OB emergencies
36-year-old G2P2002 with a h/o homozygous factor V Leiden has been on Lovenox prophylaxis during pregnancy. Her last dose was yesterday and she had an uncomplicated vaginal delivery without epidural anesthesia today. When should her Lovenox be restarted postpartum?
4-6 hours
In which scenario would you NOT recommend or offer a CD to prevent perinatal HSV?
A) Active genital lesions
B) HSV lesion on buttock, back or thigh
C) Prodromal symptoms of pain/burning
D) Primary or non-primary first episode of genital HSV during the third trimester
B) HSV lesion on buttock, back or thigh
36-year-old G3P2002 undergoes cell-free DNA screening at 11 weeks of gestation. The results are consistent with trisomy 21. What is the most appropriate next test.
Chorionic villus sampling
A 30-year-old G2P1001 at 38w2d presents to triage and is found to have an MVP of 1.2 cm. She has a history of one prior LTCS for breech presentation. She strongly desires a vaginal delivery in this pregnancy. FHR is reactive. SVE 1/40/-4. What is the most appropriate next step in management.
Transcervical balloon (foley or Cook)
Fibrinogen
Increased
After a 5 minute shoulder dystocia, on day of life #1, the neonate exhibits isolated left hand paralysis with loss of grasp reflex and Horner's syndrome. Name this palsy.
Klumpke Palsy: C8-T1
35 year old at 16w0d presents with a reticular rash on her trunk and joint pain. She works at a daycare. At her anatomy scan 4 weeks later at 20w0d, US shows size equal to dates with fetal hydrops (ascites and pleural effusion). What additional screening test would you want?
A) Umbilical artery dopplers
B) Ductus venosus dopplers
C) Middle cerebral artery dopplers
D) Uterine artery dopplers
C) Middle cerebral artery dopplers
A 35-year-old G1P0 undergoes a nuchal translucency US at 13w4d and NT measures 3.1 mm. The patient elects to diagnostic testing which reveals a normal karyotype and microarray analysis. What is the most likely fetal structural abnormality if one were to be detected.
Cardiac defect
At what gestation does the fetal thyroid begin producing thyroid hormone?
~12 weeks
Systemic vascular resistance
Decreased
17-year-old G1P0 presents at 29w4d for persistent nausea, vomiting, and diarrhea for the past 2 days. On initial evaluation, she appears ill and reports generalized abdominal pain. Her temperature is 38.5°C, BP 146/98 mm Hg, HR 121 bpm. Neurologic examination is normal. Laboratory results include a white blood cell count of 17.0 × 109/L, hematocrit level of 28%, platelet count of 17,000/mm3, creatinine of 3.1 mg/dL, and normal transaminases. Schistocytes are identified on the peripheral smear. What is the most likely diagnosis.
Hemolytic uremic syndrome
A 23-year-old G1P0, presents at 11w0d. Her prenatal labs shows a positive RPR with a titer of 1:16. TP:PA is positive. She has no known history of syphilis and denies any symptoms. Her current partner has no history of syphilis. She has no drug allergies. What is her best treatment option.
IM Penicillin G benzathine x 3 weekly doses
Which of the following is NOT a reason for a no call result with cfDNA?
A) Early gestational age (<9-10 weeks)
B) Genetic conditions (T13 or 18)
C) Low maternal BMI (<18 kg/m2)
D) LMWH
C) Low BMI
A 32-year-old G3P1011 presents for her first prenatal visit at 11w3d. She has a prior DVT after a femur fracture. You order a thrombophilia panel to assess for underlying predisposition to VTE. The test result that is most influenced by pregnancy is
(A) antithrombin activity level
(B) factor V Leiden mutation
(C) methylenetetrahydrofolate reductase (MTHFR) mutation
(D) protein C activity level
(E) protein S activity level
(E) protein S activity level
Tidal volume
Increases by ~ 30-50%
A patient has two prior C/S and is planning her third repeat C/S. She is noted to have a placenta previa on US. What is her a priori risk of accreta?
40%
24 yo G3P1011 at 36 weeks GA, who is living with the diagnosis of HIV positivity. Her labs are: VL 2000, CD4 400. In order to decrease risk of vertical transmission, what would be your:
1. delivery mode/timing
2. Peri-delivery medications
A) Prelabor cesarean section at 38 weeks gestation and IV Zidovudine 3 hours preoperatively
What is a 40 year-old's age-related risk of Down’s Syndrome AND any chromosomal abnormality?
A) 1/365, 1/180
B) 1/50, 1/100
C) 1/36, 1/18
D) 1/100, 1/50
D) 1/100 (Down syndrome); 1/50 any chromosomal abnormality
A 37-year-old at PPD #10 presents with shortness of breath. Her pregnancy was complicated by preeclampsia. On exam, BP 140/90mm Hg, HR 110 bpm, RR 22, and pedal edema is present. She is afebrile. Rales are noted in both lung bases. CXR shows cardiomegaly and increased pulmonary vascularity. TTE reveals a dilated left ventricle and an ejection fraction of 30%. The first medication she should receive is:
(A) anticoagulant
(B) angiotensin-converting enzyme (ACE) inhibitor
(C) β-blocker
(D) diuretic
(E) vasodilator
Renin-angiotensin-aldosterone system (RAAS)
Increased
Name 3 conditions in which pregnancy is contraindicated (mWHO Risk Class IV)
- Pulmonary arterial hypertension
- Systemic ventricular dysfunction (EF<30%, NYHA III-IV)
- Previous peripartum cardiomyopathy with any residual impairment of LV function
- Severe symptomatic mitral stenosis
- Severe symptomatic aortic stenosis
- Aortic dilation >45 mm in Marfan's syndrome
- Aortic dilation >50 mm in bicuspid aortic valve
- Vascular Ehlers-Danlos
- Severe coarctation
- Fontan circulation with ANY complication
What is the mortality rate of neonatal herpes with disseminated neonatal disease?
Disseminated disease (25% of infections, 30% mortality)
37 year-old G1P0 at 20w0d presents for a routine second trimester anatomy US which shows fetal holoprosencephaly and a midline facial cleft. What is the most likely abnormal fetal karyotype.
47,XX,+13
A newborn boy is completely pink and his heart rate is 120 bpm. He has a weak cry, flexes somewhat, and grimaces in response to stimulation. What is his APGAR?
7
A: +2
P: +2
G: +1
A: +1
R: +1
Antithrombin III activity
Decreased