Ob-Gyne Pathology Flashcards
Puerperium is defined as _________
4-6 weeks postpartum
Episiotomies will heal when?
1-2 weeks
In the puerperial period, blood volume returns to normal when?
1 week
In the puerperial period, CO returns when?
2 weeks
Obstetrical neuropathies?
Footdrop from lumbosacral root compression
Common fibular (peroneal) nerve injury is caused by
Stirrups
What is shedding of decidua superficialis?
Lochia
Most common cause of mastitis
S. Aureus
Puerperial infection manifested by persistence of fever more than 72 hours despite IV antimicrobials
Parametrial phlegmon
Time period of postpartum blues
Occurs within 10 days
Resolves 3 days after
Return of menses returns for non-lactating?
7-8weeks
Postpartum checkup?
4-6 weeks
Undergo papsmear postpartum what period?
6 months
MINIMUM criteria of preeclampsia
> 140/90mmHg after 20 weeks
Proteinurua >300mg/24 hours or >+1 dipstick
Severe preeclampsia is defined as ________
160/110mmHg
>2gm/24 hours
Basic Pathology of preeclampsia
Vasospasm
Passage of meconium is a sign of _______ due to stimulation of posterior pitiitary gland which produce ADH thereby increases GI motility
Fetal hypoxia
Normal leve of MgSO4
4-7 meq/L
Mg 10meq/L will manifest as
Disappearance of patellar reflex
Mg 12meq/L will manifest as ________
Respiratory paralysis and depression
Antidote for MgSO4 toxicity
Calcium gluconate
When is the BP of postpartum mother returns back to normal?
< 12 weeks
What is chronic hypertension with superimposed severe preeclampsia?
New onset proteinuria >= 300mg/24 hours in hypertensive women but no proteinuria before 20 weeks’ AOG
What is chronic hypertension?
BP equals to or >140/90 mmHg before pregnancy or diagnosed before 20 weeks gestafion nir attributable to GTD
Hypertension first diagnosed after 20 weeks’ AOG and persistent after 12 weeks postpartum
MAP value in the 2nd trimester
> 90 mmHg
MAP value in the 3rd trimester
> 105 mmHg
What are the screening maneuvers of pre-eclampsia?
MAP
Supine pressure test or roll-over test
Conbination of MAP and roll-over test
What is the finding at 12-14 weeks AOG that is considered to be a useful tool in predicting the developement of hypertensive disorders in high risk prengnancy?
Bilateral notching
Effective test in predicting PIH at 24 weeks AOG
Doppler velocimetry of the uterine and uteroplacental arteries
Glycoprotein derived principally from the liver and endothelialbcells and its release into plasma is a marker of vascular disruption and endothelial cell activation
Fibronectin
Level of fibronectjn that is capable of predicting preeclampsja in the 3rd trimester
40mg/dL
Tests to predict preeclampsia for chronic HPN
Hypocalciuria and calcium/creatinine ratio
2nd most common cause of maternal death
Eclampsia
Stage of preeclampsia characterized by faulty vascular remodeling of uterine artery cauding placental hypoxia
Stage 1 - preclinical
Stage of preeclampsia characterized by release of placental factors into the ciculationb-> SIR and endothelial activation
Stage 2 - late stage
Hallmark of eclampsia
Hemoconcentration
Renal biopsy finding of eclamptic pregnant
Glomerular capillafy endotheliosis
Headache and scotoma (as a manifestation of eclampsia) are thought to arise from cerebrovascular hyperperfusion that has predilection at what part of the brain?
Occipital lobe
Proposed MOA of MgSO4 in the prevention of eclampsia
- Reduced presynaptic release of glutamate
- Blockade of NMDA
- Potentiation of adenosine action
- Improved mitochondrial calcium buffering
- Blockade of clacium entry
Maneuver stating that the fetal head should be maintained in a flexed position during delivery to allow passage of the smallesr diameter of the head
Mauriceau Smellie Veit maneuver
Maneuver employed when the arm of the baby cannot be deliver during breevih delivery. Fetal body is turned 90 degreesbinto then transverse, reached over the baby’s shoulder and slipsnthenfinger down into brachial plexus sweeping the arm down in front of the baby’s body
Loveset’s maneuver
Forceps that may br used if the mentum is anterior
Kielland forcep
Prophylactic CS is warranted if with the following EFW findings
EFW >4,500g (with maternal DM)
EFW >5,000g (without DM)
What is the dystocia drill?
Call for help Episiotomy Suprapubic pressure McRobert maneuver Delivery of posterior arm Woods screw maneuver Rubin maneuver Zavanelli maneuver Cleidotomy Symphysiotomy
Maneuver that involves progressively rotates the posterior shoulder 180 degrees, the impacted anterior shoulder could be released
Woods screw maneuver
Maneuver that involves the fetal shoulders rocked from side to side by applying force to the maternal abdomen
Rubin maneuver
Maneuver that most often abducts both shoulders which in turn produces a smaller shoulder to shoulder diameter which permits displacement of the anterior shoulder behind the symphysis
Rubin maneuver
Maneuver that replaces or flexes the fetal head back into the vagina and then CS is performed
Zavanelli maneuver
Deliberate fracture of the anterior clavicle to free the shoulder impaction
Cleidotomy
Intervening symphyseal cartilage and much of its ligamentous support is cut to widen the symphysis
Symphysiotomy
Maneuver needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows and the lower leg is swept medially and out of the vagina
Pinard maneuver
Elective CS for vasa previa is done at what AOG?
35-37 weeks AOG
Mode of delivery for pregnants who develop primary genital herpes within 6 weeks of delivery
CS
AOG wherein elective CS with HBV profile are as follows: HbeAg positive, HBV DNA copies >1,000,000 and does not received oral antiretroviral therapy
39 weeks
AOG of planned CS
39 weeks
The following anomalies may benefit from CS:
a. NTDs with fetus in breech
b. NTDs with sac > 6cm
c. Cystic hygromas
d. Sacricoccygeal teratomas > 5cm
e. Hydrocephalus with BPD > 10cm
Sexual intercourse may be resumed as early as how many week postpartum?
2 weeks
Most common chromosomal abnormality in abortion
Autosomal trisomy
Most common type of abortion
Incomplete
Type of abortion with dead fetus retained in utero for more than 4 weeks
Missed abortion
Management of missed abortion
< 12 weeks
> 12 weeks
< 12 weeks: vaginal evacuation
> 12 weeks: induce
Most common heart disease in pregnancy
Rheumatic heart disease
2nd most common heart disease in pregnancy
Congenital heart disease
AOG most CHF occurs
30-32 weeks
Amount of polyhydramnios
2000mL
Amount of oligohydramnios
<1,000mL
Developmental problem in the child with GDM
Autism
Normal glycosuria level in pregnancy
300mg/day
Postpartum hemorrhage is defined as blood loss of how much after completion of 3rd stage of labor
> 500mL
What theory is placenta previa based on and its principle?
Dropping down theory - poor decidual reaction in the upper segment
Elective CS for asymptomatic placenta previa is done at what AOG?
> 37 weeks
Elective CS for suspected placenta accreta is done at what AOG?
> 36 weeks
Important cause of vaginal bleeding in the 2nd half of pregnancy complicating about 1% of births
Abruptio placenta
Most common cause of abruptio placenta
PIH
Illicit drug use that causes placental abruption
Cocaine
What diagnostic imaging is used if the clinical circumstance of UTZ findings are confusing?
MRI
Classification of abruptio placenta:
Class I
Class II
Class III
*only indicated what’s confusing among the three
Class I (mildest - 48%) No coagulopahty No fetal distress Class II (moderate - 27%) Low fibrinogen present Fetal distress Class III (severe - 24%) Coagulopathy Fetal death
Mild abruptio management
Vaginal delivery
Moderate abruptio management
CS
Severe abruptio management
Vaginal delivery
It is known as uteroplacental apoplexy as a compication of abruptio wherein there is extensive extravasation of blood into the uterine musculature
Couvelaire’s uterus
Most common cause of early postpartum hemorrhage
Uterine atony
Most common cause of maternal mortality
Uterine atony
What are the arteries ligated in devascularization as a management of uterine atony?
Uterine artery
Internal iliac artery
In women para ____or greater, the 2.7% incidence of postpartum hemorrhage was increased fourfold compared with that of the general obstetrical population
7
Location where uterine artery ligation is done in women suffering from uterine atony
Superiorly at the approximate junction between the utero-ovarian ligament and the uterus and inferiorly just below the uterine incision
Classification of uterine inversion wherein the inverted fundus extends beyond the introitus
Prolapsed
Classification of uterine inversion wherein the uterus and vaginal wall inverts
Total
Classification of uterine inversion wherein the fundus extends beyond the external os
Complete
What are the classifications of uterine inversion?
Invomplete, complete, prolapsed, total
When does acute uterine inversion occurs?
Before cervical ring contraction
When does subacute uterine inversion occurs?
Contracted cervical rings
When does chronic uterine inversion occurs?
4 weeks after the event
Physical examination finding of uterine inversion
Abnormal palpation of the crater-like depression and vaginal palpaion of the fundal wall in the LUs and cervix
Maneuver done for uterine inversion by immediately pushin up on the fundus with the palm of the hand and fingers in the direction of te long axis of the vagina
Johnson maneuver
Procedure in uterine inversion described as laparotomy, clamps placed in cup of inversion below cervical rung, gentle upward traction, repeated clamping and traction
Huntington procedure
Procedure in uterine inversion described as incision inposterior portion of inversion ring, through the abdoment to increase the size of the rong and allow repositionong of the uterus
Haultaim procedure
What is commonly referred as iterine dehiscence?
Incomplete uterine rupture
Classification of uterine rupture and describe
Complete: all layers of the uterine wall are separated
Incomplete: when the uterine muscle is separated but the visceral peritoneum is intact
Most common sign of uterine rupture
Non-reassuring fetal heart rate pattern
Primary surrogate for cervical neoplasia
HPV
High risk HPV types
16, 18, 31 and 45
Intermediate risk HPV
33, 35, 39, 51, 53, 56, 58, 59, 73
Low risk HPV
6, 11, 53
How many individual HPV types?
70
HPV 16 and 18 causes
Cervical, vaginal and anal cancers
HPV 6, 11 causes
Condyloma acuminata
HPV lesions appearance
4-6 weeks
Molecular police
p53 and Rb
HPV early proteins that immortalizes human keratinocytes
E6 and E7
Screening methods of HPV
- Cervical cytology
- Visual inspection using Acetic acid or Lugol’s iodine
- HPV test
Premalignant HPV lesions fall into 3 categories:
ASCUS
LSIL
HSIL
Pre-malignant lesion characterized as mild cervical intraepithelial neoplasia and other HPv associated lesions (condylomatous atypia or koilocytic atypia)
LSIL
Pre-malignant lesion characterized as moderatento severe cervical intraepithelial neoplasia and carcinoma - in situ
HSIL
When and how often is papsmear done?
Starts as 18 y/o or at initiation of sexual activity and to continue annually
After 2 negative consecutive results, 1 year apart and to proceed every 3 years to age 69
If CIN I or LSIL is found, when is papsmear done?
Repeated every 6 months for 2 years
Immeidate colposcopy is done in what type of cervical dysplasia?
Moderate dysplasia
Component of molecular hybridization in cervical CA
Southern DNa blotting
Dot blotting
In siti DNA hybridization
Test sensitive for HPV DNA
PCR
Cervical CA clinical staging
Stage 1: confined to the cervix
Stage 2: beyond the cervix, not to the pelvic sidewall, not to the lower third of the vagina
Stabe 3: extension to the pelvic sidewall, involves the lower third of the vagina, with hydronephrosis or non-functioning kidney
Stage 4: extension to beyodn the true pelvis, clinically involved (biopsy proven) the mucosa of the bladder or rectum
Mechanism of HPV vaccination
DNa-free viruanlike particles synthesized by sef assembly of fusion proteins of the major capsid antigen L1 found to induce humoral response with neutralizing antibodies (type specific)
Most common cause of maternal death
Puerperal sepsis
Endotoxin cause by
Gram negative
Exotoxin A caused by
P. Aeruginosa
Toxic shock syndrome toxin caused by
S. Aureus
Circulation volume initially restored leads to high CO + low systemic vascular resistance
Warm phase of septic shock
Uncorrected with vigorous fluid infusion leads to peripheral vasoconstrixtion+ oliguria
Cold phase of septic shock
Diagnostic criteria of chorioamnionitis
Maternal fever + 2 of the following:
Maternal tachycardia
Purulent and foul-smelling amniotic fluid
Maternal leukocytosis
Single most significant risk factor for postpartum uterine infection
Abdominal delivery
Gold standard antibiotic for chorioamnionitis
Clindamycin + Gentamycin
Intrapartum infection causing chorioamnionitis
Group B strep
Curdy vaginal discharge with beefy red itchy vulva
Fungal vaginitis caused by C.albicans
Criteria to diagnose bacterial vaginosis
Vaginal pH >4.7
Clue cells
Thin homogenous discharge
Fishy odor (adding potassium hydroxide)
Green, frothy vaginal discharge
Trichomonas vaginalis
Diagnosis of trichomonas vaginalis
Normal saline wet mount demonstrates flagellates
Diagnosis media of Gonorrhea
Thayer Martin Broth
Diagnosis media of Chlamydia
Giemsa or Wright’s strain
Diagnostic tool for syphilis
Darkfield microscopy
Screening test for syphilis
VDRL or RPR
Specific test for syphilis
FTA-ABS
Most common cause of serious liver disease or jaundice in pregnancy
Viral hepatitis
AOG highest incidence of UTI
9th-17th
Screening of asymptomatic bacteriuria
16 weeks AOG
Organism causing Sterile pyuria
C. Trochomatis
Most common non-obstetric indiction for hospitalization of the pregnant patient
Acute pyelonephritis
50% unilateral on the _______because of the dextrorotation of the uterus causing pyelonephritis
Right
How many days after exposure to rubella for antibody?
10 days
If given with rubella virus vaccine, avoid pregnancy within how many months?
2-3 months
Susceptibel pregnant women with varicella exposure should be given VZIG within how many hours of exposure
Within 96 Hours
Lichen sclerosus is also called as
Chronic atrophic vulvitis
4 cardinal histologic features of lichen sclerosus
- Thinning of the epidermis with disappearance of rete pegs
- Hydropic degeneration of basal cells
- Replacement of dermis by dense collagenous fibrous tissue
- Monoclonal bandlike lymphocytic infiltrate
Complication of lichen sclerosus
Carcinoma
Lichen simplex chronicus is also known as:
Squamous hyperplasia, hyoerolastic dystrophy
Nonspecific condition of the female genital tract that arises from rubbing and scratching of skin
Lichen simplex chronicus
What layer of the epidermis is expanded in lichen simplex chronicus?
Stratum granulosum
Papillary hidradenoma is identical to what condition?
Intraductal papilloma of the breast
Types of vulvar carcinoma
Vulvar intraepithelial neoplasia
Basaloid carcinoma
Warty carcinoma
Most common location of papillary hidradenoma
Labia majora or interlabial folds
