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Step 2 CK: Obstetrics & Gynecology > Pregnancy, Childbirth & Puerperium > Flashcards

Pregnancy, Childbirth & Puerperium Flashcards

1
Q

Clinical Manifestation:

  1. Painful third-trimester vaginal bleeding
  2. hypertonic uterus
A

Abruptio placentae (placental abruption)

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2
Q

What are the common risk factors for placental abruption?

A
  1. maternal hypertension
  2. smoking
  3. cocaine

These things can cause placental hypoperfusion and hemorrhage in the decidua basalis.

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3
Q

Define preeclampsia.

A

New-onset hypertension AND proteinuria OR end-organ damage at >/= 20 weeks gestation.

proteinuria= >/=300 mg/24hr, protein/creatinine ratio >/= 0.3, or dipstick of >/=1+

end-organ damage= severe headache, persistent right upper quadrant or epigastric pain, renal insufficiency, pulmonary edema

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4
Q

What are signs of end-organ damage in preeclampsia?

A
  1. severe headache
  2. right upper gastric or epigastric pain
  3. renal insufficiency
  4. pulmonary edema
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5
Q

What is considered elevated blood pressure or hypertension in a pregnant woman?

A

systolic BP >/= 140 mmHg

diastolic BP >/=90 mmHg

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6
Q

What are the severe features of preeclampsia?

A
  1. BP >/= 160mmHg systolic or 110 mmHg diastolic on 2 occasions greater than 4 hours apart on bed rest
  2. Thrombocytopenia 1.1mg/dL OR doubling of serum creatinine
  3. Elevated transaminases
  4. Pulmonary edema
  5. New-onset visual or cerebral symptoms
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7
Q

Treatment:

Hypertensive emergency in pregnancy

A
  1. Labetalol IV
  2. Hydralazine IV
  3. Nifedipine PO
  4. Magnesium sulfate to prevent seizures if patient is preeclamptic

Hypertensive emergency= systolic BP >/= 160 mmHg and/or diastolic BP >/= 110 mmHg persisting for >/= 15 minutes

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8
Q

Treatment:

Seizure protection in preeclamptic patients

A

magnesium sulfate

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9
Q

Definition:

Threatened abortion

A

Threatened abortion is characterized by any hemorrhage occurring before the 20th week of gestation with a live fetus and a closed cervix.

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10
Q

Treatment:

Threatened abortion

A

Reassurance and outpatient follow up is standard of care for threatened abortion.

Note, you can suggest that patients take bed rest and abstain from sex in case a complete abortion occurs, but there is no evidence to support these are preventative measures.

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11
Q

Pathophysiology:

Klumpke palsy

A

Injury to the 8th cervical and 1st thoracic nerve resulting in hand paralysis and ipsilateral Horner syndrome (miosis & ptosis).

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12
Q

What is a rare, but potentially permanent complication of shoulder dystocia?

A

Klumpke palsy “claw hand”

Other complications of shoulder dystocia include: fractured clavicle, fractured humerus, Erb-Duchenne palsy & perinatal asphyxia.

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13
Q

Diagnosis:

  1. vaginal bleeding
  2. fluid discharge
  3. lower abdominal cramps
  4. dilated cervix
  5. products of conception visualized through cervix
A

Inevitable abortion

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14
Q

What is the work-up for decreased fetal movement?

A
  1. Nonstress test (NST)
  2. Contraction stress test (CST)
  3. Biophysical profile

Do #2 & 3 if one is nonreactive. Also contraction stress test should only be done when there are no contraindications to labor.

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15
Q

How should a patient with a normal contraction stress test be managed?

A

Repeat antepartum fetal testing in 1 week

A normal CST indicates that fetal compromise is unlikely.

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16
Q

Diagnosis:

  1. sudden onset of abdominal pain
  2. fetal heart rate abnormalities
  3. recession of the fetal station during active labor
A

uterine rupture

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17
Q

What are some risk factors for uterine rupture.

A
  1. pre-existing uterine scar

2. abdominal trauma

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18
Q

Diagnosis:

Intrauterine fetal demise (IUFD)

A

ultrasonography

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19
Q

When should an autopsy be performed on a stillborn fetus?

A

Autopsy of the fetus and placenta should be performed in all cases of stillbirth with the permission of the parents.

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20
Q

Treatment:

Preterm premature rupture of membranes (PPROM)

A
  1. Penicillin prophylaxis if maternal GBS status is unknown
  2. Delivery is recommended for babies >34 weeks with PPROM; the risks of continued expectant management outweight the risks of prematurity at this point
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21
Q

What are the two most common causes of hyperandrogenism in pregnancy?

A
  1. Luteoma

2. Theca luteum cysts

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22
Q

Diagnosis:

  1. new onset hirsutism and acne in a pregnant woman
  2. solid mass on ultrasound
A

Luteoma

These can induce virilization in female fetuses!

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23
Q

Diagnosis:

  1. new onset hirsutism and acne in a pregnant woman
  2. bilateral ovarian cysts on ultrasound
A

Theca leuteum cyst

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24
Q

Treatment (maternal):

Luteoma

A

no maternal treatment warranted

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25
Q

Treatment (maternal):

Theca luteum cysts

A
  1. Ususally, no maternal treatment warranted

2. Suction curettage if the underlying cause is molar pregnancy

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26
Q

Diagnosis:

grand-mal seizures in the setting of preeclampsia

A

Eclampsia

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27
Q

Treatment:

Eclampsia

A

Magnesium sulfate

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28
Q

Treatment:

preeclampsia-eclampsia syndrome

A
  1. stabilize the patient
  2. initiate seizure and stroke treatment as indicated
  3. proceed with delivery
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29
Q

What complications are associated with pregnancy for women with a current or previous diagnosis of anorexia nervosa?

A
  1. Intrauterine growth retardation
  2. hyperemesis gravidarum
  3. miscarriage
  4. premature birth
  5. cesarean delivery
  6. postpartum depression
  7. osteoporosis (maternal)
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30
Q

What is the earliest sign of magnesium sulfate toxicity?

A

Depression of the deep tendon reflexes

The second sign of magnesium toxicity is respiratory depression.

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31
Q

Treatment:

Magnesium sulfate toxicity

A
  1. Stop Magnesium sulfate

2. Replace w/ calcium gluconate

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32
Q

Diagnosis:

Painless third-trimester vaginal bleeding

A

Placenta previa

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33
Q

What causes early decelerations?

A

Fetal head compression followed by a vagal response

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34
Q

Fetal heart traces showing variability and late deceleration indicate what risks?

A
  1. hypoxemia

2. acidosis

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35
Q

What are the physiological effects of pregnancy on the pulmonary system?

A
  1. Increased Tidal Volume
  2. Increased Minute Ventilation
  3. Increased PaO2
  4. Chronic compensated respiratory alkalosis
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36
Q

Pathology:

normal hyperventilation of pregnancy

A

elevated progesterone > stimulation of the medullary respiratory center in the brain > increased tidal volume and minute ventilation

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37
Q

Diagnosis:

stillborn baby with

  1. limb deformities
  2. growth retardation
  3. multiple fractures
  4. blue sclerae
A

Type I Osteogenesis Imperfecta

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38
Q

What is the genetic inheritance associated with osteogenesis imperfecta?

A

Autosomal dominant

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39
Q

Pathogenesis:

Osteogenesis imperfecta

A

mutation in type I collagen

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40
Q

Clinical Manifestations:

Severe type II Osteogenesis imperfecta

A

These babies have multiple intrauterine or perinatal fractures and typically die in utero.

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41
Q

Diagnosis:

Urine Analysis in Glomerulonephritis

  1. Protein?
  2. Blood?
A
  1. proteinuria
  2. hematuria
  3. RBC casts
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42
Q

Diagnosis:

Systemic Lupus Erythematosus in pregnancy

A
  1. massive proteinuria
  2. malar rash
  3. strongly positive ANA titer
  4. hypertension
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43
Q

What is the one absolute infant contraindication to breastfeeding?

A

Galactosemia

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44
Q

What are the maternal contraindications to breastfeeding?

A
  1. Active, untreated tuberculosis
  2. Maternal HIV infection
  3. Herpetic breast lesions
  4. Varicella infection
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45
Q

Management:

Patient with symptoms of hyperemesis gravidarum and newly detected pregnancy

A

Pelvic ultrasonogram

Patients with multi-fetal gestation and molar pregnancy are at increased risk for hyperemesis gravidarum.

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46
Q

Diagnosis:

Hyperemesis gravidarum

A
  1. severe, persistent nausea and vomiting
  2. > 5% loss of pre-pregnancy weight
  3. dehydration
  4. malnourishment
  5. No other explanation
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47
Q

Diagnosis:

gestational trophoblastic disease on ultrasound

A

large abnormal placenta (“ central heterogeneous mass with numerous cystic spaces and no fetal pole”)

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48
Q

Diagnosis:

  1. Bilateral ovarian enlargement
  2. Ovarian cyst formation
A

Gestational trophoblastic disease

  1. Ovarian enlargement is due to hyper stimulation
  2. Ovarian cysts are also called theca lutein cysts
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49
Q

Treatment:

5 week pregnant female with acne currently controlled with isotretinoin

A

STOP isotretinoin!

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50
Q

How does lithium affect pregnancy?

A

Lithium is associated with congenital heart disease, especially Epstein’s anomaly.

Epstein’s anomaly= displacement of the septal and posterior tricuspid leaflet towards the apex of the heart.

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51
Q

Are inhaled corticosteroids safe during pregnancy?

A

Yes.

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52
Q

Treatment:

Pregnant woman inadvertently vaccinated for rubella

A

Routine pregnant care

Wild-type rubella has been associated with birth defects, but there are no cases associated with vaccination. Nonetheless, pregnant women should NOT receive live vaccines directly before or during pregnancy as a precaution.

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53
Q

Diagnosis:

Placental abruption

A
  1. sudden vaginal bleeding (~80% of cases)
  2. abdominal pain
  3. hypertonic, tender uterus
  4. uterine contractions

The absence of blood on pelvic exam DOES NOT rule out this condition.

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54
Q

What is an important risk factor for placental abruption?

A

Hypertension during pregnancy

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55
Q

Treatment:

Placental abruption with rapid maternal or fetal deterioration

A

Emergency cesarean delivery

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56
Q

At what lecithin/sphingomyelin ratio is prematurity a major concern?

A

L/S

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57
Q

Definition:

rupture of fetal membranes before onset of labor

A

Premature rupture of membranes (PROM)

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58
Q

Defintion:

rupture of fetal membranes before onset of labor in a preterm baby

A

Preterm premature rupture of membranes (PROM)

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59
Q

Treatment:

PPROM at (???)

A

Steroids

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60
Q

Mechanism of Action:

Steroid in PPROM

A

Steroids enhance fetal lung maturity

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61
Q

What is the most important complication of PPROM?

A

pulmonary hypoplasia

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62
Q

Diagnosis:

  1. painless antepartum hemorrhage
  2. sudden fetal deterioration after ROM
A

Vasa previa

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63
Q

Clinical Manifestation (maternal):

Vasa previa

A
  1. abdominal examination= WNL
  2. vital signs=WNL

The bleeding originates from the fetus, not the mother.

64
Q

Diagnosis:

  1. antepartum hemorrhage
  2. tachycardia then bradycardia then sinusoidal pattern on fetal heart rate monitor
A

Vasa previa

65
Q

What is a common side effect of epidural anesthesia?

A

Hypotension

66
Q

Pathophysiology:

Hypotension after epidural anesthesia

A
  1. anesthesia causes a sympathetic blockade
  2. blood is redistributed to the lower extremities
  3. blood pools in the venous system because of the sympathetic blockade
67
Q

Diagnosis:

Uterine atony

A
  1. soft, boggy, poorly contracted uterus

2. uterus remaining at the level of the umbilicus postpartum

68
Q

What is the most common cause of postpartum hemorrhage within 24 hours of labor?

A

Uterine atony is responsible of 80% of all postpartum hemorrhage cases occurring within 24 hours of delivery.

69
Q

Treatment:

Uterine atony

A
  1. bimanual uterine massage
  2. fluid resuscitation
  3. uterotonic agents (eg, oxytocin, methylergonovine or carboprost infusion)
  4. blood transfusion as needed
70
Q

How do you manage PPROM when the fetus has been found to have a severe congenital anomaly incompatible with life?

A

You should allow the patient to proceed with labor.

71
Q

Diagnosis:

10 week pregnant patient reports

  1. pain and uterine contractions that eventually subsided
  2. closed cervix on examination
  3. empty uterus
A

complete abortion

72
Q

Which vaccinations, covering sexually transmitted infections, must every pregnant woman receive regardless of risk factors?

A
  1. Syphilis (eg rapid plasma reagin RPR)
  2. HIV
  3. Hepatitis B
73
Q

Screening for these three sexually transmitted infections is done in pregnant women IF they have risk factors…

A
  1. Chlamydia
  2. Gonorrhea
  3. Hepatitis C
74
Q

When should anti-D immune globulin be given to Rh (D)-negative women?

A
  1. Between 28-32 weeks gestation

2. after delivery of Rh positive baby

75
Q

Treatment:

preterm labor + repetitive late decelerations

A

emergency cesarean section

76
Q

What are the indications for emergent caesarian section with newfound placenta previa?

A
  1. active, uncontrolled antepartum hemorrhage
  2. unstable vital signs
  3. unreassuring fetal heart rates

REGARDLESS OF GESTATIONAL AGE

77
Q

List the risk factors for maternal cervical insufficiency/incompetent cervix.

A
  1. Hx of maternal obstetrical trauma (including cervical LEEP or cone biopsy)
  2. DES exposure
  3. multiple gestation
  4. Hx of preterm birth
  5. Hx of second trimester pregnancy loss
78
Q

Diagnosis:

Gold standard method for evaluating cervical incompetence in pregnancy

A

Transvaginal ultrasound

79
Q

What cervical length is considered a short cervix?

A

cervical length

80
Q

Treatment:

Oligohydramnios in a late-term or post-term pregnancy

A

delivery

81
Q

Diagnosis:

Postterm baby whose ultrasound shows low amniotic fluid

A

oligohydramnios

82
Q

How are babies with placenta previa delivered?

A

cesarean section

83
Q

Diagnosis:

  1. Fever
  2. Postpartum uterine tenderness
  3. Foul-smelling lochia
A

Endometritis

84
Q

Definiton:

lochia

A

post-partum uterine discharge

85
Q

What are the risk factors for endometritis?

A
  1. prolonged ROM
  2. prolonged labor
  3. operative vaginal delivery
  4. caesarian section
86
Q

What organism is typically responsible for postpartum endometritis?

A

Endometritis is typically a polymicrobial infection (gram positive, gram negative, aerobic and anaerobic organisms).

87
Q

Treatment:

Postpartum endometritis

A

IV clindamycin and gentamicin

88
Q

Pathogenesis:

Sheehan syndrome

A

postpartum ischemic necrosis of the anterior pituitary

89
Q

Clinical Manifestation:

Sheehan syndrome

A
  1. Failure of postpartum lactation
  2. Anterior pituitary hormone deficiencies (GH, Prl, FSH, LH, TSH, ACTH)
  3. Amenorrhea
  4. Loss of sexual hair, anorexia, weight loss & lethargy
  5. Hyponatremia

***It is very uncommon for these patients to have posterior pituitary hormone deficiencies.

90
Q

Clinical Manifestation:

Endometritis

A
  1. Fever
  2. Post-partum uterine tenderness
  3. Foul-smelling lochia
91
Q

What are the risk factors for endometritis?

A
  1. prolonged ROM
  2. prolonged labor
  3. operative vaginal delivery
  4. caesarian section
92
Q

What pathogen is the most common cause of endometritis?

A

Endometritis is most commonly a polymicrobial infection composed of gram positive, gram negative, aerobic and anaerobic organisms.

93
Q

Treatment:

postpartum endometritis

A

IV clindamycin and gentamicin

94
Q

Clinical Manifestation:

Sheehan syndrome

A
  1. Failure of postpartum lactation
  2. Deficiency of other anterior pituitary hormones

*Sheehan syndrome is not often associated with a deficiency in posterior pituitary hormones.

95
Q

Define a missed abortion.

A

A missed abortion is a form of spontaneous abortion.

  1. Intrauterine death before 20 weeks gestational age
  2. Complete retained products of conception
  3. Closed cervix
96
Q

Clinical manifestation:

Missed abortion

A
  1. Scant to light vaginal discharge

2. Loss of pregnancy symptoms

97
Q

How do you diagnose missed abortion?

A

Pelvic ultrasound

98
Q

Diagnosis:

Down syndrome on maternal quadruple screen

A

Increased:
Beta-hCG & Inhibin A

Decreased:
Maternal serum alpha-fetoprotein (MSAFP) & Estriol

99
Q

Diagnosis:

Trisomy 18 on maternal quadruple screen

A

Normal:
Inhibin A

Decreased:
MSAFP, Estriol & beta-hCG

100
Q

Diagnosis:

Open neural tube defects & abdominal wall defects on maternal quadruple screen

A

Increased:
MSAFP

Normal:
Inhibin A, Estriol & beta-hCG

101
Q

What should be done after an elevation in MSAFP is detected?

A

Perform an ultrasound to evaluate the fetal anatomy

102
Q

Clinical Manifestation:

  1. lightheadedness
  2. diffuse abdominal pain
  3. adnexal tenderness
  4. hemodynamic instability
A

Ruptured ectopic pregnancy

103
Q

Treatment:

Ruptured ectopic pregnancy

A

Urgent surgical evaluation

104
Q

Define arrest of labor in the first stage.

A

Dilation >/= 6 cm with ruptured membranes in the setting of:

  1. no cervical change for >/= 4 hours despite adequate contractions OR
  2. no cervical change for >/= 6 hours with inadequate contractions
105
Q

What is the next stage of management in a patient who does not fit the criteria for arrest of labor, but lacks signs of fetal distress?

A

Observation

106
Q

Pathophysiology:

Variable decelerations

A

umbilical cord compression

107
Q

Definition:

Intermittent variable decelerations

A

variable decelerations occurring independently of the majority of the contractions

108
Q

Treatment:

Intermittent variable decelerations

A

No treatment required

109
Q

Definition:

Recurrent variable decelerations

A

variable decelerations accompanying >/= 50% of contractions

110
Q

Management:

Recurrent variable decelerations

A
  1. evaluation

2. maternal intrauterine resuscitative measures

111
Q

Clinical Manifestation:

HELLP syndrome in a pregnant patient

A
  1. RUQ pain
  2. Hemolytic anemia
  3. Elevated liver enzymes
  4. Low platelet count

*HELLP syndrome is a manifestation of severe preeclampsia.

112
Q

Pathophysiology:

Abdominal pain in a pregnant patient with HELLP syndrome

A
  1. the liver begins to swell

2. the hepatic capsule (Glisson’s capsule) begins to distend, causing pain

113
Q

What is the alternative name for the hepatic capsule?

A

Glisson’s capsule

114
Q

Pathophysiology:

Pulmonary edema in the setting of severe preeclampsia

A

PE is caused by:

  1. Systemic vascular resistance
  2. Capillary permeability
  3. Pulmonary capillary hydrostatic pressure
  4. Decreased albumin
115
Q

Management:

Decreased of imperceptible fetal movement as noted by mother

A

nonstress test should be performed to document fetal well-being

116
Q

What is the first step in the evaluation of a women of childbearing age with an absence of menses for > 1 month?

A

Urine pregnancy test

117
Q

Clinical Manifestation:

Depot medroxyprogesterone acetate side effects

A
  1. menstrual irregularities (prolonged bleedign/spotting)
  2. amenorrhea after 1 year
  3. weight gain
  4. nausea
  5. breast tenderness
118
Q

True vs. False:

Overt diabetes insipidus is common in patients with Sheehan’s syndrome

A

False, overt diabetes insipidus is uncommon.

119
Q

What is an important risk factor for the development of chorioamnionitis?

A

prolonged rupture of membranes

120
Q

How do you clinically diagnose chorioamnionitis?

A

maternal fever AND 1 or more of the following:

  1. uterine tenderness
  2. maternal or fetal tachycardia
  3. malodorous amniotic fluid
  4. purulent vaginal discharge
121
Q

Treatment:

Chorioamnionitis

A
  1. Prompt administration of broad spectrum antibiotics

2. Delivery

122
Q

Why is it important to proceed with delivery after administering broad spectrum antibiotics in a case of chorioamnionitis?

A

Delivery will reduce the risk of life-threatening neonatal infection and maternal complications.

123
Q

True vs. False

Chorioamnionitis alone is indication for cesarean delivery

A

False

124
Q

When is surgical management indicated for patients with spontaneous abortion (miscarriage)?

A

Surgical management is indicated for hemodynamically unstable patients.

Spontaneous abortion can be managed expectantly, medically or surgically.

125
Q

When is external cephalic version indicated in the diagnosis of breech presentation?

A

If breech presentation persists after 37 weeks.

126
Q

What is the next step to convert to vertex presentation if external cephalic version fails?

A

planned cesarean delivery

127
Q

When do you observe breech presentation.

A

When breech presentation is identified before 37 weeks gestation. Breech presentations often convert to vertex before the 37th week.

128
Q

When is the quadruple screen performed?

A

second trimester

129
Q

Diagnosis:

  1. MSAFP
  2. Estriol
  3. Beta-hCG
  4. Inhibin A

in Trisomy 21

A
  1. MSAFP-decreased
  2. Estriol-decreased
  3. Beta-hCG-increased
  4. Inhibin A-increased
130
Q

Treatment:

Your patient has a low-grade fever, leukocytosis and vaginal discharge in the immediate postpartum period.

A

No treatment necessary. Low-grade fever, leukocytosis and vaginal discharge are normal findings in the immediate postpartum period. The loch is initially bloody, then serous and finally white to yellow days after delivery.

131
Q

True vs. False

According to the CDC, pregnant women should not receive the influenza vaccination.

A

False, it is recommended that all pregnant women be vaccinated against influenza without contraindications.

132
Q

Define incomplete abortion.

A

Incomplete abortion is the partial passage of fetal tissue.

133
Q

Clinical Manifestation:

  1. bleeding
  2. cramping
  3. partial passage of fetal tissue
A

incomplete abortion

134
Q

Treatment:

Incomplete abortion

A
  1. Expectant management
  2. Misoprostol
  3. Dilation and Evacuation
135
Q

Pathophysiology:

Low back pain in the third trimester of pregnancy

A

low back pain in pregnancy is caused by:

  1. an increase in lumbar lordosis
  2. relaxation of the ligaments supporting the joints of the pelvic girdle
136
Q

What are the most common causes of symmetric growth restriction?

A
  1. fetal anomalies
  2. abnormal fetal karyotype
  3. early maternal viral infection
137
Q

What are the most common causes of asymmetric growth restriction?

A
  1. maternal vascular disease (i.e. hypertension, diabetes & smoking)
138
Q

Treatment:

Stillbirth in third trimester

A
  1. Vaginal delivery
  2. Cesarean delivery

via oxytocin labor induction

139
Q

Clinical Manifestation:

Uterine rupture

A
  1. vaginal bleeding
  2. intra-abdominal hemorrhage
  3. fetal distress or demise
    …in a women with prior cesarean delivery
140
Q

How do you differentiate uterine rupture from placental abruption?

A

Uterine rupture is associated with:

  1. loss of fetal station vaginally
  2. palpable fetal parts through the site of rupture
141
Q

When is cesarean delivery indicated in placental abruption?

A
  1. mother is hypotensive and has severe bleeding
  2. fetus deteriorates

Laboring patients at term should be allowed to deliver vaginally.

142
Q

Treatment:

Septic abortion

A
  1. broad-spectrum antibiotics
  2. surgical evacuation of the uterus

Septic abortion is a medical emergency. After initial treatment patients should be monitored for systemic sepsis.

143
Q

Clinical Manifestation:

False labor

A
  1. Absence of progressive cervical changes
  2. Irregular contractions
  3. Discomfort relieved by sedation
144
Q

What are the activity recommendations for healthy pregnant women?

A

Healthy pregnant women should be encouraged to exercise for >/= 30 minutes per day at low or moderate intensity.

Healthy pregnant women should NOT partake in contact sports or activities with high fall risk.

145
Q

Fetal macrosomia is a risk factor for this vaginal delivery complication.

A

Shoulder dystocia

African-American boys are at a increased risk for fetal macrosomia.

146
Q

Pathophysiology:

Erb-Duchenne palsy

A

Excessive traction on the neck during a difficult delivery

147
Q

Clinical Manifestation:

Erb-Duchenne palsy

A
  1. “waiter’s tip” posture
148
Q

Treatment:

Erb-Duchenne palsy

A

No treatment needed. Most infants recover arm function spontaneously or within a few months.

149
Q

Treatment:

Preterm labor at

A
  1. Tocolytic agent (calcium channel blockers)
  2. Magnesium sulfate for neuroprotection
  3. Corticosteroids fo acceleration of fetal lung maturity
150
Q

Define preterm labor

A

Regular contractions causing cervical dilation and/or effacement at

151
Q

Clinical Manifestation:

Adducted and internally rotated arm after tonic-clonic seizures

A

posterior shoulder dislocation

152
Q

What is the most noninvasive and highly specific screening test for fetal aneuploidy.

A

cell-free fetal DNA testing

This testing can be ordered at >/= 10 weeks gestation

153
Q

How can you confirm an abnormal cell-free fetal DNA test?

A
  1. chorionic villus sampling at 10-12 weeks

2. amniocentesis at 15-20 weeks

154
Q

True vs. False

PPX cesarean section and induction of labor prevent complications related to shoulder dystocia.

A

False, these interventions have not been consistently shown to prevent complications related to shoulder dystocia.

155
Q

What is a normal result for a nonusers test?

A

2 heart rate accelerations

156
Q

How often should a non-stress test be performed in a third trimester pregnancy requiring antepartum fetal surveillance.

A

Once every week during the third trimester

157
Q

Management:

Patients with intrauterine fetal demise who develop coagulation abnormalities?

A

Induction of labor without delay

Step 2 CK: Obstetrics & Gynecology (15 decks)

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