OB/GYN Flashcards
What signs and tests could confirm the presence of rupture of membranes?
- Visualization of amniotic fluid leaking from the cervix
- Presence of pooling of amniotic fluid in the posterior vaginal fornix
- Demonstration of a pH above 6.5 in fluid collected from the vagina using Nitrazine paper
- Visualization of “ferning” on a sample fluid on an air-dried microscopic slide
What is the recommended treatment for Group B strep infection during pregnancy?
- IV penicillin (or ampicillin, cephalothin, erythromycin, clindamycin, vancomycin)
What are the 3 stages of labor?
1) Onset of labor until the cervix in completely dilated
2) From cervical dilation (10cm) to the delivery of the fetus
3) Delivery of the baby to the delivery of the placenta and membranes
What is the range for a baseline fetal heart rate?
- 110-160bpm
What agent is given when contractions are inadequate in frequency or power?
- Oxytocin
What is shoulder dystocia?
- Shoulder dystocia => anterior shoulder does not readily pass below the pubic symphysis and requires re-orienting the baby, the mother, or episiotomy
What are the maternal benefits of breastfeeding?
- more rapid return of uterine tone with reduced bleeding and quicker return to non-pregnant size
- more rapid return to prepregnancy body weight
- reduced incidence of ovarian and breast cancer
- lower cost ( no need to purchase formula)
What hormonal contraceptives can be used in breastfeeding women?
- Progestin only “minipill” is recommended as combined hormonal contraceptives can interfere with milk supply
What is endometritis?
- polymicrobial infection of the endometrium of the uterus, usually caused by ascending infection from the vagina
What is lochia?
- yellow-white discharge consisting of blood cells, decidual cells, and fibrinous products that occurs following delivery
When does menstruation return for NON breastfeeding women?
- menstruation usually restarts by the third post partum month
What are th 4 Ts of postpartum hemorrhage?
- Tone: uterine atony (most common)
- Trauma: cervical, vaginal, or perineal lacerations; uterine inversion
- Tissue: retained placenta or membranes
- Thrombin: coagulopathies
What is the initial management of uterine atony?
- IV administration of oxytocin and initiation of bimanual uterine massage
- Methylergonovine if above fails to control bleeding (contraindicated in HTN; can increase BP)
- If above fails/is contraindicated prostaglandin F2a (hemabate) IM or intramyometrially (do not give in asthma)
- If above fails/is contraindicated Misoprostol can be given rectally or orally
What is a sign of postpartum endometriosis?
- postpartum fever
- uterine tenderness
- foul smelling lochia
- more common in Cesarean deliveries
Apart from endometriosis what are the other causes of postpartum fever?
- atelectasis
- wound infection
- venous thromboembolic disease
What percentage of women experience maternity blues and postpartum depression?
- Maternity blues: 30-70% and up to 10 days
- Postpartum depression: 10-20% and within 4 weeks but up to 1 year.
What group of women will be unable to breastfeed?
- ACTIVE (not chronic) Hep B, C, HIV, and breast reduction with nipple transplantation
When can a breastfeeding woman begin oral contraceptives?
- 6 weeks post partum
- IM depo-provera/medroxyprogseterone, IUDs, and refitted diaphragms can also be started 6 weeks postpartum
When can non-breastfeeding women begin oral contraceptives?
- 3 weeks as the risk of thromboembolic disease is higher in those who start at earlier times
What is the contraception rate of women who breastfeed exclusively?
- 98% for 6 months as lactation induces amenorrhea
What type of contraception is contraindicated in women >35 who smoke?
- oral contraception
What are the various types f hormonal contraceptives?
- combination pill
- progestin pill
- norplant
- depo-provera
- transdermal
- intravaginal ring
What are various types of barrier contraceptives?
- spermicides
- condoms
- sponge
- diaphragm
- cervical cap
What are the various types if IUDs?
- Progesterone
- Copper T
What are various types of post-coital contraception?
- Plan B: Levonorgestrel
- Mifepristine: RU 486
What is the mechanism of action of the combination (progestin and estrogen) oral contraceptive?
- suppresses ovulation through inhibition of the hypothalamic-pituitary-ovarian axis
- thickens cervical mucous to inhibit sperm penetration
- discourages implantation into an unfavorable, thin endometrium
- alters motility of uterus and fallopian tubes
What conditions do oral contraceptives protect against?
- Ovarian cancer
- endometrial cancer
- iron deficiency anemia
- pelvic inflammatory disease
- fibrocystic breast disease
Who are barrier agents best suited for?
- individuals not desiring hormones
- Decrease STI
What are the disadvantages and contraindications for barrier contraceptive agents?
- pelvic organ prolapse
- patient discomfort with placing devices on genitals
- lack of spontaneity
- allergies to material
- diaphragm may be associated with more UTIs
What are the disadvantages and contraindications of combined hormonal contraceptives?
- thrombogenic mutations, prior thromboembolic event
- cerebrovascular or coronary artery disease
- contraindicated in smokers over 35
- uncontrolled hypertention
- diabetic retinopathy, nephropathy, peripheral vascular disease
- known/suspected breast or endometrial cancer
- undiagnosed vaginal bleeding
- migraines with aura
- liver tumors, disease, or failure
- known or suspected pregnancy
Who is the progestin only oral pill best suited for?
- mechanism similar to combined hormonal contraceptives
- best for breast feeding women
What is the mechanism of action of injectable contraception?
- inhibits ovulation
- thins endometrium
- alters cervical mucus to inhibit sperm penetration
Who is the injection contraception best suited for?
- Breast feeding women
- Desire for long term contraception
- Iron deficiency anemia
- Sickle cell disease
- Epilepsy
- Dysmenorrhea
- Ovarian cysts
- Endometriosis
