OB/GYN Flashcards
primary amenorrhea
no menses by 13 + absence of secondary characteristics
or no menses by 15 even if secondary characteristics are present
secondary amenorrhea
3 mos if regular cycles
6 mos if irregular cycles
MCC secondary amenorrhea
pregnancy
MC location of ectopic pregnancy
ampulla of the fallopian tube
sx ectopic pregnancy
unilateral pelvic pain + vaginal bleeding + amenorrhea
beta hCG in ectopic pregnancy
decreased
strongest risk factor for ectopic
prior ectopic
tx ectopic
stable - methotrexate + follow up with serial b HCG
unstable - laparoscopic salpingostomy
sx endometriosis
dyspareunia
dyschezia
dysmenorrhea
cyclic pelvic pain 1-2 days before menses onset
PE endometriosis
uterus is fixed and retroflexed
dx endometriosis
laparoscopy + biopsy = gold standard
tx endometriosis
surgical resection
NSAIDs, OCPs
good NST test
2 accerations in 20 min + increase in HR by 15 BPM for at least 15 seconds
APGAR
appearance
pulse
grimace
activity
respirations
tx PID
IM Cef (one time) + doxy BID x 14 days
can add flagyl BID x 14 days
when does placenta abruption occur
after 20 weeks
sx placenta abruption
PAINFUL uterine bleeding
tender rigid pelvis
should you perform a pelvic exam in placenta abruption
NO
tx placenta abruption
delivery for everyone if greater than/equal to 36 weeks
what is placenta previa
placenta covers all/part of the os
should you perform a pelvic exam for placenta previa
NO
sx placenta previa
painless vaginal bleeding
premature rupture of membranes
> /= 37 weeks
can lead to chorioamnionitis/endometritis
sx PROM
gush of clear fluid
dx PROM
sterile speculum exam - pooling of secretions
nitrazine paper test - turns blue if pH > 6.5
FERN test
GPTPAL
G - # times pregnant
P - # times given birth
T - term berms after 37 weeks
P - premature births
A - abortions < 20 weeks
L - living children
MCC mastitis
staph aureus
tx mastitis
continue breastfeeding on affected side
dicloxacilin, cephalosporin, erythromycin, clindamycin
tx breast abscess
don’t breastfeed on affected side
Antibiotics and ultrasound-guided needle aspiration
MC ovarian cyst
follicular
tx ovarian cyst
> 5 cm –> laparoscopy
what is the only abortion that is potentially viable
threatened
MCC abortion
chromosomal abnormalities
characteristics of BV
gray/white discharge
pH > 4.5
> 20% clue cells
tx BV
metro or clinda
characteristics of trich
yellow-green discharge
pH > 4.5
strawberry cervix
mobile protozoan
tx trich
metronidazole 500 mg orally twice daily for 7 days
sx ovarian torsion
acute onset of unilateral pelvic pain often accompanied by nausea and vomiting
They may relate previous episodes of similar pain due to intermittent torsion
dx ovarian torsion
pelvic US - ovarian enlargement due to venous and lymphatic engorgement
what is warranted for all cases of confirmed or suspected ovarian torsion
gyn consult
tx abnormal uterine bleeding
acute hemorrhage - IV estrogen
later - COC
definition of postpartum hemorrhage
Cumulative blood loss > 1,000 mL OR
Bleeding associated with signs or symptoms of
hypovolemia within 24 hours of delivery regardless of route
Anti-D immune globulin must be administered within
72 hours
What is the most accepted hCG discriminatory zone for visualizing a gestational sac on transvaginal ultrasound?
1,500 IU/L.
What is the most common risk factor of placenta previa?
Multiparity
beta-human chorionic gonadotropin (hCG) levels hydatiform mole
significantly above expected levels for gestational age
What are the most common sites of metastasis for gestational trophoblastic neoplasms?
Vagina and lungs
tx endometritis
inpatient empiric antibiotics are clindamycin and gentamicin
most common risk factor for the development of placental abruption
HTN
