OB/GYN uWISE Flashcards
causes of breech presentation
prematurity multiple gestation genetic disorders hydrocephalus polyhydro fibroids anencephaly uterine anomalies
time frames of “prolong latent phase” When should you artificially rupture membranes?
nullip >20 hours multip >14 hours tx: rest or augmentation do no rupture in latent phase because increased risk of infection
how does cervical change typically prgoress in the active phase?
1 cm for nullips 1-2cm for multips
LOTS of bleeding and disproportionate cervical exam change during active phase, think…
abruption
whats in FFP?
fibrinogen, V, VIII
chorioamnionitis association
PROM **also think of any bacterial infection for this, like BV
causes of preterm labor
IDEOPATHIC uterine distortion dehydration
list three major drugs that should be given in preterm labor before 32 weeks
bethamesasone nifedipine –> give time for steroids to work ampicillin –> for GBS
if fetal heart tones are baseline 150 with a category 1 tracing do you need to do a contraction stress test for preterm labor?
NO, category I means they are contracting with variability and accels
contraindications for: -terbutaline -mag sulfate -indomethacin
-terbutaline in diabetics, or over 48 hours -mag sulfate in myastehnia gravis (resp depression) -indo after 33 weeks for closure of ductus
effects of bethasmesasone
-lung development/ decreased RDS -decreased ICH -decreased NEC
do you test vaginal mucus or cervical mucus for ferning?
VAGINAL cervix has higher false positive rates
whats the benefits in tocolytics before 32 weeks?
time to administer steroids NOT necessarily to wait for fetal lung maturity, because don’t wan tto use for >48hours
what antibiotic regimen has been shown to increase latency 5-7 days in PPROM?
amp + erythro
use of 17-a-hydroxyprogesterone
prevent PROM fom 16-36 weeks
postpartum fever differential
mastitis cystitis endometritis infection
most common site of fever on postpartum day 1?
LUNGS, esp if patient had anesthesia for csection, think aspiration PNA
associations for postterm pregnancy
placental sulfatase deficiency anencephaly fetal adrenal hypoplasia inaccurate dates
late term preg associations?
macrosomia oligohydramnios meconium aspiration ureteroplacental insufficiency
fetal dysmaturity
seen over 43 weeks withered, meconium stained, long fingernails, small placenta
antibiotics for mastitis
dicloxacillin, cephalexin
why would you think candida mastitis?
nipple pain out of proportion to physical exam burning, shotting pain
things to think about with uterus small for gestational age
oligo IUGR IUFD
pharm for hyperemesis gravidarum? vs pharm for NVP?
zofran (odansetron) reglan (metoclopramide) pyridoxine (B6) and doxylamine
maternal risk factors assoc with ASSYMETRIC IUGR? When in pregnancy does this occur?
think of DISEASE states: dm,htn,sle,cvd smoking/cocaine this tends to occur LATER in pregnancy 80% of IUGR is ASSYM.
twins from 4-8 day splits? 13?
Mo, Di 4x2=8 13= unlucky= conjoined
what murmur on PE are you concerned about, what are you not?
systolic is not concerning diastolic (think mitral stenosis) can be sign of heart failure
most common defects seen in women with diabetes before pregnancy?
problems with organogenesis –> mostly cardiac or NTD
how do you manage a patient who fails GTTs?
diet and exercise.
do you see IUGR with gestational diabetes?
no, generally pre-existing
potential lab finding indicative of contractions due to dehydration?
ketones in the urine
therapuetic range of mag? resp depression range?
4-7mEq/L 11-14
definition of hydrops
fluid accumulation in two or more body cavities -ascites -pleural effu -pericardial effu -scalp edema
what should you look for on exam of high AFP before jumping to NTD?
high fundal height –> think twins!
what should you look for on exam of high AFP before jumping to NTD?
high fundal height –> think twins!
most proven way to prevent preterm birth in twin gestation?
good weightgain early, 20-24 weeks. This will help to grow the placentas
whats a b-lynch suture?
technique for ligating uterine vessels surgically in PPH when pharm has failed
nerves at risk from low transverse incision? decribe their course
ilioinguinal, iliohypogastric –> both exit T12/L1, through psoas, laterally through transversus abd, courses on anterior abd wall to ASIS, then medially between internal/external oblique. Becomes CUTANEOUS 1cm sup to inguinal ring
hypogastric does sensation of groin/skin overlying pubis
inguinal does sensation of symphysis, groin, labium, UPPER THIGH
pain with adduction indicative of what nerves? inability to adduct indicative of what nerve?
iliohypogastric, ilioinguinal obturator
if OCPs are not adequately controlling hirsituism, what can youadd?
spirinolactone
physiology of increased free T in PCOS?
inc LH–>inc androgen production –> dec sex hormone binding globulin –> increase free T
how do combo OCPs help with dysmen?
progestin causes endometrial atrophy –> endometrium produces prostaglandins which causecramping
how can BSO after menopause “recreate” menopausal symptoms?
ovaries continue to produce androgens which get peripherally converted to estrogen
how long to wait to attempt pregnancy after mole?
6 months AFTER last negative bhCG
how does HPV/pap screening workfor women ages 30-65?
HPV testing every FIVE years, but acceptable to do pap alone every three years
CT or US for evaluting female pelvic anatomy?
US!!
salpingectomy vs salpingostomy. Which one needs bhCG f/u?
salpinectomy removes entire chunk of tube with pregnancy and does not require f/u
salpingostomy just remove pregnancy via hole intueb and DOES REQ F/U
