OBGYN Flashcards
Definition of preeclampsia/eclampsia
After the 20th gestational week
Preeclampsia: BP > 140/90 mmHg
Proteinuria > 300mg/24 hours
Eclampsia: Tonic-clonic seizures
Gestational diabetes
Done in all pregnancies, screen at 24-28w
Fasting glucose < 5.6mmol/l: Healthy
Fasting glucose 5.6-7.0mmol/l: Do OGTT
Fasting glucose > 7.0mmol/l on two separate
measurements: DM
Indications for C-section
M/F: Cephalopelvic disproportion or Failed induction of labor
Maternal:
- Eclampsia
- Cervical cancer
- Fibroids, tumor
- Herpes
Fetal: Non-reassuring fetal HR (bradycardia)
- Cord prolapses
- Malpresentation
- Multiple gestations
- Fetal abnormalities - Hydrocephalus
Placental: Previa
- Abruptio
US in pregnancy
0 (6-7w) = Confirm (gestational sac, HR)
Location: Intra-/extrauterine
Twins
I (11-13w) = Congenital malformations
Nuchal translucency (Down’s)
Neural tube defects
Biometrics
II (18-20w) = Congenital malformations
Genetics
III (30-31w) = IUGR
Late congenital malformations
IV (36-38w) = Fetal presentation
Fetal weight
Info for delivery
Placenta abruptio / placenta previa
Use hands to palpate the uterus
Abruptio: Painful, hard uterus - C-section
Previa: Painless, CTG normal
Post-partum haemorrhage
Tissue: Retained placenta
Trauma: Vaginal lacerations
Thrombin: Coagulopathy (DIC)
Tone: Uterine atony (exclude other causes)
Stages of birth
- Onset of labor: Longest stage
a. Latent (3cm)
b. Active (3-10cm) - Baby: 30-90mins
a. Propulsive phase (full dilation, descend to pelvic floor)
b. Expulsion phase (ends with delivery of baby) - Placenta: 5-30mins, separation
a. Expulsion of placenta
b. Expulsion of membranes - Recovery: 2 hours, after expulsion of placenta
a. Increased risk of bleeding
b. Repair lacerations
c. RhoGAM
Techniques of C-section
Abdominal wall: Transverse (Pfannenstiel)/Vertical (Midline)
Uterus: Lower segment incision (Transverse) / Classical (Vertical)
Pearl index
No. of pregnancies in 100 females/year with chosen contraceptive.
OCP: 0.1-2.5
Post-coital pill: 0.5-2.5
IUD: 0.5-5
Condom: 3-28
Sterilization: 0.3-6
Routine exams
Routine exams
Colposcopy
Cytology
Bimanual exam
Breast exam
Long-term OCP use
Good:
Decrease ovarian/endometrial cancer
Decrease bone loss
Decrease dysmenorrhea
Decrease acne
Decrease risk of trisomies in high maternal age
Regulates cycle
Bad:
Increase DVT/stroke
Increase BP
Increased Weight
Depression
Endometriosis
Endometrial-like tissue outside the uterine cavity.
Dx: Gold standard –> Laparoscopic visualization
Tx:
Surgery
Drugs: Pseudopregnancy, Pseudomenopause: GnRH analogue
Urinary incontinence
Irritative: Urinalysis - Cystitis/tumor/foreign body
Stress: Loss of bladder support - Cough
Urge: Hypertonic - increased detrusor (Tx: Anticholinergics)
Overflow/neurogenic: Hypotonic w/ dribbles (Tx: Cholinergics)
Main vaginal infections
Bacterial vaginosis
Trichomonas
Mycosis (Candida)
Condyloma
Spontaneous abortion
Hx: Pain + bleeding
Dx: Cervix, US, hCG
Contraindications to tocolysis
Obstetric:
- Severe abruption
- Ruptured membranes
- Chorioamnionitis
Fetal:
- Lethal anomaly
- Fetus is already dead
- Fetal jeopardy
Maternal:
- Eclampsia
- Advanced dilation
Leopold maneuvers
- Fundal grip = Palpate upper abdomen with both hands
- Umbilical grip = Palpate to localize fetal back. One palm to fix, while the other explores one side then change.
- Pelvic grip (1st pelvic grip) = Determine what fetal part is lying above the inlet. Grasp lower portion of abdomen just above the pubic symphysis with thumb and fingers of the right hand.
- Pawlick grip (2nd pelvic grip) = Face woman’s feet, attempt to locate fetus’ brow. Fingers of both hands moved gently down the sides of the uterus - Pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.
Stopping uterine bleeding
Young: Progesterone to preserve fertility
Old: D&C
Mayer-Rokitansky-Küster-Hauser Syndrome
Fancy word for Müllerian agenesis.
- Congenital malformation
- Failure of Müllerian duct to develop
o Missing uterus, cervix, vagina
o Variable degree of upper vaginal hypoplasia (shortened)
- Causes 15% of primary amenorrhea
- Ovaries intact, ovulation usually occurs
- Will enter puberty and have secondary sexual characteristics
Pap smear
P0: Improper sample
P1: Negative, superficial cells on slide
P2: Superficial cells and WBCs
P3: Unsure
P4: Atypical cells - Suspect malignancy
P5: True malignancy
Bethesda
Reporting cervical or vaginal cytological Pap smear results.
Important steps:
1. Quality of the slide
2. Whether the result is positive or negative
3. Details of the slide (types of cells, LSIL/HSIL)
4. Physician recommendation of how to proceed
Prenatal care
Starts before conception
Puerperium
Period beginning immediately after the birth of a
child extending for ~ 6w.
Statistics
Neonatal Mortality Rate: No. of neonatal deaths
during the 1st month/1,000 live births.
Early NMR: 1st week
Late NMR: 2-4th weeks
Perinatal Mortality Rate: No. of perinatal deaths
(stillbirths + neonatal deaths, from 22nd gestational
week to 7th week postpartum)/1,000 total births.
