OBGYN 3 Flashcards
What is vasa previa
Umbilical vessels that are not protected by cord or membranes, which ross the internal cervical os in front of the fetal presenting part
What does sinusoidal FHR pattern indicate
Usually indicates fetal anemia or bleeding
What does chorionicity refer to
• The number of placentas in a twin or higher order gestation
What does amnionicity refer to
• The number of amniotic sacs in a twin or higher order gestation
Describe the chorionicity/amnionicity of twinning based on timing of division
♣ 0-4 days – dichorionic/diamniotic
♣ 4-8 days – monochorionic/diamniotic
♣ 8-12 days – monochorionic/monoamniotic
♣ >13 days – conjoined twins
Describe possible chorionicity/amnionicity of mono vs. dizygotic twins
Dizygotic twins are always dichorionic/diamniotic
Monozygotic twins can be mono/mono, mono/di, or di/di
Indications for C-sx in mom’s with HSV
Presence of prodromal sx of lesions along the genital tract
What is the point of treating with Acyclovir in a primary infection of pregnant woman
Decreases viral shedding and duration of infection
Does NOT affect the likelihood of future recurrence, patient’s immune response, or transplacental transmission
What are the 2 most common causes of antepartum hemorrhage
Placenta previa and placenta abruption
Describe the difference in presentation between placenta previa and abruption
Previa = painless vaginal bleeding
Abruption = painful secondary to contractions
Management of placenta previa
Expectant management as long as the bleedin is not excessive. C-sx at 34 weeks gestation
Cocaine use is a risk factor for what antepartum complication
Placenta abruption
due to vasospasm
What is the most significant risk factor for placenta abruption
Trauma
Management of placental abruption with fetal demise
Vaginal delivery
What is a myomectomy
Surgical removal of fibroids from the uterus
Diagnose: No separation of placenta after delivery
Placenta accreta
Management of placenta accreta
Hysterectomy
Define placenta accreta
placenta attaches to myometrium without penetration
Define placenta increta
placenta penetrates into myometrium
Define placenta percreta
placenta penetrates and perforates through the myometrium
Describe risk factors for placenta accreta
- Low-lying placentation
- Placenta previa
- Prior cesarean delivery
- Prior uterine curettage
- Prior myomectomy
What is the recommendation for pap smear screening in older women
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
What is the current guideline for screening of cervical cancer in women between 30-65 y/o
Cotesting [Cytology (pap smear) and HPV testing] every 5 years OR
Cytology (pap smear) alone every 3 years
Next step in management of someone with ASCUS on pap smear
HPV typing
Next step in management of patient with ASCUS + high risk HPV type
Colposcopy with biopsies
At what age should women begin getting mammograms
40 y/o
What is the recommendation for screening colonoscopies
For patients with average risk for colon cancer, begin screening at age 50 and then every 10 years if normal
What is the best preventative measure for osteoporosis
Weight-bearing exercise
Why might there be normocytic anemia in a pregnant woman?
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
What might you expect to see in an arterial blood gas of a pregnancy woman
Compensated respiratory alkalosis (low CO2 with compensatory low HCO3)
Low CO2 is due to the increased minute ventilation during pregnancy
Describe the change in maternal cardiac output during pregnancy
It increased up to 33% due to increase in both HR and SV
Describe change in thyroid hormone levels during pregnancy
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
Next step in management of patient with molar pregnancy
Chest x-ray - lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease
What is the risk of fetal loss associated with chorionic villi sampling
1%
What is the most common cause of inherited mental retardation
Fragile X Syndrome
What is the most effective screening test for Down syndrome
Cell-free DNA
What is the recommended amount of folic acid supplementation in a pregnancy woman with previous pregnancy complicated by NTD
4 mg of folic acid daily
Folic acid amount recommendation for non-high risk patients
0.6 mg/day
What is the diagnostic criteria for preeclampsia
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
Treatment for tachysystole
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
Describe presentation of ovarian torsion
Acute onset of COLICKY pain
Describe presentation of ruptured corpus luteum
Sudden onset of severe lower abd pain; often presenting with hemoperitoneum
Treatment of ruptured corpus luteum
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
What must you do if you have to remove the corpus luteum surgically early in pregnancy
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
Describe the criteria for arrest of labor
No progress in the active phase of labor with ruptured membranes for 4 hours with adequate contractions, or 6 hours of inadequate contractions
What is considered adequate contractions
at least 200 MVU (add up peak of each contraction) within a 10 min period
What is the first sign of hypovolemia
Decreased urine output (even before tachycardia)
