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Patho OB > Prelim > Flashcards

Prelim Flashcards

1
Q

Define dystocia

A

includes any discorder that may be encountered during pregnancy which may cause complication

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2
Q

What are the top 3 causes of maternter dealth before the 20th century?

A

Puerperal Complications

. Pre-exclampsia
. OB Hemorrhages
. Puerperal infections

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3
Q

What are the major complication that account for nearly 75% of all maternal deaths?

A 
. Infections (post-partum)
. Severe bleeding (post-partum)
. High blood pressure
. Complications from delivery
. Unsafe abortion
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4
Q

Define puerperal fever

A

Any temperature elevation of 38C or highter which occur on any 2 of the first 10 days postpartum

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5
Q

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

a. 20%

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6
Q

This percentage of women are febrile in the first 24 hours of peurperium after CA

a. 20%
b. 30%
c. 50%
d. 70%

A

d. 70%

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7
Q

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?

A

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

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8
Q

Common causes of puerperal infection

A
  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
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9
Q

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?

A

. Temp <39C
. Fever abates w/n 24 hours
. Treat by expressing milk

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10
Q

Puerperal fever due to urinary tract infection is common/not common. Why?

A

Not common due to normal diuresis during post partum (reaction to increased plasma volume during pregnancy)

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11
Q

You suspect the pt has puerperal fever due to acute pyelonephritis. What other clinical signs do you look for?

A

. CVA (costovertebral angle) tenderness

. Nausea and vomiting

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12
Q

Febrile pt underwent CS with general anesthesia. What puerpral complication are we concerned with and how is it treated?

A

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

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13
Q

Uterine infections have historically been known as:

What is the current accepted term?

A

. Puerperal sepsis, endometritis, endoparametritis

. Metritis with pelvic cellulitis

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14
Q

What is the most common cause of infection after childbirth?

  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
A
  1. uterine infections

Metritis with pelvic cellulitis

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15
Q

What are common factors of uterine infection regardlesss of route of delivery?

A

. Membrane rupture
. Prolong labor
. Multiple cervical examination
. Internal fetal monitoring

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16
Q

What predisposiing factors to uterine infection associated with NSVD?

A

. Intra amniotic infection

. Manual removal of placenta

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17
Q

Why do we perform IE only as needed? What is the underlying cause?

A

Bacteria will penetrate and can cause LGTI

. Group B streptococcus
. C trachomatis
. Mycoplasma hominis
. Ureaplasma urealyticum
. Gardnerella vaginalis
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18
Q

Other than route of dlivery, what are other risk factors for uterine infections?

A 
. Socioeconimic status
. Poor nutrition
. LGTI
. General anesthesia
. Multifetal gestation
. Young maternal age
. Nulliparity
. Obesity
. Meconium stained AF
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19
Q

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?

A

. Group a, b, c, d streptococci
. Enterococcus
. Staphylococcus aureus
. Staphylococcus epidermis

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20
Q

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?

A

. Escherichia coli
. Klebsiella
. Proteus species

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21
Q

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?

A

. Gardnerella vaginalis

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22
Q

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?

A

. Cocci - peptostretococcus and peptococcus species

. Other clostridium bacteriodes and fusobacterium species, mobiluncus species

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23
Q

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?

A

. Mycoplasma
. Chlamydia
. Neisseria gonorrhea

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24
Q

Inoculation of uterine incision provides aerobic/anaerobic conditions

A

anaerobic

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25
Q

What are factors affect virulence of metritis?

A

. Polymicrobial
. Hematomas
. Devitalized tissue

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26
Q

What tissue is often devitalised during delivery?

A

. Cervix
. Vagina
. Uterine cavity

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27
Q

The uterine cavity is normally sterile. By what route does it become contaminated?

A

. Labor
. Delivery
. Multiple manipulations

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28
Q

What are the usual sites involved in metritis following normal delivery?

A

. Placental implantation site
. Decidua
. Adjacent myometrium
. Cervicovaginal lacerations

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29
Q

What are the usual sites involved in metritis following cesarian section?

A

. Placental implantation site
. Decidua
. Adjacent myometrium
. Uterine incision site

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30
Q

What is the clinical course of metritis? Which is the least clinically significant?

A

. 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

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31
Q

A pt with metritis experiences chills. What is the cause?

A

chills due to excretion of endotoxin and bacteriolysis

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32
Q

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

A. Oral antibiotics

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33
Q

A febrile pt with metritis presents with cellulitis and parametrial involvement. What treatment would you prescribe?

A. Oral antibiotics
B. Parenteral antibiotics

A

B. Parenteral antibiotics

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34
Q

Choice of antibiotics is the same for vaginal delivery and CS.

T/F

A

FALSE

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35
Q

What is the choice of antimicrobials for vaginal delivery?

A . Ampicillin + Gentamycin
B . Clindamycin + gentamycin
C . Clindamycin + Aztreonam
D . Metronidazole + Ampicillin + Gentamicin

A

A . Ampicillin + Gentamycin

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36
Q

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

A

B . Clindamycin + gentamycin

  • ampicillin with sepsis or suspected enteroccocal infection
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37
Q

(Perioperative/postoperative) antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections

A

Perioperative antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections

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38
Q

What causes toxic shock syndrome in metritis?

A

group A and B haemolytic strep

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39
Q

What surgical techniques help prevent infection?

A

. Preoperative vaginal cleasing
. Allowing the placenta to separate spontaneously
. Exteriorizing the uterus
. Close subcutaneous tissue in obese women

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40
Q

What are the complications of abdominal incisional infection? (6)

A 
. Wound infection
. Wound dehiscence
. Necrotizing fascitis
. Peritonitis
. Adnexal infection
. Parametral phlegmon
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41
Q

What is the most common cause of antrimicrobial failure?

A

wound infection

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42
Q

What are risks of wound infection?

A 
(factors inhibiting wound healing)
. Obesity
. Uncontrolled diabetes
. Corticoid therapy
. Immunosuppressions
. Anemia
. Poor hemostasis
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43
Q

What is the treatment for wound infection of abdominal incisional infection?

A

. Antimicrobials
. Surgical drainage
. Careful inspection of the abdominal fascia

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44
Q

Question

A

Answer

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45
Q

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

A

D. Cell culture failure

Williams, pg 293
. Amniotic fluid leakage

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46
Q

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

A

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

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47
Q

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

A

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

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48
Q

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

A

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.

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49
Q

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

A

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.
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50
Q

aneuploidy is typically associated with neural tube defects, EXCEPT:

a. trisomy 21
b. trisomy 18
c. turner syndrome
d. 46 XXY

A

c. turner syndrome

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51
Q

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

A

c. antepartal serial ultrasound of femoral length ALONE to monitor fetal growth

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52
Q

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

A

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

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53
Q

herniation of a meningeal sac containing neural elements

a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis

A

a. myelomeningocele

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54
Q

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

A

b. meningocele

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55
Q

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

A

c. anencephaly

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56
Q

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%

A

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%
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57
Q

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

a. Fetal growth restriction

Williams, pg 283
Table 14-6

Adverse outcomes include fetal growth restriction, preeclampsia, pre-term birth, fetal demise, and stillbirth

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58
Q

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

A. Trisomy 21

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59
Q

MSAFP is best measured during this time:

A. 12-14 weeks
B. 14-16 weeks

A

b. 14-16 weeks

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60
Q

Trisomy 21

A

Down Syndrome

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61
Q

Trisomy 18

A

Edward Syndrome

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62
Q

Trisomy 13

A

Patau Syndrome

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63
Q

45, X

A

Turner Syndrome

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64
Q

In addition to neural tube defects, elevated AFP and + acetylcholisterase are also present in other fetal obnormalities such as

A 
. Ventral wall defects
. Esophageal atresia
. Fetal tetratoma
. Cloacal extrophy
. Skin abnormalities such as epidermolysis bullosa
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65
Q

Signs of Trisomy 18

A

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

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66
Q

In addition to maternal age, other risk factors for down syndrom and other aneuploidy are

A

. Numerical chromosomal abnormality or structural chromosomal rearrangements in the woman or her parterner
. Prior pregnancy with autosomal trisomy or triploidy

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67
Q

What 4 structures do you look for in first trimester scan in sagittal section of the fetus?

A

. Nuchal translucency (most important)
. Nasal bone
. Skin - hyperechoic line
. Intracranial

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68
Q

What is suspected if there is tricuspid valve regurgitation as found by doppler?

A

Trisomy 21, Down Syndrome

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69
Q

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

A

f. aota

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70
Q

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

a. trisomy 21

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71
Q

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

A

f. aota

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72
Q

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

A

e. B and C

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73
Q

What is the limit for nuchal translucency?

A

<3cm

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74
Q

Nuchal translucency must be defferentiated from?

A

cystic hygroma

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75
Q

What is cystic hygroma?

A

a venolymphatic malformation that appears as a septated hypoechoic space behind the neck, extending along the length of the back

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76
Q

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

A

d. A and B

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77
Q

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

a. trisomy 21

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78
Q

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

A

d. A and B

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79
Q

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

a. trisomy 21

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80
Q

What tests are performed during first trimester aneuploidy screening?

A

. B-hCG
. Pregnancy-associated plasma protein A (PAPP-A)
. Sonographic measurement of Nuchal Translucency (NT)

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81
Q

What tests are performed during second trimester aneuploidy screening?

A

. Maternal serum SFP
. B-hCG
. Unconjugated estriol
. Dimeric inhibin

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82
Q

What is the upper limit of MSAFP level?

a. 1.0 MoM
b. 1.5 MoM
c. 2.0 MoM
d. 2.5 MoM

A

d. 2.5 MoM

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83
Q

Adverse maternal outcomes associated with elevated MSAFP

A 
. FGR
. Preeclampsia
. Preterm birth
. Fetal demise
. Still birth
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84
Q

Adverse maternal outcomes associated with low maternal serum estriol levels

A

. Smith-Lemli-Opitz syndrome

. Steroid sulfate deficiency

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85
Q

Adverse maternal outcomes associated with steroid sulfate deficiency

A

. X-linked ichthyosis
. Kallman syndrome
. Chondrodysplasia punctata
. Mental retardation

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86
Q

When is the latest that a patient should have aneuploidy screening?

A

15-21 weeks

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87
Q

What are the diseases looked for in carrier screening?

A 
. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
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88
Q

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
A

. Cystic fibrosis

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89
Q

Mutation on gene that encodes for chloride-channel protein

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Cystic fibrosis

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90
Q

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
A

. Cystic fibrosis

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91
Q

Autosomal recessive disorder

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Spinal muscular atrophy (SMA)

. Tay-Sachs

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92
Q

Results in spinal cord motor neuron degeneration

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Spinal muscular atrophy (SMA)

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93
Q

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
A

. Spinal muscular atrophy (SMA)

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94
Q

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
A

. Sickle hemoglobinopathies

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95
Q

Most common single-gene disorder

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Thalassemias

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96
Q

Hb Barts disease

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. A-Thalassemia

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97
Q

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

. A-Thalassemia

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98
Q

Based on molecular genetic testing

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. A-Thalassemia

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99
Q

Based on hemoglobin electrophoresis

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. B- Thalassemia

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100
Q

Spot in macula

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Tay-Sachs

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101
Q

Hex A storage deficiency

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Tay-Sachs

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102
Q

Examples of single-gene disorders found in preimplantation genetic diagnosis

A

. Cystic fibrosis
. 3-thalassemia
. Hemophilia

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103
Q

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

a. polar body analysis

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104
Q

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

A

b. blastomere biopsy

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105
Q

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

A

c. trophectoderm biopsy

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106
Q

Questions

A

Answers

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107
Q

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

A

b. Cord prolapse

pg 542
Compared with cephalic presentation, umbilical cord prolapse is more frequent with breech fetuses

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108
Q

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

A

c. Cord prolapse

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109
Q

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

A

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

110
Q

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

A

d. Engagement of the presenting part is not considered a contraindication to version

111
Q

Causes of breech, except:

a. Premature
b. Multiple pregnancy
c. Placenta previa totalis
d. Subserous fundal fibroid

A

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
112
Q

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

A

b. CS

113
Q

A G5P4 (4004), term, footling breech in labor, with ruptured bag of membranes

a. Vaginal delivery
b. CS
c. Either A or B

A

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

114
Q

G4P2 (2012), 22 weeks, franks breech, in labor

a. Vaginal delivery
b. CS
c. Either A or B

A

a. Vaginal delivery

541
periviable fetuses, 20-<26 weeks, do no support routine cesarean delivery to improve mortality

115
Q

A G1P0, term, frank breech in labor

a. Vaginal delivery
b. CS
c. Either A or B

A

c. Either A or B

116
Q

One knee lie below breech

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

c. Incomplete breech

117
Q

Lower extremities are flexed

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

d. A and B (Complete and Frank)

118
Q

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

a. Complete breech

119
Q

The lower extremities are extended at the knees

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

b. Frank breech

120
Q

Double footling breech

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

c. Incomplete breech

121
Q

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

A

b. Assisted breech delivery / partial breech extraction

122
Q

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

a. Spontaneous breech delivery

123
Q

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

A

b. Assisted breech delivery / partial breech extraction

124
Q

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

A

c. Total breech extraction

125
Q

All are risk factors for breech presentation, EXCEPT:

a. Smoking
b. Hydrocephalus
c. Increased maternal age
d. Pelvic tumor

A

c. Increased maternal age

126
Q

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.

A

c. Breech presentation is associated with a higher perinatal mortality regardless of the mode of delivery.

127
Q

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

A

c. Fetal position

128
Q

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

a. Fetal lie

129
Q

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

A

b. Fetal presentation

130
Q

characteristic posture assumed by the fetus in the latter months of pregnancy

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

d. Fetal attitude

131
Q

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

A

pg 424

Breech - large, nodular mass
Head - hard and round and more moveable

a. Fetal lie

132
Q

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

A

pg 424

Back - hard, resistant structure
Fetal extremities - small, irregular mobile parts

c. Fetal position

133
Q

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

A

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

134
Q

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

A

e. Modified Prague maneuver

135
Q

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

a. Pinard’s maneuver

136
Q

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

A

c. Loveset’s maneuver

137
Q

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

A

f. Zavanelli maneuver

138
Q

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

A

b. Piper forceps

139
Q

What fetal weight is exclusionary in breech presentation?

A

> 2500g and <3800-4000g or evidence of growth restriction

140
Q

What BPD is exclusionary for vaginal delivery?

A

> 90-100mm

141
Q

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

A

e. ≥ 10.5 cm

142
Q

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

A

f. ≥ 12 cm

143
Q

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

A

d. ≥ 10 cm

144
Q

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

A

b. ≥ 15 mm

145
Q

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

A

c. ≥25mm

146
Q

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

a. ≥ 0mm

147
Q

Absolute contraindication for version

A 
. Placenta previa
. Multifetal gestation
. Early labor
. Oligohydramnios or rupture of membrane
. Known nuchal cord
. Structural uterine abnormalities
. Fetal-growth restriction
. Prior abruption
148
Q

Indication for version

A

breech presentation is recognized prior to labor in a woman who has reached 37 weeks’ gestation

149
Q

Factors that can improve the chances of a successful attempts at version

A 
. Multiparity
. Unengaged presenting part
. Nonanterior placenta
. Nonobese patient
. Abundant amniotic fluid
150
Q

Complicatioins of version

A 
. Abruption
. Preterm labor
. Fetal compromise
. Uterine rupture
. Fetomaternal hemorrhage
. Alloimmunization
. Amnionic fluid embolism
. Death
151
Q

Which tocolytics are used prior to ECV?

A

beta-mimetics terbutaline and ritodrine subcutaneous terbutaline

152
Q

Which accupressure point is used in ECV?

A

BL 67

153
Q

Question

A

Answer

154
Q

Implantation anywhere other than this is considered an ectopic pregnancy

A

Endometrial lining of uterine cavity

155
Q

What type of EP is the most common?

A

Tubal EP - 95%

156
Q

What type of tubal EP is the most common? What is 2nd most common?

A

Ampulla - 70%
Isthmus - 12%

Fimbria - 11%
Interstial - 2%

157
Q

What is heterotopic pregnancy?

A

Multifetal pregnancy with one normally implanted and one EP

158
Q

What confers the highest risk for EP?

A

surgeries for prior tubal pregnancy, for fertility restoration, or sterilization

159
Q

What is the risk of having an EP when there was a previous EP?

A

5 times

160
Q

What are the risks for EP?

A 
. 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
161
Q

What is salpingitis isthmica nodosa?

A

epithelium-lined diverticula extend into a hypertrophied muscularis layer

162
Q

A female fetus is exposed to diethylstilbesterol in utero. What is a possible consequence for the fetus?

A

Congenital fallopian tube anomaly

163
Q

What are the possible outcomes for EP?

A

. Tubal rupture
. Tubal abortion
. Pregnancy failure w/ resolution

164
Q

With EP (proximal/distal) implatations are favored.

A

Distal

165
Q

What are the possible outcomes for tubal abortion?

A

. 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

166
Q

What is tubal abortion?

A

When pregnancy passes out of the distal fallopian tube

167
Q

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.

A

Chronic EP; abnormal trophoblast dies early and thus negative or low static serum B-hCG levels are found

168
Q

Which has a high serum B-hCG level? Acute or chronic

A

Acute

169
Q

A pt has delayed menstruation, abdominal pain, and vaginal bleeding. LMP was 8 weeks ago. What is most likely diagnosis?

A

Ectopic pregnancy

The classic triad is delayed menstruation, abdominal pain, and vaginal bleeding or spotting.

170
Q

What are manifestations of tubal rupture of EP?

A 
. Lower abdominal and pelvic pain
. Bulging posterior vaginal fornix due to collection of blood
. Tender, boggy mass beside uterus
. Enlarged uterus
. Diaphragmatic irritation
. (+) culdocentesis
171
Q

After a suspected acute hemorrhage, hemoglobin or hematocrit readings are taken. Which is more valuable? Initial reading or serial readings?

A

Serial readings; Hemoglobin or hematocrit may only initiall show a slight reduction

172
Q

A pt has passed a decidual cast. Did pt have an ectopic pregnancy or abortion? How do you differentiate?

A

EP is no clear gestational sac or villi identified histologically

173
Q

Why are there increasing rates of EP?

A 
. STD
. early diagnosis for hCG and TVUS
. Certain contraception
. Unsuccessful tubal sterilization
. ART (assisted reproductive technique)
. Induced abortion
. Increased tubal surgery
174
Q

Define tubal pregnancy

A

pregnancy occuring in the fallopian tube

175
Q

Define interstial pregnancy

A

pregnancy that implants within the interstitial portion of the fallopian tube

176
Q

Differentiate and define abdominal pregnancy

A

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

177
Q

Define cervical pregnancy

A

implatation of the developing conceptus in the cervical canal

178
Q

Define Ligamentous pregnancy

A

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

179
Q

Define heterotropic pregnancy

A

condition in which ectopic and intrauterine pregnancies coexist

180
Q

Define Ovarian pregnancy

A

EP implants within the ovarian cortex

181
Q

What are the possible outcomes of tubal pregnancy?

A 
. Tubal rupture
. Tubal abortion
. Pregnancy failure
. Tubal abortion
. Acute EP
. Chronic EP
182
Q

Nixon sign vs Dodd’s sign

A

Nixon: unilateral pulsation

Dodd’s: unilateral tenderness

183
Q

What are the key components for EP diagnosis?

A

. Physical finding
. Transvaginal sonography (TVS)
. Serum B-hCG (initial and serial)
. Diagnostic surgery

184
Q

What are the lower limits for ELISA used as pregnancy test?

A

.Urine: 20 - 25 mIU/mL

. Serum < or = 5 mIU/mL

185
Q

What is the important of the Discriminatory Zone?

A

B-hCG levels above which failure to visualize a uterine pregnancy indicates that the pregnancy either is not alive or is ectopic

186
Q

What are the values of the Discriminatory Zone for hCG?

A

. 1500 - 1800 mIU/mL with TVS

. 600 - 6500 mIU/mL with abdominal ultrasound

187
Q

A pt has a serum B-hCG concentration of 1700 mIU/mL and TVS showed an empty uterus. What are the likey differentials?

A

. Failing IUP
. Complete abortion
. EP

188
Q

What is the mean doubling time for serum b-hCG level?

A

48 hours

189
Q

hCG assay are accurate for EP. True or false

A

True. hCG assays positive for 99% of EP

190
Q

A pt has serum progesterone level of 28 ng/mL. Can this be an ectopic pregnancy?

A

No. >25 ng/mL excludes EP

191
Q

A pt has serum progesterone level of 23 ng/mL. Can this be an ectopic pregnancy?

A

Inconclusive. Most ectopic pregnancies have values between 10 and 25 ng/mL.

192
Q

A pt has serum progesterone level of 3 ng/mL. Can this be an ectopic pregnancy?

A

Possibly. <5ng/mL suggests a dead fetus or EP

193
Q

In normal IUP when are the following found with TVS?

GS:
YS:
FP w/ FHR:

A

Gestational Sac: 4.5 to 5 wks
Yolk Sac: 5 to 6 wks
Fetal with fetal heart rate: 5.5 to 6 wks

194
Q

What would be the TVS findings in an EP? What is considered diagnostic?

A 
. 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
195
Q

What would be the TVS findings in an IUP?

A 
. Round
. Eccentric
. Well defined margins
. Intradecidual sign
. Double decidual sac sign
. Growth rate: 0.8 mm/day
196
Q

What are the three most common adnexal findings?

A

. Inhomogenous mass adjacent to the oary - 60%
. Hyperechoic ring - 20%
. Gestational sac with fetal pole - 13%

197
Q

“Ring of fire” was the radiologic finding. What modality was used? Define “ring of fire”. Is this diagnostic?

A

. 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.

198
Q

What are the TVS findings in hemoperitoneum?

A

. anechoic or hypoechoic fluid in the dependent retrouterine cul-de-sac >50ml
. Blood in the Morison pouch near liver (400-700 mL)

199
Q

What are the two ways to asess hemoperitoneum?

A

. TVS

. Culdocentesis

200
Q

Pt was found to have peritoneal fluid + adnexal mass. What is the likely dx? What are some ddx?

A

. EP

. Ascites from ovarian or other cancer

201
Q

How is a culdocentesis performed? What do positive and negative findings mean? What is the significance of clots and clotting? Is it diagnostic?

A

. 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.

202
Q

What is the importance of endometrial sampling? What are the most common findings?

A

. Lack coexisting trophoblast
. 42% decidual reaction
. 22% secretory reaction
. 12% proliferative endometrium

203
Q

What is the most common adnexal mass?

A

corpus luteum

204
Q

What is the importance of laproscopy in EP?

A

Reliable diagnosis due to direct visualization of the fallopian tube and pelvis AND ready transition to operative therapy if needed

205
Q

In evaluation of EP what is the first consideration after presentation of classic traid of symptoms?

A

Determine if pt is hemodynamically stable

206
Q

If pt with classic triad of EP is hemodynamically stable what is the next course of action?

A

TVS

207
Q

If pt with classic triad of EP is NOT hemodynamically stable what is the next course of action?

A

Surgical management

208
Q

If pt with classic triad of EP has a non-diagnostic TVS, what is the next step in evaluation? What are most common findings?

A

. serum b-hCG
. >1500 discriminatory level is ectopic pregnancy
. <1500 discriminatory level = repeat in 48 hours

209
Q

What are the criteria for a expectant management of EP?

A

. 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

210
Q

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?

A

No. Serial b-hCG should be decreasing.

211
Q

What is the MOA of methotrexate in EP?

A

. Folic acid antagonist
. Blocks reduction of dihyrofolate to tetrahydrofolate (active form)
. Purine and pyrimidine synthesis is halted
. Arrest of DNA, RNA, and protein synthesis

212
Q

What is the tubal pregnancy resolution rate for MTX?

A

. 90%

213
Q

What are the adverse effects for MTX for EP?

A

. 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

214
Q

What are the teratogenix effects of MTX?

A

. Craniofacial and skeletal abnormalities, IUGR

215
Q

For single dose MTX, what days do you test B- hCG? What trend are you looking for? What is the management?

A

. Days 4 and 7
. 15% difference
. =/>15% difference, repeat test weekly until undetectable
. <15% difference, repeat MTX and begin new day 1

216
Q

Question

A

Answer

217
Q

Define abortion

a. less than 15 weeks
b. less than 20 weeks
c. less than 500g
d. less than 250g

A

b. or c.

Loss of a fetus less than 20 weeks age of gestation or a birthweight less than 500g

218
Q

When do more than 80% of spontaneous abortion occur?

A

First 12 weeks

219
Q

Fetal factors of abortion and which is more likely?

A

. Anembryonic
. Embryonic

Both are 50%

220
Q

What is/are the anembryonic defect?

A

Blighted ovum; fertilized egg attaches to the uterine wall but does not develop

221
Q

What is/are the embryonic defect?

A

. Aneuploid

. Euploid

222
Q

Which embryonic defect has normal chromosomes?

A

Euploid

Aneuploid has chromosomal anomalies

223
Q

Which trimester is aneuploid abortion most likely?

A

First trimester - 55%

2nd - 35%, 3rd 5%

224
Q

Which parent is most likely to contribute to aneuploid abortion?

A

Maternal gametogenesis errors 95%

Paternal - 5%

225
Q

What are the 5 types of aneuploid abortion? Which are the first most common and second most common?

A

. Autosomal trisomy - 1st mc
. Monosomy X (45, X) aka Turner Syndrome - 2nd mc

. Triploidy
. Tetraploid aboruses
. Chromosomal structural abnormalities

226
Q

Which is the most likely cause of trisomy?

A

Isolated nondisjunction

227
Q

Most common trisomy autosomes are?

A

13, 16, 18, 21, 22

228
Q

When do most aneuploid abortions occur?

A

By 8 weeks - 75%

229
Q

Which of the following is aborted later and when does it peak?

. Aneuploid
. Euploid

A

Euploid; peaks are 13 weeks

230
Q

Which infections increases abortion?

A 
. Chlamydia trachomatis
. Polymicrobial infection fromperiodental disease
. Mycoplasma
. Ureaplasma
. HIV
231
Q

When does bacterial vaginosis cause abortion?

A

2nd trimester

232
Q

When is the best time for operation for benign ovarian cyst? Why?

A

2nd trimester (14-16 weeks); placenta is already established

233
Q

When is abdominal trauma most likely to cause miscariage? Earlier or later gestation

A

Advanced AOG

234
Q

What are the the pathophysiological models of the immunoligical factors of abortion? Which is most potent?

A

. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma

. Alloimmunity; against another person

235
Q

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

A

b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction

236
Q

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

A

c. increasing uterine contractility by stimulating the myometrium directly

237
Q

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

a. acts on trophoblast and halts implantation

238
Q

What thyroid related lab result is a marker for increase of miscarriage?

A

high serum to level of Ab to thyroid peroxidase

239
Q

This level of caffeine consumption is associatd with increased risk of miscarriage

a. 200 mg
b. 300 mg
c. 400 mg
d. 500 mg

A

d. 500 mg

200 mg is moderate

240
Q

What environmental toxins are linked to miscarriage

A

. Bisphenol A
. Phthalates
. Polychlorinated byphenyls
. DDT

241
Q

What serum progestorone concentrations suggest a dying pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

A. <5 ng/ml

242
Q

What serum progestorone concentrations suggest a healthy pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

d. > 20ng/ml

243
Q

What is the bhCG levels discriminatry for transvaginal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

A. 1500

244
Q

What is the bhCG levels discriminatry for transabdominal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

d. 6000

245
Q

What is yolk sac visible and diameter?

A

5.5 weeks w/ 10 mm

246
Q

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
A

. Curettage
. Misoprostol (oral)
. Expectant management

247
Q

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
A

. Observation
. acetaminophen-based analgesia
. bed rest

248
Q

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
A

. observation

249
Q

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
A

. surgical or medical evactuation
. Misoprostol (vaginal)
. Observation

250
Q

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
A

. Curettage

251
Q

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
A

. suction curretage

. administration of broad spectrum antibiotic

252
Q

What type of medicine id misoprostol? (letters)

A

Prostaglandin E1

253
Q

What is the characteristic findings of complete abortion?

A

minimally thickened endometrium without a gestational sac

254
Q

Complete gestation in complete abortion should be discerned from what 2?

A

Blood clots

Decidual cast

255
Q

What is a decidual cast?

A

a layer of endometrium in the shape of the uterine cavity can appear as collapsed sac

256
Q

When can fetal cardiac activity be detected?

A

6 to 6.5 weeks

257
Q

What value difference of <5mm raises concern in missed abortion?

A

MSD (mean sac diameter) and CRL

258
Q

In cases of suspected inevitable abortion what is the laboratory finding?

A

amnionic fluid will fern on a microscope slide or will have a pH of >7

259
Q

What sonographic finding in suspected inevitable abortion?

A

oligohydramnios

260
Q

What are biological causes of septic abortion?

A

. Group a streptococcus-S pyogenes

. Clostridium perigens

261
Q

In recurrent miscarriagees are what the two most common chromosomal abnormalities?

A
  1. reciprocal translocation

2. robertsonian translocation

262
Q

What are anatomical factors in recurrent miscarriage?

A

. Ascherman syndrom - uterine synechiae
. Uterine leiomyomas
. Congenital genital tract anamolies

263
Q

What is the treatment for ascherman syndrome?

A

hysteroscopic adhesiolysis

264
Q

What is antiphospholipid antibody syndrome?

A

defined by antiphospholipid antibodies in combination with barious forms of reprodutive loss and increased risks for venous thromboembolism

265
Q

Cervical clerage is offered to women whose cervical length is

a. <15mm
b. <20mm
c. <25mm
d. <30mm

A

c. < 25mm

266
Q

When is cervical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

b. 12 - 14 weeks

267
Q

When is vagical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

c. 15 - 18 weeks

268
Q

In surgical abortion, what is often used for cervical ripening?

A. antiprogestin mifepristone

b. hygroscopic dilators
c. dilapan-S
d. Misoprostol

A

d. Misoprostol

269
Q

In suction curettage, what is swabbed on cervix?

A

Povidoneiodine

270
Q

For pregnancies beyond 16 weeks what instrument is used?

A

sopher forceps

271
Q

What drugs are used for medical abortion?

A

. Mifepristone + Misoprostol

or

. Misoprostol

Patho OB (12 decks)

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