Flashcards in UWorld OB Deck (42)
OCP is protective against?
1. Benign breast disease
2. Ovarian cysts /cancer
3. Endometrial cancer
Serious side effects of OCPs?
6, MI in smokers over 35
Acute fatty liver pregnancy – Trimester? Symptoms? Labs? Histology? Can lead to?
nausea, abdominal pain, headache
Prolonged prothrombin time and elevated transaminases
Micro vesicular deposition in about a site without inflammation or necrosis
Acute renal failure
Risk factors for cervical insufficiency during pregnancy?
1. Procedures - elective abortions, LEEP procedure or cone biopsy
2. Obstetrical trauma
3. Multiple gestation
4. History of second trimester pregnancy loss
5. Mullerian abnormalities
Risk factors for placental abruption?
1. Maternal disease – Diabetes, SLE
3. Maternal drugs - smoking, Cocaine, alcohol
4. External cephalic version
Risk factors for uterine rupture?
2. Advanced maternal age
3. Previous C-sections/myomectomies
Risk factors for polyhydramnios?
1. Fetal malformations/genetic disorders
3. Multiple gestation
4. Fetal anemia
Cervical length at 24 weeks? Gold standard for evaluating Surbex for cervical incompetence?
25 mm; transvaginal ultrasound
Patient with septic abortion – treatment?
3. Gentle suction curettage (Vigorous curettage may perforate uterus)
Postterm pregnancy associated with an increased risk for?
UTI drugs contraindicated in pregnancy? Use instead?
Tetracyclines, fluoroquinolones, Bactrim
Use nitrofurantoin, amoxicillin, cephalexin
Risperidone – used to treat? Mechanism of action? Side effects in women?
Schizophrenia bipolar; dopamine antagonist
Increases serum prolactin levels causing oligomenorrhea, galactorrhea
Pregnant patient comes in complaining of brown vaginal discharge – Suspect? Test? If positive, tx?
Missed abortion; pelvic ultrasound
D&C, misoprostol/mifepristone or expectant management for POC elimination
TSH and thyroid hormone in pregnancy?
1. Estrogen in pregnancy increases thyroid binding globulin, increasing TDG-bound T3 and T4. Free T3 and T4 remain normal. Therefore total T3 and T4 are elevated
2. HCG in pregnancy can mildly stimulate TSH receptor, resulting in a small increase in free T3/T4. Levels are slightly elevated and remain within normal range
3. TSH remains the same
Patient with suspected lichen sclerosis - next step? (Why?)
Punch biopsy (r/o vulvar squamous cell carcinoma)
Premature ovarian failure – FSH to LH ratio?
FSH increases more than LH
FSH/LH ratio >1
Tests for every pregnant patient?
FRIED (flu, Rh/type and screen/CBC, infection, exam, down syndrome screening)
1. Cervical psychology
2. Rh type and antibody screen
3. Hematocrit, hemoglobin, MCV
4. Rubella, varicella, hepatitis B screening
5. STI – syphilis, HIV
6. Flu vaccine during flu season
7. Screening for down syndrome, cystic fibrosis
Test for specific, at risk pregnant patients?
1. Thyroid function
4. Hemoglobin electrophoresis
5. Lead levels
Indications for GBS prophylaxis if status is unknown?
1. Delivery under 37 weeks
2. Duration of membrane rupture over 18 hours
3. Any amount of GBS bacteriuria
4. Prior history GBS sepsis
Intrauterine fetal demise may cause? Mechanism? Early sign?
DIC; due to release of tissue factor from the placenta into maternal circulation which triggers intrinsic pathway
Low normal fibrinogen (~160)
Emergency contraception is offered up to how long after intercourse? Plan B a.k.a.?
Second trimester abortifacient?
120 hrs; levonorgestrel
Prostaglandin E2 suppositories
NST – when to conduct?
Over 32 weeks with decreased fetal movements
Contraction stress test?
Mother given oxytocin infusion until three contractions every 10 minutes.
Effect of contractions fetal heart activity is recorded. Test is positive and delivery recommended if late decelerations are present
Most important risk factor squamous cell carcinoma the vagina?
Female offspring of women who ingest DES during pregnancy are at an increased risk for developing?
1. Clear-cell adenocarcinoma of vagina/cervix
2. Cervical anomalies
3. Uterine malformations
Amniotic fluid embolism Sx?
Sudden respiratory failure, seizures, cardiogenic shock, DIC
Immediately postpartum, possibly worrisome symptoms that are actually normal?
Low-grade fever, leukocytosis, vaginal discharge, chills
Patient given epidural for labor – side effect? Mechanism?
Hypotension from Venus pooling
Ideal range for maternal glucose?
Gestational diabetes – Child at increased risk for?
Macrosomia, hypoglycemia, hypocalcemia, polycythemia, respiratory difficulties, heart failure
Contraception can be used postpartum?
Sterilization, barrier methods, IUD, progestin-only
(OCP may decrease milk production and pass into milk)
Patient with cytologic specimens suggesting HSIL – next step? If pregnant?
Colposcopy and biopsy
If not pregnant and colposcopy positive - LEEP excision
If pregnant and Biopsy negative, second biopsy six weeks after delivery
Preferred way to screen for gestational diabetes? If positive?
One hour 50 g glucose tolerance test
1. 75 g oral glucose tolerance test
2. Three hour 100 g oral glucose tolerance test
Gestational diabetes is diagnosed if three hour test values are?
Fasting glucose > 95
One hour glucose >180
Two hour glucose >155
Three-hour glucose >140
hCG doubles until? Alpha versus beta subunits?
Also similar structure to TSH, LH, FSH
Beta subunits unique to HCG
Roles of hCG in pregnancy?
1. Maintenance of corpus luteum
2. Promotion of male sexual differentiation
3. Stimulation of maternal thyroid gland
Down syndrome markers?
Beta hCG high
When to give RhoGAM? When will Standard dose need to be adjusted?
At 28 weeks of first pregnancy and immediately postpartum
Maternal-feel hemorrhage (placental abruption) – will need to increase dose of RhoGAM based on Kleihaur-Betke
Why is Rh incompatibility worse than ABO incompatibility?
Why can ABO incompatibility happen in the first pregnancy?
ABO has fewer IgM antibodies that cross placenta, causing only mild disease
A & B antigens are found in food and bacteria in the environment
Discharge consistent with ovulation?
"Egg white like" thickening
Management after biophysical profile?
6 without oligohydramnios: deliver if greater than 37 weeks (Repeat BPP in 24 hours if less than 37 weeks, and deliver if no improvement)
6 with oligohydramnios – deliver if above 32 weeks (daily monitoring less than 32 weeks)
4 or less – deliver if greater than 26 weeks