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OB/Gyn Flashcards

1
Q

MC first symptom of pregnancy

A

Amenorrhea

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2
Q

What leads to sx in pregnancy

A

Surge in estrogen, progesterone and b-HCG

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3
Q

First step in pt w/ sx of pregnancy

A

Pregnancy test

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4
Q

Cause of morning sickness

A

Increase in b-HCG by placenta

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5
Q

Define embryo

A

Fertilization to 8 weeks

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6
Q

Define fetus

A

8wks to birth

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7
Q

Define infant

A

Birth to 1 yr

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8
Q

Define developmental age

A

Days since fertilization

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9
Q

Define gestational age

A

Days/weeks since LMP (2 weeks longer than DA)

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10
Q

Nagele rule

A

LMP - 3mos + 7 days

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11
Q

First trimester

A

Fertilization till 12wks (DA) or 14wks (GA)

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12
Q

Second trimester

A

12/14 to 24/26

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13
Q

Third trimester

A

24/26 until delivery

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14
Q

Pre-viable fetus

A

Born before 24wks

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15
Q

Preterm

A

Born 25-37wks

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16
Q

Term

A

Born 38-42wks

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17
Q

Postterm

A

Born after 42wks

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18
Q

Gravidity

A

Number of times woman has been pregnant

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19
Q

Parity breakdown

A

Full term
Preterm
Abortion
Living children

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20
Q

First sign of pregnancy on physical exam

A

Goodell - softening of cervix

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21
Q

What is quickening

A

1st time mother feels baby kick

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22
Q

When is Goodell sign seen

A

4 weeks

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23
Q

Ladin sign

A

Softening of the midline of the uterus

6 weeks

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24
Q

Chadwick sign

A

Blue discoloration of vagina and cervix

6-8wks

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25
Q

When are telangiectasias/palmar erythema seen in pregnancy

A

First trimester

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26
Q

What is cloasma

A

Hyperpigmentation of face on forehead, nose and cheeks

Can worsen with the sun

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27
Q

When is cloasma seen in pregnancy

A

16 weeks

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28
Q

Linea nigra in pregnancy

A

Line of hyperpigmentation from xyphoid to pubic symphisis

2nd trimester

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29
Q

Best initial test when suspecting pregnancy

A

b-HCG

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30
Q

bHCG levels in pregnancy

A

Doubles every 48hrs for 4 wks
Peak at 10wks
Drops in 2nd trim
Increases to 20,000-30,000 in 3rd trim

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31
Q

How to confirm intrauterine pregnancy

A

U/S - gestational sac seen at 5wks

bHCG = 1000-1500

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32
Q

Cardio changes in pregnancy

A

Increased CO

Slightly lower BP

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33
Q

GI changes in pregnancy

A

Morning sickness
GE reflux as LES tone decreases
Constipation as large intestine motility decreases

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34
Q

Renal changes in pregnancy

A

Increased size of kidneys and ureters - risk of pyelo
Increased GFR
Decreased BUN/Cr

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35
Q

Heme changes in pregnancy

A

Anemia
Hypercoagulable state - Increased fibrinogen
Venous stasis

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36
Q

How often should mother be seen in 1st trim

A

Every 4-6 weeks

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37
Q

What is checked at 11-14 weeks

A

U/S confirming GA and check nuchal translucency

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38
Q

What does a thickened/enlarged nuchal translucency indicate

A

Down

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39
Q

When can fetal heart sounds be heard

A

End of 1st trim

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40
Q

Tests done during 1st trim

A

Blood tests
PAP
Gonorrhea/Chlamydia
Screening for chromosomal abnormalities

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41
Q

Most accurate method to determine GA at 11-14wks

A

U/S

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42
Q

What screen is done in 2nd trim

A

Triple or Quad - 15-20wks

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43
Q

What is the triple screen

A

MSAFP
b-HCG
Estriol

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44
Q

What is the quad screen

A

MSAFP
b-HCG
Estriol
Inhibin A

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45
Q

What does an increase in MSAFP indicate

A

Dating error
Neural tube defect
Abd wall defect

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46
Q

What increases the sensitivity of MSAFP

A

b-HCG
Estriol
Inhibin A

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47
Q

What other tests are done in 2nd trim

A

Auscultation of fetal HR
Quickening - 16-20wks
U/S for fetal malformation - 18-20wks

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48
Q

How often are 3rd trim visits

A

Every 2-3 wks

Every week after 36wks

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49
Q

When do Braxton-Hicks contractions occur

A

3rd trim

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50
Q

What are Braxton-Hicks contractions

A

Sporadic contractions that do not cause cervical dilation

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51
Q

Difference between Braxton-Hicks contractions and preterm labor

A

Preterm labor opens cervix

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52
Q

What should be done starting at 37 weeks

A

Cervix checked every visit

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53
Q

Testing at 27 weeks

A

CBC - replace Fe if Hb

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54
Q

Testing at 24-28 wks

A

Glucose load

Glc >140 @ 1hr, do glucose tolerance test

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55
Q

Testing at 36 weeks

A

Cervical culture for chlamydia and gonorrhea
- Rx if positive
Rectovaginal Cx for GBS
- ABX PPX in labor if positive

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56
Q

What is the glucose tolerance test

A

Ingest 100g glucose and check serum levels at 1, 2, 3hrs

Elevation in and 2 is gestational diabetes

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57
Q

What is given with Fe supplementation

A

Stool softeners

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58
Q

When is CVS done

A

10-13wks in advanced maternal age or known genetic disease in parent

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59
Q

What is the purpose of CVS

A

Fetal karyotype

Cathetier into intrauterine cavity to aspirate chorionic villi from placenta

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60
Q

When is amniocentesis done

A

11-14wks in advanced maternal age or known genetic disease in parent

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61
Q

What is the purpose of amniocentesis

A

Fetal karyotype

Needle transabdominally to remove amniotic fluid

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62
Q

When is fetal blood sampling done

A

Pts w/ Rh isoimmunization

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63
Q

How is fetal blood sampling done

A

Needle transabdominally into uterus to get blood from umbilical cord

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64
Q

MC site for ectopic pregnancy

A

Ampulla of fallopian tube

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65
Q

RFs for ectopic pregnancy

A

PID
IUD
Previous ectopic pregnancies

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66
Q

Presentation of ectopic pregnancy

A

Unilateral lower abd/pelvic pain
Vaginal bleeding
Hypotensive w/ peritoneal irritation if ruptured

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67
Q

Dx tests for ectopic pregnancy

A

b-HCG
U/S - Locate
Laparoscopy - Treat

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68
Q

Stabilize ruptured ectopic pregnancy

A

IV fluids
Blood products
DA

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69
Q

Baseline exams for medical rx of ectopic pregnancy

A

CBC
Blood type and screen
Tranaminases
b-HCG

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70
Q

Medical management of ectopic pregnancy

A

MTX for 4-7 days
If there is not a 15% drop in b-HCG, give 2nd dose
Still no decrease in b-HCG, surgery

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71
Q

When to avoid MTX

A 
Immunocompromised
Non-compliant
Liver disease
Ectopic > 3.5cm
Fetal heartbeat present
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72
Q

Removal of ectopic pregnancy

A

Salpingostomy to preserve fallopian tube

Salpingectomy

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73
Q

Give to Rh- mothers during removal of ectopic

A

RhoGAM - Anti-D Rh IG

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74
Q

What is abortion

A

Pregnancy ends before 20wks or fetus

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75
Q

When do spontaneous abortions occur

A

Prior to 12wks

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76
Q

MCC spontaneous abortions

A

Chromosomal abnormalities

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77
Q

Maternal factors that increase risk of abortion

A 
Anatomic abnormalities
STDs
APL
Uncontrolled hyperthyroidism or DM
Malnutrition
Trauma
Rh isoimmunization
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78
Q

Presentation of spontaneous abortion

A

Cramping abd pain
Vaginal bleeding
Stable or unstable

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79
Q

Dx tests for spontaneous abortion

A

CBC
Blood type and Rh
U/S

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80
Q

Only way to know type of abortion

A

U/S

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81
Q

Medical management of abortion

A

Misoprostol to induce labor

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82
Q

Complete abortion

A

No products found

F/U in office

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83
Q

Incomplete abortion

A

Some products found

D&C/medical

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84
Q

Inevitable abortion

A

Products intact
Intrauterine bleeding
Dilation of cervix
D&C/medical

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85
Q

Threatened abortion

A

Products intact
Intrauterine bleeding
No cervical dilation
Bed rest, pelvic rest

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86
Q

Missed abortion

A

Death of fetus but all products present

D&C/medical

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87
Q

Septic abortion

A

Infection of uterus

D&C w/ IV ABX (Levo, metro)

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88
Q

What increases the chances of multiple gestations

A

Fertility drugs

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89
Q

Presentation of multiple gestations

A

Exponential growth of uterus
Rapid wt gain by mother
Elevated b-HCG and MSAFP (First clue)

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90
Q

Dx test for multiple gestation

A

U/S to visualize

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91
Q

Complications of multiple gestations

A

Spontaneous abortion of 1 fetus
Premature labor and delivery
Placenta previa
Anemia

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92
Q

How is preterm labor diagnosed

A

Contractions w/ cervical dilation

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93
Q

RFs for preterm labor

A

PROM
Multiple gestations
Previous Hx
Placental abruption

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94
Q

Maternal RFs for preterm labor

A

Uterine anatomic abnormalities
Infection
Preeclampsia
Intraabdominal surgery

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95
Q

When does preterm labor occur

A

20-37wks

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96
Q

What must be evaluated in fetus during preterm labor

A

Wt
GA
Presenting part

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97
Q

When should delivery occur in preterm labor

A 
Preeclampsia/eclampsia
Maternal cardiac disease
Dilation >4cm
Maternal hemorrhage
Fetal death
Chorio
34-37 GA, >2500g
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98
Q

What should be given to stop preterm labor

A

Tocolytics

Betamethasone to mature lungs

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99
Q

MC used tocolytic

A

Mg sulfate

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100
Q

Side effects of Mg sulfate

A

Flushing
HA
Diplopia
Fatigue

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101
Q

What should be checked in pts getting Mg sulfate

A

Toxicity - resp depression, cardiac arrest

Check DTRs

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102
Q

Other tocolytics

A

CCBs - HA, flushing, dizziness

Terbutaline - palpitations, hypotension

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103
Q

Presentation of PROM

A

Gush of fluid from vagina

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104
Q

Dx test for PROM

A

Fluid in posterior fornix
Turns nitrazine paper blue
Ferning

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105
Q

When is PROM a big problem

A

Prolongued (labor starts more than 24hrs before delivery)

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106
Q

What can PROM lead to

A

Preterm labor
Cord prolapse
Placental abruption
Chorio - therefore do less exams w/ PROM

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107
Q

PROM w/ chorio, now what

A

Deliver

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108
Q

Term fetus, no chorio, PROM

A

Wait 6-12hrs for spontaneous delivery

Induce if there isn’t

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109
Q

Preterm fetus, no chorio, PROM

A

Betamethasone
Tocolytics
Amp + 1 dose azithromycin

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110
Q

Chorio PPX w/ PCN allergy

A

Rash - cefazolin + 1 dose azithro

Anaphylaxis - clinda + 1 dose azithro

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111
Q

Placenta previa

A

Abnormal implantation over internal cervical os

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112
Q

Increased risk of placenta previa with

A

Previous C-section
Previous uterine surgery
Multiple gestation
Previous placenta previa

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113
Q

Contraindication in 3rd trim bleeding

A

Digital vaginal exam

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114
Q

Next best step in 3rd trim bleeding

A

Transabdominal U/S

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115
Q

Presentation of placenta previa

A

Painless vaginal bleeding

Usually not till 28wks

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116
Q

Why is transvaginal U/S or digital vaginal exam not done in placenta previa

A

Can separate placenta from uterus

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117
Q

Complete placenta previa

A

Completely cover internal os (full moon)

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118
Q

Partial placenta previa

A

Partial covering of internal os (Half moon)

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119
Q

Marginal placenta previa

A

Placenta adjacent to internal os (crescent moon)

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120
Q

Vasa previa

A

Fetal vessel present over internal os

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121
Q

Low lying placenta

A

Implanted in lower segments of uterus but not covering internal os (

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122
Q

When is placenta previa treated

A

Large volume bleeding or drop in HCT

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123
Q

Rx placenta previa

A

Strict pelvic rest

No vaginal insertion

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124
Q

Indications for immediate C-section in placenta previa

A

Cervix >4cm
Severe hemorrhage
Fetal distress

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125
Q

How to prepare preterm fetuses for delivery

A

Betamethasone

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126
Q

Placenta accreta

A

Adheres to superficial uterine wall

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127
Q

Placenta increta

A

Adheres to myometrium

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128
Q

Placenta percreta

A

Invades uterine serosa, bladder wall or rectum wall

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129
Q

What happens if the placent doesn’t detach in delivery

A

Catastrophic hemorrhage and shock

Pt needs hysterectomy

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130
Q

Placental abruption

A

Premature separation of placenta from uterus

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131
Q

Complications of placental abruption

A 
Life threatening bleeding
Premature delivery
Uterine tetany
DIC
Hypovolemic shock
Sheehan
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132
Q

Precipitating factors for placental abruption

A 
Maternal HTN
Prior placental abruption
Cocaine use
External trauma
Smoking
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133
Q

Presentation of placental abruption

A

Painful 3rd trim bleeding
Severe abd pain
Contractions
Fetal distress

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134
Q

Dx placental abruption

A

Transabdominal U/S, may not be seen

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135
Q

Concealed placental abruption

A

Blood is within uterine cavity

Placenta more likely to be completely detached

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136
Q

External placental abruption

A

Blood drains through cervix

Placenta more likely to be partially detached

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137
Q

Which placental abruption type has more complications

A

Concealed

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138
Q

Indications for C-section in placental abruption

A

Uncontrollable maternal hemorrhage
Rapidly expanding concealed hemorrhage
Fetal distress
Rapid placental separation

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139
Q

Indications for vaginal delivery in placental abruption

A

Separation limited
Fetal heart tracing assuring
Separation extensive and fetus is dead

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140
Q

When does uterine rupture occur

A

During delivery

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141
Q

RFs uterine rupture

A 
Previous C-sections
- Longitudinal > Low transverse
Trauma - MVA
Myomectomy
Uterine overdistention
- Polyhydramnios
- Multiple gestation
Placenta percreta
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142
Q

Presentation of uterine rupture

A

Sudden onset extreme abd pain
Abnormal bump in abd
No CTX
Regression of fetus

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143
Q

Rx uterine rupture

A

Immediate laparotomy w/ fetus delivery

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144
Q

Why is C-section not done in

A

Baby may not be in uterus but floating in abd

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145
Q

If uterus is repaired after rupture, how will future pregnancies be managed

A

Delivered via C-section at 36wks

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146
Q

When does Rh incompatibility occur

A

Mother is Rh- but baby is Rh+

147
Q

What happens when Rh- mother delivers first Rh+ baby

A

Fetal RBCs cross placenta into mother bloodstream and she makes ABX against them

148
Q

What happens in hemolytic disease of the newborn

A

Fetal anemia
Extramedullary production of RBCs
Erythroblastosis fetalis

149
Q

What is characteristic of erythroblastosis fetalis

A

High fetal cardiac output (CHF)

150
Q

What does Rh unsensitized mean

A

Rh- without Abs

151
Q

When to give RhoGAM to Rh unsensitized mothers

A

Fetal RBCs may cross placenta

  • Amnio
  • Abortion
  • Vaginal bleeding
  • Placental abruption
  • Delivery
152
Q

When is prenatal Rh Ab screening done

153
Q

RhoGAM PPx

A

Mother unsensitized at 28wks

154
Q

Ab titer in sensitized pts

155
Q

Ab titer

A

No treatment

156
Q

Ab Titer reaches 1:16 some time in pregnancy

A

Serial Amnio to evaluate fetal bili

157
Q

Amnio shows low bili

A

Repeat in 2-3 wks

158
Q

Amnio shows medium bili

A

Repeat in 1-2 wks

159
Q

Amnio shows high bili

A

Fetus anemia
Do percutaneous umbilical blood sample
- If HCT low, do intrauterine transfusion

160
Q

Characteristics of preeclampsia

A

HTN
Edema
Proteinuria

161
Q

Eclampsia

A

Preeclampsia w/ seizures

162
Q

HELLP

A

Preeclampsia w/ elevated liver enzymes and low platelets

163
Q

Chronic HTN in pregnancy

A

BP>140/90 before pt became pregnant

164
Q

Rx Chronic HTN in pregnancy

A

Methyldopa
Labetalol
Nifedipine

165
Q

Gestational HTN

A

BP>140/90 starting after 20wks

No proteinuria or edema

166
Q

Rx Gestational HTN

A

Rx only during pregnancy
Methyldopa
Labetalol
Nifedipine

167
Q

Preeclampsia RFs

A

Chronic HTN

Renal disease

168
Q

Only definitive rx in preeclampsia

169
Q

Features of mild preeclampsia

A

BP > 140/90

1+ to 2+ proteinuria

170
Q

Features of severe preeclampsia

A

BP > 160/110

3+ to 4+ proteinuria

171
Q

Management of mild preeclampsia at term

A

Induce delivery

172
Q

Management of preterm mild preeclampsia

A

Betamethasone

Mg sulfate

173
Q

Management of severe preeclampsia at term

A

Mg sulfate
Hydralazine
Induce delivery

174
Q

Management of severe preeclampsia preterm

A

Mg sulfate
Hydralazine
Betamethasone

175
Q

What is Eclampsia

A

Tonic clonic seizures in pt w/ Hx preeclampsia

176
Q

Rx Eclampsia

A

Stabilize pt, deliver baby

Mg sulfate, Hydralazine

177
Q

HELLP features

A

Hemolysis
Elevated liver enzymes
Low platelets

178
Q

Pregenstational diabetes

A

Diabetes before getting pregnant

179
Q

Maternal complications of pregestational DM

A

4x more likely to have preeclampsia
2x more likely to have spontaneous abortion
Increased infection rate
Increased postpartum hemorrhage

180
Q

Fetal complications of pregestational DM

A

Increase in congenital anomalies
Macrosomia - shoulder dystocia
Preterm labor

181
Q

Evaluation of pregestational DM

A

EKG
24hr urine - Cr clearance, protein
HbA1c
Opthalmological exam

182
Q

Rx type I pregestational DM

A

Insulin pump (NPH)

183
Q

Rx type II pregestational DM

A

SubQ insulin (NPH, lispro)

184
Q

What is NST done for

A

Fetal well-being

185
Q

What is BPP done for

A

Amount of amniotic fluid and fetal well-being

186
Q

What is lecithin/sphingomyelin (L/S) ratio done for

A

Assess fetal lung maturity

187
Q

What is done at 32-36wks

A

Weekly NST and U/S

188
Q

What is done >36wks

A

1 NST and BPP weekly

189
Q

What is done at 37wks

190
Q

What is done at 38-39wks if pt refuses L/S ratio

A

Induction of labor

191
Q

Complications of gestational DM

A

Preterm
Fetal macrosomia and injuries from this
Neonatal hypoglycemia
Mother 4-10x more likely to develop DM II

192
Q

When is gestational DM screened

193
Q

How is gestational DM screened

A

Glucose load - 50g and measured 1hr later
If >140, glucose tolerance (100g measured at 1,2,3hrs)
If any are elevated, then confirmed

194
Q

First line rx for gestational DM

A

Diabetic diet and exercise

195
Q

When is medication indicated in gestational DM

A

Fasting > 95

1hr postprandial > 140

196
Q

What medication is given for gestational DM

A

Insulin w/ NPH before bed

Aspart before meals

197
Q

What do you not tell pregnant gestational DM pts to do

A

Lose weight

198
Q

What is IUGR

A

Weight in bottom 10%for GA

199
Q

What is symmetric IUGR

A

Brain in proportion

Occurs before 20wks

200
Q

What is asymmetric IUGR

A

Brain weight not decreased
Abd smaller than head
Occurs after 20wks

201
Q

Causes of IUGR

A

Chromosomal abnormalities
Neural tube defects
Multiple gestations
Maternal HTN or renal disease

202
Q

Number 1 preventable cause of IUGR in USA

203
Q

Dx IUGR

204
Q

Complications of IUGR

A 
Premature labor
Stillbirth
Fetal hypoxia
Lower IQ
Seizures
Mental retardation
205
Q

Prevent IUGR

A

Stop smoking

Prevent maternal infections w/ immunizations

206
Q

What is macrosomia

207
Q

RFs for macrosomia

A

Maternal DM or obesity
Advanced maternal age
Postterm pregnancy

208
Q

Dx tests for macrosomia

A

Fundal height 3cm greater than GA

209
Q

If fundal height indicates macrosomia what is the next step

210
Q

What measurements in U/S are used to estimate gestational wt

A

Femur length
Abd circumference
Head diameter

211
Q

Complications of macrosomia

A

Shoulder dystocia
Birth injuries
Low Apgar
Hypoglycemia

212
Q

When should induction of labor occur in macrosomia

A

Lungs are mature before fetus is >4500g

213
Q

Delivery in macrosomia

214
Q

What does NST measure

A

Fetal movements and assess fetal HR

215
Q

What is a reactive NST

A

Detection of 2 fetal movements

Acceleration >15bpm lasting 15-20s over 20min

216
Q

What does a nonreassuring NST often indicate

A

Fetus is sleeping

Wake with vibroacoustic stimulation

217
Q

What does a BPP consist of

A 
NST
Fetal chest expansion (1 or more in 30min)
Fetal movement (>3cm in 30min)
Fetal muscle tone
Amniotic fluid index
218
Q

Interpretation of BPP

A

NL - 8-10
Inconclusive - 4-8
Abnormal -

219
Q

NL fetal HR

220
Q

Variable decels

A

Cord compression

221
Q

Early decels

A

Head compression

222
Q

Accelerations

223
Q

Late decels

A

Placental insufficiency (fetal hypoxia)

224
Q

What is lightening in labor

A

Fetal descent into pelvic brim

225
Q

What is bloody show

A

Blood-tinged mucous from vagina released w/ cervical effacement

226
Q

What is stage 1 Labor

A

Onset to full dilation of cervix
Prim - 6-18hrs
Mulit - 2-10hrs

227
Q

What is the latent phase of stage 1 labor

A

Onset to 4cm
Prim - 6-7hrs
Mulit - 4-5hrs

228
Q

What is the active phase of stage 1 labor

A

4cm to full dilation of cervix
Prim - 1cm/hr
Mulit - 1.2cm/hr

229
Q

What is stage 2 of labor

A

Full dilation to delivery of neonate
Prim - 30min-3hr
Multi - 5-30min

230
Q

What is stage 3 of labor

A

Delivery of neonate to delivery of placenta

30min

231
Q

What to monitor in stage 1 of labor

A 
Maternal BP and pulse
Fetal HR and CTX
Cervical dilation
Cervical effacement
Station
232
Q

Steps in stage 2 of labor

A

Engagement - head enters pelvic occiput
Descent - CTX and mom pushing
Flexion
Internal rotation - Rotates at ischial spines
Extension - So that head can pass through vagina
External rotation - Shoulder room to descent
Delivery of anterior shoulder - Push down on head
Delivery of posterior shoulder - Push up on head

233
Q

What to do in Stage 3 of labor

A

Inspect and repair lacerations

234
Q

Signs of placental separation

A

Fresh bleeding from vagina
Umbilical cord lengthening
Uterine fundus rising
Uterus becomes firm

235
Q

How to induce labor

A

Prostaglandin E2 - not to asthmatics
Oxytocin
Amniotomy - puncture w/ amnio hook

236
Q

What is arrest of dilation

A

No dilation of cervix for more than 2hrs

237
Q

What is prolonged latent stage

A

Latent phase lasts >20hrs in prim, >14hrs in multi

238
Q

Causes of prolongued latent stage

A

Sedation
Unfavorable cervix
Uterine dysfunction w/ irregular or weak CTX

239
Q

Rx prolongued latent stage of labor

A

Rest and hydration

Most convert to spontaneous delivery in 6-12hrs

240
Q

What is protracted cervical dilation

A

Slow dilation during active phase, less than 1.2cm/hr primi,

241
Q

Etiology of protracted cervical dilation

A

Power - strength and freq of uterine CTX
Passenger - size and position of fetus
Passage - cephalopelvic disproportion

242
Q

Rx protracted cervical dilation

A

C-section

Give oxy if CTX weak

243
Q

Types of labor arrest disorders

A

Cervical dilation arrest - None for 2hrs

Fetal descent arrest - None for 1hr

244
Q

Etiology of labor arrest disorders

A

Cephalopelvic disproportion - 50% of all, rx c-section
Malpresentation - older than 36wks
Excessive sedation/anesthesia

245
Q

Confirming breech position

246
Q

Presentation of breech

A

Lower half of fetus is presenting part

Can be felt on PE

247
Q

Dx breach

248
Q

What is frank breech

A

Hips flex w/ extended knees b/l

249
Q

What is complete breech

A

Hips and knees flexed b/l

250
Q

What is footling breech

A

Feet first

251
Q

When can external cephalic version be done

252
Q

What is shoulder dystocia

A

Fetus head delivered but anterior shoulder stuck behind pubic symphysis

253
Q

RFs shoulder dystocia

A

Maternal DM and obesity causing fetal macrosomia
Postterm pregnancy
Hx prior

254
Q

First line rx shoulder dystocia

A

McRobert’s maneuver

255
Q

What is McRobert’s maneuver

A

Maternal flexion of knees into abd w/ suprapubic pression

256
Q

What is Rubin maneuver

A

Rotate fetus shoulders by pushing posterior shoulder towards the fetal head

257
Q

What is Woods maneuver

A

Rotation of fetus shoulders by pushing posterior shoulder towards fetus back

258
Q

What is Zavanelli maneuver

A

Push fetal head back into uterus and perform C-section

259
Q

Other ways to fix shoulder dystocia

A

Deliver posterior arm

Deliberate Fx of fetal clavical

260
Q

What is postpartum hemorrhage

A

More than 500mL after delivery

261
Q

What is early postpartum hemorrhage

A

Within 24hrs

262
Q

What is late postpartum hemorrhage

A

24hrs to 6 wks

263
Q

Etiology of postpartum hemorrhage

A

Atony - 80% of cases
Laceration
Retained parts
Coagulopathy

264
Q

RFs Atony

A 
Anesthesia
Uterine overdistention
Prolongued labor
Laceration
Pretained placenta coagulopathy
265
Q

Rx postpartum hemorrhage

A

Assume no rupture and no retained placenta
Bimanual compression and massage
Oxy if it doesn\t work

266
Q

Presentation of sheehan after postpartum hemorrhage

A

Inability to breastfeed

267
Q

Sx PMS or PMDD

A

HA
Breast tenderness
Pelvic pain and bloating
Irritability or lack of energy

268
Q

Difference between PMS and PMDD

A

PMDD interferes with daily activities

269
Q

Dx criteria for PMDD

A

Sx present for 2 consecutive cycles
Sx free for 1 week in first part of cycle
Sx present in second half of cycle
Dysfunction in life

270
Q

Rx PMDD

A

Decrease consumption of coffee, alcohol, cigarettes and chocolate
Exercise
SSRIs if severe

271
Q

Menopause

A

Permanent loss of estrogen

48-52

272
Q

How does menopause start

A

Irregular menstrual bleeding
Oocytes produce less estrogen and progesterone
FSH, LH rise

273
Q

How long is menopause symptomatic

274
Q

Sx of menopause

A

Menstrual irregularities
Sweats and hot flashes
Mood changes
Dyspareunia

275
Q

PE findings in menopause

A

Atrophic vaginitis
Decreased breast size
Vaginal and cervical atruphy

276
Q

Dx menopause

A

Increased FSH

277
Q

HRT in menopause

A

Short term symptomatic relief

Prevent osteoporosis

278
Q

What is associated with HRT

A

Endometrial hyperplasia and carcinoma

279
Q

Contraindications to HRT

A

Breast or endometrial CA

Hx PE or DVT

280
Q

Post coital bleeding is

A

Cervical CA until proven otherwise

281
Q

What is menorrhagia

A

Heavy and prolongued
Gushing of blood
Clots

282
Q

What causes menorrhagia

A

Endometrial hyperplasia
Uterine fibroids
Dysfunctional uterine bleeding
IUD

283
Q

What is hypomenorrhea

A

Light menstrual flow

Only spotting

284
Q

What causes hypomenorrhea

A

Obstruction

OCPs

285
Q

What is metrorrhagia

A

Intermenstrual bleeding

286
Q

What causes metrorrhagia

A

Endometrial polyps
Endometrial/cervical CA
Exogenous estrogen

287
Q

What is menometrorrhagia

A

Irregular bleeding

  • Time intervals
  • Duration
  • Amount
288
Q

What causes menometrorrhagia

A

Endometrial polyps
Endometrial/cervical CA
Exogenous estrogen
Malignancy

289
Q

What is oligomenorrhea

A

Menstrual cycle >35 days long

290
Q

What causes oligomenorrhea

A

Pregnancy
Menopause
Significant wt loss
Estrogen secreting tumor

291
Q

What causes postcoital bleeding

A

Cervical CA!!
Cervical polyps
Atrophic vaginitis

292
Q

Dx tests for abnormal uterine bleeding

A

CBC
PT/PTT
Pelvic U/S

293
Q

What is DUB

A

Unexplained abnormal bleeding

Also occurs when pt is anovulatory

294
Q

Pathophysiology of DUB

A

Ovary produces estrogen but no corpus luteum

295
Q

What to r/o in DUB

A

Hypothyroid
Hyperprolactinemia
Carcinoma (Endometrial Bx in pts >35

296
Q

Rx DUB

A

OCP
- Adolescents/young women who are anovulatory
- >35 w/ NL endometrial Bx
D&C to stop acute hemorrhage

297
Q

Rx DUB refractory to OCP/severe causing anemia

A

Endometrial ablation

Hysterectomy

298
Q

Placement of vaginal diaphragm

A

6hrs before intercourse

Left there for 6hrs after intercourse

299
Q

OCPs reduce risk of

A

Ovarian carcinoma
Endometrial carcinoma
Ectopic pregnancy

300
Q

How long is vaginal ring inserted

A

3 weeks - withdraw bleeding when removed

301
Q

How long does a transdermal patch placed

302
Q

How log does a depot injection last

303
Q

How long can an IUD last

304
Q

Types of IUDs

A

Copper

Levonorgestrel

305
Q

IUDs are associated w/

A

PID

Genital Cx before placement

306
Q

Tubal ligation increases the risk of

A

Ectopic pregnancy

307
Q

MCC labial fusion

A

21-B hydroxylase deficiency

- Excess androgens

308
Q

Rx labial fusion

A

Reconstructive surgery

309
Q

Lichen sclerosis increases the risk of what

A

CA in postmenopausal women

310
Q

What does lichen sclerosis look like

A

White, thin skin

311
Q

Rx lichen sclerosis

A

Topical steroids

312
Q

RF squamous cell hyperplasia

A

Chronic vulvar pruritis

313
Q

What does squamous cell hyperplasia look like

A

Hyperkeratosis - raised white lesion

314
Q

Rx squamous cell hyperplasia

A

Sitz baths or lubricants to relieve pruritis

315
Q

Who gets lichen planus

316
Q

What does lichen planus look like

A

Violet, flat papules

317
Q

Rx Lichen planus

A

Topical steroids

318
Q

Sx of bartholin cyst

A

Pain
Tenderness
Dyspareunia

319
Q

Rx bartholin cyst

A

I&D

Cx fluid for STIs

320
Q

What marsulialization

A

I&D where open cyst is kept open

Decreases risk of recurrence of bartholin cyst

321
Q

RFs vaginitis

A

Anything that increases vaginal pH

  • ABX use
  • DM
  • Overgrowth of normal flora
322
Q

Sx of vaginitis

A

Itching
Pain
Abnormal odor
Discharge

323
Q

Cause of bacterial vaginosis

A

Gardnerella

324
Q

D/C in bacterial vaginosis

A

Gray-white

FIshy odor

325
Q

Dx bacterial vaginosis

A

Saline wet mount

Clue cells

326
Q

Rx bacterial vaginosis

A

Metro

Clinda

327
Q

D/C in candidal vaginosis

A

White, cheesy

328
Q

Dx candidal vaginosis

A

KOH showing pseudohyphae

329
Q

Rx candidal vaginosis

A

Miconazole
Clotrimazole
Econazole
Nystatin

330
Q

Most common nonviral STI

A

Trichomonas

331
Q

D/C in trichomonas vaginalis

A

Profuse, frothy green

332
Q

Dx trichomonas vaginalis

A

Saline wet mount

Motile flagellates

333
Q

Rx trichomonas vaginalis

A

Both partners w/ Metro

334
Q

Who gets vaginal paget

A

Postmenopausal caucasian women

335
Q

Presentation of vaginal paget

A

Red lesion w/ superficial white coating

336
Q

Definitive Dx of vaginal paget

337
Q

Rx b/l vaginal paget

A

Radical vulvectomy

338
Q

Rx unilateral vaginal paget

A

Modified vulvectomy

339
Q

MC type of vulvar CA

A

Squamous cell carcinoma

340
Q

Presentation of vulvar squamous cell carcinoma

A

Pruritis
Vaginal discharge
Postmenopausal bleeding
Large cauliflower-like lesion

341
Q

Dx vulvar squamous cell carcinoma

342
Q

Stages of vulvar squamous cell carcinoma

A 
0 - in situ
I - Vaginal wall, 2cm
III - Lower urethra/anus, unilateral LN
IV - Bladder, rectum or B/L LN
IVa - Distant mets
343
Q

Rx vulvar squamous cell carcinoma

A

Unilateral, no LNs - modified radical vulvectomy
B/L - Radical vulvectomy
Lymadenectomy as required

344
Q

Adenomyosis

A

Invasion of endometrial glands into myometrium

345
Q

Who gets adenomyosis

346
Q

RFs adenomyosis

A

Endometriosis

Uterine fibroids

347
Q

Presentation of adenomyosis

A

Dysmenorrhea

Menorrhagia

348
Q

Uterus on PE for adenomyosis

A

Large, globular, boggy

349
Q

Most accurate test for adenomyosis

350
Q

Only Rx adenomyosis

A

Hysterectomy

351
Q

Endometriosis

A

Implantation of endometrial tissue outside the endometrial cavity

352
Q

MC sites for endometriosis

A

Ovary

Pelvic peritoneum

353
Q

Who gets endometriosis

A

Women of reproductive age

4x more likely if 1st degree relative has it

354
Q

Presentation of endometriosis

A

Cyclic pelvic pain 1-2 weeks before menstruation
Peaks 1-2 days after menstruation
Dysmenorrhea, Dyspareunia
Nodular uterus and adnexal mass

355
Q

Only way to dx endometriosis

A

Direct visualization via laparoscopy

356
Q

Rx endometriosis

A

NSAIDs for pain
OCPs for mild sx
Danazole or leuprolide for moderate/severe

357
Q

Danazol AE

A

Acne
Oily skin
Wt gain
Hirsuitism

358
Q

Leuprolide AE

A

Hot flashes

Decreased bone density

359
Q

Rx endometriosis in pt who has finished having children

A

Total abdominal hysterectomy w/ b/l salpingoophorectomy

360
Q

Sx PCOS

A

Amenorrhea, irregular menses
Hirsuitism and obesity
Acne
DM 2

361
Q

Pelvic U/S in PCOS

A

B/L enlarged ovaries w/ multiple cysts

362
Q

Labs in PCOS

A

Elevated free testosterone
Increased estrogen outside ovary
LH stimulation inhibiting FSH
- Ratio > 3:1

363
Q

Rx PCOS

A

Wt loss decreases insulin resistance
OCPs if pt doesn’t want children
Clomiphene and metformin in pts who want to conceive

Step 2 CK (21 decks)

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