Prelim Flashcards
Define dystocia
includes any discorder that may be encountered during pregnancy which may cause complication
What are the top 3 causes of maternter dealth before the 20th century?
Puerperal Complications
. Pre-exclampsia
. OB Hemorrhages
. Puerperal infections
What are the major complication that account for nearly 75% of all maternal deaths?
. Infections (post-partum) . Severe bleeding (post-partum) . High blood pressure . Complications from delivery . Unsafe abortion
Define puerperal fever
Any temperature elevation of 38C or highter which occur on any 2 of the first 10 days postpartum
This percentage of women are febrile in the first 24 hours of peurperium after vaginal birth
a. 20%
b. 30%
c. 50%
d. 70%
a. 20%
This percentage of women are febrile in the first 24 hours of peurperium after CA
a. 20%
b. 30%
c. 50%
d. 70%
d. 70%
Febrile patient with 40C fever responds to medicine and returns. She delivered vaginally 8 hours ago. What do you suspect is the cause of fever?
High spiking fever, 39C or higher, developing within the first 24 hours after birth may be associated with a very virulent pelvic infection caused by either group A or group B streptococcus
Common causes of puerperal infection
- genital tract infections
- breast engorgement
- uti
- atelectasis (respiratory distorder)
- uterine infections
- acute pyelonephritis
Febrile pt with 38C presents with red, stretch, shiny skin over breasts. When will you tell the patient the fever will abate? What is the treatment?
. Temp <39C
. Fever abates w/n 24 hours
. Treat by expressing milk
Puerperal fever due to urinary tract infection is common/not common. Why?
Not common due to normal diuresis during post partum (reaction to increased plasma volume during pregnancy)
You suspect the pt has puerperal fever due to acute pyelonephritis. What other clinical signs do you look for?
. CVA (costovertebral angle) tenderness
. Nausea and vomiting
Febrile pt underwent CS with general anesthesia. What puerpral complication are we concerned with and how is it treated?
Atelectasis usually follow an abdominal delivery. The mucus plug is higher in the alveoli and may be related to hypoventilation
Treat by: immediate ambulation, coughing, and deep breathing
Uterine infections have historically been known as:
What is the current accepted term?
. Puerperal sepsis, endometritis, endoparametritis
. Metritis with pelvic cellulitis
What is the most common cause of infection after childbirth?
- genital tract infections
- breast engorgement
- uti
- atelectasis (respiratory distorder)
- uterine infections
- acute pyelonephritis
- uterine infections
Metritis with pelvic cellulitis
What are common factors of uterine infection regardlesss of route of delivery?
. Membrane rupture
. Prolong labor
. Multiple cervical examination
. Internal fetal monitoring
What predisposiing factors to uterine infection associated with NSVD?
. Intra amniotic infection
. Manual removal of placenta
Why do we perform IE only as needed? What is the underlying cause?
Bacteria will penetrate and can cause LGTI
. Group B streptococcus . C trachomatis . Mycoplasma hominis . Ureaplasma urealyticum . Gardnerella vaginalis
Other than route of dlivery, what are other risk factors for uterine infections?
. Socioeconimic status . Poor nutrition . LGTI . General anesthesia . Multifetal gestation . Young maternal age . Nulliparity . Obesity . Meconium stained AF
Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-positive species. What are the possible bacterial infections?
. Group a, b, c, d streptococci
. Enterococcus
. Staphylococcus aureus
. Staphylococcus epidermis
Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-negative species. What are the possible bacterial infections?
. Escherichia coli
. Klebsiella
. Proteus species
Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is inconclusive for gram positive and negartive species. What are the possible bacterial infections?
. Gardnerella vaginalis
Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is anaerobic. What are the possible bacterial infections?
. Cocci - peptostretococcus and peptococcus species
. Other clostridium bacteriodes and fusobacterium species, mobiluncus species
Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is neither aerobic or anearobic. What are the possible bacterial infections?
. Mycoplasma
. Chlamydia
. Neisseria gonorrhea
Inoculation of uterine incision provides aerobic/anaerobic conditions
anaerobic
What are factors affect virulence of metritis?
. Polymicrobial
. Hematomas
. Devitalized tissue
What tissue is often devitalised during delivery?
. Cervix
. Vagina
. Uterine cavity
The uterine cavity is normally sterile. By what route does it become contaminated?
. Labor
. Delivery
. Multiple manipulations
What are the usual sites involved in metritis following normal delivery?
. Placental implantation site
. Decidua
. Adjacent myometrium
. Cervicovaginal lacerations
What are the usual sites involved in metritis following cesarian section?
. Placental implantation site
. Decidua
. Adjacent myometrium
. Uterine incision site
What is the clinical course of metritis? Which is the least clinically significant?
. Fever >38
. Chills
. Pulse rate follows the temperature curve
. Parametrial tenderness
. (possible) foul lochia
. Leucocytosis - least clinically significant as there is leucocytosis in normal pregnancy
A pt with metritis experiences chills. What is the cause?
chills due to excretion of endotoxin and bacteriolysis
A febrile pt with metritis presents with no spiking fever that responds well to medicine. What treatment would you prescribe?
A. Oral antibiotics
B. Parenteral antibiotics
A. Oral antibiotics
A febrile pt with metritis presents with cellulitis and parametrial involvement. What treatment would you prescribe?
A. Oral antibiotics
B. Parenteral antibiotics
B. Parenteral antibiotics
Choice of antibiotics is the same for vaginal delivery and CS.
T/F
FALSE
What is the choice of antimicrobials for vaginal delivery?
A . Ampicillin + Gentamycin
B . Clindamycin + gentamycin
C . Clindamycin + Aztreonam
D . Metronidazole + Ampicillin + Gentamicin
A . Ampicillin + Gentamycin
What is the choice of antimicrobials for CS? Under what circumstance would you add a 3rd anti-microbial?
A . Ampicillin + Gentamycin
B . Clindamycin + gentamycin
C . Clindamycin + Aztreonam
D . Metronidazole + Ampicillin + Gentamicin
B . Clindamycin + gentamycin
- ampicillin with sepsis or suspected enteroccocal infection
(Perioperative/postoperative) antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections
Perioperative antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections
What causes toxic shock syndrome in metritis?
group A and B haemolytic strep
What surgical techniques help prevent infection?
. Preoperative vaginal cleasing
. Allowing the placenta to separate spontaneously
. Exteriorizing the uterus
. Close subcutaneous tissue in obese women
What are the complications of abdominal incisional infection? (6)
. Wound infection . Wound dehiscence . Necrotizing fascitis . Peritonitis . Adnexal infection . Parametral phlegmon
What is the most common cause of antrimicrobial failure?
wound infection
What are risks of wound infection?
(factors inhibiting wound healing) . Obesity . Uncontrolled diabetes . Corticoid therapy . Immunosuppressions . Anemia . Poor hemostasis
What is the treatment for wound infection of abdominal incisional infection?
. Antimicrobials
. Surgical drainage
. Careful inspection of the abdominal fascia
Question
Answer
A 42-year-old in your office who is now 5 weeks pregnant
with her fifth baby. She is very concerned regarding the risk of down syndrome because of her advance maternal age.
After extensive genetic counseling, she has decided to
undergo a second-trimester amniocentesis to determine
the karyotype of her fetus. Prior to performing the procedure, you inform the patient that all of the following are possible complications of the amniocentesis. EXCEPT:
a. Amniotic fluid leakage
b. Chorioamnionitis
c. Limb reduction defects
d. Cell culture failure
D. Cell culture failure
Williams, pg 293
. Amniotic fluid leakage
The risk of having a baby with down syndrome for a 30 yo woman increase
a. if the father of the baby is 40 yo
b. if her pregnancy has achieved by induction of
ovulation by menotropins (follistin, gonadal F)
c. if she has had a previous baby with triploidy
d. if she has had three first trimester spontaneous abortion
c. if she has had a previous baby with triploidy
Williams, pg 278
Other important fetal aneuploidy risk factors (other than age) include numerical chromosomal abnormality or structural chromosomal rearrangement in the woman or her partner or a prior pregnancy with autosomal trisomy or triploidy
a 24 yo white woman has a maternal serum a-fetoprotein (MAFP) at 17 weeks gestation of 6.0 mutliples of the median (MOM). The next step should be
a. A second MSAFP test
b. Ultrasound examination
c. Amniocentesis
d. Amniography
b. Ultrasound examination
Williams, pg 283
Most centers now use targeted sonography as the primary method to evaluate elevated MSAFP levels and as the prenatal diagnostic test of choice for neural-tube defects.
MSAFP level of 2.5 MoM as the upper limit of normal
Advantages of ultrasound nuchal translucency over
biochemical screening for down syndrome include
a. Uses transvaginal approach
b. More consistent measurements than lab
tests
c. Better in multiple gestation
d. Wide gestational age range
e. More convenient for patients
c. better in multiple gestation
Williams, pg 286
Sonography can augmesnt screening by providing acurate gestational age assessment by detecting multifetal gestations and by identifying major sturctural abnormalities and minor sonographic markers.
the embryonic neural tube is formed via neuralation, which involves shaping, folding, and midline fusion of the neural plate and is complete after how many days from conception?
a. 14 days
b. 21 days
c. 25 days
d. 35 days
d. 35 days
Williams, pg 192
NTDs result from incomplete closure of the neaural tube by the embryonic age of 26 to 28 days.
Presomite- 19 days
-differentiation of body stalk and en embryonic sac is formed
7 somites- 21 days
-neural groove begins forming
17 somites- 22 days
PERIODS:
- IMPLANTATION: 1-2 Weeks
- EMBRYONIC PERIOD/ ORGANOGENESIS: In here neural tube develops in the 3rd -4th week.
aneuploidy is typically associated with neural tube defects, EXCEPT:
a. trisomy 21
b. trisomy 18
c. turner syndrome
d. 46 XXY
c. turner syndrome
true regarding antenatal monitoring of neural tube
defects, EXCEPT:
a. fetal echocardiogram is requested for cardiac function and structure
b. amniocentesis should be considered for fetal karyotyping
c. antepartal serial ultrasound of femoral length alone to monitor fetal growth
d. determination of alpha feto protein is an integral part during antepartum
c. antepartal serial ultrasound of femoral length ALONE to monitor fetal growth
this form of neural tube defect appears as a wide
splaying of the vertebral arch with no visible covering
a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis
d. myeloschisis
pg 192
Myelomeningocele - herniation of a meningeal sac containing neural elements
Meningocele – is a birth defect where there is a sac protruding from the spinal column. The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with meninges
Anencephaly - is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.
Myeloschisis - a developmental defect characterized by a cleft spinal cord that results from the failure of the neural plate to fuse and form a complete neural tube
herniation of a meningeal sac containing neural elements
a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis
a. myelomeningocele
birth defect where there is a sac protruding from the spinal column. The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with meninges
a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis
b. meningocele
the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.
a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis
c. anencephaly
combining both free beta hCG and pregnancy associated plasma protein –A alone can identify trisomy 21 in
how many percent?
a. 40-45%
b. 55-60%
c. 60-65%
d. 65-70%
d. 65-70% (should be 80-84%)
pg 280 Table 14-4 1st trim screen NT, hCG, PAPP-A = 80-84% 1st trim NT alone = 64-70%
the possible consequences of higher AFP or unexplained
elevation in AFP level in structurally normal pregnancy is
associated with development of
a. fetal growth restriction
b. polyhydramnios
c. placenta previa
d. abortion or 1st trimester loss
a. Fetal growth restriction
Williams, pg 283
Table 14-6
Adverse outcomes include fetal growth restriction, preeclampsia, pre-term birth, fetal demise, and stillbirth
Aneuploidy is typically associated with neural tube defect and is present in 10% of cases of
A. Trisomy 21
B. Trisomy 18
C. Turner Syndrome
D. 46XX
A. Trisomy 21
MSAFP is best measured during this time:
A. 12-14 weeks
B. 14-16 weeks
b. 14-16 weeks
Trisomy 21
Down Syndrome
Trisomy 18
Edward Syndrome
Trisomy 13
Patau Syndrome
45, X
Turner Syndrome
In addition to neural tube defects, elevated AFP and + acetylcholisterase are also present in other fetal obnormalities such as
. Ventral wall defects . Esophageal atresia . Fetal tetratoma . Cloacal extrophy . Skin abnormalities such as epidermolysis bullosa
Signs of Trisomy 18
Edward Syndrome
. Unusally small head
. Back of head is prominent
. Ears are malformed and low-set
. Mouth and jaw are small (may also have cleft palate)
. Hands are clenched into fists, and the index finger overlaps the other fingers
. Clubfeet (or rocker bottom feet) and toes may be webbed or fused
In addition to maternal age, other risk factors for down syndrom and other aneuploidy are
. Numerical chromosomal abnormality or structural chromosomal rearrangements in the woman or her parterner
. Prior pregnancy with autosomal trisomy or triploidy
What 4 structures do you look for in first trimester scan in sagittal section of the fetus?
. Nuchal translucency (most important)
. Nasal bone
. Skin - hyperechoic line
. Intracranial
What is suspected if there is tricuspid valve regurgitation as found by doppler?
Trisomy 21, Down Syndrome
Performed 11-14 weeks aneuploidy screening
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
f. aota
First trimester Serum b-hCG level is higher
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
a. trisomy 21
First trimester Serum PAPP-A is lower
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
f. aota
First trimester Both b-hCG level and PAPP-A is lower
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
e. B and C
What is the limit for nuchal translucency?
<3cm
Nuchal translucency must be defferentiated from?
cystic hygroma
What is cystic hygroma?
a venolymphatic malformation that appears as a septated hypoechoic space behind the neck, extending along the length of the back
In second trimester, maternal serum SFP is lower
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
d. A and B
In second trimester, higher b-hCG
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
a. trisomy 21
In second trimester, lower unconjugated estriol
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
d. A and B
In second semester, higher dimeric inhibin
a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota
a. trisomy 21
What tests are performed during first trimester aneuploidy screening?
. B-hCG
. Pregnancy-associated plasma protein A (PAPP-A)
. Sonographic measurement of Nuchal Translucency (NT)
What tests are performed during second trimester aneuploidy screening?
. Maternal serum SFP
. B-hCG
. Unconjugated estriol
. Dimeric inhibin
What is the upper limit of MSAFP level?
a. 1.0 MoM
b. 1.5 MoM
c. 2.0 MoM
d. 2.5 MoM
d. 2.5 MoM
Adverse maternal outcomes associated with elevated MSAFP
. FGR . Preeclampsia . Preterm birth . Fetal demise . Still birth
Adverse maternal outcomes associated with low maternal serum estriol levels
. Smith-Lemli-Opitz syndrome
. Steroid sulfate deficiency
Adverse maternal outcomes associated with steroid sulfate deficiency
. X-linked ichthyosis
. Kallman syndrome
. Chondrodysplasia punctata
. Mental retardation
When is the latest that a patient should have aneuploidy screening?
15-21 weeks
What are the diseases looked for in carrier screening?
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
Mutation in the CFTR gene on the long arm of chromosome 7
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Cystic fibrosis
Mutation on gene that encodes for chloride-channel protein
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Cystic fibrosis
One mutation must be present in each copy of the gener but they need not be the same mutation
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Cystic fibrosis
Autosomal recessive disorder
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Spinal muscular atrophy (SMA)
. Tay-Sachs
Results in spinal cord motor neuron degeneration
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Spinal muscular atrophy (SMA)
Caused by mutations in the SMN1 gene, located on long arm of chromosome 5
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Spinal muscular atrophy (SMA)
Prenatal diagnosis can be performed witheither chorionic villus sampling or amniocentesis
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Sickle hemoglobinopathies
Most common single-gene disorder
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Thalassemias
Hb Barts disease
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. A-Thalassemia
Cis deletion for both parents leads to hydrops and fetal loss
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. A-Thalassemia
Based on molecular genetic testing
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. A-Thalassemia
Based on hemoglobin electrophoresis
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. B- Thalassemia
Spot in macula
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Tay-Sachs
Hex A storage deficiency
. Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs
. Tay-Sachs
Examples of single-gene disorders found in preimplantation genetic diagnosis
. Cystic fibrosis
. 3-thalassemia
. Hemophilia
This technique is used to infer whether a developing oocyte is afected by a maternally inherited genetic disorder
a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy
a. polar body analysis
This technique is done at the 6t to 8-cell (cleavage) stage when an embryo is 3 days old. This allows both maternal and paternal genomes to be evaluated. Cell removed from zona pellucid.
a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy
b. blastomere biopsy
This technique involved removal of 5-7 cells froma 5 to 6 day blastocyst. No cells are removed from developing embryo.
a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy
c. trophectoderm biopsy
Questions
Answers
A 32 y/o (2002) requested for an external cephalic version at 34-36 wks aog after it was diagnosed with utz as complete breech she is afraid that most severe frequent complication of vaginal breech delivery might happen to her baby which is
a. Head entrapment
b. Cord prolapse
c. Spinal cord injury
d. Abruptio placenta
b. Cord prolapse
pg 542
Compared with cephalic presentation, umbilical cord prolapse is more frequent with breech fetuses
Based on nursery statistics received, the most major neonatal morbidity and mortality with breech presentation is:
a. Birth trauma
b. IUGR
c. Cord prolapse
d. Cerebral palsy
c. Cord prolapse
29 y/o G5P4 (4004) is in latent phase of labor. Absolute contraindication for vaginal breech delivery:
a. Prolong missed abortion
b. Footling breech
c. Hyperflexion of fetal head
d. Prolonged latent phase of labor
b. Footling breech
Table 28-1. Factors favoring Cesarean Delivery of the Breech Fetus
. Lack of operator experience
. Patient request for cesarean delivery
. Large fetus >3800 to 4000g
. Apparently healthy and viable preterm fetus either with active labor or with indicated delivery
. Severe fetal-growth restriction
. Fetal anomaly incompatible with birth trauma
. Incomplete or footling breech presentation
. Hyperextended head
. Pelvic contraction or unfavorable pelvic shape determined clinically or with pelvimetry
. Prior cesarean delivery
A 22 y/o G1P0, 37 weeks AOG, in breech position and is advised External Cephalic Version. She should be told that:
a. She should be offered General anesthesia
b. The procedure can be done with oligohydramnios
c. Tocolysis will improve the result of external version
d. Engagement of the presenting part is not considered a contraindication to version
d. Engagement of the presenting part is not considered a contraindication to version
Causes of breech, except:
a. Premature
b. Multiple pregnancy
c. Placenta previa totalis
d. Subserous fundal fibroid
d. Subserous fundal fibroid
pg 540 Risks include . Early gestational age . Extremes of amniotic fluid volume . Multifetal gestation . Hydrocephaly . Anencephaly . Structural uterine abnormalities . Placenta previa . Pelvic tumors . Prior breech delivery
G3P2 (2002), term, frank breech in labor, intrauterine fetal death, G1 delivered vaginally, G2 delivered by caesarean section due to fetal distress, mgt?
a. Vaginal delivery
b. CS
c. Either A or B
b. CS
A G5P4 (4004), term, footling breech in labor, with ruptured bag of membranes
a. Vaginal delivery
b. CS
c. Either A or B
b. CS
Table 28-1. Factors favoring Cesarean Delivery of the Breech Fetus
. Lack of operator experience
. Patient request for cesarean delivery
. Large fetus >3800 to 4000g
. Apparently healthy and viable preterm fetus either with active labor or with indicated delivery
. Severe fetal-growth restriction
. Fetal anomaly incompatible with birth trauma
. Incomplete or footling breech presentation
. Hyperextended head
. Pelvic contraction or unfavorable pelvic shape determined clinically or with pelvimetry
. Prior cesarean delivery
G4P2 (2012), 22 weeks, franks breech, in labor
a. Vaginal delivery
b. CS
c. Either A or B
a. Vaginal delivery
541
periviable fetuses, 20-<26 weeks, do no support routine cesarean delivery to improve mortality
A G1P0, term, frank breech in labor
a. Vaginal delivery
b. CS
c. Either A or B
c. Either A or B
One knee lie below breech
a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B
c. Incomplete breech
Lower extremities are flexed
a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B
d. A and B (Complete and Frank)
Both hips are flexed and one or both knees are also flexed
a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B
a. Complete breech
The lower extremities are extended at the knees
a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B
b. Frank breech
Double footling breech
a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B
c. Incomplete breech
What do you call the type of vaginal breech where an infant was delivered without assurance as far as the umbilicus, and the reminder of the body is manually assisted by the obstetrician?
a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction
d. A and B only
b. Assisted breech delivery / partial breech extraction
fetus is expelled entirely spontaneously without any traction or manipulation other than support of the newborn
a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction
a. Spontaneous breech delivery
the fetus is delivered spontaneously as far as the umbilicus, but the remainder of the body is extracted or delivered with operator with operator traction and assisted maneuvers, with or without maternal expulsive efforts
a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction
b. Assisted breech delivery / partial breech extraction
the entire body of the fetus is extracted by the obstetrician.
a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction
c. Total breech extraction
All are risk factors for breech presentation, EXCEPT:
a. Smoking
b. Hydrocephalus
c. Increased maternal age
d. Pelvic tumor
c. Increased maternal age
Which of the statements is INCORRECT?
a. Breech presentation is more common in babies.
b. All women with a breech presentation should be offered external cephalic version at 37-38 weeks.
c. Breech presentation is associated with a higher perinatal mortality regardless of the mode of delivery.
d. CS should be offered to all women with twins where the presentation is cephalic in the first twin and breech in the second twin.
c. Breech presentation is associated with a higher perinatal mortality regardless of the mode of delivery.
Refers to the relationship of an arbitrarily chosen portion of the presenting part to the right or left side of the birth canal.
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
c. Fetal position
the relation of the fetal long axis to that of the mother and is either longitudinal or transverse
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
a. Fetal lie
the presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
b. Fetal presentation
characteristic posture assumed by the fetus in the latter months of pregnancy
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
d. Fetal attitude
What are the two options that can be felt with Leopold’s Maneuver 1? What do they describe? What can be told from the following?
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
pg 424
Breech - large, nodular mass
Head - hard and round and more moveable
a. Fetal lie
What are the two options that can be felt with Leopold’s Maneuver 2? What do they describe? What can be told from the following?
a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude
pg 424
Back - hard, resistant structure
Fetal extremities - small, irregular mobile parts
c. Fetal position
Which maneuver is normally used during breech delivery to deliver head?
a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver
b. Mauriceau maneuver
pg 546
Index and middle finger of one hand are applied over the maxilla, to flex the head, while the fetal body rests on the palm of the same hand and forearm
What maneuver is used when the breech is born with back posterior?
a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver
e. Modified Prague maneuver
What maneuver is used in frank breech?
a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver
a. Pinard’s maneuver
What maneuver is used for nuchal arm?
a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver
c. Loveset’s maneuver
What maneuver is used for head entrapment?
a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver
f. Zavanelli maneuver
The forceps specifically designed for the delivery of the aftercoming head in the breech birth.
a. Simpson forceps
b. Piper forceps
c. Ovum forceps
d. Uterine forceps
b. Piper forceps
What fetal weight is exclusionary in breech presentation?
> 2500g and <3800-4000g or evidence of growth restriction
What BPD is exclusionary for vaginal delivery?
> 90-100mm
What measurement will permit planned vaginal delivery for inlet anteroposterior diameter?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
e. ≥ 10.5 cm
What measurement will permit planned vaginal delivery for inlet transverse diameter?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
f. ≥ 12 cm
What measurement will permit planned vaginal delivery for midpelvic interspinous distance?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
d. ≥ 10 cm
What is the recommend fetal biometry of the sum of the inlet obstetrical conjugate minus the fetal BPD?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
b. ≥ 15 mm
What is the recommended fetal biometry of the inlet transverse diameter minus the BPD?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
c. ≥25mm
What is the recommended fetal biometry of the midpelvis interspinous distance minus the BPD?
a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm
a. ≥ 0mm
Absolute contraindication for version
. Placenta previa . Multifetal gestation . Early labor . Oligohydramnios or rupture of membrane . Known nuchal cord . Structural uterine abnormalities . Fetal-growth restriction . Prior abruption
Indication for version
breech presentation is recognized prior to labor in a woman who has reached 37 weeks’ gestation
Factors that can improve the chances of a successful attempts at version
. Multiparity . Unengaged presenting part . Nonanterior placenta . Nonobese patient . Abundant amniotic fluid
Complicatioins of version
. Abruption . Preterm labor . Fetal compromise . Uterine rupture . Fetomaternal hemorrhage . Alloimmunization . Amnionic fluid embolism . Death
Which tocolytics are used prior to ECV?
beta-mimetics terbutaline and ritodrine subcutaneous terbutaline
Which accupressure point is used in ECV?
BL 67
Question
Answer
Implantation anywhere other than this is considered an ectopic pregnancy
Endometrial lining of uterine cavity
What type of EP is the most common?
Tubal EP - 95%
What type of tubal EP is the most common? What is 2nd most common?
Ampulla - 70%
Isthmus - 12%
Fimbria - 11%
Interstial - 2%
What is heterotopic pregnancy?
Multifetal pregnancy with one normally implanted and one EP
What confers the highest risk for EP?
surgeries for prior tubal pregnancy, for fertility restoration, or sterilization
What is the risk of having an EP when there was a previous EP?
5 times
What are the risks for EP?
. Surgery . Prior STD . Tubal infection . Peritubal adhesions secondary to salpingitis, appendicitis, or endometriosis . Salpingitis ithmica nodosa . Congenital fallopian tube anomalies . Infertility/ART . Smoking . IUD . Progesterone only contraceptives
What is salpingitis isthmica nodosa?
epithelium-lined diverticula extend into a hypertrophied muscularis layer
A female fetus is exposed to diethylstilbesterol in utero. What is a possible consequence for the fetus?
Congenital fallopian tube anomaly
What are the possible outcomes for EP?
. Tubal rupture
. Tubal abortion
. Pregnancy failure w/ resolution
With EP (proximal/distal) implatations are favored.
Distal
What are the possible outcomes for tubal abortion?
. Hemorrhage may cease and symptoms eventually dissapear
. Bleeding persists as products remain in tube
. Blood pools in rectouterine cul-de-sac (Pouch of Douglas)
. If fimbruated extremity is occluded, hematosalpinx
. Reabsorption
. Reimplantation for become abdominal pregnancy
What is tubal abortion?
When pregnancy passes out of the distal fallopian tube
A pt has a history of EP. Previous test results show that serum B-hCG levels were low at the time. What type of EP did the pt have? Support diagnosis.
Chronic EP; abnormal trophoblast dies early and thus negative or low static serum B-hCG levels are found
Which has a high serum B-hCG level? Acute or chronic
Acute
A pt has delayed menstruation, abdominal pain, and vaginal bleeding. LMP was 8 weeks ago. What is most likely diagnosis?
Ectopic pregnancy
The classic triad is delayed menstruation, abdominal pain, and vaginal bleeding or spotting.
What are manifestations of tubal rupture of EP?
. Lower abdominal and pelvic pain . Bulging posterior vaginal fornix due to collection of blood . Tender, boggy mass beside uterus . Enlarged uterus . Diaphragmatic irritation . (+) culdocentesis
After a suspected acute hemorrhage, hemoglobin or hematocrit readings are taken. Which is more valuable? Initial reading or serial readings?
Serial readings; Hemoglobin or hematocrit may only initiall show a slight reduction
A pt has passed a decidual cast. Did pt have an ectopic pregnancy or abortion? How do you differentiate?
EP is no clear gestational sac or villi identified histologically
Why are there increasing rates of EP?
. STD . early diagnosis for hCG and TVUS . Certain contraception . Unsuccessful tubal sterilization . ART (assisted reproductive technique) . Induced abortion . Increased tubal surgery
Define tubal pregnancy
pregnancy occuring in the fallopian tube
Define interstial pregnancy
pregnancy that implants within the interstitial portion of the fallopian tube
Differentiate and define abdominal pregnancy
Primary - the 1st and only implatation occurs on a peritonieal surface
Secondary - implatation originally in the tubal ostia, subsequently aborted and then reimplanted intothe peritoneal surface
Define cervical pregnancy
implatation of the developing conceptus in the cervical canal
Define Ligamentous pregnancy
a secondary form of EP in which a primary tubal pregnancy erods intot he mesosalpinx and is located between the leaves of the broad ligament
Define heterotropic pregnancy
condition in which ectopic and intrauterine pregnancies coexist
Define Ovarian pregnancy
EP implants within the ovarian cortex
What are the possible outcomes of tubal pregnancy?
. Tubal rupture . Tubal abortion . Pregnancy failure . Tubal abortion . Acute EP . Chronic EP
Nixon sign vs Dodd’s sign
Nixon: unilateral pulsation
Dodd’s: unilateral tenderness
What are the key components for EP diagnosis?
. Physical finding
. Transvaginal sonography (TVS)
. Serum B-hCG (initial and serial)
. Diagnostic surgery
What are the lower limits for ELISA used as pregnancy test?
.Urine: 20 - 25 mIU/mL
. Serum < or = 5 mIU/mL
What is the important of the Discriminatory Zone?
B-hCG levels above which failure to visualize a uterine pregnancy indicates that the pregnancy either is not alive or is ectopic
What are the values of the Discriminatory Zone for hCG?
. 1500 - 1800 mIU/mL with TVS
. 600 - 6500 mIU/mL with abdominal ultrasound
A pt has a serum B-hCG concentration of 1700 mIU/mL and TVS showed an empty uterus. What are the likey differentials?
. Failing IUP
. Complete abortion
. EP
What is the mean doubling time for serum b-hCG level?
48 hours
hCG assay are accurate for EP. True or false
True. hCG assays positive for 99% of EP
A pt has serum progesterone level of 28 ng/mL. Can this be an ectopic pregnancy?
No. >25 ng/mL excludes EP
A pt has serum progesterone level of 23 ng/mL. Can this be an ectopic pregnancy?
Inconclusive. Most ectopic pregnancies have values between 10 and 25 ng/mL.
A pt has serum progesterone level of 3 ng/mL. Can this be an ectopic pregnancy?
Possibly. <5ng/mL suggests a dead fetus or EP
In normal IUP when are the following found with TVS?
GS:
YS:
FP w/ FHR:
Gestational Sac: 4.5 to 5 wks
Yolk Sac: 5 to 6 wks
Fetal with fetal heart rate: 5.5 to 6 wks
What would be the TVS findings in an EP? What is considered diagnostic?
. Trilaminar endometrial pattern (diagnostic) . Anechoic fluid collection (pseudogestational sac and decidual cyst) . Ovoid . Central . Poorly defined margins . Absent decidual reaction . Single decidual layer . No double decidual sac sign
What would be the TVS findings in an IUP?
. Round . Eccentric . Well defined margins . Intradecidual sign . Double decidual sac sign . Growth rate: 0.8 mm/day
What are the three most common adnexal findings?
. Inhomogenous mass adjacent to the oary - 60%
. Hyperechoic ring - 20%
. Gestational sac with fetal pole - 13%
“Ring of fire” was the radiologic finding. What modality was used? Define “ring of fire”. Is this diagnostic?
. Used Doppler color imaging
. increased vascularity resulting in plaental blood flow within the periphery of the complex adnexal mass
. Not diagnostic. Can be EP or corpus luteym cyst.
What are the TVS findings in hemoperitoneum?
. anechoic or hypoechoic fluid in the dependent retrouterine cul-de-sac >50ml
. Blood in the Morison pouch near liver (400-700 mL)
What are the two ways to asess hemoperitoneum?
. TVS
. Culdocentesis
Pt was found to have peritoneal fluid + adnexal mass. What is the likely dx? What are some ddx?
. EP
. Ascites from ovarian or other cancer
How is a culdocentesis performed? What do positive and negative findings mean? What is the significance of clots and clotting? Is it diagnostic?
. Cervis is pulled outward and upward toward the symphysis with a tenaculum, and a long 18-gauge needle is inserted through the posterior vaginal fornix into the retrouterine cul-de-sac.
. (+) fluid containg fragments of old clots or bloody fluid; non-clotting bloody fluid
. (-) unsat entry into the cul-de-sac
. Old clots or non-clotting bloody fluid does not suggest hemoperitoneum; blood samples that clot can be from an adjacent blood vessel or form a brisk ectopic pregnancy.
What is the importance of endometrial sampling? What are the most common findings?
. Lack coexisting trophoblast
. 42% decidual reaction
. 22% secretory reaction
. 12% proliferative endometrium
What is the most common adnexal mass?
corpus luteum
What is the importance of laproscopy in EP?
Reliable diagnosis due to direct visualization of the fallopian tube and pelvis AND ready transition to operative therapy if needed
In evaluation of EP what is the first consideration after presentation of classic traid of symptoms?
Determine if pt is hemodynamically stable
If pt with classic triad of EP is hemodynamically stable what is the next course of action?
TVS
If pt with classic triad of EP is NOT hemodynamically stable what is the next course of action?
Surgical management
If pt with classic triad of EP has a non-diagnostic TVS, what is the next step in evaluation? What are most common findings?
. serum b-hCG
. >1500 discriminatory level is ectopic pregnancy
. <1500 discriminatory level = repeat in 48 hours
What are the criteria for a expectant management of EP?
. Asymptomatic, hemodynamically stable
. Tubal EP
. Decreasing serial b-hCG (esp if initial was =/<1500)
. Small ectopic mass
. No TVS evidence of intra-abdominal bleeding or rupture
. <100 ml fluid in pouch of Douglas
A pt has been diagnosed with tubal EP. She is asymptomatic and hemodynamically stable. Her serial b-hCG shows an increase. Can we use expectant management?
No. Serial b-hCG should be decreasing.
What is the MOA of methotrexate in EP?
. Folic acid antagonist
. Blocks reduction of dihyrofolate to tetrahydrofolate (active form)
. Purine and pyrimidine synthesis is halted
. Arrest of DNA, RNA, and protein synthesis
What is the tubal pregnancy resolution rate for MTX?
. 90%
What are the adverse effects for MTX for EP?
. Harm to bone marrow, GI mucossa, respiratory epithelium
. Toxic to hepatocytes and renally excreted
. Teratogen
.excreted in breast milk and may accumulate in neonatal tissue
What are the teratogenix effects of MTX?
. Craniofacial and skeletal abnormalities, IUGR
For single dose MTX, what days do you test B- hCG? What trend are you looking for? What is the management?
. Days 4 and 7
. 15% difference
. =/>15% difference, repeat test weekly until undetectable
. <15% difference, repeat MTX and begin new day 1
Question
Answer
Define abortion
a. less than 15 weeks
b. less than 20 weeks
c. less than 500g
d. less than 250g
b. or c.
Loss of a fetus less than 20 weeks age of gestation or a birthweight less than 500g
When do more than 80% of spontaneous abortion occur?
First 12 weeks
Fetal factors of abortion and which is more likely?
. Anembryonic
. Embryonic
Both are 50%
What is/are the anembryonic defect?
Blighted ovum; fertilized egg attaches to the uterine wall but does not develop
What is/are the embryonic defect?
. Aneuploid
. Euploid
Which embryonic defect has normal chromosomes?
Euploid
Aneuploid has chromosomal anomalies
Which trimester is aneuploid abortion most likely?
First trimester - 55%
2nd - 35%, 3rd 5%
Which parent is most likely to contribute to aneuploid abortion?
Maternal gametogenesis errors 95%
Paternal - 5%
What are the 5 types of aneuploid abortion? Which are the first most common and second most common?
. Autosomal trisomy - 1st mc
. Monosomy X (45, X) aka Turner Syndrome - 2nd mc
. Triploidy
. Tetraploid aboruses
. Chromosomal structural abnormalities
Which is the most likely cause of trisomy?
Isolated nondisjunction
Most common trisomy autosomes are?
13, 16, 18, 21, 22
When do most aneuploid abortions occur?
By 8 weeks - 75%
Which of the following is aborted later and when does it peak?
. Aneuploid
. Euploid
Euploid; peaks are 13 weeks
Which infections increases abortion?
. Chlamydia trachomatis . Polymicrobial infection fromperiodental disease . Mycoplasma . Ureaplasma . HIV
When does bacterial vaginosis cause abortion?
2nd trimester
When is the best time for operation for benign ovarian cyst? Why?
2nd trimester (14-16 weeks); placenta is already established
When is abdominal trauma most likely to cause miscariage? Earlier or later gestation
Advanced AOG
What are the the pathophysiological models of the immunoligical factors of abortion? Which is most potent?
. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma
. Alloimmunity; against another person
MOA of Mifepristone
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
MOA of Misoprostol
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
c. increasing uterine contractility by stimulating the myometrium directly
MOA of Methotrexate
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
a. acts on trophoblast and halts implantation
What thyroid related lab result is a marker for increase of miscarriage?
high serum to level of Ab to thyroid peroxidase
This level of caffeine consumption is associatd with increased risk of miscarriage
a. 200 mg
b. 300 mg
c. 400 mg
d. 500 mg
d. 500 mg
200 mg is moderate
What environmental toxins are linked to miscarriage
. Bisphenol A
. Phthalates
. Polychlorinated byphenyls
. DDT
What serum progestorone concentrations suggest a dying pregnancy?
A. <5 ng/ml
b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml
A. <5 ng/ml
What serum progestorone concentrations suggest a healthy pregnancy?
A. <5 ng/ml
b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml
d. > 20ng/ml
What is the bhCG levels discriminatry for transvaginal sonography?
A. 1500
b. 3000
c. 4500
d. 6000
A. 1500
What is the bhCG levels discriminatry for transabdominal sonography?
A. 1500
b. 3000
c. 4500
d. 6000
d. 6000
What is yolk sac visible and diameter?
5.5 weeks w/ 10 mm
What is the management for incomplete abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Curettage
. Misoprostol (oral)
. Expectant management
What is the management for threatened abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Observation
. acetaminophen-based analgesia
. bed rest
What is the management for complete abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. observation
What is the management for missed abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. surgical or medical evactuation
. Misoprostol (vaginal)
. Observation
What is the management for inevitable abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Curettage
What is the management for septic abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. suction curretage
. administration of broad spectrum antibiotic
What type of medicine id misoprostol? (letters)
Prostaglandin E1
What is the characteristic findings of complete abortion?
minimally thickened endometrium without a gestational sac
Complete gestation in complete abortion should be discerned from what 2?
Blood clots
Decidual cast
What is a decidual cast?
a layer of endometrium in the shape of the uterine cavity can appear as collapsed sac
When can fetal cardiac activity be detected?
6 to 6.5 weeks
What value difference of <5mm raises concern in missed abortion?
MSD (mean sac diameter) and CRL
In cases of suspected inevitable abortion what is the laboratory finding?
amnionic fluid will fern on a microscope slide or will have a pH of >7
What sonographic finding in suspected inevitable abortion?
oligohydramnios
What are biological causes of septic abortion?
. Group a streptococcus-S pyogenes
. Clostridium perigens
In recurrent miscarriagees are what the two most common chromosomal abnormalities?
- reciprocal translocation
2. robertsonian translocation
What are anatomical factors in recurrent miscarriage?
. Ascherman syndrom - uterine synechiae
. Uterine leiomyomas
. Congenital genital tract anamolies
What is the treatment for ascherman syndrome?
hysteroscopic adhesiolysis
What is antiphospholipid antibody syndrome?
defined by antiphospholipid antibodies in combination with barious forms of reprodutive loss and increased risks for venous thromboembolism
Cervical clerage is offered to women whose cervical length is
a. <15mm
b. <20mm
c. <25mm
d. <30mm
c. < 25mm
When is cervical cerclage often performed?
A. 8 - 12 weeks
b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks
b. 12 - 14 weeks
When is vagical cerclage often performed?
A. 8 - 12 weeks
b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks
c. 15 - 18 weeks
In surgical abortion, what is often used for cervical ripening?
A. antiprogestin mifepristone
b. hygroscopic dilators
c. dilapan-S
d. Misoprostol
d. Misoprostol
In suction curettage, what is swabbed on cervix?
Povidoneiodine
For pregnancies beyond 16 weeks what instrument is used?
sopher forceps
What drugs are used for medical abortion?
. Mifepristone + Misoprostol
or
. Misoprostol