OB/GYN Flashcards
Placenta previa
What? RF? Dx? CI? Comp
PAINLESS vaginal bleeding >20 weeks
Blood is maternal so FHR is normal
RF: prior c-sec, multiparity, multi gestation, tobacco use
Dx: transvaginal US
CI: digital cervical examine
Comp: Hemorrhage, preterm delivery
Amniotic fluid embolism
AE? MOA? Presentation? Tx
AE: C-section, placenta previa or abruption, preeclampsia
MOA: amniotic fluid enters circulation –> triggers massive anaphylactoid reaction
Presentation: shock, respiratory failure, DIC, coma, seizure
TX: support plus transfusion
Subchorionic hemorrhage
What, Presentation, Tx, Comp
Collection of blood between gestational sac and uterine wall
Presentation: Asx or vaginal bleeding
Tx: Expectant management
Comp: Nothing (most common), spontaneous abortion, placenta abruption, preterm premature ROM, preterm delivery, death
Choriocarcinoma
What is it, Tx
Malignancy transformation of chorionic villi or trophoblast
Tx: Chemotherapy (MTX) and hysterectomy
Ovarian tumors
Sertoli leydig features
Sertoli-Leydig: androgen-secreting –> rapid onset of hirsutism, acne, male pattern balding, voice deepening, clitoromegaly, increased muscle mass, vulvovaginal atrophy, breast atrophy, oligomenorrhea
PCOS
1st line tx, then for oral contraception, ovulation, hirsutism
High androgen –> high estrogen conversion in adipose tissue
- 1st line: weight loss
- Oral contraception for menstrual regulation
- 1st line for ovulation induction: Letrozole or Clomiphene
- 2nd line ovulation: Gonadotropins (LH, FSH)
- Spironolactone to treat hirsutism
Endometriosis
Sx, Dx (if needed), Tx
Sx: Pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia
Tx: NSAID + oral contraception (decrease endometrial implant shedding)
If needed, Dx: –> Laparoscopy
Urethral diverticulum
RF, Sx, Dx, Tx
RF: repeat infection, inflammation and trauma (vaginal delivery or surgery).
Sx: dysuria, postvoid dribbling, dyspareunia, anterior vaginal mass, hematuria
Dx: UA, Ucx, MRI of pelvis, Transvaginal US
Tx: Manual decompression, needle aspiration, surgical repair
Physiologic changes in pregnancy
Cardio, Pulm, Renal, Heme
Cardio: Increase blood volume (plasma > RBC), decrease SVR, Increase HR and CO
Pulm: Increase central respiratory drive, decrease PaCO2 (resp alk), and increase PaO2
Renal: Increase renal blood flow and urine output. Increase GFR, decrease BUN and creatinine. Increase HCO3 excretion (metabolic compensation). Decrease Na concentration (high ADH)
Heme: Increase prothrombotic coagulation factors. Decrease Hgb concentration (dilutional anemia)
CI of pregnancy
Cases and management
- Pulmonary arterial hypertension
- Peripartum cardiomyopathy with residual LV dysfunction
- HF with LVEF <30%
- Severe coarctation
- Severe mitral stenosis
- Severe symptomatic aortic stenosis
- Severe aortic dilation (Marfan syndrome)
Management:
- Recommend again pregnancy
- If pregnancy, discuss abortio
- If abortion decline, regular cardio follow up
Neonatal polycythemia
3 main causes categories, Tx, Comp
Hematocrit >65%
Cause:
1. Erythropoiesis from intrauterine hypoxia: gDM, HTN, Smoking. IUGR.
2. Erythrocyte transfusion: delayed cord clamping, twin-twin transfusion
3. Genetic/metabolic disease: hypo/hyperthyroid, trisomies
Tx: IVF, Glucose, partial exchange transfusion
Comp: vascular sludging and thrombosis (renal vein thrombosis)
Pregnancy and Sz meds
Most common cause of secondary amenorrhea is pregnancy.
Many commonly used anti-seizure meds (phenytoin, carbamazepine, ethosuximide, phenobarbital, topiramate) decrease efficacy of OCP by inducing cytochrome P-450 –> increase metabolism.
Those that don’t increase OCP metabolism are gabapentin and valproate.
IUD or etonogestrel implant are less affected by P-450 induction and are better for patients with seizure disorders.
- Although anti-seizures meds are teratogenic, majority of women with epilepsy have normal pregnancies.
- Valproate have the highest risk of teratogenicty therefore, change to an alternative (LEVETIRACETAM) 6 months prior is preferred.
- NO CHANGES in anti-epileptic meds should be made after conception, esp since there is little benefit (organogenesis occurrs between weeks 3-8). Should take high-dose folic acid and screen for neural tube defects (alpha fetoprotein and anatomy US).
- Abrupt changes can trigger seizures.
Breastfeeding should continue (benefits outweigh the risk)
Pregnancy and vaccines
Recommended vs CI
Recommended
- Tdap, influenza, Rho(D) immunoglobulin
High risk patients:
- Hep A, Hep B, Pneuococus, H.influenza, Meingicoccus, Varicella-zoster immunoglobulin
CI:
- HPV
- MMR
- Varicella
- Liver attenuated influnza
Abortions
Medial abortion meds
Ectopic pregnancy RF and Tx
Septic abortion: Sx, Tx, Comp
Intrauterine pregnancy can be seen on US once B-hCG >3,500
Medical abortion:
1. Mifepristone: anti-progesterone agent that primes uterus.
2. Misoprostol: prostaglandin that causes uterine contractions and expulsion of productions.
Ectopic:
RF: Previous ectopic, pelvic/tubal surgery, PID, tobacco use, infertility, in vitro fertilization
Tx: Methotrexate
Septic abortion
Sx: Fever, lower abd pain, purulent discharge, boggy tender uterus, dilated cervix
Tx: Cx, Abx, Suction and curettage, Hysterectomy
Comp: Myometrial infection/necrosis, sepsis, ARDS, DIC, Death
Contraception
IUD >99%
- Progestin releasing: less bleeding
- Copper: more bleeding but no hormones
Implant >99%
Injection 94%
Pills, patch, ring 91%
Condoms 80%
Withdrawal 75%
Long-acting reversible contraception (IUD and implants) are 1st line for adolscents
