OB/GYN Flashcards by Daniel Aaron

how do you estimate due date

example LMP of november 1st would be

subtract 3 months from LMP and add 7 days to the first day of the LMP

august 8 due date

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late decelerations that occur together with decreased variability suggests what

acidosis

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interventions for prolonged decelerations

hypotension

IV fluid bolus, or administer vasopressor agent like ephedrine

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treatment of umbilical cord prolapse

elevate presenting part and emergency cesarean

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pt has uterine contraction pattern of excessive number of contractions or tachysystole what can you do and also has late decelerations

give a beta mimetic agent like terbulatine to cause uterine relaxation and resolve late decels

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what is considered tachysystole number of contractions

over 5 in 10 minutes

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what is the best managment for a prolonged latent phase

continued observation on oxytocin

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repetitive deep variable decels is from what and what to help

umbilical cord compression and amnioinfusion would help

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FHR monitor

category III

fetal hypoxia or acidosis

absent baseline variability with recurrent late or variable decels or bradycardia or sinusoidal heart pattern

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FHR monitor cat II

bears watching

fetal tachy without decels would be example

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HR monitor cat I

noraml baseline and variability, no later or variable decels

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fetal scalp stimulation inducing an acceleration is reassuring for what

umbilical cord pH > 7.20

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what can be helpful in FHR with repetivie variable decels

amnioinfusion

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pt with an elevated Hb A2 level pregnant and anemia has what

from what

anemia due to b thalassemia minor

decreased b globulin gene

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macrocytic anemia in pregnancy is most likely from a deficiency of what

folate, B12 stores last for many years

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what are the four signs of placental separation

1) gush of blood
2) lengthening of the cord
3) globular and firm shape of the uterus
4) uterus rises up to anterior abdominal wall

GLUG

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if placenta doesn’t completely seperate what can happen when it is removed

looks like what

complication

uterine inversion

reddish bulging mass adjacent to placenta (endometrial surface)
mass has shaggy appearance

postpart hemmorhage

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treatment of uterine inversion

uterine relaxation agent with halothane and surgery

manual replacement

two IV lines

terbutaline or mg sulfate can relax uterus if needed prior to uterine replacement

once replaced use uterotonic agents like oxytocin to stop re inversion and slow down bleeding

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examples of uterotonic agents

oxytocin, misoprostol or ergotamine

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placental implantation site at what part of the uterus would predisopse to an inverted uterus

fundal

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if placenta does not deliver after 30 minutes what should you do

attempt manual extraction

cord should be clamped after birth when in preterm infants

within 30-60 seconds

what is the mcroberts maneuver

maternal thighs are sharply flexed aginast her abdomen

nerves injured in erbs palsy

C5-C6

if suspected umbilical cord prolapse what do you do first then second fetal bradycardia in the face of rupture of membranes

vaginal exam to assess for it, if feel ropy cord then emergent C section

onset of fetal bradycardia steps to take

confirm fetal heart rate with internal fetal scalp electrode or US to distinguish from maternal pulse rate 1) place on side to move uterus from great vessels to return flow to heart 2) IV fluid bolus if pt is vol depleted 3) admin of 100% oxygen by face mask 4) stop oxytocin if it has been given, consider beta agonist

late decelerations after an epidural and treatment

hypotension IV fluids, then vasopressive agent like ephedrine

woman with postpartum hemorrhage that does not respond to medical therapy, needs surgery but still wants child in future, what should you do

ligation of the hypogastric artery ascending branch of the uterine artery and internal (hypogastric) artery are methods for decreaseing the pulse pressure to the uterus and help with PPH ligation of uteroovarian lig can be done in addiation to ligtion of uterine arteries

what is the most common cause of late postpartum hemorrhage tx

subinvolution of the uterus tx: uterotonic agents like ergot alkaloids or misoprostol usually decreases quickly within 12 hrs

bleeding from multiple venipuncture sites together with abruption suggests what

coagulopathy

placental abruption can lead to _____ from a decrease in ___

coagulopathy fibrinogen

is an US good for dx placental abruption? good for previa?

no, good for previa

placenta accreta management

hysterectomy can try conservative management by removing as much of placenta as possible and packing the uterus

how many prior c sections with placenta previa are associated with 50% risk of placenta accreta?

is an anterior or posterior placenta more at risk for accreta

posterior

does previous myomectomy increase risk of placenta accreta

order of assessing infertility managment

male sperm and erections MMOHL Unexplained (get adoption) male, mucous (female), ovulation, hysterosalpinogram, laproscopy (for endometriosisis)

anything greater than CIN1 is considered what

HSIL

abnormal pap then do ___ next and if have +/- ecto and a + endo then get ____ if have + ecto and - endo then get ___

colposcopy cone biopsy laser ablation

if find atypical squamous cellus of undetermined signifgance (ASCUS) do what

`get HPV DNA

vulvar cancer if have melanoma or SCC what do you do | what about pagets

vulvectomy and LN dissection local resection for pagets

SCC of vagina usually from what

HPV

complete mole can lead to elevated ____ which can cause what

b hcg hyperthyroidism

choriocarcinoma can metastasize to where

lung and brain

treatment for choriocarcinoma

surgery: TAH or debulking medical: MAC methotrexate, actinomycin D, cyclophosphamide

how does hypothyroid cause amennorrhea

TRH is increased which stimulates more prolactin prolactin inhibits GnRH

what does prolactin inhibit

GnRH

what inhibits prolcatin

dopamine dopamine antagonist like antipsychotics stop inhibition

if have prolactinoma what is treatment

ropinorole and pramipraxole dopamine antagonists

secondary ammenhoria and then positive progest challange is probably what negative

PCOS anovulation neg: ashermans, endometrial problem