OB/GYN Flashcards
Treatment for uti in pregnancy
Cefpodoxime, amox-clav, or fosfomycin
Try to avoid nitrofurantoin or trim-sulfa esp in t1 and t3
Avoid cipro
Treat asx bacteriuria same way
Cx to guide tx and as test of cure
Pyelo tx in preg
Ctx or cefepime, once af for 48 hrs switch to Orals, then daily suppressive until 6wks Pp
Gestational thrombocytopenia
Benign, asx, trend and usually resolves Pp
Plts 70-150k
Hemodilution or destruction
Usually in t2 or t3
Defn of protracted labor vs arrest of labor
In active phase (6-10cm), less than 1cm in 2 hours
Usually bc of inadequate contractions (less frequent than every 2-3min)
Tx is oxytocin and amniotomy
Arrest is no cervical change over four hours with adequate contractions or 6hrs with inadequate contractions —>CS
Ddx of vaginitis
- bv - gardnerella, thin white dc with fishy odor and no inflamm, clue cells, pos whiff test with koh, metronid or clinda
- trich- thin, yellow green dc, malodorous with vag inflamm, 7d oral metronid
- Candida - thick white dc with inflamm, flucon
Gastroschesis mgmt
No need for cs
Delivery at term if all else ok
Put lower half of body in bag
Og or ngt for decompression
Iv abx for vag flora (eg amp, gent)
Surgical repair
Meds for postpartum hemorrhage
Either stimulate uterine contraction (oxytocin, other prostaglandin analogs like carbaprost (not in htn), methylergonovine (not in htn)) or stabilize clots (txa)
Most effective contraception
Progestin subdermal implant
Give antenatal steroids at labor up to
34 weeks
Interventions for preterm labor at <32 weeks vs 32-34 weeks
<32: steroids, indometh for tocolysis, mg sulfate
32-34: steroids, nifed for tocolysis
Always pcn if gbs+ or unknown
Rho gam after delivery if mom is neg and baby is pos
Tx for cystitis vs pyelo in pregnancy
Cystitis: nitrofurantoin or amox-clav
Pyelo: ivf and ctx
PCOS treatment
Weight loss
Ovulation induction with clomiphene (binds estrogen rec so body sees less est and makes lh and fsh) and letrozole (aromatase inhib —> less est)
Gonadotropins are second line for ovulation
OCPs to protect endometrium
Spiro to decrease androgens
Tx for intrapartum intraamniotic infxn vs PP endometritis
Inteaamniotic - amp/gent
Endo - clinda/gent for more anaerobes
When to give abx to unknown gbs?
Preterm (<37 weeks)
Fever
Prolonged rom (over 18 hours)
First trimester routine screening
Anemia, rh, pap, ua for asx bacteriuria (always treat with cephalosporin or amox and test of cure), hep b and rubella, syph, hiv, chlam/gon, bv, trich, tb, trisomy 21 (optional - papp, hcg, nuchal translucency, or cell free)
Second trimester tests
Quad screen - afp, hcg, estriol, inhibin a
AFP up in ntd etc
AFP low in trisomies - 21 hcg and inhibin high; 18 all low
Can start with afp and then if abnormal confirm dates with us, if correct do amnio
Third trimester tests
Diabetes (wk 24-28), anemia, indirect Coombs if rh neg (if they have anti d ig don’t give rhogam), gbs screen at 35-37 wks
What do do with hiv in pregnancy
Triple therapy for mom
Zdv at delivery if viral load
No invasive stuff (eg fse, arom)
Vag delivery ok unless load high
6 wks zdv for baby for ppx
No BF
Immediately deliver in hellp if
> 34 wks or severe maternal or fetal distress (eg placental abrupto on, liver infarction)
FHR tracings
Normal hr 110-160
Accels with mvmt are normal
Early decels with contractions are normal
Late decels = uteroplac insuff
Variable decels = cord compression
Meds for uterine atony
Carboprost (pg analog, ci in htn)
Miso (pg analog —> contractions)
Methylergo —> vasospasm (ci htn)
What ocp can you use while breastfeeding?
Progestin only (estrogen decreases lactation plus increases hypercoag state so can’t use within three weeks of labor)
Letrozole
Clomiphene
Leuprolide
-letrozole - inhibit androgen to est conversion —> less estrogen —> increased lh and fsh
- clomiphene binds est receptors in ht and pit —> receptor depletion and release from neg feedback —> release more lh and fsh
- leuprolide when given continuously down regulates pit gnrh receptors (it’s a gnrh agonist) —> low lh and fsh (menopause)
Lcis vs dcis management
Dcis lumpectomy, radiation, tamox for five years to prevent invasive disease
Lcis just tamox for five years or surveillance, low malig potl
Endometrial lining should be <__mm in postmen
4mm
Endometrial bx—> if cancer, do surgery staging (tah with bso, ln dissection and peritoneal washings)—> if mets etc add radiation and chemo
Cervical cancer screening guidelines
Start at 21 regardless
If <30, every three years
Then every three with just cytology or every 5 with Hpv cotesting
Contraindications to use of MTX
Renal or hepatic failure, high likelihood, treatment, failure, if high, hCG, or fetal heartbeat, breast-feeding, peptic ulcers, immuno deficiency, pulmonary disease
Intrahepatic cholestasis of preg tx
Ursodeoxycholic acid, antihist, deliver at 37 weeks
Ovarian hyperstim sx and cause
Cause - increased hcg from injection for induction causes vascular perm and fluid shifts
S/s- n/v/abd pain, ascites, resp distress, hemoconc, hypercoag, electrolyte imbalances, multi organ failure, doc
Ruptured ovarian cyst presentation
Sudden onset, pelvic pain, following strenuous activity, with free fluid on ultrasound from hemoperitoneum, which also causes acute abdomen and anemia
Ulipristal
Most effective oral emergency contraception
Copper iud most effective overall
Granulosa cell tumor
Ovarian cancer that releases extra estrogen and inhibin, estrogen causes prolif of endometrium and can increase risk of endometrial cancer and cause bleeding etc
Abnormal uterine bleeding after menopause, what do you do?
Endometrial bx for cancer
Cephalohematoma vs caput succedaneum
Cephalo is subperiosteal and doesn’t cross sutures, often see with vacuum etc, resolves within weeks
CS is superior to periosteum and crosses sutures, usually at vertex and resolves over few days
Interstitial cystitis
Bladder pain with filling, increased frequency, etc, assoc with psych and pain disorders
Normal ua
No curative tx
Risk of postponing delivery after IUFD
DIC not infection!
Afi for oligo vs polyhydramnios
Poly >=24
Oligo<5
