OBGYN #4 Flashcards
When does premature rupture of membranes occur?
Prior to 37 weeks gestation
Symptoms of PROM
Gush of fluid or persistent leakage form vagina
Diagnostics for PROM
- sterile speculum exam: pooling of secretions
- Nitrazine paper test: turns blue if pH > 6.5
- Fern test: amniotic fluid dries in a fern pattern
90% will go into spontaneous labor within _____ hours after PROM
24 hours
If under 34 weeks, administer ______ (Betamethasone) to enhance fetal lung maturity
Corticosteroids
MC location of ectopic pregnancy implantation
Ampulla of fallopian tube
Risk Factors for ectopic pregnancy
- Previous ectopic pregnancy
- History of PID
- IUD use
- Infertility
- Smoking
- Multiple Partners
Symptoms of Ectopic Pregnancy
- Adnexal mass
- Cervical motion tenderness
- Triad: unilateral pelvic pain, vaginal bleeding, amenorrhea
Symptoms of a ruptured ectopic pregnancy
- Severe abdominal, left shoulder pain (Kehr Sign)
- N/V
- Dizziness
- Syncope
- Hypotension
- Tachycardia
What is endometriosis
Implantation of endometrial tissue outside the uterus
MC location for endometriosis
Ovaries
Risk factors for endometriosis
- Prolonged estrogen exposure (nulliparity, late first pregnancy, early menarche, family history, heavy menstruation)
- Age 25-35
Symptoms of endometriosis
- Classic triad: cyclic premenstrual pelvic pain, dysmenorrhea, dyspareunia
- Fixed, retroverted uterus
Initial imaging study of choice for endometriosis
US
What is the definitive diagnosis for endometriosis
-Laparoscopy with biopsy
Treatment for endometriosis
- Medical: combined OCPs first line. NSAIDs for pain.
- Surgical: Laparoscopy with ablation (if fertility desired)
- Total hysterectomy and bilateral salpingo-oophorectomy if no fertility desired
Infection of the decidua (pregnancy endometrium)
Endometritis
What is the biggest risk factor for endometritis
C-section
Symptoms of endometritis
- Fever
- Tachycardia, abdominal pain
- Uterine tenderness 2-3 days after C-section
Management for endometritis post C-section
Clindamycin + Gentamicin
- May add Ampicillin
- Augmentin is alternative
Prophylaxis for Endometritis
Cefazolin x 1 dose during C-section
MCC of Pelvic Inflammatory Disease
-Usually mixed (Chlamydia and Gonorrhea)
Symptoms of PID
- Lower abdominal tenderness
- Fever
- Purulent Cervical discharge
- Cervical motion tenderness (Chandelier Sign)
Diagnostics for PID
- Pregnancy test (rule out ectopic pregnancy)
- NAAT for Gonorrhea and Chlamydia
- Laparoscopy is the most specific
Outpatient management for PID
- Ceftriaxone + Doxy
- Metronidazole often added
Inpatient management for PID
-Cefoxitin or Cefotetan + IV Doxy
Physical exam findings of an ectopic pregnancy?
- Adnexal mass
- Cervical motion tenderness
- Unilateral pelvic pain + amenorrhea + vaginal bleeding
Diagnostics for ectopic pregnancy
- Quantitative beta-hCG: confirms pregnancy (fails to double)
- Transvaginal US: absence of gestational sac with HCG > 2,000
Management of a stable ectopic pregnancy
-Methotrexate (destroys trophoblastic tissue)
Management of unstable/ruptured ectopic pregnancy
-Laparoscopic salpingostomy
What should be done after management of an ectopic pregnancy?
Beta HCG serial to make sure it returns to 0
-Contraception should be used for at least 2 months after
