Pregnancy4

Question 1

A pt on her second post C/S day develops fever. Uterus is tender to palpation n there’s foul smelling discharge on pelvic examination
Dx?
Best treatment regimen?

Answer 1

Postpartum endometritis

- clindamycin plus gentamicin

Question 2

Active phase arrest is defined as?

Mx?

Answer 2

No cervical change for >|=4 hrs despite adequate contraction (>200montevideo units in 10 min
Or
No cervical change for>|=6 hrs with inadequate contraction
It’s best managed with C/S

Question 3

Local anesthetic systemic toxicity, eg, a complication of epidural anesthesia (eg, bupivacaine) in a laboring mother- accidental insertion of the catheter into the epidural vasculature
Sxs?

Answer 3

Perioral numbness, metallic taste in the mouth, tinnitus, GTC seizure, cardiovascular abnormalities

Question 4

A 15yr old girl comes with severe headache, nausea, vomiting, abdominal pain. She is sexually active n her LMP was 4months ago. BP is 150/90. There is RUQ tenderness, a non tender palpable mass extending from the suprapubic bone to the umbilicus. 3+ DTR n sustained clonus. Serum B-hCG is elevated
Most likely Dx?

Answer 4

Hydatidiform mole- this pt presented with severe features of preeclampsia, which can occur before 20 wks in those with GTD.

Question 5

Second stage arrest of labor is defined as ( in primi n multi)
Mx?

Answer 5

After attaining cervical dilation of 10, lack of fetal descent Primigravida- >3hr of pushing or>4 with epidural
Multi->2hr or 3 hr with epidural
Mx- operative vaginal delivery

Question 6

Patients with history based cervical insufficiency ( >|=2 prior consecutive, painless, second TM px losses) which typically present with mild sxs ( vaginal discharge , light spotting) followed by precipitous delivery
How should they b managed in their subsequent pregnancies?

Answer 6

Prophylactic cervical cerclage should b performed in the first TM( 12-14wks) despite normal cervical length(>2.5cm)

Question 7

Initial mx steps( maneuvers) in shoulder dystocia r?

Answer 7

McRoverts maneuver- flexion of the hips towards the abdomen and application of suprapubic pressure

Question 8

Second trimester quadruple screening- trisomy 21 Vs 18

Answer 8

MSAFP and estriol are decreased in both
Trisomy 21- B-hCG is raised, inhibin A- raised;
Trisomy 18- B-hCG is decreased; inhibin A is typically normal;

Question 9

A pt is experiencing hypotension after administration of epidural anesthesia
Cause is?

Answer 9

Vasodilation n venous pooling secondary to blockade of sympathetic nerve fibers responsible for vascular tone.

Question 10

A 24 yr old primigravida with type 1 DM comes for an initial prenatal visit. U/S shows twin intrauterine pregnancy. Which of the ff is important in the mx of this pt?
A) quantitative B-hCG. B) 24hr urine protein

Answer 10

24 hr urine protein as this pt is at risk for preeclampsia (DM and also multiple gestation) and she can have proteinuria as part of the DM itself- a baseline proteinuria assessment should be established at initial visit

Question 11

Hydatidiform mole is managed with?

Answer 11

Dilation n curettage, post evacuation serial hCG, contraception for 6months

Question 11

Fetal abnormalities that increase n decrease maternal serum AFP

Answer 11

Increase- open neural tube defects, central wall defects ( omphalocele, gastroschisis)
Decrease- aneuploidies eg trisomy 18 n 21

Question 12

Patients with breech presentation n no contraindications for vaginal delivery are offered— at>|=37 weeks of gestation

Answer 12

External cephalic version

Question 13

A pregnant lady experiencing vaginal leakage or wetness without labor, if no fluid emerges from the cervix on valsalva and nitrazine n fern tests r negative, the lady is most likely experiencing?

Answer 13

Stress urinary incontinence

Speculum- May show a small pool of fluid(urine) in the posterior fornix

Question 14

Mechanism of GDM is?

Answer 14

Insulin resistance

increased human placental lactogen/hPL and placental somatomammotropin

Question 16

A pt comes after 2 wks of forceps assisted vaginal delivery which was complicated by third degree laceration repaired with absorbable suture. Vaginal packing was placed. On pelvic examination, the perineum is intact n there is small dark red velvety area on the posterior vaginal wall with an associated malodorous, tan-brown discharge
Most likely Dx?

Answer 16

Rectovaginal fistula - which often occurs after a third or fourth degree perineal lacerations with inadequate repair or wound infection n breakdown.

Question 17

Early decelerations are due to?

Mx?

Answer 17

Fetal head compression as it descends closer to the cervix, which contracts n causes narrowing of the anterior fontanelle-> transient alteration in cerebral blood flow-> vagal stimulation-> slow heart rate
- benign- no intervention needed

Question 18

A pregnant lady with myasthenia gravis came with preeclampsia. Which drug is contraindicated?

Answer 18

Magnesium sulfate- May trigger myastenic crisis

Question 19

A 6 hour old newborn has tachycardia,warm skin, irritability. He was born at 40 wks to a 30 yr old woman who had undergone thyroidectomy for Graves’ disease 6months ago.
The neonates problem is?
Cause?

Answer 19

Neonatal hyperthyroidism

• transplacental passage of maternal anti-TSH receptor antibodies
• self resolves within the first few months of life.
• symptomatic pts May need Rx with metimazole, B-blocker

Question 20

A 34 yr old comes at her 2nd week postpartum with stress urinary incontinence (leakage with valsalva) and she sometimes doesn’t feel the urge to urinate.
The best next step in the mx is?

Answer 20

Observation and reassurance, kegel exercise but if it persists more than six weeks postpartum, pessary or midurethral sling are used.
-common following labor n delivery- weakening of pelvic floor mm and stretch injury to the pudendal nerve are the causes of incontinence