OB Gyn Flashcards
small bowel obstruction
adjustment disorder is diagnosed when
symptoms occur within 3 months of stressor
Asherman syndrome
intrauterine adhesions
symtoms: amenorrhea, infertility
light period due to decreased amount of functioning endometrium
azoospermia
no sperm in ejaculate
Baby who has Horner’s Syndrome and klumpke palsy most likely has injury to ?
C8 and T1 nerves
Bactrim use in pregnancy
avoided in 3rd trimester cus of risk of kernicterus
Beneficence vs nonmaleficence
beneficence: addition of benefits
nonmaleficience: avoidance of a harm
causes of second stage arrest of labor?
Definition of arrest of labor?
complete procidentia
severe form of pelvic organ prolapse
contraindications to exercise for pregnant women
critical valueof of anti-D immuneglobulin titer
1:32
cystic fibrosis gene
delta f508 mutation
Delivery method recommendation for pregnant patient who has received a classical c-section
c-section at 37 weeks
dichorionic diamniotic pregnancy has ___ placentas
whereas a monochorionic diamniotic has ____
Dichorionic - 2 placentas
monochorionic- 1 placenta
during labor, a protruding vaginal mass, min signs of vaginal bleeding, but with hypovolemic shock is probably
vaginal hematoma
ectopic pregnancy: when to treat with MTX and when not ?
Hemodynamically stable, pt reliable for followup
IUP ruled out
size <3.5 cm
no fetal cardiac activity
BHcg less than or equal to 5000
When not to use:
BHCG greater than or equal to 15000
size >3.5cm or ruptured
Thrombocytopenia: PLT < 100,000
Renal or Hepatic Disease
active peptic ulcer disease
IUP, breastfeedimg
Female Puberty Stages
Thalarche ( Breast Development) 9.5 yrs
Adrenarche
Growth Spurt
Menustration
TAG M
Menstruation within 1-2 yrs after thelarche
gestational trophoblastic disease
haas chorionic villi and bHCG> 500k
hormone produced during menustratio, that causes increase in body temperature
progesterone
how long is the corpus luteum the primary source of progesterone for pregnancy?
8-10 weeks getation
how would hyperemesis gravidarum affect the developing fetus?
- no impact if treated
- if it isn’t treated appropriately then premature birth
Hydrosalpinx
accumulation of fluid of in Fallopian tube due to chronic inflammation
Hysterosalpingogram (HSG) is? useful for?
- contrast is injected through the cervix to outline the uterine cavity and Fallopian tubes
- detecting abnormalities in those areas— ie bicornate uterus, hydrosalpinx, salpingitis isthmica nodosum
- doesn’t detect things outside ie endometriosis, ovarian tumor
- fallopian tube patrency and uterine lining
immune thrombocytopenia purpura
autoantibodies aginst platelet surface antigens, causing thrombocytopenia and increaed bleeding
In a pregnant patient with HIV when do you start antivirals?
combinations antiretroviral as soon as possible
inadequate contractions
< 200 Montevideo units over 10. minutes
Inevitable abortion
< 20 weeks, vaginal bleeding, pelvic pain, dilated cervix
Infertility diagosis
<35yo - no concepiton after 12 months of trying’ >35 yo 6 months of trying
intra-amniotic infection/ chorioamnioitis signs:
* common with
signs: N&V, uterine fundal tenderness, abnormal uterine muscle contractility
diagnosis: maternal fever + 1 of following
- fetal tachycardia (>160) for at least 10 min, maternal leukocytosis, maternal tachycardia, purulent amniotic fluid
- premature rupture of membranes
intrammniotic fluid infection (IAI) treatment
- broad spectrum antibiotics
- immediate delivery with augmentation
- pt with PPROM + IAI –> always deliver not expectant management
vulvar lichen planus
2 types
1) Erosive variant
associated with oral ulcers, erosive glazed lesions with white border
2) papulosquamous variant
small pruritic papules with purple hue
McCune Allbirght Syndrome 3 P’s
- precocious puberty
- polyostotic fibrous dysplasia (normal tissue is replaced. by fibrous tissue causing x-ray changes)
- pigmentation Café-au-lait spots
Mittelschmerz
- Enlargement and rupture of the follicular cyst and contraction of Fallopian tubes during midcycle ovulation lead to transient peritoneal irritation from follicular fluid.
- Physical examination: lower abdominal pain on palpation, enlarged adnexa
- Diagnostics: Pelvic ultrasound shows simple follicular cyst and small amount of intraperitoneal fluid
- Management: reassurance and symptomatic treatment with NSAIDs prn
MSAFP is low for
aneuploidies, trisomy
myelomeningocele
neural crest arch fails to fully form posteriorly - dura and spinal cord protrude posteriorly out of the spinal cord
- can be due to folate metabolism abnormality or lack of adequate folic acid concentrations
neuraxial anesthesia lengthens which stage of labor?
the second stage
normal post partum bleeding. lochia lasts
6-8 weeks
normal semen analysis: sperm count, motility, morphology, volume
sperm count >15 million/mL; motility (>40%); morphology >4%; >1.5mL
Ovarian torsion vs appendicitis
Ovarian torsion, sudden onset; appendicitis occurs over days with leukocytosis and fever
Intrauterine Fetal Demise Causes
death after 20 weeks gestation, while still in utero
persistent mullerian duct syndrome
karyotype and sx?
46, xy
mullerian structures include uterus, Fallopian tube, cervix, part of vagina
deficiency of mullerian inhibiting
factor in males causes persistence of these structures
-will see normal male genitalia with female structures internally
- infertile
Placental abruption can cause, risk factors?
postpartum fever
Temp > 38 degree or 100.4 F
precocious puberty age and treatment
girls <8yo
boys <9 yo
Treatment
GnRh agonist (leuprolide),
will initially see increased GnRh and in sex steroids week 1-2 of treatment, d/c at age of puberty
Preeclampsia with severe features
When do you deliver?
Deliver if > 34 weeks
LirN, PT
Liver abnormality ( RUQ pain, AST/ALT > 2ULN)
Renal abnormality Scr >1.1, 2x increase
Neural defects ( Scotomata AMAS)
Pulmonary edema
Thrombocytopenia < 100K
primary amenorrhea diagnosis and evaluation
13yo or older : no menses or sex characteristics
15yo or older: no menses with sex characteristics
Evaluation TSH and pelvic ultrasound
Primary amenorrhea, breast present, but uterus absent
- mullerian agenesis ( 46,xx) mullerian structures just don’t form, normal testosterone 2. Androgen insensitivity syndrome (46, xy) male but no androgen receptor so will see no pubic hair
primary amenorrhea: no breasts, no uterus
17 alpha hydroxylase deficiency
46,XY female external genitalia but internal male genitalia, infertile
primary amenorrhea: no breasts, uterus present
- no ovarian follicle top produce sex steroid, estrogen ( FSH high) GT17 Gonadal Dysgenesis, Turner Syndrome 17alpha-Hydroxylase deficiency 46(,XX) 2. HPA Axis disorder, low (FSH from lack of GnRh secretion) Kallman Syndrome, lesion in brain
Primary dysmmenorrhea signs and ysmtoms
sx: pains 2-3 days of menses, n&V, diarrhea, normal pelvic exam
in pregnancy, progesterone therapy is indicated for
patients with a prior spontaneous preterm delivery
Pt with recent surgery, no flatus, bowel moment, mildly distended abdomen/ decreased bowel sounds. How should they be ,=managed?
post op ileus self resolves
- antiemetics, bowel rest, and serial examinations
- avoid opioids and rectal enema will worsen issue
risk factors for intrauterine adhesions includes
infection, intrauterine surgery (d&C)
routine pregnancy test for first visit
sarcoma botyroides
rhabdosarcoma of the vagina
- soft nodules at the vaginal entrance that has the appearance of a cluster of grapes ( no bleeding or discomfort)
should a woman with blood type O who gives birth to an infant with blood type a or b be concerned? why or why not?
No because, A and B antigens will be present on fetal tissue ( in addition to RBC) neutralizing the hemolytic antibody response
- newborns will only have milder form of disease that can be managed with phototherapy, oral rehydration, exchange transfusion for severe cases
Shoulder dystocia Management
BE CALM
- Breath
- Elevate hip, flex hips, thighs against abdomen and apply pressure to surpapubic area (mc roberts)
-Call for Help
- enLarge vaginal opening with episiotomy ( laceration to vagina)
-Maneuvers
- deliver posterior arm
-Woods ScrewL rotate posterior shoulder
-Rubin: Adduct posterior shoulder
-Gaskin: mother on all fours
- Zavanelli: replace fetal head into pelvis for c-section
Signs of cephalopelvic disproportion and caused by?
molding and caput, can be caused by malposition of fetus
Caput: swelling on baby scalp due to pressure from squeezing through pelvis in difficult delivery
Molding: changing of shape of head from squeezing through a small birth canal
signs of DIC, associated labs
- increased fibrinolysis causes:
—-lower fibrinogen (protein that helps form clots, low means you can’t form clots) and increased d-dimer
- low platelets
- prolonged bleeding time
- bleeding from all sites
signs of infected perineal laceration and treatment
fever, wound breakdown, purulent drainage
tx: suture removal, antibiotic, surgical debridement
signs of liver failure
hypoglycemia, thrombocytopenia, not seen with cholecystitis
single lab to assess ovarian reserve
anti-mullerian hormone
sinusoidal fetal heart tracing is a sign of
fetal anemia
Surgical management of ectopic pregnancy
laparoscopy unless patient is hemodynamically unstable or large intraperitoneal bleed (laparotomy preferred for more emergent cases)
salpingectomy: removes fallopian tube, good if pregnancy is ruptured or tube is severely damaged
salpingostomy: unruptured distal tubal ectopic pregnancy, spares the tubes
Symmetric fetal growth restriction(FGR) that occures during the first trimester is likely due to “________ “vs asymmetric FGR where is head is larger, 2nd 3rd trimester onset , due to “________”
chromosomal abnormality, congenitial infection
uteroplacental insufficiency / maternal malnutrition
Symptoms of Sheehan syndrome
Tanner Stage 2
Tanner Stage 4
Tanner Stage 3
Tanner Stage 5
Tanner Stage 4
these birth defects are a result of
alcohol use
these birth defects are a result of
hydantoin or phenytoin use
To assess ovulation, what hormone level, when, cutoff?
day 21 (mid luteal phase) progesterone >3ng/mL means pt is ovulatory
transfuse RBC when
Hct<21 of Hg < 7
treatment of retroperitoneal hematoma
surgical intervention
treatment of vulvar and vaginal hematoma
ice pack, potentially incision and drainage
fever, diffuse lower abdominal pain
US: multicystic adnexal mass with thickened walls
tubovarianabscess symptoms
urethritis is and is caused by?
urinary urgency, frequency, and dysuria
cause: chlamydia, gonnorrhea
uterine leiomyoma vs endometrial polyp vs adenomyosis
endometrial polyp: light menstrual bleeding, lesions are inside uterus so uterus is small
uterine leiomyoma: fibroid, heavy prolonged menses and enlarged bulky uterus, pain with menses
-adenomyosis: uniformly enlarged, boggy uterus
uterine rupture is characterized by
- management?
- pain, signs of fetal distress, loss of fetal station, light to moderate vaginal bleeding
- Management: emergent laparotomy with c-sections within 30 minutes
uterine septum resection would fix
recurrent pregnancy loss
varicoceles are?
effect on semen analysis
dilatation of the pampiniform plexus of spermatic vein and scrotum
decrease in spermatozoa, motility and increased abnormal forms
virilization
female developing characteristics associated with male hormones
vulvar hematoma is caused by
vagina hematoma
retroperitoneal hematoma
injury to pudendal artery
uterine artery
hypogastric artery
What is this ? Treatment?
Erb’s palsy c-5-6 brachial plexus injury
- observe for 3 months ad if it doesn’t resolve, consider nerve repair surgery
when do you deliver a baby with pre-ecclamsia with severe features?
> 34 weeks
When do you place a cerclage?
more than 2 painless, 2nd trimester losses
When do you put in an iupc
Takes longer s that 1cm/2hrs for patient to dilate in active phase of labor, want to put in the Cather to see if contractions are adequate and augment with oxytocin if < 200 montevideos per 10 min
When should hysterosalpingogram be performed and why?
day 6-11 of cycle to avoid contrast injection when patient is pregnant
When to deliver a baby with gestation hypertension
> 37 weeks
Gonadal dysgenesis
ovaries are replaced by tissue called gonadal streak, no produciton of ovarian steroids ie estrogen, so no breasts, but internal and extern al gentialia are phenotypically female FSH LH elevted due to lack of negative feedback,
maternal serum alpha-fetoprotein (MSAFP) is elevated for
- fetal abdominal wall defects, open neural tube, and mutiple gestation
**major protein produced by fetal yolk sac, liver, and GI tract, measured at 15-20 wks
** when elevated need US to evaluate fetal anatomy
