OBGYN 8 Flashcards
Tx of chorioamnionitis
♣ Broad spectrum IV antibiotics (e.g. ampicillin, gentamicin, clindamycin)
♣ Induction of labor
What are contraindications to using Indomethacin to stop preterm labor
3rd trimester (closure of ductus arteriosus)
What are contraindications to using Nifedipine to stope preterm labor
Hypotension
What are contraindications to using Mag to stop preterm labor
Myasthenia gravis
What are contraindications to using terbutaline to stop preterm labor
Terb is NOT used to stop preterm labor because it is ineffective and dangerous if used for long periods of time
Contraindications to using beta agonists (Terb and Ritodrine) as tocolytics
arrhythmia, HTN, seizure disorder, diabetes
Describe the results of amniocentesis in chorioamniotiis
- Elevated IL-6
- Low amniotic fluid glucose
- Presence of leukocytes has low predictive value
When do you give steroids in PPROm
< 34 weeks
When do you give mag in PPROM
< 32 weeks
When do you augment delivery in PPROM
> 34 weeks
Adverse effects of oxytocin
- Hyponatremia (Oxytocin is produced by posterior pituitary and can act similar to antidiuretic hormone)
- Hypotension
- Tachysystole
Management of woman with history of genital HSV
Prophylactic acyclovir or valacyclovir beginning at 36 weeks to reduce risk of outbreak during delivery
What are the severe features of preeclampsia
♣ Thrombocytopenia (platelets <100,000) ♣ Impaired LFTs (2x normal) ♣ Renal insufficiency (Cr > 1.1) ♣ Pulmonary edema ♣ New onset cerebral disturbance, or visual impairment
Meds to treat severe HTN in pregnancy
- Labetalol IV (do not give if bradycardic)
- Hydralazine IV
- Nifedipine PO
Diagnostic test for endometriosis
Laparoscopy - allows for direct visualiztaion, biopsy, and removal of endometriotic lesions
Common complication of endometriosis
Infertility - Cyclic accumulation of ectopic foci of hemorrhage and adhesions can distort pelvic anatomy and impair fertility by obstructing oocyte release or sperm entry
Management of spontaneous abortion without expulsion of fetal parts
- Expectant or medical induction (misoprostol) if hemodynamically stable
- Suction curettage is infection or hemodynamically unstable
Tx of lichen sclerosis
Topical steroids
What medication induces ovulation
Clomiphine
Tx of CAH
Replacement of cortisol and aldosterone
Recall that disease is caused due to defective enzyme preventing creation of cortisol/aldosterone, which leads to positive feedback to bump up the adrenal gland and all excess activity gets shunted to androgen production
Tx of hot flashes
SSRI (Venlofaxine)
Tx of osteoporosis after menopause
Bisphosphonates
Vitamin D + Calcium supplements as prophylaxis
What type of drug is Hemabate (category + MOA)
Prostaglandin F2-alpha
Stimulates myometrial contraction via smooth muscle constriction
Contraindication for Hemabate
Asthma - also causes bronchoconstriction
What is a B-lynch suture
Compression suture used to manually compress an atonic uterus in the setting of postpartum hemorrhage
Empiric tx of postpartum endometritis
Ampicillin + Gentamycin
+ Clindamycin for anaerobes if delivery was C-section
Tx of septic pelvic thrombophlebitis
♣ Anticoagulation
♣ Broad-spectrum antibiotics
How do you differentiate postpartum blues from depression
Blues usually resolve within 10 days
Depression lasts at least 2 weeks
What complications are associated with postterm pregnancy
- Macrosomia
- Oligohydramnios
- Meconium aspiration
- Uteroplacental insufficiency
- Dysmaturity
Management of diagnosed IUGR
Once- or twice-weekly NST + BPP
On a microscopic level, what is happening that leads to cervical change
Breakage of disulfide bonds
What is the most common cause of unilateral bloody nipple discharge with no associated mass
Intraductal papilloma
Management of intraductal papilloma
Is a benign lesion
Work up = mammography US
Biopsy +/- excision
Describe presentation of Erb Duchenne palsy
- Extended elbow
- Pronated forearm
- Flexed wrist and fingers
Describe what nerves are damaged and presentation of Klumpke palsy
- “Claw hand”
- Extended wrist
- Hyperextended MCP joing
- Flexed interphalangeal joints
- Horner syndrome (ptosis, miosis)
Describe Moro reflex in Erb Duchenne vs. Klumpke palsy
Erb = decreased Moro Klumpke = intact moro
THINK: Erb is more a damage to proximal (shoulder/upper arm) vs Klumpke is distal (hand)
Describe grasp reflex in Erb vs. Klumpke palsy
Erb = intact grasp Klumpke = absent grasp
THINK: Erb is more a damage to proximal vs. Klumpke which is distal
What does symmetric vs. asymmetric fetal growth restriction refer to
Symmetric = global; proportionate growth lag between head and abd
Asymmetric = usually more restriction to abd than to head (“head-sparing” growth lag)
Causes of symmetric IUGR
- Chromosomal abnormalities (more common)
- Congenital infection
Causes of asymmetric IUGR
- Uteroplacental insufficiency
- Maternal malnutrition
What are the two levels that are both the same (either decreased or increased) in Trisomy 21 and 18
AFP and estriol
Are both decreased
Are b-hCG and Inhibin A increased or decreased in Downs
Increased (THINK Down is up)
Are b-hCG and Inhibin A increased or decreased in Trisomy 18
Decreased b-hCG
Normal Inhibin A
MOA of Clomiphene
Selective estrogen modulator
Management of pregnant woman with HSIL (high grade squamous intraepithelial lesion) on pap smear
Colposcopy (safe in pregnancy)
If positive for invasive cancer, proceed with surgical excision
Management of stable vs. unstable ectopic pregancy
Stable = methotrexate Unstable = surgery
D&C can be used to remove uterine contents for spontaneous or incomplete abortion. Not for ectopic
Biggest risk factor for adenocarcinoma of the vagina
DES exposure in utero
Diagnose: US showing adnexal mass with lack of doppler flow
Ovarian torsion
Tx of ovarian torsion
Surgical
How can endometriosis lead to infertility
Pelvic adhesions
How does menopause affect urinary function
Can lead to incontinence and UTI because hypoestrogenemia results in atrophy of superficial and intermediate layers of urethral mucosal epithelium
