OB/GYN PAEA TOPIC LIST EXAM 100%
CORRECT RATED A+ FOR SUCCESS
Fetal positions - ANSWER*LOA- anterior fontanelle is felt on patients left side towards
pubic symphonis
*Breech is butt down or footling presentation, frank breech legs will be straight up
monozygotic twins - ANSWERtwins who are genetically identical
dizygotic twins - ANSWERfraternal twins
wt gain pregnancy - ANSWER*(BMI)-specific weight gains in twin pregnancies for
normal weight women of 37-54 pounds, overweight women of 31-50 pounds, and obese
women of 25-42 pounds.[
twin complications - ANSWER*Monochorionic, monoamniotic twins are at increased risk
for perinatal mortality primarily due to cord entanglement
*Twin-to-twin transfusion syndrome (TTTS) complicates approximately 15% of
monochorionic pregnancies, specifically, monochorionic (one placenta), diamniotic (2
sacs) placentations
when to deliver twins - ANSWERUncomplicated dichorionic, diamniotic twin gestation-
38 weeks
• Uncomplicated monochorionic, diamniotic twin gestation- between 34-37 6/7 weeks
• Uncomplicated monochorionic, monoamniotic twin gestations- 32-34 weeks
APGAR scores - ANSWER-Activity (muscle tone), Pulse, Grimace (reflex irritability),
Appearance (color), Respiration
*7-10 is good, 6 or less is not, done at 1 and 5 minutes, 10 minutes if nessesary
Spontaneous abortion - ANSWER*With missed, incomplete, or inevitable abortion
present before 13 weeks' gestation, the standard therapy has been suction D&C.
misoprostol is an effective alternative medical therapy
Ectopic pregnancy - ANSWER*MC in the ampulla of the fallopian tube, B-hcg should
double every 24-48hrs but it will only rise 66% as expected,
*TX is MTX if <3cm and no heartbeat, or if ruptured do laparoscopic salpingostomy
* if the hCG level is elevated, no history of passing tissue is present, and the
ultrasonography demonstrates an empty uterus, one must assume that an ectopic
pregnancy is present until proven otherwise.
*If the pain is occurring only on one side, consider an ectopic pregnancy or a ruptured
ovarian cyst as possible causes.
*Prior to administering the methotrexate, renal and liver function tests are measured
and results should be normal
,*A patient who is less than 3 weeks from expected menses (7 wk from last menstrual
period [LMP]), has an hCG level less than 4000 mIU/mL, and has an ectopic size less
than 3 cm has a 95% chance of success with methotrexate
**What is the most likely cause of abnormal uterine bleeding (AUB) in the following
patient: Positive beta-hCG + severe pain + no fetus in uterus on U/S?
Placental abruption - ANSWERpainful bleeding, uterine contractions, and fetal distress.
A significant cause of third-trimester bleeding associated with fetal and maternal
morbidity and mortality,
*Class 2 characteristics include the following: No vaginal bleeding to moderate vaginal
bleeding • Moderate to severe uterine tenderness with possible tetanic contractions •
Maternal tachycardia with orthostatic changes in BP and heart rate • Fetal distress •
Hypofibrinogenemia (ie, 50-250 mg/dL)
*Elevated second trimester maternal serum alpha-fetoprotein (associated with up to a
10-fold increased risk of abruption)
*Class 3 characteristics include the following:• No vaginal bleeding to heavy vaginal
bleeding • Very painful tetanic uterus • Maternal shock • Hypofibrinogenemia (ie, < 150
mg/dL) • Coagulopathy • Fetal death
*Causes: Maternal hypertension - MC cause of abruption , Maternal trauma (eg, motor
vehicle collision [MVC], assaults, falls) - Causes 1.5-9.4% of all cases , Cigarette
smoking , Alcohol consumption ,Cocaine use
*TX: Begin continuous external fetal monitoring for the fetal heart rate and contractions.,
crystalloid fluid resuscitation , Type and crossmatch blood, Begin a transfusion if the
patient is hemodynamically unstable after fluid resuscitation., Correct coagulopathy, if
present., Administer Rh immune globulin if the patient is Rh-negative.
incompetent cervix - ANSWER*Painless cervical dilatation and bulging fetal membranes
upon presentation in the second trimester of pregnancy, Preterm premature rupture of
membranes (PPROM) , Rapid delivery of a previable infant , absent uterine contractions
* positive fFN and a cervical length of less than 30 mm
*TX: cerclage placement, progesterone supplementation starting at 16-24 weeks'
gestation and continuing up to 36 weeks' gestation, in order to reduce the risk of
recurrent preterm birth.
Placenta previa - ANSWERthere is no pain, there is bleeding
*Abnormal implantation of placenta in the lower uterine segment; 1/250 pregnancies;
bleeding usually begins in the third trimester; previous uterine scars, surgery and fibroid
tumors are associated with this; medical emergency
*do not do digital exam, must do c section
*deliver when stable: >36wks, early if L:S ratio>2, blood loss >500ml
*May use mg sulfate to prevent preterm labor
gestational diabetes - ANSWERFastin >100, 1hr >190, 2hr165, 3hr145
*2+ elevated=diabetes
*TX: diet exercise, glyburide, insulin, check glucose every day fasting and 2 hours post
prandial
, Preeclampsia - ANSWERabnormal condition associated with pregnancy, marked by
high blood pressure, proteinuria, edema, and headache/vis disturbances
*Do a urinalysis, 24 hr protein urine, CMP, CBC, and serial LFT's
*Mild is 140/90, watch and wait
*Severe is 160/110, give steroids and deliver asap
HELLP syndrome - ANSWERpreeclampsia + low platelets + elevated LFTs + hemolysis
*TX is emerg delivery
Molar pregnancy - ANSWER*complete is no dna egg fertilized by 1 or 2 sperm with
higher risk of malignancy
*partial is egg fertilized by 2 sperm, malformed fetus may present
*MC symptom is painless bleeding 1st TM, uterine size/date discrepancy, hyperemesis
graviderum
*new-onset hypertension with either proteinuria or end-organ dysfunction before 20th
week of pregnancy suggests...
*DX: b-hcg elevated >100k, ery low serum alpha protein, cystic appearance (bunch of
grapes/snowstorm) on ultraound with strange looking fetus
*TX: D&C, serial HCG level monitoring, chemo for mets
hyperemesis graviderum - ANSWERexcessive nausea and vommiting that interefere
with her food intake and fluid balance
choriocarcinoma - ANSWERmetastasis of molar pregnancy to lungs MC, or lower
genital tract, pelvic mass
*HCG levels continue after d&C of molar pregnancy
*TX chemo/methotrexate to destroy trophoblastic tissue
RH incompatibility - ANSWERan incompatibility between the Rh negative mother's
blood with her Rh positive baby's blood, causing the mother's body to develop
antibodies that will destroy the Rh positive blood
*TX: Rhogam 28w, within 72 hours after delivery, Coombs test
dystocia - ANSWERSuspected when there is a lack of progress in cervical dilation; lack
of fetal descent; lack of change in uterine contraction characteristics
fetal distress - ANSWERFHR < 110 >10 minutes
*FHR is below 110/min or above 160/min; FHR shows decreased or no variability; fetal
hyperactivity or no activity; fetal blood pH is <7.2
*meconuium stained amniotic fluid
*DO c section
meconium stained - ANSWER-means the baby is in distress
-Obstetric emergency where the fetus has passed the first stool before birth
•Aspiration into the trachobronchial tree is a risk, may develop pneomia
CORRECT RATED A+ FOR SUCCESS
Fetal positions - ANSWER*LOA- anterior fontanelle is felt on patients left side towards
pubic symphonis
*Breech is butt down or footling presentation, frank breech legs will be straight up
monozygotic twins - ANSWERtwins who are genetically identical
dizygotic twins - ANSWERfraternal twins
wt gain pregnancy - ANSWER*(BMI)-specific weight gains in twin pregnancies for
normal weight women of 37-54 pounds, overweight women of 31-50 pounds, and obese
women of 25-42 pounds.[
twin complications - ANSWER*Monochorionic, monoamniotic twins are at increased risk
for perinatal mortality primarily due to cord entanglement
*Twin-to-twin transfusion syndrome (TTTS) complicates approximately 15% of
monochorionic pregnancies, specifically, monochorionic (one placenta), diamniotic (2
sacs) placentations
when to deliver twins - ANSWERUncomplicated dichorionic, diamniotic twin gestation-
38 weeks
• Uncomplicated monochorionic, diamniotic twin gestation- between 34-37 6/7 weeks
• Uncomplicated monochorionic, monoamniotic twin gestations- 32-34 weeks
APGAR scores - ANSWER-Activity (muscle tone), Pulse, Grimace (reflex irritability),
Appearance (color), Respiration
*7-10 is good, 6 or less is not, done at 1 and 5 minutes, 10 minutes if nessesary
Spontaneous abortion - ANSWER*With missed, incomplete, or inevitable abortion
present before 13 weeks' gestation, the standard therapy has been suction D&C.
misoprostol is an effective alternative medical therapy
Ectopic pregnancy - ANSWER*MC in the ampulla of the fallopian tube, B-hcg should
double every 24-48hrs but it will only rise 66% as expected,
*TX is MTX if <3cm and no heartbeat, or if ruptured do laparoscopic salpingostomy
* if the hCG level is elevated, no history of passing tissue is present, and the
ultrasonography demonstrates an empty uterus, one must assume that an ectopic
pregnancy is present until proven otherwise.
*If the pain is occurring only on one side, consider an ectopic pregnancy or a ruptured
ovarian cyst as possible causes.
*Prior to administering the methotrexate, renal and liver function tests are measured
and results should be normal
,*A patient who is less than 3 weeks from expected menses (7 wk from last menstrual
period [LMP]), has an hCG level less than 4000 mIU/mL, and has an ectopic size less
than 3 cm has a 95% chance of success with methotrexate
**What is the most likely cause of abnormal uterine bleeding (AUB) in the following
patient: Positive beta-hCG + severe pain + no fetus in uterus on U/S?
Placental abruption - ANSWERpainful bleeding, uterine contractions, and fetal distress.
A significant cause of third-trimester bleeding associated with fetal and maternal
morbidity and mortality,
*Class 2 characteristics include the following: No vaginal bleeding to moderate vaginal
bleeding • Moderate to severe uterine tenderness with possible tetanic contractions •
Maternal tachycardia with orthostatic changes in BP and heart rate • Fetal distress •
Hypofibrinogenemia (ie, 50-250 mg/dL)
*Elevated second trimester maternal serum alpha-fetoprotein (associated with up to a
10-fold increased risk of abruption)
*Class 3 characteristics include the following:• No vaginal bleeding to heavy vaginal
bleeding • Very painful tetanic uterus • Maternal shock • Hypofibrinogenemia (ie, < 150
mg/dL) • Coagulopathy • Fetal death
*Causes: Maternal hypertension - MC cause of abruption , Maternal trauma (eg, motor
vehicle collision [MVC], assaults, falls) - Causes 1.5-9.4% of all cases , Cigarette
smoking , Alcohol consumption ,Cocaine use
*TX: Begin continuous external fetal monitoring for the fetal heart rate and contractions.,
crystalloid fluid resuscitation , Type and crossmatch blood, Begin a transfusion if the
patient is hemodynamically unstable after fluid resuscitation., Correct coagulopathy, if
present., Administer Rh immune globulin if the patient is Rh-negative.
incompetent cervix - ANSWER*Painless cervical dilatation and bulging fetal membranes
upon presentation in the second trimester of pregnancy, Preterm premature rupture of
membranes (PPROM) , Rapid delivery of a previable infant , absent uterine contractions
* positive fFN and a cervical length of less than 30 mm
*TX: cerclage placement, progesterone supplementation starting at 16-24 weeks'
gestation and continuing up to 36 weeks' gestation, in order to reduce the risk of
recurrent preterm birth.
Placenta previa - ANSWERthere is no pain, there is bleeding
*Abnormal implantation of placenta in the lower uterine segment; 1/250 pregnancies;
bleeding usually begins in the third trimester; previous uterine scars, surgery and fibroid
tumors are associated with this; medical emergency
*do not do digital exam, must do c section
*deliver when stable: >36wks, early if L:S ratio>2, blood loss >500ml
*May use mg sulfate to prevent preterm labor
gestational diabetes - ANSWERFastin >100, 1hr >190, 2hr165, 3hr145
*2+ elevated=diabetes
*TX: diet exercise, glyburide, insulin, check glucose every day fasting and 2 hours post
prandial
, Preeclampsia - ANSWERabnormal condition associated with pregnancy, marked by
high blood pressure, proteinuria, edema, and headache/vis disturbances
*Do a urinalysis, 24 hr protein urine, CMP, CBC, and serial LFT's
*Mild is 140/90, watch and wait
*Severe is 160/110, give steroids and deliver asap
HELLP syndrome - ANSWERpreeclampsia + low platelets + elevated LFTs + hemolysis
*TX is emerg delivery
Molar pregnancy - ANSWER*complete is no dna egg fertilized by 1 or 2 sperm with
higher risk of malignancy
*partial is egg fertilized by 2 sperm, malformed fetus may present
*MC symptom is painless bleeding 1st TM, uterine size/date discrepancy, hyperemesis
graviderum
*new-onset hypertension with either proteinuria or end-organ dysfunction before 20th
week of pregnancy suggests...
*DX: b-hcg elevated >100k, ery low serum alpha protein, cystic appearance (bunch of
grapes/snowstorm) on ultraound with strange looking fetus
*TX: D&C, serial HCG level monitoring, chemo for mets
hyperemesis graviderum - ANSWERexcessive nausea and vommiting that interefere
with her food intake and fluid balance
choriocarcinoma - ANSWERmetastasis of molar pregnancy to lungs MC, or lower
genital tract, pelvic mass
*HCG levels continue after d&C of molar pregnancy
*TX chemo/methotrexate to destroy trophoblastic tissue
RH incompatibility - ANSWERan incompatibility between the Rh negative mother's
blood with her Rh positive baby's blood, causing the mother's body to develop
antibodies that will destroy the Rh positive blood
*TX: Rhogam 28w, within 72 hours after delivery, Coombs test
dystocia - ANSWERSuspected when there is a lack of progress in cervical dilation; lack
of fetal descent; lack of change in uterine contraction characteristics
fetal distress - ANSWERFHR < 110 >10 minutes
*FHR is below 110/min or above 160/min; FHR shows decreased or no variability; fetal
hyperactivity or no activity; fetal blood pH is <7.2
*meconuium stained amniotic fluid
*DO c section
meconium stained - ANSWER-means the baby is in distress
-Obstetric emergency where the fetus has passed the first stool before birth
•Aspiration into the trachobronchial tree is a risk, may develop pneomia
