OBGYN 7 Flashcards
Where do ovarian arteries branch from?
Directly off the aorta
Where do ovarian veins branch from
R side branches directly off the IVC (think that R is closer to IVC than left)
L side branches off renal vein
Where do uterine arteries branch from
Off the internal iliac arteries
What are the size cut-offs for ovarian cysts that can be ignored vs. removed
If it is <3 cm = most likely simple cyst, can ignore
If it is <10 cm = most likely simple cyst, but should reimage
If it is >10 cm = less likely to resolve on it’s own / possibly a tumor - remove
What is an endometrioma
♣ Chocolate cyst
Caused by endometriosis
♣ Dx: diagnostic laparoscopy with laser ablation
Tx of endometriosis
♣ NSAIDS and/or OCPs
What is the discriminatory zone
• “Discriminatory zone” when BHCG >1500-2000, should see some findings of IUP (i.e. gestational sac) on US
Describe pH of different causes of vulvovaginitis
BV = pH > 4.5 Trich = pH > 4.5 Candida = pH < 4.5
What are the causes of cervicitis
♣ Gonorrhea/Chlamydia
♣ Or organisms that cause vulvovaginitis (BV, Trich, Candida)
Describe subtypes of PID
♣ Endometritis
♣ Salpingitis
♣ Tuboovarian abscess
♣ Peritonitis
What are the causative organisms of PID
- Gonorrhea (33%)
- Chlamydia (33%)
- Vaginal flora (33%)
Diagnosis of PID
♣ Pelvic or abd pain ♣ No other cause for symptoms ♣ 1 of the following positive: • Cervical motion tenderness • Adnexal tenderness • Uterine tenderness
Tx of PID
• Ceftriaxone IM x1 + Doxy + Metronidazole
o Ceftriaxone cover gonorrhea
o Doxy covers chlamydia
o Metro covers anaerobes
What is criteria to be able to use methotrexate as tx for an ectopic pregnancy
bhCG < 5000
Gestational sac < 3.5 cm
No fetal heart tones
What are the causes of abnormal uterine bleeding
PALM COIEN
PALM = structural P = poly A = adenomyosis L = leiomyoma M = malignancy
COEIN = nonstructural C = coagulopathy O = ovulatory dysfunction E = endometrial I = iatrogenic N = not yet classified
What is a leimyoma
- Benign neoplastic proliferation of smooth muscle arising from myometrium
- are estrogen responsive
Tx of fibroids
♣ First line:
• OCP/IUD +/- NSAIDs for pain
♣ Surgery:
• Leuprolide to shrink prior to surgery
• Myomectomy if want to maintain fertility
• TAH if she doesn’t want kids
How do you diagnose PCOS
(1) + (2) or (3)
(1) Oligo- or anovulation
(2) Hyperandrogenism
♣ Elevated DHEAS
♣ Elevated Testosterone
♣ LH:FHS > 3:1
(3) Polycystic ovaries on US
Treatment of PCOS
- Metformin
- OCPs (if don’t want kids)
- Ovulation induction (if wants kids) - Clomiphene
- Spironolactone (for hirsutism)
- Weight loss
Describe order of events of puberty in women
(Think: Tits, pits, mits, and lips) ♣ Breasts (8) ♣ Axillary (9) ♣ Growth (10) ♣ Menarche (11)
Define: False pregnancy – appearance of clinical or subclinical signs and symptoms associated with pregnancy when a person is not actually pregnant
Pseudocyesis
Tx of pseudocyesis
Psychiatric eval and tx
Tx of Bartholin duct cyst
Observation - most resolve spontaneously
If it is symptomatic you can treat it as you would a Bartholin duct abscess - with I&D
At what gestational age do you screen for GBS in a pregnant woman
35-37 weeks
At what gestatioal age should RHOGAM be given in a Rh negative patient
28 weeks and after delivery if infant is Rh(D) positive
What antidepressant is contraindicated in pregnancy
Paroxetine - increased risk of cardiac malformations and persistent pulmonary HTN
Describe intrahepatic cholestasis of pregnancy (ICP)
- Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash
- Bile salts are incompletely cleared by the liver, accumulate in the body, and are deposited in the dermis, causing pruritus
Tx of ICP
• Ursodeoxycholic acid (UDCA) – decreases total serum bile acid levels and helps to relieve the itching
Describe Pruritic urticarial papules and plaques of pregnancy (PUPP)
♣ A common skin condition of unknown etiology unique to pregnancy characterized by intense pruritic and erythematous papules on the abdomen that spread extremities and often the buttocks
Tx of PUPP
♣ Therapy includes topical corticosteroids and antihistamines
What proteinuria values are diagnostic for Pre-E
> 300 mg on a 24 hour urine, P:C >0.3
What proteinuria value is diagnostic for Pre-E with severe features
> 500 mg*
Tx of 39 week woman with new Pre-E without severe features
Delivery
Do not need mag
Tx of eclampsia
- Magnesium IM or IV
- Delivery after maternal stabilization
What is the therapeutic level of magnesium
4-7 mEq/L
At what level of magnesium does loss of DTR occur
7-10 meq/L
What can occur at mag levels of 11-15
Respiratory depression
What can occur at mag levels >15
Cardiac arrest
What is the risk of isoimmunization in an Rh- woman who gave birth to a Rh+ baby without Rhogam
2% antepartum
7% after full term delivery
7% with subsequent pregnancy
So less than 20% total
Best non-invasive test to detect fetal anemia in an Rh- mom
US - middle cerebral artery peak systolic velocity
What will be seen on US on fetal hydrops
- Collection of fluid in two or more body cavities (e.g. ascites, pericardial fluid, pleural fluid, scalp edema)
- Placentomegaly (placental edema)
- Polyhydramnios
Describe theory for etiology of hydrops fetalis
Severe anemia may cause heart failure, or induction of the hematopoietic centers in the liver to replace normal liver tissue, leading to low serum protein
What intervention has shown to decrease preterm delivery of twins
Adequate weight gain in the first 20-24 weeks of pregnancy
What type of twins can experience twin twin transfusion syndromr
Monochorionic/diamniotic
What is the most concerning complication for multiple gestation
Preterm delivery
What gestational age time frame is most at risk for developing intellectual disability in response to radiation exposure
8-15 weeks
Most common cause of preterm labor
Idiopathic
