OBG Flashcards
Maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia indicates ____
A major risk factor is ____
chorioamnionitis
premature rupture of membranes (PROM)
Tx
Vag birth: (IV ampicillin + gentamicin)
C-sec: (IV ampicillin + gentamicin + clindamycin)
A tender, erythematous, palpable cord with nodular thickening at the lower extremities that remains visible when the limb is raised suggests
superficial thrombophlebitis (ST)
get a duplex u/s
Uterine atony can be managed with bimanual uterine massage + uterine stimulant (uterotonic) ____ + additional uterotonic agents like (1-3)
Surgical interventions (hysterectomy) may be necessary if conservative therapy has no effect within 30 minutes.
oxytocin
misoprostol, methylergonovine &
tranexamic acid (TXA)
____ is indicated as a first-line test in the diagnostic workup of patients with AUB who are >45 years old, or in < 45 with risk factors for endometrial cancer (obesity, PCOS, nulliparity, early menarche, DM, on tamoxifen) or do not respond to medical management.
Endometrial biopsy
Name 2 gonadotropins
FSH
LH
____ is the best management option for patients with endometrial cancer who do not wish to preserve fertility or have reached menopause.
Total hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)
For patients with advanced disease (myometrial invasion) Additional therapy should be given (Radiation therapy, chemotherapy).
____ can be considered in young patients with
early-stage ENDOMETRIAL CANCER
confined to the uterus
who desire future pregnancies.
High-dose progestins
Women with GBS bacteriuria occurring anytime during pregnancy or history of a previous newborn with GBS infection should _____.
receive ppx Penicillin
&
don’t need screening for GBS
Intrauterine Fetal Demise
what do next?
Induction of labor with IV Oxytocin
NOT C-Section!
Offer grief counseling and AUTOPSY
Pregnant woman with Asymptomatic Bacteuria
what do next?
Treat and get a test of cure
Nitrof, Amoxicillin, Phosphamycin
Pregnant woman with Pyelonephritis
what do next?
Treat with IV Ceftriaxone
+ Nitro for rest of pregnancy
Isolated increase in AFP (5)
what mean?
Incorrect dating (MCC) Neural Tube defect, Abdominal wall defect, Twins, fetal Hypothyroidism
+ Quad screen
what do next?
get u/s
What week do we give
RhD Ig in Rh (-) mom
28w
GBS vaginal swab when?
35-37w
NTD screen via U/S
when?
18-20w
Elevated prolactin inhibits what?
GnRH thus FSH, LH
Contraindications to breast feeding?
4
HIV
Active HSV
Galactosemia
Drugs (PCP, Cocaine, Cannabis etc.)
MCC of Fever s/p C-Section
tx:
Endometritis
Clinda + Gent
Prolonged rupture of membranes can cause:
Chorioamnionitis
(foul amnio smell)
tx: Oxytocin, Ampicillin + Gentamicin, GBS ppx
Baby ≥ __g
do a C-section
5,000g (11 Ibs) (really 4990g)
4,540g (10 Ibs) → Diabetic Mothers
Complications of Gestational Diabetes?
4
Polyhydraminos, Pre-eclampsia, Polycythemia Fetal Hypoglycemia, Macrosomia
Chronic maternal DM baby complications?
3
Hypertrophic Cardiomyopathy
Caudal Regression
small left colon (Meconium Illeus)
MCC of Post-Menopausal Bleeding?
Genital Tract Atrophy
MCC (lethal): Endometrial Cancer
Other causes: HRT, Radiation, Polyps, Fibromas, Endometrial Hyperplasia, Adenomyosis
Symptoms of Endometriosis (6)
Pelvic Pain Spotting Dysmenorrhea Dyschezia Dyspareunia INFERTILITY
(Dis-poh-rue-nia)
Non-cyclical Pelvic pain
+/- Menorrhagia, Dysmenorrhea
Adenomyosis
Pelvic masses differential:
5
Fibroids
Ovarian Cyst
TO-Abscess
Endometriomas
Tumors (Teratomas, etc.)
HIV mom w/ a viral load < 50 copies/mL
what give baby?
If viral load 50 or MORE, then what?
Zidovudine for 4 weeks
Zidovudine + Nevirapine
or
Zidovudine + Nevirapine/Raltegravir + Lamivudine
(Neh-vee-ruh-peen)
(Raal-teh-gruh-veer)
(Luh-mi-vyuh-deen)
A low lecithin-sphingomyelin ratio in amniotic fluid
( Less than ___) indicates fetal lung immaturity
or a low foam stability index (< __)
< 1.5
< 0.48
Neonatal respiratory distress syndrome (NRDS) is characterized by low levels of surfactant (lecithin).
alveolar surface tension is ___ causing alveolar atelectasis and decreased lung ____
All lung volumes become ____
Pulmonary vascular resistance becomes _____
increased
compliance
decreased (including FRC)
increased
Neonatal respiratory distress syndrome (NRDS)
causes an increased risk of _____
persistent ductus arteriosus
An excisional procedure such as ___ is an acceptable option for nonpregnant patients 25 and older with HSIL on Pap smear.
LEEP
A ____ is indicated for patients ages 21 – 24 years with a Pap smear remarkable for ASC-US or LSIL.
repeat Pap smear at 12 months
ASC-US: Atypical squamous cells of undetermined significance
If Pap smear shows AGC, HSIL, AND ASC-H should urgently undergo
Colposcopy & Endocervical Curettage and
- +Endometrial Biopsy if pt 35+ w/ risk factors
ASC-H: Atypical squamous cells (cannot exclude HSIL)
AGC: atypical glandular cells
HPV testing may be performed for patients with ___ on Pap smear
ASC-US
Atypical squamous cells of undetermined significance
Pap smear and colposcopy every __ months for up to __ years is the next best step in a patient 21–24 years of age with HSIL (CIN II/III) on Pap smear, which are NOT confirmed on colposcopy examination.
6 months
2 years
Endometriosis treatment
1st NSAIDs
2nd OCPs
Pediatric patients with estrogen secreting tumors typically present with (2)
bone age above their chronological age
Precocious Puberty
Pre-eclampsia without severe features what do next?
Mom is fine otherwise
Induce labor at 37 weeks
If a breech presentation does not resolve by 37 w the patient has several options:
1.
2.
3.
- external cephalic version (ECV) before spontaneous labor with a trial of vaginal birth (either normal vaginal delivery or breech delivery)
- Scheduled c-section w/o ECV
- Trial of vaginal birth w/o ECV
___ are usually asymptomatic and ultrasound usually shows diffusely thick walls with wall vascularity.
Commonly hemorrhage or rupture
Corpus luteum cysts
A ____ is seen a single unilateral thin-walled and unilocular on u/s
forms when a Graafian follicle fails to ovulate and continues to grow instead.
While mostly asymptomatic, they may cause dull pelvic pain due to mass effect or menstrual cycle irregularities due to ____ production and endometrial hyperplasia.
follicular cyst
estrogen
_____ are commonly asymptomatic and appear on ultrasound as thin-walled, multiple, multilocular, and BILATERAL ovarian cysts .
Theca lutein cysts
Ultrasound typically shows a asymptomatic, multilocular UNILATERAL cystic ovarian mass with numerous thin septations.
mucinous cystadenoma
Ultrasound typically shows a complex cystic mass with calcifications and solid components.
Most common type of ovarian neoplasm.
More common in women 20–40 years old.
Cystic teratoma (Dermoid cysts)
A thin-walled, homogeneous, and unilocular cyst without solid components with sxs of endometriosis may raise suspicion for an ____.
endometrioma
Pelvic ultrasound of a ___ shows a single fluid-filled, unilocular, anechoic cyst with a thin and smooth wall and without solid components.
In the absence of complications watchful waiting is recommended because they often regress spontaneously.
Follicular cyst
______ is the first step in the diagnosis of patients with suspected PPROM
Sterile speculum examination
The diagnostic criteria for HELLP syndrome:
Hemolysis (low Hb and elevated LDH)
Elevated AST
Low platelets
Most women also have ___ and ___, although this is not required for the diagnosis of HELLP.
hypertension
proteinuria
DELETE
DELETE
____ (not AFP increase) most commonly occur in the setting of
multiple gestations
gestational trophoblastic disease
or exogenous ovarian hyperstimulation
(ex: ovulation induction with clomiphene)
Theca lutein cysts
DELETE
DELETE
One feared complication of HELLP syndrome is _____, which can rupture, resulting in exsanguination.
All pregnant patients with HELLP thus require an immediate _____ if they develop severe abdominal pain.
hepatic subcapsular hematoma
ultrasound
***Abdominal pain 2/2 stretching of Glisson capsule (fibrous layer of the heptic capsule covering the liver) from hepatic swelling is a common symptom.
Amniotic fluid leaking from the cervix and pooling in the vaginal vault
Confirmation of dx via:
positive nitrazine test
positive fern test
or
rapid detection test for IGF- 1 or placental alpha microglobulin-1.
PPROM
PPROM in stable patients at 34+ weeks’ gestation, both expectant management and ____ can be considered.
If patients are managed expectantly, a single course of ANTEnatal ___ should be administered.
induction of labor
corticosteroids
- **No antibiotic ppx for pt w/ PPROM at 34+ weeks
- **STILL screen for (GBS) on admission & manage accordingly
A ____ is recommended for patients with secondary amenorrhea who are not pregnant and have normal levels of hypothalamic-pituitary hormones (prolactin, FSH, and TSH).
progesterone withdrawal test
excessive ___ also stimulates the lactotroph cells of the anterior pituitary to release prolactin (prolactinemia)
TRH (which causes release of TSH)
hypothyroidism
The status of ___ in patients with breast cancer is considered the most important prognostic factor for disease outcome.
axillary lymph nodes
+axillary nodes = worse prognosis
HIV postexposure prophylaxis (PEP) should be offered to all individuals who present within 72 hours after experiencing a sexual assault involving vaginal penetration, and it usually includes a triple regimen of
Raltegravir/ Dolutegravir (integrase inhibitor)
Emtricitabine
Tenofovir
(Doll-you-teh-gruh-veer)
(Em-truh-sai-duh-bean)
Empiric antibiotic therapy with ____ is indicated for the treatment of common STIs (chlamydia/gonorrhea/trich)
in pts who have experienced a sexual assault.
ceftriaxone, azithromycin & tinidazole
OCP contraindications
Age 35+ years and smoking 15+ cigarettes per day
2+ CAD risk factors (Smoking, DM, and HTN)
HTN: 140 mmHg or diastolic 90 mmHg
h/o Thrombotic event not on AG (Stroke, TIA, VTE, PE, subacute bacterial endocarditis, A-fib, pulm HTN)
h/o ischemic heart disease
h/o Breast cancer
h/o Cirrhosis
Migraine with aura
Hepatocellular adenoma or malignant hepatoma
There are no known interactions between OCPs and ___ anticoagulation
However, it is generally recommended that women with acute DVT USING anticoagulation use ____.
warfarin
progestogen-only or other contraceptive methods (IUD).
(there are no contraindications to COC use in women USING oral anticoagulation)
3rd Trimester dark vaginal bleeding and lower abdominal and back pain, together with a history of smoking, suggest
abruption placentae
Echogenic tubal ring (tubal ring sign) is suggestive of tubal
ectopic pregnancy (EP)
A complex, echogenic intrauterine mass interspersed with many hypoechogenic cystic spaces would be a typical finding in
complete hydatidiform mole
other typical findings include:
vaginal bleeding, preeclampsia, hyperemesis, or hyperthyroidism
A distended fallopian tube with incomplete septations is characteristic of ____, a complication of ____, in which inflammation of the fallopian tubes leads to stenosis and accumulation of fluids in the tubes.
hydrosalpinx
pelvic inflammatory disease (PID)
Hypoechoic mass with a thin smooth wall and posterior wall enhancement (no signs of blood flow or septae) suggests
Ovarian Cyst
*monitor
Combination therapy with ___ & ___ is used to treat pelvic inflammatory disease (PID) and its complications, such as tuboovarian abscesses.
clindamycin and gentamicin
A maneuver done in cases of breech presentation in order to maximize the chances of vaginal cephalic delivery.
This maneuver is usually done NEAR term but PRIOR to labor.
External cephalic version
__ is used to strengthen uterine contractions when there is a prolonged latent phase of labor.
Oxytocin
Prolonged latent phase
Slow progression (contraction frequency) with a cervical dilation ≤ __ cm for more than:
Nullparity > __ hours
Multiparity > __ hours
6cm
20
14
The nitrazine test is used for the diagnosis of ____, which typically presents with significant leakage of vaginal fluid before labor onset.
premature rupture of membranes
___ can be used for cervical ripening and labor induction
Misoprostol
__ is a topical antifungal agent and the first-line treatment for vulvovaginal candidiasis in pregnancy.
Intravaginal clotrimazole
all patients who undergo lumpectomy require ___ in order to minimize the risk of recurrence.
Radiation or chemotherapy
(if E,P,HER2 + hormone therapy is also indicated
