OB GYN Flashcards
Preeclampsia
- RF
- > 40 yo
- nulliparity
- fam hx
- oesity
- twins
- hx HTN, DM, renal dz
Preeclampsia
- dx
- new onset HTN >140/90
- proteinuria >300 mg/24 hour
- > 20 weeks gestation
Preeclampsia
- mgmt
- > 37 weeks: deliver
- 34-37 weeks: induced if severe dz
- <34 weeks: steroids
Mifepristone
- CI
- chronic adrenal failure
- long term steroid use
- drug is glucocorticoid receptor antagonist
Medical abortion
- meds
- Mifepristone followed by misoprostol
- copper IUD
Cyclical breast pain
- mgmt
- Reassurance, physical support (bra) and NSAID/tylenol
- second line: tamoxifen, danazol for 1-3 months only
APGAR
score range
details
0-10 - Appearance: 0 blue/pale 1 body pink extremities blue 2 pink all over - Pulse: 0 absent 1 <100 2 >100 - Grimace 0 Flaccid 1 grimace with stimulation 2 active motion - sneeze, cough, pulls away - Activity / m tone 0 absent 1 arms/legs flexed 2 active movement - Respiration 0 absent 1 slow, irregular 2 vigorous cry
Fetal station
Position of presenting part (usu head) in centimeters relative to line across ischial spines
- superior = negative station (negative numbers 1-5)
- inferior = positive station (pos numbers 1-5)
- at the line: 0 station
Best way to dx herpes simplex
PCR
- Tzanck less sensitive/specific
Placental abruption
- biggest RF
prior placental abruption
also HTN, cigs, cocaine, multiparty
Ovarian torsion
- definitive dx
laparoscopy
- pelvic US first line
Labor induction
- ripen cervix (Bishop <6): prostaglandin E2 or E1 (dinoprostin/misoprostol)
- oxytocin
Bishop score
Higher = greater chance of successful vag delivery
Cord prolapse
- mgmt
- elevate presenting part of fetus
- trendelenburg position
- tocolytic
Infertility
- dx best test
- anti-mullerian hormone: decline steadily with age, undetectable at menopause
Fetal non stress test
- overview
measures
- fetal heart rate
- uterine contractions
Reactive (nl) if
- 2+ fetal HR accelerations 15 bpm for 15 second in 20 min
Nonreactive (abnl)
- no sig acceleration of HR, repeat in 30 min (sleeping?)
Fetal biophysical profile
- measure what
- fetal tone
- fetal breathing
- fetal movement
- amniotic fluid volume
Early vs. late decelerations
Early: fetal head compression
Late: fetal hypoxemia - placental insufficiency or cord compression
Ovarian cancer
MCC gyn cancer death
- MC epithelial cell origin
- pelvic US to start
Ovarian cancer tumor marker
CA 125
Placenta accreta spectrum
- accreta: attaches to myometrium
- increta: into myometrium
- percreta: penetrates through myometrium
Lymphogranuloma venereum
- bug
- location
- chlamydia trachomatis
- Africa, SE Asia, Caribbean, S. America
Lymphogranuloma venereum
- clinical
- painless vesicle or ulcer, resolves spontaneously
- inguinal buboes bilaterally > multiple draining sinuses
- proctitis with tenesmus, bloody purulent drainage from anal region, scarring of perirectal tissue
Lymphogranuloma venereum
- mgmt
- doxy 100 mg BID X 21 D
- I&D inguinal buboes
Anterior fontanelle
- composed of what sutures
- coronal
- frontal
- sagittal
Best fetal presentation
- longitudinal
- cephalic
- vertex
- occiput anterior
Adenomyosis
- overview
- endometrial tissue is in myometrium
Adenomyosis
- clinical
- abnl uterine bleeding
- painful menses
- uterine enlargement
- globular, boggy, symmetric uterus on palpation
Adenomyosis
- mgmt
- NSAIDs
- OCPs
- endometrial ablation, resection if conservative fails
- definitive: hysterectomy
First line dx for dysfunctional uterine bleeding
- transvaginal US
Abnormal Uterine Bleeding
- causes
PALM COEIN
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy/hyperplasia
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified
Hypermg
- sx
- Loss of DTR
- Decr respirations
- Impaired urinary output
Endometrial Hyperplasia
- RF
- increased exposure to estrogen: obesity, PCOS, exogenous E
Endometrial Hyperplasia
- clinical
- abnormal uterine bleeding
Endometrial Hyperplasia
- dx
- endometrial bx
- pelvic US to ro other causes of AUB
Endometrial Hyperplasia
- mgmt
- no atypia: Progestins (IUD)
- atypia: Hysterectomy (keep the eggs)
