Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP 2 CK > OB > Flashcards

OB Flashcards

1
Q

No vaginal bleeding, closed cervical os, no fetal cardiac activity, empty sac

A

Missed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Vaginal bleeding, closed cervical os, fetal cardiac activity

A

Threatened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vaginal bleeding, dilated cervical os, products of conception may be seen or felt at or above cervical os

A

Inevitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Vaginal bleeding, dilated cervical os, some products of conception expelled & some remain

A

Incomplete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Vaginal bleeding or none, closed cervical os, products of conception completely expelled

A

Complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus

A

Fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dysmenorrhea, pelvic pain, heavy menses, bulky, globular & tender uterus

A

Adenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Obesity, no kids, chronic anovulation, irregular bleeding, intermenstrual bleeding, or postmenopausal bleeding, nontender uterus

A

Endometrial cancer/ hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

No cervical change for > or = 4 hours with adequate contractions

A

Labor arrest get a C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

No cervical change for > or = 6 hours with inadequate contractions

A

Labor arrest get a C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cervical change slower than expected?

A

Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MC cause of labor protraction

A

contraction inadequacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MC ovarian cancer in postmenopausal women? Tx?

A

Epithelial ovarian carcinoma. Vague sx. Pleural effusion and rectovaginal nodularity = mets. Tx: Ex Lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nagle Rule

A

Subtract 3 months from last period and add 7 days = date of birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preterm

A

25-37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Early term

A

37 wks - 38 wk and 6 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Full Term

A

39 weeks - 40 wks and 6 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Late Term

A

41wks - 41wks and 6 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Post Term

A

after 42 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Previabile

A

before 24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

First sign of pregnancy on physical exam. Where cervix softens.

A

Goodell’s Sign happens at 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ladin Sign

A

Midline uterus softens at 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chadwick Sign

A

Blue discoloration of vagina and cervix 6-8wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

the “mask of pregnancy” hyperpigmentation of the face. Can worsen with sun exposure

A

Cholasma 16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When does a pregnant women develop telangiectasias

A

First Trimester - develop in palms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Fist trimester

A

14 wks GA 12 weeks DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

2nd trimester

A

24 weeks DA and 26 weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When can a gestational sack be seen on US? What’s the Beta HCG

A

5 weeks or Beta-HCG of 1000-1500 or higher. (go with 1500 if have to pick)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Beta HCG has increased to 20,000-30,000 what trimester is it

A

3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Beta HCG is dropping, what trimester is it

A

2nd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Changes in Cardiology when pregnant?

A

Increased CO (increased HR) and decreased BP (slightly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

GI changes when pregnant?

A

Morning sickness (from incerased E and P, and HCG from placenta), GERD, and Constipation (Decreased colon motility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Renal changes when pregnant

A

Increased risk of pyelo due to increase in kidney and ureter size. Bigger uterus can compress ureters. Increases GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Hematology when prego

A

Anemic (from increased plasma), Hypercoaguable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

First Trimester… What happens?

A

See pt every 4-6 weeks. Get a US between 11 and 14wks. Hear heart at end of trimester. Get bloodwork, pap, and gonorrhea/chlamydia. Screening if desired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Most precise time to get fetus age?

A

US first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

2nd Trimester… what happens?

A

Screen for genetic and congenital problems at 15-20weeks (triple or quad screen). Auscultate fetal heart rate. 16-20wks quickening (feel fetal movement 1st time), multiparous may feel sooner. 18-20wks routine US for malformation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Quad Screen

A

Use MSAFP, Beta-HCG, Estriol, and Inhibin A(neural tube or abdominal wall defect) Looking for Downs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Third Trimester… what happens?

A

Visits every 2-3 weeks. After 36 weeks you visit every week. Get a CBC at week 27 (replace Fe orally as needed). Get a glucose load (at 24-28wk) if high confirm with oral glucose tolerance test. Cervical cultures for Chlamydia/ Gonorrhea and GBS at 36 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

3rd Trimester contractions. Sporadic and no cervical dilation

A

Braxton Hicks contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

If Braxton Hicks Contractions become regular, what do you do?

A

Check cervix to rule out preterm labor before 37 weeks. If preterm labor, cervix will be open.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do you treat GBS

A

Prophylactic abx during labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When do you treat Chlamydia and Gonorrhea when prego

A

Treat it when you see it. Get it out of there!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

A test done at 10-13 weeks in advanced maternal age or known genetic disease in parent.

A

Chorionic Villus Sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Chorionic Villus Sampling

A

10-13wks, obtains Karyotype, catheter into intrauterine cavity to aspirate chorionic villi from placenta (transabdominally or transvaginally)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Done after 11-14 weeks for advanced maternal age or known genetic disease in parent

A

Amniocentesis (gives fetal karyotype. Needle transabdominally into amniotic sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When do you get a fetal blood sample?

A

Patients w/ Rh isoimmunization and when a fetal CBC is needed. Needle transabdominally into uterus to get blood from umbilical cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Where does ectopic pregnancy usually implant?

A

Ampulla of the fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Ectopic pregnancy risk factors?

A

PID, Intrauterine Devices, Previous ectopic pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Strongest risk factor for Ectopic Pregnancy?

A

Previous Ectopic Pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

test for ectopic pregnancy?

A

Beta-HCG, US (location), Laparoscopy (removal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

If suspect Ectopic, what meds?

A

1 dose of methotrexate (follow for 4-7 days). Watch for a 15% decrease. If no decrease give another dose. If no decrease… surgerize. Follow until Beta-HCG is zero.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

If giving methotrexate… what labs should you follow

A

Transaminases to detet changes indicating hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

When to avoid methotrexate for ectopic treatment?

A

Immunodeficient, noncompliant, Liver problems, If ectopic is 3.5cm or larger. If you can auscultate a fetal heartbeat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Surgery treatment for ectopic pregnancy?

A

Salpingostomy (cut whole in fallopian tube to preserve it). Do a salpingectomy if needed and just remove it all. If mom is Rh negative, give her Rhogam so that other pregnancies won’t be affected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Pregnancy that ends before 20 weeks or a fetus <500g

A

Abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When do most spontaneous abortions occur?

A

before 12 weeks (60-80% due to chromosomal problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Maternal factors that increase risk of abortion?

A

Anatomic abnormalities, STDs, Antiphospholipid Syndrome, Endocrine (DM or Hyperthyroid), Malnutrition, Trauma, Rh isoimmunization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Prego with crampy abdominal pain and vaginal bleeding. What do you need to be thinking about?

A

Abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you distinguish the different types of abortions?

A

GET A US!!! MUST GET IT!!! need to get a CBC for blood loss and Blood type for Rh, but US makes the diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Complete Abortion treatment

A

F/U in office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Incomplete Abortion treatment

A

Dilation and curettage (D&C/medical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Inevitable Abortion treatment

A

D&C/ medical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Threatened Abortion

A

Bed rest, pelvic rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Missed Abortion

A

D&C/ medical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Septic Abortion

A

D&C and IV antibiotics, such as levofloxacin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Mom has big uterus, rapid weight gain, and incresed beta-HCG and MSAFP (higher than expected for gestational age)

A

CONGRATULATIONS! You have twins! Drinks for everyone!!! Except you, cause you’re pregnant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Monozygotic

A

1 egg and 1 sperm that split. Identical Twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Dizygotic

A

2 eggs and 2 sperm. Fraternal Twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Complications/ Risks for twins (or more) in utero

A

Spontaneous abortion of one fetus, premature labor and delivery, placenta previa, anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Number 1 risk factor for preterm labor

A

Other preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Contractions, dilation of cervix, (between 20-37wks)

A

Preterm Labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Evaluation of fetus in preterm labor?

A

weight, GA, and presenting part (Cephalic vs. breech)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

When do you not stop preterm labor?

A

Preeclampsia/eclampsia, Maternal cardiac disease, cervical dilation >4cm, Maternal hemorrhage (abruptio placenta, DIC), fetal death, or chroioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

When do you stop preterm delivery?

A

If 24-33 Estimated GA and 600-2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

How do you stop preterm delivery?

A

Betamethasone and Tocolytics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When do you not stop preterm labor?

A

34-37wk estimated GA and/or >2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What does betamethasone do for preterm labor/ fetus?

A

matures fetus’s lungs (effect starts at 24 hours, peaks at 48 hours and lasts for 7 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What do tocolytics do for preterm labor/ fetus?

A

Administer after steroids. Slow progression of surgical dilation by decreasing uterine contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Common tocolytics?

A

Mg, CCBs, Terbutaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What’s most common tocolytic, what are it’s side effects?

A

MG sulfate. SE: flushing, Head aches, diplopia, and fatigue. Toxicity can cause respiratory depression and cardiac arrest. Check via deep tendon reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Terbutaline

A

causes myometrial relaxation. SE: increased HR leading to palpitations and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

CCB

A

SE: Head ache, flushing, and dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Indomethacin can be used as a tocolytic. When do you use it?

A

NEVER!!! DONT YOU DARE F’ING PUT IT AS AN ANSWER!!!!! IT’S ONLY USED TO CLOSE A PDA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Gush of fluid from vagina in pregnant woman, what happened?

A

Premature Rupture of Membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How do you diagnose Preterm Rupture of Membranes

A

Speculums: fluid in posterior fornix, fluid turns nitrazine paper blue, fluid has a ferning pattern when allowed to air dry (WTF?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

When is premature rupture of membranes a problem?

A

When it becomes prolonged. 24 hours before delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Premature rupture of membranes leads to?

A

Premature labor, cord relapse, placental abruption, chroioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Premature rupture of membranes treatment

A

Chorioamnitis = delivery now. If fetus is term then deliver. Preterm fetus (betamethasone, tocolytics, ampicillin and 1 dose azithromycin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Abnormal implantation of placenta over the internal cervical os

A

Placenta Previa (cause of 20% of prenatal hemorrhages)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Increased risk of placenta previa

A

Previous c section, previous uterine surgery, multiple gestations, previous placenta previa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

when is digital vaginal exam or transabdominal US contraindicated?

A

Third trimester vaginal bleeding. May cause increased separation between placenta and uterus = sever hemorrhage. (Placenta Previa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Painless vaginal bleeding in pregnant woman, >28 weeks

A

Placenta Previa (can detect on US)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Diagnose placenta previa

A

transabdominal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Types of placenta previa

A

Complete, Partial, Marginal, Vasa Previa, Low-Lying Placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Placenta Previa - Complete

A

Complete covering of internal cercial os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Placenta Previa - Partial

A

Partial covering of the cercial os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Placenta Previa - Marginal

A

Placenta is adjacent to the internal os (often touching he edge of os)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Placenta Previa - Vasa Previa

A

Fetal vessel is present of the cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Placenta Previa - Low Lying Placenta

A

Placenta that is implanted in the lower segments of the uterus, but not covering the internal cervical os (more than 0cm, but less than 2cm away)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Placenta Previa Tx

A

Treat if lots of bleeding or decreased hematocrit. Treatment is strict pelvic rest (with no sexy time!!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

When do you deliver with Placenta Previa?

A

Unstaoppable labor (cervix dilated more than 4cm), Severe hemorrhage, Fetal distress. Give betamethasone, If have to deliver, you’re headed to Rome get that C-Section!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Placenta Acreta

A

abnormally adheres to the superficial uterine wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

placenta attaches to the myometrium

A

Placenta Increta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Placenta invades into the uterine serosa, bladder wall, or rectum wall

A

Placenta percreta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Why is placenta acreta bad?

A

When it’s time for he placenta to detach, it can’t. Results in hemorrhage and shock. Patient will likely need a hysterectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Placental Abruption

A

premature separation of the placenta form the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Why is placental abruption bad?

A

tears the placental blood vessels and results in hemorrhaging into separated space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What can placental abruption result in?

A

life-threatening bleeding, premature delivery, uterine tetany, DIC, and hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Risk factors for placental abruption

A

Maternal HTN, prior placental abruption, cocaine, exgternal trauma, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Placental abruption presentation?

A

Third trimester vaginal bleeding, severe abdominal pain, contractions, fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Tx for placental abruption

A

Immediate laparotomy w/ delivery of fetus. They don’t do a c-section because the baby might not be in the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Patient had placental abruption and their uterus was repaired after delivery. How does this affect subsequent pregnancies

A

All new pregnancies will be delivered at 36 weeks by c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Mom is Rh - and baby Rh +… what happens

A

Not a problem in first pregnancy. Mom antibodies attach baby. Causing hemolysis of fetus’s RBCs or hemolytic disease of the new born.

115
Q

Fetal anemia and extramedulary production of RBCs. Can result in Kernicterus.

A

Hemolytic disease of the Newborn (hemolysis increses released heme and bili)

116
Q

When do you test mom’s Rh?

A

Initial prenatal visit

117
Q

Mom initially tests Rh-, what’s next?

A

get an Rh antibody titer done. if it’s negative, then mom is unsensitized.

118
Q

What is the antibody screen of mom for?

A

see if mom is Rh- or +

119
Q

What is the antibody titer of mom for?

A

see how many antibodies to Rh+ blood mom has

120
Q

If mom is unsensitzed how do you keep her that way?

A

Give RhoGam anytime fetal antibodies might cross the placenta: (amniocentesis, abortion, vaginal bleeding, placental abruption, delivery)

121
Q

Prenatal antibody screening done at 28 and 35 weeks… Mom is still unsenstized, what next?

A

Give RhoGam to mom

122
Q

Mom is unsensitized and baby is Rh+ at delivery. What next?

A

Give RhoGam to mom

123
Q

Mom is sensitized if titer is > 1.4. What happens if it rises to above 1.16?

A

She gets RhoGam if it’s 1.4 or more. If its above 1.16 she gets amniocentesis to check fetal bilirubin level.

124
Q

Chronic HTN?

A

BP above 140/90 before the patient became pregnant or before 20 weeks gestation.

125
Q

What do you use to treat Chronic HTN?

A

Methyldopa, Labetalol, or Nifedipine

126
Q

BP > 140/90 that starts after 20 weeks gestation. (no proteinuria and no edema)

A

Gestational HTN, treat with methyldopa, labetalol, or nifedeipine

127
Q

Risk Factors for preeclampsia

A

Chronic HTN, Renal disease

128
Q

Severe Preeclampsia

A

3+ protein on dipstick, mental status changes, changes in vision, impaired liver function. (you have end organ damage sort of)

129
Q

What med prevents eclampsia

A

Mg Sulfate

130
Q

Patient with history of preeclampsia has a tonic clonic seizure

A

It’s eclampsia

131
Q

Eclampsia tx?

A

stabilize mom, then deliver baby. Control seizure with mg sulfate and bp with hydralazine

132
Q

HELLP

A

Hemolysis, Elevated LIver enzymes, Low Platelets

133
Q

How do you treat HELLP?

A

Same as eclampsia: stabilize mom then deliver baby

134
Q

Complications of pregestational DM (Type 1 or 2)

A

4x more likely preeclampsia, 2x more likely spontaneous abortion, increased rate of infection, increased postpartum hemorrhage

135
Q

Fetal complications of Moms pregestational DM (Type 1 or 2)

A

Increase in congenital anomalies (heart and neural tube defects), Macrosomnia

136
Q

Macrosomnia complications

A

Shoulder dystocia (shoulder gets stuck under the symphysis pubis during delivery)

137
Q

How do you evaluate mom with pregestation DM

A

EKG, 24 hour urine (creatine clearance and protein), HbA1C, Opthalmological exam

138
Q

How do you evaluate fetus when mom has pregestation DM

A

32-36wk (weekly nonstress test w/ US; >36wk twice weekly testing (one NST and one Biophysical Profile); 37wk Lesithin/sphingomyelin ration; 38-39wk just induce labor

139
Q

Gestational DM Complications

A

Preterm birth, Fetal Macrosomnia (etc.), Neonatal hypoglycemia. 2-4x more likely to develop type 2 dm after delivery

140
Q

Gestaional DM evaluated?

A

Screen between 24 and 28 weeks. Glucose load test first, if above 140 then do glucose tolerance test. If any of the 3 measurements in glucose tolerance test are elevated then you have gestational diabetes.

141
Q

Gestational DM treatment

A

Diet and exercise. then insulin (never tell a pregnant woman to lose weight)

142
Q

Fetus <10% for gestational age?

A

Fetal Growth Restriction

143
Q

Symmetric Intrauterine Fetal Growth Restriction

A

Brain in proportion to rest of body. Happens before 20 weeks gestation

144
Q

Brain weight is not decreased, Abdomen is smaller than head. Occurs after 20 weeks

A

Asymmetric Intrauterine Fetal Growth Restriction

145
Q

Number 1 preventable cause of Intrauterine Fetal Growth Restriction in US

A

Smoking

146
Q

Intrauterine Fetal Growth Restriction Dx:

A

US to confirm weight and gestational age

147
Q

Intrauterine Fetal Growth Restriction Complications

A

Premature labor, stillbirth, fetal hypoxia, low IQ, seizures, mental retardation

148
Q

Intrauterine Fetal Growth Restriction Treatment

A

Quit smoking, and get immunized to prevent infections, but no live immunizations when pregnant

149
Q

Fetus with an estimated birth weight >4500g

A

Macrosomia

150
Q

Macrosomia Risk Factors?

A

Maternal DM or Obesity, advanced maternal age, Postterm pregnancy

151
Q

Macrosomia Dx:

A

Fundal height > 3cm gestation age. Then get a US. US confirms gestational age

152
Q

How does a US confirm gestational age?

A

Mesaure femul length, abdominal circumference, and head diameter

153
Q

Macrosomia complications

A

Shoulder dystocia, Birth injuries (clavical fracture), low apgar, hypoglycemia

154
Q

Macrosomia tx:

A

Induction of labor if lungs are mature before fetus is >4500g

155
Q

If fetus is > 4500g what do you?

A

All Roads Lead to Rome, get a Cesarean Section

156
Q

Non Stress Test

A

Measures fetal movements and assesses the HR.

157
Q

Reactive Non Stress Test

A

Detection of 2 fetal movements, and acceleration of HR greater than 15bpm lasting 15-20s over a 20 min period

158
Q

If non stress test is reactive…

A

Fetus doing well

159
Q

if non stress test is nonreassuring…

A

Fetus could be sleeping. Use Vibroacoustic stimulation to wake up the baby.

160
Q

Biophysical Profile consists of?

A

NST, Fetal chest expansions (normal is 1/ 30 min), Fetal movement (normal is 3/30 min), Fetal muscle tone, & Amniotic fluid index (volume based on US). Each category is worth 2 points.

161
Q

Score Ranges of a Biophysical Profile?

A

8-10 = normal; 4-8 = inconclusive; 4 = below normal (consider delivery)

162
Q

Normal fetal HR

A

110-160BPM

163
Q

What’s a normal acceleration of fetal HR?

A

increase in HR of 15 or more bpm for longer than 15-20s. Twice in 20 minures is normal

164
Q

What is an early deceleration and what causes it?

A

Decrease in HR that occurs with contractions. Head Compression

165
Q

What is a variable deceleration and what causes it?

A

Decrease in HR and return to baseline with no relationship to contractions. Umbilical Cord Compression

166
Q

What is a late Deceleration? is it serious? what causes it?

A

Decrease in HR after contraction started. No return to baseline until contractions ends. Most serious. Fetal Hypoxia

167
Q

Fetal descent into the pelvic brim?

A

Lightening

168
Q

Benign contractions that don’t result in cervical dilation?

A

Braxton Hicks

169
Q

Blood tinged mucus from vagina, released with cervical effacement?

A

Bloody Show

170
Q

Stage 1 of Labor

A

Onset to full dilation of cervix. Primipara = 6-18 hours. Multiparious: 2-10 hours

171
Q

Latent Phase of Labor

A

Onset to 4cm dilation. Primipara = 6-7 hours. Multiparious: 4-5 hours

172
Q

Active Phase of Labor

A

4cm dilation to full dilation. Primipara = 1cm/hour. Multipara: 1.2cm/hour

173
Q

Stage 2 of Labor

A

Full dilation of cervix to delivery. Primipara: 30 minutes-3 hours. Multipara: 5-30minutes. This is where fetal descent happens.

174
Q

Stage 3 of Labor

A

Delivery of neonate to delivery of placenta. 30 minutes

175
Q

While waiting for the placental separation in stage 3, what should you do?

A

inspect and repair any lacerations of the vagina

176
Q

Medications used to induce labor?

A

Prostaglandin E2 (cerivical ripening). Oxytocin (increases uterine contractions). Amniotomy (puncture the amniotic sac via an amnio hook)

177
Q

Arrest of Cervical Dilation

A

no cervical dilation for more than 2 hours

178
Q

Prolonged latent stage

A

latent phase lasts longer than 20 hours for primipara or 14 hours multipara.

179
Q

Prolonged latent stage tx

A

Hydration and rest. Most will convert to spontaneous labor in 6-12 hours.

180
Q

Protracted Cervical Dilation

A

Slow dilation during active phase of labor. <1.2cm for primipara and <1.5cm for multipara

181
Q

3 Ps of Protracted Cervical Dilation

A

Power (contraction strength and frequency), Passenger (size and position of fetus), and Passage (fetus is larger than pelvis (cephalopelvic disproportion)

182
Q

Protracted Cervical Dilation - Cephalopelvic Disproportion Tx?

A

C-Section, all roads lead to Rome

183
Q

Protracted Cervical Dilation - Weak contractions Tx?

A

Oxytocin

184
Q

Types of Arrest Disorders

A

Cervical Dilation (no dilation for 2 hours) and Fetal Descent (no fetal descent for 1 hour)

185
Q

Etiology of Arrest Disorders?

A

Fetal presentation, , Cephalopelvic Disproportion, Excessive sedation/anesthesia

186
Q

Malpresentation (arrest disorder) what do you feel on vaginal exam?

A

a soft mass instead of the normal hard surface of the skull. Confirm with US

187
Q

Fetus’s hips are flexed and extended knees bilaterally?

A

Frank Breech

188
Q

Complete breech

A

Fetus hips and knees are flexed bilaterally

189
Q

Fetus’s feet are first: one leg (single footling) or both legs (double footling)

A

Footling Breech

190
Q

When do you perform an external cephalic version for breech?

A

After 36 weeks. Fetus will likely maneuver itself before 36 weeks.

191
Q

Shoulder Dystocia

A

Anterior shoulder is stuck behind the pubic symphysis.

192
Q

Risk Factors of Shoulder Dystocia

A

maternal DM and obesity, postterm pregnancy, hx of prior shoulder dystocia

193
Q

Treatment of Shoulder Dystocia

A

In this order!!! 1. McRoberts Maneuver. 2. Rubin Maneuver. 3. Woods maneuver. 4. Deliberate fetal clavicle fracture. 5. Zavanelli maneuver

194
Q

McRoberts Maneuver?

A

Mom Knees to chest to increase suprapubic pressure

195
Q

Bleeding more than 500ml after delivery

A

Postpartum hemorrhage

196
Q

Early postpartum hemorrhage timeline?

A

w/in 24 hours after delivery

197
Q

Late postpartum hemorrhage timeline?

A

w/in 24hrs-6 weeks after delivery

198
Q

Most common cause of postpartum hemorrhage?

A

Uterine Atony

199
Q

Inability to breastfeed after postpartum hemorrhage?

A

Sheehan Syndrome

200
Q

Tx of postpartum bleeding?

A

Check for rupture. If the exam is normal then do a bimanual compression and massage. If that doesn’t work give oxytocin.

201
Q

When do Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) begin?

A

When women are in their 20-30s

202
Q

PMDD is a more severe version of?

A

PMS. It will disrupt daily activities

203
Q

PMS and PMDD sx

A

Head Ache, Breast Tenderness, Pelvic Pain and bloating, Irritability and Lack of energy.

204
Q

PMS and PMDD Dx

A

Sx for 2 consecutive cycles, sx free period of 1 week in first part of the cycle (follicular phase). Sx must be present in the 2nd half of the cycle (luteal phase) and dysfunction in life

205
Q

PMS and PMDD Tx:

A

Decrease caffeine consumption and smoking. Give SSRI’s if sx are severe

206
Q

Menopause Age

A

48-52

207
Q

How does menopause start?

A

Irregular menstrual bleeding. Oocytes produce less estrogen and progesterone, both have LH and FSH start to rise. Women are asymptomatic for 12 months. Some women experience symptoms for years.

208
Q

Menopause Sx

A

menstrual irregularity, sweats and hot flashes (vasospasms), Mood changes, dyspareunia (pain in sex)

209
Q

Physical Exam findings of Menopause

A

Atropic vaginitis, decreased breast size, vaginal and cervical atrophy

210
Q

Menopause Dx

A

Increased FSH is diagnostic of menopause

211
Q

Tx of menopause

A

HRT for short term symptom relief and prevention of osteoporosis

212
Q

HRT is associated with ________________ and can lead to ________________.

A

Endometrial hyperplasia and endometrial carcinoma

213
Q

Contraindications to HRT in menopause

A

Estrogen dependent carcinoma (breast or endometrial cancer). History PE or DVT.

214
Q

Postcoital bleeding is….

A

Cervical Cancer until proven otherwise

215
Q

Menorrhagia, what is it?

A

Heavy and prolonged menstrual bleeding

216
Q

Hypomenorrhea, what is it?

A

Light menstrual flow. May only have spotting

217
Q

Metrorrhagia, what is it?

A

Intermenstrual bleeding

218
Q

Menometrorrhagia, what is it?

A

Irregual bleeding (time intervals, duration, amount of bleeding).

219
Q

Oligomenorrhea

A

Menstrual cycles >35 days long

220
Q

Postcoital bleeding

A

Bleeding after sexy times (cervical cancer till proven otherwise)

221
Q

Menorrhaia causes

A

Endometrial hyperplasia, uterine fibroids, dysfunctional uterine bleeding, IUD

222
Q

Hypomenorrhea causes

A

Obstruction (hymen, cervical stenosis), OCP

223
Q

Metrorrhagia causes

A

Endometrial polyps, endometrail/cervical cancer, exogenous E administration

224
Q

Menometrorrhagia causes

A

Endometrial polyps, endometrial/cervical cancer, Exogenous E administration, Malignant Tumors

225
Q

Oligomenorrhea causes

A

Pregnancy, Menopause, Significant weight loss (anorexia), Tumor secreting E

226
Q

Postcoital bleeding

A

Cervical Cancer, Cervical Polyps. Atrophic Vaginitis

227
Q

Dysfunctional Uterine Bleeding (DUB)

A

Unexplained or abnormal bleeding. Happens with anovulation. Ovaries make E but no corpus luteum is formed, so no progesterone. Endometrium will out grow blood supply and result in bleeding.

228
Q

Dx DUB ?

A

Endometrial biopsy for women over 35 to exclude carcinoma

229
Q

Any patient older than 35 with DUB should get what?

A

Endometrial biopsy to rule out carcinoma

230
Q

DUB Tx?

A

OCPs. D&C can be done to stop bleeding.

231
Q

DUB Severe Tx?

A

when patients are anemic, can’t be controlled by OCPs, or compromised lifestyle. Tx endometrial ablation or hysterectomy

232
Q

OCPs reduce risk of:

A

Ovarian carcinoma, endometrial carcinoma, and ectopic pregnancy.

233
Q

OCP risk?

A

Thromboembolism and Hepatocellular Adenoma

234
Q

IUD SE?

A

PID when placed. Must do genital cultures before they are placed.

235
Q

When does labial fusion occur?

A

Presence of excess androgens. MC cause is 21-B-hydroxylase deficiency.

236
Q

Labial fusion treatment?

A

Reconstructive surgery

237
Q

Who does Lichen Sclerosis affect?

A

affects any age. Postmenopause is increased risk of cancer

238
Q

Lichen Sclerosis and treatment?

A

White, thin skin extending from labia to perianal area. Tx is topical steroids.

239
Q

Who does Squamous Cell Carcinoma affect?

A

Any age, patients who have had chronic vulvar pruritus

240
Q

Squamous Cell Carcinoma and treatment?

A

Patients with chronic irritation develop hyperkeratosis (raised white lesion). Ts: sitz baths or lubricants (relieve the pruritis)

241
Q

Who does Lichen Planus affect?

A

30s-60s

242
Q

Lichen Planus and treatment?

A

Viole, flat papules. Tx: Topical Steroids

243
Q

where are Bartholin Glands?

A

Lateral sides of the vulva at 4 and 8 o’clock

244
Q

Bartholin Gland cysts/ abscess treatment?

A

I&D with cultures for gonorrhea and chlamydia

245
Q

Recurrent Bartholin Gland cyst/abscess tx?

A

Marsupialization (I&D where space is kept open with sutures)

246
Q

Vaginitis Risk Factors?

A

Antibioitcs, DM, Overgrowth of normal flora. Any factor that will increase the pH of the vagina

247
Q

Vaginitis sx?

A

itching, pain, abdominal odor, and discharge

248
Q

Saline wet mount shows clue cells

A

Bacterial Vaginosis = Gardnerella

249
Q

KOH shows psuedohyphae

A

Candida

250
Q

White cheesy vaginal discharge

A

Candida

251
Q

Candida tx

A

Pick an “azole” or nystatin

252
Q

Gardnerella Tx

A

Metronidazole or Clindamycin

253
Q

Profuse, green, frothy vaginal discharge

A

Trichomonas

254
Q

Saline wet mount shows motile flagellates

A

Trichomonas

255
Q

Trichomonas treatment

A

patient and partner with metronidazole

256
Q

Vulvar soreness and pruritis appearing as a red lesion with a superficial white coating

A

Pagets

257
Q

Who does Pagets affect

A

postmenopausal caucasion women

258
Q

Treatment of Pagets

A

vulvectomy

259
Q

Most common type of vulvar cancer

A

Squamous Cell Carcinoma

260
Q

Pruritis, bloody vaginal discharge, and postmenopausal bleeding

A

Squamous Cell Carcinoma

261
Q

How do you diagnose pagets or squamous cell carcinoma? When is staging done?

A

Biopsy. staging done in surgery

262
Q

Tx of unilateral squamous cell lesions w/out lymph node invovlement

A

modified radical vulvectomy. If lymph nodes are involved they must be excised (lymphadenectomy)

263
Q

Adenomyosis

A

invasion of endometrial glands into myometrium

264
Q

What age does adenomyosis affect?

A

Women age 35-65

265
Q

Endometriosis and uterine fibroids are risk factors for what?

A

Adenomyosis

266
Q

How do you diagnose adenomyosis definitively?

A

Hysterectomy

267
Q

Large, globular, and boggy uterus

A

Likely adenomyosis

268
Q

What is endometriosis

A

implantation of endeometrial tissue outside of the endometrium

269
Q

What sites are most common for endometriosis

A

ovary and pelvic peritoneum

270
Q

Who does endometriosis affect?

A

Women of reproductive age

271
Q

Endometriosis presentation

A

Cyclical pelvic pain that starts 1-2 weeks before menstruation and peaks 1 to 2 days before menstruation. Pain ends with menstruation. Abdnormal bleeding, and nodular uterus and adnexal mass are common!!!

272
Q

Endometriosis dx

A

Visualization via laparoscopy. Will look dark and rusty. Potentially described as chocolate cyst on ovary

273
Q

Endometriosis tx

A

NSAIDs, OCPs for mild. Moderate to severe = Danazole or Leuprolide (Decrease FSH)

274
Q

Androgen derivative that is associated with acne, oily skin, weight gain, and hirsutism

A

Danazol

275
Q

GnRH agonist and when given continuously suppresses E. Ass/ w/ hot flashes and decreased bone density.

A

Leuprolide

276
Q

When to surgerize for Endometriosis?

A

Severe or infertile. Goal is to restore pelvic anatomy and remove endometrial implants. May receive total hysterectomy and bilateral salpingo-oophorectomy

277
Q

PCOS Sx

A

Amenorrhea, or irregular menses, hirsutism and obesity. Acne, DM type 2

278
Q

Dx PCOS?

A

Bilaterally enlarged ovaries with multiple cysts on US. Increased T and obese. Increased LSH and decreased FSH. LSH/ FSH ration of 3:1

279
Q

Tx of PCOS

A

Weight loss. OCPs (controls androgens and prevents endometrial hyperplasia) Use OCPs if they don’t want kids

280
Q

PCOS and want to conceive?

A

Clomiphene and metformin

281
Q

Vaccines Contraindicated in Pregnancy

A

HPV, MMR, Live Attenuated Influenza, Varicella

282
Q

Recommended Vaccines during Pregnancy

A

TDAP, Inactivated Influenza, Rho(D) Immunoglobulin

283
Q

Vaccines indicated if high risk Pregnancy

A

Hep B, and Hep A, Pneumococcus, H. Influenza, Meningococcus, Varicella Zoster Immunoglobulin

STEP 2 CK (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions