Obstetrics Flashcards
(129 cards)
1
Q
Number of times a woman has been pregnant?
A
Gravidity
2
Q
Number times a woman has given birth?
A
Parity
3
Q
When should preconception care begin?
A
3 months prior to conception
4
Q
Folic acid recommendation is
A
400 mcg
5
Q
What trimester does the blood pressure decrease
A
1st and 2 nd trimester
6
Q
What trimester does the blood pressure return to baseline
A
3rd trimester
7
Q
Chronic HTN increases the risk for what complications during pregnancy?
A
- Pre-eclampsia
- Preterm labor
- Placental abruption
8
Q
Complications of diabetes during pregnancy?
A
- Congenital malformations
- Pregnancy loss
- Fetal macrosomia/growth restriction
- DKA
- Maternal and perinatal mortality
9
Q
What percentage of women with asthma during pregnancy will.
- Get worse
- No change
- Improve
A
1/3
10
Q
Why are ace inhibitors not given during pregnancy?
A
- They can cause renal agenesis
11
Q
If a woman stops smoking prior to 24 weeks in pregnancy what is the outcome?
A
- The same as someone who has never smoked
12
Q
complications from smoking during pregnancy include?
A
- Placental abruption
- Preterm labor
- Premature rupture of membranes
- fetal growth restriction
- SIDS
13
Q
During pregnancy systemic vascular resistance is increased or decreased?
A
Decreased
14
Q
What happens to mean arterial pressure during pregnancy?
A
decreases
15
Q
Does the heart rate increase or decrease during pregnancy?
A
increases
16
Q
Is cardiac output increased or decreased during pregnancy
A
increased
17
Q
During pregnancy blood volume increases to
A
40-45% above the non pregnant state
18
Q
What makes pregnant women at increased risk for blood clots during pregnancy
A
Their blood is hyper-coagulable
19
Q
Is pregnancy an immunodeficient state
A
yes
20
Q
During pregnancy how many centimeters does the diaphragm rise?
A
4 cm
21
Q
During pregnancy does residual lung volume increase or decrease?
A
Decrease
22
Q
Does tidal volume increase or decrease in the pregnant female
A
Increases
23
Q
does functional residual capacity decrease or increase during pregnancy
A
decrease
24
Q
Cardiac output increases during pregnancy does the heart rate increase as well?
A
the heart rate increases during pregnancy
25
During pregnancy where is the woman's heart located?
The heart is displaced leftward and upward
26
What is the reason for acid reflux for women in the first and third trimester
Decreased tone of the lower esophageal sphincter
27
What happens to the size of the kidney's during pregnancy?
The are slightly larger due to increased blood volume.
28
When is hydro-nephrosis more common during pregnancy and which ureter is most often times affected?
Common after 2nd trimester and the right is more often affected than the left
29
During pregnancy:
1. Serum creatinine is?
2. Creatinine clearance is
3. GFR is?
1. Serum Cr-decreased
2. Cr Clearance-increased
3. GFR-increased
30
What is the likely cause of glucose in the pregnant woman's urine besides GD
1. Glucose because of the increased GFR
31
basal metabolic rate in pregnancy increases by
10-20%
32
In pregnancy water retention is increased by 6.5 l due to what?
Decrease plasma osmolality
33
During pregnancy does progesterone and estrogen increase or decrease?
Increase
34
During pregnancy does aldosterone and renin increase or decrease?
Increase
35
During pregnancy does relaxin increase or decrease
increase
36
The uterus increased to how many grams by the time the fetus is term?
5 liters
37
Linea nigra is a result of what during pregnancy
Increase in melanocytes
38
What is Naegele's rule?
LMP subtract 3 months and add 7 days.
39
Beta HCG is at least what number should something be seen in the uterus on vaginal u/x
2000
40
If the beta hcg is at least (1) clinicians should be able to see something in the uterus using an abdominal u/s
6000
41
Serum pregnancy test is
quantitative
42
Gestational age on ultrasound in the 1 st trimester should be how many weeks from the LMP
1 week
43
Which trimester u/s is most accurate for establishing gestational age?
2nd trimester
44
Initial prenatal visit routine screening?
1. Blood type RH factor
2. CBC
3. Infections: Rubella, HIV, RPR/VDRL, Hep B
4. Pap smear and culture gonorrhea and chlamydia
5. Hemoglobinopathies and inherited disease
45
When is the fetal anatomy u/s conducted?
Between 18-22 weeks gestation
46
If a patient has a random 140 result is that a positive screen for GD?
yes
47
When is the pertussis vaccine given?
3rd trimester
48
GBS screening is done during what weeks of pregnancy?
35-37 weeks
49
How is hyperemesis gravidarum treated?
1. Slow IV hydration
2. Correct electrolyte disturbance
3. anti-emetic vitamin b6 and doxylamine
50
What reverses the side effects of extrapyramidal movements related to Reglan
1. Benadryl
51
Which of the following can be a complication of IV hydration in patients with hyperemesis gravidarum?
Worsening thiamine deficiency
52
What 3 ways are women screened for down syndrome?
1. Free fetal DNA
2. Integrated sequential contingency screening 11 weeks to 13 weeks and 6 days. Done as probability
4. Quad screen 15 weeks and 22 weeks 6 days gestation
53
If screening test are abnormal for down syndrome what are the two invasive test that are done?
1. Chorionic villi sampling
| 2. amniocentesis
54
What is considered reactive on a non stress test of the fetus?
Reactive = two accelerations of greater than 15 bpm lasting at least 15 seconds over a 20 minute time period.
55
What is included in the biophysical profile
1. Fetal movement
2. Fetal tone
3. Fetal breathing
4. Ammonitic fluid
5. Non stress test
56
Biophysical profile can be used as confirmation the fetus is doing well in place of?
1. A non reactive stress test
57
A Biophysical score of >8 means
1. Fetus is doing well
58
A score of 6 is equivocal on a biophysical profile but also means
if the fetus is term delivery is warranted
59
A score of <4 on a biophysical profile is concerning for what?
asphyxia
60
A contraction stress test is negative if
Less than 50% of contractions are associated with late decelerations
61
Umbilical artery doppler is done with
suspicion of fetal growth restriction
62
Which of the following defines a POSITIVE contraction stress test?
If more than 50% of induced contractions are associated with late decelerations in the fetal heart rate over 10 minutes
63
What are the 4 types of abortions before 20 weeks gestation?
1. Threatened
2. Incomplete
3. Inevitable
4. Missed
64
How is threatened abortion managed?
1. Expectant management
2. medical care if vaginal bleeding or pelvic pain
3. Rhogham if RH negative
65
How is incomplete abortion managed?
1. stable patient expectant management medically misoprostol or surgically
2. Hemodynamic unstable patient: surgical d&C
66
How is inevitable abortion managed?
Patients can be managed expectantly or medically or surgically if hemodynamically unstable
67
How is missed abortion managed?
Can be managed medically or surgically
68
How is spontaneous or complete abortion managed
should be confirmed by ultrasound and serial beta hcg
69
What are complications of multiple fetus during pregnancy
1. preterm labor
2. twin-twin transfusion
3. fetal growth restriction
4. hypertensive disorders
5. anemia
6. GD
7. malpresentation
8. post partum hemorrhage
70
how often should a women pregnant with multiples have an ultra sounds
every 2 weeks
71
If embryonic division occurs 4-8 days from conception, what kind of twins are most likely to develop?
Monochorionic/ diamniotic twins
72
If embryonic division occurs 0-4 days after conception, what kind of twins are most likely to develop?
Dichorionic/ diamniotic twins
73
f embryonic division occurs in an implanted blastocyte 8-14 days after conceptions, what kind of twins are most likely to develop?
Monochorionic/ monoamniotic twins
74
In a twin-twin transfusion, which of the following is most likely to be seen in the donor twin?
fetal growth restriction
75
In what type of twin chronicity is the complication of twin-twin transfusion MOST likely to occur?
Monochorionic/ Diamniotic twins
76
When should high risk women be screened for GD
1. First trimester and again at 24-28 weeks
77
What are high risk factors for screening women for GD twice?
1. History of GD
2. Obesity
3. Advanced maternal age
4. African American-Hispanic
5. History of infant with macrosomia
78
How many values need to be abnormal to screen positive for GD?
2 or more values
79
Women with GD have a what percent risk of developing diabetes?
15-50% lifetime risk
80
What is preeclampsia
1. blood pressure >140/90 but <160/110
2. protein/creatinine ratio of >0.3
3. 24 hour urine protein >300
4. Absence of severe features
81
What is pre-eclampsia with severe features?
```
Blood pressure >160/110
New onset cerebral or visual disturbance
pulmonary edema
HELLP Syndrome
Renal insufficiency
```
82
What does HELLP syndrome stand for?
1. Hemolysis
2. Elevated liver enzymes
3. Low platelets
83
What is eclampsia
1. HTN
2. Proteinuria
3. Seizures
84
When is delivery recommended for gestational HTN
37 weeks
85
How is pre-eclampsia with severe features managed/
1. Magnesium sulfate
2. Antihypertensive medications
3. delivery if diagnosed after 34 weeks
86
How is eclampsia treated?
1. Stop seizures and stabilize the patient
| 2. deliver
87
Magnesium sulfate is given to pregnant women for women for what reason
1. 4 or 6 gram to load 2 g/h
calcium channel blocker
seizure prophylaxis
88
What is the recommended dose of Alpha methyldopa for treatment of HTN disorders in pregnancy?
250-500 mg management of chronic HTN in pregnancy
89
What is the recommended dose of Labetalol for management of HTN d/o in pregnancy
100-400 mg beta blocker management of HTN in pregnancy, acute
90
What is the recommended dose of Nifedipine in pregnant women with HTN?
30-60 mg calcium channel blocker management of HTN in pregnancy, acute
91
What is the recommended dosage of hydralazine for pregnant women with HTN D/O
5-10 mg acute and chronic management of HTN in pregnancy
| smooth muscle relaxer
92
Maternal side of the placenta is called?
Basal plate
93
The fetal side of the placenta is called?
Chorionic plate
94
The anatomy of the placenta is
1. Placenta disc
2. Membranes
3. Three vessel umbilical cord
95
What are the abnormal placental locations?
1. Placenta previa
2. placenta accreta
3. Placenta increta
4. Placenta
96
Placenta located near or over the cervix?
Placenta previa
97
Recommended method of delivery if a female has placenta previa
C-section
98
What is placenta accreta?
Placental trophoblast invade to the myometrium.
absence of nitabuch;s
can be associated with placenta previa
placenta can be difficult to remove at the time of delivery
99
Placenta increta
Placenta trophoblast invade through the myometrium
100
How is placenta increta managed?
C section with hysterectomy
101
Placenta trophoblast are through the serosa
placenta percreta
102
How is placenta percreta managed
C-section hysterectomy with some placenta left in situ is the usual management
103
Which of the following placental abnormalities is most associated with antepartum hemorrhage and fetal death
Placental previa
104
Mentum posterior
chin is facing the ceiling
105
Can face presentation be delivered vaginally?
no
106
What is a frank breech
the fetal legs are straight
107
what are the risk of vaginal delivery with a breech fetus
1. Cord prolapse
2. fetal head entrapment
3. risk of fetal injury and death
108
What is external cephalic version
done at 37 weeks, clinician turns the fetus manually
109
Risks associated with external cephalic version
1. placental abruption
2. rupture of membranes
3. cord prolapse
4. fetal distress
5. fetal hemorrhage
110
symptoms of placenta previa
1. painless vaginal bleeding
2. do not perform digital exam
3. deliver by c -section
111
what is placental abruption?
placenta is separated from the uterus
112
causes of placental abruption
1. HTN
2. Trauma
3. Cocaine or tobacco use
4. quick decompression of the uterus
113
What can cause fetal growth restriction
1. pre-pregnancy medical conditions
2. substance abuse
3. pregnancy related conditions
4. multifetal gestation
5. infections
114
How is fetal growth restriction defined?
The estimated fetal weight by ultrasound is less than the 10ᵗʰ percentile for its gestational age
115
What is the most common infectious cause for fetal growth restriction worldwide?
Malaria
116
In the case of fetal growth restriction, what other factor must be regularly monitored every three to four weeks in addition to monitoring interval fetal growth?
Amniotic fluid level
117
What does TORCHES mean
1. Toxoplasmosis
2. Others-Varicella, Hep B, Hep C, GBS
3. Rubella
4. CMV
5. Herpes, HIV
6. Syphillis
118
Rupture of membranes before 37 weeks of gestation
premature rupture of membranes.
119
What are the psychiatric disorders associated with pregnancy>
1. Post partum blues
2. post partum depression
3. post partum psychosis
120
When does post partum usually onset
Birth 2 weeks after delivery
121
What are risk factors for post partum depression?
1. history of depression
2. poor social support
3. baby has health problems or another child
4. Difficulty breast feeding
5. Financial difficulties
122
how many pregnancies does post partum depression occur
15-25%
123
When is the post partum scale administered?
From 2 weeks after delivery up to a year
124
What is the treatment for post partum depression
psychotherapy
| SSRI's
125
Symptoms of post partum depression
visual or auditory hallucinations
126
What is the treatment for psychosis
treatment under a psychiatrist with antipsychotics
127
How common is post partum psychosis
less than 1% of pregnancy
128
When should tocolytics be used?
In the case of preterm premature rupture of membranes prior to 34 weeks gestational for up to 48 hours to allow administration of steroids
129
Which of the following can be a complication of IV hydration in patients with hyperemesis gravidarum
Worsening thiamine (vitamin B1) deficiency
