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Blueprints Flashcards

1
Q

Gravida

A

number of times a woman has been pregnant

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2
Q

Para

A

number of pregnancies that led to a birth (> or equal to 20 weeks GA or > 500g)

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3
Q

Gestational age

A

age in weeks and days measured from last menstrual period

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4
Q

Developmental age (aka conceptional/embryonic age)

A

number of weeks and days since fertilization

-usually 2 wks off from GA (egg fertilized 14 days after first day of prior menstrual period)

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5
Q

a-subunit of hCG is identical to…

A

alpha subunits of LH, FSH, and TSH

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6
Q

Placenta produces… (4)

A

1) ESTROGEN (from circulating plasma-borne precursors produced by maternal adrenal glands
2) hCG (peaks 10-12 wks) –> maintains corpus luteum in early pregnancy
3) PROGESTERONE - after corpus luteum degrades
4) Human placental lactogen (hPL) –> maintain nutrient supply to fetus - induces lipolysis, insulin antagonist = DIABETOGENIC

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7
Q

Why are women at increased risk for complicated UTI during pregnancy?

A
  • increased urinary stasis from mechanical compression of the ureters
  • progesterone mediated smooth muscle relaxation
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8
Q

Third trimester tests (4)

A

1) Hct
2) RPR/VDRL
3) GLT (glucose loading test) -50g glucose –> check 1 hr later (<140)
4) GBS culture

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9
Q

NST (nonstress test)

A

normal is at least two accelerations of the FHR in 20 min that are at least 15 beats above baseline HR and last for at least 15 seconds

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10
Q

Braxton-Hicks contractions

A

occasional, irregular contractions that do not lead to cervical change - can occur several times per day, up to several times per hour

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11
Q

BPP (biophysical profile)

A

assesses fetal well-being using amniotic fluid volume, fetal tone, activity, breathing movements, and a nonstress test either 0 or 2 points for each of the five categories.

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12
Q

L/S ratio

A

L/S ratio > 2 is a good sign that RDS is unlikely

  • Type II pneumocytes secrete surfactant
  • Lecithin increases as the lung matures, and sphingomyelin decreases beyond 32 weeks
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13
Q

Ectopic pregnancy

A

pregnancy that implants outside the uterine cavity

-typically fallopian tube (ampulla 70%, isthmus 12%, fimbriae 11%)

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14
Q

Presentation of incompetent cercix

A

painless dilation and effacement of the cervix, often in the 2nd trimester

VS. preterm labor which begins with contractions –> cervical change

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15
Q

When should MTX be used in ectopic pregnancy

A

patients with a small ectopic pregnancy ( <4cm, bHCG<5,000 and without a fetal hearbeat

+ pt must have reliable follow up for recheck of B-hcg at 7 days. (B-hcg should be falling by 10-15% by then)

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16
Q

Missed abortion

A

death of an embryo with retention of all POCs

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17
Q

incomplete abortion

A

partial expulsion of POC prior to 20 weeks

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18
Q

inevitable abortion

A

pregnancy complicated by vaginal bleeding with a dilated cervic

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19
Q

Cervical ripening agents

A

PGE2, cervidil, PGE1M (misoprostol) –> dilate cervix and reduce risk of cesarian delivery

Maternal contraindications to PG = asthma, glaucoma

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20
Q

Fetal scalp electrode

A

better at getting more sensitive beat-to-beat HR variability readings

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21
Q

Normal fetal pH and pulse ox readings

A

pH = 7.2-7.25

O2 sat = above 30%

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22
Q

Cardinal movements of labor

A
  • engagement
  • descent
  • flexion (allows smallest diameter of head through pelvis)
  • internal rotation
  • extension
  • external rotation
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23
Q

Hypertonus

A

single contraction lasting 2 minutes or longer

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24
Q

tachysystole

A

more than 5 contractions in a 10 minute period

–> can tx with terbutaline to help relax the uterus

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25
three signs of placental seperation
1) gush of blood 2) lengthening of cord 3) uterine fundal rebound as placenta detaches from uterine wall
26
Risks of c-section
increased mortality vs. vaginal increased morbidity from - infection, thrombotic events, wound dehiscence, recovery time -increased risk future deliveries have to be c-section, increased risk for placenta accreta and previa
27
Indications for c-section
- failure to progress in labor (e.g. no cervical change over 2-4 hours) - breech presentation - transverse lie - shoulder presentation - placenta previa - placental abruption - fetal intolerance of labor - non-reassuring fetal status - cord prolapse - prolonged second stage - failed operative vaginal delivery - active herpes lesions - PRIOR C SECTION
28
VBAC (vaginal birth after cesarian)
prior incision must be low transverse incision (kerr) or low vertical incision (kronig)
29
Trial of labor after cesarean (TOLAC)
biggest risk is rupture of prior uterine scar *prior classical hysterotomy or other vertical uterine incisions is an absolute contraindication to TOLAC
30
3 types of placenta previa
1) complete previa = placenta completely covers internal os 2) partial previa = covers part of internal os 3) marginal previa = edge of placenta reaches the margin of the os
31
Placental abruption - risks? - complications?
risks = maternal HTN, preeclampsia, maternal use of cocaine or meth, trauma complications = DIC, hypovolemic shock
32
Vasa previa
unprotected vessels cross over the internal cervical os, making them vulnerable to compression or tearing when membranes rupture vasa previa is rare, but perinatal mortality is high (40-60%) because baby can bleed out very quickly
33
Velamentous cord insertion
blood vessels insert between the amnion and chorion away from the placenta instead of inserting directly into the chorionic plate -cause of most pregnancies complicated by rupture of fetal vessels
34
sinusoidal pattern on fetal heart monitoring indicates what?
fetal anemia
35
UTIs in pregnancy: asymptomatic bacteruria in early pregnancy causes an increased risk of...
1) 20-30x increased risk acute pyelonephritis in pregnancy --> maternal sepsis/ARDS 2) preterm birth 3) low birth weight infants
36
Treatment of maternal pyelonephritis
``` IVF IV abx (cephalosporin or amp+gent) until asx for 24-48 hrs ``` -transition to oral abx
37
Bacterial vaginosis in pregnancy
increases risk of PPROM, preterm delivery, chorioamnionitis/endometritis
38
GBS in pregnancy
responsible for: UTIs, chorio, endomyometritis, neonatal sepsis get rectovaginal swap between 35-37 weeks TX with ampicillin/penicillin, or clinda if penicillin allergic
39
Signs/symptoms of choria
1) fetal tachycardia (>160bpm) 2) maternal tachycardia 3) foul-smelling amniotic fluid 4) fever (>38) 5) WBC > 15 6) uterine tenderness 7) low amniotic fluid glucose 8) elevated IL-6 in amnionitic fluid
40
Genital herpes
primary infection during pregnancy has higher risk of perinatal transmission Can result in neonatal disease: -disseminated disease, CNS disease, disease limited to eyes, skin, or mouth --> viral sepsis, pneumonia, or herpes encephalitis
41
Varicella neonatal infection
occurs transplacentally via vertical transmission congenital varicella syndrome --> skin scarring, limb hypoplasia, chorioretinitis, microcephaly
42
Parvovirus B19
In MOM: erythema infectiousum = low grade fever, malaise, myalgias, arthralgias, red macular "slapped cheek" facial rash In BABY: fetal infection, death, miscarriage, fetal hydrops
43
Congenital rubella
virus crosses placenta hematogenously sx: 1) deafness 2) cataracts/retinitis 3) CNS defect 4) cardiac malformations (e.g. PDA)
44
Hyperemesis gravidarium
persistent vomiting weight loss >5% ketonuria *common in setting of MOLAR PREGNANCIES
45
Tx of DVT in pregnancy
LMWH (preferred) or unfractionated heparin (goal of PTT of 2.5x normal) -if using LMWH, must initial start with IV heparin, and be transitioned to SQ heparin WARFARIN is CONTRAINDICATED
46
Vaginal delivery, common complications (6)
1) PPH 2) vaginal hematoma 3) cervical lacerations 4) retained POCs 5) Mastitis 6) Postpartum depression Rare complications: - endomyometritis - episiotomy infections - episiotomy breakdown
47
Cesarean delivery, common complications
1) PPH 2) Surgical blood loss 3) wound infection 4) Endomyometritis 5) Mastitis 6) postpartum depression Rare complications: - Wound separation - Wound dehiscence
48
Progression of uterine atony treatment
1) uterine massage 2) IV oxytocin (Pitocin) 3) methylergonovine (Methergine) 4) Hemabate (PGF2) 5) Misoprostol (PGE1) 6) D+C to r/o retained POCs 7) If bleeding rate is mild --> Bakri ballon (uterine tambonade) 8) Uterine artery embolization 9) Exploratory laparotomy with ligation of pelvic vessels and possible hysterectomy Other surgical options: - O'leary sutures (tie off uterine arteries) - Ligation of hypogastric or internal iliac arteries - B-Lynch sutures
49
Postpartum blues
rapid mood swings changes in appetite changes in concentration and sleep occur within 2-3 days after delivery - resolve within 2 wks
50
Postpartum depression
sx of sadness and disinterest -low energy, anhedonia, anorexia, apathy, sleep disturbances, extreme sadness persist after 2 wks. TX with SSRIs
51
Menorrhagia
regularly timed menstrual cycles, but abnormally heavy flow or duration -Most commonly due to uterine fibroids, adenomyosis, endometrial polyps, cancer, endometrial hyperplasia, cancer, or cervical polyps
52
hypomenorrhea
regularly timed menses but an unusually light amount of flow
53
Metrorrhagia
characterized by bleeding that occurs between regular menstrual periods
54
Polymenorrhea
frequent periods that occur less than 21 days apart
55
oligomenorrhea
periods > 35 days apart
56
Nabothian cyst vs. Bartholin gland cyst vs. Skene's gland cyst
Nabothian = bubble uder the surface of the cervix, often bluish in color Bartholin's gland cysts = found in the labia majora Skene's gland cysts = located near the urethral meatus
57
Fitzhugh Curtis sx
perihepatitis from ascending PID infection associated with GC/CT RUQ pain or pleuritic pain in context of PID elevated LFTs (sometimes) laparoscopy is gold standard for dx (violin string adhesions)
58
HIV pt pap smear schedule
Pap smear 6 months apart x2 --> if normal, can do yearly pap smears continue pap smears every 6 months with prior HPC infection, CIN, or symptomatic HIV disease
59
Voiding: - parasympathetic - sympathetic - voluntary
- parasympathetic = pelvic nerve, results in voiding (S2-S4) - sympathetic = hypogastric nerve (T10-L2) - voluntary = pudendal nerve (external sphincter contraction)
60
Labs in PCOS
``` Elevated LH normal/low FSH nml estrogen elevated testosterone nml/increased inhibin ```

OBGYN (3 decks)

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