OB Flashcards
Endometrial hyperplasia
-dx and tx
Abnormal uterine bleeding (usually in fat lady)… do endometrial biopsy
A) Shows hyperplasia w/ NO atypic: tx w/ progestin (it stops the effects of unopposed estrogen–remember the lady is fat as hell)
B) Shows hyperplasia W/ ATYPIA: do hysterectomy b/c cancer risk. Unless she wants more kids then just do progestin therapy
Gestational HTN dx
has to be >20 wks into pregnancy for dx. Otherwise it is just primary hypertension
Pera-shaped motile organisms dx and tx and SE from tx
- Trichomonal vaginalis
- tx=metronidazole.
- SE=alcohol use. Disulfiram-like rxn (flushing, nausea, com, Hypotension from acetaldehyde build-up)
Gestational Diabetes tx
1) Diat and exercise
2) Insulin or an oral med like Metformin or Glyburide
Small left colon syn
- inability to temporarily pass meconium but resolves spontaneously.
- happens in infants of diabetic mothers
MEN1 MEN2A MEN2B -What gene for all? -What kind of prophylaxis?
MEN1: primary hyperParathyridism, Pancreas tumors, and Pituitary tumors
MEN2A: medullary Thyroid carcinoma, Pheochromocytoma, and Parathyroid hyperplasia
MEN2B: medullary Thyroid carcinoma, Marfan habitus, Mucosal and intestinal neuromas, and Pheochromocytomas
-RET proto-oncogene
-All pts w/ MEN2 should get total thyroidectomy in early childhood b/c risk for getting MTC is like 100%
Amniotic fluid embolus tx
1) intubate and ventilate!
2) respiratory and hemodynamic support (whatever that means… ) also maybe do a transfusion if mom is really sick
Nonstress Test
- should be repeated AT LEAST weekly during the THIRD trimester of high risk pregnancies.
- reactive: 2 or more accelerations
- nonreactive: less than 2 accels, or a variable or late decel
Vasa previa
-when you go to rupture the membranes and a bunch of blood comes pouring out b/c you poked the umbilical cord that unfortunately was sitting just being the os. Baby is bleeding out. Question will show that baby will rapidly deteriorate and mom/uterus will be just fine.
What cancer does PCOS increase the risk for?
- Endometiral carcinoma
- b/c they have excess estrogen and less progesterone which leads to endometrial hyperplasia and thus the cancer risk. NO increased risk for ovarian cancer.
So you do a prenatal exam and find the baby in breech presentation…
-when to correct? what to do? what if that doesn’t work?
- most breech presentations correct by 37 weeks
- if after 37 weeks, then do external cephalic version
- if that doesn’t work then do a c-section
Severe features of preeclampsia
- BP at least 160 on two occasions >4hrs apart
- Thrombocytopenia
- Creatinine >1.1 or it doubles
- High Transaminases
- Pulm edema
- New-onset visual or cerebral sx
Severe Preeclampsia tx
IV hydralazine or IV labatalol (to prevent stroke) Mag sulfate (prevent seizures)
Lichen sclerosis tx
-what is it associated w/?
corticosteroids (not estrogen!!!)
-SCC
Arrest of labor in the FRIST stage?
-what do you do about it?
-no cervical change for at least 4hrs w/ ADEQUATE contractions. Do a C-section (NOT oxytocin if her contractions are adequate… duh!)
OR
-no cervical change for at least 6hrs w/ INADEQUATE contractions
Active labor definition?
6cm dilated. Any less is Latent Labor
-^that is stage 1. Stage 2 is 10cm dilated
Commonest causes of hyperandrogegism in pregnancy?
1) Luteomas: you’ll sees SOLID ovarian masses on US. 50% are b/l. High likelyhood of fetal female virilization
2) Theca Luteum cysts: b/l ovarian masses. LOL likelyhood of fetal female virilization
3) aromatase def
Indications for prophylactic anti-D immune globulin for an unsensitized Rh-negative pregnant woman.
- at 28-32wks gestation
- w/in 72hrs of delivery of a Rh-positive infant or if she has a threatened, spontaneous or induced abortion
- ectopic pregnancy
- hydatidiform mole pregnancy
- CVS, amnioscentesis
- abdominal trauma
- 2nd or 3rd trimester bleeding
- External cephalic version
GBS testing a preggo
-test at 35-37wks b/c the results last for about 5 weeks
No fetal heart tones? What’s the next step?
US!!!! Needed for dx.
-then check PT, PTT and INR and B-HCG
ASC-US management
1) do HPV testing
- Positive? Do colposcopy
- Negative? repeat PAP smear AND HPV testing in 3 years
Mom had a stillbirth and she is stable. What next?
Always ask for an autopsy of placenta and fetus
When and why to perform amniocentesis?
-16-20 wks for confirmation of an abnormal triple screen. Be sure to get US first
When and why to perform CVS?
-10-13wks. Used for women who want an early karyotype.
HELLP syndrome
-Hemolysis (schistocytes)
-Elevates Liver enzymes and
-Low Platelets
-ALSO almost all pts have RUQ abdominal pain and nausea/vom. Liver issues include centrilobular necrosis, hematoma formation and thrombi in the portal capillary system. These things lead to liver swelling which distend Glisson’s capsule = pain
btw alk phos is normally elevated in pregnancy
