136 Obstetrics and Gynecology Board Review •••
❍ Which inhaled corticosteroid is preferred?
Budesonide (class B), because there is more data for its safety in pregnancy.
❍ What is the definition of status asthmaticus?
Severe asthma not responding to 30 to 60 minutes of intensive therapy. Intensive care admission and intubation
when necessary to maintain oxygenation are important next steps.
❍ Which malformation has been associated with oral corticosteroid use during the first trimester?
Isolated cleft lip with or without cleft palate.
❍ When are stress dose steroids required?
When a woman has had >20 mg/day of prednisone for 3 weeks or more.
❍ What is the most effective treatment of allergic rhinitis?
Intranasal corticosteroids.
❍ What fetal monitoring should be considered for patients with moderate-to-severe asthma?
Serial ultrasounds for fetal growth.
❍ What medication used for postpartum hemorrhage must be avoided in patients with asthma?
Hemabate, or prostaglandin F2, because it may cause significant bronchospasm.
❍ What is a complication of viral upper respiratory infection that may have severe consequences in pregnancy?
Pneumonia.
❍ What are typical symptoms of pneumonia?
Cough, sputum production, dyspnea, and pleuritic chest pain.
❍ What diagnostic test should be ordered when a pregnant woman is suspected to have pneumonia?
Chest X-ray.
❍ What are the most common bacteria that cause pneumonia?
Streptococcus pneumonia. Other causes include Mycoplasma and Chlamydophila.
❍ What are criteria for severe pneumonia for which ICU admission is suggested?
Relative risk (RR) ≥ 30 /min, PaO 2 /FiO 2 ratio ≤250, multilobular infiltrates, confusion or disorientation, uremia,
leukopenia (WBC < 4000 /μL), hypothermia, and hypotension.
❍ What is the treatment of severe pneumonia?
A respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin) or a beta lactam plus a macrolide
(amoxicillin clavulanate, Augmentin, or ceftriaxone plus azithromycin, clarithromycin, or erythromycin).
Uncomplicated pneumonia may be treated with macrolide monotherapy.