Pregnancy

Question 1

A 26 yr old came on active First stage of labor FHR tracing on admission is category 1. Rupture of membranes results in bright red amniotic fluid. Current fetal monitoring is shown to have sinusoidal pattern. The most likely cause is?

Answer 1

Fetal blood loss from ruptured vasa previa. Sinusoidal FHR tracing is considered category lll and indicates severe fetal anemia.
Urgent CS is indicated.

Question 2

A pregnant woman >35 yrs r advised to undergo screening test for chromosomal abnormalities. This test is?

Answer 2

Cell-free fetal DNA testing- non invasive, at >10 wks of gestation. If abnormal, it is confirmed by fetal karyotyping ( chorionic villi sampling or amniocentesis)

Question 3

Indomethacin is given to a 27yr old primigravida at 25wks gestation with preterm labor.
Indication?
Complication?

Answer 3

For tocolysis in preterm labor <32 wks of gestation.
- oligohydramnios(amniotic fluid index<5cm) - because of premature closure of the ductus, renal perfusion decreases-> oligo

Question 4

Pregnant patients with hx of cervical surgery ( eg cold knife conization) are at increased risk for preterm labor. The gold standard method for further evaluation of their risk is?
If short cervix(<2cm) is detected before 24wks gestation, the best next step in the mx is?

Answer 4

Transvaginal ultrasound measurement of cervical length

- mx- IM progesterone which maintains uterine quiescence

Question 5

A pregnant woman comes with new onset hyperandrogenism .

U/S shows bilateral ovarian solid masses. Mx is?

Answer 5

Observation n expectant mx.
This usually occurs due to benign bilateral ovarian masses such as luteomas( solid masses) or theca lutein cysts( cystic masses)
Sxs n masses regress spontaneously after delivery

Question 6

A38 yr old primigravida comes at 12 wks gestation with elevated BP >140/90 measured at two different occasions. Urine dipstick is negative for protein and glucose. U/s shows intrauterine px consistent with dates.
Dx?

Answer 6

Chronic hypertension

Gestational htn n preeclampsia r diagnosed after 20wks

Question 7

The expected ABG analysis during px is?

Answer 7

Chronic respiratory alkalosis with metabolic compensation. Because progesterone increases tidal volume, minute ventilation and PaO2

Question 9

Cervical circlage is done in which pts?

Answer 9

Prior preterm delivery secondary to cervical insufficiency or short cervix(<2.5cm) on ultrasound

Question 10

A 27 yr old primigravida came at 14wks gestation. U/s shows 2 intrauterine fetal poles. Any prophylaxis needed?

Answer 10

Low dose aspirin is given starting from 12-28 wks gestation throughout px as a prophylaxis for preeclampsia as multiple px is one of the risk factors for preeclampsia. Other risk factors include chronic htn, DM, CKD, autoimmune diseases, prior preeclampsia

Question 10

When is Screening for GDM performed? What test is done?

Answer 10

24 to 28 weeks of gestation.

Most commonly 1st 1 hour 50g GCT( glucose challenge test) followed by confirmation with a 3hr 100g GTT.

Question 10

The major risk factor for preterm delivery is?

Prevention, mx?

Answer 10

Hx of previous preterm delivery.
IM progesterone is given during the second n third trimesters
- serial cervical length measurements by transvaginal u/s should b performed in the second trimester n circlage should b considered if a short cervix is identified.

Question 11

Is hepC screening routinely done during px?

Answer 11

No , only those with risk factors r screened ( eg HIV pts)

Question 12

Late term(>41 wks gestation) or post term pregnancy with oligohydramnious ( single pocket <2cm) or late deceleration on non stress test 
What’s the best next step in the mx?

Answer 12

Induction of labor( if no contraindications)

Question 13

A 27yr old primigravida came with absent fetal movements at her 28 wks gestation. Fundal height is 24 cm. Fetal heart tones r not heard by Doppler
The most appropriate next step is?

Answer 13

Trans abdominal ultrasound should be done to confirm the dx of fetal demise(IUFD)

Question 14

A 33 yr old multigravida undergoes induction of labor at 39wks for new onset hypertension. she is obese n has gained 13.6kg during the px. After 2 hrs of pushing, the fetal head delivers and retracts into the maternal perineum. The greatest risk factor for her condition is?

Answer 14

Shoulder dystocia
Maternal weight is a major risk factor in this case.
Other conditions predisposing to fetal macrosomia such as DM, post term px r also responsible

Question 16

IUFD associated with multiple limb fractures, shortened femur, hypoplastic thoracic cage is ?

Answer 16

Osteogenesis imperfecta

Question 17

A 36 yrs at 29wks gestation came with clear vaginal discharge. Speculum shows clear fluid in the posterior fornix that increases with valsalva. Microscopy shows ferning n squamous epithelial cells with no stippling.this pt is at increased risk of
A) placenta acreta b) p previa c) p abruption
D) uterine rupture

Answer 17

Placental abruption!
Dx is preterm PROM
Other complications include infection, cord prolapse, preterm labor

Question 18

Asymmetric Vs symmetric fetal growth restrictions - etiologies

Answer 18

Asymmetric( abdominal growth restriction more pronounced than head) - second or third TM placental insufficiency eg., hypertension
Symmetric FGR- congenital disorders or first trimester infections.
FGR is defined as estimated fetal wt <10 percentile for gestational age.

Question 19

Polyhydramnios mx

• severe or symptomatic at preterm gestation
• mild, asymptomatic at term

Answer 19

• severe or symptomatic at preterm gestation - amnioreduction (removal by amniocentesis) because of increased risk of complication
• mild, asymptomatic at term- expectant mx
  Polyhydramnios Definition - amniotic fluid index >24cm or deepest vertical pocket >8cm.

Question 20

Administration of magnesium sulfate in a preeclamptic/eclamptic pt with an elevated baseline creatinine level may result in?

Answer 20

Magnesium toxicity- because it’s solely excreted by the kidneys pts with renal insufficiency r at increased risk of toxicity
Rx - stop infusion n give calcium gluconate.

Question 21

What r the indications for intrapartum group B strept prophylaxis regardless of the 36th-38th wk screening results ( even without doing it)

Answer 21

1) prior infant with early onset neonatal sepsis ( because EONS r most likely due to GBS)
2) GBS bacteruria or GBS UTI in the current pregnancy.