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OBGYN Boards > Pregnancy Facts > Flashcards

Pregnancy Facts Flashcards

1
Q

What are chemo agents that increase risk of ovarian dysfunction?

A

Alkylating: Busulfan, carmustine, chlorambucil, cyclophosphamide, ifosfamide, lomustine, mechlorethamine, melphalan, procarbazine, thiotepa

non-classical alkylators: Dacarbazine, temozolomide

Metals: Carboplatin, cisplatin

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2
Q

What are cytotoxic effect of ovarian radiation doses?

A

Dose 0.6 -> no effect
Dose 1.5 -> No effect if <40 y/o
Dose 2.5 -5.0 -> permanent ovarian insufficiency in 60% females aged 15-40 yrs, can cause transient amenorrhea

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3
Q

What is treatment for headache in pregnancy?

A

Tylenol, caffeine, CCB (amlodipine, nifedipine, verapamil)
AVOID: triptans (SGA, cardiac anomalies), ergot alkaloids, beta blocker (heart anomalies, cleft lip, neural tube defects, FGR), clonidine (hypotension)

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4
Q

What are etiologies of fetal growth restriction?

A

Maternal medical conditions
pre gestational DM
renal insufficiency
autoimmune dz
cyanotic cardiac dz
PIH
antiphospholipid Ab syndrome
Substanse use
Multiple gestation
Infectious diseases (malaria, CMV, rubella, oxo, syphilis)
Genetic/structural disorders (Trisomy 13/18, gastroschisis)
Placental disorders/umbilical cord abnormalities

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5
Q

How many mL (cc) of blood does a super plus tampon hold?

A

15-18cc

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6
Q

What are the different pelvic shapes?

A

Gynecoid: Round, good

AnthrOPoid: anterior-posterior egg shape, increased OP delivery (blacks, blunted ischial spines, medium pubic arch)

Android: transverse-limited, BAD delivery shape

Platypelloid: flat oval shape, persistent transverse (Koreans)

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7
Q

When do di-di twins split?

A

0-3 days
Twin peak/lambda sign (triangle shape btw placentas

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8
Q

When do mono-di twins split?

A

4-8 days
(T sign on US)

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9
Q

When do mono-mono twins split?

A

9-12 days

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10
Q

When do conjoined twins split?

A

13+ days (thoracovagus most common)

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11
Q

Fetal heart completes morphological development at what gestational age?

A

8 wks

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12
Q

What are cranial neural tube defects?

A

Anencephaly: failure of fusion of cephalic portion neural folds
Exencephaly: failure of scalp/skull formation, exteriorization of abnormally formed brain
Encephalocele: failure of complete skull formation, brain tissue extrudes
Iniencephaly: defect of cervical/thoracic vertebrae: abnormally formed brain tissue and retroflexed upper spine

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13
Q

What are spinal neural tube defects?

A

Spina bifida: failure of fusion of caudal neural tube (vertebrae, spinal cord or meninges) exposued to amniotic fluid
Meningocele: failure of fusion of caudal portion of neural tube, meninges exposed
Myelomeningocele: meninges and neural tissue exposed
Myeloschisis: flattened mass of neural tissue exposed
Holoraschisis: failure of fusion of vertebral arches, entire spinal cord exposed
Craniorachischisis: coexisting anencephaly and open neural tube defect, in cervical-thoracic region

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14
Q

How do you close 1cm tear on bladder dome?

A

Polyglactin (vicryl) 910 first layer running, second layer imbricating

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15
Q

What is cervical cancer staging?

A

Stage 1A1: stromal invasion, <3mm depth. Can tx w/ cervical conization to preserve fertility or simple hyst (extra-fascial) if done w/ childbearing.
Stage 1A2: stromal infasion, 3-5mm depth. Tx=modified radical hyst w/ LAD, bc incr risk parametrial involvement so can’t just do simple hyst.
Stage 1B1: grossly visible tumor confined to cervix, < 4cm in diameter.
Stage 1B2: > 4cm in diameter
Stage IIA: spread to upper vagina, no parametrium
Stage IIB: parametrium included but not pelvic side wall
Stage IIIA: extension into lower ⅓ vagina, no pelvic side wall
Stage IIIB: extension into pelvic side wall and/or ureter
Stage IV: tx=chemotherapy

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16
Q

What is a gene mutation associated with cardiomyopathy in pregnancy?

A

MYH7

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17
Q

Does metformin cross the placenta?

A

Yes

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18
Q

What are facts about Glyburide in pregnancy?

A

sulfonylurea increases insulin secretion and sensitivity of peripheral tissues.
- avoid in sulfa allergy
- incr risk hypoglycemia in infants

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19
Q

In what phase of cell division are oocytes arrested between birth and ovulation?

A

Prophase 1

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20
Q

When does the placenta take over progesterone production?

A

10 weeks

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21
Q

When does Warfarin embryopathy occur?

A

If used between 6-12 wks. Causes nasal/facial hypoplasia, stipping/rings of vertebral/femoral epiphyses on US

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22
Q

What is the most common DVT in pregnancy?

A

proximal L leg (iliac/iliofemoral) 2/2 incr venous stasis from compression of L iliac vein by R iliac artery and IVC compression

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23
Q

What are the stages of twin twin transfusion syndrome?

A

Stage 1: mono-di twins w/ oligo and poly
Stage 2: absent bladder in donor twin
Stage 3: abnormal dopplers
Stage 4: hydrops
Stage 5: death of one or both twins.

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24
Q

What is Rhogam dosing?

A

300 mcg dose, covers 30ml fetal whole blood or 15ml fetal RBC.

  • test indirect Coombs test of mom before giving Rhogam.

Rhogam works by Blocking D antigenic determinants on the erythrocyte membrane

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25
Q

What is first trimester screening?

A

NT (>3mm=bad) + b-hcg, PAPP-A, AFP

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26
Q

What is second trimester screening?

A

Screens for open neural tube defects + T18/21.
HCG, AFP, inhibin A, estradiol

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27
Q

What are environmental factors associated with neural tube defects?

A

antiepileptic carbamazepine (spina bidifda), valproic acid, fungal toxin fumonisin, maternal hyperthermia, pregestational diabetes, obesity, Chinese race
- neural tube defects: high risk of latex allergy!!

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28
Q

What is the role of AFP in screening for neural tube defects?

A

screen in 15-18wks, can detect NTD if MSAFP > 2.5 multiples of the mean.

29
Q

What are facts about FGR?

A

Drugs associated w/ FGR: cyclophosphamide, valproic acid, warfarin
Malaria=most common cause infection-related FGR
Incr risk stillbirth. If <10%, risk of death is 1.5%, if <5%, risk is 2.5%.

30
Q

What are group 1 conditions associated with pregnancy mortality?

A

<1% mortality:
ASD, VSD, PDA, pulmonic/tricuspid disease, corrected tetralogy of fallout, porcine valve, mitral stenosis (class 1 and 2)

31
Q

What are group 2 conditions associated with pregnancy mortality?

A

5-15% mortality
Mitral stenosis w/ fib, artificial valve, mitral stenosis (class 3 and 4), aortic stenosis, coarctation of aorta, uncorrected tetralogy of allot, previous MI, Marfan syndrome

32
Q

What are group 3 conditions associated with pregnancy mortality?

A

25-50% mortality
pHTN, complicated aortic coarctation, Eisenmenger syndrome, Marfan syndrome with aortic involvement (>4cm)

33
Q

What are causes of maternal death

A

Cardiovascular (14%)
Infection (13.6%)
Cardiomyopathy (12%)
Hemorrhage (10%)
Preeclampsia (9.4%)
Thromboembolism (9.3%)

34
Q

What are infectious causes of maternal death

A

KEEPS killing
Klebsiella
E. Coli
Enterobacter
Enterococcus
Peptostreptococcus
Proteus
Streptopeptococcus

35
Q

What are iron requirements in pregnancy?

A

4mg/day of iron
1000 mg of additional iron throughout entire pregnancy

36
Q

What is peripartum cardiomyopathy?

A

diagnosis of exclusion
- LV systolic dysfunction
- most common cause=myocarditis
Finding: CARDIOMYOPATHY
- BUZZ WORDS: soluble FMS-like tyrosine kinase, oxidative stress, impaired VEGF signaling
- mortality rate 10% within 2 years of diagnosis
EF <45%

37
Q

What is treatment for peripartum cardiomyopathy?

A

Diuretics to decrease preload
Hydralazine to decrease after load
Digoxin for inotropic effects
Heparin for anticoagulation
Worse prognosis: blacks, >35 y/o, EF <25%

38
Q

What are the most common causes of mastitis?

A

Staphylococcus.
- Tx: Reflex or Dicloxacillin (Dynapen) or Augmentin. Erythromycin if PCN allergy.
- If suspect MRSA, give bactrim or clinda.

39
Q

What are findings DIAGNOSTIC of pregnancy failure?

A

CRL >7mm with no heartbeat
MSD >25 with no embryo
absence of embryo w/ heart beat 2 weeks after scan with GS w/o YS
absence of embryo owtih heartbeat 11 d after scan w/ GS + YS

40
Q

What are findings SUSPICIOUS for pregnancy failure?

A

CRL <7 and no heartbeat
MSD 16-24mm and no embryo
Absence of embryo w/ HB 7-13d after gS w/o YS
absence of embryo for 6wks after LMP
Empty amnion
Enlarged yolk sac (>7mm)
small GS in relation to embryo size

41
Q

What percent of all pregnancy loss occurs in 1st trimester?

A

80%

42
Q

How does multiple sclerosis change during pregnancy?

A

no change
If flare, Tx: IV methylpred then pO prednisone. Prevent postpartum relapse with IVIG

43
Q

What are risks associated with assisted reproductive technology?

A

Placenta previa, pre-eclampsia, placental abruption, SGA, prematurity, birth defects, imprinting disorders

44
Q

When is head circumference equal to abdominal circumference?

A

32 weeks

45
Q

How many grams is fetus at 20 weeks?

A

300 grams

46
Q

How many grams is fetus at 28 wks?

A

1000g

47
Q

How many grams is fetus at 32 and 34 weeks?

A

1600, 2000g

48
Q

How many grams is fetus at 36,38,40 wks?

A

36=2500g
38=3000g
40=3500g

49
Q

What are the cardinal movements of labor?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. INTERNAL rotation
  5. Extension
  6. EXTERNAL rotation
  7. Expulsion
50
Q

What are oocyte numbers by age?

A

20 wks gestation=6-7 million
term birth =1-2 million
puberty=500K
after 50=1000

51
Q

What are factors that go into bishop score?

A

Dilation, effacement, station, consistency, position
Low score <5, high score >9
- all categories have max of 3 exception consistency/position have max of 2

52
Q

What are components of apgar score?

A

Activity (Tone)
Pulse (HR)
Grimace (reflex irritability)
Appearance (color)
Respirations

53
Q

What is Erb’s Palsy?

A

Duchenne/Erb’s Palsy=most common
“Waiter’s HIGH tip” =upper arm palsy
-Injury to C5-6 nerve roots
paralysis: deltoid, infraspinatus, flexor muscle (forearm)

54
Q

What is Klumpke’s Palsy?

A

“Klaw hand”=lower arm palsy
Injury to C8-T1 nerve roots
paralysis: hand muscle
15% infants with brachial plexus injury left with significant residual, otherwise resolves

55
Q

What is a chorioangioma?

A

Placental tumor.
- 1/5000 pregnancies.
- can cause fetal anemia, thrombocytopenia, fetal heart failure, hydrops, placentomegaly, AV shunting, polyhydramnios, pre-eclampsia

56
Q

What is safest amount radiation in pregnancy?

A

below 50 mGy is considered safe
- Xray=safest. US and MRI have no radiation.

57
Q

How do you diagnose Zika?

A

NAAT PCR (urine or blood) and Plaque reduction neutralization test (PRNT) - tests for neutralizing antibody

58
Q

What is the perinatal period?

A

20 wks gestation to 28 days postpartum

59
Q

Where is hemoglobin F produced?

A

Liver

60
Q

In a normal pregnancy HCG levels increase in a curvilinear pattern and then plateau of 100,000 mIU /mL at
how many weeks?

A

10 WEEKS

61
Q

What are risk factors for transverse lie?

A

Polyhydramnios
Uterine abnormality.
Placenta previa
Prematurity
Fibroids
Narrow or contracted pelvis.
multiple gestation

62
Q

What are effects of ARB use in pregnancy?

A

renal failure, lung dysplasia, cranial hypoplasia, limb contractures, and fetal or neonatal death.

63
Q

How do you calculate mean arterial pressure?

A

(2 x Diastolic + Systolic)/3

64
Q

What is the indigo carmine PPROM test?

A

inject indigo carmine via amnioinfusion and see if it comes out through vagina (via tampon) in 20-30 min.

65
Q

What percent of pregnancies are breech?

A

3-4%

66
Q

What is neonatal alloimmune thrombocytopenia?

A

2/2 maternal alloimmunization to fetal platelet antigens, can cause severe thrombocytopenia in fetus (<20,000) and intracranial hemorrhage
- most common antigen is HPA-1a
- maternal platelets not affected
- sx: petechiae/ecchmyosis, bleeding after circumcision
- 100% future pregnancies affected
- IVIG w/ prednisone=treatment!

67
Q

What is amount of folic acid recommended?

A

400 mcg daily starting 1 month prior to pregnancy and continue until at least 12wks GA.
- if high risk, then take 4000 mcg daily and start 3 months before.
- folate resistant NTD: poor glucose control,, obesity, aneuploidy. Anti-epileptics

68
Q

What is the Gaskin maneuver?

A

attempt to deliver the fetal shoulder with mom on hands and knees

OBGYN Boards (30 decks)

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