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Obstetrics Flashcards

1
Q

Number of times a woman has been pregnant?

A

Gravidity

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2
Q

Number times a woman has given birth?

A

Parity

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3
Q

When should preconception care begin?

A

3 months prior to conception

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4
Q

Folic acid recommendation is

A

400 mcg

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5
Q

What trimester does the blood pressure decrease

A

1st and 2 nd trimester

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6
Q

What trimester does the blood pressure return to baseline

A

3rd trimester

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7
Q

Chronic HTN increases the risk for what complications during pregnancy?

A
  1. Pre-eclampsia
  2. Preterm labor
  3. Placental abruption
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8
Q

Complications of diabetes during pregnancy?

A
  1. Congenital malformations
  2. Pregnancy loss
  3. Fetal macrosomia/growth restriction
  4. DKA
  5. Maternal and perinatal mortality
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9
Q

What percentage of women with asthma during pregnancy will.

  1. Get worse
  2. No change
  3. Improve
A

1/3

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10
Q

Why are ace inhibitors not given during pregnancy?

A
  1. They can cause renal agenesis
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11
Q

If a woman stops smoking prior to 24 weeks in pregnancy what is the outcome?

A
  1. The same as someone who has never smoked
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12
Q

complications from smoking during pregnancy include?

A
  1. Placental abruption
  2. Preterm labor
  3. Premature rupture of membranes
  4. fetal growth restriction
  5. SIDS
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13
Q

During pregnancy systemic vascular resistance is increased or decreased?

A

Decreased

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14
Q

What happens to mean arterial pressure during pregnancy?

A

decreases

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15
Q

Does the heart rate increase or decrease during pregnancy?

A

increases

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16
Q

Is cardiac output increased or decreased during pregnancy

A

increased

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17
Q

During pregnancy blood volume increases to

A

40-45% above the non pregnant state

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18
Q

What makes pregnant women at increased risk for blood clots during pregnancy

A

Their blood is hyper-coagulable

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19
Q

Is pregnancy an immunodeficient state

A

yes

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20
Q

During pregnancy how many centimeters does the diaphragm rise?

A

4 cm

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21
Q

During pregnancy does residual lung volume increase or decrease?

A

Decrease

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22
Q

Does tidal volume increase or decrease in the pregnant female

A

Increases

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23
Q

does functional residual capacity decrease or increase during pregnancy

A

decrease

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24
Q

Cardiac output increases during pregnancy does the heart rate increase as well?

A

the heart rate increases during pregnancy

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25
Q

During pregnancy where is the woman’s heart located?

A

The heart is displaced leftward and upward

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26
Q

What is the reason for acid reflux for women in the first and third trimester

A

Decreased tone of the lower esophageal sphincter

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27
Q

What happens to the size of the kidney’s during pregnancy?

A

The are slightly larger due to increased blood volume.

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28
Q

When is hydro-nephrosis more common during pregnancy and which ureter is most often times affected?

A

Common after 2nd trimester and the right is more often affected than the left

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29
Q

During pregnancy:

  1. Serum creatinine is?
  2. Creatinine clearance is
  3. GFR is?
A
  1. Serum Cr-decreased
  2. Cr Clearance-increased
  3. GFR-increased
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30
Q

What is the likely cause of glucose in the pregnant woman’s urine besides GD

A
  1. Glucose because of the increased GFR
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31
Q

basal metabolic rate in pregnancy increases by

A

10-20%

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32
Q

In pregnancy water retention is increased by 6.5 l due to what?

A

Decrease plasma osmolality

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33
Q

During pregnancy does progesterone and estrogen increase or decrease?

A

Increase

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34
Q

During pregnancy does aldosterone and renin increase or decrease?

A

Increase

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35
Q

During pregnancy does relaxin increase or decrease

A

increase

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36
Q

The uterus increased to how many grams by the time the fetus is term?

A

5 liters

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37
Q

Linea nigra is a result of what during pregnancy

A

Increase in melanocytes

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38
Q

What is Naegele’s rule?

A

LMP subtract 3 months and add 7 days.

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39
Q

Beta HCG is at least what number should something be seen in the uterus on vaginal u/x

A

2000

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40
Q

If the beta hcg is at least (1) clinicians should be able to see something in the uterus using an abdominal u/s

A

6000

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41
Q

Serum pregnancy test is

A

quantitative

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42
Q

Gestational age on ultrasound in the 1 st trimester should be how many weeks from the LMP

A

1 week

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43
Q

Which trimester u/s is most accurate for establishing gestational age?

A

2nd trimester

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44
Q

Initial prenatal visit routine screening?

A
  1. Blood type RH factor
  2. CBC
  3. Infections: Rubella, HIV, RPR/VDRL, Hep B
  4. Pap smear and culture gonorrhea and chlamydia
  5. Hemoglobinopathies and inherited disease
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45
Q

When is the fetal anatomy u/s conducted?

A

Between 18-22 weeks gestation

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46
Q

If a patient has a random 140 result is that a positive screen for GD?

A

yes

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47
Q

When is the pertussis vaccine given?

A

3rd trimester

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48
Q

GBS screening is done during what weeks of pregnancy?

A

35-37 weeks

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49
Q

How is hyperemesis gravidarum treated?

A
  1. Slow IV hydration
  2. Correct electrolyte disturbance
  3. anti-emetic vitamin b6 and doxylamine
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50
Q

What reverses the side effects of extrapyramidal movements related to Reglan

A
  1. Benadryl
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51
Q

Which of the following can be a complication of IV hydration in patients with hyperemesis gravidarum?

A

Worsening thiamine deficiency

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52
Q

What 3 ways are women screened for down syndrome?

A
  1. Free fetal DNA
  2. Integrated sequential contingency screening 11 weeks to 13 weeks and 6 days. Done as probability
  3. Quad screen 15 weeks and 22 weeks 6 days gestation
53
Q

If screening test are abnormal for down syndrome what are the two invasive test that are done?

A
  1. Chorionic villi sampling

2. amniocentesis

54
Q

What is considered reactive on a non stress test of the fetus?

A

Reactive = two accelerations of greater than 15 bpm lasting at least 15 seconds over a 20 minute time period.

55
Q

What is included in the biophysical profile

A
  1. Fetal movement
  2. Fetal tone
  3. Fetal breathing
  4. Ammonitic fluid
  5. Non stress test
56
Q

Biophysical profile can be used as confirmation the fetus is doing well in place of?

A
  1. A non reactive stress test
57
Q

A Biophysical score of >8 means

A
  1. Fetus is doing well
58
Q

A score of 6 is equivocal on a biophysical profile but also means

A

if the fetus is term delivery is warranted

59
Q

A score of <4 on a biophysical profile is concerning for what?

60
Q

A contraction stress test is negative if

A

Less than 50% of contractions are associated with late decelerations

61
Q

Umbilical artery doppler is done with

A

suspicion of fetal growth restriction

62
Q

Which of the following defines a POSITIVE contraction stress test?

A

If more than 50% of induced contractions are associated with late decelerations in the fetal heart rate over 10 minutes

63
Q

What are the 4 types of abortions before 20 weeks gestation?

A
  1. Threatened
  2. Incomplete
  3. Inevitable
  4. Missed
64
Q

How is threatened abortion managed?

A
  1. Expectant management
  2. medical care if vaginal bleeding or pelvic pain
  3. Rhogham if RH negative
65
Q

How is incomplete abortion managed?

A
  1. stable patient expectant management medically misoprostol or surgically
  2. Hemodynamic unstable patient: surgical d&C
66
Q

How is inevitable abortion managed?

A

Patients can be managed expectantly or medically or surgically if hemodynamically unstable

67
Q

How is missed abortion managed?

A

Can be managed medically or surgically

68
Q

How is spontaneous or complete abortion managed

A

should be confirmed by ultrasound and serial beta hcg

69
Q

What are complications of multiple fetus during pregnancy

A
  1. preterm labor
  2. twin-twin transfusion
  3. fetal growth restriction
  4. hypertensive disorders
  5. anemia
  6. GD
  7. malpresentation
  8. post partum hemorrhage
70
Q

how often should a women pregnant with multiples have an ultra sounds

A

every 2 weeks

71
Q

If embryonic division occurs 4-8 days from conception, what kind of twins are most likely to develop?

A

Monochorionic/ diamniotic twins

72
Q

If embryonic division occurs 0-4 days after conception, what kind of twins are most likely to develop?

A

Dichorionic/ diamniotic twins

73
Q

f embryonic division occurs in an implanted blastocyte 8-14 days after conceptions, what kind of twins are most likely to develop?

A

Monochorionic/ monoamniotic twins

74
Q

In a twin-twin transfusion, which of the following is most likely to be seen in the donor twin?

A

fetal growth restriction

75
Q

In what type of twin chronicity is the complication of twin-twin transfusion MOST likely to occur?

A

Monochorionic/ Diamniotic twins

76
Q

When should high risk women be screened for GD

A
  1. First trimester and again at 24-28 weeks
77
Q

What are high risk factors for screening women for GD twice?

A
  1. History of GD
  2. Obesity
  3. Advanced maternal age
  4. African American-Hispanic
  5. History of infant with macrosomia
78
Q

How many values need to be abnormal to screen positive for GD?

A

2 or more values

79
Q

Women with GD have a what percent risk of developing diabetes?

A

15-50% lifetime risk

80
Q

What is preeclampsia

A
  1. blood pressure >140/90 but <160/110
  2. protein/creatinine ratio of >0.3
  3. 24 hour urine protein >300
  4. Absence of severe features
81
Q

What is pre-eclampsia with severe features?

A 
Blood pressure >160/110
New onset cerebral or visual disturbance
pulmonary edema
HELLP Syndrome
Renal insufficiency
82
Q

What does HELLP syndrome stand for?

A
  1. Hemolysis
  2. Elevated liver enzymes
  3. Low platelets
83
Q

What is eclampsia

A
  1. HTN
  2. Proteinuria
  3. Seizures
84
Q

When is delivery recommended for gestational HTN

85
Q

How is pre-eclampsia with severe features managed/

A
  1. Magnesium sulfate
  2. Antihypertensive medications
  3. delivery if diagnosed after 34 weeks
86
Q

How is eclampsia treated?

A
  1. Stop seizures and stabilize the patient

2. deliver

87
Q

Magnesium sulfate is given to pregnant women for women for what reason

A
  1. 4 or 6 gram to load 2 g/h
    calcium channel blocker
    seizure prophylaxis
88
Q

What is the recommended dose of Alpha methyldopa for treatment of HTN disorders in pregnancy?

A

250-500 mg management of chronic HTN in pregnancy

89
Q

What is the recommended dose of Labetalol for management of HTN d/o in pregnancy

A

100-400 mg beta blocker management of HTN in pregnancy, acute

90
Q

What is the recommended dose of Nifedipine in pregnant women with HTN?

A

30-60 mg calcium channel blocker management of HTN in pregnancy, acute

91
Q

What is the recommended dosage of hydralazine for pregnant women with HTN D/O

A

5-10 mg acute and chronic management of HTN in pregnancy

smooth muscle relaxer

92
Q

Maternal side of the placenta is called?

A

Basal plate

93
Q

The fetal side of the placenta is called?

A

Chorionic plate

94
Q

The anatomy of the placenta is

A
  1. Placenta disc
  2. Membranes
  3. Three vessel umbilical cord
95
Q

What are the abnormal placental locations?

A
  1. Placenta previa
  2. placenta accreta
  3. Placenta increta
  4. Placenta
96
Q

Placenta located near or over the cervix?

A

Placenta previa

97
Q

Recommended method of delivery if a female has placenta previa

98
Q

What is placenta accreta?

A

Placental trophoblast invade to the myometrium.
absence of nitabuch;s
can be associated with placenta previa
placenta can be difficult to remove at the time of delivery

99
Q

Placenta increta

A

Placenta trophoblast invade through the myometrium

100
Q

How is placenta increta managed?

A

C section with hysterectomy

101
Q

Placenta trophoblast are through the serosa

A

placenta percreta

102
Q

How is placenta percreta managed

A

C-section hysterectomy with some placenta left in situ is the usual management

103
Q

Which of the following placental abnormalities is most associated with antepartum hemorrhage and fetal death

A

Placental previa

104
Q

Mentum posterior

A

chin is facing the ceiling

105
Q

Can face presentation be delivered vaginally?

106
Q

What is a frank breech

A

the fetal legs are straight

107
Q

what are the risk of vaginal delivery with a breech fetus

A
  1. Cord prolapse
  2. fetal head entrapment
  3. risk of fetal injury and death
108
Q

What is external cephalic version

A

done at 37 weeks, clinician turns the fetus manually

109
Q

Risks associated with external cephalic version

A
  1. placental abruption
  2. rupture of membranes
  3. cord prolapse
  4. fetal distress
  5. fetal hemorrhage
110
Q

symptoms of placenta previa

A
  1. painless vaginal bleeding
  2. do not perform digital exam
  3. deliver by c -section
111
Q

what is placental abruption?

A

placenta is separated from the uterus

112
Q

causes of placental abruption

A
  1. HTN
  2. Trauma
  3. Cocaine or tobacco use
  4. quick decompression of the uterus
113
Q

What can cause fetal growth restriction

A
  1. pre-pregnancy medical conditions
  2. substance abuse
  3. pregnancy related conditions
  4. multifetal gestation
  5. infections
114
Q

How is fetal growth restriction defined?

A

The estimated fetal weight by ultrasound is less than the 10ᵗʰ percentile for its gestational age

115
Q

What is the most common infectious cause for fetal growth restriction worldwide?

116
Q

In the case of fetal growth restriction, what other factor must be regularly monitored every three to four weeks in addition to monitoring interval fetal growth?

A

Amniotic fluid level

117
Q

What does TORCHES mean

A
  1. Toxoplasmosis
  2. Others-Varicella, Hep B, Hep C, GBS
  3. Rubella
  4. CMV
  5. Herpes, HIV
  6. Syphillis
118
Q

Rupture of membranes before 37 weeks of gestation

A

premature rupture of membranes.

119
Q

What are the psychiatric disorders associated with pregnancy>

A
  1. Post partum blues
  2. post partum depression
  3. post partum psychosis
120
Q

When does post partum usually onset

A

Birth 2 weeks after delivery

121
Q

What are risk factors for post partum depression?

A
  1. history of depression
  2. poor social support
  3. baby has health problems or another child
  4. Difficulty breast feeding
  5. Financial difficulties
122
Q

how many pregnancies does post partum depression occur

123
Q

When is the post partum scale administered?

A

From 2 weeks after delivery up to a year

124
Q

What is the treatment for post partum depression

A

psychotherapy

SSRI’s

125
Q

Symptoms of post partum depression

A

visual or auditory hallucinations

126
Q

What is the treatment for psychosis

A

treatment under a psychiatrist with antipsychotics

127
Q

How common is post partum psychosis

A

less than 1% of pregnancy

128
Q

When should tocolytics be used?

A

In the case of preterm premature rupture of membranes prior to 34 weeks gestational for up to 48 hours to allow administration of steroids

129
Q

Which of the following can be a complication of IV hydration in patients with hyperemesis gravidarum

A

Worsening thiamine (vitamin B1) deficiency

Neonate (6 decks)

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