OB Flashcards
3 signs of placental separation after delivery of baby
Gush of blood
Lengthening of cord
Uterine changes: hardening
Stages of labor
- Cervical dilation and effacement
Ends when cervical is fully dilated (10 cm) - Delivery of fetus
- Delivery of placenta
What is the role of hCG?
Maintenance of the corpus luteum in order to maintain progesterone secretion until the placenta is able to produce progesterone on its own
Premature rupture of membranes can cause what type of decelerations?
Variable – cord compression due to lack of amniotic fluid
Treat with amnioinfusion!
What does the progesterone challenge test look for?
Presence of estrogen
If there is withdrawal bleeding - pt has estrogen (PCOS)
If there is no withdrawal bleeding- pt does not have enough estrogen or has an anatomic condition (Ashermans syndrome)
When can you start to hear fetal heart tones?
12 weeks via Doppler
Erb palsy vs Klumpke
Erb: 5th and 6th cervical nerves
Klumpke: 8th cervical nerve and 1st thoracic nerve
Symmetric vs asymmetric IUGR
Symmetric IUGR
o Chromosomal abnormalities, congenital anomalies, fetal infections
Asymmetric IUGR
- Low abd circumference, normal biparietal diameter
o When fetal access to nutrients is compromised
o Maternal nutritional deficiency, HTN, uteroplacental insufficiency
What imaging should be done after a patient has an ultrasound-confirmed molar pregnancy?
CXR: most likely to metastasize to the lungs
Recommendation for seizure meds in pregnancy
High dose folic acid and stay on seizure meds
Treatment of dysmenorrhea
- NSAIDs
2. OCPs
Medical management of ectopic pregnancy
Methotrexate
Thyroid hormones changes in pregnancy
Free T3 and T4 levels = unchanged
TBG = increased
Total T4 = increased
Acid base status in pregnancy
Chronic respiratory alalosis with metabilic compensation
Why should asymptomatic UTIs be treated in all pregnant women?
Progsterone levels cause smooth muscle relaxation and ureteral dilation – increases risk of ascending infection (acute pyelonephritis)
Need to do a test of cure after antibiotic to make sure the infection has cleared
Twin twin tranfusion syndrome is seen in most in what type of twins
Monochorionic diamniotic
Most common cause of postpartum hemorrhage
Uterine Atony
Other causes: Tone: atony Tissue: retained placenta Trauma: laceration Thrombin: underlying coagulopathy
Protein level in 24 hours seen in severe preeclampsia
> 5000 mg (5 g)
The ovarian artery runs through which structure?
The suspensory ligament
Causes of fetal tachycardia
Maternal fever (chorio), maternal hyperthyroidism, medication use, placental abruption
Obesity is a risk factor for what type of cancer?
Endometrial: excess adipose tissue causes unopposed estrogen
Aromatase in adipose cells converts androgens into estrogens
What is the most effective screening test for Down Syndrome?
Cell free DNA
Treatment of early decels
Nothing. Related to head compression
What is the most accurate way of assessing gestational age?
First trimester US with crown-rump length
Atypical glandular cells on Pap test may be due to?
Cervical or endometrial adenocarcinoma
Colposcopy, endocervical curettage, endometrial biopsy
When, during pregnancy, are steroids no longer indicated?
After 34 weeks gestation
What antidepressant should not be used in pregnancy?
Paroxetine
Branches of the anterior division of the internal iliac artery
Obturator Inferior vesicle Internal pudendal Inferior gluteal Vaginal Uterine
What tests to order in secondary amenorrhea
1 = pregnancy test!
IF negative then order FSH, TSH , prolactin
Definitive diagnosis of endometriosis
Diagnostic laparoscopy
Most common congenital defect in maternal diabetes?
Cardiac defect
Treatment of lichen sclerosis and atrophic vaginitis
Lichen sclerosis: high dose topical steroids
Atrophic vaginitis: topical estrogen
What size cystic adnexal mass should be explored surgically in the reproductive age perido
10 cm
8cm if solid
Inc bhCG (in terms of cancer)
Choriocarcinoma
Cardinal movements of labor
Every Decent Family In Europe Eats Eggs
Engagement Descent Flexion Internal rotation Extension External rotation Expulsion
Oxytocin
Produced in hypothalamus and is secreted from the posterior pituitary gland
Stimulates uterine contractions
Pitocin is the synthetic form
Drugs used to control postpartum hemorrhage
Oxytocin
Methergine (contraindicated in HTN)
Hemabate (contraindicated in asthma)
Misoprostol
Painless vaginal bleeding after 20 weeks gestation
Placenta previa: the presence of placental tissue overlying or proximate to the internal cervical os
SUdden onset of pelvic pain in a woman with a known ovarian cyst should make you suspect?
Ovarian torsion
Glucose screening prenatal care
24-28 weeks
Sheehan Syndrome
When a patient experiences a significant blood loss during delivery, this can result in anterior pituitary necrosis (loss of prolactin, TSH, ACTH, gonadotropin, LH)
Slow mental function Weight gain Fatigue Difficulty staying warm No milk production Hypotension Amenorrhea
Down syndrome quad screen MSAFP Estriol hCG Inhibin
MSAFP low
Estriol low
bhCG high
Inhibin high
Treatment of late decels
Rotate mom
Give mom fluids, O2, tranfusion (if there is a hemorrhage)
OCPs post pregnancy
Non breastfeeding women
Can initiate progestin only products (micronor) right away
Initiate combined OCPs 3-4 weeks postpartum after hypercoagulability resolves
Breastfeeding women
Start progestin only pills 2-3 weeks postpartum
Wait to start combined OCPs for at least 6 weeks when lactation is well established
treatment of variable decels
Amnioinfusion
Antihypertensives in pregnancy
Labetalol
Hydralazine
Nifedipine
Treatment of postpartum endometritis
Clindamycin and gentamicin
Corticosteroids have what benefits on premature infants?
Protects against NEC and intraventricular hemorrhage
Increases surfactant production (lung maturation)
What hormone suppresses lactation during pregnancy
Estrogen
Inc inhibin
Ovarian cancer: granulosa cell tumor
When is anti-D immune globulin given to an Rh negative mother?
28-32 weeks gestation
GBS prophylaxis
<37 weeks unknown GBS status = everyone gets antibiotics
> 37 weeks unknown GBS status, treat all of the following
- GBS UTI during pregnancy
- previous infant with GBS sepsis
- maternal fever
- prolonged rupture of membranes >18 hours
When is tocolysis indicated
Before 35 weeks gestation
Where is a baby if they are at zero station?
At the level of the ischial spines
What is the threshold bHCG level for visualizing pregnancy on transvaginal US?
2000
Pelvic inflammatory disease antibiotics
Ceftriaxone + doxycycline
or
Ceftriaxone + azithromycin
Where does the ovarian artery branch from
Aorta
Inc LDH
Ovarian cancer: dysgerminoma
Why is renal insufficiency a risk factor for magnesium toxicity?
How do you treat magnesium toxicity
Magnesium is SOLELY excreted by the kidneys
Treat toxicity with calcium gluconate
Hormone levels in primary ovarian insufficiency
Dec estrogen, inc GnRH, inc FSH
Decreased ovarian function –> dec estrogen –> dec negative feeback on hypothalamus –> inc GnRH –> inc FSH –> infertility
How can you differentiate between hyperemesis gravidarum and typical nausea/vomiting of pregnancy?
Presence of ketones in urine
Hypokalemic hypochloremic metabolic alkalosis
PCOS increases risk of what cancer?
Endometrial (due to chronic unopposed estrogen)
1st trimester spontaneous abortions are seen in what chronic disease
DM
In utero exposure to DES can lead to what?
Clear cell adenocarcinoma of the vagina and cervix
Hydrops
Presentation and treatment
Abnormal fluid accumulation in 2+ sites: thorax, abdomen, skin
Tx with fetal transfusion
what part of the colposcopy is not performed in pregnancy?
ECC (endocervical curettage)
How does pyelonephritis lead to ARDS in pregnancy? (Pulmonary edema)
Endotoxin release!
Phases of delivery
Phase 0: uterine quiescence
Phase 1: preparation for labor
Phase 2: labor
Phase 3: post party
In someone who is less than 20 weeks pregnant and presents with signs of preeclampsia, what should you suspect?
Hydatidiform mole
What medical management can prevent preterm deliver
Weekly progesterone injections
Cervical diameter at active phase of labor
6 cm
Why should Bactrim be avoided in the third trimester of pregnancy? What other trimester(s) should it be avoided in?
It can cause kernicterus
Should also be avoided in the 1st trimester as it interferes with folate metabolism
Paget disease is associated with what type of breast cancer?
Adenocarcinoma
Enlarged placenta and a fetus with abnormalities, suspect…
Congenital syphilis
Branches of the posterior division of the internal iliac artery
Iliolumbar
Lateral sacral
Superior gluteal
Anatomical difference between atrophic vaginitis and lichen sclerosis
In lichen sclerosis, the vagina is not involved
What should you suspect in a post partum patient who is being treated for endometritis but has a fever that is unresponsive to antibiotics? How should you proceed?
Septic pelvic thrombophlebitis
Treat with anticoagulation and broad spectrum antibiotics
Inc AFP
Ovarian cancer: endodermal sinus tumor
Cerclage
Indicated in a patient with a history of >1 2nd trimester pregnancy loss related to cervical incompetence
Magnesium sulfate in preterm labor
Administered for fetal neuroprotection before 32 weeks
Medical treatment of uterine leiomyoma
GnRH agonist
When is rhogam given during prenatal care
24-28 weeks
Naegele’s Rule
Estimated day of delivery
Add seven to the date of the 1st day of the LMP and count back 3 months
Baby size in T1DM vs gestational diabetes
T1: small babies
Gestation: large babies
Babies can be hypoglycemic at birth
Drugs used to induce labor
Cervical ripening:
Dinoprostone (cervidil) – intravaginal, lasts 12 hours
Misoprostol (cytotec) – oral
After cervical dilation:
Oxytocin
Which choices of contraception have a <1% pregnancy rate?
Depo provera
Sterilization
LARCs (IUD or Nexplanon)
Adverse effects of oxytocin
Hyponatremia
Hypotension
Tachysystole (abnormally frequent uterine contractions)
When is Mg sulfate given in preterm labor? How about steroids?
Mg: less than 32 weeks
Steroids: less than 34 weeks
First trimester bleeding differential
Physiologic
Ectopic
Miscarriage
Structural pathology (cervical, vaginal, etc)
Minimum diagnostic criteria for PID
- Pelvic or lower abdominal pain
- Uterine tenderness or cervical motion tenderness or adnexal tenderness
(Chandelier sign)
Kleihauer Beck test
Used to determine if there has been fetal to maternal hemorrhage
Genetic screening timing
15-20 weeks
What is the most common karyotype in a spontaneous abortion
Autosomal trisomy (trisomy 16)
When should you repeat bHCG if you suspect miscarriage?
After 48 hours
How can you tell if someone has chronic HTN vs Gestational HTN?
Chronic HTN = before 20 weeks gestation
Gestational HTN = after 20 weeks gestation
What is the most common cause of sepsis in pregnancy?
Pyelonephritis
Cervical mucus prior to ovulation is due to what hormone?
Due to the surge of LH
Postpartum hemorrhage
500 cc in vaginal delivery
1000 cc in C section
What is a normal finding in urine in pregnancy that is abnormal otherwise?
Glucosuria
Magnesium mechanism as a tocolytic agent
Competes with Ca for entry into cells
Apt test
Used to dx vasa previa
Condyloma acuminata is caused by which strains of HPV
HPV 6/11
Fundal height
20 weeks = umbilicus
Above 20 weeks, fundus will be gestational age in cm
Indomethacin is contraindicated in….
Oligohydramnios
Treatment of chorioamnionitis
Broad spectrum antibiotics (ampicillin and gentamicin)\
Induction of delivery
Painful vaginal bleeding after 20 weeks gestation
Placenta abruptio: decidual hemorrhage leading to the premature separation of the placenta prior to delivery of the fetus
Managment of preeclampsia
W/o severe features: delivery after 37 weeks
W/ severe features: delivery after 34 weeks
Mg Sulfate
Antihypertensives
How do OCPS help with hirsutism in PCOS?
Inc the amount of sex hormone binding globulin, which will lower circulating free testosterone
