Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
Abruptio Placentae - ansPregnant woman who is in the late third trimester of pregnancy
complains of sudden onset of vaginal bleeding accompanied by a contracted uterus that feels
hard (hypertonic) and is very painful. Associated with a sudden onset of dark red-colored
vaginal bleeding. Up to 20% of women do not have vaginal bleeding (blood is trapped
between
placenta and uterine wall). If mild, blood is reabsorbed and affected area reimplants. Severe
cases cause hemorrhage; fetus must be delivered to save mother's life. Higher risk in females
with history of hypertension, preeclampsia/eclampsia, cocaine use, or history of abruptio
placentae.
Placenta Previa - ansA multipara who is in the late second to third trimester complains of new
onset of painless vaginal bleeding that is worsened by intercourse. Blood is bright red in
color. Uterus
is soft and nontender. If cervix is not dilated, treatment is strict bed rest. Intravenous
magnesium sulfate if there is uterine cramping. Uterus will usually reimplant itself if mild.
Any vaginal or rectal insertion or stimulation is an absolute contraindication (can precipitate
hemorrhage). If cervix is dilated or if hemorrhaging, fetus is delivered by C-section. Severe
cases cause hemorrhage; fetus must be delivered to save mother's life.
Severe Preeclampsia - ansA primigravida who is in the late third trimester of pregnancy
(more than 34 weeks) complains of a sudden onset of severe recurrent headaches, visual
abnormalities (blurred vision, scotomas), and pitting edema. Edema easily seen on the
face/eyes and fingers. Sudden rapid weight gain within 1 to 2 days (greater than 2 lbs/week).
New onset of right upper quadrant abdominal pain. Blood pressure more than
140/90 mmHg. Urine protein 1+ or higher. Sudden decrease in urine output (oliguria).
Nausea and vomiting is a worrisome sign (encephalopathy). If seizures occur, it is
reclassified as eclampsia. Earliest time period that preeclampsia/eclampsia can occur is at 20
weeks of gestation (and up to 4 weeks postpartum). Only known "cure" is delivery of
fetus/baby.
HELLP (Hemolysis, Elevated Liver Enzymes, and
Low Platelets) Syndrome - ansSerious but rare complication of preeclampsia. Classic patient
is a multipara older than 25 years who is in the third trimester of pregnancy. Presence of the
signs and symptoms of preeclampsia that is accompanied by right upper quadrant (or
midepigastric) abdominal pain with nausea/vomiting and malaise. Symptoms can present
suddenly. Lab abnormalities are elevation of the alanine aminotranferease (AST), aspartate
aminotransferase (ALT), total bilirubin, lactate dehydrogenase (LDH) with decreased number
of platelets (<100,000 cells/microl) and hemoglobin and hematocrit.
Laboratory Testing - ansUrinalysis (Dipstick)
,Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
Obtain mid-stream urine before gynecologic exam (minimizes contamination from vaginal
discharge). Check protein, leukocytes, nitrite, blood, glucose.
■ Protein: trace and from 1+ to 4+ is abnormal.
■ If 20 weeks of gestation or more, rule out preeclampsia.
■ If proteinuria present, order 24-hour urine for protein and creatinine clearance.
Liver Function Tests
ALT, AST, bilirubin, and gamma glutamyl transpeptidase (GGT) remain the same except for
alkaline phosphatase.
Alkaline Phosphatase
Alkaline phosphatase is expected to increase during pregnancy due to the growth of the fetal
bones. Values higher in multiple gestation pregnancies.
White Blood Cells
The white blood cell (WBC) count is elevated throughout pregnancy especially during the
third trimester. Leukocytosis with neutrophilia is "normal" during pregnancy (if it is not
accompanied by signs of infection). The WBC may climb as high as 16 mm3.
Hemoglobin and Hematocrit
Both values go down during pregnancy due to hemodilution. Physiologic anemia of
pregnancy is most obvious during the second to third trimesters. The hemoglobin value may
be as low as 9.5 g/dL and the hematocrit value may go down to 28 g/dL (by the third
trimester).
Erythrocyte Sedimentation Rate
Increases during pregnancy.
Thyroid Function Tests
Total T3 and total T4 are higher during pregnancy due to increase levels of thyroid-binding
globulin (TBG). The TSH, free T3, and free T4 results remain unchanged.
Serum Alpha-Fetoprotein (AFP)
Manufactured by the liver of the fetus and mother. Majority of maternal AFP comes from the
fetus (liver, fetal yolk sac, gastrointestinal tract).
Low AFP Results
,Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
■ Mature maternal age is the most common risk factor for Down's syndrome (35-year-old or
older female has a 1:200 chance).
■ If AFP is low, order the Triple Screen test (AFP, hCG
Category A Drugs - ansAnimal and human data show no risk to pregnant women. Examples
are prenatal vitamins, insulin, and thyroid hormone. High-dosed multivitamins are not used
during pregnancy.
Category B Drugs - ansAnimal studies show no risk. No human data available.
■ Antacids (Tums, Maalox).
■ Docusate sodium (Colace). Colace is a stool softener and is approved for pregnant women.
It is not a laxative. Avoid laxatives (e.g., Ex-lax, Bisacodyl), especially in the third trimester
(may induce labor).
■ Analgesics (acetaminophen preferred to NSAIDs especially in the third trimester).
Category C Drugs - ansAdverse effects seen in animal studies. No human data available.
■ Sulfa drugs
- Category C in third trimester because it can cause hyperbilirubinemia. Sulfa drugs displace
bilirubin from albumin. High blood levels of unconjugated bilirubin can
cross the blood-brain barrier and cause brain damage (mental retardation, seizures, deafness,
etc.).
■ Trimethoprim-sulfamethoxazole (e.g., Bactrim DS, Septra)
- Clarithryomycin (Biaxin) is the only category C macrolide antibiotic. Avoid using in
pregnant women. Consult with physician before using category C drugs during pregnancy.
■ NSAIDs
- Avoid using in the third trimester (especially the last 2 weeks) because it blocks
prostaglandins. Category B or C (depends on type of NSAID).
- Ibuprofen (Advil) is category B (fi rst and second trimesters) and category D (third
trimester).
Category D Drugs - ansEvidence of fetal risk. Benefi ts should outweigh the risk of using the
drug.
■ Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers
(ARBs)
- Causes fetal renal abnormalities, renal failure, and hypotension.
- Captopril (Capoten) and losartan (Hyzaar).
- Category C in fi rst trimester.
- Category D in second and third trimester.
■ Fluoroquinolones
, Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
- Affects fetal cartilage development. A rare side effect is Achilles tendon rupture in athletes.
Contraindicated in pregnant or lactating women and children younger than 18 years.
- Ciprofloxacin (Cipro)
- Ofloxacin (Floxin)
- Levofloxacin (Levaquin)
■ Tetracyclines
- Stains growing tooth enamel.
- Tetracycline, minocin (Minocycline).
- Avoid in the third trimester
■ NSAIDs
- Block prostaglandins and may cause premature labor. Avoid using especially in
the last 2 weeks of pregnancy.
■ Sulfa drugs
- Risk of hyperbilirubinemia (neonatal jaundice or kernicterus). Sulfa drugs displace bilirubin
from albumin. High levels of unconjugated bilirubin will cross the blood-brain barrier and
cause brain damage (mental retardation, seizures, deafness, etc.)
Category X Drugs - ansProven fetal risks outweighs the benefi ts.
■ Accutane (isotretinoin, a vitamin A derivative)
- Used for severe cystic and nodular acne recalcitrant to treatment. Highly teratogenic.
■ Methotrexate (anti-metabolite)
- Some types of autoimmune diseases (psoriasis, rheumatoid arthritis) and certain cancers.
■ Proscar (anti-androgen)
- Used for BPH and prostate cancer.
■ Misoprostol (prostaglandin analogue)
- Used as one of the drugs in medical abortions (a component of the "abortion pill").
■ Evista (selective estrogen receptor blocker)
- Used for treating osteoporosis.
■ All hormonal drugs (natural or synthetic) are category X in pregnancy—all forms of
estrogens, progesterone, testosterone, and mefiristone (RU-86).
■ Any drug that blocks hormone synthesis or binding.
■ Depo Lupron is used for infertility, hormone-dependent cancers, and endometriosis.
Antibiotics for Pregnant Women - ansThe antibiotics below are category B.
■ Penicillins
- Amoxicillin (Amoxil), penicillin, dicloxacillin.
■ Cephalosporins
- First generation: cephalexin (Keflex), cefadroxil (Duricef).
- Second generation: cefuroxime axetil (Ceftin), cefaclor (Ceclor), cefprozil (Cefzil).
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
Abruptio Placentae - ansPregnant woman who is in the late third trimester of pregnancy
complains of sudden onset of vaginal bleeding accompanied by a contracted uterus that feels
hard (hypertonic) and is very painful. Associated with a sudden onset of dark red-colored
vaginal bleeding. Up to 20% of women do not have vaginal bleeding (blood is trapped
between
placenta and uterine wall). If mild, blood is reabsorbed and affected area reimplants. Severe
cases cause hemorrhage; fetus must be delivered to save mother's life. Higher risk in females
with history of hypertension, preeclampsia/eclampsia, cocaine use, or history of abruptio
placentae.
Placenta Previa - ansA multipara who is in the late second to third trimester complains of new
onset of painless vaginal bleeding that is worsened by intercourse. Blood is bright red in
color. Uterus
is soft and nontender. If cervix is not dilated, treatment is strict bed rest. Intravenous
magnesium sulfate if there is uterine cramping. Uterus will usually reimplant itself if mild.
Any vaginal or rectal insertion or stimulation is an absolute contraindication (can precipitate
hemorrhage). If cervix is dilated or if hemorrhaging, fetus is delivered by C-section. Severe
cases cause hemorrhage; fetus must be delivered to save mother's life.
Severe Preeclampsia - ansA primigravida who is in the late third trimester of pregnancy
(more than 34 weeks) complains of a sudden onset of severe recurrent headaches, visual
abnormalities (blurred vision, scotomas), and pitting edema. Edema easily seen on the
face/eyes and fingers. Sudden rapid weight gain within 1 to 2 days (greater than 2 lbs/week).
New onset of right upper quadrant abdominal pain. Blood pressure more than
140/90 mmHg. Urine protein 1+ or higher. Sudden decrease in urine output (oliguria).
Nausea and vomiting is a worrisome sign (encephalopathy). If seizures occur, it is
reclassified as eclampsia. Earliest time period that preeclampsia/eclampsia can occur is at 20
weeks of gestation (and up to 4 weeks postpartum). Only known "cure" is delivery of
fetus/baby.
HELLP (Hemolysis, Elevated Liver Enzymes, and
Low Platelets) Syndrome - ansSerious but rare complication of preeclampsia. Classic patient
is a multipara older than 25 years who is in the third trimester of pregnancy. Presence of the
signs and symptoms of preeclampsia that is accompanied by right upper quadrant (or
midepigastric) abdominal pain with nausea/vomiting and malaise. Symptoms can present
suddenly. Lab abnormalities are elevation of the alanine aminotranferease (AST), aspartate
aminotransferase (ALT), total bilirubin, lactate dehydrogenase (LDH) with decreased number
of platelets (<100,000 cells/microl) and hemoglobin and hematocrit.
Laboratory Testing - ansUrinalysis (Dipstick)
,Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
Obtain mid-stream urine before gynecologic exam (minimizes contamination from vaginal
discharge). Check protein, leukocytes, nitrite, blood, glucose.
■ Protein: trace and from 1+ to 4+ is abnormal.
■ If 20 weeks of gestation or more, rule out preeclampsia.
■ If proteinuria present, order 24-hour urine for protein and creatinine clearance.
Liver Function Tests
ALT, AST, bilirubin, and gamma glutamyl transpeptidase (GGT) remain the same except for
alkaline phosphatase.
Alkaline Phosphatase
Alkaline phosphatase is expected to increase during pregnancy due to the growth of the fetal
bones. Values higher in multiple gestation pregnancies.
White Blood Cells
The white blood cell (WBC) count is elevated throughout pregnancy especially during the
third trimester. Leukocytosis with neutrophilia is "normal" during pregnancy (if it is not
accompanied by signs of infection). The WBC may climb as high as 16 mm3.
Hemoglobin and Hematocrit
Both values go down during pregnancy due to hemodilution. Physiologic anemia of
pregnancy is most obvious during the second to third trimesters. The hemoglobin value may
be as low as 9.5 g/dL and the hematocrit value may go down to 28 g/dL (by the third
trimester).
Erythrocyte Sedimentation Rate
Increases during pregnancy.
Thyroid Function Tests
Total T3 and total T4 are higher during pregnancy due to increase levels of thyroid-binding
globulin (TBG). The TSH, free T3, and free T4 results remain unchanged.
Serum Alpha-Fetoprotein (AFP)
Manufactured by the liver of the fetus and mother. Majority of maternal AFP comes from the
fetus (liver, fetal yolk sac, gastrointestinal tract).
Low AFP Results
,Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
■ Mature maternal age is the most common risk factor for Down's syndrome (35-year-old or
older female has a 1:200 chance).
■ If AFP is low, order the Triple Screen test (AFP, hCG
Category A Drugs - ansAnimal and human data show no risk to pregnant women. Examples
are prenatal vitamins, insulin, and thyroid hormone. High-dosed multivitamins are not used
during pregnancy.
Category B Drugs - ansAnimal studies show no risk. No human data available.
■ Antacids (Tums, Maalox).
■ Docusate sodium (Colace). Colace is a stool softener and is approved for pregnant women.
It is not a laxative. Avoid laxatives (e.g., Ex-lax, Bisacodyl), especially in the third trimester
(may induce labor).
■ Analgesics (acetaminophen preferred to NSAIDs especially in the third trimester).
Category C Drugs - ansAdverse effects seen in animal studies. No human data available.
■ Sulfa drugs
- Category C in third trimester because it can cause hyperbilirubinemia. Sulfa drugs displace
bilirubin from albumin. High blood levels of unconjugated bilirubin can
cross the blood-brain barrier and cause brain damage (mental retardation, seizures, deafness,
etc.).
■ Trimethoprim-sulfamethoxazole (e.g., Bactrim DS, Septra)
- Clarithryomycin (Biaxin) is the only category C macrolide antibiotic. Avoid using in
pregnant women. Consult with physician before using category C drugs during pregnancy.
■ NSAIDs
- Avoid using in the third trimester (especially the last 2 weeks) because it blocks
prostaglandins. Category B or C (depends on type of NSAID).
- Ibuprofen (Advil) is category B (fi rst and second trimesters) and category D (third
trimester).
Category D Drugs - ansEvidence of fetal risk. Benefi ts should outweigh the risk of using the
drug.
■ Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers
(ARBs)
- Causes fetal renal abnormalities, renal failure, and hypotension.
- Captopril (Capoten) and losartan (Hyzaar).
- Category C in fi rst trimester.
- Category D in second and third trimester.
■ Fluoroquinolones
, Comprehensive Women's health
exam 2 clinical 1. Top Rated
Study Guide with Verified
Questions and Answers.
Latest Updated 2026/2027
- Affects fetal cartilage development. A rare side effect is Achilles tendon rupture in athletes.
Contraindicated in pregnant or lactating women and children younger than 18 years.
- Ciprofloxacin (Cipro)
- Ofloxacin (Floxin)
- Levofloxacin (Levaquin)
■ Tetracyclines
- Stains growing tooth enamel.
- Tetracycline, minocin (Minocycline).
- Avoid in the third trimester
■ NSAIDs
- Block prostaglandins and may cause premature labor. Avoid using especially in
the last 2 weeks of pregnancy.
■ Sulfa drugs
- Risk of hyperbilirubinemia (neonatal jaundice or kernicterus). Sulfa drugs displace bilirubin
from albumin. High levels of unconjugated bilirubin will cross the blood-brain barrier and
cause brain damage (mental retardation, seizures, deafness, etc.)
Category X Drugs - ansProven fetal risks outweighs the benefi ts.
■ Accutane (isotretinoin, a vitamin A derivative)
- Used for severe cystic and nodular acne recalcitrant to treatment. Highly teratogenic.
■ Methotrexate (anti-metabolite)
- Some types of autoimmune diseases (psoriasis, rheumatoid arthritis) and certain cancers.
■ Proscar (anti-androgen)
- Used for BPH and prostate cancer.
■ Misoprostol (prostaglandin analogue)
- Used as one of the drugs in medical abortions (a component of the "abortion pill").
■ Evista (selective estrogen receptor blocker)
- Used for treating osteoporosis.
■ All hormonal drugs (natural or synthetic) are category X in pregnancy—all forms of
estrogens, progesterone, testosterone, and mefiristone (RU-86).
■ Any drug that blocks hormone synthesis or binding.
■ Depo Lupron is used for infertility, hormone-dependent cancers, and endometriosis.
Antibiotics for Pregnant Women - ansThe antibiotics below are category B.
■ Penicillins
- Amoxicillin (Amoxil), penicillin, dicloxacillin.
■ Cephalosporins
- First generation: cephalexin (Keflex), cefadroxil (Duricef).
- Second generation: cefuroxime axetil (Ceftin), cefaclor (Ceclor), cefprozil (Cefzil).
