Ob/Gyn Flashcards
Term lengths: Previable - Preterm - Term - Early - Full - Late - Postterm -
Term lengths: Previable - <24 w Preterm - 25-37 w Term - 37 w Early - 37 to 38 and 6 Full - 39 to 40 and 6 Late - 41 to 41 and 6 Postterm - >42 w
Beta hCG >1500 or 5 weeks =
gestational sac on U/S
Fibrinogen is _ in pregnancy
increased
Routine prenatal labs
- Initial prenatal visit
- 24-28 weeks
- 35-37 weeks
Routine prenatal labs
- Initial prenatal visit: Rh(D) type, ab screen, Hb/Hct/MCV*, HIV, VDRL/RPR, HBsAg, Rubella and Varicella immunity, Chlamydia, urine culture, urine protein
- 24-28 weeks: Hb/Hct, ab screen if Rh(D) negative, 50 g 1-h oral glucose challenge test**
- 35-37 weeks: GBS culture
- treat iron deficiency anemia with iron + stool softener
- *if positive, perform glucose tolerance test
what labs do you need for someone taking methotrexate?
liver enzymes
medical tx of ectopic pregnancy
1) get baseline exams: CBC, blood type/screen, LFTs, and beta-hCG
2) give methotrexate and recheck beta-hCG in 4-7 days
3) if <15% drop in beta-hCG, give second dose
4) if persistently high levels –> surgery
ectopics >3.5 cm are at greater risk of failure with MTX
if surgery is performed, Rh negative mothers should receive RhoGAM
types of abortion
- complete
- incomplete
- inevitable
- threatened
- missed
- septic
types of abortion
- complete - no products of conception left
- incomplete - some products
- inevitable - products intact, bleeding, cervix dilated
- threatened - same as above, but cervix closed
- missed - intact but dead
- septic - infection
Late and postterm pregnancy complications for the fetus and the mother
fetus - oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions
mother - cesarean delivery, infection, postpartum hemorrhage, perineal trauma
circumstances in which preterm labor should not be stopped with tocolytics and delivery should occur
- severe hypertension (preeclampsia, eclampsia)
- cardiac disease
- cervical dilation >4 cm
- hemorrhage
- fetal death
- chorioamnionitis
if preterm labor is occurring (contractions + cervical dilation), when do you stop and when do you deliver?
stop if 24-33 w (or 600-2500 g) –> give betamethasone*, tocolytics, if <32 w –> add magnesium sulfate**
deliver if >34 weeks (or >2500 g)
*steroids need 24 h for full effect (beta completion), peak at 48 h, and last 7 days; must give tocolytic to allow then time to work
** magnesium tox can lead to respiratory depression and cardiac arrest, so check DTRs often
what to do with patient with PROM and term fetus? preterm fetus?
PROM + term fetus –> wait 6-12 hours for spontaneous delivery –> none –> induce labor
PROM + preterm fetus –> give betamethasone, tocolytics, and antibiotics (to lower risk of chorioamnionitis)
- no allergies - ampicillin + azithromycin
- penicillin allergy - cefazolin + azithro
- anaphylaxis risk - clindamycin + azithro
third trimester vaginal bleeding? imaging and digital exam
digital vaginal exam is C/I in 3rd trimester vaginal bleeding, do transabdominal U/S first (may do TVUS after)
tx of placenta previa
strict pelvic rest (no sex, nothing in the vagina)
placenta previa presents with pain_ vaginal bleeding
placental abruption presents with pain_ vaginal bleeding
placenta previa presents with painLESS vaginal bleeding
placental abruption presents with painFULL vaginal bleeding
mgmt of Rh incompatibility
at initial prenatal visit, do Rh ab screen –> if negative, check titers –> if unsensitized, repeat test again at 28 weeks and if patient continues to be unsensitized, we try to keep her unsensitized by given her RhoGAM (which binds any fetal Rh that may enter mother’s circulation and keeps her from mounting immune response) –> if at any point sensitized and titers are high (>1:16), do amniocentesis at 16-20 weeks to look at fetal Rh and bilirubin levels –> if bili levels are high, check fetal Hct and if low do intrauterine transfusion
how does U/S confirm gestational age?
femur length, abdominal circumference, and head diameter
tx of hyperemesis gravidarum
1st non pharmacological (diet, avoid triggers, etc) then diphenhydramine (H1) then metoclopramide (DA) finally ondansetron (H2)
asx bacteriuria in pregnancy
we treat it, other can result in preterm birth, low birth weight, and perinatal morbidity
acute pyelo in pregnancy warrants
hospitalization and IV ceftriaxone
antibiotics to avoid in pregnancy
TMP-SMX in first trimester (folic acid antagonism)
Aminoglycosides (amikacin, gentamicin, kanamycin, streptomycin, tobramycin) - ototoxicity
Tetracyclines and fluoroquinolones
Tx of pruritic urticarial papule and plaques of pregnancy
topical steroids
severe preeclampsia <20 weeks gestation
can be a manifestation of hydatiform mole
HTN during pregnancy with edema, joint pain, malar rash, and proteinuria and RBC casts likely
SLE complicated by nephritis
fetal nonstress test
detection of 2 fetal movements and acceleration of HR >15 bmp lasting 12-20 seconds in a 20 minute period
biophysical profile
B - breathing (chest expansions) A - amniotic fluid index (volume) T - fetal Tone (flexing) M - movement (3 in 30 mins) A ------------------------------------- N - Nonstress test
each one is assigned 2 points
8-10 = normal
4-8 = inconclusive
<4 = abnormal
do not give _ to asthma patients
prostaglandins (e.g. for cervical ripening or to stop bleeding)
most common cause of prolonged or arrested 2nd stage of labor is
fetal malposition (head not engaged with pelvis properly; optima = occiput anterior)
arrest of cervical dilation is when …
there is no dilation for more than 2 hours
causes of protracted dilation (i.e. cervix is too slow to dilate during the active phase)
the 3 P’s: power, passenger, and passage (–> cephalopelvic disproportion)
Leopold maneuver does what?
set of 4 maneuvers that estimate the fetal wight and presenting part of the fetus
fetus can maneuver itself into cephalic (vertex) presentation by
36 weeks; after that –> external rotation
neonatal clavicular fx prognosis
spontaneous healing
mgmt of postpartum hemorrhage
1) bimanual massage
2) oxytocin
3) other uterotonics
- methylergovine - do not use in HTN
- carboprost - do not use in asthma
pubic symphysis diastisis
can occur after traumatic delivery; radiating supra public pain and point tenderness; exacerbated by ambulation or weight bearing
bulk-related sxs, size-date discrepancy, irregular contours
fibroids
what kind of sports should be avoided in pregnancy
contact sports and activities with high fall risk
contraindications to breastfeeding
active and untreated TB, varicella infection, herpetic breast lesion, current chemo, illicit drug use
marijuana use during breastfeeding
THC is concentrated in breast milk, asso with decreased muscle tone, poor sucking, sedation, and delayed motor development at 1 year of age
second trimester quad screen
trisomy 18 - low AFP, beta-hCG and estriol, normal inhibin A
trisomy 21 - low AFP and estriol, high beta-hCG and inhibin A (if put in alphabetical order: low low high high)
NT or abdominal wall defect - high AFP
fetus with multiple limb fx’s
osteogenesis imperfecta
bladder atony with urinary retention and inability to void/dribbling results from
prolonged labor, perineal trama, and regional analgesia
newborns with fetal growth restriction typically have
loose skin, thin umbilical cord, and wide anterior fontanelle; assess placenta for signs of infection or infarction
patient with persistent postop/partum fever unresponsive no antibiotics
not endometritis (which is response to abx) but septic pelvic thrombophlebitis –> tx with anticoagulation and broad-spectrum abx
side effect of epidural
vasodilation/venous pooling –> hypoTN
preeclampsia + signs of end organ damage
preeclampsia with severe features
should not use this medication to tx preeclampsia in woman who presents with HTN and bradycardia
labetalol - will slow down the heart even further
use hydralazine
In patients with FH of breast cancer, start screening at
40 years of age
what is the most important consideration in the tx of breast cancer?
tumor burden (TNM)
EtOH’s has a dose-dependent effect on
breast cancer
OCP use lowers risk of ____ cancer but has no effect on incidence of ____ cancer
ovarian
breast
s/e’s that all the SERMs share
hot flashes and risk of VTE
tamoxifen - increased risk of endometrial hyperplasia/CA
trastuzumab major s/e
cardiotoxic, must do baseline Echo
patients with primary ovarian insufficiency have a hx of
autoimmune disease of Turner syndrome
evaluation of primary amenorrhea
1- first thing you do is check if there’s an uterus
2- if uterus present, check FSH levels
- high –> do karyotyping
- low –> get cranial MRI
- if no uterus, do karyotyping and serum testosterone levels
most common cause of secondary amenorrhea
pregnancy
PMS vs PMDD
PMDD is a more severe version of PMS; disrupts patients daily activities; ask patient to chart her sxs
tx: lower caffeine, EtOH, cigarette and chocolate consumption; if sxs are severe: SSRI
Lichen simplex chronicus
hyperplastic response to repetitive scratching and irritation
Lichen sclerosis
usually coexists with autoimmune conditions
in postmenopausal woman, may mimic UTI…
atrophic vaginitis
neonatal vaginal bleeding d/t
maternal estrogen w/drawal
any patient >35 with abnormal bleeding should endergo
endometrial bx to r/o cancer
postmenopausal bleeding consider ___ until proven otherwise
endometrial cancer
labial fusion occurs with …
androgen excess
tx of sx vs asx bartholin cyst
I&D if sx; obs if asx
tx of PID
IV ceftriaxone or cefotetan plus oral doxy
OR clindamycin plus gentamicin
if trichomonas if diagnosed, tx….
patient and partner
vaginal discharge with fishy odor, gray-white
BV (Gardnerella - clue cells)
white, cheesy vaginal discharge
Candidiasis (pseudohyphae)
profuse green, frothy vaginal discharge
Trichomonas (motile flagellates)
best way to dx HSV ulcer infectious etiology
PCR
postmenopausal woman with vulvar soreness and pruritus appearing as a red lesion with superficial white coating
Paget disease - an intraepithelial neoplasia, tx with vulvectomy
HPV vaccine ages
males - 11 - 21, if risk factors –> up to 26
females - 11 - 26
fixed, immobile uterus
endometriosis
endometriosis tx
NSAIDs, OCPs, danazole (–>androgenism) or leuprolide (–> hot flashes, osteoporosis)
choricarcinoma likes to metastasize to
the lungs
Magnesium sulfate toxicity
common adverse effects include HA, nausea, fatigue, diaphoresis
signs of toxicity include loss of DTRs, somnolence, and respiratory depression
solely excreted by the kidneys, so renal insufficiency is a risk factor for toxicity
tx with calcium gluconate
homogenous cystic ovarian mass
endometrioma
