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EOR - OB Flashcards

1
Q

what are contraindications to estrogen use for birth control? (4)

A

Migraines with aura, DVT, Uncontrolled HTN, Smoking >35

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2
Q

DVT, PE, CVA, MI, Seizure meds can decrease effectiveness.. all are ADRs of what kind of birth control?

A

COCs - estrogen/progesterone pills + NuvaRing

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3
Q

Irregular bleeding, Weight gain, Length of time to resume ovulation (5 months)… all are ADRs of what kind of birth control?

A

Depot shot

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4
Q

how long does the nexplanon implant last?

A

3 years

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5
Q

what is the timeframe for taking plan b?

A

72 hrs (3 days)

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6
Q

what are three ways to Dx infertility?

A

semen analysis, ovarian reserve evaluation, tubal evaluation

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7
Q

what are medication options for infertility? (7)

A

clomiphene citrate (MC for PCOS), letrozole (aromatase inhibitor), human menopausal gonadotropin, FSH, GnRH, metformin, dopamine agonists (bromocriptine or cabergoline)

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8
Q

normal changes in pregnancy: cardiac

A

increased blood volume, CO, HR (by 10-15 bpm). increase plasma and RBC volume = anemia
increase clotting factors = hypercoaguable
decreased systemic vascular resistance, BP (in 2nd trimester - normalizes in third)

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9
Q

normal changes in pregnancy: pulmonary

A

increased tidal volume and minute ventilation = respiratory alkalosis

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10
Q

normal changes in pregnancy: renal

A

increase GFR, decreased urea + creatinine

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11
Q

normal changes in pregnancy: GI

A

constipation, increase GERD,

changes in bile composition = increase risk of cholestasis, hyperbilirubinemia + jaundice

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12
Q

normal changes in pregnancy: genital

A

vaginal pH decreases and increase glycogen in vaginal epithelium= increased risk chorioamnionitis

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13
Q

when is fundal height at the pubic symphysis ?

A

12 wks

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14
Q

when are doppler heart tones heard?

A

10 wks -12 wks

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15
Q

what is the rate of serum beta-HcG increase in pregnancy?

A

doubles every 2 days in early pregnancy

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16
Q

how many days after conception is serum and urine BhCG detected?

A

Serum HcG detect 5days after conception

Urine HcG detects 14days after conception

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17
Q

when is “quickening” felt? (fetal movement by mom)

A

16-20 wks (earlier in multigravida moms)

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18
Q

when is fetus able to detect on pelvic US

A

5-6 wks

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19
Q

“signs” of changes in pregnancy: ladins, hegars, piskaceks, goodell’s, chadwicks

A

Uterus changes: ladin’s sign (uterus softens after 6 wks); hegar’s sign (uterine isthmus softens after 6-8wks); Piskacek’s sign (palpable lateral bulge or softening of uterine corneus 7-8wks)
Cervix changes: goodell’s sign (cervical softening 4-5wks), chadwick’s sign (blue cervix/vulva 8-12 wks)

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20
Q

EDD (Naegele’s rule)

A

1st day of LMP + 7 days - 3 months.

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21
Q

when is 50g GTT for DM checked if pt HAS risk factors? if they dont? when level indicates a second test?

A

risk factors: prenatal screen
none: 28 wks.
50gm glucola on ALL pts, if >130-140 at 1hr → do 100g 3hr GTT w/in a week.

GDM is Dx if 3hr test shows 2 of the following. >95 fasting, >180 1hr, >155 2hr >140 3hrs

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22
Q

what infectious diseases are screen in prenatal visit?

A

HepB, HIV, Syphilis, rubella titer

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23
Q

what are the first, second and third trimesters?

A

1-12, 13-27, 28-42 (or birth)

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24
Q

what is included in the “first trimester screening” ? what levels would increase risk? when is it done?

A

done @ 10-13wks
abnormal high or low HcG level, low PAPP-A + thickened nuchal translucency (10-13wks w/ US), combined with maternal age = patient-specific risk level or anueoploidy (trisomy 18, down syndrome)

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25
Q

IF there is increased risk for genetic abnormality of the baby, when is chorionic villus sampling done?

A

10-13wks.

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26
Q

what does NIPT look for and when is it done?

A

10 wks, cell-free DNA looks for increased risk of aneuoploidy, extra or missing X, Y.

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27
Q

when is the “quad screen” done and what do abnormal levels indicate?

A

15-20 :check alpha fetoprotein, B-hCG, estradiol + inhibin A
High BhCG and others low = down syndrome
All low = trisomy 18
High alpha fetoprotein = open neural tube defect (spina bifida)
Inhibin A: high levels = chromosomal abnormalities

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28
Q

when is Rh tested and when is Rhogam given (if needed) ?

A

tested prenatal and @ 28wks

given @ 28 wks + 72hrs after birth (or if blood mixing)

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29
Q

when is GBS screen done? what is the txt if positive?

A

screen 32-37wks (vaginal/rectal culture); Txt with PCN G when in labor

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30
Q

when are these tested? HgB/Hct, Antibody Screen, VDRL, RPR, HIV

A

prenatal + again at 28 wks

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31
Q

what is a BPP ?

A

Fetal breathing, fetal tones, amniotic fluid level/index (AFI) [weekly], NST + gross fetal movements [2 points for each]
< 4 is abnormal, 8-10 is ideal

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32
Q

when do twice weekly NSTs start (w/ AFI once per week)?

A

41 wks

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33
Q

why and when would a BPP be ordered?

A

if you are a high risk pregnancy, typically starting after week 24 or 32 wks

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34
Q

what is considered a “high risk” pregnancy? and reason for a BPP? (9)

A 
have a history of pregnancy complications
have high blood pressure, diabetes, or heart disease
are at least 2 weeks past your due date
have a history of pregnancy loss
have abnormal amniotic fluid levels
have obesity (BMI greater than 30)
are older than 35
are carrying multiples
are Rh negative
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35
Q

reactive vs nonreactive NST

A

Reactive (good): >2 accelerations in 20min, increased FHR >15bpm from baseline lasting >15second → repeat weekly

Non Reactive (bad): no accelerations or <15bpm <15seconds. = sleeping/immature/compromised → vibratory stimulation, may try contraction stress test

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36
Q

what is the routine followup schedule in pregnancy?

A

Q4wks until 28wks, Q2 wks 28-36wks, Qweek 36-41 wks.

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37
Q

what are the 3 stages of birth?

A

I: onset of labor (true contractions) → full dilation of cervix: latent + active (rapid dilation at 5-6cm) phase
II: full dilation → delivery of fetus: passive + active phase (active maternal expulsive efforts)
III: delivery of fetus → delivery of placenta: lasts 0-30min.

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38
Q

define a spontaneous abortion + give the MC cause

A

Termination of pregnancy <20wks. Caused MC by fetal chromosome abnormality

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39
Q

threatened abortion: define + txt

A

ONLY ONE ASSOC. W/ VIABLE FETUS= possibly salvageable . MC cause of 1st trimester bleeding. No POC expelled, Closed os, blood vaginal discharge.
Txt: supportive, serial bhCG to see if doubling

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40
Q

inevitable abortion: define + txt

A

no POC, pregressive cervix dilation >3cm, effaced. +/- rupture of membranes.
Txt: D+C or D+E

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41
Q

incomplete abortion: define + txt

A

some POC expelled, cervix DILATED, heavy bleeding, retained tissue + boggy uterus.
Txt:D+C or D+E, pitocin

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42
Q

complete abortion: define + txt

A

complete passage of all products, closed os.

Txt: none needed

43
Q

missed abortion: define + txt

A

fetal demise but still retained in uterus, no POC expelled, closed os.
Txt: D+E, misoprostol

44
Q

septic abortion: define + txt

A

retained POC becomes infected → infection of uterus + organs. Closed os w/ cervical motion tenderness. foul/brown discharge, fever chills
Txt: D+E to remove POC, broad spectrum abx

45
Q

when can a medical vs surgical elective abortion be performed?

A

medical: <9wks, surgical 9-24 wks

46
Q

options for elective medical abortion (3)

A
  1. Mifepristone (blocks progesterone = thin endometrial lining) and misoprostol (stimulates uterine contraction) - up to a week to abort
  2. Methotrexate (folic antagonist- for ectopics) and misoprostol - may take up to a month to abort
  3. Vaginal misoprostol alone
47
Q

options for elective surgical abortion (2)

A

D+C (4-12 wks) or D + suction (>12 wks)

48
Q

MC cause of abruptio placenta + txt?

A

delivery ( C-section preferred) +/- observation and meds for baby to protect heart and lungs until delivery .
*MC cause- maternal HTN

49
Q

what can placenta previa progress to?

A

May separate (abruptio) from the uterus as the cervix dilates –> so NEED C-section delivery @ 36 wks!

50
Q

Dx and txt for placenta previa

A

Dx: painless third trimester bleeding + US

txt: stabilize the fetus → tocolytics (Mg sulfate-inhibits uterine contraction for preterm labor) . Delivery when stable

51
Q

MC cause of bleeding in early pregnancy

A

early pregnancy loss (MC- threatened abortion)

others- infection, ectopic

52
Q

placenta accreta

A

part of placenta invades and is inseparable from uterine wall = risk of life threatening blood loss during delivery for mom

53
Q

3 most common indications for c-section

A

Failure to progress during labor
Nonreassuring fetal status
Fetal malpresentation

54
Q

if C-section is by maternal request, what GA is it at?

A

40 wks

55
Q

Abx prophylaxis options for C-section

if PCN allergic, if already on some for GBS, if already on for chorioamnionitis

A

cephazolin 60min before incision (PCN allergy - clindamycin or gentamicin) +azithromycin for those in labor or PROM
OR if GBS prophylaxis is on board (PCN G) only need to add Azithromycin
OR if chorioamnionitis prophylaxis is on board (ampicillin + gentamicin) we add clindamycin or metronidazole

56
Q

MC cause of cord prolapse

A

MC cause is premature rupture of membrane.

57
Q

what is erb’s palsy?

A

brachial plexus injury from shoulder dystocia

58
Q

“turtle head” retraction of baby’s head back into the vagina - this is a sign of what?

A

shoulder dystocia

59
Q

what are two maneuvers you can do for shoulder dystocia?

A

non-manipulative =McRoberts Maneuver (hyperflex mom’s legs into abd) or manipulative = woods “corkscrew” (180 degree shoulder rotation)

60
Q

Dx of ectopic

A

TVUS absence of gestational sac w/ bhCG level >2,000,

61
Q

txt options for ectopic

A

methotrexate (contraindicated if ruptured or h/o TB) → would then need laparoscopic salpingostomy

62
Q

fetal bradycardia signaling oxidative distress.. what are your next steps?

A

give mom O2, increase IV fluids, turn woman on her side. +/- Stop oxytocin and give terbutaline to slow contractions. If these don’t work → emergent delivery

63
Q

complications that come with gestational DM

A

large baby, preterm delivery, breathing difficulties, HYPOGLYCEMIA OF BABY, stillbirth, obesity + type II DM later in life of baby.

64
Q

GDM - what is the schedule for blood glucose checks and what are the target levels?

A

Take BS 4 times daily with target levels of 90-95 fasting and <120 two hours after a meal.

65
Q

first and second line txt options for GDM

A

First line is insulin (metformin as an alternate)

Insulin: NPH dosed am and bedtime + a short acting at mealtime

66
Q

what is gestational trophoblastic dz and what are the four types?

A

nonviable fertilized egg implants in uterus → ABNORMAL PLACENTAL DEVELOPMENT 4 types
1. Molar (benign) 2. Invasive mole 3. Choriocarcinoma 4. Placental site trophoblastic tumor.

67
Q

what is a hyatidiform mole (molar pregnancy) ?

A

neoplasm due to abnormal placental development with trophoblastic tissue proliferation arising from gestational tissue (not maternal in origin). MC type, 80% benign. - complete (egg w/ no DNA- all paternal chromosomes) or partial (some fetal development but not viable)

68
Q

dx of gestational trophoblastic dz/molar pregnancy?

A

bhCG MARKEDLY elevated (>100,000) + US = “snowstorm” or “cluster of grapes”

69
Q

txt of gestational trophoblastic dz/molar pregnancy ?

A

suction curettage +/- chemo/hysterectomy if METS

70
Q

hyperemesis gravidarum S+S, what metabolic manifestations can it lead to?

A

severe, excessive N/V, weight loss 5%, electrolyte imbalance (metabolic acidosis from starvation, hypochloremic alkalosis from vomiting).

71
Q

how is the Dx of incompetent cervix made?

A

Hx painless cervical dilation + 2nd trimester deliveries.Advanced cervical dilation and effacement before week 24 of pregnancy without painful contractions, vaginal bleeding, water breaking (ruptured membranes) or infection

72
Q

txt for incompetent cervix

A

: progesterone, cervical cerclage <14wks (stitches removed in last month of labor)

73
Q

define postpartum hemorrhage. what is early vs late?

A

Blood loss >500ml if vaginal delivery. >1000mL if C-section.
Early 24hrs postpartum, late >24hrs up to 8wks postpartum.

74
Q

beside bleeding, what are other signs of postpartum hemorrhage ?

A

signs of hypovolemic shock, uterine atony = soft/boggy uterus

75
Q

txt options for postpartum hemorrhage

A

bimanual uterine massage, txt underlying cause, IV access. + uterotonic agents (IV oxytocin, methylergonovine) prostaglandin analogs (IM carboprost tromethamine, Misoprostol).

76
Q

dx chronic htn before pregnancy vs gestational htn vs preclampsia vs chronic HTN w/ superimposed preclampsia

A

Chronic htn in pregnancy: >140/90 BEFORE 20wks and no proteinuria
Gestational HTN: new HTN >20wks w/out systemic findings
Preclampsia: newly elevated BP and proteinuria in pregnancy after 20wks.
chronic HTN w/ superimposed preclampsia: S+S of d/o along with chronic HTN

77
Q

when do kick counts start?

A

20 wks

78
Q

who does not need GBS screen?

A

C-section delivery

79
Q

leading cause of morbidity/mortality in pregnancy?

A

preclampsia/eclampsia

80
Q

Dx of preclampsia (BP, what if severe?)

A

BP >140/90 (>160/110 if severe) on 2 separate occasions at least 6hrs apart w/ Proteinuria >300mg/24hr or end organ damage.

81
Q

what is HELLP syndrome?

A

complication of preclampsia: Hemolytic anemia, Elevated Liver enzymes, Low Platelets

82
Q

what 3 fetal complications can arise from preclampsia?

A

growth restriction, preterm labor, placenta abruption

83
Q

txt for preclampsia + preclampsia w/ severe features

A

delivery at 37wks, steroids (betamethasone) to mature lungs if <34wks
Monitor: BP, UA/dipstick, 2x-week NST,
Severe = prompt delivery (at 34 wks) + Mg Sulfate (seizure prevention) + BP meds (labetalol, nifedipine, hydralazine)

84
Q

S+S eclampsia

A

preclampsia + abrupt tonic-clonic seizure 1-2min → post-ictal state. Hyperreflexive → resp distress → coma

85
Q

txt for eclampsia

A

Mg sulfate(seizure prevention/txt) (+lorazepam if refractory), delivery (once stable), + hydralazine or labetalol.

86
Q

what is the concern with Rh incompatibility ?

A

if another Rh+ fetus, antibodies may cross placentae and attack fetal RBCs. =fetal hemolytic dz –>
hemolytic anemia, jaundice, kernicterus (brain damage from bilirubin), hepatosplenomegaly, fetal hydrops (fluid accumulation in two spaces - pericardial effusion, ascites, pleural effusion, subcutaneous edema), CHF.

87
Q

hemolytic dz of newborn = erythroblastosis fetalis, what is the txt?

A

antigen-negative RBCs through US guided umbilical vein transfusion.

88
Q

why are UTIs common in pregnancy? what does it increase risk of?

A

Common b/c uterus puts pressure on the bladder and urinary tract + ureteral dilation.
= increased risk of premature labor. Screen pregnant pts for asymp bacteriuria.

89
Q

txt of UTI in pregnancy

A

amoxicillin,Nitrofurantoin (macrobid), augmentin, keflex, cefpodoxime, Fosfomycin. 7-14days

90
Q

what are the two classifications for common birth defects and what are included in them ?

A

Structural: heart defects, cleft lip/palate, spina bifida, club foot
Functional/developmental: down syndrome, sickle cell, cystic fibrosis

91
Q

chorionic villus sampling: when and why is it done? risk/benefit versus amniocentesis?

A

Done in 1st trimester (>10wks)- available earlier than amniocentesis but has higher diagnostic uncertainty and is more dangerous.
Available to all women, regardless of risk. MC done if >35yo or prior pregnancy w/ genetic abnormality, etc.

92
Q

risk assoc. with chorionic villus sampling and amniocentesis?

A

miscarriage

93
Q

what are the indications for amniocentesis ?

A

MC evaluate for genetic abnormalities, also fetal infection, degree of hemolytic anemia, blood/plt type, neural tube defects.
Also used as therapeutic txt for polyhydramnios or twin-twin transfusion syndrome or prolapsed fetal membrane.

94
Q

when is amniocentesis done?

A

15-17wks

95
Q

which abnormal pap test results are the ONLY ones that dont need colposcopy?

A

Atypical squamous cells of undetermined significance (ASC-US):
Under 30 years repeat in one year
Over 30 years: Acceptable to repeat cotesting at 1 year.
HPV positive colposcopy
HPV negative repeat in 3 years
*all others (ASC-H, LSIL, HSIL, and AGC need colposcopy)

96
Q

what are tocolytic options (to slow labor) ?

A

“Its Not My Time”

indomethacin, nifedipine, Mg sulfate, terbutaline

97
Q

when is tocolysis of preterm labor contraindicated?

A

When the maternal and fetal risks of prolonging pregnancy or the risks associated with these drugs are greater than the risks associated with preterm birth (e.g. pre-eclampsia and intra-amniotic infection).

98
Q

what are risk factors for placenta previa?

A

increased maternal age, multiparity, prior placenta previa, and prior cesarean delivery.

99
Q

what are fetal complications of placenta previa (other than perpartum hemorrhage)?

A

The rate of congenital malformations (namely neurologic, cardiovascular, gastrointestinal, and respiratory) doubles with placenta previa.

100
Q

nitrazine test (swab changes with orange to blue) is to confirm what?

A

presence of amniotic fluid - PROM

101
Q

when checking for PROM - what pH will indicate a positive finding?

A

pH >6.5 (normal vaginal fluid is 3.5-6)

102
Q

clinical manifestations of molar pregnancy (5)

A

vaginal bleeding, pelvic pain/pressure, uterine size >GA, hyperemesis gravidarum, preclampsia <20wks

103
Q

dietary deficiency of what vitamin increases risk of molar pregnancy?

A

vitamin A

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