Obstetrics Flashcards
(154 cards)
1
Q
Does MAP decrease or increase in pregnancy?
A
Descrease
2
Q
Does preload decrease or increase in pregnancy?
A
Increase
3
Q
Does heart rate decrease or increase in pregnancy?
A
increase
4
Q
Does systemic vascular resistance decrease or increase in pregnancy?
A
Decrease
5
Q
Does hemoglobin decrease or increase in pregnancy?
A
Decrease (RBC increase but plasma increases more)
6
Q
Does FEV1 decrease or increase in pregnancy?
A
Doesn’t change
7
Q
Does PaO2 decrease or increase in pregnancy?
A
Doesn’t change
8
Q
Does the functional residual capacity decrease or increase in pregnancy?
A
Decrease
9
Q
Does the tidal volume decrease or increase in pregnancy?
A
Increases
10
Q
Changes in coagulation during pregnancy
A
↑von Willebrand factor= more fibrinogen
↑factors 7, 8, 10
↑inhibitor to tPA
↓Protein C, S and antithrombin
11
Q
Nephrologic changes during pregnancy
A
o ↑GFR
o ↑Creatinine (0.4–0.8)
o More risk of kidney stones (usually at the pelvic brim)
12
Q
GI changes durign pregnancy
A
o Reflux: PPI
o Nausea: Ondansetron
o Constipation: stool softener and motility agents
o Iron deficiency: Iron with stool softener and motility agents
o Gallbladder disease
13
Q
What to do during the preconception visit
A
Safety: - Genetics - Age - Screen for domestic violence and abuse Vitamins: Folate Vaccines: - Flu IM - Hep B - MMRV (live attenuated) Lifestyle: - Smoking - Alcohol - Drugs/medications - Getting enough sleep - Manage stress - Plan maternity leave - Safe to have sex Optimization of disease - DM - HTN - Hypothyroid
14
Q
First-trimester visit assessment.
A
Person
- Is the pregnancy desired? (abortion, adoption)
- Barriers to care
- Vitals
- Weight
- Screen for abuse and safety
- Social, medical, surgical, family histories
- Medications and allergies
15
Q
First trimester visiti assessment tests/labs
A
- UPT
- Confirm with TV U/S (location of pregnancy, gestational age, multiple gestation)
- Hgb/hct
- ABO type
- Rh status
- HIV
- Hep B
- RPR
- Titers for varicella and rubella
- U/A + Urinary culture (infection and bBaseline of proteinuria)
- Screen for gonorrhea and chlamydia
- Cytology
- Genetic screen (cystic fibrosis for caucasic and sickle cell disease for african Americans)
16
Q
Existing nomenclature to establish obstetric history
A
- GPAC (gravid, para, abortions, c-sections)
* (G)TPAL (gravid, term, pre-term, abortion, living)
17
Q
Examples of aneuploidies
A
Trisomy
• Down’s: 21
• Edwards: 18
• Patau’s: 13
18
Q
1st trimester screening for aneuploidy
A
- Nuchal translucency in a U/S (normal < 3 mm)
- PAPP-A
- hCG
19
Q
2nd trimester screening for aneuploidy results for Down’s
A
↑ hCG
↓ PAPP-A
↓ Estriol
↑ Inhibin A
20
Q
2nd trimester screening for aneuploidy results for Edward’s
A
↓ hCG
↓ AFP
↓ Estriol
↓ Inhibin A
21
Q
Combined vs sequential screening for aneuploidy
A
Combined screening
- 1st trimester + 2nd trimester
- ↑Sensitivity
- It’s good when mom is negative, but if positive, she’ll have less options because you waited
Sequential screening
- 1st trimester –> invasive test if positive
- ↑Specific but more invasive
22
Q
Risk factors of gestational diabetes
A
BMI > 30
Hx of gestational DM
Pre-diabetic
23
Q
Dx of gestational diabetes
A
1-hr glucose tolerance test (50 gr)
• Positive if > 140
• If positive, do the 3-hr
3-hr glucose tolerance test (100 gr) Dx is made with 2 or more of these positive o Fasting > 95 o 1 hr > 180 o 2hr > 155 o 3 hr > 140
24
Q
Tx of gestational diabetes
A
Insulin
- Goal: postprandial < 180
25
Patient with hemoglobin < 10 at 28 weeks of gestation.
| Next step, tx?
Iron studies
| Tx: Iron
26
Accuracy of gestational age estimation in U/S
- 1st trim: GA +/- 1 week
- 2nd trim: GA +/- 2 week
- 3rd trim: GA +/- 3 week
27
Transcraneal dopple. When to use it?
Highly sensitive. Used to rule out fetal anemia (alloimmunization at week 20)
Screening test; Not diagnostic
28
Amniocentesis. When to use it?
```
Genetic disorders (down’s)
It’s less used because can only be used until week 16 (too close to 21 weeks for termination of pregnancy)
```
29
Chorionic villus sampling. When to use it?
Genetic disorders, karyotype at week 10.
| Early identification allows for early termination in high-risk pregnancies
30
Percutaneous umbilicus blood sampling (PUBS). When to use it?
Fetal anemia
| Confirm and treat fetal anemia (e.g., transfusion)
31
Asx pregnant patient with the following results on the uroanalysis:
- Nitrites
- Leuko esterase
- Lots WBC
- Bacteruria
- No Epithelial cells
Dx, tx?
Bacteruria Asx
Treat with amocilin (nitrofurantoin if penicil allergic)
Rescreen with uroanalisis at the end of the tx
32
Pregnant patient with Urgency/frequency dysuria. No fever, no CVA tenderness. The following are the results on the uroanalysis:
- Nitrites
- Leuko esterase
- Lots WBC
- Bacteruria
- No Epithelial cells
Dx, tx?
Cystitis
Treat with amocilin (nitrofurantoin if penicil allergic)
Rescreen with uroanalisis at the end of the tx
33
Pregnant patient with Urgency/frequency dysuria. Has fever and CVA tenderness. The following are the results on the uroanalysis:
- Nitrites
- Leuko esterase
- Lots WBC
- Bacteruria
- No Epithelial cells
Dx, tx?
Pyelonephritis
Take cultures, admit and start ceftriaxone.
Reassess in 3 days.
- If better continue abx for 10 days according to sensitivity of culture.
- If she doesn't improve, consider abscess and get a U/A. Abx for 14 days according to sensitivity of culture.
34
Tx of hyperthyroidism during pregnancy?
Propylthiouracil (PTU)
o F/u: TSH q4weeks
35
Tx of hypothyroidism during pregnancy?
| How often to assess TSH?
Levothyroxine
o F/u: TSH q4weeks
36
Safe antiepileptics during pregnancy
Levetiracetam, lamotrigine, phenobarbital
37
Patient with HTN who wants to get prenant. She is on ACE. What are the safe drugs in pregnancy?
• Alfa methyl dopa
• Labetalol
• Hydralazine
(ACE, ARB, CCB, diruetics are theratogens)
38
Diabetic woman on metformin who is planing to get pregnant. What is the target of A1C and want change needs to be done?
- Target A1C < 7%
- Diet + exercise
- Change orals to insulin
39
Tx of known diabetes (not gestational) during pregnancy?
- Basal-bolus strategy (Long acting insulin PM + rapid insulin with each meal)
- Target postprandial
40
Stages of normal labor
```
Stage I (From 0 to 10 cm of dilation)
- Latent: 0–6 cm
- Active: 6–10 cm
Stage II (From 10 cm to baby delivery)
Stage III (From baby delivery to placenta delivery)
"Stage IV" (Posdelivery)
```
41
How much time should it take for the placenta fo be delivered?
30 min after baby delivery regardless of G/O Hx
42
Pathophysiology of changes in cervix during normal labor
Fetal head engagement leads to breakage of disulfide bonds between collagen and diffusion of water
43
Sequence of changes in cervix during normal labor
- Softening
- Effacement
- Dilation
- Position
44
How is fetal station defined in normal labor?
Defined according to position of baby according to the ischial spine (goes from -5cm to +5 cm)
45
What are the types of fetal positions?
Longitudinal cephalic (normal)
Longitudinal breech
Longotudinal transverse
46
Types of breech Birth
Frank (hips flexed, knees extended)
Complete (hips flexed, knees flexed)
Footling (hips extended, knees in any position)
47
Nulli patient in labor. Dilatation < 6 cm, but she's taking > 20 hrs to achieve 6 cm of dilatation (> 14 hrs in multi) .
Dx, tx?
Prolonged latent phase
Tx:
- Balloon
- Amniotomy
- Misoprostol
- Oxytocin
48
Nulli patient in labor. Dilatation 7 cm, but no significant change in dilatation after 4 hours (> 5 hrs in multi) .
Dx, tx?
Prolonged active phase
Tx: Evaluate the 3 P's
- If problem with Passenger: C-section
- If problem with Pelvis: C-section
- If problem with Power: Oxytocin first, then C-section
• To determine power:
o At least 200 Montevideo Units in 10 mins Intrauterine pressure catheter (IUPC)
o Or 3 contractions in > 30 mins (normal 3 in 10 mins)
49
Nulli patient in labor. Dilatation 10 cm, but baby is not delivered after 3 hours (> 2 hrs in multi) .
Dx, tx?
Prolonged stage II
Tx:
Evaluate Passenger and Pelvis. If problem, C-section
If power:
• Oxytocin first
• If oxytocin fails + negative fetal station: C-section
• If oxytocin fails + positive fetal station: Forceps or vacuum
50
Patient who is in labor and just delivered baby. However, delivery of placenta is taking more than 30 mins.
Dx, tx?
Prolonged stage III
Tx:
- First uterine massage
- Then, Oxytocin
- Then, manual extraction
51
Gestational age to consider a pregnancy as "abrotion"`?
< 20–24 (varies)
52
Gestational age to consider a pregnancy as "preterm"?
24–37
53
Gestational age to consider a pregnancy as " term"
37–42
54
Gestational age to consider a pregnancy as "postdate"
> 42
55
Pregnant patient with rush of clear fluid. How to confirm that this fluid is in fact amnitic fluid?
- Confirm with Nitralazine tests (paper or swab turns blue) or…
- Confirm with a dry slide in which you see ferning
- U/S: Oligohydramnios
56
Pregnant patient in 38 week, with rush of clear fluid, but has no contractions. You confirm that it's amniptic fluid.
Dx, next step and tx?
Premature ROM
Next step: Check GBS status
Tx:
- Delivery
- If baby GBS (+) or unknown statu: give ampicillin
57
Pregnant patient in 35 week, with rush of clear fluid, but has no contractions. You confirm that it's amniptic fluid.
Dx and tx?
Preterm premature ROM
Tx:
> 34: deliver
58
Pregnant patient in 29 week, with rush of clear fluid, but has no contractions. You confirm that it's amniptic fluid.
Dx and tx?
Preterm premature ROM
Tx:
24–34: steroids for lungs
59
Pregnant patient in 19 week, with rush of clear fluid, but has no contractions. You confirm that it's amniptic fluid.
Dx and tx?
Preterm premature ROM
Tx:
< 24: abortion
60
Patient who > 18 hrs after ROM has not delivered.
Dx, next step and tx?
Prolonged rupture of membranes
Next step: Check group B strep (GBS) status
Tx:
- Delivery
- If baby GBS (+) or unknown status --> give ampicillin
61
Patient with recent prolonged ROM who not has fever and is toxic.
Dx, next step and tx?
Chorioamnionitis (if baby is in) and endometritis (if baby was delivered)
Next step: Rule out other infections (e.g., uroanalysis, chest xR, blood cultures)
Tx: ampicillin + gentamicin + clindamycin
62
Risks factors for preterm labor
- Cigarette smoking
- Young maternal age
- Multiple gestations
- Preterm mom
- Anatomical defects
63
Patient with pregnancy of 36 weeks, she has contractions and cervical changes.
Dx and tx?
Preterm labor
> 34: deliver
64
Patient with pregnancy of 30 weeks, she has contractions and cervical changes.
Dx and tx?
Preterm labor
20–34: steroids + tocolytics (nifedipine) and transfer patient to tertiary care
65
Patient with pregnancy of 19 weeks, she has contractions and cervical changes.
Dx and tx
Preterm labor
< 20: abortion
66
Definition and tx of postdate labor
> 40 by conception or > 42 by last menstrual period
Tx:
- Sure of dates + favorable cervix: induction
- Sure of dates + not favorable cervix: C-section
- If not sure: biophysical profile (non-stress test and U/S)
67
Pregnant woman with size-date discrepancy and ↑AFP.
U/S shows babies with different genders
Type of pregnancy and risks associated with it?
Di-zygotic, di-chorionic, di-amniotic
Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage
68
Pregnant woman with size-date discrepancy and ↑AFP.
U/S shows babies with same gender and 2 placentas
Type of pregnancy and risks associated with it?
Mono-zygotic, di-chorionic, di-amniotic
Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage
69
Pregnant woman with size-date discrepancy and ↑AFP.
U/S shows babies with same gender, 1 placenta and septum (2 sacs).
Type of pregnancy and risks associated with it?
Mono-zygotic, mono-chorionic, di-amniotic
Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage, twin-twin transfusion
70
Pregnant woman with size-date discrepancy and ↑AFP.
U/S shows babies with same gender, 1 placenta, and 1 sac
Type of pregnancy and risks associated with it?
Mono-zygotic, mono-chorionic, mono-amniotic
Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage, twin-twin transfusion, conjoined twins, cord entanglement
71
Pregnant patient with non-sustained elevation of BP > 140/80. No other symptoms..
Dx and Management?
Transient HTN
Ambulatory BP
72
Pregnant patient < 20 weeks with sustained BP > 140/80 without other symptoms.
Dx and Tx?
Chronic HTN (cHTN)
Alfa-methyl-dopa or
Labetalol or
Hydralazine
(Other meds are teratogenic)
Frequent U/A and U/S (assess growth restriction)
73
Pregnant patient > 20 weeks with sustained BP > 140/80 without other symptoms.
Dx and Tx?
Gestational HTN
Alfa-methyl-dopa or
Labetalol or
Hydralazine
(Other meds are teratogenic)
Frequent U/A and U/S (assess growth restriction)
74
Pregnant patient 20-36 weeks with sustained BP > 140/80 without other symptoms. Proteinuria > 5 g/dL
Dx and Tx?
Preeclampsia without severe features
Tx: wait and Weekly f/u to assess Sxs
75
Pregnant patient >37 weeks with sustained BP > 140/80 without other symptoms. Proteinuria > 5 g/dL
Dx and Tx?
Preeclampsia without severe features
Tx: induce delivery
76
Pregnant patient with sustained BP > 140/80 with proteinuria > 5 g/dL and severe sx (e.g., RUQ, pulmonary edema, headaches, vision changes)
Dx and Tx?
Preeclampsia with severe features
Tx: Magnesium and deliver (you may need to balance risk and benefict depending on gestational age and severity of symtoms)
77
Pregnant patient without history of epilepsy who sudenly has a sezure.
Dx and tx?
Eclampsia
Tx: Magnesium and deliver (usually C/S) regardless of gestational age
78
What are the alarm symptoms in preeclampsia?
```
↓Ptls
↓LFTS
RUQ abd pain
↑Cr
Pulmonary edema
Headaches
Vision changes
```
79
Patient with preeclampsia with severe features who is on magnesium. You notice decreased deep tendon reflexes. What is the antidote of magnesium?
Ca++
80
Definition of postpartum hemorrhage
o > 500 cc of loss in a vaginal delivery
| o > 1000 cc of loss in a C-section
81
Patient with postpartum hemorrhage. On physicial exam you feel a Buggy uterus.
Dx and tx?
Uterine atony
Tx:
- Uterine massage
- Oxytocin
- Methylergometrine
- Bakri balloon
82
Patient with postpartum hemorrhage. On physicial exam you don't feel the uterous, on speculum exam you see the uterus in vaginal canal.
Dx and tx?
Uterine inversion
Tx:
- Tocolytics
- Manually put it back in place
- Then Oxytocin to help with the manual maneuver
- Surgery if manual maneuver is not successful
83
Patient with postpartum hemorrhage. On physicial exam you feel a normal uterus.
Next step?
Perform visual exploration a look for a vaginal laceration. Apply preasure and suture if needed.
84
Patient with postpartum hemorrhage. On physicial exam you feel a firm uterus.
Next step?
Inspect placenta, verify that vessels go to the edges as reained placenta is the most likely Dx.
85
Patient with postpartum hemorrhage. On physicial exam you feel a firm uterus.
Some of the vessels of placenta don't go to the edges.
Dx and tx?
Retained placenta
Tx:
- D/C
- Hysterectomy
F/U: B-HCG levels to go to 0
86
Patient with postpartum hemorrhage in whom you have tried everything and she keeps bleeding.
Tx?
- 2 large bore IV (> 18 G)
- IVF
- Transfuse as needed
- Prepare for either ligation, embolization or hysterectomy
87
What do you see in a non-stress test?
```
Variability
o Too little variability (flat line) and too much variability are bad
Accelerations: 15/15, 2 in 20 is normal
o Change in HR ↑15 bpm during 15 seconds
o 2 raise in HR in 20 mins
```
88
Pregnant patient who doesn't feel baby moving. You perform a non-stress test and it presents good variabily and 2 normal accelerations in 20 mins.
Next step?
Reassuring result
No need to repeat it
89
Pregnant patient with a high risk pregnancy. You perform a non-stress test and it presents good variabily and 2 normal accelerations in 20 mins.
Next step?
Reassuring result
Repeat q week beacuse of high risk of pregnancy
90
Pregnant patient who doesn't feel baby moving. You perform a non-stress test and it shows a flat line in baby's HR.
Next step?
Non-reassuring result (poor variability)
Next step: vibroacoustic estimulation and perform a new non-stress test (same interpretation)
91
Pregnant patient who doesn't feel baby moving. You perform a non-stress test and it shows a flat line in baby's HR. You then perform vibroacoustic estimulation and perform a new non-stress test obtaining the same result.
Next step?
Non-reassuring result (poor variability)
Next step: perform a biophysical profile
92
What do you see in a bipphysical profile?
It's like an “APGAR” but in-utero
Score 0–10:
- NST (0–2 points)
- Amniotic fluid index (0–2 points)
- Breathing (0–2 points)
- Movement (0–2 points)
- Tone (0–2 points)
93
Score 8–10 in a biphysical profile. Next step?
Reassurance
94
Score 3–7 in a biphysical profile. Next step?
Use gestational age to decide next step (delivery vs wait)
95
Score 0–2 in a biophysical profile. Next step?
Fetal demise--> emergency C-section
96
Patient in labor who is having 3 contractions in 10 mins. The patient is being moniored (contraction stress test) and you see decelerations that mirror each contraction.
Next step?
Early decelerations (head compression)
No action needed, continue labor
97
Patient in labor who is having 3 contractions in 10 mins. The patient is being moniored (contraction stress test) and you see decelerations that have nothing to do with the contractions.
Next step?
Variable decelerations (cord compression)
No action needed, continue labor
98
Patient in labor who is having 3 contractions in 10 mins. The patient is being monitored (contraction stress test) and you see decelerations that start right after the contractions.
Next step?
Late decelerations (utero-placenta insufficiency)
Take baby out! Most likely by c-section
99
Most common causes of 3rd trimester bleeding?
- Cervical lesions
- Secondary to cervical dilatation
- ROM with a bit of blood
Howerver, always assess mom a baby to rule out severe diseases
- Mom’s Vitals, physical, Hgb, Plt, coags
- NST or CST
- U/S look for fetal HR
100
Multiparous pregnant in 3rd trimester patient who presents with painless bleeding.
- U/S: transversal lie
- NST/CST: fetal distress
Dx, next step?
Placenta Previa (Placenta grows across the os. When cervix dilates--> placenta tears)
`Tx: urgent c-section
101
Pregnant patient in 3rd trimester who presents with painless bleeding.
- U/S: nromal
- NST/CST: fetal distress
Dx, next step?
Vasa Previa (Accessory lobe connected to main placenta, which are located across the os)
Tx: urgent c-section
102
Pregnant patient with history of c-section who is attempting vaginal delivery. Suddently she presents painful bleeding, loss of fetal station and loss of contractions.
Dx and next step?
Uterine Rupture
Next step: “crash”-section! (don't wait to do any test)
103
Pregnant patient in 3rd trimester, with history of HTN and cocaine use, who presents with painful bleeding.
Dx, next step and tx?
Placenta Abruption (Placenta rips off and the endometrium is teared )
Next step:
- U/S
- NST/CST
- Mom’s vitals, Hgb, Plt, mental status
Tx: Urgent c-section
104
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+). Next step to assess for alloimmunization?
Get Rh Ab status and titers
105
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).
Rh Ab (-)
Next step?
Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing
106
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).
Rh Ab (+) titers < 1:8
Next step?
Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing
107
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).
Rh Ab (+) titers > 1:8
Next step?
Perform transcraneal doppler
108
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).
```
Rh Ab (+) titers > 1:8
Normal flow on transcraneal doppler
```
Next step?
Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing
109
Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).
```
Rh Ab (+) titers > 1:8
High flow on transcraneal doppler
```
Next step?
If gestational age < 32 --> Percutaneous umbilical sampling (PUBS) and transfuse
If gestational age > 32 --> Deliver
110
When to give RhD Immunoglobulin >
Mother: Ag (-), Ab (-)
Father: Ag (+) or unknown
Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing
- Delivery
- D/C
- C-section
- Post-partum hemorrhage
111
Pregnant patient with group B positive screening (uroanalysis and urorinary culture).
Next step?
Ampicillin
| - If allergic: cefazolin, clinda, vancomycin
112
Patient with negative group B screening but with high risk factor (Previous strep B in former pregnancy, Prolonged ROM, Intrapartum fever)
Should you treat?
Yes (Despite de negative screening), give Ampicillin
| - If allergic: cefazolin, clinda, vancomycin
113
Pregnant patient with positive Hep B screening.
| How to manage delivery?
- C-section to avoid maternal-fetal mixing
- Give baby Hep B IV immunoglobulin (even if C-section) and HepB vaccine
- Ideally, vaccinate mom before pregnancy
114
Treatment of HIV in pregnancy
HAART “2+1”: 2 nucleoside reverse transcriptase inhibitors (NRT-i) + 1 Non- nucleoside reverse transcriptase inhibitors (NNRT-i)/ Protease inhibitor (P-i)
o NRT-i: Tenofovir + Emtricitabine or zidovudine + lamibudine
o NNRT-i: Nevirapine
o P-i: Atazanavir
115
When can a HIV+ pregnant woman have vaginal delivery?
If VL < 1000 + HAART: vaginal delivery
• If VL > 1000 or no HAART: C-section
116
Immigrant patient from Africa in delivery, you don't know her HIV status. She didn't have any prenatal care. Next step?
AZT
117
Pregnant patient with Toxo Ab(+).
| Next step?
Reassurance. She has immune response against the infection.
118
Pregnant patient with Toxo Ab(-).
| Next step?
Avoidance of risk factors:
- Cat feces
- Undercook meat
- Cyst in soil
119
Pregnant patient with painless chancre.
| Dx and tx?
Primary syphilis
Tx: Penicillin x 1 IM
120
Pregnant patient with targetoid lesions in palms and soles.
| Dx, next steps and tx?
Secondary syphilis
Next steps: RPR, if positive confirm with FTA-Abs
Tx: Penicillin x 1 IM
121
Pregnant patient with tabes dorsalis.
| Dx, next steps and tx?
Terticiary syphilis
Nexy step: Lumbar punction--> CSF-RPR, if positive confirm with CSF-FTA-Abs
Tx: Penicillin q4h IV x 10 days
122
Congenital syphilis manisfestations?
Rhinorrhea, saber shins, saddle nose, hutchinson’s
123
Congenital rubella manisfestations?
Baby with congenital rubella ‘blueberry muffin’
• Petechiae purpura
• Cataracts
• Congenital heart defects
• Deafness
• Intrauterine growth restriction
• Abortion if contracted in 1st trimester
124
Pregnant patient who didn't received vaccination against MMRV. Recomendation to avoid rubella?
Stay away from kids who haven’t completed MMRV series. Stay away from sick people.
125
Pregnant patient with vesicles on erythematous base in vagina.
Dx and tx?
Herpes simplex
Tx:
- Valacyclovir or acyclovir
- C-section to avoid baby passing through an infectious vaginal canal
126
Congenital herpes manisfestations?
- Intrauterine growth restriction
- Preterm
- Blindness
127
Duration of implanon?
3 years
128
Duration of hormal IDU?
5 years
129
Duration of copper IDU?
10 years
130
Duration of depro-provera injection?
3 motnhs
131
Contraceptive patches. Duration?
1 month
132
Contraception method with the highest risk of DVT/PE?
Patches
133
Contraception and DVT/PE. What are the risk factors?
- Estrogen-based methods
- Smoking
- Age > 35
134
Indications for vacuum delivery or forceps?
- Prolong or arrest of labor
- Fetal distress
- Full effacement of cervix and > 2+ station
135
Indications for episiotomy?
- Macrosomia
- First-time mom
- Prevent uncontrolled lacerations
- Prevent shoulder dystocia
136
Types of episiotomy
- Median: less pain, heals better. More risk of laceration
| - Medio-lateral: hurts more, heals poorer. Less risk of laceration.
137
Patient with history of multiple 2nd trimester loses.
| Dx and tx?
Incompetent cervix
Cerclage at week 14. Remove at week 36 to prevent risk of cervical laceration
138
Risk of opiates in labor
- Risk of prolonged latent phase
| - Risk of respiratory depression in baby
139
1° causes of third-trimester bleeding.
Placental abruption and placenta previa.
140
Classic ultrasound and gross appearance of complete
| hydatidiform mole.
Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross examination.
141
Chromosomal pattern of a complete mole.
46,XX.
142
Molar pregnancy containing fetal tissue.
Partial mole.
143
Symptoms of placental abruption.
Continuous, painful vaginal bleeding.
144
Symptoms of placenta previa.
Self-limited, painless vaginal bleeding.
145
When should a vaginal exam be performed with suspected placenta previa?
Never.
146
Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.
147
Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis.
148
Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone × 48 hours.
149
The most common cause of postpartum hemorrhage.
Uterine atony.
150
Treatment for postpartum hemorrhage.
Uterine massage; if that fails, give oxytocin.
151
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin.
152
A patient fails to lactate after an emergency C-section with marked blood loss.
Dx?
Sheehan’s syndrome (postpartum pituitary necrosis).
153
Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion.
154
Uterine bleeding at 18 weeks’ gestation; no products
| expelled; cervical os closed.
Threatened abortion.
