UWise Ob/Gyn

Question 1

Patient presents in labor. She says she felt her water break 24hours ago and now how a fever of 101F. What is she at risk of? What lab value from amniotic fluid can be diagnostic?

Answer 1

Chorioamnionitis from prolonged rupture of membranes

Low amniotic glucose < 20 mg/dL. Leukocytes is a poor predictor!

Question 2

23yo patient presents one day after a medical abortion for unwanted pregnancy. She has been soaking through a pad an hour for the last 5 hours and now has a hematocrit of 29%. Otherwise she is hemodynamically stable. Next step?

Answer 2

Dilation and curettage because of extent of bleeding (normal hematocrit 35-45%).
This is more bleeding than is reasonable for a medical abortion

Question 3

20yo patient at 40weeks gestation presents in labor. Initial assessment is 2cm/90%/0. After 3hrs her exam is unchanged. Next step?

Answer 3

Just wait! She is not in active phase of labor (>4cm). Never rupture membranes in latent labor! Increases risk for chorioamnionitis
Latent phase of labor is okay up to 20hrs for a nullip or 14hrs for a multip

Question 4

Thinking about classification of lacerations (1st - 4th degree)

Answer 4

2nd: perineum involvement → 3rd: rectal sphincter involvement → 4th: rectal mucosa involvement (into rectal lumen)

Question 5

Mechanism of ovulation predictor kits? Timing of sex?

Answer 5

Urine tests for LH. They detect the LH surge which directly precedes ovulation. Thus, patients should have lots of sex nonstop for 24-48hrs after this

Question 6

How much RhoGAM neutralizes how much fetal blood?

Answer 6

10micrograms for every 1cc of fetal blood (assuming 50% hematocrit)

Question 7

25yo woman presents with abnormal uterine bleeding. Transvaginal ultrasound reveals an endometrial polyp <1.5cm. The patient desires future pregnancies. Next step?

Answer 7

Observation. If polyp > 1.5cm, consider a polypectomy or curettage. Sometime progestin is an option too

Question 8

Patient delivers a baby at 44weeks gestation. The baby has a very small placenta and is described as withered, meconium stained, long-nailed, and fragile. Diagnosis?

Answer 8

Dysmaturity! These are at high risk for still birth, especially at >43 weeks gestation

Question 9

Best way to prevent preterm, low-birthweight babies in a woman pregnant with twins?

Answer 9

Early weight gain during the first 20-24 weeks!!