OB Flashcards
(79 cards)
1
Q
ENUMERATE:
Essential prenatal labs
A
CBC w/ PC BT w/ RH Urine CS RPR/VDRL ICC ELISA HBsAg Rubella IgG 75g OGTT BPP/Biometry Pap Smear
2
Q
ENUMERATE:
High Risk Pregnancies
A
Age < 17 Primigravid > 35 Multiple Gestation Poor Obstetric History Maternal Medical Conditions Psychiatric Conditions Reproductive Tract Problems Malignancy Trophoblastic Disease Unsure Fetal Size and Aging Placenta Abruptio/Previa Polyhydramnios/Oligohydramnios
3
Q
Identify the required intake of the ff:
Protein
Folic Acid
Calcium Carbonate
Iron
A
- Protein
5-6 g/day - Folic Acid
No NTD: 400 mcg/day
w/ NTD: 4 g/day - Calcium carbonate
1000 mg/day - Iron
27 mg/day
4
Q
ENUMERATE:
Indications for Operative Vaginal Delivery
A
Fetal Indications:
- Non-reassuring fetal status
- Premature placental separation
Maternal indications:
- Exhaustion
- Prolonged 2nd stage of labor
- Heart Disease
- Pulmonary Compromise
- Neurologic Conditions
- Infections
5
Q
ENUMERATE:
Prerequisites for Forceps Delivery
A
F - fully dilated O - occiput anterior R - ruptured BOW C - cephalopelvic disproportion ruled out E - engaged P - position known S - skilled operator
6
Q
ENUMERATE:
Complications of Forceps Delivery
A
Cervical/vaginal lacerations
Pelvic floor disorders
Caput succedaneum
Cephalhematoma
7
Q
ENUMERATE:
Factors that increase failure rate in Forceps Delivery
A
Absence of anesthesia
Persistent occiput posterior
Weight > 4000 g
8
Q
ENUMERATE:
Types of multiple fetal gestation, with their respective times of separation
A
- Dichorionic, diamniotic: 0-3 days
- Monochorionic, diamniotic: 4-8 days
- Monochorionic, monoamniotic: 8-12 days
- Conjoined twins: >13 days
9
Q
ENUMERATE:
Types of Breech Presentation
A
- Complete
- Incomplete
- Frank
10
Q
ENUMERATE:
Risk factors for Breech Presentation
A
Maternal: Uterine anomalies Lax abdominal walls Pelvic tumors Contracted pelvis Abnormal placentation Hydramnios (poly, oligo)
Fetal: Fetal anomalies Multiple fetal gestation Fetal neurologic conditions Short umbilical cord
11
Q
ENUMERATE:
Types of forceps
A
Simpson
Tucker McLane
Kielland
Piper
12
Q
DESCRIBE:
Mariceau maneuver
A
- fetal body on examiner’s hand and forearm
- index and middle finger flexing head down on chin
- other hand supporting shoulders
- gentle suprapubic pressure by assistant to keep head flexed
13
Q
OUTLINE:
Diagnostic Criteria for Pre-eclampsia
A
BP > 140/90, on at least 2 measurements, 4 hours apart, at or beyond 20 wks AoG, with previously normotensive woman
BP > 160/110
+
Proteinuria
300 mg in 24 hour urine collection
Protein/creatinine ratio > 0.3
+1 on dipstick
OR
Thrombocytopenia Renal insufficiency Liver dysfunction Pulmonary edema Cerebral or visual symptoms
14
Q
ENUMERATE:
Severe features of pre-eclampsia
A
Thrombocytopenia (<100,000)
Renal insufficiency (>1.1 mg /dL serum creatinine)
Elevated liver enzymes (2-3 times elevated)
Persistent RUQ pain
Pulmonary edema
Cerebral or visual symptoms
15
Q
ENUMERATE/OUTLINE:
Mechanisms of Pre-eclampsia
A
- Abnormal trophoblastic invasion, leading to endothelial activation and vessel leakage, eventually leading to poor end-organ perfusion and damage
- Maternal hypersensitivity to paternal antigens
- Genetic predisposition
16
Q
DEFINE:
Eclampsia
A
Development of generalized seizures
with no other attributable cause
in woman with pre-eclampsia
17
Q
ENUMERATE:
Objectives of Eclampsia Management
A
- Control BP
- Control seizures
- Correct hypoxia and acidosis
- Delivery of fetus
18
Q
DESCRIBE:
How to give MgSO4 for seizure prophylaxis/prevention
A
IV
Loading: 4-6 g IV in 100 mL, over 20 minutes
Maintenance: 2 g/hr in 100 mL solution
IM:
4g as 20% solution, at rate of 1g/min
10g of 50% solution, injected 5 g at each buttock (upper-outer)
Thereafter
5g of 50% solution on alternate buttocks, after every 4 hours
Discontinue MgSO4 24 hrs after delivery
19
Q
ENUMERATE:
Maneuvers/Techniques for Breech Delivery
A
Mariceau Maneuver Modified Prague Maneuver Bracht Maneuver Duhrssen Incision Piper Forceps for after-coming head
20
Q
OUTLINE:
Criteria for diagnosis of Overt DM in pregnancy
A
FPG > 126 mg/dL
HbA1c > 6.5%
RBS > 200 mg/dL
75g OGTT 2nd hr > 200 mg/dL
21
Q
OUTLINE:
Target control levels for FPG, 5g OGTT, and HbA1c
A
FPG: < 95 mg/dL
75g OGTT
1st hr < 140 mg/dL
2nd hr < 120 mg/dL
HbA1c < 6%
22
Q
DEFINE:
GDM
A
Diabetes Mellitus diagnosed in the 2nd or 3rd trimester
In a woman with no overt DM or DM prior to gestation
23
Q
OUTLINE:
Criteria for Diagnosis of GDM
A
FPG > 92 mg/dL
1st hr OGTT > 180 mg/dL
2nd hr OGTT > 153 mg/dL
24
Q
ENUMERATE:
4 Cornerstones of Management of DM in Pregnancy
A
- Fetal Well-Being Studies
- Lifestyle modifications - diet & exercise
- Control of blood sugar
- Prevention of DM-related complications
25
OUTLINE:
| Dosage and administration of insulin per trimester
1st trimester: 0.7-0.8 U/kg actual body weight
2nd trimester: 1 U/kg actual body weight
3rd trimester: 1.2 U/kg actual body weight
2/3 of insulin in the AM (2/3 NPH, 1/3 rapid)
1/3 of insulin in the PM (1/3 NPH, 2/3 rapid)
26
ENUMERATE:
| Complications of GDM (Maternal, Fetal, Neonatal)
```
MATERNAL:
Retinopathy
Nephropathy
Neuropathy
Cardiovascular System Complications
Susceptibility to Infection
Ketoacidosis
Operative Delivery
```
```
FETAL:
Congenital Anomalies
Altered Fetal Growth
Abortion
Unexplained Fetal Death
Preterm Delivery
Hydramnios
```
```
NEONATAL:
RDS
Hypoglycemia
Hypocalcemia
Hypomagnesemia
Polycythemia
Hyperbilirubinemia
Renal thrombosis
Cardiac hypertrophy
Macrosomia
IUGR
```
27
ENUMERATE:
| Caldwell-Moloy Pelvic Types, with a brief description of each
Gynecoid - "female" pelvis
Android - "male" pelvis
Anthropoid - "ape-like" pelvis
Platypelloid - "flat" pelvis
28
ENUMERATE:
| Diameters of the Pelvic Inlet and their normal measurements
ANTEROPOSTERIOR:
Diagonal Conjugate: 11.5 cm
Obstetric Conjugate: 10 cm
True Conjugate: 10.3 cm
TRANSVERSE: 13.5 cm
29
ENUMERATE:
| Diameters of the Pelvic Midplane and their normal measurements
ANTEROPOSTERIOR: 11.5 cm
TRANSVERSE (Bispinous): >9.5-10 cm
30
ENUMERATE:
| Diameters of the Pelvic Outlet and their normal measurements
ANTEROPOSTERIOR: 9.5-11.5 cm
TRANSVERSE (Bituberous): >8.5 cm
31
OUTLINE:
| Complete pelvimetry with normal measurements/findings
INLET:
Diagonal conjugate: >11.5 cm
```
MIDPLANE:
Pelvic sidewalls: parallel
Ischial spines: blunt
Bispinous diameter: >9.5 cm
Sacral inclination: posterior
Sacral notch: wide
Sacral width: wide
Sacral curvature: hollow
```
OUTLET:
Coccyx - movable
Pubic arch - >90 degrees
Bituberous diameter: >8.5 cm
32
ENUMERATE:
| Bones of the pelvis
Innominate bone - ilium, ischium, pubis
Sacrum
Coccyx
33
ENUMERATE:
| Factors to check before administering MgSO4
Urine output
Respiratory depression
Deep Tendon Reflexes
34
Rupture rate of:
1. single previous LSCS?
2. multiple previous LSCS?
3. Classical incision
1. 0.2-0.9%
2. 0.9-1.8%
3. 2-9%
35
ENUMERATE:
| Indications for CS
Previous CS
Unreassuring fetal status
Dystocia
Breech delivery
36
ENUMERATE:
| Transverse Abdominal Incisions used in CS
```
Pfannenstiel (most common)
Kutsner
Cherney
Maylard
Joel-Cohen
```
37
OUTLINE:
| Degrees of birth canal lacerations
1ST DEGREE - vaginal mucosa, fourchette, subcutaneous fat
2ND DEGREE - fascia and muscles (superficial transverse perineal, bulbocavernosus, deep transverse perineal, pubococcygeus)
3RD DEGREE
3a: <50% of External Anal Sphincter (EAS)
3b: >50% of EAS
3c: Involvement of IAS
4TH DEGREE:
Rectal mucosa
38
ENUMERATE:
| Advantages of Midline Episiotomy over Mediolateral
1. Easier repair
2. Excellent healing
3. Minimal post-op pain
4. Good anatomical result
5. Less bleeding
6. Less dyspareunia
39
ENUMERATE:
| Advantages of Mediolateral Episiotomy over Midline
Less risk of extension to 3rd and 4th degree lacerations
40
ENUMERATE:
| All natural family planning methods
Abstinence
Coitus interruptus
```
(CBC-STS-L)
Cervical mucus method
Basal body temperature
Calendar rhythm method
Sympto-thermal method
Two days method
Standard days method
Lactation amenorrhea
```
41
OUTLINE:
| Requirements for successful Lactation Amenorrhea
Breastfeeding 4 hrs/day & 6 hrs/night, everyday
At least 6 months postpartum
Amenorrheic
42
DESCRIBE:
| How to determine fertile days using the Calendar Rhythm Method
1. get shortest cycle duration and longest cycle duration
2. # of days of shortest duration - 18 = FIRST FERTILE DAY
3. # of days of longest duration - 11 = LAST FERTILE DAY
43
DESCRIBE:
| How to determine fertile days using Sympto-thermal method
1st day: first day of stringy cervical mucus
| Last day: changes in BBT
44
OUTLINE:
| Mechanisms by which COCs prevent pregnancy
1. Prevent ovulation
2. Thickening of cervical mucus
3. Creation of unfavorable endometrium for implantation
45
OUTLINE:
| Mechanisms by which POPs prevent pregnancy
1. Prevent ovulation (less effective)
2. Thickening of cervical mucus
3. Creation of unfavorable endometrium for implantation
46
ENUMERATE:
| Contraindications to COC use
```
Breastfeeding
Pregnant
Thrombotic disorders
Thrombogenic arrhythmias
Diabetes with vascular complications
Hypertension with poor control
Known or suspected Breast Ca
Known or suspected Endometrial Ca
Cholestatic jaundice
Hepatic masses
Liver disease
Cigarette smoking
```
47
ENUMERATE:
| Off-label benefits of COCs
IMPROVES:
Dysmenorrhea, Acne, RA symptoms
DECREASES:
Risk for Breast, Endometrial, and Ovarian Cancer
PREVENTS:
Hirsutism
Atheroformation
Abnormal bleeding
Good for Bones
48
ENUMERATE:
| Contraindications to POP use
```
Breastfeeding
Pregnant
Breast Cancer
Unexplained uterine bleeding
Liver Disease
```
49
IDENTIFY:
| Active estrogen component of COCs
Ethinyl estradiol
50
DESCRIBE:
1. MPA
2. How it works
3. Side effects
1. Methoxyprogesterone Acetate - injectable progestin-only contraceptive
2. Prevents ovulation by suppression of LH
3. Irregular bleeding, decreased bone density, weight gain
51
DESCRIBE:
1. Implanon
2. How it works
3. Side effects
1. Levonorgestrel subdermal implant
2. Prevents ovulation by suppression of LH. Slow, continuous release of progestin
3. Irregular bleeding, decreased bone density, weight gain
52
DESCRIBE:
| How IUDs work
- prevents fertilization via inflammatory reactions
- prevents implantation by creating unfavorable endometrium
- slow, continuous release of hormones (chemical IUDs)
53
DEFINE:
| Abortion
1. Fetus < 500 g weight
| 2. Pregnancy terminated before 20 wks AoG
54
ENUMERATE:
| Factors noted in characterizing type of abortion
1. Presence of bleeding/show
2. Uterine contractions
3. Cervix (dilated or not)
4. BOW (ruptured or not)
5. Uterine size (equal to AOG or not)
6. FHT
55
OUTLINE:
| Management for the different types of abortion
Threatened - analgesia, rest, expectant management
Missed - medical/surgical management
Complete - observation
Imminent - await expulsion then curettage
Inevitable - await expulsion then curettage
Incomplete - curettage
56
ENUMERATE:
| Fetal and Maternal Etiologies of Abortion
FETAL
1. Abnormal zygote development
2. Aneuploidy
3. Euploid/Idiopathic
```
MATERNAL:
Trauma
Infection
Exposure
Thrombophilia
Immunologic
Endocrine pathology
Paternal Factor
Uterine Anomalies
Gametes are agng
Cervix incompetent
```
(Tie Tie the PUG Cer!)
57
ENUMERATE:
| Indications for Methotrexate Therapy in Ectopic Pregnancy
(How to know? - BRS BISHHH)
B HCG < 5000 mIU/mL
Renal pathology absent
Size < 3.5 cm
```
Breastfeeding not
Immunocompromised not
Stable
Heart tones absent
Hepatic pathology absent
Hypersensitivity ruled out
Hemodynamically stable
```
58
DESCRIBE:
| Single dose Methotrexate Regimen for Ectopic Pregnancy
50 mg/m2 BSA IM on 1st day
Measure on 4th and 7th day
If >15% decrease in B HCG from 4th to 7th - repeat weekly until undetectable
59
DESCRIBE:
| Multiple dose Methotrexate regimen for Ectopic Pregnancy
Methotrexate 1 mg/kg IM Day 1 3 5 7
Leucovorin 0.1 mg/kg IM Day 2 4 6 8
Max 4 doses of Methotrexate
Continue alternate doses until >15% decrease in BHCG in 48 hours
Continue weekly until BHCG < 0.5 mIU/mL
60
IDENTIFY:
| Criteria for failed medical treatment of Ectopic Pregnancy
1. Presence of FHT after 3 cycles of Methotrexate
| 2. No significant decrease in BHCG after 3 cycles of Methotrexate
61
ENUMERATE:
| Criteria for expectant management in Ectopic pregnancy
Hemodynamically stable
Falling serial B HCG levels
Absence of intraabdominal bleeding/rupture
Size < 3.5 cm
62
ENUMERATE:
| Classic triad of Ectopic Pregnancy
Amenorrhea
Vaginal bleeding
Lower abdominal pain
63
ENUMERATE:
| Risk factors for Ectopic Pregnancy
```
Previous ectopic pregnancy
Pelvic surgery
Tubal pathology
Tubal sterilization
History of PID
IUD use
Smoking
```
64
ENUMERATE:
| Differentials for Ectopic Pregnancy
```
Subchorionic Hemorrhage
Hydatidiform mole
Abortion
Acute appendicitis
PID
```
65
ENUMERATE:
Tumor Markers for the following tumors
1. Ovarian CA
2. Choriocarcinoma
3. Yolk Sac Tumor
4. Colon Cancer
5. Pancreatic Cancer
6. Dysgerminoma
1. CA 125
2. B HCG
3. AFP
4. CA 19-9
5. CA 19-9
6. LDH
66
ENUMERATE:
| Mechanisms by which Myoma Uteri can cause AUB
1. Mechanical increase in surface area of endometrium
2. Increased production of bleeding factors
3. Abnormal vascular growth of the endometrium
4. Ulcerations and hemorrhage of the endometrium
5. mechanical compression and dilation of venous plexuses
67
ENUMERATE:
| Risk factors for Cervical Cancer
```
Early coitus
Multiple sexual partners
History of STDs
HPV Infection
Smoking
OCP use > 5 years
Multiparity
Low socioeconomic status
```
68
ENUMERATE:
| Leopold's Manuevers and their significance
1. Fundal grip - Fetal Pole
2. Umbilical grip - Fetal Orientation
3. Pawlick's grip - Fetal Presentation
4. Pelvic grip - Engagement
69
OUTLINE:
| Johnson's Formula for estimation of fetal weight
If station < 0
Fundal Height - 12 x 155
If station 0 and above
Fundal Height - 11 x 155
NOTE: for Vertex Cephalic Presentation only
70
```
OUTLINE:
Criteria for:
1. Prolonged Latent Phase
2. Prolonged Decceleration Phase
3. Prolonged 2nd Stage of Labor
```
in Nulliparas and Multiparas
1. Prolonged Latent
Nullipara: Latent Phase > 20 hrs
Multipara: Latent Phase > 14 hrs
2. Prolonged Decceleration
Nullipara: > 3 hrs
Multipara: > 1 hr
3. Prolonged 2nd Stage
Nullipara: >3 (with analgesia), >2 (w/o analgesia)
Multipara: >2 (with analgesia), >1 (w/o analgesia)
71
OUTLINE:
Criteria for:
1. Protracted active phase
2. Protracted descent
in Nulliparas and Multiparas
1. Protracted active phase
Nullipara: < 1.2 cm/hr
Multipara: < 1.5 cm/hr
2. Protracted descent
Nullipara: < 1 cm/hr
Multipara: <2 cm/hr
72
```
OUTLINE:
Criteria for
1. Arrest of Dilation
2. Arrest of Descent
3. Failure of Descent
```
in Nulliparas and Multiparas
For BOTH Nulliparas and Multiparas
1. > 2 hrs with no change in dilation
2. Not fully dilated + > 1 hr with no change in position
3. Fully dilated + no change in position
73
IDENTIFY:
| Etiologies of each of the 3 types of deccelerations
1. Early - head compression
2. Late - uteroplacental insufficiency
3. Variable - cord compression
74
ENUMERATE:
| 4 peaks of Cardiac Load
1. 28th weeks AoG
2. Labor
3. Upon Deliver
4. 7-10 days postpartum
75
ENUMERATE and DESCRIBE:
| NYHA Heart Failure Classes
I - no limitation in activities
II - mild limitation, symptoms on ordinary activities, asymptomatic at rest
III - moderate limitation, symptoms on less than ordinary activities, asymptomatic at rest
IV - severe limitation, symptomatic at rest
76
ENUMERATE:
| 4 conditions with that pose the highest mortality risk in Gravidocardiac patients
1. Pulmonary Hypertension - primary & secondary
2. Coarctation of the Aorta with Valve problems
3. Marfan Syndrome with Aortic invovlement
4. Peripartal Cardiomyopathy
77
ENUMERATE:
| Indications for providing IE prophylaxis to Gravidocardiac patients
Previous IE
Prosthetic Valve
Unrepaired cyanotic heart disease
78
DESCRIBE:
| Giving of IE prophylaxis to Gravidocardiac Patients
```
(30-60 minutes prior to delivery)
Ampicillin 2g IV
Cefazolin 1g IV
OR
Clindamycin 600 mg IV
Vancomycin 1g IV (if with enterococcus, MRSA)
```
(While in Labor)
Ampicillin 1g IV q4-6
79
ENUMERATE:
| Non-obstetric indications for CS in Gravidocardiac patients
1. Marfan Syndrome with Aortic Dissection
2. Preterm Labor on Anti-coagulants
3. Intractable Heart Failure
