OB/GYN Shelf Review
A 17-year-antique G1P0 lady at 39 weeks presents with multiplied swelling in her face and
fingers during the last two days. Her blood strain is 155/99. She has 2 plus pitting edema of
the decrease extremities. A 24-hour urine collection indicates 440 mg of protein. What is the
next satisfactory step within the management of this affected person?
A. Fluid restrict
B. Magnesium sulfate
C. Furosemide
D. Hydralazine
E. Delivery - ANS-Correct answer is E. This patient has a analysis of preeclampsia. Delivery
is usually recommended for women with gestational high blood pressure or preeclampsia
without extreme features at or past 37 zero/7 weeks of gestation. Fluid control have to be
monitored closely on this character as sufferers with preeclampsia are at danger for growing
pulmonary edema. Treatment with magnesium sulfate isn't endorsed for girls with
preeclampsia with systolic BP of much less than 160 mm Hg and a diastolic BP much less
than one hundred ten mm Hg and no maternal signs. Diuretics have to no longer be
administrated to this patient as it would in addition use up her intravascular quantity, but may
be indicated in the placing of pulmonary edema. Treatment with antihypertensive retailers is
not indicated for patients with preeclampsia with a persistent BP of much less than a
hundred and sixty mm Hg systolic or 110 mm Hg diastolic.
A 19-12 months-old G2P1 African American lady at 30 weeks gestation affords with preterm
rupture of membranes six hours in the past. Her prenatal path has been complicated by way
of two episodes of bacterial vaginosis for which she turned into handled. She takes prenatal
vitamins and iron. She denies substance abuse or alcohol use, however admits to smoking
five cigarettes every day. Her prior pregnancy changed into brought vaginally at forty one
weeks after spontaneous rupture of membranes. Her blood pressure is one hundred ten/70;
pulse 84; temperature 98.6°F (37.Zero°C). Pertinent sonographic findings display
oligohydramnios and a cervical duration of 30 mm. Which of the following is the most in all
likelihood purpose of preterm untimely rupture of membranes on this affected person?
A. Ethnicity
B. Smoking
C. Previous untimely rupture of membranes
D. Cervical period
E. Genital tract infections - ANS-The primary threat element for preterm rupture of
membranes is genital tract infection, in particular associated with bacterial vaginosis. All of
the opposite listed options are hazard elements. Smoking and previous preterm premature
rupture of membranes (which she did not have formerly because she added at forty one
weeks) will increase the chance of preterm rupture of membranes -fold. A shortened cervical
period is also a danger thing, however her cervical duration is ordinary.
A 20-yr-vintage G1 lady at 40 weeks gestation provides to exertions and shipping
complaining of painful contractions every three-four minutes for the reason that middle of the
night. Her examination on admission become 2 centimeters dilated, 90% effaced and 0
,station. Three hours later, her exam is unchanged. The affected person is still having
contractions every three-four minutes. She is discouraged about her lack of progress. Which
of the subsequent is the maximum suitable next step in the management of this affected
person?
A. Laminaria placement
B. Artificial rupture of membranes
C. Counseling about latent phase of exertions and relaxation
D. Manual cervical dilation
E. Cesarean phase for arrest of exertions - ANS-Correct solution is C. The affected person
is within the latent phase of labor and has now not yet reached the energetic section (more
than 4 cm). A prolonged latent phase is described as >20 hours for nulliparas and >14 hours
for multiparas, and may be dealt with with rest or augmentation of labor. Artificial rupture of
membranes is not recommended in the latent section because it places the affected person
at improved hazard of contamination. Cervical dilation or laminaria placement are not
indicated.
A 23-yr-antique G1P1 woman brought her first infant days in the past after an clear-cut labor
and vaginal transport. She desires to breastfeed and has been running with the lactation
crew. Prior to discharge, her temperature turned into a hundred.4° F (38° C) and different
vitals have been regular. She denies urinary frequency or dysuria and her lochia is moderate
without smell. On exam, her lungs are clear, cardiac examination regular, and stomach and
uterine fundus are nontender. Her breasts are company and gentle at some stage in, without
erythema, and nipples are intact. Which of the subsequent is the maximum in all likelihood
reason of her fever?
A. Endomyometritis
B. Septic pelvic thrombophlebitis
C. Mastitis
D. Breast engorgement
E. Vaginitis - ANS-Correct answer is D. Breast engorgement is an exaggerated response to
the lymphatic and venous congestion associated with lactation. Milk "let-down" commonly
occurs on postpartum day or 3. If the child is not feeding properly, the breast can end up
engorged, which could motive a low-grade fever. Lactating ladies are advocated to feed their
baby frequently, and use a breast pump to save you painful engorgement and mastitis.
Postpartum fever differential consists of endometritis, cystitis and mastitis. These are smooth
distinguished, based on clinical findings. Vaginitis is not accompanied by using fever. Septic
pelvic thrombophlebitis is a rare circumstance and characterised by excessive fever not
responsive to antibiotics and is a diagnosis of exclusion.
A 24-yr-old G1P0 at 32 weeks gestation gives with vaginal bleeding maximum likely resulting
from placental abruption. She receives a standard dose of 300 micrograms of RhoGAM.
What quantity of fetal blood is neutralized by way of this dose?
A. 10 cc
B. 20 cc
C. 30 cc
D. 40 cc
E. 50 cc - ANS-Correct! 30 cc of fetal blood is neutralized with the aid of the three hundred
micrograms dose of RhoGAM. This is equivalent to fifteen cc of fetal pink blood cells. At
28-weeks gestation, 300 micrograms of Rh-immune globulin is automatically administered
, after testing for sensitization with an indirect Coombs' test. Administration is given following
amniocentesis at any gestational age.
A 24-yr-vintage G2P1 lady has a fetus that is suffering from Rh disorder. At 30 weeks
gestation, the delta OD450 (optical density deviation at 450 nm) outcomes plot on the Liley
curve in Zone 3 indicating severe hemolytic sickness. Which of the subsequent is the most
appropriate next step inside the management of this affected person?
A. Immediate Cesarean shipping
B. Induction of exertions
C. Intrauterine intravascular fetal transfusion
D. Umbilical blood sampling
E. Maternal plasmapheresis - ANS-Correct answer is C. Values in Zone three of the Liley
curve suggest the presence of severe hemolytic disease, with hydrops and fetal dying
possibly within 7-10 days, hence stressful instantaneous delivery or fetal transfusion. At 30
weeks gestation, the fetus could advantage from extra time in utero. An try have to be made
to correct the underlying anemia. Intravascular transfusion into the umbilical vein is the
desired approach. Intraperitoneal transfusion is used while intravascular transfusion is
technically not possible. If fetal hydrops is present, the reversal of the fetal anemia occurs an
awful lot greater slowly through intraperitoneal transfusion. Percutaneous umbilical blood
sampling should no longer be used as a primary-line approach to evaluate fetal status.
Maternal plasmapheresis is used in excessive disease when intrauterine transfusions are
not possible.
A 24-12 months-antique G2P1 lady is recognized with Rh hemolytic ailment at 24 weeks
gestation. Measurement of which of the following inside the amniotic fluid is high-quality
indicative of the severity of the disease?
A. Hemoglobin
B. Iron
C. Anti-D antibody titer
D. Glucose
E. Bilirubin - ANS-Correct! In the presence of a severely erythroblastotic fetus, the amniotic
fluid is stained yellow. The yellow pigment is bilirubin, which may be quantified most
appropriately by spectrophotometric measurements of the optical density between 420 and
460nm, the wavelength absorbed by way of bilirubin. The deviation from linearity of the
optical density analyzing at 450nm is because of the presence of heme pigment, a
trademark of intense hemolysis.
A 24-yr-old Rh-negative G1P1 woman just delivered a healthful term little one who is
Rh-high-quality. You suggest RhoGAM management however she declines due to the fact
she does no longer choice any blood merchandise. What is her approximate threat of
isoimmunization if she does now not acquire the RhoGAM?
A. Less than 20%
B. Forty%
C. 60%
D. 80%
E. A hundred% - ANS-Correct solution is A.
The risk of isoimmunization is 2% antepartum, 7% after full time period transport, and 7%
with subsequent being pregnant.
A 17-year-antique G1P0 lady at 39 weeks presents with multiplied swelling in her face and
fingers during the last two days. Her blood strain is 155/99. She has 2 plus pitting edema of
the decrease extremities. A 24-hour urine collection indicates 440 mg of protein. What is the
next satisfactory step within the management of this affected person?
A. Fluid restrict
B. Magnesium sulfate
C. Furosemide
D. Hydralazine
E. Delivery - ANS-Correct answer is E. This patient has a analysis of preeclampsia. Delivery
is usually recommended for women with gestational high blood pressure or preeclampsia
without extreme features at or past 37 zero/7 weeks of gestation. Fluid control have to be
monitored closely on this character as sufferers with preeclampsia are at danger for growing
pulmonary edema. Treatment with magnesium sulfate isn't endorsed for girls with
preeclampsia with systolic BP of much less than 160 mm Hg and a diastolic BP much less
than one hundred ten mm Hg and no maternal signs. Diuretics have to no longer be
administrated to this patient as it would in addition use up her intravascular quantity, but may
be indicated in the placing of pulmonary edema. Treatment with antihypertensive retailers is
not indicated for patients with preeclampsia with a persistent BP of much less than a
hundred and sixty mm Hg systolic or 110 mm Hg diastolic.
A 19-12 months-old G2P1 African American lady at 30 weeks gestation affords with preterm
rupture of membranes six hours in the past. Her prenatal path has been complicated by way
of two episodes of bacterial vaginosis for which she turned into handled. She takes prenatal
vitamins and iron. She denies substance abuse or alcohol use, however admits to smoking
five cigarettes every day. Her prior pregnancy changed into brought vaginally at forty one
weeks after spontaneous rupture of membranes. Her blood pressure is one hundred ten/70;
pulse 84; temperature 98.6°F (37.Zero°C). Pertinent sonographic findings display
oligohydramnios and a cervical duration of 30 mm. Which of the following is the most in all
likelihood purpose of preterm untimely rupture of membranes on this affected person?
A. Ethnicity
B. Smoking
C. Previous untimely rupture of membranes
D. Cervical period
E. Genital tract infections - ANS-The primary threat element for preterm rupture of
membranes is genital tract infection, in particular associated with bacterial vaginosis. All of
the opposite listed options are hazard elements. Smoking and previous preterm premature
rupture of membranes (which she did not have formerly because she added at forty one
weeks) will increase the chance of preterm rupture of membranes -fold. A shortened cervical
period is also a danger thing, however her cervical duration is ordinary.
A 20-yr-vintage G1 lady at 40 weeks gestation provides to exertions and shipping
complaining of painful contractions every three-four minutes for the reason that middle of the
night. Her examination on admission become 2 centimeters dilated, 90% effaced and 0
,station. Three hours later, her exam is unchanged. The affected person is still having
contractions every three-four minutes. She is discouraged about her lack of progress. Which
of the subsequent is the maximum suitable next step in the management of this affected
person?
A. Laminaria placement
B. Artificial rupture of membranes
C. Counseling about latent phase of exertions and relaxation
D. Manual cervical dilation
E. Cesarean phase for arrest of exertions - ANS-Correct solution is C. The affected person
is within the latent phase of labor and has now not yet reached the energetic section (more
than 4 cm). A prolonged latent phase is described as >20 hours for nulliparas and >14 hours
for multiparas, and may be dealt with with rest or augmentation of labor. Artificial rupture of
membranes is not recommended in the latent section because it places the affected person
at improved hazard of contamination. Cervical dilation or laminaria placement are not
indicated.
A 23-yr-antique G1P1 woman brought her first infant days in the past after an clear-cut labor
and vaginal transport. She desires to breastfeed and has been running with the lactation
crew. Prior to discharge, her temperature turned into a hundred.4° F (38° C) and different
vitals have been regular. She denies urinary frequency or dysuria and her lochia is moderate
without smell. On exam, her lungs are clear, cardiac examination regular, and stomach and
uterine fundus are nontender. Her breasts are company and gentle at some stage in, without
erythema, and nipples are intact. Which of the subsequent is the maximum in all likelihood
reason of her fever?
A. Endomyometritis
B. Septic pelvic thrombophlebitis
C. Mastitis
D. Breast engorgement
E. Vaginitis - ANS-Correct answer is D. Breast engorgement is an exaggerated response to
the lymphatic and venous congestion associated with lactation. Milk "let-down" commonly
occurs on postpartum day or 3. If the child is not feeding properly, the breast can end up
engorged, which could motive a low-grade fever. Lactating ladies are advocated to feed their
baby frequently, and use a breast pump to save you painful engorgement and mastitis.
Postpartum fever differential consists of endometritis, cystitis and mastitis. These are smooth
distinguished, based on clinical findings. Vaginitis is not accompanied by using fever. Septic
pelvic thrombophlebitis is a rare circumstance and characterised by excessive fever not
responsive to antibiotics and is a diagnosis of exclusion.
A 24-yr-old G1P0 at 32 weeks gestation gives with vaginal bleeding maximum likely resulting
from placental abruption. She receives a standard dose of 300 micrograms of RhoGAM.
What quantity of fetal blood is neutralized by way of this dose?
A. 10 cc
B. 20 cc
C. 30 cc
D. 40 cc
E. 50 cc - ANS-Correct! 30 cc of fetal blood is neutralized with the aid of the three hundred
micrograms dose of RhoGAM. This is equivalent to fifteen cc of fetal pink blood cells. At
28-weeks gestation, 300 micrograms of Rh-immune globulin is automatically administered
, after testing for sensitization with an indirect Coombs' test. Administration is given following
amniocentesis at any gestational age.
A 24-yr-vintage G2P1 lady has a fetus that is suffering from Rh disorder. At 30 weeks
gestation, the delta OD450 (optical density deviation at 450 nm) outcomes plot on the Liley
curve in Zone 3 indicating severe hemolytic sickness. Which of the subsequent is the most
appropriate next step inside the management of this affected person?
A. Immediate Cesarean shipping
B. Induction of exertions
C. Intrauterine intravascular fetal transfusion
D. Umbilical blood sampling
E. Maternal plasmapheresis - ANS-Correct answer is C. Values in Zone three of the Liley
curve suggest the presence of severe hemolytic disease, with hydrops and fetal dying
possibly within 7-10 days, hence stressful instantaneous delivery or fetal transfusion. At 30
weeks gestation, the fetus could advantage from extra time in utero. An try have to be made
to correct the underlying anemia. Intravascular transfusion into the umbilical vein is the
desired approach. Intraperitoneal transfusion is used while intravascular transfusion is
technically not possible. If fetal hydrops is present, the reversal of the fetal anemia occurs an
awful lot greater slowly through intraperitoneal transfusion. Percutaneous umbilical blood
sampling should no longer be used as a primary-line approach to evaluate fetal status.
Maternal plasmapheresis is used in excessive disease when intrauterine transfusions are
not possible.
A 24-12 months-antique G2P1 lady is recognized with Rh hemolytic ailment at 24 weeks
gestation. Measurement of which of the following inside the amniotic fluid is high-quality
indicative of the severity of the disease?
A. Hemoglobin
B. Iron
C. Anti-D antibody titer
D. Glucose
E. Bilirubin - ANS-Correct! In the presence of a severely erythroblastotic fetus, the amniotic
fluid is stained yellow. The yellow pigment is bilirubin, which may be quantified most
appropriately by spectrophotometric measurements of the optical density between 420 and
460nm, the wavelength absorbed by way of bilirubin. The deviation from linearity of the
optical density analyzing at 450nm is because of the presence of heme pigment, a
trademark of intense hemolysis.
A 24-yr-old Rh-negative G1P1 woman just delivered a healthful term little one who is
Rh-high-quality. You suggest RhoGAM management however she declines due to the fact
she does no longer choice any blood merchandise. What is her approximate threat of
isoimmunization if she does now not acquire the RhoGAM?
A. Less than 20%
B. Forty%
C. 60%
D. 80%
E. A hundred% - ANS-Correct solution is A.
The risk of isoimmunization is 2% antepartum, 7% after full time period transport, and 7%
with subsequent being pregnant.
