ob/gyn emergencies Flashcards
- US: less blood to ovary w/ ovarian cyst
- unilateral abdominal pain
ovarian cyst
call OBGYN ASAP– SURGICAL EMERGENCY
3 risk factors for ovarian torsion
- cysts
- PCOS
- masses
very painful condition diagnosed via transvaginal US; not a surgical emergency
ovarian cyst– benign
- tx: pain control and f/u w/ OBGYN d/t risk of torsion
- can give OC to prevent future cysts
triad: fever, RLQ pain, anorexia
CT is used for definitive diagnosis
rebound tenderness w/ mcburney’s point
(+) herosin sign
tx: broad spectrum abx– zosyn, ceftriaxone, etc
appendicitis
- infection; obstruction of cystic duct
- RUQ pain
- US/HIDA scan
- (+) Murphys
acute cholecystitis
tx: cholecystectomy, abx
- obstruction common bile duct; RUQ pain w/ jaundice
choledocholithiasis
- US/ERCP
reynolds pentad: RUQ, jaundice, fever, AMS, hypotension
acute ascending cholangitis
US/ERCP; Abx
cervical motion tenderness
high WBC, ESR/CRP, fever
PID
tx for gonorrhea
ceftriaxone 500mg IM
tx for chlamydia
doxycyline 100 mg BID
complication of PID that can rupture or result in sepsis
dx with US
tx with abx and gyn consult
tuboovarian abscess
condition & tx
malodorous discharge, postcoital bleeding, dysparenunia, dysuria
cervical petechiae (strawberry cervix)
dx w/ wet mount
trichomoniasis vaginalis
tx: metronidazole
condition & tx
- candida albicans overgrowth- wet prep shows hyphae/spores
- irritation, erythema, discomfort
- thick white discharge
- normal pH
vulvovaginal candidiasis
tx: fluconazole, cotton undies, no bubble baths
condition & tx
- odor thats worse after intercourse, itching/irritation, thin watery gray discharge w/ fishy smell
- clue cells
bacterial vaginosis
tx: metronidazole
which two conditions will have pH above 5
BV
trich
condition & tx
- infected gland causing pain and tenderness
- unilateral swelling on PE; fluctuant if abscess
bartholian cyst
tx: I & D w/ abx if its an abscess; if no sx then no intervention
3 things to include in work up? 3 treatments
- unexplained bleeding in non pregnant woman w/ normal P.E
- work up: STD check, HCG, endometrial biopsy if postmenopausal
- tx: support –> OCP/IUD –> endometrial ablation/hysterectomy
what does PALM-COEIN mean in abnormal uterine bleeding
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not yet classified
what is this? what are you concerned for?
- rupture of membranes before labor + before 37 wks
Preterm prelabor rupture of membranes (PPROM)
- if under 34 wks, concerned about underdeveloped lungs– give steroids to delay labor and increase surfactant
- Tocolytics to delay delivery
- abx
rupture of membranes after 37 wks but before labor
PROM– admit for fetal monitoring; will go into labor or will induce it
3 ways to diagnose premature rupture of membranes
sterile speculum exam (NO DIGITAL VAGINAL EXAM)
nitrazine paper test (positive if ph over 6.5)
fern test w/ amniotic fluid
what are the 4 types of miscarriages? which one is viable?
- threatened: viable; closed os
- inevitable: open os but still in; do cervical evacuation
- incomplete: open os; half in/out; do cervical evacuation
- complete: nothing inside; os may be closed
who gets RhoGAM & when
- RH neg females and antibody neg females if there is any mixing of blood (abortion, ectopic too)
- w/in 72 hours of delivery
condition & 4 things to do to manage it
- abdominal pain, vaginal bleeding, h.o positive pregnant test
- beta HCG does NOT double q 2-3 days
- left shoulder pain if it ruptures; could be in shock
ectopic pregnancy
1. confirm pregnancy w/ quantitative betaHCG (repeat in 2-3 daysif below 1500); call OB if a lot of bleeding or shock
2. TVUS shows no gestational sac w/ beta HCG over 2000
3. MTX +/- RhoGAM if hemodynamically stable & beta HCG under 5K (another dose if it doesnt drop to 0)
4. if unstable or rupured do lap salp w/ RhoGAM
what is this? tx?
- painless vaginal bleeding, uterine size/date mismatch & high beta HCG (over 100K)
- US: snowstorm/cluster of grapes w/o fetal parts/heart tones
Molar pregnancy: abnormal placenta w/ trophoblastic tissue
- tx: surgery before choriocarcinoma develops; weekly beta HCG till back to undetectable
what are the two types of molar pregnancies
complete (diploid): empty egg fertilized by sperm; most common; becomes choriocarcinoma
partial (triploid): egg fertilized by 2 sperm of 1 that duplicates its chromosome
what is this? how is mild vs severe managed?
- HTN after 20 wks + proteinuria in previously healthy person
- can have end organ disfunctional or renal involvement
preeclampsia
Mild full term: delivery; mild under 37 wks: steroids & close f/u
severe: delivery, labetolol, nifedipine, methldopa, hydralazine, Magnesium
what is HELLP
a form of preeclampsia
Hemolytic Anemia
Elevated Liver enzymes
Low platelets
what is this? tx?
- preeclampsia + seizures
eclampsia
tx: delivery + IV magnesium or lorazepam
IV labetolol, hydralazine, nicardipine
what is it? diagnosis? treatment
- painless vaginal bleeding in 3rd trimester
- placenta covering cervical os
- risk factors: previous occurance, C section, multiple gestation
placenta
dx: US
tx: pelvic rest and delivery
conditon? diagnosis? tx?
- painful vaginal bleeding/firm uterus in 3rd trimester
- placenta separating from uterine wall
- RF: HTN, tobacco/alc, cocaine, older maternal age, trauma, multiple gestations
placental abruption
dx: clinical/US
tx: delivery and supportive care
what is it? 4 ways to tx
- vomiting in pregnant person causing hypokalemia, hypophosphatemia, hypomagnesium & wt loss
hyperemesis gravidarum
tx: pyridoxine + doxylamine, Metoclopromide/promethaxine, zofran, IV fluids/electrolytes
what is this? 4 causes?
blood loss over 500mL (vaginal delivery) or over 1000mL (c-section)
postpartum hemorrhage
- uterine atony
- retained placenta tissue
- trauma
- coagulation abnormalities
conditon? 3 tx?
- soft flaccid boggy uterus
- RF: c-section, over distended uterus, prolonged labor
uterine atony
- uterine massage
- oxytocin to increase contractions
- arterial embolization or hysterectomy
what is this? 3 ways to tx?
s. aureus infection of the breast
mastitis
tx: compress, pain meds, dicloxacillin or nafcillin
moms should keep feeding
what is this? tx?
- polymicrobial infection of endometrium
- fever, tachy, pain, foul smelling lochia
endometritis
tx: clindamycin + gentamicin or augmentin
can give 1st gen ceph in c-section for prophylaxis
