Patho OB Midterm Flashcards by Frankie Aguinot

Hypovolemic shock may happen even in minimal bleeding

Abruptio Placenta
Placenta Previa
Both
Neither

Abruptio Placenta

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Which of the ffg is the recommended management of macrosomic fetuses to prevent shoulder dystocia according to ACOG?

a. Prophylactic use of Low dose aspirin starting at 20 weeks AOG
b .Dietary restriction starting at 32weeks where cellular hypertrophy occurs
c. Elective CS when estimated fetal weight is 5000 grams in patients without DM
d. Elective CS when estimated fetal weight is 4250 grams with gestational hypertension

c. Elective CS when estimated fetal weight is 5000 grams in patients without DM

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occurs due to the fusion of amniotic sheets.

A. Amniotic Cyst
B. Amnion nodosum
C. Amniotic Band
D. Amniotic Sheets

A. Amniotic Cyst

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2nd phase of fetal growth

up to 32 weeks - hyperplasia and hypertrophy

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fetal growth disorder is usually attributed to�

placental lesions and infection, the most common is viral - why we check Rubella titers

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failure of any structure

acardius amorphus

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If internal rotation did not occur, face presentation may engage but it can only descend with accompanying molding. Capput succedaneum and molding is obvious in this part of fetal head.

A. Parietooccipital area
B. Parietal area
C. Frontal area
D. Occipital area

A. Parietooccipital area

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Speculum Exam

Abruptio Placenta
Placenta Previa
Both
Neither

Placenta Previa

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UC colitis

which portion of bowel
colonoscopy
diarrhea symptoms
cancer risk
surgical intervention

UC colitis

. which portion of bowel: large bowel mucosa and submucosa
. Colonoscopy: rectal involvement very common
. diarrhea symptoms: bloody
. cancer risk: 3-5%
. surgical intervention: proctocolectomy

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A variant of placenta membranacea. Placenta is annular, partial or complete ring of placental tissue

A. circummarginate placenta
B. circumvallate placenta
C. placenta abruptio
D. annular placentation

D. annular placentation

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What component of the complement may be an indicator of FGR? What is it associated with?

C4d - chronic villitis

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3rd phase of fetal growth

after 32 weeks - hypertrophy

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chorion in t sign

monochorionic

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he risk of Fetal Growth Restriction is subsequent pregnancy nearly approaches what percentage?

15%
25%
50%
70%

25 percent

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perinatal death, induction of labor and cesarean delivery were markedly reduced because of early antepartal surveillance and appropriate Doppler assessment of this vessel

a. Uterine artery
b. Middle cerebral artery
c. Umbilical artery
d. Ductus venosus

c. Umbilical artery

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Mentum anterior, force of labor, flex head and brow presentation.

A.Vertex occiput anterior
B.Vertex occiput posterior
C.Brow presentation
D.Transverse presentation

C.Brow presentation

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Ultrasound confirms diagnosis

Abruptio Placenta
Placenta Previa
Both
Neither

Placenta Previa

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Amniotomy is done

Abruptio Placenta
Placenta Previa
Both
Neither

Abruptio Placenta

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A 36y/o G3P3 (3003) came in with complaints of 6 months� amenorrhea. She has just delivered her baby __ months PTC. Pregnancy test is negative. Most likely suffering from

A. Sheehan�s syndrome
B. Simmond�s dusease
C. Post-partum depression
D. DIC

A. Sheehan�s syndrome

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The largest dimension of the fetal head that should negotiate with the inlet of the pelvis in Brow presentation is:

A. Occipitobregmatic diameter
B. Occipitofrontal diameter
C. Suboccipitobregmatic diameter
D. Occipitomental diameter

D. Occipitomental diameter

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Implantation in the LUS is such that the placental edge does not reach the internal os and

A. Placenta previa
B. Low lying placenta
C. Marginal placenta
D. Vasa previa

B. Low lying placenta

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at what AOG does AF start to decline

38 weeks

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Test performed at 22-24 weeks gestation in populations to be high risk preeclampsia and fetal growth restriction.

A. Uterine Artery Doppler Velocimetry
B. Umbilical Artery Doppler Velocimetry
C. Middle Cerebral Artery Doppler Velocimetry
D. Fetal Thoracic Aorta Doppler Velocimetry

A. Uterine Artery Doppler Velocimetry

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failed head growth

acardius acephalus

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HELLP Syndrome:

Hemolysis Elevated Liver enzymes Low Platelet count

Type of hematoma found between placenta and amnion A. Retroplacental hematoma B. Subchorionic hematoma C. Subamnionic hematoma D. Subchorional thrombosis

C. Subamnionic hematoma

``` A form of periodic fetal heart pattern on EFM encountered in post term gestation complicated by fetal distress and oligohydramnios ``` a. prolonged bradycardia b. sinusoidal pattern c. . prolonged deceleration d. moderate variablitiy

c.. prolonged deceleration

Which method controls bleeding after delivery of a placenta implanted in the LUS by obliteration the major blood supply to the uterus A. Bilateral hypogastric artery ligation B. CS hysterectomy C. Packing with gauze D. NOTA

D. NOTA (Internal Iliac Artery Ligation)

ACOG recommended elective delivery A. 37 weeks B. 38 weeks C. 39 weeks D. 40 weeks

C. 39 weeks

Transverse lie abdominal palpation, narrow left, large nodular right Right acromionodular anterior Left acromionodular anterior Right acromionodular posterior Left acrominonodular posterior

Right acromionodular posterior

Cause of symmetric growth restriction

early insult could result in a relative decrease in cell number and size

Cause of asymmetric growth restriction

late pregnancy insult such as placental insufciency from hypertension.

Due to increase age and parity Abruptio Placenta Placenta Previa Both Neither

Both

ormed from disruption of amnion; entraps fetus impairing growth and development. Risk of fetal intrauterine amputation. A. Amniotic Cyst B. Amnion nodosum C. Amniotic Band D. Amniotic Sheets

C. Amniotic Band

fetal testing at 41 weeks REPEAT

1. counting fetal movements during a 2-hr period each 2. non stress testing three times weekly 3. amniotic fluid volume assessment two to three times weekly, with pockets <3 cm considered abnormal

risk factors for posterm

Parity Previous post term birth Socioeconomic class Age

dystocia, suprapubic pressure should be applied to the posterior aspect of the anterior shoulder of the fetus, this would duel success because A. It compresses the soft tissues allowing the release of the impaction B. Helps to rotate the anterior shoulder away from the symphysis pubis C. Pressure will rotate into the direction of theiss of the maternal pelvis D. A&B only E. A, B & C

D. A&B only A. It compresses the soft tissues allowing the release of the impaction B. Helps to rotate the anterior shoulder away from the symphysis pubis

Most common intrapartum complication in compound presentation A. Dysfunctional labor/dystocia B. Cord prolapse C. Non reassuring fetal heart rate pattern D. Intrapartal death

B. Cord prolapse

bishop unfavorable score

< 7

major cause of death perinatal post term

gestational hypertension

The fetal head presentation positioned bet. face presentation & vertex presentation thus anterior fontanelle is the presenting part in digital pelvic examination. A. Compound B. Sinciput (aka Forehead ) C. Asynclitic vertex presentation D. Midface

B. Sinciput (aka Forehead )

Significantly associated with prolonged pregnancy.

Obesity

Which of the following is the most appropriate management for placenta previa at/near term with stable condition A. Classical CS at 37-38wks AOG B. Vaginal delivery C. Adequate oxytocin administration to control hemorrhage from the placental implantation site D. B & C only

A. Classical CS at 37-38wks AOG

Hallmark of oligohydramnios characterized by small, light tan nodules overlying the placenta A. Amniotic Cyst B. Amnion nodosum C. Amniotic Band D. Amniotic Sheets

B. Amnion nodosum

Middle Cerebral Artery Doppler velocimetry isprimarily cardiovascular factor in predicting neonatal outcome True or False

. False

uterine incision delivery in a back-down transverse lie fetus: A. Kerr B. Kronig C. Classical D. T incision

C. Classical

Which of the ffg is associated with fetal overgrowth? A. Decrease cord C- peptide levels B. Increase lipolytic activity C. Decrease trophoblastic lipase expression D. Increase neonatal hypoxia

B. Increase lipolytic activity

True of the mechanism of labor in face presentation A. In face presentation, labor may initially start in brow presentation B. Internal rotation in face presentation occur between the ischial spines and ischial tuberosities C. The anterior fetal chin passes under the symphysis and flexion of the head occurs D. A & C E. A, B & C

D. A & C A. In face presentation, labor may initially start in brow presentation C. The anterior fetal chin passes under the symphysis and flexion of the head occurs

Fibrin and old hemorrhage lie between the placenta and the overlying amniochorion A. circummarginate placenta B. circumvallate placenta C. placenta abruptio D. annular placentation

A. circummarginate placenta

Safest interval of delivery between first and | second twin

A. 30 mins

Amionic, Chorionic 13 days

Conjoined Twins

DIC increases the risk Abruptio Placenta Placenta Previa Both Neither

Abruptio Placenta

normal amniochorion draped over preexisting uterine synechia. Risk of preterm delivery and placental abruption. A. Amniotic Cyst B. Amnion nodosum C. Amniotic Band D. Amniotic Sheets

D. Amniotic Sheets

Amionic, Chorionic 4 days

Diamnionic, Dichorionic Twin Pregnancy (2 embryo, 2 | amnion, 2 chorion)

posterm definition

42 completed weeks or 294 days

For the following hemoglobin levels, what should be administered ``` 10-11 g/dl 9-9.9 g/dl <9 g/dl <8.5 g/dl <7 g/dl ```

``` 10-11 g/dl Oral Iron, 200 mg/day 9-9.9 g/dl Iron Sucrose, 200mg 1-2x/wk <9 g/dl Iron Sucrose, 200mg 2x/wk <8.5 g/dl rHEPO with Iron Sucrose <7 g/dl Blood Transfusion ```

ductus venosus Doppler parameters were the primary cardiovascular factor in predicting neonatal outcome True or False

. True

quintero 2 3

2. urine not visible within the donor's bladder | 3. abnormal doppler status of the umbilical artery, ductus venosus, or umbilical vein

partial head with limbs

arcardius myelocephalus

Initial workup for IDA

Inital work up A. red cell indices B. hct C. Serum ferritn PBS

Breus mole A. Retroplacental hematoma B. Subchorionic hematoma C. Subamnionic hematoma D. Subchorional thrombosis

D. Subchorional thrombosis

Hypertension is a risk factor Abruptio Placenta Placenta Previa Both Neither

Abruptio Placenta

OB attempts or maneuver to rotate a posterior position to a more favorable anterior mentum position are rarely successful and are associated with fetal morbidity and mortality which includes: ``` A. Fetal cervical spine injury B. Neurological impairment C. Erb Duchenne D. A and B E. A, B and C ```

C. Erb Duchenne

Which of the ffg is the standard in the evaluation and management of growth restricted fetuses? Serial biometry Non stress test Doppler velocimetry Amniotic fluid measurement

Doppler velocimetry

Twin-twin transfusion syndrom is most | common in?

MONOCHORIONIC

Which of the ffg fetal biometric measurements is the most frequently abnormal in growth restricted fetuses? Femur length Biparietal diameter Head circumference Abdominal circumference

Abdominal circumference

he primary modality to assess fetal growth restriction: A. fundic height B. serum analyte C. Ultrasound D. abdominal assessment of fetal weight

A. fundic height

By international definition of prolonged gestation, which of the following is correct? a. 284 or more from first day LMP b. 41 and 0/7 weeks c. 2 weeks beyond term gestation d. none of the above

d. none of the above

Prominent vaginal examination in persistent occiput position include/s A. Posterior fontanel is on the anterior quadrant of the pelvis B. Anterior and Posterior sutures are deflected C. Lambda shaped Posterior fontanel is in the posterior quadrant of the pelvis D. A and B E. B and C

B. Anterior and Posterior sutures are deflected | C. Lambda shaped Posterior fontanel is in the posterior quadrant of the pelvis

Refers to the fertilization of 2 ova during the same cycle but at separate days and the sperms not necessarily from the same man

B. Superfecundation

IDA diagnosis

. Microcytic hypochromic . Serum ferritin LOW . Can go <7

What level of hemoglobin will you administer the following ``` Oral Iron, 200 mg/day Iron Sucrose, 200mg 1-2x/wk Iron Sucrose, 200mg 2x/wk rHEPO with Iron Sucrose Blood Transfusion ```

``` 10-11 g/dl Oral Iron, 200 mg/day 9-9.9 g/dl Iron Sucrose, 200mg 1-2x/wk <9 g/dl Iron Sucrose, 200mg 2x/wk <8.5 g/dl rHEPO with Iron Sucrose <7 g/dl Blood Transfusion ```

which biometric measurement/parameter in ultrasound highly affected by fetal growth disturbances a. head circumference b. bpd c. abdomen circumference d. femur length

c. abdomen circumference

Placenta previa can result to fetal growth restriction True or False

True Several placental abnormalities may cause poor fetal growth.

High incidence of perinatal mortality associated with transverse lie is reportedly due to high risk of A. Prematurity B. Birth asphaxia C. Low birth weight D. Perinatal infection

A. Prematurity

type of forceps used in vaginal birth after cs

piper forceps

What phase of fetal growth does most fetal fat andglycogen accumulates? A. Phase of cellular hyperplasia B. Cellular hyperplasia & hypertrophy C. Cellular hypertrophy D. Cellular atrophy

C. Cellular hypertrophy

IDA patients who cannot tolerate oral iron should be advised:� A. Iron sucrose IV B. Iron dextran IM C. BT D. Recombinant erythropoietin

B. Iron dextran IM

Which of the following scenario is vaginal delivery possible in preterm transverse lie? Fetal shoulder is forced and accommodated in large pelvis Fetal assumes �conduplicato corpore� attitude One arm prolapses and is delivered first followed by the shoulder None of the above

Fetal assumes �conduplicato corpore� attitude

Placental dysfunction in post term pregnancy a. placental hemorrhage b. placental apoptosis c. increased cord blood erythro� d. AOTA e. B & C

e. B & C (a. placental hemorrhage / c. increased cord blood erythro�)

preterm labor prediction: best at 28 weeks

fetal fibronectin levels (other is cervical length)

1st phase of fetal growth

16 weeks - hyperplasia

A. IDA B. Anemia with chronic disease C. Both ``` Total iron demand in pregnancy - Microcytic Hypochromic morphology - _ serum ferritin levels � _serum ferritin levels - Recombinant erythropoietin for treatment � ```

matching Total iron demand in pregnancy - IDA Microcytic Hypochromic morphology � BOTH _ serum ferritin levels � ANEMIA WITH CHRONIC DISEASE _serum ferritin levels - IDA Recombinant erythropoietin for treatment � ANEMIA WITH CHRONIC DISEASE

What is the most common type of vascular anastomosis in twin- twin transfusion syndrome? Aa, av, vv

ARTERY-ARTERY ANASTOMOSE

Later in adult life, one who had a history of Fetal Growth Restriction has higher incidence of? IUGR Sibling Severe malnutrition Obesity Hypercholesterolemia

Hypercholesterolemia

Hematoma starts at basalis layer Abruptio Placenta Placenta Previa Both Neither

Abruptio Placenta

Umbilical cord vessel thrombosis A. Umbilical artery B. Umbilical vein C. U. Art. & Vein

B. Umbilical vein

what is the most common type of vascular anastomosis in twin- twin transfusion syndrome? Aa, av, vv

artery to artery

What is the objective of the internal rotation of the face? To flex the head To bring chin under symphysis pubis Short neck can span the anterior surface of the sacrum The longer occipito-mental diameter can pass through the symphysis pubis

To bring chin under symphysis pubis

Possible etiological factor/s for Face presentation: A. Lax uterus, multifetal pregnancies, polyhydramnios B. Deflexed fetal head C. Dolicocephalic fetus (means: long head) D. A & B E. A, B & C

A. Lax uterus, multifetal pregnancies, polyhydramnios B. Deflexed fetal head C. Dolicocephalic fetus (means: long head)

External podalic version in the management of transverse lie requires an intact bag of water, placenta and should be performed safely on this age of gestation A. 32-34 weeks B. 34-36 weeks C. 36-37 weeks D. Beyond 40 weeks

C. 36-37 weeks

What is the modality offered to test for aneuploidy and infection for severe growth restriction (EFW = >3%) with gestational age >24 weeks A. Noninvasive prenatal testing B. Amniocentesis C. Cordocentesis D. Chorionic Villous Sampling

B. Amniocentesis

Substance abuse such as intake of heroin is associated with decreased birthweight by lowering the fetal plasma level of this hormone? Ghrelin Chemerin Leptin Omentin 1

Leptin

Etiology of face or brow as /are ``` A. Preterm B. Increasing parity C. CPD D. a and b E. AOTA ```

E. AOTA

Normal delivery may be attempted if the fetus is dead and the mother is stable Abruptio Placenta Placenta Previa Both Neither

Abruptio Placenta

A separating membrane of 0.3 cm is highly | suggestive of?

DICHORIONIC

Iron (Ferrous sulfate) daily requirement for pregnant woman� A. 10-20 mg B. 30-60 mg C. 90-120 mg D. 150-180 mg

B. 30-60 mg

Asymmetic growth restriction resulting from intrinsic fetal factor including aneuploidy, congenital malformations or infections True or False

. False

in post term what does viscous AF signify

thick meconium that may be aspirated

The greatest direct antenatal risk factor for shoulder dystocia is: A. History of shoulder dystocia in a prior vaginal delivery B. Fetal macrosomia C. GDM, overt DM, and impaired glucose tolerance D. Contracted pelvis

C. GDM, overt DM, and impaired glucose tolerance

The most frequent cause of placental abruption is A. Prior CS B.HPN C. Chorioamnionitis D. Advanced maternal age

C. Chorioamnionitis

Optimal timing to decrease rate of fetal growth restriction is with pregnancy interval of a. <6mos b. 6-12 mos c. 12-18 mos d. 18-23 mos

b. 6-12 mos

Amionic, Chorionic 8-13 days

Monoamnionic, Monochorionic Twin The chorion and amnion has already differentiated (2 embryo with common amniotic san and common chorion)

The mechanism of labor consists of the cardinal movements following engagement in face presentation descent takes place, the widest diameter of the fetal head negotiating the pelvis is A. Suboccipitobregmatic B.submentobregmatic C. Mentooccipital D. Frontooccipital

C. Mentooccipital

Type of hematoma found between the placenta and adjacent decidua A. Retroplacental hematoma B. Subchorionic hematoma C. Subamnionic hematoma D. Subchorional thrombosis

A. Retroplacental hematoma

preterm labor prediction: best at 24 weeks

cervical length (other is fetal fibronectin levels)

max velocity weight gain

37 weeks

Mentum (anterior/posterior) is deliverabl via vaginal delivery

Mentum anterior is deliverable via vaginal delivery

In compound presentation, vertex-arm combination is the most frequent type of presentation? A. True B. False

A. True

G5P4 (4004) after delivering vaginally, the uterus remained boggy. What management? A. Misoprostol B. Peripartum Hysterectomy

B. Peripartum Hysterectomy

Which differentiates face from breech during IE? Breech and ischial tuberosities in same line (Anus and ischial tuberosities in straight line) Mouth and malar eminence form a triangle Mouth is bigger than anus A and B

A and B Breech and ischial tuberosities in same line (Anus and ischial tuberosities in straight line) Mouth and malar eminence form a triangle

he chorion periphery is thickened, opaque, gray-white circular ridge composed of double fold of chorion and amnion. A. circummarginate placenta B. circumvallate placenta C. placenta abruptio D. annular placentation

B. circumvallate placenta

CS is the management for all cases Abruptio Placenta Placenta Previa Both Neither

Placenta Previa

Type of hematoma found between the chorion and decidua A. Retroplacental hematoma B. Subchorionic hematoma C. Subamnionic hematoma D. Subchorional thrombosis

B. Subchorionic hematoma

Amionic, Chorionic 4-8 days

Diamnionic, Monochorionic Twin (2 embryo, 2 amnion, | 1 chorion)

a 42 y/o G2P1 was noted to have a large amount of subchorionic hemorrhage by ultrasound at 10 weeks AOG. The pregnancy progressed. At 22 weeks AOG, she had vaginal bleeding. A repeat ultrasound showed oligohydramnios. What is the clinical diagnosis? A.Placenta previa with severe hemorrhage B.Chronic abruptiooligohydramnios sequence C.Abruptio placenta with concealed hemorrhage D.Placenta accrete with ruptured membrane

B.Chronic abruptiooligohydramnios sequence

The UZ finding of �twin peak� is seen in what | type of twinning?

B. Diamnionic,dichorionic