Table of Contents:

• Physiology of Pregnancy
• Blood Pressure
• Pearl: Benign Ejection Murmur
• Pearl: Peripheral Edema
• Renal Function
• Pearl: Protoeinuria
• UTI in Pregnancy
• ↑Minute Ventilation (VM)
• Pearl: Dyspnea of Pregnancy
• Dilutional Anemia of Pregnancy
• Hypercoagulable State
• GERD
• Constipation
• Pearl: Nausea and Vomiting
• Pearl: Hyperemesis Gravidarum
• Summary of Physiologic Changes of Pregnancy

High yield topic alert!

Physiology of Pregnancy

We will be covering several high yield physiologic changes that occur across various organ systems, including our cardiovascular system, renal, pulmonary, hematologic, and GI organ systems.

The key takeaway from this lesson is going to be that there are several changes during pregnancy (which will often be put in examination questions) that may seem abnormal. It may lead you to want to pursue additional diagnostic testing or look further into the patient's condition.

However, if we understand the physiology of pregnancy, then we can...

Table of Contents:

• Fundus Landmarks
• Fundal Height
  
  • Short Fundal Height
  • Large Fundal Height
• Antepartum Fetal Surveillance
  
  • Non-Stress Test (NST)
    
    • Nonreactive NST
  • Contraction Stress Test (CST)
  • Biophysical Profile (BPP Score)
  • Umbilical Artery Doppler
• Approach to Fetal Surveillance

©2019 BoardsMD

This can be a pretty challenging topic at the medical student level, and it is often very poorly taught and very poorly organized in other lecture series.

We are going to completely demystify and break down the various modalities that we have at our disposal when it comes to fetal surveillance.

Fundus Landmarks

One very high yield pearl that is especially useful in the context of exam questions is having the ability to compare the fundal height to the gestational age.

In the STEM of a given patient vignette, they will often tell you, the number of weeks gestational age of the patient in question.

We can then compare that patients reported gestational age w...

Table of Contents:

• Fetal surveillance Indications
• Short Fundal Height
• Chronic Hypertension
• Gestational Hypertension
• Preeclampsia without severe features
• Preeclampsia with severe features
• Eclampsia
• HELLP syndrome
• Approach to Hypertension in Pregnancy

Important principles for the purposes of examinations:

• Hypertension in pregnancy affect the way that we treat and manage our pregnant women. It matters significantly, and is therefore a frequently tested topic.
• Management of hypertension in pregnancy is different from those in our typical patients, especially because several of our usual antihypertensive agents are contraindicated due to their teratogenic effects.

Fetal surveillance Indications

As I stated earlier, hypertension in pregnancy has significant implications for management of our patients, in particular when it comes to fetal surveillance.

©2019 BoardsMD

 Fetal surveillance includes the use of modalities such as:

• NON-STRESS TEST (NST)
• Contraction Str...

Table of Contents:

• Genetic Disease Screening
• Maternal Serum Screen
• Quad Screen Interpretation
• AFP
• Screening for Aneuploidy
• Cell-Free Fetal DNA
• Drawbacks
• Ultrasound
• Biophysical (BPP)
• Chorionic Villus Sampling (CVS)
• Amniocentesis
• Anti-D Immunoglobulin
• Summary

In this article we will discuss Genetic Screening methods that we use throughout pregnancy.

I love how high yield this article is, in that we really dive into a lot of key modalities that you see casually mentioned in question stems that are often not really clarified or well explained at the medical student level.

These include:                                             

1. Genetic Disease Screening, which for examination purposes, we will most commonly see in the context of cystic fibrosis, as well as sickle cell disease.
2. Maternal Serum Screen which as we will see is performed in all patients, looking for AFP,  B-hCG, Estriol and Inhibin, in order to identify aneuploidy, as well as ventral wall defects and o
...

Contents

1. UTI in Pregnancy
2. Group B Strep
3. Chorioamnionitis
4. HIV

When studying maternal infections, take note that infections affecting the mother can ultimately affect the baby as well. We see this in a major way with genital ulcers, HSV, and other similar conditions. 

There are several high yield maternal infections that we need to be aware of that can have significant effects on the fetus and ultimately the infant. 

High yield topics in this section:

• UTI in Pregnancy can increase the risk of preterm delivery
• Group B Strep (GBS) can result in neonatal sepsis and understanding the management of GBS is essential, both clinically and on examinations.
• Chorioamnionitis can result in fetal tachycardia and fetal distress
• Maternal HIV, if transmitted to the newborn, can result in diarrhea and ultimately failure to thrive

This relationship between mother and fetus is going to be essential as we move forward.

UTI in Pregnancy

Presentation

When it comes to understanding UTI...

Table of Contents:

• Chemical Neonatal Conjunctivitis
• Neonatal Gonococcal Conjunctivitis
• Chlamydial Neonatal Conjunctivitis

In this module, we're going to focus on neonatal conjunctivitis.

There are three high-yield subtypes of neonatal conjunctivitis to be aware of your examinations. These include: 

• Chemical Neonatal Conjuctivis
• Neisseria Gonorrhea
• Chlamydia Trachomatis.

When we use the term conjunctivitis, we're referring to inflammation of the conjunctiva, which essentially wraps around the front of the eye and also covers the inside of the eyelids.

Chemical Neonatal Conjunctivitis.

In chemical neonatal conjunctivitis, the patient will present with bilateral watery discharge and may also have conjunctival injection, which is redness of the conjunctiva. It is important to note here is it is going to present within the first 24 hours following delivery.

Pathophysiology

The classic pathophysiology for chemical conjunctivitis is the use of silver nitrate. Silver ni...

Table of Contents:

• Spontaneous Abortion vs. Intrauterine Fetal Demise
• Abortion
• Recurrent Pregnancy Loss
• Anti-D Immune Globulin
• Threatened Abortion
• Inevitable Abortion
• Incomplete Abortion
• Complete Abortion
• Missed Abortion
• Septic Abortion
• Boggy Uterus
• Overall Approach to Abortion

There are several key subtypes of spontaneous abortion that we need to be aware of for examinations.

These include all the types pictured below as well as the septic abortion, all of which we will cover in detail.

However, before we discuss each type of spontaneous abortion individually, we will first need to discuss some key principles which pertain to abortion in general.

Spontaneous Abortion vs. Intrauterine Fetal Demise

One important thing to establish before we begin our discussion of spontaneous abortion is to be able to distinguish between spontaneous abortions and intrauterine fetal demise.

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An intrauterine fetal demise is a fetal death which occurs at 20 weeks or ...

Table of Contents:

• Choosing the Correct Form of Contraception for Your Patient
• Barrier Contraception
• Hormonal Contraception
• Oral Contraceptive Pills
• Injections
• Implants
• IUDs
  
  • Copper IUD
  • Levonorgestrel IUD
• Sterilization
• Approach to Contraception

There are several high yield types of contraception that we need to cover.

Before we discuss each method of contraception individually, let's first start by forming a framework for how to approach contraception and how to select the correct method in our given patient.

Choosing the Correct Form of Contraception for Your Patient

For the purposes of examinations if we simply know the answers to 4 key questions, then we can easily select the correct answer choice and determine the correct type of contraception for our particular patient.

These four questions are:

• Does the patient desire STI protection?
• Does the patient have any contraindications to hormonal therapy including estrogen and progesterone?
• Does the patient
...

In This Module:

• Five Key Components of Fetal Heart Rate Tracings
• Early Deceleration
• Late Deceleration
• Variable Deceleration
• Oligohydramnios
• Fetal Tachycardia
• Sinusoidal Pattern
• Approach to FHR Training

In this section, we'll review fetal heart rating tracings. Before we delve into some of the high-yield pathologies in this topic, we'll first review some of the key components that go into these tracings.

©2019 BoardsMD

Pictured here is a typical schematic of a fetal heart rate tracing. We can see the actual fetal heart rate represented here in beats per minute or BPM on the top half of this schematic.

The fetal heart rate will oscillate up and down, up and down. By interpreting changes in the fetal heart rate over time, you can use these tracings to help us measure the health and viability of the fetus and to determine whether any intervention is required.

On the bottom half of this schematic, we have the contractions coming from the mother. The strength of these cont...

In This Module:

• Approach to Postpartum Fever
• Atelectasis
• Endometritis
• Breast Engorgement
• Septic Pelvic Thrombophlebitis
• Mastitis

Postpartum fever is defined as a temperature greater than 100.4 degrees Fahrenheit or greater than 38 degrees Celsius which occurs at least 24 hours after delivery.

When encountering these questions on examinations, the key is to use the number of days postpartum to narrow down your differential diagnosis.

Once we know the postpartum day on which the fever is occurring, there will only be one or two options to choose from. This can be extremely useful on exam questions.

One caveat to also keep in mind is that chills and rigors immediately after delivery of the placenta are completely NORMAL in the context of pregnancy and delivery. This is something that examiners like to include to throw you off when they're writing questions.

So keep in mind that chills and rigors immediately after delivery of the placenta are normal and do not constitute any...