OB emergencies
A 24 yo G2P1001 with a h/o homozygous factor V leiden on prophylactic lovenox presents in labor. Her last dose of lovenox was 4 hours ago. When can she get an epidural?
8 additional hours (12 hours)
Antibiotics given to a GBS positive patient with anaphylaxis to PCN without sensitivities
Vanc
Pulmonary changes that increase in pregnancy
Inspiratory Capacity
Total Volume
Recommended weight gain for a BMI of 35
11-20lbs
<18.5?
18.5-24.9?
25-35?
An anthropoid pelvis increases what fetal position at delivery
OP
A patient has 2 prior CS and is planning her third repeat CS. She is noted to have a placenta previa on US. What is her risk of accreta?
0 CS (3%)
1 prior CS (11%)
2 prior CS (40%)
3 prior CS (61%)
4 prior (67%)
Cardinal movements of labor
Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion
What is this condition
open NTD
Aka Lemon sign
Components of a first trimester genetic screening
NT + PaPP-A, bHCG
Chamber in the fetal heart that contains to the most amount of O2
Right atrium
What are the mechanisms of the 3 most common antihypertensives used in pregnancy
Hydralazine: direct dilation of arterioles
Labetalol: alpha1 and non selective beta blocker
Nifedipine: Calcium channel blocker
Muscles injured during a 2nd degree perineal body lacerations
Bulbospongiosus
Superficial transverse perineal
Patient presents for late prenatal care approx 28 weeks and on bedside US in triage you see some fluid in the fetal abdomen and her antibody screen is positive for anti-Kell antibodies titer (1:64). What US test do you do next?
MCA Dopper
What is a 40 year-old's age-related risk of Down’s Syndrome AND any chromosomal abnormality?
1/100, 1/50
Coagulation factors that decrease in pregnancy
Factors 11, 13, Protein S
25yo presents at 32 weeks with N/V and seems confused. BP 160/82, HR 98, RR 18, Temp 99.0 Labs: Hg 11.0, Plts 52k, wbc 14, AST 500/ALT 650, LDH 400, Cr 1.2, FSBG 41, INR 1.8
AFLP
Appropriate placement of the vacuum extractor on the fetal head
Center of vacuum 3-cm anterior to the posterior fontanelle along the sagittal suture
The 3 indications of cerclage
1. Hx indicated (1 or more 2nd trimester losses from CI or prior rescue cerclage) 2. Exam indicated 3. US indicated (singleton, prior PTB, CL < 25mm prior to 24wks)
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?
MCA dopplers
Parvo B19
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
Treatment of thyroid storm (in order)
Beta block
thionamide (PTU/methimazole)
Iodine (after thionamides)
corticosteroids
A 28 yo woman delivered a stillborn infant at 35wks gestation. The pregnancy was complicated by a flu-like illness and low-grade fever on the day before delivery. The infant had a papular rash on the back and thighs, and placental histology showed subchorionic abscesses and gram-positive bacteria. What is the most likely causative organism is?
Listeria monocytogenes
Additional information:
Acquired from food products (unpasteurized milks/cheeses, raw vegetables/fruits, undercooked meats, deli meats, raw fish)
Dx by blood culture and placental culture after delivery
If symptomatic but afebrile then can either test blood cultures (treat if positive) or observe without testing
If febrile with or without other symptoms: test and treat
Treatment: Ampicillin 6g/day for 14+ days (if PCN allergy, then trimethoprim w sulfamethoxazole preferred)
This crosses the placenta via endocytosis
IgG
Bonus: bulk flow?
US findings of stage III twin-twin transfusion syndrome
Abnormal umbilical dopplers
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 (skin color): +2
P (pulse): +2
G (grimace/refex) : +1
A (muscle tone): +1
R (respiration): +1