Obstetrics

Question 1

diagnosing pregnancy

Answer 1

• presence of gestational sac (4-5 wks by transvaginal US)
• fetal heart motion (5-6 wks)
• fetal heart sounds (8-10 wks)
• fetal movements (after 20 wks)

Question 2

first trimester ROUTINE tests

Answer 2

• CBC
• type and screen
• direct and indirect Coombs
• cervical PAP smear
• UA/urine culture
• rubella Ab
• hepatitis B surface Ag
• VDRL or RPR
• HIV
• cervical culture (chlamydia and gonorrhea)

Question 3

third trimester ROUTINE tests

Answer 3

• diabetes (OGTT at 24-28 wks)
• CBC
• indirect Coombs test
• GBS (vaginal and rectal culture at 35-37 wks)

Question 4

• sudden onset vaginal bleeding
• SEVERE, constant pelvic PAIN
• h/o HTN or trauma

Answer 4

abruptio placenta

Question 5

• sudden-onset painLESS bleeding
• occurs at REST or during activity w/o warning
• h/o trauma, coitus, or pelvic examination

Answer 5

placenta previa

Question 6

placental implantation over a previous uterine scar possibly causing intractable BLEEDING

Answer 6

placenta accreta

Question 7

• life-threatening for fetus

- fetal vessels crossing or running in close proximity to the inner os

Answer 7

vasa previa

Question 8

1. rupture of membranes
2. painLESS vaginal bleeding
3. fetal bradycardia

Answer 8

classic triad for vasa previa

Question 9

first step in management

Answer 9

ALWAYS EMERGENCY CESAREAN SECTION

Question 10

• h/o uterine scar w/ SUDDEN-ONSET abdominal pain and vaginal bleeding
• associated w/ loss of electronic fetal HR, uterine contractions, and recession of fetal head

Answer 10

uterine rupture

Question 11

ALWAYS r/o what in patients presenting w/ fetal demise?

Answer 11

coagulopathy by ordering:

• platelet count
• D-dimer
• fibrinogen
• PT/PTT

Question 12

onset of regular UC

Answer 12

stage 1; latent phase effacement

Question 13

prepares cervix for dilation

Answer 13

stage 1; active phase dilation

Question 14

10cm cervical dilation

Answer 14

stage 2; descent

Question 15

delivery of baby

Answer 15

stage 3; expulsion

Question 16

• abrupt increases in FHR lasting less than 2 minutes
• unrelated to contractions
• ALWAYS REASSURING

Answer 16

accelerations

Question 17

• GRADUAL decreases in FHR
• beginning and ending w/ contractions
• occur in response to FETAL HEAD compression

Answer 17

EARLY decelerations

Question 18

• ABRUPT decreases in FHR
• UNRELATED to contractions
• related to UMBILICAL CORD compression
• nonreassuring

Answer 18

VARIABLE decelerations

Question 19

• GRADUAL decreases in FHR and DELAYED in relation to contractions
• related to UTEROPLACENTAL INSUFFICIENCY
• nonreassuring

Answer 19

LATE decelerations