USMLE Step 2 (Fach) / Obstetrics (Lektion)
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Step 2 CK
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- Hyperemesis gravidarum Severe, persistent nausea and vomiting associated with a > 5% loss of pre-pregnancy weight and ketonuria with no other identifiable cause.Epidemiology:- Occurs in 0.5-2% of pregnancies- Most common in ...
- Gestational and chronic hypertension Gestational hypertension = pregnancy-induced hypertension with onset after 20 weeks gestation. Defined as a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on 2 separate ...
- Antepartum hemorrhage Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester (after 20 weeks). - Complicates 3-5% of pregnancies (prior to 20 weeks, bleeding is referred to as threatened ...
- Ectopic pregnancy Localization: Fallopian tube (ampulla >> isthmus > fimbriae > interstitial), ovarian, abdominal, or cervical Risk factors:- Anatomic alteration of the fallopian tubes: → History of PID→ Previous ...
- Placental abruption The partial or complete separation of the placenta from the uterus prior to delivery. Epidemiology:- Incidence: ∼ 0.2-1% of pregnancies- Occurs most often in the third trimester- The recurrence rate ...
- Placenta previa Presence of the placenta in lower uterine segment, which might lead to partial or full obstruction of the neck of the uterus with high risk of hemorrhage (rupture of placental vessels) and birth complications. ...
- Intrauterine growth restriction (IUGR) Defined as an estimated fetal weight ≤ 10th percentile for gestational age. There are two types of IUGR: asymmetrical and symmetrical. Pathophysiology:- Asymmetrical IUGR: Caused by extrinsic factors, ...
- Fetal macrosomia Birth weight > 90th percentile or > 4000-4500 g.A common sequela of gestational diabetes. Diagnosis: Weigh the newborn at birth (prenatal diagnosis is imprecise) Treatment: Planned cesarean delivery may ...
- Polyhydramnios Excessive amniotic fluid volume (> 2000 mL in the third trimester) that results in uterine distention and is associated with an increased risk of fetal complications. Etiology: - Fetal anomalies: Esophageal ...
- Oligohydramnios Amount of amniotic fluid < 500 mL in the third trimester. Etiology:- Fetal anomalies: Urethral obstruction (e.g., posterior urethral valves), bilateral renal agenesis, ARPKD- Chromosomal aberrations (e.g., ...
- Rh isoimmunization Fetal RBCs leak into the maternal circulation and maternal anti-Rh IgG antibodies form that can cross the placenta, leading to hemolysis of fetal Rh RBCs (erythroblastosis fetalis). There is an ↑ risk ...
- Gestational trophoblastic disease Complete moles: Usually result from sperm fertilization of an empty ovum; 46,XX (paternally derived)Incomplete (partial moles): Occur when a normal ovum is fertilized by two sperm; usually 69,XXY and ...
- Fetal malpresentation Defined as any presentation other than vertex (i.e. head closest to birth canal, chin to chest, occiput anterior). Risk factors include prematurity, prior breech delivery, uterine anomalies, poly- or ...
- Indications for cesarean section For both elective and indicated cesarean delivery, sodium citrate should be used to ↓ gastric acidity and prevent acid aspiration syndrome. Maternal factors:- Prior classical C-section (midline)- ...
- Uterine atony Failure of the uterus to effectively contract and retract after complete or incomplete delivery of the placenta, which can lead to severe postpartum bleeding from the myometrial vessels. Epidemiology: ...
- First-trimester evaluation Initial examination (~10 weeks' gestation):- Personal and family history, previous pregnancies- Screen for violence at home, barriers to care- Gynecological examination (ultrasound, bimanual exam)- Blood ...
- Genetic screening First-trimester screening:- Timing: 11-13 weeks gestation→ Sonographic nuchal translucency (NT)→ β-HCG (human chorionic gonadotropin) in maternal serum→ PAPP-A (pregnancy-associatedprotein A) ...
- Gestational diabetes Impaired glucose tolerance diagnosed during pregnancy; associated with an increased risk of maternal and fetal morbidity. Epidemiology:- Occurs in 5-7% of all pregnancies- Usually in the second and third ...
- Stages of labor First stage = Period from the onset of labor until complete dilation of the cervix has occurred- Latent phase→ Occurs during onset of labor (regular contraction) → ends at 6 cm of cervical dilation→ ...
- Obstructed labor Arrest of vaginal delivery because of a mechanical obstruction. Etiology:- Fetal: malpresentations, malpositions, congenital anomalies, macrosomia- Maternal: bony or soft tissue masses in maternal pelvis ...
- Abnormal labor Etiology: the 3 P's - Pelvis: size and shape of the maternal pelvis (e.g., small bony pelvis)- Passenger: size and position of the infant (e.g., fetal macrosomia or abnormal orientation)- Power: strength ...
- Premature rupture of membranes (PROM) Rupture of membranes occurring before onset of labor at term. Epidemiology: ∼ 15% of pregnancies Risk factors:- Ascending infection (common)- Cigarette smoking- Multiple pregnancy- Previous PPROM Clinical ...
- Preterm premature rupture of membranes (PPROM) Rupture of membranes before onset of uterine contractions AND before 37 weeks' gestation. Epidemiology: occurs in 2-5 % pregnancies Risk factors: - Previous PPROM- Genitourinary infection (e.g., asymptomatic ...
- Chorioamnionitis Etiology:- Infection of the amniotic fluid, fetal membranes, and placenta- Most commonly due to Ureaplasma urealyticum (up to 50% of cases), Mycoplasma hominis (up to 30% of cases), Gardnerella vaginalis, ...
- Preterm labor Regular uterine contractions with cervical effacement, dilation, or both between 20-37 weeks gestation. Epidemiology: - Preterm birth rate in the US: approx. 12% of all live births- Leading cause of neonatal ...
- Eclampsia Severe form of preeclampsia with convulsive seizures and/or coma. Epidemiology: < 0.1% of all deliveries Clinical features:- Onset: the majority of cases occur in the intrapartum and postpartum period- ...
- HELLP syndrome A life-threatening form of preeclampsia HELLP is an acronym: H = hemolysis; EL = elevated liver enzymes; LP = low platelets Epidemiology: ∼ 0.5% of all pregnancies Clinical features:- Onset: most commonly ...
- Multiple pregnancy Predisposing factors:- Advanced maternal age (> 35 years)- Previous multiple pregnancy- Use of fertility enhancing treatments- Maternal family history of dizygotic twins Dizygotic twins:- ⅔ of all twin ...
- Postpartum hemorrhage Definitions:- Blood loss > 500 mL after vaginal birth - Blood loss > 1000 mL for cesarean section - Primary PPH (most common): blood loss within 24 hours- Secondary PPH: blood loss from 24 hours to ...
- Abnormal placenta separation Abnormal placental attachment = Defective decidual layer of the placenta leading to abnormal attachment and separation during postpartum period Epidemiology: 0.2-1% of all pregnancies Risk factors: prior ...
- Uterine inversion Obstetric emergency in which the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out following vaginal birth. Risk factors:- Nulliparity- Cord traction ...
- Antepartum fetal surveillance Nonstress test (NST) = a noninvasive test (CTG) that measures FHR reactivity to fetal movements- Indications: maternal medical conditions (e.g., gestational diabetes, preeclampsia) or fetal conditions ...
- Vasa previa Condition in which the fetal vessels are located in the membranes near the internal os of the cervix, putting them at risk of injury if the membranes rupture. Epidemiology: 1/2500 births Risk factors:- ...
- Cervical insufficiency Painless cervical dilation, in the absence of uterine contractions and/or labor, in the second trimester of pregnancy. Risk factors:- Previous midtrimester pregnancy loss and/or preterm birth- Previous ...
- Forceps delivery A forcep is a metal device that enables gentle rotation and/or traction of the fetal head during vaginal delivery. Indications:- Prolonged second stage of labor- Breech presentation- Nonreassuring fetal ...
- Vacuum delivery A vacuum extractor is a metal or plastic cup, attached to the fetal head with a suction device, that enables traction of the fetal head during vaginal delivery. Indications:- Prolonged second stage of ...
- Cesarean section The delivery of a newborn through a vertical or horizontal incision in the lower abdominal and uterine wall. Indications:Primary cesarean section:- Placenta praevia totalis- Refractory HELLP syndrome ...
- Absolute contraindications to the use of OCPs 1. Undiagnosed vaginal bleeding2. Pregnancy3. Thromboembolic disorders4. History of CVA/Stroke5. CAD6. Breast cancer7. Any estrogen-dependent cancer8. Any tumor of the liver9. Tobacco use in a woman over ...
- Shoulder dystocia Obstetric emergency in which the anterior shoulder of the fetus becomes impacted behind the maternal pubic symphysis during vaginal delivery Epidemiology: ∼ 0.2-3% of births Risk factors:- History of ...
- Postpartum endometritis Etiology: Mostly polymicrobial (2-3 ascending organisms, e.g., Gardnerella vaginalis, Staphylococcus epidermidis, group B Streptococcus and/or Ureaplasma urealyticum) that are usually found in the normal ...
- Amniotic fluid index A semi-quantitative estimate of amniotic fluid volume measured antenatally via ultrasonography of a pregnant uterus. It is part of the biophysical profile. 8-18 = normalAFI ≤ 5 cm = oligohydramniosAFI ...
- Down syndrome comorbidities Neurology:- Intellectual disability- Early-onset Alzheimer disease Cardiology:- Complete atrioventricular septal defect- Ventricular septal defect- Atrial septal defect Gastroenterology:- Duodenal atresia- ...
- Birth-related clavicle fracture Most common fracture during birth (∼ 2% of deliveries) Clinical features:- Usually asymptomatic- Possible pseudoparalysis- Bone irregularities, crepitus, and tenderness over the clavicle possible on ...
- Routine prenatal laboratory tests Initial prenatal visit:- Rh(D) type, antibody screen- Hemoglobin/hematocrit, MCV- HIV, VDRL/RPR, HBsAg- Rubella & varicella immunity- Pap test (if screening indicated)- Chlamydia PCR- Urine culture- Dipstick ...
- Intrauterine fetal demise Definition: Fetal death at ≥ 20 weeks Risk factors:- Nulliparity- Obesity- Hypertension- Diabetes mellitus Clinical features:- Decreased or absent fetal movement Diagnostics: Ultrasound Management:- ...
- Breastfeeding benefits & contraindications Benefits:- More rapid uterine involution & decreased postpartum bleeding- Faster return to prepartum weight- Improved child spacing- Improved maternal-infant bonding- Reduced risk of breast & ovarian ...
- Breech presentation No intervention necessary before 37 weeks' gestation, as most fetuses spontaneously convert to cephalic presentationas they get closer to term External cephalic version:- Should be offered in all cases ...
- Montevideo units A measurement of uterine contraction during labor. Measurements are made by placing a pressure catheter within the uterus and adding the pressure of individual contractions over the course of 10 minutes. ...
- Second stage of labor Definition: stage of labor that begins once the cervix is completely dilated and ends with the birth of the infant Insufficient fetal descent after pushing for - ≥ 3 hours if nulliparous- ≥ 2 hours ...
- Fetal heart rate tracing patterns Category I: Requires all the following criteria:- Baseline 110-160/min- Moderate variability (6-25/min)- No late/variable decelerations- ± Early decelerations- ± Accelerations Category II: Not category ...