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Obstetrics and Gyne > All cards > Flashcards

All cards Flashcards

1
Q

borders of the perineum

A

Pubic symphysis
Ischial tuberosities, ischiopubic rami and sacrotuberous ligaments laterally,
coccyx

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2
Q

the anal triangle contains 3 things

A

anal aperture
external anal sphincter
ischioanal fossae

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3
Q

the urogenital triangle contains

A
  • roots of the external genetalia
  • openings of the urethra and the vagina
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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

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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

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6
Q

What structure gets cut during episiotomy

A

perineal body

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7
Q

The vagina is lined by what kind of epithelium

A

non keratinized stratified epithelium

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8
Q

The uterus is lined by what kind of epithelium

A

columnar, muciparous epithelium

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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

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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
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11
Q

lateral folds of the parietal peritoneum are called the

A

broad ligament which has 3 parts: mesometrium, mesalpinx, mesopvarium

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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

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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

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14
Q

Day 6

A

blastocyst adheres to uterine lining

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15
Q

Day 7

A

the trophoblast divides into superficial syncitiotrophblast and inner cytotrophoblast

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16
Q

What produces hCG

A

syncitiotrophoblast

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17
Q

purpose of hCG

A

to preserve activity of the corpus luteum (produce estradiol and progesterone)

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18
Q

Day 8-11

A

amniotic cavity appears inside the ICM. This cavity grows to become the amniotic sac.

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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

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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

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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

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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

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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

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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

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25
Q

Poor remodling of uteroplacental spiral arteries leads to

A

early onset pre eclampsia, FGR, placental abruption, spontaneous preterm, premature rupture of membranes

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26
Q

the total surface of placental villi is

A

15 m2

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27
Q

Weeks 9-12

A

urine starts to be produced
Liver is the main site of erythropoiesis

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28
Q

Until which week can it be considered a preterm birth

A

37

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29
Q

Phases of parturition

A

Quiescence
Activation
Active labor

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30
Q

First phase of parturition

A

Quiescence: is 95% of prenancy, and has uterine smooth muscle tranquility and cervical structure integrity maintenance

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31
Q

Second phase of partuiriton

A

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

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32
Q

The bishop score ranges from 0-3 and includes (3 is closest to labor)

A

dilation
position of cervix
effacement
station
cervical consistency

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33
Q

Phase 3 of parturition

A

Active labor (note that this is divided into 3 stages)

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34
Q

Stages of labor

A

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

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35
Q

Diagnosis of active labor can only be made if

A

3-4 cm cervical dilation with a completly effaced cervix
rhythmic, regular and painful contractions lasting 40-60 mins

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36
Q

Tachysystolia is

A

more than 5 in 10 mins

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37
Q

External dynamometry measures

A

changes in shape of the abdominal wall (is qualitative)

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38
Q

Direct measure of intrauterine pressure is done by

A

insertion of a pressure transducer directly into the uterine cavity usually through the cervix after rupture of the fetal membranes

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39
Q

Fetal lie can be

A

longitudinal, transverse, and oblique

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40
Q

Fetal presentation options

A

cephalic, sideways, complete breech, frank breech

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41
Q

Fetal attitude options

A

vertex
bregma
brow
face

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42
Q

Protracted labor definition

A

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

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43
Q

define engagement

A

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

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44
Q

Define descent

A

the highest rate of descent occurs during the deceleration phase of the first stage and second stage

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45
Q

When can you perform an episiotomy

A

OPVD or fetal distress

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46
Q

Define dystocia

A

difficult labor. There is first and second stage dystocia

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47
Q

3 categories which result in dystocia are

A
  • uterine dysfunction
  • fetal abnormalities
  • structural changes
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48
Q

Abnormalities in fetopelvic proportion becomes clearer as the fetus attempts to descend which is in the

A

second stage

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49
Q

T/F ineffective labor is generally accepted as a possible warning sign of fetopelvic disproportion

A

T

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50
Q

In order to diagnose a woman with protraction disorder or arrest disorder a woman must be in

A

the active phase of labor, which is defined by cervical change (> 6cm of dilation)

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51
Q

Treatment for first stage of labor dystocia

A

oxytocin (go to C section only if A(>=6cm dilation plus 4 hr contraction) or B(6h oxytocin with no change in cervix)

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52
Q

Treatment of second stage of dystocia

A

OPVD
manual rotation of the fetal occiput for malposition

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53
Q

Define shoulder dystocia

A

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

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54
Q

Direct antenatal RF for shoulder dystocia are

A
  • history of shoulder dystocia in prior vaginal delivery
  • fetal macrosomia
  • diabetes/impaired glucose intolerance
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55
Q

RF for macrosomia which are indirect causes of shoulder dystocia

A

excessive weight gain during pregnancy
maternal obesity
asymmetrical accelerated fetal groath in non diabetic pts
post term pregnancy
parity

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56
Q

Intrapartum RF for shoulder dystocia

A

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)
)

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57
Q

Management of shoulder dystocia

A
  • 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
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58
Q

Indications for C-section

A

Arrest
Nonassuring fetal status
malpresentation
multiples

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59
Q

Robson classification for C sectoin

A

parity
# of fetuses
previous CS
onset of labor
gestational age
fetal presentation

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60
Q

Leiomyomas (aka myomas/fibroids) arise from

A

smooth muscle in the myometrium

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61
Q

RF for leiomyomas

A

ethnicity
familiarity
high BMI
nulliparity
early menarch (<10 years)

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62
Q

Classification of leiomyomas (from inside to outside)

A

intracavitary (5%)
submucosal (15%)
intramural (70%)
subserosal (5%)
Pedunculated (5%)

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63
Q

Most leiomyomas are asymptomatic, only 20-50% have symptoms which can be

A

menorrhagia (29-59%)
pelvic pain/pressure (40%)
infertility (27%)
torsion and necrosis (<10%)
expulsion/extrusion

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64
Q

Conditions associated with uterine leiomyomas can be

A

polycythemia
ascites
impingement
related complications
sarcomatous changes

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65
Q

DX of uterine leiomyoma

A
  • increased uterus size, irregular profile, hard consistency
  • US
  • dopler
  • hyteroscopy
  • MRI
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66
Q

TX for leimyoma in asymtomatic women

A

is non interventional except if
- infertile women with distortion of uterine cavity
- women with previous pregnancy complicated by fibroids

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67
Q

Medical TX for firbroids

A

progestins/E+P (Lead to endometrial atrophy and bleeding control)
Progesterone antagonist (Mifepristone) which decreases tumor size
GnRH analogue

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68
Q

Causes of fetal growth disorders

A

vascular: HTN/pre-eclampsia
infective: CMV, parvo, adeno, coxsackie, VZV, rubeo
chro/genetic dx
teratogenic

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69
Q

Early FGR vs late

A

before 32 wks and after

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70
Q

FGR definition

A

EFW below cut off
10 percentile
US diagnosis

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71
Q

SGA parameters

A

EFW between 3-10 centile
Maternal and fetal doppler velocimetries are normal

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72
Q

FGR early onset and late onset have different velocimetry patterns

A

T

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73
Q

FGR >32 weeks definition

A

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)

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74
Q

FGR <32 weeks if

A

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)

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75
Q

Which vessels can you doppler

A

uterine, umbilical, middle cerebral, cerebroplacental ratio
- ductus venosus if <32 wks and AED in the UA

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76
Q

An increase in UA doppler is due to

A
  • reduction nutrient exchange at placenta
  • increases fetal circulation resitance
  • progressive placental vascualr insufficienct (seen by the absent diastolic flow) in advanced stages.
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77
Q

T/F UA doppler should be the primary surveillance tool in the SGA fetus

A

T

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78
Q

Brain sparing effect

A

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

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79
Q

Women who have a major RF for SGA vs those with minor RF’s should undergo UA doppler when

A
  • major RF: from 26-28 wks
  • minor RF: from 20-24 wks
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80
Q

Clinical diagnosis of SGA baby

A

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

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81
Q

3 things when FGR is dx

A

check for correct GA
chech for prenantal diagnosis
rule out malformation infection (CMV)

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82
Q

What is the purpose of OPVD

A

to ensure safe vaginal delivery for maternal or fetal indications

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83
Q

Maternal indications for OPVD

A
  • prolonged second stage of labor
  • need to shorten second stage of labor for maternal benefit
  • inefficient maternal effort
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84
Q

Fetal indications for OPVD

A

suspicion of compromised fetal conditions (CTG, bradycardia)

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85
Q

Contraindications for OPVD

A

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

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86
Q

Complications of OPVD

A

Maternal: vaginal wall injuries, perineal injuries
Fetal: intracranial hemorrhage, neonatal facial injuries, vacuum duration is in direct association with greater adverse neonatal risks

87
Q

Define cephaloematoma

A

blood between periosteum and parietal bone. It does not override the sutures. Appears after 6-24 hours after delivery

88
Q

Subgaleal hematoma is

A

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
Q

The most widespread congenital infection and the primary cause of sensorineural hearing loss is

A

CMV

90
Q

CMV symptoms

A

85% are asymptomatic
the rest have mono symptoms

91
Q

T/F CMV transplacental transmission is related to GA

A

T
40% average

92
Q

Routine screening for CMV is not recommeded

A

T

93
Q

Low avidity meaning for CMV

A

an acute infection in the past 3 months

94
Q

High avidity

A

excludes a primary infection in the past 3 months

95
Q

CMV fetal infection diagnosis

A

amniocentesis is gold standard.
- at least 6-8 weeks from the beginning of maternal infection
funicolocentesis

96
Q

When is gestational diabetes diagnosed

A

most commonly during the second and third trimester

97
Q

Adverse outcomes due to pregestational diabetes

A

stillbirth/macrosomia
neonatal death/premature delivery
major malformation/ C section

98
Q

Pathogenesis/Selective permeability of gestational diabetes

A

maternal hyperglycemia stimulates the fetal pancreas, leading to fetal hyperinsulinemia, and eventual insulin resistance syndrome

99
Q

T/F Insulin does not pass through the placenta but IgG bound insulin does

A

T

100
Q

Metabolic derangements during early pregnancy results in

A

early growth delay
organ malfunctions (Fuel mediated teratogenesis)

101
Q

Metabolic derangements during late pregnancy result in

A

Risk of macrosomia

102
Q

T/F therapeutic targets for gestational diabetes are different than outside pregnancy

A

True

103
Q

Progressive increase of insulin resistance during GD is due to 3 hormones

A

HPL, prolactin, cortisol

104
Q

Adverse outcomes due to gestational diabetes

A

Maternal: birth trauma, preterm labor, pregnancy induced HTN, OPVD
Fetal: birth trauma, preterm labor, childhood obesity, childhood impaired glucose tolerance

105
Q

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

A

T

106
Q

T/F metformin/glibenclamide both cross the placenta

A

T (metformin more than glibenclamide)

107
Q

Define early PPH

A

PPH within 24 hours from delivery

108
Q

Late PPH is

A

after 24 hours to 6 weeks after delivery

109
Q

Minor, major (mod and severe) PPH volumes

A

Minor: 500-1000L
Mod: 1-2L
Severe: >2L

110
Q

RF for PPH

A

previous PPH
twins
macrosoma
coagulopathies
mutliparity
pre-eclampsia
- retained placenta or cotyledons
- prolonged second stage (tone, trauma, tissue, thrombin)
- trauma
- OPVD

111
Q

Prevention given to those at risk for PPH

A

10 IU oxy given I.M after placental expulsion AND 20 IU in 500 ml saline given IV
- active management of labor

112
Q

DX of PPH

A
  • verify uterine contractility
  • verify presence of placental tissue or fetal membranes within the uterus
  • verify the integrity of the birth canal
113
Q

In PPH you want to maintain a systolic BP of? diuresis? ph? T?

A

> 80 mmHg
0.5 ml/kg/hr
7.2
35

114
Q

First choice of fluids during PPH is

A

crystalloids (ringers lactate) 3:1 give 2L (for colloids give 1.5L)

115
Q

What parameters dictate the severity of PPH

A

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
Q

T/F 25% of women will need to have labor induced

A

T

117
Q

Define induction of labor

A

techniques to stimulate uterine contractions before the onset of a spontaneous labor
!!! Avoid if before week 39

118
Q

Indications for induction of labor

A

prolonged pregnancy (41-42 weeks)
PROM at term
oligo/anhydramnios
HTN
FGR
Intrahepatic cholestasis
diabetes
still birth (advanced maternal age>40)

119
Q

Contraindications on induction of labor

A

non reassuring fetal conditions
ongoing labor
placenta previa
cord prolapse

120
Q

Define oligohydramnios

A

less amniotic fluid
it is diagnosed by US
amniotic fluid index<5cm, single deepest pocket <2cm

121
Q

T/F not all women undergoing induction of labor need cervical ripening

A

T

122
Q

What BISHOP score is defined as “undesirable”?

A

less than or equal to 6

123
Q

Pharmacological agents for cervical ripening

A

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
Q

The most common medical disorder in pregnancy is

A

HTN (5-10%)

125
Q

DX of HTN in pregnancy is done using

A

BP measurement. Note, ABPM is more accurate but is not done due to time and money constraints
!!! Dont use automated monitors

126
Q

What are the parametes for HTN in preg

A

mild: 140-159/90-109
severe: >160/110

127
Q

define:
Chronic/pre-existing HTN
Gestational HTN
Preeclampsia - Eclampsia
Chronic HTN with superimposed preec/eclampsia

A
  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
Q

Tests given to those with chronic HTN in pregnancy

A
  • FBC
  • Liver enzymes and function tests
  • serum creatinine, electrolytes and uric acid
  • urinalysis and microscopy
129
Q

How does pre eclampsia develop

A
  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
Q

is hyper reflexia a symptom of pre eclampsia

A

Yes

131
Q

HELLP syndrome dx

A

hemolysis, elevated liver enzymes, low platelet count
A THIRD TRIMESTER CONDITION

132
Q

Pre eclampsia prevention

A

low dose (81 mg/day) aspirin as prophylaxis, start between 12 weeks and 28 weeks of gestation and continue until delivery

133
Q

what 5 interventions are available to reduce preterm birth

A
  • supplemental progesterone
  • bed rest
  • cerclage
  • tocolytics
  • pessary
134
Q

3 steps for management of preterm birth in twin pregn

A
  • short term tocolytics (CCB NSAID)
  • corticosteroids (if 24-34 wks)
  • magnesium sulfate if before 32 wks
135
Q

selective termination for twins

A
  • 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
Q

MC pregnancy problems

A
  • TTTS
  • TAPS
  • TRAP
  • Selective fetal growth restriction
137
Q

signs that help determine chorionicity before 10 weeks

A

the number of gestational sacs
number of amniotic sacs within the chorionic cavity
number of yolk sacs

138
Q

signs that help determine chorionicity after 10 weeks

A

fetal genetalia
placental number
chorionic peak sign
membrane characteristics

139
Q

define preterm labor

A

before 37 weeks and after 20 weeks

140
Q

prevention of preterm labor

A

administer vaginal progesterone.
perform cervical cercalge

141
Q

spontaneous abortion is defined at what week

A

all abortions till 24 weeks

142
Q

define asherman syndrome

A

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
Q

threatened abortion
inevitable abortion
incomplete abortion

A

bleeding before 20th week (no passage of products)
bleeding before 20th week with dilation of cervix
passage of some but not all products

144
Q

PROM definition

A

rupture before the onset of active labor

145
Q

RF for PROM

A

decidual hemorrhage
history of spontaneous preterm birth
bacterial colonization of membranes
amniocentesis

146
Q

What are 4 consequences of PROM

A

preterm labor
prolapse of the cord
placental abruption
intrauterine infection

147
Q

T/F chorioamnionitis is an important sequela of PROM nad may preceed endomyometritis or sepsis of the newborn

A

T

148
Q

The most significatn maternal consequence of term PROM is

A

intrauterine infection

149
Q

Initial management of PROM

A
  • 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
Q

Define recurrent pregnancy loss

A

2 or more failed clinical pregnancies (not including molar pregnancy, ectopic, implantation failure)

151
Q

recurrent pregnancy loss uterine factors are

A

congenital anomalies (septate uterus)
leiomyoma
endometriosis/adenomyosis
endometrial polyps
intrauterine adhesions
cervical insuff
defective endo receptivity

152
Q

Most ectopic pregnancies occur where

A

ampulla >85%
isthmus 8%
(abdomen, cornual, cervix, ovary)

153
Q

Define ectopic pregnancy

A

implantation of the gestational sac outside of the uterine cavity

154
Q

Define heterotopic pregnancy

A

the co existence of an intrauterine and an ectopic pregnancy

155
Q

When is bHCG detectable in serum

A

from 8th day after fertilization

156
Q

dx of ectopic pregnancy is done via

A

trans vaginal US (hhyperechoic and moderately thickened endometrial rhyme - the empty uterus sign)

157
Q

Conservative tx for ectopic pregnancy

A

fimbrial expression
salpingotomy
methotrexate (only works if HCG <5000)

158
Q

demolitive tx for ectopic pregnancy

A

salpingectomy

159
Q

avoid pregnancy for x months after methotrexate

A

3 months

160
Q

pearl index definition

A

the number of unwanted pregnancies that occur during 100 woman years of exposure

161
Q

emergency contraceptives

A

levonorgestrel
mifepristone
ulipristal acetate

162
Q

T/F fertility is not reduced in SARDs pts

A

T

163
Q

Major pregnancy complications occur for which SARDS conditions

A

at multi organ involvement, presence of anti-SSA/B and antiphospholipid antibodies
SLE
APS
Systemic sclerosis
vasculitis

164
Q

the most severe manifestation of neonatal SLE is

A

AV heart block

165
Q

use of cyclophosphamide during which trimester of pregnancy results in the greatest risk of birth defects

A

first

166
Q

use of mycophenolate mofetil during pregnancy results in

A

microtia
cleft lip/palate
external auditory canal atresia
ocular anomalies
diaphragmatic hernia
congential heart defects

167
Q

abnormal blood flow after week 23 means

A

pre eclampsia
HTN
intrauterine growth restriction

168
Q

the leading cause of miscarriage is

A

chromosomal abnormalities (the most common of which is aneuploidy)

169
Q

in fetuses with trisomy 21 what happens to nuchal translucency

A

it is increased in more than 75% of cases
B HCG is also increased
PAPP-A is decreased in trisomy 21

170
Q

Define infertility

A

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
Q

define subfertile
infertile
sterile

A

fecundability inferior to the 5th centile of fertile pop
no pregnancy 2 months after sex
absolute infertility (no ovaries, salpingis, azoospermia)

172
Q

primary vs secondary infertility

A

primary is infertility without a previous pregnancy or live brith, and secondary is failure to conceive after a pregnancy (either successful or miscarriage)

173
Q

causes of natural infertility in females

A

cervical: low mucus quantity
uterine: deformed
ovarian: anovulation, luteal defects
tubal: bilateral occlusion or dysfunction
pelvic: endometriosis, adhesions

174
Q

disorders of ovulation

A

type 1: hypogonadal hypogonadism
type 2: normogonadotropic anovulation
type 3: hyperdonadotropic hypogonadism
type 4: hyperprolactinemia

175
Q

most common types of ovarian cancers

A

epithelial (75)
germ cell (20)
sex chord stromal

176
Q

measures to reduce risk of ovarian cancer

A

use of OC
tubal ligation
breast feeding
risk reducing oopherectomy

177
Q

the risk of malignancy index is

A

a tool which combines serum CA125 values with US findings and menopausal status to determine risk of ovarian cancer

178
Q

adjuvent therapy for ovarian cancer can be

A

chemo with caboplatinum and taxol (NO SPACE FOR RT)

179
Q

endometrial carcinoma is a

A

disease of post menopausal women which commonly presents as bleeding

180
Q

pathophysiology of dysmenorrhea

A

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
Q

treatment of dysmenorrhea (hormonal imbalance)

A

cyclopxygenase inhibitors
OC
oral progestins or medicated IUD’s

182
Q

tx of PMS (dysfunction of CNS neurotransmitters)

A

SSRI
acupuncture

183
Q

partial mole is more common than a complete mole

A

T

184
Q

presentation of hydratiform moles

A

vaginal bleeding and elevated levels of bHCG

185
Q

tx of a molar pregnancy

A

suction evacuation and curettage
hysterectomy

186
Q

tx of gestational trophoblastic neoplasia

A

chemotherapy

187
Q

PROM test

A

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
Q

Initial management of PROM

A

swab test for Strep Agalactaciae
check the fetus status
evaluate gestational age

189
Q

PROM management

A
  • 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
Q

How do you diagnose polyhydramnios

A

uterine size is large for gestational age (seen on US)

191
Q

Obstetric cholestasis is associated with

A

still birth, meconium stained liquor, and preterm birth

192
Q

What is most used for cervical ripening if the Bishop score is <6

A

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
Q

In ovarian cancer, the lower the parity the higher the risk of cancer development?

A

T

194
Q

The most common benign neoplasm in reproductive age are? TX is?

A

mature cystic teratoma (dermoid cyst)
serous cystadenoma
mucinous cyst adenoma
TX: always surgical removal

195
Q

Most common histological type of ovarian cancer

A

epithelial carcinoma

196
Q

Germ cell tumors arise from

A

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
Q

Sex chord stromal tumors arise from

A

the cell population that would normally give rise to the cells surrounding the oocytes (from cells that produce ovarian hormones)

198
Q

Define abruptio placenta

A

premature separation of normally implanted placenta from the uterine wall after 20 wks (1/3 of all antepartum bleeding in the third trimester)

199
Q

Symptoms of abruptio placenta

A

fetal distress
tatanic uterine activity
uterine bleeding

200
Q

Placenta previa def

A

placenta implant so that placental tissue is overlying the internal cervical os.
it is the leading cause of third trimester bleeding

201
Q

DX of placenta previa

A

painless vaginal bleeding
US finding

202
Q

Vasa previa definition

A

when fetal vessels traverse within the membranes without protection of whartons jelly (type 1 or type 2)

203
Q

DX of vasa previa

A

US evidence, painless vaginal bleeding, may be associated with fetal HR abnormalities
TX: immediate delivery

204
Q

The four T rule of PPH

A

Tone (atony) causes 70% of PPH
Trauma (20%)
tissue: retained placenta or cotyledons
Thrombin (coagulopathies)

205
Q

PPH management steps

A

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
Q

Twin Twin transfusion syndrome

A

is a complication of MCDA. It leads to unequall fetal placental sharing. US should be done every 2 weks from 16 wks

207
Q

Twin anemia polycythemis sequences

A

is a complication of MC pregnancies

208
Q

Normal fetus starts moving from

A

20-22 week

209
Q

normal fetal heart rate

A

110-160

210
Q

malformation vs deformation vs destruction

A

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
Q

US are started from

A

19-22 weeks

212
Q

duodenal atresia is associated with

A

downs syndrome (US shows double bubble sign)

213
Q

lower intestine atresia is in pts with

A

CF
(trisomy 12- edwards syndrome, trisomy 13- patau syndrome. The only monosomy compatible with life is Turner syndrome)

Obstetrics and Gyne (2 decks)

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