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pance > 6. Reproductive > Flashcards

6. Reproductive Flashcards

1
Q

Basic PathoPhysiology of Mense cycles

A

Day 1-12

  • GnRH -> FSH, LH -> Estrogen
  • FSH increase cause follicle & egg matruation
  • LH stimulates the maturing follicle to produce estrogen to build endometrium (preparing pregenancy environment)

Ovulation 12-14

  • LH surge cause release egg

Day 14-28

  • Estrogen decrease and Progesterone increase

1st day of mensteration

  • fall of estrogen and progesteron cause lose of endometrium (shed tissue and bleed)
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2
Q

Type of amenorrhea explain

  1. Amenorrhea
  2. Cryptomenorrhea
  3. Menorrhea
  4. Metrorrhea
  5. MenoMetrorrhagia
  6. Oligomenorrhea
  7. Polymenorrhagia
A
  1. not bleeding
  2. light bleeding
  3. Large bleeding
  4. Irregular bleeding
  5. Large irregular bleeding
  6. Prolonged cycle length >35 days
  7. Frequent cycle interval <21 days
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3
Q

US normal, normal pep, but irregular bleeding

Name/Etio/Dx/Tx

A

Name: DUB (dysfunctional uterine bleeding)

Etio: Anovulation(high estrogen), Ovulation

Dx: Diagnosis of exclusion

Tx

  1. OCP
  2. Progesterone
  3. Surgery
    • Hysterectomy (definitive)
    • Endometrial ablation (pt who wants keep productive)
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4
Q

Diffuse pelvic pain right before or with the onset of menses

Name/Tx

A

Name: Dysmenorrhea

Tx: NSAID

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5
Q

Physical, behavioral & mood change with cyclical occurence during luteal phase (1-2 weeks before mense)

Name/Other type/Tx/Workup differentiate

A

Name: Premenstural syndrome

Other type: Premenstrual dysphoric disorder (PMDD)

  • additional sx: Anger & irritabillity

Tx: SSRI, OCP

Workup: Hyper/hypothyroidism check (may mimic)

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6
Q

Failure of mense before 15y or no second sex characteristic by 13y

Name

  1. Uterine present + breast absent=?
  2. Uterine absent + breast present=?
A

Name: Primary amenorrhea

  1. 2type
    • FSH, LH low - hypothalamus
    • FSH, LH high - Turner
  2. Mullerine, androgen
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7
Q

Not bleeding but no genetic issue

Possible 5 dz/Dx/Tx

A
  • MC cause pregnancy
  • Hypothalamus
    • Dx: low LH, FSH
    • Tx: Clomephen
  • Pituitary dysfunction
    • Dx: low FSH, LH, + Prolactin high
    • Tx: TSS
  • Ovarien failure
    • Dx: high FSH, LH + low estrogen
  • Uterine disorder
    • Dx: Pelvic US, hysteroscopy
    • Tx: estrogen tx
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8
Q

age of 50y women + has not bleeding for a year

+ hot flashes and mood change

Name/Risk/PE/Dx/Complication/Tx

Premanopause vs perimanopause Term?

A

Name: Menopause

Risk: 50-52y

PE: bone density low, Vaginal atropy

Dx: FSH (1st) -> FSH high LH high but estrogen low

Complication: Osteoporosis

Tx: HRT

  • Estrogen only
    • Benefit: good for sx
    • Risk: endometrial cancer, thromboembolism
    • Often use this for nonintact uterus
  • Estrogen + progesterone (best option often)
    • Benefit: protect against endometrial cancer
    • Often use this for intact uterus

Vaginal atrophy: estrogen cream

Premanopause - no sx

Perimanopause - estrogen drop and shows sx

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9
Q

leiomyoma vs adenomyosis

A

Leiomyoma

  • Benign smooth muscle tumor
  • MC AA
  • PE: Asymetric, firm, nontender mass
  • Dx: US
  • Tx: Observe + leuprolide (GnRH inhibitor)
    • Definitive: hysterectomy, myodectomy for preserve inferility

Adenomyosis

  • Ectopic endometrial hypetrophy within muscle layer of uterine
  • PE: Symetric, soft, tender mass
  • Dx: MRI
  • Tx: Total abdominal hysterectomy
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10
Q

infection post C-section + fever, tachycardia

Name/Pathogen/Tx

A

Name: Endometritis

Pathogen: GBS

Risk: C-section

Tx: Clinda + gentamycin

Prophylaxis: 1st gen cephalosporin

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11
Q

nulliparty + pelvic pain + painful intercourse

Name/Patho/Risk/Dx/Tx

A

Name: Endometriosis

Patho: ectopic endometrial tissue (MC ovaries)

Risk: Nulliparty, <35y

Dx: Laparoscopy w/ biopsy

Tx: OCP + NSAID, Danzol, leuprolide

  • Surgical
    • Keep fertility -> abalation
    • Not keep fertility -> total abdominal hysterectomy
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12
Q

Precursor to endometrial cancer + Post menopausal bleeding

Name/Patho/Dx/Tx

A

Name: Endometrial hyperplasia

Patho: estrogen high by hyperplasia

Dx: Transvaginal US (1st) - endometrial stripe >4mm -> Endometrial bx (definitive)

Tx

  • Hyperplasia w/o atypia - progestin
  • Hyperplasia w/ atypia - hysterectomy
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13
Q

Manopausal bleeding + hx of use estrogen

Name/Risk/Dx/Tx

A

Name: Endometrial Cancer

Risk: hx of use estrogen

Dx: Transvaginal US (1st) - endometrial stripe >4mm ->endometrial bx

Tx: Hysterectomy

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14
Q

Uterine prolapse

3 type/Grade/Sx/PE/Tx

A

3 type

  • Cystocele: Posterior bladder herinating into Anterior vagina
  • Enterocele: Small bowel herniate into Upper vagina
  • Rectocele: sigmoid colon(rectum) herniate into Posterior distal vagina

Grade

  1. descent into upper 2/3 of the vagina
  2. cervix approaches introitus
  3. outside introitus
  4. entire uterus out

Sx: pevic or vaginal heaviness, fullness, falling out sensation

PE: Bulging mass when introabdominal pressure (valsalva)

Tx

  • Prophylactic - kegel exercise
  • Nonsurgical - pessaries
  • Surgical - hysterectomy (grade 4)
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15
Q

Unilateral RLQ or LLQ pain + otherwise normal

Name/Dx/Tx

A

Name: Functional ovarian cysts

Dx: Pelvic US

Tx: Supportive

  • Cyst <8cm - rest, NSAID
  • if 8cm< - laparoscopy or laparotomy
  • Repeat US after 6 weeks
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16
Q

Palpable overain mass + postmenopausal bleeding

Name/Risk/Dx/Tx/Protective factors

A

Name: Overian cancer

Risk: hx of fx, BRCA

Dx: Biopsy 90% Epithelial, CA 125 serum

Tx

  • TAH-BSO
  • Chemo + surgery

Protective factors: OCP

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17
Q

Amenorrhea + Obesity + Hirsutism + hx of DM

Name/Dx/Tx

A

Name: PCOS (polycystic overian syndrome)

Dx: LH:FSH >3:1, Labs - testosterone

  • Pelvic US: string of Pearls

Tx: OCP (main)

  • Hirsutism: spironlactone
  • Infertility: clomiphene
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18
Q

Cervical test result/bx - tx

A
  • Negative - Normal pap -> NO HPV test
  • ASC-US - if >25y
    • HPV test
      • neg -> 3y
      • POS -> colposcopy
  • ASC-H - Colposcopy
  • LSIL
    • 25-29 -> colposcopy
    • >30 - HPV test
      • Neg -> Pap 1y
      • POS -> colposcopy w/ bx
  • HSIL - Colposcopy

Biopsy result

  • CIN 1 - mild -> Observe or leep
  • CIN2,3 - Moderate(1/3 - 2/3 thick), severe -> leep or abalation
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19
Q

Bleeding after sex, Non-menstrual bleeding

Name/Risk/Dx/Tx

A

Name: Cervical carcinoma

Risk: DES exposure (estrogen), HPV 16/18

  • MC Squamous

Dx: Colposcopy w/ bx

Tx: early - leep, abalation

  • Stage 1 - 2a - TAH-BSO
  • Stage 2a above - TAH-BSO + Chemo
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20
Q

HPV vaccination recommendation

Age/type of vaccine/schedule

A

HPV vaccination: 11-26y

  • Gardasil: HPV 6,11,16,18
  • Gardasil 9: 5 more then regular

Schedule

  • <15y 2 dose HPV 6month apart
  • >15y 3 dose 2,4month apart
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21
Q

Cervical cancer screening

Age initiate/Discontinue/Recommendation pap

A

Age: 21

Discontinue: 65

Test

  • 21-29: Pap test
  • >30: Pap 3y HPV 5y
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22
Q

Painless cervical dilation in 2nd trimester

Name/Risk/Tx

A

Name: Cervical insufficiency

Risk: DES exposure

Tx: cerclage + bed rest (may add 17 alpha-hydroxyprogesterone)

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23
Q

Tender vulvar 4 or 8 o’clock

Name/Dx/Tx

A

Name: Bartholin cyst/abscess

Patho: bartholin duct obstruction

Sx

  • Tender - infected
  • Nontender - not infected

Dx: CBC, culture

Tx: I & D w/ abx

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24
Q

significant pruritus + red/white ulcerative

Name/Risk/Tx

A

Name: Vulvar cancer

Risk: 90% squamous (HPV 16,18,31)

Tx: Surgical remove + Chemo

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25
Q

Vagnial dryness, dyspareunia (painful sex)

Name/Tx

A

Name: Vulvovaginal atrophy

Tx: Vaginal estrogen cream

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26
Q

Unilateral breast pain

Name/Risk/Tx

A

Name: Mastitis/breast abscess

Pathogen: S. Aureus

Sx

  • Unilateral - infected
  • Bilateral - congestive
  • Breast Abscess - induration with fluctuance

Tx

  • Infected - dicloxacillin, Continue breast pump
  • Congestive - ice pack, tight-fitting bras
  • Breast abscess - I & D, discontinue breastfeeding from the affected breast
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27
Q

Cyst become bigger or smaller in size with menstrual hormonal change

Name/Dx/Tx

A

Name: Fibrocystic breast disorder

Dx: US(1st), FNA (straw-colored fluid)

Tx: Most spontaneously

28
Q

Smooth, well circumscribed Non tender freely mobile fixed mass + No change in size

Name/Tx

A

Name: Fibroadenoma of the breast

Tx: Observe

29
Q

breast mass painless hard fixed + blood discharge from nipple (unilateral)

Name/Risk/Type/PE/Dx/Tx

A

Name: Breast cancer

Risk: BRCA, fx hx

Type: ductal carcinoma MC

PE: Itchy scaling rash on the nipple + Peau d’orange (peel of an orange looking)

Dx: US (1st) -> Mammogram, Biopsy (def)

Tx: Lumpectomy (save breast), Mastectomy (remove breast)

  • Medication - tamoxifene, raloxifene
30
Q

Mammogram

  1. ACS screening recommendation
  2. ACOG screening recommendation
  3. USPSTF screening recommendation

Clincal Breast exam recommendation

When to start self breast exam?

A

Mammogram

  1. 45-54y annually, 55 above q2y
  2. 40 above annually
  3. 50-74y q2y

Breast Exam in clinic - q3y in women age 20-39, 40 above annually

Self exam should start age of 20 monthly

31
Q

abd tenderness + cervical motion tenderness + adnexal tenderness

Name/Infection site/pathogen/Dx/Tx

A

Name: Pelvic inflammatory disease

Infection site: upper reproductive region

Pathogen: Gonorrhea & chlamydia

Dx: Clinical, maybe used US for abscess

Tx

  • Outpatient - doxy + ceftx
  • Inpatient - IV doxy + cefo
32
Q

hx of tampon use + fever + skin macular rash + hypotension

Name/Pathogen/Dx/Tx

A

Name: Toxic shock syndrome

Pathogen: S. Aureus

Dx: CBC

Tx: Admission

  • Vanco + clinda + fluid replacement
33
Q

Grey white fish rotten smell

Name/Pathogen/Dx(results)/Tx/Prevention

A

Name: Bacterial vaginosis

Pathogen: Gardnerella vaginallis

Dx

  • PH 5<
  • Fish smell
  • Wiff test POS with 10% KOH
  • Microscopic: clue cell

Tx: Metronidazole

Prevention: avoid douching, NO need tx partner

34
Q

FROTHY yellow green discharge + strawberry cervix

Name/Pathogen/Dx/Tx/Prevention

A

Name: Trichomoniasis

Pathogen: Trichomonas vaginalis

Dx

  • PH 5<
  • Wiff test may POS
  • Wet Mount (Flagellated)

Tx: Metronidazole 2g oral

Prevention: Must tx partner

35
Q

Thick curd like/cottage cheese like discharge

Name/Pathogen/Dx/Tx

A

Name: Candida

Pathogen: Candida albicans

Dx

  • PH normal acidic (3.8-4.2)
  • Wiff test (neg)
  • Microscopic (hyphae, yeast)

Tx: Fluconazole

36
Q

Cauliflower like lesion (flesh colored growths)

Name/Dx/Tx

A

Name: HPV infection

Dx: whitening with 4% acetic acid

Tx: Acetic acid, podofilox, imiquimod

37
Q
  1. which meds approve for PMDD?
  2. Which meds last 3 years and S/E?
  3. Which meds last 3 month and S/E
  4. What is OCP S/E?
  5. Safe OCP for lactation?
  6. 5 year long OCP?
  7. 10 year long OCP?
A
  1. Progestin + estrogen
  2. Implane, Osteoprosis
  3. Depo shot, weight gain
  4. Imgraine or smoker >35 should avoid
  5. Progestin only
  6. Mirena
  7. Paragard
38
Q

Uncomplicated pregnancy

Dx/PE/Timeline(fetal movement/pelvic US/heart tone)

A

Dx

  • Serum HCG - detect pregnancy 5 days after conception
  • Urine HCG - 14 days after conception

PE

  • Uterus (soften)
    • Ladin - 6 weeks
    • Hegar - 6-8 weeks
    • Piskacek - 7-8 weeks
  • Cervix
    • Goodell - cervix soften
    • Chadwick - blue color cervix 8-12hr

Timeline

  • Fetal heart tone - 10-12 weeks
  • Pelvic US - detect fetus 5-6 weeks
  • Fetal movement - 16-20 weeks
39
Q

GPA and Fundal height measurement

GPA classification/timeline for height explain

A

GPA

  • Gravida - # of pregnancy
  • Para - # birth
  • Abortus - # of loss

Fundus height

  • 12 weeks - pubix symphysis
  • 20 weeks - at ubilicus
  • 38 weeks - below xiphoid process
40
Q

Estimated date of delivery (EDD)

A

Naegele’s rule

  • (1st day of last mense + 7 days) - 3month
41
Q

First trimaster visit tests (1-12wks)

A
  • Maternal blood screening test for down syndrome
    • HCG(high or low), PAPP-A(low), Nucal translucency (thick abnormal)
  • US
    • Feter heart tone - 10-12wks
    • heat beat check - 5-6 wks
  • Chorionic villus sampling (CVS)
    • age >35 at risk option to test chromosomal abnormality
42
Q

Second trimaster visit test (13-27 weeks)

A
  • Triple screening test (15-20wks)
    • beta hCG high - down syndrome (trisomy 21)
    • Alpha fetoprotein high - Neural tube defect
    • everything low (trisomy 18) - usually die in 1st year of life
  • US
  • In 15-18 wks, Aminocentesis offered to check chromosomal abnormality (maternal 35y)
  • Gestational diabetes screening 24-28wks
43
Q

Third trimaster visit test (28 wks - till birth)

A
  • RhoGAM - 28 wks and within 72 hours after child birth
  • GBS screening to prevent endometritis 32-37 wks
  • Non stress test - 2 acceleration in 20 min, if no acceleration -> contraction stress test - NO late deceleration (no problem), if late deceleration present -> delivery
44
Q

Failure to conceive after 1 year trial

Name/RIsk/Dx/Tx

A

Name: Infertility

Risk: Male (40%), Female (30%)

Dx: check male sperm first and Hysterosalpingography

Tx: Clomephene (induce ovulation), Intrauterine insemination

  • if fallopian tube defect - vitro ferilization
45
Q

Unilateral pelvic pain + amennorrhea

Name/Risk/MC site/Dx/Tx

A

Name: Ectopic pregnancy

Risk: hx of abd surgery or tubal (due to adhesions)

MC site: Fallopian tube MC

Dx

  • Beta hCG - 2000< or doubling in 24-48hrs
  • Transvaginal US - absence of sac

Tx

  • MTX
  • lararoscopic salpingostoy (unstable)
  • RhoGAM if mother is RH negative
46
Q

Abortion cases tx

  • NO POC expelled + Cervical close
  • some POC expelled + Cervical close
  • some POC expelled + Cervical open
  • NO POC shown + Cervical closed
  • NO POC expelled + Cervical close + fetal demise (death)
  • Some POC expelled + cervical tenderness + cervical closed
A

Basic Tx: D&E except for threatened

  • Threatened
  • Inevitable
  • Incomplete
  • Complete
  • Missed
  • Septic
47
Q

Medical vs surgical

A

Medical

  • MTX
  • Misoprostol
  • Mifepristone

Surgical

  • D & C - 4-12 wks
  • D & E - 12wks <
48
Q

No proteinuria + HTN + Pregnancy 20 wks

Name/Tx

A

Name: Gestational HTN

Tx: Hydralazine

49
Q

ProteinUrea + HTN + Pregnancy

Name/Complication/Tx

A

Name: Preclampsia

Complication: HELLP syndrome

Tx

  • 37wks< - delivery NOW
  • 34wks> - admission tx w/ mag sulfate + hydralazine
50
Q

Seizure or coma + HTN + Pregnancy

Name/type of seizure/Tx

A

Name: Eclampsia

Type: Tonic-clonic 1,2 min -> postictal state

Tx: ABCD 1st, Mag sulfate + hydralazine or labetalol

  • Once stable - DELIVERY (life thretening)
51
Q

HTN before 20 weeks pregnancy

Name/Tx

A

Name: Chronic HTN

Tx: Methyldopa

52
Q

3rd trimaster + Painless bleeding (bright red)

Name/Patho/Fetal HR/Dx/Tx

A

Name: Placenta previa

Patho: abnormal place for placenta

Fetal heart rate: Normal

Dx: Pevic US

Tx: hospotalization

  • tocolytic (mag sulfate)
  • if less than 34 wks give steriod for surfactant
  • once stable - delivery
53
Q

3rd trimaster + severe sudden painful bleeding

Name/Patho/Risk/fetal HR/Dx/Tx

A

Name: Abruptio placenta

Patho: seperation of placenta from uterine wall

Risk: HTN, Smoking

Fetal HR: Brady

Dx: Pelvic US

Tx: Delivery NOW

54
Q

Painless vagnial bleed + 3rd trimaster bleeding

Name/Patho/Fetal HR/Dx/Tx

A

Name: VASA Previa

Patho: fetal vessel traverse the fetal membrane over cervical os

Fetal HR: Brady

Dx: Pelvic US

Tx: C-section NOW

55
Q

Pregnancy + obesity + hx of DM

Name/Risk/Dx/Tx

A

Name: Gestational DM

Risk: Obesity, hx of DM, 4g over baby birth

Dx

  1. 50g glucose challenge at 24-28 wks
    • if >140 after 1 hour -> 3 hr test
  2. 3 hour 100g glucose tolerence test (GTT)
    • Overnight fast and test in the morning
    • Fasting >95, 1hr >180, 2 hr >155, 3 hr >140

Tx: Insulin

56
Q

Postpatum blues vs depression

A

Blue - do not think of harm baby 2-4 days onset

  • No need tx resolve in 10 days

Depression - 2 wks - 2 month onset and THINK OF HARM BABY

  • May need antidepressant, may last 3-14 month
57
Q

beta hCG more than 100,000 + Snowstorm shown in US

Name/Dx/Tx

A

Name: Molar pregnancy

Patho: Neoplasm growth due to abnormal placental development (Hidaform Mole)

Dx: US, hCG

Tx: Surgical uterine evacuation (Suction curettage)

  • MTX can be used if METS
58
Q

Pregnancy + hepatosplenomegaly + jaundice

Name/Patho/Dx/Tx

A

Name: RH allomunization

Patho

  • 1st pregnancy (Mom RH-, Baby RH+) develop antibody
  • 2nd pregnancy (Mom RH-, Baby RH+) developed antibody from 1st pregnancy will cross to attack baby RBC

Dx

  • Pt must be RH- abo and 2nd pregnancy

Tx

  • given at 28 weeks
  • within 72 hrs of delivery
  • anytime bleeding during pregnancy
    • if bleed less than 12 weeks - 50 RoGAM
    • if bleed more than 12 weeks - 300 RoGAM
59
Q

Severe emesis during pregnancy

Name/Tx

A

Name: Motion sickness or HEG (hyperemesis Gravidarum)

Tx

  • Fluid, electrolyte repletion
  • Pyridoxine (Vit B6) + Doxylamine
60
Q

Stage of Labor explain

Contraction but no Cervial dilation called?

A
  • Stage 1 - dilation of cervix (10 cm)
  • Stage 2 - delivery of fetus
  • Stage 3 - delivery of placenta
  • Stage 4 - 1-2 hr after delivery and assessed for complication
  • Called as Braxton-hicks contraction
61
Q

APGAR score category

A
  • Appearance - pink
  • Pulse - 100<
  • Grimace - pull away, sneeze, or cough
  • Activity - arm, leg flex and resists extension
  • Repiratory - strong, crying
62
Q

Postpartum Physical difference 4 things

A
  • Uterus - shrink in 2 days, decends back to 2 weeks, Normal size in 6 weeks
  • Lochia serosa - bleeding 4-10 days, Resolves 3-4 weeks
  • Breast - milk in 3-5 days
  • Mense - restart if no breast milk, usually restart in 6-8 weeks
63
Q

loss of blood more than 500ml during delivery

Name/Risk/Patho/PE/Dx/Tx

A

Name: Postpartum hemorrhage

Risk: 500ml vaginal, 1000ml C-section

Patho: Uterine atony (uterus unable to contact to stop bleeding)

PE: soft boggy uterus

Dx: CBC, type & cross

Tx

  • Bimanual uterine massage
  • IV fluid + oxytocin
64
Q

hx of smoking + sudden pooling of secretion in vagina (pregnacy)

Name/Dx/Tx

A

Name: Premature rupture of membrane

Risk: STD, SMOKING

Dx

  • Nitrazine paper test - turn blue PH 6.5<
  • Fern test - fern pattern crystalization

Tx: Labor + monitor for infection

65
Q

Any delivery before 37 wks

Name/Dx/Tx

A

Name: Premature Labor

Dx

  • Fern test - crystal
  • Nitrazine paper test - blue (ph 6.5<)
  • Presence of FETAL FIBRONECTIN

Tx

  • Beclomethasone (premature lung)
  • Tocolytic - It’s Not My Time
    • Indomethacin
    • Nifedipine
    • Meg sulfate
    • Terbutaline
  • ABX for GBS infection (ampicilin + amox)
66
Q

During delivery baby head is out but shoulder stuck at mother pubis

Name/Tx

A

Name: Shoulder dystocia

Tx

  • Nonmanipulation - McRobert maneuver (lift leg up and push w/ hand on mother suprapubis) 1stline
  • Manipulation - Wood “Corkscrew” Maneuver (180 should rotation)
67
Q

Induction of labor medication

A
  • Oxytocin IV - 1cm dilation with some effacement
  • Prostaglandin gel - unfavorable cervice

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