OBGYN Flashcards
round ligament
anteverts uterus; travels in inguinal canal
broad ligament
contains uterine vessels; lateral uterus to pelvic sidewalls
infundibular ligament “suspensory ligaments”
contains ovarian aa, nerve, and vein
cardinal ligament
holds cervix and vagina
ectopic preg mgmt
methotrexate or salpingotomy - STABLE
salpingetomy - UNSTABLE
mittelschmerz what ruptures
graafian follicle
risk factor clear cell ca of vagina
DES diethylstilbestrol
mgmt vaginal SCC
RADIATION
vulvular intraepithelial neoplasms
VIN = premalignant (HPV)
HSIL - WLE 0.5-1cm, laser, or TOPICAL IMIQUIMOD with annual surveillance
vulvar SCC ca <2cm (stage I) mgmt
WLE 2 cm margin, ipsilateral inguinal node dissection
vulvar SCC ca >2cm (II+ stage) mgmt
radical vulvectomy (b/l labia) with b/l inguinal dissection and postop XRT if close margins <1cm
ovarian cyst concerning features
thick septation
solid + vascularity
papillary projections
>10 cm
if there, oophorectomy with intraop sections
ovarian cyst mgmt
US surveillance if no high risk features
ovarian torsion risk factors
5cm cyst
ovarian ca risk factors
nulliparity
late menopause
early menarche
PCOS
endometriosis
smoking
family hx
BRCA, Lynch
protective factors for ovarian ca
OCPs
bilateral tubal ligation
previous pregnancies
breastfeeding
ovarian ca types
teratoma
granulosa-theca (ESTROGEN- early puberty)
Sertoli Leydig (ANDROGEN - manly)
struma ovarii (thyroid)
chorio (B-HCG)
mucinous
serous
papillary
clear cell type = worst prognosis
staging ovarian ca
I: 1 or 2 ovaries
II; limited to pelvis
III; spread throughout abdomen
IV: distant mets
indication for omentectomy for survival
met from ovary
mgmt ovarian ca
TAH BSO + pelvic/paraaortic LN dissection, omentectomy, 4 quadrant washes, cytology of diaphragm, and CHEMOt
what Is chemo for ovarian ca
cisplatin and paclitaxol
Meiges syndrome
pelvic ovarian fibroma causing ascites and hydrothorax (just excise primary)
Krukenberg
gastric met to ovary (path: signet ring cells)
MC gyn ca
endometrial ca
risk factors endometrial ca
unopposed E… nulliparity, later in life first pregnancy, obesity, use of tamoxifen
endometrial ca staging
I: endometrium
II: cervix
III: vagina/peritoneum/ovary
IV: bladder/rectum
mgmt endometrial ca
TAH and BSO (add XRT once extends beyond cervix)
cervical ca staging
I: cervix
II: upper 2/3 vagina
III: pelvis/side wall/lower 1/3 vagina/hydronpehrosis
IV: bladder/rectum
where does cervical ca spread
obturator nodes
mgmt cervical ca
cone bx if only CIS
TAH (I and IIA)
chemoXRT (IIB to IV) cisplatin/paclitaxel like ovarian
mgmt fibroids
GnRH agonis (leuprolide)
mgmt anovulation
clomiphene citrate
tocolytic contraindication
> 34 wks, nonreassuring fetal HR
severe fetal bradycardia
<80 bpm
causes: cord compression, cord prolapse, tetanic uterine contractions, maternal seizure, anesthesia effects
stat C section indication
nonreassuring fetal heart rate
prolapsed cord
placental abruption
uterine rutpure
maternal cardiac arrest
Rh alloimmunization concept
if mom is Rh-: give mom Rh IgG within 72 hours and at delivery (if confirmed baby is Rh-positive)
what fetal monitoring to for EGS
< 24 wks: pre & post op fetal herat tones
> 24 wks: continuous intraop fetal HR monitoring +/- tocodynamometry
physiologic changes to CV system in pregnancy
dilutional anemia
leukocytosis
thrombocytosis
increased fibrinogen and 7, 8, 9, 10
physiologic changes to Pulm system in pregnancy
increased tidal volume
decreased functional residual capacity
O2 consumption
chronic compensated respiratory alkalosis
physiologic changes to GI system in pregnancy
decreased motility
decreased esophageal sphincter competency
increased aspiration risk
nonoperative ectopic indications
HD normal
B-hcg < 5000
no fetal cardiac activity
give methotrexate:
follow up with B-hcg monitoring until undetectable
CI: if hemodynamically abnormal, simultaneous pregnancy, active pulmonary disease, renal insufficiency, peptic ulcer disease, immunosuppression, actively breast feeding
operative ectopic indcations
salpingostomy: if want pregnancy in future
salpingectomy: if ruptured, tubal damage, uncontrolled bleeding, gestation is >3-5cm (too large for salpingostomy)
CT scan A/P risk
2.5 rad
5 is organogenesis risk
ACOG and ASA for GA
no risk to in utero developmentrime
trimester restrictions to laparoscopcy
NONE
laparoscopic port insertion in pregant patient
Hasson
6cm above most gravid part
1st tri: normal
fetal fast
of fetuses
position placenta
location placenta
amniotic fluid volume
fetal cardiac activity
fetal femur length
kleinhauser Bekte test
positive = abruption and is an indicator for preterm labor
do prompt Rh Ig administration
mgmt TOA
clindamycin + aminoglycoside then PO
missed abortion
bleeding, closed os, positive sac, NO HEARTBEAT
threatened abortion
1st trimester bleeding, positive heartbeat
incomplete abortion
tissue protrudes through os
PID tx
doxycycline and ceftriaxone
hydatidiform mole
partial is malignant risk
complete: paternal origin
chemo = methotrexate
