ObGyn Flashcards
what are the ONLY 2 reasons to perform emergency Csection?
- Fetal tachycardia
2. unstable hemodynamics in mom
normal wt loss rule in new borns (what percent is lost & when is it gained back)
within first 7 days <7% of weight is lost
over next 2 weeks weight is gained back
how does monochorionic diamnionic monozygotic pregnancy lead to twin-to-twin transfusion syndrome?
2 diff amniotic sacs, but SAME placenta (chorion)
donor twin develops anemia, oliguria, and complications of oligohydramnios (e.g., craniofacial abnormalities and clubfoot due to intrauterine growth restriction). The recipient twin develops polycythemia.
at what week can you see intrauterine pregnancy?
5 weeks
at what bHCG can you see intrauterine pregnancy?
> 1500 mIU/mL. So do NOT attempt transvaginal US until bHCG is elevated to 1500
What is the appropriate rate in rise of bHCG in early pregnancy?
doubling of β-hCG approx. every 2.5 days within the first 4 weeks
how does obstructed labor/prolonged labor lead to a vesicovaginal fistula?
when labor is obstructed, the fetus head compresses the vaginal canal> pressure necrosis of the vaginal wall and bladder> vesicovaginal fistula
Cervical insufficiency criteria:
- PMHx
- cervix response to intraabdominal pressure
- cervical length
pt has cervical insufficiency IF:
1) previous preterm birth!!!
2) cervix dilates to 1cm w/ pressure
3) cervix is < 25cm
at what weeks can pt receive cerclage for cervical insufficiency?
only when <24 weeks
what are the contraindications to cerclage placement?
what is the other tx option in these cases?
contraindications:
- no Hx of preterm birth
- active preterm labor, chorio, premature rupture of membranes, high risk of miscarriage
vaginal progesterone supplementation can be considered if there are contraindications to cerclage
at what week do you face the fact that the breeched baby is not going to spontaneously flip into a normal position?
what do you offer mom to prevent birth complications ( fetal asphyxia and delivery-related injury)?
week 37 = baby can no longer flippity flip in belly
external cephalic version at 37 weeks
what benign, bilateral ovarian tumor forms during Pregnancy and causes hyper-andgrogenism (hirsutism, deep voice, facial acne, clitoromegaly)
Leutomas
what are 2 emergency complications of Luteomas?
1) ureter obstruction
2) ovarian torsion!
pregnancy causes what nerve complication
carpal tunnel syndrome
- physiological fluid retention, which leads to edema of soft tissue in and around the carpal tunnel.
preterm
term
post term
late term
preterm = <37 weeks (<28 weeks is extremely preterm & may not be viable) TERM = 39 weeks late = 40-41 weeks post = 42 weeks
post term babies are at high risk for what complication?
meconium aspiration syndrome (an OLD placenta cant clear meconium as well as a term placenta can)
what causes caudal regression syndrome? (aka lower/caudal deformities)
maternal diabetes
at what gestational week can you no longer perform an abortion?
13 weeks!
is parental consent required when treating a minor (<18yo) sexually transmitted infections or substance abuse, access to birth control, or prenatal care?
NO.
when is the only time you need parental consent to treat a minor?
when someone <18yo is requesting an abortion for a pregnancy that was NOT brought on by incest/rape
what type of PPH does magnesium sulfate cause?
Atony.
magnesium sulfate stops cerebral palsy BUT it is also a TOCOLYTIC> stops uterus from contraction> atony
what are the complications of PID?
infertility
peritonitis (Fitz-Hugh-Curtis syndrome/perihepatitis or peri-appendicitis)
tubo-ovarian abscess !!
management of chorioamnionitis depends on the form of delivery;
what is the management for vaginal vs cesarean delivery?
Vaginal delivery: IV ampicillin plus gentamicin
Cesarean delivery: IV ampicillin and gentamicin, PLUS clindamycin (anaerobe coverage to minimize postcesarean complications, e.g., endometritis)
what is the range of a normal amniotic fluid index?
between 5-25 is normal
<5 = oligo
>25 = poly
what are the 2 most common causes of polyhydraminos?
fetal abnormalities (hydrops fetalis, neural tube defects, upper GI probs)
&
Diabetes!!!!
what week is screening for GDM recommended?
how is the screen done?
between 24-28 weeks
2 parts:
- 1 hour 50g glucose challenge (>130 = positive)
- 3 hour 100g OGTT (if 1 hr challenge was high)
what is another name for a vestibular gland cyst?
where is it located?
vestibular = Skene gland cyst
para-urethral location
what is the pathognomonic TVUS findings in Adenomyosis?
asymmetric thickening of the myometrium
what are the 3 Absolute contraindications for an @ home birth?
1) breech presentation
2) multiple gestations (twins)
3) prior CSection
hypergonadotrophin (FSH/LH) HYPOgonadism (estrogen/androgen)
is associated with what 2 syndromes?
klinefelter syn (47 XXY or 48 XXXY):
- hypoplastic testes> hypogonadism (NO Inhibin B or Testosterone)
- low hormones> + FBL = hypergonadotropin production (FSH/LH)
turner syn (45XO):
- streaked ovaries = NO estrogen or androgen production
- low hormones> + FBL = hypergonadotropin production (FSH/LH)
what is the pathophys of Hypogonadotropic hypogonadism ?
No GNRH (gonadotrophin) to tell gonads to release hormones = low GNRH > Low FSH/LH > Low estrogen/androgen
examples of Hypogonadotropic hypogonadism (secondary hypogonadism)?
- Kallman syndrome
- Prader-Willi syndrome (deficiency in hypothalamic/pituitary GH)
- Gaucher disease
- hypothalamus or pituitary lesions (> no FSH/LH release)
- opioids (inhibit GnRH release)
- eating disorders (no GnRH release under stress/ malnutrition)
Hypergonadotrophic hypergonadism is associated with what sexual development disorder?
Androgen Insensitivity Syndrome (AIS) = males who look like females bc there are defects in the androgen receptor on organs in the body:
»> inc GnRH> inc LH/FSH > inc testosterone/estrogen
A pregnant woman is taking DES to prevent miscarriage:
- what cancer is she at risk for developing?
- what cancer is her child at risk for developing?
DES exposure> breast & endometrial cancer in mom
DES IN UTERO> VAGINAL clear cell adenocarcinoma (CCA)
a ruptured VASA previa causes hemodynamic instability for mom or baby?
BABY! bc the vessel that was being previewed (vasa previa) has ruptured & that was the BLOOD SUPPLY TO THE BABY
(mom will show no signs of stress)
abortions are only abortions if they occur before what gestational week?
must happen b4 week 20 (when fetus isnt viable)
