All cards Flashcards
1
Q
borders of the perineum
A
Pubic symphysis
Ischial tuberosities, ischiopubic rami and sacrotuberous ligaments laterally,
coccyx
2
Q
the anal triangle contains 3 things
A
anal aperture
external anal sphincter
ischioanal fossae
3
Q
the urogenital triangle contains
A
- roots of the external genetalia
- openings of the urethra and the vagina
4
Q
Deep to superficial, the urogenital triangles layers are
A
Deep perineal pouch
Perineal membrane (provides attachment for the muscles of the external genitalia)
Superficial perineal pouch (contains erectile tissues, Bartholin’s glands, ischiocavernosus, bulbospongiosus, and superficial transverse perineal muscles)
Perineal fascia
Skin
5
Q
What is the perineal body
A
irregular fibromuscular mass located at the junction of the urogenital and anal triangles. It acts as a point of attachment for muscle fibers. It supports the posterior part of the vaginal wall against prolapse
6
Q
What structure gets cut during episiotomy
A
perineal body
7
Q
The vagina is lined by what kind of epithelium
A
non keratinized stratified epithelium
8
Q
The uterus is lined by what kind of epithelium
A
columnar, muciparous epithelium
9
Q
The distinctions of the fallopian tubes are
A
uterine part (0.7mm wide, 1 cmlong and is within the myometrium)
Isthmus (1-5mm wide, 3 cm long)
ampulla (is the widest portion of the tube and has a folded interior)
Infundibulum
10
Q
The peritoneal and ligamentous supports of the ovary consist of
A
- suspensory ligament (contains ovarian vessels and nerves)
- proper ovarian ligament (this relfects off the uterus as the round ligament of the uterus)
- the mesovarium
11
Q
lateral folds of the parietal peritoneum are called the
A
broad ligament which has 3 parts: mesometrium, mesalpinx, mesopvarium
12
Q
blood supply to the pelvis arises from the paired internal ilaic arteries. Only the ovary receives blood supply directly from the aorta and runs in the suspensory ligament of the ovary
A
uterine artery
vaginal artery
pudendal artery
13
Q
Four functions of the placenta are
A
tolerance: prevents rejection of the fetus
Transfer: nutrients, O2 and CO2 and waste
Endocrine function: hCG, estrogens and progesterone, placental lactogen
14
Q
Day 6
A
blastocyst adheres to uterine lining
15
Q
Day 7
A
the trophoblast divides into superficial syncitiotrophblast and inner cytotrophoblast
16
Q
What produces hCG
A
syncitiotrophoblast
17
Q
purpose of hCG
A
to preserve activity of the corpus luteum (produce estradiol and progesterone)
18
Q
Day 8-11
A
amniotic cavity appears inside the ICM. This cavity grows to become the amniotic sac.
19
Q
Day 12
A
the ST breaks maternal blood vessels and creates a lacunar area full of maternal blood.
The decidual reaction has occured
20
Q
At the end of the second week status of placenta and embryo
A
Placenta: primary chorionic villus
Embryo: ICM divides into hypoblast and epiblast
21
Q
define chorion
A
is a double layered membrane formed by the trophoblast and the extra embryonic mesoderm and eventually becomes the fetal part of the placenta
22
Q
Yolk sac and it’s diverticulum the allantois are the
A
major means of nutrition exchange in mammals but forms the gut tube in humans. The allantois attaches to the urinary bladder
23
Q
Day 16-21
A
primary chorionic villu become secondary
Day 21: fetal blood cells run inside the chorion and colonise the secondary villi and become tertiary chorionic villi
24
Q
Week 7-8
A
tertiary villi surround the entire circimference of the chorion by in the following weeks 70% of them degenerate and persist only at one side where the placenta will reside
25
Poor remodling of uteroplacental spiral arteries leads to
early onset pre eclampsia, FGR, placental abruption, spontaneous preterm, premature rupture of membranes
26
the total surface of placental villi is
15 m2
27
Weeks 9-12
urine starts to be produced
Liver is the main site of erythropoiesis
28
Until which week can it be considered a preterm birth
37
29
Phases of parturition
Quiescence
Activation
Active labor
30
First phase of parturition
Quiescence: is 95% of prenancy, and has uterine smooth muscle tranquility and cervical structure integrity maintenance
31
Second phase of partuiriton
Activation: myometrial changes occur to prep for labor and there is the formation of lower uterine segment from the isthmus
This is where cervical ripening occurs - Bishop score
32
The bishop score ranges from 0-3 and includes (3 is closest to labor)
dilation
position of cervix
effacement
station
cervical consistency
33
Phase 3 of parturition
Active labor (note that this is divided into 3 stages)
34
Stages of labor
First: divided into early latent (with mild irregular uterine contractions that start to soften the cervix) then active phase
Second: transition: from 10 cm to station 0. Active second stage: after internal rotation, vaginal distension, need to push
Third: delivery of placenta
35
Diagnosis of active labor can only be made if
3-4 cm cervical dilation with a completly effaced cervix
rhythmic, regular and painful contractions lasting 40-60 mins
36
Tachysystolia is
more than 5 in 10 mins
37
External dynamometry measures
changes in shape of the abdominal wall (is qualitative)
38
Direct measure of intrauterine pressure is done by
insertion of a pressure transducer directly into the uterine cavity usually through the cervix after rupture of the fetal membranes
39
Fetal lie can be
longitudinal, transverse, and oblique
40
Fetal presentation options
cephalic, sideways, complete breech, frank breech
41
Fetal attitude options
vertex
bregma
brow
face
42
Protracted labor definition
longer than 2 hours in nulliparus without regional anaesthetic, and 3 hours with an epidural.
Longer than 1 hour in multiparus without epidural and 2 hours with regional anaesthesia
43
define engagement
the descent of the widest part of the presenting fetal part below the plane of the pelvic inlet. The widest diameter in the cephalic presentation is the biparietal diameter
44
Define descent
the highest rate of descent occurs during the deceleration phase of the first stage and second stage
45
When can you perform an episiotomy
OPVD or fetal distress
46
Define dystocia
difficult labor. There is first and second stage dystocia
47
3 categories which result in dystocia are
- uterine dysfunction
- fetal abnormalities
- structural changes
48
Abnormalities in fetopelvic proportion becomes clearer as the fetus attempts to descend which is in the
second stage
49
T/F ineffective labor is generally accepted as a possible warning sign of fetopelvic disproportion
T
50
In order to diagnose a woman with protraction disorder or arrest disorder a woman must be in
the active phase of labor, which is defined by cervical change (> 6cm of dilation)
51
Treatment for first stage of labor dystocia
oxytocin (go to C section only if A(>=6cm dilation plus 4 hr contraction) or B(6h oxytocin with no change in cervix)
52
Treatment of second stage of dystocia
OPVD
manual rotation of the fetal occiput for malposition
53
Define shoulder dystocia
an obstetric emergency where progression of labor is halted after the delivery of the head, It typically occurs when the descent of the ant/post/both shoulders is obstructed
Incidence: .58-.7% of vaginal delivery
54
Direct antenatal RF for shoulder dystocia are
- history of shoulder dystocia in prior vaginal delivery
- fetal macrosomia
- diabetes/impaired glucose intolerance
55
RF for macrosomia which are indirect causes of shoulder dystocia
excessive weight gain during pregnancy
maternal obesity
asymmetrical accelerated fetal groath in non diabetic pts
post term pregnancy
parity
56
Intrapartum RF for shoulder dystocia
quick second stage (<20mins)
OPVD
Prolonged second stage (Without regional anesthesia: (>2 h for nulliparous patients, or >1 h for multiparous patients)
With regional anesthesia (>3 h for nulliparous patient, >2 h for others)
)
57
Management of shoulder dystocia
- call help
- evaluate for episiotomy
- legs- mcroberts maneuver
- suprapubic pressure
- enter: rotational maneuvers
- remover the posterior arm
- roll the pt to her hands and knees
58
Indications for C-section
Arrest
Nonassuring fetal status
malpresentation
multiples
59
Robson classification for C sectoin
parity
# of fetuses
previous CS
onset of labor
gestational age
fetal presentation
60
Leiomyomas (aka myomas/fibroids) arise from
smooth muscle in the myometrium
61
RF for leiomyomas
ethnicity
familiarity
high BMI
nulliparity
early menarch (<10 years)
62
Classification of leiomyomas (from inside to outside)
intracavitary (5%)
submucosal (15%)
intramural (70%)
subserosal (5%)
Pedunculated (5%)
63
Most leiomyomas are asymptomatic, only 20-50% have symptoms which can be
menorrhagia (29-59%)
pelvic pain/pressure (40%)
infertility (27%)
torsion and necrosis (<10%)
expulsion/extrusion
64
Conditions associated with uterine leiomyomas can be
polycythemia
ascites
impingement
related complications
sarcomatous changes
65
DX of uterine leiomyoma
- increased uterus size, irregular profile, hard consistency
- US
- dopler
- hyteroscopy
- MRI
66
TX for leimyoma in asymtomatic women
is non interventional except if
- infertile women with distortion of uterine cavity
- women with previous pregnancy complicated by fibroids
67
Medical TX for firbroids
progestins/E+P (Lead to endometrial atrophy and bleeding control)
Progesterone antagonist (Mifepristone) which decreases tumor size
GnRH analogue
68
Causes of fetal growth disorders
vascular: HTN/pre-eclampsia
infective: CMV, parvo, adeno, coxsackie, VZV, rubeo
chro/genetic dx
teratogenic
69
Early FGR vs late
before 32 wks and after
70
FGR definition
EFW below cut off
10 percentile
US diagnosis
71
SGA parameters
EFW between 3-10 centile
Maternal and fetal doppler velocimetries are normal
72
FGR early onset and late onset have different velocimetry patterns
T
73
FGR >32 weeks definition
Or at least 2 of the followings:
1) AC/EFW <10° centile with abnormal Umbilical Artery Pulsatility Index (UA PI) > 95° centile
2) Cerebroplacental Index CPR < 1
MCA (Middle Cerebral Artery) PI / UA PI
3) Abnormal Uterine artery Doppler flow (AUt PI > 95° centile);
4) Decrease of 50 centile in growth trajectory (eg. from 70° to 20° centile)
74
FGR <32 weeks if
Or at least 2 of the followings:
1) AC/EFW <10° centile with absent end-diastolic flow in the umbilical artery (AED);
2) Abnormal uterine arteries Doppler (PI > 95° centile);
3) Abnormal umbilical artery Doppler with increased resistance (PI >95° centile)
75
Which vessels can you doppler
uterine, umbilical, middle cerebral, cerebroplacental ratio
- ductus venosus if <32 wks and AED in the UA
76
An increase in UA doppler is due to
- reduction nutrient exchange at placenta
- increases fetal circulation resitance
- progressive placental vascualr insufficienct (seen by the absent diastolic flow) in advanced stages.
77
T/F UA doppler should be the primary surveillance tool in the SGA fetus
T
78
Brain sparing effect
when there is fetal hypoxemia, there is centralization of blood flow which causes increased blood to reach the brain, heart, adrenal glands.
There is an increase in diastolic flow in the MCA
79
Women who have a major RF for SGA vs those with minor RF's should undergo UA doppler when
- major RF: from 26-28 wks
- minor RF: from 20-24 wks
80
Clinical diagnosis of SGA baby
symphysis to fundal height check from 24-26 wks (is less than 10th centile for GA. Or if it doesn't increase in 2 or more consecutive measurements). This is not reliable in obese women, myomas or polyhydramnios
81
3 things when FGR is dx
check for correct GA
chech for prenantal diagnosis
rule out malformation infection (CMV)
82
What is the purpose of OPVD
to ensure safe vaginal delivery for maternal or fetal indications
83
Maternal indications for OPVD
- prolonged second stage of labor
- need to shorten second stage of labor for maternal benefit
- inefficient maternal effort
84
Fetal indications for OPVD
suspicion of compromised fetal conditions (CTG, bradycardia)
85
Contraindications for OPVD
non vertex presentation
unengaged fetal head
unknown fetal head position
fetal prematurity of less than 34 weeks
known fetal coagulation disorders
known fetal bone disorders
86
Complications of OPVD
Maternal: vaginal wall injuries, perineal injuries
Fetal: intracranial hemorrhage, neonatal facial injuries, vacuum duration is in direct association with greater adverse neonatal risks
87
Define cephaloematoma
blood between periosteum and parietal bone. It does not override the sutures. Appears after 6-24 hours after delivery
88
Subgaleal hematoma is
between galeal aponeruosis and the skin of the head. Overrides the sutures. Appears in the first hours after delivery and can lead to hypovolemic shock
89
The most widespread congenital infection and the primary cause of sensorineural hearing loss is
CMV
90
CMV symptoms
85% are asymptomatic
the rest have mono symptoms
91
T/F CMV transplacental transmission is related to GA
T
40% average
92
Routine screening for CMV is not recommeded
T
93
Low avidity meaning for CMV
an acute infection in the past 3 months
94
High avidity
excludes a primary infection in the past 3 months
95
CMV fetal infection diagnosis
amniocentesis is gold standard.
- at least 6-8 weeks from the beginning of maternal infection
funicolocentesis
96
When is gestational diabetes diagnosed
most commonly during the second and third trimester
97
Adverse outcomes due to pregestational diabetes
stillbirth/macrosomia
neonatal death/premature delivery
major malformation/ C section
98
Pathogenesis/Selective permeability of gestational diabetes
maternal hyperglycemia stimulates the fetal pancreas, leading to fetal hyperinsulinemia, and eventual insulin resistance syndrome
99
T/F Insulin does not pass through the placenta but IgG bound insulin does
T
100
Metabolic derangements during early pregnancy results in
early growth delay
organ malfunctions (Fuel mediated teratogenesis)
101
Metabolic derangements during late pregnancy result in
Risk of macrosomia
102
T/F therapeutic targets for gestational diabetes are different than outside pregnancy
True
103
Progressive increase of insulin resistance during GD is due to 3 hormones
HPL, prolactin, cortisol
104
Adverse outcomes due to gestational diabetes
Maternal: birth trauma, preterm labor, pregnancy induced HTN, OPVD
Fetal: birth trauma, preterm labor, childhood obesity, childhood impaired glucose tolerance
105
T/F developmental or physical defects happen during first trimester (1-8 wk) and bc GD usually develops at 24 wks it doesn't increase the risk of malformations
T
106
T/F metformin/glibenclamide both cross the placenta
T (metformin more than glibenclamide)
107
Define early PPH
PPH within 24 hours from delivery
108
Late PPH is
after 24 hours to 6 weeks after delivery
109
Minor, major (mod and severe) PPH volumes
Minor: 500-1000L
Mod: 1-2L
Severe: >2L
110
RF for PPH
previous PPH
twins
macrosoma
coagulopathies
mutliparity
pre-eclampsia
- retained placenta or cotyledons
- prolonged second stage (tone, trauma, tissue, thrombin)
- trauma
- OPVD
111
Prevention given to those at risk for PPH
10 IU oxy given I.M after placental expulsion AND 20 IU in 500 ml saline given IV
- active management of labor
112
DX of PPH
- verify uterine contractility
- verify presence of placental tissue or fetal membranes within the uterus
- verify the integrity of the birth canal
113
In PPH you want to maintain a systolic BP of? diuresis? ph? T?
>80 mmHg
>0.5 ml/kg/hr
>7.2
>35
114
First choice of fluids during PPH is
crystalloids (ringers lactate) 3:1 give 2L (for colloids give 1.5L)
115
What parameters dictate the severity of PPH
fibrinogen: <200 mg/dl
Hb<4
need 4 units of blood
need of procedures like: D/C, bakri balloon, uterine sutures, uterine embolisation, hysterectomy
116
T/F 25% of women will need to have labor induced
T
117
Define induction of labor
techniques to stimulate uterine contractions before the onset of a spontaneous labor
!!! Avoid if before week 39
118
Indications for induction of labor
prolonged pregnancy (41-42 weeks)
PROM at term
oligo/anhydramnios
HTN
FGR
Intrahepatic cholestasis
diabetes
still birth (advanced maternal age>40)
119
Contraindications on induction of labor
non reassuring fetal conditions
ongoing labor
placenta previa
cord prolapse
120
Define oligohydramnios
less amniotic fluid
it is diagnosed by US
amniotic fluid index<5cm, single deepest pocket <2cm
121
T/F not all women undergoing induction of labor need cervical ripening
T
122
What BISHOP score is defined as "undesirable"?
less than or equal to 6
123
Pharmacological agents for cervical ripening
prostaglandins (the myometrium and decidua release it and cause uterine contractions. Note that they have an increased risk of uterine rupture if pt has a scarred uterus)
Ocytoxin (side effect: uterine tachysystole, fetal heart rate abnormalities.)
124
The most common medical disorder in pregnancy is
HTN (5-10%)
125
DX of HTN in pregnancy is done using
BP measurement. Note, ABPM is more accurate but is not done due to time and money constraints
!!! Dont use automated monitors
126
What are the parametes for HTN in preg
mild: 140-159/90-109
severe: >160/110
127
define:
Chronic/pre-existing HTN
Gestational HTN
Preeclampsia - Eclampsia
Chronic HTN with superimposed preec/eclampsia
1. HTN pre 20 wks gestation
2. HTN de novo after 20wks and normalised after pregnancy
3. de novo after 20 wks with either proteinuria, kidney/liver/blood complications or uteroplacental dysfunction
4. chronic with symptions of preeclampsia after 20 wks
128
Tests given to those with chronic HTN in pregnancy
- FBC
- Liver enzymes and function tests
- serum creatinine, electrolytes and uric acid
- urinalysis and microscopy
129
How does pre eclampsia develop
1. due to abnormal placentation in the first trimester followed by
2. maternal syndrome in the sec and third trimester characterised by excess of anti angiogenic factors
130
is hyper reflexia a symptom of pre eclampsia
Yes
131
HELLP syndrome dx
hemolysis, elevated liver enzymes, low platelet count
A THIRD TRIMESTER CONDITION
132
Pre eclampsia prevention
low dose (81 mg/day) aspirin as prophylaxis, start between 12 weeks and 28 weeks of gestation and continue until delivery
133
what 5 interventions are available to reduce preterm birth
- supplemental progesterone
- bed rest
- cerclage
- tocolytics
- pessary
134
3 steps for management of preterm birth in twin pregn
- short term tocolytics (CCB NSAID)
- corticosteroids (if 24-34 wks)
- magnesium sulfate if before 32 wks
135
selective termination for twins
- to maximise chance of one twin surviving
- cut off 16 wks
- for Dichorionic: intracardiac KCL
- for monochorionic: cord occlusion
- for monoamniotic: cord occlusion before delivery
136
MC pregnancy problems
- TTTS
- TAPS
- TRAP
- Selective fetal growth restriction
137
signs that help determine chorionicity before 10 weeks
the number of gestational sacs
number of amniotic sacs within the chorionic cavity
number of yolk sacs
138
signs that help determine chorionicity after 10 weeks
fetal genetalia
placental number
chorionic peak sign
membrane characteristics
139
define preterm labor
before 37 weeks and after 20 weeks
140
prevention of preterm labor
administer vaginal progesterone.
perform cervical cercalge
141
spontaneous abortion is defined at what week
all abortions till 24 weeks
142
define asherman syndrome
the formation of scar tissue, synechiae, within the uterine cavity that leads to infertility/recurrent miscarriage (most commonly found after dilation and curettage of the gravid uterus)
143
threatened abortion
inevitable abortion
incomplete abortion
bleeding before 20th week (no passage of products)
bleeding before 20th week with dilation of cervix
passage of some but not all products
144
PROM definition
rupture before the onset of active labor
145
RF for PROM
decidual hemorrhage
history of spontaneous preterm birth
bacterial colonization of membranes
amniocentesis
146
What are 4 consequences of PROM
preterm labor
prolapse of the cord
placental abruption
intrauterine infection
147
T/F chorioamnionitis is an important sequela of PROM nad may preceed endomyometritis or sepsis of the newborn
T
148
The most significatn maternal consequence of term PROM is
intrauterine infection
149
Initial management of PROM
- Identify gestational age, fetal presentation, fetal well being
- evaluate for intrauterine infection, abruptio placentae, fetal compromise
- culture for group B streptococci
- induction of labor with prostaglandins
150
Define recurrent pregnancy loss
2 or more failed clinical pregnancies (not including molar pregnancy, ectopic, implantation failure)
151
recurrent pregnancy loss uterine factors are
congenital anomalies (septate uterus)
leiomyoma
endometriosis/adenomyosis
endometrial polyps
intrauterine adhesions
cervical insuff
defective endo receptivity
152
Most ectopic pregnancies occur where
ampulla >85%
isthmus 8%
(abdomen, cornual, cervix, ovary)
153
Define ectopic pregnancy
implantation of the gestational sac outside of the uterine cavity
154
Define heterotopic pregnancy
the co existence of an intrauterine and an ectopic pregnancy
155
When is bHCG detectable in serum
from 8th day after fertilization
156
dx of ectopic pregnancy is done via
trans vaginal US (hhyperechoic and moderately thickened endometrial rhyme - the empty uterus sign)
157
Conservative tx for ectopic pregnancy
fimbrial expression
salpingotomy
methotrexate (only works if HCG <5000)
158
demolitive tx for ectopic pregnancy
salpingectomy
159
avoid pregnancy for x months after methotrexate
3 months
160
pearl index definition
the number of unwanted pregnancies that occur during 100 woman years of exposure
161
emergency contraceptives
levonorgestrel
mifepristone
ulipristal acetate
162
T/F fertility is not reduced in SARDs pts
T
163
Major pregnancy complications occur for which SARDS conditions
at multi organ involvement, presence of anti-SSA/B and antiphospholipid antibodies
SLE
APS
Systemic sclerosis
vasculitis
164
the most severe manifestation of neonatal SLE is
AV heart block
165
use of cyclophosphamide during which trimester of pregnancy results in the greatest risk of birth defects
first
166
use of mycophenolate mofetil during pregnancy results in
microtia
cleft lip/palate
external auditory canal atresia
ocular anomalies
diaphragmatic hernia
congential heart defects
167
abnormal blood flow after week 23 means
pre eclampsia
HTN
intrauterine growth restriction
168
the leading cause of miscarriage is
chromosomal abnormalities (the most common of which is aneuploidy)
169
in fetuses with trisomy 21 what happens to nuchal translucency
it is increased in more than 75% of cases
B HCG is also increased
PAPP-A is decreased in trisomy 21
170
Define infertility
failure to achieve a pregnancy after 12 months or more of regular unprotected intercourse or exposure to sperm
or 6 months for women over 35
171
define subfertile
infertile
sterile
fecundability inferior to the 5th centile of fertile pop
no pregnancy 2 months after sex
absolute infertility (no ovaries, salpingis, azoospermia)
172
primary vs secondary infertility
primary is infertility without a previous pregnancy or live brith, and secondary is failure to conceive after a pregnancy (either successful or miscarriage)
173
causes of natural infertility in females
cervical: low mucus quantity
uterine: deformed
ovarian: anovulation, luteal defects
tubal: bilateral occlusion or dysfunction
pelvic: endometriosis, adhesions
174
disorders of ovulation
type 1: hypogonadal hypogonadism
type 2: normogonadotropic anovulation
type 3: hyperdonadotropic hypogonadism
type 4: hyperprolactinemia
175
most common types of ovarian cancers
epithelial (75)
germ cell (20)
sex chord stromal
176
measures to reduce risk of ovarian cancer
use of OC
tubal ligation
breast feeding
risk reducing oopherectomy
177
the risk of malignancy index is
a tool which combines serum CA125 values with US findings and menopausal status to determine risk of ovarian cancer
178
adjuvent therapy for ovarian cancer can be
chemo with caboplatinum and taxol (NO SPACE FOR RT)
179
endometrial carcinoma is a
disease of post menopausal women which commonly presents as bleeding
180
pathophysiology of dysmenorrhea
decline in progesterone at the end of the luteal phase activates the onset of menstruation (PGF2 PGE2) which induce myometrial contraction, vasoconstriction, hypersensitization of pain fibers
181
treatment of dysmenorrhea (hormonal imbalance)
cyclopxygenase inhibitors
OC
oral progestins or medicated IUD's
182
tx of PMS (dysfunction of CNS neurotransmitters)
SSRI
acupuncture
183
partial mole is more common than a complete mole
T
184
presentation of hydratiform moles
vaginal bleeding and elevated levels of bHCG
185
tx of a molar pregnancy
suction evacuation and curettage
hysterectomy
186
tx of gestational trophoblastic neoplasia
chemotherapy
187
PROM test
vaginal swab testing for IGF1 presence
!!! fetal fibronectin should not be detectible in vaginal fluids betweent he 22 and 35 wks of prengnacy. If it is positive, the risk of preterm delivery is increased over the next 7-14 days.
188
Initial management of PROM
swab test for Strep Agalactaciae
check the fetus status
evaluate gestational age
189
PROM management
- ANTENATAL: expectant management (CS, infection screening, prophylactic antibiotics- ampicillin and erythromycin) or labor induction (if there is intrauterine infection, placental abruption, fetal distress, high risk of chord prolapse plus over 35 wks)
190
How do you diagnose polyhydramnios
uterine size is large for gestational age (seen on US)
191
Obstetric cholestasis is associated with
still birth, meconium stained liquor, and preterm birth
192
What is most used for cervical ripening if the Bishop score is <6
foley catheter (cervical ripening balloon) - preferred method for women with previous C section
- Pharmacological: prostaglandins and oxytocin (most common method for induction of labor once membranes have ruptured- need to use CTG with it)
193
In ovarian cancer, the lower the parity the higher the risk of cancer development?
T
194
The most common benign neoplasm in reproductive age are? TX is?
mature cystic teratoma (dermoid cyst)
serous cystadenoma
mucinous cyst adenoma
TX: always surgical removal
195
Most common histological type of ovarian cancer
epithelial carcinoma
196
Germ cell tumors arise from
primordial germ cells of the ovary (can be benign or malignant) - the most common in post menopausal women is malignancy degeneration of a teratoma
197
Sex chord stromal tumors arise from
the cell population that would normally give rise to the cells surrounding the oocytes (from cells that produce ovarian hormones)
198
Define abruptio placenta
premature separation of normally implanted placenta from the uterine wall after 20 wks (1/3 of all antepartum bleeding in the third trimester)
199
Symptoms of abruptio placenta
fetal distress
tatanic uterine activity
uterine bleeding
200
Placenta previa def
placenta implant so that placental tissue is overlying the internal cervical os.
it is the leading cause of third trimester bleeding
201
DX of placenta previa
painless vaginal bleeding
US finding
202
Vasa previa definition
when fetal vessels traverse within the membranes without protection of whartons jelly (type 1 or type 2)
203
DX of vasa previa
US evidence, painless vaginal bleeding, may be associated with fetal HR abnormalities
TX: immediate delivery
204
The four T rule of PPH
Tone (atony) causes 70% of PPH
Trauma (20%)
tissue: retained placenta or cotyledons
Thrombin (coagulopathies)
205
PPH management steps
estimate blood loss (>500)
1. second venoud access and increase infusions
2. give oxytocin
3. urinary catheter
4. bimanual compression of uterus
5. give 0.2mg IM of methylergonovine (methergin) every 2-4 hours. Or tranexamic acid/fibrinogen
6. look for cause
7. give o.5 mg nalador (sulprostone) or 800-1000mch IR of misoprostol.
206
Twin Twin transfusion syndrome
is a complication of MCDA. It leads to unequall fetal placental sharing. US should be done every 2 weks from 16 wks
207
Twin anemia polycythemis sequences
is a complication of MC pregnancies
208
Normal fetus starts moving from
20-22 week
209
normal fetal heart rate
110-160
210
malformation vs deformation vs destruction
1- abnormal morphogenesis due to an intrinsic problem
2- deformations: abnormality due to extrinsic force
3- Destruction: destructive force acting on an otherwise normal structure
211
US are started from
19-22 weeks
212
duodenal atresia is associated with
downs syndrome (US shows double bubble sign)
213
lower intestine atresia is in pts with
CF
(trisomy 12- edwards syndrome, trisomy 13- patau syndrome. The only monosomy compatible with life is Turner syndrome)
