Pregnancy 3

Question 1

A 33 yr old at 29 wks gestation comes with rt sided abdominal pain since yesterday. Pain has increased in severity n has nausea n vomiting. Abdomen is tender to palpation, the uterus has fundal tenderness n an associated firm, tender mass. Leukocyte-19,000
The most likely dx?

Answer 1

Uterine fibroid degeneration - because myometrial blood flow shifts toward the developing fetus n placenta, infarction n degeneration of fibroids can occur
Mx- conservative with acute pain control ( indomethacin for <32wks)

Question 2

Magnesium sulfate toxicity treatment

Answer 2

Cessation of magnesium sulfate and initiation of calcium gluconate

Question 3

A pt developed seizure after repeated administration of oxytocin postpartum. The cause is?

Answer 3

Oxytocin induced hyponatremia, a rare but serious complication of oxytocin.

Question 4

A 1hr old boy delivered vaginally to a 26yr old, no prenatal follow up. He has multiple contractures, rt club foot, hypotonia and microcephaly
CT- thin cerebral cortices, intracerebral calcifications.
Dx?
Risk factor?

Answer 4

Congenital zika syndrome
Zika virus( flavivirus group)
Travel to a tropical, mosquito-infested region is a risk factor, as Aedes mosquito can transmit the infection. It’s also transmitted sexually

Question 5

Intrauterine synechiae is? Clinical presentation?

Answer 5

AKA asherman syndrome- is scaring and adhesion of the endometrial cavity which occurs as a complication of intrauterine surgeries. Pts present with amenorrhea, infertility and negative progesterone withdrawal test.

Question 6

Intimate partner violence screening is done during which postpartum weeks?
For which pts is it recommended?

Answer 6

3-6 weeks after delivery.

Every postpartal women

Question 7

The most common cause of a nonreactive nonstress test( eg no acceleration) is?

Answer 7

Quiet fetal sleep

Question 8

During delivery of the placenta excessive traction on the cord caused avulsion and the placenta is manually extracted. Then u/s shows a thin endometrial stripe. After an hour, pt develops pph. Uterus is boggy
Cause of pph is?

Answer 8

Uterine Antony.

Thin endometrial stripe suggests an empty, normal uterus- retained tissue is ruled out

Question 8

Modes of delivery of a breech presentation

Answer 8

Typically c/s is done at term.
For those who don’t want to have c/s, ECV(external cephalic version) is offered after 37wks. But, if they have contraindications for vaginal delivery like previous c/s especially classical, … c/s is the preferred one.

Question 9

Lactational mastitis Vs breast engorgement

Answer 9

• Lactational mastitis - flue like sxs, unilateral breast pain with a focal area of erythema and tenderness
• breast engorgement- bilateral fullness , diffuse tenderness n erythema

Question 10

Inevitable abortion mx

Answer 10

Hemodynamically stable, minimal bleeding- expectant or medical( eg misoprostol)
Hemodynamically unstable- surgical eg. Suction curettage

Question 11

Bilateral hydronephrosis in a pregnant lady is most suggestive of?

Answer 11

Physiologic hydronephrosis of pregnancy.

Pts can have back, groin pain; urinary frequency, nocturia as part of normal px ( don’t be fooled by the sxs)

Question 12

The optimal fetal position during labor in a cephalic presentation is? If it deviates from this position the risk of — increases

Answer 12

Occiput anterior position

Deviations eg, occiput transverse- can cause second stage arrest secondary to cephalic-pelvic disproportion

Question 13

In a laboring mom with previous c/s, intense abdominal pain, vaginal bleeding, FHR tracing abnormalities, loss of fetal station( eg from 0 to -3), irregular protuberance r indicative of?

Answer 13

Uterine rupture.

Placental abruption- loss of station n fetal parts palpation( irregular protuberance) r unlikely

Question 14

Complications associated with short interpregnancy interval( <6-18months between delivery n next pregnancy) include?

Answer 14

Preterm PROM, preterm labor, low birth wt, maternal anemia

Question 16

A pt at 37 wks gestation is laboring and has a taut, bulging bag with no palpable presenting fetal part on cervical examination
The best next step in the mx is?

Answer 16

Trans abdominal u/s should b done to determine the fetal presentation and the safest route of delivery. ( if cephalic- expectant mx, if breech- c/s)

Question 17

Light brown, irregularly shaped macules on the bilateral cheeks n nasal bridge sparing the nasolabial folds in a pregnant lady is consistent with? Any further testing ?

Answer 17

Melasma

No further testing needed

Question 18

A 23 yr old woman comes with a complaint of decreased fetal movement. She has had fatigue n joint stiffness for the past one month. On p/e, she has erythematous confluent facial rash. FHR tracing shows persistent bradycardia
The most likely cause of this FHR tracing is?

Answer 18

Fetal AV block secondary to SLE
( fatigue, jt stiffness, malar rash)
Neonatal lupus occurs due to passive transfer of autoantibodies through the placenta.
Prolonged complete heart block can lead to cardiomyopathy n fetal hydrops

Question 19

A 1 day old boy is brought with Horner syndrome and claw hand. Delivery was complicated by shoulder dystocia. Which nerves r affected?

Answer 19

C8 n T1

Question 20

A 32 yr old primigravida comes at 18 wks gestation with increasing confusion n incoherence. She has become very unsteady while standing n has fallen twice. She also has nystagmus. Her pregnancy is complicated by hyperemesis gravidarum. Cause of her current condition is?

Answer 20

Thiamine deficiency => wernicke encephalopathy

Question 21

A laboring mother who has been given neuraxial anesthesia is having protracted cervical dilation(<1cm every 2hrs). The most likely cause is?
A) neuraxial anesthesia. B) CPD

Answer 21

CPD - is one of the commonest causes of active phase protraction.
- neuraxial anesthesia lengthens the second stage of labor, not AFSOL