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OBGYN > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Calculate EDD from LMP w/ Nagele’s rule

A

Subtract 3 months, add 7 days

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2
Q

Changes during pregnancy:

  • CO
  • SVR
  • HR
  • TV
  • TLC
  • PaCO2
A

Changes during pregnancy:

  • CO: increases 30-50%
  • SVR: decreases bc progesterone relaxes smooth muscles (resulting in decreased arterial BP)
  • HR: increases
  • TV: increases 30-40%
  • TLC: decreases 5% (bc diaphragm elevated)
  • PaCO2: decreases to facilitate gradient where O2 is delivered to fetus and CO2 goes back to mom
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3
Q

GI changes in pregnancy:

  • Gastric emptying
  • GE sphincter tone
  • large bowel motility
A

GI changes in pregnancy:

  • Gastric emptying: prolonged
  • GE sphincter tone: decreased (leads to reflux)
  • large bowel motility: decreased (leads to increased water reabsorption and constipation)
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4
Q

GRF increases, which leads to (increase/decrease) in BUN and Creatinine

A

GRF increases, which leads to (decrease) in BUN and Creatinine

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5
Q

Increased rate of thrombotic events is due to…?

A

elements of Virchow triad (increased venous stasis, vessel endothelial damage)

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6
Q

What is the purpose of hCG?

A

maintains corpus luteum in early pregnancy (corpus luteum produces progesterone, which maintains the endometrium)

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7
Q

What is the purpose of hPL?

A

ensures constant nutrient supply to the fetus (causes lipolysis –> increase in free fatty acids)

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8
Q

Elevated AFP suggests ____________ and decreased AFP suggests ___________

A
  • elevated AFP: NT defects

- decreased AFP: Down syndrome

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9
Q

(Lecithin/Sphingomyelin) increases as the lung matures, while (Lecithin/Sphingomyelin) decreases beyond 32 weeks

A

(Lecithin) increases as the lung matures, while (Sphingomyelin) decreases beyond 32 weeks

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10
Q

What are the 5 components of the biophysical profile?

A
  • amniotic fluid volume
  • fetal tone
  • fetal activity
  • fetal breathing movement
  • NST
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11
Q

Presentation of patient w/ ectopic pregnancy

A
  • sxs: unilateral pelvic pain, vaginal bleeding

- signs: tender adnexal mass, bleeding from cervix, hypotensive, peritoneal abdomen

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12
Q

Risk factors for cervical incompetence

A
  • hx cervical surgery (ie: cone bx, dilation of cervix)
  • hx cervical lacerations w/ vaginal delivery
  • uterine anomalies
  • DES exposure
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13
Q

Difference in presentation between cervical incompetence and PTL

A
  • incompetent cervix: presents w/ painless dilation

- PTL: painful contractions

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14
Q

Antiphospholipid antibody syndrome

A
  • autoimmune disorder where body makes antibodies that attack phospholipids (a type of fat found in blood vessels)
  • antibodies attack phospholipids –> damages blood vessels –> blood clots
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15
Q

2 common causes of recurrent pregnancy loss and treatments

A
  • antiphospholipid antibody syndrome (ASA)

- luteal phase defect (progesterone)

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16
Q

Sickle cell disease is an (AD/AR) disease caused by a _______ mutation in the gene for _____________

A
  • AR
  • point mutation
  • beta chain in Hgb
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17
Q

Symptoms of Tay Sachs Disease

A
  • loss of alertness
  • excessive reaction to noise (hyperacusis)
  • developmental delay
  • cherry red spot
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18
Q

Tay Sachs is due to a deficiency in what enzyme?

A

-Hexosaminidase A (enzyme responsible for degradation of Gm2 ganglioside)

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19
Q

CBC and Hgb electrophoresis findings for pt w/ beta thalassemia

A

CBC:

  • mild hemolytic anemia
  • low MVC

Hgb electrophoresis: increased alpha:beta ratio (Hgb A2)

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20
Q

Quad screen components

A

AFP, estriol, bhCG, inhibin

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21
Q

Edward syndrome

A
  • Trisomy 18
  • sxs: clenched fists, overlapping digits, rocker bottom feet, VSD, tetralogy of Fallot, omphalocele, congenital diaphragmatic hernia, NT defects, choroid plexus cysts
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22
Q

Patau syndrome

A
  • Trisomy 13
  • sxs: holoprosencephaly, cleft lip and palate, cystic hygroma, omphalocele, hypoplastic left heart, clubfoot, polydactyly, overlapping fingers
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23
Q

Progression of ova through fertilization

A

egg –> combines w/ sperm –> morula –> blastocyst (inner cell mass and outer cell layer ) –> embryo and trophoblast –> trophoblast differentiates into cytotrophoblast and syncytiotrophoblast (placenta) and embryo differentiates into epiblast –> ectoderm, endoderm, mesoderm

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24
Q

What serum factor is elevated in spina bifida?

A

AFP (open tube leads to AFP crossing into maternal serum)

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25
Q

The bulbus cordis (caudal section of heart tube) forms:

  • proximal third –>
  • midportion (cous cordis) –>
  • distal segment (truncus arteriosus) –>
A
  • proximal third –> trabeculated part of R. ventricle
  • midportion (cous cordis) –> outflow tracts of ventricles
  • distal segment (truncus arteriosus) –> proximal portion of aorta and pulmonary artery
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26
Q

Eisenmenger physiology

A

-VSD that doesn’t get repaired –> RVH, pulmonary HTN, R–>L shunt

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27
Q

Tetralogy of Fallot

A
  • VSD w/ overriding aorta
  • pulmonary stenosis
  • RVH
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28
Q

The kidneys are formed from the…

A

intermediate mesoderm

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29
Q

The mesonephros create the…

A 
mesonephric duct (wolffian duct)
-in the presence of testosterone, also creates the vas deferens, epididymis, ejaculatory duct, seminal vesicles
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30
Q

The ureteric bud creates the…

A

collecting tubules, calyces, renal pelvis, ureter

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31
Q

The metanephros creates the…

A

kidney

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32
Q

Levels of AFP, Estriol, and B-hCG in…

  • Trisomy 21
  • Trisomy 18
  • Trisomy 13
A
  • Trisomy 21: decreased, decreased, increased
  • Trisomy 18: decreased, decreased, decreased
  • Trisomy 13: depends
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33
Q

When might PUBS be useful?

A
  • to obtain fetal Hct (in setting of Rh alloimmunization, fetal anemia, etc.)
  • rapid karyotype analysis
  • transfuse fetus in cases of fetal anemia
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34
Q

Fetal diagnosis in the first trimester is by _________, which obtains ____________ cells. Fetal diagnosis in the second trimester is by ___________, which obtains ___________ cells.

A

-1st trimester: CVS, trophoblastic cells (from placenta)

2nd trimester: amniocentesis, fetal cells in amniotic fluid

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35
Q

Causes of baby being small for gestational age

A
  • decreased growth potential: congenital abnormalities, intrauterine infxns (CMV, rubella), teratogens (alcohol, cigarettes)
  • IUGR (maternal risk factors: HTN, anemia, renal disease, APLA syndrome, SLE, malnutrition; placental factors: previa, marginal cord insertion, placental thrombosis; multiple gestations)
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36
Q

Risk factors for macrosomic infants

A
  • DM
  • maternal obesity
  • post-term pregnancy
  • previous LGA or macrosomic infant
  • multiparity
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37
Q

Fetal hydrops

A
  • Rh+ moms have IgG Abs that cross placenta –> hemolysis –> anemia –> extramedullary fetal RBC production
  • hyperdynamic state, HF, diffuse edema, ascites, pericardial effusion
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38
Q

What is a Kleihauer-Betke test?

A

tests for amount of fetal RBCs in maternal circulation (for Rh incompatibility)

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39
Q

What is the risk of a retained IUFD?

A

DIC (fetus releases thromboplastic substances –> hypofibrinogenemia)

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40
Q

What twin type is most likely to develop twin-to-twin transfusion syndrome?

A

monochorionic (one placenta) diamniotic (two amniotic sacs)

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41
Q

Pathogenesis of different types of twins

A
  • Di-Di (days 1-3): separation before differentiation of trophoblasts
  • Mo-Di (days 3-8): separation after trophoblast differentiation and before amnion formation
  • Mo-Mo (days 8-13): division after amnion formation
  • Conjoined twins (days 13-15)
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42
Q

What is the pathophysiology of preeclampsia?

A

involves generalized arteriolar constriction (vasospasm) and intravascular depletion secondary to a generalized transudative edema

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43
Q

How is uteroplacental insufficiency caused in pre-eclampsia?

A

vasoconstriction –> decreased blood flow to placenta

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44
Q

What labs are associated with acute fatty liver of pregnancy?

A
  • elevated ammonia
  • BG <50
  • reduced fibrinogen and anti-thrombin III
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45
Q

How do you stabilize a pt w/ severe pre-eclampsia?

A
  • magnesium sulfate (seizure ppx)

- hydralazine (direct arteriolar dilator) or labetalol (beta and alpha blockade) for BP control

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46
Q

What treatment can help pts w/ HELLP syndrome to avoid post-partum thrombocytopenia?

A

corticosteroids

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47
Q

What do you give in the context of Mg overdose for pre-eclampsia?

A

calcium chloride (for cardiac protection)

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48
Q

labetalol

A

BB w/ concomitant alpha blockade

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49
Q

nifedipine

A

peripheral CCB

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50
Q

Why do pregnant women experience GMD?

A

placenta produces hPL –> hPL acts as anti-insulin agent –> increased insulin resistance and carb intolerance

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51
Q

Common BV organisms

A
  • Gardnerella vaginosis
  • Bacteroides
  • Mycoplasma hominis
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52
Q

Group B strep is responsible for…

A
  • UTIs
  • chorioamnionitis
  • endomyometritis
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53
Q

Who is treated w/ penicillin for GBS?

A
  • people who swab positive
  • women w/ unknown GBS status who labor before 37 weeks
  • women w/ >18hr ROM
54
Q

What is chorioamnionitis?

A
  • infxn of membranes and amniotic fluid surrounding the fetus
  • can cause neonatal sepsis and maternal endomyometritis and septic shock
55
Q

What is the most sensitive screening test for chorioamnionitis?

A

IL-6 levels in amniotic fluid that rise prior to changes in other screening tests

56
Q

What type of virus is VZV?

A

-DNA herpes virus

57
Q

What is parvovirus B19 associated with at different stages of pregnancy?

A
  • 1st trimester: miscarriage

- mid-trimester and later: fetal hydrops (attacks fetal erythrocytes –> hemolytic anemia, hydrops, death)

58
Q

Infant sxs of CMV

A

hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis

59
Q

Maternal sxs of rubella

A

maculopapular rash, arthritis, arthralgias, diffuse LAD

60
Q

Infant sxs of rubella

A

deafness, cardiac abnormalities, cataracts, mental retardation

61
Q

Virchow’s triad

A
  • increased coagulation factors
  • endothelial damage
  • venous stasis
62
Q

In pregnancy, the production of clotting factors is (increased/decreased), turnover time for fibrinogen is (increased/decreased), and there are (increased/decreased) levels of circulating fibrin.

A

In pregnancy, the production of clotting factors is (increased), turnover time for fibrinogen is (decreased), and there are (increased) levels of circulating fibrin.

63
Q

How do you treat prophylactically for DVT in pregnancy?

A

IV heparin –> subQ heparin or LMWH (Lovenox)

-Lovenox –> unfractionated heparin at 36wks bc Lovenox has long half-life and increased risk of epidural hematoma

64
Q

What are the infants of moms w/ Graves disease at risk of?

A

fetal goiter (Graves is result of thyroid-stimulating immunoglobulin)

65
Q

What causes high rates of early pregnancy loss in the first and second trimesters for women with SLE or APLA?

A

placental thrombosis

66
Q

How do you tell the difference between a lupus flare and pre-E?

A
  • pts w/ lupus have reduced C3 & C4, pre-E have nml levels
  • lupus flares are accompanied by an active urine sediment whereas pre-E is not
67
Q

What are sxs of fetal alcohol syndrome?

A
  • growth retardation
  • CNS effects
  • abnml facies
  • cardiac defects
68
Q

Cocaine use in pregnancy is associated with increased risk of…

A

abruption placentae, IUGR, preterm labor and delivery

69
Q

Common causes of PPH

A
  • uterine atony
  • retained POCs
  • placenta accrete (superficial invasion into myometrium)
  • cervical lacerations
  • vaginal lacerations
70
Q

How do you distinguish a lupus flare from preeclampsia?

A

Obtain complement levels (decreased C3, C4 signal lupus flare)

71
Q

What is the classic triad of pre-eclampsia?

A
  • HTN
  • proteinuria
  • nondependent edema in the face and hand
72
Q

During pregnancy, what happens to…?

  • MAP
  • CO
  • SVR
A
  • MAP: decreases
  • CO: increases (bc HR increases)
  • SVR: decreases
73
Q

Why does Hgb decrease in pregnancy?

A

because Hgb = RBC/plasma and RBCs increase but plasma increases a lot

74
Q

How do you treat endometritis/chorioamnionitis?

A

Amp, gent, clinda

75
Q

What is the biggest cause of placenta abruption?

A

maternal HTN (followed by prior hx of abruption, AMA, multiparity, cocaine abuse, vascular disease)

76
Q

How does ITP affect the fetus?

A

IgG antibodies cross placenta –> destroy fetal platelets

77
Q

What increases susceptibility to pulmonary edema in pregnancy?

A

decreased plasma osmolality

78
Q

What are common causes of acute pulmonary edema in pregnancy?

A

tocolytics, cardiac disease, fluid overload, pre-E

79
Q

In pregnancy, TBG (increases/decreases) because of circulating ____________ and an increase in ________________

A

increases, estrogen, total thyroxine

80
Q

After a molar pregnancy has been identified, what is the appropriate next step/test?

A

CXR (most likely to metastasize to lungs)

81
Q

In people who are Black, what preconception screening is recommended?

A

Hgb electrophoresis and CBC

82
Q

What are some examples of diseases that occur with an increased incidence in Ashkenazi Jews?

A
  • Fanconi anemia
  • Tay-Sachs disease
  • Cystic Fibrosis
  • Niemann-Pick
83
Q

Chorionic villous sampling can be used to detect…

A
  • fetal chromosomal abnormalities

- biochemical or DNA-based mutations

84
Q

What is the difference between placenta previa and vasa previa?

A

Both present with painless vaginal bleeding >20 weeks gestation but vasa previa leads to rapid deterioration in FHR

85
Q

Why does pre-E cause fetal growth restriction/low birth weight?

A

chronic uteroplacental insufficiency

86
Q

What are first line drugs for treating HTN in pts w/ pre-E?

A 
IV hydralazine (vasodilator)
IV labetalol (alpha-blocking BB)
oral nifedipine (CCB)
87
Q

Difficulty ambulating, radiating suprapubic pain, pubic symphysis tenderness, and an intact neuro exam suggest…

A

pubic symphysis diastasis

88
Q

What are risk factors for pubic symphysis diastasis?

A

fetal macrosomia, multiparity, precipitous labor, operative vaginal delivery

89
Q

In neonatal thyrotoxicosis, there is transplacental passage of maternal ___________, which bind to the infant’s ____ receptors and cause excessive thyroid hormones

A
  • TSH receptor antibodies

- TSH receptors

90
Q

How does oxytocin toxicity present?

A

hyponatreia, hypotension, tachysystole, seizure

91
Q

What is the most common inherited form of intellectual disability?

A

Fragile X

92
Q

How should placenta previa be managed?

A

no sex, no digital cervical exam, inpatient admission for bleeding

93
Q

Pregnancy results in a (acute/chronic) (respiratory/metabolic) (acidosis/alkalosis) (with/without) compensation

A

chronic respiratory alkalosis with metabolic compensatin

94
Q

___________ stimulates the respiratory centers to (increase/decrease) TV and MV

A

progesterone, increase

95
Q

The prothrombotic state in pregnancy is created because of a hormone-mediated (increase/decrease) in ________ and (increase/decrease) in fibrinogen and coagulation factors

A

decrease in protein S, increase in fibrinogen and coagulation factors

96
Q

Mild hyponatremia occurs because…

A

hormones reset threshold to increase ADH release from pituitary

97
Q

Lactation failure, amenorrhea, fatigue, bradycardia, weight loss, hypotension, and decreased lean body mass can be sxs of…

A

Sheehan syndrome

  • decreased prolactin (lactation failure)
  • decreased FSH, LH (amenorrhea, hot flashes, vaginal dryness)
  • decreased TSH (fatigue, bradycardia)
  • decreased ACTH (anorexia, weight loss)
  • decreased growth hormone (decreased lean body mass)
98
Q

Patients with dehydration present with …

A

maternal tachycardia, ketonuria

99
Q

How do you treat a woman with hx of neonate with early onset GBS?

A

intrapartum antibiotic prophylaxis (no need for cultures)

100
Q

What bacteria cause endometritis?

A

polymicrobial (anaerobes and aerobes; staph and strep)

101
Q

What is the most common abnormal karyotype seen in SABs?

A

autosomal trisomy

102
Q

When should women with risk factors for DM be screened during pregnancy?

A

at their first visit

103
Q

What is someone with a history of depression or psychiatric illness at greatest risk for post-partum?

A

postpartum depressio

104
Q

What effects can maternal use of SSRIs have on neonates?

A
  • abnormal muscle mvmts (EPS)

- withdrawal sxs (agitation, change in muscle tone, tremor, sleepiness, difficulty breathing and feeding)

105
Q

Proper follow-up after surgical abortion includes…

A

IV antibiotics (doxycycline)

106
Q

ABO incompatibility typically occurs between a mom with _____ blood type and an infant with ____ blood type

A

mom: O
baby: AB

107
Q

Obesity in pregnancy increases the risk of…

A
  • chronic HTN
  • GDM
  • pre-E
  • fetal macrosomia
  • C/S
  • postpartum complications
108
Q

What SSRI should not be used in pregnancy and why?

A

paroxetine: increased risk of fetal cardiac malformations and persistent pulmonary HTN

109
Q

What is the best test for noninvasive diagnosis of fetal anemia?

A

middle cerebral artery peak systolic velocity

110
Q

What are Lewis antibodies?

A

IgM antibodies that do not cross placenta (so not associated with isosensitization)

111
Q

Recurrent pregnancy loss and transient ischemic attacks suggest…

A

APLA syndrome

112
Q

At what gestational age is the fetus most at risk for microcephaly and brain damage?

A

8-15 weeks

113
Q

___________ mutation is associated with obstetric complications, including stillbirth, pre-E, placental abruption, and IUGR

A

factor V leiden

114
Q

_____________ during pregnancy is associated with NT defects and polyhydramnios

A

uncontrolled DM

115
Q

What happens to the liver in HELLP syndrome?

A

process can cause liver swelling and distension of hepatic capsule –> RUQ or epigastric pain

116
Q

How does HELLP syndrome differ from fatty infiltration of the liver?

A
  • Acute fatty liver of pregnancy: n/v, abdominal pain, elevated liver markers, leukocytosis, hypoglycemia, AKI
  • HELLP: severe HTN
117
Q

A nonreactive NST requires further testing with a…

A

biophysical profile

118
Q

Wernicke encephalopathy is a complication of ____________ due to __________ deficiency

A
  • hyperemesis gravidarum

- thiamine

119
Q

What is the most common explanation for an increased AFP?

A

underestimation of gestational age

120
Q

How do you treat asymptomatic bacteria in the first trimester?

A

amoxicillin-clavulonate

121
Q

Increasing lower abdominal pain, nausea, scant bleeding, fever, tender uterus, 8mm endometrial stripe two days post-op from D&C suggest…

A

uterine perforation

122
Q

Insulin-dependent diabetes increases the risk of…

A

spontaneous abortion & major congenital malformations

123
Q

When can amniocentesis be done and when can CVS be done?

A
  • amniocentesis: 10-13 weeks

- CVS: 15-20 weeks

124
Q

Is syphilis tested for in pregnancy and, if so, when?

A

yes - universally in 1st trimester

125
Q

How is postpartum endometritis treated?

A

clindamycin & gentamycin

126
Q

How should symptomatic mitral valve prolapse be treated in pregnancy?

A

beta-blocker

127
Q

How do you treat cholestasis of pregnancy?

A
  1. antihistamines, topical emollients

2. urosdeoxycholic acid

128
Q

How do you distinguish between normal nausea & vomiting of pregnancy and hyperemesis gravidarum?

A

hyperemesis gravidarum has ketones on UA

129
Q

How do you further work up a non-reactive NST?

A

biophysical profile

130
Q

How can OCPs affect breastfeeding women?

A

delayed uterine involution

OBGYN (5 decks)

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