AAPD Oral Board Exam with Accurate
Answers
When are antenatal steroids recommended? - ✔✔24w0d-33w6d including patients with ROM
and multiple gestations.
Describe rescue steroids. - ✔✔Given if >14 days since initial course, as early as 7 days after last
course depending on scenario.
What are the doses of steroids acceptable? - ✔✔12mg IM every 24 hours for 2 doses or 6mg IM
every 12 hours for 4 doses.
What is prevalence of preterm labor in the US? - ✔✔10%
What are indications for tocolysis? - ✔✔Essentially getting through the steroid window. Not
indicated prior to viability.
When is magnesium for neuroprotection indicated? - ✔✔When birth is anticipated prior to
32wks gestation to reduce risk of cerebral palsy.
What are risk factors for PROM? - ✔✔Hx PPROM or PTL, short cervix, 2/3TM bleeding, low BMI,
low SES, tobacco / drug use.
How is diagnosis of PPROM made? - ✔✔Clinical exam with pooling/ferning/nitrazine testing.
Can do blue dye test if truly equivocal.
What is management of late preterm PPROM? - ✔✔Start steroids but do not delay delivery.
Treat for GBS and obtain swab, do not give latency abx. Do NOT tocolyze.
, What is management of preterm PPROM? - ✔✔Latency abx if not contracting, steroids, and
mag if <32wks.
Exception for steroids in management of PPROM? - ✔✔If late preterm, PPROM'ed, and infected
do not give steroids.
Give dosage for latency abx in PPROM. - ✔✔Ampicillin 2g IV q6 hours for 48hrs, Erythromycin
250mg PO every 6 hours or Azithro 1000mg once,
Amoxicillin 250mg PO every 8 hours. Add Valtrex if known HSV.
How do we interpret the Bishop score? - ✔✔Score less than 6 > ripening needed.
Score greater than 8 > proceed without ripening.
Define tachysystole. - ✔✔More than 5 ctx in 10 minutes, averaged over 30 minute window.
Always qualified as to presence or absence of associated decels.
Active phase arrest definition - ✔✔No cervical change after ROM on pitocin with adequate ctx
for 4 hours or inadequate for 6hrs.
Friedman vs Zhang labor curve - ✔✔Friedman: active starts at 4cm.
Zhang: active starts at 6cm.
Describe a prolonged latent phase of labor and its importance. - ✔✔Latent phase >16 hours.
There is no evidence that defines latent stage arrest, avoid CS for this indication.
Failed IOL definition - ✔✔12-18h after AROM on pit without progressing past 5cm.
When should pushing commence? - ✔✔As soon as complete dilation is reached as this mimics
labor without neuraxial anesthesia.
Answers
When are antenatal steroids recommended? - ✔✔24w0d-33w6d including patients with ROM
and multiple gestations.
Describe rescue steroids. - ✔✔Given if >14 days since initial course, as early as 7 days after last
course depending on scenario.
What are the doses of steroids acceptable? - ✔✔12mg IM every 24 hours for 2 doses or 6mg IM
every 12 hours for 4 doses.
What is prevalence of preterm labor in the US? - ✔✔10%
What are indications for tocolysis? - ✔✔Essentially getting through the steroid window. Not
indicated prior to viability.
When is magnesium for neuroprotection indicated? - ✔✔When birth is anticipated prior to
32wks gestation to reduce risk of cerebral palsy.
What are risk factors for PROM? - ✔✔Hx PPROM or PTL, short cervix, 2/3TM bleeding, low BMI,
low SES, tobacco / drug use.
How is diagnosis of PPROM made? - ✔✔Clinical exam with pooling/ferning/nitrazine testing.
Can do blue dye test if truly equivocal.
What is management of late preterm PPROM? - ✔✔Start steroids but do not delay delivery.
Treat for GBS and obtain swab, do not give latency abx. Do NOT tocolyze.
, What is management of preterm PPROM? - ✔✔Latency abx if not contracting, steroids, and
mag if <32wks.
Exception for steroids in management of PPROM? - ✔✔If late preterm, PPROM'ed, and infected
do not give steroids.
Give dosage for latency abx in PPROM. - ✔✔Ampicillin 2g IV q6 hours for 48hrs, Erythromycin
250mg PO every 6 hours or Azithro 1000mg once,
Amoxicillin 250mg PO every 8 hours. Add Valtrex if known HSV.
How do we interpret the Bishop score? - ✔✔Score less than 6 > ripening needed.
Score greater than 8 > proceed without ripening.
Define tachysystole. - ✔✔More than 5 ctx in 10 minutes, averaged over 30 minute window.
Always qualified as to presence or absence of associated decels.
Active phase arrest definition - ✔✔No cervical change after ROM on pitocin with adequate ctx
for 4 hours or inadequate for 6hrs.
Friedman vs Zhang labor curve - ✔✔Friedman: active starts at 4cm.
Zhang: active starts at 6cm.
Describe a prolonged latent phase of labor and its importance. - ✔✔Latent phase >16 hours.
There is no evidence that defines latent stage arrest, avoid CS for this indication.
Failed IOL definition - ✔✔12-18h after AROM on pit without progressing past 5cm.
When should pushing commence? - ✔✔As soon as complete dilation is reached as this mimics
labor without neuraxial anesthesia.
