Fall_25_OB_Wrap_Up

Question 1

Define ectopic pregnancy.

Answer 1

Implantation of a fertilized ovum outside the endometrial lining of the uterus; most are tubal. Expanded: recognize as life‑threatening hemorrhage risk. 【84†3】【84†11】

Question 2

U.S. frequency of ectopic pregnancy (approx.).

Answer 2

About 5–20 per 1,000 pregnancies; higher mortality where access to obstetric care is limited. 【84†3】

Question 3

Name key risk factors for ectopic pregnancy.

Answer 3

Prior ectopic, ART/IVF, prior pelvic infection or tubal surgery, advanced maternal age; 1/3 have no identifiable risk factors. 【84†4】

Question 4

Two clinical reasons ectopic mortality is higher in some groups.

Answer 4

Delayed presentation and reduced access to obstetric care (e.g., teens, racial minorities, low SES). 【84†3】

Question 5

Common sites of ectopic implantation.

Answer 5

Fallopian tube (most common), but interstitial, cervical, cesarean‑scar, abdominal also occur. 【84†11】

Question 6

Classic triad before/at rupture.

Answer 6

Abdominal/pelvic pain, delayed menses, and vaginal bleeding; pain often precedes bleeding. 【84†6】

Question 7

Symptoms/signs of significant hemoperitoneum.

Answer 7

Dizziness/syncope, urge to defecate (cul‑de‑sac blood), shoulder pain (diaphragmatic irritation), shock. 【84†6】

Question 8

Key physical findings suggesting ectopic.

Answer 8

Uterus smaller than dates, abdominal tenderness (± rebound), tender adnexal mass. 【84†6】

Question 9

Initial diagnostic rule for any patient with pelvic pain and positive pregnancy test.

Answer 9

Exclude ectopic pregnancy first; use targeted differential. 【84†7】

Question 10

Preferred imaging modality for confirmation.

Answer 10

Transvaginal ultrasonography. Rationale: best sensitivity for early ectopic/pelvic findings. 【84†7】

Question 11

Examples in the differential diagnosis.

Answer 11

Threatened/inevitable/incomplete loss, PID, degenerating fibroid, appendicitis/GI, ovarian torsion/cyst, trapped retroverted uterus, nephrolithiasis. 【84†7】

Question 12

Impact of prompt diagnosis.

Answer 12

Reduces morbidity and mortality by preventing rupture/hemorrhage. 【84†7】

Question 13

Three management options for ectopic pregnancy.

Answer 13

Expectant, medical, and surgical; selection depends on activity, stability, and location. 【84†8】

Question 14

Criteria favoring expectant management (PUL/very low activity).

Answer 14

No symptoms, plateauing hCG trend; careful follow‑up until resolution; methotrexate not beneficial here. 【84†8】

Question 15

Methotrexate (MTX) mechanism in ectopic therapy.

Answer 15

Folate antagonist inhibiting DNA synthesis in trophoblasts → growth arrest. 【84†8】

Question 16

MTX eligibility and administration.

Answer 16

IM dosing if negative screen for renal, hepatic, hematologic disease; can be single or multiple doses. 【84†8】

Question 17

MTX side effects to counsel.

Answer 17

Abdominal pain, vomiting, stomatitis, severe neutropenia, pneumonitis. 【84†8】

Question 18

Definition of MTX treatment success window.

Answer 18

≥15% drop in hCG from day 4 to day 7 post‑dose; otherwise repeat dose or proceed to surgery. 【84†8】

Question 19

When is surgical management indicated?

Answer 19

Hemodynamic instability, MTX failure, difficult locations, or surgeon/equipment considerations. 【84†9】

Question 20

Preferred surgical approach when feasible.

Answer 20

Laparoscopy to locate and treat ectopic; laparotomy if uncontrolled bleeding or limited expertise. 【84†9】

Question 21

Salpingectomy considerations.

Answer 21

Partial/total salpingectomy may be required in tubal rupture or uncontrolled bleeding. 【84†9】

Question 22

Follow‑up necessity after MTX or surgery.

Answer 22

Serial hCG to non‑pregnant levels; risk of rupture persists until resolution. 【84†8】

Question 23

Anesthetic options for ectopic surgery (laparoscopy/laparotomy).

Answer 23

General anesthesia commonly preferred; neuraxial with sensory level to ≥T4 may be considered in select stable cases. 【84†10】

Question 24

Common postoperative complaint after laparoscopy.

Answer 24

Shoulder pain from diaphragmatic irritation—treat with IV analgesics. 【84†10】

Question 25

Primary intraoperative priorities in ruptured ectopic.

Answer 25

Rapid control of hemorrhage, restore circulating volume, maintain oxygenation and perfusion for maternal stability. 【84†9】【84†10】

Question 26

Define baseline FHR and normal range.

Answer 26

Approximate mean FHR over a 10‑min segment (≥2 min measured); normal 110–160 bpm. 【84†13】

Question 27

Define FHR variability and normal category.

Answer 27

Fluctuations around baseline; moderate variability = 6–25 bpm peak‑to‑trough and is normal/reassuring. 【84†13】

Question 28

Categorize variability levels.

Answer 28

Absent (undetectable), minimal (≤5 bpm), moderate (6–25 bpm), marked (>25 bpm). 【84†13】

Question 29

Define an acceleration ≥32 weeks.

Answer 29

Abrupt rise ≥15 bpm for ≥15 s but <2 min (≥10 bpm/≥10 s if <32 weeks). 【84†14】

Question 30

Define prolonged acceleration.

Answer 30

Acceleration ≥2 min but <10 min; ≥10 min is a baseline change. 【84†14】

Question 31

Define early deceleration.

Answer 31

Gradual decrease with onset/nadir/recovery mirroring the contraction; mechanism: head compression/vagal response. 【84†15】

Question 32

Define variable deceleration.

Answer 32

Abrupt drop ≥15 bpm for ≥15 s but <2 min, variable timing/morphology; mechanism: umbilical cord compression. 【84†15】

Question 33

Define late deceleration.

Answer 33

Gradual decrease with nadir after contraction peak and recovery after contraction ends; mechanism: uteroplacental insufficiency. 【84†15】

Question 34

Define prolonged deceleration and recurrent decelerations.

Answer 34

Prolonged: ≥2 min but <10 min. Recurrent: decelerations with >50% of contractions in any 20‑min period. 【84†15】

Question 35

Mnemonic VEAL‑CHOP (map types to causes).

Answer 35

Variable‑Cord, Early‑Head, Accelerations‑OK, Late‑Placental insufficiency. 【84†21】

Question 36

Clinical meaning of accelerations with moderate variability.

Answer 36

Generally reassuring—adequate oxygenation/neurologic responsiveness. 【84†13】【84†14】

Question 37

Immediate steps for recurrent late decelerations intra‑anesthesia.

Answer 37

Reposition (left lateral), treat hypotension, reduce uterotonic infusion, oxygen by mask, correct tachysystole, consider tocolysis. 【84†15】

Question 38

Management for recurrent variable decelerations.

Answer 38

Maternal repositioning, amnioinfusion if membranes ruptured to relieve cord compression, assess for cord prolapse. 【84†15】

Question 39

When prolonged decels occur, what is the first principle?

Answer 39

Assess maternal hemodynamics/airway/oxygenation first—fetal status depends on maternal perfusion. 【84†15】

Question 40

Category most concerning for fetal acidemia risk.

Answer 40

Persistent late decelerations with absent/minimal variability. Rationale: impaired uteroplacental oxygen delivery. 【84†15】

Question 41

What qualifies as baseline for NST analysis?

Answer 41

Average FHR in a 10‑min segment with at least 2 min of identifiable baseline; excludes marked variability and long accelerations. 【84†13】【84†14】

Question 42

Significance of minimal variability.

Answer 42

May indicate fetal sleep, medications, or hypoxia; interpret with clinical context. 【84†13】【84†22】

Question 43

Significance of marked variability.

Answer 43

Wide oscillations (>25 bpm) may reflect acute hypoxia or fetal activity; trend with other signs. 【84†13】

Question 44

Accelerations <10×10 in preterm (<32 w).

Answer 44

Still reassuring for GA <32 weeks; threshold is ≥10 bpm for ≥10 s. 【84†14】

Question 45

Name agents associated with fetal tachycardia.

Answer 45

Atropine, epinephrine, and beta‑agonists (ritodrine, terbutaline). Mechanism: sympathomimetic/fetal β‑stimulation. 【84†22】

Question 46

Anesthesia relevance of tachycardia‑inducing drugs.

Answer 46

Maternal administration can increase fetal HR; correlate with maternal meds before assuming hypoxia. 【84†22】

Question 47

Agents linked to fetal bradycardia.

Answer 47

Antithyroid meds (e.g., PTU), β‑blockers (propranolol), intrathecal/epidural analgesia, methylergonovine, excessive oxytocin (via tachysystole/hypoxia). 【84†22】

Question 48

Agents that diminish variability.

Answer 48

Atropine, general anesthetics, promethazine, anticonvulsants (not phenytoin), hypnotics, β‑blockers, insulin (with hypoglycemia), antenatal corticosteroids, ethanol, magnesium, systemic opioids. 【84†22】

Question 49

Drug class linked to sinusoidal FHR pattern.

Answer 49

Systemic opioid analgesia. 【84†22】

Question 50

Implication of reduced variability after anesthesia.

Answer 50

Consider medication effect vs hypoxia; integrate with decel pattern and maternal status. 【84†22】【84†13】

Question 51

First maternal maneuver for concerning FHR patterns under neuraxial anesthesia.

Answer 51

Left uterine displacement and fluid/vasopressor for hypotension; optimize oxygenation. 【84†15】

Question 52

Oxytocin‑associated FHR concerns: action plan.

Answer 52

Reduce/stop infusion if tachysystole/late decels; treat uterine hypertonus and maternal hypotension. 【84†22】【84†15】

Question 53

Role of tocolysis in FHR resuscitation.

Answer 53

Consider terbutaline for uterine tachysystole causing recurrent late/variable decels. 【84†15】

Question 54

When to expedite delivery for FHR abnormalities.

Answer 54

Persistent non‑reassuring pattern despite resuscitation, especially late decels with minimal variability or prolonged bradycardia. 【84†15】

Question 55

Why is ectopic pregnancy emphasized alongside FHR in OB wrap‑up?

Answer 55

Both represent time‑sensitive OB emergencies where rapid diagnosis and maternal stabilization drive fetal outcome. 【84†2】【84†3】【84†15】

Question 56

Shared anesthesia principle across these topics.

Answer 56

Maternal physiology first: correct hypotension/hypoxemia promptly to improve fetal status or surgical safety. 【84†10】【84†15】

Question 57

Normal FHR baseline (memorize).

Answer 57

110–160 bpm. 【84†13】

Question 58

Normal variability amplitude range.

Answer 58

6–25 bpm (moderate). 【84†13】

Question 59

Acceleration thresholds ≥32 weeks vs <32 weeks.

Answer 59

≥15×15 vs ≥10×10. 【84†14】

Question 60

Early decels cause?

Answer 60

Fetal head compression. 【84†21】

Question 61

Late decels cause?

Answer 61

Uteroplacental insufficiency. 【84†21】

Question 62

Variable decels cause?

Answer 62

Umbilical cord compression. 【84†21】

Question 63

Two symptoms strongly suggesting intra‑abdominal blood from ectopic.

Answer 63

Urge to defecate and shoulder pain from diaphragmatic irritation. 【84†6】

Question 64

MTX success benchmark (days 4–7).

Answer 64

≥15% fall in hCG. 【84†8】

Question 65

Best imaging for suspected ectopic in ED/clinic.

Answer 65

Transvaginal ultrasound. 【84†7】