OBgyn Notes Flashcards
The CDC defines anemia in pregnancy as a hematocrit below 33% in the first and third trimesters or below 32% in the second trimester. What is the most likely recommendation in a pt with hematocrit of 33% in the first trimester?
Oral ferrous sulfate
[iron supplementation]
Uterine eccyesis
Ectopic pregnancy
_____ incontinence is failure to empty adequately due to underactive detrusor; presents with increased post-void residual (normal = 50-60 cc)
Overflow
Fetal growth restriction is a significant risk factor for subsequent development of what diseases as an adult?
Cardiovascular disease Chronic HTN Stroke COPD Type II diabetes mellitus Obesity Cognitive delay
Treatment for chorioamnionitis
Gentamicin
Clindamycin
Indomethacin is contraindicated as a tocolytic after ____ weeks due to risk of premature closure of ductus arteriosus
32 weeks
A patient presents with incomplete spontaneous abortion and products of conception can be visualized at the cervical os. What is the next best step in management?
A. Dilation and curettage B. Expectant management C. Misoprostol D. Pelvic rest E. Tissue extraction with forceps
E. Tissue extraction with forceps
Biophysical profile shows score of 8-10 — what do you do?
Nothing - this is reassuring
Preferred HAART in early prenatal care when mom is HIV positive
Tenofovir + Emtricitabine
Etiology and management of early decelerations on FHR monitoring
Fetal head compression
Do nothing - these are not worrisome
Most common ovarian neoplasm in women older than 30
Epithelial cell tumors
Features of severe preeclampsia
BP > 160/110 on 2 occasions Thrombocytopenia Impaired liver function Renal insufficiency Pulmonary edema New onset cerebral or visual disturbance
ACOG recommendations for routine cervical cancer screening
Begin at age 21
Age 21-29 = Cytology q3 years
Age 30-65 = Cytology + HPV cotesting q5 years
Stop screening after age 65 if no history of moderate/severe dysplasia or cancer, and either 3 negative paps in a row OR 2 negative co-test results in a row in the past 10 years with most recent test in the last 5 years
Tocolytic that competes with calcium for entry into cells; indicated in pts less than 32 weeks for neuroprotection
Magnesium sulfate
Methods to confirm rupture of membranes include testing ____ fluid for ferning and nitrazine testing
Vaginal fluid
[cervical fluid will give false positive ferning. Normal pH of vaginal secretions is 4.5-6.0, amniotic fluid has pH of 7.1-7.3 which will turn nitrazine paper blue. False positives occur when semen or blood is present]
Rotterdam criteria for PCOS
Chronic anovulation
Hyperandrogenism
Polycystic ovaries on ultrasound
[dx requires 2/3]
Progestin mini pills for contraception MOA:
A. Immobilize sperm B. Inhibit estrogen C. Inhibit ovulation D. Thicken cervical mucus E. Thicken endometrium
D. Thicken cervical mucus
Endometrial tumor invades less than half of the myometrium or endometrium
A. Stage Ia B. Stage Ib C. Stage II D. Stage III E. Stage IV
A. Stage Ia
Molar pregnancy leads to very high concentrations of hCG — which has an alpha subunit that is identical to those found in LH and TSH. What are the consequences of this hormone change?
Lutein ovarian cysts
Elevated T3/T4 (thus low TSH)
Treatment for group B strep if pt is allergic to PCN but it is not an anaphylactic allergy
Cefazolin
Recommended dose of folic acid in women with a previous pregnancy complicated by a fetal neural tube defect
4 mg/day
Endometrial tumor invades more than half the myometrium
A. Stage Ia B. Stage Ib C. Stage II D. Stage III E. Stage IV
B. Stage Ib
What progesterone level is suggestive of a normal pregnancy?
> 25 ng/mL
When would you NOT need to treat a patient positive for group B strep with antibiotics during delivery?
Only if patient is having C section and there was no rupture of membranes at onset of labor
Antibiotic used for GBS prophylaxis in pts with penicillin allergy who do NOT have a history of anaphylaxis
Cefazolin
When should pts with known BRCA mutations begin breast cancer screening?
Age 25
How long before pregnancy must MMR vaccine be given to be safe?
3 months prior
5 components of Bishop score
Dilation Effacement Station Consistency Position
If previous HIV status unknown and now mom is delivering with active HIV, she should be treated with ____ at the time of delivery
AZT (Zidovudine)
Define late-term pregnancy vs. post-term pregnancy
Late-term = 41 to 41+6 weeks
Post-term = 42+ weeks
In a patient with preterm labor, antibiotic therapy with ____ and ____ has been found to prolong the latency period by 5-7 days as well as reduces incidence of maternal chorioamnionitis and neonatal sepsis
Ampicillin
Erythromycin
What category of fetal heart tracing is described below?
Absent variability, fetal bradycardia, recurrent late or variable decelerations
Category 3
[GO IMMEDIATELY TO C SECTION]
Both are typically treated together, but to be specific:
Gonorrhea is treated with either _____ or _______
Chlamydia is treated with either _____or ______
Ceftriaxone; fluoroquinolone
Doxycycline; azithromycin
Medical treatment options for urge incontinence and their associated contraindications
Beta-3 agonists such as Mirabegron (myrbetriq) — contraindicated in HTN, ESRD, or liver disease
Tolterodine (Detrol) — contraindicated in narrow angle glaucoma
Patient in labor with umbilical cord prolapse but reassuring fetal heart tones. How do you manage pt?
Elevate fetal head and proceed to C section
Biophysical profile shows score of 0-2, what do you do?
Deliver!
Third trimester use of SSRIs for anxiety/depression has been associated with what fetal effects?
Neonatal agitation Abnormally increased or decreased muscle tone Tremor Temperature instability Insomnia or somnolence Difficulty feeding
Quad screen result for Downs
Beta hCG and inhibin A = elevated
Estriol and AFP = decreased
Factor V leiden mutation results in an altered factor V that is resistant to inactivation by protein C. What pregnancy complications are associated with this mutation?
Stillbirth, preeclampsia, placental abruption, and IUGR
Fetal growth restriction can be assessed with amniotic fluid volume, umbilical artery Doppler studies, and NST. What is the purpose of the umbilical artery Doppler study?
Reveals the systolic/diastolic ratio
A normal S/D ratio indicates fetal well-being. An increase in ratio reflects increased vascular resistance
Incontinence characterized by overactive detrusor
Urge incontinence
At _____ weeks gestation, the uterus is approximately at the level of the pubic symphysis
At _____ weeks gestation, the uterus is halfway between the pubic symphysis and umbilicus
At _____ weeks gestation, the fundus of the uterus is at the level of the umbilicus
12
16
20
OCPs are the primary tx for dysmenorrhea. This is because the ____ in OCPs cuases endometrial atrophy, thus there are less prostaglandins being produced
Progestin
Blueberry muffin baby, deafness, cataracts, congenital heart defects, IUGR and abortion in 1st trimester, petechiae and purpura in 3rd trimester
Congenital rubella (german measles)
Tocolytic that acts as nonspecific COX inhibitor, thus blocking prostaglandin production
Indomethacin
What is the first step in management following an abnormal MSAFP test (found on triple screen)?
Ultrasonography
This is to rule out multiple gestation or inaccurate dating
Depression in pregnancy is typically tx with SSRIs. Which SSRI is considered category D drug due to increased risk of fetal cardiac malformations and persistent pulmonary HTN, and thus should NOT be used in pregnancy?
Paroxetine
Confirm HSV 1 or 2 infection with ____ of active lesions.
Prophylaxis is tx with acyclovir from week ____ to delivery
PCR
Week 36
Use of indomethacin as a tocolytic is associated with what intrapartum complication?
Oligohydramnios
Endometrial tumor invades stromal CT but confined to uterus
A. Stage Ia B. Stage Ib C. Stage II D. Stage III E. Stage IV
C. Stage II
Define fetal growth restriction
Weight less than 10th percentile
At the time of delivery, you note retraction of the fetal head (turtle sign) indicating shoulder dystocia. What is the next best step in management?
McRoberts maneuver — hyperflex moms legs to her abdomen
[this widens the pelvis and flattens lumbar spine; note that fundal pressure and operative vaginal delivery are contraindicated in shoulder dystocia]
Tx for tertiary/neurosyphilis in pregnancy
IV PCN q4hours for 7-10 days
______ syndrome patients have male karyotype, 46XY, but female phenotype. This results from mutation or structural abnormality of the Y chromosome. All subjects are phenotypic women of normal height who fail to undergo puberty and possess normal femal external genitalia, uterus, and fallopian tubes. These patients possess gonadal streaks which require removal to prevent development of malignant transformation. They typically present with complaints of delayed puberty
Swyer syndrome
What happens if mom gets infected with syphilis in the 1st trimester?
Fetal demise —> dead and macerated fetus
What medical condition is a contraindication to use of magnesium sulfate as tocolytic?
Myasthenia gravis
T/F: small, asymptomatic subserosal fibroids do not require tx or monitoring in pregnancy
True
Fetus resumes “face-forward” position, with occiput and spine lying in the same plane
A. Engagement B. Descent C. Flexion D. Internal rotation E. Extension F. External rotation G. Expulsion
F. External rotation
CCB tocolytic that decreases intracellular free calcium concentration and induces myometrial relaxation; associated with fetal hypoxia and decreased uteroplacental blood flow
Nifedipine
What trisomy is associated with low birth weight, overlapping fingers, micrognathia, and cardiac defects?
Trisomy 18
Chronic follicular disease that affects the apocrine or sebaceous glands. It is found in the axillary, groin, perianal, perineal, and mammary areas. Initially one solitary lesion appears. After a period of time, the nodule progresses to form an abscess that yields purulent or serosanguinous drainage. Painful clusters of abscesses, sinus tracts, and sores with evidence of scarring are characteristics of chronic disease. Similar to pilonidal disease but its affinity for other intertriginous areas of the skin makes it distinctive
Hidradenitis suppurativa
Tocolytic that acts as oxytocin receptor antagonist, blocking the intracytoplasmic calcium release associated with contractions and downregulates prostaglandin synthesis
Atosiban
What 2 types of fibroids are most likely to cause issues in pregnancy?
Submucosal
Intracavitary
A pt in labor requires high-dose oxytocin therapy for induction. What electrolyte is most appropriate to replace?
Sodium
High dose oxytocin stimulates antidiuresis and natriuresis which can lead to hyponatremia. Oxytocin is structurally similar to vasopressin and at high doses can decrease urine excretion via antidiuresis independent of volume status. The resultant volume overload is sensed by the atria which release ANP, promoting natriuresis. In addition, high doses of oxytocin itself stimulates renal natriuresis.
PALM-COEIN mnemonic for AUB
Structural causes = PALM Polyp Adenomyosis Leiomyoma Malignancy (or hyperplasia)
Non-structural causes = COEIN Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic/IUD Not otherwise classified
Fetal occiput rotates from its original position (usually transverse) toward the symphysis pubis (occiput anterior), or less commonly, toward the hollow of the sacrum (occiput posterior)
A. Engagement B. Descent C. Flexion D. Internal rotation E. Extension F. External rotation G. Expulsion
D. Internal rotation
What category of fetal heart tracing is described below?
Everything is normal and expected with few or absent abnormals; managed with watchful waiting
Category 1
Initial management of hydatidiform mole
Suction D and C
Chest Xray
Labs (CBC, PT/PTT, type and screen)
Rhogam if Rh negative
Serial beta-hCG (48 hours, then weekly until 0, then monthly x6months)
Advise against pregnancy x6-12 months following evacuation
What testing should be done on patient with 3 successive first trimester losses?
Lupus anticoagulant Anticardiolipin antibodies Diabetes mellitus Thyroid disease Maternal and paternal karyotypes Uterine imaging to r/o anomaly
Most common cause for a delay in the latent phase of labor
Unripe cervix
Black box warning on depo injections for contraception
May cause bone mineralization loss and long-term use is not advised
First-line treatment for uterine relaxation for retained placenta
Nitroglycerin
Biophysical profile is between 3-7 in a patient at 36+ weeks gestation, what do you do?
Deliver
Most common cause of preterm labor
Idiopathic
When should treatment for osteoporosis be initiated according to FRAX score?
FRAX score >20% risk for major osteoporotic fracture OR >3% risk for hip fracture
An epidermal inclusion cyst is a benign, fluid filled cyst that can be found on the skin. It is lined with cornified epithelium and contains lamellated keratin. Formation of epidermal cysts, osteomas of the skull, and polyposis characterizes ______ syndrome, which is an AD disease caused by mutation in APC gene on Chr 5
Gardner’s
Criteria for gestational diabetes:
Serum glucose greater than _____ 1 hour after 50 g oral glucose
130-140 mg/dL
When inducing labor, prostaglandins should be given first when cervix is unfavorable, followed by oxytocin. Prostaglandins are contraindicated in what patient population?
Pts with hx of cesarean delivery (increased risk of uterine rupture)
Manual vacuum aspiration can be done to terminate pregnancy up to what gestational age?
<8 weeks
Saddle nose, saber shins, Hutchinson teeth, nasal discharge, generalized LAD, HSM
Congenital syphilis
What uterotonic must be avoided in asthmatic patients due to bronchoconstrictive effect?
Hemabate (PGF2 alpha)
[other AEs include diarrhea, fever, tachycardia]
Foul smelling yellow-green vaginal discharge with vaginal pH >5.4
Trichomoniasis
The incidence of _____ _____ approaches 10% when gestational age exceeds 43 weeks. Characteristics include long thin body, long nails, meconium stained skin and nails, dry peeling skin, and an associated small placenta. There is increased risk for oligohydramnios, cord compression, meconium passage, and stillbirth
Fetal dysmaturity
Etiology and management of variable decelerations on FHR monitoring
Cord compression
If few of these, do nothing they are not worrisome. If repetitive variable decelerations, can treat with amnioinfusion
Identical twins, 2 placentas, 2 sacs - when did the egg split?
Day 0-3
List uterotonics used to control postpartum hemorrhage
Methergine Misoprostol (PGE1) Dinoprost (PGE2) Hemabate (PGF2 alpha) Oxytocin Methylergonovine
How often is bone mineral density reassessed to monitor treatment on bisphosphonates?
q2 years
Most common vaginal cancer in postmenopausal women
Squamous cell carcinoma
What disease process should be considered in the setting of late postpartum hemorrhage (48-72 hours after delivery)?
Von willebrand disease
What pulmonary function test gets worse in pregnancy?
Functional residual capacity
Treatment with betamethasone from ____-____ weeks gestation increases pulmonary maturity, reduces incidence/severity of RDS, and decreases risk for intracerebral hemorrhage and necrotizing enterocolitis
24-34 weeks
[but steroid administration is considered in patients between 34 and 36+6 weeks]
_____ is an ergot alkaloid that is a potent smooth muscle constrictor and thus can be used as a uterotonic in postpartum hemorrhage. It is contraindicated in women with HTN and/or preeclampsia due to vasoconstrictive effect
Methylergonovine
Tx for Kallmann syndrome
Pulsatile GnRH therapy
Which of the following pregnant patients has the lowest risk of maternal mortality?
A. 25 y/o AA female with adequate prenatal care
B. 25 y/o AA female with low SES
C. 25 y/o caucasian female with crash C section
D. 25 y/o caucasian female with BMI 25 kg/m
E. 35 y/o caucasian female with excellent prenatal care
D. 25 y/o caucasian female with BMI 25 kg/m
Most maternal deaths are after live birth - most commonly d/t PE or HTN. Other risk factors for maternal death are advanced maternal age (>35 at time of delivery), AA or hispanic race, and multifetal gestation
Recommended dose of folic acid in non-high risk patients
0.4 mg/day
Define “prolonged latent phase of labor” in nulliparas and multiparas
> 20 hours for nulliparas
> 14 hours for multiparas
Postpartum telogen effluvium (postpartum hair loss) affects 40-50% of women postpartum. What is the etiology?
High estrogen levels in pregnancy increase synchrony of hair growth — thus hair grows in same phase and is shed at the same time. This can result in hair loss at 1-5 months postpartum
___________ is an FDA approved lab used in women with symptoms of preterm labor from 24-35 weeks and during routine screening of asymptomatic patients from 22-30 weeks gestation. 99/100 women with a single negative test result will not deliver in the next 14 days.
Fetal fibronectin
[fibronectin is an ECM protein thought to act as an adhesive between fetal membranes and underlying decidua. Its presence in the cervical mucous between 22 and 34 weeks is thought to indicate a disruption or injury to the maternal-fetal interface]
Tocolysis should not be continued beyond ____ hours
48 hours
Endometrial tumor involves vagina, adnexa, with positive regional LNs
A. Stage Ia B. Stage Ib C. Stage II D. Stage III E. Stage IV
D. Stage III
Guidelines for weight gain in pregnancy based on BMI
BMI <18.5 — gain 28-40 lbs
BMI 18.5-24.9 — gain 25-35 lbs
BMI 25-29.9 — gain 15-25 lbs
BMI >30 — gain 11-20 lbs
Patient presents with urinary incontinence, urgency, and nocturia. She describes the urine loss as large and lasting several seconds. Urine loss occurs while standing or sitting and is not associated with specific activity. Post-void residual is 45 cc.
What type of incontinence?
Urge incontinence
A pregnant female presents at 30 weeks gestation with history of IUGR. Which of the following is the most appropriate screening test?
A. Biophysical profile B. Contraction stress test C. Modified biophysical profile D. Nonstress test E. Umbilical artery doppler velocimetry
E. Umbilical artery doppler velocimetry
[used to noninvasively monitor maternal and fetal hemodynamics because IUGR is associated with diminished blood flow to maternal and fetal vessels]
Etiology and management of late decelerations on FHR monitoring
Uteroplacental insufficiency (fetal hypoxia and acidemia, commonly due to chronic HTN and post-date pregnancy)
Initial measures to evaluate and treat — change maternal position to left lateral, maternal O2 supplementation, tx maternal hypotension, discontinue oxytocin, intrauterine resuscitation with tocolytics, IV fluids
If initial measures fail, proceed to C section
Arrest of labor is defined as the cessation of previously normal active phase cervical dilation for a period of ____ or more
2 hours
What imaging modality is required once diagnosis of molar pregnancy is confirmed? What other 2 labs MUST be checked?
Chest x-ray
Liver and thyroid function
[lungs are most common area affected in gestational trophoblastic disease]
What LARC can be used as emergency contraception?
Copper IUD
Biophysical profile is 3-7 in a patient <36 weeks gestation, what do you do?
Next step is contraction stress test
Which of the following is a modifiable risk factor for tubal pregnancy?
A. Age B. Current IUD C. History of C section D. In-utero DES exposure E. Smoking
E. Smoking
Treatment for group B strep
Ampicillin
What is included on triple and quad screen?
Triple = estriol + B-hCG + MSAFP
Quad = triple + inhibin A
One dose of RhoGAM suppresses the immune response to up to ___ cc of whole fetal blood
30 cc
Smoking increases risk of what complications in pregnancy?
Placental abruption Placenta previa Fetal growth restriction Preeclampsia Infection
T/F: a mom that is positive for hepatitis B antigen CANNOT breastfeed
False - breastfeeding is ok as long as baby has received IVIG Hep B and Hep B vaccine
Maternal obesity increases risk of what maternal morbidities?
Chronic HTN
Gestational diabetes
Preeclampsia
Fetal macrosomia
Higher rates of C section and postpartum complications
Sympathetics to ovaries/testes
T10-11
Preterm premature rupture of membranes may manifest as what finding on fetal heart tracing?
Variable decelerations
[decrease in amniotic fluid —> cord compression —> variable decelerations]
Primary intervention that reduces risk for preterm, low-birthweight infant
Early adequate weight gain
______ = more severe form of PCOS associated with virilization due to the high androstenedione production and testosterone levels, resulting in temporal balding, clitoral enlargement, and deepening of the voice
Hyperthecosis
Transmission of _____ in the 1st trimester results in fetal effects including brain calcifications, ventriculomegaly, seizures, hearing loss, visual disturbance, and developmental delay
Toxoplasmosis
Most common ovarian neoplasm in women younger than 30
Germ cell tumors
Which of the following is least likely to occur with gestational diabetes?
A. Polyhydramnios B. Neonatal hypoglycemia C. IUGR D. Preeclampsia E. Fetal macrosomia
C. IUGR
IUGR is more typical of women with pre-existing diabetes, not gestational. Complications of gestational include shoulder dystocia, metabolic disturbance, preeclampsia, polyhydramnios, and fetal macrosomia
Elevation of which of the following would be concerning for an adrenal gland tumor being the underlying cause of infertility?
A. Androstenedione B. Cortisol C. DHEA D. DHEA-S E. Testosterone
D. DHEA-S
DHEA-S is produced by adrenals, not ovarian tissue - A, C, and E are produced by both ovaries and adrenals
2 options for medical treatment of pruritis associated with intrahepatic cholestasis of pregnancy (once antihistamines and topical emollients have failed)
Ursodeoxycholic acid (relieves itching and lowers serum enzyme levels)
Naltrexone (opioid antagonist)
Tocolytic that impairs intracellular cAMP concentration resulting in myometrial relaxation; contraindicated in diabetic patients
Ritodrine
2 primary indications of fetal lung maturity
34 weeks gestational age
Positive phosphatidylglycerol in vaginal fluid
A pt at 12 weeks gestation has serum lab studies revealing PAPP-A of 0.1 MoM and B-hCG of 0.2 MoM, both below normal for this gestational age. What is the next best step in management?
A. Amniocentesis B. Chorionic villous sampling C. Colposcopy D. Nuchal translucency E. Urine beta hCG
D. Nuchal translucency
Low PAPP-A and serum b-hCG = fetal aneuploidy. Ultrasound (weeks 9-13) provides earlier method for diagnosis than amniocentesis (weeks 15-20) and CVS (10-12 weeks)
3 medical treatment options for heavy bleeding associated with fibroids
- NSAIDs
- OCPs
- GnRH agonists (also decreases myoma size)
Most common complaint with copper IUD
Heavy, painful periods
Treatment for primary, secondary, or early latent syphilis in pregnancy
IM PCN x1
How does a multiple-gestation affect the estimated delivery date?
Every extra gestation beyond the first pushes up the due date by 4 weeks
[4 fetuses = 3 extra x 4 weeks = 12 weeks early = EDD 28 weeks]
What is the goal for viral load of HIV+ mom in order to proceed with cesarean delivery? Vaginal delivery?
<1000 copies/mL for C-section
Must be undetectable for vaginal delivery
What method of contraception is associated with proportionally higher risk of DVT/PE?
The patch
Which of the following uterotonics should be avoided in a pt with asthma?
A. Carboprost tromethamine B. Methylergonovine maleate C. Oxytocin D. Ritodrine E. Terbutaline
A. Carboprost tromethamine (PGF2a analog)
Avoid methylergonovine in HTN or preeclampsia
Chronic HTN is defined as high blood pressure known to predate the conception or detected before ____ weeks gestation
20 weeks
What are the delivery and treatment implications in a pregnant mom with positive hepatitis B antigen?
C-section
IVIG hepatitis B
Hepatitis B vaccine at day 0
What is considered “reactive” on fetal NST in >32 weeks gestation in terms of accelerations and variability?
Increased HR of 15 bpm sustained for 15 seconds and occurring twice in 20 minutes (15x15, 2 in 20)
Moderate variability
[if <32 weeks gestation, goal is 10x10, 2 in 20]
Followup periods for prenatal care
q4 weeks until 28 weeks
q2 weeks until 36 weeks
q1week until delivery
Late decelerations suggest possible uteroplacental insufficiency and fetal hypoxia. What are common causes of uteroplacental insufficiency?
Placental abruption Maternal hypotension Uterine hyperactivity Postdate gestation Preeclampsia Chronic HTN Diabetes mellitus
Midcycle bleeding at the time of ovulation may occur and is due to a drop in _____
Estrogen
Well-circumscribed, non-encapsulated myometrium = ______
Fibroids
What category of fetal heart tracing is described below?
Variability is present, but there’s an abnormal heart rate, or an occasional deceleration
Category 2
[Do not need to deliver emergently, but watch closely]
5 factors in biophysical profile
NST Breathing Body movement Tone Amniotic fluid
[each worth 2 points]
Endometrial tumor involves bladder mucosa with distant mets
A. Stage Ia B. Stage Ib C. Stage II D. Stage III E. Stage IV
E. Stage IV
Ultrasound criteria for a missed abortion
Crown-rump length of 7 mm with no cardiac activity
Most common cause of septic arthritis in young adults
N.gonorrhea
Sympathetics for external genitalia
T12
Tx for preeclampsia-associated HTN in pt with hx of asthma
Nifedipine
[labetolol is typically first line but must be avoided in asthma due to beta blocking properties]
Most common symptom of uterine leiomyomas
Heavy menstrual bleeding
Procedure indicated in severe pelvic prolapse in which vagina is surgically obliterated and can be performed quickly without the need for general anesthesia
Colpocleisis
What effect can high dose vasopressin administration have on the uterus?
Due to structural similarities between oxytocin and vasopressin, high dose vasopressin administration can cause uterine contractions
The Bishop score is used to determine the likelihood of a vaginal delivery. It is used to determine if a cervix is favorable, and thus the mode of induction. A score greater than ____ indicates high likelihood of SVD. A score of less than _____ indicates cervix is unfavorable and will need a cervical ripening agent.
8
6
What conditions need to be met in order to manage ectopic pregnancy with methotrexate?
Hemodynamic stability Non-ruptured ectopic Size <4 cm without fetal heart tones Size <3.5 with fetal heart tones Normal liver enzymes and renal function Normal WBC Reliable follow up
Treatment for group B strep if pt has anaphylactic allergy to PCN and GBS is found to be resistant to clindamycin and erythromycin
Vancomycin
5 parameters of BPP
Fetal breathing Fetal tone Fetal movement Amniotic fluid volume Repeated NST
Indications for breast MRI as screening tool
BRCA mutation carriers
First degree relatives of BRCA carriers
Li-Fraumeni syndrome
Women with 20-25% lifetime risk (prediction modeling)
History of chest irradiation during ages 10-30
Descent of the biparietal diameter of the fetal head below the plane of the pelvic inlet
A. Engagement B. Descent C. Flexion D. Internal rotation E. Extension F. External rotation G. Expulsion
A. Engagement
Vaginal vault prolapse is surgically repaired by supporting the vaginal cuff to the ______ or ______ ligaments, or by sacrocolpopexy
Uterosacral; sacrospinous
Complication associated with abnormal fetal presentation, particularly back-up transverse lie
Cord prolapse
Etiology of third trimester bleeding that presents accompanied by abdominal pain, uterine hypertonus, fetal distress, and risk factors include smoking, cocaine, chronic HTN, trauma, and prolonged PROM?
Placental abruption
How are HDL and LDL levels affected by combination HRT?
HDL levels increase
LDL levels decrease
Olfactory tract hypoplasia
Arcuate nucleus does not secrete GnRH —> no secondary sex characteristics
Present with delayed puberty
Kallmann syndrome
A passive movement that permits the smallest diameter of the fetal head to pass through the maternal pelvis
A. Engagement B. Descent C. Flexion D. Internal rotation E. Extension F. External rotation G. Expulsion
C. Flexion
What result on Q tip test is indicative of stress incontinence?
Q tip motion >30 degrees from horizon
________ = fertilization of two different ova at two separate acts of intercourse in the same cycle
Superfecundation
Central and/or lateral cystoceles are surgically repaired by fixing defects in the _____ fascia or reattaching it to the sidewall
Pubocervical
Treatment for group B strep if pt has anaphylactic allergy to penicillin
Clindamycin; Erythromycin
______ describes regular menstruation cycles occurring at irregularly shortened intermenstruation intervals, defined as 21 days or fewer
Polymenorrhea
T/F: in the case of intra-amniotic infection, preterm delivery is warranted
True
Medical treatment that has been shown to reduce the risk of premature labor from all causes including PPROM; administered weekly until 36 weeks gestation
17 alpha-hydroxyprogesterone
Serious complication of uterine/pelvic infections caused by the spread of the infection to the pelvic venous system. Damage to the pelvic vein endothelium leads to altered blood flow, hypercoagulability, and increased risk for septic embolization. Patients present with back pain and “picket” fence, oscillating fever. Tx is broad spectrum abx and anticoagulation with heparin
Septic pelvic thrombophlebitis
What do you look for on contraction stress test?
3 contractions q10 minutes
Also look for decelerations
________ is defined as an irregularly prolonged or heavy menstrual period that maintains a normal menstrual cycle (b/w 21-35 days). Repeat occurrences warrant a workup as there are several potential causes including coagulopathy, endometriosis, leiomyoma, or neoplasms
Menorrhagia
2 regimen options for outpatient tx of PID
Ceftriaxone IM x 1 dose + Doxycycline PO x 14 days +/- Metronidazole PO x 14 days (add if suspect concurrent BV or if pt underwent recent gynecologic instrumentation)
OR
Cefoxitin IM x 1 dose with probenecid PO (inhibits tubular secretion of abx —> increased plasma levels) + Doxycycline PO x14 days +/- metronidazole PO x14 days
If indicated in the workup for infertility, __________ hormone levels can be tested to determine what the patient’s ovarian reserve is
Anti-mullerian hormone (marker of primordial follicles)
Twin-twin transfusion syndrome is most common in what type of twinning?
Monochorionic diamniotic twins
Multiple prior cesarean deliveries result in scar tissue that prevents proper implantation of the placenta, resulting in higher risk for what placental abnormality?
Placenta accreta
Which of the following is the most reliable sign of uterine rupture during labor?
A. Abdominal pain B. Hypotension C. Maternal tachycardia D. Non-reassuring fetal heart pattern E. Vaginal bleeding
D. Non-reassuring fetal heart pattern
[usually bradycardia]
3 out of 4 of Amsel’s criteria are used to diagnose _____ _____
Bacterial vaginosis
Criteria:
- Homogenous vaginal discharge
- Discharge with pH >4.5
- Positive whiff test: an amine-like odor when mixed with 10% KOH
- Wet mount demonstrates 20% more clue cells than vaginal epithelial cells
[note other causes of BV include Prevotella, Mobiluncus, Bacteroides, Peptostreptococcus, Fusobacterium, Veillonella, Eubacterium, Mycoplasma hominis, Ureaplasma urealyticum, Strep viridans, and Atopobium vaginae]
Tx for late latent syphilis in pregnancy
IM PCN weekly x3 weeks
Exercise-induced hypothalamic amenorrhea is characterized by _____ FSH and ____ estrogen
Normal FSH; low estrogen
Benign ovarian masses associated with pregnancy; more common with molar pregnancy, multiple gestation, or ovarian hyperstimulation
Theca lutein cysts
Factors associated with breech presentation
Prematurity Multiple gestation Genetic disorders Polyhydramnios Hydrocephaly Anencephaly Placenta previa Uterine anomalies Fibroids
_______ tumors are rare breast masses characterized by their large, multilobular shape. Treatment involves wide local excision
Phyllodes tumors
A pt at 31 weeks gestation presents in labor. She has a hx of insulin-dependent diabetes, myasthenia gravis, and peptic ulcer disease. She is experiencing regular contractions every 3 minutes; there is a fetal heart rate of 135/min. On pelvic exam, her cervix is 3 cm dilated and the fetus is at -1 station. Her temp is 98.6 and BP is 130/85. Which of the following is the most appropriate tocolytic for her?
A. Indomethacin B. Magnesium sulfate C. Nifedipine D. Ritodrine E. Terbutaline
C. Nifedipine
[indomethacin is first-line in LESS THAN 32 weeks and is contraindicated in hx of PUD, renal dz, hepatic dz, and bleeding d/o. Mg is contraindicated in myasthenia gravis, ritodrine and terbutaline are beta 2 agonists and can cause hyperglycemia in diabetic moms]
If intrapartum fetal surveillance reveals non-reactive NST, what is the next step in management?
Biophysical profile
G protein mutation resulting in premature menses before breast and pubic hair development, polyostotic fibrous dysplasia, cafe-au-lait spots, and endocrinopathies
McCune Albright Syndrome
