B8-018 Diseases/Disorders of Gestation

Question 1

2 screening options for gestational diabetes

Answer 1

Two step approach: 1 hr glucose challenge test

One-step approach: 2 hr glucose tolerance test

Question 2

what medication is the “gold standard” for controlling hyperglycemia in pregancy?

Answer 2

insulin

(metformin is a safe oral alternative)

Question 3

advanced maternal age is considered any mother who will be […] or older at time of delivery

Answer 3

35

Question 4

risk factors associated with AMA [4]

Answer 4

aneuploidy
early onset gestational diabetes
preterm delivery
stillbirth

Question 5

preeclampia is new onset HTN on two separate occasions […] hours apart after […] weeks gestational age plus proteinuria

Answer 5

4 hours
20 weeks

Question 6

new onset HTN with either proteinuria or end-organ dysfunction after 20 weeks gestation

Answer 6

preeclampsia

Question 7

only intervention shown to decrease the risk of preeclampsia in subsequent pregnancies

Answer 7

aspirin

(decreases thromboxane: prostacyclin)

Question 8

risk factors for the development of preeclampsia

Answer 8

hx of preeclampsia
multifetal gestation
chronic HTN
diabetes
kidney disease
autoimmune diseases
AMA
obesity

Question 9

aspirin should be given to women at a high risk of developing preeclampsia beginning at […] weeks gestation

Answer 9

12

Question 10

BP > 140/90 after 20 weeks gestation
no preexisting hypertension
no proteinuria or end-organ damage

Answer 10

gestational hypertension

Question 11

hypertension prior to 20 weeks gestation suggests

Answer 11

chronic (overt) hypertension

Question 12

antihypertensives safe in pregnancy [4]

Answer 12

hydralazine
a-methyldopa
labetalol
nifedipinie

(Hypertensive Moms Love Nifedipine)

Question 13

caused by abnormal placement of the placental spiral arteries causing endothelial dysfunction, vasoconstriction, and ischemia

Answer 13

preeclampsia

Question 14

prophylaxis for preeclampsia

Answer 14

aspirin

Question 15

treatment for preeclampsia

Answer 15

antihypertensives
IV magnesium sulfate
delivery

Question 16

preeclampsia with seizures

Answer 16

eclampsia

Question 17

preeclampsia with thrombotic microangiopathy of the liver

Answer 17

HELLP syndrome

Question 18

what does HELLP syndrome stand for?

Answer 18

Hemolysis
Elevated
Liver enzymes
Low
Platelets

Question 19

blood smear in HELLP syndrome will show

Answer 19

shistocytes

Question 20

treatment for HELLP syndrome

Answer 20

immediate delivery

Question 21

hormone that promotes insulin resistance to supply the growing fetus with glucose and amino acids

Answer 21

human placental lactogen

(implicated in gestational diabetes)

Question 22

PPROM is anytime before […] weeks gestational age

Answer 22

37

Question 23

preterm labor is defined as regular contraction that induce […]

Answer 23

cervical change

Question 24

signs of PPROM on speculum exam [3]

Answer 24

fluid pooling in vaginal vault
ferning on light microscopy
positive nitrazine pH test

(also can send fluid to lab form specific protein testing)

Question 25

if GBS status is unknown, what is should be done?

Answer 25

give antibiotics

Question 26

intraamniotic infection associated with significant maternal fetal mortality

Answer 26

chorioamnionitis

Question 27

signs of chorioamnionitis [5]

Answer 27

fever changes in fetal heart rate high maternal WBC with left shift purulent fluid on speculum exam fundal tenderness to palpation

Question 28

treatment of chorioamnionitis

Answer 28

delivery

Question 29

administration of [...] decreases premature infant mobidity/mortality [2]

Answer 29

mag sulfate corticosteroids

Question 30

fluorinated steroids [2]

Answer 30

betamethasone dexamethasone (can cross the placenta)

Question 31

there is no benefit to giving corticosteroids before [...] weeks gestational age

Answer 31

22-23

Question 32

magnesium sulfate given within [...] hours of delivery lowers the incidence of cerebral palsy and infant death

Answer 32

24 hours

Question 33

magnesium sulfate should be given to any pregnancy threatened to deliver before [...] weeks gestational age to decrease chance of cerebral palsy/fetal death

Answer 33

32 weeks

Question 34

neurologic morbidity significantly decreases after [...] weeks gestational age

Answer 34

32

Question 35

what is the definition of hypertension in a pregnant mother?

Answer 35

BP > 140/90 on more than one occasion

Question 36

a creatinine level that doubles from baseline or is greater than 1.1 mg/dl indicates severe

Answer 36

preeclampsia

Question 37

severe features of preeclampsia

Answer 37

thrombocytopenia doubling of liver enzymes pulmonary edema papilledema headaches hyperreflexia hemolysis

Question 38

proteinuria is defined as a 24 hour urine collection containing greater than [...] mg of protein

Answer 38

300

Question 39

patients of AMA should be offered [...] screening

Answer 39

aneuploidy (higher incidence of trisomies 13, 18, 21)

Question 40

risks to the fetus associated with maternal hyperglycemia [4]

Answer 40

congenital anomalies newborn episodes of hypoglycemia newborn hyperbilirubinemia injury during delivery due to size

Question 41

most appropriate test for determining if amniotic membranes have ruptured

Answer 41

sterile speculum exam

Question 42

definition of preterm labor

Answer 42

regular, painful contractions accompanied by cervical change prior to 37 weeks

Question 43

interventions shown to improve outcomes in PPROM [3]

Answer 43

antibiotics corticosteroids magnesium sulfate