OB/Gyn + Peds Flashcards
describe abnormal uterine bleeding?
lasting > 7 days or more freq that every 21 days
OR less freq than every 35 days.
WU: CBC + US for structural causes
If >45 + RF for endometrial hyperplasia: endometrial bx also indicated.
what indicates urethral hypermobility
inserting a cotton swab into the urethral orfice, angle >30 degress from the horizontal on increase intraabdominal pressure signifies urethral hypermobility.
This can lead to stress incontinence
when do we screen for gestational hyperglycemia?
all women between 24-28 weeks.
during second and third trimesters, placental hormones (to increase fetal growth and metabolism) create increase maternal insulin resistance adn can result in pathologic maternal hyperglycemia.
If extensive RF: obesity, excessive wt gain, fam hx DM, previous macrosomic infant, complications-miscarriages, birth defects, macrosomia, preeclampsia; can possibly undergo screening during their initial visit
systemic changes seen during pregnancy:
increase CO, increase plasma vol, dec SVR, dec BP, systolic ejection murmur can be heard, peripheral edema dt plasma vol expansion, noctural leg pain dt muscle cramping from lactic acid and pyruvic acid accumulation.
When is external cephalic version possible?
pt at >37 weeks with breech presentation should be offered an ECV. If ECV fails and fetus continues to be breech, c-section will be necessary.
PCOS:
presents with hyperandregenism, irregular menses
inc risk for endometrial hyperplasia/CA dt unreg endometrial proliferation from unopposed E stimulation
Tx: progesterone, OCP, IUD
Third trimester bleeds:
Placenta previa - painles bleed, FHR normal since its a maternal not fetal bleed. Digital exams and sex should be avoided. contraindication to vaginal delivery! should undergo c-section at 36-37 wks.
Placental abruption- painful bleed, FHR distress
Uterine rupture - painful bleed
Vasa previa - painless bleed, but usually with rapid FHR tracing deterioration as the hemorrahage is of fetal origin
Uterine rupture
vaginal and/or intra-abdominal bleeding, pain fetal distress/demise
PE: abdominally palpable fetal parts at rupture site and no presenting fetal parts vaginally (loss of fetal station)
RF: prior c-section, myomectomy, uterine surgery
FHR: show fetal hypoxia = fetal tachy, minimal var, late decels.
emergent lap to confirm dx and expediate delivery
Pseudocyesis:
condition in which a nonpsych women presents with s/s of early pregnancy and belief she is pregnant
mag AE:
somnolence, areflexia, respirator suppression.
Renally excreted, pt with RI are at increased risk (look for elevated serum Cr, if at inc risk maybe lower mag dose/close obs)
if tox occurs: stop mag, give IV calcium gluconate bolus
When to give Rh?
RhoD at 28 weeks for RhD negative patient and after delivery if infant is RH positive.
First trimester only in the setting of uterine bleeding.
