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MS3 - OB/GYN > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

How is the EDD calculated?

A

Add 40 weeks from the 1st day of the patient’s LMP

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2
Q

beta HCG imitates which type of activity?

A

beta HCG has thyrotropin levels –> increase T4

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3
Q

What are some changes in the GI system that occur during pregnancy?

A

Progesterone causes smooth muscle relaxation leading to:

  • GERD (decreased LES tone)
  • Gallstones (decreased contractility)
  • Constipation (decreased motility)
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4
Q

When does emesis improve during pregnancy?

A

14-16 weeks (as beta HCG declines)

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5
Q

What are some changes in the CV system that occur during pregnancy?

A
  • Increased CO (30-50%)

- Decreased BP (progesterone causes vasodilation)

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6
Q

What are some changes in the respiratory system that occur during pregnancy?

A
  • Increased MV
  • Compensated respiratory alkalosis
  • Subcostal angle widens
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7
Q

What are some changes in the hematologic system that occur during pregnancy?

A
  • 45% increase in plasma blood volume
  • 35% increase in RBC volume (leads to physiologic anemia)
  • Increase in fibrinogen
  • Decrease in Protein C and S
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8
Q

How many umbilical arteries and veins exist?

A
  • Two umbilical arteries

- One umbilical vein

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9
Q

What are the 3 major shunts of pregnancy:

A
  • 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)
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10
Q

What are the BP classifications in pregnancy?

A
  • Normal: <140/90
  • Mild-to-moderate: 140-159/90-109
  • Severe: > 160/110
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11
Q

Which anti-hypertensives are contra-indicated in pregnancy?

A
  • ACE inhibitors
  • ARBs
  • Direct renin inhibitors
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12
Q

Which anti-hypertensives are safe and commonly used during pregnancy?

A
  • Lebatalol and methyldopa
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13
Q

True or False:

Live vaccines can be administered during pregnancy?

A

False

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14
Q

What is the leading preventable cause of intellectual disability, developmental delay, and birth defects in the fetus?

A

Alcohol use during pregnancy

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15
Q

What is the antepartum visit schedule?

A
  • 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
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16
Q

When does the OGTT occur?

A

24-28 weeks (at initial pre-natal visit in obese patients)

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17
Q

What is the last fetal system to mature completely?

A

Lungs

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18
Q

What is the appropriate folic acid dose for women during pregnancy?

A

0.4 mg daily

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19
Q

What is the appropriate folic acid dose for women during pregnancy who have previously had NTDs?

A

4 mg daily

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20
Q

Which two criteria are necessary for “true labor”

A
  • Painful uterine contractions

- Cervical dilation

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21
Q

Which hormones are responsible for breast alveolar hypertrophy and lobule growth respectively?

A

PALE:

  • Progesterone –> Alveolar hypertrophy
  • Lobule growth –> Estrogen
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22
Q

What happens to the appearance of the areola during pregnancy and why?

A

The areola darkens such that the baby can see it better

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23
Q

When does breast milk production begin?

A

48-72 hours after delivery

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24
Q

What causes mastitis?

A

An impediment (galactocele or plugged duct) to forward flow of breast milk causing it to back up in the breast tissue

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25
Q

What is the treatment of mastitis?

A

Dicloxacilin

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26
Q

What are some contraindications to breastfeeding?

A
  • Infections (HIV, Hep B, TB, Herpetic lesions)

- Infants born with galactosemia

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27
Q

Where are the majority of ectopic pregnancies found?

A
  • 98% in the fallopian tube (most in the ampulla)
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28
Q

What are some risk factors for ectopic pregnancy?

A
  • History of ectopic pregnancy
  • History of tubal surgery
  • History of chlamydial infection
  • History of PID
  • Smoking
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29
Q

What are signs of ectopic pregnancy?

A
  • Amenorrhea
  • Abdominal pain
  • Vaginal bleeding
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30
Q

What is the pharmacologic treatment for ectopic pregnancy?

A
  • Methotrexate
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31
Q

What are contraindications for using methotrexate in the treatment of ectopic pregnancy?

A
  • Hemodynamic instability
  • Lung disease
  • Liver/kidney abnormalities
  • Currently breastfeeding
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32
Q

What are the two main options for surgical management of ectopic pregnancy?

A
  • Salpingectomy

- Salpingostomy (requires post-procedure HCG levels to make sure the ectopic pregnancy was completely removed)

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33
Q

What is the definition of spontaneous abortion?

A

Loss of pregnancy <20 weeks gestation

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34
Q

What change in beta HCG indicates that a pregnancy is not viable?

A

Decrease over a 48 hour period (normally we see a 50% increase)

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35
Q

What is the rule of 10’s for beta HCG levels?

A
  • Peaks at 10 weeks EGA at 100,000

- Term HCG decreases to 10,000

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36
Q

What is a complete abortion?

A

All products have passed without need for intervention and the cervix is completely closed

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37
Q

What is an incomplete abortion?

A

Some but not all products have passed and the cervix is open

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38
Q

What is an inevitable abortion?

A

But the products have not passed and the cervix is open

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39
Q

What is a missed abortion?

A

There has usually been a fetal demise for many weeks, but the products have never been expelled

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40
Q

What is the most common cause of SAB in the 1st trimester?

A

Chromosomal abnormalities (esp. trisomies)

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41
Q

What is the most common cause of SAB in the 2nd trimester?

A
  • Maternal systemic disease

- Abnormal placentation

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42
Q

What is pre-eclampsia?

A

New-onset HTN diagnosed > 20 weeks GA + proteinuria OR end-organ dysfunction

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43
Q

What is chronic hypertension?

A

HTN that pre-dates the pregnancy or is diagnosed <20 weeks GA

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44
Q

What is chronic hypertension with superimposed preeclampsia?

A

Signs/symptoms of preeclampsia along with chronic hypertension

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45
Q

What is gestational hypertension?

A

An elevated BP diagnosed > 20 weeks GA without the systemic findings of preeclampsia

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46
Q

What is the #1 risk factor for pre-eclampsia?

A
  • Previous history of preeclampsia
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47
Q

Aside from a prior history of preeclampsia what are some other risk factors?

A
  • Hx of preeclampsia in 1st-degree relative
  • Primaparity
  • Multiple gestation pregnancy
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48
Q

How is preeclampsia diagnosed?

A
  • 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.)
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49
Q

When should antihypertensives be started in a patient with preeclampsia?

A

SBP >160 OR DBP>110

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50
Q

Which drug is provided for seizure prophylaxis in preeclampsia?

A

Magnesium sulfate

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51
Q

What are signs that an infant is receiving sufficient milk?

A
  • 3-4 stools in 24 hours
  • 6 wet diapers in 24 hours
  • Weight gain
  • Sounds of swallowing
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52
Q

What is the most common cause of inherited intellectual disability?

A

Fragile X syndrome

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53
Q

In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides within the first 3 days?

A

Diamniotic Dichorionic twins

  • Two chorions
  • Two amnions
  • Two placentas
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54
Q

In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides between days 4-8?

A

Diamniotic Monochorionic twins

  • One chorion
  • Two amnions
  • One placenta
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55
Q

In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides between days 9-12?

A

Monoamniotic Monochorionic

  • One chorion
  • One amnion
  • One placenta
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56
Q

In the case of multiple gestation pregnancies, what happens if the fertilized ovum divides after day 12?

A

Increased risk of conjoined twins

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57
Q

What are some increased risk factors for multiple gestation pregnancies?

A
  • Increasing maternal age
  • Increasing parity
  • Moms with family history of twins
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58
Q

What is one of the most serious complications for di-mo twins?

A

Twin twin transfusion syndrome

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59
Q

What is the 1st-line therapy for twin twin transfusion syndrome?

A

Endoscopic intrauterine laser ablation

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60
Q

What is one of the most serious complications for mo-mo twins?

A

Cord entanglement and fetal death

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61
Q

What are some of the health complications that are more common in multiple gestational pregnancies?

A
  • Hyperemesis gravidarum
  • Gestational diabetes
  • Post-partum depression
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62
Q

What rate of uterine contractions is sufficient for labor?

A

3 in a 10 min span

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63
Q

What device is used to measure the strength of contractions?

A

IUPC = intrauterine pressure catheter

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64
Q

What Montevideo Unit (MVU) is considered sufficient for the force of uterine contractions?

A

> 200 MVU

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65
Q

What fetal positioning is considered most ideal?

A

Occiput Anterior

- OA is OK

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66
Q

What is McRobert’s maneuver?

A
  • Hyperflexion + Abduction of the hips
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67
Q

What is the classic presentation of placenta previa?

A

Painless vaginal bleeding

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68
Q

What is the classic presentation of placental abruption?

A

Vaginal bleeding with abdominal pain

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69
Q

What are some risk factors for placental abruption?

A
  • Trauma (e.g. MVA)
  • Cocaine use
  • HTN
  • Multiple gestations
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70
Q

What is the definition of massive transfusion protocol?

A

Delivery is > 10 units of PRBCs in 24 hours

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71
Q

How much would 1 unit of packed RBCs raise hematocrit?

A

3-4%

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72
Q

What are the leading causes of morbidity/mortality in pre-term infants?

A
  • Respiratory distress
  • Infection
  • Intraventricular hemorrhage
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73
Q

What are the

A
  • History of preterm birth
  • Short cervical length (<25 mm)
  • Cervical surgery
  • Vaginal bleeding and genital tract infections
  • Smoking/reduced maternal BMI
  • Short interpregnancy intervals
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74
Q

What are the most common tocolytics?

A

Calcium channel blockers

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75
Q

What is the definition of premature rupture of membranes (PROM)?

A

Rupture of membranes prior to the onset of labor

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76
Q

What is the definition of preterm premature rupture of membranes (PPROM)?

A

Rupture of membranes prior to the onset of labor AND prior to full-term GA

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77
Q

What are risk factors for PROM?

A

Anything that weakens the strength of the chorio-amniotic membrane:

  • Ascending infections
  • Smoking
  • Hx of prior PROM
  • Polyhydramnios/mutliple gestations
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78
Q

What are the steps of interpreting the fetal heart tracing?

A
  • Baseline (nml HR 110-160)
  • Variability (beat to beat change in fetal heart rate)
  • Accelerations
  • Decelerations
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79
Q

What does moderate variability indicate on a fetal heart rate tracing represent?

A

Adequate fetal oxygenation

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80
Q

What do variable decelerations on the fetal heart tracing indicate?

A

Cord compression

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81
Q

What do early decelerations on the fetal heart tracing indicate?

A

Head compression

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82
Q

What do accelerations on the fetal heart tracing indicate?

A

Nothing, they’re okay!

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83
Q

What do late decelerations on the fetal heart tracing indicate?

A

Placental insufficiency/fetal hypoxia

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84
Q

Define the VEAL CHOP nemonic

A
  • Variable decelerations = Cord compression
  • Early decelerations = Head compression
  • Accelerations = OK!
  • Late decelerations = Placental insufficiency
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85
Q

What are features of a Category I fetal heart tracing?

A
  • Baseline: 110-160
  • Moderate variability
  • No late or variable decelerations
  • ± Early decelerations
  • ± Accelerations
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86
Q

What are features of a Category III fetal heart tracing?

A

Absent baseline variability + at least one of the following:

  • Recurrent late decelerations
  • Recurrent variable decelerations
  • Sinusoidal wave pattern
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87
Q

What are features of a Category II fetal heart tracing?

A

Everything between I and II

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88
Q

How is postpartum hemorrhage defined for a vaginal delivery?

A

Blood loss > 500 cc

89
Q

How is postpartum hemorrhage defined for a Cesarean delivery?

A

Blood loss > 1000 cc

90
Q

What are some risk factors of uterine atony?

A
  • Polyhydramnios
  • Multiple gestations
  • Prolonged labor/augmented w/ oxytocin
  • History of PPH
91
Q

What are some pharmacologic therapies for the management of uterine atony?

A
  • Methergine (CI in HTN)
  • Hemabate (CI in asthmatics)
  • IV oxytocin
  • Misoprostol
92
Q

What are the top four most likely types of postpartum infections?

A
  • UTI
  • Wound infection
  • Mastitis or breast abscess
  • Endometritis
93
Q

What are the most common abx used for the treatment of postpartum UTI?

A
  • Nitrofurantoin

- Cephalosporin

94
Q

What is the first-line treatment for postpartum wound infection?

A
  • Cephalosporin
95
Q

What is the first-line treatment for mastitis?

A
  • 7-10 day course of dicloxacilin
96
Q

What are the first-line therapies for endometritis?

A
  • Gentamicin

- Clindamycin

97
Q

What features characterize postpartum blues?

A
  • Tearfulness
  • Fatigue
  • Irritability
  • Depressed affect
  • Mild insomnia
  • Usually self-limited
98
Q

What is the definition of postpartum depression?

A

Major episode of depression that occurs within the first 4 weeks or 6 months postpartum

99
Q

What features characterize postpartum psychosis?

A
  • Confusion
  • Clouded sensorium
  • Distractibility
100
Q

What is the definition of post-term pregnancy?

A

Reaching or extending beyond 42 weeks GA

101
Q

What is the definition of late-term pregnancy?

A

GA between 41+0 days and 41+6 days

102
Q

What are some maternal risks of post-term pregnancy?

A
  • Vaginal trauma

- Cesarean delivery

103
Q

What are some neonatal risks of post-term pregnancy?

A
  • Macrosomia
  • Postmaturity syndrome
  • Meconium aspiration syndrome
  • Oligohydramnios
104
Q

What is the definition of macrosomia?

A

Fetus > 4000/4500 g

105
Q

What are some maternal risk factors for fetal macrosomia?

A
  • History of fetal macrosomia
  • Glucose intolerance
  • Pregnancy weight gain
106
Q

What are the ACOG recommendations for delivering a macrosomic baby?

A
  • Cesarean section if EFW > 5000g (4500 g if mom has DM)
107
Q

What is the definition of FGR/IUGR?

A

Fetus less than 10%ile

108
Q

What type of fetal growth characterizes early onset IUGR?

A

Cellular hyperPlasia

109
Q

What type of fetal growth characterizes late onset IUGR?

A

Cellular hyperTrophy

110
Q

What type of maternal factors contribute to early onset IUGR?

A
  • Infection (e.g. rubella, varicella, CMV)
  • Smoking
  • Multiple pregnancies
  • Chronic maternal illness
111
Q

What type of maternal factors contribute to late onset IUGR?

A

Uteroplacental insufficiency

112
Q

How does the progesterone IUD work?

A
  • Thickens cervical mucus to prevent sperm from entering the uterus
113
Q

How long does the progesterone IUD last?

A

3-5 years

114
Q

What is a side effect of the progesterone IUD?

A

Lighter menstrual cycles or amenorrhea

115
Q

How does the copper IUD work?

A
  • Creates an unfavorable environment for the sperm to fertilize the egg
116
Q

How long does the copper IUD last?

A

10 years

117
Q

What is a side effect of the copper IUD?

A

Heavier and crampier menses

118
Q

How does the implant work?

A

Etonogestrel inhibits ovulation

119
Q

What is a side effect of the implant?

A

Irregular bleeding/spotting

120
Q

How does the Depo-Provera injection work?

A

A progesterone shot that last 3 months

121
Q

What is a side effect of the Depo-Provera shot?

A

Weight gain (10 lbs average)

122
Q

How does emergency contraception work?

A

Prevents ovulation and fertilization

123
Q

Which IUD can also be used for emergency contraception?

A

Copper IUD

124
Q

Which three terms define unintended pregnancy?

A
  • Mistimed
  • Unwanted
  • Unplanned
125
Q

When can pregnancy termination be performed?

A
  • 1st trimester (12 weeks GA)

- 2nd trimester (13-26 weeks GA)

126
Q

How does Mifepristone work in terminating a pregnancy?

A

Mifepristone is a progesterone antagonist that works by stopping the growth of the pregnancy

127
Q

How does Misoprostol work in terminating a pregnancy?

A

Misoprostol is a prostaglandin analog that works by induces uterine cramping and expulsion of the products of conception

128
Q

What are some risk factors for amniotic fluid embolism?

A
  • Advanced maternal age
  • High gravida (≥5)
  • Prior cesarean (more arterial access for embolism)
129
Q

How is amniotic fluid embolism managed?

A

It usually presents with cardiorespiratory failure, so you’ll want to manage by supporting respiration

130
Q

What is the definition of a short cervix during pregnancy and how is it managed?

A
  • Cervix length ≤2.5cm

- Cerclage

131
Q

What are components of the biophysical profile (BPP)?

A
  • Non-stress test (NST)
  • Amniotic fluid volume
  • Fetal movements
  • Fetal tone
  • Fetal breathing
132
Q

What is a normal amniotic fluid volume for the BPP?

A

Maximum vertical pocket ≥2cm or amniotic fluid index > 5

133
Q

What defines normal fetal movements for the BPP?

A

≥3 in 30 minutes

134
Q

What defines normal fetal tone for the BPP?

A

≥1 flexion/extension episode in 30 minutes

135
Q

What defines normal fetal breathing during the BPP?

A

≥1 breathing episode lasting ≥30 second in 30 minutes

136
Q

What are the features of Horner Syndrome?

A
  • Ptosis
  • Miosis (affected pupil is constricted relative to the other)
  • Anhidrosis
137
Q

What is Klumpke Paralysis?

A

Caused by shoulder dystocia, and presents with:

  • “Claw hand” due to lack of grasp reflex
  • Horner syndrome
138
Q

What is a major risk factor for lactational mastitis?

A
  • Inadequate milk drainage (e.g. pumping instead of direct breastfeeding or poor latch)
139
Q

What happens to minute ventilation during pregnancy and what is the resultant acid-base status?

A
  • Minute ventilation increases

- Results in a compensated respiratory alkalosis

140
Q

What is the most common site of metastasis in the setting of molar pregnancy, and what test should be performed to rule out disease?

A
  • Lungs

- Chest X-ray

141
Q

What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI < 18.5?

A

28-40 pounds

142
Q

What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI between 18.5-24.9?

A

25-35 pounds

143
Q

What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI between 25-29.9?

A

15-25 pounds

144
Q

What are the Institute of Medicine (IOM) pregnancy weight gain recommendations for a woman with a BMI > 30?

A

11-20 pounds

145
Q

What is the most effective screening test for Down Syndrome?

A

Cell-free DNA

146
Q

What are the components of the pregnancy triple screen?

A

(Alphabetical)

  • Alpha fetal protein (AFP)
  • Beta-HCG
  • Estriol
147
Q

What are the components of the pregnancy quadruple screen?

A

(Alphabetical) = Triple Screen + Inhibin A

  • Alpha fetal protein (AFP)
  • Beta-HCG
  • Estriol
  • Inhibin A
148
Q

When is screening for Gestational Diabetes performed and why at this time?

A
  • Between 24-28 weeks GA

- This is when human Placental Lactogen (hPL) is at its peak and decreases maternal insulin sensitivity

149
Q

How is screening for gestational diabetes performed?

A
  • First with a 1-hour glucose load test

- Followed by a 3-hour glucose tolerance test

150
Q

Describe the 1-hour glucose load test and what its results indicate

A

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

151
Q

Describe the 3-hour glucose tolerance test and what its results indicate

A

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
152
Q

Does fetal IUGR occur in the setting of gestational DM or pregestational DM?

A

Pre-gestational DM

153
Q

How much folic acid should a woman who previously had a pregnancy complicated by NTDs be taking?

A

4.0mg

154
Q

What pregnancy screening tests can be offered to women during the 1st trimester?

A
  • Combined test
  • Cell-free DNA
  • Chorionic villus sampling (if genetic aneuploidy screening is positive)
155
Q

What composes the “combined” pregnancy screen?

A
  • Maternal beta-HCG
  • Maternal PAPPA-A
  • Nuchal translucency
156
Q

What pregnancy screening tests can be offered to women during the 2nd trimester?

A
  • Triple screen
  • Quadruple (quad) screen
  • Amniocentesis (in women >35yo and if genetic aneuploidy screening is positive)
157
Q

What may a significant amount of vaginal bleeding with placement of an intrauterine pressure catheter (IUPC) represent?

A

Potential placental separation or uterine perforation

158
Q

What should be done in response to significant vaginal bleeding with placement of an intrauterine pressure catheter (IUPC) represent?

A

Withdraw the catheter, monitor the fetus, and observe for signs of fetal compromise

159
Q

What is the most appropriate management/treatment of umbilical cord prolapse?

A

Manual elevation of the fetal head (to prevent compression of the cord) and emergency Cesarean section

160
Q

How should one manage an infant born to an HIV-positive mother?

A
  • 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
161
Q

How often should obstetric follow-up occur in a pregnant woman?

A
  • Q4 weeks until GA 28
  • Q2 weeks until GA 36
  • Q1 week until delivery
162
Q

What is the most common cause of postpartum infection?

A

Endometritis (inflammation/infection of the uterine lining)

163
Q

What are some factors that increase the risk of endometritis?

A
  • C-section
  • Or if vaginal delivery:
    • prolonged labor
    • prolonged rupture of membranes
    • multiple vaginal examinations
    • internal fetal monitoring
    • manual removal of the placenta
164
Q

What is postpartum blues and how long does it last?

A

Signs and symptoms of depression (sadness, mood lability, tearfulness) that begin immediately after birth and last no more than two weeks

165
Q

What is the treatment for postpartum blues?

A

Self-limited; supportive

166
Q

What is postpartum depression and how long does it last?

A

Signs and symptoms of depression that occur between 2 weeks and 6 months following delivery

167
Q

Outside of timing, how might postpartum depression be distinguished from postpartum blues?

A

In postpartum depression, the mom may have ambivalence or negative feelings toward the baby

168
Q

What type of contraception should are least-desirable immediately after delivery and why?

A
  • Estrogen-containing contraception

- Estrogen decreases lactation (esp. in the 30-day postpartum period)

169
Q

What is the most common cause of vesicovaginal fistula (VVF) worldwide?

A

Obstruction of labor

170
Q

How is vesicovaginal fistula (VVF) diagnosed?

A

Bladder dye test

171
Q

What is the pathophysiology of vesicovaginal fistula (VVF)

A

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”)

172
Q

What are the the relative directions of the the values of AFP, HCG, estriol and Inhibin-A in screening for Down Syndrome?

A

Remember “Down’s is Up”

  • Increased hCG and Inhibin A
  • Decreased AFP and decreased estriol
173
Q

What are the the relative directions of the the values of AFP, HCG, estriol and Inhibin-A in screening for Edward Syndrome?

A
  • All decreased

“Down vote” - Chromosome 18 = voting age

174
Q

How do the combined screen and sequential screening differ?

A
  • 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
175
Q

What 3 important diseases should you be evaluating for during the 3rd trimester?

A
  • Gestational DM
  • Alloimmunization
  • Maternal anemia
176
Q

What is the treatment for gestational diabetes?

A

Insulin (esp. postprandial)

177
Q

What is the blood glucose target for gestational DM?

A

Post-prandial GLC < 180

178
Q

If a pregnant woman is Rh-Ab negative, what should her alloimmunization management be?

A
  • Give Rho-gam at 28 weeks
    AND
  • Give Rho-gam w/in 72 hours of delivery
179
Q

If a pregnant woman is Rh-Ag negative and Rh-Ab positive, what should her alloimmunization management be?

A
  • TCD = transcranial doppler to assess for fetal anemia
180
Q

How is maternal anemia diagnosed?

A
  • Hgb <10
    OR
  • Hct < 30
181
Q

What is the most common cause of maternal anemia and how is it treated?

A
  • Iron deficiency

- Iron supplementation

182
Q

What defines the latent and active phases of Stage 1 of labor?

A
  • Latent: cervical dilation up to 6cm

- Active: cervical dilation from 6cm to full (10cm)

183
Q

What is Stage 2 of labor?

A

Full dilation of cervix to delivery of the infant

184
Q

What is Stage 3 of labor?

A

Delivery of infant to delivery of placenta

185
Q

What is the strongest risk factor for ectopic pregnancy?

A

Previous ectopic pregnancy

186
Q

What beta-HCG level corresponds to being able to visualize an intra-uterine pregnancy on transvaginal ultrasound?

A

beta-HCG > 2,000

187
Q

What is the standard surgical management of a ruptured ectopic pregnancy?

A

Removal of ectopic pregnancy
+
Salpingectomy

188
Q

What is the most-common complication of dilation and curettage?

A

Uterine perforation (esp. in pregnant uterus due to softening of the uterine myometrium)

189
Q

Which drugs are safe to use in the treatment of hyperthyroidism in pregnancy?

A
  • Propylthiouracil (PTU) - 1st trimester

- Methimazole - 2nd/3rd trimesters

190
Q

What is an important birth defect associated with methimazole use during pregnancy?

A

Aplasia cutis

191
Q

Which antiepileptic drugs are safe to use in pregnancy?

A

The “L” drugs: Lamotrigine (Lamictal) and Levetiracetam (Keppra)

192
Q

Which antihypertensive drugs are safe to use in pregnancy?

A
  • Alpha-methyldopa
  • Hydralazine
  • Labetalol
193
Q

On a molecular level, what is the mechanism of cervical change during labor?

A

Breakage of disulfide bonds

194
Q

How is the baby positioned during a Frank breech presentation?

A
  • Hips flexed
  • Knees extended
    (Like a “V”)
195
Q

How is the baby positioned during a Complete breech presentation?

A
  • Hips flexed
  • knees flexed
    (Like a Buddha)
196
Q

How is the baby positioned during a Footling breech presentation?

A
  • Hips extended

1 or 2 feet first

197
Q

Which antidepressant is contraindicated in pregnancy and why?

A

Paroxetine (Paxil) because it causes congenital heart anomalies and pulmonary hypertension

198
Q

What are some signs of magnesium sulfate toxicity in the management of preeclampsia?

A
  • 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
199
Q

How is magnesium sulfate toxicity treated?

A

Discontinue Mg Sulfate and add calcium gluconate

200
Q

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?

A

Hypoglycemia is AFLP

201
Q

How can placenta previa and placental abruption be distinguished?

A
  • Placenta previa = painLESS vaginal bleeding

- Placental abruption = painFUL vaginal bleeding

202
Q

What important finding can easily distinguish placental abruption from uterine rupture

A

Think! Uterine rupture involves a hole in the uterus, therefore contractions will be absent

203
Q

What are the greatest risk factors for preeclampsia?

A
  • Chronic hypertension

- Chronic renal disease

204
Q

How is fetal anemia assessed?

A

Middle cerebral artery peak systolic velocity via transcranial doppler (TCD)

205
Q

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?

A
  1. Denial
  2. Anger
  3. Bargaining - e.g. “God please give me more time”
  4. Depression
  5. Acceptance
206
Q

What are some risk factors for breech presentation?

A
  • Uterine abnormalities (e.g. fibroids)
  • Polyhydramnios
  • Prematurity
  • Multiple gestation (e.g. twins, triplets)
  • Congenital anomalies (e.g. NTDs)
  • Placenta previa
207
Q

How is prolonged latent stage of labor defined for primaparas?

A

> 20 hours

208
Q

How is prolonged latent stage of labor defined for multiparas?

A

> 14 hours

209
Q

Why is the use of magnesium sulfate for tocolysis contraindicated in patients with Myasthenia Gravis?

A

Because patients with Myasthenia Gravis already have impaired neuromuscular conduction, and Mg toxicity is associated with absent DTRs and muscle weakness

210
Q

What is fetal fibronectin and what is the test used for?

A

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

211
Q

On a biostats level, what are some of the strengths of the fetal fibronectin test?

A
  • High negative predictive value (96-99%) of preterm labor

- High specificity (~86%)

212
Q

What are some signs of chorioamnionitis?

A
  • Maternal fever
  • High WBC count
  • Maternal and fetal tachycardia
  • Uterine tenderness
213
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony (80% of all PPH)

214
Q

“Pale globular mass appearing at the introitus” might describe what cause of postpartum hemorrhage?

A

Uterine inversion (especially if there is a history of umbilical cord traction during the 3rd stage of labor)

215
Q

What is the umbilical artery doppler used for and what does the result tell you?

A

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).

216
Q

Which form of contraception decreases a woman’s risk for ovarian and endometrial carcinoma?

A

Combined oral contraceptive pills (OCPs)

217
Q

What is the first-line emergency contraceptive?

A

Copper IUD (up to 5 days following intercourse and also has the benefit of being kept in place for the prevention of future pregnancies)

218
Q

What are two potential hemodynamic complications of placental abruption?

A
  • Hypovolemic shock

- Disseminated intravascular coagulation (DIC) = from decidual release of tissue factor

219
Q

How should one adjust the dose of a woman with pre-existing hypothyroidism once she becomes pregnant?

A

Increase

MS3 - OB/GYN (4 decks)

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