Pregnancy2

Question 1

The best option for mx of IUFD is

• > 24 wks
• <24 wks

Answer 1

• > 24 wks - induction of labor for vaginal delivery

- <24 wks- dilation n evacuation

Question 2

Mx of pre term PROM?

complications such as infection ( chorioamnionitis) can occur, what r the signs n mx?

Answer 2

PPROM is mx is expectant until 34wks of gestation then delivery. At 33 wks, steroids n a course of abx r given.
If chorioamnionitis occurs, fever, fetal tachycardia (>160), maternal leukocytosis, purulent amniotic fluid can b seen. Mx is delivery regardless of the gestational age ( immediate induction of labor)

Question 3

A fetal ultrasound in a 21 yr old primigravida shows a large defect in the calvaria n meninges, with only small cerebellum n brainstem. Amniotic fluid volume measures 26cm(<24 is normal)
The major risk factor for this presentation is?

Answer 3

Anencephaly ( a severe open neural tube defect)

Folate deficiency in the mother

Question 4

A mother in preterm labor at <32 wks gestation requires? 3 drugs to administer

Answer 4

1)Corticosteroids , 2)tocolytics ( indomethacin is the 1st line), 3)magnesium sulfate ( fetal neuroprotection eg. Cerebral palsy)

Question 5

A 33 yr old primigravida comes at 28wks gestation. She has uncontrolled DM. Fundal height is 24cm, non stress test is reactive n reassuring. U/S reveals a cephalic fetus measuring at the 4th percentile for gestational age. Amniotic fluid index is 3cm. The best next step in the mx is?

Answer 5

Umbilical aa Doppler U/S

- FGR( wt<10th percentile), oligohydramnios (5-24 cm is the normal index) r suggestive of uteroplacental insufficiency

Question 6

A macrosomic baby whose delivery was complicated with shoulder dystocia presented with rt upper extremity held in adduction, internal rotation, elbow extended, forearm pronated, wrist n fingers flexed
Dx?
Mx?

Answer 6

Erb-duchenne palsy ( waiter’s tip)

Mx includes observation and physical therapy because 80% will have spontaneous recovery within 3months

Question 7

RUQ or epigastric pain in severe preeclampsia is secondary to?

Answer 7

Liver swelling with distention of hepatic( glisson’s) capsul

Remember HEELP syndrome ( hemolysis, elevated liver enzymes, low platelet )

Question 8

A 39 yr old gravida 4, para0, aborta 3 came in labor. She had myomectomy done 2 years ago. FHR is 145, contraction occurs every 2-3min, lasts for 45sec, cervix is 4cm dilated 100%effaced. Best next step in the mx is

Answer 8

C/S delivery
Myomectomy with uterine cavity entry , classical(vertical) C/S r contraindications for VBAC
Myomectomy without uterine cavity entry is not a contraindication

Question 9

Decreased sensation of fetal movement by the mother(>10 movements in 2hrs is normal) should further b evaluated by? The evaluation is interpreted as?

Answer 9

Nonstress test
Reactive NSTs->/=2accelerations, baseline100-160, moderate variability- consistent wit normal fetal acid base status.
Nonreactive- May indicate fetal hypoxemia and acidemia- additional testing eg. Biophysical profile is indicated

Question 10

The etiology of IUFD mostly is?

Answer 10

Unknown

Question 11

A 35 yr old gravida 4, para1, aborta 2 comes with vaginal bleeding n cramping at 7th week gestation. She had one full term delivery followed by 2 early first trimester losses. 6 months ago she had isolated episode of sudden rt arm wkness n slurred speech which resolved spontaneously
U/s shows fibroids 2cm in diameter
Most likely cause of her miscarriage?

Answer 11

Hypercoagulable state ( antiphospholipid antibody syndrome)

Question 12

A 28yr old primigravida comes at 12 wks gestation. At 10 weeks she completed a course of abx for asymptomatic bacteruria. The next step in the mx should b?

Answer 12

Repeat urine culture ( test of cure)

Question 13

The fate of transverse lie at earlier gestational stages( before term) is mostly?

Answer 13

Spontaneous rotation into a longitudinal lie at term

Question 14

A 41 yr old gravida 2, para 1 comes at 35 wks gestation with 3-5contractions every hour. She had a positive rectovaginal culture for GBS at her visit earlier this week. Nonstress test has a baseline of 120, moderate variability n multiple accelerations. Cervix is closed on PV. Tocodynamometery reveals irregular uterine contractions. The best next step in the mx?

Answer 14

False labor. Reassure n discharge the pt with labor precautions.
- positive third TM GBS screening- Rx is during labor to prevent vertical transmission. No point of Rx before labor as GBS quickly recolonizes the maternal perineum.

Question 15

A 39 yr old primigravida comes for routine check up at 32wks gestation. She has preeclampsia n is on labetalol. Nonstress test is reactive, biophysical profile is 8/10, next step in the mx?
Is contraction stress test recommended?

Answer 15

CST is not recommended because it’s equivalent to BPP which is reassuring in this pt(8-10/10)
Next step is to repeat testing after 1 wk, as such pts need weekly BPP starting from 32wks

Question 16

Pregnant pts positive for GBS screening,, when r medications administered? Which two agents r first line? If allergy to these agents exists, what’s the most appropriate medication?

Answer 16

Penicillin n ampicillin given iv, intrapartum( during labor)

- if allergic to penicillin, cefazolin, a 1st generation cephalosporin is used

Question 17

Ovarian hyperstimulation syndrome is? C/f, cause

Answer 17

OHSS is a complication of ovulation induction for fertility Rx.
Sxs develop within 1-2 wks of Rx. Sxs include abdominal pain, ascites, bilaterally enlarged cystic ovaries, third spacing leading to intravascular volume depletion eg hemoconcentration

Question 18

Variable decelerations r typically due to? Commonly occur after? Mx?

Answer 18

Typically due to umbilical cord compression, common after abrupt rupture of membranes
Mx is maternal repositioning, if no improvement amnioinfusion is done

Question 19

A lady came at her 35 wks gestation with a complaint of absent fetal kick for the past 24 hrs. Her u/s at 32wks gestation showed breech presentation with placenta previa. A nonstress test shows a baseline of 130, moderate variability, no decelerations, no acceleration despite vibroacoustic stimulation. The most appropriate next step?

Answer 19

BPP! ( nonstress test, to be reactive, there should be 2 or more accelerations)
CST(Oxytocin or nipple stimulation) can’t b done for this pt because of her placenta previa( contraindications of cst include those of labor, such as myomectomy, placenta previa,…)

Question 20

How is STI screening in pregnant high risk patients( high risk for STI) different from routine px ?
Who r the high risk groups?

Answer 20

High risk pts- age<25, prior STI, multiple partners or commercial sex workers
Screening is done not only at the 1st visit but repeated at the 3rd TM.
And screening for gonorrhea n chlamydia r added to the routine( hiv, syphilis, hepB)

Question 21

Traumatic vaginal delivery (usu associated with macrosomia, operative vaginal delivery…)followed by radiating suprapubic pain, difficulty ambulating, pubic symphysis tenderness is consistent with?

Answer 21

Pubic symphysis diastasis