General Obs and Gyne Flashcards

Question

Is clotting affected in pregnancy?

Answer 1

Clotting factors are not affected by pregnancy Fibrinogen becomes higher in pregnancy (goes up to 4) so if you check for DIC and it is 2, then you are actually low

Answer 2

Tone Tissue Truama Thrombin

Answer 3

Tamponading --\> Bakri baloon, folley, packing with gauze

Answer 4

1)Suture the uterus--\>B-Lynch sutures

Answer 5

C/S increases your risk of placental acreta, increta...

Answer 6

Bleeding from or into the genital tract occuring from 24+0 to prior to the birth includes labour Leading cause of perinatal and maternal mortality Previa and uterine rupture are rare and bad post coital bleeding, cervical polyps, cervical dysplasia, urinary tract and rectal are common and no bad

Answer 7

Vaginal exams are contraindicated in previa Speculum exams are not contraindicated in previa

Answer 8

The APT test tests for fetal blood from vagina, it is the same as the Klienhauer-Betke test

Answer 9

Premature separation of a normal implanted placenta 4 classes 1) revealed 2) concealed 3) Total 4) Partial/marginal Risks of placental abruption--\> spontaneous preterm birth, iatrogenic preterm delivery Risk factors for placental abruption * Abruption in a previous pregnancy * 4.4% incidence of recurrent abruption (OR 8.7) * If 2 previous pregnancies with abruption: 19-25% recurrence * Preeclampsia * Multiparity * Low BMI * Pregnancy following ART • Intrauterine infection * PPROM * Thrombophilia (FVL and Prothrombin gene defect) • Abdominal trauma * Smoking * Cocaine / amphetamines

Answer 10

1) Ultrasound looking for jello sign (thickened heterogenous placenta) 2) Kliehauer-Betke test --\> tests for maternal fetal hemorrhage gives you an idea of appropriate Rhogam dosing ( for every 30 ml of fetal blood in maternal blood-\> give 300 ul of rhogam --\> you must always order if RH negative, or if want to document FMH in APH

Answer 11

If spotting and not previa: home If heavier than spotting and/or ongoing: remain inpatient until bleeding stopped • No data regarding duration of hospital stay No tocolysis • Should not delay delivery in an unstable patient • Generally contraindicated ObGyn care RhIg with each bleed Serial ultrasound assessment of fetal growth and well-being (risk of IUGR, oligohydramnios, PPROM, PTL) Increased surveillance for remainder of pregnancy Likely delivery at or after 37+0 GA

Answer 12

Placenta implanted in the lower segment of the uterus presenting ahead of the leading pole of the fetus 2.8-4/ 1000 ( greater risk with twins) Increased risk of maternal mortality, PPH and hysterectomy Location of placenta previa a) complete--\> completely covers interal os b) partial- partially covers the internal os c) marginal-reaches internal os (0mm away) d) low lying (1-29mm) **Management** There is a relative upward shift due to differential growth of the lower seqment in the third trimester--\> most previas self resolve \*\* the previa is very unlikely to persist past the first trimester unless the overlap is \> 10mm\*\* - between 18-24 weeks the placenta reaches or overlaps the internal os on TVS--\> mandatory follow up in third trimester - if between 18-24 weeks 1mm or more away from internal os--\> no follow up required - at \>26 weeks if \< 20mm from cervical os--\> further follow up needed + higher risk of C section - check again at 35 weeks when a) \> 20mm away from os--\> high likelihood VD b) 0-20mm away from os 40-90% c/s rate with closer to os= higher c/s c) 0mm from os--\> C/S **It is very important to document the location of the chord insertion if low lying or previa to assess risk of chord prolapse**

Answer 13

Previous Previa Previous C/S Multiparity Previous termination of pregnancy Advanced maternal age Smoking Assisted conception

Answer 14

Placenta previa is a normal placenta in an abnormal position in the uterus ( close to the cervical os) vasa previa is an abnormal placenta with umbilical vessels that are unsupported by the umbilical chord or placental tissue that traverse the fetal membranes above the cervix ( so a placenta previa with an abnormal placenta ) - it is usually associated with an abnormal placenta a) velementous insertion (chord and vessels attach to membranes and then travel to placent) b) bi-lobed placenta c) succinturiate lobe (an accessory lobe) Risk factors for Vasa Previa are 1) IVF 2) 2nd trimester placenta previa 3) abnormal placental morphology 4) Associations with APH, IUGR, prematurity Diagnosis in first or second trimester is very important and saves lives People who should be screened for vasa previa at 18-20 week ultrasound 1)all low lying placentas (0-20mmm Consider trans-vaginal ultrasound in people who are high risk 1) IVF 2) 2nd trimester previa 3) abnormal placental morphology 4) patients with vaginal bleeding Management 1) serial ultrasounds 2) Neonatal consult + betamethasone if neccessary 3) Admission to tertiary care

Answer 15

Give to a Rh- mother Don't give to Rh+ mother if she is anti-body positive - still give if anti-kell - don't give if anti-d

Answer 16

Should do routine screening between 24-28 weeks with OGCT (50g) **_for all women except_** \< 25 years old caucasian or low prevalence of diabetes ethnicity pregnant BMI= 27 No previous hx GDM or glucose intolerance No first degree family hisotory No history of adverse GDM related outcomes If GDM is diagnosed --\> use 75g OGTT

Answer 17

The diagnostic criteria for post-partum depression are the same as for non-peurpural major depression Must occur within 4 weeks of birth to be given the diagnosis of MDD with peripartum onset for 2 weeks in the last month meet the criteria of 1) mood 2) sleep 3) interests 4) guilt 5) energy 6) concentration 7) appearance 8) psychomotor agitation or depression 9) suicidality

Answer 18

The sonographic presence of thick heterogeneous placenta is strongly associated with an adverse pregnancy outcome and often with perinatal death. Jello sign is the name for this It is important to asess the placenta in all types of antepartum hemmorhage

Answer 19

1) A woman who is Rh negative, and who has negative anti-d titres 2) Routinely give at 28 weeks if antibody titire is still negative 3) Rh negative with antibodies other than anti-D 4) antipartum bleeding ( spontaneous or induced abortion, treatment of ectopic, significant vaginal bleeding, amniocentesis, abdominal trauma, ECV) 5) Give to all Rh negative, anti-D negative women who deliver an Rh-positive infant within 72 hours of delivery Dosage of Rho-GAM 1) for \< 30ml of transplacental hemorrhage 300ug of anti-D is sufficient 2) Additional Rho-GAM can be given at a dose of 10 ug for every 1m of transplacental hemorrage as determined on Kleinhauer Betke test

Answer 20

APT test--\> qualitative done on a slide with blood from antepartum hemorrhage and mixed with NaOH. If supernatant turns pink= fetal, yellow= maternal Kleihauer betke--\> quantitative test to determine how much fetal blood is in maternal circulation at time of transplacental hemorrhage Wright stain--\> qualitative test to look for nucleated red blood cells ( fetal)

Answer 21

The first trimester screen is composed of 1) nuchal transulscency on US and is done at 11-14 weeks 2) PAPP-A PAPP-A is a complex, high molecular weight glycoprotein. **Its levels, on average, are lower in pregnancies affected with fetal Down syndrome.** In contrast to beta-hCG, PAPP-A performance as a screening marker decreases with increasing gestational age between 9 and 13 weeks 3) B-HCG Beta-HCG levels are, on average, twice as high in pregnancies affected with fetal Down syndrome than in euploid pregnancies. Beta-hCG can be assayed in its free or total form. Free beta-hCG is effective at 90/7ths to 136/7ths weeks, and the performance improves as gestational age advances within this interval [21]. Total beta-hCG is effective at 110/7ths to 136/7ths weeks, and the performance improves as gestational age advances within this interval [7,8,17]. Between 110/7ths and 136/7ths weeks, there is no consensus as to whether free beta-hCG performs significantly better than total beta-hCG for Down syndrome screening when interpreted in conjunction with measurement of PAPP-A and nuchal translucency [7,8,21].

Answer 22

1)dating ultrasound --\> 8-12 weeks gestation (crown rump length) +/- 3 days - change to this date if \> 1 week difference from Naegeles rule 2) Nuchal Translucency Ultrasound (11-14 weeks gestation) 3) fetal growth and anomaly ultrasound (18-20 weeks) +/- 7 days acuracy

Answer 23

confirmed or suspected ectopic Presence of an IUD IBD breastfeeding haemorrhagic disorder, or on anti-coagulation known or suspected ischemic heart disease or myocardial infarction severe asthma on long term corticosteroids identified non-compliance potential

Answer 24

Transvaginal (TV) is always smaller Embryo no cardiac activity \> 7mm TV, \> 9mm TA Gestational sac, no yolk sac, no embryo \>8mm TV, \> 20mm TA Gestational sac with yolk sac, no embryo \> 25mm TV, \> 25mm TA

Answer 25

The RMI or risk of malignancy index is an important metric used to calculate the risk a patient has of having a malignant ovarian cancer RMI=ultrasound scoreX menopausal score x CA125 level in U/ml an RMI\> 200 neccesitates referral to gynechology oncology Ovarian cancer should be on the differential for persistent pelvic pain/ abdominal pain, urinary urgency/frequency, increased abdominal size/bloading, difficulty eating CA125 is a useful test in this case

Answer 26

**Absolute contraindications** - smoking \> age 35 - migraine with neurological symptoms including aura - congenital hypertriglyceridemia - impaired liver function assocaited with acute liver disease - known or suspected pregnancy - vaginal bleeding of unknown origin - estrogen dependant cancer (breast or ovarian) - past thromboembolic events or thromboembolic disease (factor V lieden, protein C or protein S deficiency, hemophillia) - coronary artery disease - cerebrovascular disease - uncontrolled hypertension **relative contraindications to estrogen based OCP** - migraines- non focal with aura\< 1h - diabetes mellitus complicated by vascular disease - SLE - controlled hypertension - hyperlipidemia - sickle cell anemia - gallbladder disease

Answer 27

levonestrogel ( plan B) 750 ug q12 mette 2 doses (75-95% effective) Yupzee method OVRAL (ethinyl estradiol 100 ug/ levonestrogel 500ug) 2 tabs po q12 x 2 Copper IUD (can be done up to 7 days postcoitus, and has a 1% failure rate

Answer 28

\< 5mm is normal in an asymptomatic woman \> 4-5 mm in a bleeding postmenopausal woman is grounds for endometrial biopsy \>11 mm or other positive findings on U/S such as increased vascularity, inhomegineity of the endometrium, particulate fluid are grounds for referral to a gynechologist

Answer 29

Hypertension Cocaine use Short umbilical chord Trauma Uterplacental insufficiency Submucous leiomyomata Sudden uterine decompression (hydramnios) Cigarette smoking Preterm premature rupture of membranes

Answer 30

HPV infection (serotypes 16,18) smoking high risk behaviours (multiple partners, other STI's, early age at first intercourse, high risk male partner) poor screening uptake is the most important risk factor for cervical cancer in Canda

Answer 31

TRH stimulates both TSH and prolcatin relase.

Answer 32

**cholestasis (pruritis) of pregnancy** - associated with a high level of circulating bile acids, increased ethnic propensity - commonly no elevation in liver enzymes - cholestasis in pregnancy **particularly** **when associated with jaundice** is associated with a higher degree of prematurity, fetal distress, fetal loss **puritic urticarial papules and plaques of preganncy (PUPPP)** - lesions begin on abdomen and spread to thighs and sometimes buttocks and arms - lesions are erythematous urticarial plaques and small papules surrounded by a narrow, pale halo - 1% incedence - histologically is related to perivascular infiltrate of lymphocytes and histocytes associated with edema of the papillary dermis - there is no known effect on fetal and maternal outcomes - treatment includes topical steroid and antihistamines **Herpes gestationis** - thought to be compliment mediated, IgG triggered reaction to antibodies in the basement membrane. - clinically is intense pruritis followed by extensive patches of cutaneous ethythema and subsequent formation of small vessicles and tense bullae - limbs are affected more than the trunk - biopsy is the only true diagnosis - treatment is corticosteroids - there is an increase in growth retardation and stillbirths - if untreated and in labour, likely will be neonatal lesions, but they will heal

Answer 33

Caused usualy by chlamydia, gonorrhea, some anaerobic bacteria, and other agents - common presentation is young, dysparunia, vaginal discharge, lower abdominal pain - diagnosis of PID is made clinically with abdominal tenderness, cervical motion tenderness, adnexal tenderness +/- fever, pelvic mass common sequelae- tubo ovarian abscess treatment 1) outpatient- must have low fever, no peritonitis, and be a candidate for oral therapy - ceftriaxone IM once + oral doxycycline BID for 10-14 days

Answer 34

Multiple organisms causitive - Chlamydia - Neiserria - endogenous flora, anaerobic, aerobic or both - E.coli, staphylococcus, streptococcus, entercoccus, bacteriodes, peptostreptococcus, H. Influenza, G. vaginalis - Actinomyces israeli risk factors - age\< 30 - douching - IUD - invasive gynechological procedures

Answer 35

They are symptoms around ovulation - mood changes - breast tenderness - abdominal pain

Answer 36

over 35-40 with abnormal uterine bleeding Under 35-40 with AUB and risk factors Persistent AUB Presence of atypical glandular cells on cervical cytology Presence of glandular cells on cervical cytology in a woman\>/= 40 years old woman with hereditary nonpolyposis colorectal cancer guidelines for postmenopausal women are biopsy if \> 11mm biopsy is between 5-11mm ( SOGC says to biopsy) \< 5mm DO NOT BIOPSY

Answer 37

Both the direct and indirect coombs test are looking at the recipients blood products to look for antigens and antibodies The direct coombs test looks at the recipients RBC's and are incubated with antihuman antibodies--\> if there are antigens and antibodies on the RBC surface then there is coagulation The indirect only looks at antibodies in the serum of the recipient. Donor RBC's are mixed with recipient serum. That combination is then mixed with anti-human IgG's (coombs reagent) and if there is aglutination, then the test is positive The important antibodies are anti-lewis- OK anti-kell-Bad anti-duffy-Bad The mneumonic is "Lewis Lives, Kell Kills, Duffy Dies" The antibodies are not important until they get to more than a 1:8 dilution factor ( can be detected past that)

Answer 38

cesarean sectionand hysterectomy in people known to have placenta acreta or greater internal illiac balloon catheterization can be done to reduce the intraoperative bleeding

Answer 39

`\<6 weeks postpartum if breastfeeding smoker \> 35 years (≥ 15 cigarettes per day) hypertension ( systolic ≥ 160mm Hg or diastolic ≥100 mm Hg) Current or past VTE CAD past CVA Complicated valvular disease (pulmonary hypertension, atrial fibrilation, history of subacute bacterial endocarditis) migraine headaches with focal neurological symptoms Current breast cancer Diabetes with retinopathy/ nephropathy/ neuropathy Severe cirrhosis Liver tumor (adenoma or hepatoma)

Answer 40

pregnancy(known or suspected) unexplained vaginal bleeding current diagnosis of breast cancer

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General Obs and Gyne Flashcards

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