OB Shelf Flashcards
Plasma osmolality is ??? during pregnancy
Decreased; increasing the susceptibility to pulmonary edema
An increase in maternal blood volume has a relative dilutional effect that ??? hemoglobin and ??? MCV
Hemodilution of Pregnancy: lowers Hg and has no change in MCV
During pregnancy, circulating estrogens cause an ??? in thyroid binding globulin(TBG) and total T4
Increase
Most common sight of metastatic disease in patients with gestational trophoblastic disease/molar pregnancy
Lungs (*order CXR)
Pregnancy weight gain recs:
BMI <18 = ???, BMI 18-25 = ???, BMI 25-30 = ???, BMI 30 = ???
28-40 lbs,
25-35 lbs,
15-25 lbs,
11-20 lbs
Best screen for Downs syndrome
Sequential screen: (1st trimester = Nuchal Translucency and PAPP-A) then (2nd trimester = quad screen)
Quad screen for Downs Syndrome
Alpha FP is normal, estriol is normal, hCG is elevated, Inhibin-A is elevated
Miscarriage risk associated with CVS
1%
Risks associated with gestational diabetes:
Shoulder dystopia, fetal macrosomia, polyhydramnios, preeclampsia, neonatal hypoglycemia
Folic acid amount given 4 weeks prior to conception in non-high risk patients and high risk patients?
0.4 mg and 4 mg
Short/less intense and irregular contractions that manifest as lower abdominal pain
Braxton-Hicks contractions
Labor Warnings:
Contractions every 5 minutes for 1 hour, ROM, fetal movement <10 per 2 hours, vaginal bleeding
Test to confirm ROM?
Nitrazine test
If fetal HR or well being cant be confirmed using external methods, most reliable way to document fetal well being?
Apply fetal scalp electrode
Variable decelerations are typically caused by ??? and are the most common decelerations seen in labor.
Umbilical Cord Compression
Late decelerations are associated with ???
Uteroplacental insufficiency
Magnesium Sulfate tx for preeclampsia carries risk of ??? 2/2 Mg use
Respiratory distress
Type 1 Diabetes is associated with ??? infants, and gestational diabetes is associated with ??? Infants
Small, Large(macrosomia)
An imbalance in the blood flow through communicating vessels across a shared placenta leading to under perfusion/anemia/oligohydramnios to one twin, and over perfusion/polycythemia/polyhydramnios to the other twin
Twin-twin transfusion syndrome
Infants born to diabetic mothers are at increased risk for developing:
Polycythemia, hyperbilirubinemia, hypocalcemia, hypoglycemia, respiratory distress
HIV positive mom post-labor protocol for newborn
Tx with Zidovudine(AZT) immediately, HIV testing at 24hrs, discourage breastfeeding
Define postpartum hemorrhage for vaginal delivery and Cesarean delivery
Vag: >500 ml blood loss
Cesarean: >1000 ml blood loss
Most common cause of postpartum hemorrhage
Uterine atony
Most common cause of postpartum fever
Endometritis
Signs/symptoms of depression that are less then two weeks post partum? Depressive s/s 2 wks - 6 mos postpartum?
Postpartum blues.
Postpartum depression.
Breast-feeding has shown to decrease the incidence of ??? cancer
Ovarian
Infant-mother position for breastfeeding
Belly to belly
After delivery, prolactin is no longer inhibited by ??? and ???, causing milk synthesis
Estrogen and progesterone
Mastitis 2/2 candida presents as
Intense nipple pain/sensitivity
??? is responsible for milk ejection and is stimulated by suckling
Oxytocin
??? intake can increase the pain associated with fibrocystic breast changes
Caffeine
Mastitis ABX?
Dicloxacillin; or Erythromycin if allergic to penicillins
Most common cause of abnormal vaginal discharge?
Bacterial Vaginosis
Most accurate estimator of GA in 1st trimester? 2nd trimester? 3rd trimester?
Crown-rump length.
Biparietal diameter, femur length.
Ab circumference, BP diameter, femur.
Management of LSIL is initial colposcopic examination unless patient is ???
Pregnant, postmenopausal, adolescent
Mammogram protocol:
Every two years between ages 40 to 50, and yearly after age 50
Colposcopy resulting in CIN-I, what is following management?
Follow-up Pap smear in 6 to 12 months or HPV DNA testing at 12 months
Definitive treatment for pelvic pain secondary to endometriosis?
Hysterectomy and B/L salpingoopherectomy
Best initial work up for an adnexal mass?
Transvaginal US
Emergency contraception should be started within ?? hours and no later then ?? hours
72; 120 hours
Contra indications to estrogen OCP:
History of thromboembolic disease, current lactation, > 35 smoker, history of severe nausea with previous OCP use
OCP’s will decrease risk of ??? and ??? cancer
Ovarian and endometrial
Higher dose OCP’s will increase risk of ??? cancer
Breast
Tubal ligation has slight reduction in risk of ??? cancer
Ovarian
Management of septic abortion?
Uterine evacuation and broad-spectrum antibiotics
Antibodies associated with recurrent pregnancy loss?
Antiphospholipid antibody’s
Treatment of recurrent abortions secondary to antiphospholipid antibody syndrome?
Aspirin and heparin
Medical abortion is associated with higher ??? than surgical abortion
Blood loss
Abortion is legal until ??? weeks gestation, unless a fetal anomaly inconsistent with extrauterine life is identified
24 wks
Surgical abortion method if fetus < 16 weeks?
Dilation and curettage
Surgical abortion method if fetus >16 weeks?
Dilation and evacuation
Management of heavy bleeding secondary to medical abortion?
D & C
Curdish vaginal discharge with organisms on KOH or Gram stain?
Candidiasis
Initial management of pelvic prolapse?
Pessary fitting
What size should ovarian cyst be referred to gynecologist?
6 cm
Most common cause of failure to progress labor?
Cephalopelvic disproportion
Dysfunctional uterine bleeding is from anovulation increases risk for ??? cancer
Endometrial
Percentage of infants born to HIV infected mothers who will be infected?
25%
Transdermal and vaginal ring delivery of estradiol bypasses GI conversion of estradiol to estrone, causing ???
No association with increased risk of venous thromboembolism
G & C ABX’s?
Ceftriaxone (cefotetan) and Doxycycline (azithromycin)
Infertility secondary to history of STI’s most commonly due to ??
Tubal disease/scarring
Progesterone withdrawal induces ??? of endometrium
Sloughing
??? restores and causes endometrial proliferation
Estrogen
??? “stabilizes” endometrium
Progesterone
Most common dyscrasia in adolescents with uncontrolled ovulatory bleeding?
Von Willebrand disease
Abnormal ovulatory bleeding secondary to von Willebrand’s disease: Dx? Rx?
Dx-decreased vWF, increased bleeding time, normal plt count, decreased ristocetin-induced plt agg.
Rx-DDAVP (desmopressin) or Factor VIII
Estrogen breakthrough bleeding:
Growing follicle makes estradiol, E2 stimulates endometrial proliferation. *if no progesterone to stabilize endometrium or withdrawal sloughing, the E2 “driven” endometrium will outgrow blood supply, causing necrosis/detachment/bleeding and increased risk of CA
Progestin therapy for ovulatory AUB?
Continuous
Progestin therapy for anovulatory AUB?
Cyclic
Danazol: a synthetic ???, that ??? ovulatory AUB, adverse effects of acne, weight gain, deepening voice.
Androgen. Decreases.
T or F: endometrial ablation is meant to induce amenorrhea?
False it’s meant to resume a normal menses, but has a 50% chance of amenorrhea
Fetal macrosomia defined as > ??? grams
4500 g
GDM management glucose levels: fasting? 2 hour postprandial?
< 90 mg/dl; <120 mg/dl
Vaginal CA lymph node drainage: upper 2/3? Distal 1/3?
Pelvic nodes; Inguinal nodes
Vaginal CA stages: I? II? III? IVa? IVb?
Limited to mucosa. Infiltrate into parametria. Pelvic side wall involved. Spread to adjacent organs. Spread to distant organs.
Infant vaginal bleeding/grape-like clusters?
Sarcoma botryoides/Rhabdomyosarcoma
HSV vesicular genital lesions are preceded by prodrome of ???
Vulvar burning/irritation
Syphillis ulcers/chancres are preceded by ???
Painless pa piles
Dx antepartum vaginal bleeding 2/2 placenta previa? Tx?
Dx- transvaginal US. Tx- if hemodynamically stable, pelvic rest; if hemodynamically unstable, admit and tx.
Placenta Previa delivery?
C/S (low lying placenta offered trial of labor)
Placental villi attached to myometrium?
Placenta accreta
Placental villi invade myometrium?
Placenta increta
Placental villi penetrate through myometrium and into serosa/adj organs?
Placenta percreta
Fetal vessels close to internal os?
Vasa previa
Abruptio placenta presents with ???
Antepartum vaginal bleeding, non-reassuring fetal testing, uterine contrxns/tenderness
Vertex position? Breech position? Frank position?
Head first. Bottom/feet first. Bottom (feet superior/closer to head)
Frank position delivery method?
C/S
Breech position delivery method?
Pinard maneuver
Describe the McRoberts maneuver for managing shoulder dystocia?
Maximal flexion and ABduction of maternal hips
Most common histopathologic Dx found in evaluation of AGUS?
CIN
Tx of primary dysmenorrhea with ???, while symptoms often resolve after ???
NSAIDs. First pregnancy
Most reliable clinical symptom of uterine rupture?
Fetal distress
Patients must have ?/4 Amsel criteria to be Dx with BV
3/4
Amsel criteria for BV:
pH > 4.5 (most sensitive), clue cells (most specific), homogenous discharge, + whiff test
T or F: no current available method for screening for ovarian CA
True
If pregnancy is viable, hCG levels should double every ??? days
2-3
Tx of chlamydia during pregnancy?
Azithromycin
Any attempt to convert breech into vertex is not indicated until ??? week of gestation
37th
Tx of genital warts in pregnancy?
TCA or cryotherapy with liquid nitrogen
Epidural anesthesia is associated with a longer ??? stage of labor
2nd
Most accurate test to determine preterm labor?
Vaginal fetal fibronectin
Diabetes drug for PCOS?
Metformin
Early decelerations most likely due to ?
Head compression
Intrauterine adhesions/scarring that occur 2/2 trauma from a D&C. Has clinical symptoms of amenorrhea, infertility, and recurrent miscarriages.
Ashermans Syndrome
GnRH mechanism of action/physio for endometriosis tx: GnRH’s ??? regulate the hypothalamic-pituitary production/release of FSH & LH, leading to ??? in estradiol levels
Down. Reductions.
??? suppresses the mid-cycle surges of LH & FSH, in tx of endometriosis.
Danazol, synthetic androgen
??? classically presents in pregnancy, most commonly due to rheumatic heart Dz and increased blood volume. Presenting with symptoms of pulmonary edema and AFib
Mitral Stenosis
Premature ovarian failure refers to menopause before age ???
40
Exercise induced infertility is common in ???
Long distance runners
B/l breast tenderness and swelling 24-72 hrs PP, without signs of infection, likely 2/2 ,
Breast engorgement
Abdominal pain 2/2 HELLP syndrome occurs due to ???
Swelling/distention of liver capsule
Mag sulfate causes neuromuscular depression, which presents as RDS and decreased ???
DTRs
Anti-D immune globulin is given to Rh- moms at ??? wks and ??? hrs within delivery if baby is Rh+
28-32 was; 72 hrs
Test/screen for GBS at ??? was
35-37
ASCUS initial management: pts 21-24 yo? Pts 25 or older?
Repeat PAP in 1 yr. HPV DNA testing.
Age 25 or greater pt with ASCUS with +HPV DNA test, next management?
Colposcopy
Age 25 or greater pt with ASCUS with -HPV DNA test, next management?
Repeat PAP smear and HPV test in 3 yrs
Painful ulcers DDx? Painless ulcers DDx?
HSV vs. H.ducreyi; Syphillis vs. chlamydia
??? is indicated in pts in labor with active HSV lesions/prodrome
C/S
HSV prophylaxis with -cyclovir beginning at ??? wks
36
T or F: CDC recommends influenza vaccine in all pregnant women, vaccine given during any trimester.
True
Infant postnatal management of HIV?
Zidovudine for at least 6 wks and HIV PCR testing
Most important intervention to prevent HIV transmission from mom to infant?
Triple antiretroviral therapy THROUGHOUT pregnancy
Menorrhagia is associated with ???, while oligo/amenorrhea is associated with ???
Hypothyroidism, hyperthyroidism
Prenatal vitamins are started ??? prior to conception
3 months
T or F: 1 ovary ovulates one month, then other ovary ovulates next month
True
Uterus > ??? is considered enlarged
10 cm
NST with greater than or equal to ? accelerations is normal/reassuring
2
NST is performed ??? during 3rd trimester
Weekly
Women 35 or older are at increased risk of fetal aneuploidy and should be offered ??? at 10 wks or later
Cell free fetal DNA testing (cffDNA)
Abnormal cffDNA results can be confirmed by ??? @ 10-12 wks or by ??? @ 15-20 wks
CVS. Amniocentesis
Most common adverse effect of CVS?
Fetomaternal hemorrhage/spotting
Rh- pts are at risk for ??? during CVS
Alloimmunization
Screening for ??? is recommended in all pregnant women, while screening for all other infections is based on risk factors
Syphillis, HIV, and Hep B
Steroids should be started in pts with PPROM before ??? wks to decrease risks of RDS, necrotizing enterocolitis, neonatal IVH, death.
32
Asymptomatic bacteruria of pregnancy tx?
Nitrofurantoin, amoxicillin-clavulonate, cephalexin, fosfomycin
All pregnant woman should be screened for asymptomatic bacteruria @ ??? wks
12-16 wks
Untreated bacteruria can lead to ???
Cystitis, acute pyelonephritis, preterm birth, low birth weight
Tx for ectopic pregnancy?
Methotrexate
Incontinence characterized by failure to empty bladder adequately, with PVR volume > 300 cc and continuous leakage. Usually due to underactive detrusor muscle or obstruction. Dx?
Overflow incontinence
Incontinence characterized by uninhibited contraction of bladder while filling. Due to detrusor instability/overactivity. Dx?
Urge incontinence
loss of urine 2/2 increased abdominal pressure in absence of a detrusor contraction. Majority are due to urethral hypermobility (q tip angle > 30), but also due to intrinsic sphinteric deficiency. Dx?
Stress incontinence
Initial management of intrinsic sphincteric deficiency?
Urethral bulking
Urge incontinence/detrusor instability medical management?
Anticholinergics (oxybutynin, tolterodine)
??? may improve urethral tone in Tx of stress incontinence
Pseudoephedrine
In tx of uterine prolapse: if pessary fittings fail, best surgical option is ???
Colpocleisis
If NSAIDs can’t manage pelvic pain of endometriosis, next step in management is ???
OCPs
Tx of mag sulfate toxicity
Calcium carbonate
Hypothyroidism may result in amenorrhea and galactorrhea, because ??? stimulates ??? production.
TRH stimulates prolactin production
To suppress milk production pts are advised to ???, as bromocriptine is no longer FDA approved
Wear tight fitting bras and apply ice packs (also avoid nipple stimulation)
An intrauterine pregnancy should be seen on transvaginal US at beta-HCG levels of ???
1500-2000
The amenorrhea that occurs in lactating mothers is 2/2 high levels of ??? which inhibits the production of ???
Prolactin; GnRH
On wet mount, epithelial cells coated with bacteria are called?
Clue cells (BV)
T or F: Tx of BV in pregnant and nonpregnant patients is metronidazole
True
In a pregnant SLE pt, ??? will cause proteinuria, hematuria, and RBC casts.
Glomerulonephritis
Overflow incontinence 2/2 epidural anesthesia is best treated with ???
Intermittent catheterization
Infertility in premature ovarian failure is treated with ???
In vitro fertilization with donor oocytes
??? and ??? are usually decreasedin pregnant pts due to increase in renal plasma flow and GFR.
BUN and Cr.
Uterine rupture is differentiated from placental abruption by ???
Loss of fetal station vaginally or palpable fetal parts on abdominal examination.
Infants born to pts with Graves Dz treated with surgery are at risk for thyrotoxicosis 2/2 passage of ??? across placenta
Thyroid stimulating immunoglobulin
An intrauterine pregnancy should be seen on transvaginal US at beta-HCG levels of ???
1500-2000
The amenorrhea that occurs in lactating mothers is 2/2 high levels of ??? which inhibits the production of ???
Prolactin; GnRH
On wet mount, epithelial cells coated with bacteria are called?
Clue cells (BV)
T or F: Tx of BV in pregnant and nonpregnant patients is metronidazole
True
In a pregnant SLE pt, ??? will cause proteinuria, hematuria, and RBC casts.
Glomerulonephritis
Overflow incontinence 2/2 epidural anesthesia is best treated with ???
Intermittent catheterization
Infertility in premature ovarian failure is treated with ???
In vitro fertilization with donor oocytes
??? and ??? are usually decreasedin pregnant pts due to increase in renal plasma flow and GFR.
BUN and Cr.
Uterine rupture is differentiated from placental abruption by ???
Loss of fetal station vaginally or palpable fetal parts on abdominal examination.
Infants born to pts with Graves Dz treated with surgery are at risk for thyrotoxicosis 2/2 passage of ??? across placenta
Thyroid stimulating immunoglobulin
T or F: obese menopausal pt with mild symptoms is due to peripheral production of estrogen by adipose tissue
False, milder postmenopausal symptoms due to androgen conversion to estrogen by adipose tissue/AROMATASE**
??? is the gold standard for evaluating the cervix for cervical incompetence
Transvaginal US
Pt with normal internal genitalia, ambiguous external genitalia, clitoral hypertrophy, high FSH/LH levels, low estrogen levels. Dx?
Aromatase deficiency
First line med for tx of hypertensive emergencies in pregnant pts?
Labetalol or hydralizine. (Meal dopa has slow onset so not for emergencies)
Female infants < 3 months sometimes develop vaginal spotting/bleeding that is due to ???
Maternal estrogens crossing placenta and causing a pubertal effect which disappear hormone is cleared from circulation
Hypotension is a common SE of epidural anesthesia, occurring 2/2 ???
Venous pooling from sympathetic blockade
When NSAIDs and OCPs fail to manage endometriosis symptoms, next step is ???
Laparoscopy
Corticosteroid tx of lung immaturity is limited in use to b’wn ?? - ?? wks, and requires ?? - ?? hrs to have max effect.
24-34 wks; 24-48 hrs (so no use in urgent/emergency deliveries)
Psychiatric condition in which a woman presents with several signs of pregnancy but physical exam is normal and urine pregnancy test is negative
Pseudocyesis
When Rx Bactrim, must assess for pregnancy because of risk of ???
Neural tube defects (trimethoprim is folic acid antagonist)
Patients with decreased fetal movement should undergo antenatal fetal testing, starting with NST followed by ??? (If no contraindications to labor) or a ??? if NST is nonreactive.
Contraction Stress Test. Biophysical profile
No fetal movement, but + fetal hear tones: evaluate with ???.
No fetal movement, no fetal heart tones: evaluate with ???.
NST.
Ultrasonography
Order a ??? to Dx acute appendicitis of pregnancy
US
When moisturizers/lubricants fail to work, ??? is tx of choice for atrophic vaginitis
Vaginal estrogen
??? typically presents with abdominal pain, cervical and adnexal tenderness, lightheadedness, hemodynamic instability, and amenorrhea.
Ruptured ectopic pregnancy
??? is thought to result from abnormal placentation, triggering systemic inflammation and activation of the coagulation system and complement cascade.
HELLP Syndrome
Vaginal CA: squamous cell commonly presents in the ??? of the vagina, whereas clear cell adenocarcinoma commonly present in the ???.
Upper 1/3 of posterior vaginal wall. Upper 1/3 of anterior vaginal wall.
Agent of infection for postpartum endometritis is likely ???
Polymicrobial
Tx of choice for endometritis is ??? and ???
Clindamycin and Gentamicin
Re-current spontaneous abortions necessitates further workup, including ???
Hypercoagulability panel (factor V Leiden)
Tx for postpartum endometritis?
Clindamycin and gentamicin
Pharm agents for Tx of gestational HTN
Labetalol, hydralazine, methyldopa, nifedipine
Bleeding: placenta previa vs. placental abruption
Painless, bright red vs. Painful, dark red
During pregnancy, it is common to develop a compensated ??? alkalosis
Respiratory
Pt with amenorrhea and anosmia (can’t smell): likely dx?
Kallmann Syndrome (46 XX, normal internal reproductive organs)
External cephalic version can be performed between ??? and ???
37 weeks - onset of labor
Important side effects of combined OCPs
HTN, VTE, increased triglycerides, increased risk of cervical CA
HTN during pregnancy carries risks of ???
Placental abruption, IUGR, preterm birth, cesarean delivery, superimposed preeclampsia
Painless vaginal bleeding with fetal deterioration that is preceded by ROM is most likely due to ???
Vasa previa
Medical treatment options for acute abnormal uterine bleeding?
High dose Estrogen, combo OCP, progestin, Tranexamic acid (for pts with contraindications to estrogen/progestin)
Etiology of amenorrhea in women athletes?
Decreased LH and GnRH, causing estrogen deficiency
Tx for candida vulvovaginitis
*topical Nystatin or oral Fluconazole
Quadruple screen results of a trisomy 18 fetus?
Normal inhibin, decreased aFP/hCG/estriol
Test used to determine the dose of Rh Ig to prevent Rh sensitization?
Kleihauer-Betke
Mild/unilateral midcycle pain due to normal follicular enlargement?
Mittelschmerz
Acute onset of unilateral pelvic pain after strenuous activity of sexual intercourse; Pelvic US shows ovarian mass with free fluid. Dx?
Ovarian cyst rupture
Pathophysiology of primary dysmenorrhea
Release of prostaglandins from endometrium causes uterine contractions
Newborn with small body size, microcephaly, hypoplasia of the distal phalanges, excess hair and cleft palate. Mom probably was using ??? during pregnancy
Phenytoin
A GnRH stimulation test is used to evaluate for ???
Precocious puberty
Pt’s nucleic acid amplification test returns + for Chlamydia and - for Gonorrhea. Pt is still asymptomatic. Tx?
Single dose azithromycin or 7 days of doxycycline (if screen for Gono is -, no tx for Gono)
Vaginismus tx?
Relaxation, Kegels, desensitization via insertion of objects of gradually increasing size.
Most accurate method of determining GA?
1st trimester US with crown-rump length
Pear-shaped motile organisms on wet-mount?
Trichomonas
Asymmetric FGR is due to ??? factors, whereas symmetric FGR is due to ??? factors
Maternal; fetal
Turner syndrome pts have low estrogen levels due to ???, and high ??? levels due to lack of negative feedback.
Ovarian dysgenesis; FSH
A L/S ratio < ???, indicates lung prematurity
2
Infertility 2/2 PCOS is likely due to ???
Anovulation
Most effective emergency contraceptive?
Copper IUD (99% efficacy)
Emergency contraception options within 3-5 days after intercourse?
Copper IUD and Ulipristal pill
???-sided adnexal torsions are more common due to longer utero-ovarian ligament on that side
Right
Marked pruritus, elevated bile acids and liver enzymes. No jaundice. Dx?
Intrahepatic cholestasis of pregnancy (AFLP won’t have itching, will have jaundice)
Screening tests for Syphillis? Confirmation test?
VDRL & RPR; dark field microscopy or FTA-ABS.
Tx of choice for Syphillis in pregnancy
Penicillin
In secondary amenorrhea, after negative pregnancy test what is next best test to order? If negative, then what?
Serum prolactin and TSH (to R/o prolactinoma or hypothyroidism).
FSH/LH to r/o ovarian failure or hypothalamic pituitary disorders
Patients in preterm labor <34 wks should receive 3 meds?
Tocolyitc (CCB), mag sulfate, steroids.
Arrest of labor in the 1st stage is Dx when dilation is >/equal to 6cm with ROM and 1 of following:
No cervical change for > 4 hours despite adequate contractions. Or
No cervical change for > 6 hours with inadequate contractions
Elevated MSaFP is seen with what fetal abnormalities?
Neural tube defects, gastroschisis, omphalocele, multiple gestations.
Preferred hormonal contraception for lactating moms?
Progestin-only OCPs
Test of choice for Dx of ectopic pregnancy when b-hCG levels at 1500-6500?
Transvaginal US
Endometrial hyperplasia without atypia, Tx?
Progestin therapy
Endometrial hyperplasia with atypia, tx?
If considering future pregnancy = progestin therapy. If no pregnancy plans = hysterectomy
T/F: B/l gonadectomy is recommended before puberty in androgen insensitivity pts to decrease risk of gonadal malignancy.
False, it’s recommended after puberty.
In most hypothyroid pts who become pregnant, the levothyroxine dose is ???
Increased
Tx for infertility in a PCOS pt?
Clomiphene citrate
Raloxifene is contraindicated in pts with h/o ???
DVT
Oligohydramnios is defined by an AFI < ?? cm. polyhydramnios has an AFI > ?? cm.
5 cm; 24 cm
Smoking protects against ??? cancer
Endometrial
Tests to differentiate maternal blood from fetal blood?
Apt test and Kleihauer-Betke test
Stress incontinence is due to?
Weak pelvic floor muscles
Continuous GnRH therapy induces ???, whereas Pulsatile GnRH therapy induces ???
Anovulation/Amenorrhea; Ovulation
Hyperemesis gravidarum may cause volume depletion and loss of gastric acid, leading to a ??? Alkalosis
Metabolic
