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  1. When is the placenta formed
    7-10 weeks
  2. Progesterone coming from the corpus luteum accomplishes what
    Keeps the endometrium in a receptive state (keeps it ready for implantation)
  3. High prolactin will shut down __ axis
    Ovarian
  4. If FSH is high it is __ failure
    Ovarian
  5. What is the most common reason a woman might not be ovulating
    PCOS
  6. Two out of three findings are needed for the diagnosis of PCOS. What are the three findings
    Oligo- and or anovulation, hyperandrogenism, US with polycystic ovaries
  7. How do oral medications such as Clomid and tamoxifen stimulate ovulation
    They trick the brain into thinking there is no estrogen in the body so it stimulates the ovaries into producing more
  8. As egg number decreases, there is less feedback from the ovaries, which causes a rise in __
    FSH
  9. As FSH levels increase, likelihood of pregnancy __
    Decreases
  10. What is an HSG
    Hysterosalpingogram (tests for tubal patency)
  11. Why would you do a laparoscopy for an infertile woman
    Abnormalities on HSG, pelvic pain, high suspicion for endometriosis
  12. What affect do most vaginal lubricants have on sperm motility
    Decreased
  13. Where does spermatogenesis take place
    Seminiferous tubules
  14. How many days prior to semen analysis does the man need to stay abstinent
    2-5 days
  15. How soon should the semen sample make it to the lab for analysis
    Within 1 hour
  16. Infertility & Endometriosis: Possible mechanisms
    Distorted pelvic anatomy; Altered peritoneal fn (peritoneal fluid tox to sperm, embryos); Altered hormonal & cell-mediated fn; Endocrine/ ovulatory abnormalities; impaired implantation
  17. What are the two systems that continue to develop throughout pregnancy
    Brain and genitalia
  18. A union between individuals who are related
    Consanguinity
  19. Consanguinity increases the risk for __ disorders
    Autosomal recessive
  20. As a general rule everyone carries __ autosomal recessive genes
    5-7
  21. What is First trimester screening or “Nuchal Translucency Screening”
    Ultrasound measurements of the nuchal translucency obtained 10-13 6/7 gestational weeks. Designed to identify fetuses at risk for Down syndrome, trisomy 13 and trisomy 18
  22. What does CVS stand for
    chorionic villus sampling, basically a biopsy of placental tissue
  23. Ultrasound can identify __% of babies with Down syndrome
    50
  24. Ultrasound cannot __ all chromosome conditions or birth defects
    Rule out
  25. Ultrasound an identify __% of babies with any chromosome condition, although those that are detected tend to be the most severe
    30
  26. A fluid collection in 3 or more body parts
    Hydrops
  27. The earlier a spontaneous abortion occurs the more likely it was due to __
    A chromosomal abnormality
  28. What are the three most common trisomic conditions seen in living individuals
    Trisomy 13,18 and 21
  29. What is the most frequent abnormality related to a chromosome abnormality
    Down syndrome
  30. What is the most common type of Down syndrome
    Trisomy 21
  31. There is a positive correlation with the frequency of Down syndrome and __
    Maternal age
  32. Babies with Down syndrome are more often born to __ mothers
    Teenage, and over 35
  33. What is the incidence of babies born with Down syndrome to mothers over the age of 45
    1 in 40 deliveries
  34. What is the incidence of babies born with Down syndrome to mothers over the age of 40
    1 in 100 deliveries
  35. What is the incidence of babies born with Down syndrome in the general population
    1 in 600 deliveries
  36. What are some examples of neural tube defects
    Anencephaly, spina bifida, and meningomyelocele
  37. If a couple has a child with a neural tube defect what is the chance that they will have another child affected with the disease. What if they had 2 children affected with the disease
    2-5%, 10% respectively
  38. __ screening detects about 85% of all open NTD, and 90% of all anencephalic infants, however it does not detect closed forms of NTDs
    Maternal serum AFP
  39. When is amniocentesis generally carried out
    15-17 weeks
  40. What is the underlying risk of amniocentesis when performed at 15 weeks of gestation and beyond
    Increased risk of miscarriage
  41. How long does the process of karyotyping take place
    10-14 days
  42. If 1 parent is affected by an autosomal dominant disorder what are the chances that the child will be affected
    1 in 2
  43. If both parents are affected by an autosomal recessive disorder what is the chance the child will be affected, what is the chance that the child will be a carrier
    1 in 4 of being affected, 1 in 2 of being a carrier
  44. Nuchal translucency, measured between 11 and 13 6/7 weeks, combined with free b-hcg, and pregnancy associated plasma protein A levels has been found to have 87% sensitivity for detection of __
    Trisomy 21
  45. In the absence of chromosomal abnormalities an increased nuchal translucency is associeated with an increased risk of __
    Structural cardiac abnormalities and skeletal dysplasia
  46. What is included in the maternal serum analyte testing (triple screen)
    Maternal serum alpha-fetoprotein, beta hCG, and estriol
  47. What is added to the triple screen to make it the quad screen in some institutions
    Inhibin
  48. To which populations should screening for sickle cell disease be offered
    Individuals of African/African American descent, those from the Mediterranean basin, the middle east, and India
  49. What is the definitive test to determine the carrier status of sickle cell disease
    Hemoglobin electrophoresis
  50. What two groups have the highest rates of cystic fibrosis
    Caucasians and Ashkenazi jews
  51. What type of information does a standard US examination provide
    Fetal number, presentation, documentation of viability, gestational age, amniotic volume, placental location, fetal biometry, and an anatomic survey
  52. When is a specialized US exam performed
    When an anomaly is suspected based on history, biochemical abnormalities, or results of either the limited or standard scan
  53. When is the typical fetal anatomic survey performed
    17-20 weeks
  54. When is amniocentesis often performed
    15-20 weeks
  55. What is the risk of abortion as a result of amniocentesis
    1 in 200 to 1 in 450
  56. When is chorionic villus sampling performed
    10-12 weeks
  57. What is the benefit of CVS over amniocentesis
    Its availability earlier in pregnancy
  58. What are some disadvantages of CVS over amniocentesis
    Higher rate of abortion, does not allow diagnosis of neural tube defects
  59. What does PUBS stand for
    Percutaneous umbilical blood sampling
  60. What are some benefits of PUBS
    Rapid result turnaround and the ability to perform the procedure in the second and third trimesters
  61. Fetal movements associated with __ provide reassurance that the fetus is not acidotic or neurologically depressed
    Accelerations of fetal heart rate
  62. A reactive and therefore reassuring non-stress test is defined as
    2 or more FHR accelerations, at least 15 bpm above baseline and lasting at least 15 seconds within a 20 min period
  63. What are high levels of maternal serum AFP associated with
    Open neural tube defects
  64. __ levels in amniotic fluid appear to be more specific than the AFP test in predicting neural tube defects
    Acetylcholinesterase
  65. Low levels of AFP in conjunction with estriol and comparatively high levels of hCG have been shoen to be predictive for __
    Down syndrome
  66. __ is the most common congenital cause of severe mental retardation with an incidence of about 1.3 per 1000 live births
    Down syndrome
  67. What is the most common consideration in selecting women for diagnostic amniocentesis
    Advanced maternal age
  68. After __ weeks both amniotic fluid and maternal plasma volume decrease
    38
  69. If a young female patient is hypertensive and having a seizure she is __ until proven otherwise
    Preeclamptic
  70. Hypertension with proteinuria and or pathologic edema
    Preeclampsia
  71. Hypertension without proteinuria or pathologic edema during pregnancy
    Pregnancy induced hypertension
  72. Hypertension with proteinuria and or pathologic edema with convulsions
    Eclampsia
  73. Signs and symptoms of preeclampsia
    HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria
  74. What does HELLP stand for
    Hemolysis, Elevated Liver enzymes, Low Platelets
  75. Primary symptom of HELLP syndrome
    Malaise, fatigue
  76. Classic presentation of HELLP syndrome
    Malaise/fatigue, N/V, HA, RUQ pain, severe elevated BP, 3+ protein/85% of the time
  77. Partial or complete detachment of placenta from uterine wall, after 20 weeks gestation
    Abruptio Placenta
  78. What are some risk factors of abruptio placenta
    Cocaine use, maternal hypertension, trauma
  79. Placenta previa is __ bleeding
    Painless/silent
  80. Placenta abruption is __ bleeding
    painful
  81. When do you screen with 1 hour glucose
    At 24-28 weeks in patients >25 or family history of DM or Ethnic risk
  82. Risk factors for GDM
    > 25 years, prior GDM/family hx, prior big baby/still birth, BMI greater than or equal to 27, chronic hypertension, glycosuria
  83. What is the biggest complication of GDM
    Big babies that don’t want to come out (macrosomia/shoulder dystocia)
  84. What are the birth traumas associated with macrosomia
    Brachial plexus injury, clavicular injury, facial nerve injury
  85. Risk factors for fetal growth restriction
    CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition
  86. __% of women are GBS vaginal/rectal colonized
    10-30%
  87. What is the most common cause of neonatal sepsis
    GBS
  88. GBS bacteruria indicates
    Heavy colonization
  89. What is something you see in babies born to mothers on AZT for HIV
    Lower white counts and macrocytic anemia (will resolve over time)
  90. What is the average volume of amniotic fluid at term
    800mL
  91. How is oligohydramnios determined
    Identification of the largest pocket of fluid measuring less than 2cmx 2cm or the total of 4 quadrants less than 5 cm
  92. What is oligohydramnios associated with
    SGA fetus, renal tract abnormalities (renal agenesis), and urinary tract dysplasia
  93. The clinical manifestation of oligohydramnios is a direct result of __
    The impairment of urine flow ot the amniotic fluid in the late part of the first half of pregnancy or during the second and third trimesters
  94. Infants in the __ percentile are classified as having intrauterine growth restriction (IUGR)
    < or =10th
  95. Infants in the __ percentile are classified as large for gestational age (LGA)
    > or = 90th
  96. Both IUGR and LGA fetuses have increased risk for __
    Perinatal morbidity and mortality
  97. A pregnancy cannot be described as IUGR unless what is known with certainty
    Gestational age
  98. What does symmetric IUGR refer to
    Infants in which all organs are decreased proportionally
  99. Symmetric IUGR infants are more likely to have __
    An endogenous defect that results in impairment of early fetal cellular hyperplasia
  100. What does asymmetric IUGR refer to
    Infants in which all organs are decreased disproportionately (abdominal circumference is affected to a greater degree than head circumference)
  101. Asymmetric IUGR infants are more likely caused by __
    Intrauterine deprivation that results in redistribution of flow to the brain and heart at the expense of less important organs such as the liver and kidneys
  102. An infant with an autosomal __ is more likely to be IUGR
    Trisomal
  103. What is the most common autosomal trisomy and what is the rate
    Trisomy 21 (Down syndrome) 1 in 600 live births
  104. What is the second most common autosomal trisomy and what is the rate
    Trisomy 18 (Edward’s syndrome) 1 in 6000-8000 live births
  105. Turner’s syndrome is associated with an average birthweight of approximately __ below average
    400g
  106. Fetuses with neural tube defects are frequently
    IUGR weighing approximately 250g less than controls
  107. Chronic intrauterine infection is responsible for __% of IUGR pregnancies
    5-10
  108. What is the most commonly identified pathogen responsible for IUGR
    CMV
  109. What is the most common protozoan, acquired by eating raw meat, that is responsible for IUGR
    Toxoplasma gondii
  110. Bacterial infections occur commonly in pregnancy and frequently are implicated in premature delivery, however they are not commonly associated with IUGR. The exception to this rule is chronic infection with __
    Listeria monocytogenes
  111. What is the clinical picture of an infant born to a mother infected with chronic listeria monocytogenes
    Critically ill, encephalitis, pneumonitis, myocarditis, hepatosplenomegaly, jaundice, and petechiae
  112. Multiple gestation is associated with a __% increased incidence of IUGR fetuses
    20-30
  113. What is the most common maternal complication causing IUGR
    Hypertension
  114. Women who stop smoking before __ weeks gestation are not at increased risk for having an IUGR infant
    16
  115. Poor maternal wt gain is associated with an increased risk of having an IUGR infant. Daily intake must be reduced to less than __kcal/d before a measurable effect on birthweight becomes evident
    1500
  116. What are some vascular diseases that are risk factors for having an IUGR infant
    Collagen vascular disease, insulin-dependent diabetes mellitus associated with microvasculopathy and preeclampsia
  117. What is the best parameter for early dating of pregnancy on ultra sound
    Crown-rump length
  118. What are the most accurate parameters for dating of pregnancy in the second trimester
    Biparietal diameter, and HC
  119. what is the most accurate parameter for dating of pregnancy in the third trimester
    Head circumference
  120. What is the single most common preventable cause of IUGR in infants in the US
    Smoking
  121. Data shows that IUGR infants appear to catch up in weight in the first __ of life
    6 months
  122. Taken as a group IUGR infants have more __ than do their AGA peers
    Neurologic and intellectual deficits
  123. The incidence of __ is increased in IUGR infants
    Sudden infant death syndrome
  124. In the second half of pregnancy, increased concentrations of __ combine to produce modest maternal insulin resistance which is countered by postprandial hyperinsulinemia
  125. Human placental lactogen, free and total cortisol, and prolactin
    • Maternal obesity is associated with a __ increased likelihood of fetal macrosomia
    • 3-4 fold
  126. Male fetuses are __g heavier on average than female fetuses
    150
  127. What is the best single measure in evaluating macrosomia by ultrasound in diabetic mothers
    Abdominal circumference
  128. Estimated fetal wt. by __ is not very accurate
    Ultrasound
  129. What is the most common medical complication of pregnancy
    Diabetes mellitus
  130. Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies
    1-3
  131. Defined as any degree of glucose intolerance with first recognition during pregnancy
    Gestational diabetes
  132. GDM complicates __% of pregnancies
    4
  133. Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years
    50
  134. __ is the hormone mainly responsible for insulin resistance and lipolysis. It is similar in structure to growth hormone and acts by reducing the insulin affinity to insulin receptors
    Human placental lactogen
  135. H A1C can predict the risk for __ when measured in the first trimester
    Malformation
  136. Higher glucose level in mothers lead to higher glucose levels in the fetus. This leads to higher levels of insulin which can cause __ in the fetus
    Macrosomia, central fat deposition, enlargement of internal organs such as the heart
  137. What are risk factors for developing GDM
    Obesity, prior hx of GDM, heavy glycosuria, unexplained stillbirth, prior infant with major malformation, family hx of DM in first degree relative
  138. When should at risk pregnant women be screened for GDM
    As soon as feasible and again between 24 and 28 weeks
  139. Which women can be omitted for GDM screening
    Age <25, normal body wt, no family hx, no hx of abnormal glucose metabolism/poor OB outcome, and not a member of an ethnic or racial group at high risk
  140. What are the ethnic or racial groups with a high prevalence of diabetes
    Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders
  141. What is the mainstay of treatment in the pregnant women with pregestational diabetes
    Rigorous control of blood glucose
  142. What is an optimal fasting glucose in pregnancy
    70-95
  143. What is an optimal 1-hr postprandial glucose value during pregnancy
    Less than 140
  144. What is an optimal 2-hr postprandial glucose value during pregnancy
    Less than 120
  145. Characterized by the onset of hypertension and proteinuria, usually during the third trimester of pregnancy
    Preeclampsia
  146. Characterized by a history of high blood pressure before pregnancy, elevation of BP during the first half of pregnancy, or high blood pressure that lasts for longer than 12 weeks after delivery
    Chronic hypertension
  147. An ECG may reveal __ in the patient with long-standing hypertension
    Left ventricular hypertrophy
  148. What is mild hypertension
    Systolic >/= 140, diastolic >/=90
  149. What is severe hypertension
    Diastolic >/= 180, diastolic >/=110
  150. what is proteinuria as defined for preeclampsia
    Urinary excretion of >/= 0.3g protein in a 24 hour urine specimen, usually correlates with a finding of 1+ or greater on dipstick
  151. new onset of grand mal seizures in a woman with preeclampsia that cannot be attributed to other causes
    Eclampsia
  152. how is preeclampsia distinguished from gestational hypertension
    There is no proteinuria in gestational hypertension
  153. what are the mainline antihypertensives used during pregnancy
    Methyldopa, labetalol, nifedipine
  154. normal pregnancy is associated with decreased maternal sensitivity to __. This effect leads to expansion of the intravascular space
    Endogenous vasopressors
  155. women destined to develop preeclampsia do not exhibit normal refractoriness to __. As a result normal expansion of the intravascular space does not occur
    Endogenous vasopressors
  156. in addition to the classic findings of hypertension and proteinuria, women with preeclampsia may complain of what other symptoms
    Scotomata, blurred vision, or pain in the epigastrium or right upper quadrant
  157. lab work of patients with preeclampsia will reveal __
    Elevated levels of hematocrit, lactate dehydrogenase, serum transaminase, and uric acid, and thrombocytopenia
  158. in the management of preeclampsia, with few exceptions, maternal interests are best served by __
    Immediate delivery
  159. how are women with mild preeclampsia before 37 weeks managed
    Expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation
  160. severe preeclampsia mandates __
    Hospitalization
  161. in the case of severe preeclampsia delivery is indicated it the gestational age is __ weeks or greater, fetal pulmonary is confirmed, or evidence of deteriorating maternal or fetal status is seen
    34
  162. in the case of severe hypertension what is the goal of antihypertensives
    • Systolic <160 and diastolic <105
    • in the case of severe preeclampsia acute blood pressure control may be achieved with what drugs
  163. Hydralazine, labetalol, or nifedipine
    • in severe preeclampsia between 33 and 35 weeks consideration should be given to __ for pulmonary maturity studies
    • Amniocentesis
  164. loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher
    10
  165. respiratory paralysis may occur at magnesium levels of __ or higher
    15
  166. Increased maternal age is defined as a mother who will be __ years or older on the day of delivery
    35
  167. Why do we worry about increased maternal age
    The risk to have a child with a chromosome condition is increased
  168. Multiple pregnancy losses are defined as __ pregnancy losses
    Three or more
  169. Maternal conditions that may increase the risk of birth defects
    Insulin dependent diabetics, lupus, seizure disorders, substance abuse
  170. An exposure during embryogenesis which has a harmful effect on the developing fetus
    Teratogens
  171. What are the two systems that continue to develop throughout pregnancy
    Brain and genitalia
  172. What is First trimester screening or “Nuchal Translucency Screening”
    Ultrasound measurements of the nuchal translucency obtained 10-13 6/7 gestational weeks. Designed to identify fetuses at risk for Down syndrome, trisomy 13 and trisomy 18
  173. What does CVS stand for
    chorionic villus sampling, basically a biopsy of placental tissue
  174. Ultrasound can identify __% of babies with Down syndrome
    50
  175. Ultrasound cannot __ all chromosome conditions or birth defects
    Rule out
  176. Ultrasound an identify __% of babies with any chromosome condition, although those that are detected tend to be the most severe
    30
  177. A fluid collection in 3 or more body parts
    Hydrops
  178. The earlier a spontaneous abortion occurs the more likely it was due to __
    A chromosomal abnormality
  179. Couples who experience habitual abortion constitute about __% of the population
    0.005
  180. Recurrent pregnancy loss is now defined as __ spontaneous abortions
    2 or more
  181. What are the three most common trisomic conditions seen in living individuals
    Trisomy 13,18 and 21
  182. What is the most frequent abnormality related to a chromosome abnormality
    Down syndrome
  183. What is the most common type of Down syndrome
    Trisomy 21
  184. There is a positive correlation with the frequency of Down syndrome and __
    Maternal age
  185. Babies with Down syndrome are more often born to __ mothers
    Teenage, and over 35
  186. What is the incidence of babies born with Down syndrome to mothers over the age of 45
    1 in 40 deliveries
  187. What is the incidence of babies born with Down syndrome to mothers over the age of 40
    1 in 100 deliveries
  188. What is the incidence of babies born with Down syndrome in the general population
    1 in 600 deliveries
  189. What are some examples of neural tube defects
    Anencephaly, spina bifida, and meningomyelocele
  190. Fetal movements associated with __ provide reassurance that the fetus is not acidotic or neurologically depressed
    Accelerations of fetal heart rate
  191. A reactive and therefore reassuring non-stress test is defined as
    2 or more FHR accelerations, at least 15 bpm above baseline and lasting at least 15 seconds within a 20 min period
  192. What are high levels of maternal serum AFP associated with
    Open neural tube defects
  193. __ levels in amniotic fluid appear to be more specific than the AFP test in predicting neural tube defects
    Acetylcholinesterase
  194. Low levels of AFP in conjunction with estriol and comparatively high levels of hCG have been shoen to be predictive for __
    Down syndrome
  195. __ is the most common congenital cause of severe mental retardation with an incidence of about 1.3 per 1000 live births
    Down syndrome
  196. What is the most common consideration in selecting women for diagnostic amniocentesis
    Advanced maternal age
  197. After __ weeks both amniotic fluid and maternal plasma volume decrease
    38
  198. In a normal pregnancy the hCG doubles every __
    48 hours
  199. Beta-hCG is first detectable in maternal blood __ after conception
    6-8 days
  200. False positive pregnancy tests occur at hCG levels of __mIU/ml
    5-25
  201. If the fetus is lost before 22 weeks it is classified as a __
    Miscarriage
  202. If the fetus is lost after 22 weeks of gestation it is classified as a __
    Stillbirth
  203. What is considered the gestational age of viability
    22 weeks
  204. During pregnancy hemodilution is normal and produces __
    Physiologic Anemia
  205. During pregnancy body water increases by __
    6.5-8.5L (most significant adaptation in PG)
  206. How is the heart affected during pregnancy
    Displaced to the left and upward, increase in left ventricular end diastolic dimension, output is increased by 30-50%
  207. What are some normal changes in pregnancy that may mimic heart disease
    Dyspnea (most common complaint before 20 wks), decreased exercise tolerance/ fatigue/ occasional orthopnea/ chest discomfort, Edema
  208. What happens to nasal mucosa during pregnancy
    It becomes more edematous and erythematous, hypersecretion of mucus
  209. What happens to lung volume during pregnancy
    Decreases by 5%, max volume that can be inhaled increased by 5-10%
  210. What happens to pulmonary function during pregnancy
    Hyperventilation
  211. Pregnancy causes a state of chronic respiratory __
    Alkalosis
  212. The kidneys excrete more __ during pregnancy
    Bicarb
  213. What changes with WBC’s during pregnancy
    Increased by 5,600-12,000
  214. Renal plasma flow __ in pregnancy
    Increases
  215. Because of dilation of the renal pelvis there is an increased incidence of __ in pregnancy
    Pyelonephritis
  216. What happens to appetite during pregnancy
    Increased by about 200 Kcal/day
  217. What happens to the stomach during pregnancy
    Tone and motility decreases, increased GERD
  218. Morning sickness complicates __% of pregnancies
    70
  219. What is the time frame of morning sickness (onset/improvement)
    Onset in 4-8 weeks, improvement by 14-16 weeks
  220. What is the treatment of morning sickness
    Largely supportive (reassurance, avoid triggers, frequent small meals, acupressure/ginger/V B6
  221. What are the skin changes in pregnancy
    Hyperpigmentation, linea alba becomes linea nigra, pigmented nevi/freckles/recent scars
  222. What are the hair changes in pregnancy
    Mild degree of hirsutism
  223. Striae (stretch marks) affect up to __% of pregnant women
    0.9
  224. In the fetus what is the vasculature that bypasses the liver
    Ductus venosus
  225. What is the bypass that allows blood to flow from the right atrium to the left atrium
    Foramen ovale
  226. What is the bridge that allows blood to pass from pulmonary veins to the aorta
    Ductus arteriosus
  227. When does the foramen ovale change to the fossa ovalis
    When the baby takes its first breath, the pressure from the lungs closes the valve
  228. What happens to the ductus venosus and the ductus arteriosus after a child is born
    They become ligaments (ligamentum venosum, ligamentum arteriosum)
  229. The hypervolemia of pregnancy compensates for maternal blood loss at delivery, which averages __ml for vaginal and __ml for c-section
    500-600, 1000
  230. With uterine enlargement and diaphragmatic elevation, the heart rotates on its long axis in left upward displacement. As a result the apical beat shifts __
    Laterally
  231. if hCG results uncertain, repeat test in:
    2 days
  232. very high hCG levels seen in:
    molar PG (gestational trophoblastic disease)
  233. Not normal symptoms (re: heart)
    syncope, chest pain with exertion, progressive orthopnea, and hemoptysis
  234. Physiologic process by which a fetus is expelled from the uterus
    Labor
  235. Defined as an increase in myometrial contractility resulting in effacement and dilation of the uterine cervix
    Labor
  236. What are the two major functions of contractions during labor
    To dilate the cervix, to push the fetus through the birth canal
  237. What are the three mechanical variables during delivery known as the three P’s
    the powers, the passenger, and the passage
  238. One of the three P’s it is the force generated by uterine musculature
    Powers
  239. What does an external tocodynamometer measure
    Number of contractions in an average 10 minute window, intensity, and duration of contractions
  240. What is the most precise method of measuring contractions
    Intrauterine pressure monitoring via internal pressure transducers (IUPC)
  241. What is classically considered to be adequate labor
    3-5 contractions in 10 minutes, however there is no consensus for criteria
  242. Macrosomia is considered to be an infant over __
    4,500 g
  243. What is the lie of the fetus
    The longitudinal axis of the fetus to the uterus
  244. What are the different presentations of the fetus
    vertex, breech, shoulder, compound
  245. What does the station of the fetus mean
    A measurement of descent through the birth canal
  246. How often are breech presentations found in term pregnancies
    3-4%
  247. External cephalic version is routinely done after __ weeks
    36
  248. What landmarks designate 0 station for the fetus
    Ischial spines
  249. Cardinal movements of labor: passage of widest diameter of presenting part to below the plane of the pelvis
    Engagement
  250. Cardinal movements of labor: downward passage of presenting part through the pelvis
    Descent
  251. Cardinal movements of labor: passive flexion of fetal head as it descends due to resistance related to body pelvis
    Flexion
  252. Cardinal movements of labor: rotation of presenting part (usually from transverse to anterior-posterior)
    Internal rotation
  253. Cardinal movements of labor: brings base of occiput in contact with the inferior margin of the pubic symphysis, head is delivered by extension
    Extension
  254. Cardinal movements of labor: rotation to the correct anatomic position in relation to the fetal torso
    External rotation (restitution)
  255. Cardinal movements of labor: delivery of body of fetus
    Expulsion
  256. What are the Cardinal movements of labor
    Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), expulsion
  257. What is the first stage of labor
    Onset of labor to full dilation
  258. What is the second stage of labor
    Interval between full dilation (10cm) and delivery
  259. What is the third stage of labor
    Time from delivery to expulsion of placenta
  260. What are the risks of parenteral pain management in labor (fentanyl PCA)
    Maternal risk for aspiration and respiratory depression, fetal risk for respiratory depression (common need for Narcan at delivery)
  261. An epidural may slow down labor, however it does not increase the risk of __
    C-section
  262. __ is characterized by the slow, abnormal progression of labor
    Dystocia of labor
  263. What is the leading indication of primary c-section
    Dystocia of labor
  264. What is the rate of c-section in the US
    1 in every 10 births
  265. 60% of all c-sections in the US are attributable to the diagnosis of __
    Dystocia of labor
  266. What terms should we never use when talking about dystocia of labor
    Failure to progress, or CPD (cephalopelvic disproportion)
  267. What are acceptable terms to use when referring to dystocia of labor
    Labor slower than normal (protraction disorder), complete cessation of progress (arrest disorder)
  268. What are the risk factors for prolonged labor
    Older, medical (DM, HTN, obesity), macrosomia, prolonge rupture of membranes and or chorioamnionitis, short maternal stature, high station at complete dilation, occiput posterior position, pelvic abnormalities
  269. What are the intervention options for arrest of descend
    Forceps, vacuum, c-section
  270. What is AROM
    Artificial rupture of membranes
  271. What are the contraindications of labor induction
    Prior classical c-section, active genital herpes, placenta or vasa previa, umbilical cord prolapse, transverse lie
  272. What is the best tool to predict the likelihood of successful labor induction (resulting in vaginal delivery)
    Bishop score
  273. A bishop score of __ or greater is favorable for induction of labor
    6
  274. What are cervical ripening agents
    Prostaglandins such as misoprostol
  275. List the methods of labor induction
    Cervical ripening agents (misoprostol), membrane stripping, oxytocin, mechanical dilation, amniotomy (artificial rupture of membranes)
  276. What is the mechanism by which membrane stripping works to induce labor
    Increases prostaglandin release
  277. Delivery that requires additional maneuvers following failure of gently downward traction on the fetal head to effect delivery of the shoulders
    Shoulder dystocia
  278. What is the rate of shoulder dystocia
    .06-1.4% of deliveries
  279. What are the risk factors for shoulder dystocia
    Maternal obesity, diabetes, hx of macrosomic infant, current macrosomia, hx of shoulder dystocia
  280. Warning signs of shoulder dystocia
    Prolonged 2nd stage, recoil of head on perineum (turtle sign), lack of spontaneous restitution
  281. Fetal complications of shoulder dystocia
    Brachial plexus injury, clavicle/humerus fx, asphyxia
  282. Treatment for shoulder dystocia
    McRoberts maneuver, episiotomy, suprapubic pressure, Rubin’s screw, Wood’s screw, delivery of posterior shoulder (humerus fx), Zavanelli
  283. What is McRoberts maneuver
    Dorsiflexion of hips against the abdomen to ease birth of fetus with shoulder dystocia.
  284. What is the most common cause of postterm pregnancy
    Error in dating
  285. With postterm pregnancy what are the risks to the fetus
    Stillbirth, meconium aspiration, intrauterine infection, uteroplacental insufficiency
  286. With postterm pregnancy what are the risks to the mother
    Increased labor dystocia, perineal injury related to macrosomia, and c-section rate
  287. What are the leading causes of preterm deliveries
    Preterm labor (PTL) and preterm premature rupture of membranes (PPROM)
  288. Preterm delivery is before __ weeks
    37
  289. Major determinant of infant mortality in developed countries
    Preterm delivery
  290. Preterm delivery is particularly acute among what group
    African Americans
  291. Leading cause of developmental disability in children
    Preterm delivery
  292. What are the key risk factors for preterm delivery
    Smoking, African American, maternal age (young and old), social factors (poverty, poor housing, crime)
  293. The fetal fibronectin test has a high __ value in predicting delivery within the next 14 days
    Negative predictive
  294. What is the best tool we have right now to determine patients not at risk for imminent delivery
    Fetal fibronectin and cervical length
  295. What is the purpose for prolonging pregnancy when the patient goes into preterm labor
    To allow administration of steroids for fetal lung maturity and maternal transport to a facility with a NICU
  296. What doesn’t work in preventing preterm labor
    Bedrest, hydration, pelvic rest, antibiotics
  297. What are the tocolytic agents used in the management of pre term labor
    Beta-mimetic (terbutaline), magnesium sulfate, calcium channel blockers (Procardia), prostaglandin synthetase inhibitors (indomethacin)
  298. What should be given to women at risk for preterm delivery between 24-34 weeks to reduce the risk of respiratory distress syndrome, mortality, and intraventricular hemorrhage
  299. Antenatal steroids (betamethasone, dexamethasone)
    What are the risk factors for PPROM
  300. Intraamniotic infection, prior hx, lower SES/teens, smokers, hx of STD, hx of cervical cerclage, uterine overdistention
  301. What do you do if the mother goes in to labor any time after 34 weeks
    Proceed with delivery, GBS prophylaxis
  302. What do you do if the mother goes in to labor between 24/23 -31 weeks
    Expectant management, GBS prophylaxis, steroids recommended, tocolysis, antibiotics
  303. What do you do if the mother goes in to labor before 24/23 weeks
    Patient counseling about poor outcome, expectant management, no steroids, no GBS prophylaxis or antibiotics
  304. The only sonogram that is indicated in a normal pregnancy is done at __, it is called the anatomy ultrasound
    18 weeks
  305. Two major goals of prenatal care in the last half of pregnancy are diagnosis of __
    Preeclampsia and fetal malpresentation
  306. What are the routine examination pieces that are done at each prenatal visit
    Measurement of blood pressure, measurement of uterine fundus to assess fetal growth, auscultation of fetal heart tones/assessment of fetal activity, (determination of fetal presentation in the third trimester)
  307. What are some safe and common medications used during pregnancy
    Acetaminophen, Benadryl, Claritin/Zyrtec, Sudafed (with caution/elevation of BP), Metamucil
  308. Two main medications to avoid in pregnancy
    NSAIDS, fluoroquinolones
  309. In general what antibiotics are safe in pregnancy
    Any of the penicillins
  310. If the patient is allergic to penicillin what is another antibiotic that can be used during pregnancy
    Clindamycin
  311. Presumptive symptoms of pregnancy
    Amenorrhea, N/V, breast tenderness, fatigue, urinary frequency, quickening, increased basal body temp, chloasma, linea nigra, stretch marks, spider telangiectases
  312. When do most women experience quickening
    18-20 weeks primigravidas, 14-16 weeks multigravidas
  313. Name the sign: Bluish or purplish discoloration of vagina and cervix
    Chadwick’s sign
  314. Name the sign: Softening of the uterine isthmus
    Hegar’s sign
  315. Name the sign: Softening of the cervix
    Goodell’s sign
  316. Positive manifestations of pregnancy
    Fetal heart tones, palpation of fetus, ultrasound of fetus
  317. When can fetal heart sounds be heard with Doppler
    10 weeks
  318. When can the fetus be palpated
    22 weeks
  319. When can you discover cardiac activity on ultrasound of the fetus
    5-6 weeks
  320. When can you see limb buds on ultrasound of the fetus
    7-8 weeks
  321. When can you see general movement on ultrasound of the fetus
    9-10 weeks
  322. Serum pregnancy test can detect pregnancy as early as __ after conception
    1 week
  323. When should a serum pregnancy test be done
    When question of normal development, ectopic, signs of pregnancy loss, previous loss
  324. hCG is produced by the placenta about __ after fertilization
    8 days
  325. hCG is detectable __ after conception
    8-11 days
  326. hCG doubles every __
    48 hours
  327. when does hCG peak
    10-12 weeks
  328. when do hCG levels return to normal after termination or delivery
    21-24 days
  329. what does a very rapid increase in hCG indicate
    Multiples, or molar pregnancy
  330. what does a very slow rising level of hCG indicate
    Ectopic or non-viable pregnancy
  331. how long does a normal pregnancy last
    280 days, 40 weeks, 10 lunar months, 9 calendar months
  332. What is Nagele’s rule
    From the date of the last normal menstrual period, subtract 3 months and add 7 days
  333. What is the most accurate noninvasive method of finding gestational age
    Ultrasound (esp early US); also is most widely used method to determine GA
  334. If cardiac activity can be seen by transvaginal ultrasound by 8 weeks there is only a __% risk of pregnancy loss
    3
  335. When is a transabdominal ultrasound done
    Once uterus above pelvic brim, about 8-12 weeks
  336. What is the window of time during which a transabdominal ultrasound can be used to evaluate fetal growth/anatomy
    After 16 weeks, before 22 weeks
  337. __% of pregnancies are dangerous to the health of the mother and or fetus
    5-20
  338. What are some major structural anomalies that can be detected on transabdominal ultrasound
    DS markers; 2 vessel cord, neural tube defect, anencephaly, hydrocephaly, cleft lip/palate, diaphragmatic hernia
  339. When should prenatal care ideally start
    3 months before conception
  340. A pregnant woman can get supine hypotensive syndrome after __ weeks
    20
  341. The fundus of the uterus is at the pubic symphysis at __
    8 weeks
  342. The fundus of the uterus is palpable in the abdomen at __
    12 weeks
  343. The fundus of the uterus is at the midpoint between symphysis and umbilicus at __
    16 weeks
  344. The fundus of the uterus is at the umbilicus at __
    20 weeks
  345. When do you start measuring from the symphysis to fundus in centimeters
    26-34 weeks
  346. When does fundal height start to decrease (as the head descends)
    36 weeks
  347. What is included in the maternal blood tests
    CBC, type and screen, RPR (syphilis), Rubella, Hep B, HIV, glucose tolerance test, maternal serum screen
  348. When is the maternal serum screen offered
    15-20 weeks
  349. What is the purpose of the maternal serum screen
    Screen for open neural tube defects (spina bifida, anecephaly) and chromosomal abnormalities (trisomy 21 and 18). If the mother would not do anything different with her pregnancy regardless of results test should not be done
  350. When is the 1 hour glucose challenge test done
    26-28 weeks, earlier if at high risk for gestational diabetes (by 24, ideally by 12 wk)
  351. When should you check mom for group B strep
    35-37 weeks
  352. What do you tell mom to do if she doesn’t feel baby move later in pregnancy
    Tell her to drink some juice or water, lay on her left side and feel for movement for one hour. If there is still no movement tell her to come in for evaluation
  353. What is the normal fetal heart rate
    110-160
  354. What is fetal bradycardia
    <110
  355. What is fetal tachycardia
    >160
  356. What is part of the fetal biophysical profile
    Non-stress test, fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume
  357. What score on the biophysical profile is considered normal
    8-10
  358. What score on the biophysical profile is considered abnormal and requires intervention
    4 or less
  359. Fetal US: 5-13 weeks, measure:
    fetal crown-to-rump length
  360. Fetal US: after 13 weeks, measure:
    femur length, abdominal circumference and biparietal diameter; after 30 weeks, accuracy decreases
  361. Quad screen: diff btw Trisomy 21 & 18
    • DS: high hCG/DIA, low AFP/uE3; Edwards: low AFP, hCG, uE3; diff is high hCG in DS
    • GDM RFs
  362. FH, h/o previous stillbirth, h/o macrosomia (>9lbs), prenatal wt >180lbs, advanced maternal age, history of HTN
  363. Antenatal visits start:
    at 8-12 weeks (unless prior PG loss, fertility tx, or maternal illness)
  364. Most widely used test of fetal lung maturity
    Fluorescence polarization; direct measure of surfactant concentration
  365. erythroblastosis fetalis =
    heart failure, edema, ascites & pericardial effusion; d/t RBC destruction exceeding production
  366. Screening for Down syndrome can be performed when:
    1st or 2nd trimester; 1st trimester test characteristics are better than those in 2nd trimester only
  367. Follow-up antenatal visits detect __% of fetuses with growth abnormality, prevent __% of eclampsia, & uncover __% of breech presentations prior to labor
    50% of growth abnormality, prevent 70% of eclampsia, 80% of breech presentations
  368. What is the average volume of amniotic fluid at term
    800 mL
  369. How is oligohydramnios determined
    Identification of the largest pocket of fluid measuring less than 2cmx 2cm or the total of 4 quadrants less than 5 cm
  370. What is oligohydramnios associated with
    SGA fetus, renal tract abnormalities (renal agenesis), and urinary tract dysplasia
  371. The clinical manifestation of oligohydramnios is a direct result of __
    The impairment of urine flow ot the amniotic fluid in the late part of the first half of pregnancy or during the second and third trimesters
  372. What is the most common autosomal trisomy and what is the rate
    Trisomy 21 (Down syndrome) 1 in 600 live births
  373. What is the second most common autosomal trisomy and what is the rate
    Trisomy 18 (Edward’s syndrome) 1 in 6000-8000 live births
  374. Turner’s syndrome is associated with an average birthweight of approximately __ below average
    400g
  375. Fetuses with neural tube defects are frequently
    IUGR weighing approximately 250g less than controls
  376. Partial or complete detachment of placenta from uterine wall, after 20 weeks gestation
    Abruptio Placenta
  377. What are some risk factors of abruptio placenta
    Cocaine use, maternal hypertension, trauma
  378. Placenta previa is __ bleeding
    Painless/silent
  379. Placenta abruption is __ bleeding
    painful
  380. __% of women are GBS vaginal/rectal colonized
    10-30%
  381. What is the most common cause of neonatal sepsis
    GBS
  382. GBS bacteruria indicates
    Heavy colonization
  383. What is something you see in babies born to mothers on AZT for HIV
    Lower WBC counts & macrocytic anemia (will resolve over time)
  384. Chronic intrauterine infection is responsible for __% of IUGR pregnancies
    5 to 10
  385. What is the most commonly identified pathogen responsible for IUGR
    CMV
  386. What is the most common protozoan, acquired by eating raw meat, that is responsible for IUGR
    Toxoplasma gondii
  387. Bacterial infections occur commonly in PG & frequently are implicated in PTD; but they are not commonly assoc w/IUGR; exception to this rule is chronic infx with:
    Listeria monocytogenes
  388. What is the clinical picture of an infant born to a mother infected with chronic listeria monocytogenes
    Critically ill, encephalitis, pneumonitis, myocarditis, hepatosplenomegaly, jaundice, and petechiae
  389. Early GBS =
    1st 6 days of life; 75% of cases; in utero or during birth; RFs: PTL, PROM, PPROM
  390. Late GBS =
    After 1st week of life; nosocomial or CA
  391. BV adverse outcomes
    PTD/LBW; intraamniotic or placental infxn (ID & Rx did not improve outcomes); USPSTF: no routine screen; tx sx
  392. If PG pt pos for HBSAg:
    check acute/chronic (HBcAb,LFT); test partner, if neg, vax
  393. Hep E antigen =
    increased risk of infectivity (vertical trans in maternal chronic Hep B)
  394. Hep B vertical transmission: tx
    Recombivax, HBIg to neonate after delivery (90% effective); mom can breastfeed after tx
  395. Most common effects of rubella transmission
    Heart, eye, ear; risks are GA dependent
  396. Acyclovir is Category:
    C
  397. VZV: perinatal exposure: tx
    VZIg perinatally (5 days before - 2 days after delivery); acyclovir for maternal VZV
  398. Which vax can be given during PG?
    Hep B, flu, tetanus (Tdap); DO NOT GIVE VZV or Rubella (live)
  399. GBS RFs and when to tx/not to tx
    Do not tx if at term w/o RF; Tx if PTL or term w/RFs: fever, h/o GBS, ROM >24 hr
  400. Infants in the __ percentile are classified as having intrauterine growth restriction (IUGR)
    < or =10th
  401. Infants in the __ percentile are classified as large for gestational age (LGA)
    > or = 90th
  402. Both IUGR and LGA fetuses have increased risk for __
    Perinatal morbidity and mortality
  403. A pregnancy cannot be described as IUGR unless what is known with certainty
    Gestational age
  404. What does symmetric IUGR refer to
    Infants in which all organs are decreased proportionally
  405. Symmetric IUGR infants are more likely to have __
    An endogenous defect that results in impairment of early fetal cellular hyperplasi
  406. What does asymmetric IUGR refer to
    Infants in which all organs are decreased disproportionately (abdominal circumference is affected to a greater degree than head circumference)
  407. Asymmetric IUGR infants are more likely caused by __
    Intrauterine deprivation that results in redistribution of flow to the brain and heart at the expense of less important organs such as the liver and kidneys
  408. An infant with an autosomal __ is more likely to be IUGR
    Trisomal
  409. Multiple gestation is associated with a __% increased incidence of IUGR fetuses
    20-30
  410. What is the most common maternal complication causing IUGR
    Hypertension
  411. Women who stop smoking before __ weeks gestation are not at increased risk for having an IUGR infant
    16
  412. Poor maternal wt gain is associated with an increased risk of having an IUGR infant. Daily intake must be reduced to less than __kcal/d before a measurable effect on birthweight becomes evident
    1500
  413. What are some vascular diseases that are risk factors for having an IUGR infant
    Collagen vascular disease, insulin-dependent diabetes mellitus associated with microvasculopathy and preeclampsia
  414. What is the best parameter for early dating of pregnancy on ultra sound
    Crown-rump length
  415. What are the most accurate parameters for dating of pregnancy in the second trimester
    Biparietal diameter, and HC
  416. Most accurate parameter for dating of pregnancy in the third trimester
    Head circumference
  417. Single most common preventable cause of IUGR in infants in the US
    Smoking
  418. Data shows that IUGR infants appear to catch up in weight in the first __ of life
    6 months
  419. Taken as a group IUGR infants have more __ than do their AGA peers
    Neurologic and intellectual deficits
  420. The incidence of __ is increased in IUGR infants
    Sudden infant death syndrome
  421. Maternal obesity is associated with a __ increased likelihood of fetal macrosomia
    3-4 fold
  422. Male fetuses are __g heavier on average than female fetuses
    150
  423. What is the best single measure in evaluating macrosomia by ultrasound in diabetic mothers
    Abdominal circumference
  424. Estimated fetal wt. by __ is not very accurate
    Ultrasound
  425. When do you screen with 1 hour glucose
    At 24-28 weeks in patients >25 or family history of DM or Ethnic risk
  426. Risk factors for GDM
    > 25 years, prior GDM/family hx, prior big baby/still birth, BMI greater than or equal to 27, chronic hypertension, glycosuria
  427. What is the biggest complication of GDM
    Big babies that don’t want to come out (macrosomia/ shoulder dystocia)
  428. What are the birth traumas associated with macrosomia
    Brachial plexus injury, clavicular injury, facial nerve injury
  429. Risk factors for fetal growth restriction
    CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition
  430. In second half of PG, increased concentrations of __ combine to produce modest maternal insulin resistance, which is countered by postprandial hyperinsulinemia
    Human placental lactogen, free and total cortisol, and prolactin
  431. What is the most common medical complication of pregnancy
    Diabetes mellitus
  432. Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies
    1 to 3
  433. Defined as any degree of glucose intolerance with first recognition during pregnancy
    Gestational diabetes
  434. GDM complicates __% of pregnancies
    4
  435. Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years
    50
  436. __ is the hormone mainly responsible for insulin resistance and lipolysis. It is similar in structure to growth hormone and acts by reducing the insulin affinity to insulin receptors
    Human placental lactogen
  437. HbA1C can predict the risk for __ when measured in the first trimester
    Malformation
  438. Higher glucose level in mothers lead to higher glucose levels in the fetus. This leads to higher levels of insulin which can cause __ in the fetus
    Macrosomia, central fat deposition, enlargement of internal organs such as the heart
  439. What are risk factors for developing GDM
    Obesity, prior hx of GDM, heavy glycosuria, unexplained stillbirth, prior infant with major malformation, family hx of DM in first degree relative
  440. When should at risk pregnant women be screened for GDM
    As soon as feasible and again between 24 and 28 weeks
  441. Which women can be omitted for GDM screening
    Age <25, normal body wt, no family hx, no hx of abnormal glucose metabolism/poor OB outcome, and not a member of an ethnic or racial group at high risk
  442. What are the ethnic or racial groups with a high prevalence of diabetes
    Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders
  443. What is the mainstay of treatment in the pregnant women with pregestational diabetes
    Rigorous control of blood glucose
  444. What is an optimal fasting glucose in pregnancy
    70-95
  445. What is an optimal 1-hr postprandial glucose value during pregnancy
    Less than 140
  446. What is an optimal 2-hr postprandial glucose value during pregnancy
    Less than 120
  447. If a young female patient is hypertensive and having a seizure she is __ until proven otherwise
    Preeclamptic
  448. Hypertension complicates __ of all pregnancies
    5-7%
  449. Preeclampsia/eclampsia is responsible for __% of hypertension in pregnancy
    70
  450. Hypertension with proteinuria and or pathologic edema
    Preeclampsia
  451. Hypertension without proteinuria or pathologic edema during pregnancy
    Pregnancy induced hypertension
  452. Hypertension with proteinuria and or pathologic edema with convulsions
    Eclampsia
  453. Signs and symptoms of preeclampsia
    HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria

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Author:
 HuskerDevil
ID:
 85324
Filename:
 OB 2
Updated:
2011-05-12 02:09:07
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DPAP2012 OB
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