Random OB
How do we diagnose rupture of membranes?
+ferning, +nitrazine, +pooling (+/- ROM plus)
The four uterotonics used in PPH and their dosing
Hemabate (250mcg IM q15-90min with 8 dose max), Methergine (0.2mg IM every 2-4h), misoprostol (600mcg oral once), pitocin (10-40U IV or 10U IM)
What uterotonic is contraindicated with a history of asthma?
hemabate
What is the definition of FGR? Severe FGR?
EFW < 10%ile
EFW < 3%ile
What is the definition of anemia in each trimester?
hemoglobin (g/dL) and hematocrit (percentage) levels below 11 g/dL and 33%, respectively, in the first trimester; 10.5 g/dL and 32%, respectively, in the second trimester; and 11 g/dL and 33%, respectively, in the third trimester
Definition of arrest of dilation/active phase arrest
In active labor, no cervical change over 4 hours with adequate contractions or 6 hours with inadequate contractions.
How is ovarian torsion diagnosed?
Surgically
But things that should make you suspect torsion:
-sudden onset intermittent pain w/ N/V, ultrasound findings (sometimes--increased volume, peripheralization of follicles, whirlpool sign, lack of flow, free fluid)
What is thought to be the cause of hyperemesis gravidarum?
hormonal stimulants (hCG, estrogen)
evolutionary adaptation?
Who is generally not considered a candidate for late preterm steroids?
Women with diabetes
Women who have already had a course of steroids
Women diagnosed with IAI
Who should be tested for antiphospholipid antibody syndrome? (name two groups)
Vascular thrombosis
One or more clinical episodes of arterial, venous, or small vessel thrombosis, in any tissue or organ, or
Pregnancy morbidity
One or more unexplained deaths of a morphologically normal fetus at or beyond the 10th week of gestation, with normal fetal morphology documented by ultrasound or by direct examination of the fetus, or
One or more premature births of a morphologically normal neonate before the 34th week of gestation because of eclampsia or severe pre-eclampsia, or features consistent with placental insufficiency, or
Three or more unexplained consecutive spontaneous pregnancy losses before the 10th week of pregnancy, with maternal anatomic or hormonal abnormalities and paternal and maternal chromosomal causes excluded.
Loss of fetal station
Changes in FHT
New or increased pain
Vaginal bleeding
What is the ACOG definition of prolonged second stage of labor?
More than 3 hours of pushing in nulliparous women, more than 2 in multiparous.
But individualize based on the patient and situation
What are women with GDM at increased risk for later in life?
T2DM, heart disease, GDM in future pregnancies, metabolic syndrome, HTN, HLD
After what kind of UTI should women be on suppressive therapy for the rest of pregnancy?
Pyelonephritis or recurrent UTI
What are latency antibiotics and why do we use them?
7 day course of antibiotics--48 hours of amp + erythromycin or azithromycin followed by amoxicillin (for us in ampicillin 2g q6h for 48 hours + 1g azithromycin x 1 followed by amoxicillin 500mg q8h for 5 days)
Prolong pregnancy, reduce infection and morbidity risk
Who should be treated with ampicillin for GBS prophylaxis during labor?
1) women who were GBS positive
2) GBS bacteruria
3) Preterm patients if GBS is unknown
4) Prolonged rupture of membranes (>18hours) and unknown status
5) GBS sepsis in prior pregnancy
Name at least four absolute contraindications for methotrexate in the setting of ectopic pregnancy.
IUP, Immunodeficiency,moderate to severe anemia, leukopenia or thrombocytopenia, Active pulmonary disease, active peptic ulcer disease, clinically important hepatic dysfunction, clinically important renal dysfunction, breastfeeding, ruptured ectopic, hemodynamically unstable, inability to follow up
relative: cardiac activity, high hCG, >4cm, refusal to accept blood
What are the types/classifications of fibroids (0-7)?
Type 0: pedunculated intracavitary
1: <50% intramural
2: >50% intramural
3: 100% intramural, contacts endometrium
4: intramural
5: subserous >50% intramural
6: subserous <50% intramural
7: subserous pedunculated
How do you manage an IOL for a patient with an IUFD and prior CS?
Prior to 28wks can give misoprostol (dosing recommendation unclear), after 28wks induce like you would for full term
How are women with hyper and hypothyroid monitored and treated during pregnancy?
Hypothyroid: treat with levothyroxine, monitor with TSH, goal is to have TSH between lower limit of normal and 2.5
Hyperthyroid: treat with methimazole or PTU, usually avoid methimazole in the first trimester (risk of esophageal and choanal atresia as well as aplasia cutis) with PTU risk of hepatotoxicity. Monitor with T4 levels, goal is to have T4 at the upper end of normal pregnancy range
Name the criteria for severe features for preeclampsia.
1) Platelets <100k
2) Cr >1.1 or twice baseline
3) LFTs 2 x upper limit of normal
4) severe range blood pressures (requiring treatment or 4 hours apart)
5) severe RUQ pain/epigastric pain
6) pulmonary edema
7) new onset headache that does not respond to medications
8) visual changes
How should you counsel someone who is coming in for an induction and who is on lovenox? (for both prophylactic and adjusted dose regimen)
Discontinue at least 12 hours prior for prophylactic dosing, discontinue at least 24 hours prior for adjusted dose regiment
What people qualify for an ultrasound indicated cercalge?
Singleton with no history of PTB and cervical length <10mm OR singleton with history of PTB and cervical length < 25mm
What is the recommended delivery timing for patients with FGR based on severity?
-uncomplicated 3-10%ile, 38w0d-39w0d
-uncomplicated <3%ile, 37wks
-abnormal dopplers, but EDF present, 37wks
-absent EDF, 33w0d-34w0d
-reversed EDF, 30w0d-32w0d
A prophylactic dose of 300 micrograms of anti-D immune globulin can prevent Rh D alloimmunization after exposure to up to 30 mL of Rh D-positive fetal whole blood or 15 mL of fetal red blood cells