Obstetrics Chapter 1: Contraindications to Pregnancy
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A 30-year-old female with a history of recurrent pregnancy loss wants to improve her immunity before trying to conceive. Which vaccine should be given to her?

  • Rubella vaccine (correct)
  • Varicella vaccine
  • Influenza vaccine
  • Hepatitis vaccine
  • What is the primary benefit of giving a rubella vaccine to a woman before conception?

  • Preventing influenza infection during pregnancy
  • Protecting against congenital rubella syndrome (correct)
  • Reducing the risk of stillbirths
  • Boosting her immunity against varicella
  • A woman is planning to conceive in the winter season. Which vaccine should be given to her before conception?

  • Influenza vaccine (correct)
  • Hepatitis vaccine
  • Rubella vaccine
  • Varicella vaccine
  • What is the indication for giving a rubella vaccine to a woman before pregnancy?

    <p>To prevent congenital rubella syndrome</p> Signup and view all the answers

    A 25-year-old woman wants to conceive and asks her doctor about the necessary vaccines before conception. Which vaccine is most essential to prevent stillbirth?

    <p>Rubella vaccine</p> Signup and view all the answers

    What is the primary goal of preconception immunization?

    <p>To reduce the risk of infectious diseases during pregnancy</p> Signup and view all the answers

    A woman is planning to conceive and wants to know about the necessary vaccines before pregnancy. Which vaccine is given to prevent a specific seasonal infection?

    <p>Influenza vaccine</p> Signup and view all the answers

    What is the consequence of not giving a rubella vaccine to a woman before conception?

    <p>Congenital rubella syndrome</p> Signup and view all the answers

    What is the definition of prolonged active phase of labor?

    <p>≥ 6 cm cervical dilation and no change in cervical dilation after 6 hours of inadequate contractions</p> Signup and view all the answers

    How is arrested active phase of labor managed?

    <p>Cesarean Section</p> Signup and view all the answers

    What is the minimum cervical dilation required for diagnosis of prolonged active phase?

    <p>6 cm</p> Signup and view all the answers

    What is the purpose of amniotomy in labor management?

    <p>To augment labor</p> Signup and view all the answers

    What is the appropriate management for a patient with 6cm dilation, 80% effacement, 0 station, and late deceleration on CTG?

    <p>Cesarean Section</p> Signup and view all the answers

    What is the definition of arrested active phase of labor?

    <p>≥ 6 cm cervical dilation with ruptured membranes and no cervical change after 6 hours of inadequate contractions</p> Signup and view all the answers

    What is the purpose of oxytocin administration in labor management?

    <p>To augment labor for hypotonic contractions</p> Signup and view all the answers

    What is the minimum duration of inadequate contractions required for diagnosis of prolonged active phase?

    <p>6 hours</p> Signup and view all the answers

    What is the primary indication for cesarean delivery in a pregnant woman with DIC?

    <p>All of the above</p> Signup and view all the answers

    What is the management of a hemodynamically stable mother with a dead or nonviable fetus and DIC?

    <p>Induction of labor</p> Signup and view all the answers

    What is the primary concern in a hemodynamically unstable mother with DIC?

    <p>Maternal mortality risk</p> Signup and view all the answers

    What is the benefit of removing the products of conception in a hemodynamically stable mother with a dead or nonviable fetus and DIC?

    <p>Removes the trigger for DIC</p> Signup and view all the answers

    What is the management of a hemodynamically stable mother with a viable fetus and reassuring fetal status and DIC?

    <p>Conservative management</p> Signup and view all the answers

    What is the primary reason for avoiding cesarean delivery in a hemodynamically stable mother with a dead or nonviable fetus and DIC?

    <p>Risk of uncontrollable hemorrhage from surgical incisions and lacerations</p> Signup and view all the answers

    What is the primary goal of cesarean delivery in a hemodynamically unstable mother with DIC?

    <p>To save the mother's life</p> Signup and view all the answers

    What is the indication for induction of labor in a pregnant woman with DIC?

    <p>Dead or nonviable fetus</p> Signup and view all the answers

    Which medication is known to cause minimal or reduced variability in fetal heart rate?

    <p>Mg Sulfate</p> Signup and view all the answers

    What is the primary cause of late or prolonged decelerations in fetal heart rate associated with epidural analgesia?

    <p>Maternal hypotension</p> Signup and view all the answers

    What is the best way to prevent adhesions after a C-section?

    <p>Add an adhesion barrier consisting of oxidized regenerated cellulose before closing the wound</p> Signup and view all the answers

    In a normal vaginal delivery, a baby weighing 4.2kg is born with a laceration reaching the rectal mucosa. What degree of perineal tear is this?

    <p>Fourth</p> Signup and view all the answers

    What is the management for a 35-year-old pregnant lady with fetal death and DIC, whose cervix is 4cm dilated?

    <p>Induction of labor</p> Signup and view all the answers

    Which of the following is NOT a cause of late or prolonged decelerations in fetal heart rate?

    <p>Mg Sulfate</p> Signup and view all the answers

    What is the primary mechanism by which epidural analgesia affects fetal heart rate?

    <p>Maternal hypotension</p> Signup and view all the answers

    What is the degree of perineal tear that involves the sphincter muscle?

    <p>Third</p> Signup and view all the answers

    What is the correct management for a pregnant woman with DKA?

    <p>Manage DKA with insulin and hydration, then induce labor after correction of her status</p> Signup and view all the answers

    What is the most common aneurysm occurring in the abdomen?

    <p>Aortic aneurysm</p> Signup and view all the answers

    During which trimester does a Splenic artery aneurysm most commonly rupture?

    <p>Third trimester</p> Signup and view all the answers

    What is the maternal mortality rate when a Splenic artery aneurysm ruptures during pregnancy?

    <p>75%</p> Signup and view all the answers

    What is the risk of rupture of a Splenic artery aneurysm during pregnancy if a woman has an existing SAA?

    <p>20-50%</p> Signup and view all the answers

    Why should obstetricians consider a ruptured Splenic artery aneurysm in any pregnant woman?

    <p>Because it presents with an acute surgical abdomen</p> Signup and view all the answers

    What is the fetal mortality rate when a Splenic artery aneurysm ruptures during pregnancy?

    <p>95%</p> Signup and view all the answers

    Why is it important to consider Splenic artery aneurysm in pregnant women?

    <p>Because it carries a high risk of maternal and fetal mortality</p> Signup and view all the answers

    Study Notes

    Contraindications to Pregnancy

    • Rubella vaccine is recommended for women who want to conceive, especially those with a history of recurrent pregnancy loss or stillbirth, to prevent congenital rubella syndrome.
    • Congenital rubella syndrome can result in spontaneous abortion, fetal infection, stillbirth, or intrauterine growth restriction.
    • Influenza vaccine is recommended for women who will be pregnant during flu season, especially those with high-risk conditions.

    Management of Labor

    • Prolonged active phase of labor is defined as ≥ 6 cm cervical dilation with no change in cervical dilation after 6 hours of inadequate contractions or 4 hours of adequate contractions.
    • Management of prolonged active phase includes augmentation with oxytocin and amniotomy.
    • Arrested active phase is defined as ≥ 6 cm cervical dilation with ruptured membranes and no cervical change after 4 hours of adequate contractions or 6 hours of inadequate contractions.
    • Management of arrested active phase includes cesarean section.

    Fetal Heart Rate

    • Medications that can affect fetal heart rate include:
      • Magnesium sulfate, which causes minimal or reduced variability.
      • Epidural analgesia, which causes maternal hypotension leading to uteroplacental insufficiency and late or prolonged decelerations.
      • Oxytocin, which causes late or prolonged decelerations and uterine hyperstimulation.

    Prevention of Adhesions

    • The best way to prevent adhesions after cesarean section is to add an adhesion barrier consisting of oxidized regenerated cellulose before closing the wound.

    Perineal Tears

    • Degrees of perineal tears include:
      • First degree: Skin
      • Second degree: Muscle
      • Third degree: Sphincter
      • Fourth degree: Rectal mucosa

    Management of Fetal Death and DIC

    • In hemodynamically unstable mothers or those with fetal distress, urgent cesarean delivery is indicated.
    • In hemodynamically stable mothers with a dead or nonviable fetus, induction of labor is indicated.
    • In hemodynamically stable mothers with a viable fetus and reassuring fetal status, delivery is not immediately necessary.

    Splenic Artery Aneurysms

    • Splenic artery aneurysms are more common in women, especially during pregnancy, and are associated with increased flow.
    • Rupture of a splenic artery aneurysm during pregnancy carries a high risk of maternal and fetal mortality.
    • Obstetricians should consider a ruptured splenic artery aneurysm in any pregnant woman who presents with an acute surgical abdomen.

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    Description

    This quiz covers contraindications to pregnancy, including medications and vaccines, for a 28-year-old female with a history of recurrent pregnancy loss. Improve your knowledge in obstetrics and gynecology with this SMLE question and answer session.

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