OB/GYN Disorders Flashcards
Examiner best next steps if cord prolapse found on cervical exam
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
What is the vascular anatomy of the umbilical cord, and which structure should be used when obtaining umbilical vascular access?
Two arteries and one vein
Vein should be catheterized for vascular access
Most common ultrasound finding for patients with ovarian torsion?
Enlargement of the ovary
What is the underlying pathophysiology of the cyclic edema associated with premenstrual syndrome?
Alterations in the renin-angiotensin-aldosterone axis; altered antidiuretic hormone function
Treatment for premenstrual syndrome?
- Decrease caffeine intake
- Exercise
- Stress reduction
- NSAIDs
- SSRIs
- OCPs
Premenstrual syndrome vs. premenstrual dysphoric disorder
In premenstrual dysphoric disorder, symptoms hinder personal/professional life
Which organisms are commonly found in TOAs?
Often polymicrobial
- E. Coli
- Aerobic streptococci
- Bacteroides
Diagnostic criteria for pre-eclampsia
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+
Diagnostic criteria for preeclampsia with severe features
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
Risk factors for preeclampsia
- Nulliparity
- Multifetal gestation
- Obesity
- DM
Clinical findings of hydatidiform mole (gestational trophoblastic disease)
- 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
4T’s of postpartum hemorrhage
Tone (uterine atony most common cause)
Trauma
Tissue (retained fetal or placental tissue)
Thrombin (coagulopathy)
Tx of postpartum hemorrhage due to uterine atony
Uterine massage, oxytocin, prostaglandins, hysterectomy
Most common cause of fetal demise after trauma?
Maternal death
Placental abruption next most common
Risk factors for placental abruption
- Previous abruption
- HTN
- Cocaine use
- Trauma
- Multiparity
- Smoking
Empiric Tx for STIs after Sexual Assault
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
Tx for hyperemesis gravidarum
- Pyridoxine alone or in combination with doxylamine
- Add antihistamine or 5HT3 antagonist
- Diphenhydramine
- Meclizine
- Dimenhydrinate - Ondansetron, prochlorperazine, metoclopramide, or promethazine
Hallmark of late decelerations
Onset, nadir, and recovery of decel follow onset, peak, and end of contraction
Causes of late decelerations
Uteroplacental insufficiency
- Maternal hypotension or hypoxia
- Placental abruption
- Umbilical cord prolapse
- Uterine tachysystole
Management of late decelerations
- 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
Definition of moderate variability on fetal heart tracing?
Fluctuations in baseline HR of 6-25 beats per minute
Most appropriate IVF for pregnant woman with hyperemesis gravidarum
5% Dextrose in 0.9% saline or in LR
Most common factor that puts a postpartum woman at risk for endometritis?
Cesarean delivery
Tx for endometritis
Clindamycin plus gentamicin
Other risk factors for postpartum endometritis
- 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
What organism should be strongly suspected in patients who present to the ED with postpartum endometritis within 48 hours of delivery?
Group A streptococcus
What is a threatened abortion?
Abdominal pain or bleeding <20 weeks gestation
Os is closed and no fetal tissue passed
What is an inevitable abortion?
Abdominal pain or bleeding in first 20 weeks of gestation
Os is open , no passage of fetal tissue
What is an incomplete abortion?
Abdominal pain or bleeding in first 20 weeks of gestation
Os is open, some products of conception have passed
What is a complete abortion?
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
What is a missed abortion?
In utero death of embryo or fetus prior to 20 weeks gestation with retention of pregnancy
Os is closed, no passage of fetal tissue
Usual bacteria involved in septic abortion?
Staph aureus
Definition of postpartum hemorrhage
Cumulative blood loss equal or greater than 1,000 cc or bleeding associated with s/s of hypovolemia within 24 hours of giving birth
What is the most common cause of infectious vaginitis?
Bacterial vaginosis (candida is second most common)
What risk factor causes the greatest increase in risk for cervical ectopic pregnancy?
In-vitro fertilization
Options for Emergency Contraception
- Levonorgestrel - up to 3 days s/p unprotected intercourse
- Estrogen plus progesterone - up to 5 days
- Mifepristone - up to 5 days
- Copper IUD - up to 5 days
- Ulipristal - up to 5 days
Presentation of ovarian hyperstimulation syndrome
- Abd pain
- Fatigue
- SOB
- Ascites
Can progress to obtunded status or death if not addressed properly
Complications of ovarian hyperstimulation syndrome
- Hemoconcentration
- Liver failure
- Electrolyte derangements
- Coagulopathies
- Renal failure
- Multiorgan system failure
If not sure where US shows gestational sac what to look for
- free fluid
- is hcg level >1500? If seeing something that looks like pseudosac in question, if hcg<1500 may be ectopic
