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obgyn > Abnormal Obstetrics > Flashcards

Abnormal Obstetrics Flashcards

1
Q

b-hCG discriminatory zone

A

2000

*Doubles ever 48 hours in normal pregnancy, until 42 days old

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2
Q

Progesterone level in normal pregnancy

A

> 25 ng/ml

<5 suggests abnormal or extrauterine pregnancy

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3
Q

Mifepristone

A

progesterone receptor antagonist: emergency contraception to block ovulation, or with misoprostol for abortion

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4
Q

Diagnosis of ectopic pregnancy

A

Either:

1) Fetal pole is visualized outside the uterus on ultrasound;
2) Beta-hCG level > 2000 but no IUP on ultrasound; or
3) Inappropriately rising Beta-hCG level <50% increase in 48 hours, and has levels which do not fall following diagnostic dilation and curettage

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5
Q

Ectopic treatment, if hemodynamically stable and no signs of ruptue (but okay if small amount of free fluid)

A

Methotrexate

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6
Q

Ectopic with hypovolemia, peritoneal signs (rebound, guarding and severe abdominal tenderness)

A

Ruptured ectopic -> laparoscopy

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7
Q

Threatened abortion

A

Vaginal bleeding before 20 weeks without the passage of any products; no further assessment

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8
Q

Most common cause of first trimester abortion

A

Conceptus genetic abnormality (most commonly autosomal trisomy);
*If late 2nd trimester, other cause

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9
Q

Systemic disease that can cause SAB

A

DM, CKD, SLE (not HTN, not hx of preeclampsia)

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10
Q

Environmental factors than can cause SAB

A

smoking, alcohol and radiation

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11
Q

Incompetent cervix tx

A

Cerclage at 14 weeks

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12
Q

Workup of recurrent abortion (3 successive first trim losses)

A

Antiphospholipid ab, DM, Thyroid; Maternal and paternal karyotypes; infectious causes; uterine imaging

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13
Q

Migraines in pregnancy treatment

A

TCAs amitriptyline

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14
Q

ACE-I in pregnancy

A

Beyond the first trimester of pregnancy has been associated with oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death.

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15
Q

HIV in pregnancy treatment

A

Intravenous zidovudine in labor and zidovudine treatment for the neonate; C-section

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16
Q

Most common cause of septic shock during pregnancy

A

Pyelonephritis&raquo_space; chorioamnionitis and PNA

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17
Q

Asthma in pregnancy

A

Worsens in 40%

inhaled corticosteroids or cromolyn sodium

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18
Q

Thyroid storm in pregnancy tx

A

Thioamides (i.e. PTU), propranolol, sodium iodide and dexamethasone. Oxygen, digitalis, antipyretics and fluid replacement may also be indicated.
No radioactive iodine -131

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19
Q

Syphillis diagnosis and tx in pregnancy

A

+RPR –> +FTA-ABS –> PenG –> If allergic, IgE skin test –> desensitization and IM PenG

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20
Q

BV tx in pregnancy

A

PO metronidazole reduces risk of preterm labor

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21
Q

Pulmonary HTN in pregnancy

A

25% death rate, greatest risk when diminished venous return and right ventricular filling

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22
Q

MVP in pregnancy (systolic murmur with click) treatment

A

Beta-blocker if symptomatic (anxiety, palpitations, atypical chest pain, syncope)

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23
Q

Diagnosis of PNA in pregnancy

A

Symptoms –> CXR

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24
Q

Obesity in pregnancy increases risks of…

A

Preeclampsia, HTN, GDM, fetal macrosomia, Cesarean delivery and postpartum complications

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25
Q

SLE in pregnancy treatment

A

Steroids

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26
Q

Breast lump –> adenocarcinoma in pregnancy –> treatment?

A

Regional lymph nodes are more likely to contain microscopic metastases. Surgical treatment – wide excisional biopsy (absence of mets), modified radical mastectomy, or total mastectomy with axillary node staging.
*No adjunct radiotherapy

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27
Q

Depression in pregnancy treatment

A

SSRIs (no paroxetine d/t cardiac malformations and pulmonary HTN), TCAs (no risk), and Buproprion

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28
Q

Treatment of pruritis gravidum (bile salt retention, itching, lesions)

A

Emolients and antihistamines -> Ursodeoxycholic acid

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29
Q

Fever, nausea, vomiting, abdominal pain in pregnancy

A

R/o appendicitis: graded compression US.

Peritonitis and appendiceal rupture are more common during pregnancy

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30
Q

Preeclampsia diagnosis and tx

A

Mild: 300mg and 140/90
Severe: 5000mg or 160/110
(mild or severe doesn’t dictate tx)
Tx: Delivery unless too early, with magnesium sulfate during labor and for 24 hours postpartum to lower the seizure threshold

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31
Q

Risk factors for preeclampsia

A

Race, genetics, previous preeclampsia, chronic hypertension, multifetal pregnancy, molar pregnancy, extremes age, DM, CKD, Antiphospholipid ab, CT disease, Triploidy

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32
Q

Mg toxicity

A

Therapeutic is 4-7
7-10 loss of DTR
11-15 respiratory depression
≥15 cardiact arrest

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33
Q

Indications for delivery in preeclampsia before 32 weeks

A

Platelets < 100,000; HTN with 2 meds; non-reassuring FHR; LFTs >2x normal; eclampsia; CNS symptoms and oliguria
*Does NOT depend on degree of proteinuria

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34
Q

HELLP cx

A

Liver capsule swelling and rupture

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35
Q

Most common cause of 3rd trimester bleeding

A

Placental abruption

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36
Q

Fetal hydrops

A

Collection of fluid in two or more body cavities, such as ascites, pericardial and/or pleural fluid and scalp edema

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37
Q

RhoGAM administration, dose to fetal blood ration

A

30 cc of fetal blood is neutralized by the 300 micrograms dose (=15 cc RBCs)

38
Q

Kleihauer-Betke test

A

Acid elution test to determine incidence and size of fetal transplacental hemorrhage.

39
Q

Severity of erythroblastosis fetalis

A

Bilirubin measurement in amniotic fluid: spectrophotometric measurements of the optical density between 420 and 460nm (absorbed by bili)

40
Q

Severe hemolytic disease at 30 weeks GA as shown by delta OD450 results on Liley curve in Zone 3. Tx?

A

Intrauterine intravascular fetal transfusion into umbilical vein

41
Q

Markers of dizygotic twins

A
  • Dividing membrane > 2 mm thick
  • Twin peak (lambda) sign
  • Different fetal genders
  • Two separate placentas
    3, 8, 12, 13 (conjoined)
42
Q

Risk of twin pregnancy

A

5x risk of death and CP; increased IUGR and prematurity (use early good weight gain) and congenital anomalies

43
Q

TTTS

A

Surviving twin has higher risk of neurologic sequelae (like CP)

44
Q

Most serious risk of triplet pregnancy

A

Preterm delivery

45
Q

optimal mode of delivery for twins in which the first twin is in the breech presentation

A

Cesarean (vag delivery has risk of head entrapment and umbilical cord prolapse)

46
Q

Risk of x-ray in pregnancy is greatest when?

A

microcephaly and severe mental retardation is greatest between 8-15 weeks

47
Q

Lab test in pregnant woman with bleeding

A

Bloodtype

48
Q

Death of one twin at 23 weeks, no prenatal care (so unknown when death occurred), and nosebleed yesterday. Next step?

A

Fibrinogen level (decreased in coagulopathy at 3-4 weeks)

49
Q

VBAC

A

Decreasing d/t association with uterine rupture. Also, OB’s less willings to do forceps/vaccum delivery or breech vaginal.

50
Q

G2P1 at 40 weeks with severe back pain, wants induction. Closed cervix. Next step?

A

Misoprostol prior to pitocin

51
Q

Breech presentation risk factors

A
  • Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids*
52
Q

Normal latent phase (until 4 cm)

A

Primipar: 20 hours
Multipar: 14 hours

53
Q

VBAC success affected by what?

A

Lower success rate after two C-sections than one

54
Q

Breech types

A

Frank (buttocks first; most common); complete breech (criss-crossed legs with feet down); incomplete (one foot straight up)

55
Q

Bleeding at 25 weeks GA. Next step?

A

Pelvic US to r/o p. previa before digital exam

56
Q

Third episode of bleeding at 36 weeks with known p. previa. Management?

A

C-section

57
Q

FFP and Cryo contain what?

A

FFP: Fibrinogen, factors 5 and 8
Cryo: Fibrinogen, factors 8, 13, vWF

58
Q

Crack cocaine user and smoker at 32 weeks with abdominal pain, bleeding, tense and tender uterus, and fetal distress. Diagnosis and treatment.

A

Placental abruption. C-section, IVF, blood products.

59
Q

Risk factors for placental abruption

A

Smoking, cocaine use, abdominal trauma, chronic hypertension, multiparity and prolonged premature rupture of membranes

60
Q

Smoking consequences

A

placental abruption, placenta previa, fetal growth restriction, preeclampsia and infection

61
Q

Third trim bleeding

A

Placenta previa, placental abruption, bloody show (friable cervix in labor), cervicitis (chlamydia, gonorrhea, trichomonas infection not in labor)

62
Q

Bleeding and cervical lesion in pregnancy, in a woman without adequate screening

A

Cervical cancer

63
Q

Fundal height at navel

A

20 weeks

64
Q

Most common cause of preterm labor

A

Idiopathic

65
Q

Woman at 28 weeks with contractions, tachycardia, leukocytosis, and fever. Reassuring FHR.

A

Intramniotic infection -> induction of labor

66
Q

Mg Sulfate as tocolytic: contraindication

A

Myasthenia gravis

67
Q

Contraindicated tocolytics in DM

A

Terbutaline and ritodrine

not really used anyways

68
Q

Mg Sulfate as tocolytic: mechanism

A

Competes with Ca2+ for entry into cells

69
Q

Terbutaline (and ritodrine) mechanism as tocolytic; SE

A

Beta-2-adrenergic -> increased cAMP -> decreased free Ca2+

  • SE: tachycardia, hypotension, anxiety, CP
  • Do not use, or at least no more than 48 hours
70
Q

Indomethacin mechanism as tocolytic; SE

A

Decreased prostaglandin synthesis

*SE: Premature constriction of DA, especially after 32 weeks

71
Q

Nifedipine for tocolysis: Mech and SE

A

Ca Channel Blocker

- Fetal hypoxia, decreased uteroplacental blood flow

72
Q

Result of betamethasone steroid use between 24-34 weeks pregnancy

A
  • Increased pulmonary maturity and reduced RDS

- Decreased ICH and NEC

73
Q

Fibronectin testing

A

Negative predictive value

  • 99 out of every 100 patients with a single negative test result will not deliver in the next 14 days
74
Q

Risk factor for PROM

A

Genital tract infection (BV) > smoking, prior hx, short cervical length < 2.5cm?

75
Q

Best med to delay labor in PPROM?

A
  • Antibiotic therapy, by 5-7 days, and also reduce amnionitis and sepsis.
  • Corticosteroids (betamethasone) and tocolytics may also prolong the pregnancy for less time
76
Q

PPROM before 25 weeks - greatest risk to fetus?

A

Pulmonary hypoplasia: because the lack of amniotic fluid interferes with the normal intrauterine breathing process

77
Q

Results indicating intraamniotic infection on amniocentesis?

A

Glucose < 20, increased IL-6

78
Q

What med could reduce risk of Preterm PROM, in patient with hx of PPROM?

A

17 alpha-hydroxyprogesterone (decreased risk of premature labor)

79
Q

PPROM at 36 weeks, and not in labor. treatment?

A

Augmentation of labor

80
Q

Normal NST

A

two fetal heart rate accelerations of 15 beats/minute for 15 seconds within 20 minutes

81
Q

Treatment of late decels (uteroplacental insuff and fetal hypoperfusion)

A

Left lateral position which increases perfusion to the uterus, supplemental oxygenation, treatment of maternal hypotension, discontinue oxytocin, consider intrauterine resuscitation with tocolytics and intravenous fluids, fetal acid-base assessment with fetal scalp capillary blood gas or pH measurement

82
Q

Globular pale mass at introitus after delivery

A

Uterine inversion

83
Q

Most likely cause of PPH in a woman with low-lying anterior placenta and history of multiple Cesarean births

A

Placenta accreta

84
Q

The following are associated with retained placenta

A

Prior Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta.

85
Q

Method of delivery of uterotonics

A

Prostaglandin F2alpha: IM or into uterine muscle
Oxytocin: IV infusion (not push)
Misoprostol: oral or rectal

86
Q

Prolonged second (active) stage

A

Primipar: 1.2 cm/hr
Multipar: 1.5 cm/hr

87
Q

SSRIs in pregnancy SE

A

pulmonary hypertension of the newborn and a self-limiting neonatal behavioral syndrome.

88
Q

Risk factors for postterm pregnancy (>42 weeks)

A

placental sulfatase deficiency, fetal adrenal hypOplasia, anencephaly, inaccurate or unknown dates and extrauterine pregnancy.

89
Q

Indication for amnioinfusion

A

repetitive variable decelerations,

90
Q

Indication for twice weekly non-stress tests with amniotic fluid index.

A

Unsure dating

91
Q

Associations with dysmature postdate infant

A

withered, meconium stained, long-nailed, peeling skin, fragile, small placenta, still birth

92
Q

CVS and amniocentesis timing

A

CVS: 10-12
Amnio: >15

obgyn (4 decks)

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