OB/GYN 5 Flashcards
How do you manage PRETERM labor if:
- 34-37 weeks?
- 32-34 weeks?
- < 32 weeks?
34-37 weeks:
- IM Betamethasone
- PCN if GBS +ve or unknown
32-34 weeks:
- IM Betamethasone
- TOCOLYTICS - Nifedipine
- PCN if GBS +ve or unknown
<32 weeks:
- IM Betamethasone
- Nifedipine
- Magnesium Sulfate (Neuroprotective for fetus - decreased CP incidence)
- PCN if GBS +ve or unknown
Post-Partum endometritis is the most common cause of post-partum fever. What are the 4 classic S/S?
What are the 4 main risk factors?
How do you TRX?
S/S:
- Fever > 24 hours postpartum
- Boddy uterus
- Uterus fundus tenderness
- Vaginal dc and bleeding
RFs:
- C-section
- PPROM/PROM
- Protracted labor
- GBS colonization
TRX = Broad spec abx with CLINDAMYCIN + GENTAMICIN.
IF a baby is in BREECH position, once can perform an External Cephalic Version…but you should wait until what gestational age? Why?
37 weeks, bc can induce pre-term labor.
What 6 things put pregnant women in “high risk” for PRE-ECLAMPSIA?
- Hx of Pre-E
- CKD
- HTN before pregnancy
- DM
- Multiparity
- Autoimmune disease.
Amniotic Fluid Index (AFI) is done during routing pre-natal US. Normal values are 5-23.
What 4 things can cause OLIGOHYDRAMNIOS (AFI < 5)?
What 5 things can cause POLYHYDRAMNIOS (AFI >24)?
OLIGOHYDRAMNIOS:
- PRE-E
- Uteroplacental insufficiency
- NSAID use
- Renal anomalies
POLYHYDRAMNIOS:
- Esophageal/duodenal atresia
- Anencephaly
- Multiparity
- DM
- Congenital infection (PARVO)
What condition presents with CYCLIC abdominal pain, absence of amenorrhea, Uterine enlargement and blue mass protruding from vagina?
Imperforate Hymen
How do you treat imperforate hymen?
Delay in tx can cause what complication?
Hymenectomy
Delayed trx can cause repeated retrograde menses causing intra-abdominal adhesions.
What are the defining SYMPTOMATIC DIFFERENCES btw:
- Stress Incontinence?
- Urge incontinence?
- Overflow incontinence?
Stress = leakage during increased valsalva (laughing, sneezing, ext)
Urge = Sudden overwhelming urge to urinate.
Overflow = Incomplete emptying and constant dribbling of urine.
What is the STRUCTURAL ABNORMALITY in:
- Stress Incontinence?
- Urge incontinence?
- Overflow incontinence?
Stress = Decreased urethral sphincter tone + Urethral hypermobility
Urge= Detrusor muscle hyperactivity
Overflow = Impaired contraction of Detrusor muscle.
What are the five main RFs for Stress incontinence?
How do you manage/TRX?
RFs:
- Obesity
- Increased Age
- Pregnancy
- Smoking
- Caffeine
TRX = first manage RFs = lose weight, stop smoking/caffeine.
IF that fails, can do urethral swing surgery.
What is the most common location of Ectopic pregnancy?
AMPULLA of Fallopian tubes.
Ectopic pregnancy can present with ABD pain, vaginal spotting, palpable abdominal mass, cervical motion tenderness, and hypovolemic shock (if ruptured)…
How do dx?
How do you TRX?
DX:
- B-HCG (confirm pregnancy)
- Transvaginal US
TRX:
Stable = MTX
Unstable = Surgery
Anovulatory bleed is HEAVY, irregular bleeding, following a period of amenorrhea…
All women above the age of 45 yo with Anovulatory Bleed, should be concerned about what?
ENDOMETRIAL CANCER…they need a Bx to r/o.
What are the three most effective forms of contraception?
- IUD
- Implant (Progestin)
- Female/male sterilization
(all these are 99% effective)
