OB Handout Flashcards
Maternal Physio, Abortion, GTD, Preterm Labor, Delivery (286 cards)
1
Q
defined as 3 unsuccessful forceps delivery
A
failed forceps
2
Q
the ONLY used forceps delivery
A
outlet FORCEPS
3
Q
scalp is visible at introitus without separating the labia
A
outlet forceps
4
Q
leading point of fetal skull is at station <2cm and not on pelvic floor
A
low forceps
5
Q
degree of perineal lesion that involve
fourchette, perineal skin, and vaginal mucous membrane but not the underlying fascia and muscle
A
1st degree
6
Q
criteria prior to operative vaginal delivery
A
membranes ruptured
cervix completely/fully dilated
fetal head position determined
7
Q
degree of laceration that extend through skin, mucous membrane, perineal body and anal sphincter
A
3rd degree
8
Q
effective 1st line prophylactic uterotonic that is safe to use on all patients
A
oxytocin
9
Q
uterotonic drugs contraindicated to hypertensive patients
A
ergot alkaloids
methylergonovine
10
Q
Most common complication of 4th degree perineal laceration.
A
Rectovaginal fistula
11
Q
breech spontaneous delivery up to the umbilicus, but remaining body is delivered with operator traction
A
partial breech extraction
12
Q
2 fingers are inserted along the extremity to the knee, which is then pushed away from the midline after spontaneous flexion
A
Pinard Maneuver
13
Q
Goal is to bring fetal feet within reach.
A
Breech Decomposition
14
Q
32wks AOG at preterm labor, cervix completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve the complication?
A
Dührssen incision
15
Q
Direct cause of most maternal deaths involving regional anesthesia
A
High Spinal Blockade
16
Q
Anesthetic associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels
A
Bupivacaine
17
Q
Most common complication encountered during epidural anesthesia
A
Hypotension
18
Q
adverse effects of regional anesthesia
A
high spinal or epidural blocks
respiratory failure
drug reaction
19
Q
Interval following delivery required for the typical uterus to complete involution
A
4 weeks
20
Q
Lochia, in its various forms, typically resolves after how many weeks post partum?
A
5 weeks
4 and 6 weeks
21
Q
contraction of the uterus after delivery
A
Afterpains
22
Q
Ovulation of Lactating Women
A
2nd-18th month after delivery
23
Q
Organism that has been implicated in late post partum hemorrhage
A
Chlamydia trachomatis
24
Q
causes of late post partum hemorrhage
A
Retained placental fragment
Uterine artery pseudoaneurysm
VW disease or inherited coagulopathies
25
2 Vit that are reduced or absent from mature breast milk and requires supplementation
D and K
26
Method that requires counting the number of days in the shortest and longest menstrual cycle during 6- to -12 mo span
Calendar method
27
combines the use of changes in cervical mucus and changes in basal body temperature
Symptothermal
28
34, undergoing oxy induction, cervix 6-7 dilated, cephalic, 6contraction per 10mins for past 45mins
Tachysystole
29
Compared with the uterine body, the cervix has a significant lower percentage of?
Smooth muscle
30
A dx of arrest disorder can only be made on a parturient who is in active phase of labor with at least?
3-4 cm dilation
31
28, G2P1 38wks AOG came in due to bloody show.
IE: 4cm, 60%, -2, +BOW. She was asked to ambulate. Another 3hrs passed, IE: 6cm, 80%, -1, +BOW.
what is the best mgt?
Amniotomy & start Oxytocin
32
28, G1P0 38wks AOG, came in due to leaking BOW.
150s, strong every 5-6mins.
IE:6cm, 80%, -1, -BOW.
3hrs, IE 8cms, fully effaced, 0.
3 hrs same IE. What is the condition of labor?
Prolonged Deceleration phase
33
Adverse outcomes associated with Dystocia
Chorioamnionitis
Puerperal endometritis
Postpartum hemorrhage
34
3Ps Etiology of Dystocia
Power: Expulsive forces, abnormal
Passenger: Fetal abnormalities
Passage: Bony Pelvis abnormalities
35
Initial Step in performing Zavanelli maneuver
Restore the fetal head to an occiput anterior or posterior position
36
what is Gaskin Maneuver?
Patient in all 4's.
| Deliver.
37
Abdominal Maneuver, suprapubic pressure over posterior aspect of anterior shoulder.
Mazzanti maneuver
38
Vaginal maneuver, 2 fingers vaginally pushing the posterior aspect of anterior shoulder towards the chest.
Rubin maneuver
39
Manual crushing of clavicle
Cleidotomy
40
Maneuver applied to reduce the nuchal arm in breech delivery
Loveset maneuver
41
Months interval between pregrnancies associated with increased risk of preterm birth
18 months
42
Most common causes of indicated preterm birth
Placenta previa
43
Adverse effect of Indomethacin on pregnant
Premature closure of Ductus arteriosus
44
Regular contractions associated with cervical change before 37weeks AOG
Preterm Labor
45
Fetus, pregnancy or neonate that is between 20 to 37 weeks (WHO)
Preterm
46
Includes Preterm labor with intact membranes, PPROM, preterm cervical effacemeny or insufficiency , and uterine bleeding
Spontaneous Preterm Birth
47
Single most powerful predictor of Preterm birth
Transvaginal Ultrasound
48
When administering MgSO4, 3 signs and symptoms to watch and monitor.
UO, DTR, RR
49
Tocolytic agent of Choice for Premature labor
Nifedipine
50
When can steroids be given in Premature labor?
between 24 and 34 weeks AOG
51
The ONLY reliable indicator of clinical chorioamnionitis in women with preterm rupture of fetal membranes
Fever
52
A 25y/o primigravida at 34 5/7 weeks AOG is found to have PROM. What is the most appropriate mgt strategy?
Expedited delivery
53
Which antibiotic should be avoided in prolonging latency of PPROM because it has been associated with an increased risk of necrotizing entericolitis in newborn?
Co-Amoxiclav
54
Reversible complication seen in Indomethacin use for tocolysis longer than 24 to 48 hrs.
Oligohydramnios
55
Corticosteroid can decrease rates of respiratory distress in preterm birth if the birth is delayed for at least what amount of time after initiation of therapy?
24 hours
56
Symmetrical growth restriction is characterized by a reduction in which part?
Both Body and Head Size.
57
The following risk factors are assoc with fetal overgrowth, except:
a. obesity
b. postterm gestation
c. nulliparity
d. advancing maternal age
C. Nulliparity
*It should be Multiparity.
58
Intrapartum administration of MgSO4 to women who deliver preterm has been demonstrated to reduce rates of what neonatal outcome?
Cerebral Palsy
59
Which is least likely to be linked with higher 1st tri miscarriage rates?
a. Obesity
b. DM
c. Parvovirus infection
d. Maternal age >40yo
c. Parvovirus infection
60
18yo,G1P0 presents with 12wks amenorrhea & heavy vaginal bleeding, positive PT. Tissue with appearance of placenta is seen through an open cervical os. What are your dx and plan?
Diagnosis: Incomplete Abortion
Plan: Dilatation and Curettage
61
20yo,16wks AOG presents with fever 38.5 and lower abdominal pain but w/o bleeding. She reports small leakage of vaginal fluid yday. What is your mgt?
Primary: IV antibiotics
Plan: Labor induction
62
23yo,G1P0 w vaginal bleeding & passage of meaty tissue. 4mos missed menses. PT positive. Speculum: minimal bleeding per os. IE: Cervix closed. Uterus not enlarged What is your dx & plan?
Diagnosis: Complete Abortion
Plan: Request TVS to check for retained seccundins.
63
10wks AOG noted morning sickness resolved & breast fullness. TVD noted IU pregnancy. No FHT, Cervux closed, no blood on examining finger, uterus not enlarged. Dx & Plan?
Diagnosis: Missed Abortion
Plan: Ripen the Cervix then D&C.
64
Non-viable, genetically abnormal pregnancy due to an excess expression of paternal genes with or without an abnormal fetus or embryo.
Hydatidiform Mole
65
Type of H-mole that is paternal chromosome only plus an empty ovum that gives rise to generalized placental villi swelling and absent fetal component.
Complete H-Mole
66
Most accurate non-invasive imaging modality.
Ultrasound
67
Pharmacologic treatment for Gestational Trophoblastic Neoplasia.
```
Etoposide
Methotrexate
Actinomycin D
Cyclophosphamide
Vincristine
```
68
In cases of Tubal ectopic pregnancy, contraindications for methotrexate iclude, except:
a. Breastfeeding
b. Thrombocytopenia
c. Migraine headache
d. Intraabdominal hemorrhage
c. Migraine headache
69
Most common presentation in Tubal pregnancy.
Pelvic and Abdominal pain with associated vaginal bleeding or spotting.
70
Gold standard diagnostic for Tubal pregnancy.
Laparoscopy
71
Which is NOT assoc with Primary uterine rupture?
a. Hydramnios
b. Forceps delivery
c. Breech extraction
d. Prior Cesarean delivery
d. Prior Cesarean delivery
| * secondary uterine rupture because its pre existing.
72
Premature separation of normally implanted placenta.
Abruptio Placenta
73
Most Frequent Signs and symptoms of abruptio placenta.
Virchow's triad:
1. Vaginal bleeding after 20wks
2. Increased uterine tone
3. Abdominal pain, uterine tenderness or back pain
74
Complication in which abruptio is the most common etiology.
DIC
75
What is the boundary threshold that defines low-lying placenta?
Placental edge within 2-3cm (2cm) from the os.
76
Placenta implanted in the LUS ofnthe uterus, presenting ahead of the leading pole of fetus.
Placenta Previa
77
Classic presentation of Placenta Previa.
Painless vaginal bleeding.
78
Risk Fators for massive bleeding during CS with previa.
○ Advanced maternal age
○ Previous CS
○ Presence of sponge-like UD findings in the cervix
79
Placenta abnormally firm adherence to myometrium.
Placenta Accreta
80
Placental villi that penetrate through the myometrium and to or through the serosa.
Placenta percreta
81
2 most important risks factors of placenta accreta
1. Previa
| 2. Prior CS
82
Process of exfoliation and downgrowth of endometrium as well as development of endometrial tissue.
Placental Site Involution
83
Management of placenta accreta typically requires what procedure?
Classical cesarean
| Hysterectomy
84
Widespread systemic activation of coagulation leading to thrombotic destruction of small and midsize blood vessels that cause ischemia and bleeding.
DIC
85
Pathogenesis of INTRINSIC pathway activation in DIC.
Endothelial damage
86
Pathogenesis of EXTRINSIC Pathway activation in DIC.
Massive Tissue Injury
87
Conditions associated in activation of Coagulation Cascade through Intrinsic Pathway.
Septic Abortion
| Chorioamnionitis
88
Conditions associated in activation of Coagulation Cascade through Extrinsic Pathway.
Abruptio Placenta
Amniotic Fluid Embolism
Retained Dead Fetus
Saline induced Abortion
89
Only well accepted risk factor in DIC
Primiparity
90
Obstetrical conditions that can lead to significant Consumptive coagulation
● Placental abruption
● Amniotic fluid embolism
● Gram-negative bacterial sepsis
91
Successive atrong contractions with severe back pains and urge to defecate. What is the frequent complication of this type of labor?
Uterine Atony
92
A patient develops HPN in the 3rd tri & at delivery with BP 148/94 mmHg with trace urine protein in dipstick, her crea level is 0.76 and her HPN has resolved by time of her discharge. What is her dx?
Gestational Hypertension
93
The combination of Nifedipine with what other tocolytic agent can potentially cause dangerous neuromuscular blockade?
Magnesium sulfate
94
Occurence of convulsions, not caused by coincidental neurologic disease, in a woman with pre eclampsia.
Eclampsia
95
HPN without proteinuria occurring after 20wks gestation and BP levels return to normal after 12wks post partum.
Gestational Hypertension
96
BP >140/90 mmHg prior to pregnancy or before 20wks AOG and persists after 12wks post partum.
Chronic Hypertension
97
The underlying etiology of proteinuria that is seen in pre eclampsia,
Increased Capillary Permeability
98
A preeclampsia patient at 36wks AOG presents with BP 150/110 given Hydralazine by slow IV push as 1st line antiHPN drug. What is known neonatal SE of this drug?
Neonatal thrombocytopenia
99
Traget magnesium level when used for eclampsia prophylaxis
4.8 - 8.4 mg/dl
100
Clinical sign or test used to detect hyper-magnesemia prior to development of respiratory depression.
Patellar reflex
101
TRUE regarding antepartum and intra-partum care of patients with CV disease.
Vaginal delivery is preferred.
102
For patients with Congenital heart disease, what is the most common adverse Cardiovascular event encountered in pregnancy?
Arrhythmia
103
Recommended treatment for mild persistent asthma symptoms.
SABAS
| Low Dose ICS (Budesonide)
104
G1P0 24wks AOG with 1wk productive cough with yellowish sputum. CXR noted interstitial infiltrates on both lower lung. Crackles on LLF. VS: 120/80, 25, 90, 130s. What is the MC complication of this case?
Premature rupture of membranes
105
Most common etiologic agent of CAP.
Strep pneumoniae
106
Fetal response to maternal hypoxemia.
Decreased CO
107
Sign of potentially fatal asthma attack.
Central cyanosis
108
28y/o G1P0 18wks AOG complained of fishy-odor vaginal discharge. Pap smear noted clue cells. What drug is safe to use as treatment?
Metronidazole 500mg BID x 7days
109
G1P0 23wks AOG diagnosed with T2DM, complained of vaginal pruritus with curd-like vaginal discharge. KOH revealed pseudo hyphae. What anti-fungal drug should be avoided?
Fluconazole
110
30y/o, G3P2 at 20wks AOG consulted because of painless ulcers in her vulva. Initial impression was syphilis. What is recommended management?
Benzathin penicillin G, single dose, IM
111
Clinical presentation of Bacterial Vaginosis.
- Asymptomatic (50%)
- Fishy smelling discharge
- Vaginal pruritus
112
Criteria used in diagnosis of Bacterial vaginosis.
Amsel's criteria
113
Presents with green-yellow frothy vaginal discharge, "strawberry cervix", dyspareunia associated with vulvovaginal soreness and itching.
Trichomonas
114
Gold standard in diagnosis of Trichomonas.
Culture
115
Most common clinical manifestation of Vulvovaginal Candidiasis (VVC).
Vulvar pruritus
116
KOH visualization of pseudo hyphae (mycelia) and/or budding yeast (conidia)
VVC
117
Recommended treatment during pregnancy in Chlamydia.
Azithromycin 1g PO as single dose; or
| Amoxicillin 500mg PO TID x 7days
118
Gold standard in diagnosing Gonorrhea.
Thayer-Martin Culture
119
Most common transmission of syphilis.
Transplacental transmission
120
Confirmatory test for Syphilis.
FTA-ABS
TP-PA
MHA-TP, TP-PA
121
Recommended treatment for Syphilis.
Early: Benzathin PenG IM
Neurosyphilis: Aqueous crystalline pen G or Aqueous procaine penicillin
122
Reaction that often appears after penicillin treatment of women with 1&2 syphilis characterized by uterine contractions accompanied with late FH decelerations.
Jarisch-Herxheimer reaction
123
Incubation period of Herpes simplex.
2 to 10 days
124
17y/o,G1P0 at 16wks AOG presents for her 1st PNCU with urine culture >100,000 gram-negative rods. Denies any symptoms. What is your diagnosis?
Asymptomatic bacteriuria
125
Hallmark finding in nephrotic syndrome.
Proteinuria
126
All of the ff are known complication of nephrotic syndrome in pregnancy, except:
a. Preeclampsia
b. Polycythemia
c. Proteinuria
d. Peripheral edema
b. Polycythemia
127
All are common indication for surgery during pregnancy, except:
a. Appendicitis
b. Adnexal mass
c. Cholecystitis
d. Nephrolithiasis
d. Nephrolithiasis
MC: appendicitis
128
Common initial complications in severe hyperemesis gravidarum, except:
a. Acidosis
b. Dehydration
c. Hypokalemia
d. Mild transaminitis
a. Acidosis
| * Severe Hyperemesis gravidarum causes Alkalosis.
129
A patient develops HPN in the 3rd tri & at delivery with BP 148/94 mmHg with trace urine protein in dipstick, her crea level is 0.76 and her HPN has resolved by time of her discharge. What is her dx?
Gestational Hypertension
130
The combination of Nifedipine with what other tocolytic agent can potentially cause dangerous neuromuscular blockade?
Magnesium sulfate
131
Occurence of convulsions, not caused by coincidental neurologic disease, in a woman with pre eclampsia.
Eclampsia
132
HPN without proteinuria occurring after 20wks gestation and BP levels return to normal after 12wks post partum.
Gestational Hypertension
133
BP >140/90 mmHg prior to pregnancy or before 20wks AOG and persists after 12wks post partum.
Chronic Hypertension
134
The underlying etiology of proteinuria that is seen in pre eclampsia,
Increased Capillary Permeability
135
A preeclampsia patient at 36wks AOG presents with BP 150/110 given Hydralazine by slow IV push as 1st line antiHPN drug. What is known neonatal SE of this drug?
Neonatal thrombocytopenia
136
Traget magnesium level when used for eclampsia prophylaxis
4.8 - 8.4 mg/dl
137
Clinical sign or test used to detect hyper-magnesemia prior to development of respiratory depression.
Patellar reflex
138
TRUE regarding antepartum and intra-partum care of patients with CV disease.
Vaginal delivery is preferred.
139
For patients with Congenital heart disease, what is the most common adverse Cardiovascular event encountered in pregnancy?
Arrhythmia
140
Recommended treatment for mild persistent asthma symptoms.
SABAS
| Low Dose ICS (Budesonide)
141
G1P0 24wks AOG with 1wk productive cough with yellowish sputum. CXR noted interstitial infiltrates on both lower lung. Crackles on LLF. VS: 120/80, 25, 90, 130s. What is the MC complication of this case?
Premature rupture of membranes
142
Most common etiologic agent of CAP.
Strep pneumoniae
143
Fetal response to maternal hypoxemia.
Decreased CO
144
Sign of potentially fatal asthma attack.
Central cyanosis
145
28y/o G1P0 18wks AOG complained of fishy-odor vaginal discharge. Pap smear noted clue cells. What drug is safe to use as treatment?
Metronidazole 500mg BID x 7days
146
G1P0 23wks AOG diagnosed with T2DM, complained of vaginal pruritus with curd-like vaginal discharge. KOH revealed pseudo hyphae. What anti-fungal drug should be avoided?
Fluconazole
147
30y/o, G3P2 at 20wks AOG consulted because of painless ulcers in her vulva. Initial impression was syphilis. What is recommended management?
Benzathin penicillin G, single dose, IM
148
Clinical presentation of Bacterial Vaginosis.
- Asymptomatic (50%)
- Fishy smelling discharge
- Vaginal pruritus
149
Criteria used in diagnosis of Bacterial vaginosis.
Amsel's criteria
150
Presents with green-yellow frothy vaginal discharge, "strawberry cervix", dyspareunia associated with vulvovaginal soreness and itching.
Trichomonas
151
Gold standard in diagnosis of Trichomonas.
Culture
152
Most common clinical manifestation of Vulvovaginal Candidiasis (VVC).
Vulvar pruritus
153
KOH visualization of pseudo hyphae (mycelia) and/or budding yeast (conidia)
VVC
154
Recommended treatment during pregnancy in Chlamydia.
Azithromycin 1g PO as single dose; or
| Amoxicillin 500mg PO TID x 7days
155
Gold standard in diagnosing Gonorrhea.
Thayer-Martin Culture
156
Most common transmission of syphilis.
Transplacental transmission
157
Confirmatory test for Syphilis.
FTA-ABS
TP-PA
MHA-TP, TP-PA
158
Recommended treatment for Syphilis.
Early: Benzathin PenG IM
Neurosyphilis: Aqueous crystalline pen G or Aqueous procaine penicillin
159
Reaction that often appears after penicillin treatment of women with 1&2 syphilis characterized by uterine contractions accompanied with late FH decelerations.
Jarisch-Herxheimer reaction
160
Incubation period of Herpes simplex.
2 to 10 days
161
17y/o,G1P0 at 16wks AOG presents for her 1st PNCU with urine culture >100,000 gram-negative rods. Denies any symptoms. What is your diagnosis?
Asymptomatic bacteriuria
162
Hallmark finding in nephrotic syndrome.
Proteinuria
163
All of the ff are known complication of nephrotic syndrome in pregnancy, except:
a. Preeclampsia
b. Polycythemia
c. Proteinuria
d. Peripheral edema
b. Polycythemia
164
All are common indication for surgery during pregnancy, except:
a. Appendicitis
b. Adnexal mass
c. Cholecystitis
d. Nephrolithiasis
d. Nephrolithiasis
MC: appendicitis
165
Common initial complications in severe hyperemesis gravidarum, except:
a. Acidosis
b. Dehydration
c. Hypokalemia
d. Mild transaminitis
a. Acidosis
| * Severe Hyperemesis gravidarum causes Alkalosis.
166
FBS level used as threshold to diagnose overt diabetes.
126 mg/dl
167
28y/o, G1P0 had her 1st PNCU. PMH and FH are unremarkable. HbA1c is 5%. What is the appropriate steps in her follow-up?
Screen at 24-28 wks AOG using a 2-hr 75g OGTT.
168
Women with thyroid peroxidase (TPO) antibodies has an associated increased risk of what complication?
Placenta abruption
169
Anti-hyperthyroid drug associated with hepatotoxicity when used throughout pregnancy.
Propylthiouracil
170
Anti-thyroid drug associated with embryopathy in 1st trimester of pregnancy.
Methimazole
*started after 1st trimester after PTU treatment.
171
Increased incidence of pregnancy outcome that have been linked with maternal subclinical hypothyroidism.
Pre eclampsia
172
Antidote used for Magnesium sulfate overdose in cases of preeclampsia.
Calcium gluconate IV
173
Normal blood loss in a normal singleton spontaneous vaginal delivery.
500 ml
174
Physiologic changes responsible for remission of autoimmune disorders during pregnancy.
Supressed Th1 respone
175
Increase agent in cervical mucus plug that act as barrier against infection for the fetus.
IgA
176
Increased CO during pregnancy is attributed to what physiologic changes?
5wks AOG: Dec systemic vascular resistance
| 10-20wks AOG: Inc Preload; plasma volume expansion begins
177
Organs producing components of RAAs in pregnancy.
Renin: Kidney and Placenta
Angiotensinogen: Maternal and Fetal Liver
178
Marked change in BP at 24 to 26 wks AOG due to vasodilation of spiral arterioles.
Decrease arterial pressure.
| Decreased diastolic pressure more than that of Systolic.
179
Potent vasodilator released by endothelial cells and have important implication for modifying vascular resistance during pregnancy.
Nitric Oxide
180
Potent vasoconstrictor in endothelial and vascular smooth muscle cells and regulates local vasomotor tone.
Endothelin
181
Principal prostaglandin of endothelium, that is decreased in pre eclampsia.
Prostacyclin
182
Required dose of Iron for normal pregnancy.
1,000 mg
* 300mg: actively transferred to fetus and placenta
* 200mg: GIT
* 500mg: inc in total circulating erythrocyte volume
183
Coagulation factor increased in pregnancy.
Fibrinogen
Factor 7
Factor 10
Plasminogen
184
Results from increased tidal volume that lowers the blood PCO2.
Physiologic dyspnea
185
Stimulates increase of 2,3 diphosphoglycerate in maternal blood that shifts the curve back to the right.
Slight pH increase.
186
Softening of the uterine isthmus.
Hegar sign
187
20wks AOG with IE: cervix soft in consistency. What is the explanation of this finding?
Increased cervical edema
188
Violaceous color of vaginal vault is due to?
Increased vascularity
189
Total urine blood flow from uterine and ovarian arteries.
450 to 650 mL/min
190
Cyanosis due to increased vascularity and edema of the entire cervix.
Goodell's sign
191
Cervical mucus characteristic due to progesterone.
Beading
192
Cervical mucus characteristic due to presence of amniotic fluid.
Ferning
193
Described as endocervical glands hyperplasia and hypersecretory appearance.
Arias-Stella reaction
194
Produces progesterone at 6-7 wks AOG.
Corpus luteum
195
Elevated patches of tissue which bleed easily.
Decidual reaction
196
Protein hormone secreted by the corpus luteum, decidua, and placenta.
Relaxin
197
Violet discoloration of vagina due to increased vascularity.
Chadwick sign
198
Irreversible stretch marks due to loosening of abdominal fibers.
Striae gravidarum
199
Melasma gravidarum aka Mask of Pregnancy.
Choalasma
200
Component of Biophysical Profile.
```
Nonstress test
Fetal breathing
Fetal movements
Fetal tone
Amniotic fluid volume
```
201
Average weight gain in pregnancy.
12,5 kg or 27.5 lbs
202
Associated condition in Leptin deficiency.
Anovulation
| Infertility
203
Elevated Leptin is associated with?
Preeclampsia
| Gestational Dm
204
A peptide hormone secreted primarily by the adipose tissue and placenta that plays a role in body fat and energy expenditure.
Leptin
205
Carbohydrate metabolism features in pregnancy.
* Mild fasting HYPOglycemia
* Postprandial HYPERglycemia
* HYPERinsulinemia
206
Secreted primarily by the stomach in response to hunger; cooperates with Leptin in energy and homeostasis modulation.
Ghrelin
207
Decreased venous pressure below the level of the uterus due to partial vena cava occlusion and Decresed interstitial colloid osmotic pressure, will result to?
Pitting edema
208
Focal, highly vascular swelling of the gums but regresses spontaneously after delivery.
Epulis
209
Itchiness caused by retained bile salts.
Pruritus gravidarum
210
Hormone responsible in inhibiting CCK-mediated smooth muscle stimulation that impairs GB contraction.
Progesterone
211
Source of Growth hormone at 17 weeks AOG.
Placenta
212
Hormone produced by uterine decidua that prevent water transfer from fetus into maternal compartment to prevent fetal dehydration.
Prolactin in Amniotic fluid
213
3 shunts in Fetal Circulation
* Ductus venosus
* Foramen ovale
* Ductus arteriosus
214
After birth, the intra abdominal remnants of the umbilical vein form as?
Ligamentum teres
215
Remnant of Umbilical artery.
Umbilical ligament
216
Remnant of Ductus venosus.
Ligamentum venosum
| Falciform ligament
217
Anatomical closure of Ductus arteriosus and venosus happens when?
2-3 weeks after birth.
218
Most active component of pulmonary surfactant.
Dipalmitoylphophatidylcholine
| DPPC
219
25 y/0 at 19wks AOG came in due to ruptured membranes and subsequently delivered a non viable fetus. What would be the histological finding of the fetal lung on autopsy?
Normal bronchial branching.
220
Fetal period of surfactant differentiation.
24 to 32 weeks
221
In early pregnancy, amniotic fluid is composed mainly of?
Ultrafiltrate of maternal plasma
* 2nd tri: ECF diffused through fetal skin
* >20wks: Fetal urine
* 12wks: Fetal kidney
222
Normal amniotic fluid volume by term.
840 ml
* 12 wks: 60 ml
* 34-36 wks: 1L
* 42 wks: 540 ml
223
Complication linked to binge drinking in pregnancy.
Stillbirth
224
1st trimester antibiotic exposure that causes hypoplastic left heart syndrome.
Nitrofurantoin
225
Drug that causes choanal atresia in 1st trimester exposure.
Sulfonamides
226
Malformation consistent in exposure to Warfarin.
Nasal hypopplasia
Choanal atresia
Embryopathy (6th-9th wk)
227
Most common non lethal trisomy.
Trisomy 21 (Down syndrome)
228
Only monosomy compatible with life.
Turner syndrome (45,XO)
229
Most common sex chromosome abnormality.
Klinefelter syndrome(47, XXY)
230
Characteristic Holoprosencephaly.
(Trisomy 13)
| Patau syndrome
231
Strawberry shaped cranium.
(Trisomy 18)
| Edward syndrome
232
Fetal movement typically perceived at 16-18wks AOG in multiparous and 18-120wks in primigravid.
Quickening
233
Hormone produced by syncytiotrophoblast, detected by 8-9 days after ovulation.
hCG
234
Most accurate tool for gestational age assignment.
CRL
*predictive of AOG within 4 days up to 12wks.
235
RDA for Folate for ALL women planning to get pregnant.
0.4 to 0.8 mg/day
* 400 mcg/day: prevent NTD
* 4 mg/day: with previous NTD baby
236
Vaccines recommended for pregnant.
Tdap: 3 doses IM, 0,1, 6-12 mos (at 27 to 36wks)
Influenza: 1 dose IM. once a year
Hep B: 3 doses IM, 0, 1, 6mos
237
Normal Fetal Activity
10 FM in up to 2 hrs.
238
Pathophysiology of Decelerations.
Early: Fetal head compression
Late: Utero placental Insufficiency
Variable: Cord compression
239
Characteristic feature of phases of parturition.
Phase 1: Uterine QUIESCENCE, Cervical SOFTENING
Phase 2: Uterine ACTIVATION, Cervical RIPENING
Phase 3: Uterine CONTRACTION, Cervical DILATATION
Phase 4: Uterine INVOLUTION, Cervical REMODELLING
240
Phases of Parturition.
1: Quiescent
2: Activation
3: Stimulation
4: Involution
241
Normal FHR
110 - 160 bpm
242
Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3-5 bpm which persists for >20 min
Sinusoidal pattern
243
Consistency of cervix in non pregnant women
Closed, firm and Nasal cartilage.
244
Spontaneous release of a small amount of blood-tinged mucus from the vagina.
Labor initiation
245
Cervical stretching during dilatation-stripping of fetal membranes increase blood levels of PGF2a metabolite.
Ferguson reflex
246
Physiology of pain in uterine smooth muscle.
* Hypoxia
* Compression of nerve ganglia
* Cervical stretching
247
Lower segment thinning and concomitant upper segment thickening.
Physiological retraction ring
248
Pathological retraction ring, happens when thinning of the lower segment is extreme.
Bandl ring
249
Shortening of the cervical canal
Cervical effacement
250
Pattern of cervical dilatation during the preparatory and dilatational divisions of normal labor.
Sigmoid curve
251
2 phases of 1st stage of labor
Latent phase
| Active phase
252
Divided into acceleration phase, phase of maximum slope, and deceleration phase.
Active phase
253
Duration is variable and sensitive to changes by extraneous factors.
Latent phase
254
Formed when the station of the fetal head is plotted as a function of labor duration.
Hyperbolic curve
255
Descent of the fetal BPD in relation to a line drawn between maternal ischial spines.
Station
256
Most important pelvic floor structure.
Levator ani muscle
257
Components of pelvic floor.
Pubovisceral
Puborectalis
Iliococcygeous
258
Blood from the placentas site pours into the membrane sac and does not escape externally until after extrusion of the placenta.
Schultze mechanism
259
Placenta separates 1st at the periphery and blood collects between the membranes and the uterine wall and escapes from the vagina.
Duncan mechanism
260
Changes in maternal blood volume and cardiac output in pregnancy may mimic what disease states?
Thyrotoxicosis
261
Tocolytic drug binds to beta-adrenergic receptors to cause cellular responses that cause uterine relaxation.
Increased cAMP levels
262
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CI to labor induction, except:
A. Twin gestation
B. Breech presentation
C. Fetal growth restriction
D. Prior CS delivery
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C. Fetal growth restriction
263
Quantifiable method used to predict labor induction outcomes.
Bishop scores
264
Contractions lasting more than 120 seconds.
Hypertonus
265
Potential to inc local PG, and may reduce pregnancy duration or preempt formal induction of labor with oxytocin or amniotomy.
Membrane stripping
266
Relation of the long axis of the fetus to that of the mother.
Fetal Lie
267
Presenting part foremost in the birth canal or in closest proximity with it.
Fetal Presentation
268
Relationship of an arbitrarily chosen presenting part to the right side of the Maternal birth canal.
Fetal Position
269
Mechanism by which the biparietal diameter passes through the pelvic inlet.
Engagement
270
Greatest transverse diameter in an occiput presentation.
Biparietal diameter
271
Factors affecting latent phase of duration.
* Excessive sedation or epidural anesthesia
* Unfavorable cervical condition
* False labor
272
Cardinal movements of labor.
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Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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273
20yo,G1P0 at 39wks AOG complained with strong contractions. Her cervix is dilated 1cm. She is given sedation and 4hrs later, contractions stopped still the same. What is the diagnosis?
Prolonged Latent Phase
274
The only measurable conjugate.
Diagonal conjugate
275
Greatest diameter between lines.
Transverse conjugate
276
Promontory to posterior symphysis.
Obstetric conjugate
277
First requisite for birth of the newborn.
Descent
278
Occurs as the descending head meets resistance, whether, from the cervix, pelvic walls, or pelvic floor.
Flexion
279
The occiput gradually moves toward the symphysis pubis anteriorly from the original position, and is essential for completion of labor.
Internal rotation
280
Corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the AP diameter of the pelvic outlet.
External rotation
281
Anterior shoulder appears under the symphysis pubis, and perineum soon becomes distended by the posterior shoulder.
Expulsion
282
Lateral defletion of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis.
Asynclitism
283
Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers.
Anterior asynclitism
284
Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.
Posterior asynclitism
285
Signs of Placental separation.
* Sudden gush of blood
* Globular & firmer fundus
* Lengthening of umbilical cord
* Rise of uterus into the abdomen
286
Unang Yakap (DOH)
* Immediate and thorough drying
* Early skin to skin contact
* Properly timed cord clamping
* Non separation for early breastfeeding
