Obgyn Clerkship

Front 1

Risk of spontaneous abortion with:

a) CVS

b) amniocentesis

Back 1

a) 1%

2) 0.5%

Front 2

Most common chromosomal abnormalities in spontaneous abortion?

Back 2

Aneuploidy (autosomal trisomies)

Front 3

Compare the physical exam (pelvic, U/S) findings with: threatened, inevitable, incomplete, complete, and missed abortion

Back 3

Threatened: + FHR, + bleeding at cervix

Inevitable: + bleeding at cervix, +open cervix

Incomplete: POC (products of conception) partially expelled (underwear, vagina, at cervix)

Complete: all POC present outside of uterus, cervix closed, +/- uterus contracted

Missed: - pregnancy sx, -FHR, +crumpled gestational sac, no POC found outside of the uterus

Front 4

Most common cause of lower abdo pain in women?

Back 4

PID

Front 5

Most common organisms responsible for PID?

Back 5

N. Gonorrhoea+ chlamydia

Front 6

Clinical exam criteria for PID?

Back 6

1. Adnexal, cervical motion tenderness

2. Lower abdo pain

Front 7

Gold standard for dx PID?

Back 7

1. Laparoscopy (fallopian tube would be erythematous/have exudates)

Front 8

Is Lithium contraindicated in pregnancy?

Back 8

Lithium is usually contraindicated due to increased concentrations found in breast milk. If necessary for the mother to be on lithium, follow the lithium levels in the infant, as excretion levels vary between women.

Front 9

Define infertility (both secondary and primary)

Back 9

1yr of unprotected sex without conception. Approx 85-90% of healthy young couples will conceive in one year.

Secondary (have had a child before)

Front 10

Laboratory investigations for infertility ? (name 3/4)

Back 10

1. Day 3 FSH, LH, estradiol (ovarian reserve, ovulation)

2. Day 21 serum PROG (confirms ovulation happened)

3. Urinary LH surge

4. Male sperm analysis

Front 11

What are the typical sx of PCOS?

Back 11

Acne, obesity, hirsutism

Front 12

Semen WHO criteria? (there are 6)

Back 12

1. N morphology >14%

2. N motility 50%

3. Sperm # >40 million/ejaculate

4. sperm concentration >20 million/ml

5. pH >7.2

6. ejaculate 1.5-5 mL

x2 samples, q4wks, 2-3 days abstinence

Front 13

How do HSG and laparoscopy differ (ie. what anatomy do they show)?

Back 13

HSG: uterine cavity, shows internal architecture of tubal lumen (can be done as outpatient)

Lap: pelvic anatomy, shows adhesions, endometriosis (more invasive)

Front 14

What is clomid used for and what is it's mechanism of action (MOA)?

Back 14

Clomid is a SERM. It inhibits the Estrogen Rs in the hypothalamus, thereby inhibiting the negative feedback Estrogen has on GnRH. This increases the HPG axis activity. Given early in the menstrual cycle, it increases FSH and LH, leading to more follicles.

Front 15

When is macrosomia dx?

Back 15

You can have a clinical suspicion of macrosomia if the SFH >2cm than expected, but cannot DIAGNOSE until born.

>4000 g bw

Front 16

Pregnancy risks when woman is obese?

Back 16

HTN, GDM, abruption, macrosomia, shoulder dystocia, NICU admission

Front 17

Difference between IUGR and SGA?

Back 17

IUGR is an intrauterine dx, while SGA is neonatal.

<10th percentile for wt at GA.

Front 18

What are the two main types of IUGR?

Back 18

Asymmetric and Symmetric

Front 19

What type of IUGR is most common?

Back 19

Asymmetric: 70-80% of cases.

Increased deficit in abdo circumference vs head circumference.

At the expense of non-vital fetal organs" liver, kidney, and lungs, blood is redirected to the brain and heart.

Happens late in 2nd-3rd trimester.

Front 20

How common is symmetric IUGR and when does it most common present on U/S?

Back 20

20-30% of cases

Presents early 2nd trimester

Front 21

After ___ weeks, the SFH measurement in cm should be equal to the number of gestational weeks

Back 21

22 weeks

Front 22

What are some common fetal causes of IUGR?

Back 22

Chromosomal (symmetric)

Infection (CMV, Rubella, Toxo)

Congenital

Multiple gestation

Front 23

What are some common placental causes of IUGR?

Back 23

(usually asymmetric)

Infarcts

Abnormal cord insertion/trophoblast invasion

Front 24

What are some common maternal causes of IUGR?

Back 24

Autoimmune, nutrition, diabetes, renal disease, smoking, EtOH

Front 25

What is the formal definition of fetal death?

Back 25

intrauterine demise=death prior to delivery

Front 26

Compare fetal death and spontaneous abortion

Back 26

SA --> <20 weeks

IUD --> >20 weeks

Front 27

What is the most common maternal complaint in cases of IUD?

Back 27

Decreased fetal movement

Front 28

Is nulliparity a risk factor for IUD?

Back 28

NO!

Front 29

What are some maternal pathologies that can lead to IUD?

Back 29

>42 weeks gestation, GDM, lupus, HTN, APLS

Front 30

What are some common fetal pathologies that can lead to IUD?

Back 30

IUGR, chromosomal abnormalities, infection (TORCH)

Front 31

What are some placental pathologies that can lead to IUD?

Back 31

abruption, cord abnormalities, PROM, vasa previa

Front 32

When do coagulopathies typically occur in the mother following death of the fetus?

Back 32

Rare complication and doesn't occur until 3-4 weeks after IUD. Thus, immediate induction is not necessary.

Front 33

What is the workup for an IUD?

Back 33

coag screen, TORCH, Nerihaus, glucose, group and screen, ANA (lupus).

After induction, fetus requires autopsy, karyotype--placenta should also be examined.

They STILL NEED POSTPARTUM F/U!

Front 34

How do you manage an inevitable spontaneous abortion? (3 options)

Back 34

1. Misoprostol

2. D+C

3. Wait and do nothing

Front 35

What is Asherman's syndrome and what is it a complication of?

Back 35

Intrauterine adhesions --> walls of the uterus stick together.

Rare complication of a D+C abortion (TA).

Front 36

What is a fetal maternal hemorrhage?

Back 36

Loss of fetal blood into maternal circulation

Front 37

Does placenta previa cause painful bleeding?

Back 37

PREVIA IS PAINLESS. The uterus is soft, not tender on palpation, the head is not engaged.

Front 38

Up to _____% of women in early pregnancy have a low lying placenta

Back 38

20%; The placenta "moves up" as the uterus extends.

Front 39

Does placental abruption cause painful bleeding?

Back 39

YES!

It is the rupture of the maternal vessels in the decidua basalis. Blood accumulates causing further separation.

Front 40

Does placental abruption always cause bleeding?

Back 40

No. The bleeding may be behind the placenta, further away from the cervical os.

Front 41

Clinical signs of a placental abruption

Back 41

1. uterus has increased tone

2. Uterus is tender on palpation

3. FHR can be nonreassuring

Front 42

What is vasa previa?

Back 42

Fetal vessels from the placenta run along the internal cervical os. Increased risk of fetal mortality. C/S indicated.

Front 43

What is a severe complication of placental abruption

Back 43

DIC.

Thromboplastin is released from the dislocated placenta, goes into maternal circulation.

Front 44

Compare: accreta, increta, percreta

Back 44

accreta: abn implantation, superficial myometrium

Increta: deep into the myometrium

Percreta: through the myometrium

Front 45

What are the Nierhaus (Kleihauer-Betke) and Apt tests? What are they used for and what do they dx?

Back 45

NB: measures fetal cells in maternal circulation, used for ? abruption

APT: collects vaginal bloods and detects fetal blood; pink --> fetal cells; yellow ---> maternal; used to with ? vasa previa

Front 46

Most common location for an ectopic?

Back 46

Ampulla (78%)