OB 2 Flashcards
3 things that cause elevated AFP in pregnancy
open NT defects, ventral well defects, multiple gestation
Is AFP up or down in aneuploidies
down
You get lab results with elevated AFP, what next?
fetal anatomy US
deltaF508 mutation
CF
Quad screen profile for Down Syndrome
low MSAFP and estradiol, elevated BHCG and inhibin A levels
sudden-onset, severe, unilateral lower abdominal pain with N/V
ovarian torsion
after sx pt develops fever, tachycardia and tachypnea, muscle rigidity
malignant hyperthermia, stop anesthesia and give DANTROLENE
difference between NMS and MH
NMS = neuroleptic agents (haloperidol, promethazine) and develops over course of DAYS
you suspect a gynecological tumor, what imaging to do first?
US
why do endometrial biopsy?
when suspect hyperplasia or carcinoma
with what gynecological problems do we use diagnostic laparoscopy?
endometriosis or pelvic adhesions
what is pseudocyesis
cond’n in which a nonpsychotic woman presents with signs and symptoms of early pregnancy and the belief that she is pregnant but evaluation excludes prenancy
N/V, uterine size larger than dates, markedly elevated BhCG, uterus filled with a heterogeneous cystic mass
hydatidiform mole
irregular menses, unable to get pregnant and low FSH and low Estradiol
hypogonadotropic hypogonadism - loss of pulsatile GnRH secretion previptated by weight loss, stress, chronic illnes
GDM target blood glucose levels
Fasting < 95
1 hr post-prandia < 140
2 hr post-prandial < 120
Woman presents in labor at 34 weeks, do you do tocolysis or proceed?
proceed when > 34 wks
Who gets external cephalic version?
> 37 weeks, breech, no CI to vaginal delivery
unilateral pelivc pain precipitated by strenuous activity or sex, free fluid in pelvis
ruptured ovarian cyst
complex multilocular adnexal mass, fever, leukocytosis,
tubo-ovarian abscess
bright, glazed, red-purple plaques and papules with an overlying white, lacy pattern, pruritus, pain, dyspareunia, other mucosal lesions (mouth)
lichen planus
hypopigmented skin, thin wrinkled appearance, pruritus, vaginal introitus stenosis
vulvar lichen sclerosus (post menopausal and young girls)
painless vaginal bleeding > 20 weeks
placenta previa - FHR tracing will look good, blood is maternal
risk factors for placenta previa
prior PP or c-section, multiple gestation
this causes second trimester pregnancy loss
cervical insufficiency (look for previous conization)
bleeding, abdominal pain, fetal decelerations, smokers
placental abruption - stabilize mom with aggressive fluid resuscitation and have mom on left lateral decubitas for uterine displacement
dx and tx or lichen planus
vulvar punch biopsy, high-potency corticosteroids
postcoital bleeding, mucopurulent d/c friable cervix
acute cervicitis
thin, grey d/c, fishey odor
BV
indications for vacuum/forceps
protracted second stage of labor, fetal HR abnormalities, maternal CI to pushing
Signs for Sertoli-Leydig tumor
frank virilization - voice deepening, male-pattern baldness, increased mucle bulk, clitoromegaly; and estrogen deficiency (breast atropy, vulvovaginal atrophy)
mgmt of labor < 32 wks
mag sulfate and indomethacin
when is indomethacin CI
> 32 wkns due to risk of premature fetal ductus arterosus closure
what can be prescribed to adolescents with irregular heavy menstrual bleeding
progesterone - stabilizes unregulated endometrial proliferation
post-partum hemorrhage, lactation failure, hypotension, anorexia
sheehan - piturity ischemic necrosis
endometrial glands within the myometrium bulky, tender uterus that is UNIFORMLY enlarged
adenomyosis
proliferation of smooth muscle cells within the myometrium, heavy menstural bleeding, IRREGULARLY enlarged uterus
leiomyomata uteri (fibroids)
When do you give Rhogam to Rh - mom
28-32 weeks and after delivery of baby is Rh + (do a test to determine amount of dose; inadeqate dose = alloimmunization)
mgmt of IUFD 20-23 wks
Dilation and evacuation or vaginal delivery
mgmt of IUFG >24 wks
vaginal delivery
critical elements of IUFD evluation
fetal autopsy, karyotype, placental examination, maternal lab testing for fetomaternal hemorrhage and APS
at what hBCG level should pregnancy be visible by US
1500-2000
raloxifene
antagonist in breast and uterus, agonist in bone; CI in pt with hx of thromboembolism
(tamoxifene = antag of breast and agonist of uterus, risk of endometrial proliferation)
what are SAB tx options
expectant mgmt, medical induction (misoprostol), suction curretage if infxn or hemodynamic instability
tamsulosin
a-blocker used for tx of overflow inctoninence by BPH
deafness, cardiac defects, hepatosplenomegaly, micocephaly, cataracts
congenital rubella syndrome
> 60 with new vaginal bleeding, malodorous discharge, irregular vaginal lesions
r/o vaginal cancer with biopsy
5 complications of shoulder dystocia
fractured clavicle fracture humerus erb-duchenne palsy klumpke palsy asphyxia
shoulder dystocia, decreased moro and biceps reflex on right side, righ arm with extended elbow, pronated forearm, flexed wrist and fingers, intact grap reflex
erb duchenne palsy
describe presentation of klumpke palsy
claw hand with extended wrist, hyperextended MCP, flexed interphalangeal, absent grasp, horner syndrome, intact moro and biceps
which nerves are injured in klumpke palsy
C8 and T1
waiters tip, 5th and 6th cervical nerves
erb-duchenne palsy
lab findings consistent with POI
elevated FSH
secondary amenorrhea, elevated FSH, vaginal atrophy, thin endometrium
POI
absolute CI to combined hormone contraceptives
migraine with aura > 15 cigarettes/day + age > 35 HTN heart disease DM with end-organ damage hx of TE disease or stroke APS Breast CA Cirrhosis and liver CA Major sx with prolonged immobilization use < 3 wks post partum
GnRH, FSH and Estrogen for POI
GnRH high, FSH high, Estrogen low
GnRH, FSH, and Estrogen for Hypothalamic hypogonadism
GnRH low, FSH low, Estrogen low
who gets hypothalamic hypogonadism
eating disorders or strenuous exercise (GnRH is low, and so is FSH and estrogen)
When start pregnant lady of acyclovir ppx for delivery
> 36 weeks
pH > 4.5, clue cells, positive whiff test, metronidazole or clindamycin
BV
pH > 4.5 in both of these causes of vaginal symptoms
BV and trichomoniasis
thin, yellow-green, malodorous, motile trichomonad, tx pt and sexual partner with metronidazole
trichomoniasis
pH < 4.5 (normal)
candid vaginitis
eclampsia tx
mag sulfate for seizure recurrence prevention, BP control, expedient delivery
normal cervical length?
> 2.5 cm
mgmt of pregnant lady with hx of preterm delivery
progesterone supplementation + serial cervical length measurements
impaired virilization during embryogenesis and testosterone to DHT conversion
5 alpha reductase deficiency
intrahepatic cholestasis of pregnancy
third trimester pruritus, elevated total bile acids, manage with ursodeoxycholic acid and delivery at 37 weeks
empiric tx of acute cervicitis
ceftriaxone + azithromycin
PID tx
cefoxitin + doxycycline
when to use progesterone withdrawal test
evalute secondary amenorrhea
most common cause of second stage arrest
cephalopelvic disproportion
what is adequate contractions?
> 200 mV unites average over 10 minutes
unilateral bloody nipple d/c without co-existing breast mass
intraductal papilloma
redness, ulceration, scaling and flaking of nipple
mammary paget disease
active phase arrest
no cervical change for > 4 hrs with adquate contractions OR > 6 hrs with inadequate contractions –> c-section
risk with short interpregnancy intervals
preterm labor, preterm prelabor ROM, low birth weight
epithelial cells coated with bacteria
clue cells of BV - tx = metronidazole or clindamycin
is labor and vaginal delivery CI after classical c-section (vertical incision) and myomectomy with uterine cavity entry?
YES due to significant risk of uterine rupture
placenta accreta risk factors
prio c-section, dilation and curretage, advaced maternal age
pt with secondary amenorrhea, elevated FSH levels, low estrogen (lack of withdawal bleeding after a progesterone stimulation challenge)
POI
can choriocarcinoma occur after hydatidiform mole, normal gestation and spontaneous abortion?
yes
where does choriocarcinoma metastasize?
the lungs; check bHCG
intrauterine synechiae
Asherman syndrome ; complication of intrauterine surgeries (myomectomy, curettage)
undercooked meat, cat feces, unwashed produce + bilateral ventriculomegaly, diffuse intracranial calcifications, fetal growth restriction + chorioretinitis, hearing loss, seizures
congenital toxoplasmosis
struma ovarii
teratoma composed of mature thyroid tissue
QUAD screen results for Trisomy 21
elevated BHCG and Inhibin A, low AFP
BhCG and Inhibin A are elevated in what abnormality?
Trisomy 21
These 3 values are decreased in Trisomy 18
MSAFP, BhCG, Estriol (afp is low in aneuploidy)
This value is increased in neural tube or abdominal wall defects and multiple gestation
MSAFP
Combined OCPs can be used in patients > X week pp while breastfeeding
6 weeks
vaginal bleeding, abdominal/pelvic pain that is excrutiating, uterine tenderness/rigidity
abruptio placenta (contrast to placental previa which is painless bleeding)
HSP tx
doxycycline
RUQ pain, leukocytosis, mildly elevated LFTs, hypoglyemcia, hyperbilirubinemai, thrombocytopenia
AFLP
> 40, dysmenorrhea, heavy bleeding, progressive chronic pelvic pain, boggy, tender and symmetrically enlarged uterus
adenomyosis
genotypically male pt that appears phenotypically female with primary amenorrhea, normal breast and female external genitalia development, and minimal or no axillary and pubic hair
androgen insensitivy syndrome (contrast to 5 alpha reductase deficiency where external genitalia is ambiguous)
how to differentiate AIS from mullerian agenesis
AIS = elevated testosterone and no hair
Mullerian agenesis = normal testosterone, normal female development with pubic and axillary hair
condyloma acuminata
HPV 6 and 11, nontender, verrucous genital lesions, tx = tricholoacetic acid or surgical excision
condyloma acuminata vs lata
acuminata = HPV, cauliflower shaped and raised lata = secondary syphillis, broad smooth base
first line HTN tx in pregnancy
labetaolol and methyldopa
what does early rupture of membranes put a pt at risk of
placental abruption, intraamniotic infection, umbilical cord prolapse, preterm labor
female pt with normal internal genitalia but ambiguous external genitalia
congenital aromatase deficiency; blocks conversion of androgens to estrogens
severe microcephaly, thin cerebral cortices, multiple intracranial calcification, craniosynostosis, multiple contractures, hypertonicitiy
zika
intracranial calcifications, hydrocephalus, chorioretinitis
toxo
what do these ovarian US findings suggest: solid mass with thick septations and the presence of ascites
malignancy - epithelial ovarian carcinoma
dysmenorrhea, deep dyspareunia, dyschezia
endometriosis, start on OCP
Describe thyroid function in pregnancy
T hormone prodxn + during pregnancy to cope with metabolic demands; estrogen causes + TBG, leading to increased total (but not free) T levels; hCG directly stimulates TSH receptors, causing + T prodxn
how to differentiate hyperemesis gravidarum from typical nausea and vomiting of pregnancy?
urinary ketones
presentation of vWD in pregnancy
PPH and prolonged bleeding - a PTT may be normal or prolonged
severe unilateral pain + abdominal mass
ovarian torsion
uterine tachysystole
> 5 contractions in 10 minutes
