Labor of LOVE
What is the minimum duration of pushing that defines a prolonged second stage in a multiparous patient?
what is : 2 hours at least
A patient has painless third-trimester vaginal bleeding and ultrasound shows the placenta covering the internal cervical os. What is the diagnosis
What is placenta previa
A patient requests a cesarean delivery without a medical indication. What should be the first step?
what is: Counsel her regarding the risks and benefits of cesarean versus vaginal delivery and explore her reasons/preferences
According to ACOG, how many times per day should a breastfeeding newborn generally feed to establish an adequate milk supply?
What is: 8–12 times per day
A patient has a suspected placental abruption and a nonreassuring fetal heart tracing. What is the primary concern?
What is Fetal hypoxia/acidemia due to compromised placental perfusion
Before performing a cesarean for second-stage arrest, what alternative should be assessed when appropriate
What is an operative delivery
A patient with suspected PAS undergoes cesarean delivery. The placenta does not spontaneously separate. What should you NOT do? (what Delke does do)
What is Do not forcibly remove the placenta.
During closure of a cesarean incision, the surgeon notices an enlarging, tense hematoma in the broad ligament. The patient's blood pressure is stable. What complication should you be concerned about?
What is: Uterine artery or other pelvic vascular injury causing a retroperitoneal/broad ligament hematoma.
A breastfeeding patient needs IV contrast for a CT scan. Should she "pump and dump"?
What is No. Breastfeeding can safely continue after IV contrast.
A patient with chronic placental abruption is being managed expectantly as an outpatient. How frequently may ACOG consider antenatal fetal surveillance
What is Once or twice weekly
A G2P1001 is 6 cm and ruptured. She has had no cervical change for 5 hours. Contractions are inadequate despite oxytocin. Can you diagnose active-phase arrest?
What is Not yet.
At cesarean delivery for arrest of descent, the fetal head is deeply impacted in the pelvis. Fundal pressure and routine extraction are unsuccessful. What complication is the surgeon particularly trying to avoid with excessive traction
What is Extension of the hysterotomy into the cervix/lower uterine segment and/or uterine vessels, as well as fetal trauma.
The substance most commonly responsible for an intern's ability to function on postpartum rounds
Coffee
What resident is most likely to stay completely unphased during the most chaotic abruption and stat section and then at the end of everything go "well, that was stressful"
Sami Kegel
who documented that this was the pt's cervical exam: 3/100/-2
What is midwife
what resdient thinks her brother is "placentally challeged and just hasnt been diagnosed? extra points if you know his name
Gabby, Carlyle
Who is Reese
A patient with mastitis has been taking antibiotics for 48 hours with no improvement. What two diagnoses should move higher on your differential?
what is MRSA and breast abscess
A 34-week G2P1001 presents with painful vaginal bleeding and a firm, tender uterus. FHR shows recurrent late decelerations.
Labs:
The resident says, “Her hemoglobin isn't that low and her coagulation studies aren't terrible.”
Which laboratory abnormality is the biggest red flag, and why?
what is : Fibrinogen 145 mg/dL.
A patient is 9 cm with an anterior lip that has been present for 2 hours. The fetal head is +1 and OA. FHR is reassuring. Her nurse tells you she has "failed to progress." What's the problem with that statement?
What is: She isn't technically in the second stage yet, and "failed to progress" is not automatically diagnosed simply from duration at 9 cm.
A patient has placenta previa and 3 prior cesarean deliveries. Approximately what is her risk of placenta accreta spectrum according to ACOG?
What is approx 61%
How do you correctly document a bladder injury in an op report?
What is : Cystotomy made in standard fashion. Foley bulb noted to be in correct positioning. At this point, we decided not to ask any further questions.
What resident is most likely to give a 15-minute lecture on breastfeeding despite never having personally breastfed?
Who is Luke
A 36-week G2P1 presents with sudden severe abdominal pain, vaginal bleeding, and a rigid, tender uterus. FHR is 90 bpm. She has an emergent cesarean delivery. Initial labs show:
Twenty minutes later, she develops diffuse oozing from the surgical field. Repeat labs show:
What is the most likely diagnosis?
What is: DIC secondary to severe placental abruption