Clinical questions - OBGYN Flashcards
What should be performed at every prenatal visit?
maternal weight BP - monitor for pregnancy induced htn assess gestational age fetal tones after 12-13 weeks Fetal movement After 3rd trimester - fetal presentation (cephalic or breech)
Fetal age assessment at 6-8 weeks
bimanual exam - uterus size of lemon
Fetal age assessment at 8-10 weeks
bimanual exam - uterus size of orange
Fetal age assessment at 10-12 weeks
bimanual exam - uterus size of grapefruit
Fetal age assessment at 12 weeks
pubic symphysis
Fetal age assessment at 16 weeks
1/2 way between pubic symphysis and umbilicus
Fetal age assessment at 20 weeks
at umbilicus
Fetal age assessment at 20-34 weeks
measure from pubic symphysis to top of funds - cm approx equal to weeks gestation
counseling of smoking in pregnancy
increase risk of placental abruption, preterm birth, low birth weight, SIDS
cessation encouraged - nicotine replacement, bupropion
alcohol use in pregnancy
teratogen
fetal alcohol syndrome
abstain completely
Exercise in pregnancy
30 min per day, avoid abdominal trauma or falls
Travel in pregnancy
no airplane travel after 36 weeks, avoid prolonged immobilization due to increased risk of DVTs
Sexual intercourse in pregnancy
avoid in placenta previa
Fetal alcohol syndrome
CNS problems
Growth retardation
Facial abnormalities - short palpebral fissure, smooth philtrum, thin vermillion border
Leiomyoata uteri
benign tumors of smooth muscle of uterus - leiomyomas, fibroids
most asx
Sx:
menorrhagia - risk low Hgb, iron supplementation
Pelvic pressure
Tx:
Hormonal contraceptive to reduce bleeding but causes increased fibroid size
Endometrial ablation
Myomectomy if desire fertility
If done having kids - uterine artery embolization, hysterectomy
Hyperemesis gravidarum
Severe nausea/vomiting causing dehydration, abnormal labs, wt loss
Mgmt: admission, IVF, IV antiemetics
Normal N/V of pregnancy
resolves as pregnancy advances
Lifestyle changes - bland foods, slow eating, small frequent meals, avoid triggers
1st med: pyridoxine (B6) + doxylamine (unasom)
Benadryl or meclizine, or zofran
Management of ovarian cysts
5-10 cm can watch
>10 cm requires surgery with risk of ovarian torsion
During pregnancy, when is screening performed for syphilis
RPR or VDRL at 1st prenatal visit, if high risk beginning of 3rd trimester as well
confirm with treponema Ab tests
- FTA-Abs
- MHA-TP
During pregnancy, when is screening performed for HIV
1st visit, if high risk 3rd trimester
During pregnancy, when is triple/quadruple screening?
15-20 weeks
During pregnancy, when is screening performed for gestational diabetes
24-28 wks
1 hr 50 g GTT, if abnl then 3 hr 100 g GTT
Administration of Rh immune globulin if Rh negative
28 weeks, after delivery, any time risk of fetomaternal hemorrhage (miscarriage)
During pregnancy, when is screening performed for g/c chlamydia
1st visit, high risk also in 3rd trimester
During pregnancy, when is screening performed for GBS
35-37 weeks
if positive IV PCN during labor
Asymptomatic bacturia in pregnancy
outside of pregnancy- not treated
Always treat if pregnant - high risk of pyelonephritis with dilated ureters d/t pregnancy
PO abx for 3-7 days Nitrofurantoin Amox Augmentin Cephalexin fosfomycin - one dose
Repeat UCx 1 week after abx completed
Anyone with a UCx positive after 2 cycles of abx needs suppressive tx with macrobid for remainder of pregnancy
Management of suspected ectopic pregnancy
If unstable - immediate surgery
Stable:
TVUS
Quant bhCG
-if bhCG >1500 IUP should be seen on TVUS, absence suggests ectopic pregnancy
-if less than 1500, repeat in 48-72 hrs
> If bhCG lower - failed pregnancy, follow level to 0
> if higher but not appropriately so proceed to D&C, if chorionic villi then failed IUP, if absent chorionic villi ectopic pregnancy
> If increased 66% in 48 hrs, repeat TVUS when >1500
Nonstress test
normal 2 or more accelerations in 20 minutes
Contraction stress test
give mom oxytocin and monitor for decals with contractions, sign of utter-placental insufficiency
Biophysical profile
Nonstress test fetal breathing fetal movement fetal tone amniotic fluid volume
Congenital syphilis infection
Growth restriction prematurity still birth snuffles hutchinson teeth saber shins
Management of post-menopausal bleeding
endometrial biopsy to r/o hyperplasia and cancer
MC cause - atrophy of endometrium
10% endometrial cancer
Nutritional recommendations in pregnancy
supplement with folate and iron
additional 300-500 kcal daily
fully cooked meats
avoid unpasteurized dairy, deli meats (risk listeriosis)
limit fish to 12 oz per week - avoid shark, swordfish, king mackerel, tile fish
Weight gain recommendation for pregnancy with BMI of less than 18.5
28-40 lbs
Weight gain recommendation for pregnancy with BMI of 18.5-24.9
25-35 lbs
Weight gain recommendation for pregnancy with BMI of 25-29.9
15-25 lbs
Weight gain recommendation for pregnancy with BMI of 30 or more
11-20 lbs
teratogenic agent associated with abstain cardiac anomaly
Lithium
teratogenic agent associated with clear cell adenocarcinoma of the vagina
diesthylstilbestrol (DES)
teratogenic agent associated with microcephaly, intellectual disability, smooth philtrum
alcohol
teratogenic agent associated with gray baby syndrome
chloramphenicol (tx of RMSF in pregnancy, meningitis tx )
teratogenic agent associated with phocomelia (malformation of limbs)
Thalidomide
teratogenic agent associated with craniofacial anomalies, fingernail hypoplasia, developmental delay
phenytoin
Treatment of PID
GC and chlamydia penetrate the protective mucus and normal flora follow - treat as a polymicrobial infection
Output:
-Ceftriaxone IM + doxy OR PO cefoxitine + probenecid + doxy
inpt:
-IV (cefoxitine or cefotetan) + PO or IV doxy
OR IV clinda + gent
Pregestational diabetes
DM before pregnancy - type 1 or 2
Risk malformations, still births
Tx:
Insulin
fetal surveillance - weekly non stress tests starting 32-34 weeks
Deliver at 38 weeks - risk of late term fetal demise
