Ob/ Gyn/ Male Flashcards
Gestational sac is visible on u/s
5 weeks
b-hCG 1000-1500
What increases in pregnancy
Renal flow
GFR
Weight gain guidelines
< 19.8: 12-18 kg
19.8-26: 11-16 kg
26- 29: 7-11 kg
> 29: 5-9 kg
<18.5: 28-40 lbs
18.5-24.9: 25-35 lbs
25-29: 15-25 lbs
> 29.0: 11-20 lbs
Quad screen
maternal sesrum Alpha fetoprotein
Inhibin A
Estriol
beta-hCG
Trisomy 18
Decreased MSAFP
Decreased Estriol
Decreased Inhibin A
Decreased beta-hCG
Trisomy 21
Decreased MSAFP
Decreased Estriol
Increased Inhibin A
Increased beta-hCG
TORCHeS
Tocoplasmosis Other Rubella CMV Herpes simplex virus HIV Syphilis
Other: Parvo, varicella, Listeria, TB, marlaria, fungi
Hydrocephalus
Intracranial calcifications
Chorioretinitis
Ring-enhancing lesions on MRI
- Name
- Tx
- Prophylaxis
Toxoplasmosis
Congenital infxn
Pyrimethamine + sulfadiazine
Spiramycin prophylaxis for third trimester
Rash Cataracts Mental retardation Hearing loss PDA
Rubella
No tx
Petechial rash
Periventricular calcifications
CMV
Postpartum ganciclovir
Maculopapular rash Lymphadenopathy Hepatomegaly Snuffles Osteitis
Syphilis
Penicillin
Abortion
Mifepristone + misoprostol
- 49 days
Methotrexate + misoprostol
- 49 days
Vaginal/ sublingual/ buccal misoprostol
- 59 days
Surgical options
- 13 weeks
Oxytocin side effects
Hyponatremia
Tachysystole
Hypotension
Decelerations
VEaL CHoP
Variable deceleration= Cord compression
Early deceleration= Head compression
Late deceleration= Placental insufficiency
Normal fetal HR
110-160 bpm
Reactive Nonstress test
Normal response
Two accelerations last at least 15 seconds over 20 minute period
Biophysical profile evaluates
Test the Baby, MAN
Fetal Tone Fetal Breathing Fetal Movement Amniotic fluid volume Nonstress test
Morning sickness lasting past first trimester
- Name
- Labs (2)
- Tx
Hyperemesis gradivarum
Persistent vomiting
Acute starvation (large ketonuria)
WL
Increased beta-hCG
Increased estradiol
Evaluate for trophoblastic disease
Dietary changes
Doxylamine-pyridoxine
UA before 20 weeks reveals glycosuria
Pregestational diabetes
Gestational HTN
BP > 140 or > 90
Develops at > 20 weeks
SE pregestational DM (9)
Macrosomia or IUGR
Cardiac and renal defects
Neural tube defects
Hypocalcemia Polycythemia Hyperbilirubinemia Hypoglycemia Shoulder dystocia
Preeclampsia
HTN
Proteinuria
Edema
Hemolytic anemia
Elevated liver enzymes
Low platelets
HELLP syndrome
Prophylaxis for seizures with preclampsia
- Risk of Tx
- Fix for that
Continuous magneisum sulfate drip
Magnexium toxicity (loss of DTRs, respiratory paralysis, Coma)
Tx Magnesium toxicity: IV calcium gluconate
Tx Eclampsia
IV diazepam for seizures
Delivery
Tx Asymptomatic bacteriuria and UTI in pregnancy
3-7 days nitrofurantoin, cephalexin or amoxicillin-clavulanate
Tx Pyelonephritis in pregnancy
IV fluids
IV third generation cephalosporins
Vasa Previa
Velamentous umbilical cord insertion and/or bilobed placenta causing vessels to pass over the internal os
Polyhydramnios
Oligohydramnios
Polyhydramnios: >= 25
Oligohydramnos <5
Antibodies across placenta
IgG
Erythroblastosis fetalis
Rh negative mothers
Hydrops fetalis
When fetal hemoglobin < 7
First trimester uterine bleeding
Hyperemesis gravidarum
Preeclampsia < 24 weeks
- Name
- U/S appearance
- Lab
- Progress to
Gestational trophoblastic disease
Snowstorm on pelvic ultrasound
Increased beta-HCG > 100,000
Can progress to invasive hydatidiform moles or choriocarcinoma
Complete vs incomplete moles
Complete
- Sperm fertilization of empty ovum
- 46, XX
- No fetal tissue
Incomplete
- Normal ovum fertilized by two sperm
- 69, XXY
- Contains fetal tissue
What is elevated with multiple gestations
Beta-hCG
Human placental lactogen
MSAFP
Rupture of membranes
+ Nitrazine paper test
+ Fern test
What should be used with c-section
Sodium citrate given to mother to reduce gastric acidity and prevent acid aspiration syndrome
Third degree Episiotomy
Extension to anal sphincter
Fourth degree Episiomy
Extension to rectum
Fever > 38 C within 36 hrs of delivery
Uterine tenderness
Malodorous lochi
Tx
Postpartum Endometritis
Tx IV clindamycin and gentamicin
Post partum
Abdominal pain
Back pain
Fever that swings from normal to as high as 105
Unresponsive to antibiotics
Septic pelvic thrombophlebitis
Pelvic infection leads to infection of vein wall
Clot invaded by microorganisms
CT for pelvic abscess
Broad spectrum antibiotics and anticoagulation
Positive VDRL
High sensitivity
Low specificity
Confirm with FTA-ABS test
Positive VDRL
Two miscarriages
Low platelets
Prolonged PTT
- Name
- Tx
Antiphospholipid antibody syndrome
False positive VDRL
Started on low molecular weigth heparin (LMWH)
Cleft lip
Wide anterior fontanelle
Distal phalange hypoplasia
Microcephaly
- Name
- Cause (3)
- Also seen (2)
Fetal hydantoin syndrome
Exposure to antiepileptic
- Phenytoin
- Carbamazepine
- Valproate
Cardiac anomalies
- pulmonary stenosis
- aortic stenosis
Alcohol use while in utero (2)
Microcephaly
Mid facial hypoplasia
[No cleft lip]
Oligohydramnios
Pulmonary hypoplasia
Growth restirctions
Limb defects
- What
- Causes
ACE-I in utero
Fetal reanl failure
Gestational HTN need evaluation
BPP weekly starting at 32 weeks
Pruritus
Third trimester
Worse on hands
No rash
Increased total bile acids
- Name
- Tx
Intrahepatic cholestasis of pregnancy
Delivery at 37 weeks
Ursodeoxycholic acid
Antihistamines
Increased Alpha feto protein
Multiple gestation
Abdominal wall defects
Tx Intrauterine fetal demise
20-23 weeks
- Dilation & evacuation or vaginal delivery
>
- 24 weeks
- vaginal delivery
Ultrasound showed a thin endometrial stripe
Suggests an empty and normal uterine cavity
Tx Postpartum hemorrhage
- Bimanual uterine massage + oxytocin
- Uterotonics
- Methylergonovine
- carboprost
- misoprostol - Balloon tamponade
- Uterine artery embolization
- Hysterectomy
Infants who are small for gestational age are at risk for (7)
Hypoxia Perinatal asphyxia Meconium aspiration Hypothermia Hypoglycemia Hypocalcemia Polycythemia
Discrepancy between uterine size and gestational age
Enlarged uterus with irregular contour
Leiomyomata uteri
- uterine fibroids
Evaluating risk of preterm labor
Transvaginal ultrasound
Measures cervical length
short cervix tx
Progesterone maintains uterine quiescence
Pregnant
Joint pain
Malar rash
FHR: 80 bpm
- Name
- Causes (3)
SLE
—> Fetal atrioventricular (AV) block
Ventricular HR: 50-80/min
Fetal bradycardia
Optimal fetal position
Occiput anterior
Baby head facing back/butt
Sharp groin pain in pregnancy
Round ligament pain
Bilateral kidney enlargement and bilateral dilation of the renal pelvises and proximal ureters
- Name
- MOA
Physiologic hydronephrosis of pregnancy
Kidney enlargement occurs because there is an increase in maternal blood volume that requires increased filtration
Intrauterine fetal demise
Multiple limb fractures
Hypoplastic thoracic cavity
- Name
- Inheritence
Type II osteogenesis imperfecta
AD
Macrocephaly Frontal bossing Midface hypoplasia Genu varum Limb shortening
achrondroplasia
Inevitable abortion presents at
< 20 weeks
Placental abruption vs placenta previa
Placental abruption
- Vaginal bleeding
- Constant abdominal pain
- Tender uterus
- Fetal decelerations
Placenta previa
- Vaginal bleeding
- non tender uterus
- normal fetal HR
Medication to avoid in delivery with myasthenia gravis (6)
Magnesium sulfate
Fluroquinolones
Opioids
Beta blockers
CCB
Statins
Sudden vaginal bleeding
Severe lower abdominal pain
Gestational diabetes
Smoker
Dilated cervix
3+ protein
158/96
Contractions every 2 minutes and last for 20 seconds
- Name
- Feature (2)
- At risk for
Placental abruption
High frequency, low intensity contractions
Hypertonic tender uterus
RISK of: DIC
When to use tocolytics
- Examples (2)
Indomethacin
Nifedipine
< 34 weeks
Preeclampsia prevention
Low-dose aspirin at 12 weeks gestation
Daily until delivery
When to manual rotation breech baby
> = 37 weeks
Pain when ambulating
Sharp lower midline abdominal pain
Tenderness to palpation just below bladder
Nontender uterine fundus
- Name
- MOA
Pubic symphysis diastasis
Levels of progesterone and relaxin increase pelvic mobility and promote a physiologic widening of pubic symphysis
Postcoital bleeding
Thick mucopurulent discharge
Pregnant
Acute cervicitis
Pulmonary hypoplasia
Oligohydramnios
Distended bladder
Enlarged kidneys
Thin renal cortices
Posterior urethral `
Indomethacin tocolysis can cause
decreases prostaglandin production —> fetal vasoconstriction (premature closure of ductus arteriosus)
Decreased renal perfusion —> oligohydramnios
Gestational DM when you need insulin
Fasting <= 95
1 hr <= 140
2 hr <= 120
Shoulder dystocia what to do
BE CALM
Breathe; do not push
Elevate legs & flex hips (McRoberts)
Call for help
Apply suprapubic pressure
EnLarge vaginal opening with episiotomy
No fetal pole
No embyo
Missed abortion
Closed cervix
Tx Preterm labor
< 32 weeks
Corticosteriods (Betamethasone) Tocolytics (indomethacin) Magnesium sulfate (provide fetal neuroprotection)
Infection that causes temporal lobe edema and hemorrhage
Herpes simplex virus
Feel bulging bag with no palpable presenting fetal part
Get transabdominal ultrasound
Risk factors Shoulder dystocia (5)
Fetal macrosomia Maternal obesity Excessive weight gain in pregnancy Gestational diabetes Postterm pregnancy
Group B strep tested at
35-37 weeks
Do what at 28 weeks
Anti-D immune globulin
HIV delivery
Viral load > 1,000 = high risk vertical transmission
Decreased fetal movement what to do
Reactive NST
Next Biophysical profile or contraction stress test
[Dont use CST if placenta previa]
Single fluid pocket of 1.5 x 1 cm
Oligohydramnios
Single deepest pocket < 2cm
or amniotic fluid index < 5
Intrauterine fetal demise
Watery diarrhea after eating at picnic
Listeria monocytogenes
Pericardial effusion
Bilateral pleural effusions
Polyhydramnios
on ultrasound of fetus
- Name
- Due to
- Causes
Fetal hydrops
Rh(D) alloimmunization
Parvovirus B19
Thalassemia
SLE nephritis in pregnancy symptoms (5)
Edema
Malar rash
Arthritis
Hematuria
Proteinuria
Medication CI in postpartum atony and hemorrhage
- Name
- CI
- CI due to
Methylergonovine
CI in HTN disorders
Due to risk of stroke
HELLP results in
Distension of liver capsule
Premature rupture of membranes give when
Prophylactic latency antibiotics
Corticosteriods
Preeclampsia risk factors (3)
- Prophylaxis
DM
Chronic HTN
Multiple gestations
Give lose dose aspirin
Lochia timeline
3-4 days dark or bright red
4-14 pink/ brownish
11th - 6 wk: white/ yellow creamy
Increase after breastfeeding
Fetus with double bubble sign
- Name
- Causes
- Associated with (2)
- Check for
Duodenal atresia
causes polyhydramnios
Duodenal atresia associated with trisomy 21 and VACTERL
Vertebral Anal atresia Cardiac Trachoesophageal fistula Esophageal atresia Renal Limb
Check for VSD
Post labor
Preeclampsia
Patellar reflexes absent
Magnesium sulfate toxicity
No cervical change for >4 hours despite adequate contractions (>200)
Arrest
Cesarean delivery
Breast development age
Menarche age
8-13
10-16
Menopause duration
Labs
at least 12 months
Increased FSH and LH
Start screening for osteoporosis
65 years old
Absence of menses
Absence of 2nd sexual characteristics
Turners
Absence of menses
Secondary sexual characteristics
Absence of upper two third of vagina
Mullerian agenesis
Absence of menses
Secondary sexual characteristics
Breast development
No pubic hair
Complete androgen insensitivity
Turner heart conditions
Streak gonads
Amenorrhea
Aortic coarctation
Bicuspid aortic valve
Amenorrhea
Present uterus
Increased FSH
Turner’s
Primary ovarian insufficiency
WIthdrawal bleed from progestin challenge
Increased LH
PCOS or premature menopause
Pain
Menorrhagia
Enlarged boggy symmetrical uterus
Tx
Adenomyosis
NSAIDS
Acute heavy bleeding
High dose estrogen IV stabilizes the endometrial lining
If bleeding not controlled within 12-24 hours then D&C
Serum pH > 7.45 HTN Hypokalemia Decreased aldosterone Increased cortisol
- Acquired from
- Tx
Syndrome of Apparent Mineralocorticoid Excess (SAME)
Hereditary deficiency of 11beta-hydroxysteroid dehydrogenase
- cortisol not converted to cortisone
Can acquire from glycyrrhetinic acid (present in licorice)
Tx: Corticosteriods