8 OB

Question 1

Answer 1

Question 2

at what rate does the b-HCG rise during the first 4 weeks of normal pregnancy?

Answer 2

doubles evry 48 hrs

Question 3

What do the “triple” and “quad” screens include?

When should they be performed?

Answer 3

1. maternal serum alpha fetoprotein (MSAFP)
2. beta-HCG
3. estriol

quad 4. inhibin A

15-18 weeks gestation

Question 4

Combines with an increased MSAFP what does this indicate?

Answer 4

neural tube defect

(compression of the cerebellum in posterior fossa)

Question 5

What does the first screening include?

When is it performed

Answer 5

Combined Test:

1. HCG
2. PAPP-A
3. nucal translucency

9-13 wks

Question 6

When can the cell -free DNA testing be performed?

Answer 6

7 wks

Question 7

What does the Quad test for a trysomy 21 look like?

Answer 7

MSAFP ↓

bHCG ​↑

estriol ↑

inhibin A ↓

Question 8

What does the Quad test for a trysomy 18 look like?

Answer 8

MSAFP ↓

bHCG ↓

estriol ↓

Question 9

Normal Biophysical Profile (BPP)

Answer 9

*in 30 minutes

1. NST ≥ 2 accelarations (15bmp)
2. Fetal Breathing ≥ 1 lasting 30 seconds
3. Fetal Movements > 3
4. Fetal Muscle Tone ≥ 1 episode of flex/ext

5 Amniotic Fluid Index ≥ 2 cm max vertical pocket

Question 10

birth steps

Answer 10

1. engagement
2. descent
3. flexion
4. internal rotation
5. extension
6. external rotation
7. expulsion

Question 11

most common implantation site for ectopic pregnancies?

Answer 11

ampulla

(90% in fallopian tube, 70-80% ampulla)

Question 12

Qualifiers for treatment of ectopic pregnancy with metotrexate?

Answer 12

1. sable
2. available for follow up
3. bHCG <5000
4. no fetal heart rate
5. lab tests normal

• CBC
• blood type/screen
• liver function
• kidney function

Question 13

Contraindications for treatment for ectopic pregnancy with metotrexate?

Answer 13

• does not neet criteria
• inmunodeficiency
• concurrent viable pregnancy
• ruptured ectopic pregnancy
• breats feeding
• hypersensitivity to metrotraxate

relative:

• >3.5 mass
• fetal heart rate

Question 14

When should preterm labor occur?

Answer 14

MATERNAL

1. severe HTN
2. cardiac disease
3. hemorrage

PREGNANCY

1. cervical dilation >4 cm
2. premature membrane rupture >34 wks
3. chorioamnionitis

FETAL

1. death
2. distress
3. IUGR with reverse diasistolic flow

Question 15

What should I give a patient with:

• >37 wks gestation
• unknown GBS
• PROM >18 hrs

Answer 15

prophylactic penicilin!

Question 16

up to what weeks can I administer corticosteroids to a patient with preterm labor?

Answer 16

up to 34 wks

GA: 24-36.6

weight 600-<2500

Question 17

up to what weeks can I administer corticosteroids to a patient with PPROM?

Answer 17

32 wks

Question 18

what is the first thing I should think about when I have a patient with third semester bleeding?

Answer 18

placenta previa

Question 19

what exam is contraindicated in a patient with suspected placenta previa?

Answer 19

digital exam!!!

do not introduce anything in the vagina -> no transvaginal US

Question 20

what are some of the risk factors of placental abruption?

Answer 20

HTN

cocaine use

smoking

trauma

previous abruption

Question 21

what is the treatment for uterine rupture?

Answer 21

immediate laparotomy with delivery of the fetus

Question 22

In what scenarios is the RhoGAM given (to unsensitized patients)?

Answer 22

1. abortion
2. delivery
3. vaginal bleeding
4. placental abruption
5. amniocentesis

Question 23

what is the antidote of magnesium sulfate?

Answer 23

calcium gluconate

Question 24

symmetric IUGR

Answer 24

brain in proportion to body

before 20 wks

intrinsic factor

Question 25

asymmetric IUGR

Answer 25

brain weight is NOT decreased abdomen smaller than the head after 20 wks extrinsic factors

Question 26

empiric treatment for asymptomatic bacteriuria

Answer 26

1. nitrofurantoin 2. amoxicillin 3. cephalexin

Question 27

when should women be tested for asymptomatic bacteriuria?

Answer 27

12-16 wks

Question 28

what is the treatment sequence for hyperemesis gravidarum

Answer 28

1. dietary modification + avoidance of triggers + non-pharmachological (acupuncture, giner, vitamin B6) 2. diphenydramine 3. metoclopramide 4. ondansetron

Question 29

antibiotics that should be avoided during pregnancy

Answer 29

* TMP-SMX (1st trim) * aminoglucosydes * tetracyclines * fluoroquinolones

Question 30

drugs that can be used to treat hypertension (chronic and gestational) during pregnancy?

Answer 30

metildopa labetalol nifedipine

Question 31

what is the only definitive treatment of preeclampsia?

Answer 31

delivery!

Question 32

thyroid disease in pregnancy: what crosses the placenta?

Answer 32

TRH inmunoglobulins against TSH receptor

Question 33

thyroid disease in pregnancy: what does not cross the palcenta?

Answer 33

TSH T4

Question 34

type of deceleration? what does it indicate?

Answer 34

early decelerations head compression

Question 35

type of deceleration? what does it indicate?

Answer 35

variable decelerations umbilical cord compression

Question 36

type of deceleration? what does it indicate?

Answer 36

late decelerations fetal hypoxia **DELIVER!**

Question 37

Duration of the stages of labor: Stage 1

Answer 37

primigravid: 6-18 multipara: 2-10

Question 38

Duration of the stages of labor: latent phase / active phase

Answer 38

latent phase: - primigravid: 6-7 - multipara: 4-5 active phase: - primigravid: \>1.2 cm/hr - mulitpara: \>1.5 cm/hr

Question 39

what is the treatment for septic abortion

Answer 39

D&C + IV ATB Clindamycin + gentamycin Cefoxitin + doxicycline