ACOG Practice Bulletins Questions with
Correct Answers
what medical therapies are most appropriate for AUB-O in 19-40 yo age range? 1. low
dose combined hormonal contraceptives or
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in 40+ yo age range?` in Late
perimenopausal women, cyclic progestin therapy, low dose oral contraceptives, levonorgestrel
IUD or cyclic hormone therapy
It was found that perimenopausal symptoms were better managed with cyclic hormone therapy
whats are the added benefit for younger patients who have a coagulopathy and AUB-O who
take combined oral contraceptives? combined hormonal contraceptives also have the
added benefit of increased factor VIII and VWD levels, therefore combating coagulopathy
,whats are the added benefit for younger patients who have PCOS and AUB-O who take
combined oral contraceptives? combined oral contraceptives suppress ovarian and
adrenal androgen production and increase hormone binding globulin, therefore decreasing
androgens which in turn improve symptoms of hirsuitism and acne in PCOS
In patients with AUB-O who have completed childbearing, what are the potential concerns of
endometrial ablation treatment? - risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial distortion, strictures, synechiae
what is the suggested further investigation of women with AUB-O who have failed medical
management? 1. hysteroscopy
2. TVUS (in pre-menopausal women, should be conducted when endometrium is thinnest at
days 4-6)
3. saline infusion sonohysterography (high sensitivity and high NPV)
what method of contraception has been show to effectively treat AUB? levonorgestrel
IUD
,which women are candidates for hysterecomy without cervical preservation secondary to AUB?
women who have completed child bearing
women have failed medical therapy
women with contraindications
What are the goal ranges of insulin therapy for women with pre-gestational diabetes mellitus
(i.e. at fasting, pre-meal, 1 hour postprandial, and 2 hour) fasting = <95 mg/dL
pre meal = <100
1 hour = <140
2 hour = <120
when are the various insulins utilized during management of patient glucose levels?
short/rapid acting = before meals
intermediate acting = before breakfast and before dinner (with short/rapid acting)
longer acting = utilized to restrain hepatic glucose production during fasting states
what are the uses for magnesium sulfate during pregnancy? - tocolysis during pre-term
labor to provide time for steroid administration
, - neuroprotection
What are the indications for treatment with magnesium sulfate for neuroprotection? -
PPROM
-PTL with intact membranes
-indicated Pre term delivery
- limited to pregnancies less than 32 weeks GA
What dose of magnesium sulfate is given for neuroprotection? loading dose 4 grams
followed by 1 gram/hr for maintenance; discontinue after 24 hours if delivery has not occurred
what are the side effects of magnesium sulfate? diaphoresis
flushing
nausea
headache
magnesium toxicity (cardiac arrest, respiratory depression)
Correct Answers
what medical therapies are most appropriate for AUB-O in 19-40 yo age range? 1. low
dose combined hormonal contraceptives or
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in 40+ yo age range?` in Late
perimenopausal women, cyclic progestin therapy, low dose oral contraceptives, levonorgestrel
IUD or cyclic hormone therapy
It was found that perimenopausal symptoms were better managed with cyclic hormone therapy
whats are the added benefit for younger patients who have a coagulopathy and AUB-O who
take combined oral contraceptives? combined hormonal contraceptives also have the
added benefit of increased factor VIII and VWD levels, therefore combating coagulopathy
,whats are the added benefit for younger patients who have PCOS and AUB-O who take
combined oral contraceptives? combined oral contraceptives suppress ovarian and
adrenal androgen production and increase hormone binding globulin, therefore decreasing
androgens which in turn improve symptoms of hirsuitism and acne in PCOS
In patients with AUB-O who have completed childbearing, what are the potential concerns of
endometrial ablation treatment? - risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial distortion, strictures, synechiae
what is the suggested further investigation of women with AUB-O who have failed medical
management? 1. hysteroscopy
2. TVUS (in pre-menopausal women, should be conducted when endometrium is thinnest at
days 4-6)
3. saline infusion sonohysterography (high sensitivity and high NPV)
what method of contraception has been show to effectively treat AUB? levonorgestrel
IUD
,which women are candidates for hysterecomy without cervical preservation secondary to AUB?
women who have completed child bearing
women have failed medical therapy
women with contraindications
What are the goal ranges of insulin therapy for women with pre-gestational diabetes mellitus
(i.e. at fasting, pre-meal, 1 hour postprandial, and 2 hour) fasting = <95 mg/dL
pre meal = <100
1 hour = <140
2 hour = <120
when are the various insulins utilized during management of patient glucose levels?
short/rapid acting = before meals
intermediate acting = before breakfast and before dinner (with short/rapid acting)
longer acting = utilized to restrain hepatic glucose production during fasting states
what are the uses for magnesium sulfate during pregnancy? - tocolysis during pre-term
labor to provide time for steroid administration
, - neuroprotection
What are the indications for treatment with magnesium sulfate for neuroprotection? -
PPROM
-PTL with intact membranes
-indicated Pre term delivery
- limited to pregnancies less than 32 weeks GA
What dose of magnesium sulfate is given for neuroprotection? loading dose 4 grams
followed by 1 gram/hr for maintenance; discontinue after 24 hours if delivery has not occurred
what are the side effects of magnesium sulfate? diaphoresis
flushing
nausea
headache
magnesium toxicity (cardiac arrest, respiratory depression)
