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OBS Flashcards

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1
Q

What is the risk of placenta accreta in the presence of a previa and 0, 1, 2, 3, 4 CS

A

Previa and:

  • 0 prior CS: 3 %
  • 1 prior CS: 25 %
  • 2 prior CS: 40 %
  • 3 prior CS: 61 %
  • 4 prior CS: 67 %
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2
Q

What is the risk of placenta accreta in the absence of placenta previa

A

Accreta without previa

  • 1 prior CS: 6.6 %
  • 2 prior CS: 17%
  • > 3 prior CS: 55%
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3
Q

What is the risk of accreta with 1 prior CS and with and without previa

A

One previous CS

  • No previa: 6.6%
  • Previa: 25%
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4
Q

What is the risk of accreta with 2 prior CS and with and without previa

A

Two (2) previous CS

  • No previa: 17%
  • Previa: 40%
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5
Q

What is the risk of accreta with 3 prior CS and with and without previa

A
  • No previa: 55%
  • Previa: 61%
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6
Q

Name the indications for aspirin in pregnancy (10)

A
  • AMA (Age > 40)
  • ART
  • BMI > 30
  • History of IUGR
  • History of PET
  • Chronic HTN or previous GHTN
  • Multiple pregnancy
  • DM 1 or DM2
  • History of placental abruption
  • History of placental infarct
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7
Q

When should ASA be started

A

12- 16 weeks

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8
Q

What is the mechanism of action of labetolol

A

Mixed alpha + beta adrenergic ANTAGONIST

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9
Q

What is the mechanism of action of metyldopa

A

Alpha-2 adrenergic AGONIST

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10
Q

What is the mechanism of action of hydralazine

A

Vascular smooth muscle relaxant

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11
Q

Name the sources of progesterone in pregnancy (2)

A
  • Corpus luteum cyst (until 6-7 weeks)
  • Placenta
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12
Q

What are the most common congenital anomalies in patient with T1 or T2 DM

A

Neural tube defect (4.2 fold increase)

Congenital heart disease (3.4 fold increase)

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13
Q

What does BV in pregnancy predispose to?

A

PPROM

PTL

PTB

Post partum endometritis

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14
Q

When are depression symptoms worse in adolescent pregnancy?

A

Between T2 and T3

1/2 have symptoms in early post partum period

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15
Q

What adverse outcomes are adolescent pregnancy linked to?

A

PTB

PPROM

LBW/ IUGR

NICU admissions

Stillbirth

Congenital anomalies

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16
Q

What congenital anomalies are linked to adolescent pregnancies?

A

CNS

(anencephaly, spina bifida, hydrocephaly, microcephaly)

GI

(Gastroschesis, omphalocele)

MSK

(clift lip, cleft palate, polydactyliy, syndactaly)

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17
Q

What is the most common lower genital tract disorder in women of reproductive age?

A

Bacterial vaginosis

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18
Q

What are some risk factors for BV (4?)

A

Black race

Smoking

Sexual activity

Use of vaginal douches

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19
Q

What are the two ways to establish a diagnosis of BV?

A

Amsel criteria

Nugent score (Gram stain, score > 7)

Amsel criteria:

Adherent and homogenous vaginal discharge

Vaginal pH > 4.5

Detection of clue cells

Positive wiff test

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20
Q

What is the treatment + f/u of BV in pregnancy ?

A

Metronidazole (Flagyl) 500 mg PO BID x 7 days

Clinda 300 mg PO daily x 7 days

Repeat culture 1 month after treatment - high recurrence

Topical agents have similar cure rates but

  • Not effective to prevent PTL in high risk population
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21
Q

Name the adverse pregnancy outcomes with BV (5)

A

Spontaneous abortion

PTL and PTB

PPROM

Chorioamionitis

PP infections (Endometritis + CS wound infection)

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22
Q

When should you screen for BV in pregnancy?

A

NO routine screening

Screen if bothersome and persistent discharge

Screen at 12-16 weeks in high risk women

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23
Q

What is oral fluconazole in pregnancy associated to?

A

Tetralogy of Fallot

Safety in 2nd and 3rd trimester not investigated

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24
Q

What is boric acid associated to in pregnancy?

A

2 fold increase in birth defects (during first 4 months)

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25
Define shock index
HR / sBP \< 0.7 → normal \> 0.7 → transfuse
26
Absolute contraindications to neuraxial anesthesia
**Maternal coagulopathy** **Thrombocytopenia** **LMWH within 12h** Sepsis Skin infection at site of needle placement ***Refractory maternal hypotension*** ***Increased intracranial pressure caused by mass lesion*** 3 coags / 2 infection / 2 BP
27
Describe the following signs: Goodell Chadwick Hegar
Goodell : Softening of LUS **C**hadwick : **C**yanosis / bluish discoloration Hegar: Softening of cervix (Hegar = cx dilator)
28
What test should you order to r/o GDM in patient who underwent gastric bypass surgery? (# 393)
Fasting glucose 1h post prandial blood glucose HbA1c
29
Who should you screen before 24-28 weeks for GDM ? (#393)
Maternal age \> 35 yo Pre-pregnancy BMI \> 30 PCOS Acanthosis nigricans Corticosteroid use Ethnicity (Aboriginal, African, Asian, Hispanic, South Asian) Family Hx of DM Previous pregnancy with GDM Previous macrosomic infant
30
What are the benefits of optimal glucose control (5)? (#393)
↓ PET ↓ Fetal macrosomia ↓ Shoulder dystocia ↓ CS ↓ IUFD
31
What is the advantage of immediate breat feeding in diabetic mothers (1)? (#393)
↓ neonatal hypoglycemia
32
In GDM mothers, BF x 6 months has what advantages (2)? (#393)
Reduce childhood obesity Reduce maternal hyperglycemia
33
What proportion of GDM mothers have DM at PP visit? (#393)
1/3
34
What proportion of GDM mothers will have DM later in life? (#393)
15-50 %
35
Describe the different levels of foreceps application (4) (#381)
Outlet : Head visible at introitus without spreading the labias Low: station \> +2 \*\* Mid: Station between 0 and +2 \*\* High: Station above 0 (head not engaged) \*\* 2 subdivisions - Rotation \< 45 ° from OA position - Rotation \> 45 ° from OA position (including OP)
36
When should you induce GDM patients ? | (#393)
Diet controlled: before 40 weeks Insulin dependant: 39 weeks
37
How and when do you test for post partum DM? (#393)
2h 75g OGTT Between 6 weeks and 6 mo post partum When planning another pregnancy
38
**When** and **how** to test for GDM in patients who received betamethasone? (#393)
\> 7 days post last dose of beta 2h 75 OGTT
39
Describe antenatal testing for GDM | (#393)
US q 3-4 weeks starting at 28 weeks * EFW * Amniotic fluid volume Weekly testing at 36 weeks * NST * NST + AFI * BPP
40
41
What dermatomes need to be blocked for vaginal delivery and CS?
Vaginal delivery: T10 - S5 CS: T4 - S1 (Williams OB p 513)
42
What complication of DM1 in pregnancy leads to the highest number of PTB? (Williams OB p 1131)
Pre-ecclampsia
43
How do you follow a DM1 pregnancy ? | (Berghella)
**Pre-conception** * Normalization of HbA1c \< 7 % * Eye exam * 24h urine protein * EKG Antenatal * Viability scan * Early anatomy scan (14 -16 wks) if HbA1c \> 8% * AFP screening 16-20 wks * Anatomy scan (18-20 wks) * Fetal echocardiography (20-22 weeks) * Serial growth US * 28 weeks: onset of antenatal testing if glucose poorly controlled * 32 - 36 weeks: NST and BPP weekly or twice weekly * 36 weeks to delivery : Twice weekly **Delivery:** * 39 weeks * If CS, administer evening dose of long acting and hold morning short acting dose **Post partum** * Decrease insulin dose by half and administer with onset of PO intake
44
What are the neonatal effects of DM1 (5)? (Berghella + Williams)
Hypoglycemia Hypocalcemia Hyperbilirubinemia + polycythemia Cardiomyopathy Mortality
45
What is the impact of pregnancy on typical DM1 complications (7)? (Berghella + Williams)
**Pre-ecclampsia** **Retinopathy** → can significantly worsen **Nephropathy** → if severe, can lead to end stage disease **Neuropathy** → no effect, only if gastroparesis (high risk of complication + poor perinatal outcome) **Cardiovascular disease** → no change in pregnancy **Ketacidosis** → ↑ risk **Infection** → ↑ risk of all infections
46
What is a contraindication of pregnancy in pts with DM1? (Berghella)
Symptomatic cardiovascular disease
47
How do you prevent progression of retinopathy in DM1 patients?
Good glycemic control Photocoagulation
48
When does the fetal thyroid start functioning ? What are thryroid hormone sources before and after that time?
**10 - 12 weeks** * Starts concentrating iodine * Start formning TSH * Small amount of thyroid hormones **18-20 weeks** * Increased fetal secretion Before 10-12 weeks → amternal T4 = only source
49
Which Thyroid hormones cross the placenta?
T3 T4 TRH (small amount) TSH receptor Antibody Does not cross: TSH
50
Describe the different periods of the development of a fetus and corresponding dates (W OB p 128)
Weeks 1-2 : implantation Weeks 3-8: Embryonic period = organogenesis Weeks 9-38: fetal period = growth
51
Inheritance pattern of G6PD disorder ? What medication/ substance should be avoided ?
X-linked (recessive) Methylene blue / Nitrofurantoin + long list but none are used in gyne
52
Which stage of labour is affected by obesity?
First stage
53
What maternal infections are associated with stillbirth? (#394)
CMV Parvo B19 Listeria
54
What is the timeline of PP psychosis?
Within 2 weeks of birth
55
What is often the first signe of PP psychosis? (UpToDate)
Severe insomnia (more than to take care of infant)
56
What is the most common cause of maternal death during the first year PP?
Suicide (UpToDate: post partum psychosis)
57
What is the risk of infanticide with PP psychosis? (UpToDate: PP Psychosis)
4 %
58
What medical condition is increased in PP psychosis? (UpToDate PP Psychosis)
Autoimmune thyroid disease Primary Hypoparathyroidism
59
What are the RF for GDM ? | (Berghella p 60)
Hx of GDM Family Hx of DM Obesity Age \> 35 Non white etchnicity Prior macrosomic infant Chronic steroid use Glycosuria Know impaired glucose metabolism Prior infant with congenital anomaly Prior unexplained stillbirth
60
What is the mechanism of GDM (2)? Berghella p 61
**Insulin resistance caused by:** * ↑ human placental lactogen (maternal and placental production) * Progesterone * Growth hormone * Cortisol * Prolactin * ↑ BMI and caloric intake **↓ function of pancreatic islet cells**
61
What is the % of RhD - in the caucasian population?
15 % In Basque : 30 % In Asians : 1%
62
If and RhD - patient does not get Rhogham, what is her chance of immunization? (Berghella)
17 %
63
What is the most common reason for izoimmunization ? (Berghella)
Fetomaternal hemorrhage at delivery (\>90%) Third trimester (10%)
64
Other than pregnancy, what are other causes of RBC alloimmunization? Berghella
Amnio 7- 15 % CVS: 14 % Induced abortions : 4-5 % ECV: 2-6 % First trimester loss (1-2%)
65
How long is Rogham effective for? Berghella
12 weeks Half life = 16- 24 days
66
What is the incidence of Kell alloimmunization? (Berghella)
0.1 - 0.3 %
67
What is the risk of fetal demise with fetal blood transfusion? (Berghella)
1-2 %
68
What is the risk of error following fetal sex determination by US ? (#192)
3 %
69
Describe warfarin embryopathy ? When administered in which trimester does it have the worse impact? What are the other impacts of warfarin on pregnancy? (#308)
Nasal and limb hypoplasia Stippled bone epiphyses (pattern of focal bone calcification) Worse in First Trimester (between 6-7 wks) Effect is dose dependant Pregnancy loss Antigoagulation at time of delivery
70
How do you manage an ovarian mass in pregnancy?
* **\< 5 cm** → no surveillance needed * **5- 10 cm**, US surveillance. * Remove if grows, maliganant features, symptomatic * Surgery between 14 - 20 wks (most benign cyst will have resolved by then) * **\> 10 cm** → Remove (↑ risk of malignancy) * NO EVIDENCE for tumor markers except Ca125 * If 15 wks → delivery, Ca125 between 1000 and 10 000 → ABNORMAL
71
What nerve roots and muscles are affected with Erb's palsy ?
C5 - C6 Paralysis of deltoid, infraspinatus, flexor muscles of forearm Arm is straight (elbow extended), internally rotated, wrist is flexed (fingers flexed or spared)

RC OBGYN (CG) (13 decks)

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