The likelihood of postpartum depression is increased by which one of the following?
Correct Answer E:
Women who report inadequate social supports, marital discord or dissatisfaction, or recent negative life events, such as a death in the family, financial difficulties, or loss of employment, are more likely to experience postpartum depression. Women with a previous history of depression, a family history of a mood disorder, or depression during the current pregnancy are at increased risk for postpartum depression. Furthermore, women with a previous history of postpartum depression or psychosis have a risk of recurrence of up to 90%.
Although levels of estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery, women with postpartum depression do not differ significantly from non-depressed women with regard to levels of estrogen, progesterone, prolactin, and cortisol or in the degree to which these hormone levels change.
Which one of the following is absolutely contraindicated in the treatment and prophylaxis of migraine during early pregnancy?
Correct Answer C:
Headaches, and migraines in particular, are very common in women of childbearing age. Migraine sufferers usually have improvement of symptoms in pregnancy and many have complete remission. Most medications used for prophylaxis and abortive treatments of migraines in the nonpregnant patient can also be used in pregnant patients.
→ Most beta-blockers and calcium channel blockers are safe.
→ Acetaminophen and narcotics can be used for acute pain.
→ Ibuprofen can also be used but should be avoided late in pregnancy because it is associated with premature closure of the ductus arteriosus and oligohydramnios.
→ Metoclopramide is FDA pregnancy category B and may be used intravenously for migraine or orally for associated nausea.
Ergotamines are abortifacients and are absolutely contraindicated in pregnant women and women of childbearing age who are not using reliable contraception. Prolonged vasoconstriction of uterine vessels with increased myometrial tone may lead to reduced myometrial and placental blood flow and contribute to fetal growth retardation seen in animal studies.
The probability of pregnancy after unprotected intercourse is the highest at which one of the following times?
Correct Answer B:
There is a 30% probability of pregnancy resulting from unprotected intercourse 1 or 2 days before ovulation, 15% 3 days before, 12% the day of ovulation, and essentially 0% 1-2 days after ovulation. Knowing the time of ovulation therefore has implications not only for “natural” family planning, but also for decisions regarding postcoital contraception.
A 30-year-old female presents with concerns about vaginal bleeding. She states that her menstrual periods have occurred at regular intervals of 28-30 days for the past 15 years, but recently bleeding has also occurred for a day or two in the middle of her cycle. This bleeding has been heavy enough to require the use of multiple pads.
Which one of the following terms best describes her bleeding pattern?
This patient has metrorrhagia, or “bleeding intermenstrual”, characterized by bleeding heavy enough to require the use of multiple pads; the heavy bleeding occurs between normal menstrual bleeding. It is important to evaluate metrorrhagia because potential causes include cervical disease, problems with IUDs, endometritis, polyps, submucous myomas, endometrial hyperplasia, and cancer.
→ Mid-cycle spotting, as the term implies, refers to light spotting, and is often caused by a decline in estrogen levels.
→ Polymenorrhea is bleeding occurring at intervals of less than 21 days.
→ Menorrhagia is very heavy bleeding during a regular period or prolonged bleeding (> 8 days).
→ Acute emergent abnormal uterine bleeding is characterized by significant blood loss resulting in hypovolemia.
A 30-year-old gravida 3 para 2 at 28 weeks gestation is a restrained passenger in a high-speed motor vehicle accident. After initial stabilization in the field with supplemental oxygen and intravenous fluids, she is brought into the emergency department on a backboard and wearing a cervical collar.
Until you are able to rule out a spinal injury, in what position should the patient be kept?
In general, it is best to place a woman who is greater than 20 weeks pregnant in the left lateral decubitus position because the uterus can compress the great vessels, resulting in decreased systolic blood pressure and uterine blood flow.
However, in the case of trauma where a spinal cord injury cannot be ruled out, the woman needs to be kept supine on a backboard. The weight of the uterus can be shifted off the great vessels by either manual deflection laterally or by elevating the right hip 4-6 inches by placing towels under the backboard. The Trendelenburg position does not relieve the weight of the uterus on the great vessels. The prone position does not provide adequate spinal cord protection, and would be extremely awkward in a large pregnant woman.
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