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1
Q

Amnisure

A

identify placental α-microglobulin-1 via immunoassay

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2
Q

active labor cm?

A

6 cm

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3
Q

indication operative vaginal delivery

A

prolonged second stage,

maternal exhaustion, or the need to hasten delivery

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4
Q

Scalp is visible at the introitus without separating the labia
Fetal skull has reached pelvic floor
Sagittal suture is in anteroposterior diameter or right or left
occiput anterior or posterior position
Fetal head is at or on perineum
Rotation does not exceed 45 degrees

A

Outlet forceps

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5
Q

Leading point of fetal skull is at station 2 or greater, but not
on the pelvic floor
Rotation <45 degrees (left or right occiput anterior to occiput
anterior, or left or right occiput posterior to occiput
posterior)
Rotation >45 degrees

A

Low forceps

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6
Q

Station above +2 cm but head engaged

A

Midforceps

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7
Q

conditions necessary for safe application of forceps

A

full dilation of the cervix, ruptured membranes, engaged head and at least +2 station, absolute knowledge of fetal position, no evidence of CPD, adequate anesthesia, empty bladder, and—most important—an experienced operator.

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8
Q

Complications from forceps application

A

bruising on the face and
head, lacerations to the fetal head, cervix, vagina, and perineum, facial nerve
palsy, and, rarely, skull fracture and/or intracranial damage.

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9
Q

most common complications of use of the vacuum

A

scalp laceration and cephalohematoma.

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10
Q

rupture of the prior uterine scar percent

A

0.5% to 1.0%

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11
Q

Increased Success of TOLAC

A

Prior vaginal birth, Prior VBAC, Nonrecurring indication
for prior C/S (herpes,
previa, breech), Presentation in labor at:
>3 cm dilated, >75% effaced

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12
Q

Risk of Uterine Rupture

A

More than one prior cesarean delivery, Prior classical cesarean, Induction of labor
Use of prostaglandins
Use of high amounts of oxytocin, Time from last cesarean <18 mo

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13
Q

complication of both forms of anesthesia

A

maternal hypotension secondary
to decreased systemic vascular resistance, which can lead to decreased
placental perfusion and fetal bradycardia.

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14
Q

Circumvallate

placenta

A

Occurs when the membranes double back over the edge of the placenta, forming a dense ring around the periphery of the placenta.
Often considered a variant of placental abruption, it is a major cause of second-trimester hemorrhage

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15
Q

Succenturiate

placenta

A

An extra lobe of the placenta that is implanted at some distance away
from the rest of the placenta
Fetal vessels may course between the two lobes, possibly over the
cervix, leaving these blood vessels unprotected and at risk for rupture

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16
Q

percent placenta previa

A

20%

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17
Q

Predisposing Factors for Placenta Previa

A 
Prior cesarean section and uterine surgery (e.g., myomectomy)
Multiparity
Multiple gestation
Erythroblastosis
Smoking
History of placenta previa
Increasing maternal age
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18
Q

Findings on ultrasound suggestive of a placenta accreta

A

irregular
shaped placental lacunae, thinning of the myometrium over the placenta, loss
of the retroplacental space, protrusion of the placenta into the bladder,
increased vascularity of the uterine serosa–bladder interface, and turbulent
blood flow through the lacunae on ultrasound.

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19
Q

percent of abruptions occur
before labor and after 30 weeks of gestation/ occur during labor/ identified only on placental inspection after delivery

A

50%/15%/30%

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20
Q

Predisposing factors abruptio

A 
Hypertension
Previous placental abruption
Advanced maternal age
Multiparity
Uterine distension
Multiple pregnancy
Polyhydramnios
Vascular deficiency
Diabetes mellitus
Collagen vascular disease
Cocaine use
Methamphetamine use
Cigarette smoking
Alcohol use (>14 drinks/wk)
Circumvallate placenta
Short umbilical cord
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21
Q

Precipitating factors abruptio

A 
Trauma
External/internal version
Motor vehicle accident
Abdominal trauma
Sudden uterine volume loss
Delivery of first twin
Rupture of membranes with polyhydramnios
PPROM
PPROM, preterm premature rupture of membrane
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22
Q

risk of abruption in future pregnancy %?

A

10% after one abruption

and 25% after two prior abruptions

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23
Q

Presentation of Abruptio Placentae

A

Vaginal bleeding 80%
Uterine tenderness/abdominal or back pain 67
Abnormal contractions/increased uterine tone 34
Fetal distress 50
Fetal demise 15

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24
Q

Risk Factors for Uterine Rupture

A 
Prior uterine surgery/uterine scar
Injudicious use of oxytocin
Grand multiparity
Marked uterine distension
Abnormal fetal lie
Large fetus
External version
Trauma
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25
Risk factors for fetal vessel rupture
abnormal placentation leading to a succenturiate lobe as well as multiple gestations that increase the risk of velamentous insertion
26
Apt test
examination of the blood for nucleated (fetal) RBCs. If the resulting mixture is pink, it indicates fetal blood; a yellow-brown color is seen with maternal blood
27
RACE of infants were 50% more | likely to be born preterm compared with their Caucasian counterparts
African american
28
risk factors have been associated with PTL
(ROM); chorioamnionitis; multiple gestations; uterine anomalies, such as a bicornuate uterus; previous preterm delivery; maternal prepregnancy weight less than 50 kg; placental abruption; maternal disease, including preeclampsia, infections, intra-abdominal disease or surgery; substance abuse; and low socioeconomic status.
29
principal goal of tocolytic therapy
delay delivery by at least 48 | hours.
30
principle that a dehydrated patient has | increased levels of this hormone? action on contraction?
ADH. ADH differs from oxytocin by only one amino acid, it may bind with oxytocin receptors and lead to contractions
31
tocolytic contraindicated in women with preload-dependent cardiac lesions and hypotension and should be used with caution in women with left ventricular dysfunction.
Nifedipine
32
nifedipine and magnesium sulfate
potential synergistic effect that results in respiratory depression.
33
Maternal contraindications to | indomethacin
platelet dysfunction, hepatic dysfunction, | gastrointestinal ulcerative disease, renal dysfunction, and asthma
34
magnesium sulfate administration
loaded as a 6-g bolus over 20 minutes, and then maintained at a 2 g/hour continuous infusion. A slower infusion should be used in the case of renal insufficiency because magnesium is cleared via the kidneys. β-Mimetics
35
black box warning to the use of terbutaline IV beyond 24 to 48 hrs
cause maternal death and cardiac events, including tachycardia, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia,
36
tampon test
amniocentesis dye test can be performed by injecting a dye via amniocentesis and observing whether or not the dye leaks into the vagina
37
PPROM <34 weeks, use of antibiotics
leads to a longer latency period before the | onset of labor
38
Factors | associated with breech presentation
previous breech delivery, uterine anomalies, polyhydramnios, oligohydramnios, multiple gestation, PPROM, hydrocephaly, and anencephaly.
39
Complications of breech | deliveries
cord prolapse, entrapment of the fetal head, and fetal | neurologic injury.
40
criteria trial of labor of breech presentation
``` favorable pelvis (by clinical examination, pelvic radiograph, MRI, or CT pelvimetry), a flexed head, estimated fetal weight between 2,000 and 3,800 g, and frank or complete breech ```
41
only face presentation that will allow for a vaginal | delivery.
mentum anterior
42
common complication of compound | presentation
umbilical cord prolapse
43
cardinal movement of internal rotation usually converts the fetus to the ____ position
OA
44
persistent OT position leading to arrest of labor is more common in women with a ___ pelvis
platypelloid
45
Risk factors for | shoulder dystocia
``` fetal macrosomia (weight greater than 4,000 g), preconceptional and gestational diabetes, previous shoulder dystocia, maternal obesity, postterm pregnancy, prolonged second stage of labor, and operative vaginal delivery. ```
46
elective cesarean delivery fetal wt
fetus is suspected to weigh greater than 5,000 g in women without diabetes and greater than 4,500 g in women with diabetes
47
% of patients with preeclampsia | with severe features develop HELLP syndrome.
10%
48
any patient who presents with RUQ pain, | epigastric pain, or nausea and vomiting in the third trimester
R/O HELLP syndrome
49
smoking appears to be associated with an increased or decreased risk of preeclampsia?
decreased
50
preeclampsia has an alloimmunogenic pathophysiology
A tolerance effect is seen in women who cohabitate with the father of the baby longer than 1 year prior to conceiving in comparison to women who conceive sooner.
51
DX HELLP syndrome
Hemolytic anemia Schistocytes on peripheral blood smear Elevated lactate dehydrogenase Elevated total bilirubin Elevated liver enzymes Increase in aspartate aminotransferase Increase in alanine aminotransferase Low platelets Thrombocytopenia
52
AFLP
exhibit evidence of liver failure, including an elevated | ammonia level, blood glucose less than 50 mg/dL, and markedly reduced fibrinogen and antithrombin III levels.
53
recurrence rate in subsequent pregnancies pre eclampsia
25- 33%
54
both chronic hypertension and preeclampsia, the risk of recurrence
70%
55
eclampsia
breakdown in the autoregulatory system of cerebral circulation due to hyperperfusion, endothelial dysfunction, and brain edema.
56
MgSO4 use for eclampsia
decrease hyperreflexia and | prevent further seizures by raising the seizure threshold
57
eclampsia overdose
10 mL 10% calcium chloride or calcium gluconate should be | rapidly administered intravenously for cardiac protection
58
mgso4 levels response
``` 4.8–8.4 Therapeutic seizure prophylaxis 8 CNS depression 10 Loss of deep tendon reflexes 15 Respiratory depression/paralysis 17 Coma 20–25 Cardiac arrest ```
59
differentiate preeclampsia from exacerbation of | hypertension in patient with renal disease
elevated uric acid above 6.0 to 6.5
60
calories per day is recommended for all patients with diabetes during pregnancy
2200
61
g of carbohydrates per day
200 to 220 g
62
target range values control gdm
(fasting values <90 mg/dL and 1-hour postprandial | values <140 mg/dL or 2-hour postprandial values <120 mg/dL),
63
fetal monitoring gdm
(NST) or modified biophysical profile (BPP) is typically begun between 32 and 36 weeks of gestation and continued until delivery on a weekly or biweekly basis. estimated fetal weight (EFW) between 34 and 37 weeks
64
``` Scheduled delivery (typically via induction of labor) at ____ wks of gestation is common in patients on insulin or a hypoglycemic agent ```
39 weeks
65
% will experience GDM in subsequent | pregnancies,
50%
66
% will go on to develop overt diabetes within 5 years.
25% to 35%
67
Obstetric complications pregestational dm
``` Polyhydramnios Preeclampsia Miscarriage Infection Postpartum hemorrhage Increased cesarean section ```
68
HgbA1c greater than or equal to 12% are estimated to have a__% rate of congenital anomalies.
25%
69
effects of progesterone in GUT pregnancy
smooth muscle relaxation effects of progesterone decrease bladder tone and cause ureteral and renal pelvis dilation, as well as decrease ureteral peristalsis.
70
gold standard for diagnosing a UTI
quantitative culture | containing at least 100,000 CFU/mL.
71
routine urine culture is used to screen for ASB between____weeks of gestation.
12 and 16
72
prophylaxis for 2 or more uti pregnancy
nitrofurantoin or | trimethoprim/sulfamethoxazole
73
DX Chorioamnioniitis
fever ≥39°C or 102.2°F based on oral maternal temperature with another clinical sign, including elevated maternal WBC count (>15,000/mL), purulent fluid from cervical os or fetal tachycardia (>160 beats per minute), or evidence from an amniocentesis that is consistent with microbial invasion
74
gold standard for diagnosis | of chorioamnionitis
culture of the amniotic fluid
75
causative organisms chorio
polymicrobial
76
infection develops during the first 12 weeks of | gestation, the risk of hydrops is
5% to 10%
77
detect evolving fetal anemia
Doppler velocimetry to | examine the peak systolic velocity of the middle cerebral artery (MCA).
78
is the most | common severe sequela of secondary infection CMV
Congenital hearing loss
79
diagnosis of maternal rubella infection
serology studies
80
if woman is within the window of seroconversion and has a suspected acute HIV infection, what test to do?
plasma HIV PCR
81
Tx babies born to hiv mothers
within 12 hours should receive a course of | ZDV therapy, which should be continued for 4 to 6 weeks
82
tx diff stages syphilis
primary syphilis, one dose of 2.4 million units benzathine penicillin G secondary or latent syphilis, the patient will require weekly treatments of 2.4 million units of benzathine penicillin G for 3 consecutive weeks neurosyphilis should be treated with high doses of aqueous penicillin G.
83
estrogen in seizures
increase the function of the P450 enzymes, which leads to more rapid hepatic metabolism of AEDs
84
best predictor of seizure frequency in pregnancy
appears to | be the amount of seizures in the year prior to pregnancy

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