Conditions of Pregnancy

Question 1

What are common symptoms experience during pregnancy?

Answer 1

Constipation
Hemorrhoids
Leg cramps/Restless legs
Nausea and vomiting
Urinary Tract infections
Vaginitis
Varicose veins

Question 2

What are the common signs and symptoms of gestational trophoblastic disease?

Answer 2

Abnormal uterine growth
Vaginal bleeding in 1st trimester
Severe nausea and vomiting
Signs of preeclampsia in 1st trimester: edema, hypertension

Question 3

What is the danger of rubella infection during pregnancy?

Answer 3

Can cause severe birth defects in an exposed fetus

Question 4

How is rubella transmitted?

Answer 4

Respiratory droplets

Question 5

What normal flora of the vaginal mucosa may cause an infection of the newborn with possible life-threatening diseas?

Answer 5

Group B streptococcal sepsis

Question 6

What are the risk factors for developing toxoplasmosis in pregnancy?

Answer 6

Exposure to cat feces especially cat litter
Exposure to contaminated water
Raw or undercooked meat
Blood Transfusion

Question 7

What are the symptoms of toxoplasmosis?

Answer 7

Usually asymptomatic
Head and neck LAO
Systemic symptoms: fatigue, fever, malaise

Question 8

What is found on serology with toxoplasmosis?

Answer 8

High IgM titers: acute infection
Low IgM, IgG: previous infection
No IgG: never infected

Question 9

What are some of the risks of developing gestational diabetes?

Answer 9

History of babies > 9 pounds
History of hyperglycemia, history of family history of DM
BMI > 25

Question 10

What should be part of the prenatal screening that might help pick up the beginning of gestational diabetes?

Answer 10

Urinalysis for glycosuria
Oral glucose tolerance test

Question 11

What is the lab test done to diagnose gestational diabetes?

Answer 11

Oral glucose test

Question 12

What is the definition of pregnancy-induced hypertension?

Answer 12

> 140/90 BP or rise of more than 30 systolic or 15 diastolic from the intake baseline

Question 13

What is the most common pregnancy complication and the cause of maternal death in the US and the world?

Answer 13

Preeclampsia

Question 14

What clinical findings are present with preeclampsia?

Answer 14

Pregnancy induced HTN
Proteinuria
Edema and excessive weight gain

Question 15

What is the usual time period for preeclampsia to occur?

Answer 15

Week 20 to the end of 1st week postpartum

Question 16

What is added to the symptoms of preeclampsia or toxemia situation?

Answer 16

Seizures and/or coma

Question 17

What are some ominous findings in preeclampsia?

Answer 17

HA, visual changes, retinal changes: nicking , oliguria

Question 18

What finding on a urine dipstick is consistent with preeclampsia?

Answer 18

High urine protein

Question 19

How does preeclampsia affect urine calcium?

Answer 19

It will cause a decrease

Question 20

What are the signs and symptoms of abruptio placentae?

Answer 20

Vaginal bleeding after 20 weeks gestation
Abdominal pain
Uterine tenderness
Fetal Heart Rate changes

Question 21

What might you expect in a history of someone with ectopic pregnancy?

Answer 21

Infertility treatment
History of PID or abdominal/pelvic surgery
Post tubal ligation
Current IUD use
Hx of endometriosis

Question 22

What are the signs and symptoms of ectopic pregnancy?

Answer 22

1) Severe lower abdominal pain and tenderness about 5-10 weeks into pregnancy with rebound tenderness and rigidity

2) Amenorrhea
3) Vaginal bleeding or spotting with brownish discharge
4) Referred neck and shoulder pain

Question 23

How is a diagnosis of ectopic pregnancy made?

Answer 23

1) Positive pregnancy test
2) Transvaginal ultrasound finds non-pregnant uterus
3) Beta hCG levels do not double as they should in a normal pregnancy

Question 24

What is in the DDx for ectopic pregnancy?

Answer 24

Appendicitis
PID
Ovarian tumor
Spontaneous abortion
Ruptured cyst
Kidney stones

Question 25

What are the common signs and symptoms of placenta previa?

Answer 25

Painless vaginal bleeding during second half of pregnancy

Question 26

In what condition do you get erythroblastosis fetalis?

Answer 26

Rh incompatibility between mother and infant

Question 27

What causes Rh incompatibility?

Answer 27

Mother who is Rh negative and a father who is Rh positive

Question 28

What does Rh compatibility become a problem?

Answer 28

In a second or later pregnancy: first pregnancy causes sensitization

Question 29

How is the mother affected by Rh incompatibility?

Answer 29

Asymptomatic

Question 30

What are the symptoms of erythroblastosis fetalis?

Answer 30

Causes RBC destruction leading to fetal death or high bilirubin levels at birth, followed by poor feeding, flaccidity, seizures, apnea and neonatal death

Question 31

When do most spontaneous abortions occur?

Answer 31

Between 8-12 weeks

Question 32

How long might it take after fetal death for the fetus to be expelled?

Answer 32

2-4 weeks

Question 33

What is usually done to confirm fetal death?

Answer 33

Ultrasound, beta hCG levels

Question 34

What might indicate the onset of spontaneous abortion?

Answer 34

Cramping and/or bleeding without tissue loss

Question 35

What can be triggered by retained products of conception?

Answer 35

DIC

Question 36

What labs are indicated to closely to monitor for DIC?

Answer 36

PT, fibrinogen and platelet levels

Question 37

What defines recurrent pregnancy loss?

Answer 37

History of 3 or more consecutive spontaneous abortions

Question 38

What might be some of the causes of recurrent pregnancy loss?

Answer 38

1) Endocrine Factors: PCOS, luteal phase defect, DM, thyroid autoimmunity 2) Chromosomal abnormalities 3) Infection: Toxoplasmosis, cytomegalovirus 4) Uterine anomalies 5) Cervical insufficiency 6) Antiphospholipid syndrome 7) Factor XII deficiency

Question 39

What are some of the risk factors for developing postpartum depression?

Answer 39

1) Personal history of depression 2) Lack of social/family/ financial support 3) Unplanned pregnancy 4) Miscarriage

Question 40

What are common causes for lactation disorders?

Answer 40

Inadequate milk supply Nipple and breast pain Lip and tongue ties Poor milk extraction by infant

Question 41

What are the common presentations of postpartum thyroiditis?

Answer 41

1) Classic: hyperthyroidism, followed by hypothyroidism; followed by return to normal thyroid function 25% 2) Transient hyperthyroidism followed by return to normal thyroid function 32% 3) Transient hypothyroidism followed by return to normal thyroid function 43% 4) 30% remain hypothyroid 1 year after presentation

Question 42

What are the common signs and symptoms of symphysis pubis dysfunction?

Answer 42

Suprapubic pain Pain radiates to legs, hip or back Worse with weight bearing, turning in bed or getting up from a chair Symphysis separation >10-13 mm on imaging (not usually performed)