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OB/GYN > Additional > Flashcards

Additional Flashcards

1
Q

Most common sx in eclampsia (antecedent)

A 
HIV + proteinuria
HA
Visual changes
RUQ/Epigastric pain
Ankle clonus
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2
Q

When does eclampsia occur?

A 
#1 Antepartum
#2 Intrapartum
#3 ≤ 48hrs post-partum
#4 > 48hrs post-partum
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3
Q

Finding on neuroimaging in eclampsia

A

Reversible posterior leukoencephalopathy syndrome

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4
Q

What is seen in Reversible posterior leukoencephalopathy syndrome?

A

Patchy T2/FLAIR hyperintensity in subcortical white and gray matter of parietal + occipital cortex

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5
Q

MCC death s/p eclampsia

A

Cerebral hemorrhage

 - Petechial
 - Occipital
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6
Q

Eclampsia DDx

A 
Tumor
Ruptured aneurysm
TTP/HUS
Cerebral vein thrombosis
Metabolic, toxic, ID, trauma
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7
Q

Why give anti-HTNs in eclampsia?

A

Prevent stroke

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8
Q

Anticonvulsive DOC in eclampsia

A

Mg sulfate

Prevents recurrent seizures

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9
Q

Complications in subsequent pregnancies for eclampsia pts

A

Abruptio placenta
Preterm delivery
IUGR
Perinatal mortality

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10
Q

Indications for diagnostic D&C

A

Biopsy showing high risk for endometrial CA
Endometrial hyperplasia where CA must be excluded
Not enough tissue in office bx
Cervical stenosis prevents office bx
Hysteroscopy/Laparoscopy is also needed

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11
Q

Therapeutic indications for D&C

A

Incomplete/inevitable/missed/septic/induced abortions
Molar pregnancies
Prolongued/excessive vaginal bleeding (failed hormonal therapy)
Suction curettage for potpartum hemorrhage due to retained products

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12
Q

Features of pre-eclampsia

A

New onset HTN
Proteinuria/End organ dysfunction
Last 1/2 of pregnancy (>20wks)

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13
Q

HELLP

A 
Hemolysis
Elevated
Liver enzymes
Low
Platelets
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14
Q

Features of pre-eclampsia on pre-existing HTN

A

New onset proteinuria/end organ dysfunction
> 20 weeks
Already have HTN

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15
Q

Gestational HTN

A

HTN w/o proteinuria or pre-eclampsia sx @ >20wks

Resolve by 12 wks post-partum

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16
Q

Suspected gestational HTN resolves postpartum

A

Transient HTN of pregnancy

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17
Q

Suspected gestational HTN continues >12wks post-partum

A

Chronic/Pre-existing HTN

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18
Q

Pre-eclampsia RFs

A 
Primagravida
Hx pre-eclampsia
FHx pre-eclampsia
DM
HTN (≥100, ≥110) <20wks
Anti-phospholipid Abs
BMI ≥26.1
CKD
Twins
Old mom
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19
Q

Sign and Sx in pre-eclampsia

A 
Severe HTN
Persistent/Severe HA
Vision abnormalities
Abd pain (upper/epigastric)
N/V
Dyspnea
Retrosternal CP
Change in MS
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20
Q

Lab changes in Pre-eclampsia

A

MHA
Thrombocytopenia
↑ Cr
↑ LFTs 2x ULN

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21
Q

Pre-eclampsia < 20wks indicates:

A

Complete/Partial Molar Pregnancy

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22
Q

15% of pts with HELLP present with what

A

HTN or proteinuria

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23
Q

What is delayed/post-partum pre-eclampsia

A

Signs/Sx leading to readmission >2 days, <6wks after delivering

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24
Q

Edema clues in pre-eclampsia

A

Facial edema

Sudden, rapid weight gain (>5lb/wk)

25
Q

What always results in complete resolution of signs/sx or pre-eclampsia?

A

Delivery of placenta

26
Q

What constitutes severe pre-eclampsia?

A

SBP ≥ 160/DBP ≥110 x2 ≥4hrs apart

27
Q

Diagnosis of proteinuria in pre-eclampsia

A 
≥0.3g in 24hr sample
OR
1+ on dipstick (persistent)
OR
Random protein:Cr ≥0.3
28
Q

Severe renal disease in pre-eclampsia

A

Cr > 1.1 or Doubling of Cr

29
Q

Most common coagulation abnormality in pre-eclampsia

A

Thrombocytopenia

30
Q

What is seen in significant liver disease in pre-eclampsia

A

PT/PTT changes

31
Q

Clues for microangiopathic hemolysis in pre-eclampsia

A 
Schistocytes
Helmet cells
↑ Helmet cells
↑WBC
↓ Hct
32
Q

Clues for pre-eclampsia HA

A

Persistence w/ OTC analgesics

33
Q

What percentage of pregnancy associated strokes are caused by pre-eclampsia?

A

36%

34
Q

New onset HTN in pregnancy?

A

Assume pre-eclampsia until proven otherwise

35
Q

Pre-eclampsia Dx criteria

A 
SBP ≥ 140 or DBP ≥ 90
AND
Proteinuria > 0.3 or Protein:Cr ≥ 0.3 in 24hrs
OR
End organ dysfunction
     - Platelets 1.1 or doubled
     - ↑ AST/ALT 2x ULN
36
Q

Pre-eclampsia DDx

A

Underlying Renal Disease
Acute fatty liver disease of pregnancy
TTP/HUS
Lupus exacerbation

37
Q

Category I tracings definition

A 
Baseline rate 110-160
Moderate FHR variability (6-25)
No late/variable deceleration
± Early decels 
± Accels
38
Q

Category III tracings definition

A 
Absent baseline FHR variability
AND any of:
Recurrent late decels
Recurrent variable decels
Bradycardia
OR
A sinusoidal pattern
39
Q

In utero resuscitation methods to improve uteroplacental perfusion and materal/fetal oxygenation

A 
Reposition pt on L or R side
Administer O2
Administer IV bolus (NS or LR)
Discontinue uterotonic drugs
Administer tocolytic drug
Give alpha-agonist to reduce SNS blocade
40
Q

What does repositioning pt on L or R side do?

A

Decreases cord compression

41
Q

Can O2 alone correct fetal acidemia

A

NO

42
Q

Category II tracings definition

A

Anything that’s not category I or III

43
Q

What is the purpose of scalp stimulation

A

Provokes FHR acceleration

Probability or fetal acidosis = <10%

44
Q

ST ↑/↓ on fetal EKG is suggestive of what?

A

Fetal hypoxemia

45
Q

Is there any reason to get O2 sat of the fetus?

A

NO

46
Q

When do you see fetal hypoxia leading to late decels?

A 
Uterine tachysystole
Maternal hypotension
Maternal hypoxia
Maternal vasculopathy
Placental disorders associated with placental insufficiency
47
Q

What is moderate variability strongly associated with?

A

Umbilical pH >7.15

48
Q

What are spontaneous/elicited accels strongly associated with?

A

Umbilical pH >7.10

49
Q

Major causes of fetal tachycardia

A 
Maternal-fetal infection
Meds
Maternal hyperthyroidism
Placental abruption
Fetal hypoxia
Elevated maternal catecholamines
50
Q

When is fetal tachy associated with acidemia?

A 
When accompanied by:
Recurrent decels
OR
Absent accels
OR
Minimal/absent variability
51
Q

When do variable decels occur?

A

Cord compression

52
Q

2nd line for cord compression

A

Amnioinfusion

53
Q

Most common meds decreasing FHR variability

A

Mg sulfate

Maternal Opioids

54
Q

Causes of prolongued decel or fetal brady

A 
Rapid fetal descent
Cord prolapse
Placental abruption
Maternal hypotension
Uterine rupture
Tachystole
55
Q

When do you start PAP smear screening?

A

Age 21

56
Q

When do we start treating cervical dysplasia?

A

CIN II and higher

57
Q

How often should PAPs be done?

A

Every 3 years until 30, then every 5

58
Q

What is labor?

A

CTX with cervical changes

OB/GYN (3 decks)

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