ObGyn-UW/APGO (Answered 2022/2023)
when is cerclage indicated
hx of 2nd-TM babies
short cervix (<2.5cm)
management/Tx for placenta previa
NO sex or pelvic exam
C/S @ 36-37 wks
BPP <= 4 means what...
indication for delivery
low BPP (<=4) in a late-term pregnancy is assoc w what
uteroplacental insufficiency (hypoxia)
tx for persistent variable deceleration due to cord compression; what if it fails
maternal repositioning
> amnioinfusion (inc. AF)
FHT signs of hypoxia
tachy, low variability, late decels
signs of uterine rupture (3)
palpable abdominal parts
intense lower abd pain "pop"
loss of fetal station
fetal signs of uterine rupture (2)
tachy
variable decels
maternal sx of uterine rupture (4)
tachy, agitation, hypervent, bleeding
uterine rupture Mx
ex-lap > possible hysterectomy
sinusoidal FHT (2)
fetomaternal hemorrhage (anemia)
vasa previa
risk factors for uterine rupture
previous C/S (classical)
myomectomy
FHT in previa
normal (effect is maternal)
FHT in vasa previa
rapid deterioration
AE of oxytocin
tachysystole (-> fetal hypoxia)
hyponatremia (like ADH)
hypotension
precipitous labor
w/in 3 hrs of contraction
> due to multiparity
,DM complxns in pregnancy
seizure during pregnancy
ECLAMPSIA (due to pre-E)
sx of eclampsia
HA/visual/RUQ pain -> tonic-clonic szr
htn
no neuro signs
stable bipolar pt on lithium who is pregnant; what to do
wean lithium during first TM (dec risk of relapse)
>20 wks, no FM/FHT, FH < GA; next step to confirm Dx
TVUS (no cardiac activity)
IUFD @ 20-23 wks; management
D&E or delivery
IUFD > 24 wks ; management
delivery
IUFD complxn
coagulopathy (DIC)
kleihauer-betke test; what is it for
fetomaternal hemorrhage/transfusion
> determines RhoGAM dose for Rh- mom
causes of IUFD
APA, fetomaternal bleed
fetal karyotype
abruption, infection (placenta)
Mx/prognosis of shoulder dystocia/palsy
PT (dec contractures)
most recover by 3 mo
prognosis/Tx for brachial plexus injur
3 mo recovery
surgery if no improvement by 3 mo
pt declines amnio/CVS; what to do to assess risk of aneuploidy
fetal cell DNA (non-diagnostic)
Mag fails to stop eclamptic szr; what next
diazepam
phenytoin
causes of death due to eclampsia (3)
abruption
DIC
arrest
Tx eclampsia (3)
mag
BP control
deliver
mag toxicity; tx
ca-gluconate
when does fatty liver of pregnancy occur
,3rd TM
APA syndrome features (4)
+VDRL/-FTA-ABS
low platelets
prolonged PTT
thromboses (SAB)
tx for APA syndrome
LMWH
low dose ASA
fetal complxns of maternal htn (3)
preterm labor
FGR
oligo
maternal complxns of htn (5)
pre-e
postpartum bleed
GDM
abruption
c/s
high AFP (3)
NTD
ventral wall defect
multiple gestation
maternal liver dz
elevated AFP; what next
ultrasound
> confirm GA, anatomy, #
you suspect down's; next step
maternal serum fetal DNA (10 wks)
if pos, confirm w CVS or amnio
vaginal delivery is safe after what type of C/S
low transverse
management of pregnancy w hx of classical C/S
C/S @ 36-37 wks
amnioinfusion is contraindicated when
uterine surgery
amnioinfusion indicated when
recurrent variable decels due to cord compression/oligo
FGR baby features
loose skin
low fat
thin umbilical cord
wide ant fontanel
FGR baby; what tests to order (4)
placenta path (infxn, infrxn)
karyotype (if genetic syndrome)
, urine tox (maternal sub abuse)
TORCH serology
laboring pt, risk of uterine rupture
deliver via laparotomy
liver problems due to HELLP, pre-E
capsule distention due to liver swelling
AFLP vs HELLP
AFLP: more leukocytosis, hypoglycemia, AKI, less severe HTN
when does AFLP present
late in pregnancy
why pulm edema in pre-E
high SVR, permeability, pressure
low albumin
chorio presentation
PROM/prolonged
maternal fever+1:
maternal/fetal tachy
maternal leukocytosis
fundal tenderness
chorio baby looks like
lethargic
pale
fever
chorio Mx (3)
abx
fluids
delivery (vd if fht good)
chorio complxns (maternal)
postpartum endometritis, hemorrhage
chorio complxns (fetal)
preterm, sepsis, PNA, encephalopathy
abnormal pap smear; next step
colposcopy
ASCUS pap; next step
HPV testing or repeat in 1 yr
colposcopy if HPV+/ASCUS
ASCUS pap; HPV-
next step
cytology/HPV in 3 years
when is pap not indicated
>65 yo w 3 consec nl paps
hysterectomy (unless CA/dysplasia)
MMGs how often and for whom
annually @ 40 yo
cervical CA screening: 30-65 yo
when is cerclage indicated
hx of 2nd-TM babies
short cervix (<2.5cm)
management/Tx for placenta previa
NO sex or pelvic exam
C/S @ 36-37 wks
BPP <= 4 means what...
indication for delivery
low BPP (<=4) in a late-term pregnancy is assoc w what
uteroplacental insufficiency (hypoxia)
tx for persistent variable deceleration due to cord compression; what if it fails
maternal repositioning
> amnioinfusion (inc. AF)
FHT signs of hypoxia
tachy, low variability, late decels
signs of uterine rupture (3)
palpable abdominal parts
intense lower abd pain "pop"
loss of fetal station
fetal signs of uterine rupture (2)
tachy
variable decels
maternal sx of uterine rupture (4)
tachy, agitation, hypervent, bleeding
uterine rupture Mx
ex-lap > possible hysterectomy
sinusoidal FHT (2)
fetomaternal hemorrhage (anemia)
vasa previa
risk factors for uterine rupture
previous C/S (classical)
myomectomy
FHT in previa
normal (effect is maternal)
FHT in vasa previa
rapid deterioration
AE of oxytocin
tachysystole (-> fetal hypoxia)
hyponatremia (like ADH)
hypotension
precipitous labor
w/in 3 hrs of contraction
> due to multiparity
,DM complxns in pregnancy
seizure during pregnancy
ECLAMPSIA (due to pre-E)
sx of eclampsia
HA/visual/RUQ pain -> tonic-clonic szr
htn
no neuro signs
stable bipolar pt on lithium who is pregnant; what to do
wean lithium during first TM (dec risk of relapse)
>20 wks, no FM/FHT, FH < GA; next step to confirm Dx
TVUS (no cardiac activity)
IUFD @ 20-23 wks; management
D&E or delivery
IUFD > 24 wks ; management
delivery
IUFD complxn
coagulopathy (DIC)
kleihauer-betke test; what is it for
fetomaternal hemorrhage/transfusion
> determines RhoGAM dose for Rh- mom
causes of IUFD
APA, fetomaternal bleed
fetal karyotype
abruption, infection (placenta)
Mx/prognosis of shoulder dystocia/palsy
PT (dec contractures)
most recover by 3 mo
prognosis/Tx for brachial plexus injur
3 mo recovery
surgery if no improvement by 3 mo
pt declines amnio/CVS; what to do to assess risk of aneuploidy
fetal cell DNA (non-diagnostic)
Mag fails to stop eclamptic szr; what next
diazepam
phenytoin
causes of death due to eclampsia (3)
abruption
DIC
arrest
Tx eclampsia (3)
mag
BP control
deliver
mag toxicity; tx
ca-gluconate
when does fatty liver of pregnancy occur
,3rd TM
APA syndrome features (4)
+VDRL/-FTA-ABS
low platelets
prolonged PTT
thromboses (SAB)
tx for APA syndrome
LMWH
low dose ASA
fetal complxns of maternal htn (3)
preterm labor
FGR
oligo
maternal complxns of htn (5)
pre-e
postpartum bleed
GDM
abruption
c/s
high AFP (3)
NTD
ventral wall defect
multiple gestation
maternal liver dz
elevated AFP; what next
ultrasound
> confirm GA, anatomy, #
you suspect down's; next step
maternal serum fetal DNA (10 wks)
if pos, confirm w CVS or amnio
vaginal delivery is safe after what type of C/S
low transverse
management of pregnancy w hx of classical C/S
C/S @ 36-37 wks
amnioinfusion is contraindicated when
uterine surgery
amnioinfusion indicated when
recurrent variable decels due to cord compression/oligo
FGR baby features
loose skin
low fat
thin umbilical cord
wide ant fontanel
FGR baby; what tests to order (4)
placenta path (infxn, infrxn)
karyotype (if genetic syndrome)
, urine tox (maternal sub abuse)
TORCH serology
laboring pt, risk of uterine rupture
deliver via laparotomy
liver problems due to HELLP, pre-E
capsule distention due to liver swelling
AFLP vs HELLP
AFLP: more leukocytosis, hypoglycemia, AKI, less severe HTN
when does AFLP present
late in pregnancy
why pulm edema in pre-E
high SVR, permeability, pressure
low albumin
chorio presentation
PROM/prolonged
maternal fever+1:
maternal/fetal tachy
maternal leukocytosis
fundal tenderness
chorio baby looks like
lethargic
pale
fever
chorio Mx (3)
abx
fluids
delivery (vd if fht good)
chorio complxns (maternal)
postpartum endometritis, hemorrhage
chorio complxns (fetal)
preterm, sepsis, PNA, encephalopathy
abnormal pap smear; next step
colposcopy
ASCUS pap; next step
HPV testing or repeat in 1 yr
colposcopy if HPV+/ASCUS
ASCUS pap; HPV-
next step
cytology/HPV in 3 years
when is pap not indicated
>65 yo w 3 consec nl paps
hysterectomy (unless CA/dysplasia)
MMGs how often and for whom
annually @ 40 yo
cervical CA screening: 30-65 yo
