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MS3 > OBGYN 3 > Flashcards

OBGYN 3 Flashcards

1
Q

What is vasa previa

A

Umbilical vessels that are not protected by cord or membranes, which ross the internal cervical os in front of the fetal presenting part

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2
Q

What does sinusoidal FHR pattern indicate

A

Usually indicates fetal anemia or bleeding

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3
Q

What does chorionicity refer to

A

• The number of placentas in a twin or higher order gestation

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4
Q

What does amnionicity refer to

A

• The number of amniotic sacs in a twin or higher order gestation

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5
Q

Describe the chorionicity/amnionicity of twinning based on timing of division

A

♣ 0-4 days – dichorionic/diamniotic
♣ 4-8 days – monochorionic/diamniotic
♣ 8-12 days – monochorionic/monoamniotic
♣ >13 days – conjoined twins

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6
Q

Describe possible chorionicity/amnionicity of mono vs. dizygotic twins

A

Dizygotic twins are always dichorionic/diamniotic

Monozygotic twins can be mono/mono, mono/di, or di/di

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7
Q

Indications for C-sx in mom’s with HSV

A

Presence of prodromal sx of lesions along the genital tract

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8
Q

What is the point of treating with Acyclovir in a primary infection of pregnant woman

A

Decreases viral shedding and duration of infection

Does NOT affect the likelihood of future recurrence, patient’s immune response, or transplacental transmission

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9
Q

What are the 2 most common causes of antepartum hemorrhage

A

Placenta previa and placenta abruption

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10
Q

Describe the difference in presentation between placenta previa and abruption

A

Previa = painless vaginal bleeding

Abruption = painful secondary to contractions

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11
Q

Management of placenta previa

A

Expectant management as long as the bleedin is not excessive. C-sx at 34 weeks gestation

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12
Q

Cocaine use is a risk factor for what antepartum complication

A

Placenta abruption

due to vasospasm

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13
Q

What is the most significant risk factor for placenta abruption

A

Trauma

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14
Q

Management of placental abruption with fetal demise

A

Vaginal delivery

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15
Q

What is a myomectomy

A

Surgical removal of fibroids from the uterus

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16
Q

Diagnose: No separation of placenta after delivery

A

Placenta accreta

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17
Q

Management of placenta accreta

A

Hysterectomy

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18
Q

Define placenta accreta

A

placenta attaches to myometrium without penetration

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19
Q

Define placenta increta

A

placenta penetrates into myometrium

20
Q

Define placenta percreta

A

placenta penetrates and perforates through the myometrium

21
Q

Describe risk factors for placenta accreta

A
  • Low-lying placentation
  • Placenta previa
  • Prior cesarean delivery
  • Prior uterine curettage
  • Prior myomectomy
22
Q

What is the recommendation for pap smear screening in older women

A

Patients with a uterus can discontinue cervical cancer screening between the ages of 65-70 if they have had three consecutive negative smears or two negative consecutive cotesting in the last 10 years and no history of high grade CIN or cancer

23
Q

What is the current guideline for screening of cervical cancer in women between 30-65 y/o

A

Cotesting [Cytology (pap smear) and HPV testing] every 5 years OR

Cytology (pap smear) alone every 3 years

24
Q

Next step in management of someone with ASCUS on pap smear

A

HPV typing

25
Q

Next step in management of patient with ASCUS + high risk HPV type

A

Colposcopy with biopsies

26
Q

At what age should women begin getting mammograms

A

40 y/o

27
Q

What is the recommendation for screening colonoscopies

A

For patients with average risk for colon cancer, begin screening at age 50 and then every 10 years if normal

28
Q

What is the best preventative measure for osteoporosis

A

Weight-bearing exercise

29
Q

Why might there be normocytic anemia in a pregnant woman?

A

Due to the relative hemodilution of pregnancy - there is normally a 47% increase in maternal plasma volume during pregnancy and only a 17% increase in RBC mass

30
Q

What might you expect to see in an arterial blood gas of a pregnancy woman

A

Compensated respiratory alkalosis (low CO2 with compensatory low HCO3)

Low CO2 is due to the increased minute ventilation during pregnancy

31
Q

Describe the change in maternal cardiac output during pregnancy

A

It increased up to 33% due to increase in both HR and SV

32
Q

Describe change in thyroid hormone levels during pregnancy

A

Thyroid binding globulin (TBG) is increased due to increased circulating estrogens

This causes increase in total thyroxine levels with normal free T3 and T4 levels

33
Q

Next step in management of patient with molar pregnancy

A

Chest x-ray - lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease

34
Q

What is the risk of fetal loss associated with chorionic villi sampling

A

1%

35
Q

What is the most common cause of inherited mental retardation

A

Fragile X Syndrome

36
Q

What is the most effective screening test for Down syndrome

A

Cell-free DNA

37
Q

What is the recommended amount of folic acid supplementation in a pregnancy woman with previous pregnancy complicated by NTD

A

4 mg of folic acid daily

38
Q

Folic acid amount recommendation for non-high risk patients

A

0.6 mg/day

39
Q

What is the diagnostic criteria for preeclampsia

A

Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two occasions at least four hours apart after 20 weeks of gestation in a previously normotensive patient

AND

Proteinuria – Urine P:C > 0.3, 24hr urine protein > 300mg

40
Q

Treatment for tachysystole

A

If during spontaneous delivery:

  • Cat I tracing = no intervention
  • Cat II/III = intrauterine resuscitative measures; if failed, consider tocolytics (e.g Terbutaline)

If during induced labor:

  • Cat I = reduce uterotonics
  • Cat II/III = reduce or stop uterotonics; intrauterine resiscitation; if failed, consider tocolytics
41
Q

Describe presentation of ovarian torsion

A

Acute onset of COLICKY pain

42
Q

Describe presentation of ruptured corpus luteum

A

Sudden onset of severe lower abd pain; often presenting with hemoperitoneum

43
Q

Treatment of ruptured corpus luteum

A

Secure hemostasis. If bleeding stops, no further therapy required. If bleeding continues, cystectomy should be performed with preservation of the remaining normal portion of the ovary

44
Q

What must you do if you have to remove the corpus luteum surgically early in pregnancy

A

Recall that the corpus luteum is maintained by bHCG in order to produce progesterone until the placenta is capable (10-12 weeks)

So if the corpus luteum is removed surgically prior to 10-12 weeks, exogenous progesterone is needed to sustain the pregnancy

45
Q

Describe the criteria for arrest of labor

A

No progress in the active phase of labor with ruptured membranes for 4 hours with adequate contractions, or 6 hours of inadequate contractions

46
Q

What is considered adequate contractions

A

at least 200 MVU (add up peak of each contraction) within a 10 min period

47
Q

What is the first sign of hypovolemia

A

Decreased urine output (even before tachycardia)

MS3 (88 decks)

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