OBGYN Flashcards
What are the indications for use of forceps and a vacuum?
- Maternal exhaustion
- Prolonged 2nd stage of labor
- Fetal distress
- Inadequate maternal expulsion
- Need to avoid maternal expuslive efforts (cardiac or CNS disease)
What are contraindications to the use of forceps or a vacuum during labor?
- Fetal prematuritin
- Osteogenesis imperfecta
- Fetal bleeding disease (e.g., hemophilia)
- Unengaged head
- Unknown fetal position
Early decelerations are assoc. w/?
Uterine contractions (“mirror images”)
{{BLANK}} decelerations are a result of fetal head compression
Early decelerations
{{BLANK}} decelerations follow maternal contractions
Late decelerations
Late decelerations are assoc. w/
uteroplacental insufficiency
Early onset neonatal encephalopathy after 34 weeks of gestational age and fetal metabolic acidosis are assoc. w/?
Cerebral palsy
Preterm labor versus incompetent cervix
- Preterm labor: regular contractions; revival effacement before 37 wks gestation
- Incompetent cervix: cervix begins to dilate & efface before pregnancy has reached term; absence of contractions
Placental abruption versus placental previa
Both cause bleeding but which one causes pain?
- Placental abruption: Abnormal premature separation of normal placenta in 3rd trimester; painful
- Placental previa: Placental location close to internal cervical os in 3rd trimester; w/o pain
What are risk factors for placental abruption?
- Chronic HTN
- Preeclampsia
- Multiple gestation
- Advanced maternal age
- Multiparity
- Smoking
- Choroamniotis
- Trauma
{{BLANK}} placental tissue extends into superficial layer of myometrium
Placental accreta
{{BLANK}} placental tissue extends into myometrium
Placental increta
{{BLANK}} placental tissue extends completely from myometrium to serosa of uterus
Placental percreta
What are you going to see if a patient in labor has uterine rupture?
- Vaginal bleeding, sudden pain between contractions, recession of baby in birth canal, loss of station, slowing of contractions
- Turtling
What are the laboratory charts show in fetal demise?
- AFP will increase
- DHEA-S & 16-OH-DS will decline
- hCG will decline
- Urinary estriol E3 will decline within 24-48 hours
How do you calculate an APGAR score?
- HR: absent/< 100/>100
- Tone: limp/mild/active
- Respiration: absent/slow/good cry
- Reflex: absent/grimace/crying or coughing
- Color: blue/blue extremities/pink
0/1/2; 7-10 good; 4-7 mild; < 4 rescucitate
What hormones come from the posterior pituitary?
- Oxytocin
- ADH
What hormones come from the anterior pituitary?
- GH
- TSH
- ACTH
- LH
- FSH
- Prolactin
{{BLANK}} is poor contraction of the uterus (myometrium) following delivery of baby
Uterine atony
{{BLANK}} are first line treatments of uterine atony
- Oxytocin
- Massaging the uterus
If you have a patient with septic pelvic thrombophlebitis, how do you treat?
Heparin
If you have a post-op patient that has unrelenting fever no mattery what is wrong with them, what do you think they have?
Septic pelvic thrombophlebitis
* Sequela of pelvic infection w/ residual fever & tachycardia
What are the stages of grieving?
- Shock: disbelief, detachment
- Searching: guilt, hostility, empty
- Disorientation: depression
- Reorganization: gradual adjustment of loss; return to normal activity
How do molar pregnancies present on ultrasound?
- cluster of grapes
- Snowstrom
- Honeycombed uterus
If you have a couple trying to have a baby but fail to do so, what do you check?
- Woman, if she is fertile
- Then check male
What is supposed to be normal on hysterosplaningography?
- Smooth symmetrical endometrial cavity
- Slender proximal tubes w/ dilation at the ends
- Constrast media easily spilling out of fimbriae
What are ABSOLUTE contraindications to hormonal birth control?
- Thrombophlebitis/Thromboembolic disease
- Cerebral vascular disease
- Coronary artery occlusion
- Impaired liver function or hepatic necrosis
- Known or suspected breast cancer or pregnancy
- Undiagnosed abnormal vaginal bleeding
- Smokers over 35 yo
What are the (2) best treatments for PCOS?
- Weight loss
- Hormonal birth control
What medications are given for preterm labor?
- Atobsian
- Magnesium sulfate
- Nifedipine
What medications induce labor?
Oxytocin analogs
Autonomic dysreflexia is an uncoordinated response to demands of heart and vascular tone due to a lesion below T6. This can induce labor. What is the treatment?
Epidural to T10
When is MTX repeated in the case of ectopic pregnancy?
- To ensure fetus has been aborted
- Measure hCG on day 4, if not below > 15%, continue w/ more MTX
MTX is initiated IM x 2 doses (1 in ea. cheek)
What are the most common places for ectopic pregnancy?
- Fallopian tubes (esp. ampulla)
Absence of menses is not an issue unless?
- Pt ≥15 yo w/ 2° sex characteristics
- Pt is 13 ≥w/o 2° sex characteristics
Why/how do you perform percutaneous umbilical cord blood sampling?
- Transabdominal needle w/ aspiration of umbilical cord
- > 20 wks
Looking for abnormality
Why/How do you perform chorionic villus sampling?
- Reserved for pts w/ > 0.5% chance of abnormality
- Women > 35 yo or w/ probable genetic predisposition
- Can be done earlier (versus percutaneous umbilical cord sampling)
What are causes of primary amenorrhea?
- Turner syndrome 45,X (most common)
- Pregnancy
- Alterations in genital outflow tract
- Premature ovarian failure
- Hypogonadotrophic hypogonadism
- Kallman’s syndrome
- Marijuana use
{{BLANK}} is the most common cause of primary amenorrhea
Hint: 45, X
Turner syndrome
{{BLANK}} syndrome is assoc. w/ primary amenorrhea, absence of GnRH and hypoplasia of olfactory tracts
Kallman syndrome
Marijuana use blocks the release of {{BLANK}} so it can cause primary amenorrhea
Blocks release of GnRH
Why do you treat early menarche?
- Early closure of bone epiphysis
- Short stature
When do you give Rhogam to a pregnant patient?
- Exposure of RBCs –> anti-RBC Abs
- Rh- mother can develop Rh antibodies
- therefore, in f/u pregnancy, give rhogam
Specifically, if < 1:8
{{BLANK}} can cross the placenta and cause hydrops fetalis. To prevent this, you give Rhogam
IgG
Macrocytic versus microcytic anemia
- Macrocytic: MCV > 100
- Microcytic: MCV < 80
How is hypothyroidism treated in pregnancy?
Increase the dose of levothyroxine
How is hyperthyroidism treated in pregnancy?
- 1st trimester: PTU
- 2nd/3rd: MMI
HbS trait is assoc. w/ increased {{BLANK}} during pregnancy
UTI
Explain the difference regarding dichorionic/diamniotic, monochorionic/diamniotic, and monochorionic/monamniotic.
- Dichorionic/Diamniotic: 2 distinct amniotic cavities w/ their own placenta & chorionic sac
- Monochorionic/Diamniotic: Identical twins who each share a placenta but not chorionic sac
- Monochorionic/Monamniotic: Identical twins who share placenta & amniotic sacs (separate umbilical cords)
What measurements do you suspect in a fetus with IUGR?
- Fundal height ≤4 cm
- Fetus est. weight < 10th percentile for age
- Fetus abdominal circumference < 2.5 percentile for age
- Birth weight for IUGR is < 2.5 kg
What qualifies as macrosomnia?
- Fetus > 90% percentile at gestational age
- Weights > 4 kg
How long does Rhogam last? When do you give it?
- T1/2 ~16 days
- within 72-hours post-delivery
Symmetric IUGR versus Asymmetric
- Symmetric: early onset, decreased cell #; irreversible diminution of organ size & function; BPD/HC small & HC/AC normal (
- Asymmetric: late onset; decrease cell size; amenable to adequate nutrition; BPD/HC normal & HC/AC increased
1st & 2nd line Tx fr post-partum hemorrhage?
- 1st: massage
- 2nd: oxytocin analog
If a patient comes in Hx of fetal demise & O- blood type. What do you give?
Rhogam
If a patient comes in full-term after MVC and have a port-wine vaginal bleeding. Both her & the baby are O-. Do you need to use Rhogam?
No
If a patient comes in w/ low fundal height, what in her hx would cause IUGR?
HTN
What are the maternal factors that increase IUGR?
- Preeclampsia
- Eclampsia
- Smoking
- Malnurishment
- Connective tissue dx
Fibroids are NOT a risk factor
What do you do for a patient who is 34 weeks gestation and her water broke?
Induce labor
Which trocolytic medicine has data that it can prevent preterm labor?
Atobisan
When does the splitting of monozygotic twins occur?
Within 0-3 days
What are the complications of increased risk w/ twins/triplets?
- High incidence of congenital malformations
- Higher risk of miscarriage
- Increased risk of IUGR
- Higher risk of pre-eclampsia
- Higher risk of placental or umbilical cord issues
{{BLANK}} is the removal of the uterus
Hysterectomy
{{BLANK}} placement of occlusive device in tubal ostia bilaterally
Hysteroscopy
{{BLANK}} is the surgical cutting of vas deferens
Vasectomy
What is the best choice for teenagers who have never had a baby and may not remember to take pill everyday?
- Implant in arm
- Nuvaring
- Dep-provera
What is the MOA of clomiphene?
Binds to ERs in hypothalamus & increases FSH production
Why do you perform a semen analysis?
40% of infertility cases are due to defects in spermatogenesis
What are cardiac problems that it is okay for them to get pregnant?
- Septal defect
- PDA
- mild mitral & aortic valve disorders
- Grades 1/2 CHF
What are the cardiac problems that it is NOT okay to get pregnant?
- Primary PHTN
- Tetralogy of Fallot
- Eisenmenger syndrome
- Marfan syndrome w/ aortic root dilation
- Grades 3/4 CHF
If a pregnant patient comes in w/ flank pain, what do you worry about?
Pyelonephritis or kidney stone
{{BLANK}} deficiency is more common in people w/ multiple gestations & people taking phenytoin.
Def. = increased risk of neural tube defects
Folate deficiencies
