OBGYN 6 Flashcards
What are fetal complications associated with late term and postterm pregnancy
♣ Oligohydramnios (single deepest vertical pocket =2 cm) ♣ Meconium aspiration ♣ Stillbirth ♣ Macrosomia ♣ Convulsions
What are maternal complications associated with late term and postterm pregnancy
♣ Cesarean delivery
♣ Infection
♣ Postpartum hemorrhage
♣ Perineal trauma
Tx of stress incontinence
- Lifestyle modification
- Pelvic floor exercises
- Pessary
- Pelvic floor surgery
Tx of urge incontinence
- Lifestyle modifications
- Bladder training
- Antimuscarinic drugs
What is the most accurate method for measuring gestational age
First trimester US
Diagnoses: laboring patient with intense abd pain, tachycardia, vaginal bleeding, and loss of fetal station (fetal part retracts)
Uterine rupture
What are the 2 pathways that lead to endometrial cancer
o (1) Hyperplasia pathway (75%)
♣ Carcinoma arising from endometrial hyperplasia
o (2) Sporadic pathway (25%)
♣ Carcinoma arising in atrophic endometrium
Describe risk factors for endometrial hyperplasia
Excess estrogen – Obesity, chronic anovulation/PCOS, nulliparity, early menarche/late menopause, Tamoxifen use
Tx of endometrial hyperplasia
o Progestin therapy or hysterectomy
Describe functional hypothalamic amenorrhea
♣ Caused by: excessive physical training, very low calorie diet, weight loss, chronic illness, stress and depression, anorexia nervosa
♣ This causes transmitters that affect the hypothalamus and decrease GnRH, with a subsequent deficiency in LH/FSH and estrogen
At what gestational age of preterm labor should corticosteroids be given
<37 weeks (all preterm labor)
At what gestational age of preterm labor should tocolytics be given
<34 weeks
At what gestational age of preterm labor should mag be given
< 32 weeks
Describe antepartum tx of woman with HIV
♣ HIV RNA viral load at initial visit, every 2-4 weeks after initiation or change of therapy, monthly until undetectable, then every 3 months
♣ CD4 cell count every 3-6 months
♣ Resistance testing if not previously performed
♣ ART initiation as early as possible
♣ Avoid amniocentesis unless viral load <1,000 copies/mL
What should be avoided during deliver in an HIV+ woman
♣ Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery
Describe intrapartum tx of woman with HIV viral load <1000
ART + vaginal delivery
Describe intrapartum tx of woman with HIV viral load >1000
ART + zidovudine + cesarean section
Postpartum tx of infant born to mother with viral load <1000
Zidovudine
Postpartum tx of infant born to mother with viral load >1000
multi-drug ART
What is cut off for GDM after 1 hour GTT
Positive if >/= 140
What is cut off for GDM after 3 hour GTT
- Fasting positive > 90
- 1 hour > 180
- 2 hour > 155
- 3 hour > 140
What are the first steps in management of shoulder dystocia
o B = breathe; do not push
o E = elevate legs and flex hips, thighs against abdomen (McRoberts)
o C = call for help
o A = apply suprapubic pressure
o L = enLarge vaginal opening with episiotomy
o M = Maneuvers:
Describe effects of Raloxifene and Tamoxifen on breast and endometrium
Both are used for prevention of breast cancer (have antagonist effects)
Raloxifene also has antagonist effects on endometrium but Tamoxifen can cause endometrial hyperplasia and carcinoma
Recommendation for lactation suppression
o Wearing comfortable and supportive bra, avoidance of nipple stimulation and manipulation, application of ice packs to breast, and NSAIDs to reduce inflammation and pain
o Dopamine agonists (inhibits prolactin secretion) are no longer approved due to side effects
