OBGYN 9 Flashcards
1 hour glucose results positive for GDM
> /= 140
Positive results for 3 hour GTT
- Fasting positive > 90
- 1 hour > 180
- 2 hour > 155
- 3 hour > 140
Define arrest of labor
• No progress in the active phase of labor (>6 cm) with ruptured membranes for 4 hours without adequate contractions, or 6 hours of inadequate contractions
Managent of PROM
GBS status and deliver
Management of PPROM
Deliver after 34 weeks
Give steroids
Give the full name of a mono/di twin
Monochorionic/diamniotic
Time frame of twinning
♣ 0-4 days – dichorionic/diamniotic
♣ 4-8 days – monochorionic/diamniotic
♣ 8-12 days – monochorionic/monoamniotic
♣ >13 days – conjoined twins
Tx of uterine atony
♣ First line
• Dilute IV oxytocin + bedside uterine massage
♣ If first line is ineffective:
• Prostaglandin F2-alpha (Hemabate aka Carbaprost)
o Prostaglandin compound that stimulates myometrial contraction
o Contraindicated in asthmatic patients due to potential for bronchoconstriction
• Rectal misoprostol
• Methylergonovine Maleate (Methergine)
o An ergot alkaloid agent that induces myometrial contraction as a treatment of uterine atony
o Contraindicated in hypertension due to risk of stroke
Management of chorioamnionitis
♣ Broad spectrum IV antibiotics (e.g. ampicillin, gentamicin, clindamycin)
♣ Induction of labor - Caesarean is not necessary unless indicated
What is a threatened abortion
Pregnancy with vaginal spotting during the first half of pregnancy; but fetus is still viable
What is an incomplete abortion
Pregnancy <20 weeks associated with cramping, vaginal bleeding, open cervical os, and some passage of tissue but also retained tissue in utero
What is a missed abortion
Pregnancy <20 weeks with embryonic or fetal demise but no sx such as bleeding or cramping
What is an inevitable abortion
o Bleeding and cramping in the presence of a dilated cervix; indicates that passage of the conceptus is unavoidable
Management of septic abortion
Broad spectrum abx + uterine evacuation
What is the disease associated with recurrent pregnancy loss
Antiphospholipid syndrome
Tx of antiphospholipid syndrome
Anticoagulation = Aspirin + Heparin
What are the drugs used for medical abortion
Mifepristone (terminates pregnancy)
Followed by Misoprostol (Uterine cramping + expulsion of POC)
Next step in management of Rh- mom with +antibodies
Transcranial doppler - increased flow means that mom is attacking baby and baby is increasing flow to compensate for anemia
Describe the 3 antibodies that you worry about in pregnancy
Lewis (lives)
Duffy/Rh(D) (dies)
Kell (kills)
At what gestational age do you deliver Rh alloimmunization anemic baby
Deliver if > 32 weeks
what if baby is <32 weeks
transfusion
Intrapartum tx of mom with HIV
♣ Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery
♣ Viral load <1000 copies = ART + vaginal delivery
♣ Viral load >1000 copies = ART + zidovudine + cesarean section
Postpartum tx of baby with HIV+ mom
♣ maternal viral load <1000 copies = Zidovudine
♣ maternal viral load >1000 copies = multi-drug ART
Most likely diagnosis/organism: vaginal discharge with friable cervix that bleeds with manipulation
Acute cervicitis - usually caused by gonorrhea/chlamydia
When (timing) is chorionic villus sampling vs. amniocentesis indicated
Chorionic villus sampling = 10-13 weeks
Amniocentesis = 15-20 weeks
Describe likely complication of baby born to mom with preeclampsia with severe features
Fetal growth restriction/low birth weight
Preeclampsia is caused by abnormal placental development which puts the fetus at risk for chronic uteroplacental insufficiency
Describe the difference in management of PPROM based on gestational age, signs of infection/fetal distress
34-37 weeks:
o Antibiotics
o +/- corticosteroids
o Delivery
<34 weeks: -- No signs of infection or fetal compromise ♣ Antibiotics ♣ Corticosteroids -- Signs of infection or fetal compromise ♣ Antibiotics ♣ Corticosteroids ♣ Magnesium if <32 weeks ♣ Delivery
Describe the pathogenesis of hypotension secondary to epidural
Hypotension occurs when the sympathetic nerve fibers responsible for vascular tone are blocked, resulting in vasodilation (venous pooling), decreased venous return, and decreased cardiac output
Prevention and tx of hypotension secondary to epidural
Prevention = IV fluid expansion prior to epidural
Tx = IV fluid bolus, L uterine displacement (mom on L side) to improve venous return, or vasopressor
What happens to pH, PCO2, and HCO3 in normal pregnancy
Primary respiratory alkalosis with partial metabolic compensation
(pH increased - 7.45; PCO2 decreased, HCO3 decreased)
What happen kidney function in pregnancy
Increased GFR leads to lower Creatinine
Management of ASCUS in pregnancy
re-Pap postpartum
Management of HSIL in pregnancy
Colposcopy
What are risks of hormone replacement therapy in menopausal women
o Venous thrombosis
o Stroke
o CHD (combined therapy)
o Breast cancer (combined therapy)
What are contraindications to OCPs
o Uncontrolled HTN o DM with end organ disease o Smokers o Age > 35 o Migraine HA with aura
Describe interstitial cystitis
A chronic inflammatory condition of the bladder, clinically characterized by recurrent irritative voiding sx of urgency and frequency. Etiology is unknown
How often should mammograms be perfomed
Bi-annually
Or annually according to ACOG
How often should colonoscopies be performed
q10 years
What is a common exacerbating factor of cyclic mastalgia
caffeine
Next step in managment of breast lump with bloody needle aspiration
Mammogram + excisional biopsy
Next step in management of breast lump with clear needle aspiration
Reexamination in 2 months
Order of pubertal events
(Think: Tits, pits, mits, and lips) ♣ Thelarche (Breasts) (8) ♣ Pubarche (Axillary and pubic hair) (9) ♣ Growth (10) ♣ Menarche (11)
What are the components of McCune Albright
o Precocious puberty
o Café-au-lait spots
o Polyostotic fibrous dysplasia
Diagnose: Normal ovaries with absent uterus and fallopian tubes
Mullerian agenesis
Describe GnRH, LH, FSH, Prolactin, and TSH in hypothalamic amenorrhea
o Functional hypothalamic amenorrhea (aka low GnRH) ♣ FSH low ♣ LH low ♣ Prolactin normal ♣ TSH normal
Most common locations for ureteral injury during hysterectomy
- Cardinal ligament - when ligating the uterine arteries
- During ligation of ovarian vessels
- At uterovesicular junction (where ureters enter the bladder) - when vaginal cuff is ligated
