obgyn Flashcards
(63 cards)
Q: What is the treatment of choice for asymptomatic bacteriuria in pregnancy (regardless of trimester)?
**A: Ampicillin **
First-line (empiric) treatment options
✔️ Safe and commonly used in all trimesters:
Fosfomycin trometamol
Single dose
Convenient and well tolerated
Beta-lactam antibiotics (5–7 days)
Oral cephalosporins (e.g., cefpodoxime)
Amoxicillin–clavulanic acid
Preferred if local resistance patterns are favorable
Second-line or conditional agents
✔️ Use only during specific trimesters due to safety concerns:
Nitrofurantoin (5 days)
Avoid near term (last weeks of pregnancy) due to risk of neonatal hemolytic anemia
Trimethoprim-sulfamethoxazole (TMP-SMX) (3 days)
Avoid in the 1st trimester (neural tube defects)
Avoid after 32 weeks (risk of kernicterus in newborn)
~~~
Q: What is the next step in a 32-week pregnant woman with 2 prior C-sections and painless vaginal bleeding with reassuring CTG?
A: Observation and further investigations
Placenta Previa: Implantation of placenta over or near the cervical os
Classic symptom: Painless vaginal bleeding, usually in third trimester
Diagnosis: Ultrasound (transvaginal preferred over transabdominal)
Contraindicated: Digital vaginal examination due to risk of hemorrhage
Management: Monitor if stable; admit if recurrent bleeding
Delivery: Planned cesarean section at 36 0/7 to 37 6/7 weeks
Q: What is the best initial step in a reproductive-aged woman with irregular menses?
β-hCG
Q: Pregnant woman at 27 weeks with BP 150/?, normal urine and labs. Diagnosis?
A: Gestational HTN
Most appropriate next step for a 27-week pregnant woman in preterm labor with cervical dilation and +GBS?
IM Betamethasone
Definition: Preterm labor = contractions + cervical dilation between 20–37 weeks.
Risk Factors: PROM, multiple gestation, prior preterm labor, abruption, infections, uterine anomalies, preeclampsia, surgery.
Presentation: Contractions (abdominal/back/pelvic pain), cervical dilation, 20–37 weeks GA.
Tocolytics:
- 1st-line: CCBs (Nifedipine)
- 2nd-line: Terbutaline (β-agonist)
- Avoid: Indomethacin used for (PDA closure)
Corticosteroids: Betamethasone given if 24–34 wks to mature fetal lungs. Start effect in 24h, peak at 48h, lasts 7d.
(anser is delivery):
- Severe preeclampsia/eclampsia
- Cardiac disease
- Cervix >4 cm
- Chorioamnionitis
- Abruption/DIC
- Fetal death
- Do NOT delay labor
- Give betamethasone if <34 weeks
GBS Management in Preterm Labor:
- If GBS status unknown in <37 weeks:
- Give intrapartum IV penicillin if:
- ROM ≥18 hours
- Maternal fever ≥38°C
- GA <37 weeks
- Give intrapartum IV penicillin if:
- If GBS positive: Always give IV penicillin during labor
- Penicillin allergy: Use cefazolin (or clindamycin if susceptible)
Algorithm:
- 24–33 wks + 600–2500g: Give steroids + tocolytics
- 34–37 wks or >2500g: Allow delivery
What is the most appropriate test to assess severity in a pregnant woman with nausea, vomiting, and mild dehydration?
A: Urine ketone body
hyperemesis gravidarum:
Definition: Severe, persistent nausea and vomiting in pregnancy
Associated with: ≥5% loss of prepregnancy weight, ketonuria, hypokalemia, hypochloremia, metabolic alkalosis (or starvation-induced acidosis), no alternative identifiable cause
First-line treatment: Pyridoxine (Vitamin B6) ± doxylamine
Antihistamines (H1 blockers): Diphenhydramine, dimenhydrinate, doxylamine
Dopamine antagonists: Metoclopramide
Serotonin antagonists: Ondansetron
Last-resort treatment: Chlorpromazine or methylprednisolone
Steroid caveat: Methylprednisolone is contraindicated in the first 10 weeks of gestation
What is the most likely diagnosis in a 36-week pregnant woman with painful vaginal bleeding after trauma?
Placenta abruption
Placental Abruption:
Risk factors: prior Hx, hypertension, trauma, cocaine and methamphetamine use, cigarette smoking.
Painful vaginal bleeding
Most often during the third trimester
Tx: fetal monitoring, hemodynamic stabilization, - delivery for maternal or fetal instability at any gestational age.
-
Mother stable and category I FHR
- < 34 weeks: antenatal steroids and magnesium sulfate for fetal neuroprotection
- 34–36 weeks: consider antenatal steroids
- > 36 weeks: delivery
A woman in labor with 5 cm cervical dilation and 40% effacement is in which stage of labor?
A: First stage (latent phase)
First stage: From onset of true labor contractions to full cervical dilation (10 cm), includes latent (0–6 cm) and active (6–10 cm) phases.
Second stage: From full cervical dilation to delivery of the baby.
Third stage: From delivery of the baby to expulsion of the placenta.
Fourth stage: Immediate postpartum period (about 1 hour after placenta), focused on maternal monitoring.
Patient case: Cervix 5 cm dilated → still in latent phase of first stage.
Most appropriate next step for 29-year-old woman with LSIL on Pap and negative HPV?
colposcopy’s
What is the diagnosis for a pregnant woman at 11 weeks with vaginal bleeding, closed os, and positive fetal heart?
Threatened abortion
What is the most likely cause of contractions in a 33-week pregnant woman with regular contractions and cervical dilation of 3 cm?
A: Preterm labor
Braxton-Hicks vs True Labor: Comparison of contraction features and labor progression.
Contraction pattern: Braxton-Hicks are irregular and infrequent, while true labor contractions are regular and increase in frequency.
Pain: Braxton-Hicks are mild or painless; true labor contractions are painful and increase in intensity.
Cervical change: Braxton-Hicks do not cause dilation or effacement, whereas true labor leads to progressive cervical changes.
Response to rest: Braxton-Hicks typically resolve with rest or hydration; true labor contractions persist despite rest.
What is the next step in a 29-week pregnant woman with painless bright red vaginal bleeding?
Obstetric ultrasound to rule out placenta previa
27F with adnexal mass, left pelvic pain, nausea, and unknown LMP. Most likely diagnosis?
Ectopic pregnancy
Risk factors: prior ectopic pregnancy, PID, tubal surgery, IVF, IUD in situ
Sx: abdominal pain, pelvic pain, amenorrhea, or vaginal bleeding
Lab results: positive pregnancy test, serum beta-hCG levels may be lower than expected
Diagnosis: pelvic ultrasound
* Nonspecific findings: empty uterus + free fluid or adnexal mass
* Definitive Dx: gestational sac with a yolk sac or embryo outside of the uterine cavity
* Free fluid with debris is suggestive of ruptured ectopic pregnancy
Most commonly located in a fallopian tube
Tx: methotrexate or surgery
Best test to confirm ectopic pregnancy in a woman with RLQ pain and spotting?
next step ?
concern for ectopic pregnancy ,best:
(Transvaginal ultrasound)
NEXT:
Repeat HCG
What is the appropriate management in labor for a woman with GBS during early pregnancy, and get medication?
IV penicillin
Indications for Intrapartum GBS Prophylaxis:
Positive rectovaginal GBS culture during current pregnancy (35–37 wks)
GBS bacteriuria at any point during current pregnancy even she received Ab
Previous infant with invasive GBS disease
Unknown GBS status + any risk factor (preterm labor <37 wks, ROM ≥18 hrs, intrapartum fever ≥38°C)
GBS positive by rapid NAAT at labor if culture not available
Pregnant woman at 33 weeks with headache, proteinuria, elevated liver enzymes, low platelets – best next step?
C/S (urgent delivery due to severe preeclampsia/HELLP)
What is the 2-hour postprandial glucose target in gestational diabetes?
A: ≤ 120 mg/dL
target :
Fasting: ≤ 95 mg/dL
1 hour postprandial: ≤ 140 mg/dL
2 hours postprandial: ≤ 120 mg/dL
Pregnant woman at 16 weeks with FBS 7.3 and HbA1c 6.9% — most likely diagnosis?
T2DM 16 weeks after 20 week for GDM
Gestational Diabetes Mellitus: Early screening in obese/high-risk women; universal screening at 24–28 weeks with 50g OGTT
Screening: 1-hour 50 g OGTT; abnormal if glucose > 130–140 mg/dL depending on protocol
Diagnosis (ADA criteria): 3-hour 100 g OGTT
> 95 mg/dL fasting
> 180 mg/dL at 1 hour
> 155 mg/dL at 2 hours
> 140 mg/dL at 3 hours
Management: Lifestyle changes, glucose monitoring, fetal growth and antepartum surveillance, insulin preferred if needed
Delivery timing: 39 0/7–39 6/7 weeks for A2 GDM
C-section consideration: If estimated fetal weight > 4,500 g
Fetal risks: Macrosomia, neonatal hypoglycemia, respiratory distress
Maternal risk: Increased risk of developing type 2 diabetes
Postpartum follow-up: FPG or 2-hour OGTT at 4–12 weeks postpartum; repeat every 1–3 years if normal
What is the management for a 16-week pregnant woman with nitrite-positive, leukocyte-positive urinalysis?
Antibiotics
Step 1: Screen in first trimester with urine culture, not urinalysis
Step 2: If positive in one, repeat culture to confirm (AMBOSS view)
Step 3: If confirmed ASB (≥10⁵ CFU of same organism in 2 samples, no symptoms) → Treat with antibiotics
Step 4: Do test of cure (TOC) after treatment (7–14 days later)
Clinical Pearl: Urinalysis is supportive but not diagnostic for ASB. Urine culture is essential before initiating
treatment.
Recommended first-line empiric options:
Fosfomycin (single dose)
Cephalosporins (e.g., cefpodoxime): for 5–7 days
Amoxicillin/clavulanic acid: for 5–7 days
What is the most likely diagnosis in a pregnant woman at 10 week, uterus bigger than expects, with vaginal bleeding, very high β-hCG, uterine enlargement, and snowstorm appearance on ultrasound?
**A: Hydatidiform mole **
What is the next step for a 16-week pregnant woman with a history of GDM (regarding screening of GDM) ?
**A: Oral glucose tolerance test now **
High-risk factors for GDM: History of GDM, obesity (BMI ≥ 30), family history of T2DM, previous macrosomia (> 4,000 g), PCOS, glycosuria, high-risk ethnicity
Management: Do early OGTT at first prenatal visit (before 20 weeks), repeat OGTT at 24–28 weeks if initial screen is normal
What is the most likely cause of recurrent miscarriages with positive anticardiolipin and lupus antibody?
A: Antiphospholipid syndrome
What is the most likely diagnosis in a 26-year-old woman with secondary amenorrhea, history of irregular menses, high FSH/LH, normal BMI, normal thyroid and prolactin, absence of hirsutism or acne, normal ovaries on ultrasound, and signs of low estrogen (e.g., thin vaginal mucosa, decreased menstrual flow)?
A: Primary ovarian insufficiency
What is the most likely cause of off-white vaginal discharge, alkaline pH, clue cells, and no pruritus?
Bacterial Vaginosis
Sx: malodorous vaginal discharge
Dx: Amsel criteria (at least three of four):
Homogeneous, thin, white-gray discharge
> 20% clue cells on saline microscopy
Vaginal fluid pH > 4.5
Positive potassium hydroxide whiff test result
Most common bacteria: Gardnerella vaginalis (due to ↓ Lactobacillus spp)
Recommended management:
Metronidazole 500 mg PO twice daily for 7 days
Metronidazole gel 0.75% (5 g) PV daily for 5 days
Clindamycin cream 2% (5 g) PV at bedtime for 7 days
