OBGYN Flashcards
cervical cancer screening divided by age group
younger than 21 - no screening indicated
21-29 years old - pap smear alone every 3 years
29-65 - pap smear (q3 years), hrHPV alone (every 5 years), cotesting (every 5 years)
65 or older - if previously adequately tested, no screening indicated
breast cancer screening by age group
women aged 50-74 years - mammography q2 years
women 40-49 years - depends on the values of the woman and their risk factors. false positives are higher and overdiagnosis is more likely (too much medicine)
what STIs are screened for early in pregnancy?
HIV, HBS, chlamydia, syphillis
what are the features of severe preeclampsia?
SBP > 160, DBP >110
creat > 1.1
plts < 100,000
transaminitis
headaches/visual changes
what are the uterotonic agents?
contraindications?
oxytocin
methylergonovine - hypertension
carboprost - asthma
which uterine operations are so high-risk for uterine rupture that trial of labour is contraindicated?
classical cesarean section
extensive myomectomy with entry into the uterine cavity
how do you measure the strength of uterine contractions during labour and what is the value that indicates adequare contractility?
intrauterine pressure catheter
measurement in Montevideo units
>200 is adequate
which stage of labour is affected by neuraxial anaesthesia?
the second stage
first stage of labour is unaffected
what is the rate of cervical dilation that is expected during the active first stage of labour?
active first stage - uterine contractions are dilating the cervix, 6-10 cm
>1 cm/2 hours
when do you give MMR to rubella non-immune pregnant patients?
after the pregnancy
MMR is a live vaccine and is contraindicated during pregnancy
what are the indications for anti-D in Rh -ve mothers?
28-32 weeks and within 3 days following delivery
other events that will need anti-D:
- ectopic pregnancy
- threatened abortion
- hydatiform mole
- chorionic villus sampling, amniocentesis
- abdominal trauma
- 2nd-/3rd- trimester bleeding
- ECV
what is the exception to the rule for anti-D prophylaxis?
if the father is Rh -ve as well
what is the definition of an acceleration?
>15 bpm from baseline achieved in under 30 seconds
what is the definition of a reactive NST?
>2 accelerations in 30 mins
a score lower than what on biophysical profile indicates foetal distress?
less than or equal to 4
what are the definitions of foetal tachycardia/bradycardia on CTG?
tachy > 160
brady <110
what is the follow up for medical management of ectopic pregnancy?
measure b-HCG in 4-7 days to ensure a 15% decrease
give another dose of MTX if this is not achieved
continue weekly b-HCG until the level is 0
what is the maximum size of the pregnancy you can offer MTX medical management for?
3.5 cm
what is a missed abortion?
death of a foetus (no FHB) but POC are in the uterus and the cervical os is closed
what are the endocrine factors for recurrent early miscarriage?
uncontrolled hyper/hypothyroidism, diabetes
hypoprolactinaemia
what level of dilation should tocolytics not be used to halt preterm labour?
what is the gestational age and weight criteria for delaying preterm labour? what are the agents used for this?
>4 cm
GA 24-33, weight 600-2500 g
tocolytic - CCB or terbutaline
corticosteroids - betamethasone
what is the definition of an early decceleration?
mirror image of contractions
reaches nadir slowly , >30 seconds
occurs due to foetal head compression
what is the treatment for PROM?
tocolytics and steroids
ampicillin and stat azithromycin
mild-pen allergic: cefazolin and stat azithromycin
pen-anaphylaxis: clindamycin and stat azithromycin
what are the indications for emergency delivery in placenta praevia?
unstoppable labour (>4 cm dilation)
heavy vaginal bleeding
foetal distress
how should the foetus be delivered if there is extensive concealed placental abruption and foetal demise?
vaginal delivery
foetus was descending into the pelvis until onset of abdominal pain followed by ascension…
what is the management?
uterine rupture
laparotomy - not cesearian section
can repair the uterus after deliver of the foetus, or hysterectomy
what are the upper foetal weight threshold for cesearian section delivery?
4500 g in diabetic mothers
5000 g in non-diabetic mothers
what is the treatment algorithm for hyperemesis gravidarum?
- non-pharmacologic therapy
- ginger
- vitamin B6
- accupuncture
- antihistamines
- doxylamine, diphenhydramine
- antidopaminergics
- metoclopramide
- antiserotonergics
- ondansetron
what is the screening and management of bacteuria in pregnancy?
screen with urine MC&S at 12 and 16 weeks
if present, even asymptomatic, give anitbiotics
- nitrofurantoin, cefalexin, amoxicillin
what is the difference between chronic hypertension diagnosed in pregnancy and gestational hypertension?
chronic HTN - diagnosis <20 weeks
gestational HTN - diagnosis >20 weeks
patch of scalp missing from a newborn
what was the teratogen?
aplasia cutis - methimazole/carbimazole
what are the definitions for prolonged latent stage?
primiparous - more than 20 hours to reach 6 cm
multiparous - more than 14 hours to reach 6 cm
what are the aetiologies of protracted cervical dilation?
what are the management options?
3 P’s - power, passage, passenger
power - irregular/weak uterine contractions - oxytocin
passage/passenger - cephalopelvis dysproportion - cesearian section
what is the management of uterine inversion?
manual repositioning manouvers
uterine relaxing agents - terbutaline, GTN, MgSO4
laparotomy
what are the first timester screening and diagnostic tests for foetel aneuploidy?
screening
- first-trimester screen (NT, bHCG, PAPPa)
- cell-free foetal DNA
diagnostic
- chorionic villus sampling
what are the second trimester diagnostic and screening tests for foetal aneuploidy?
screening
- quadruple screen (E3, inhibin A, bHCG, AFP)
diagnostic
- amniocentesis
- anomaly scan (>20 week US)
what are the limits for oligohydramnios and polyhydramnios by amniotic fluid index
<5 - oligo
>24 - poly
what is the management of prior genital herpes in pregnancy?
no active infection - viral supression from 36 weeks
lesions during labour - cesearian section
no lesions during labour - vaginal delivery
how do you manage short cervical length?
no previous preterm birth - vaginal progesterone
what is the management if the mother had a previous preterm birth?
serial TVUS-CL until 24 wk gestation, progesterone injections
if short cervix - cervical circlage
after what gestation are tocolytics contraindicated?
>34 weeks
what are the complications of PROM?
intra-amniotic infection
placental abruption
preterm labour
umbilical cord prolapse
what are the associations with increased and decreased maternal AFP levels?
high - neural tube defects, abdominal wall defects, multiple gestation
low - aneuploidy
what are the glucose control targets in GDM?
fasting <95
1-hour post-prandial <140
2-hours post-prandial <120
what is the medical management of preterm labour before 32 weeks?
tocolytics, betamethasone and magnesium sulphate
what is the mangement for hypothyroidism ahead of planning for pregnancy?
need to increase the dose of levothyroxine by 30% then measure TSH and T4 at 4-week intervals
compare with pregnancy-specific normal values
what are the quad screen results for downs?
low AFP
high bHCG
low E3
high inhibin A
what are the quad screen results for trisomy 18 (edwards syndrome)
low AFP, low E3, low bHCG
normal inhibin A
what are the foetal complications of hyperemesis gravidarum?
preterm labour
foetal growth restriction
what are the foetal complications of late-term delivery?
foetal dysmaturity syndrome
oligohydramnios (preferential perfusion to head, hypoperfusion to kidneys)
macrosomia
demise
what are the physiologic renal changes in pregnancy?
increased circulating volume and cardiac output - increase renal perfusion
no change in creatinine and BUN production
decreased serum Cr and BUN
more permeable glomerular membranes
increased urinary protein excretion
what is the antibiotic treatment for postpartum endometritis?
clindamycin and gentamicin
what is the presenting complaint, diagnostic test and treament for intraductal papilloma?
bloody nipple discharge
core needle Bx
excision to remove occult CA
antibiotic treatment for mastitis?
dicloxacillin
cephalexin
what is the screening age for breast cancer and what is the test?
50-74 every other year with mammogram
start at age 40 if they have a family history of breast CA
what are the contraindications to HRT?
oestrogen-dependant CA: breat or endometrial
history of VTE
what are the contraindications to OCP?
migraine with aura
hypertension
smokers >35 years
how long is a depot progestogen injection valid contraception for?
3 months
what is the treatment for trich vaginalis?
metronidazole for both patient and partner
what is the underlying malignancy in paget’s disease of the nipple?
adenocarcinoma
what is the screening for gonorrhoea and chlamydia in young adults?
screening annually in sexually active women <25 years
what is the inheritance pattern of androgen insensitivity syndrome?
what is the management
X-linked recessive
gender councelling, gonadectomy
will have cryptorchid testes with increased risk of malignancy
what is the antibiotic treatment for postpartum endometritis?
clindamycin and gentamicin
what is the initial management of active phase arrest?
how long until you would opt for LSCS?
oxytocin infusion - the most common cause would be inadequate contractions that may be resolved with medical therapy
arrest for 4-6 hours
chancroid
presentation and treatment
painful ulceration
treat with azithromycin
lymphogranuloma venerium
presentation and treatment
supurrative tender lymphadenopathy
doxycycline
US findings that differentiate MCDA or DCDA(fused) twins?
MCDA - thin intertwin membrane, T sign
DCDA - thick intertwin membrane, lamba sign, representing the placenta that has creeped up inbetween the adjacent amniotic sacs
how long after rupture of membranes do you have to start antibiotics regardless of GBS status?
18 hours
risk of chorioamionitis is high at this point
what are the risks of a short interpregnancy interval?
maternal anaemia
PPROM
preterm birth
low birth weight
what are the indications for intrapartum antibiotics GBS prevention in those with unknown GBS status?
- ROM >18 hours
- <37 weeks gestation
- maternal fever
positive whiff test
what will the pH be?
bacterial vaginosis
G vaginalis
metronidazole or clindamycin only for the patient
alkalinization - pH >4.5
pH for vaginal candidiasis?
normal: 3.8-4.5
