Obstetrics Flashcards
What’s the gestational age?
Number of days/weeks since last menstrual period
What’s the estimated day of delivery?
LMP- 3 months+7 days = estimated day of delivery
What defines the first trimester?
Up to 14 weeks
What defines the second trimester?
14-28 weeks
What defines the third trimester?
28 weeks-delivery
What if the fetus is born before 22 weeks?
No resuscitation
What if the fetus is born between 23-25 weeks?
Case by case
What if the fetus is born after 25 weeks?
Resuscitation always
What’s considered a preterm fetus?
25-37 weeks
What does TPAL stand for in parity?
Term births
Preterm births
Abortions
Living children
What cardiac parameter decreases in pregnancy (all others increase)?
Afterload
Is the FEV1/FVC changed in pregnancy?
No
Is the TV changed in pregnancy?
Yes, it’s increased
Is the RR changed in pregnancy?
No
Why does the LES have decreased tone in pregnancy?
Progesterone
How does GFR change in pregnancy?
It increases
What comprises the triple screen?
- AFP
- B-hCG
- Estriol
What comprises the quad screen?
- AFP
- B-hCG
- Estriol
- Inhibin A
When is the triple or quad screen done?
15-18 weeks
Why is the quad screen more sensitive than the triple screen?
Inhibin A
What does cell-free DNA testing test for in the first trimester at 7 weeks?
fetal sex, Rh factor, aneuploidy, genetic studies
Is cell-free DNA testing non-invasive?
Yep
What does the PAPP-A test involve in the first trimester?
B-hCG
PAPP-A
Nuchal translucency
After __ weeks, there is a visit every week?
36
At how many weeks is the CBC?
27
At how many weeks is the 1-hour glucose challenge test?
24-28
If glucose >___ at one hour, perform oral glucose tolerance test?
130
When do you swab for GBS?
Week 36
If Braxton-Hicks contractions become regular, what should be done?
Check cervix to rule out preterm labor
Which can be done earlier: chorionic villi sampling or amniocentesis?
Chorionic villi (10-13 weeks vs 15-17 weeks)
What’s the indication for chorionic villi sampling and amniocentesis?
If genetic aneuploidy screening test is positive
Do both chorionic villi and amniocentesis measure fetal karyotype?
Yes
Which is more dangerous: chorionic villi or amniocentesis?
Chorionic villi
What defines a reactive NST test?
2+ accelerations within 30 min
What do you do if the NST is nonreactive?
Vibroacoustic stimulation to wake the baby up
What does a BPP test?
Breathing, HR, movement, etc.
What does a BPP <4 indicate?
Fetal compromise
What’s the normal fetal HR?
110-160
What defines a fetal HR acceleration?
Increase in HR of 15 or more for longer than 15 sec
What are early decels?
Decrease in HR that occurs with contractions
What’s the cause of early decels?
Head compression
What’s the cause of variable decels?
Umbilical cord compression
What’s the cause of late decels?
Fetal hypoxia due to decreased placental perfusion
Which type of decel is most serious?
Late
“Don’t be late– its serious”
What’s stage 1 of labor?
Onset of labor to full dilation of cervix (2-18 hours)
What’s the latent phase of labor?
Onset of labor to 6cm dilation (4-7 hours)
What’s the active phase of labor?
6cm- to full dilation (1-1.5cm/hour)
What’s stage 2 of labor?
Full dilation of cervix to delivery (30 min to 3 hours)
What’s stage 3 of labor?
Delivery of neonate to delivery of placenta
What’s used for cervical ripening?
PG E2
What’s used for exaggerating uterine contractions?
Oxytocin
Can ectopic pregnancy cause vaginal bleeding?
Yes
What dx presents with hypotension, vaginal bleeding, and h/o PID?
Ectopic pregnancy
What’s the tx of an ectopic pregnancy?
Fluids and surgery if unstable, MTX if stable
What are the exclusion criteria for MTX?
- Immunodeficiency
- Noncompliancy (need to follow-up)
- Liver disease
- Ectopic 3.5cm+
- Fetal heartbeat
What kind of operation is performed to remove an ectopic pregnancy?
Salpingosotomy
What defines an inevitable abortion?
Vaginal bleeding with a dilated cervix
What is a missed abortion?
Death of fetus but all products of conception present in uterus and cervical os is closed
What is a septic abortion?
Infex of uterus
What abx do you treat a septic abortion with?
Cefoxitin + doxycycline
What should Rh- mothers receive after an abortion?
Anti-D Rh immunoglobulin
How is preterm labor defined?
Contractions with cervical dilation
What are 2 examples of tocolytics?
- Terbutaline
2. CCB’s (preferred)
What does it mean if the amniotic fluid has the following characteristics:?
Present in posterior fornix
Turns nitrazine paper blue
Ferning pattern
Prelabor rupture of membranes
How long should you wait before inducing labor for PROM?
6-12 hours
What’s the next step if there’s chorioamnionitis?
Delivery now
What types of organisms usually cause chorioamnionitis?
Vaginal flora such as gardnarella, GBS, ureaplasma, or mycoplasma
What dx presents with maternal fever, high WBC’s, maternal and fetal tachycardia, and uterine tenderness?
Chorioamnionitis
What is placenta previa?
Placenta over internal cervical os, causes painless vaginal bleeding, requiring strict pelvic rest or urgent c-section
What is vasa previa?
Fetal umbilical cord is present over the cervical os, causes heavy vaginal bleeding and needs emergent c-section
What dx presents with sudden fetal bradycardia and palpable umbilical cord on vaginal exam?
Cord prolapse
What are the 3 types of placental invasion and what’s the quick way of remembering them?
- Accreta: attaches
- Increta: invades
- Percreta: penetrates
What dx presents with third trimester vaginal bleeding, contractions, severe abdominal pain, and possible fetal distress?
Placental abruption
What is placental abruption
Premature separation of the placenta from the uterus
How do you differentiate between placental abruption and placenta previa?
US
What dx presents with sudden onset of extreme abdominal pain, abnormal bump in abdomen, no uterine contractions, and loss of fetal station?
Uterine rupture
What’s the tx for uterine rupture?
Immediate laparotomy
Rh incompatibility occurs when the mother is Rh __ and the fetus is Rh __?
Mother is Rh-
Fetus is Rh+
What are the two categories of IUGR?
- Symmetric (brain in proportion)
2. Asymmetric (brain normal weight)
What causes symmetric IUGR?
Genetic issues or fetal infex
What causes asymmetric IUGR?
Uteroplacental insufficiency
What’s considered a macrosomic baby (in grams)?
4500+ grams
What dx presents with severe nausea and vomiting in pregnancy with a weight loss of >5% or >6lb?
Hyperemesis gravidarum
What’s the best initial therapy for hyperemesis gravidarum?
Dietary modification
In women with severe hyperemesis gravidarum what tx is beneficial?
Doxylamine or diphenhydramine
How do you differentiate hyperemesis gravidarum from normal pregnancy nausea?
Urine ketones
When do you screen for asymptomatic bacteriuria?
12-16 weeks
Is colposcopy safe in pregnancy?
Yes
Is endocervical curettage safe in pregnancy?
No
What’s the tx of PUPPP (the rash from the insta account)?
Topical corticosteroids
What dx during pregnancy presents with priuritis and elevated serum bile acid concentration?
Intrahepatic cholestasis of pregnancy
What does intrahepatic cholestasis of pregnancy increase the risk of?
Intrauterine fetal death
What’s the treatment for intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid and induction of labor at term
What dx presents with nausea, vomiting, jaundice, and elevation in AST, ALT, and bili, and prolonged PT and during pregnancy?
Acute fatty liver of pregnancy
How do you differentiate between acute fatty liver of pregnancy vs HELLP syndrome?
Acute fatty liver of pregnancy presents with hepatic insufficiency and abnormalities in coagulation profile
What’s the tx for AFLP?
Stabilization and delivery
What dx presents with hemolysis, elevated liver enzymes, low platelet count and is a complication of preeclampsia?
HELLP syndrome
What dx presents with HTN, edema, and proteinuria during preg?
Preeclampsia
What are the “severe features” in pre-eclampsia with severe features?
Mental status and vision changes, and RUQ pain
What dx presents as a tonic-clonic seizure occurring in a patient with h/o pre-eclampsia?
Eclampsia
What meds are used in eclampsia (2)?
- MgSO4
2. Hydralazine
In Trisomy 18, which quad screen levels are decreased?
All of them
Which trisomy presents with elevated inhibin A and B-hCG?
Trisomy 21
What is normal variability in fetal HR?
6-25 bpm
Do TRH and TSH receptor antibodies cross the placenta?
Yes
Do TSH and T4 cross the placenta?
No
How is hypothyroidism treated in pregnancy?
Levothyroxine
How is hyperthyroidism treated in the first trimester of pregnancy?
Propylthiouracil
How is hyperthyroidism treated in the second and third trimesters of pregnancy?
Methimazole
What birth defect is associated with methimazole?
Aplasia cutis
What defines prolonged latent stage?
When the latent stage lasts longer than 20 hours for the primipara and longer than 14 hours for the multipara
What defines protracted cervical dilation?
When the primipara’s cervix does not dilate more than 1.2cm per hour or less than 1.5cm per hour in a multipara
What defines arrest of descent?
When the fetal head doesn’t move down into the canal
What defines arrest of cervical dilation?
When there is no dilation of the cervix for more than 2 hours
Always remember to define each word piece by piece if you don’t immediately know an answer
Ok!
You should not perform external cephalic version until after week ___?
37
What dx presents when the fetus’s head has been delivered but the anterior shoulder is stuck behind the pubic symphysis?
Shoulder dystocia
What’s the tx for mastitis?
Dicloxacillin
What’s the tx for uterine inversion?
- Stop all uterotonic drugs
2. Manually reposition the uterus
What’s the difference between postpartum blues vs postpartum depression?
Postpartum blues is transient and starts 2-3 days after delivery and resolves on its own in 2 weeks
Is active TB a contraindication to breastfeeding?
Yes
What’s the next step for a complicated breast cyst?
Biopsy and repeat imaging in 6 mos
Primary amenorrhea is defined as the absence of menstruation by age __?
15
Secondary amehorrhea is the absence of menses for more than __ mos in a female who menstruates regularly, and more than __ in a female with irregular menstrual cycles?
3, 6
What’s the initial test for amenorrhea?
B-hCG
What’s the first line tx for emergency contraception?
Copper IUD
Levonorgestrel can be used up to __ days for emergency contraception?
3
Paget disease vs. lichen sclerosis?
Paget is priuritic with a red lesion with a superficial white coating
What’s the next step for Paget disease?
Biopsy
What dx presents with a large, globular, boggy uterus?
Adenomyosis
What is adenomyosis?
Invasion of the endometrial glands into the myometrium
What’s the best initial step for postmenopausal (or even > age 45) bleeding?
Biopsy
What type of HPV produces condyloma acuminata (genital warts)?
6 and 11
If a patient with ovarian cancer has family history of ovarian cancer, what test is indicated?
BRCA
