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OB/GYN > Pregnancy complications/genetic defects > Flashcards

Pregnancy complications/genetic defects Flashcards

1
Q

What is the next step that should be taken after a molar pregnancy is confirmed by ultrasound and elevated beta-hCG levels?

A

A chest x-ray - the lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease.

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2
Q

What are some of the more common congenital diseases seen with increased frequency in the Ashkenazi Jewish population?

A

Fanconi anemia, Tay-Sachs disease, Cystic Fibrosis, Niemann-Pick disease, Gauche disease, and congenital deafness

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3
Q

What congenital cardiac defects are infants of diabetic mothers at increased risk for?

A

Ventricular septal defect, transposition of great arteries and aortic stenosis.

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4
Q

What nervous system defects are infants of diabetic mothers at risk for?

A

Neural tube defects

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5
Q

What is the most common cause of inherited mental retardation?

A

Fragile X syndrome

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6
Q

Is fetal growth restriction more likely to be seen with pre-existing diabetes or gestational diabetes?

A

Pre-existing (not typically seen in gestational)

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7
Q

What genetic anomaly causes sandal gap toes?

A

Down syndrome

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8
Q

How large (relatively) are fetuses of type I diabetic mothers?

A

Small

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9
Q

What is the typical presentation of a septic infant (energy, appearance, and temp)?

A

Lethargic, pale, with an elevated temperature

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10
Q

What immediate disturbances are infants of diabetic mother most at risk for in the hours following delivery?

A

Hypoglycemia, polychythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress

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11
Q

What should be done after the delivery of an infant of a mother with HIV even if the viral load is undetectable in the mother?

A

Start AZT in the infant immediately and test for HIV at 24 hours.

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12
Q

What medications should be given to a woman with chorioamnionitis?

A

Broad-spectrum antibiotic (e.g. ampicillin, clindamycin, gentamycin), oxytocin (to induce labor), and an antipyretic (to reduce fetal distress from mother’s elevated temp)

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13
Q

What are risk factors for infection from vaginal birth?

A

Prolonged labor, prolonged ruptured membranes, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually, and low socioeconomic status

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14
Q

What is the most common cause of postpartum fever?

A

Endometritis

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15
Q

How can beta-hCG be used to evaluate for ectopic pregnancy?

A

If beta-hCG increases by more than 50% in 48 hrs, ectopic pregnancy is less likely.

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16
Q

What conditions need to be met for initiation of methotrexate therapy in the setting of ectopic pregnancy?

A

Hemodynamic stability, non-ruptured ectopic pregnancy, size of ectopic mass <4.0 cm without fetal heart rate or <3.5 cm in the presence of fetal heart rate, normal liver enzymes and renal function, normal white cell count, and the ability of the patient to follow up rapidly if her condition changes.

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17
Q

What is the most common abnormal karyotype encountered in spontaneous abortuses?

A

Autosomal trisomy

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18
Q

What maternal diseases are associated with early pregnancy loss?

A

Diabetes mellitus, chronic renal disease, and lupus

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19
Q

What is treatment for an incompetent cervix that has resulted in previous pregnancy losses?

A

Placement of a cervical cerclage at 14 weeks. Losses in the second trimester are less likely to be due to genetic anomalies so waiting till 14 weeks is preferred

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20
Q

What is the most common cause of sepsis in pregnancy?

A

Acute pyelonephritis

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21
Q

What is the mortality risk for a pregnant woman with pulmonary hypertension?

A

25-50%

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22
Q

How much is the increase for preeclampsia and HTN in a class II obese woman (BMI 35-39.9)?

A

7-fold increase for preeclampsia and 3-fold for HTN

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23
Q

What are the criteria for diagnosis of preeclampsia with severe features?

A

Systolic BP >160, Diastolic >110 on more than one occasion spaced greater than 4 hours apart, or 24 hour urine protein > 5000 mg

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24
Q

What are signs on a fetal heart tracing of fetal anemia?

A

Tachycardia and a sinusoidal heart rate pattern

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25
Q

After how many weeks is delivery over expectant management indicated for severe preeclampsia?

A

34 weeks

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26
Q

What is the definition of fetal hydrops?

A

A collection of fluid in two or more cavities (e.g. ascites, pericardial and/or pleural fluid and scalp edema)

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27
Q

What is the most common abnormal karyotype found in spontaneous abortuses?

A

Autosomal trisomy

28
Q

At what gestational age are fetuses most susceptible to developing intellectual disability from sufficient doses of radiation (e.g. x-ray)?

A

Between 8 and 15 weeks

29
Q

What is the definition of arrest of active labor?

A

The absence of cervical change for 2 hours or more in the presence of adequate uterine contractions and cervical dilation of at least 4 cm. Patients should get oxytocin if this occurs.

30
Q

What are risk factors for placental abruption?

A

Smoking, cocaine use, chronic hypertension, trauma, prolonged rupture of membranes, multiparity and a history of prior abruption.

31
Q

What complications in pregnancy are women at risk for if they smoke?

A

Placental abruption, placenta previa, fetal growth restriction, preeclampsia, and infection.

32
Q

What is the concern with bacterial vaginosis in pregnancy?

A

Increased risk for preterm delivery

33
Q

What is uterine inversion?

A

Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.

34
Q

What is the definition of postpartum hemorrhage?

A

Bleeding in excess of 500 cc after vaginal delivery or in excess of 1000 cc in Cesarean delivery

35
Q

What are risk factors for retained placenta?

A

Prior C-section, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta

36
Q

What complications are associated with postterm delivery?

A

Macrosomia, oligohydramnios, meconium aspiration, uroplacental insufficiency, and dysmaturity.

37
Q

What does an increased systolic/diastolic ratio of the umbilical artery indicate (seen on Doppler ultrasound)?

A

Vascular resistance

38
Q

What are signs of a septic abortion?

A

Fever, vaginal bleeding, and a dilated cervix

39
Q

What are signs of a threatened abortion?

A

Vaginal bleeding with a closed or uneffaced cervical os

40
Q

What is the management of a septic abortion?

A

Broad-spectrum antibiotics with uterine evacuation.

41
Q

What are risk factors for molar pregnancy?

A

Asian race, younger than 20 or older than 40, decreased beta-carotene and folic acid intake (pay attention to cultural diets)

42
Q

What is the management of a molar pregnancy?

A

Suction curettage.

Do not induce due to risk of severe bleeding.

43
Q

How do partial vs complete moles present?

A

Partial moles often have lower beta-hCG levels, affect older patients, have longer gestations, and are often diagnosed as missed or incomplete abortions. Complete moles usually present with larger uteri, preeclampsia and a higher likelihood of developing post-molar gestational trophoblastic disease.

44
Q

How long should women wait to get pregnant after a molar pregnancy?

A

6 months after negative beta-hCG levels

45
Q

What pattern is seen on quad screen for Down Syndrome?

A

Increased beta-hCG, increased inhibin A, decreased estriol, decreased alpha fetal protein

46
Q

How does a normal 17-20 week ultrasound affect the chance of having a child with Down Syndrome?

A

It halves the pretest risk

47
Q

What are the affects on fetuses at different gestational ages if exposed to radiation?

A

Prior to two weeks gestation an exposure of 100 mGy (10 rads) may lead to death of the embryo. From two to 10 weeks gestation the teratogenic effects prevail, after 10 weeks the risks are of mental retardation, growth retardation and childhood cancer.

48
Q

What pregnancy complications does smoking increase the risk of during pregnancy?

A

Placental abruption, placenta previa, fetal growth restriction, preeclampsia, and infection

49
Q

What are common causes of postterm pregnancy?

A

Placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, and inaccurate or unknown dates

50
Q

What diseases are infants at risk for developing as an adult if they had fetal growth restriction?

A

Cardiovascular disease, chronic hypertension, stroke, chronic obstructive lung disease, type 2 diabetes and obesity.

51
Q

How is uterine inversion treated?

A

Manually replace the uterus (this can be aided by the use of uterine relaxants, such as nitroglycerine or terbutaline, if the initial attempt to replace the uterus is unsuccessful). Once the uterus is replaced, uterotonics (e.g. oxytocin, misoprostol) should be given to prevent further hemorrhage.

52
Q

What causes RUQ pain in HELLP syndrome?

A

Swelling and distention of the liver due to centrilobular necrosis, hematoma formation, and thrombi in the portal capillary system.

53
Q

What is hydantoin syndrome?

A

Can be due to exposure in utero to anticonvulsant medications (especially phenytoin and carbamazepine). It is characterized by midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism, and developmental delay.

54
Q

What nerves are damaged in Klumpke palsy?

A

8th cervical and 1st thoracic. Leads to a “claw hand”, forearm supination, absent grasp reflex, and Horner syndrome. There is intact moro and biceps reflexes

55
Q

HTN in pregnancy is a risk factor for what pregnancy-related complications?

A

Superimposed preeclampsia, placental abruption, fetal growth restriction, preterm labor, and stillbirth

56
Q

What vitamin deficiency are women with hyperemesis gravidarum at risk for developing?

A

Thiamine deficiency - may lead to Wernicke encephalopathy in extreme cases

57
Q

What does retraction of the presenting fetal part (loos of fetal station) a sign of?

A

Uterine rupture

58
Q

What are late decelerations in combination with minimal variability indicative of?

A

Fetal acidemia

59
Q

What is the best treatment for placenta accreta?

A

Immediate hysterectomy following C-section delivery

60
Q

When should women deliver if they have placenta previa or accreta?

A

At 34 weeks by C-section

61
Q

What is herpes gestationis?

A

Rare skin condition only seen in pregnancy; it is characterized by intense itching and vesicles on the abdomen and extremities.

62
Q

When do practitioners usually deliver a woman with cholestasis of pregnancy?

A

37 weeks

63
Q

How are serum glucose levels affected by acute fatty liver of pregnancy?

A

Hypoglycemia is relatively unique to acute fatty liver of pregnancy. Because of the liver insufficiency, glycogen storage is compromised leading to low serum glucose levels, which often require multiple doses of dextrose.

64
Q

What is the most common cause of maternal mortality?

A

Thromboembolism

65
Q

Between what weeks of gestation are fetuses at risk for CNS damage if exposed to >50 rads radiation?

A

8-15 weeks

OB/GYN (14 decks)

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