OB/gyn Flashcards
Admin of pgf2 (method)
IM
Appropriate weight gain for preg.
If normal weight
Obese
Normal 25-35
Obese 11-20
Labor warnings fetal movement
10 per 2 hours
Variable decelerations mcc
Cord compression
Early decelerations mcc
Head compressions
Late decelerations mcc
Placental insufficiency (hypoxia = concerning)
Trichomonas discharge gross
Yellow and frothy
Montevideo units and cutoff
Sum up internal changes in 10 minutes. 200 required for adequate labor.
Definition embryo
To 8 weeks
Pre viable
Before 24 weeks
Post term
42 weeks
Goodell sign
Softening of cervix
1st sign of preg equals 4 weeks
Time of teleangiectasias and palmar erythema
1st trimester
Chloasma and time
Hyper pigmentation 2nd trimester
Linea nigra
Line of hyper pigmentation. 2nd trimester
Time when US can confirm gestational age
11 to 14 weeks
Quickening time period
16 to 20
Time period for triple or quad
15 to 20
Time for gbs and chlamydia screen
36
Time period for cervical checks in 3rd trimester
37 weeks
Abortion def
Demise before 20 weeks
Test necessary to dx type of abortion
US
Complete vs incomplete abortion
Complete means no products of conception left
Products of conception with intrauterine bleeding(2)
Cervix dilated or not
Cervix dilated is inevitable
No dilation is threatened
Death of fetus with all products of conception in uterus
Missed abortion
Abortion with infection of uterus
Septic abortion
First 2 clues to multip
Increased msafp and Bhcg
Fetal weight cutoff for underweight at delivery
2500 mg
2 most common tocolytics in order
Mg sulfate - neuroprotection
CCBs
dosing of folic acid
nonrisk and risk (2)
nonrisk =.4
risk = 4
appropriate weight gain for obese women in pregnancy
11-20 lbs
apgar (5)
Include amt of p
appearance pulse =>100 for 2 points grimace activity respiration
acrocyanosis
blue at extremities only
apgar score =1
tx fir placenta previa with bleeding or drop in hematocrit
strict pelvic rest
placental abruptions which are
serious
minimal complications
concealed = serious external = minimal complications
cause of death in erythroblastosis fetalis (hemolytic disease of newborn)
+CO = CHF
test for Ab
indirect coombs
management if patient sensitized with > 1:16
Transcranial Doppler, if positive:
serial amniocentesis to assess bili level
tx (2) high bili level in sensitized mom
percutaneous umbilical blood sample
perform intrauterine transfusion
tx for HELLP
same for preeclampsia;
term = deliver
preterm = betamethasone for lungs, mg sulfate for seizures
if severe, hydralazine for BP
DM tests during pregnancy
32 weeks+
36 weeks+
37 weeks
38-39 weeks
32 weeks + = weekly NST
36 weeks + = NST + BPP
37 weeks = L/S ratio for lungs (if mature, deliver)
38-39 weeks = induce delivery.
2 timings and types of IUGR
symmetric. first 20 weeks
asymmetric. smaller head. second 20 weeks
First 2 causes of IUGR
smoking
maternal infections = #2 (immunize!)
definition macrosomia
> 4500 g
AFI normal
8-18
AFI normal
8-18
5 components of BPP
TB-MAN tone breathing (30 in 30 minutes) movement (3 in 30 minutes) AFI NST (2 accelerations in 20 minutes)
definition accelerations
more than 15
definition variable decel
decrease in HR with no relation to contractions
significance variable decel
umbilical cord compression
late decels significance
fetal hypoxia (very concerning; often uteroplacental insufficiency)
lightening
fetal descent into pelvic brim (before labor)
2 signs of placental separation besides blood, cord lengthening
uterus fundus rising
uterus becoming firm
contraindication for PGE2 for cervical ripening
asthma
definition of protraction of cervix of prime
arrest
if no more than 1.2 cm in hour
arrest = no cervical change for 2 hours
prolonged latent stage cutoffs of prime and multipara
prime = 20 hours multi = 14 hours
tx (2) for prolonged latent stage
rest and hydration
frank vs complete breech
frank = hips flexed with extended knees complete = hips and knees flexed.
time period where you can do cephalic version
after 36 weeks
PROM vs PPROM
prom = before labor PPROM = before labor and before term
tx PPROM
abx
2 indicators of fetal lung maturity (1 is a gestational age)
positive phosphatidylglycerol or 34 weeks gestational age
evidence of chorioamniotis on amniocentesis
glucose less than 20
moderate variability def
6-25
admin of PGF2a
IM or uterine injection
tx for unresponsive uterine atony
B lynch suture
placental enzyme deficiency that can lead to postterm
sulfatase
S/D ratio abnormality in umbilical arteries in IUGR
increase in the S/D ratio reflects increased vascular resistance.
metrorrhagia
intermenstrual bleeding
oligomenorrhea
mentrual cycle >35 days
lichen sclerosis vs lichen planus
sclerosis = cancer risk if postmenopausal planus = violet, flat papules
tx both with topical steroids.
marsupialization
I&D where you keep lesion (bartholin gland, for ex) with sutures.
vaginal discharge with a fishy odor
vaginosis
profuse, green, frothy vaginal discharge
trichomonas
clue cells on KOH
dz and pathogen
bacterial vaginosis
gardnerella
tx trichomonas
metronidazole for patient AND partner
vulvar soreness and pruritis
red lesion with superficial white coating
paget dz
paget dz of vulva dx and tx
dx = bx tx= vulvectomy
squamous cell carcinoma stage 0 vs I vs II of vagina
O= in situ
1=2 cm vulva o perineum
SCC of vagina stage III vs IV vs IVa
III = urethra or anus. unilateral nodes IV = bladder, rectum or bilateral nodes IVa = distant metastasis
2 med tx for severe endometriosis (vs OCPs for mild)
danazole = androgen leuprolide = GnRH agonist constant admin
LH: FSH ratio in PCOS
greater than 3:1
GSI vs ISD
both types of stress continence
GSI = bladder instability (genuine stress incontinence)
ISD = sphincter probs (idiopathic sphincter deficiency, less common)
cause of urge incontinence
detrusor instability
2 tx for urge incontinence in a post menopausal female (categories)
vaginal estrogens
anticholinergics
fixed, drain pipe urethra and incontinence
name and tx
intrinsic sphincteric deficiency ( a more rare form of stress continence).
urethral bulking procedure
q tip test with angle greater than 30
hypermobile urethra
stress urinary incontinence
nerve cutaneous sensation to the groin and the skin overlying the pubis
iliohypogastric
nerve cutaneous sensation to the groin, symphysis, labium and upper inner thigh
ilioinguinal
inability to adduct thigh = what nerve
obturator
type of pregnancy assoc. w/placental sulfatase deficiency, fetal adrenal hypoplasia
postterm
obese woman should gain how many pounds in pregnancy?
11-20
dx tool for appendicitis during pregnancy
graded compression ultrasonography
Normal age range for menarche
9-17
Mullerian agenesis
Associated prob
Renal anomalies.
Gartner’s cyst
Mesonephric cyst of upper vagina
Nabothian vs mesonephric cysts
Cysts of cervix. Nabothian is superficial.
Hyperthecosis
Severe PCOS
time period where vacuum aspiration is OK for elective abortion
embryos only! (< 8 weeks)
method of obtaining PRL level
fasting
score for osteopenia
T score between -1 and -2.5
making dx of urge incontinence on cystometrogram
uninhibited contraction of the bladder with filling
3 factors necessary to develop 2ndary sexual characteristics
adequate body weight, sleep and optic exposure to sunlight
Colpocleisis
surgical closure of vagina- used to tx prolapse
3 vitamin deficiencies assoc. w/PMS
ABE has 6 dates of PMS
A, E and B6
tx for anti-phospholipid antibody syndrome (2)
aspirin plus heparin
complete mole
karyotype?
fetal parts?
risk od post-molar GTD?
diploid (XX or XY) - empty egg
no fetus
+risk of post-molar GTD
definition of microinvasive cervical cancer
invasion <3 mm below basement
relationship between OCPs and ovarian cancer
OCPs are protective
ectropion of cervix
outward turning edge of cervix
lyonization of genes
X inactivation
tx for cholestasis of pregnancy (2)
ursodeoxycholic acid
naltrexone
use of clomiphene challenge test
to test for ovarian reserve in old patient
way to suppress lactation if patient does not want to breast feed (3, 2 would be a reasonable answer)
breast binders
ice packs
analgesics
bloody show during labor. etiology of blood
friable cervix
BV risk in pregnancy
PPROM
polymenorhea
cycle length <21 days
normal flow
malignant trophoblastic gestational dz
vs
choriocarcinoma
choriocarcinoma has metastasis
time of division of mono-di twins
4-8 days
primary amenorrhea (2)
no menses by:
age 16
OR
4 years post-thelarche
secondary amenorrhea (2)
no menses in previous menstrual patient:
missed 3 cycles
OR
none for 6 mos.
reactive NST
2 accelerations greater than 15 bpm/over 15 seconds within 20 minute window
normal variability of FHT
6-25
acceleration
+15 bpm over 15 seconds
failure to progress during active labor
no change in 2 hours
4 causes of postpartum hemorrhage
Tone (uterine atony leading to continued bleeding)
Trauma (perineal or cervical lacerations, uterine inversion)
Tissue (retained or invasive placental tissue in the uterus)
Thrombin (a bleeding disorder-much less common that the other three causes)
general rule of thumb for neonatal weight gain once milk is in
1 oz gain/day
nonstress test pass
2 or more accels in 20-40 minutes
risk of trastuzumab (herceptin)
cardiotoxicity
most common complication of postterm
oligohydramnios
B-HCG is + how long after mab
4-6 weeks
etiology of symmetric (head and body) vs asymmetric IUGR
symmetric tends to be fetal origin
asymmetric tends to be maternal vascular dz
if dilation is 6 or greater arrest is considered (2)
no change for 4 hours despite adequate contractions
no change for 6 hours with inadequate contractions
when in gestation can you dx gestational htn or preeclampsia?
after 20 weeks
corticosteroids necessary at what gestation
less than 34 weeks
cutoff for Hg for anemia in pregnancy
11
normal contraction stress test (equivalent of BPP)
no variable or late decels
tx (2) of postpartum endometritis
IV clinda and gent
tx for bacterial vaginosis
metronidazole
reason for Mg admin during preterm labor
neuroprotection (prevents CP)
approach to recurrent late decels
indication for C/S
