USMLE World Flashcards
A 28 y/o G2P2 at 26 wks comes in with 4 days of right flank pain that radiates to her groin. She has had an uncomplicated pregnancy thus far, has a PMHx significant for PID, and has moderate right flank percussion tenderness with microscopic hematuria without nitrites or leukocyte esterase in the urine. Next step?
Patient likely has renal colic - aka. stones. She needs a US of her kidneys and renal pelvis. Shockwave lithotripsy is CI’d in pregnancy. Can consider low-dose CT urography in second and third trimesters only.
37 y/o with LMP -25days comes in with a BP 130/80, HR 110, RR25, T 36.8, and bilateral lower quadrant pain with mild guarding. She describes pain in the periumbilical area that localized to the lower abdomen. Her WC# is 10,9. What is the next step?
Even though it is unlikely, a B-HCG is necessary to rule out pregnancy. It can pick up a pregnancy within 4 days of implantation. She would need a US if the pregnancy test was positive, or an abdominal CT if it was negative.
47 y/o with history of mastitis with her first child 20 years ago, comes in with left breast swelling and pain. She has a 7x6 cm area of edema and erythema, and a poorly localized mass without fluctuation. She has scant non-bloody discharge at the nipple and several large axillary LNs. What do we do next?
This patient likely has Peau d’ orange on her breast which is a sign of inflammatory breast carcinoma. It is often associated with axillary LAD, spontaneous nipple d/c. Do histology on a biopsy to exclude or confirm the diagnosis, then treat. 1/4 of patients have mets at presentation.
Patient comes to you looking for emergency contraception options. What can you offer her?
Copper IUD (99% effective within 5d), Ulipristal pill (anti-progestin, delays ovulation, >85% effective within 5d), Levonorgestrel pill (progestin, delays ovulation, 85% effective within 3d), OCPs (75% effective within 3 d).
What cancers does Tamoxifen increase the risk for?
Endometrial Cancer and Uterine Sarcoma.
What are the options for prenatal testing for a female with a family history of Down syndrome to rule out aneuploidy?
If the Patient is >34, give Cell-free fetal DNA testing (cffDNA), ~99% for trisomy 21, ~92% for Trisomy 18, ~80% for Trisomy 13. If
A 22 y/o G1P0 at 13 weeks comes in with vaginal bleeding without tissue passage. She has no history of trauma, tobacco, alcohol, or drugs. She has a closed cervix, a slightly tender uterus c/w gestational age, and free adnexae. US shows normal fetal heart motion. dx?
Threatened Abortion: term used to describe hemorrhage before 20 weeks, closed cervix, no passage of fetal tissue. Incomplete Abortion includes passage of some, but not all tissue. Inevitable abortion has vaginal bleeding, cramps that radiate to the back and perineum, dilated cervix, and US shows no fetal heart motion and a collapsed gestational sac. Follow this up Outpatient.
A 49 y/o woman presents with a strange, itchy rash on her left nipple; an excezematous plaque. Biopsy shows halo-like areas invading the epidermis. Dx?
Adenocarcinoma. The skin finding is Paget Disease of the breast, which results from infiltration of a ductal carcinoma into a dermal lymphatic system.
A woman with hypertension during pregnancy. What meds can you use?
Methyldopa, labetalol (B-blockers), Hydralazine, CCBs. Thiazides and Clonidine are second line.
What is the most accurate way to measure gestational age in a pregnant woman?
First trimester ultrasound with crown-rump length. Ideally it should be done from 7-10 weeks (which gives accuracy of +/- 3 d).
39 y/o primiparum comes in with 3 weeks of nausea and vomiting that have progressively worsened. She has had intermittent vaginal bleeding since her most recent period, 2 months ago, and has been having intercourse with her husband without protection in order to conceive. She is dehydrated and has a 10week uterus. What does she have?
Hyperemesis Gravidarum.
Risk Factors: HG in prior pregnancy, multiple gestation, molar pregancy.
Clinical: Severe, persistent vomiting, fluid/electrolyte abnormalities, ketonuria, >5% wt loss.
Workup: Orthostatic vitals, serum lytes, BUN, Cr, TSH, UA.
Trt: Diet, hydration, ginger, B6 +/- doxylamine.
Patient with postpartum hemmorhage with passage of large blood clots. She had normal labor, normal placental pathology, and has a soft fundus at the umbilicus. What is the cause?
Atony of the uterus. 80% of PPH is caused by this. Next step is fundal massage, IV access, oxytocin. If still uncontrolled, uterine packing (ballooning) can be used.
When should CVS be completed in order to give a definitive karyotype?
10-13 weeks
Patient has abnormal values on a quad-screen. Whats the next step?
US. Then Amnio (15-20 weeks) or CVS (10-13 weeks).
Neonate is born with a birth weight of 2080g, a temp of 37.2, and a HR of 190. Mother had a surgically resected thyroid for graves disease 6 months prior, and became hypothyroid post-surgery for which she took levothyroxine. What is the best treatment?
Methimazole PLUS B-blocker. Will self-resolve within 3 months; Neonatal Thyrotoxicosis from transplacental TSH-receptor Ab.
A 22 y/o shows up after her first few experiences with intercourse stating that she had intense pain during sexual activity due to tensing of her vagina. Speculum exam is not possible due to tense perineal musculature. Dx and trt?
Vaginismus; prescribe kegel exercises and gradual dilatation. Most often caused by strict, negative upbringings towards sex, leading to involuntary contraction of the perineal musculature; psychological cause.
A 28 y/o comes in for a pap smear and ASC-US is found. Next step?
> 25 y/o, HPV testing. Colposcopy if abnormal.21-24 should get repeat pap at 12 months.
73 year old female presents with foul-smelling, bloody vaginal d/c for several months. She has a 40 year pack history of smoking, has not been sexually active for the past 10 years, and has an atrophic vagina with an irregular lesion of 1cm in the upper 1/3 of the posterior wall. Whats next?
She likely has a squamous cell carcinoma (HPV 16/18), which is caused by cig use, age >60, and often is found in the upper 1/3 of the posterior wall (vice upper 1/3 of anterior wall and history of DES in utero in a young woman for clear cell carcinoma). She should get a biopsy.
Woman presents at 37th week with a breech fetus. What is a contraindication to external version?
Placental abnormalities, fetopelvic disporportion, hyperextended fetal head. Note that prior to 37th week, no intervention would be completed. Failure leads to C-S.
Woman comes in with urinary frequency x2 days, suprapubic tenderness, and UA significant for nitrite, leukocyte esterase, and bacteria. Why do women get this problem more than men?
UTI: women> men due to shorter urethra. Other predisposing factors include altered normal flora by recent Abx, sexual intercourse, spermicide use, FHx.
A 29 y/o nulligravida comes in with a contraceptive history of OCPs until 1 year ago, and >6months of amennorhea. She had irregular periods before OCPs, but got off them in an effort to conceive . She eats well, exercises regularly, has a BMI of 22, and is not pregnant (negative B-HCG). Next step?
Amenorrhea for >3 cycles or >6 months = secondary amenorrhea. If Negative Pregnancy test, check PRL, TSH, FSH to check for need for MRI, hypothyroid, Premature ovarian failure. Prior history of an intrauterine infection could indicate a need for a hysteroscopy.
A 30 y/o G2P1 at 37wks comes in with sudden vaginal bleeding and painful uterine contractions. Her pregnancy was uncomplicated, though she has been trying to quit smoking. Her VS are wnl, PE shows a 3cm dilated cervix, vaginal bleeding, and a vertex presentation. Contractions are every 3 minutes. Fetal heart tracing is 140bpm, good variability, access no decels. Whats next?
Vaginal delivery. This patient has had a placental abruption, which can be caused by maternal HTN, abdominal trauma, cocaine + tobacco use. It presents with sudden-onset vaginal bleeding, abdominal/back pain, high frequency/low intensity contractions, hypertonic tender uterus. Treatment depends on mom’s stability - unstable - go to Cesarian (emergency), stable and >34wks - try vaginal birth.
A 32 y/o nullip comes in for an epidural placement for pain control during delivery. After induction, she feels light-headed, has a pressure drop from 120/90 to 90/55, and her HR spikes to 120 with RR of 12. She has normal strength and sensation in her upper extremities. Whats the cause and treatment?
This patient has hypotension as a side effect of epidural anesthesia. It causes vasodilation and venous pooling, which can be combatted by good hydration (IV fluids) and left uterine displacement (position patient on their left) to improve venous return. Pressors can also be used.
A 24 year old comes in with a self-palpated breast lump. She found it in the shower, and says that it is mildly tender. She has regular periods every 26 days, and her LMP was 3 weeks ago. She has no family history of breast cancer, has no LAD. Next step?
Have her come back after her menstrual period. The probability of benign disease is very high if the mass decreases in size, and therefore is a good first step before more invasive diagnostic techniques are done.
A 27 y/o at 10 weeks gestation comes to the ER with vaginal bleeding and cramping lower abdominal pain. She has normal vitals with an effaced and dilated cervix. Gestational tissue is visualized through the internal cervical os, and bimanual exam finds a soft and enlarged uterus. Dx?
Inevitable Abortion - vaginal bleeding and fluid discharge, cramps, and visualized conception products.
33 y/o at 35 weeks with di/di twins presents with high blood pressure (Stable at 160s/100s), 2+ pitting edema, and Cr. 1.4. DX?
Pre-Eclampsia with severe features. Conditions are New onset systolic >140 +/or Diastolic >90 after 20 weeks gestation AND Severe Features (>160/>110, TTP 1.1, 2xULN Transaminases, Pulmonary Edema, visual/cerebral symptoms).
29 y/o G3P2011 at 10 weeks comes in after not seeing a physician for many years for prenatal care. Her current pressures were 145/95. There are no signs of end-organ damage. Dx?
Chronic Hypertension. This is before 20 weeks = not caused by the baby.
Patient with pre-E comes in needing stat treatment. Options?
Hydralazine or Labetalol IV for BP lowering, IV Mag Sulfate for seizure prophylaxis. Methyldopa is great for long term, but is slow onset.
What causes a person with Hypothyroidism to start to lactate??
TRH stimulates prolactin stimulation (directly). The affects on PRL include stimulation of production by serotonin and TRH and inhibition of production by Dopamine.
25 y/o caucasian woman comes in with a history of anorexia nervosa. She is still moderately underweight, but has recovered from her previously very poor eating. She wants to know what affects this can have on her future pregnancies. Thoughts?
Can cause an SGA baby due to chronic nutrient deprivation (IUGR), a premature baby, and postpartum can have hyperemesis gravidarum, C/S, and postpartum depression. Children born to anorexic mothers often suffer from poor growth and intellectual impairment.
A patient comes in at 39weeks 0 days with nitrazine-positive clear fluid pooling in the vaginal fornix. Microscopy shows ferrying. Fetal heart monitoring shows a heart rate of 165/min, moderate variability, and no accels/decels. Fluid analysis shows 18.5k WBCs. Dx?
Intraamniotic infection (chiorioamnionitis). The patients FHT is c/w a Cat II tracing. Patients with increased risk include prolonged rupture of membranes (ROM). Maternal Fever + (uterine tenderness, maternal/fetal tachy, malodorous amniotic fluid, purulent vaginal d/c).
How do you manage a patient with chorio at 33 weeks?
Intravenous Broad-Spectrum Abx (Amp, Gent, Clinda), Corticosteroids for 24-34 weeks if likely to have baby.
24 y/o female comes in with increasing facial acne, recent menstrual irregularities. She weights 170#, and is 62in tall. What condition is she at risk of?
PCOS increases the risk of endometrial cancer. Excessive estrogens are converted to androgens.
Why should an Rh+, blood group O female and Rh+ blood group AB male not worry about alloimmunization in their first child?
Ab’s to ABO antigens cause mild disease in most newborns, and specifically have a milder course than Rh incompatibility. Most have mild anemia and have jaundice fixed by phototherapy. Exposure in the first pregnancy is usually required before causing disease in subsequent pregnancies.
Primary Hypertension increases the risk of what in pregnancy?
Long-term CVD, Chronic Kidney disease, DM. Short-term, placental abruption.
Patient comes in with left lower quadrant pain that started 24 hours ago. It is a 5/10 in severity. She denies fevers, vomiting, dysuria, diarrhea, vaginal bleed. Last menstrual period was -2weeks. Dx?
Mittleschmerz (midcycle pain) in women not on OCPs. Timing and lack of systemic symptoms are the major clues; usually unilateral due to caused by release of egg.
62 y/o postmenopausal woman comes in with right adnexal enlargement on pelvic exam. No bleeding, no ascots, no other symptoms. Next step?
Ca-125 is 61-90% sensitive and 71-93% specific for malignancy in a adnexal mass.
A patient with eclampsia presenting after a grand-mal seizure comes in with her arm adducted and internal rotated. She has no sensory loss. What occurred?
She dislocated her shoulder - posterior. Caused by violent muscle contractions dislocating the glenohumeral joint. Exam shows a flattened shoulder, prominent coracoid process, and positioning as in the vignette with an inability to externally rotate the arm.
A 28 y/o G1P0 at 41weeks comes in for antepartum surveillance. She has an NST with baseline 140bpm, moderate variability, no accelerations, and 1 late decel. A BPP shows a score of 4. Most likely dx?
Uteroplacental Insufficiency. The order of BPP abnormalities in a metabolically compromised fetus are HR decelerations, absent fetal breathing movements, decreased body movements/tone, Oligohydramnios. Deliver at 4 or less.
Indications for anti-D IgG for an Rh-neg mom?
28-32 weeks w/in 72 hrs of delivery of an Rh+ infant Ectopic pregnancy Hydatidiform mole CVS/Amniocentesis Abdominal Trauma 2/3rd trimester bleed. External cephalic version.
When do we do routine GBS culture?
They are valid for 5 weeks - so at 35-37 weeks gestation.
Patient is 36 weeks with IUGR. After a NST, what other test is important for evaluation?
Umbilical artery dopper velocimetry; evaluates flow.
A follow-up for a patient with a nonreactive NST in the setting of decreased movement, who doesn’t have a contraindication for labor (placenta previa) would be what test?
CST> BPP. BPP can always be done, but at CST is equivalent and can show distress when you give oxytocin or stimulate the patient.
Patient with a normal CST after a non-reactive NST. How long is the testing good for?
Liklihood of stillbirth is low for 1 week. Then follow-up testing is appropriate.
Pregnant 24 y/o lady needs STI screening without having risk factors. Name some risk factors and what she needs done.
GC/CL for for women
A 16 y/o female with a history of irregular menstruation since 12, comes in with hirsutism. She has normal external female genital and an otherwise normal exam. Labs show LH and FSH at slightly high levels, 17-OH-P at 100x normal, Testosterone at ULN, and DHEAS at ULN. What is her dx?
CAH; non-classic CAH shows up as oligo-ovulation, hyperandrgogenemia and increased 17-OH-P. Ddx is PCOS (not likely with this 17-OH-P), Ovarian/Adrenal tumor, hyper-PRL, cushings, Acromegaly.
a 38 y/o G0P0 African American woman with 6 months of chronic constipation, urinary frequency, abdominal fullness with irregular menses and a pelvic exam c/w a 14 week uterus that is irregular and mobile with a prominent posterior mass. UPT is negative. Family history of ovarian cancer in mother and GM. Most likely cause?
Leiomyoma»_space; Malignancy. Posterior masses often present with compression symptoms and heavy, prolonged menstrual bleeding.
Newborn with tonic-clonic siezures; CT shows hydrocephalus and intracranial calcifications. Dx?
Congenital toxoplasmosis.
Congenital Rubella = deafness, cataracts, cardiac defects.
Patient with positive RPR and FTA-ABS comes in for treatment in the setting of a 25 week gestation pregnancy. She has a history of true allergy to Penicillin. Of Doxy, Erythromycin, Cipro, or Penicillin, which do you give?
You do penicillin desensitization by giving her increasing doses of oral Pen V. Tetracyclines are effective but are teratogenic. Erythromycin does not cross the placenta. Cipro does not work against syphillus and also causes teratogenicity.
24 y/o G2P1 comes in at 26 weeks’ gestation with bilateral 2+ pitting edema and otherwise normal PE and Vitals. Management?
Reassurance and routine followup. The patient has engine edema of pregnancy - watch for DVT, but without fever, unilateral leg pain, redness, calf tenderness, its not likely.
A 17 y/o girl presents for an eval of vaginal d/c. It is copious, white, and mucoid vaginal d/c without odor. There is a predominance of squamous cells and rare PMNs on microscopic exam. She has been sexually active for 6 months. Dx?
Physiologic leukorrhea. Even if it is copious, white or yellow, non malodorous d/c without symptoms of pruritus, burning or fever are likely to be physiologic»_space; pathologic.
A 29 y/o with thin, gray-white vaginal d/c, Vaginal pH >4.5, an amine-like fishy smell with addition of KOH, and vaginal epithelial cells with adherent bacteria on wet mount. Dx?
Bacterial Vaginosis. bacteria are coccobacilli (Clue Cells).
Name some normal Renal changes in pregnant women.
Renal: Increase GFR and decreased BUN and Scr; due to increased CO, RBF, and excretion. Urinary frequency and nocturia; increased Uout and sodium excretion. Mild hyponatremia; hormones reset threshold due to increased ADH from pit.
Name some normal Heme changes in pregnant women.
Dilutional Anemia; Increased Plasma Volume and RBC mass. Prothrombotic state; Hormone mediated dec in protein S and increase in fibrinogen and coag factors.
Name some normal CV change in pregnant women.
Increased CO and HR due to increased Blood volume and decreased SVR.
Name some normal pulmonary changes in pregnant women.
Chronic resp. alkalosis with metabolic compensation (Increased PaO2 and decreased PaCO2); Progesterone and directly stimulates the central resp. centers to tidal volume minute ventilation.
A 43 y/o G6P5 female has a generalized tonic-clonic seizure in the delivery room 20 minutes after NSVD. She is disoriented, lightheaded, cyanotic. Her Vitals are T36.2, RR 30 and 75% on facemask, BP 80/30, Pulse 110. A generalized purpuric rash and bleeding from her IV site are noted. What next?
Inubation and mechanical ventilation; this patient has Amniotic fluid embolism and is in DIC. Risk Factors include AMA, Gravid 5+, C/s or instrument delivery, Placenta Previa/Abruption, Pre-E. Presentation is usually Cardiogenic Shock, Hypoxemic resp. failure, DIC, coma, and/or seizures. Treat with Resp. and hemodynamic support +/- transfusion.
38 y/o with inter menstrual bleeding, heavy menses, and occasional missed periods for the last year. She has a history of T2DM for 4 years, and is obese (BMI 35). PE shows nl vitals, slight pallor, and a normal uterus in size and shape. Hbg is 10.8, PT/PTTs are nl, she has a negative B-HCG. Whats next step?
Endometrial Biopsy.
Work up includes; B-HCG, blood counts, coags, TSH.
Next step: Risk factors for Endometrial Cancer (obesity, DM, periods of amennorhea) => biopsy.
Whats the DDx of Abnormal Uterine Bleeding?
PALM-COEIN
Structural = PALM; Polyps, Adenomyosis, Leiomyoma, Malignancy
Non-Structural = COEIN; Coagulopathy, Ovulatory dysfn (PCOS, PRL), Endometrial, Iatrogenic, Not- yet classified.
What are the risk factors for Endometrial Carcinoma?
Age >45, Obesity, DM, Unopposed estrogen (iatrogenic, Breast Cancer drugs, amennorhea), PCOS, early menarche, late menopause.
Indications for an Endometrial Biopsy in AUB?
Women >45 and all post menopausal women, Women
What are the complications (3), management (3), and prevention (4) strategies for Hep C patients during pregnancy?
Complications: GDM, cholestasis, preterm.
Mgmt: No Ribavirin, no need for condoms in serodiscordant monogamous couples, Vaccinate against Hep A&B.
Prevent vertical trans: Increased transmission with viral load and HIV+, CS doesn’t prevent, scalp electrodes should not be used, encourage breastfeeding unless actively bleeding.
30 y/o G2P2 comes in with fatigue, mood swings, irritability, breast tenderness, bloating, and HA monthly. They are worse after her menses and resolve but the 3rd day of her cycle.
PMS - Premenstrual Syndrome. If she got angry/irritable = Premenstrual dysphoric disorder PMDD. Often 1-2 weeks prior to menses and resolve with flow. Ddx includes hypothyroidism.
Hyporeflexia in a Pre-E patient is indicative of what?
MgSO4 toxicity; stop Mg, give Calcium gluconate. Toxicity leads to hyporeflexia, then respiratory depression.
What is the normal pH of the vagina?
3.8-4.2
Patient with thin, yellow-green malodorous d/c and vaginal redness/irritation. pH is 5.3. Dx and management?
Will find motile trichomonads (highly motile pear-shaped organisms with 3-5 flagella) on wet mount = trichomoniasis. treat pt and partner with Metronidazole.
Thick, “cottage cheese” d/c and vaginal redness/irritation. pH is 3.9. Dx and management?
Will find psuedohyphae on wet-mount = candidiasis. Treat with fluconazole.
Thin, ivory colored d/c with fishy odor, no signs of irritation or redness in the vagina. pH is 5.3. Dx and management?
Will find Clue cells and have amine odor with KOH on wet mount = Gardarella vaginitis (BV). treat pt with Metronidazole/tindazole. Increased likelihood after sex.
Woman with 3 months of amenorrhea and 12 months of hot flashes, dyspareunia, and mood disturbances at 34 y/o. Studies show High FSH:LH, low E. What are is the dx, risk factors/causes, and how do you get them pregnant?
Premature Ovarian Failure: often idiopathic, but can be caused by Mumps, oophoritis, irradiation, chemo, Hashimoto’s thyroiditis, Addison’s, T1DM, and pernicious anemia. Give IVF with donor oocyte.
Patient with PCOS wants to get pregnant. What symptoms does she have and what do you give her?
PCOS symptoms: Infrequent/absent/missed periods, acne, dandruff, oily skin, hirsutism, infertility, ovarian cysts (non-painful), weight gain, male-pattern baldness. Give her clomiphene citrate (Estrogen analog = induces ovulation), pulsatile GnRH.
What are the indications for administration of prophylactic anti-D immune globulin (RhoGAM), for an unsensitized Rh- pregnant patient?
28-32 weeks gestation, within 72hrs of delivery in an Rh+ baby/ abortion (even threatened), Ectopic, Molar pregnancy, CVS/Amniocentesis, 2/3rd trimester bleeding, External cephalic version.
A patient presents with unpredictable periods for the last 2 years and 12 months of infertility with good effort. She works out for 2 hours 6 days a week and has a lot of stress at work. Her BMI is 20, her LH and FSH are low. What medication can treat her infertility?
This patient likely has acquitted hypogonadotropic hypogonadism due to stress and exercise. Her LH and FSH are both low. She should attempt lifestyle modifications and stress relief, then use pulsatile GnRH.
What are the contraindications to external cephalic version?
Indications for CS regardless of fetal lie (failure to progress, non-reassuring fetal heart tones), placenta previa/abruption, oligohydramnios, ruptured membranes, hyperextended fetal head, fetal/uterine anomaly, multiple gestation, prior to 37 weeks gestation.
20 y/o G0P0 complains of vaginal bleeding lower quadrant pain, and a missed period. her vitals are stable and her PE shows right lower quadrant tenderness without rebound or guarding. There is no active vaginal bleeding and the cervical os is closed. She is Rh+ and her B-HCG is 1000, and TVUS shows no intrauterine or extrauterine pregnancies. What is the next step, and at what level BHCG should you be able to see an IUP?
Wait 48hrs and do another B-HCG. You can’t see an IUP until 1500-2000 B-HCG. In a viable IUP, B-HCG levels will double every 48hrs. If she was Rh -ve and this was an ectopic/threatened abortion, you might consider RhoGAM.
A baby is born to a mother with uncontrolled diabetes. If her diabetes was more uncontrolled in the first trimester, what is the likely outcome? If 2nd/3rd trimester, what four consequences often result?
1st Trimester = spontaneous abortion - often due to congenital anomalies, NTDs, small left colon syndrome.
2nd/3rd Trimester > LGA => Fetal hyperinsulinemia = polycythema, organomegaly, shoulder dystocia => injury, neonatal hyperglycemia.
Best control is good glucose control.
What should you do if a women gets rubella in the first trimester? Should you have given her the vaccine during the pregnancy? If you did without knowing, what should you do?
First trimester rubella often leads to congenital rubella syndrome - offer an abortion.
Don’t give the vaccine during pregnancy; don’t get pregnant within 28 days of vaccine (MMR).
If it happens without knowing, just reassure and do routine visits/prenatal care.
A patient from Bolivia comes into your office with a history of 1 prior NSVD and 1 prior classic (vertical) Cesarean section for breach in Bolivia. She is currently 36 weeks pregnant and 6/80%/0 on exam. She suddenly becomes tachycardic to 140 and tachypneic to 24, and seems agitated with intense diffuse abdominal pain. Bleeding is noted from the vagina. Fetal heart tracing shows variable decelerations and the fetus has changed from 0 to -2 station. What is the dx?
Uterine rupture; Trial of Labor after Cesarean (TOLAC) has a risk of rupture of less than 1%. If the uterine incision is a classic (vertical) incision, the chances can be as high as 9%. A Loss of Fetal Station is the key ‘red flag’ for uterine rupture. Other risk factors include multiparty, AMA, previous myomectomy.
What are the risk factors for cervical incompetence/ insufficiency? Definition of CI?
Prior gyne surgery (LEEP/ cone biopsy), prior obstetrical trauma, multiple gestation, mullerian anomalies, DES exposure, and a history of preterm birth/second trimester (>13week) pregnancy loss. Evaluate with TVUS (gold standard). Definition =
What are the risk factors for placental abruption?
Maternal trauma, chronic hypertension, maternal smoking, history of external cephalic version.
Risk factors for polyhydramnios are?
Fetal malformations and genetic disorders, maternal DM, multiple gestation, fetal anemia.
