
- Cell-free DNA
- Chorionic villus sampling (if genetic aneuploidy screening is positive)
What composes the “combined” pregnancy screen?
- Maternal beta-HCG
- Maternal PAPPA-A
- Nuchal translucency
What pregnancy screening tests can be offered to women during the 2nd trimester?
- Triple screen
- Quadruple (quad) screen
- Amniocentesis (in women >35yo and if genetic aneuploidy screening is positive)
What may a significant amount of vaginal bleeding with placement of an intrauterine pressure catheter (IUPC) represent?
Potential placental separation or uterine perforation
What should be done in response to significant vaginal bleeding with placement of an intrauterine pressure catheter (IUPC) represent?
Withdraw the catheter, monitor the fetus, and observe for signs of fetal compromise
What is the most appropriate management/treatment of umbilical cord prolapse?
Manual elevation of the fetal head (to prevent compression of the cord) and emergency Cesarean section
How should one manage an infant born to an HIV-positive mother?
- If Mom’s viral load is > 1,000/µL at delivery, C-section should be performed
- All babies should begin treatment with zidovudine (AZT) immediately upon delivery
How often should obstetric follow-up occur in a pregnant woman?
- Q4 weeks until GA 28
- Q2 weeks until GA 36
- Q1 week until delivery
What is the most common cause of postpartum infection?
Endometritis (inflammation/infection of the uterine lining)
What are some factors that increase the risk of endometritis?
- C-section
- Or if vaginal delivery:
- prolonged labor
- prolonged rupture of membranes
- multiple vaginal examinations
- internal fetal monitoring
- manual removal of the placenta
What is postpartum blues and how long does it last?
Signs and symptoms of depression (sadness, mood lability, tearfulness) that begin immediately after birth and last no more than two weeks
What is the treatment for postpartum blues?
Self-limited; supportive
What is postpartum depression and how long does it last?
Signs and symptoms of depression that occur between 2 weeks and 6 months following delivery
Outside of timing, how might postpartum depression be distinguished from postpartum blues?
In postpartum depression, the mom may have ambivalence or negative feelings toward the baby
What type of contraception should are least-desirable immediately after delivery and why?
- Estrogen-containing contraception
- Estrogen decreases lactation (esp. in the 30-day postpartum period)
What is the most common cause of vesicovaginal fistula (VVF) worldwide?
Obstruction of labor
How is vesicovaginal fistula (VVF) diagnosed?
Bladder dye test
What is the pathophysiology of vesicovaginal fistula (VVF)
Prolonged labor or extended active face results in compression of the vesicovaginal area by the fetuses head –> necrosis of tissue –> creation of fistula –> leakage of fluid from bladder through the fistula and out of the vagina (“pooling”)
What are the the relative directions of the the values of AFP, HCG, estriol and Inhibin-A in screening for Down Syndrome?
Remember “Down’s is Up”
- Increased hCG and Inhibin A
- Decreased AFP and decreased estriol
What are the the relative directions of the the values of AFP, HCG, estriol and Inhibin-A in screening for Edward Syndrome?
- All decreased
“Down vote” - Chromosome 18 = voting age
How do the combined screen and sequential screening differ?
- Combined: 1st Trimester + 2nd Trimester at same time
- Sequential: 1st trimester done first –> if negative go to 2nd trimester screen; if positive go straight to invasive testing
What 3 important diseases should you be evaluating for during the 3rd trimester?
- Gestational DM
- Alloimmunization
- Maternal anemia
What is the treatment for gestational diabetes?
Insulin (esp. postprandial)
What is the blood glucose target for gestational DM?
Post-prandial GLC < 180
If a pregnant woman is Rh-Ab negative, what should her alloimmunization management be?
- Give Rho-gam at 28 weeks
AND - Give Rho-gam w/in 72 hours of delivery
If a pregnant woman is Rh-Ag negative and Rh-Ab positive, what should her alloimmunization management be?
- TCD = transcranial doppler to assess for fetal anemia
How is maternal anemia diagnosed?
- Hgb <10
OR - Hct < 30
What is the most common cause of maternal anemia and how is it treated?
- Iron deficiency
- Iron supplementation
What defines the latent and active phases of Stage 1 of labor?
- Latent: cervical dilation up to 6cm
- Active: cervical dilation from 6cm to full (10cm)
What is Stage 2 of labor?
Full dilation of cervix to delivery of the infant
What is Stage 3 of labor?
Delivery of infant to delivery of placenta
What is the strongest risk factor for ectopic pregnancy?
Previous ectopic pregnancy
What beta-HCG level corresponds to being able to visualize an intra-uterine pregnancy on transvaginal ultrasound?
beta-HCG > 2,000
What is the standard surgical management of a ruptured ectopic pregnancy?
Removal of ectopic pregnancy
+
Salpingectomy
What is the most-common complication of dilation and curettage?
Uterine perforation (esp. in pregnant uterus due to softening of the uterine myometrium)
Which drugs are safe to use in the treatment of hyperthyroidism in pregnancy?
- Propylthiouracil (PTU) - 1st trimester
- Methimazole - 2nd/3rd trimesters
What is an important birth defect associated with methimazole use during pregnancy?
Aplasia cutis
Which antiepileptic drugs are safe to use in pregnancy?
The “L” drugs: Lamotrigine (Lamictal) and Levetiracetam (Keppra)
Which antihypertensive drugs are safe to use in pregnancy?
- Alpha-methyldopa
- Hydralazine
- Labetalol
On a molecular level, what is the mechanism of cervical change during labor?
Breakage of disulfide bonds
How is the baby positioned during a Frank breech presentation?
- Hips flexed
- Knees extended
(Like a “V”)
How is the baby positioned during a Complete breech presentation?
- Hips flexed
- knees flexed
(Like a Buddha)
How is the baby positioned during a Footling breech presentation?
- Hips extended
1 or 2 feet first
Which antidepressant is contraindicated in pregnancy and why?
Paroxetine (Paxil) because it causes congenital heart anomalies and pulmonary hypertension
What are some signs of magnesium sulfate toxicity in the management of preeclampsia?
- Loss of DTRs (occurs at 7-10 mEq)
- Respiratory depression (occurs at 11-13 mEq)
- Cardiac conduction issues (occurs at > 15 mEq)
- Cardiac arrest (occurs at > 25 mEq)
- Muscle weakness
- Nausea
How is magnesium sulfate toxicity treated?
Discontinue Mg Sulfate and add calcium gluconate
While acute fatty liver of pregnancy (AFLP) and HELLP syndrome, have similarities such as elevated bilirubin, elevated liver enzymes and low platelets, there is one major distinguishing factor that points toward AFLP. What is that factor?
Hypoglycemia is AFLP
How can placenta previa and placental abruption be distinguished?
- Placenta previa = painLESS vaginal bleeding
- Placental abruption = painFUL vaginal bleeding
What important finding can easily distinguish placental abruption from uterine rupture
Think! Uterine rupture involves a hole in the uterus, therefore contractions will be absent
What are the greatest risk factors for preeclampsia?
- Chronic hypertension
- Chronic renal disease
How is fetal anemia assessed?
Middle cerebral artery peak systolic velocity via transcranial doppler (TCD)
In thinking of a couple who just experienced a fetal demise (or anyone experiencing a major loss), what are the 5 Kubler-Ross stages of grief?
- Denial
- Anger
- Bargaining - e.g. “God please give me more time”
- Depression
- Acceptance
What are some risk factors for breech presentation?
- Uterine abnormalities (e.g. fibroids)
- Polyhydramnios
- Prematurity
- Multiple gestation (e.g. twins, triplets)
- Congenital anomalies (e.g. NTDs)
- Placenta previa
How is prolonged latent stage of labor defined for primaparas?
> 20 hours
How is prolonged latent stage of labor defined for multiparas?
> 14 hours
Why is the use of magnesium sulfate for tocolysis contraindicated in patients with Myasthenia Gravis?
Because patients with Myasthenia Gravis already have impaired neuromuscular conduction, and Mg toxicity is associated with absent DTRs and muscle weakness
What is fetal fibronectin and what is the test used for?
Fetal fibronectin = an extracellular matrix protein secreted by fetal cells that acts as an “adhesive” between the chorion and underlying fetal decidua
It can be used to predict preterm delivery as presence of fetal fibronectin indicates disruption of the maternal-fetal interface
On a biostats level, what are some of the strengths of the fetal fibronectin test?
- High negative predictive value (96-99%) of preterm labor
- High specificity (~86%)
What are some signs of chorioamnionitis?
- Maternal fever
- High WBC count
- Maternal and fetal tachycardia
- Uterine tenderness
What is the most common cause of postpartum hemorrhage?
Uterine atony (80% of all PPH)
“Pale globular mass appearing at the introitus” might describe what cause of postpartum hemorrhage?
Uterine inversion (especially if there is a history of umbilical cord traction during the 3rd stage of labor)
What is the umbilical artery doppler used for and what does the result tell you?
Umbilical artery doppler can be used to obtain the systolic/diastolic (S/D) ratio, which is a measure of fetal systemic vascular resistance. In increased S/D ratio signifies increased vascular resistance which indicates that the fetus is not in good health standing (e.g. IUGR).
Which form of contraception decreases a woman’s risk for ovarian and endometrial carcinoma?
Combined oral contraceptive pills (OCPs)
What is the first-line emergency contraceptive?
Copper IUD (up to 5 days following intercourse and also has the benefit of being kept in place for the prevention of future pregnancies)
What are two potential hemodynamic complications of placental abruption?
- Hypovolemic shock
- Disseminated intravascular coagulation (DIC) = from decidual release of tissue factor
How should one adjust the dose of a woman with pre-existing hypothyroidism once she becomes pregnant?
Increase
