OB GYN Flashcards
placenta previa should be delivered how?
C section at 36-37 weeks
when to use cerclage?
hx of second trimester deliveries or a short cervix (<2.5 cm)
complications for mom due to placental abruption?
risk for hypovolemic shock and DIC
HYPEREMESIS GRAVIDARUM
sx?
tx?
risks factors:
sx n/v persistent and severe, weight loss, and sx of dehydration
tx: IV ANTIEMETICS, fluids and electrolyte repletion
risks: multiple gestatiom, hydatidiform mole, and hx of reflux
greatest risk factor for cerebral palsy
premature birth before 32 weeks
breast feeding failure jaundice vs breast milk jaundice
BFFJ = decreased bilirubine elimination and inreased enterohepatic circulation (dehydrated, suboptimal feeding) –> signs of dehydration/jaundice and few diapers(red crystals), baby just needs to feed more
BMJ = high level of B-glucuronidase in milk deconjugates intestinal bilirubin –> adequate breast feeding, normal exam
is trial of labor contraindicated in px with hx of myomectomy?
YESq
primary htn vs gestational htn vs preE vs Eclampsia
primary = 140/90 + prior to conception or before 20 weeks gestation
gestational = after 20 weeks, no proteinuria
preE = htn after 20 weeks and proteinuria or end organ damage sx
eclampsia = preE and new onset seizures
htn increases the risk of PPROM and preterm labor.
true or false
false, it only increases the risk of preterm labor, NOT PPROM
PPROM is associated with genital tract infection and hx of prior PPROM
does levothyroxine dose stay the same, decrease or increase in pregnancy?
dose must increase since estrogen in pregnancy induces an increase in thyroxine binding globulin levels (more binding sites that must be saturated)
a normal non stress test (NST) shows….
2 or more heart rate accelerations that are 15 + beats/min above baseline within a 20 min period
**test can last up to 40 min to account for fetal sleep
a normal BPP…
score of 8-10
nonstress test, fetal movement, tone, breathing, and AFI
each get 2 max
does chorioamnionitis require c section?
no
give broad spectrum abx and oxytocin to accelerate labor/delivery if 38+ weeks old
what is the only current indication for hormone replacement therapy?
vasomotor symptoms in women <60 who have undergone menopause in past 10 years
**it is NO longer used to precent CAD, thromboembolism, or osteoporosis/fractures
after breast cyst in young woman is aspirated (mass decreases size), what do you do?
ultrasound in 2-4 months
dont send the fluid for culture!
most effective emergency contraceptive?
copper IUD inserted up to 5 days after unprotected sex
pills are less effective
most common heart defect in edwards (tri 18)?
VSD
what do the following indicate:
1 early decels
2 late decels
3 variable decels
1 fetal head compression (symmetric to ctx)
2 uteroplacental insufficiency / Fetal hypoxia
3 abrupt decels; cord compression or cord prolapse
nagele rule to estimate day of delivery
LMP - 3 months + 7 days
when is fetus viable?
after 24 weeks
4 P categories in GP numbers
full pregnancies
preterm pregnancies
abortions
living children
goodell sign
first sign on PE to indicate preganncy
at 4 weeks = softerning of cervix
when is triple or quad screen done? what is added in the quad?
2nd trimester 15-20 weeks
AFP, estriol, bHCG, + inhibin A
if braxton hicks ctxs become continued…
check cervix (true braxton hicks dont dil,ate cervix)
chorionic villus sampling vs amniocentesis
CVS done at 10-13 weeks in AMA to get karyotype
Amnio done after 11-14 weeks in AMA to get karyotype
stable patient w ectopic pregnancy can be treated with…
methotrexate…look for 15% decrease in hCG…second dose if bHCG doesnt decrease…if no decrease after 2nd dose –> surgery
inevitable abortion
intrauterine bleeding + dilated cervix
threatened abortion
intrauterine bleeding but no dilation of cervix
missed abortion
fetal death but all POC are in the uterus
what med to induce labor for an abortion?
misoprostol (pg e1)
preterm labor at 24-33…..next step?
if stable, stop and give tocolytics(mg) and betamethasone
placenta previa presents w
painless bleeding
normal HR for fetus
110-160
arrest of cervical dilation
no cervical change for 2 hrs
do not perform external cephalic version until after ___ weeks
36
what syndrome leaves woman unable to breast feed after delivery
sheehan syndrome
tx for PMS/PMDD
lifestyle (exercise, stop cafferine and smoking)
or
SSRI
horone replacement therapy is associated w what unwanted s/e
endometrial hyperplasia which can lead to camcer
postcoital bleeding is ___ until proven otherwise
cancer
dx step for any women >35 with abnormal bleeding
endometrial biopsy
endometriosis
implantation of endometrial glands outside of the endometrial cavity
cyclical poelvic pain
rustry datrk brown lesions
tx ocps, danazol, leuprolide, or surgery
LH:FSH ratio >3:1
polycystic ovarian syndriome
clomiphene citrate
med for pcos pt who wants to get pregnant
htn meds for pregnancy
which are contraindicated?
methyldopa, labetalol, hydralazine, or nifedipine
NO: ace i, arbs, spironolactone, furosemide
which cancer does alcohol have a dose dependent effect on?
breast
counsel those worried about breast ca to decrease alc intake
