OBGyn - Quiz

• Sx: persistent yellow, frothy discharge, external vulvar irritation, no odor, erythematous patches on cervix ("strawberry cervicitis"), 
• Microscope: motile ovoid protozoa with flagella
• Tx:

• Trichomonas
• frothy, yellow-green vaginal discharge with strong odor
• clue cells: characterized by adherent coccobacillary bacteria that obscure the edges of the cells
• Fishy odor: KOH releases amines from the cell

• Yeast vaginitis
• Thick, white clumpy discharge
• Sx: erythema, swelling, intense pruritis

• painful ulcers involving vulva
• fluid filled, open or crusted
• cultures: highly specific, but 10-20% false negative rate

39 weeks

• Neural tube defect
• absence of major portion of brain, skull, and scalp

• 1.4 to 2/1000
• Previous NTD pregnancy: 3-4%

• Second trimester:
• -1 to 2% risk of amniotic fluid leakage
• -0.5% fetal loss rate
• -transient transvaginal spotting
• -0.1% risk of chorioamnionitis
• -rare risk of cell culture failure

Performed at GA <9 weeks: fetal limb reduction defects

• Tetracycline: contraindicated in all three trimesters
• Skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, fatal maternal liver decompensation

• Kernicterus in the newborn (billirubin-induced brain dysfunction)
• Contraindicated during the last 2 to 6 weeks of pregnancy

prolonged tx of TB in pregnancy, streptomycin has been associated with fetal hearing loss

• Gray baby syndrome: infants can't metabolize the drug
• toxic levels reached by day 4, can lead to death within 1 to 2 days

• 1 set per 250 births
• unaffected by race, heredity, age, parity, or infertility agents
• Division after formation of embryonic disk will result in conjoined twins
• 20 to 30% have dichorionic placentation

dichorionic and diamniotic, regardleses of the sex of the twins

• Frequency in singletons: 0.7 to 0.8%
• frequency in abortuses: 2.5%
• Frequency in twins: 5%
• Increased incidence in newborns of diabetic mothers
• White > blacks (2:1)

• fetal vessels cross the internal oss
• Increases risk of rupture of membranes to be accompanied by rupture of a fetal vessel, leading to exsanguination

• Normal!
• Tends to be greater on the right side (due to dextrorotation of the uterus)

• Trace glucosuria: 1 in 6 women
• Trace protein: common in normal pregnancies
• Abnormal: WBCs and blood (infection)

• Often physiologic
• increased tidal lung volume
• increased minute ventilation
• systolic ejection murmur = increased blood flow across the aortic and pulmonic valves

one or more smaller accessory lobes that develop in the membranes at a distance from the main placenta

Rare anomaly where the central portion of the placenta is a rare anomaly where the central portion of the placenta is missing

• All fetal membranes are covered by villi
• Placenta develops as a thin membranous structure

• The shortest distance between the sacral promontory and the symphysis pubis
• Generally measures 10.5 cm

Distance from the lower margin of the symphysis to the sacral promontory

From the top of the symphysis to the sacral promontory

• Transverse measurement of the midplane
• generally the smallest diameter of the plevis

• classic female pelvis
• Posterior sagittal diameter of the inlet only slightly shorter than the anterior sagittal diameter

• posterior sagittal diameter at the inlet is much shorter than the anterior sagital diameter
• Limits the use of the posterior space by the fetal head

• Anteroposterior (AP) diameter of the inlet is greater than the transverse diameter
• Oval with large sacrosciatic notches and convergent side walls

• flattened with a short AP and wide trnasverse diameter
• Wide sacrosciatic notches are common

Seen in : Rh-isoimmunized fetuses, normal fetuses, associated with maternal medication

• episodes of brief and acute hypoxia in the previously normally oxygenated fetus
• Seen during labor; not before

• Lecithin/sphingomyelin ratio of 2.0:1
• ratio is close to 1 until ~34 weeks
• ratio is predictive of RDS risk

worrysome: fetal status is deteriorating

• FHR monitoring (nonstress testing)
• amniotic fluid volume:single vertical pocket exceding 2cm
• fetal breathing: one or more episode of fetal breathing movements of 30s or more within 30 min
• fetal body movements: three or more discrete body or limb movements within 30 min
• fetal body tones: one or more episode of extension of fetal extremity with return to flexion, or opening or closing of hand
• Scoring: each gets 0 to 2; normal is 8 to 10, score less than 4 promps delivery
• False-negative rate: 0.1%
• False-positive rate: relatively frequent
• Bad signs: oligohydramnios, spontaneous decelerations

• Daily increase of 300kcal is recommended
• Total weight gain: 25 to 35 lb
• T2-T3: normal weight gain is about 1lb/week

• sharp, exacerbated by movement and exercise
• due to stretching of the ligaments from the gravid uterus
• Right side > left (dextrorotation)
• Tx: local heat and analgesics

• fetus with breech presentation is manipulated through the abdominal wall
• If not performed, 80% will remain breach
• Success rate: 60%, better if unengaged breech and normal AFI

• Dilation, effacement, station, consistency, position
• more points, more favorable
• Favorable position: anterior

BPP testing

• Admit to hospital for cervical ripening and induction of labor
• Oligohydramnios at term should be delivered

Cesarean section (emergent)

Nonstress test

+ 1 year, minus 3 months, + 7 days

vaginal delivery + postpartum tubal has less risk

• Donor twin: always anemic, due to direct transfer of blood to the recipient
• Recipient twin: polycythemic; may also suffer thromboses secondary to hypertransfusion and subsequent hemoconcentration
• Donor placenta: pale, atrophied
• Recipient placenta: congested and enlarged
• Hydramnios can develop in either twin, but is more frequent in the recipient

• Dx: presence of painless cervical dilation with a h/o pregnancy loss in the second trimester or early-third-trimester preterm delivery 
• Cerclage: 3 or more of the above. NOT for first trimester losses
• Cervical length <25mm or funneling of more than 25% or both is associated with increased risk of preterm delivery

expulsion of all fetal and placental tissue from the uterine cavity

Passage of some but not all placental tissue through the cervix

Uterine bleeding without any cervical dilation

Fetal death without expulsion of any fetal or maternal tissue for at least 8 weeks

Uterine bleeding with cervical dilation without passage of tisseu

• BP >140/90 after 20 weeks GA in women with previously normal BP
• Proteinuria: >300mg on 24hr urine
• Severe preeclampsia: >160/110, proteinuria >5g or 3+, oliguria of <500ml in 24hr, cerebral or visual disturbances, pulmonary edema or cyanosis, RUQ pain, impaired liver function, thrombocytopenia, fetal growth restriction

• Previous pre-eclamptic pregnancies
• Chronic HTN
• Pregestational DM
• Mulitfetal gestations
• Vascular or CT disease
• Nephropathy
• Antiphospholipid syndrome
• obesity
• older age
• AA race

• stabilize
• Magnesium - prevent further seizures
• anti-hypertensives
• deliver in timely fashion

• Vaginal bleeding, enlarged-for-dates uterus
• other sx: hypertension, proteinuria, hyperthyroidism

• D&C (if incomplete abortion)
• weekly hCG titers
• check for metastatic disease

• Used if levels of hCG remain elevated 8 weeks after evacuation
• 50% of pts who have persistently high hCG will develop malignant sequelae
• metastases: need to use combination chemotherapy

• Removal of fluid from the pelvic cavity via ultrasound guided needle (?)
• Uses: confirm ruptured tubal pregnancy accompanied by hemoperitoneum (as long as it has not clotted)

• can be done via laparoscopic surgery
• parallel incision in the tube, removing the ectopic pregnancy

• often done via laparotomy (or mini laparotomy)
• Removal of tube, or portion of tube that has the pregnancy

• Pelvic inflammatory disease (previous)
• operative procedures on the fallopian tubes
• tubal sterilization (fulgaration > clips, rings)
• DES exposure
• induction of ovulation
• IUD use

• intractable vomiting of pregnancy associated with disturbed nutrition:
• weight loss
• ketonuria
• electrolye abnormalities (potassium depletion)
• Jaundice (later finding)

• parenteral fluids and electrolytes
• sedation
• rest, vitamins, antiemetics

• #1: Antibiotics
• steroids, tocolytics... not helpful when delivery is imminent

• presence of maternal fever, tachycardia, uterine tenderness
• leukocyte counts are nonspecific

• ultrasound, to determine placental location
• Digital exam after the placenta is shown to not be previa

• Risk: teratogenic
• 1st trimester infection: 80% risk to fetus
• 2nd trimester infection: 25% by the end

• Pregnant: Spectinomycin, erythromycin
• Non-pregnant: ceftriaxone 250mg IM + Azithromycin 1g PO or Doxycycline 100mg PO BID x 7 days

Protozoal infection caused by toxoplasma gondii results from ingestion undercooked or raw meat

• Incidence is unchanged: 1 in 2000
• Dx is more difficult: leukocytosis, nausea, vomiting are common in pregnancy

• Prevalence: 2 to 12%
• Higher incidence in black multips with sickle cell trait
• 20 to 40% of women with ASB develop an acute infection during that pregnancy

• Ampicillin and cephalosporins
• Avoid: sulfonamides (disrupt albumin binding to bilirubin), Nitrofurantoin (nausea), tetracyclines (dental staining in the fetus)

• 90% have systolic ejection murmurs
• 20% have soft diastolic murmur

• Pruritic urticarial papules and plaques of pregnancy
• more common in nulliparous women
• T2 and T3
• -Erythematous papules and plaques that are intensely pruritic
• presentation: abdomen first, buttocks, thighs, extremities, sparing the face

• incidence of major malformations in women with DM: 5 to 10%
• Cardiac: 38% (VSD, etc.)
• MSK: 15%
• CNS: 10%