OB Flashcards by Justin Holmes

Which diagnosis? “Copper penny” lesions on hands/soles

Syphilis

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Which diagnosis? “Strawberry Cervicitis”

Trichomonas

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DEXA scan indicated at age __.

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Most common form of inherited mental retardation

Fragile X Syndrome

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Which defects? Valproic acid (4)

NTDs, cardiac defects, limb defects, facial clefts

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Which defects? Androgens

Virilization of females (labial fusion)

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Which defects? Fetal hydantoin syndrome (6)

IUGR, microcephaly, facial defects, digital hypoplasia, developmental delay, hirsutism

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Which defects? Methotrexate (2)

skeletal defects, limb defects

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Which defects? Retinoid acid (2)

NTDs, facial defects

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Which defects? ACEIs/ARBs (5)

Skull defects, limb defects, renal dysgenesis/failure, oligohydramnios, pulmonary hypoplasia

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NSAIDs should not be used after ___WGA

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Which defects? Alcohol (4)

IUGR, microcephaly, midface hypoplasia, CNS damage

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Which defects? Cocaine (2)

Risk of placental abruption, hypo perfusion in utero

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Down Syndrome Quad Screen

High hCG, high Inhibin A, low estriol, low AFP

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PAPP-A is ___ in all trisomies

decreased

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Trisomy 18 Quad Screen

Low hCG, low estriol, low AFP

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___ WGA when fundal height is at level of umbilicus

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AMA = age over ___ at delivery

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Complications of gonococcal infection during pregnancy (2)

Preterm labor, neonatal blindness

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Complications of chlamydia infection during pregnancy (2)

Neonatal blindness, pneumonia

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Components of biophysical profile (5)

NST, fetal movement, fetal tone, fetal breathing, AFI

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Indication for umbilical artery doppler velocity

IUGR

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Arrest of Active Phase

4 hours with no cervical change (6 hours if inadequate contractions)

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Indications for GBS prophylaxis in GBS-unknown case (3)

Rupture membranes 18 hours, fever during labor, Preterm labor

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Recurrent late decelerations are suggestive of _____.

Fetal acidemia

Which diagnosis? Fetal tachycardia with minimal variability followed by pale, lethargic neonatal with fever

Chorioamnionitis

Complications of chorioamnionitis (3)

Preterm delivery, encephalopathy, cerebral palsy

Most common cause of postpartum fever

Endometritis (polymicrobial)

Which diagnosis? severe discomfort/pain, burning pain in breasts during feeding, nipples pink/shiny/peeling

Candida

Which diagnosis? Non-erythematous fluctuant mass

galactocele

Lactation reduces maternal risk for ____ (6)

endometrial/breast/ovarian cancers, osteoporosis, diabetes, weight retention

Contraindications to lactation

Infant classic galactosemia; Maternal HIV, HSV, TB, or specific substance/medication (ab)use

____ abortion: vaginal spotting during the first half of pregnancy – cannot determine viability of pregnancy

threatened

____ abortion: abortion less than 20 weeks with cramping contractions, cervical dilation, and no passage of tissue

inevitable

____ abortion: abortion less than 20 weeks with cramping contractions, passage of tissue, and continued cervical dilation

Incomplete

____ abortion: abortion less than 20 weeks with cramping contractions that resolve, accompanied by passage of tissue and cervical dilation during the cramping

Complete

Management for completed abortion

Follow hCG levels until negative

Management of septic abortion (3)

Maintain BP, Abx, D&C (4 hours after abx)

When to deliver: Pre-gestational DM

38-39wks

Complications of syphilis for fetus/neonate (7)

hepatomegaly, rhinitis, skin lesions, keratitis, Hutchinson teeth, Saber shins, deafness

Complications of HSV for fetus/neonate (3)

skin infection, eye infection, encephalitis

Complications of Hepatitis C for fetus/neonate (3)

preterm delivery, cholestasis of pregnancy, GDM

Complications of Parvovirus B19 for fetus/neonate (2)

Fetal anemia, hydrops

Complications of CMV for fetus/neonate (6)

Microcephaly, periventricular calcifications, deafness, chorioretinitis/blindness, seizures, pneumonia

Complications of Rubella for fetus/neonate (4)

Cataracts, deafness, cardiac defects, thrombocytopenia purpura

Complications of Toxoplasmosis for fetus/neonate?

Hydrocephalus, intracranial calcifications, chorioretinitis/blindness

Most common perinatal infection worldwide

CMV

Complications of Bacterial Vaginosis for fetus/neonate

Preterm labor

Which diagnosis? Sudden dyspnea/hypoxia, hypotension (cardiogenic shock, coagulopathy (DIC); progresses to cardiac failure

Amniotic fluid embolism

Thyroid medication C/I in 1st trimester

Methimazole (fetal scalp defects, aplasia)

Thyroid medication with higher risk of hepatotoxicity

PTU

Which diagnosis? Yellow or yellow-brown solid ovarian mass consisting of large cells that may cause fetal virilization; typically regress after pregnancy

Luteoma

Which diagnosis? Intensely pruritic disease with erythematous patches and development of vesicles and bullae; more prominent on limbs than trunk

Herpes gestationis

Which diagnosis? Severe pruritis typically more on extremities than trunk, including involvement of palms/soles

ICP

When to deliver: Chronic HTN

38-39 WGA

When to deliver: Gestational HTN

Term (37 WGA)

Pre-eclampsia diagnostic criteria: Plt

Less than 100

Pre-eclampsia diagnostic criteria: Proteinuria per day

Greater than 300mg

Pre-eclampsia diagnostic criteria: Urine prot/cr ratio

Greater than 0.3

Pre-eclampsia diagnostic criteria: LFTs

2x nl

Pre-eclampsia diagnostic criteria: Renal insufficiency

Cr greater than 1.1

Pre-eclampsia diagnostic criteria: Alternative severe clinical features (3)

Pulmonary edema, visual disturbances, cerebral disturbances

C/I to expectant management for pre-eclampsia (7)

Oliguria, non-reassuring FHT, eclampsia, visual disturbances, thrombocytopenia, elevated liver enzymes, ability to control BP

Pre-eclampsia delivery before 34 WGA

Mag sulfate, corticosteroids, delivery in 48 hours

Pre-eclampsia delivery after 34 WGA

Mag sulfate and deliver

Which diagnosis? Malaise, anorexia, nausea, persistent vomiting, epigastric/RUQ late in pregnancy

HELLP

Diagnostic procedure for fetal anemia

Middle cerebral artery peak systolic flow

Definition of Prolonged latent phase

14 hours (multips) / 20 hours (nullips)

When to Deliver: placenta accreta

34-35 WGA

Preterm Labor Management (4)

Tocolytics, Steroids (before 34WGA), Ampicillin (GBS prophylaxis), Magnesium sulfate (before 32WGA)

Intra-amniotic infections demonstrate ____ IL-6 and ___ glucose.

increased; decreased

Magnesium sulfate should be given for deliveries prior to ___ WGA.

Greatest risk factor for endometritis

C-Section

Endometritis: fever most common on post-op day __

C-Section surgical site infection: fever most common on post-op day __

Which diagnosis? postpartum fevers refractory to abx

Septic Pelvic Thrombophlebitis (Tx w/anticoagulation)

Most common cause of fever on 1st postpartum day

Lungs

When to deliver: post-term if cervix is favorable

Induction at 41 WGA

Umbilical artery doppler showing increased systolic to diastolic ratio is suggestive of ____

IUGR

When to deliver: IUGR with reverse end-diastolic flow

Before 32 WGA

______: maternal thighs sharply flexed against maternal abdomen, which straightens the sacrum with the lumbar spine and rotates the pubic symphysis anteriorly

McRoberts Maneuver