Obstetrics

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pszurnicki
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208367
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Obstetrics
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2013-03-22 15:49:25
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Obstetrics
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Obstetrics
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  1. definition of embryo?
    fetus?
    infant?
    • up to 8 weeks
    • 8weeks to birth
    • birth to one year old
  2. how do you estimate the date of delivery?
    LMP - 3 months +7 days
  3. difference between developmental age and gestational age?
    • developmental age is time since fertilization
    • gestational age is time since LMP
  4. how many weeks is a term fetus?
    38-42
  5. what is the first physical sign of pregnancy?
    softening of cervix at 4 weeks
  6. at how many weeks o what level of beta hcg, can ultrasound detect an intrauterine pregnancy?
    5 weeks or 1000
  7. enlarged nuchal transulency is seen in what ?
    down syndrome
  8. when are fetal heart sounds heard?
    at the end of 1st trimester
  9. what is hte most accurate way of establishing gestational age?
    ultrasound
  10. what is screened for in 1st trimester?
    • nuchal translucency via ultrasound
    • karyotype/genetic diseases via Chorionic v. sampling
  11. when is chorionic villi sampling done?
    amniocentesis?

    amniocentesis
    chorionic vi. sampling-12 weeks

    amniocentesis---15 weeks
  12. after how many weeks are visits to the ob every week?
    after 36 weeks
  13. what kind of contractions occur in 3rd trimester?
    braxton hicks contractions
  14. what should you do with continued braxton hicks contractions?
    check the cervix
  15. what needs to be given with iron supplements?
    stool softeners--docusate
  16. what 3 tests are done in 3rd trimester?
    • 1-cbc--anemia if present give oral iron
    • 2-glucose load if above 140 give glucose tolerance
    • 3- cervical cultures for chlamydia and gbs
  17. how is glucose load testing done and what is the management if the levels are high?
    • glucose load--50 mg whether fasting or not,  check at 1 hour if >140
    • then give 100mg while fasting and check at 1, 2, 3 hrs
  18. when is fetal blood sampling done
    • need fetus' cbc
    • rh isoimmunization
  19. diagnostic tests for ectopic pregnancy?
    • beta hcg
    • ultrasound
    • laparoscopy
  20. how is ectopic pregnancy managed?
    if pt is stable and ectopic intact-mtx--observe for 15% drop in beta hcg--if not present--give another dose of mtx..if it fails..surgery

    • if ectopic is rupture--surgery
    • if ectopic is ruptured and pt is unstable--stablizize pt and then surgery
  21. exclusion criteria for mtx for ectopic?
    • pt completed their families
    • ectopic larger than 3.5
    • liver disease
    • pt is non compliant
    • fetal heart beats
    • immunodeficiency
  22. what is the procedure called for surgery for an ectopic?
    • salpingostomy--cut in the fallopian tube
    • salpingectomy-- removal of fallopian tube
  23. when do spontaneous abortions take place, how many weeks?
    before 20 weeks
  24. most common cause of spontaneous abortions?
    chromosomal abnormalities
  25. how does each of the following abortions present on ultrasound? rx?
    1-complete
    2-incomplete
    3-inevitable
    4-threatened abortion
    5-missed abortion
    6-septic abortion
    • 1-no products of conception-follow up in office
    • 2-some products of conception -d/c
    • 3-products of conception present but dilated cervix with intrauterine bleeding-d/c
    • 4- products of conception present, intrauterine bleeding but no dilated cervix- rest
    • 5- death of fetus but all products of conception in the uterus - d/c
    • 6-infection of uterus and the surrounding areas- d/c and antibiotics
  26. during what procedures should mothers receive  anti- D Rh ig?
    salpigectomy and during d/c
  27. how do multiple gestations present?
    • rapid growth
    • high beta hcg and maternal fetal protein than expected
  28. how is preterm labor defined? during what time
    premature rupture of membranes?
    • combinations of contractions and cervical dilation
    • between 20-37 weeks
    • blood loss
  29. diagnosis of multiple gestations?
    multiple fetuses on on ultrasound
  30. when should you deliver a preterm baby?
    • pre ecclampsia, ecclampsia
    • fetal death
    • maternal hemorrhage
    • maternal cardiac dz
    • cervix dilation >4cm
    • chorioamnionitis
  31. what 2 conditions dictate stopping premature labor?
    • weight <2500grams
    • 24-33 EGA
  32. how is preterm labor stopped?
    • tocolytics
    • bethamethasone
  33. how do you check for magnesium toxicity?
    deep tendon reflexes
  34. what is the most commonly used tocolytic?
    magnesium
  35. 2 tocolytics?
    • magnesium
    • ccb
  36. which tocolytics is not an answer?
    indomethacin
  37. management of premature rupture of of the membranes?
    • if preterm and no chorioamniotitis--amp/gent with tocolytic, steroids
    • if term and no chorioamniotis--wait 6 to 12 hours and deliver
    • if term and chorioamnionitis--deliver now
  38. 4 complications of premature rupture of the membranes?
    • cord prolapse
    • premature labor
    • chorioamnionitis
    • placental abruption
  39. placenta previa?
    placenta over the internal cervical os
  40. next step in management of painless vaginal bleeding in a 32 week ga?
    transdominal ultrasound to rule out placenta previa
  41. digital vaginal exam in not done in what trimester?
    3rd
  42. what allows for diagnosis of premature rupture of membrane
    • gush of fluid
    • amniotic fluid examination--ferning pattern
  43. placental vasa previa is what?
    fetal blood vessels lying over the internal cervical os
  44. rx for placenta previa?
    when do you do immediate cesearean section for it?
    pelvic rest

    • c section if cervix >4cm
    • severe hemorrhage
    • fetal distress
  45. 3 types of placental invasion?
    • acreta--attaches to superficial uterine wall
    • increta-uterine myometrium
    • percreta--uterine serosa, bladder and rectum wall
  46. causes of placental abruption?
    • trauma
    • hypertension
    • cocaine use
    • prior abruption
  47. placenta previa vs placental abruption presentation?
    • previa--painless bleeding
    • abruption--painful bleeding
  48. 2 types of placental abruption?
    concealed--placenta is most likely detached and complications are severe

    extenal--placenta is semi detached and complications are minimal
  49. risk factors or uterine rupture?
    • previoius c sections--
    • 1- longitudinal
    • 2-low transverse
    • trauma
    • large baby
    • polyhydramnios
    • placenta percreta
  50. rx for uterine rupture?
    laparatomy and delivery..no c section
  51. erythroblastosis fetalis is cuased by?
    rh incompatibility
  52. gestational hypertension vs preecclampsia?
    • gestations htn is htn without proteinuria or edema
    • it starts after 20 weeks of gestation
  53. rx for chronic htn, gestational htn?
    • labetalol
    • alpha methyl dopa
    • nifedipine
    • hydralazine
  54. rx for  mild precclampsia in the following situation?
    term?
    preterm?
    severe precclampsia?
    • delivery
    • betamethasone and mgso4 for prophylaxis

    severe--mgso4 for prophylaxis, hydralazine
  55. ecclampsia presents with what?
    tonic-clonic seizures
  56. what is HELLP syndrome?
    rx?
    • hemolysis
    • elevated liver enzymes
    • low platelets

    mg and hydralazine
  57. rx of pregestational diabetes mellitus?
    • type 1--insulin pump
    • type 2--subQ insulin
  58. what other tests are done for diabetics who are pregnant?
    • ekg
    • 24 creatinine/protein
    • HbA1c
    • EYE exam
  59. are mothers with gestational diabetes more likely to develop diabetes?
    yes
  60. when is gestational diabetes screened for?
    • 3rd trimester-- 
    • 24 weeks
    • 28 weeks
  61. rx for gestational diabetes?
    diabetic diet and exercise

    no weight loss
  62. what kind of tests are done from 32 week to 38? if the patients are put on insulin
    32-36 non stress tests and ultrasound weekly

    • >36 twice a week non stress tests and biophysical profile
    • 37 weeks L/S ratio
  63. criteria for IUGR?
    infants weigh in the bottom 10%
  64. when does symmetric IUGR occur?
    NOn symmetric?
    • before 20 weeks
    • after 20 weeks
  65. rx for macrosomia?
    • induce labor if lungs are mature and fetus is <4500grams
    • if fetus is >4500 grams, c section
  66. what is a reactive nonstress test?
    • 2 fetal movements
    •  hr increased by 15bpm for 15mins
  67. biophysical profile consists of?
    • NST
    • feta chest expansions
    • fetal movement
    • fetaml muscle tone
    • amniotic fluid index
  68. what is normal fetal heart rate during labor?
    brady?
    tachy?
    • brady <110
    • normal 110-160
    • Tachy >160
  69. what is the normal  hr acceleration during labor?
    hr increases by 15 beats for 15 seconds
  70. how many  Stages of Labor are there?
    3 stages
  71. what happens during the 3 stages of labor?
    • 1st stage--onset of labor to full dilation of cervix
    • 2nd stage--full dilation of cervix to delivery 
    • 3rd stage-delivery of baby to delivery of placenta
  72. signs of placental separation
    • umbilical cord lengthening
    • fresh bleeding
    • uterine fundus rising
    • uterus becoming firm
  73. how is induction of labor done?
    • prostoglandin
    • oxytoxin
    • puncture of the amniotic sac
  74. in what pts you shouldnt give prostaglandin to induce labor?
    asthmatic patients
  75. what is an arrest of cervical dilation?
    when the cervix does not dilate for 2 hours
  76. what is prolonged latent stage?
    in stage one when the cervix takes more than 20 hours to dilate 4 cm
  77. rx for prolonged latent stage?
    rest and hydration..labor progresses spontaneously
  78. what is protracted cervical dilation?
    slow dilation of the active stage of stage 1
  79. etiology of protracted cervical dilation?
    • power
    • passenger
    • passage
  80. rx for protracted cervical dilation?
    • c section 
    • oxytocin
  81. what is arrest of cervical dilation?
    • no dilation for 2 hours
    • no fetal descent for 1 hour
  82. rx for arrest of cervical dilation?
    c section
  83. how is a breech diagnosed?
    ultrasound
  84. 3 types of breech?
    • frank
    • complete
    • footling
  85. what are the maneuvers in order to deliver a baby taht is at risk for shoulder dystocia?
    • McRoberts maneuver
    • Rubin
    • woods
    • Delivery of posterior arm
    • deliberate fracture of fetal clavicle
    • Zavanelli Maneuver
  86. how much blood is lost in a post partum hemorrhage?
    500mL
  87. rx for postpartum hemorrgae?
    • compression and massage
    • oxytocin
  88. what is the work up of rh incompatibility?
    • screen at 15 weeks
    • if no antibodies, repeat at 28 weeks and if still negative give anti-D Rh IV

    if positive at 15 weeks, titer, if titer is bigger than 1:16, do amnio and see if fetal cells rh negative, if they are..normal pregnancy

    if fetal cells rh positive, look at bilirubin, if low, repeat amnio, if high, take blood sample and see hct and if low transfuse
  89. teratogens cause abnormalities when?
    between 2 adn 12 weeks
  90. Chadwick sign?
    bluish discoloration of vagina
  91. hegar sign
    softening of the lower uterus
  92. what causes glucose intolerance in pregnancy?
    human placental lactogen
  93. when should a woman not have sex in pregnancy?
    • recurrent uti
    • placenta previa
    • history of spontaneous abortions
  94. what seizure meds interrupt folate metabolism
    • valproate
    • carbamezapine
  95. what are the levels of afp, estriol, beta hcg and inhibin a?
    in down syndrome
    edwards
    turners?
    down--afp and estriol are down, beta hcg and inhibin are up

    • edwards---everything is down except inhibin
    • turner--just like down syndorm
  96. low maternal papp-a is associated with what?
    trisomy 21 and 18
  97. when is percutaneous umbilical venous sampling done?
    • thrombocytopenia
    • thyroid disorder
    • fetal anemia due to rh incompatibility
  98. vaccines ok in pregnancy?
    not ok in pregnancy?
    • tetanus
    • pneumococcal
    • meningococcal
    • influenza
    • hep a and b
  99. 5 types of lacunar strokes?
    • pure sensory
    • pure motor
    • ataxic hemiparesis
    • dysarthia clumsy hand syndrome
    • sensory motor
  100. rx for cerebral palsy contractures?
    • dantrolene
    • baclofen
    • botox
    • benzos
  101. brain tumors?
    mgm studios
    • metatasis
    • glioblastoma
    • meningioma
    • shwannoma
  102. brain tumors in kids?
    • astrocytoma
    • medulloblastoma
    • epyndymoma
  103. exploration of neck after trauma?
    • zone one--ct angiogram
    • zone two--surgical
    • zone 3--angiogram
  104. most sensitive and specific test for chronic pancreatitis?
    low fecal elastase level
  105. what is a reactive non stress test?
    2 15bpm accelerations of the heart held for 15 seconds in 20 minutes
  106. what makes up the biophysical profile?
    • amniotic fluid index
    • movement
    • breathing
    • tone
  107. what is pathologic, early or late deceleration?
    late deceleration due to placental insufficiency
  108. acidosis in the baby will manifest itself as late or early deceleration?
    late
  109. sinusoidal heart rate means what?
    anemia
  110. cause of fetal tachy?
    • maternal infection
    • chorioamniotis
    • anemia
    • maternal thyrotoxicosis
    • fetal arrythmia
    • terbutaline
  111. when does arrest of labor occur?
    in the active phase >2 hours
  112. what is uterine hyperstimulation?
    5 contractions/10 minutes
  113. when is breast feeding contraindicated?
    • hiv
    • tetracycline
    • chloramphenicol
    • galactoseemia
    • topiramate
    • amiodarone
    • drugs
  114. ocp for lactating woman?
    progesterone
  115. post partum bleeding for vaginal delivey?
    c section?
    • 500ml
    • 1000ml
  116. rx for uterine atony/postpartum hemorrhage?
    • uterine massage
    • oxytocin
    • prostaglandins
    • ergots
  117. rx for postpartum hemorrhage if hypertensive?
    prostaglandin
  118. reasons for vertical incision for c section?
    • transverse lie
    • adhesions or fibroids
    • hysterectomy planned
    • cervical cancer
    • postmortem delivery
  119. when is c section done? for mother
    for infant
    • placenta previa
    • ecclampsia
    • prior uterine surgery
    • cardiac disease
    • cervical death
    • herpes
    • maternal death
    • for infant:
    • acute fetal distress
    • malpresentation
    • cord prolapse
    • macrosomia
    • failel labor progression
    • abruptio placenta
    • cephalopelvic disproportion
  120. adverse events after a vbac?
    • uterine ruprue1/100
    • baby or mother death 1/1000
  121. rx for post partum endometritis?
    amp and gent
  122. mx of breech baby after 36 weeks?
    extenral cephalic version
  123. arrest of descent?
    > hours in stage 2

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