Reproductive: Maternal Disorders

Question 1

When can you call cervical length short (i.e. cervical incompetence)?

Answer 1

When the endocervical canal is < 2.5 cm

Question 2

Fetal hydronephrosis is seen in _____ percent of pregnancies

Answer 2

80%

Note: This is probably due to mechanical compression of the ureters (right is more often affected than the left).

Question 3

When are fibroids most likely to grow during pregnancy?

Answer 3

Early in pregnancy (due to elevated estrogen)

Note: Elevated progesterone later in pregnancy actually inhibits fibroid growth.

Question 4

Why are fibroids more prone to infarction/cystic degeneration during pregnancy?

Answer 4

Stretching of the uterus likely affects arterial blood supply

Question 5

When is a uterine rupture most likely to occur?

Answer 5

During the 3rd trimester (at the site of a prior c section scar)

Question 6

Risk factors for uterine rupture

Answer 6

• Prior c section
• Unicornuate uterus
• Prior uterine curettage
• “trapped uterus” (persistent retroflexion due to adhesion)
• Interstitial implantation

Question 7

HELLP Syndrome

Answer 7

Hemolysis, Elevated Liver enzymes, Low Platelets (the most severe form of pre-eclampsia)

Note: 20-40% of these pts get DIC.

Question 8

Young female pt with third trimester pregnancy

Answer 8

Think HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)

Note: Subcapsular hepatic hematoma in a pregnant pt.

Question 9

1 month s/p cesarean section

Answer 9

Peripartum cardiomyopathy

Note: Cardiac MRI usually demonstrates global depressed function and non-vascular territory subepicardial late enhancement (corresponding to cellular lymphocytic infiltrate).

Question 10

Sheehan syndrome

Answer 10

Pituitary apoplexy seen in postpartum females who suffered large volume hemorrhage, causing acute hypotension.

Question 11

Postpartum female

Answer 11

Sheehan syndrome (pituitary apoplexy)

Note: This is acute, the chronic findings would be ring enhancement around an empty sella.

Question 12

History of pregnancy complicated by placenta percreta

Answer 12

Chronic Sheehan syndrome (pituitary apoplexy)

Question 13

Postpartum fever

Answer 13

Bilateral ovarian vein thrombophlebitis

Question 14

Which side is more commonly involved in postpartum ovarian vein thrombophlebitis?

Answer 14

The right side (5x)

Question 15

Measurement 7 mm s/p dilation and curettage 1 day prior

Answer 15

Think retained products of conception

Note: Endometrial thickness should be 5 mm or less after dilation and curettage.

Question 16

Persistant bleeding s/p delivery of a twin gestation

Answer 16

Retained products of conception

Note: Irregular thickening of the endometrium. The endometrium should be 10 mm or less after delivery.

Question 17

Risk factors for retained products of conception

Answer 17

• Medical termination of pregnancy (abortion)
• 2nd trimester miscarriage
• Placenta accreta/percreta

Question 18

Fever s/p recent c section for prolonged delivery

Answer 18

Think endometritis