Pathologic Obstetrics

Question 1

Criteria for Chorioamnionitis

Answer 1

Maternal fever >/= 38
plus one of the ff
-fetal tachycardia 
-uterine tenderness
-purulent or foul-smelling discharge 
-leukocytosis 
-elevated ESR

Question 2

presents with vaginal bleeding, uterine enlargement, acute abdomen due to tumor perforation, bleeding from metastatic sites

Answer 2

Gestational Trophoblastic Neoplasia

Question 3

Classic presentation of placenta previa

Answer 3

Painless vaginal bleeding

Question 4

Most common obstetric cause of DIC

Answer 4

Abruptio Placenta

Question 5

Gestational HTN is defined as

Answer 5

HTN without proteinuria occuring after 20 weeks gestation and BP levels return to normal 12 weeks postpartum

Question 6

Preeclampsia mild is defined

Answer 6

(without severe features)
BP ≥ 140/90 beyond 20 wks AOG associated with ANY of the ff:
-with or without proteinuria (NEW criteria)
-impaire liver function

Question 7

Preeclampsia severe is defined as

Answer 7

(with severe features)
BP ≥ 160/110 beyond 20 wks AOG
Associated with ANY of the ff:
-RUQ/epi pain, thrombocytopenia: Plt <100,000/mL, impaired liver func: transaminase 2x above normal; renal insufficiency:serum crea>1.1 or 1.2 mg/dL in the absence of renal dse or oliguria <400-500 mL/day, pulmonary edema, cerebral disturbance (severe headache, altered mental status), visual disturbance

Question 8

Eclampsia is defined as

Answer 8

occurence of convulsions, not caused by incidental neurologic dse, in a woman with preeclampsia

Question 9

Chronic HTN is defined as

Answer 9

BP ≥ 140/90 prior to pregnancy before 20 wks AOG and persists after 12 wks postpartum

also

HTN first dx after 20 wks and persistent 12 wks postpartum

Question 10

Chronic HTN with superimposed preeclampsia is defined as

Answer 10

pre-existing chronic HTN with new-onset proteinuria and signs and sx of various end-organ dysfunction

Question 11

Prevention of pre-eclampsia syndrome

Answer 11

High-dose Ca: 1.5-2g/day before 32 weeks

Low dose aspirin: 60-80 mg/day to start on 2nd trimester

Question 12

When to consider hospitalization and delivery for gestational HTN?

Answer 12

• AOG ≥ 40 wks
• AOG ≥ 37 wks if (NBF): NR NST, bishop score >5, fetal weight <10th percentile
• AOG ≥ 34 wks with (CRAVL): criteria for severe pre-eclampsia, ROM, Abn BPS, VB, labor)

Question 13

Weekly check-up for GHTN should include

Answer 13

BP, Plt ct and liver enzymes, NST, fetal growth every 2-3 wks

Question 14

Antidote fot MgSO4 overdose

Answer 14

Calcium gluconate IV (10 mL of 10% solution)

Question 15

Level of MgSO4 that can prevent convulsion

Answer 15

4-7 mEq/L

Question 16

Diagnosis of Bacterial Vaginosis

Answer 16

Amsel’s Criteria (3 out of 4 features):

• vaginal pH >4.7
• presence of clue cells
• homogenous, milky white discharge
• fishy odor when KOH is added

Question 17

“strawberry cervix”

Answer 17

Trichomonas

Question 18

Tx for Bacterial Vaginosis

Answer 18

Metronidazole 500 mg/tab BID for 7 days

Question 19

Tx for Trichomonas infection

Answer 19

Metronidazole 2g single dose

Question 20

Tx of VVC in pregnant pt

Answer 20

Azole creams such as butoconazole, clotrimazole, miconazole, terconazole (Fluconazole is CI)

Question 21

Tx of Chlamydia during pregnancy

Answer 21

• Azithromycin 1g PO as single dose (DOC)

- Amoxicillin 500 mg PO TID for 7 days

Question 22

Tx for early syphilis

Answer 22

Benzathine Pen G as single IM dose

Question 23

Tx for neurosyphilis

Answer 23

Aqueous crystalline pen G or aqueous procaine penicillin

Question 24

Most common single defect of Congenital Rubella syndrome

Answer 24

Sensorineural deafness

Question 25

Fever, tachycardia out of proportion of the fever

Answer 25

C. perfringens

Question 26

Toxoplasmosis triad (neonatal)

Answer 26

chorioretinitis, intracranial calcifications, hydrocephalus *convulsions

Question 27

Screening cut-off for Overt diabetes

Answer 27

FBS > 126 mg/dL (7 mmol/L)
RBS > 200 mg/dL (11.1 mmol/L)
HbA1c > 6.5
2 hr 75 g OGTT > 200 mg/dL (11.1 mmol/L)

Question 28

Preferred tx for overty hypothyroidism in the 1st trimester

Answer 28

PTU

shifted to Methimazole in 2nd trimester due to hepatotoxicity