OBY GYNE WAFA Flashcards
(157 cards)
1
Q
When is cerclage indicated based on history?
A
A. History of second-trimester pregnancy losses due to painless cervical dilation
2
Q
When is cerclage indicated based on prior cerclage?
A
B. Prior cerclage for painless cervical dilation in the second trimester
3
Q
At what gestational age is cerclage typically placed for history indicated cases?
A
C. Approximately 13-14 weeks
4
Q
When is physical examination indicated cerclage performed?
A
When painless cervical dilation occurs in the second trimester
5
Q
What is the ultrasonographic finding that indicates cerclage in women with a history of preterm birth?
A
Current singleton pregnancy, prior spontaneous preterm birth before 34 weeks, and cervical length less than 25mm
6
Q
What criteria are used to indicate cerclage in women with a history of preterm birth?
A
Current singleton pregnancy, prior spontaneous preterm birth before 34 weeks, and cervical length less than 25mm
7
Q
What is the definition of preeclampsia?
A
new-onset gestational hypertension with proteinuria or end-organ dysfunction
8
Q
What is eclampsia characterized by?
A
severe form of preeclampsia with convulsive seizures
9
Q
When does gestational hypertension typically onset?
A
after 20 weeks’ gestation without proteinuria or end-organ dysfunction
10
Q
What is the definition of chronic hypertension in pregnancy?
A
onset before 20 weeks’ gestation or before pregnancy
11
Q
What is superimposed hypertension in pregnancy?
A
chronic hypertension with superimposed preeclampsia
12
Q
What are the recommended oral antihypertensive drugs for chronic maintenance treatment in pregnancy?
A
Labetalol (100- 200 mg bid) and Nifedipine (30 - 60 mg od )
13
Q
Which oral antihypertensive drug is generally less favored for pregnant women?
A
Methyldopa (250 mg bid or tid )
14
Q
What are the recommended oral antihypertensive agents for urgent blood pressure control in pregnancy?
A
IV labetalol ( 10 - 20 mg iv then 20 - 80 mg iv every 10 - 30 min max dose 300 mg or inf 1 - 2 mg/min ) and IV hydralazine ( 5mg iv or im then 5 -10 mg iv every 20- 40 min tell max 20 mg or inf 0.5 - 10 mg /hr)
15
Q
What are the key components of the ABC management for eclampsia in pregnancy?
A
Calling for help, prevention of maternal injury, lateral decubitus position, prevention of aspiration, administration of oxygen, monitoring vital signs including oxygen saturation
16
Q
What is the recommended anticonvulsive therapy for eclampsia in pregnancy?
A
Magnesium sulfate
17
Q
When is delivery recommended in the management of eclampsia after maternal hemodynamic stabilization?
A
Delivery
18
Q
What is the management protocol for preeclampsia cases before 37 weeks of gestation without severe features?
A
Expectant management + oral labetalol or nifedipine
19
Q
What is the management protocol for preeclampsia cases at or after 37 weeks of gestation without severe features?
A
IOL + oral labetalol or nifedipine
20
Q
What is the management protocol for preeclampsia cases at or after 34 weeks of gestation with preterm labor or PPROM without severe features?
A
IOL + oral labetalol or nifedipine
21
Q
What is the management protocol for preeclampsia cases before 34 weeks of gestation with severe features?
A
Expectant management + admission + corticosteroid + magnesium sulfate (seizure prophylaxis) + IV labetalol
22
Q
What is the management protocol for preeclampsia cases at or after 34 weeks of gestation with severe features?
A
IOL after stabilizing the mother + magnesium sulfate (seizure prophylaxis) + IV labetalol
23
Q
What are some risk factors for Preeclampsia related to pregnancy history?
A
Nulliparity, Multifetal gestations, Preeclampsia in a previous pregnancy
23
Q
What preexisting conditions can increase the risk of Preeclampsia?
A
Chronic hypertension, Pregestational diabetes, Gestational diabetes, Thrombophilia, Systemic lupus erythematosus
24
How does maternal health and age influence the risk of Preeclampsia?
Prepregnancy body mass index greater than 30, Antiphospholipid antibody syndrome, Maternal age ≥35 years or <18 years, Kidney disease
25
Who should receive low-dose aspirin for preeclampsia prophylaxis?
Women with high-risk factors (previous preeclampsia, multifetal gestation, renal or autoimmune disease, type 1 or type 2 diabetes, chronic hypertension) and those with multiple moderate-risk factors (first pregnancy, maternal age ≥35, BMI >30, family history of preeclampsia)
25
What other factors can contribute to the risk of Preeclampsia?
Assisted reproductive technology (IVF), Obstructive sleep apnea, Obesity (BMI≥30), Hydatidiform mole, Family history of preeclampsia
26
When should low-dose aspirin be initiated for preeclampsia prophylaxis?
Between 12 to 28 weeks of gestation, preferably before 16 weeks, and continued until delivery
27
At what blood pressure levels should treatment be withheld for mild to moderate hypertension in most women before pregnancy?
Systolic < 160 mm Hg and diastolic < 105 mm Hg
28
What are the goals of treating severe hypertension in pregnancy according to ACOG?
Prevent congestive heart failure, myocardial ischemia, renal injury or failure, and ischemic or hemorrhagic stroke
29
What is the purpose of using antihypertensive drugs in pregnancies with hypertensive disorders according to Williams Obstetrics?
To prolong pregnancy or modify perinatal outcomes
30
In cases of early mild preeclampsia, what did Sibai and colleagues find about the use of labetalol in terms of blood pressure and pregnancy outcomes?
Lower mean blood pressures without significant differences in pregnancy prolongation, gestational age at delivery, birthweight, cesarean delivery rate, or newborn admissions; increased frequency of growth-restricted neonates
31
What is the recommended treatment for severe hypertension in labor to prevent stroke according to UTD?
Prompt treatment with intravenous labetalol (avoid in asthma patients), hydralazine, or oral nifedipine
32
What are the initial steps in managing Eclampsia according to guidelines?
Call for help, prevent maternal injury, place in lateral decubitus position, prevent aspiration, administer oxygen, and monitor vital signs and oxygen saturation
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What is the dosing regimen for Magnesium sulfate in Eclampsia treatment?
4-6 g loading dose over 20-30 minutes, followed by a maintenance dose of 1-2 g/hour via IV
34
How does Magnesium sulfate function in treating Eclampsia?
It is used to prevent recurrent convulsions, not to stop the seizure itself
34
What are the potential side effects of Magnesium sulfate administration?
Loss of deep tendon reflexes, warmth and flushing, respiratory depression, and cardiac arrest
35
When should the infusion of Magnesium sulfate be stopped due to toxicity, and how should it be managed?
Stop the infusion and provide emergency correction with calcium gluconate 10% solution 10 mL IV over 3 minutes and furosemide intravenously to accelerate urinary excretion
36
How is the diagnosis of HELLP Syndrome made according to the Tennessee classification?
Hemolysis (indicated by peripheral smear with schistocytes burr cells, elevated serum bilirubin ≥1.2 mg/dL, low haptoglobin (≤25 mg/dL) or high LDH ≥2 times, severe anemia), Elevated liver enzymes (AST or ALT ≥2 times normal), Low platelet count (<100,000 cells/microL)
37
In what circumstances are Diazepine and phenytoin considered for Eclampsia treatment?
When magnesium sulfate is contraindicated or unavailable, such as in myasthenia gravis, hypocalcemia, renal failure, cardiac issues like ischemia or heart block
38
What are common clinical symptoms associated with HELLP Syndrome?
Right upper quadrant pain, generalized malaise, nausea, and vomiting
39
What is the recommended management for women diagnosed with HELLP Syndrome?
Delivery should be carried out regardless of gestational age
40
What is the typical blood volume for women of average size, and how does it change during the last weeks of a normal pregnancy?
3000 mL initially, increasing to 4500 mL in late pregnancy
41
What is a key characteristic of eclampsia regarding blood volume?
Hemoconcentration due to loss of anticipated excess blood volume
42
What causes hemoconcentration in eclampsia, and how does it occur?
Generalized vasospasm leads to endothelial activation and plasma leakage into the interstitial space
43
What is the recommended HbA1C level in the second and third trimesters to reduce the risk of large-for-gestational-age infants?
Less than 6%
44
Why is early aggressive glycemic control important in the first trimester for reducing the risk of fetal anomalies?
To mitigate the association between elevated glucose levels and congenital anomalies during embryogenesis
45
Why are women with true Gestational Diabetes Mellitus (GDM) not at increased risk of congenital malformations?
Because the onset of GDM is after organogenesis and they do not experience diabetes-related vasculopathy due to the short duration of the disorder
45
When is the optimal time to vaccinate against influenza as recommended by CDC and ACOG?
October or November Prior to flu season
46
What should be done if a woman is found nonimmune to rubella during screening?
Vaccinate and counsel on effective contraception
47
Who should update their Tdap vaccination according to the guidelines?
All reproductive-aged women
48
What action should be taken for nonimmune individuals after screening for varicella immunity?
Vaccinate and counsel on effective contraception
49
When should pregnant women ideally receive the Tdap vaccine?
During the early part of the 27 to 36 week gestational age range (third trimester)
50
Who should receive the inactivated influenza vaccine during flu season, according to guidelines?
All women who are pregnant or might be pregnant
51
According to ACIP and ACOG, what is the recommendation if MMR or varicella vaccines are inadvertently administered during pregnancy?
It should not generally be considered a reason for pregnancy termination
52
What is the recommended precaution to take after receiving a live vaccine like MMR or varicella?
Avoid pregnancy for one month following each dose
52
Which vaccines should be given before discharge to protect a nonimmune mother and newborn?
MMR and varicella
52
When is the first dose of varicella vaccine given to women without evidence of immunity?
While the patient is in the hospital
53
Who should receive the MMR vaccine before discharge if nonimmune to rubella or measles?
Women nonimmune to rubella or measles
54
When is the second dose of varicella vaccine typically given to coincide with the routine postpartum visit?
Four to eight weeks later
55
Why should female prepregnancy folic acid supplementation be encouraged?
To reduce the risk of neural tube defects (NTDs)
56
Is breastfeeding a contraindication to the administration of MMR and varicella vaccines postpartum?
No
57
What is the recommended folic acid supplementation for all women of reproductive age (15-45 years)?
400 micrograms per day
58
How much folic acid should women at increased risk of NTDs take daily?
4 mg
58
What is the standard amount of folate in prenatal vitamins?
1 mg
59
What can cause virilization in an XX individual with normal female internal anatomy during gestation?
Exposure to maternal androgen or synthetic progestational agents
60
What is required for maternal androgens to cause virilization of the fetus despite placental aromatase activity?
Very high levels of maternal androgens
60
How does the placenta play a role in preventing fetal virilization from maternal androgens?
By producing the aromatase enzyme, which converts androgens to estrogens
61
What are some possible causes of gestational hyperandrogenism leading to virilization in the fetus?
Maternal luteoma or theca lutein cysts
62
How can disorders like maternal luteoma or theca lutein cysts be indicated during pregnancy?
By a history of maternal virilization or exogenous progestin/androgen exposure
63
What happens in Placenta Accreta in terms of chorionic villi attachment?
Chorionic villi attach to the myometrium
64
What characterizes Placenta Increta in relation to chorionic villi?
Chorionic villi invade or penetrate into the myometrium
65
What is the traditional schedule for prenatal visits until 28 weeks of pregnancy?
Every 4 weeks
65
How is Placenta Percreta defined based on chorionic villi penetration?
Chorionic villi penetrate through the myometrium and reach the serosa
66
How often are prenatal visits scheduled from 28 weeks until 36 weeks of pregnancy?
Every 2 weeks
67
In what situations might women with complicated pregnancies need more frequent return visits?
For example, with twins or diabetes 1- to 2-week intervals
67
When does the frequency of prenatal visits increase to weekly according to the traditional schedule?
After 36 weeks
68
When are routine antepartum GBS (Group B Streptococcus) cultures typically performed on pregnant women?
At 35 to 37 weeks of pregnancy
69
What causes hyperthyroidism in pregnancy?
Direct stimulation of the maternal thyroid gland by elevated hCG levels
69
How can hyperthyroidism in pregnancy affect TRH and TSH levels?
Associated with a transient lowering in serum TRH and TSH levels
70
What are the components of the second-trimester QUADRUPLE test?
hCG, dimeric inhibin A (DIA), AFP, unconjugated estriol (uE3)
71
Why is the QUADRUPLE test preferred over BhCG alone in the second trimester?
It is more sensitive in detecting abnormalities
72
When should prenatal care ideally begin during pregnancy?
First trimester, ideally by 10 weeks of gestation
72
Why is it important to initiate prenatal care early in pregnancy?
To allow for timely performance of screening and diagnostic tests around 10 to 11 weeks of gestation
73
What is the Chadwick sign in early pregnancy?
Bluish discoloration of the mucous membranes of the vulva, vagina, and cervix
74
At what gestational age does the Chadwick sign typically appear?
Around 8 to 12 weeks of gestation
75
Are uterine fibroids typically symptomatic during pregnancy?
No, they are usually asymptomatic
76
How are painful fibroids managed during pregnancy?
With analgesics (pain relievers)
76
When is surgery considered for fibroid-related pain during pregnancy?
If pain cannot be adequately controlled by other means, surgery may be considered
76
What are common symptoms of uterine fibroids in pregnancy for some individuals?
Pain (11% most common), pelvic pressure, and vaginal bleeding
77
Who is the prevention of varicella-zoster virus infection targeted towards in pregnancy?
Susceptible hosts without a history of infection or prior exposure
78
Is it safe to administer the varicella vaccine to pregnant patients?
No, varicella vaccine should not be given to pregnant patients
79
Which method is the most accurate for estimating gestational age in the first trimester?
Sonographic assessment of Crown-Rump Length (CRL)
80
What is the most accurate parameter for estimating gestational age in early pregnancy?
Crown-Rump Length (CRL) up to 13 6/7 weeks, with an accuracy of ±2–7 days
81
Which measurement is considered the best predictor of gestational dating in the second trimester beyond 14 weeks?
Head circumference or Biparietal Diameter (BPD)
82
At what gestational age range is BPD most accurate for dating in early pregnancy?
Between 12 and 14 weeks
83
Which combination of biometric parameters is commonly used for dating by ultrasound in the second and third trimesters?
BPD, Head Circumference (HC), Abdominal Circumference (AC), and Femur Length (FL)
84
What is anti-D immune globulin used for in pregnancy?
Selective prophylaxis for complications related to fetomaternal bleeding
85
When is anti-D immune globulin often administered to pregnant patients?
In cases of significant clinical bleeding, not just spotting
86
What is the recommended management for threatened abortion?
Expectant management and resuming physical activity
87
What are the small elevations found in the areola called?
Montgomery tubercles
During pregnancy and lactation
88
What is Placenta Accreta characterized by?
Anchoring placental villi attaching to the myometrium
88
What is the definition of Placenta Accreta Spectrum (PAS)?
A term describing varying degrees of invasiveness involving placental attachment to the uterine wall
88
How is Placenta Increta defined?
Anchoring placental villi penetrating into the myometrium
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What is the distinguishing feature of Placenta Percreta?
Anchoring placental villi penetrating through the myometrium to the uterine serosa or adjacent organs
90
What is the incidence of Placenta Accreta, Placenta Increta, and Placenta Percreta?
Accreta: 63%, Increta: 15%, Percreta: 22%
91
What is the initial diagnostic imaging modality for a pregnant or lactating patient with a palpable breast mass?
Ultrasound
91
What are some risk factors associated with Placenta Accreta Spectrum?
Placenta previa after a prior cesarean birth, history of uterine surgery, multiparity, assisted reproductive techniques, obesity, advanced maternal age
92
Besides preeclampsia, what other adverse pregnancy outcomes can low-dose aspirin help reduce?
Preterm birth and growth restriction
92
How should fetal death be confirmed before informing the parent(s)?
By visualizing the fetal heart without any activity through ultrasound
93
When is mammography typically performed for pregnant or lactating patients with suspicious sonographic findings?
If the ultrasound findings suggest malignancy
94
What is the effect of low-dose aspirin on preeclampsia frequency and related outcomes in pregnant patients at moderate to high risk?
Reduces by 10 to 20 percent
95
What are the hemodynamic changes in pregnancy related to cardiac output and vascular resistance?
Increase in cardiac output, decrease in systemic and pulmonary vascular resistance
95
How does pregnancy affect heart rate and blood pressure overall?
Increased heart rate and decreased blood pressure
96
What changes occur in blood volume, plasma volume, and erythrocyte volume during pregnancy?
All increase, with a greater relative increase in plasma volume
97
What effect does the increase in plasma volume have on hematocrit levels?
Results in a dilutional lowering of hematocrit and other blood indices
98
By how much does plasma volume typically increase from 12 to 36 weeks of pregnancy?
40-60%
99
How much does hematocrit decrease by the 36th week of pregnancy?
3-5%
99
When is the ideal timing for the initial prenatal visit?
Around 6-8 weeks of pregnancy
100
When is screening for asymptomatic bacteriuria recommended for all pregnant women?
At the first prenatal visit
100
Name some pregnancy complications more frequent in older mothers.
Ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa, gestational diabetes, preeclampsia, cesarean birth
101
What is a potential consequence of pregnancy complications in older mothers?
Increased risk of preterm birth and perinatal mortality
102
What adverse outcomes are associated with cigarette smoking during pregnancy?
Placental abruption, preterm premature rupture of membranes (PPROM), placenta previa, preterm labor and delivery, low birth weight (LBW), ectopic pregnancy
103
How much does active maternal smoking increase the risk of stillbirth and neonatal death?
Nearly 50% for stillbirth and over 20% for neonatal death
104
How much anti-D immune globulin can prevent Rh D alloimmunization after exposure to 30 mL of Rh D-positive fetal whole blood?
300 micrograms
105
How much anti-D immune globulin is needed to prevent Rh D alloimmunization after exposure to 15 mL of fetal red blood cells?
300 micrograms
106
How is the dosage of anti-D immune globulin determined according to Williams Obstetrics?
Based on the estimated volume of fetal-to-maternal hemorrhage
106
How many doses of 300 μg anti-D immune globulin are given for each 30 mL of fetal whole blood to be neutralized?
One dose
107
What genetic evaluation is recommended for all stillbirth cases?
Karyotype or preferably micro-array
107
How many doses of 300 μg anti-D immune globulin are given for each 15 mL of fetal red cells to be neutralized?
One dose
108
When is it ideal to perform an amniocentesis in cases of stillbirth?
Prior to delivery
109
When should immediate delivery be considered for pregnancies with REDV?
At any gestational age beyond 32 weeks
110
What does the Society for Maternal-Fetal Medicine recommend for pregnancies with REDV until 32 weeks?
Intense fetal surveillance and expectant management
110
What antenatal fetal surveillance methods can be considered for a pregnant individual reporting decreased fetal movement after viability?
Fetal movement assessment, nonstress test, contraction stress test, fetal biophysical profile, modified biophysical profile, umbilical artery Doppler velocimetry
111
What additional tool is considered valuable for assessment if the nonstress test (NST) is reactive in pregnancies with persistent decreased fetal movement?
Ultrasound examination
112
What is the first step in the management of reduced fetal movement?
Nonstress test
113
Which assessment follows the nonstress test in the management of reduced fetal movement?
Biophysical profile (Ultrasound)
114
When is an ultrasound examination recommended in the management of decreased fetal movement?
If the NST is reactive
115
What components should be included in the ultrasound examination for reassessing fetal well-being in cases of decreased fetal movement?
Biophysical profile, fetal activity, breathing, tone, amniotic fluid volume, fetal growth
116
What is considered a normal result for a Biophysical profile in fetal evaluation?
8 or 10
117
What is the recommended monitoring schedule for women <37 weeks of gestation with persistent decreased fetal movement and normal fetal evaluation?
Nonstress testing and ultrasound examination twice weekly
118
What is the standard approach for managing alloimmunized pregnant patients regarding delivery?
Prolong pregnancy until fetal survival gestational age is reached
118
Up to what gestational age can intrauterine transfusion be performed to limit neonatal morbidity?
36 weeks
119
What are the methods used for definitive prenatal diagnosis of Down syndrome?
Chorionic villi sampling (CVS) or Amniocentesis
119
When can delivery be considered in alloimmunized pregnant patients after completing intrauterine transfusions?
Between 37 and 38 weeks of gestation
119
What is the next step after MCA doppler in a scenario of fetal anemia diagnosis for obtaining fetal blood for hemoglobin determination?
Cordocentesis
120
What does the combined test involve for Down syndrome prenatal screening?
Ultrasound determination of nuchal translucency (NT) + biochemical markers associated with aneuploidy
121
What is the procedure of choice for first-trimester testing? Down syndrome
Chorionic Villi Sampling (CVS)
Between 10-13 weeks of gestation
122
What is the procedure of choice for second-trimester testing according to ACOG?
Amniocentesis
Between 15-20 weeks of gestation
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