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Rosh Review > OB/GYN Disorders > Flashcards

OB/GYN Disorders Flashcards

1
Q

Examiner best next steps if cord prolapse found on cervical exam

A

Elevate fetal head and obtain emergent obstetric consult
- do not abort exam; other maneuvers if delay in c-section - Trendelenburg position, knee-chest position, bladder filling

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2
Q

What is the vascular anatomy of the umbilical cord, and which structure should be used when obtaining umbilical vascular access?

A

Two arteries and one vein

Vein should be catheterized for vascular access

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3
Q

Most common ultrasound finding for patients with ovarian torsion?

A

Enlargement of the ovary

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4
Q

What is the underlying pathophysiology of the cyclic edema associated with premenstrual syndrome?

A

Alterations in the renin-angiotensin-aldosterone axis; altered antidiuretic hormone function

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5
Q

Treatment for premenstrual syndrome?

A
  • Decrease caffeine intake
  • Exercise
  • Stress reduction
  • NSAIDs
  • SSRIs
  • OCPs
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6
Q

Premenstrual syndrome vs. premenstrual dysphoric disorder

A

In premenstrual dysphoric disorder, symptoms hinder personal/professional life

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7
Q

Which organisms are commonly found in TOAs?

A

Often polymicrobial

  • E. Coli
  • Aerobic streptococci
  • Bacteroides
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8
Q

Diagnostic criteria for pre-eclampsia

A

BP >/= 140/90 on two occasions at least 4 hours apart after 20 weeks gestation up to 6 weeks postpartum
AND
Signs of end-organ damage with or without proteinuria (>/= 300 mg per 24 hr urine collection or Protein:Creatinine ratio >0.3 or dipstic >/= 2+

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9
Q

Diagnostic criteria for preeclampsia with severe features

A

Automatically if BP >/= 160/110 and confirmed in short interval
AND
If any of the following present:
- Plt <100,000
- Cr >1.1 or doubling of serum Cr in absence of other renal disease
- Pulmonary edema
- Cerebral or visual symptoms

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10
Q

Risk factors for preeclampsia

A
  • Nulliparity
  • Multifetal gestation
  • Obesity
  • DM
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11
Q

Clinical findings of hydatidiform mole (gestational trophoblastic disease)

A
  • Very elevated B-hCG - Could have hyperthyroidism from stimulation of thyroid gland from high b-hCG levels
  • Vaginal bleeding
  • Pelvic pressure or pain
  • Uterine size > gestational age
  • Hyperemesis gravidarum
  • Preeclampsia at <20 weeks gestation
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12
Q

4T’s of postpartum hemorrhage

A

Tone (uterine atony most common cause)
Trauma
Tissue (retained fetal or placental tissue)
Thrombin (coagulopathy)

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13
Q

Tx of postpartum hemorrhage due to uterine atony

A

Uterine massage, oxytocin, prostaglandins, hysterectomy

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14
Q

Most common cause of fetal demise after trauma?

A

Maternal death

Placental abruption next most common

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15
Q

Risk factors for placental abruption

A
  • Previous abruption
  • HTN
  • Cocaine use
  • Trauma
  • Multiparity
  • Smoking
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16
Q

Empiric Tx for STIs after Sexual Assault

A

STIs: Ceftriaxone (250mg IM), Azithromycin 1g PO, Metronidazole or tinidazole 2g PO)
Hep B: if unclear about vaccination history, both hep B vaccine and immune globulin
HIV: Antiretroviral drugs
HPV: if not already administered in survivors aged 9-45
Pregnancy: should be offered

17
Q

Tx for hyperemesis gravidarum

A
  1. Pyridoxine alone or in combination with doxylamine
  2. Add antihistamine or 5HT3 antagonist
    - Diphenhydramine
    - Meclizine
    - Dimenhydrinate
  3. Ondansetron, prochlorperazine, metoclopramide, or promethazine
18
Q

Hallmark of late decelerations

A

Onset, nadir, and recovery of decel follow onset, peak, and end of contraction

19
Q

Causes of late decelerations

A

Uteroplacental insufficiency

  • Maternal hypotension or hypoxia
  • Placental abruption
  • Umbilical cord prolapse
  • Uterine tachysystole
20
Q

Management of late decelerations

A
  • Lateral recumbent position
  • Sterile vaginal exam to assess for umbilical cord prolapse, rapid cervical dilation, or descent of fetal head
  • IVF; consider O2
  • Consider tocolytis
  • If despite interventions late decels continue -> urgent surgical delivery
21
Q

Definition of moderate variability on fetal heart tracing?

A

Fluctuations in baseline HR of 6-25 beats per minute

22
Q

Most appropriate IVF for pregnant woman with hyperemesis gravidarum

A

5% Dextrose in 0.9% saline or in LR

23
Q

Most common factor that puts a postpartum woman at risk for endometritis?

A

Cesarean delivery

24
Q

Tx for endometritis

A

Clindamycin plus gentamicin

25
Q

Other risk factors for postpartum endometritis

A
  • Internal fetal monitoring
  • Multiple cervical exams
  • Prolonged labor (Stage 2 >12 hours)
  • Prolonged rupture of membranes >24 hours
  • Manual removal of placenta
  • Large amount of meconium in amniotic fluid
  • Low SES
  • Comorbidities such as diabetes or HIV
26
Q

What organism should be strongly suspected in patients who present to the ED with postpartum endometritis within 48 hours of delivery?

A

Group A streptococcus

27
Q

What is a threatened abortion?

A

Abdominal pain or bleeding <20 weeks gestation

Os is closed and no fetal tissue passed

28
Q

What is an inevitable abortion?

A

Abdominal pain or bleeding in first 20 weeks of gestation

Os is open , no passage of fetal tissue

29
Q

What is an incomplete abortion?

A

Abdominal pain or bleeding in first 20 weeks of gestation

Os is open, some products of conception have passed

30
Q

What is a complete abortion?

A

Abdominal pain or bleeding in first 20 weeks of gestation

Os is closed; there has been complete passage of fetal parts and placenta and the uterus is contracted

31
Q

What is a missed abortion?

A

In utero death of embryo or fetus prior to 20 weeks gestation with retention of pregnancy
Os is closed, no passage of fetal tissue

32
Q

Usual bacteria involved in septic abortion?

A

Staph aureus

33
Q

Definition of postpartum hemorrhage

A

Cumulative blood loss equal or greater than 1,000 cc or bleeding associated with s/s of hypovolemia within 24 hours of giving birth

34
Q

What is the most common cause of infectious vaginitis?

A

Bacterial vaginosis (candida is second most common)

35
Q

What risk factor causes the greatest increase in risk for cervical ectopic pregnancy?

A

In-vitro fertilization

36
Q

Options for Emergency Contraception

A
  1. Levonorgestrel - up to 3 days s/p unprotected intercourse
  2. Estrogen plus progesterone - up to 5 days
  3. Mifepristone - up to 5 days
  4. Copper IUD - up to 5 days
  5. Ulipristal - up to 5 days
37
Q

Presentation of ovarian hyperstimulation syndrome

A
  • Abd pain
  • Fatigue
  • SOB
  • Ascites
    Can progress to obtunded status or death if not addressed properly
38
Q

Complications of ovarian hyperstimulation syndrome

A
  • Hemoconcentration
  • Liver failure
  • Electrolyte derangements
  • Coagulopathies
  • Renal failure
  • Multiorgan system failure
39
Q

If not sure where US shows gestational sac what to look for

A
  • free fluid

- is hcg level >1500? If seeing something that looks like pseudosac in question, if hcg<1500 may be ectopic

Rosh Review (22 decks)

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