Medical Disease, Third Trimester Bleeding, Prenatal Infections, Contraception

Question 1

Why would a Ua or UCX be done to work up UTI

Answer 1

On asymptomatic screen, for frequency/dysuria/urgency, or for UFD with chills, fever, and CVA

Question 2

What are the possible outcomes of UA and UCX

Answer 2

Positive UA, positive symptoms, positive casts
Positive UA, positive symptoms, no casts
Positive UA, no symptoms

Question 3

What does Positive UA, positive symptoms, positive casts mean? How to work it up?

Answer 3

Pyelonephritis. If pregnant, admit and start zosyn.
Rescreen after dose. If pyelo is improved, it’s pyelo. If not improved then there’s an abscess. Diagnose with ultrasound and treat with I+D.

Question 4

What does Positive UA, positive symptoms, positive casts

Positive UA, positive symptoms, no casts mean? How to work it up?

Answer 4

UTI. Treat with nitro, ceftriaxone

Question 5

What does positive UA, no symptoms mean? How to work it up?

Answer 5

Asymptomatic bacteriuria. MUST treat in pregnancy with nitro or ceftriaxone. Then rescreen to make sure negative. If still positive, keep treating.

Question 6

What drugs should and should not be used to treat chronic hypertension?

Answer 6

Use methyldopa, hydralazine, labetalol. DO NOT USE acei, arbs, diuretics.

Question 7

What does fetal hyperthyroidism cause? Fetal hypothyroidism?

Answer 7

Demise

Cretinism

Question 8

Can RAIU be done in pregnancY?

Answer 8

NO

Question 9

How to treat maternal hyperthyroidism?

Answer 9

PTU is safe in pregnancy. Do surgery during second trimester. DO NOT iodine ablate.

Question 10

How to treat maternal hypothyroidism?

Answer 10

Levothyroxine.

Question 11

How to diagnose/treat lichen sclerosis?

Answer 11

Punch biopsy necessary, followed by treatment with steroids if positive

Question 12

How to treat maternal seizures?

Answer 12

Tricky because all anti-seizure medications are teratogens. Best one to use is phenobarbital. The least bad.

Question 13

How to supplement phenobarbital?

Answer 13

Give folate

Question 14

Placenta previa pathogenesis

Answer 14

Placenta implants across the os. As os dilates the placenta tears.

Question 15

How does patient with placenta previa present?

Answer 15

Presents with painless third trimester bleeding with signs of struggling baby.

Question 16

How to diagnose placenta previa?

Answer 16

Ultrasound. Can show baby in transverse lie.

Question 17

How to treat placenta previa?

Answer 17

Do a c/s

Question 18

Risk factors for placenta previa?

Answer 18

Multiple gestations, multiparity.

Question 19

Pathogenesis of placental abruption

Answer 19

Placenta tears off wall and bleeds (can be concealed too)

Question 20

What types of things cause placental abruption?

Answer 20

Hypertension, cocaine use, huge trauma

Question 21

How does a patient with placental abruption present?

Answer 21

With painful, sudden onset, heavy vaginal bleeding. Fetal distress

Question 22

How to diagnose placental abruption?

Answer 22

With ultrasound showing a tear

Question 23

How to treat placental abruption?

Answer 23

C/s

Question 24

Uterine rupture pathogenesis

Answer 24

Uterus ruptures with big contraction along c/s scar, or after pitocin use. Baby is birthed into peritoneum

Question 25

How does uterine rupture present?

Answer 25

HUGE pain, may or may not bleed. Fetal heart rate abnormalities

Question 26

How to diagnose uterine rupture?

Answer 26

No need for diagnosis, move straight to crash section

Question 27

How to treat uterine rupture

Answer 27

Crash C-section

Question 28

Vasa previa pathogenesis

Answer 28

Accessory lobe across the oss, there are bridging blood vessels. Os dilates and vessels tear.

Question 29

How does vasa previa present?

Answer 29

With painless fetal distress and third trimester bleeding.

Question 30

How to treat vasa previa?

Answer 30

C section.

Question 31

Pathogenesis of neonatal GBS infection

Answer 31

Benign colonization of vagina, exposure during delivery

Question 32

Patient presentation with GBS

Answer 32

Found on ASX screen at week 35-38. Or found on normal delivery with fetal crash within 12 hours

Question 33

How to treat GBS

Answer 33

Ampicillin. Also give penicillin for asx bacteriuria, gbs+ status, prolonged ROM, or third trimester delivery with GBS.

Question 34

How does baby get hepatitis B

Answer 34

Vertical transmission, can become chronic carrier

Question 35

How to treat to make sure baby doesn't get hep B

Answer 35

C/section with hep B IVIG and hep B vaccine

Question 36

How does maternal HSV infection affect baby?

Answer 36

Primary viremia definitely affects baby, secondary reactivation affects baby only if exposed during delivery

Question 37

How to treat secondary reactivation of HSV in pregnancy?

Answer 37

Treat with acyclovir and c/s baby

Question 38

How to prevent maternal chickenpox infection

Answer 38

Vaccinate before pregnancy or if pregnant already, isolate mom from children.

Question 39

How does baby with neonatal chicken pox present?

Answer 39

Zig zag lesions with small eyes and small extremities.

Question 40

Which method of contraception has highest risk of DVT/PE

Answer 40

Orthoevra patch, risk increases with increased age and smoking

Question 41

Can you do ECV in active labor?

Answer 41

No.