OBG 2

Question 1

magnesium should be monitored for signs of toxicity (somnolence, areflexia, respiratory suppression).
What pts are at increased risk for toxicity?

Answer 1

renal insufficiency

(bc magnesium is excreted by the kidneys)
Hypocalcemia is a potential adverse effect

Question 2

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid unilateral ovarian mass

Answer 2

Sertoli-Leydig Tumor

Surgery required (2nd trimester or postpartum)
*High fetal virilization risk

Question 3

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Cystic, bilateral ovarian masses

Answer 3

Theca lutein cyst

Spontaneous regression of masses after delivery (observe)
*Low fetal virilization risk

Question 4

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
Solid, unilateral/bilateral ovarian masses

Answer 4

Luteoma

Spontaneous regression of masses after delivery (observe)
*High fetal virilization risk

Question 5

Pregnant pt w/cc of facial hair & acne (Hyperandrogenism/Virilization)
No ovarian mass on exam

Answer 5

Placental Aromatase Deficiency

Resolution of maternal symptoms after delivery (observe)
*High fetal virilization risk

Question 6

Used to monitor fetal status in pregnancies complicated by maternal hypertension or fetal growth restriction.

Answer 6

Umbilical artery Doppler ultrasound

Question 7

Low/↓ Maternal serum α-fetoprotein on quad screen indicates what?

Answer 7

Aneuploidies (eg, trisomy 18 & 21)

Question 8

High/↑ Maternal serum α-fetoprotein on quad screen indicates what(3)?

Answer 8

Neural tube defects (anencephaly, open spina bifida)
Ventral wall defects (omphalocele, gastroschisis)
Multiple gestation
(these pts require fetal ultrasound)

Question 9

Anti-D immune globulin (RhoGAM) is indicated in unsensitized, Rh-negative women at __ weeks gestation or within 72 hours of any procedure or incident in which there is any possibility of feto-maternal blood mixing.

Answer 9

28

Question 10

Pruritus that is most severe on the palms with no associated rash occuring in the third trimester is consistent with what diagnosis?

Answer 10

Intrahepatic cholestasis of pregnancy (ICP)
s/t ↑ estrogen & progesterone levels causing hepatobiliary tract stasis and decreased bile excretion HENCE elevated total bile acids (≥10 µmol/L) which is diagnostic.

Question 11

Management of Intrahepatic cholestasis of pregnancy (ICP) includes:

Antihistamines
Delivery at 37 weeks gestation
and what medication?

Answer 11

Ursodeoxycholic acid

cx: IUFD, Preterm delivery, Meconium-stained amniotic fluid, NRDS

Question 12

Significant postpartum hemorrhage can cause _____.
Typically presents with bleeding and/or thrombosis (acute pulmonary embolus), thrombocytopenia, & prolonged PT & PTT

Answer 12

disseminated intravascular coagulation (DIC)

Question 13

Prophylactic latency antibiotics (erythromycin, ampicillin) are indicated in patients at __ weeks gestation with preterm prelabor rupture of membranes to prevent fetal infection

Answer 13

<34

Question 14

magnesium sulfate is administered for fetal neural protection to patients at __ weeks gestation

Answer 14

<32

Question 15

A rare obstetrical emergency causing rapid hemodynamic instability and pulmonary edema.

Answer 15

Amniotic fluid embolism

Question 16

A rare obstetrical emergency that can present with a vaginal mass, massive hemorrhage, and hemodynamic instability. Uterus is not palpable post-partum.

Answer 16

Uterine Inversion

Question 17

A rare obstetrical emergency that can present with a vaginal mass, Rectal or vaginal pressure, massive hemorrhage (can be concealed bleeding), ± hemodynamic instability.

Risk factors include: Operative vaginal delivery (obstetric trauma), Infant ≥ 4kg (8.8 lb)

Answer 17

Vaginal hematoma

Nonexpanding: observation
Expanding: embolization, surgery

Question 18

Preeclampsia can present up to __ weeks postpartum with headache and hypertension.

Answer 18

6
(if pt has a focal neurologic deficits a CT head is indicated)

Question 19

Patients with ___ in their current pregnancy or those who delivered a prior infant with early-onset GBS infection are high risk and require intrapartum antibiotic prophylaxis.

Answer 19

GBS bacteriuria

Question 20

Digital Cervical Exam may be insufficient for determining fetal presentation in patients with a bulging bag (which may be a normal finding s/t contractions tensing the sac).
If fetal presentation is indeterminate (no palpable presenting fetal part) on cervical exam, what is performed to confirm presentation and help determine route of delivery?

Answer 20

transabdominal ultrasound

Cephalic fetal presentation → managed expectantly
Non-cephalic (breech, transverse, funic/cord first) fetal presentations → cesarean delivery

Question 21

Presents with acute abdominal pain; a rigid, tender uterus; and high-frequency contractions.
Risk factors include cocaine and tobacco use, which cause placental vasoconstriction.

Answer 21

Placental Abruption

(20% have a concealed abruption w/ no visible bleeding. Usually have severe focal pain at the location of the placenta that progresses to diffuse uterine tenderness)

Question 22

Uncomplicated perineal lacerations (no fever or purulence) are managed how?

Answer 22

conservatively
(NSAIDs, sitz baths)

Question 23

Management of Placenta Accreta refractory to uterine massage, uterotonic meds, and manual extraction/ sharp uterine curettage of retained placenta.

Answer 23

Cesarean hysterectomy with placenta in situ

Question 24

Management of uterine inversion

Answer 24

1. manual replacement (stop uterotonics)
2. If refractory, uterine relaxants and laparotomy

Question 25

Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction. Management is with what three interventions?

Answer 25

Left lateral patient positioning IVF bolus vasopressors (phenylephrine, vasopressin)

Question 25

Neuraxial anesthesia (epidural) can cause maternal hypotension and decreased placental perfusion. FHT will show recurrent late fetal heart rate decelerations with every contraction. Management is with what three interventions?

Answer 25

Left lateral patient positioning IVF bolus vasopressors (phenylephrine, vasopressin)

Question 26

Presents with severe abdominal pain; uterine tenderness; a palpable, firm & tender mass; and signs of inflammation (eg, leukocytosis).

Answer 26

Uterine fibroid degeneration (Leiomyomata uteri become an infarcted, degenerating uterine fibroid during pregnancy)

Question 27

Category 3 FHT (very bad) are defined by 1. Sinusoidal pattern or 2. Absent variability PLUS one of what 3 FHT findings?

Answer 27

recurrent late decelerations (slow after every contraction) recurrent variable decelerations (fast not always after every contraction) bradycardia (Less than 100 bpm baseline)

Question 28

Management of Category 3 FHTs

Answer 28

Initial management is with intrauterine resuscitative interventions (maternal repositioning, Oxygen, IVFs) If no improvement with initial management and are far from delivery require immediate cesarean delivery.

Question 29

Inevitable abortion presents with heavy vaginal bleeding, cramping, and a dilated cervix without passage of gestational tissue. ____ management is indicated for patients whose condition is hemodynamically unstable or has signs of infection?

Answer 29

suction curettage (surgical management)

Question 30

In Inevitable abortion where the pt is hemodynamically stable with minimal bleeding what 2 types of management are appropriate?

Answer 30

Medical induction (Misoprostol) or expectant management

Question 31

Persistently absent or minimal variability on fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, certain ___ can also cause decreased variability (fetal CNS depression).

Answer 31

medications (opioids/narcotics)

Question 32

Indomethacin tocolysis (inhibit contractions) is indicated in patients with preterm labor at __ weeks gestation. *can cause oligohydramnios and premature closure of the fetal ductus arteriosus (benefits > risks)

Answer 32

<32

Question 33

Pregnancy complicated by chronic hypertension confers an elevated risk of ___ & ___ due to uteroplacental insufficiency.

Answer 33

fetal growth restriction (<10th percentile) oligohydramnios (amniotic fluid index [AFI] ≤5 cm)

Question 34

Obesity in pregnancy (prepregnancy BMI ≥30 kg/m²) increases risks of ___ & ___

Answer 34

Intrauterine fetal demise fetal macrosomia (>90th percentile)

Question 35

Diabetes mellitus in pregnancy increases the risk for ___ & ___

Answer 35

macrosomia (>90th percentile) polyhydramnios (AFI ≥24 cm)