most common site for ureteral injury during pelvic surgery
at level of cervix when ligating uterine vessels
at the level of the IP (pelvic brim)
lateral border of uterosacral ligament
anterior vaginal wall
CMV: most likely to be transmitted to fetus in what trimester? most likely to cause fetal anomaly in what trimester?
3rd
1st
Most common cause of nongenetic congenital deafness
CMV
MOA: depo leuprolide
(Lupron) GNRH agonist»_space; induces hypoestrogenic state
most common side effects of depo leuprolide
(Lurpon) 80% develop vasomotor symptoms, 30% vaginal symptoms
Advanced paternal age is > ___ years old
40
Effects of advanced paternal age (3)
abnormal sperm quality
adverse reproductive outcomes (decrease pregnancy rate, increase pregnancy loss, stillbirth, preterm birth, low birth weight)
offspring defects (most common genetic abnormalities result from single gene mutations, heart defects, mental health disorders, cancers)
what nerve root is affected in brachial plexus injury causing upper arm adduction, internal rotation, flexion of wrist, forearm extended
Erb Palsy C5, C6
what nerve root is affected in brachial plexus injury causing fingers extended at metacarpophalangeal joint and flexed interphalangeal joint
Klumpke palsy C8, T1
what is the greatest risk factor for placental abruption
history of placental abruption
effects of warfarin in pregnancy
warfarin embryopathy: exposure 6-12 wks GA –> nasal and midline facial hypoplasia and stippling of vertebral and femoral epiphyses
what is the half life of oxytocin
3-5 minutes
What labs should be monitored for pregnant patients with HIV and how often
CD4 and viral load at least every trimester
34-36 wks obtain CD4 count and viral load for delivery planning
delivery timing and method for viral load of HIV > 1,000
cesarean delivery at 38 wks
Risk of vertical transmission of HIV with viral load > 1,000, vaginal delivery, and no zidovudine?
Vaginal delivery with zidovudine?
Cesarean delivery with zidovudine?
25%
8%
2%
When should zidovudine be administered for pts w HIV , viral load > 1000, undergoing CS
3 hrs preoperatively as a 1 hr IV loading dose (2 mg/kg) followed by continuous infusion over 2 hours (1 mg/kg/hr) until delivery
Rank the top 9 maternal risks factors for stillbirth
- Renal disease
- Systemic lupus erythematosus
- CHTN
- Diet controlled diabetes
- Insulin controlled diabetes
- > 10 cigarettes/day
- BMI > 30
- Age 35-39
- Age 40 or greater
Is breast feeding contraindicated with hepatitis B?
no, but if mother has chronic HBV, infant must receive HBIG passive prophylaxis and vaccine active prophylxis
What antibodies (HBsAg, HBsAb, HBcAb) would be positive for each of the follow:
acute infection
window period
chronic infection
resolved infection
immunized
inactive chronic carrier
acute infection: HBsAg, HBcAb
window period: HBcAb
Chronic infection: HBsAg, HBcAB
Resolved infection: HBsAb, HBcAb
Immunized: HBsAb
Inactive chronic carrier: HBcAb
Define a positive contraction stress test
presence of late decelerations following more than half of the contractions (signals potential fetal hypoxemia)
define an equivocal-suspicious and equivocal-hyperstimulatory contraction stress test
intermittent late decelerations or significant variable decelerations
decelerations when contractions are more frequent than every 2 min or lasting longer than 90 seconds
What maternal lab tests should be included during evaluation of stillbirth
Kleihauer-Betke, syphilis, lupus anticoagulant, anticardiolipin antibodies, and beta 2 glycoprotein antibodies
also indirect coombs test, glucose screening, toxicology
Fetal demise is fetal death at or greater than 20 wks GA or weight of ___ g
350
In stillbirth evaluation, list the percent of cases that the following test provide important information:
fetal autopsy
placental pathology
fetal karyotype/microarray
autopsy: 40%
placental path: 60%
karyotype: 10%
