Pregnancy, Childbirth, Puerperium - antenatal testing

Question 1

Uterotonic agent commonly used for labor induction; prevention and management of postpartum hemorrhage

Answer 1

oxytocin

Question 2

complications of oxytocin (3)

Answer 2

tachysystole (abn frequent contrations = >5 in10min)
hyponatremia
hypotension

late decels in fetus

Question 3

Presence of maternal fever (>100.4) and one+ of the following:

• mom: uterine tenderness, maternal tachycardia, malodorous amnionic fluid, purulent vaginal discharge
• fetus: tachycardia >160

Answer 3

chorioamnionitis

Question 4

important risk factor for chorioamnionitis

Answer 4

Prolonged rupture of membranes

Question 5

tx of chorioamnionitis

Answer 5

bs abx and then delivery

Question 6

Risks of inadequate or excessive weight gain:
-Fetal growth restriction and preterm delivery
vs.
-GDM, macrosomia, csxn

Answer 6

1. inadequate

2. excessive

Question 7

tx of asx endometriosis

Answer 7

no treatment

Question 8

tx of sx endometriosis (3)

Answer 8

NSAIDs, OCPs, progesterone IUD (not copper)

Question 9

screening dates for syphilis

Answer 9

Universal: first prenatal visit

High risk: 3rd tri and delivery

Question 10

tx syphilis

Answer 10

IM pen G

Question 11

If mom is unsensitized Rh-negative pregnant patient, when do you NOT need to give ppx anti-D Ig?

Answer 11

if dad is knwn Rh negative

Question 12

antiD Ig at what points?

Answer 12

between 28-32 weeks and then w/i 72hrs of deliver

Question 13

MC African american.
Yellow or yellow-brown masses of large lutein cells. Solid ovarian mass on u/s (50% bl), regress spontaneously after delivery

Dx and fetal virilization risk

Answer 13

luteoma

high fetal virilization risk

Question 14

b/l ovarian cysts n u/s. Associated with molar pregnancy and multiple gestation (dt increased beta-hCG). regress spontaneously after delivery

Dx and fetal virilization risk

Answer 14

theca lutein cyst

low fetal virilization risk

Question 15

b/l solid ovarian masses on u/s. mets from primary GI tract cancer.

Dx and fetal virilization risk.

Answer 15

kruckenburg tumor

high fetal virilization risk

Question 16

tx of eclampsia

Answer 16

Mg sulfate
anitHTN agent
delivery

Question 17

preeclampsia at <20wks, think more that it’s a complication from what?

Answer 17

hydatidiform mole.

Question 18

Major risk factor for preterm delivery

Answer 18

hx of preterm delivery dt spontaneous preterm labor or Preterm PROM

Question 19

Pt has a hx of birth <37wks. what are three things that can be done to minimize reoccurence?

Answer 19

1. IM progesterone in 2nd/3rd trimesters
2. serial cervical length measurements by transvaginal u/s in 2nd trimester
3. cerclage is shortened cervix

Question 20

lactation issue: subareolar, mobile, well circumscribed, nontender mass. no fever

Answer 20

galactocele

Question 21

lactation issue: tenderness/erythema + fever

Answer 21

mastitis

Question 22

3-5 days post delivery. breast bilateral symmetric fullness, tenderness and warmth. no fever

tx

Answer 22

breast engorgement

cool compress, NSAIDs, breastfeed

Question 23

what two procedures make uterine rupture a high risk if trial of labor?

Answer 23

• Vertical csxn

- Abdominal myomectomy WITH uterine cavity entry (i.e. to remove intramural or submucosal fibroids)

Question 24

Postpartum: fatigue, wt los, HYPOTENSION, INABILITY TO BREASTFEED, amenorrhea

Answer 24

sheehan - postpartum hypopituitarism due to massive obstetric hemorrhage and hypovolemic shock causing ischemic necrosis of anterior pituitary

Question 25

Increased risk for what if: previous csxn, hx of D&C, maternal age >35 Postpartum bleed

Answer 25

placenta accreta (uterine villi attach to myometrium)

Question 26

Vaginal (antepartum) bleeding, abd PAIN, tense and distended uterus, fetal hr abn risk factors for this include: cocaine use, tobacco use, prior hx of this happening, bad trauma, maternal HTN or preeclampsia

Answer 26

placental abruption (premature detachment of placenta form uterus)

Question 27

Antepartum hemorrhage following contractions and cervical dilation

Answer 27

placenta previa

Question 28

when fetal vessels traverse amniotic membranes over internal cervical os. presents with PAINLESS antepartum bleeding and fetal HR abd just AFTER membrane rupture

Answer 28

vasa previa

Question 29

HSVrisk factors

Answer 29

- primary maternal infection; vaginal delivery with active lesions - longer duration of membrane rupture - vaginal delivery with active lesions - impaired skin barrier - preterm birth

Question 30

pregnant with women - ppx with ___ at ___wk

Answer 30

ppx with acyclovir/vancyclovir at 36wks

Question 31

shoulder dystocia results in neuro deficit (extended wrist, hyperext MCPs, flexed IPs, abset grasp reflex) and horner syndrome (ptosis and miosis)

Answer 31

klumpke plasy - C8-T1 and sympathetic damage

Question 32

LH surge = ?

Answer 32

menstruation

Question 33

prior to conception until 20wks: | >or= 140/ >or=90

Answer 33

chronic HTN

Question 34

>or= 20wks | new onset HTN, no proteinuria or end organ damage

Answer 34

gestational htn

Question 35

>or= 20wks | new onset HTN AND proteinuria OR signs of end organ damage

Answer 35

preeclampsia

Question 36

>or= 20wks | new onset HTN AND proteinuria OR signs of end organ damage AND new onset grand mal seizure

Answer 36

eclampsia

Question 37

chronic HTN and 1+: new onset proteinuria or worsening of existing proteinuria at >or= 20wks; sudden worsening HTN; signs of end organ damage

Answer 37

chronic HTN superimposed on preeclampsia

Question 38

test performed for pregnancies at risk for fetal hypoxia or fetal demise

Answer 38

nonstress test | - performed when decreased detal movements and fetal compromise is expected

Question 39

Be aware of giving mag to a mom with what problem?

Answer 39

renal insufficiency bc mag is renally excreted

Question 40

increased Maternal Serum AFP - thing what three things

Answer 40

open neural tube defects, ventral wall defects, multiple gestation

Question 41

decreased Maternal Serum AFP - thing what

Answer 41

aneuploidy (tri18,21)

Question 42

Post partym hemorrhage tx

Answer 42

bimanual uterine massage, IVF, O2, uterotonic meds (oxytocin, methylergonovine, carboprost, misoprostol)

Question 43

Renal physiologic changes in preg: RBF GFR Renal basement permeability

Answer 43

all increase

Question 44

Renal lab changes in preg: BUN Cr Renal protein excretion

Answer 44

BUN DECR Cr DECR Renal protein excretion INCR

Question 45

tx of preeclampsia: - BP - Seizure

Answer 45

- BP: hydralazine IV, nifedipine po, labetalol IV (will also lower HR) - Seizure - mag sulfate IV or IM

Question 46

indications for prophylactic anti-D Ig admin for unsensitized Rh-neg pregnant pt

Answer 46

``` 28-32wk gestation w/i 72h of Rh+ infant birth, threatened, or induced abortion ectopic trauma to abd hydatidiform mole amniocentesis external cephalic version 2nd/3rd tri bleed ```

Question 47

Give what 3 vaccines during pregnancy

Answer 47

Tdap Inactivated influenza RhoD

Question 48

DO NOT give any pregnant pt what four vaccines?

Answer 48

MMR (safe for breastfeeding moms, give immediately postpartum) Varicella Live influenza HPV

Question 49

Woman with hyperemesis gravidum has horizontal nystagmus and bilateral abducens palsy (oculomotor dysfunciton), encephalopathy (confusion, incoherence), and ataxis. Dx and tx

Answer 49

Dx: wernicke encephalopathy Tx: thiamine IV and glucose (dt hypoglycemia in Hyperemesis Gravidum)

Question 50

False v latent labor: 1. Contractions irregular, infrequent, weak, no-mild pain, no cervical change 2. Contractions regular and increasing frequency, increasing intensity, painful, and cervical change

Answer 50

1. false | 2. latent

Question 51

no vainal bleeding, closed vervical os, no fetal activity or empty sac

Answer 51

missed abortion (fetus dead, still attached inside uterus)

Question 52

vaginal bleeding, closed cervical os, fetal cardiac activity

Answer 52

threatened abortion (fetus alive, still attached inside uterus)

Question 53

vaginal bleeding, open cervical os, products of conception seen/felt at or above cervical os

Answer 53

inevitable abortion (fetus not still attached inside uterus, not expelled)

Question 54

vaingal bleeding, cervical os open, some products of conception expelled/some remain

Answer 54

incomplete abortion (fetus not still attached inside uterus, may/may not be expelled)

Question 55

vaingal bleeding or non, closed os, products completely expelled

Answer 55

complete abortion (fetus completely expelled)

Question 56

post csxn/surgery: fever unresponsive to abx, no localizing sx except possible BL LQ tenderness, negative infectious evaluation, dx of exclusion

Answer 56

septic pelvic thrombophlebitis - thrombosis of deep pelvic or ovarian viens

Question 57

tx of septic pelvic thrombophlebitis

Answer 57

anticoagulation and bs-abx

Question 58

fever, lower abd pain, heavy vaginal bleeding, malodorous purulent vaginal discharge, uterine tenderness after (MC) elective abortion. dx

Answer 58

septic abortion

Question 59

medical induciton of aboriton

Answer 59

MTX or misoprostol (SAB)