RR WH toughies
What is another name for a fibroadenoma found in an adolescent that is larger than 5 cm?
A giant fibroadenoma.
What condition is characterized by recurrent episodes of meningitis caused by herpes simplex virus type 2 (HSV-2)?
Mollaret meningitis.
Which autosomal dominant condition is characterized by short stature, pulmonary stenosis, hypertelorism, downslanting palpebral fissures with highly arched eyebrows, strikingly blue irises, and a webbed neck?
Noonan syndrome
Which ligaments support the uterus and attach the cervix to the posterior surface of the pubic symphysis?
Pubocervical ligaments.
What is ptyalism gravidarum?
Excessive salivation during pregnancy
What is the black box warning for metformin?
Lactic acidosis.
What are common risk factors for developing placental previa?
Multiparity, increased age, and tobacco use.
When do prolactin levels return to normal in a mother who is not nursing?
2 to 3 weeks following delivery.
A patient with a history of LSIL and a negative HPV test that has negative cytology and negative HPV at one year should have repeat cotesting at what time?
3 years later.
What is the maximum fetal weight recommended for low-risk women who elect a planned vaginal breech birth?
3,800 g
What is the average length of an umbilical cord?
50 cm.
Which human papillomavirus types most frequently cause genital warts?
6 and 11.
Day 21 progesterone level indicating ovulation
> 3 ng/mL
Cervix postpartum
After 1 week, the cervix reforms with < 1 cm dilation. Following vaginal delivery, the external os permanently becomes a large, transverse, stellate slit.
When does ovulation resume after childbirth on average?
After 45 days in nonlactating women and 189 days in lactating women.
Lochia stages
After the placenta separates from the uterine wall, the basal portion of the decidua remains. The superficial layer is shed while the deeper layer regenerates the endometrium. This initial shedding results in red or red-brown discharge (lochia rubra) that lasts for a few days following delivery. Lochia rubra is followed by lochia serosa, which has a pinkish-brown coloring that lasts for 2 to 3 weeks. The final yellowish-white discharge, termed lochia alba, is composed of serous exudate, erythrocytes, leukocytes, decidua, epithelial cells, and bacteria. Lochia may continue for up to 8 weeks postpartum.
What class of medications is associated with neural tube defects?
Antiepileptic medications, such as carbamazepine and valproic acid.
A 27-year-old G2P1001 woman presents to labor and delivery at 33 weeks and 2 days of gestation with regular uterine contractions for 2 hours. She reports no vaginal bleeding or clear leakage of fluid. Pelvic examination reveals cervical dilation to 3 cm. Which of the following is the best recommendation for tocolytic therapy? AIndomethacin BNifedipine CTerbutaline DTocolytic therapy is not indicated
BNifedipine Women at ≥ 34 weeks gestation with preterm labor are admitted for delivery. Antenatal corticosteroids and tocolytic therapy are not used after 34 weeks gestation because the neonatal morbidity and mortality are too low to outweigh the costs and potential maternal and fetal complications. Nifedipine is a calcium channel blocker and is the first-line agent for tocolytic therapy in women between 32-34 weeks gestation. Nifedipine is the second line in women between 24-32 weeks gestation.
What tumor markers would you expect to be elevated in a patient with cervical cancer?
Beta-hCG, squamous cell carcinoma, and serum sialyl-Tn (STN).
A 24-year-old woman presents to the clinic complaining of mood instability. The symptoms are affecting her relationship with her boyfriend and her ability to perform at work. She specifically complains of moodiness, increased appetite, difficulty controlling her emotions, sleeping more than usual, difficulty concentrating, and bloating. Which of the following additional findings is required to fulfill the criteria for the most likely diagnosis? AAbsence of other psychiatric disease BSymptoms occurring predominantly during the follicular phase CSymptoms occurring predominantly during the luteal phase DSymptoms starting during menses
CSymptoms occurring predominantly during the luteal phase Premenstrual disorders (premenstrual syndrome and premenstrual dysphoric disorder) are marked by both physical and behavioral symptoms that occur repetitively in the second half (luteal phase) of the menstrual cycle and are alleviated with the onset of menses
Which complication of loop electrosurgical excision procedure is characterized by recurrent second-trimester miscarriage?
Cervical insufficiency.
What form of cervical cancer is linked closely to diethylstilbestrol exposure?
Clear cell adenocarcinoma
What autosomal recessive syndrome characterized by intellectual disability and accelerated pathologic aging is an absolute contraindication to the use of metronidazole?
Cockayne syndrome.
Which fetal malformation is Zika virus classically associated with during pregnancy?
Congenital microcephaly.
What type of twins occurs with division of a fertilized egg 13 days or later after fertilization?
Conjoined twins.
A 24-year-old G1P0 woman presents to her obstetrician after a positive home pregnancy test. She has a history of irregular menses and states that her last menstrual period was 10 weeks ago. A transvaginal ultrasound is ordered. At how many weeks gestation can the yolk sac typically be visualized? A10 weeks B16 weeks C2 weeks D5 weeks
D5 weeks A transvaginal ultrasound is recommended over a transabdominal ultrasound to evaluate for the gestational sac and yolk sac, which are the earliest structures visualized in pregnancy. Transvaginal ultrasound provides clearer and more accurate images. Sonographic estimation of gestational age is indicated in patients with a history of irregular menses, uncertain last menstrual period, conception while using hormonal contraception, and a difference between uterine size on physical examination and estimated gestational age based on the last menstrual period. The gestational sac is normally clearly visible at 4.5-5 weeks gestation, and the yolk sac can typically be visualized at 5-6 weeks gestation. The fetal pole with cardiac activity is usually seen at 5.5-6 weeks. The yolk sac is the first structure to appear within the gestational sac and confirms intrauterine pregnancy. It grows to approximately 6 mm, migrates to the periphery of the chorionic cavity, and eventually degrades between 10-12 weeks gestation.
A 47-year-old woman presents to the clinic due to irregular menstrual cycles for the past 6 months. She reports that the time between her menstrual cycles has increased. She also reports hot flashes and difficulty sleeping. Which of the following is the best way to confirm the suspected cause of her symptoms? ASerum estradiol BSerum follicle-stimulating hormone CSerum luteinizing hormone DThe cause is best identified clinically
DThe cause is best identified clinically However, women who are ≥ 45 years of age who have irregular menstrual cycles and vasomotor symptoms (hot flashes) can be diagnosed clinically as being in menopausal transition.
True or false: cigarette smoking increases the risk of preeclampsia.
False. Cigarette smoking is associated with a lower risk of preeclampsia.
What is the medical term for the probability of achieving a pregnancy within one menstrual cycle?
Fecundability
What are some of the teratogenic effects of angiotensin-converting enzyme inhibitors?
Fetal kidney hypoperfusion, fetal hypotension, fetal growth restriction, and fetal demise.
Which hormones are produced by the anterior pituitary gland?
Follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, adrenocorticotropic hormone, and growth hormone.
Which medication used to treat cystitis can be administered as a single dose?
Fosfomycin
Which hormones secreted by the placenta lead to postprandial hyperglycemia, permitting more nutrients to flow to the fetus?
Growth hormone, corticotropin-releasing hormone, human placental lactogen, and progesterone.
What are the adverse effects of gonadotropin-releasing hormone agonists?
Hot flashes and decreased bone mineral density.
What are common adverse effects of clomiphene citrate?
Hot flashes, abdominal distention and pain, nausea and vomiting, and breast discomfort.`
What are the side effects of tamoxifen?
Hot flashes, vaginal dryness, joint pain, leg cramps. Tamoxifen also increases the risk of blood clots, stroke, uterine cancer, and cataracts.
Which condition refers to a fallopian tube that is blocked with fluid?
Hydrosalpinx
Which study evaluates for patency of the fallopian tube system?
Hysterosalpingogram
Which nerve plexus provides sympathetic innervation that relaxes the detrusor muscle, allowing urine to fill the bladder?
Inferior hypogastric plexus.
What are the common causes for acetowhite changes seen with colposcopy?
Inflammation, subclinical papillomavirus infection, cervical intraepithelial neoplasia, and metaplasia
Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?
Medullary carcinoma.
What is the recommended prophylactic antibiotic in pregnant women with a history of extended-spectrum beta-lactamase-producing Enterobacteriaceae?
Meropenem.
What is the recommended route, dosage, and duration of metronidazole prescribed for pregnant patients with bacterial vaginosis?
Metronidazole 500 mg PO bid for 7 days.
What are the greatest risk factors for developing placenta previa?
Multiparity, smoking, and increasing maternal age.
A 24-year-old woman presents to the emergency department after delivering a baby at a birthing center about 1 hour ago. She is pale and fatigued, with a blood pressure of 92/54 mm Hg and a heart rate of 124 beats per minute. She is wearing a pad that she states has been changed multiple times within the past hour and has been filled with bright red blood and clots. Which of the following placental complications has the greatest risk for postpartum hemorrhage due to the depth of invasion into the uterine myometrium? Placenta accreta Placenta increta Placenta percreta Placenta previa
Placenta percreta Placenta accreta is a spectrum that includes three categories: accreta, increta, and percreta. It is categorized based on the depth of invasion of the placenta into the myometrium. Placenta accreta describes the invasion of the placenta past the decidua basalis to the myometrium, increta describes a deeper invasion within the myometrium, and percreta is the most invasive type, characterized by growth through the uterine wall and even into the surrounding structures (e.g., bladder).
What tool can be used to quantify the severity of nausea and vomiting in pregnancy?
Pregnancy Unique-Quantification of Emesis (PUQE) score.
What is the name of the criteria used to diagnose polycystic ovary syndrome?
Rotterdam criteria.
What are the adverse effects of selective serotonin reuptake inhibitors?
Sexual dysfunction, weight gain, weight loss, insomnia, drowsiness, and orthostatic hypotension.
What is the presenting part of the fetal head in a position of asynclitism?
The parietal bone
What other factors may cause a thickened endometrial stripe?
The presence of endometrial polyps, obesity, diabetes, and current tamoxifen therapy.
Deficiency of which essential trace element is associated with impaired taste and smell, night blindness, decreased spermatogenesis, dermatitis, delayed wound healing, and alopecia?
Zinc
Hydrops fetalis characteristics
skin edema, ascites, pericardial effusion, pleural effusion, and severe anemia (e.g., fetal hemoglobin < 5 g/dL or a hematocrit < 15%). Thrombocytopenia and neutropenia may also be present
A 53-year-old woman presents to the clinic with hot flashes, difficulty sleeping, and vaginal dryness. She reports the symptoms have progressively gotten worse over the past 3 years. She reports no surgical history. Which of the following cancers would this patient be at significant increased risk of if she is treated with combined menopausal hormone therapy? ABreast BColorectal CEndometrial DOvarian
ABreast The risk of breast cancer is increased in women who are treated with combined menopausal hormone therapy. Menopausal hormone therapy is contraindicated in women with active liver disease, coronary heart disease, prior stroke, or prior venous thromboembolism.
A 24-year-old G2P1 woman at 32 weeks gestation presents to the ED with menstrual-like cramps, low back pain, vaginal pressure, and light vaginal bleeding. She reports no vaginal pain or drug use but smokes two packs of cigarettes each week. Uterine contractions are occurring 5 times every 20 minutes. Her vital signs are T 98.6°F, BP 136/84 mm Hg, HR 88 bpm, RR 20 breaths per minute, and pulse oximetry 98% on room air. Speculum examination reveals cervical dilation of 4 cm without any pooling of fluid into the posterior vaginal fornix. A fetal fibronectin test is positive. Her urinalysis is unremarkable. Fetal heart rate is 151 bpm, and the nonstress test is reactive. Rectovaginal swab for group B streptococcal testing is obtained. Which of the following clinical interventions is the most appropriate at this time? AAmpicillin, betamethasone, and magnesium sulfate BBetamethasone and magnesium sulfate CCervical cerclage DEmergent delivery
AAmpicillin, betamethasone, and magnesium sulfate Management of patients in preterm labor includes bed rest, oral or intravenous hydration, antenatal corticosteroid therapy (e.g., betamethasone) to enhance lung maturity, group B streptococcal infection prophylaxis (e.g., penicillin, ampicillin) until group B streptococcal testing comes back negative or the patient delivers, antibiotic treatment of any documented urinary tract or sexually transmitted infections, magnesium sulfate for neuroprotection (in patients 24-32 weeks gestation), and transfer to a better-equipped medical facility if necessary. Tocolytic drugs (e.g., indomethacin, nifedipine, magnesium sulfate, terbutaline) may be used to delay delivery for up to 48 hours to allow the antenatal corticosteroid to take full effect.
A 26-year-old nulliparous woman presents with her husband to her gynecologist with concerns about family planning. She states they have been unsuccessfully attempting to conceive for 2 years. Which of the following is the most common cause of the patient's condition? AAnovulation BDecreased sperm count CEndometriosis DSpontaneous abortion
AAnovulation Anovulation is the most common cause of infertility. A midluteal (day 21) serum progesterone level or testing for the luteinizing hormone (LH) surge can also be used to detect ovulation. A midluteal serum progesterone level < 10 ng/mL or the absence of the LH surge indicates ovulatory dysfunction. Other tests for ovulatory function include endometrial biopsy, ultrasound, day 3 follicle-stimulating hormone, estradiol level, antral follicle count, and antimüllerian hormone level testing.
A 35-year-old G2P1 woman at 41 weeks gestation is in a prolonged second stage of labor. Delivery of the fetus is blocked by perineal tissue. A category III tracing is unresponsive to resuscitative measures, and the obstetrician decides to perform an episiotomy. Which of the following is the preferred type of episiotomy to minimize the risk of anal sphincter laceration? AAnterior episiotomy BJ incision CLateral episiotomy DMediolateral episiotomy
AAnterior episiotomy The two most commonly performed types of episiotomy are median (midline) and mediolateral. The mediolateral episiotomy is associated with a lower risk of anal sphincter injury but increased blood loss compared with the median episiotomy
A 22-year-old woman presents to the emergency department with a complaint of acute-onset abdominal pain. She has a low-grade fever, but her vital signs are otherwise normal. On exam, her abdomen is tender, and she has cervical motion tenderness. Purulent vaginal discharge is also noted. She reports being sexually active with multiple casual partners. Her partners do not always use condoms nor does she know much about their medical or sexual histories, but she reports being treated for sexually transmitted infections herself "a few times." A preliminary workup is started for sexually transmitted infections, and a pelvic ultrasound is shown above. Hospital admission is initiated. Which of the following is the best choice for treatment on admission? AAntibiotic therapy alone BInvasive surgery CMinimally invasive drainage DObservation
AAntibiotic therapy alone Most women can be treated with antibiotics alone, provided they are hemodynamically stable, their abscesses are < 7 cm in diameter, and there is no evidence of rupture. In women who have larger abscesses or concern for rupture or who are not responding to antimicrobial therapy, surgical intervention should be considered in addition to antibiotics. A minimum of 14 days of antibiotics is routine, though many recommend treatment until the abscess is completely resolved, sometimes 4-6 weeks
A 24-year-old G1P1001 woman is preparing for hospital discharge after a spontaneous vaginal delivery with no complications. Which of the following is the most appropriate recommendation to give her regarding when she can return to sexual activity? AAs soon as the woman feels ready after a minimum of 2 weeks BAs soon as the woman feels ready after a minimum of 4 weeks CAs soon as the woman feels ready after a minimum of 6 weeks DAs soon as the woman feels ready after a minimum of 8 weeks
AAs soon as the woman feels ready after a minimum of 2 weeks The decision to resume intercourse after the intrapartum period should be individualized but should not be resumed for at least 2 weeks following delivery. Many women experience dyspareunia during the first 6-8 weeks postpartum due to a variety of factors (e.g., vulvovaginal lacerations, vulvovaginal sutures, vaginal dryness).
Which of the following maternal characteristics is a risk factor for preterm labor? AAsthma BBody mass index over 30 kg/m2 CProlonged interpregnancy interval (> 5 years) DSedentary lifestyle
AAsthma Women who have had prior cervical procedures, such as cervical biopsy, are at increased risk for preterm labor. Those under 17 years old or over 35 years old are also at increased risk. Lower educational level, lower social status, single marital status, poor access to medical care, and interpersonal violence are all maternal demographic risk factors for preterm labor. Women with poor nutritional status are also at increased risk for preterm labor. Several maternal medical issues play a role in preterm labor. Pregnant patients with type 1 diabetes, hypertension, thyroid disease, asthma, kidney insufficiency, nonphysiologic anemia, major depressive disorder, and certain autoimmune disorders may be predisposed to preterm labor. Certain infections during pregnancy can also contribute to preterm labor, such as gonorrhea, chlamydia, bacterial vaginosis, trichomoniasis, syphilis, urinary tract infection, pyelonephritis, endometritis, and some severe viral infections. Ingestion, injection, or inhalation of alcohol, cocaine, heroin, and tobacco are also predisposing factors for preterm labor. Pregnancy-related risk factors for preterm labor include short cervical length between 14 and 28 weeks gestation, positive fetal fibronectin at 22 and 34 weeks gestation, uterine contractions, vaginal bleeding, placenta previa, placental abruption, polyhydramnios, oligohydramnios, multiple gestation, fetal anomaly, and conception by assisted reproductive techniques.
A 21-year-old woman presents to the office with a bump on her labia that appeared 3 days ago. It is not painful to touch nor pruritic. She had unprotected intercourse with a man about 3 weeks ago and has not had any sexual contact with anyone else since. On physical exam, there is a 2 cm nontender, ulcerated, round, skin-colored lesion with an elevated rim that is located on the inside of the right labium majus. There are also palpable lymph nodes to the inguinal area bilaterally. Which of the following tests will provide a definitive diagnosis of her condition? ADarkfield microscopy BFluorescent treponemal antibody absorption test CMicrohemagglutination test for antibodies to T. pallidum DVenereal Disease Research Laboratory
ADarkfield microscopy Diagnosis can be made by microscopic examination and serologic testing. T. pallidum cannot be cultured in a laboratory, and therefore must be identified through direct visualization or detection of clinical specimens. Direct microscopic examination of fresh exudate from moist lesions or from material aspirated from regional lymph nodes can be done by darkfield microscopy. Direct fluorescent antibody (DFA) testing is another test that can be used to identify the organism. Although both tests can help to definitively diagnose this disease, they are only available in select specialized clinics, must be done by a skilled examiner, and the sample should be collected during the early stages of the disease. Therefore, they are considered alternative diagnostic tests in clinical practice. Serologic tests are more commonly used, and there are two types: nontreponemal and treponemal. Either can be used for screening, but confirmatory testing is necessary for both. Nontreponemal tests include the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), and Toluidine Red Unheated Serum Test (TRUST) tests. A positive nontreponemal test can be followed up by a confirmatory treponemal test such as the fluorescent treponemal antibody absorption (FTA-ABS) test, microhemagglutination test for antibodies to T. pallidum (MHA-TP), T. pallidum particle agglutination assay (TPPA), T. pallidum enzyme immunoassay (TP-EIA), and chemiluminescence immunoassay (CIA) to rule out false-positive results.
A 42-year-old G3P2 woman presents in early labor. She is 39 weeks pregnant. Her first two pregnancies presented cephalically and were delivered vaginally at term without complication. One child was 8 pounds, 12 ounces and the other was 9 pounds, 7 ounces. Apgar scores at 1 and 5 minutes were 8 and 9 for both children. Her current pregnancy has progressed normally. Her glucose screening test performed at 26 weeks gestation was elevated at 151 mg/dL. Her 3-hour glucose test returned within normal limits. She is obese and has gained the appropriate amount of weight during this pregnancy. On physical exam, she is in slight discomfort. Contractions are occurring regularly every 5 minutes. She is 3 cm dilated and 100% effaced. The fetus is in frank breech presentation. Which aspect of the patient's history and physical exam increases the risk of a prolapsed umbilical cord? AFrank breech presentation BHistory of abnormal glucose screening test CHistory of high birth weight infants DObesity
AFrank breech presentation Risk factors for the development of umbilical cord prolapse include malpresentation of the fetus such as frank breech, prematurity, low birth weight, uterine malformation, multiparity, long umbilical cord, prolonged labor, or an unengaged body part.
A woman who closely monitors her menstrual cycles notices clear cervical mucus similar to raw egg white. Which of the following describes the estrogen and progesterone hormone levels at her most likely stage of the menstrual cycle? AHigh estrogen and low progesterone BHigh estrogen and progesterone CLow estrogen and high progesterone DLow estrogen and progesterone
AHigh estrogen and low progesterone As these follicles develop, estrogen levels rise, which produces a spike in luteinizing hormone that triggers ovulation. The rising estrogen levels also cause the cervical mucus to become thin, giving sperm the best chance for fertilization. The cervical mucus at this stage in the cycle is sometimes described as similar in consistency to a raw egg white. Estrogen levels are high and progesterone levels are low when the cervical mucus is thin.
A 21-year-old G1P0 woman at 8 weeks gestation presents to her obstetrician for her first prenatal visit. She has been taking multiple over-the-counter vitamin supplements. Which of the following vitamins, if taken in excess, is teratogenic in the first trimester and is associated with spontaneous abortion and fetal malformation? AVitamin A BVitamin C CVitamin D DVitamin E
AVitamin A Vitamin A toxicity during pregnancy is more common in resource-rich countries compared to resource-limited countries, while vitamin A deficiency is more common in resource-limited countries. Patients without vitamin A deficiency should not exceed > 5,000 IU (1,500 mcg) per day of vitamin A.
When is ophthalmia neonatorum most likely to appear in a newborn?
About 2-5 days after birth.
A 27-year-old woman presents to her primary care physician with concern for postcoital pain and bleeding. She reports no fevers or abdominal pain. She is having normal periods. She is sexually active with men only and has had seven lifetime partners, with one new active sexual partner in the last 2 months. They do not always use a condom. On evaluation, a friable cervix is noted with a few shallow ulcerations on her vaginal tissues. She is tender in these areas but has no cervical motion tenderness. There is no active discharge or concerning odor. She otherwise appears well and reports she has never had these symptoms before. Which of the following is the best choice for treatment? AAcyclovir 10 mg/kg/dose IV every 8 hours BAcyclovir 400 mg oral three times daily CAcyclovir 400 mg oral twice daily DAcyclovir topical five times daily
BAcyclovir 400 mg oral three times daily Herpes simplex virus types 1 and 2 can both cause genital infections, but type 2 is more common. Patients may be asymptomatic, but they may also present with complaints of vaginal discharge, dyspareunia, intermenstrual or postcoital bleeding, pelvic or abdominal pain, and general vulvovaginal irritation. On exam, vesicular lesions and ulcerations are especially suggestive of HSV. A friable cervix may also be noted. Recommended courses include acyclovir (400 mg tid for 7-10 days), famciclovir (250 mg tid for 7-10 days), and valacyclovir (1,000 mg bid for 7-10 days).
A 32-year-old woman who is 24-hours post-op after delivering her first child via C-section suddenly develops abdominal pain, foul-smelling vaginal discharge, and uterine tenderness. Her vitals are O2 saturation at 99% on room air, blood pressure at 132/86 mm Hg, heart rate at 115 beats per minute, and temperature 102°F. What is the appropriate treatment for this patient's suspected diagnosis? AAmpicillin and gentamicin BClindamycin and gentamicin CDoxycycline and ceftriaxone DFirst-generation cephalosporin alone
BClindamycin and gentamicin Commonly, the combination of clindamycin and gentamicin is used if the infection occurs after a C-section. If endometritis occurs after a vaginal delivery, the combination of ampicillin and gentamicin is preferred
You are reviewing results from a 31-year-old woman who underwent recent cervical cancer screening. Her cervical cytology shows atypical squamous cells of undetermined significance, and her human papillomavirus test is positive. Her pelvic exam does not reveal any gross cervical lesions. Which of the following is the recommended next step for her? AColposcopy BColposcopy with endocervical sampling CLoop endocervical excisional procedure DRepeat cytology in 1 year
BColposcopy with endocervical sampling Women at least 25 years of age with ASC-US and a positive HPV test should be managed with colposcopy. Endocervical curettage is also recommended if these patients do not have visible lesions on physical examination.
A 25-year-old G1P0 woman at 28 weeks gestation presents to her obstetrician for a routine visit. Her blood pressure was previously normal, until her 24-week visit when it was measured at 142/92 mm Hg. Today, her blood pressure is 144/92 mm Hg. She reports no vision changes, headache, or abdominal pain. Urinalysis is significant for 2 protein. Complete blood count and kidney function testing is unremarkable. Which of the following is the most appropriate treatment at this time? AAliskiren BContinued monitoring CLabetalol DLosartan
BContinued monitoring Antihypertensive therapy to prevent stroke is indicated for patients with systolic blood pressure of ≥ 160 mm Hg or diastolic blood pressure of ≥ 110 mm Hg, but it does not prevent eclampsia. Continued monitoring is the most appropriate management for the patient in the vignette because her blood pressure is < 160/110 mm Hg, and she does not have any evidence of end-organ dysfunction.
A 24-year-old woman presents to the emergency department with sudden onset of right-sided pelvic pain associated with nausea. Vital signs are T of 97.8°F, HR of 85 bpm, BP of 132/84 mm Hg, and RR of 20/min and have been stable during the patient's 4 hours in the emergency department. Physical exam reveals no vaginal bleeding and right-sided adnexal tenderness during bimanual exam. Pregnancy test is negative. Hemoglobin is 12.5 g/dL. Pelvic ultrasound reveals a right-sided 4 cm ovarian cyst with mild to moderate surrounding blood in the pelvis. The patient's pain is improved following intravenous ketorolac. Which of the following is the best management? AAdmission for close observation BDischarge with pain control CGynecologic consultation and emergent manual detorsion DGynecologic consultation for emergent laparoscopy to stop the hemorrhage
BDischarge with pain control Patients with low concern for malignancy and hemodynamic stability are considered to have uncomplicated ovarian cyst rupture. These patients are managed outpatient with observation
A 25-year-old woman who is RhD negative presents to the clinic to establish prenatal care. She is 17 weeks pregnant with normal vital signs and positive fetal heart tones. Prior obstetric history is positive for three preterm births, each progressively earlier in gestation, with no living children. The father of her child is RhD positive (homozygous). A serum maternal anti-D titer is 1:32. Which of the following represents the best next step in the prenatal care of the patient and her fetus? AAdministration of anti-D immune globulin to the mother BDoppler velocimetry of the fetal middle cerebral artery CFetal hemoglobin measurement via cordocentesis DSerial intrauterine blood transfusions
BDoppler velocimetry of the fetal middle cerebral artery If RhD incompatibility is suspected due to parental genetics, maternal anti-D titers should be measured serially until a critical titer level (usually 1:16 or 1:32) is reached, at which time, Doppler velocimetry of the middle cerebral artery of the fetus should be measured. Increased velocity through the middle cerebral artery correlates with decreased hemoglobin. If the velocity, once adjusted for gestational age, indicates critical fetal anemia, then cordocentesis should be performed to measure fetal hemoglobin and determine the need for transfusion.
A 26-year-old G1P0 woman presents for a prenatal appointment. She is 39 weeks pregnant. On ultrasound, her fetus is in the head-down position and measures 9 lb 6 oz. The fetal heart rate is 155 bpm. Vaginal exam reveals a narrow pelvic outlet. Which of the following should be addressed as a likely result of episiotomy as compared to a spontaneous vaginal laceration when discussing the possibility of a vaginal laceration with the patient? ADecreased repeat lacerations with subsequent births BDyspareunia CLower rate of dehiscence DShorter perineal lacerations
BDyspareunia It is reserved for instances where risk of third- or fourth-degree spontaneous vaginal laceration is likely. Episiotomy is usually performed using scissors at the midline or mediolateral posterior aspect of the vaginal introitus. There are numerous complications of episiotomy as compared to spontaneous vaginal laceration. These include extension of the incision deeper into the perineum that result in more third- and fourth-degree lacerations, a higher risk of infection, a higher risk of wound dehiscence, more postpartum pain, and more dyspareunia. Additionally, episiotomy increases the risk of repeat vaginal laceration in a subsequent vaginal delivery.
A 31-year-old woman presents to her clinician. She and her partner are hoping to start a family soon, and she would like advice about having a successful and healthy pregnancy. Her family history is notable for asthma, and she has a personal history of hypothyroidism. Her partner has a child with spina bifida from a previous marriage. They are both otherwise healthy and make deliberate efforts to eat healthy and exercise. Which of the following recommendations should be made for supplementation during pregnancy for this patient, in addition to other recommendations for preconception health? AFolic acid 0.4 mg daily BFolic acid 4 mg daily CVitamin A 10,000 IU daily DVitamin A 5,000 IU daily
BFolic acid 4 mg daily For women or their partners with a personal history of neural tube defect or offspring with neural tube defect, the risk of bearing a child with a neural tube defect is significantly increased. In these women, high-dose folic acid (4 mg) is recommended for periconceptional and first-trimester supplementation to provide significant protection to the fetus. Similarly, women with medical conditions predisposing them to reduced folic acid absorption or clearance, such as celiac disease, inflammatory bowel disease, surgically shortened gastrointestinal tracts, liver disease and kidney disease, should be advised to consume higher doses of folate.
A 25-year-old pregnant woman presents to the obstetric clinic at 8 weeks gestation with dysuria for 2 days. She has had urinary frequency and urgency for the past 3 weeks. She reports no flank pain. Physical examination reveals no costovertebral angle tenderness. Urinalysis shows pyuria. Which of the following is the recommended treatment? ACiprofloxacin BFosfomycin CNitrofurantoin DSupportive treatment with acetaminophen
BFosfomycin Fosfomycin, amoxicillin-clavulanate, and cefpodoxime are each appropriate choices for the empiric treatment of acute cystitis during pregnancy. Amoxicillin and cephalexin may also be used but these agents do not have as broad of spectrum of activity. The antibiotics should be guided by the culture results once available. Patients with acute cystitis during pregnancy should have a follow-up urine culture to confirm the urine has become sterile.
A 23-year-old woman presents to her gynecologist for routine prenatal care. She is at 35 weeks gestation with her first pregnancy. She reports ongoing epigastric pain, which she associates with reflux, and in the last week, she has had a persistent headache. Her vital signs are concerning for a blood pressure of 150/100 mm Hg. Her urine dipstick is negative for protein. She is advised to return the next day for repeat evaluation, including vital signs and additional laboratory tests. On her return visit, her blood pressure is unchanged. Which of the following laboratory findings confirms the diagnosis? ACreatine concentration > 0.8 mg/dL BPlatelets < 100,000/µL CProteinuria > 100 mg in 24 hours DProteinuria on urine dipstick
BPlatelets < 100,000/µL Preeclampsia with severe features is diagnosed by the same blood pressure criteria and at least one additional symptom or laboratory finding indicative of end-organ dysfunction, namely pulmonary edema, new-onset cerebral or visual disturbances, severe and persistent right upper quadrant or epigastric pain, thrombocytopenia (platelets < 100,000/µL), progressive kidney insufficiency (creatinine concentration > 1.1 mg/dL), or serum transaminase two or more times the upper limit of normal.
A 29-year-old G3P1102 pregnant woman presents to labor and delivery at 38 weeks and 0 days gestation complaining of leakage of fluid occurring 12 hours prior to arrival. Vital signs are T of 102.3°F, HR of 125 bpm, BP of 110/75 mm Hg, RR of 20/min, and oxygen saturation of 98% on room air. Physical examination reveals uterine tenderness and purulent drainage from the cervix with speculum exam. Laboratory studies show a white blood cell count of 14,000/μL and a C-reactive protein of 8.1 mg/L. Which of the following is one of the diagnostic criteria for the most likely diagnosis? AC-reactive protein of at least 8.0 mg/L BTemperature above 102.2°F CUterine tenderness DWhite blood cell count of at least 14,000/μL
BTemperature above 102.2°F The diagnosis of intra-amniotic infection is confirmed in patients with a fever (at or above 102.2°F or above 100.4°F twice at least 30 minutes apart) without another clear source. They must also have one or more of the following: purulent-appearing fluid coming from the cervical os visualized during speculum examination, maternal white blood cell count > 15,000/μL, and a baseline fetal heart rate of at least 160 bpm for at least 10 minutes. At least one of the following objective laboratory findings must also be present: positive Gram stain of amniotic fluid, positive amniotic fluid culture, low glucose level in amniotic fluid, high white blood cell count in amniotic fluid, and histopathologic evidence of infection or inflammation of the placenta, fetal membranes, or the umbilical cord vessels. The presumptive diagnosis of intra-amniotic infection can be made in patients with a fever and at least one of the following: purulent-appearing fluid coming from the cervical os visualized during speculum examination, maternal white blood cell count > 15,000/μL, and a baseline fetal heart rate of at least 160 bpm for at least 10 minutes. Intra-amniotic infection is not an indication for cesarean delivery, as the risk of wound infection and endometritis is increased if cesarean delivery is performed. The recommended antibiotic regimen consists of ampicillin and gentamicin. Patients who have an indication for a cesarean delivery should also be treated with metronidazole or clindamycin to provide coverage against anaerobes.
What is the typical fetal response to maternal seizures in eclampsia?
Bradycardia during and immediately after the seizure.
What is interval breast cancer?
Breast cancer that presents during the period between normal mammogram screenings.
A 24-year-old G2P1 woman is in the second stage of labor. She is 10 cm dilated and 100% effaced. Fetal station is 3. She reports feeling the urge to push, and she is most comfortable in the supine position. With her next contraction, she pushes for three 10-second intervals. The fetal head is delivered and a nuchal cord is freed. Which of the cardinal movements of labor will be the next to occur? AExpulsion BExtension CExternal rotation DFlexion
C External rotation The seven cardinal movements of labor begin with engagement. This is when the largest part of the fetal head (called the biparietal diameter and measured ear to ear) is introduced into the birth canal at the level of the ischial spine. Descent is the second movement. The fetal head progresses deeper into the birth canal. This is where a large majority of the molding of the fetal head takes place. Once the head reaches the pelvic inlet, it flexes at the neck, pressing the fetal chin to the chest. This presents the smallest aspect of the fetal head at the birth canal. Internal rotation then occurs to allow the fetal head to follow the path of least resistance in the birth canal. At the pelvic inlet (the pelvic floor), the birth canal is widest laterally. At the pelvic outlet, the birth canal is widest from the anterior to the posterior surfaces. Internal rotation allows the fetal head to deliver without causing maternal back pain. Once internal rotation is complete, the fetal head passes through the pelvic arch and undergoes extension. The face and chin are born face-down as extension occurs. External rotation (also called restitution) occurs spontaneously once the fetal head is delivered. The infant's head moves from a face-down position to facing one of the maternal thighs. This rotation helps the shoulder through the pelvic arch. This is the most common time to identify a shoulder dystocia (more common in macrosomic infants). Expulsion, the final cardinal movement of labor, is often completed spontaneously or with one more gentle push.
A 32-year-old G3P2 woman presents to the office complaining of heavy menstrual bleeding. Menarche occurred at 12 years of age, and she reports a history of regular menses every 28 days since. After the birth of her second child, her menses were regular, but she now reports heavy menstrual bleeding. She is able to fill a super maxi pad every 2 hours. Her last Pap smear was performed 6 months ago and was normal. Transvaginal ultrasound reveals an 8 cm uterus with a 6 mm endometrial stripe. There are no uterine fibroids. Ovaries are normal and there are no adnexal masses. She is interested in a low-maintenance treatment that will prevent heavy bleeding or one that would cause menses to cease altogether. She is not interested in endometrial ablation or hysterectomy at this time since she is unsure whether she desires to preserve childbearing potential for the future. Which of the following clinical therapeutics is the most appropriate option? A13.5 mg levonorgestrel-releasing intrauterine device B19.5 mg levonorgestrel-releasing intrauterine device C52 mg levonorgestrel-releasing intrauterine device DCopper intrauterine device
C52 mg levonorgestrel-releasing intrauterine device There is a 52 mg levonorgestrel-releasing intrauterine 32 x 32 mm T-shaped device that is effective for up to 5 years. It is the only device approved by the Food and Drug Administration to treat menorrhagia (heavy menstrual bleeding). It may also reduce dysmenorrhea. Intrauterine devices prevent pregnancy by a number of methods. For the devices that release levonorgestrel, this medication thickens cervical mucus, preventing sperm from reaching the egg.
A 24-year-old woman presents to the emergency room with right-sided pelvic pain and vaginal bleeding. Vital signs are T of 98.4°F, HR of 108 bpm, BP of 124/78 mm Hg, RR of 20/min, and oxygen saturation of 99% on room air. The patient has right-sided adnexal tenderness on physical exam with blood in the vaginal vault. The human chorionic gonadotropin level is 6,000 mIU/mL. Her transvaginal ultrasound is shown above. Which of the following gestational ages is the most common time for this condition to present? A10-12 weeks B4-6 weeks C6-8 weeks D8-10 weeks
C6-8 weeks Ectopic pregnancies occur most frequently 6 to 8 weeks after the start of the last menstrual period. Unfortunately, tubal rupture is the initial presentation in 50% of women with ectopic pregnancy. The symptoms and signs of tubal rupture may include lightheadedness, syncope, orthostasis, hypotension, and tachycardia in addition to vaginal bleeding and abdominal pain.
Which of the following clinical scenarios is the most concerning for the diagnosis of endometrial cancer? AA 35-year-old woman who has mid-cycle breakthrough bleeding and has an endometrial stripe measurement of 8 mm BA 45-year-old woman whose last menstrual period was 4 months ago and who reports vaginal bleeding, with an endometrial stripe measurement of 4 mm CA 69-year-old woman who presents with abnormal vaginal bleeding and an endometrial stripe measurement of 5 mm DA 72-year-old woman with history of long-term tamoxifen use who presents with abnormal vaginal bleeding and has an endometrial stripe measurement of 4 mm
CA 69-year-old woman who presents with abnormal vaginal bleeding and an endometrial stripe measurement of 5 mm Postmenopausal women between 50-70 years of age are most commonly affected. An endometrial stripe measurement of 4 mm or less indicates a low likelihood of hyperplasia or endometrial cancer in postmenopasual women. If it is greater than 4 mm or if certain areas of the endometrium appear heterogeneous, there should be a high index of suspicion and an endometrial sample should be obtained. In premenopausal women, an endometrial thickness of < 5 mm can exclude endometrial carcinoma.
A 28-year-old G3P2002 woman presents to labor and delivery at 33 weeks and 1 day gestational age complaining of high home blood pressure readings. She reports no headache or visual changes. Her serial blood pressures 4 hours apart are 165/115 mm Hg and 173/102 mm Hg. Her urine dipstick shows 3 protein. Laboratory tests reveal a creatinine of 0.9 mg/dL and a platelet count of 160,000/µL of blood. Which of the following is the best management? AAdministration of betamethasone and intravenous labetalol and admission for cesarean delivery BAdministration of betamethasone and intravenous labetalol and admission for expectant management CAdministration of betamethasone and intravenous labetalol and admission for vaginal delivery DAdministration of intravenous labetalol and admission for vaginal delivery
CAdministration of betamethasone and intravenous labetalol and admission for vaginal delivery The definitive treatment of preeclampsia is delivery. However, the timing varies based on the gestational age and the presence of severe features. Severe features of preeclampsia include severe hypertension (at least 160/110 mm Hg), severe headache, visual disturbances, kidney dysfunction, hepatic dysfunction, thrombocytopenia, and pulmonary edema. Patients with preeclampsia with severe features should be delivered regardless of gestational age due to the maternal risks. Therefore, the patient in the vignette should be admitted for delivery.
A 27-year-old woman presents to the emergency department with complaints of dull low-back and lower-abdominal pain for the last 2 weeks. She reports no recent trauma, but she did travel to the Caribbean a month ago. She has increased pain with defecation but no constipation. She has had normal menstrual cycles but does seem to have more vaginal discharge than usual. Her sexual history is notable for multiple sexual partners with whom protection is not always used. She reports practicing receptive anal, oral, and vaginal intercourse. She has a history of prior gonorrhea and chlamydia diagnoses and treatments, but she has not seen a clinician for several months. Her exam is notable for tender, enlarged inguinal lymph nodes and a painful anorectal exam with palpation of several indurated tender areas in her rectal canal. A full sexually transmitted infection workup is done, including an anorectal swab sent for nucleic acid amplification testing for Chlamydia trachomatis. She reports no allergies to medications. Which of the following is the best choice for treatment for the suspected diagnosis? AAzithromycin 1 g oral once BAzithromycin 1 g oral once weekly for 3 weeks CDoxycycline 100 mg oral bid for 21 days DDoxycycline 100 mg oral bid for 7 days
CDoxycycline 100 mg oral bid for 21 days Select serotypes of Chlamydia trachomatis can cause a genital ulcer disease known as lymphogranuloma venereum that affects lymphatic tissue. Recently, it has been increasing in incidence in more temperate climates and likely affects both sexes equally, though it is more commonly reported in men because the early clinical presentation in men is more obvious. The primary phase of infection, usually manifested as genital ulcers or mucosal inflammation, can be easily missed, as it usually heals spontaneously within a few days. In the secondary phase weeks later, direct extension to regional lymph nodes can cause painful inguinal lymph nodes or the sensation of inflammatory masses in the rectum and retroperitoneum. Because vaginal lymph nodes drain to the deep iliac or perirectal nodes, women may experience lower-abdominal or low-back pain, especially if they have had receptive anal sex, which could lead to primary rectal infection. The recommended treatment for all nonpregnant patients is doxycycline 100 mg oral twice daily for 21 days.
A 28-year-old nulliparous woman presents to the clinic reporting left lower quadrant pain and severe dysmenorrhea. A pelvic ultrasound reveals a left adnexal complex mass that has smooth walls with homogeneous internal echoes that have a ground-glass appearance. Which of the following ovarian masses is the most likely diagnosis? ACorpus luteal cyst BDermoid cyst CEndometrioma DFollicular cyst
CEndometrioma On ultrasound, an endometrioma appears smooth-walled with homogeneous internal echoes that have the appearance of ground-glass. The fluid inside endometriomas is old blood and appears chocolate-colored on biopsy, so these cysts are often referred to as chocolate cysts. Treatment of endometrioma includes observation with serial ultrasounds or surgical removal.
A 25-year-old G2P1 woman at 33 weeks gestation presents to the emergency department after feeling a gush of vaginal fluid 2 hours ago. On speculum examination, clear fluid is seen pouring out of the cervical os and pooling into the vaginal vault. Nitrazine testing reveals a pH of 7.2, and microscopic examination demonstrates a ferning pattern. Ultrasound is significant for oligohydramnios. Which of the following is the most common risk factor for the patient's condition? AAntepartum bleeding BCigarette smoking CGardnerella vaginalis infection DIncreased body mass index
CGardnerella vaginalis infection A genital tract infection, such as a Gardnerella vaginalis infection, is the single most common identifiable risk factor for preterm prelabor rupture of membranes (PPROM). The pathogenesis of spontaneous rupture of membranes is unclear but may be due to biochemical changes that occur with infection (e.g., chorioamnionitis), inflammation, mechanical stress, or bleeding. While most cases have no identifiable risk factors, a history of PPROM, genital tract infections, first-trimester vaginal bleeding, and cigarette smoking is known to increase the risk of PPROM.
A 14-year-old girl presents to the clinic with abnormal uterine bleeding over the previous 6 months. Medical history reveals that menarche occurred 1 year ago. The patient states that she has been having menstrual bleeding at sporadic intervals greater than 28 days apart. Vital signs show BP 120/72 mm Hg, HR 77 bpm, RR 16/min, and BMI 21 kg/m2. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's abnormal uterine bleeding? AAdenomyosis BHyperthyroidism CImmature hypothalamic-pituitary axis DPolycystic ovary disease
CImmature hypothalamic-pituitary axis An immature hypothalamic-pituitary axis is the most common cause of abnormal uterine bleeding in adolescent women, especially within the first 1-2 years of menarche. In such cases, the abnormal uterine bleeding typically resolves without the need for therapeutic intervention.
A 24-year-old woman at 37 weeks gestation presents to the office for a routine obstetrics exam. An ultrasound reveals an amniotic fluid index of 4 cm and no signs of fetal abnormalities. Which of the following is a risk factor for this condition? AFetal esophageal atresia BFetal hyperglycemia CPreeclampsia DTrisomy 21
CPreeclampsia Oligohydramnios is characterized by a lower than normal volume of amniotic fluid, which can lead to underdevelopment of fetal lung tissue as well as fetal death. The normal volume of fluid varies throughout the pregnancy and peaks at around 800-1,000 mL near term. The most common cause of oligohydramnios is the rupture of membranes, but this is not the only cause. When the fetus is near term, it swallows amniotic fluid and produces urine. Therefore, a low amniotic fluid level can be caused by the absence of fetal urine production or fetal urinary tract blockage. Any anomaly that affects the fetal urinary tract, such as renal agenesis, polycystic kidneys, or obstructive lesions, can lead to this condition. It can also be caused by placental insufficiency due to conditions such as preeclampsia, chronic hypertension, and other maternal vascular disease or when the pregnancy is extended too long. Oligohydramnios can be evaluated by ultrasonography, which will show an amniotic fluid index < 5 cm or a single deepest pocket that is < 2 cm in depth.
A 20-year-old woman presents to her primary care provider in January with recurrent episodes of increased irritability, anxiety, and sadness for the past 3 months. She states the holidays are a stressful time for her because she does not get along well with her family. Upon further questioning, she states her mood seems normal most of the time, then all of a sudden, her symptoms will begin and last for almost a week. Which of the following is the most likely diagnosis? AGeneral anxiety disorder BPremenstrual dysphoric disorder CPremenstrual syndrome DSeasonal affective disorder
CPremenstrual syndrome The Daily Record of Severity of Problems form may be used to distinguish premenstrual syndrome from its more severe form, premenstrual dysphoric disorder. Diagnosis of premenstrual syndrome can be made if the patient has one to four symptoms that are physical, behavioral, or psychological in nature or five or more symptoms that are physical or behavioral. The patient in the vignette has three symptoms (irritability, anxiety, and sadness) with a history and course consistent with premenstrual syndrome. If a psychological symptom (e.g., mood swings, anger, irritability, hopelessness, tension, anxiety) is one of the five or more symptoms a patient has, a diagnosis of premenstrual dysphoric disorder can be made.
A 25-year-old woman who delivered her child 2 days ago is visited by a lactation consultant, who explains to her the importance of breastfeeding, especially before the body produces mature milk, due to the benefits of colostrum for the baby. Which of the following components is found in high quantities in colostrum? ACarbohydrate BFat CProtein DWater
CProtein Colostrum is the first fluid produced by mothers in the initial days after delivery and is composed of several elements that are beneficial to the infant. Colostrum is high in levels of immunoglobulins (such as secretory IgA), lactoferrin, leukocytes, and macrophages that provide passive immunity for the infant. Colostrum also has a higher protein content than mature milk. Mature milk contains much less protein but is higher in water, carbohydrate, and fat content.
Which class of nonsteroidal anti-inflammatory drugs should be avoided in patients with endometriosis who desire conception?
Cyclooxygenase-2 inhibitors (e.g., celecoxib, rofexocix, valdecoxib).
What is the most commonly encountered form of pelvic organ prolapse?
Cystocele
A 36-year-old woman who is 37 weeks pregnant with her first child presents to the hospital after feeling a gush of liquid from her vaginal area and seeing clear fluid while in the shower about 2 hours ago. She was unsure what it was but has been feeling more pelvic pressure and decided to come in for an evaluation. She is afebrile and has not had any contractions. A speculum examination reveals leakage from the cervical os with pooling of fluid in the vaginal vault. Which of the following is the best next step in management for this patient? AAdminister a tocolytic BExpectant management and delivery CImmediate cesarean section DMedical induction with oxytocin
DMedical induction with oxytocin The treatment of choice in cases of PROM is medical induction with oxytocin and prompt delivery, since the risk of intrauterine infection increases with the duration of ruptured membranes.
A 42-year-old woman presents to the office due to increasing intermittent breast pain and tenderness that has gotten increasingly worse over the past year. She states the pain peaks about 1 week before her period. She has tried wearing more supportive bras and taking over-the-counter pain relievers for the past 6 months but nothing has helped. She feels like she is not able to work when she experiences this pain. She notices her breasts feel heavy and extremely tender, especially with physical activity. Physical exam reveals very dense breasts upon palpation with rope-like texture bilaterally. Which of the following therapy is the best next step for the treatment of her condition? ADanazol BLevonorgestrel COxandrolone DTamoxifen
DTamoxifen Conservative treatment for a period of at least 6 months is the first-line treatment and includes wearing well-fitting and supportive bras, avoiding trauma to the breasts, applying heat to the breasts, and taking over-the-counter pain relievers to help alleviate symptoms. Women with more severe symptoms can be treated with second-line therapies such as tamoxifen or danazol. Tamoxifen is the preferred second-line treatment of choice since it has fewer side effects than danazol.
What are the common side effects of selective serotonin reuptake inhibitors?
Decreased libido, delayed orgasm, nausea, weight gain, headache, and insomnia.
Which muscular fibers converge at the perineal body?
Deep and superficial transverse perineal muscles, bulbocavernosus and pubococcygeus muscles, and the external anal sphincter.
Exam findings of preterm labor
Examination findings that support the diagnosis of preterm labor include ≥ 4 uterine contractions every 20 minutes or ≥ 8 in 60 minutes, digital cervical or speculum examination showing cervical dilation of ≥ 3 cm, a transvaginal ultrasound showing a short cervix of < 20 mm before 34 weeks of gestation, or a cervical length of 20-30 mm on transvaginal ultrasound with positive fetal fibronectin test.
What factors reduce the diagnostic accuracy of physical exam-based gestational age assessment?
Leiomyoma, obesity, and pregnancies of multiple gestation.
What is the most common site of early hematogenous metastases of a choriocarcinoma?
Lungs
What are some causes of fetal hypoxia?
Maternal hypertensive disease, maternal heart disease, maternal infection, placental insufficiency, fetal growth restriction, and umbilical cord prolapse.
