Obstetrics

Question 1

Pathophysiology of Pre-eclampsia

Answer 1

?Placental insufficiency, results in progressive vasospasm - leads to end organ damage if unchecked.

Question 2

HELLP syndrome Pathophysiology?

Answer 2

Vasospasm in the arterioles, leads to hemolysis (increased LDH) and endothelial injury (low platelets) and decreased perfusion to tissues particularly liver (elevated AST/ALT) and kidney (increased Cr)

Question 3

Severe features of Pre-eclampsia?

Answer 3

BP >160/ >110, headache, vision changes, RUQ pain, severe proteinuria, seizure

Can have atypical Pre-E - with no HTN

Question 4

When does blood volume expansion begin?

Answer 4

1st trimester, increases in the 2nd trimester and plateaus at week 30

• Will see a drop in hemoglobin

Question 5

HR in pregnancy?

Answer 5

Usually increases by 15 beats

Question 6

Heartburn in pregnancy

Answer 6

Starts to get worse around 35 weeks, try gaviscon - mint (according to Caroline)

Question 7

Tx for molar pregnancy

Answer 7

U/S and high bHCG, this is a cancer - so do a D&C right a way, trend the bHCG every month, no pregnancy for a year.

(Bunch of grapes on U/S)

Question 8

Rhogam at?

Answer 8

28 weeks, and after delivery 72 hours

Question 9

GBS test

Answer 9

35-37 weeks

Question 10

Morning sickness?

Answer 10

B6 try it, then diclectin

Question 11

Work up for pre-E

Answer 11

CBC, Cr/eGFR, LDH, ALT/AST, Protein, Pro/Cr, Uric acid lvl

Question 12

Eclampsia Management

Answer 12

Mg sulfate, give lorazepam until seizure stops, load with hydrazine if high BP, then do c-section.

Question 13

Lab tests for HELLP

Answer 13

CBC, platelets, LFT and enzymes, Cr/eGFR, Coags, LDH, total bilirubin

Question 14

Glucose test

Answer 14

At 28 weeks, follow up 6wks and 6months postpartum if GDM

Question 15

Depression during pregnancy?

Answer 15

Escitalapram, Sertraline

Question 16

Suspect an ectopic?

Answer 16

Get a beta-HCG, quant, urine, group and screen, and US to confirm an intrauterine

Question 17

Risk factors for ovarian torsion?

Answer 17

Pregnancy, usually young, usually presents suddenly during activity, N/V, prior Hx of same, abnormal ovaries (large cyst)

Question 18

Unusual vaginal bleeding?

Answer 18

Make sure it is actually vaginal, are they pregnant? Is it heavy?
If no to the first 2 then this is likely not an emergency - start thinking of things more like fibroids, cancer etc (gyne consult)

Question 19

When should you see a gestational sac in the uterus

Answer 19

1500 HcG transvaginal
5000 trans abdominal

Less than that have to follow up and check again

Question 20

Stages on US of pregnancy by weeks

Answer 20

4wk - gestational sac
5wk - yolk sac
6wk - fetal pole ideally with cardiac activity

Question 21

Threatened abortion

Answer 21

Any first trimester bleed

Question 22

Inevitable abortion

Answer 22

Cervix open, and no fetal cardiac activity

Question 23

Incomplete abortion

Answer 23

Some tissue passed or bleeding, but still some products of conception in uterus

Question 24

Missed abortion

Answer 24

Fetal demise in uterus - but body has not expelled yet - risk of septic abortion

Question 25

Options for miscarriage tx

Answer 25

Can wait and do nothing if stable and things progressing, can give misoprostol intravaginal , can complete surgery if unstable

Question 26

Classic triad of ectopic pregnant

Answer 26

Pain, vaginal bleeding, adnexal mass

Question 27

Ectopic risk factors

Answer 27

Hx of PID/STIs, previous gyne surgery, previous ectopic, smoking (abnormal tubal mobility), infertility, multiple sexual partners, IUD use, advanced maternal age

Question 28

Heterotopic pregnancy

Answer 28

Both intrauterine, and ectopic, high risk in IVF - ask about fertility treatments

Question 29

Management of ectopic

Answer 29

Methotrexate - need to be stable with, small sac

Surgical removal - if not

Question 30

When give rhogam?

Answer 30

If Rh negative - and had a pregnancy - or miscarriage, rhogram lasts for about 3 weeks - don’t have to repeat dose if had it within then, at 28 weeks and then 72 hours delivery, traumatic injury during pregnancy with injury not limited to extremity

Question 31

Hyperemesis gravidarum DX

Answer 31

5% Weight loss + N/V + ketonuria

Question 32

Hyperemesis management

Answer 32

Try diclactin, gravol, Maxeran, then zofran

Question 33

PID Tx

Answer 33

Ceftriaxone and Azithro - consider metronidazole, and follow up

Question 34

Trauma with pregnant lady

Answer 34

Focus on mother - try to off-load IVC with wedge on the right side, try to clear C-Spine as soon as possible

Question 35

Physiologic pregnancy and resuscitation

Answer 35

HR and RR increase, BP lower, BV is increased so may lose about 2L before showing

Physiologic WBC elevation, hyper coagulable, delayed gastric emptying - risk of aspiration, bladder is pushed up - more risk of trauma

Low reserve volume = fast desat when sedated

Question 36

Painful vaginal bleeding post trauma

Answer 36

Concern for placental abruption - monitor for at least 4 hours

Some contractions that subside after a few hours is not uncommon after a trauma

Question 37

Tests to order on a first trimester bleed?

Answer 37

CBC-D, type and screen, quantitive bHCG, urinalysis, US

Quant zone for being about to see gestational sac on US should be 1500