Lecture 16: OB-GYN Emergencies Flashcards
The MCC of abnormal vaginal bleeding in a PRE-menarcheal girl is…
Trauma/abuse :(
The MCC of abnormal vaginal bleeding once you hit reproductive age is…
Coagulopathies
It was first on her slide so im guessing MC
The MCC of abnormal vaginal bleeding in a POST-menopausal woman is…
Exogenous hormones
That OCP MHT
An unstable abnormal vaginal bleed can be treated with IV (), but a stable abnormal vaginal bleed can be treated with oral ()
- IV Estrogen
- Oral short-term MHT or TXA
The 5 RFs for an ectopic pregnancy are:
- Prior () pregnancy
- Prior () surgery
- () infections
- () disease
- (-osis)
- Prior ectopic
- Prior abd/pelvic/fallopian tube surgery
- STIs
- PID
- Endometriosis
Also smoking + older with fertility issues
The classic triad of ectopic pregnancy is:
- () pain
- () bleeding
- ()rrhea
- Abdominal pain
- Vaginal bleeding
- Amenorrhea
Which hCG lab test is preferred and WHY
Quantitative is preferred, aka it gives you an actual number like 30.
The first US you would get of a suspect ectopic pregnancy is…
TransABDOMINAL (bladder full)
TVUS is empty bladder
A typical home pregnancy test is the equivalent of hCG being ()
20
T/F: An unstable vaginal bleed in early pregnancy (< 20 weeks) with an Rh+ mother and Rh- fetus requires Rhogam and emergent OB consult.
False. It is for Rh- mothers with an Rh+ fetus
() describes the implantation of the placenta over the cervical os
Placenta previa
A pool of fluid in the posterior fornix is diagnostic of …
PROM
() describes vaginal bleeding in the first 20 weeks of pregnancy with a closed cervical os, benign exam, and no passage of tissue.
Threatened abortion
() describes partial passage of conceptus, usually between 6-14 weeks.
Incomplete abortion
() describes fetal death at less than 20 weeks without passage of any fetal tissue for 4+ weeks after fetal death
Missed abortion
The only two abortion types that require a D&C are…
- Incomplete: partial passage of products of conception
- Missed: fetus died 4 weeks ago
The empiric ABX for septic abortion are () or (), along with ()
- Unasyn or clinda
- Gentamicin
The timeframe for chronic HTN is beginning before () gestation or lasting () weeks after delivery
Started before 20 weeks or lasting 12+ weeks after delivery
AKA it already existed or it existed way beyond pregnancy
The time frame for gestational HTN is after () weeks gestation or in the immediate () period.
After 20 weeks gestation or with immediate postpartum period.
Elevated BP in pregnancy is SBP greater than () OR DBP > 90 on () occasions more than () hours apart.
- > 140
- > 90
- 2 occasions more than 4 hours apart
You should treat gestational HTN via ()
Lifestyle modifications
The presence of () turns gestational HTN into pre-eclampsia.
Proteinuria >= 300mg in 24 hrs
Alternative criteria linked
Besides proteinuria, HELLP syndrome is basically the equivalent to pre-eclampsia. It stands for…
- Hemolysis
- Elevated LFTs
- Low Platelets
HELLP!!!!!!
Severe pre-eclampsia is pre-eclampsia + ()
End-organ involvement
Pre-eclampsia becomes eclampsia once () occurs.
Seizures
In HELLP syndrome, () may not be present, which is always present in pre-eclampsia
HELLP does not always have elevated BP!!!
But it is a clinical variant of pre-eclampsia
Besides focused US for pre-eclampsia evaluation, you can also order a…
CT Abdomen
The DOC for both severe pre-eclampsia and eclampsia is…
IV MgSO4 4-6g
Severe HTN in pregnancy (with a goal to reduce by (%)), is either using () or ()
- 10% reduction in BP is goal
- IV Labetalol
- IV Hydralazine
Overall, the definitive way to solve severe pre-eclampsia/eclampsia is…
Delivering the fetus!
Pelvic pain is usually due to gynecologic pathology, but you must always get a ()
ALWAYS GET A PREGNANCY TEST N REPRODUCTIVE AGED WOMEN
Primary dysmenorrhea is essentially () pain that comes () period
Crampy abdominal pain before or after prior
NOT DURING
Mittelschmerz is pelvic pain that occurs () period
DURING period (ovulation)
Mittel like Middle
Ovarian cyst rupture causes (side) pain
Unilateral
You should be concerned about an ovarian cyst if it is greater than () cm, multi(), or (consistency)
- Greater than 8cm
- Multiloculated
- Solid
Normally just fluid filled
() describes sudden onset of unilateral, severe adnexal pain with N/V and fever. They have a hx of chemical ovulation.
Ovarian torsion
() describes chronic inflammation within the pelvis resulting from ()tissue implanting outside the uterus
- Endometriosis
- Endometrium-like tissue
T/F: Leiomyomas are benign smooth muscle tumors in the uterus and/or GI tract.
Trueeee
Uterine fibroids, the big single ones
PID encompasses 4 diseases:
- ()itis
- ()itis
- () abscess
- Pelvic ()itis
- Endometritis
- Salpingitis
- Tubo-ovarian abscess
- Pelvic Peritonitis
PID has 3 groups of diagnostic criteria:
- Group 1 (minimum criteria): () tenderness and () motion tenderness
- Group 2 (increased specificity): (systemic), Secretions elevated ESR/CRP, positive ()
- Group 3 (procedures based): lappy, Pelvic US/MRI, () biopsy
- Group 1: Uterine/adnexal tenderness and cervical motion tenderness
- Group 2: Fever, positive pelvic cultures
- Group 3: Endometrial biopsy
T/F: PID is a risk factor for ectopic pregnancy and infertility
TRUEEE
Pelvic pain is initially evaluated via a (imaging)
TVUS
T/F: A tubo-ovarian abscess causing pelvic pain is an indication to admit.
Trueee
2 ways to treat PID via IVs:
- () or (), with ()
- (), plus ()
- Cefotetan or cefoxitin, plus doxy
- Clinda plus gentamicin
- alternate: unasyn + doxy
Tin tan goes the dock, clint is a gentleman to women
If FQ resistance is high
Oral/OP tx of PID:
- () IM once, or () IM once with probenecid ORRRR
- another 3rd gen cephalo with () +/- Metronidazole
I wrote more important slide?
- Rocephin or Cefoxitin + probenecid
- 3rd gen + doxy +/- metro
