OB/GYN Shelf Review

A 17-year-old G1P0 female at 39 weeks presents with increased swelling in her face and hands over the last two days. Her blood pressure is 155/99. She has 2 plus pitting edema of the lower extremities. A 24-hour urine collection shows 440 mg of protein. W

Correct answer is E. This patient has a diagnosis of preeclampsia. Delivery is recommended for women with gestational hypertension or preeclampsia without severe features at or beyond 37 0/7 weeks of gestation. Fluid management must be monitored closely i

Outline some risk factors for pre-eclampsia.

Other risk factors for preeclampsia include a previous history of the disease, chronic hypertension, multifetal pregnancy and molar pregnancy. In addition, patients at extremes of maternal age or with diabetes, chronic renal disease, antiphospholipid anti

A therapeutic magnesium level is between _________

4-7 mEq/L.

What happens at a magnesium level of 7-10 mEq/L

Loss of deep tendon reflexes

What happens at a magnesium level of 11 mEq/L

respiratory depression

What happens at a magnesium level of 15 mEq/L. What is a side effect of magnesium therapy associated w/ the lungs? (hint: not related to toxicity from the drug)

cardiac arrest
Pulmonary edema can occur with magnesium therapy, but is not related to toxicity from the drug.

A 31-year-old G3P0 woman at 27 weeks is being managed expectantly for severe preeclampsia remote from term. Her blood pressure is 155/100 on labetalol 200 mg three times a day. Her recent 24-hour urine had 6.6 grams of protein. An ultrasound revealed a fe

Correct answer is B. Thrombocytopenia <100,000 is a contraindication to expectant management of severe preeclampsia remote from term. Delivery is recommended for patients diagnosed with severe preeclampsia when gestational age is at or beyond 34 0/7 weeks

A 24-year-old Rh-negative G1P1 woman just delivered a healthy term infant who is Rh-positive. You recommend RhoGAM administration but she declines because she does not desire any blood products. What is her approximate risk of isoimmunization if she does

Correct answer is A.
The risk of isoimmunization is 2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy.

Read card.

Fetal hydrops is easily diagnosed on ultrasound. It develops in the presence of decreased hepatic protein production. It is defined as a collection of fluid in two or more body cavities, such as ascites, pericardial and/or pleural fluid and scalp edema. O

A 24-year-old G1P0 at 32 weeks gestation presents with vaginal bleeding most likely caused by placental abruption. She receives a standard dose of 300 micrograms of RhoGAM. What amount of fetal blood is neutralized by this dose?
A. 10 cc
B. 20 cc
C. 30 cc

Correct! 30 cc of fetal blood is neutralized by the 300 micrograms dose of RhoGAM. This is equivalent to 15 cc of fetal red blood cells. At 28-weeks gestation, 300 micrograms of Rh-immune globulin is routinely administered after testing for sensitization

What is the most appropriate method to determine the correct RhoGAM dose to give to the patient?
A. Determine delta OD 450 (optical density)
B. Measure fetal hemoglobin levels
C. Perform a Kleihauer-Betke test
D. Measure maternal hemoglobin levels
E. Admi

The routine dose of RhoGAM neutralizes 30 cc of fetal blood. The Kleihauer-Betke test is an accurate and sensitive acid elution test. It has great value in determining the incidence and size of fetal transplacental hemorrhage. In this test, using acid elu

A 24-year-old G2P1 woman is diagnosed with Rh hemolytic disease at 24 weeks gestation. Measurement of which of the following in the amniotic fluid is best indicative of the severity of the disease?
A. Hemoglobin
B. Iron
C. Anti-D antibody titer
D. Glucose

Correct! In the presence of a severely erythroblastotic fetus, the amniotic fluid is stained yellow. The yellow pigment is bilirubin, which can be quantified most accurately by spectrophotometric measurements of the optical density between 420 and 460nm,

A 24-year-old G2P1 woman has a fetus that is affected by Rh disease. At 30 weeks gestation, the delta OD450 (optical density deviation at 450 nm) results plot on the Liley curve in Zone 3 indicating severe hemolytic disease. Which of the following is the

Correct answer is C. Values in Zone 3 of the Liley curve indicate the presence of severe hemolytic disease, with hydrops and fetal death likely within 7-10 days, thus demanding immediate delivery or fetal transfusion. At 30 weeks gestation, the fetus woul

A 30-year-old G2P1 woman with last menstrual period 10 weeks ago presents for her first prenatal care visit. She is healthy and takes no medications. Her previous pregnancy was an uncomplicated vaginal delivery at 39 weeks. On examination, her vital signs

Correct answer is B. The incidence of congenital anomalies is increased in twins, particularly monozygotic twins, compared to singletons. The majority of twin pairs in which an anomaly is present will be discordant for the anomaly. Twin gestations tend to

A 32-year-old G1P0 woman at 10 weeks gestation presents to your office after an ultrasound evaluation has revealed a diamniotic, dichorionic twin gestation. She is very concerned about the risk for preterm delivery. Which intervention would you recommend

Correct answer is E. Although prematurity has been recognized as a major cause of morbidity and mortality among twin gestations, interventions for prevention of prematurity have, in general, been unsuccessful. Studies show that an adequate weight gain in

A 29-year-old G4P2 woman with no previous prenatal care presents at 24 weeks gestation with signs and symptoms of preterm labor. Her cervix is 3 cm dilated and 80% effaced. Fundal height is 30 cm and an ultrasound examination reveals a twin gestation. Est

Correct answer is C. Twin-twin transfusion syndrome is the result of an intrauterine blood transfusion from one twin to the other. It most commonly occurs in monochorionic, diamniotic twins. The donor twin is often smaller and anemic at birth. The recipie

A 29-year-old G4P2 woman was diagnosed with twin-twin transfusion syndrome when an ultrasound was performed at 24 weeks gestational age. Which of the following is a complication of twin-twin transfusion syndrome?
A. Fetal macrosomia in the donor twin
B. N

Correct answer is B. Untreated severe twin-twin transfusion syndrome has a poor prognosis, with perinatal mortality rates of 70-100%. Death in utero of either twin is common. Surviving infants have increased rates of neurological morbidity, with increased

A 36-year-old G1P0 Asian woman presents to the office accompanied by her 32-year-old husband. She is thrilled that she is now pregnant with twins after undergoing in vitro fertilization. She has a history of polycystic ovarian syndrome and thought she wou

Correct answer is C. Assisted reproduction has led to an increase number of multiple gestations. The rates of multiple births after IVF (in-vitro fertilization) vary according to maternal age and the number of embryos transferred. Transfer of multiple emb

A 34-year-old G1P0 woman is in a motor vehicle accident. While in the emergency department, the doctors order multiple x-rays to evaluate her injuries. At what gestational age would the fetus be most susceptible to developing intellectual disability with

Correct answer is B. The risk of developing microcephaly and severe intellectual disability is greatest between eight and 15 weeks gestation. In 1990, the Committee on Biological Effects reported that no risk of mental retardation (now referred to as inte

Obstetric complications: FVL mutation, Trisomy 18,21, diabetes, and parvo.

The FVL mutation is associated with obstetric complications including stillbirth, preeclampsia, placental abruption and IUGR. Fetuses with Trisomy 18 are likely to have congenital anomalies that are detectable on prenatal ultrasound. Over 90% of cases of

Uncontrolled diabetes during pregnancy

Uncontrolled diabetes during organogenesis is associated with a high rate of birth defects. The most common sites affected are the spine and the heart of the fetus, although all birth defects are increased. Fetuses in utero exposed to high levels of gluco

A 40-year-old G1P0 woman at 22 weeks gestation presents to the office with a complaint of pelvic pressure. She reports that she had intercourse the night prior to presentation and noted some mucous mixed with blood this morning. Her history is significant

B. The most likely cause of painless cervical dilation which leads to pelvic pressure, bulging membranes and fetal loss is cervical incompetence or insufficiency. This patient has a history of cone biopsy which can lead to cervical incompetence. Preterm l

read.

Uncontrolled glucose is associated with adverse fetal outcome. A patient with type 1 diabetes is at risk for many pregnancy complications, including fetal death and fetal macrosomia, although fetal growth restriction may also occur. Diabetics also have in

A 33-year-old G2P1 woman presents at 12 weeks gestation for routine prenatal visit. She has had an uncomplicated prenatal course. Doppler fetal heart tones are not heard and the ultrasound today shows a crown rump length of 8 mm with no cardiac activity a

Correct answer is D. This patient has a missed abortion and should be offered uterine evacuation. Ultrasound criteria for a missed abortion are a CRL of > 7 mm with no cardiac activity. Medical induction using misoprostol has been shown to be efficacious

A 32-year-old G1P0 woman comes to your office for her first prenatal care visit. She has recently read an article about the rising Cesarean section rate in the United States and asks you about the rate in your hospital. What do you explain as the major ca

Correct answer is B. The rate of vaginal birth after Cesarean (VBAC) has decreased in recent years due to studies that showed an increased risk of complications, especially uterine rupture. This is one factor that has led to the increased Cesarean section

Factors associated w/ breech presentation

Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids are all associated with breech presentation.

A 20-year-old G1 woman at 40 weeks gestation presents to labor and delivery complaining of painful contractions every 3-4 minutes since midnight. Her examination on admission was 2 centimeters dilated, 90% effaced and 0 station. Three hours later, her exa

Correct answer is C. The patient is in the latent phase of labor and has not yet reached the active phase (more than 4 cm). A prolonged latent phase is defined as >20 hours for nulliparas and >14 hours for multiparas, and may be treated with rest or augme

A 29-year-old G1P0 woman at 28 weeks gestation who is the wife of basketball player is diagnosed with gestational diabetes. Her mother had a delivery complicated by shoulder dystocia and she is concerned about her own risk. Which of the following is her b

Fetal macrosomia, maternal obesity, diabetes mellitus, postterm pregnancy, a prior delivery complicated by a shoulder dystocia, and a prolonged second stage of labor are all associated with an increased incidence of shoulder dystocia. Although a family hi

The operative team decides to give her fresh frozen plasma (FFP) to replace which of the following components?
A. Platelets
B. Von Willebrand's factor
C. Red blood cells
D. Fibrinogen
E. Factor X

Correct answer is D. Correcting coagulation deficiencies requires replacing all necessary blood components. Fresh frozen plasma contains fibrinogen, as well as clotting factors V and VIII. Cryoprecipitate contains fibrinogen, factor VIII and von Willebran

An 18-year-old G1 woman at 32 weeks gestation presents with severe abdominal pain and a small amount of bleeding. She has received routine prenatal care, smokes one pack of cigarettes per day and admits to using crack cocaine. On exam, her blood pressure

This patient has a placental abruption. Common presenting signs of an abruption include abdominal pain, bleeding, uterine hypertonus and fetal distress. Risk factors include smoking, cocaine use, chronic hypertension, trauma, prolonged premature rupture o

A 25-year-old G0 woman presents to her doctor for preconception counseling. She is healthy without significant medical problems. She takes no medications. She smokes one pack of cigarettes per day since age 16 and drinks occasionally. She weighs 140 pound

Smoking increases the risk of several serious complications of pregnancy, including placental abruption, placenta previa, fetal growth restriction, preeclampsia and infection. Women who smoke should be counseled vigorously to quit smoking prior to concept

A 38-year-old G2P0 woman at 28 weeks gestation has been diagnosed with preterm labor and is currently stable on nifedipine. Her cervical exam has remained unchanged at 2 cm dilated, 75% effaced and -2 station. Her vital signs are stable and fetal heart tr

Treatment with betamethasone from 24 to 34 weeks gestation has been shown to increase pulmonary maturity and reduce the incidence and severity of RDS (respiratory distress syndrome) in the newborn. It is also associated with decreased intracerebral hemorr

A 19-year-old G2P1 African American woman at 30 weeks gestation presents with preterm rupture of membranes six hours ago. Her prenatal course has been complicated by two episodes of bacterial vaginosis for which she was treated. She takes prenatal vitamin

The primary risk factor for preterm rupture of membranes is genital tract infection, especially associated with bacterial vaginosis. All of the other listed options are risk factors. Smoking and prior preterm premature rupture of membranes (which she did

A 33-year-old G2P1 woman at 29 weeks gestation presents with confirmed preterm premature rupture of membranes. She denies labor. She takes prenatal vitamins and iron. She denies substance abuse, smoking or alcohol use. Her prior pregnancy was delivered va

Correct answer is A. Antibiotic therapy given to patients with preterm premature rupture of the membranes has been found to prolong the latency period by 5-7 days, as well as reduce the incidence of maternal amnionitis and neonatal sepsis. Corticosteroids

A 28-year-old G3P2 woman presents in labor at 39 weeks gestation and delivers a 3500 gram infant spontaneously after oxytocin augmentation of labor. Thirty minutes later, the placenta has not delivered. Her past medical history is significant for leiomyom

Placental abruptions, labor augmentation, degree of parity and circumvallate placenta have no impact on the risk of retained placenta. The following are associated with retained placenta: prior Cesarean delivery, uterine leiomyomas, prior uterine curettag

A 37-year-old G4P3 woman presents in labor at term. Her medical history and prenatal course are uncomplicated. She delivers a 3500 gram infant spontaneously after oxytocin augmentation of labor. Immediately postpartum, there is excessive bleeding greater

Correct answer is D. Prostaglandin F2-alpha should be administered intramuscularly. It could also be injected directly into the uterine muscle. Prostaglandin F2-alpha should not be administered IV, as it can lead to severe bronchoconstriction. Oxytocin is

A 23-year-old G1P1 woman delivered her first baby two days ago after an uncomplicated labor and vaginal delivery. She wants to breastfeed and has been working with the lactation team. Prior to discharge, her temperature was 100.4� F (38� C) and other vita

Correct answer is D. Breast engorgement is an exaggerated response to the lymphatic and venous congestion associated with lactation. Milk "let-down" generally occurs on postpartum day two or three. If the baby is not feeding well, the breast can become en

A 32-year-old G1 is seeing you in consultation at 35 weeks gestation. Ultrasound reveals limited fetal growth over the past three weeks. Biometry is consistent with 30-5/7, EFW 1900 g, less than 10th percentile. You counsel her about short and long-term c

Correct answer is E. Epidemiologic studies indicate that fetal growth restriction is a significant risk factor for the subsequent development of cardiovascular disease, chronic hypertension, chronic obstructive lung disease and diabetes. Researchers sugge

A 35-year-old G3P3 woman comes to the office to discuss tubal ligation as she desires permanent sterilization. The non-contraceptive health benefits of female sterilization reduce the risk of which of the following?
A. Breast cancer
B. Ovarian cancer
C. E

Correct answer is B. Tubal ligation has not been shown to reduce the risk of breast, cervical, or endometrial cancers, nor is there a decrease in menstrual blood flow in women who have undergone a tubal ligation. There is a slight reduction in the risk of

How calcium should be given to a postmenopausal woman?

1,200 mg

A 53-year-old G2P2 woman comes to your office complaining of six months of worsening hot flashes, vaginal dryness, night sweats, and sleep disturbances. Her last normal menstrual period was six months ago and she has been experiencing intermittent small a

The principal symptom of endometrial cancer is abnormal vaginal bleeding. Although the patient's worsening symptoms make treatment an important consideration, the specific organic cause(s) of abnormal bleeding must be ruled out prior to initiating therapy

A 48-year-old G2P2 woman comes to your office because she has skipped her menstrual period for the past three months. She denies any menopausal symptoms. Review of symptoms and physical exam are unremarkable. What is the most likely diagnosis in this pati

Although there has been a decline in the average age of menarche with the improvement in health and living conditions, the average age of menopause has remained stable. The Massachusetts Women's Health Study reports that the average age of menopause is 51

A 58-year-old G3P3 woman has been postmenopausal for five years and is concerned about osteoporosis. She has declined hormone therapy in the past. Her mother has a history of a hip fracture at age 82. A physical exam is unremarkable. In addition to weight

Calcium absorption decreases with age because of a decrease in biologically active vitamin D. A positive calcium balance is necessary to prevent osteoporosis. Calcium supplementation reduces bone loss and decreases fractures in individuals with low dietar

A 58-year-old G3P1 woman presents to your office for her a health maintenance examination. She became menopausal at age 54. Her past medical history is significant for angina. She experienced a hip fracture 14 months ago when she tripped and fell while ru

This patient has many of the major risk factors for osteoporosis including history of fracture as an adult, low body weight and being a current smoker. Patients who already have had an osteoporotic fracture may be treated on this basis alone. Prior to beg

A 54-year-old G2P2 woman presents to your office for a health maintenance examination. Her last menstrual period was eight months ago. She complains of severe vasomotor symptoms, vaginal dryness, and dyspareunia, and desires treatment for her symptoms. Sh

The American College of Obstetricians and Gynecologists (ACOG) recommendations on hormone replacement therapy considers hormone replacement therapy (HRT) the most effective treatment for severe menopausal symptoms that include hot flashes, night sweats an

A 51-year-old G1P1 woman presents for annual examination. She notes vaginal dryness, some hot flashes, and fatigue. She reports that her last menstrual period was 14 months ago. She and her husband use lubrication for intercourse, and she denies any signi

Expectant management is reasonable in this patient, as she notes minimal menopausal symptoms. Her vaginal dryness is not interfering with her ability to enjoy intercourse, and she has only occasional hot flashes. An FSH level is not indicated as by defini

A 49-year-old G2P2 woman status post hysterectomy at age 45 for fibroids presents to your office complaining of severe vasomotor symptoms for three months. Hot flashes are affecting her quality of life and she would like to discuss options for treatment.

Except for estrogen receptor modulator therapy, all of the above treatment options will improve hot flash symptoms. Treatment with estrogen is most effective, and the current recommendation is for the lowest dose for the shortest duration of time. Hot fla

A 49-year-old G1P1 woman comes to your office for menopause counseling. She has been experiencing severe sleep disturbances and night sweats for the past four months. She would like to begin hormone therapy, but is concerned because she has elevated chole

Recent data have confirmed the overall positive effects of hormone therapy on serum lipid profiles. The most important lipid effects of postmenopausal hormone treatment are the reduction in LDL cholesterol and the increase in HDL cholesterol. Estrogen inc

A 58-year-old G3P3 woman who has been menopausal since age 50 comes to you for a health maintenance examination. She is in good health, eats a balanced diet, exercises regularly, and has an unremarkable physical exam. Her bone mineral density as determine

The World Health Organization (WHO) defines osteopenia (low bone mass) as -1 to -2.5. The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion recommends that physicians interpret T scores between ?1.0 and ?2.5 in combination with

A 54-year-old G4P4 woman who has been menopausal for four years recently underwent a total vaginal hysterectomy and bilateral salpingo-oophorectomy for vaginal prolapse. She comes in for a postoperative check up and complains of hot flashes and wonders wh

Estrogen production by the ovaries does not continue beyond menopause. However, estrogen levels in postmenopausal women can be significant due to the extraglandular conversion of androstenedione and testosterone to estrogen. This conversion occurs in peri

Infertility facts

After one month, 20% of couples will conceive; after three months, 50%; after six months, 75%; and after 12 months, 90% will conceive. Primary infertility is defined as the inability to conceive for one year without contraception. The patient is young and