OBGYN Flashcards
How to estimate delivery date?
LMP - 3 months + 7 days
DA vs GA
DA = days since fertilization= shorter GA= days since LMP= longer than DA
When does first trimester end? second?
12 weeks DA or 14 wks GA
24 weeks DA or 26 weeks GA
Define lengths: pre- viability: pre-term: early term: full term: late term:
pre- viability: before 24 wks pre-term: 25-37 early term: 37-38.6 full term:39-40.6 late term: 41-41.6 postterm: 42+
When is fetal movement felt?
Whats this called?
starts 16-20 wks GA
quickening
When should anatomy scan be done?
18-20 wks GA
What are the following signs?
Goodell sign
Ladin Sign
Chadwick Sign
Goodell- softened cervix (first)
Ladin- softened uterine midline
Chadwick- blue discoloration vagina/cervix
all first trimester
When is “cholasma” seen? linea nigra?
second trimester ~16 wks; linea also second trimester
Describe BHCG trend?
rises and peaks @ 10 wks
drops during 2nd trimester
rises again 3rd trimester to 20-30k
How often should BHCG double in early pregnancy?
q48 hours for first month
At what BHCG should a gestational sac be seen on scan?
10-15k/ or 5 wks
Cards changes in pregnancy
^HR/CO
lower BP
GI changes in pregnancy
GERD and constipation due to LES decreased tone and decreased colonic motility
Renal changes in pregnancy
increased GFR, decreased BUN/Cr
increased risk pyelo due to uterine compression of GU tract
Heme changes in pregnancy
anemia, hypercoagulable (fibrinogen ^ but no PT/PTT, INR change)
Important prenatal testing done:
- early as possible
- 11-14 wks
- 16 wks
- 15-20 wks:
- 18-20 wks
- early: blood tests, pap, GC
- 11-14: gestational age, nuchal translucency
- 16 wks: fetal heart sounds
- 15-20 wks: triple or quad screen
- 18-20 wks: anatomy scan
Third trimester testing done at
27 wks
24-28 wks
36 wks
27 wks CBC
24-28 GTT
36 wks repeat GC, GBS
When to give iron supplements in pregnancy
Hgb 11 or less
How often are visits early in pregnancy?
3rd trimester?
36?
early- 4-6 wks
3rd trimester- 2-3 weeks
36+- weekly visits w/ cervical cks at each
When is chorionic villus sampling/amniocentesis a reasonable idea and when can it be done?
10-13 wks CVS; 11-14 amnio
advanced maternal age
known genetic disease in parent
MC location ectopic pregnancy
ampulla of fallopian tube
How to manage ectopic?
ruptured: stabilized –> surgery
not ruptured: medical or surgical treatment
Medication used to abort ectopic?
MTX (folate receptor antagonist)
Important followup for MTX treatment of ectopic?
follow BHCG to zero
Exclusion criteria
large or heart beat
liver disease
noncompliant
immune deficient
surg for ectopic
salpingostomy/ectomy
*need rhogam if Rh negative
SAB is inevitable when?
bleeding + dilated cervix
Abortion is before what GA?
MCC?
20 wks
(80% in first 12)
chromosomal abnl
Threatened abortion def
bleeding without dilation
Missed abortion def
abortion but all POC in uterus
Treatment of septic abortion
D&C + IV levo or metro
Difference between preterm labor and cervical incompetence?
contractions
Contraindication to tocolytics in preterm labor?
BP ^ cardiac disease dilated more than 4 DIC fetal death chorio
At what GA is preterm labor not stopped?
34-37
earlier give steroids and tocolytics
MC used tocolytic
magnesium sulfate… can also use CCB or terbutaline
Define PROM + risks
ruptured more than 24 hours before delivery
= PTL, cord prolapse, abruption, chorio
Management of PROM
chorio- always deliver
term- wait 6-12 hours for spontaneous this induce
preterm- abx, steroids, tocolytics,
Abx used in PROM
azithro 1 g and ampicillin
What is CI in all cases of third trimester bleeding?
digital exam
Presentation placenta previa
painless bleeding
Three types of placental invasion
accreta, increta, percreta
Risk assc with placental invasion
PPH (type and cross)
Treatment of bleeding assc with placenta accreta
hysterectomy
Define placental abruption
Separation of the placenta from the uterus
Risk factors for abruption
smoking, cocaine, HTN, trauma, prior hx
MC incision type for Csection modern
low transverse
Two types of abruption
concealed vs external
(concealed = bleeding into uterine cavity) * concealed in worse… DIC/hypoxia/ tetany etc
Clues to uterine rupture
fetus withdraws into abdomen during delivery
bump in abdomen
pain
no contractions
Treatment of uterine rupture
life threating… always immediate laparotomy
Management of future pregnancies after uterine rupture
IF uterus can be repaired…. deliver all future pregnancies by cesarean at 36 wks
Cause of hemolytic disease of newborn
Rh - mom, second pregnancies, develops ab’s to fetal RBCs
Result of hemolytic disease newborn
erythroblastosis fetalis –> high output CHF
Screens for Rh factor (2)
Ab SCREEN to see if momma is + or -
Antibody titer to see how many antibodies to Rh+ blood momma has (at initial visit and 28-35 wks)
Management of Rh - momma at 28-35 wks
- rhogam if unsensitized and again at birth if babe is acutally Rh+
- sensitized but less than 1:16- nothing
- sensitized more than 1:16- serial amnio
What if fetal hgb is low and bili is high?.
can perform intrauterine transfusion
Define pre-eclampsia and eclampsia
pre-eclampsia: HTN + proteinuria
eclampsia: ^ + seizures
Define chronic HTN of pregnancy
above 140/90 before 20 wks GA
Define gestational HTN of pregnancy
BP above 140/90 after 20 wks GA without proteinuria or edema
Treatment of HTN in pregnancy
methyldopa, nifedipine, labetalol
ACE/ARBs in preggos?
no… malformations.
Define “severe preeclampsia”
more than 160/110; dipstick 3+; more than 5g protein in 24 hrs; generalized edema; mental status/ vision change; impaired LF.
Treatment of mild preeclampsia
if preterm: steroids + Mag Sulfate
if term: induce delivery
Treatment of severe preeclampsia
Same as mild but add hydral
Maternal risks with pregestational DM
preeclampsia, SAB, infection, PPH
Fetal risks with pregestational DM
heart defects, NTDs, macrosomia, preterm
Maternal testing incase of pregestational DM
EKG, renal function, a1c, eye exam
Fetal testing needed in case of pregestational DM
32-26 wks: weekly NST and US
36+: weekly BPP and NST
37+: L/S ratio (can deliver now if mature)
38-39: induce delivery
Glucose testing at 24-28 wks…
describe steps
- 50g gluc load test (+ if above 140)
- if + then ingest 100g while fasting and measure glucs at 1,2,3 hours.
- load –> tolerance
Treatment of GDM
diet and exercise (not weight loss) –> metformin/glyburide –> insulin
*pregestational type 2 will likely need insulin
Define IUGR
less than 10th percentile
Two types of IUGR
symmetric: brain = rest of body, starts before 20 GA
asymmetric: brain weight better than rest of body, after 20 GA
Prevention of IUGR
stop smoking, get vaccines (but not live)
Define macrosomia
babes greater than 4500 grams
Appropriate fundal height compared to GA
fundal height in cm should equal GA in wks… do US if off by 3 cm or more
What are the three STAGES of labor?
How is stage one divided?
Stage 1: labor onset –> full dilation (latent + active starting at 4cm)
Stage 2: full dilation –> delivery
Stage 3: delivery babe –> delivery placenta
Upper limit normal stage 1 labor for primip vs multip
primip: 18 hours
multip: 10 hours
How fast should dilation go during active phase for primp/multip?
primip: 1cm/hr
multip: 1.2 cm/hr
Upper limit normal stage 2 labor for primip vs multip
primip: 3 hours
multip: 30 mins
Upper limit normal for stage 3 labor
30 mins
Stations of fetal head
-3 –> 0 –> +3
0 is pelvic brim
Chemicals for labor induction
oxytocin, PGE2
*avoid PGE in asthmatics
3P’s for evaluation of protracted cervical dilation
Power (contractions)
Passenger (babys head size)
Passage (pelvis size)
* can give oxytocin if power is the issue
Define arrest disorders
of cervical dilation: no change x 2 hours
of fetal descent: no change x 1 hour
At what age is ECV appropriate
after 36 wks GA
Define early vs late PPH and what amt of blood constitutes hemorrhage?
early first 24 hours; late after
must be more than 500 mL blood
Common causes PPH
1 atony, then lacs/retained products/ etc
Management of PPH
massage and oxytocin
Dx criteria for PMD
2 + cycles
sx absent in follicular phase
sx present in luteal phase
interferes with life
Treatment for PMDD
SSRIs/ stop caffeine, alcohol, cigarettes chocolate
Menopause age + length
48-52, must have no periods x 1 year for dx
Problem with no estrogen? problem with estrogen replacement?
no estrogen- osteoporosis
estrogen- endometrial carcinoma
Define menorrhagia? metrorrhagia?
meno- too much
metro- irregular
Causes of excess bleeding?
polyps/cancer/fibroids/estrogen excess/ etc
Postcoital bleeding is ____ until proven otherwise
cervical cancer
Dx tests for menorrhagia/abnormal bleeding
CBC, PT/PTT, pelvic US
What produces progesterone during normal cycle?
corpus luteum, dies when pt does become pregnant, then prog withdraw= bleeding
Systemic reasons for anovulation
hypothyroid
hyperprolactinoma
At what age is abnormal bleeding concerning for cancer?
35+
What three risks are decreased by OCPs
endometrial cancer, ovarian cancer, ectopics
Vaginal ring works the same way as? Patches?
OCPs same hormones, take out or off for 7 days to bleed
Depot medroxyprogesterone is effect for how long?
3 months, must get shot q3 months
Cause of labial fusion
high androgens as in 21 B hydroxylase def
Lichen sclerosis vs planus appearance + treatment of both
sclerosis is white; planus is purple
both get steroids
Appearance of squamous hyperplasia on vagina + treatment
RAISED white lesion that itches
treat with sitz bath
Treatment of Bartholin gland cyst ?
I&D + culture drainage to R/O G&C
Normal vaginal pH
lower than 4.5
Treatment of bacterial vaginosis?
metro or clinda
Treatment of trich
patient and partner with metro
Pagets disease appearance and treatment?
Rasied red lesion with white coating…. need vulvectomy
Common type of vulvar cancer + presentation?
squamous cell, often itchy
Adenomysosis appearance and treatment
endometrial glands grow into myometrium….. large boggy uterus. Treatment is hysterectomy
Treatment for severe endometriosis not managed by NSAIDs/ OCPs
danazol (test effects), leuprolide (induces reversible menopause)
extreme= surgery
Chemical dx of PCOS
LH:FSH more than 3:1
Drugs to help pt with PCOS conceive
metformin and clomiphene
