Ob/gyn Pretest Notes I

Front 1

does initial spontaneous abortion in first trimester increase or decrease risk for recurrent spont abortion

Back 1

no change

Front 2

chromosomal abnormalities are what % of: live born, still born, first trim spont abort's?

Back 2

live born = .5%
Still born = 5%
spont first trim abortions = 50%

Front 3

what % of trisomy 21 fetuses are lost before term? what percent of 45 X,O?

Back 3

75%!!
99%!!

Front 4

does miscarriage risk rise with number of prior spont abortions? waht is the birth rate with recurrent spont aborts?

Back 4

yes...15% increased risk with each new recurring abortion
live birth rate w/o tx = 50%
with tx = 80%

Front 5

if cervical incompetence, what % live birth can be achieved if place cerclage?

Back 5

90%!

Front 6

m/c cause of spont abortion in first trimester? in second? in third?

Back 6

1st =chromosomal abnormalities
2nd = uterine (bicornuate, septate, or unicornuate uterus)or enviro in origin, as well as hypothyroind, DM, collagen vasc disorders ie lupus anticoag
3rd=

Front 7

workup for 1st trimester recurrent abort's? for 2nd?

Back 7

1st- chrom analysis, karyotype
2nd - screen for thyroid, DM, collagen vasc disorders, lupus anticoag, hysterosalpingogram to r/o structural abnormalities,
endometrial bx to r/o insuff luteal phase or chronic endometritis,
measure cervical length if loss is due to cervical incompetence

Front 8

mother with three first-trimester spont abortions has increased risk for what chrom abnormalities?

Back 8

(all), but more common = DS

Front 9

Do progesterones cause birht defects?

Back 9

no

Front 10

what deformities are caused by excessive radiology in first trimester

Back 10

limb and heart defects

Front 11

only limitation to exercise in a pregnant woman who exercised before?

Back 11

Avoid supine position; this decreases venous return to the heart, resulting in decreased CO

Front 12

Should exercise resume intensity of pre-birth immediately after delivery?

Back 12

No; physiological changes need 4-6 weeks to return to normal so women should not resume the intensity of pre-pregnancy exercise regiments immediately folloowng delivery

Front 13

Is + nuchal translucency ominous even if karyotype is normal?

Back 13

yes

Front 14

when does the nuchal translucency disappear by?

Back 14

by 15 weeks

Front 15

What chrom abnormalities does nuchal translucency indicate? (3)

Back 15

DS, then trisomy 18, then Turner's

Front 16

balanced translocations are usually phenotypically normal or not? after fertilization?

Back 16

Normal; however fertilization then causes either monosomy or trisomy of offspring b/c balanced translocation cannot divide in meiosis. Trisomies 13, 18, 21 or monosomy X (turner's) are viable (but with major defects)

Front 17

outpouching of neural tissue through defect in skull?

Back 17

encephalocele

Front 18

emerges from the base of the neck with an intact skull present?

Back 18

cystic hygroma

Front 19

increased size of lateral ventricles?

Back 19

hydrocephalus

Front 20

when is MSAFP performed?

Back 20

16-18 weeks

Front 21

number of MSAFP tests that result in positive? what are done with these?

Back 21

30/1000
of these, if very high levels = do thorough ultrasound for NT defects; if mild or low, retake MSAFP. 1/3 of those u/s'd will find obvious reason ie anencephaly, twins, wrong gest age of fetus, or fetal demise.

Front 22

4 reasons for elevated MSAFP?

Back 22

anencephaly./ntube defects, twins, wrong gest age of fetus, or fetal demise

Front 23

under what circumstances should preganncy be terminated due to MSAFP levels only?

Back 23

under NO circumstances!!
MSAFP is only a screening test, is never diagnostic

Front 24

what tests are comparable to positive nuchal tlucency for DS screening?

Back 24

blood-free b-hCG and PAPP-A in first trimester; or double/ triple test in 16-18 weeks. Optimal approach is nuchal tlucency PLUS MSAFP or triple test

Front 25

nuchal translucency may be performed by?

Back 25

only those with certification; not any fetal u/s tech

Front 26

which test to check chromosomes for DS takes the shortest amout of time

Back 26

CVS does not require tissue culture as does amniocentesis, or fetal blood obtained by percutaneous umbil blood sampling (PUBS)

Front 27

CVS vs amniocentesis?

Back 27

CVS = earlier (9-12 wks) vs amnio = later (16-18wks)
CVS is via transcervical catheter and has no needles; is painless.
CVS has higher complication rate than MID-trimester amnio, but 1st trim amnio has higher complication rate than CVS
1st trim amnio also has higher risk of talipes (clubfoot due "amniotic band syndrome"= amnio rupture--> fibrotic strictures-->restriction of fetal growth ie in feet)

Front 28

what viral vaccinations are contraindicated in pregnancy?

Back 28

measles, mumps and rubella b/c these are live vaccines

Front 29

how to treat unvaccinated mothers for tetanus, varicella, rabies, hep A and B?

Back 29

tx with hyper IgG or pooled immune serum globulin

Front 30

are inactivated or killed vaccines harmful to the fetus or the mother?

Back 30

neither

Front 31

tetracyclines given to pregger can also cause what in mother?

Back 31

hepatic decomp in 3rd trimester

Front 32

when shouldn't you give tetracycline to a pregger?

Back 32

ALL trimesters!
first = causes teratogenicity
2nd and 3rd = causes fetal dental anomalies and inhibition of bone growth; maternal hepatic decomp in third trimester

Front 33

vomiting, impaired resp, hypothermia, c/v collapse in newby may be caused by what antibiotic given to mother before birth?

Back 33

CAM = causes gray baby syndrome

Front 34

TMP -SMX given to 3rd trim preggers cuases what?

Back 34

kernicterus!

Front 35

Women with previous neural tube defect have an increasd or normal recurrence risk for next pregnancy?

Back 35

increased to about 4% !

Front 36

CVS detects and does not detect what?

Back 36

for karyotype ie to check for DS, but does NOT detect AFP levels or risk for ntube defects!!

Front 37

what behavior can increase the risk of ntube defects in early pregnancy?

Back 37

hyperthermia; therevfore mothers should avoid hot tubs, hot baths, saunas, maternal fevers

Front 38

NSiM in pt with abnromal triple test?

Back 38

if high AFP do US to check for correct AGE, then to check for ntube defects, multiple gest, or fetal death (all cause increased msafp); then if no explanation, do amniocentesis to confirm maternal serum results with elevated AFP's in amniotic fluid. IF low AFP's, consider amniocentesis to check for karyotype (DS)

Front 39

Do most women with elevated msafp have fetuses with ntube defects

Back 39

no!! only 5% of those with elevated msafp have ntube defects!!

Front 40

is it recommended for obese pregnant women to lose weight and restrict diet during pregnancy?

Back 40

not recommended, nor is vigorous exercise program recommended for obese pts; however, no gain of weight during pregnancy does not result in iugr or impaired dev of fetus

Front 41

whats'the most common cause of mental retardation in US?

Back 41

FAS!!!
(top 3 = Down syndrome, fetal alcohol syndrome and Fragile X syndrome )

Front 42

is there an established safe threshold for alcohol use in pregnancy?

Back 42

no, however the occasional drink in pregnancy has not been proven to be harmful

Front 43

can fetal injury occur if only 1 drink /day?

Back 43

YES

Front 44

Do epileptic women have increased risk for fetal anomalies?

Back 44

yes; due to reduction in uterine/placental blood flow during seizure activity.

Front 45

Do epileptic women on phenytoin have less or more risk for fetal harm than if off pheyntoin?

Back 45

more; so should try to wean pt off of phenytoin, if not, should attempt to give monotherapy;

Front 46

valproic acid has increased risk for?

Back 46

spina bifida; (central nervous system dysfunction, spina bifida, development delay, intrauterine growth restriction, and cardiac anomalies)

Front 47

anticonvulsants must be given with what?

Back 47

give with folate to prevent congenital anomalies

Front 48

what vaccines CANT you give during pregancy?

Back 48

VZV, MMR, and polio (all are live)

(hep A, B, rabies, tet, and VZV may be treated with hyperimmunoglobulin during preg)

Front 49

when CDC recommendation for pregnant women to receive flu vaccine?

Back 49

after 1st trimester

Front 50

When is suggested to give live vaccines before getting pregnant?

Back 50

at least 3 months before

Front 51

LARGE amounts of radiation has only been shown to harm a fetus in what weeks? what type of harm

Back 51

8-25;
may cause mental retardation and microcephaly

Front 52

what genetic diseases do jews have increased risk for? what carrier rates?

Back 52

Canavan's 1/25
Tay Sachs 1/30
Gauche's 1/40
CF: 1/25

Front 53

what 2 diseases does ACOG recommend ALL jews screen for?

Back 53

Canavan's and Tay Sach's ;
NOT CF!!

Front 54

vegetarian preggers give birth to babies with what vit def?

Back 54

B12 (only comes from animal sources)

Front 55

are herbal remedies recommended during preg?

Back 55

not recommended, since not FDA approved!

Front 56

tobacco use during pregnancy has what deleterious effects on child? alcohol has what?

Back 56

increased spont abortion, IUGR, preterm labor, AP, PP, behavioral problems and ADHD;
alcohol: FAS, mental retardation, developmental delay

Front 57

when and why is PUBS performed?

Back 57

percutaneous umbilicall cord blood sampling is done when rapid fetal karyotyping must be done, as in severe IUGR or fetal hydrops to obtain info ie fetal platelet ct, fetal hct

Front 58

amniocentesis in 2nd trimester has what fetal loss rate?

Back 58

.5%

Front 59

what test has been associated with fetal limb reduction?

Back 59

CVS at < 9 weeks gest (normally done in weeks 9-12

Front 60

tuberous sclerosis is what kind of inheritance?

Back 60

starts as spontaneous, then is inherited auto dominant

Front 61

most common autosomal recessive disease in whites?

Back 61

CF

Front 62

huntington's disease has what inheritance?

Back 62

auto dom

Front 63

2nd and 3rd trimester cystic hygroma is assoc with? earlier trim?

Back 63

Turner's! t 13, 16, or 21

Front 64

fetuses with urinary blockage may devlop what? die of what?

Back 64

oligohydramnios, hydronephrosis, kidney damage, abd wall abnormalities, prune belly syndrome; hwoever, cause of death is pulmonary b/c low amniotic fluid causes impaired lung maturity

Front 65

what is the "lemon sign"?

Back 65

on US, frontal bossing b/c sides of cranium pulled IN due to cisterna magna pulled down from spina bifida

Front 66

splaying of the lumbar spine on US is sign of?

Back 66

spina bifida

Front 67

what do sulfonamides cause in newby? when not give?

Back 67

kernicterus: compete with bilirubin for binding sites on albumin, to leave more bilirubin free for diffusion into tissues.
don't give in last 2-6 weeks pregnancy

Front 68

streptomycin tx for TB in pregger may also cause?

Back 68

fetal hearing loss!!!

Front 69

what can nurofurantoin (an antibiotic) cause in baby?

Back 69

if baby has g6pd = may cause hemolytic anemia event ie like sulfa drugs, etc.

Front 70

CAM causes what to fetus:

Back 70

gray baby syndrome = spallid cyanosis, abd distension, vascular collapse --> death in a few days!!

Front 71

when to administer flu vaccine to pregger?

Back 71

after 1st trimester, or given earlier if underlying disease is severe

Front 72

when is polio vacc indicated for preggers?

Back 72

NOT (unless 3 mo before conception) b/c live vaccine; IS indicated if polio epidemic

Front 73

monozygotic twinning rate?

Back 73

1/250

Front 74

what identifies monozygosity?

Back 74

if only ONE chorion is identified.
If 2 are identified, may be mono or di

Front 75

division of zygote AFTER embryonic disc is formed causes what?

Back 75

conjoined twins

Front 76

dizygotic twins always have what?

Back 76

always have 2 chorions and 2 amnions...placenta may be separate or fused

Front 77

m/c type of twinning? (3) m/c type of monozygotic twinning

Back 77

The three most common variations are all dizygotic:

1 male-female twins are the most common result, 50 percent of DZ twins and the most common grouping of twins
2 female DZ twins (sometimes called sororal twins)
3 male DZ twins.

m/c type of monozygotic:
diamniotic, monochorionic placenta

Front 78

do twins have an increased risk for single umbilcal artery?

Back 78

yes! up to 5% will have!

Front 79

what is velamentous insertion of the umbilicus anad what may it cause?

Back 79

umbilical vessels separate in the membranes before reaching placenta; cause of fetal malformations!

Front 80

what does vasa previa have risk for?

Back 80

if vessels cross cervical os, may rupture when ROM occurs, and cause fetal blood loss

Front 81

vascular angiomas / spider angiomas on belly of pregger are caused by what?

Back 81

hyperestrogenemia of pregnancy

Front 82

NSiM for pregnant women with constipation, 13,000wbc's, hypoactive bowel sounds, and previous CS?

Back 82

although may just be mild gastroenteritis, must rule out obstruction ( ie from past adhesions)! do abd xray.

Front 83

intractable vomiting early part of first trimester, resolving spontaneously by 16th week?

Back 83

"morning sickness" = hyperemesis gravidarum

Front 84

fetal anemia is caused by what ? NOT caused by what?

Back 84

caused by autoimmune destruction ie by Rh- mother's AB's, or ie in the case of low RBC production such as in fetal parvovirus, or in fetal bleeding.

NOT caused by low maternal iron intake, b/c fetus takes all the iron it needs at expense of mother

Front 85

hydronephrosis and hydroureter normal or pathological in pregnancy?

Back 85

NORMAL; due to increased pressure of uterus on ureters; right is usually more dilated than left side

Front 86

glucosuria normal or pathological during pregnancy?

Back 86

normal; due to increased GFR of glucosse and decreased tubular reabsorption

Front 87

history of what has been associated with increased risk for PP? for AP?

Back 87

smoking, previous CS, grandmultiparous

AP = previous AP, htn, tobacco, cocaine, abd/pelvic trauma

Front 88

If placenta appears intact but bleeding continues after birth, and later more placenta tissue found, what is diagnosis?

Back 88

Succenturiate placenta = accessory lobe somewhere else

Front 89

central portion of placenta missing =?

Back 89

fenestrated placenta

Front 90

what is membranaceous placenta?

Back 90

when ALL membranes are covered in villi and placenta develops as a thin, membranous structure

Front 91

shortest distance b/w sacral promontory and symphysis pubis? avg length?

Back 91

obstetric conjugate 10.5 cm

Front 92

shortest diameter of pelvic outlet?

Back 92

interspinous diameter

Front 93

anterior posterior >>transverse diameter; oval shaped pelvis?

Back 93

anthropoid

Front 94

side-side longer, oval shaped pelvis?

Back 94

gynecoid

Front 95

Wide transverse diameter pelvis with sacrosciatic notches

Back 95

platypelloid pelvis

Front 96

heart shaped pelvis?

Back 96

android (also has shorter post diam at inlet than ant diam =baby's head comes more anteriorialy through the pelvic inlet

Front 97

types of lie of fetus?

Back 97

transverse oblique or longitudinal

Front 98

types of presentation?

Back 98

cephalic, breech, or shoulder
for cephalic = brow, vertex, or face

Front 99

types of position of baby?

Back 99

position = part of baby RELATIVE TO THE MOTHER = ie chin facingmother's hip = transverse mentum position

Front 100

sinusoidal FHR associated with?

Back 100

is ALWAYS seen with fetal anemia; is associated with fetal anemia due to Rh isoimmunized fetuses or placental rupture

Front 101

which non-reassuring pattern is almost invariably seen during labor and not before

Back 101

saltatory

Front 102

should preterm FHR monitoring be judged differently than term?

Back 102

no

Front 103

what pathognomonic FHR changes indicate congenital anomalies?

Back 103

no pathognomonic ones do, but in general, non-reassuring changes indicate higher rates of fetal distress, often caused by oligohydramnios, fetal IUGR, etc caused by cong abnormalities

Front 104

risk of rupture in VBAC with prior classical CS

Back 104

4-9% (vs. prior tverse uterine CS =.5%)

Front 105

l/s ratio at least what = lung maturity?

Back 105

2.0:1

Front 106

fetal lung maturity is sped up by? is delayed by?

Back 106

faster = things causing fetal stress ie maternal htn, fetal growth retard
slower = gest DM, erythroblastosis fetalis

Front 107

risk of RDS when L/S ratio is between 1:5 to 2:1? when < 1.5:1?

Back 107

40%
73%

Front 108

syst/diast pressure ratio usually does what towards end of gestation? what does it do if increased resistance in placental bed (ie in preeclampsia, IUGR, smoking?)

Back 108

decreases as end-diast flow velocity increases
|INCREASES if increased resistance in placental bed b/c pressure lost to overcome resistance

Front 109

does S/D ratio increase or decrease as fetal condition deteriorates?

Back 109

INCREASES

Front 110

absent or reverse diastolic flow meanst?

Back 110

means that S/D ratio is severely increased and fetal condition is deteriorating!

Front 111

at what age will abd ultrasound detect a gest sac?

Back 111

5-6 weeks

Front 112

at what age will a doppler us detect fetal heart tones? transvag us? fetal stethoscope?

Back 112

10 weeks - doppler
5 weeks - trans vag US
20 weeks - fetal steth

Front 113

earliest time that serum bHCG test can find positive results

Back 113

8-9 days post ovulation

Front 114

tests should be done on first prenatal visit (in first trimester)

Back 114

Hep B surf antigen, HIV, CBC plus type,

Front 115

recommended daily kcal intake for pregger?

Back 115

300kcal/day

Front 116

amt of wt allowed to gain for different bmi's?

Back 116

>29 = 15 lbs
<20 = up to 40 lb

Front 117

what side rotation of uterus innormal pregnancy?

Back 117

dextrorotation = clockwise to right ( cause of roundl ligament pain being more on r than l side)

Front 118

does breech presentation cause uterus/fundal height to be large for gestational age?

Back 118

no

Front 119

poor sign of glucose control seen on US?

Back 119

polyhydramnios

Front 120

in nulliparous patients, when does engagement of head occur and what may it cause?

Back 120

may occur as early as 2 weeks before labor; causes decrease in fundal height from max (ie from 38 to 36 cm)

Front 121

if 37 week woman with breech baby, what's NSIM?

Back 121

1) either schedule CS AFTER 39 weeks
2) schedule external cephalic version (ECV)
3) vaginal breech delivery if conditions are met:
frank breech
sufficient amniotic fluid
flexed head
EFW 2500-3800g
pelvis assessed with pelvimetry xray (not necessary if previous baby of bigger size was delivered)

Front 122

after ECV, what % of breech babies will present breech at birth?

Back 122

only 30% vs 80 if no ECV is performed

Front 123

5 conditions to be met in order to attempt vaginal breech delivery?

Back 123

frank breech
sufficient amniotic fluid
flexed head
EFW 2500-3800g
pelvis assessed with pelvimetry xray (not necessary if previous baby of bigger size was delivered)

Front 124

at what gest age may you begin induction if cervix is ripe? unripe?

Back 124

41 weeks. if unripe, FIRST do biophysical profile to make sure fetus is ok, then may WAIT... unless want to change Bishop score by giving cervical ripening agents (PGE2, etc)

Front 125

unripe cervix at 42 weeks...nsim?

Back 125

give cervical ripening agents (PGE2) to change Bishop score BEFORE giving oxytocin

Front 126

if woman really wants induction or CS but is only at 40 weeks, what do?

Back 126

wait. May induce at 41 weeks

Front 127

In normally healthy woman who wants a CS, no rf's for CS problems, is elective CS ever indicated over trial vaginal delivery?

Back 127

It's advised to do trial vaginal delivery, due to higher risks of CS surgery; however woman has final say

Front 128

what age gestation should you never let a woman go past without inducing labor or elective CS?

Back 128

42 weeks

Front 129

is "cervical ripening"= inducing labor?

Back 129

no...cerv ripening is ie PGE2 (vag gel or insert), balloons, stripping; induction of labor is giving oxytocin, etc

Front 130

patient with oligohydramnios at term...nsim?

Back 130

DELIVER!!! must ADMIT for cerv ripening and then induce labor!

Front 131

cervical ripening treatments that change the Bishop score?

Back 131

1) PGE2
2) mechanical dilation of cervix via stripping or laminara (absorbs tissue fluid)
3) balloons
4) Misoprostol (off-label)
NOT pitocin/oxytocin = labor INDUCTION agents

Front 132

what is reassuring amount of kicks/period of time?

Back 132

10 distinct kicks/2hrs time = reassuring

Front 133

NSIM if 34 week mother documents decreased fetal movements?

Back 133

go to L & D for non-stress test

Front 134

what is a non-stress test?

Back 134

fetal heart rate and contractions measurement. Movement, heart rate and “reactivity” of heart rate to movement is measured for 20-30 minutes. if baby seems sleepign, nurse may jiggle or use buzzer to try to wake the baby for last part of test

Front 135

what's the modified biophysical profile?

Back 135

MODIFIED = only do non-stress test (FHRmonitor) and amniotic fluid index

Front 136

biophysical profile score nsim's?

Back 136

0-2 = emergency CS
4-6 = repeat test (ie by superior) and delivery if persisting score
8-10 normal

Front 137

is the desire for sterilization alone enough to indicate elective CS?

Back 137

NO

Front 138

how much proteinuria in dipstick sampling is enough to dx preeclampsia

Back 138

persistent 1+ is enough

Front 139

should diuretics be used for preeclampsia? why?

Back 139

NO, they deplete ivasc volume and may compromise placental perfusion