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OB/GYN > Lectures 1 > Flashcards

Lectures 1 Flashcards

1
Q

Parameters for normal menstrual cycle

(a) duration
(b) time btwn cycles
(c) blood loss

A

Normal menstrual cycles

(a) 2-7 days, average 5 days duration
(b) 21-35 days from day 1 to day 1
(c) average 30 cc blood loss, normal is under 80 cc
- not clotted w/ endometrial debris

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2
Q

Discharge instructions for postparum mothers to prevent postpartum depression

A

Good sleep and nutrition

  • close monitoring/awareness and screening for symptoms (ex: symptom tracking)
  • ensure good support
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3
Q

Differentiate timing of delivery btwn types of twins

Didi
Dimono
Mono-mono

A

Timing of delivery- earlier and earlier the more the twins are separated

Didi twins- 38 wks
Di-mono- 34-38 wks
Mono-mono: 32-34 wks and C-sxn 2/2 risk of cord entanglement

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4
Q

Ddx for postpartum fever

A
  • endometritis
  • UTI (cystitis or pyelo)
  • wound infection
  • mastitis (clogged ducts)
  • HCAP PNA
  • C. dif, pelvic thrombophlebitis
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5
Q

Steps to decrease risk for preterm PROM in a pt w/ h/o PROM

A

Can give progesterone for PROM ppx

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6
Q

Important reminder when transfusing blood products

A

Need to use 1:1:1 ratio of FFP to pRBC to plts after 2uRBC to prevent dilution

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7
Q

Meig’s syndrome: triad of benign ovarian fibroma

A

Recall that most ovarian masses present w/ GI symptoms

Meig’s syndrome = triad of benign ovarian fibroma + ascites + right pleural effusion
-typically pleural effusion on the right b/c the transdiaphragmatic lymphatic channels are larger in diameter on the right

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8
Q

What counts as a LARC?

A

LARC = long acting reversible contraception

  1. IUD
  2. Nexplanon
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9
Q

Most common etiology of postpartum hemorrhage

A

Uterine atony

-uterus feels boggy/soft

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10
Q

2 ways we can try to prevent uterine atony

A
  • fundal massage
  • IV/IM oxytocin

= active management of the 3rd stage of labor (delivery of the placenta)
-give 20 of ptosin (oxytcin) + cord traction via suprapubic pressure

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11
Q

Describe some surgical techniques to manage uterine atony

A

Ligate the uterine artery
UAE = embolize uterine artery (via IR)k
B. Lynch sutures

Last resort = hysterectomy

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12
Q

Workup for adnexal/mass

(a) First line, second line
(b) How different if post-menopausal

A

Workup for adnexal/mass

(a) First line: Pelvic ultrasound
(b) and if post-menopausal test CA-125 (not if premenopausal b/c can be falsely elevated by endometriosis, fibroids, PID)

Second line (and definitive tx) = surgical exploration

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13
Q

Primary source of amniotic fluid

A

Amniotic fluid produced mostly by fetal urine output

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14
Q

Risk factors for postpartum hemorrhage

A

C-section
prolonged labor, prolonged induction
-large baby (anything that over-distends the uterus- b/c then it needs to get much smaller much faster)
-polyhydramnios
-infection
-use of Mg during pregnancy (used to pervent seizures in preeclampsia

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15
Q

Differentiate Braxton-Hicks from true labor contractions

A

Braxton-Hicks: irregular, inconsistent

  • usually in the third trimester
  • often can be ‘broken’: stopped when change what you’re doing or are distracted

True labor contractions: regular and consistent

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16
Q

Describe when estrogen peaks in the menstrual cycle

A

Estrogen produced by ovary and follicle (thing before ovulation causes corpus luteum), peaks at ovulation
-then LH peak comes shortly after

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17
Q

Define post-partum hemorrhage

A

Over 500 ccs after vaginal delivery

Over 1,000 cc after C-section

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18
Q

Serious consequence of persistent oligohydramnios

A

Pulmonary hypoplasia

-not enough pressure around the fetal lungs to allow for maturity

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19
Q

When do you deliver if pt has preeclampsia w/ severe features

A

34 wks

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20
Q

Define antepartum care

A

Care of pregnant mother before labor/delivery

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21
Q

Tox labs for preeclamspia

A
  • CBC for plts
  • BMP for Cr
  • LFTs
  • Uric acid (b/c builds up if kidneys can’t excrete), LDH
  • urine protein and creatinine for ratio (bad is over 3)
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22
Q

Name 3 meds that are well-established teratogens

A
  • coumadin (warfarin)
  • isotretin (acutane)
  • ACEi
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23
Q

Most common cause of coagulopathy in pregnancy

A

Placental abruption

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24
Q

Tx for uterine atony: 3 steps

A
  1. uterotonic meds
    - methergine (contraindicated in HTN)
    - hemabate (contraindicated in asthma)
    - oxytocin (pit)
    - mesoprostol
  2. bakri baloon
    - apply pressure to induce uterine tamponade to compress the spiral ateries
  3. surgical management
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25
Q

Describe medical management of uterine atony

A

Give methergine (unless HTN, then use hemabate first), then give mesoprostol (takes 20 mins to work)- then add more pit (oxytocin)

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26
Q

Describe a possible physiologic mechanism of preeclampsia

A

Abnormal migration or structure of cytotrophoblasts lining the spiral arteries => there is not appropriate decrease in resistance of the vessels

Also a component of vasoconstriction

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27
Q

3 most common causes of neonatal death in preterm births

A
  1. Respiratory distress
  2. Infection
  3. Interventricular hemorrhage
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28
Q

Describe diabetes screening during pregnancy

A

1-hr GCT (glucose control challenge) at 24-28 weeks

29
Q

Tx for endometritis

A

IV gentamycin + clindamycin

-or can use single agent unasyn (piperacillin/tazobactam)

30
Q

When can you detect fetal heart rate on transvaginal US

A

6 weeks

31
Q

Contraception recommended for the immediate post-partum period

A

Progesterone-only options b/c already have so much estrogen (pregnancy is already a hypercoagulable state), dont want to add more

Mirena IUD, Minipel, Nexplanon (lowest failure risk), Depo provera injection

32
Q

Describe the mechanism for anovulatory bleeding

A

Unopposed estrogens => no progesterone withdrawal (no corpus luteum to produce progesterone) => disordered growth of endometrium => abnormal shedding

33
Q

When is the EDD?

A

Estimated delivery date = 40 weeks after LMP

34
Q

Mneumonic for AUB

A

AUB mneumonic: PALM COIEN

PALM = structural/anatomic sources: more common post-menopause
P- polyps
A- adenomyosis
L- Leiomyoma (benign fibroids)
M- malignancy (endometrial or cervical cancer)

C- coagulopathy (VW disease- note echymoses petechiae) 
Ovarian dysfunction (ex: PCOS)
Iatrogenic- on heparin
Endometrial process
Not yet classified

ex: AUB-L for bleeding 2/2 fibroids

35
Q

Contraindication for sex during pregnancy

A

Placenta previa: placenta blocking opening of the cervix, ‘low lying’ placenta

Premature rupture of membranes

36
Q

Routine labs at first prenatal visit

A

UA, UCx, CBC, vaccination status, HIV/syphilis, blood type

-TSH

37
Q

Benefits of breast feeding

(a) for mother
(b) for baby

A

Benefits of breast feeding: suggest 6+ mo

(a) for mother: wt loss, decreased risk of breast cancer, newborn bonding, cost effective
(b) for baby: passive immunity

38
Q

PROM vs. PPROM

A

PROM = ROM before labor (so w/o cervical dilation or contractions)

PPROM = PROM before 32 weeks

39
Q

What abnormality on pap smear does not require colposcopy

A

All but ASC-US while HPV negative

40
Q

Differentiate primary and secondary postpartum hemorrhage

A

Primary- w/in 24 hrs

Secondary- over 24 hrs until 6-12 weeks post-partum

41
Q

Physical exam description of atropic vagin

A

Loss of rugae

42
Q

Recommendation for cervical cancer screening

A

Starting at age 21 (regardless of sexual activity) pap smears q3 yrs ages 21-30
-then pap smear + HPV co-testing q5yrs
(if doing just cytology w/o co-testing do pap smear q3y)

43
Q

What kind of twins have the highest risk of cord entanglement?

A

Mono-mono

44
Q

33 yo G1 s/p induction of labor for post-term baby

  • lengthy first and second stage
  • postpartum: brisk vaginal bleeding not responsive to uterine massage

Dx

A

Postpartum hemorrhage

-probably 2/2 uterine atony

45
Q

What kind of twins are most likely to require C-section

A

Mono mono b/c of the risk of cord entanglement causing fetal death

46
Q

How to date pregnancy

A

LMP, then get US to see if dates agree- if inconsistent use US dating over LMP
-consistent if w/in 1 week in the 1st T, 2 weeks in the 2nd, 3 weeks in the 3rd

47
Q

Maternal management of hep C in pregnancy

  • prevention of vertical transmission
  • breastfeeding?
A 
Don't treat- ribavirin is teratogenic...
hep A and B vaccination
-vertical transmission associated w/ maternal viral load
-C-section doesn't protect
-avoid scalp electrodes
-encourage breastfeeding
48
Q

When does menses return after pregnancy?

A

4-5 weeks, longer (can be months) if breastfeeding, especially if exclusively breast feedling

49
Q

When is C-sxn indicated for macrosomic fetuses?

A

Primary C-sxn if over 4500 w/ diabetes, over 5000 w/o diabetes

50
Q

Most common presenting feature of ovarian cancer

A

GI symptoms not gynecologic!

-bloating, abdominal pain

51
Q

Ddx for postpartum fever refractory to 48 hrs of IV abx

A

pelvic abscess

thrombophlebitis (inflammation of pelvic vasculature)

52
Q

Chorioamniontis vs. endometritis

A

Just depends on if pt has delivered yet

Fever before delivery (like in labor) = chorioamnionitis
After delivery = endometritis

53
Q

Timing and fxn of anatomy scan

A

Anatomy scan at 18-20 weeks

  • determine sex of the baby
  • assess growth of fetus
54
Q

What kind of twins are at risk of twin-twin transfusion syndrome

A

Diamniotic monochorionic

-due to collateral flow/vascular anastomosis

55
Q

3 steps when preterm delivery is imminent

A
  1. Steroids
  2. Tocolytics for 48 hrs
    - nifedipine, terbutaline, indomethacin
  3. MgSO4

-use indomethacin over nifedipine if possible when using Mg 2/2 risk of respiratory depression

56
Q

Differentiate purpose of umbilical artery vs. MCA doppler

A

Umbilical artery doppler used to assess systolic/diastolic ratio- indicative of uteroplacental insufficiency

MCA doppler to assess for anemia
-b/c there will be increased blood flow/velocity to the brain if fetus is anemic

57
Q

Treating pain in pregnancy

A

Use tylenol

-avoid NSAIDs

58
Q

Name the 3 stages of labor

A
  1. Dilation of cervix
  2. Fully dilated to end of delivery (delivery of fetus)
  3. Delivery of placenta
59
Q

You pee on a stick…what comes up as + pregnancy test?

A

b-hCG over 25 = positive test

60
Q

5 steps once PROM has been confirmed

A
  1. Admit the patient: get them on EFM (external fetal monitor) and toco
  2. Latency abx (ampicillin, erythromycin) to increase latency period by 5-7 days
  3. Betamethasone- ensure fetal lung maturity in case delivery is imminent
  4. If contracting: tocolytics for 48 hrs
  5. MgSO2 for CP ppx (if before 34 wks) if you think delivery is imminent
    - want it on board for at least 4 hrs to be effective for CP ppx
61
Q

Most common type of malignant ovarian neoplasm

A

90% of malignant ovarian neoplasms are epithelial

-includes mucinous, serous, clear cell, endometrioid

62
Q

Pt comes in not in preterm labor, what two things can you do to assess her risk of going into preterm labor

A

Negative fetal fibronectin (FFN) + cervical length of over 2.5 indicates pt is at very low risk for preterm labor

63
Q

What is lochia?

A

Vaginal discharge after birth (puerperium) containing blood, mucus, uterine tissue
-typically continues for 4-6 weeks after childbirth (known as the postpartum period)

lochia rubra (red) –> serosa (brown/pink) –> alba (yellow/white)

64
Q

2 phases on the menstrual phase based on

(a) Gonadotropins
(b) Endometrial lining

A

Menstrual cycle phases

(a) follicular and luteal based on LH
(b) Proliferative and secretory based on endometrium

65
Q

Tx for chorioamnionitis

A

Ampicillin + gentamicin

-need amp not for the mother but to protect the fetus from GBS

66
Q

Factor to determine pregnancy wt gain

A

Ideal wt gain in pregnancy depends on pre-pregnancy weight

-less wt gain if obese, vs. want more wt gain if underweight before pregnancy

67
Q

Differentiate the cause of symmetric vs. asymmetric IUGR

A

IUGR = fetus less than 10th percentile

Symmetric IUGR = early onset 2/2 TORCH infection

Asymmetric IUGR = later onset, 2/2 UPI (uteroplacental insufficiency)
-more likely to be reversible

68
Q

24 yo G1P1 3 days post-op from C-section (2/2 fetal tachycardia to 170 bpm) p/w fever of 102.2 and increased abdominal pain

Dx

A

Since she’s postpartum = endometritis

-increased risk b/c chorioamnionitis (as evidenced by fetal tachycardia)

69
Q

Tests for fetal well being in the third trimester

A

GBS and HIV test

NST = fetal non-stress test: reactive NST is 2 accelerations in 30 mins

OB/GYN (10 decks)

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