L72 + 73

Question 1

Most common site for ectopic pregnancy

Answer 1

Tube - ampulla

Question 2

RFs ecoptic

Answer 2

Use assisted repro tech
Prev tube surg // ectopic 
Infections (PID)
Endometriosis
Smoking

Question 3

Presentation of ectopic

Answer 3

Ab pain + skipped period + vag bleeding

Symptoms/vitals will depend on amt of blood loss

Question 4

How should BhCG change during a normal preg

Answer 4

Double every 48 hrs (66%)

Question 5

What BhCG means you should be able to see a fetus in the uterus?

Answer 5

> 1500

Question 6

Treat ectopic

Answer 6

MTX - f/u for BhCG fall
Lapro = treat
1. Salpingostomy = remove ectopic
2. Salpinectomy = remove tube
D&C - certain det of uterine preg (when don't see fetus on US)

Question 7

What molecule normally suppresses delivery?

Answer 7

Progesterone -> increase CRH in bound form

Suppress production of ACTH (pit) and cortisol + DHEA (adrenal cortex)

Question 8

Describe physiology of contractions

Answer 8

Less CRH
More ATCH from ant pit -> says adrenals produce 
1. Cortisol -> PGE
2. DHEA -> E (now E > P)
Changes in the myometrium

Question 9

How does pre-term birth happen?

Answer 9

Some inflam triggers the normal physiology to start early

Question 10

TESTQ: what is the def of pre-term labor

Answer 10

Regular uterine contractions causing cervical change before 37 wks

Question 11

RF pre-term birth

Answer 11

Prev pre-term birth
Multiple kids
Bleeding in preg

Question 12

What is fetal fibronetin

Answer 12

Swab vagina - amniotic fluid will form crystals on slide
High NEGATIVE predict value - don’t see it, you’re not having pre-term labor
Positive doesn’t tell you anything

Question 13

Treat pre-term birth

Answer 13

Delay to 34 wks

1. IV fluid bolus - if dehydrated, will start contractions
2. Tocolysis
3. Steroid - promote lung maturity
4. Mg - neuro protective in baby
5. Grp B strep if you’re moving towards delivery

Question 14

Meds to stop pre-term labor

Answer 14

Tocolysis
Mg
Nifedipine = Ca CB
Indomethacin = block PG, going to close PDA

Question 15

CI to tocolysis

Answer 15

Infection - just deliver
Sig vag bleeding
After 34 wks - just deliver

Question 16

What is PPROM

Answer 16

Preterm premature rupture of membranes

Dx by fluid coming out of the vagina

Question 17

2 tests to confirm PPROM

Answer 17

pH (nitrazine) - amniotic fluid should be basic

Ferning - shows crystals on slide

Question 18

Risks of PPROM

Answer 18

Infection - opening in the cervix!
Cord prolapse
Abruption
Pulm hypoplasia - depends on how early the rupture

Question 19

Treat PPROM

Answer 19

Antibiotics - also helps to stop contractions
Steroids
Tocolysis if contracting

Question 20

Describe the 4 different types of HTN you might see in preg

Answer 20

> 140/90
Chronic HTN - existing that continues in preg (pre-20 wks)
Gestation HTN - BP returns to normal after delivery
Pre-eclampsia
Eclampsia = seizures during or after delivery

Question 21

Presentation of pre-eclampsia

Answer 21

HTN + proteinuria or if no proteinuria then one symptom of HTN

Question 22

What are signs of severe pre-eclamp

Answer 22

Care b/c change management
Higher BP
TCP
↑LFTs
↑Cr > 1.1
Pulm edema

Question 23

What is HELLP syndrome

Answer 23

Variant of severe pre-eclamp

Hemolysis + ↑LFTs + TCP

Question 24

RF pre-eclamp

Answer 24

Never preg before
AA
Twins +

Question 25

Pathophys of pre-eclamp

Answer 25

Blasts didn't invade enough into the myometrium | Don't lose arterial smooth muscle as should

Question 26

What triggers pre-eclamp

Answer 26

Placenta dysfxn secretes factors that bind ligands normally protective Endothelial dysfxn -> vessels constrict -> *↑BF velocity* -> ↓O2 to fetus

Question 27

4 organs in addition to placenta effected by pre-eclamp

Answer 27

Kidney - ↑Cr, proteinuria Brain - swelling = ↑seizures Liver - swelling, RUQ pain, ↑LFT, TCP Microvasc hemolysis

Question 28

Treat pre-eclamp

Answer 28

Get to 34 wks if at all possible | + Mg = delay delivery + prevent seizure

Question 29

Long term effects of pre-eclamp

Answer 29

Lifelong ↑vasc risk | Metabolic syndrome or HTN

Question 30

2 possible causes of bleeding during preg + 1st dx step

Answer 30

Placenta privia or abruption (+pain) | TESTQ: do US, NOT PE b/c you'd increase bleeding risk if privia

Question 31

Most common complication of twin + pregnancies

Answer 31

Pre-term delivery

Question 32

Name the 4 types of twin possibilities + what see on US

Answer 32

1. Dichor diamnio = 2 separate preg (fraternal twins) lamda sign 2. Monochor diamnio = 1 placenta, 2 sacs (identical twins) T sign 3. Monochor monoamnio = 1 placenta, 1 sac (identical twins) see no membrane 4. Conjoined twins

Question 33

TESTQ: RF for adherent placenta (placenta privia)

Answer 33

Prev C section - increasing C section rate means this problem is on the rise Uterine infection HTN Smoking