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case files shelf DF > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

how do you estimate due date

example LMP of november 1st would be

A

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

august 8 due date

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2
Q

late decelerations that occur together with decreased variability suggests what

A

acidosis

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3
Q

interventions for prolonged decelerations

hypotension

A

IV fluid bolus, or administer vasopressor agent like ephedrine

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4
Q

treatment of umbilical cord prolapse

A

elevate presenting part and emergency cesarean

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5
Q

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

A

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

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6
Q

what is considered tachysystole number of contractions

A

over 5 in 10 minutes

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7
Q

what is the best managment for a prolonged latent phase

A

continued observation on oxytocin

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8
Q

repetitive deep variable decels is from what and what to help

A

umbilical cord compression and amnioinfusion would help

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9
Q

FHR monitor

category III

A

fetal hypoxia or acidosis

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

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10
Q

FHR monitor cat II

A

bears watching

fetal tachy without decels would be example

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11
Q

HR monitor cat I

A

noraml baseline and variability, no later or variable decels

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12
Q

fetal scalp stimulation inducing an acceleration is reassuring for what

A

umbilical cord pH > 7.20

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13
Q

what can be helpful in FHR with repetivie variable decels

A

amnioinfusion

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14
Q

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

from what

A

anemia due to b thalassemia minor

decreased b globulin gene

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15
Q

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

A

folate, B12 stores last for many years

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16
Q

what are the four signs of placental separation

A

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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17
Q

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

looks like what

complication

A

uterine inversion

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

postpart hemmorhage

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18
Q

treatment of uterine inversion

A

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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19
Q

examples of uterotonic agents

A

oxytocin, misoprostol or ergotamine

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20
Q

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

A

fundal

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21
Q

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

A

attempt manual extraction

22
Q

cord should be clamped after birth when in preterm infants

A

within 30-60 seconds

23
Q

what is the mcroberts maneuver

A

maternal thighs are sharply flexed aginast her abdomen

24
Q

nerves injured in erbs palsy

A

C5-C6

25
Q

if suspected umbilical cord prolapse what do you do first then second

fetal bradycardia in the face of rupture of membranes

A

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

26
Q

onset of fetal bradycardia steps to take

A

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

27
Q

late decelerations after an epidural and treatment

A

hypotension

IV fluids, then vasopressive agent like ephedrine

28
Q

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

A

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

29
Q

what is the most common cause of late postpartum hemorrhage

tx

A

subinvolution of the uterus

tx: uterotonic agents like ergot alkaloids or misoprostol

usually decreases quickly within 12 hrs

30
Q

bleeding from multiple venipuncture sites together with abruption suggests what

A

coagulopathy

31
Q

placental abruption can lead to _____ from a decrease in ___

A

coagulopathy

fibrinogen

32
Q

is an US good for dx placental abruption?

good for previa?

A

no, good for previa

33
Q

placenta accreta management

A

hysterectomy

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

34
Q

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

A

3

35
Q

is an anterior or posterior placenta more at risk for accreta

A

posterior

36
Q

does previous myomectomy increase risk of placenta accreta

A

no

37
Q

order of assessing infertility managment

A

male sperm and erections

MMOHL Unexplained (get adoption)

male, mucous (female), ovulation, hysterosalpinogram, laproscopy (for endometriosisis)

38
Q

anything greater than CIN1 is considered what

A

HSIL

39
Q

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

if have + ecto and - endo then get ___

A

colposcopy

cone biopsy

laser ablation

40
Q

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

A

`get HPV DNA

41
Q

vulvar cancer if have melanoma or SCC what do you do

what about pagets

A

vulvectomy and LN dissection

local resection for pagets

42
Q

SCC of vagina usually from what

A

HPV

43
Q

complete mole can lead to elevated ____ which can cause what

A

b hcg

hyperthyroidism

44
Q

choriocarcinoma can metastasize to where

A

lung and brain

45
Q

treatment for choriocarcinoma

A

surgery: TAH or debulking

medical: MAC
methotrexate, actinomycin D, cyclophosphamide

46
Q

how does hypothyroid cause amennorrhea

A

TRH is increased which stimulates more prolactin

prolactin inhibits GnRH

47
Q

what does prolactin inhibit

A

GnRH

48
Q

what inhibits prolcatin

A

dopamine

dopamine antagonist like antipsychotics stop inhibition

49
Q

if have prolactinoma what is treatment

A

ropinorole and pramipraxole

dopamine antagonists

50
Q

secondary ammenhoria and then positive progest challange is probably what

negative

A

PCOS

anovulation

neg: ashermans, endometrial problem

case files shelf DF (1 decks)

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