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
Describe hallmark presentation of endometriosis
♣ Dysmenorrhea
♣ Deep dyspareunia
♣ Dyschezia (pain with defecation)
• Dyspareunia and dyschezia are caused by implants in the posterior cul-de-sac
Tx of endometriosis
♣ NSAIDS and/or OCPs
Describe current pap test recommendations
• First Pap test age 21
• Test every three years until age 30
• Age > 30, HPV test with Pap test every 5 years
o Almost all young women are infected with HPV, but only transiently
o Usually clear HPV around 30 y/o
o This is why we test at 30 – because if they haven’t cleared virus by then, then we start to worry
• No more testing after hysterectomy or age 65 (with negative Pap history)
What do you do if you have abnormal pap smear results
Colposcopy
o If something positive on endo biopsy = Cone biopsy
o If something positive on ecto biopsy = Local excision (Leep or cryo)
Describe specific causes of endometrial cancer
If it comes from the hyperplasia pathway (75%), then it is due to estrogen exposure:
♣ Obesity, chronic anovulation/PCOS, nulliparity, early menarche/late menopause, Tamoxifen use
Tx of endometrial hyperplasoa
Progesterone therapy
What are the 3 main categories of ovarian tumors
- Epithelial
- Germ cell
- Stroma/sex cell
Describe presentation of germ cell tumors
♣ Are non-malignant
♣ Usually present in teenage girls as an adnexal mass and weight gain
♣ Dx: transvaginal US
♣ Tx: unilateral salpingoophorectomy
What are the 4 types of germ cell tumors
- Teratoma
- Dysgerminoma
- Endodermal sinus tumor
- Choriocarcinoma
Describe teratomas
♣ Tumor of fetal tissue
♣ Most common germ cell tumor in females
♣ Contains tissue from 2 or 3 embryologic layers
♣ Struma ovarii teratoma comprised of thyroid tissue, which can present with hyperthyroidism
Dysgerminoma is a tumor of what cell type and can be followed by what tumor marker?
♣ Tumor of oocytes
♣ “Fried egg” cells – large cells with clear cytoplasm and central nuclei
♣ Equivalent to male seminoma
♣ Tumor markers = LDH (lactic dehydrogenase)
Endodermal sinus tumor is a tumor of what cell type and can be followed by what tumor marker?
♣ Aka Yolk sac tumor
♣ Most common germ cell tumor in children
♣ Elevated serum AFP
Choriocarcinoma is a tumor of what cell type and can be followed by what tumor marker?
♣ Tumor of placenta – mimics placental tissue but villi are absent
♣ Comprised of cytotrophoblasts and syncitiotrophoblassts
♣ Elevated bHCG (produced by syncytiotrophoblasts)
What are the 4 types of epithelial ovarian tumors
- serous
- mucinous
- endometroid
- brenner
Describe diagnosis, prognosis, and tx of epithelial tumors
These are the worst - usually malignant
- no screening tool so usually discovered at stage III
- Tx = TAH + BSO
Describe Brenner tumor
Epithelial ovarian tumor composed of bladder-like (transitional) epithelium
What are the types of stromal-sex cell tumors
- Granulosa-theca cell
2. Sertoli-Leydig cell
Describe presentation of Granulosa-theca cell tumor
♣ Produces estrogen/progesterone ♣ Presentation: • Precocious puberty • Menorrhagia/metrorrhagia • Postmenopausal bleeding
Describe presentation of Sertoli-Leydig cell tumor
♣ May produce androgens hirsutism, virilization
Describe difference between complete and partial moles
Complete:
o Empty ovum fertilized by sperm – 46 chromosomes
o Fetal tissue absent (only DNA is from dad)
o Increased risk of choriocarcinoma
o Will be p57 negative
Partial:
o Normal ovum fertilized by 2 sperm – 69 chromosomes (XXX, XXY, XYY)
o Fetal tissue present
o Minimal risk for choriocarcinoma
What are the 3 cancers of the vulva
- squamous cell
- melanoma
- pagets
Describe presentation, diagnosis, and tx of squamous cell carcinoma of the vulva
- Presents as black and itchy
- Dx: biopsy
- Tx: vulvectomy and lymph node dissection
Describe presentation, diagnosis, and tx of melanoma of the vulva
Same as SCC
• Presents as black and itchy
• Dx: biopsy
• Tx: vulvectomy and lymph node dissection
Describe presentation, diagnosis, and tx of Paget disease of the vulva
• Presents as a red itchy lesion
• Dx: biopsy
• Tx: wide local resection
o Good prognosis so can be less aggressive
