OB: Pregnancy Complications 15%

Question 1

(SmartyPance)

two signs of threatened abortion

Answer 1

closed cervix

sm amt of vaginal bleeding

“…threatened abortion as evidenced by the closed cervix and small amount of vaginal bleeding. the most appropriate management for threatened abortions is reassurance with OP f/u”

Question 2

(SmartyPance)

what are signs of abruptio placentae?

Answer 2

hx of HTN
painful antepartum hemorrhage w/ nml u/s

(pt in scenario is at 38 weeks with vaginal bleeding and painful contractions, lower abd and pelvic pain b/w contractions)

Question 3

(RoshReview)

what is photopsia? What condition is it related to?

Answer 3

visual disturbances such as eye floaters or FLASHES

think PREECLAMPSIA

Question 4

(RoshReview)

what is the bp requirement for severe HTN related to severe preeclampsia?

Answer 4

> 160/110 mmHg

Question 5

(RoshReview)

what med can be offered to women with risk factors for preeclampsia to prevent preeclampsia?

Answer 5

aspirin

Question 6

(RoshReview)

stage of pregnancy to start suspecting preeclampsia

Answer 6

> 20 weeks gestation

Question 7

(RoshReview)

s/s of preeclampsia

Answer 7

visual disturances (photopsia)
severe HAs
or asymptomatic

pt shows NEW-ONSET HTN (>140/90 mmHg) w/ either PROTEINURIA (>300 mg/24hr)
~or~
SIGNIFICANT END-ORGAN DYSFUNCTION

Question 8

(RoshReview)

tx for prevention of szs for preeclampsia

Answer 8

magnesium sulfate

Question 9

(RoshReview)

if a woman <20 weeks gestation has new onset HTN, what should you suspect?

Answer 9

molar pregnancy

Question 10

(RoshReview)
if a pt >20 weeks gestation has new onset HTN, but an absence of proteinuria, check for the following five items to r/o preeclampsia w/ severe features:

Answer 10

thrombocytopenia (platelet count < 100,000/mcL)
renal insufficiency (serum Cr >1.1 mg/dL)
impaired liver fxn (liver transaminases 2x nml conc)
pulm edema
cerebral/visual symptoms

Question 11

(PPP 373)

what meds are used for bp control for preeclampsia with severe features?

Answer 11

labetalol
nifedipine
methyldopa

hydralazine alternative

Question 12

(PPP 373)

preeclampsia w/ severe features: pt is 34-37 weeks gestation, what do we do?

Answer 12

prompt delivery is definitive management

Question 13

(PPP 373)

preeclampsia w/ severe features: pt is viable to 33+6 weeks gestation, what do we do?

Answer 13

if asymptomatic or well-controlled w/ anti-HTN, expectant mgmt w/ delivery at 34 weeks

if symptomatic or not well-controlled w/ anti-HTN, deliver

Question 14

(PPP 373)

what is HELLP syndrome?

Answer 14

Hemolytic anemia

Elevated Liver enzymes

Low Platelets

Question 15

(RoshReview)

“what is the typical fetal response to maternal seizures in eclampsia?”

Answer 15

“bradycardia during and immediately after the sz”

Question 16

(RoshReview)

define threatened abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 16

= “abdominal pain or bleeding in the first 20 weeks of gestation”

closed

none

Question 17

(RoshReview)

define inevitable abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 17

= “abdominal pain or bleeding in the first 20 weeks of gestation”

open

none

Question 18

(RoshReview)

define incomplete abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 18

= “abdominal pain or bleeding in the first 20 weeks of gestation”

open

YES (some products of conception still remain in uterus)

Question 19

(RoshReview)

define complete abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 19

= “abd pain or bleeding in the first 20 weeks of gestation”

closed

complete passage of fetal parts & placenta; uterus contracted

Question 20

(RoshReview)
define missed (delayed miscarriage) abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 20

= “in utero death of embryo or fetus prior to 20 weeks of gestation with retention of pregnancy”

closed

none

Question 21

(RoshReview)

define septic abortion, the position of the cervical os, and whether there is passage of fetal tissue

Answer 21

= “infection of uterus during miscarriage, fever & chills; usually due to Staph. aureus”

open with purulent cervical discharge; uterine tenderness

none (may be incomplete)

Question 22

(RR) BUZZWORDS

retroplacental hematoma

Answer 22

think PLACENTAL ABRUPTION

Question 23

(RR)

what is most common potential complication for placental abruption?

Answer 23

DIC

“a placental abruption of >50% significantly increases the risk for acute disseminated intravascular coagulation and fetal death”

Question 24

(RR) BUZZWORDS

PAINFUL vaginal bleeding (in third trimester)

Answer 24

placental abruption

Question 25

(RR)

what med is most frequently used for induction of pregnancy?

Answer 25

oxytocin (Pitocin)

Question 26

(RR)

what is MC SE of oxytocin admin?

Answer 26

tachysystole
(avg of >5 contractions per 10 minutes for >= 30 minutes

treated w/ reduction or d/c of dose of oxytocin)

Question 27

(PPP 382)

what are two methods of inducing labor during early stages?

Answer 27

prostaglandin gel placed directly on cervix (promotes cervical ripening, may lead to uterine contractions)

balloon catheter or laminaria (dilate the cervix)

Question 28

(RR)

Pt has hydatidiform mole (molar pregnancy), removed with surgery. What is the management after surgery?

Answer 28

weekly measurements are taken until the hCG level is < 5 mIU/mL

At this point, if the patient had a complete molar pregnancy, hCG levels are obtained monthly for 3 months and then discontinued if undetectable.

If the patient had a partial molar pregnancy, an hCG level is obtained at 1 month and then discontinued if undetectable.

Question 29

(RR)

how do you prevent alloimmunization in cases of RhD incompatibility

Answer 29

through administration of anti-D immune globulin at 28 weeks of the first and each subsequent gestation.

this is std practice for all pregnant pts at risk

Question 30

(RR)

if RhD incompatibility is suspected due to parental genetics, what should be measured? what is done next?

Answer 30

maternal anti-D titers
should be measured serially until a critical titer level (usually 1:16 or 1:32) is reached,

Doppler velocimetry of the middle cerebral artery of the fetus should be measured at that time

Question 31

(RR)

if there is a situation of Rh isoimmunization, what is often seen in subsequent pregnancies?

Answer 31

jaundice
anemia
fetal death
fetal hydrops (abnormal amounts of fluid build up in two or more body areas of a fetus or newborn)

Question 32

(RR)

how do we treat Rh Isoimmunization?

Answer 32

Anti-D globulin at 28 weeks (and within 72 hrs of delivery if infant is Rh+)