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Gyge Flashcards

1
Q

Definition of Preeclampsia/Eclampsia

A

After the 20th gestational week
Preeclampsia : BP > 140/90mmHg, Proteinuria > 300mg/d
Eclampsia : Preeclampsia + Tonic Clonic Seizures

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2
Q

Indications for C-Section

A

M/F - Cephalopelvic disproportion, Failed Induction of Labor
Maternal - Eclampsia, Cervical cancer, Fibroid, Herpes
Fetal - Fetal abnormality(Hydrocephalus), Multiple Gestations, Malpresentaton, Cord Prolapse, Nonreassuring fetal HR(Bradycardia)
Placental - Previa, Abruptio

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3
Q

US in Pregnancy

A

0(6~7wks) = Confirm(Gestational sac, HR), Location Intrauterine or Extrauterine, Twins
1(11~13wks) = Congenital Malformations, Nuchal translucency(Down’s)
Neural tube defects, Biometrics
2(18~20wks) = Congenital Malformations, Genetics
3(30~31wks) = IUGR, Late Congenital Malformations
4(36~38wks) = Fetal Presentation, Fetal Weight, Info for delivery

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4
Q

Placenta abruptio / Placenta Previa Check

A

Use hands to Palpate the Uterus
Abruptio → Painful, Hard uterus → C-Section
Previa → Painless, Cardiotocograph normal → C-Section

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5
Q

PostPartum Hemorrhage

A

Retained Placenta, Vaginal Laceration, Coagulopathy(DIC), Uterine Atony(Exclude other causes)

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6
Q

Stages of Birth

A

Onset of Labor → Longest stage, Latent(3cm) / Active(3~10cm)
Baby → 30~90min, Propulsive phase(Full dilation, descend to pelvic floor), Expulsion Phase(Ends with delivery of baby)
Placenta → 5~30min, separation, Expulsion of Placenta → membrane
Recovery → 2h, after expulsion of placenta
Increased risk of bleeding, Repair laceration, RhoGAM

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7
Q

Techniques of C-section

A

Abdominal Wall : Transverse(Pfannenstiel), Vertical(Midline)
Uterus : Transverse(Lower segment incision), Vertical(Classical)

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8
Q

Pearl Index

A

Number of Pregnancies in 100 females/year with chosen contraceptive
Oral Contraceptives(0.1~2.5), PostCoital Pill(0.5~2.5)
IUD(0.5~5.5), Condom(3~28), Sterilization(0.3~6.0)

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9
Q

Routine Exam

A

Colposcopy, Cytology(pap smear), Bimanual exam, Breast exam

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10
Q

Longterm Oral Contraceptive use Advantage and disadvantage

A

Advantages - Decreased risk of Ovarian, Endometrial, Colorectal cancer
Lowers risk of Bone loss, Dysmenorrhea, Acne
Decreases risk of Trisomy in Older maternal age
Disadvantages - Increased risk of VTE(DVT, PE) due to low estrogen
Increased risk of Breast, Cervical, Liver cancer
Increased Body weight
Depression due to Low level of serotonin(Progestin)
Hypertension due to Progesterone(Cannot breakdown
bradykinin)

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11
Q

Endometriosis definition, diagnosis, Treatment

A

Definition - Endometrial like tissue outside the uterine cavity
Diagnosis - Gold standard is Laparoscopic Visualization
Treatment - Oral Contraceptives, Surgery(Ablation or excision, Segmental excision), Hysterectomy
Progesterone(Counteract estrogen and inhibit growth of endometrium)
GnRH Agonist, Aromatase inhibitor, Progesterone receptor modulator

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12
Q

Urinary Incontinence types

A

Irritative - Urinalysis → Cystitis, tumor, foreign body
Stress - Loss of Bladder support → Cough
Urge - Hypertonic → Increased Detrusor muscle → Anticholinergics
Overflow/Neurogenic - Hypotonic with dribbles → Cholinergics
Bypass/Fistula

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13
Q

Main Vaginal Infection

A

Bacterial Vaginosis, Trichomonas, Mycosis(Candida), Condyloma
pH Paper!!!!! Mycotic infection pH < 4.5

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14
Q

Spontaneous Abortion

A

Pain + Bleeding → Diagnosis by Cervix, US, hCG

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15
Q

Contraindications to Tocolysis

A

Obstetric(Severe Abruption, Ruptured membrane, Chorioamnionitis)
Fetal(Lethal Anomaly, Already dead fetus, Fetal jeopardy)
Maternal(Eclampsia, Advanced Dilation)

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16
Q

Leopold Maneuvers

A
  1. Fungal grip = Palpate upper abdomen with both hands
  2. Umbilical grip = Palpate to localize fetal back
    One palm to fix, while the other explores one side then change
  3. Pelvic grip = 1st Pelvic grip, Determine what fetal part is lying above the inlet, grasp lower portion of abdomen just above the pubic symphysis with thumb and fingers of the right hand
  4. Pawlick grip = 2nd Pelvic grip, Face woman’s feet, attempt to locate fetus brow. Fingers of both hands moved gently down the sides of the uterus to pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.
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17
Q

Stopping Uterine bleeding

A

Young = progesterone → Preserve fertility
Old = Dilation and Curettage

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18
Q

Mayer-Rokitansky-Kuster-Hauser Syndrome

A

Fancy word for Mullerian agenesis
- Congenital malformation, Failure of Mullerian duct to develop
- Missing uterus, Cervix, vagina, Variable degree of Upper vaginal hypoplasia(Shortened)
Causes 15% of Primary amenorrhea
Ovaries intact, ovulation usually occurs
Will enter Puberty and have secondary sexual characteristics

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19
Q

Pap Smear

A

p0 - Improper samble
p1 - Negative, Superficial cells on slide
p2 - Superficial cells and WBCs
p3 - Unsure
p4 - Atypical cells → Suspect Malignancy
p5 - True malignancy

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20
Q

Bethesda

A

Reporting Cervical or Vaginal Cytological Pap smear result
Important steps
1. Quality of the slide
2. Whether the result is positive or negative
3. Details of the slide(types of cells, LSIL/HSIL)
4. Physician recommendation of how to proceed

21
Q

Prenatal Care

A

Starts before conception

22
Q

Puerperium

A

Period beginning immediately after the birth of child extending for ~ 6w

23
Q

Statistics

A

Neonatal Mortality Rate - Number of Neonatal deaths during the 1st months/1000 live births
Early NMR in 1st week, Late NMR in 2~4th weeks
Perinatal Mortality Rate - Number of Perinatal deaths(Stillbirths + neonatal deaths from 22nd gestational week to 7th week postpartum) / 1000 total births

24
Q

To exclude ectopic pregnancy

A

Measure B-hCG
1000U/L Gestational sac, 7000U/L Yolk sac, 10000U/L Embryo
Brown spotting and abdominal pain indicates ectopic pregnancy
→ Check fallopian tubes
B-hCG doubles every 2nd day, if high but not doubled → Ectopic pregnancy

25
Q

Vitamin Supplements

A

Preconception : Folic acid up to 6 weeks before 400mcg/day
2nd trimester : Low dose Iron and Iodine 250mg/day

26
Q

History taking

A

Previous Operation
Allergy to medication
Obstetric anamnesis
Illness, drugs
First day of last menstrual period
- Naegele’s Rule : Can only be applied if menses are regular and cycle is 28days
- If 1st day = 20th September, +7days is 27th, -3months → June 27th delivery date

27
Q

Signs of Pregnancy

A

Presumptive sign : Chadwick’s sign → Bluish discoloration of the cervix and vagina due to pelvic vasculature engorgement(6th week)
Probable sign : Positive home urine pregnancy test, uterine enlargment, Breast engorgement
- Piskacek sign(Soft prominence over the site of implantation)
- Goodell’s sign(Softening of the cervix)
- Hegar’s sign(Softening of the cervical Isthmus)
Positive sign : Detection of a fetal Hemoglobin, recognition of fetal movement

28
Q

Location of Bartholin’s Cyst

A

Lower 1/3 of Labia Majora

29
Q

Marsupialization of Bartholin’s Cyst

A

Cyst opened at the edges + Sutured, forming an open pocket

30
Q

Asherman’s Syndrome

A

Adhesions/Fibrosis of the uterine cavity, usually from D&C, Reversible infertility

31
Q

Types of anesthetics used in C-Section

A

Spinal, Epidural(Vaginal delivery), Intratracheal Narcosis(Emergency C-Section)

32
Q

Appendicitis in Pregnancy, difficult to diagnose why?

A

Leukocytosis may occur in pregnancy

33
Q

Physiologic changes in pregnancy, renal system, hormonal changes

A

Increased RBF and GFR → Decreased Serum Creatinine
Increased Total Thyroid hormone, increased BMR

34
Q

Multiple gestation : How to differentiate dizygotic from monozygotic twins

A

If the twins are of different sex - Boy and girl = Dizygotics

35
Q

What does HELLP stands for

A

Hemolysis, Elevated liver enzymes, Low platelet count

36
Q

Toxoplasma how can you get it?

A

Household pets(Cats)

37
Q

Classification of C-section indications

A

SLIDE

38
Q

How to differentiate placenta Previa from placental abruptio

A

Put the hands on the mother’s belly and if it is firm = Abruptio

39
Q

Obstetric Emergencies

A

Massive Obstetric hemorrhage
Nonhemorrhagic shock(Amniotic fluid embolism, Acute uterine inversion)
Shoulder dystocia
Eclampsia
Cord prolapse(Cord compression)
Trauma

40
Q

Most common emergency obstetrical diseases

A

Infection, Endometritis, Pelvic Inflammatory Disease

41
Q

How to check if a fetus is infected with Toxoplasma

A

Do amniocentesis and check the viral DNA, PCR of Amniotic fluid

42
Q

Treatment of Toxoplasmosis

A

Affected women during pregnancy → Spiramycin
Infected Fetus → Pyrimethamine and Sulfadiazine

43
Q

Licit and Ilicit drug use

A

Mention the BP drugs you can give in pregnancy - Labetalol, Nifedipine, A-Methyldopa

44
Q

Preterm labor - What drugs do you give?

A

Betamethasone(Antenatal corticosteroid) + Tocolytics for 48h birth dealy for lung maturation
GBS prophylaxis(IV Ampicillin)
Mg-Sulfate for neuroprotection

45
Q

Uterine rupture how to diagnose on Physical

A

Loss of fetal station, Nature of patients pain changes to diffuse abdominal pain as opposed to contractions
Before rupture(Severe abdominal pain, Increased contraction followed by hyperactive labor, Bandl ring)
After Uterine rupture(Severe abdominal pain, Sudden pause in contraction, fetal distress - Deteriorating fetal HR, Vaginal Bleeding, Hypovolemia, Loss of fetal station, palpable fetal parts through the rupture)

46
Q

How to diagnose placental abruption / What examination would you do first?

A

Physical exam, Hypertonic Uterus

47
Q

Polyhydramnios/Oligohydramnios - How to measure (AFI), what are the cutoff values

A

<5 Oligo, >23 Poly

48
Q

Which patients would you send for genetic testing?

A

Older patient, Diabetic patient(Specifically mentioned Hba1c level)
Patient with previous pregnancy with aneuploidy or other abnormalities

49
Q

Physiological changes in Pregnancy CV changes

A

HR, CO, CV increase and Plasma volume increase

Gyne (1 decks)

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