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OMS III > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Most common first pregnancy sx

A

amenorrhea (if they have regular menses)
breast tenderness
nausea
vomiting

pregnant women experience a surge in estrogen, progesterone, and beta-human chorionic gonadotropin that leads to these sx

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2
Q

morning sickness

A

cuased by an increase in beta HCG produced by the placenta, occurs until the 12th -14th week of pregnancy

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3
Q

Embryo

A

Fertilization to eight weeks

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4
Q

Fetus

A

eight weeks to birth

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5
Q

Infant

A

birth to one year old

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6
Q

Developmental age (DA)

A

number of days since ferilization

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7
Q

Gestational age (GA)

A

number of days/weeks since the last mentrual period (usually 2 weeks longer than DA)

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8
Q

Nagele rule

A

estimation of the day of delivery by taking the last menstural period, subtracting 3 onths, and adding 7 days.

for example a woman with LMP of oct 1 2015 will have an estimated delivery date of july 8 2016

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9
Q

nagele rule:

A

LMP - 3 months + 7 days = estimated day of delivery

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10
Q

First Trimester:

A

fertilization until 12 weeks (DA) or 14 weeks (GA)

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11
Q

Second Trimester:

A

12(DA)/14(GA) weeks until the 24 week (DA) or 26 week (GA)

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12
Q

Third Trimester:

A

24 (DA)/26(GA) weeks until delivery

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13
Q

First Trimester overview

A

fertilization to 12 weeks (DA)

fertilization to 14 weeks (GA)

FIRST Screening

fetal heart tones with doppler

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14
Q

Second trimester overview

A

12 weeks DA to 24 weeks DA

14 weeks GA to 26 weeks GA

genetic triople or quad screen

fetal movement at 16-20 weeks GA

anatomic us at 18-20 weeks GA

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15
Q

third trimester overview

A

24 weeks DA to delivery

26 weeks GA to delivery

frequent visits

monitoring for labor

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16
Q

Pre-viable

A

fetus born before 24 weeks

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17
Q

pre-term

A

fetus born between 25 and 37 weeks

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18
Q

early term

A

fetus born between 37 weeks and 38 weeks, 6 days

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19
Q

full term

A

fetus born between 39 weeks and 40 weeks, 6 days

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20
Q

late term

A

fetus born between 41weesk and 41 weeks, 6 days

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21
Q

postterm

A

fetus born after 42 weeks

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22
Q

Gravidity

A

the number of times a pts has been pregnant.

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23
Q

parity

A

what happens to the pregnancy

1 full-term births
2 preterm births
3 abortions (both spontaneous and induced)
4 living children (if a pt has a multiople gestation pregnancy, one birth results in 2 living children)

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24
Q

a woman with 6th pregnancy, 2 abortions, 2 children born at term, a set of twins born preterm

A

g6p2124

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25
Q

gp tip

A

f-pal

fullterm
preterm
abortions
living children

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26
Q

Goodell Sign

Physical Finding -

Time from conception -

A

Physical Finding - softening of the cervix

Time from conception - 4 weeks (first trimester)

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27
Q

Ladin sign

Physical Finding -

Time from conception -

A

Physical Finding - softening of the midline of the uterus

Time from conception - 5 weeks (first trimester)

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28
Q

Chadwick sign

Physical Finding -

Time from conception -

A

Physical Finding - blue discoloration of vagina and cervix

Time from conception - 6-8 weeks (first trimester)

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29
Q

Telangiectasi/ palmar erythema

Physical Finding -

Time from conception -

A

Physical Finding - small blood vessels/reddening of the palms

Time from conception - first trimester

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30
Q

Chloasma

Physical Finding -

Time from conception -

A

Physical Finding - the mask of pregnancy is a hyperpigmentation of the face most commonly on forehead, nose, and cheeks; it can worsen in the sun

Time from conception - 16 weeks (2nd trimester)

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31
Q

Linea nigra

Physical Finding -

Time from conception -

A

Physical Finding - a line of hyperpigmentationthat can extend from xiphoid processs to pubic symphysis

Time from conception - second trimester

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32
Q

the best initial test when suspecting pregnanyc is a

A

beta-hcg

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33
Q

Pregnancy diagnostic evaluation

beta hcg

A

both urne and serum testing are based on this, which is produced by the placenta. betahcg is produced rapidly in the first trimester doubling every 48 hours for the first 4 weeks. at 10 weeks of gestation, the betahcg peaks and levels will typicly drop in the second trimester, in the third timester, the levels will increase slowly again to a level of 20000 to 3000 iu/ml. betah hcg tests are all highly sensitive. at 5 weeks it should be 1000 to 1500

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34
Q

Pregnancy diagnostic evaluation

us

A

used to confirm an intrauterine pregnancy. can see gestational sac

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35
Q

beta hcg >1500 or 5 weeks =

A

gestational sax on us

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36
Q

Physiologic changes in pregnancy

Cardiology

A

increase in cardiac output (results in increased heart rate)

slightly lower blood pressure (lowest point occurs at 24-28 weeks)

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37
Q

Physiologic changes in pregnancy

GI

A

morning sickness: nausea and vomiting occur anytime throughout the day and are caused by an increase in estrogen, progesterone, and hcg made by the placenta

reflus: lower esophageal sphincter has decreased tone
constipation: motility in the large intestine is decreased

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38
Q

Physiologic changes in pregnancy

renal

A

increase in the size of kidney and ureters incerases the risk of pyelonpehritis (from compression of the ureters by the uterus)

increase in GFR (secondary to a 50% increase in plasma volume), decrease in bun/creatinine

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39
Q

Physiologic changes in pregnancy

hematology

A

anemia from an increase in plasma volume by 50%

hypercoagulable state
   no increase in pt ptt or inr
   increase in fibrinogen
   virchow triad elements occur
         venous stasis
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40
Q

virchow triad

A

hypercoagulation

endothelial damage

stasis

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41
Q

Prenatal care

First Trimester

A

patients should be seen every 4 to 6 weeks

between 11 and 14 weeks a n us can be done to confrim gestational age and check for nucahl tanslucency.

fetal heart sounds can be heard at the end of the first trimester

blood tests, pap smear and gonorrhea/chlamydia tests

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42
Q

Prenatal care

first trimester screening

A

may be offered to the pt

nonvinasive evaluation to identify risks of chormosoam abnormalitit

a combo of blood tests and us that evaluates the fetus for possible down syndrome

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43
Q

most accurate way of establishing geatational age at 11 to 14 weeks

A

us

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44
Q

pts account of lmp

A

often unreliable bc histories are inaccuratly remembered

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45
Q

Prenatal care

Second trimester

A

visits in the second timerster are used to screen for genetic and congenital problems, at 15 - 20 weeks perfomr a triple or a quad

ausculatation of fetal heart rate

16-20 weeks: quickening (feeling movement for the first time)

18-20 weeks: outine us for fetal malfomration

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46
Q

triple screen

A

maternal serum alpha fetoprotein (masafp), betah cg and estriol

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47
Q

quad screen

A

maternal serum alpha fetoprotein (masafp), betah cg and estriol and inhibin a

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48
Q

increase in MASFP

A

may indicate a dating error, neural tube defect, or abdominal wall defect. the addtition of beta hcg, estriol and inhibin a helps increase the sensitivty of msaft test

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49
Q

multiparous women experience what soone than primparous women

A

quickening

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50
Q

when is triple or quad screen done

A

15 to 20 weeks

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51
Q

Prenatal care

third trimester

A

visits are every 2 to 3 weeks until 36 weeks, after 36 weeks there is a visit every week

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52
Q

Braxton hicks contractions

A

occur during the third trimester. they are spontaneous and do not cause cervical dilation. if they become regular, the cervis should be checked to rule out preterm labor before 37 weeks. preterm labor opens the cervix but braxton hicks do not. beginning at 37 weeks, the cervix should be examined at every visit

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53
Q

Continued braxton hicks means you

A

should check the cervix

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54
Q

Third trimester testing

27 weeks

A

cbc

if hemoglobin <11, replace iron daily

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55
Q

Third trimester testing

24-28 weeks

A

glucose load

if glucose is >140 at one hour, perform oral glucose tolerance test

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56
Q

Third trimester testing

36 weeks

A

cervical cultures for Chlamydia and gonorrhea
treatment if positive
rectovabinal culture for group b strep
prophylactic antibiotics during labor

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57
Q

dont forget to give what with iron supplements

A

stoll softeners bc iron causes constipation

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58
Q

glucose load test

A

fasting or nonfasting ingestion of 50 g of glucose and serum glucose check 1 hour later

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59
Q

glucose tolerance test

A

fasting serum glucose ingestion of 100 g of glucose, serum glucose checks at 1,2, and 3 hours. elevated glucose during any two of these test is gestational diabetes

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60
Q

Other screening tests

A

Chronic villous sampling

amniocentesis

fetal blood sampling

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61
Q

Chronic villous sampling

A

done at 10 to 13 weeks in advanced maternal age or known genetic disease in parent

obtains fetal karyotype

catheter into intrauterin cavity to aspirate chorionic villi from placenta (can be done transabdominally or transvaginally)

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62
Q

Amnioventesis

A

Done after 11 to 14 weeks for advanced maternal age or known genetic diseaes in parent

obtains feteal karyotype (advanced maternal age)

needle transabdominally into the amniotic sac and withdraw amniotic fluid

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63
Q

Fetal blood sampling

A

percutaneous umbilical blood sample

done in pts with rh isoimmunization and when a fetal cbc is needed

nedle transabdominally into the uterus to get blood from theumbilical cord

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64
Q

Ectopic Pregnancy

definition

A

a pregnancy that implantes in an area outside of the uterus. this most commonly occurs in the ampulla of the fallopian tube

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65
Q

anatomy picture

A

pg 503

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66
Q

Ectopic Pregnancy

risk factors

A

pid

iud

previous ectopic pregnancies (strongest risk factor)

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67
Q

Ectopic Pregnancy

presentation

A

unialteral lower abdominal or pelvic pain

vaginal bleeding

if ruptured, can be hypotensivewith peritoneal irritation

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68
Q

Ectopic Pregnancy

diagnostic tests

A

beta-hcg: done to confirm the presence of a pregnancy

us: to locate the site of implatnation
laparoscopy: invasive test and treatment to visulaize the extopic pregnancy

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69
Q

Ectopic Pregnancy

treatment

A

unstable pts (low BP, high HR) should be given fluids and sent to surgery immediatly

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70
Q

Ectopic Pregnancy

medical treatment

A

cbc to monitor for anemia

blood/type screen

tansaminases to detec changed indicating hepatoxocity from the medications (methotrexate)

beta hcg to asses for success of treatment via a decrease in beta hcg

after these are obtained methotrexate a folate antagonist may be given, the pts beta hcg is followed to see if there isa 15 % decrease in 4 to 7 days. if there is no decrease beta hcg a second dose of methotrexate may be given. i fthe pts beta hcg is still no decreasin gafter the sedon dose surgery hsould be done and beta hcg still needs to followed weekly until it reaches 0

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71
Q

Exclusion criteria for Methotrexate

A

immunodeficiency: avoid it bc it is a immunosuppressive

noncomplinat pts: who knows if they will f/u to return for evalutation to know if the treatment worked and if they need a second dose or surgery

liver disease: hepatotoxicity is a serious side effect of methotrexate. baseline liver disease increases the risk of subsequent toxicity

ectopic is greater than 3.5 cm or larger: the larger the extopic, the greater th erisk of treatemnt failure

Fetal hearbeate auscultated: a pregnancy developed enought o have a heartbeat detectabel by auscultation has in increased risk of failure with methotrexate

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72
Q

Ectopic Pregnancy

surgery

A

done to ry and preserve the fallopian tube by cutting a hole in it (salpingostomy). however, rmeoval of the whole fallopina tube (salpingectomy) may be necessary. mothers who are rh negative should receive antid rh ig so taht subsuquent pregnanies will not be affected by hemolytic disease

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73
Q

ostomy

A

cut

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74
Q

ectomy

A

remove

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75
Q

Abortion

Definiton

A

defines as a pregnancy that ends before 20 weeks gestation or a fetus less than 500 grams. almost 80% of spontaneous abortions occur prior to 12 weeks gestation

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76
Q

Abortion

etiology

A

chromosomal abnormalities in the fetus account for 60 to 80% of spontaneous abortions. however, maternal factors that increase risk of abortion include

anatomic abnormalities
infections (STDs)

immunological factos (antiphospholipid syndrome)

malnutrition

trauma

rh isoimmunization

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77
Q

Abortion

Presentation

A

cramping abdominal pain

vaginal bleeding

may be stable or unstable, depending on the amount of blood loss

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78
Q

you cannot answer the most likely diagnosis test about abortion w/o

A

us

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79
Q

Abortion

diagnostic tests

A

CBC to evaluate blood loss and need for transfusion

blood type and th screen: should blood need to be transfused, and evaluations of need for antid rh immunoglobulin

us to distingush between the types of abortions

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80
Q

Complete abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - no products of concetiop found

treatment - f/u in office

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81
Q

incomplete abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - some products of concetiop found

treatment - Dand C/medical

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82
Q

inevitable abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - products of conception intact, intrauterine bleeding, no dilations of cervix

treatment - D&C/medical

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83
Q

threatened abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - products of conception intact, intrauterin bleeding, no dilation of cervix

treatment - bed rest, pelvic rest

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84
Q

missed abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - death of getus, but all products of conception present in the uterus

treatment - D&C/medical

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85
Q

Septic abortion

US finding /answer to “most likely diagnosis” question -

treatment -

A

US finding /answer to “most likely diagnosis” question - infection of the uterus and the surrounding areas

treatment - D&C and IV antibiotics, such as levofloxacin and metronidazole

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86
Q

Abortion

medical treatment

A

occurs bia giving medications that induce laber, like misoprostol (a prostaglandin E1 analog). these agents help opne the cervix and expulse the fetus.

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87
Q

Abortion

Rh neg

A

they need rhogam

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88
Q

fertility drugs increase

A

multiple gestations

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89
Q

Multiple gestations

presentation

A

exponential growth of uterus

rapid wiegh tgain by mother

elevated beta-hcg and msafp (levels higher than expected for estimated gestational age ist he first clue to multiple gestation

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90
Q

Multiple gestations

diagnostic tests

A

us is done to visulaize the fetuses

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91
Q

monozygotic

A

1 egg and 1 sperm that splits

identical twins, same gender, same physical characteristics, same blood type, fingerprints differ

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92
Q

dizygotic

A

2 eggs and 2 sperm

fraternal twins. diff or same sex, they resemble each other, as any siblings would

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93
Q

Multiple gestations

complications

A

spontaneous abortion of one fetus

premature labor and delivery

placenta previa

anemia

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94
Q

Late pregnancy complications

Preterm labor is diagnosed when

A

there is a combination of contractions with cervical dilation

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95
Q

Late pregnancy complications

premature rupture of membranes pt

A

has a gush of fluid

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96
Q

Late pregnancy complications

pts with cervical incompetence

A

do not have a hx of contractions but there is painless dilation of the cervix

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97
Q

Late pregnancy complications

preterm labor risk factors

A

premautre ruputre of membranes

multiples gestation

previous hx of preterm labor

placental abruption

maternal factors
   uteirn anatomical abnormalitites
   infections (chorioamnionitis)
   preeclampsia
   intraabdominal surgery
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98
Q

Late pregnancy complications

preterm labor presentation

A

contractions (abdominal pain, lower back pain, or pelvic pain)

dilation of the cervix

occurs between 20 and 37 weeks

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99
Q

Late pregnancy complications

preterm labor evaluation

A

the fetus should be evaluated for weight, gestational age, and the presenting part (cephalic vs breeck).

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100
Q

Late pregnancy complications

circumstances in which preterm labor should not be stopped with tocolytics and delivery should occur are:

A

maternal severe htn (preeclampsia/eclampsia)

maternal cardiac disease

maternal cervical dilations of more than 4 cm

maternal hemorrhage (abruptio placenta, DIC)

fetal death

chorioamnionitis

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101
Q

Pretemr labor is occurring, contractions and cervical dilation

deliver if

A

34-37 EGA > 2500 grams

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102
Q

Pretemr labor is occurring, contractions and cervical dilation

stop delivery if

A

24-33 ega
600-2500 grams

betamethason
tocolytics

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103
Q

Mature the fetus’s lungs means

A

increase surfactant

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104
Q

Preterm labor

corticosteroids

A

pt should be given betamethasone, a corticosteroid used to mature the fetus’s lungs. the effects begin within 24 hours, peak at 48 hours, and persist for 7 days. corticosteroids decrease the risk of respiratory distress ydnfrome and neonatal mortality

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105
Q

Preterm labor

Tocolytics

A

when steroids are admintisterd, a tocolytic hosuld follow to allow tiem for steroids to work. tocolytics lsow the progerssion of cervical dialtion by decreasing uterine contractions

mag sulfate

ccb

terbutaline

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106
Q

mag sulfate as tocolytic

A

most commonly used tocolyitic. it decreases the uterine tone and contractions. side effects include flushing, headaches, diplopia, and fatigue.

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107
Q

ccb as tocolytics

A

side effects inclue headache, flushing, and dizziness

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108
Q

Terbutaline as a tocolyitic

A

beta-adrenergic,gectpeor agonist, causes myometrial relaxation. maternal effects include increase in heart rate leading palpitations and hypotension

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109
Q

magnesium toxicity

A

can lead to respiratory depression and cardiac arrest, so check deep tendon reflexes often.

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110
Q

indomethacin as a tocolytic

A

can be used, but is always wrong answer, ust it to close a pda

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111
Q

Premature rupture of membranes

presentation

A

presents with a hx of gush of lguid from the vagina

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112
Q

Late pregnancy complications

A

preterm labor

Premature rupture of membranes

Third trimetester bleeding

placental abruption

uterine rupture

rh incompatibilit

hypertension

diabetes

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113
Q

Premature rupture of membranes

diagnostic test

A

sterile speculum exam should confirm the fluid as amniotic fluid

fluid is present in the psoterior fonix

fluid turns nitrazine paper blue

when placed on slide and allowed to air dry, fluid has ferning pattern

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114
Q

Premature rupture of membranes

leads to

A

preterm labor

cord prolapse

placental abruption

chorioamniotis

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115
Q

Premature rupture of membranes

timeframe

A

can happen at anytime throughout pregnancy, it becomes biggest prblem whent eh fetus si preterm or wiht prlonged rupture of membranes

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116
Q

prolonged rupture ofmembranes

A

means that labor starts more than 24 ours before deliver

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117
Q

prom=

A

do fewer exams=decrease chorioamnionitis

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118
Q

Premature rupture of membranes

treatment depends on

A

depends on fetus gestational age and the presenceof chorioamniotis

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119
Q

Premature rupture of membranes

chorioamniotis

A

deliver now

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120
Q

Premature rupture of membranes

term fetus

A

wait 6 - 12 hours for spontaneous delivery, if not spontaneous then induce labor

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121
Q

Premature rupture of membranes

preterm fetus

A

w/o chorioamnionitis should be treated with betamethasone (to mature the lungs), tocolytics (to decrease contractions), ampicillin, and 1 does of azithromycin (to decrease tisk of devleoping chorioamnionitis while waiting for steroids to begin working)

if pt is penicillin allergic but low risk for anaphylaxis, cefazolin and azithromycin, if high risk for anapyhylaxis, then clindamicin and azithromycin is used

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122
Q

Third-trimester bleeding

A

placenta previa

placenta invasion (accreta, increta, percreta)

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123
Q

Placenta previa

A

is an abnormal implantation of the placenta over the internal cervical os. is the cause of about 20% of all prenatal hemorrhages

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124
Q

Placenta previa

increased risk with

A

previous cesaeran deliveries

previous uterine surgery

multiple gestations

previous placenta previa

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125
Q

why is digital vaginal exam ci in third-triemster vaginal bleeding

A

it may lead to increased separation between placenta and uterus, resulting in a severe hemorrhage.

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126
Q

first step in all thrid trimester vaginal bleeding

A

abdominal us

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127
Q

Placenta previa

presentation

A

painless vaginal bleeding

may be detected on routine us before 28 weeks, but usually does not cause bleeding until after 28 weeks

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128
Q

Placenta previa

diagnostic tests

A

a tansabdominal us is done to see where the placenta is lying in the uterus. a transvaginal us is not done for the same reason that a digital vaginal exam is not done; it is dangerous and can separate the placenta fruther from the uterus

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129
Q

Placenta previa

complete

A

complete covering of the internal cervical os

full moon

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130
Q

Placenta previa

partial

A

parital covering of the intrenal cervical os

half moon

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131
Q

Placenta previa

marginal

A

placenta is adjacent to the internal os (often touching edge of the os)

cresecent moon

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132
Q

Placenta previa

vasa previa

A

fetal vessel is present over the cervical os

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133
Q

Placenta previa

low-lying placenta

A

placenta that is impalnted in the lowr segments of the uterus bu tnot covering the intrenal cervical os (more than 0 cm but less than 2 cm away)

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134
Q

Placenta previa

when do you treat

A

wehre there is large-volume bleeding or a drop in hematocrit

indications for immediate cesarian delivery:
unstoppable labor (cervix dilated more than 4 cm)
severe hemorrhage
fetal distress

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135
Q

Placenta previa

treatment

A

strict pelvic rest, with nothing put into the vagina (intercourse)

prepare for life-threatening bleeding by type and screen of blood, cbc, and prothrombin time

prepare fetus with betamethasone for lungs

if delivery must be c section

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136
Q

Placental Invasion (accreta, increta, percreta)

A

when the placenta abnormally adheres to different areas of the uterus (placenta accreta) which is associated with placenta previa. this becomes a problem when the placenta must detach from the uterus after the fetus is born. often placental invatsion cannot be seen on prenatal us but does result in a significant amoutn of postpartum hemorrhage. pts are usually asymptomatic unless invasion into the bladder or rectum results in hematuria or rectal bleeding.if placenta cannot attach from uterine wall after delivery the result is catastrophic hemorrhage and shock, often require hysterectomy

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137
Q

placenta accreta

A

abnormally adheres to the superficical uterine wall

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138
Q

placenta increta

A

attaches to the myometrium

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139
Q

placenta percreta

A

invades into the uterine serosa, bladder wall, or rectum wall

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140
Q

Placental Abruption

A

premature separationo f the placenta form the uterus. resulsts in tearing of the placental blood vessels and hemorrhaging into the separated space. can occur before, during, or after labor. if the separation is large enough and life-threatening bleeding occurs, premature delivery. uterine tetany, disseminated intravascular coagulations, and hypovolemic shock can occur. however, if the defee of separation is amall with minor hemorrhage, then there may b eno clinical signs or sx

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141
Q

Placental Abruption

etiology

A

primary etiology is unknown

Precipitating factors:
maternal htn (chronic, pre or eclampsia)
prior placental abruption
maternal cocaine use
maternal external trauma
maternal smoking during pregnancy
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142
Q

Placental Abruption

presentation

A

third trimester vaginal bleeding

severe abdominal pain

contractions

possible fetal distress

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143
Q

Placental Abruption

diagnostic test

A

can present in a similar fashion to placental previa. ino order to distinguish between the two. a tranabdominal us is done. however, placenal abruption sill may not be seen on us

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144
Q

painful vaginal bleeding

painless vaginal bleeding

A

abruption

previa

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145
Q

concealed abruption description

A

blood is within uterine cavity

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146
Q

concealed abrutption complications

A 
serious (occur with larger abruptions):
disseminated intravascular coagulation
uterine tetany
fetal hypoxia
fetal death
sheehan syndrome (postpartum hypopituitarism)
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147
Q

external abruption

A

blood drains thorugh cervix

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148
Q

Placental Abruption

treatment

A

delivery

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149
Q

Placental Abruption

indications for cesarean delivery

A

uncontrollabe maternal hemorrhage

rapidly expanding concealed hemorrhage

fetal distress

rapid placental separation

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150
Q

Placental Abruption

vaginal deliveries are indicated if

A

palcental separation is limited

fetal heart tracing is assuring

separation is extensive and fetus is dead

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151
Q

life-threatening to mother or baby

A

immediate dleivery

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152
Q

uterine rupture

A

life-threatening to mother and the fetus and usually occurs during labor

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153
Q

uterine rupture

risk factor

A 
increase risk with previous cesarean deliveries (both types)
   classical (longitudinal along uterus): higher risk of rupture
   low transverse (more recent use)

trauma (most commonly mva)

uterin myometomy

uterine overdistention
polyhydramnios
multiple gestations

placenta percreta

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154
Q

uterine rupture

presentation

A

sudden onset of extreme abdominal pain

abnomral bump in abdomen

no uterine contractions

regression of fetus: fetus was movign toward dleivery, but is no longe rin the cnaal bc it withdrew intot he abdomen

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155
Q

uterine rupture means

A

there is a hole in the uterus

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156
Q

uterine rupture

treatment

A

treatment is an immediate laparotimy with delivery of the ferus. a cesarean delivery is not done, bc they baby may not be ni the uterus, but floating in the abdomen. repair of the uterus of hysterctocym will follow. if the pt undergoes a repair of the uterus, all subsuquent pregnancies will be deliverd via cesarean birth at 36 weeks

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157
Q

uterin rupture requires

A

immediate laparotomy and delivery of the fetus

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158
Q

Rh Incompatibility

A

occurs when the mother is rh negative and the baby rh psoitive. this is generally no a problem inthe first pregnancy as the mother has not developed antiboides to the foreing rh positive blood yet, when the first baby is delivered or getal red blood cells cross the placenta into the mother’s bloodstream, she makes anitbodies against the Rh positive blood. when the mother gets pregnant for the second time, her antibodies attaxk the second rh positive baby. this lead to hemolysis of teh ferus’s red blood cells anor hemolyti disease of the newborn

159
Q

Rh Incompatibility

antibody titer - sensitized

A

further monitoring

160
Q

Rh Incompatibility

antibody titer unsensitized

A

repeate at 28 weeks ang give rhogam as indicated

161
Q

Rh Incompatibility

hemolytic disease of newborn

A

results in fetal anemai and extramedullary production of RBCs bc the baby’s bone marrow is not able to make enough RBCs, so the live rans spleen help. Hemolyissi results in increased heme and bilirubin levels in plasma. bilirubin can be neurotoxic. these effects can lead to erythroblastosis fetalis, characterized by high fetal cardiac output (CHF)

162
Q

extramedullary means

A

outside the bone marrow

163
Q

Rh Incompatibility

initial prenatal visit

A

during the initial prenatal visit, an Rh antibody screening test is done. patietns who are Rh negative will have an Rh antibody titer done. PAtietns who are Rh negative but have no antibodies to Rh are unsensitized. patients who are th negative but have anitbodies to Rh are sensitized.

164
Q

Rh Incompatibility

antibody screen

A

done to see if mother is Rh- or Rh+

165
Q

Rh Incompatibility

antibody titer

A

done to see how many antibodies to Rh+ blood the mother has.

166
Q

Rh Incompatibility

unsensitized patients

A

do not yet have antibodies to Rh positive blood. the goal is to keep it that way, so any time that fetal blood cells may cross the placent, anti-d rh immunoglobulins (rhogam) are given.

167
Q

The following are some scenarios where fetal blood cells may cross into the mother’s blood

A

amniocentesis

abortion

vaginal bleeding

placental abruption

delivery

168
Q

Rh Incompatibility

Prenatal antibody screening unsensitized

A

prenatal antibody screening is done at 28 weeks and 35 weeks. patietns who continue to be unsensitized at 28 weeks should receive anti-d immunoglobulin prophylaxis. At deliver, if the baby is Rh positive, the mother should be given antiD immunoglobulin again

169
Q

unsensitized=

A

no anti-rh antibodies present

170
Q

Rh Incompatibility

sensitized patients

A

patients who are sensitized already have antibodies to rh positive blood. on the intial visit, if the patient is Rh negative and has antibodies, an antibody titer needs to be done via the indirect antiglobulin test. the paitent is considered sensitized if she has a titer level mroe than 1:4. if the titer is less than 1:16, no further treatment is necessary. However, if it reaches 1:16 at any point during the prenancy, serial amniocentesis should be done. serial amniocentesis allows for evaluation of the fetal bilirubin level.

171
Q

Antibody titer > 1:16

do first amniocentesis at

if fetal cells rh negative after amniocentesis

A

16-20 weeks

if fetal cells rh negative manage like normal pregnancy.

172
Q

Antibody titer > 1:16

if fetal cells rh posisitve after amniocentesis

A

do amniocentesis at 16-20 weeks.

if fetal cells rh positive, amniocentesies for fetal cells to be evaluated under spectrophotometer to evaluate biliribun

173
Q

f fetal cells rh positive, amniocentesies for fetal cells to be evaluated under spectrophotometer to evaluate biliribun

low bili level

A

repeat amniocentesis in 2-3 weeks

174
Q

f fetal cells rh positive, amniocentesies for fetal cells to be evaluated under spectrophotometer to evaluate biliribun

medium bili level

A

repeat amniocnetesis in 1-2 weeks

175
Q

f fetal cells rh positive, amniocentesies for fetal cells to be evaluated under spectrophotometer to evaluate biliribun

high bilirubin level

A

fetus probably is anemic

do a percutaneious umbilical blood sample (fetal hematocrit) if that is low perfrm an intrauterin transfusion

176
Q

preeclampsia is characterized by

A

htn, edema, proteinuria

177
Q

eclampsia is characterized by

A

preeclampsia with seizures

178
Q

hellp

A

preeclampsia with elevated liver enzymes and low platelets

179
Q

Pregnancy htn

A

chronic htn

gestational htn

preeglamspia

eclampsia

hellp syndrome

180
Q

chronic htn

A

is htn defined as a BP above 140-90 before the pt became pregnant or before 20 weeks of gestation. it may lead to preeclampsia

181
Q

chronic htn treatment

A

methyldopa, labetalol, or nifedipine

182
Q

Gestation htn

A

defined as a bp above 140/90 mm hg that starts after 20 weeks gestation, no proteinuia or edema

183
Q

Gestation htn

treatment

A

treated only during pregnancy with methyldopa, labetalol, nifedipine

184
Q

acei and arbs in pregnancy

A

cause fetal malformation, do not give

185
Q

Preeclampsia Risk Factors

A

chornic htn

renal disease

186
Q

only definitive treatment in Preeclampsia is

A

delivery

187
Q

Mild Preeclampsia

htn -

proetinuria -

edema -

mental status changes -

vision changes -

impaired liver function -

A

htn - >140/90

proetinuria - dipstick 1+ to 2+; 24 hour urin >300mg

edema - hands, feet, face

mental status changes - no

vision changes - no

impaired liver function - no

188
Q

Severe Preeclampsia

htn -

proetinuria -

edema -

mental status changes -

vision changes -

impaired liver function -

A

htn - >160/110

proetinuria - dipstick 3+; 24 urine >5 grams

edema - generalized

mental status changes - yes

vision changes - yes

impaired liver function - yes

189
Q

Mild Preeclampsia at term treatment

A

delivery

190
Q

Mild Preeclampsia preterm treatment

A
  1. betamethasone to mature feral lungs

2. mag sulfate for seizure prophylaxis

191
Q

Severe Preeclampsia treatment

A
  1. prevent eclampsia with mag sulfate
    2 contol bp with hydralazine
    3 deliver (refer to mild treatment if preterm or term)
192
Q

Eclampsia

A

defined as a tonic-clinc seizure occurring in a pt with a hx of preeclampsia

193
Q

Eclampsia treatment

A

first stabilize the mother, then deliver the baby. seizure control is done with mag sulfate and blood pressure control with hydralazine

194
Q

HELLP syndrome

A

PTs have hemolysis, elevated liver enzymes, low plateletes

195
Q

HELLP syndrome

treatment

A

first stabilize the mother, then deliver the baby. seizure control is done with mag sulfate and blood pressure control with hydralazine

196
Q

Diabetes

A

Pregestational diabetes

Gestational diabets

197
Q

Pregestational diabetes

A

means that a women had diabetes before she becamee pregnant

198
Q

Pregestational diabetes

maternal complications

A

four times more likely to have preeclampsia
two times more likley to have a spontaneous abortion
increased rate of infection
increased ostaprtum hemorrhage

199
Q

Pregestational diabetes

fetal comlications

A

increase in congenital anomalies (heart and neural tube defects)

macrosomia
     shoulder dystocia (fetus's shoulder gets stuck under the symphsysis pubis during delivery is one complications asociate with macrosomia

preterm labor

200
Q

Pregestational diabetes

evaluation

A

these tests shuld be done ina ddition to the usual prenatal tests:
EKG
24 hour urine for baseline renal function
creatinin clearance
protein
HbA1C
ophthalmological exam fro baseline eye fucntion and assessing the condition of the retina

201
Q

Pregestational diabetes

fetal testing 32-34 weeks

A

weekly nonstress test (NST) and us

NST: fetal well-being
US: fetal size

202
Q

Pregestational diabetes

fetal testing >36 weeks

A

twice-weekly testing; one nst and one biophysical profile (BPP)

nst: fetal well-being
bpp: amount of amniotic fluid and fetal well-being

203
Q

Pregestational diabetes

fetal testing 37 weeks

A

lecithin/sphingomyelin ratio (L/S ratio)

asess fetal lung maturity test (if mature>deliver)

204
Q

Pregestational diabetes

fetal testing 38-39 weeks (if patient refuses L/S ratio)

A

no test, just induction of labor

205
Q

Gestational diabetes

complications

A

preterm birth

fetal macrosomia

birth injuries from fetal macrosomia

neonatal hypoglycemia

mothers with getational diabetes are 4 to 10 ties more likely to develop type 2 diabetes after the delivery

206
Q

Gestational diabetes

evaluation

A

routinely screened for between 24 and 28 weeks of gestational age. a glucose load test is done first. it consists of nonfasting ingestion of 50 g glucose, with a measurement of serum glucose one hour later. if the serum glucose is above 140mg/dl, then a glucose toleracne test is done. the glucose tolerance test consists of the ingestion of 100 g og flucose after fasting, with 3 measurements of serum glucose at 1,2,3 hours. if any serum glucose measurements are elevated, gestational diabetes is confirmed

207
Q

glucose load test

nonfasting ingestion of 50 g of glucose followed by serum meaasurement of glucose one hour later

<140 mg/dl

A

no gestational diabetes

208
Q

glucose load test

nonfasting ingestion of 50 g of glucose followed by serum meaasurement of glucose one hour later

> 140mg/dl

A

oral glucose tolerance test

fasting ingestion of 100 mg of glucsoe gollowed by serum glucose measurements at 1,2, and 3 hours after ingestion

if all normal no further tests

elevation of serum glucose at 1,2 and 3 hours= gestational diabetes

209
Q

gestational diabetes

first -line treatment

A

diabetic diet and exercise (walking) are the first line treatments for gestational diabetes. however, if this failus to control blood sugars adequately (fasting greater than 95 mg/dl and one hour postprandial greater than 140mg/dl), medication is indicated.

210
Q

Gestational Diabetes

insulin

A

NPH before bedtime and aspart before meals

211
Q

Gestational Diabetes

refractory to diet or refuse insulin

A

both metformin and glyburide may be both safe and effective

if they have type 2 diabetes they may not achieve glycemic control with oral agents and insulin should be used

212
Q

do not tell pregnant ptiants what

A

to lose wieght it is the most common wrong answer, once patients are put on insulin they should follow fetal testing schdudel starting at 32 weeks

213
Q

Fetal growth abnormalities

A

intrauterine growth restriction

macrosomia

214
Q

Intrauterine growth restriction

definition

A

fetuses with Intrauterine growth restriction wiegh int he bottom 10% for their gestational age

215
Q

Intrauterine growth restriction

etiology

A

chromosal abrnormalities

neural tube defects

infections

multiple gestations

maternal htn or renal disease
materanal substance abuse (smoking is the number-one preventable cause in the US)

216
Q

Intrauterine growth restriction

diagnostic tests

A

us is done to cofirm gestational age and fetal weight

217
Q

Intrauterine growth restriction

complications

A

premature labor

stillbirth

fetal hypxoia

lower iq

seizures

mental retardation

218
Q

Intrauterine growth restriction

treatment

A

there is no conclusive treatment for iugr other htan to try and prevent :

quit smoking

prevent maternal infection with immunization (but not live immnizations)

219
Q

Macrosomia

definition

A

fetuses with estimated birth weight over 4500 g are considered macrosomic babies

220
Q

Macrosomia

risk factors

A

maternal diabetes or obesity

advanced maternal age

postterm pregnancy

221
Q

Macrosomia

diagnostic tests

A

on phsical exam, normally the funal height should equal the gestational age in weeks (ie the life of the patient is 28 weeks so the fundal height is 28 cm), in macrosomia the fundal height will be at least 3 cm greater thant he gestational age (ie the pt is 28 weeks and the fundal height is 31 cm)

222
Q

if fundal height is more than 3 cm greater than the gestational age

A

us should be done

us confirms gestational age by

223
Q

us confirms gestational age by

A

femur length

abdominal circumference

head diameter

224
Q

Macrosomia

A

shoulder dystocia

birth injuries

low apgar scores

hypoglycemia

clavicle fracture

brachial plexus injuries

225
Q

Macrosomia

treatment

A

induction of labor should be considered if th elungs are mature before the fetus is above 4500 g in weight

c section delivery is indicated if fetus is above 4500 g in weight

226
Q

Fetal Testing

A

Nonstress Test

Biophysical profile

227
Q

Nonstress test (NST)

A

the nst allows the physician to check for fetal well-being while still in the uterus. NST measures fetal movements and assesses the fetal heart rate

228
Q

A reactic Nonstress test (NST) is defined as:

A

detection of two fetal movements

acceleration of fetal heart rate greater than 15 bpm lasting 15 - 20 seconds over a 20 minute period

229
Q

a reactive Nonstress test (NST) shows:

A

the fetus is doing well, and no furthur testing is indicated. if the nonstress test is nonreassruing the fetus could be sleeping. vibro acoustic stimulation is done to wake up the baby

230
Q

Biophysical Profile

A

consists of NST

fetal chest expansions (count episodes fo fetal chest expansions; normal is 1 or more episodes in 30 minutes)

fetal movement (count fetal movements; normal is more than 3 in 30 minutes)

fetal muscle tone (fetus flexes an extremity)

amnioic fluid index (volume of amniotic fluid based on sonogram)

231
Q

Biophysical Profile

scoring

A

each category is owrth 2 points, a bpp of 8 to 10 is normal, to 8 is inconclusive, less tahn 4 is abnormal

232
Q

Normal Labor

A

EFM

physiological chagnes before labor

induction of labor

233
Q

Electornic Fetal monitoring

A

when a pt presents in labor, an external tocometer is placed on the gravid abdmoen to measurethe fetal heart rate and uterine contractions

234
Q

Fetal heart rate

A

normal: 110-160
brady: <110
tachy: >160

235
Q

Accelerations

A

Normal accelerations are an increase in heart rate of 15 or more beats per minutes above the heart rate baseline for longer than 15-20 seconds. if this happens twice in 20 minutes, it is reassuring or normal

236
Q

Early decelerations

A

decrease in heart rate that occurs with contractions

head compression

237
Q

variable decelerationss

A

decrease in heart rate and return to baseline with no relationship to contractions

umbilical cord compression

238
Q

Late decelerations

A

most serious and dangerous

decreasej in heart rate after contraxtion started. no return to baseline until contraction ends

fetal hypoxia

239
Q

Physiological Changes Before Labor

A

lightening: fetal descent into the pelvic brim

braxton-hicks contractions: begin contractions that do not result in cervical dilation: they routinely start to increase in frequency towards the end of pregnancy

bloody show: blood-tinged mucus from vagina that is released with cervical effacement

240
Q

Stage 1

begining to end -

duration -

A

begining to end - onset of labor > full dilation of cervix

duration - primipara 6-18 hours, multipara 2-10 hours

241
Q

latent phase

begining to end -

duration -

A

begining to end - onset of labor > 4 cm dilation

duration - primipara 6-7 hours, multipara 4-5 hours

242
Q

active phase

begining to end -

duration -

A

begining to end - 4 cm dilation > full dilation

duration - primapara 1 cm per hour (minimum), multipara 1.2 cm per hour (minimum)

243
Q

stage 2

begining to end -

duration -

A

begining to end - full dilation of cervix > delivery of neonate

duration - primipara 30 mintues to 3 hours, mutlipara 5 mintues to 30 minutes

244
Q

stage 3

begining to end -

duration -

A

begining to end - delivery of neonate > delivery of placenta

duration - 30 minutes

245
Q

Stage 1 monitor the following

A

maternal blood pressure and pulse

electronic fetal monitor: fetal herat rate and uterine contraction

examine cervix to montor the progression of labor for:
cervical dilation
cervical effaceemnt
station

246
Q

Station

A

where the fetus’s head is located in relationship to the pelvis

measured -3 thorugh +3 (bottom of the ischial tuberosity)

0 is middle of pubic ramus

3 is about where the superior head of femur is

247
Q

effaced

A

cervix is thinned out

248
Q

Stage 2 of labor

A

begins whent he cervix is fully dilated andthe mother wants to push. The rate of fetal head descent determines the progression of this stage. the fetus goes thorugh severeal steps in this stage

249
Q

Stage 2 of labor

step 1

A

engagement:

fetal head enters the pelvis occiput first

250
Q

Stage 2 of labor

step 2

A

descent:

progresses as uterine contractions and maternal pushing occur

descent continues until the gerus is delivered

251
Q

Stage 2 of labor

step 3

A

flexion:

fetal head flexion

252
Q

Stage 2 of labor

step 4

A

internal rotation:

when fetus’s head reaches the ischial spines, the fetus starts to rotate

rotation moves the safittal sutures into the forward position

253
Q

Stage 2 of labor

step 5

A

Extension:

occurs so taht the head can pass through vagina (oriented forward and upward)

254
Q

Stage 2 of labor

step 6

A

External Rotation:

during fetal head delivery, external rotation occurs, giving the shoulders room to descend

255
Q

Stage 2 of labor

step 7

A

delivery of anterior shoulder:

gently downward pressure on the fetal head will aid in delivery of antrior shoulder

256
Q

Stage 2 of labor

step 8

A

Delivery of posterior shoulder:

gentle upward pressure on the fetal head will aid in delivery of posterior shoudler

the rest of the fetus will follow

257
Q

Stage 3 of labor steps

A

immediately after delivery, inspect and repair lacerations of the vagina while waiting for placental separation.

258
Q

signs of placental separation include

A

fresh bleeding from vagina

umbilical cor-lengtheneing

uterine fundus rising

uterus becoming firm

259
Q

Induction of Labor

A

means to start labor via medical means

260
Q

Induction of Labor

medications

A

prostaglandin E2 is used for cervical ripening

oxytocin
exaggerates
normally found in the posterior pituitary (drug is aversion of the naurally occurring substance)

Amniotomy
puncture of the amniotic sac via an amniohook
inspect for a prolapsed umbilical cord before puncturing the amniotic sac

261
Q

do not give prostaglandins to who

A

asthmatic patients it may provoke bronchospasm

262
Q

arrest of cervical dilation

A

when there is no dilations of the cervix for more than 2 hours

263
Q

protracted cervical dilations occurs when the

A

primara’s cervix does not dilate more than 1.2 cm in one hour. it is dilating slowly but still dilating

264
Q

arrest of descent is when

A

the fetal head does not move down into the canal

265
Q

Prolonged latent stage

definition

A

occurs when the latent phase lasts longer thatn 20 hours for primipara and longer than 14 hours for multipara

266
Q

Prolonged latent stage

etiology

A

Sedation

unfavorable cervix

uterine dysfunction with irregular or weak contractions

267
Q

Prolonged latent stage

treatment

A

rest and hydration. most will convert to spontaneous delivery in 6 to 12 hours

268
Q

Protracted Cervical Dilation

definition

A

protraction occurs when there is slow dilation during the active phase of stage 1 labor, less than 1.2 cm per hour in primipara women, and less than 1.5 cm per hour in multipara

269
Q

Protracted Cervical Dilation

etiology

A

the 3 p’s are:

power: strength and frequency of uterine contractions
passenger: size and position of fetus
passage: if passenger is larger than pelvis= cephalopelvic disproportion

270
Q

Protracted Cervical Dilation

treatment

A

treatemnt of cephalopelvic disportion is c section. if the uterine contractions are weak, oxyctocin may be given

271
Q

Arrest Disorders

Types

A

cervical dilation: no cervical dilation for 2 hours

fetal descent: no fetal descent for 1 hour

272
Q

Arrest Disorders

etiology cephalopelvic disproportion

A

accounts for half of all arrest disorders

treat via c section

273
Q

Arrest Disorders

etiology malpresentation

A

fetus is older than 36 weeks with the presenting part soemthing other than the head, meaning the head is not downward

274
Q

Arrest Disorders

other etiology

A

excessive sedation/anethesia

275
Q

Malpresentation

lower half of fetus (pelvis and legs) is presenting part

A

the presenting part is the part of the fetal body that is closes to the vaginal canal and will be engaged when labor starts. normally it is the head (cephalic presentation); however, in malpresentation it can be a foot or a buttock

276
Q

Malpresentation

can be felt on physical exam

A

leopold manuevers are a set of 4 manuervers that estimate the fetal weight and the presenting part of the fetus

vaginal exam: with malpresentation, u feel a mass isntead of the normal hard surgace of skull.

277
Q

Malpresentation

diagnostic evaluation

A

the fetus needs to be visualized with us to confirm the diagnosis

278
Q

frank breech

A

fetus’ hips are flexed with extended knees b/l

279
Q

complete breech

A

fetus’s hips and knees are flexed b/l

280
Q

footling breech

A

fetus’s feet are first: one leg (single footling) or both legs (double footling)

281
Q

Malpresentation

treatment

A

with external cephalic version, the caregiver maneuvers the fetus into a cephalic presntation (head down) through the abdominal wall. you should not perform this aneuver until after 36 weeks gestation. the fetus can maneuver itself into a cephalic presentation (head first) before 36 weeks

282
Q

Shoulder Dystocia

A

occurs whent he fetus’s head has been delivered but the anterior shoulder is stuck behind the pubic symphysis

283
Q

Shoulder Dystocia

risk factors

A

maternal diabetes and obesity causes fetal macrosomia

postterm pregnancy allows the baby more time to grow

hx of prior shoulder dystocia

284
Q

Shoulder Dystocia

Mcroberts maneuver

A

first-line treatment

maternal flexion of knees into abdomen with suprapubic pressure

285
Q

Shoulder Dystocia

Rubin maneuver

A

rotation of the fetus’s shoulders by pushing the posterior soulder towards the fetal head

286
Q

Shoulder Dystocia

woods maneuver

A

rotation of the fetus’s shoulder by pushing the posterior choulder towards the fetal head

287
Q

Shoulder Dystocia

other treatment

A

delivery of posterior arm

deliberate fracture of fetal clavicle

288
Q

Shoulder Dystocia

Zavanelli maneuver

A

push fetal head back into the uterus and perform cesarean delivery

high rate of both maternal and fetal mortality

last maneuver to try

289
Q

Potparum hemorrhage

definition

A

postpartum hemorrhage is defined as bleeding more than 500 ml after delivery. early postpartum bleeding occurs within 24 hours of delivery, while late postpartum bleeding occurs 24 hout to 6 weeks later

290
Q

Potparum hemorrhage

etiology

A

normally, postpartum, the uterine contractions compress the blood bessels to stop blood loss. in uterine atony, this does not occur. uteirne atony accounts for 80% of postpartum hemorrhage. other causes include laceration, retained parts, and coagulopathy.

291
Q

any factor that indicates that a fetus is too big or the pelvis is too small

A

is a risk factor for shoulder dystocia

292
Q

Risk factos for Atony

A

anesthesia

uterine overdistention (such as in twins and polyhydramnios)

prolonged labor

laceration

retained placenta (can occur with placenta accreta)

coagulopathy

293
Q

Potparum hemorrhage

treatment

A

examine the uterus by bimanual examination. assure that there is no rupture of the uterus and that there is no retained placenta. if the examination is unremarkable, bimanual compression and massage should be done. this will control most cases of postpartum bleeding. if the bimanual massage does not control the postpartum bleeding, administer oxytocin to make the uterus contract, constricting the blood vessels and decresing the blood flow

294
Q

atony=

A

wihtout contractions

295
Q

sheehan syndrome

A

after postparutm hemorrhage presents as inability to breastfeed

296
Q

Premenstrual syndrome and premenstrual dysphoric disorder

definition

A

begin when women are in their 20s to 30s. PMDD is more severe version of PMS that will disrupt the pts daily activities

297
Q

Premenstrual syndrome and premenstrual dysphoric disorder

sx

A

headache

breast tenderness

pelvic pain and lboating

irritability and lack of energy

298
Q

Premenstrual syndrome and premenstrual dysphoric disorder

diagnostic tests

A

there are no tests for the diagnosis of pms or pmdd; pmdd has dsmV diagnostic criteria. the patient should chart her sx. the following must be present to meet the diagnsotic criteria:

sx should be present for 2 consecutive cycles
sx free period of 1 week in the first part of the cycle (follicular phase)
sx must be present in the secondhalf of the cycle (luteal phase)
dysfunction in life

299
Q

Premenstrual syndrome and premenstrual dysphoric disorder

treatment

A

pt should decrease consumption of caffeine, alcohol, cifarettes, and chocolate and should exercise. if sx are severe give SSRIs

300
Q

Menopause

definition

A

the result of permanenent loss of estrogen, Menopause occurs in pts aged 48 to 52. it starts with irregular menstrual bleeding. the oocytes produce less estrogen and progesterone, and both the LH and FSH start to rise. women are symptomatic for an average of 12 months, but some women can experience sx for years

301
Q

Menopause

sx

A

mentrual irregularity

sweats and hot flashes

mood changes

dyspareunia (pain during sexual intercourse)

302
Q

Menopause

physical exam findings

A

atrophic vaginitis

decrease in breast size

vaginal and cervical atrophy

303
Q

decrease estrogen =

A

osteoporosis

304
Q

Menopause

diagnostic tests/treatment

A

if the diagnosis is unclear, an increased FSH level is diagnostic. Hormone replacement therapy is indicated for short-term symptomatic relief as well as the prevention of osteoporosis

305
Q

HRt is associated with

A

endometrial hyperplasia and can lead to endometrial carcinoma

306
Q

HRT CI

A

estrogen-dependent carcinoma (breast or endometrial cancer)

hx of pe or DVT

307
Q

postcoital bleeding

A

cervical cancer until proven otherwise

308
Q

Menorrhagia

Description

A

heavy and prolonged menstrual bleeding

gushing of blood

clots may be seen

309
Q

Menorrhagia

Etiology

A

endometrial hyperplasia

uterine fibroids

dysfunctional uterine bleeding

iud

310
Q

Hypomenorrhea

Description

A

light menstrual flow

may only have spotting

311
Q

Hypomenorrhea

Etiology

A

obstruction (hymen, cervical stenosis)

oral contraceptive pills

312
Q

Metrorrhagia

Description

A

intermentrual bleeding

313
Q

Metrorrhagia

Etiology

A

endometrial polyps

endometrial/cervical cancer

exogenous estrogen adminstration

314
Q

Menometrorrhagia

Description

A

irregular bleeding

time intervals
duration
amount of bleeding

315
Q

Menometrorrhagia

Etiology

A

endometrial polyps

enomterial/cervical cancer

exogenous estogen administration

malignant tumors

316
Q

Oligomenorrhea

Description

A

mentrual cycle > 35 days long

317
Q

Oligomenorrhea

Etiology

A

pregnancy

menopause

significant weight loss (anorexia)

tumor secreting estrogen

318
Q

Postcoital bleeding

Description

A

bleeding after intercourse

319
Q

Postcoital bleeding

Etiology

A

cervical cancer

cerical polyps

atrophic vaginitis

320
Q

abnormaluterine bleeding diagnostic tests

A

cbc to see if hb and hct have dropped

pt/ptt to evaluate for coagulation disorder

pelvic us to visulaize any aatomical abnormlaity

321
Q

Dysfunnctional uterine bleeding

definition

A

unexplained abnormal bleeding. also occurs wehn pts are anuovulatory. the ovary produces estrogen, but no corpus luteum is fomred. without the corpus luteum, progesterone is no produced. this prevents the usual withdrawal bleeding. the continuously high estrogen continues to stimulate growth ofthe endometrium. bleeding occurs only once the endometrium outgorws the blood supply

322
Q

Dysfunnctional uterine bleeding

diagnostic tests

A

rule out systemic reaaseons for anovulation, such as hypothyroid and hyperprolactinimia. endometrial biopsy for women over 35 to exclude carcinoma

323
Q

there is no specific test for

A

DUB confirm by excluding other causes

324
Q

any pt older than 35 with abnormal bleeding should undergo

A

endometrial biopsy to rule out endometrial carcinoma

325
Q

Dysfunnctional uterine bleeding

ocp treatment

A

adolescents and young women who are anobulatory

women over 35 who have a normal endometrial biopsy

326
Q

Dysfunnctional uterine bleeding

acute hemorrhage

A

d and c is done to stop the bleeding

327
Q

severe Dysfunnctional uterine bleeding

A

if pts are anemic, are ot controlled by ocps, or report that their lifestyle is compomised, treat with endometrial ablation or hysterectomy

328
Q

Contraception

A

female condoms

vaginal diaphragm

ocps

vaginal ring

transdermal patch

im injection

iud

sterilization

329
Q

female condoms

A

the female condome has 2 rings and a thing material in between. one ring is placed deep into the vagina whilet the other ring is left at the introitus. female condoms offer some protection against HIV and STDs and are under female control. they are larger and bulkier than male condoms

330
Q

Vaginal Diaphragm

A

a circular ring with cotraceptiv jelly that covers the cervical canal. the diaphragm without the jelly is ineffective. the jelly is also used as a lubricant while placing the diaphragm

331
Q

Vaginal diaphragm timing

A

should bej plaed 6 hours before intercourse and left in for at least 6 hours after intercourse

332
Q

Disadvantages of a diaphragm

A

need to be fitted properly (can change with weight gain of pregnancies)

proper use of diaphragm requires advance perparation

improper placement or dislodging of diaphragm reduces efficacy

333
Q

OCPs

A

most commonly a combo pill of both estrogen and progesterone. the pill is taken for 21 days and a placebo is taken for 7 days. during the 7 days of placebo pills, the pt will experience menstruation. women should start using the ocp on the sunday after menstruation

334
Q

ocps reduce the risk of

A

ovarian carcinoma, endometrial carcinoma, and extopic pregnancy.

335
Q

ocps increase risk of

A

thromboembolism

336
Q

Vaginal Ring

A

a flexible vaginal ring that releases both estrogen and progesterone is inserted into the vagina for 3 weeks. hormones are released ona constant basis. when the ring is removed, withdrawal bleeding will occur. the gainal ring has similar side effects and efficacy to OCs

337
Q

Transdermal ptach

A

a transdermal patch with a combination of estrogen and progesterone is palced on the skin for 7 days. eah week the previous patch is removed and a new patch is placed. three weeksa of patches are folowed by a ptach free week, during whichthe pt will experience whtdrawal bleeding. pathces should not be placed on the breast. the side effects and efficacy are the same as ocps

338
Q

Im injection bc

A

depot medroxyprogesterone acetate is an im injection that is effective contraception for 3 months

339
Q

IUD

A

placed intot he uterus an dprovides contraception for 10 years. there are 2 types, a copper device and a lveonorgestrel device. these devices are associated with pelvic inflammatory disease when they are placed. genital cultures must be done before placement of these devices

340
Q

Sterilization

A

surgical sterilization can be done on both men and women. sterilization via tubal ligation and vasectomy is permanent and irreversible

341
Q

Sterilization

tubal ligation

A

surgical procedure that women may choose to undergo for permanent contraception. the risk of prenanyc is very low, but if it occurs,there is an increased incidence of ectopic pregnancy

342
Q

Sterilization

vasectomy

A

surgical procedure in which ligation of the as deferens is performed

343
Q

Labial Fusion

A

occurs wehn excess androgen are present this can occure with extaneous angdorgen administration or by increaed androgen prodution. the most common cuase is 21b hydroxylase deficiency. the treatement of labial fusion is reconsructiv surgery

344
Q

Lichen Sclerosis

age group affected

A

any age can be affected; however, is postmenopausal there is an increased risk of cancer

345
Q

Lichen Sclerosis

description

A

white, thin skin extending from labia to perianal area

346
Q

Lichen Sclerosis

treatment

A

topical steroids

347
Q

Squamos cell hyperplasia

age group affected

A

any age; pts who have had chronic vulvar pruritus

348
Q

Squamos cell hyperplasia

description

A

pt with chronic irritation develop hyperkeatosis (raised white lesion)

349
Q

Squamos cell hyperplasia

treatment

A

sitz baths or lubricants (relieve the pruritus)

350
Q

Lichen planus

age group affected

A

30s-60s

351
Q

Lichen planus

description

A

biolet, flat papules

352
Q

Lichen planus

treatment

A

topical steroids

353
Q

Bartholin gland cyst

A

bartholin glands are locatedon the lateral sides of the vulva. they secrete mucus and can become obstructed, leading to a cyst or abscess that causes pain, tenderness, and dyspareunia

354
Q

Bartholin gland cyst

pe

A

edema and inflammationof th earea with a deep fluctuant mass

355
Q

Bartholin gland cyst

treatment

A

similar to other cysts or abscesses. it needs to be drained. a simple incision and drainage (I&D) should be done. if htey continue to recur then marsupialization should be done. during i&d the fluid released should be cultured for std such as gonorrhead and chlamydia

356
Q

Bartholin gland cyst

marsupialization

A

is a form of i&d in which the open space is kept open with sutures. this allows the space to remian open, and decreases the risk of a recurrent Bartholin gland cyst

357
Q

Vaginitis

types

A

bacterial vaginosis

canidiasis

trichomonas (the most comomn nonnviral std)

358
Q

Vaginitis

risk factors

A

any factor that will increase th eph of the vagina like:

antibiotic use (lactobacillus normally keeps the vaginal ph below 4.5)

diabetes

overgrowth of normal flora

359
Q

Vaginitis

sx

A

patients present with itching, pain, abnomral odor, and dishcarge

360
Q

Bacterial Vaginosis

Pathogen -

sx -

diagnostic test -

treatment -

A

Pathogen - gardnerella

sx - vaginal discharge with fishy odor, gray white

diagnostic test - saline wet mount shows clue cells

treatment - metro or clindamycin

361
Q

Candidiasis

Pathogen -

sx -

diagnostic test -

treatment -

A

Pathogen - candida albicans

sx - white, cheesy vaginal discharge

diagnostic test - KOH shows pseudopyphae

treatment - miconazole, or clotrimazole, econazole, or nystatin

362
Q

Trichomonas (the most common nonviral STD)

Pathogen -

sx -

diagnostic test -

treatment -

A

Pathogen - trichomonas vaginalis

sx - profuse, green, frothy vaginal discharge

diagnostic test - saline wet mount shows motile flagellates

treatment - treat both pt and partner with metro

363
Q

Malignant disorders

A

paget disease

squamos cell carcinoma

364
Q

paget disease

definition

A

an intraepithelial neoplasia tha tmost commonly occurs in postmenopausal caucasian women

365
Q

paget disease

presents with

A

vulvar soreness and pruritus appearing as a red lesion with a superficial white coating

366
Q

paget disease

diagnosis

A

biopsy for definitive dx

367
Q

paget disease

treament

A

bilateral lesion is a radiacl vulvectomy if unilateral a modified vulvectomy can be done

368
Q

Squamos cell carcinoma

definition

A

most common type of vulvar cancer

369
Q

Squamos cell carcinoma

presents with

A

pruritus

blood y vaginal discharge

postmenopausal bleeding

pe can range froma small ulcerated lesion to a large cauliflowerlike lesion

370
Q

Squamos cell carcinoma

diagnosis

A

biopsy, staging is done while the pt is in surgery

371
Q

Squamos cell carcinoma

staging

A

0-4a

372
Q

Squamos cell carcinoma

state 0

A

carcinoma in situ

373
Q

Squamos cell carcinoma

stage 1

A

limited to vaingal wall <2cm

374
Q

Squamos cell carcinoma

stage 2

A

limited to vulva or pernieum >2cm

375
Q

Squamos cell carcinoma

stage 3

A

tumor spreading to lower urethra or anus, unilateral lymph nodes present

376
Q

Squamos cell carcinoma

stage 4

A

tumor invasion into bladder, rectum, or b/l lymph nodes

377
Q

Squamos cell carcinoma

treatment

A

unilateral lesions iwhtout lymph node involvmeent is a modified radical vulvectomy. treatment for bilateral involvement is radiacl vulvectomy. lymph nodes that are invovled must undergo lymphadenectomy

378
Q

Uterine abnormalities

A

adenomyosis

Endometriosis

379
Q

Adenomyosis

definition

A

the invasion of ednometrial glands into the myometrium. this usually occurs in women between the ages of 35 and 50.

380
Q

Adenomyosis

risk factors

A

endometriosis and uterin fibroids

381
Q

Adenomyosis

presents with

A

dysmenorrhea and menorrhagia

382
Q

Adenomyosis

diagnosis

A

cilinical diagnosis

on pe the uterus is large, globular, and boggy

MRI is the most accurate test

383
Q

Adenomyosis

treatment

A

hysterectomy is the only definitive treatment. it is the only way to diagnose adenomyosis definitively

384
Q

Endometriosis

definition

A

implantation of endometrial tissue outside of the endometrial cavity. Although the endometrial tissue can imoplant anywhere, the most commonsites are theovary and pelvic peritoneum. occurs in women of reproductive age andis more common if a first-degree realtive (mother or sister) has endometriosis

385
Q

Endometriosis

presents

A

cyclical pelvic pain that start 1 to 2 weeks before menstruation and peaks 1 to 2 days before mensruation. the pain ends with menstruation. abnormal bleeding is common. the pe reveals a nodular uterusand adnexal mass

386
Q

Endometriosis

diagnostic tests

A

diagnosis can be made only by direct visualization via laparoscopy. direct visualization of the endometrial impalnts looks like rusty or dark borwn lesions. on the ovary, a cluster of lesions called an endometrioma looks like a chocolate cyst.

387
Q

Endometriosis

treatment

A

analgesics can be done with nsaids, if mild ocps may work

modeate to severe sx are placed on danazole or leuprolide acetate, both are used to decrease FSH and LH

388
Q

Danazol

A

is an androgen derivative that is associated with acne, oily skin, wieght gain, hirsutism

389
Q

Leuprolide acetate (leurpron)

A

is a GnRH agonsit and when given continuously suppresses estrogen. associated with hot flashes and decreased bone density

390
Q

Endometriosis

surgical treatment

A

considered for pts who have severe sx or are infertil. surgery attempts to remove all fo the endometrial implants and adhesions, and to restore pelvic anatomy. pts who have completed their childbearing may undergo total abdominal hysterectomyy and bilateral salpingo-oophorectomy.

391
Q

PCOS

symptoms

A

occur in women of reproductive age

amenorrhea or irregular menses

hirsutism and obesity

acne

diabetes mellitus type2 (increased insulin resistance

392
Q

PCOS

diagnostic tests

A

pelvic us will show b/l enlarged ovaries with multiople cysts present. free testosterone will be elevated secondary to the high androgens. the high androgen level and obesity lead to an increase in estrogen formation outside the ovary. this stimulates LH secretion while inhibiting fsh secretion, leading to an LH to FSH ration of more than 3:1.

393
Q

PCOS

treatment

A

weight loss: pts who are obese hsould be conuseled to lose weight, which will decrease the insulin resistance

ocps control the amounts of estrogen and progestin that are in the body. this both controls the androgen levels and prevents endometrial hyperplasia. this should be used only if the pt does not wish to have children

clomiphene and metformin should be used in pts who with to conceive

OMS III (21 decks)

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