OB/GYN 1

Question 1

GBS is the most common cause of infant sepsis, PNA and Meningitis during 1 week of life…So all pregnant women get UNIVERSAL SCREENING.

1. When do you screen for GBS via rectovaginal swab?
2. What is the management for positive GBS screen?

Answer 1

UNIVERSAL SCREEN AT 35-37 weeks gestation.

IF +ve, Intrapartum (during labor) PCN, Ampicillin or Cefazolin if PCN allergy.

Question 2

IF mom’s GBS status is unknown, in what 3 situations would you administer intrapartum PCN during labor?

Answer 2

1. Pre-term labor
2. ROM > 18 hours
3. Fever.

Question 3

In what 2 situation would you give intrapartun PCN or Cefotaxime (if PCN allergy) REGARDLESS of GBS status?

Answer 3

1. GBS bacturia anytime during pregnancy (even if treated)

2. Prior hx of neonatal GBS disease (sepsis, pna, meningitis)

Question 4

For intrapartum PCN for GNS ppx, how much time before delivery should you give it?

Answer 4

at least 4 hours.

Question 5

For Rh(D) negative mothers, whom you’ve confirmed have no Anti-D ab, when do you administer Anti-D immunoglobulin?

Answer 5

At 28-32 weeks gestation (prevent alloimmunizaiton)

AND

within 72 hours after birth.

Question 6

What are 6 indications for administering Anti-D immunoglobulin to Rh(D) -ve mothers?

Answer 6

ANYTIME THERE IS MATERNAL AND FETAL BLOOD MIXING.

1. < 72 hours of spontaneous abortions
2. Chronic villous sampling/amniocentesis
3. Ectopic pregnancy
4. Hydatiform mole
5. 2nd/3rd trimester bleed
6. External Cephalic Version (twisting baby inside mother to address breech position)

Question 7

Standard Anti-D immunoglobulin that is given <72 hours of birth is 300ug…how many ml of fetal blood does this protect against?

Answer 7

30mL

IF you have massive bleeding, like abruption placentae, higher dose of Anti-D immunoglobulin is needed.

Question 8

PCOS is a condition of excess androgens and excess estrogens (Peripheral conversion of T -> E) and LH>FSH imbalance.

What are the 4 symptoms you see?

Answer 8

1. Androgenic excess (hirsuitism, male pattern baldness, acne)
2. Obesity
3. Polycystic ovaries
4. Anovulation/menstrual irregularities.

Question 9

What is the first line treatment of PCOS?
What is second line trx?
What is third line trx?

What drug can help induce ovulation to address infertility?

Answer 9

First line = weight loss
Second line = OCP
Third line = Spironolactone

Ovulation induction = Clomiphene Citrate

Question 10

Women with PCOS are at increased risk of what type of cancer?

Answer 10

Endometrial (unopposed estrogen stimulation of endometrium)

Question 11

What should you do if a person an AED, for seizure d/o, become pregnant on it?

Answer 11

Generally DON’T switch drugs (because increased risk of seizure and baby will be exposed to 2 agents)

1. HIGH dose FOLIC ACID
2. AFP levels to screen for NT defects
3. Screen with US to detect NT defects.

Question 12

Can you breast feed on AEDs?

Answer 12

Generally YES.

all AEDs get excreted in breast mild, but benefits generally outweigh risk

Question 13

what is stage 1 of labor?

What is the Latent phase?

What is the Active phase?

Answer 13

Begins at regular painful contractions to 10 cm dilation.

Latent = up to 6 cm (characterized by slow dilation) 
Active = 6cm to 10 cm (characterized by more active dilation)

Question 14

Active phase of STAGE 1 labor is when cervix dilated 6 cm - 10 cm.

What is considered ACTIVE phase Protraction?
What is considered ACTIVE phase Arrest?

Answer 14

Protraction = < 1cm/2hrs

ARREST = No cervical change for 4 hours with adequate contractions. OR
No Cervical change for > 6 hours withOUT adequate contractions.

Question 15

What is considered adequate contractions?

Answer 15

Q 2-3 min