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Obstetrics and Gynecology > General obstetrics > Flashcards

General obstetrics Flashcards

1
Q

what is CKC

A

cold knife conization

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2
Q

what is LEEP

A

loop electrocautery excision procedure

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3
Q

what is BTL

A

bilateral tubal ligation

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4
Q

what is TVH

A

trans vaginal hysterectomy

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5
Q

what is TAH

A

trans abdo hysterectomy

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6
Q

define ASCUS

A

atypical squamous cells of undetermined significance

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7
Q

define LGSIL

A

low grade squamous intra epithelial lesion

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8
Q

define HGSIL

A

high grade squamous intraepithelial lesion

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9
Q

when is home UPT positive

A

8-9 days

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10
Q

what should your beta-hCG be at 10 weeks

A

100 000

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11
Q

what should your beta-hCG be at 5 weeks

A

1500-2000 (can maybe see gestational sac this early)

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12
Q

what should your beta-hCG be at term

A

10 000

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13
Q

what is the discriminatory zone

A

b-hCG is 1200-1500

evidence of a pregnancy should be seen on transvaginal U/S (5 weeks)

when b-hCG is 6000 you can see evidence on a transabdominal U/S

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14
Q

when can you see fetal heart tone on U/S? doppler?

A

U/S at 6 weeks

doppler at 12 weeks

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15
Q

naegeles rule

A

LMP-3 months + 7 days + 1 year

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16
Q

when should you feel fetal quickening

A

16-20 weeks

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17
Q

list the signs and symptoms of pregnancy

A
  1. chadwick’s sign–blue hue of cervix
  2. Goodells sign–softening and cyanosis of cervix at 4 weeks
  3. Laddin’s sign–> softening of uterus at 6 weeks
  4. breast swelling and tenderness
  5. linea nigra
  6. palmar erythema
  7. telangiectasias
  8. nausea
  9. amenorrhea
  10. quickening
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18
Q

list 3 drugs that are okay in first trimester

A

tylenol

benadryl

phenergan

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19
Q

when do you give rhogam

A

28 weeks

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20
Q

when do you go GBS screen

A

35-37 weeks

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21
Q

what advice should be given to mothers reaching term

A

“go to labour and delivery is you have contractions every 5 min, if you feel sudden gush of fluid, if you dont feel the baby move for 12 hours, or if you have bleeding like a period. normal to have pink discharge or mucus in weeks preceeding labour”

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22
Q

list examples of routine problems of pregnancy

A

back pain

hemorrhoids

pica

edema

GERD

varicose veins

dehydration

frequency

constipation

braxton hicks

round ligament pain

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23
Q

what does increased MSAFP indicate

A

neural tube defects

omphalocele

gastrochisis

multiple gestation

fetal death

incorrect dates

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24
Q

what does decreased MSAFP indicate

A

down syndrome

certain trisomies

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25
Q

how do you test for fetal lung maturity

A

lecithin/sphinomyelin ratio–> over 2.0 indicates fetal lung maturity

FLM–> over 55mg/g is mature, good for use in diabetics

phosphatidyl glycerol–> positive or negative–> hyperglycemia delays lung maturity

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26
Q

what effect does hyperglycemia have on lung maturity

A

delays it

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27
Q

what lecithin/sphinomyelin ratio indicates lung maturity

A

over 2.0

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28
Q

where is the most common place for an ectopic pregnancy

A

ampulla of the fallopian tube

can also be in ovary, abdo wall, cervix, bowel

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29
Q

risk factor for ectopic

A

infection of tubes

PID

IUD use

previous tubal surgery

assisted reproduction

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30
Q

rate of ectopic

A

1/100 pregnancies

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31
Q

symptoms of ectopic

A

episodic lower back pain

abnormal bleeding due to inadequate progesterone support

b-hCG decreased–> normally doubles every day but doesnt in ectopics

unilateral tenderness

may have mass

Cullen’s sign–> periumbilical hernia

U/S finding of complex adnexal mass, can see sac or fetus outside uterus

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32
Q

what is the dosing of methotrexate for ectopics

A

50 mg/m2

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33
Q

what is the Arias-Stella reaction

A

associated with ectopic pregnancy

endometrial change that looks like clear cell carcinoma (but is not cancerous)

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34
Q

what are some things that can cause second trimester abortion

A

infection

maternal anatomical defects

cervical defects

systemic disease

fetotoxic agents

trauma

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35
Q

what is McCune Albright disease

A

polyostotic fibrous dysplasia –> degeneration of long bones, sexual precocity, cafe au lait spots

treat precocious puberty with medroxyprogesterone acetate

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36
Q

define a “reactive” NST

A

2 accelerations of 15 beats per minute for 15 seconds in 20 min strip

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37
Q

how do you “grade” a BPP

A 
look at:
NST
amniotic fluid index
fetal breathing movements
fetal extremity movements
fetal tone

give either 2 points or zero points and then grade it

above 8 is good, less than 4 is bad

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38
Q

define contraction stress test

A

nipple stimulation or oxytocin–shows 3 uterine contractions in 10 min to be good

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39
Q

what is EDD

A

40 weeks from LMP

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40
Q

how big is the uterus at 10 weeks

A

grapefruit

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41
Q

how big is the uterus at 20 weeks

A

at umbilicus

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42
Q

what are the requirements to use outlet forceps for delivery (these are the same requirements for vacuum delivery)

A
  1. visible scalp
  2. skull on pelvic floor
  3. occiput anterior or posterior
  4. fetal head on perineum–can see without separating labia
  5. adequate anesthesia–bladder drained
  6. maximum 45 degrees of rotation
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43
Q

requirements for use of low forceps

A

station 2 but skull not on pelvic floor

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44
Q

requirements for mid forceps

A

station higher than 2 with engaged head (NOT DONE)

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45
Q

what are the risks of vacuum delivery

A

cephalohematoma

lacerations

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46
Q

indications for induction

A

preeclampsia at term

PROM

chorioamnionitis

fetal jeopardy/demise

above 42 weeks GA

IUGR

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47
Q

name 3 types of prostaglandins used in labour induction

A

prepidil

cervidil

cytotec

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48
Q

what do prostaglandins do in labour

A

dilate cervix and increase contractions

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49
Q

when are prostaglandins contraindicated in labour induction

A

prior C/S

nonreassuring fetal monitoring

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50
Q

what is the dosing for oxytocin in labour induction/augmentation

A

10 U in 1000mL IV piggyback on pump at 2mU/min

if over 40 mU/min are used watch for SIADH

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51
Q

describe the process of delivering a baby vaginally

A
  1. crowning
  2. Ritgen’s maneuver–> hand pressure on perineum to flex head
  3. head out
  4. check for nuchal cord
  5. delivery of anterior shoulder gently by pulling straight down
  6. deliver posterior shoulder with upward movement
  7. clamp cord with 2 Kelly’s
  8. cut cord with scissors
  9. hand off baby
  10. get cord blood
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52
Q

describe how to deliver the placenta

A
  1. gentle traction on cord with suprapubic pressure to prevent uterine involution
  2. massage uterus
  3. retract placenta out and inspect
  4. inspect mom for tears, visualize complete cervix
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53
Q

what do you use to do episiotomy repairs

A

2.0 chromic or vicryl locking suture superiorly to repair vaginal mucosa

interrupted chromics to repair deep fascia if needed

simple running to repair mid fascia

sub Q stitch inferiorly and superficially

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54
Q

how is dating done on U/S

A

biparietal diameter

head circumference

femur length and abdominal circumference

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55
Q

what do we look at on doppler velocimetry

A

systolic/diastolic ratio in the umbilical cord

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56
Q

what is chorioamnionitis

A

infection of the amniotic fluid

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57
Q

how should you manage chorioamnionitis

A

requires DELIVERY

increased risk with increasing length of rupture of membranes

AMPICILLIN and GENTAMYCIN–> add clinda if C/S

58
Q

signs and symptoms of chorioamnionitis

A

fever above 38

high white count

tachy

uterus tender

foul discharge

59
Q

what is the most common cause of neonatal sepsis

A

chorioamnionitis

60
Q

risk factors for endometritis

A

prolonged labour

PROM

more associated with C/S than vaginal delivery

61
Q

what organisms cause endometritis

A

anerobes/aerobes, polymicrobial

i.e e coli, GBS, bacteroides

62
Q

symptoms of endometritis

A

uterine tenderness

foul lochia

63
Q

treatment for endometritis

A

GENTAMYCIN and CLINDAMYCIN (continue until 24-48 hours afebrile)

64
Q

define post partum hemorrhage

A

more than 500 mL blood loss following vaginal delivery

more than 1000 mL blood loss following C/S

65
Q

causes of PPH

A

uterine atony

forceps

macrosomia

coagulopathy

uterine rupture

uterine inversion

66
Q

treatment of PPH

A
  1. vigorous fundal massage
  2. oxytocin 20 U in 1000 mL NS
  3. repair laceration
  4. methergine 0.2 mg IM (contraindicated in HTN)
  5. take out placental remnants
  6. PgF2-alpha (Hemabate)–> contraindicated in asthma
  7. cytotec 800 mg rectal
  8. hysterectomy if medical therapy fails
67
Q

what is the dosing of oxytocin for PPH

A

20 U in 1000 mL NS

68
Q

what is the dosing of methergine for the tx of PPH

A

0.2 mg IM

69
Q

dosing of PgF2-alpha (hemabate) for PPH

A

?

70
Q

dosing of cytotec for PPH

A

800 mg rectal

71
Q

why do we care about Rh antibodies

A

can cross the placenta and cause a hemolysis in the newborn which may cause death

72
Q

what is rhogam and when is it given

A

passive immunization to prevent sensitization to Rh antigen in Rh - mom

given at 28 weeks

check baby at delivery

if Rh+–> give rhogam again to mom within 72 hours

73
Q

what do you do if a woman is a multip who has been sensitized to Rh

A

check a titre–> if over 1:8, do fetal survey on U/S and amniocentesis at 16-20 weeks to measure the OD 450 with the spectrophotometer

look at LILEY CURVE

if in zone 2 or 3, so intrauterine blood transfusion through umbilical artery of Rh neg blood

74
Q

what is erythroblastosis fetalis

A

hemolytic anemia in the fetus caused by transplacental movement of Rh antibodies made by Rh- mom against Rh+ kid

heart failure, diffuse edema, ascites, pericardial effusion, bilirubin breakdown–> jaundice, neurotoxic effects

75
Q

why do we care about retained POC in the setting of intrauterine fetal demise (IUFD)

A

retained IUFD over 3-4 weeks leads to hypofibrinogenemia secondary to the release of thromboplastic substance of the decomposing fetus–>

can cause DIC

76
Q

how do you diagnose IUFD on U/S

A

no FHT

77
Q

why do we care about babies being post dates

A

increased risk of macrosomia, oligohydramnions, meconium aspiration, IUFD

78
Q

what do you do for a woman who has not yet delivered at 41 weeks

A

NST–> if nonreassuring, do induction

79
Q

what do you do for a woman who has not yet delivered at 42 weeks

A

do BPP and NST twice a week–> if non reassuring, do induction

80
Q

when do you induce for post dates

A

MUST induce after 42 weeks even if fetal testing normal

81
Q

what is the rate of twins and triplets

A

1/80 twins

1/7000-8000 triplets

82
Q

what are some complications associated with multiple gestation

A

PTL

placenta previa

cord prolapse

PPH

83
Q

what are some fetal complications associated with multiple gestation

A

preterm

congenital abnormalities

SGA

malpresentation

84
Q

when do twins usually deliver? triplets?

A

twins–> 36-37 weeks

triplets–> 33-34 weeks

85
Q

define “di/di” monozygotic twins–> when does separation occur?

A

dichorionic diamniotic –> 2 chorions and 2 amnions

separation occurs BEFORE trophoblast on embryonic disk –> splits BEFORE 72 hours

86
Q

define “mono/di” monozygotic twins–> when does separation occur?

A

has one placenta but two amnions

separation 5-10 days before amnion forms

87
Q

define “mono/mono” twins

A

monochorionic monoamniotic

can be conjoined

one chorion and one amnion

88
Q

what are dizygotic twins

A

fraternal

dichorionic and diamniotic

two eggs and two sperm

89
Q

what are monozygotic twins

A

one egg one sperm

90
Q

what is HELLP syndrome

A

hemolysis, elevated liver enzymes, low platelets

usually in the severe pre-eclampsia classification

91
Q

how do you treat HELLP

A

delivery

magnesium sulfate

hydralazine

92
Q

what is eclampsia

A

pre-eclampsia plus seizures

can have cerebral herniation, hypoxic encephalopathy, aspiration, thromboembolic events

93
Q

what type of seizures are associated with eclampsia

A

tonic clonic

25% pre-labour
50% labour
25% after labour (even 7-10 days)

94
Q

how do you treat eclampsia seizures

A

magnesium sulfate for membrane stabilization

lorazepam IV

95
Q

define asymptomatic bacteriuria and why do we care about it in pregnancy

A

more than 100 000 colonies

5% of pregnancies

causes increased susceptibility to cystitis and pyelonephritis

15% complicated by bacteremia, sepsis, ARDS

96
Q

why do we treat asymptomatic bacteriuria in pregnancy

A

risks of preterm labour associated with pyelonephritis

97
Q

causes of UTI in pregnancy

A

staph saprophyticus

chlamydia

e coli

klebsiella

pseudomonas

enterococcus

proteus

coag - staph

GBS

98
Q

symptoms of UTI

A

dysuria

frequency

urgency

99
Q

diagnosis of UTI

A

UA with positive nitrites, WBC esterase, bacteria

100
Q

treatment of UTI in pregnancy

A

nitrofurantoin

101
Q

signs and symptoms of pyelonephritis

A

CVA tenderness

fever

dirty UA

*must have 2/3 criteria to diagnose

102
Q

treatment of pyelonephritis

A

IV ancef until afebrile for 48 hours then 7-14 days of PO keflex

103
Q

why is pyelonephritis more likely to occur on the right in pregnancy

A

because uterus is dextrorotated

104
Q

why are women predisposed to pyelonephritis in pregnancy

A

progesterone can cause urinary stasis which can predispose to pyelonephritis

105
Q

by when does morning sickness usually resolve

A

16 weeks

106
Q

define hyperemesis gravidarum

A

more pernicious vomiting associated with weight loss, electrolyte imbalances, dehydration and, if prolonged, hepatic and renal damage

107
Q

how do you treat hyperemesis gravidarum

A

maintain nutrition

NS with 5% dextrose

compazine

phenergan

reglan IV/IM

if needed–> TPN

108
Q

why should you not give coumadin in pregnancy

A

skeletal anomalies

nasal hypoplasia

109
Q

what should you use to treat DVT in pregnancy

A

heparin or lovenox

no coumadin

110
Q

symptoms of fetal alcohol syndrome

A

growth retardation
CNS effects
abnormal facies
cardiac defects

111
Q

treatment for alcoholism in pregnancy

A

aggressive counseling

adequate nutrition

112
Q

what are the risks of tobacco in pregnancy

A 
increased SAB
preterm birth 
abruption
decreased birth weight 
SIDS
respiratory disease
113
Q

what are the risks of cocaine in pregnancy

A

increased risk of abruption (from vasoconstriction)

IUGR

increased PTL

as a child, kid may have developmental delay

114
Q

what is the test for vasa previa

A

APT test–> uses KOH

if colour is pink–fetal
if brown–maternal

115
Q

what is the risk with heroine/methadone use in pregnancy

A

not so much use—it is the withdrawal that is the risk

116
Q

what is the risk of heroine/methadone use

A

miscarriage
PTL
IUFD

117
Q

what is the management of heroine/methadone addiction in pregnancy

A

enroll in methadone program

do not restart methadone if patient has not used for 48 hours

118
Q

when does milk letdown occur after delivery

A

24-72 hours

119
Q

can you continue to breastfeed with mastitis

A

YES

120
Q

what do you use to treat mastitis

A

dicloxacillin

121
Q

what should be used for birth control after delivery if breastfeeding

A

depo

micronor

(progesterone)

122
Q

what should be used for birth control after delivery if not breastfeeding

A

OCP
norplant
depo
orthoevra

(can have estrogen)

123
Q

define PPH

A

blood loss over 500 cc for vaginal delivery

over 1000 cc for C/S

124
Q

causes of PPH

A 
4 Ts
Tone (UTERINE ATONY)
Trauma
Thrombin 
Tissue

i.e uterine atony, retained products, placenta accreta, lacerations, uterine rupture, uterine inversion

125
Q

risk factors for uterine inversion

A

fundal placenta
atony
accreta
excess cord traction

126
Q

treatment for uterine inversion

A

manually revert
NTG
laparotomy

127
Q

risk factors for uterine atony

A

multiparity
history of atony
fibroids

128
Q

treatment for PPH

A

carbitocin

129
Q

diagnosis of hyperemesis gravidarum

A

persistent vomiting

weight loss above 5% pre-pregnancy weight

ketonuria

clinical dx

130
Q

ddx for hyperemesis gravidarum

A

multiple gestation

hyaditiform mole (molar pregnancy)

preeclampsie

HELLP

131
Q

what causes hyperemesis gravidarum

A

elevated serum progesterone and estrogen–> slowed gastric transit time–> delayed gastric emptying

and/or

elevated b-hCG–> higher levels may be correlated

cause is not definitively known these are only guesses

132
Q

non pharmacological tx for hyperemesis gravidarum

A

folic acid and multivitamin before preg

smaller more frequent meals

avoid spicy, fatty, strong odoured foods

more rest, shorter working days

motion sickness bands

ginger, peppermint

133
Q

pharmacological treatment for hyperemesis gravidarum

A

stepwise treatment protocol

  1. pyridoxine (vitamin B6) with doxylamine (antihistamine) –> AKA DICLECTIN
  2. can add a second antihistamine
  3. IV fluids and thiamine if dehydrated
  4. onsansetron if still not well managed
  5. consider dopamine antagonist (metoclopramide)
  6. prednisone tapered over two weeks
  7. consider enternal/TPN if absolutely required
134
Q

what can happen if hyperemesis gravidarum is left untreated

A

wernicke’s encephalopathy

malnutrition

rare complications:
mallory weiss tear, esophageal rupture, pneumothoraces, pneumomediastinum, rhabdo, osmotic demyelination syndrome

recurrence risk high

135
Q

what are post partum blues

A

changes in mood, appetite, sleep–> will resolve

50% of women experience

136
Q

what is post partum depression

A 
decreased energy
apathy
insomnia
anorexia
sadness

can get better or proceed to post partum psychosis

5% of women experience

137
Q

treatment for post partum depression

A

SSRIs

138
Q

what is endometritis

A

a polymicrobial infection invading the uterine wall after delivery

139
Q

signs and symptoms of endometritis

A

fever
increased WBCs
uterine tenderness at 5-10 days
foul discharge

140
Q

how do you manage endometritis

A

look for retained products–> do a D and C

treat with triple antibiotics until afebrile for 48 hours and pain gone –> AMPICILLIN, GENTAMICIN and METRONIDAZOLE
–> doxy should be used if chlamydia is the cause

Obstetrics and Gynecology (21 decks)

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