A 31-year-old woman who is 18 weeks pregnant with her third child comes to the office for a routine prenatal visit. She has used crack cocaine on and off throughout this pregnancy. You have encouraged her to seek help, however, she has made no attempt to abstain from using cocaine and she refuses to commit herself to another drug treatment program. In your attempt to persuade this patient to stop using cocaine, you advise her that if she continues to use cocaine during the pregnancy, she increases her risk for which of the following?
Correct Answer C:
Cocaine toxicity results from its intensive activation of the sympathetic nervous system, producing vasoconstriction and hypertension. Vasoconstriction produces decreased placental perfusion and placental insufficiency. Hypertension may result in placental abruption. There may be coexisting factors contributing to placental abruption in cocaine addicts. In addition to an increased risk of abruption, there is an increased incidence of congenital anomalies, particularly of the gastrointestinal and urinary tracts, when cocaine has been abused during pregnancy. This fact may also be used in a persuasive manner to convince the patient to discontinue her abuse of cocaine.
Other potential risks to the cocaine-abusing gravida include premature labor, premature delivery, and intrauterine growth retardation. If a patient refuses treatment, continued visits and inquiries about substance abuse are appropriate. Any positive efforts by the patient to discontinue use should be encouraged. Documentation of referral efforts and the fact that the patient was informed about the effects of illicit drugs on the pregnancy should be made. There is no effective chemical detoxification or replacement therapy for cocaine addicts. Treatment emphasizes abstinence and psychosocial counseling.
An infant is born. At one minute the heart rate is 120 per minute, respiratory effort is a good strong cry, muscle tone is active, reflex irritability is absent, colour is pink with blue extremities.
What is the one minute Apgar score?
The following table shows how to calculate Apgar scores:
This baby would have an APGAR score of 2+2+0+1+2 = 7.
Which of the following is the easiest and most reliable way of detecting a retained succenturiate placental lobe?
Correct Answer D:
The maternal surface of the placenta should be inspected to be certain that all cotyledons are present. Then the fetal membranes should be inspected past the edges of the placenta. Large vessels beyond these edges indicate the possibility that an entire placental lobe (e.g., succenturiate or accessory lobe) may have been retained. This can be detected by inspection of the fetal side of the placenta.
A 6-year-old female presents with vaginal bleeding. Vaginal inspection reveals the presence of a multicystic grape-like lesion.
What is the most likely diagnosis?
Correct Answer C: Sarcoma botryoides, also known as embryonal rhabdomyosarcoma, is a rare vaginal cancer. It occurs in the vagina of female infants and children, typically younger than age 8. The name comes from the gross appearance of "grape bunches." The most common clinical finding is vaginal bleeding but vaginal bleeding is not specific for sarcoma botryoides: other vaginal cancers are possible.
A 22-year-old gravida 2 para 1 presents to your office with a 1-day history of vaginal bleeding and abdominal pain. Her last menstrual period was 10 weeks ago, and she had a positive home pregnancy test 6 weeks ago. She denies any passage of clots. On pelvic examination, you note blood in the vaginal vault. The internal cervical os is open.
Which one of the following best describes the patient’s current condition?
Correct Answer A:
Inevitable abortion (choice A) is defined by bleeding, an open os, and no passage of products of conception (POCs).
→ Bleeding also occurs with completed abortion (choice B), but the os is closed and there is complete passage of POCs.
→ Threatened abortion (choice C) is also characterized by bleeding and a closed os, but there is no passage of POCs. (in this case, only blood is visualized, with absence of tissue in the vaginal vault).
→ With incomplete abortion (choice D) there is bleeding and an open os, but POCs are visualized in the os or vaginal vault.
→ There are no symptoms with missed abortion (choice E). Signs of missed miscarriage include the following: normal vital signs usually are within reference ranges. Abdominal examination may or may not reveal a palpable uterus. If palpable, the uterus usually is small for the presumed gestational age. Fetal heart tones are inaudible or unseen on sonogram. The cervical os is closed upon pelvic examination. The uterus may feel soft and enlarged.
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