Show:
Normal Labor
Shoulder Dystocia
Postpartum Hemorrhage
GYN admissions
^%*#! Call my attending!
100
At this gestational age you would give antenatal corticosteroids for fetal lung maturity if patient has preterm labor?
<34wk
100
The immediate first step once you recognize a turtle sign.
What is mark the time
100
If I could only take one drug to deliver babies on a mission trip to Uganda, I would take...
What is misoprostol?
100
27yo G4P0030 presents at 6wk by LMP with vaginal bleeding with clots Labs: Hgb/Hct 11.4/33 BT: A pos HCG 361 U/S shows: Uterus with IUP. Gestational sac measures 6w2d. No yolk sac or fetal pole present Your treatment options include:
What is expectant vs. medical vs. surgical management. Consider chromosomes, APL w/u.
100
In the past 20 years, maternal mortality rate has doubled in the US, tripled in the state of Texas primarily due to this.
What is the C-section rate?
200
True or false. Multiple late decellerations signify that a STAT C-section is indicated.
What is False. As long as there is moderate variability, the baby does not have metabolic acidosis.
200
True or false. The dystocia happens because the perineum is too tight.
What is False
200
Risk factors for postpartum hemorrhage include: (Please give at least 3)
What is fetal macrosomia, prolonged induction of labor, magnesium, grandmultiparity, chorioamnionitis, multiples
200
19yo G1 presents at ~9wk by LMP with vaginal bleeding and non-specific pelvic pain/cramping. Labs: Hgb/Hct 9.1/27.6 BT: Oneg HCG: 1629 U/S shows: Small fluid in cul de sac, Complex right adnexal cyst 2cm, small sac within endometrium 5 mm. Your management includes:
What is admission for serial abdominal exams and repeat Beta HCG? Don't forget Rhogam!
200
36yo G4P3003 presents in active labor. She is found to be complete and on the perineum, breech. Describe the steps in a breech vaginal delivery
Allow to deliver to hips on own with only pushing. Reduce legs Reduce arms turning body ? Smelli-Veet Maneuver
300
My patient never got tested for GBS. I would start antibiotic prophylaxis in labor in the following situations: (Please give at least 2)
What is if patient is preterm, maternal GBS bacturia, previous baby with GBS sepsis, rupture greater than 18 hrs.
300
I've called for backup, We've done McRobert's, Suprapubic pressure, the next best step to alleviate the dystocia.
What is deliver the posterior arm
300
Called to MBU. Pt. s/p delivery of 9#5oz baby by SVD 3 hr ago and she is found passed out in the bathroom. She is put back to bed and is found to have heavy vaginal bleeding. On exam, fundus is 3cm above umbilicus and pt is pale and tachycardic. Management?
What is good IV access, fundal massage/bimanual exam with removal of clots, stat labs, foley, misoprostol/methergine.
300
23yo G31021 presents with an IUD confirmed in place within the endometrium. She has vaginal discharge, fever, and chandelier sign. You her for G/C/T. This is your management.
What is treat for both gonorrhea and chlamydia.
300
25yo G4P0120 @ 32 wk presents in DKA with decreased fetal movement. She didn't have any refills of her insulin and also has a cold. T 99.5 FHT 170, min var, frequent shallow variable decels, many appear late. This is your management.
What is treat underlying DKA. Consider ANCS's.
400
Failure to progress is an archaic term that should be better described as either arrest of dilation or arrest of descent. Describe the steps necessary to declare a patient "arrest of dilation".
Note: patient needs to have CE > 5 cm. What is place an IUPC, be sure adequate MVUs, then no cervical dilation x 2hr.
400
So I've screwed and unscrewed and the baby still is stuck and pale. FHR in the 70's. My next step is to...
What is go to the OR. (Can try hands and knees while preparing) Redo all maneuvers. C/S
400
Describe the use of the bakeri balloon/BT catheter.
What is catheter placed within the uterus to tamponade it from the inside. Can be used with a "sandwich stitch". If not catheter available, can place lap sponges within a bag/drape inside the uterus.
400
27yo G0 obese virginal AA female presents with long history of heavy periods which she only gets every 2-3mo. She presents with heavy vaginal bleeding, shortness of breathe, fatigue and dizziness. FH: mother with heavy periods and fibroids, cousin is an "easy bleeder" Labs: Hgb/Hct 5.7/16.2 BT: A pos HCG: neg U/S: Uterus 8 x 5 x 4cm, ovaries with multiple small cysts, endometrial thickness 8mm. Your workup and management includes:
What is TSH, PT/PTT/Fibrinogen, peripheral blood smear Transfusion Suppress menses x ~3mo to allow treatment of anemia Then cycle
400
23yo G1 @ 37w6d presents with headache, GERD symptoms that will not go away with tums and ctx's. BPs 160's-170's/100's. CE 3/80/-1. U/A 1+pro UrAcid 5.2 O/W nl labs Induction with Pitocin/AROM is started. When epidural placed, BP's become 140's-150's/90's. Pt. progresses to complete quickly after epidural but during pushing, she complains of not being able to see. Just after delivery, she seizes. This is your management.
What is magnesium sulfate? Opthalmologic exam. Treat pre-eclampsia and you will treat PRES.
500
36yo G5P4004 @ 37w6d presents in labor. She is known to have HIV, but her viral load is undetectable as she has been on highly effective antiretroviral therapy. This is your next step in management and delivery planning to avoid vertical transmission.
IV AZT ?gm bolus and then ?gm/hr AZT x 4hr prior to ROM if possible. SVD Breastfeeding only if in third world. Baby receives AZT x 24hr.
500
Maneuvers do not work. The baby can neither be pushed from above nor pulled from below and expires. Now what?
What is decapitation.
500
Name 3 uterotonic agents, their dose and 1 side effect/precaution for each
What is Pitocin - 20 units to 80 units IV, IM - hypotension Methergine - 0.2mg , up to ? doses - contraindicated in hypertension Hemabate - 250mg IM , - contraindicated in Asthma Misoprostol - 200-800mcg PR q 6-8hr - fever
500
72yo G6P5 admitted for urosepsis, pelvic pain and is found to have a h/o vaginal bleeding for the past 2 years. Spotting usually, but occasionally bleeding a little less than a period. Pt. has a h/o afib and her admission INR is 4. Last pap 10yr ago CT shows enlarged, fibroid uterus, nl adnexa. This is the workup indicated.
What is transvaginal ultrasound? EMB or D&C if ET >4mm.
500
27yo P2122 presents with heavy vaginal bleeding. She presents because periods are irregular, but this one is too heavy and she has a lot of abdominal pain. WBC 12 Hgb 7.4 Hct 20.6 Plt 124 INR 1.4 PTT 39 Fib <90 Hcg + UDS+ Cocaine, THC U/S: IUP c/w 23wk, no fetal heart tones identified; large amount of complex fluid/material within uterus. Diagnosis? Management?
What is: IUFD with placental abruption Two large bore IVs Cross for 4 units. Transfuse 2, staying 4 units ahead. Transfuse 1:1:1 pRBCs: FFP: Platelets Delivery expeditiously. Vaginally if possible.