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Pance Re-Up > OBGYN Precision & Pearls #3 > Flashcards

OBGYN Precision & Pearls #3 Flashcards

1
Q

name and describe the four stages of labor

A

Stage 1: onset of labor to full dilation of cervix
–Latent Phase: onset to 4-6 cm
–Active Phase: rapid dilation to completion
Stage 2: 10 cm to delivery of baby
–Passive: dilation to active efforts
–Active: active effort to delivery
Stage 3: Postpartum to delivery of placenta
–0-30 minutes usually
–examine for three vessels and make sure intact
Stage 4: 1-2 hours after delivery

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2
Q

What testing is done in the first trimester (weeks 1-12)

A

Biochemical screening - free beta-HcG, PAPP-A
Antibody titers (HepB, HIV, sickle cell, rubella, CF)
Nuchal translucency US (for Trisomy 13, 18, 21)
Chorionic villous sampling

Others:
-Fetal heart tones by doppler at 10-12 weeks
-Transvaginal US heart tones by 5-6 weeks
-PAPP-A low in Down Syndrome
-STI testing

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3
Q

What testing is done in the second trimester (weeks 13-27)

A

-Gestational DM screen (24-28 weeks)
-Amniocentesis at 15 weeks if high risk
-Triple Screening (a-fp, beta HcG, and unconjugated estriol, inhibin A if Quad Screen)

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4
Q

What is quickening and when is it seen?

A

Moving of the fetus at 18 weeks

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5
Q

at 20 weeks, where is the fundus of the baby?

A

At the level of the umbilicus

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6
Q

Regarding the Quad Screen, explain what is seen in Trisomy 18

A

All low

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7
Q

Regarding the Quad Screen, explain what is seen in Down Syndrome (Trisomy 21)

A

High inhibin A & BhCG
Low Estriol and AfP

2 high, 2 low

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8
Q

If Afp is high on Quad Screen, what should you suspect?

A

Neural Tube Defect (spina bifida or anencephaly)

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9
Q

What testing is done in the third trimester (weeks 28-birth)

A

-DM screening at 24-28 weeks
-Group B Strep Screen at 36-37 weeks (retrovaginal culture) –> give IV Pen G during labor
-Antibody titers
-Biophysical profile (2 pts each for fetal tones, breathing, movements, etc.)
-Nonstress testing
-Contraction stress testing
-Counseling

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10
Q

What counseling is given to mothers during the third trimester?

A

No airline travel > 35 weeks
Postpartum birth control
Birth plan discussion

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11
Q

Explain what is seen on a non stress test and what does each option mean?

A

Baseline fetal HR is 120-160 bpm

Reactive (fetal well being): > 2 accelerations, rate >15 from baseline

Nonreactive (sleeping or immature fetus): no accelerations or < 15 from baseline

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12
Q

What is premature labor defined as?

A

Regular contractions (>4-6/hr), progressive cervical dilation and effacement < 37 weeks

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13
Q

Premature labor is the #1 cause of fetal morbidity and mortality. What is the definition (dilation and effacement).

A

Dilation of 3 cm or greater

80% effacement or greater

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14
Q

What are some diagnostics that are highly suggestive of preterm labor?

A

Nitrazine paper test: turns blue (suggestive of amniotic fluid because pH > 6.5)

Presence of fetal fibronectin between 20-34 weeks

L:S ratio < 2:1 = fetal lung immaturity

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15
Q

Treatment for preterm labor

A

-< 34 weeks: Delay delivery with tocolytics (Mag Sulfate, Indomethacin, Nifedipine) and give Dexamethasone to improve lung maturity

->34 weeks: admit for delivery

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16
Q

How does Plan B work.

A

Emergency Contraception pill - Uses protesting to stop ovaries from releasing an egg. Most effective if taken within 72 hours after unprotected sex

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17
Q

Explain how combination OCPs work

A

Prevent ovulation by inhibiting mid-cycle LH surge, thicken cervical mucosa and thins endometrial lining.

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18
Q

Combination (estrogen + progesterone) OCPs protect against 5 things, name them.

What are some contraindications to using combo OCPs?

A

Osteoporosis, cervical cancer, ovarian cancer, ovarian cysts, ectopic pregnancy

History of breast cancer, smoking, >35 years old, DVT/PE, severe HTN.

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19
Q

What are some Progestin-only OCP’s?

A

Depo = increases risk of osteoporosis
Nexplanon = increases risk of HA, menstrual irregularities

IUD (Mirena = 5 years, Kyleena = 5 years, Skyla = 3 years). Risk of perforation and ectopic pregnancy, PID

Copper IUD = Paragard (10 years). Increased risk of PID

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20
Q

What is the most effective Progestin only OCP besides abstinence

A

IUD = however, there is an increased risk of PID

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21
Q

True or False: Progestin only OCPs are safe during lactation?

A

True

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22
Q

Ovarian torsion is ________ and some symptoms include what?

A

compromised ovarian blood flow

-Sudden onset of acute, unilateral pelvic pain.
-Nausea, vomiting
-Abdominal tenderness or adnexal mass

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23
Q

Diagnostics done for ovarian torsion

A

-US with Doppler: shows decreased ovarian blood flow

-Surgical exploration = definitive diagnostic

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24
Q

Treatment for ovarian torsion

A

-Laparoscopy with detorsion

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25
Q

What is the pathophysiologic triad for polycystic ovarian syndrome (PCOS)? There are actually four things…

A

-Bilateral cystic ovaries + oligo/anovulation + hyperandrogenism + insulin resistance

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26
Q

Symptoms of PCOS

A

-Menstrual dysfunction
-Hirsuitism (from high androgen)
-DM, obesity, HTN
-Bilateral, smooth, enlarged ovaries
-Acanthosis nigricans

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27
Q

Labs for PCOS shows

A

-Increased testosterone (DHEA)
-Increased LH:FSH ration

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28
Q

What diagnostic is done for PCOS?

A

Pelvic US: multiple ovarian cysts with a “string of pearls” appearance

29
Q

Treatment for PCOS

A

-Lifestyle modifications (for insulin resistance)
-Combo OCP’s (Mainstay)
-Spironolactone (blocks testosterone)

30
Q

What are two risks of PCOS?

A

Increases risk of infertility and endometrial cancer

31
Q

Atrophic vaginitis occurs MC in postmenopausal women. What is it?

A

Drying due to decreased estrogen

32
Q

What are some symptoms of atrophic vaginitis?

A

Dryness, dyspareunia, pruritus, bleeding due to irritation

33
Q

Treatment for atrophic vaginitis

A

-Topical vaginal estrogen
-Moisturizers
-Alcohol free products

34
Q

What is Fitz-Hugh Syndrome?

A

Perihepatitis in RUQ with pelvic inflammatory disease

35
Q

Symptoms of Fitz-Hugh Syndrome

A

RUQ pain (may radiate to shoulder)

36
Q

What diagnostic should be done if you suspect Fitz-Hugh Syndrome?

A

Laparoscopy: violin string adhesions on liver

37
Q

Toxic Shock Syndrome occurs due to a ________. What is the pathophysiology of this condition?

A

Staph Aureus toxin

-Superantigen that releases inflammatory mediators –> multi organ failure

38
Q

What is the MC risk factor for Toxic Shock Syndrome?

A

Tampon Use (Infrequent removal)

39
Q

Symptoms of Toxic Shock Syndrome

A

-Abrupt onset of high fever
-Erythroderma (diffuse erythematous rash) resembling sunburn
-Hypotension, headache, myalgias, n/v, diarrhea (symptoms of shock)

40
Q

Treatment for toxic shock syndrome

A

-Hospital admission
-IV rehydration
-ABX (Clinda + Vanco or Linezolid)

41
Q

What is congestive mastitis?

A

Bilateral breast enlargement 2-3 days postpartum due to milk stasis.

42
Q

What is the treatment of congestive mastitis?

A

Breast drainage (manual or pump)

43
Q

What is polyhydramnios?

A

> 25cm fluid around the baby

44
Q

What are two symptoms of polyhydramnios?

A

-Uterine size large for dates
-Low fetal activity

45
Q

Polyhydramnios is associated with what conditions?

A

Maternal DM, multiple gestations, fetal issues with breathing or chromosome abnormalities

46
Q

On the contrary, what is oligohydramnios?

A

<5 cm of fluid around the baby

47
Q

Symptoms of oligohydramnios?

A

-Uterus size small for date
-Low fetal activity

48
Q

Explain what macrosomia is, what a common cause is, and what two risks associated with this condition are.

A

Macrosomia: birth weight > 95%ile

Common cause: Maternal DM

Risks: Shoulder dystocia & maternal trauma

49
Q

Treatment for macrosomia

A

-Plan C-section if estimated weight >5,000g without DM and >4,5000g with DM

50
Q

What is an APGAR score, what is normal, when is it done, and what are the components?

A

Done at 1 and 5 minutes

7 or above is normal

Appearance (Pink normal)
Pulse (>100 normal)
Grimace (cry is normal)
Activity (movement of all limbs normal)
Respiration (strong cry normal)

51
Q

A spontaneous abortion is ____________. 80% of these occur in which trimester?

What is the only type of spontaneous abortion that is potentially viable?

A

Loss of pregnancy < 20 weeks

First trimester

Threatened is the only potentially viable one

52
Q

Explain a threatened abortion

A

-Cervical OS closed
-POC intact
-Supportive tx

53
Q

MCC of spontaneous abortion

A

-Chromosomal abnormalities

54
Q

Explain an inevitable abortion

A

-Os DILATED
-POC intact
-D&C or Misoprostol evacuation

55
Q

Explain an incomplete abortion

A

-OS dilated
-Some POC expelled
-D&C or Misoprostol

56
Q

Explain a complete abortion

A

-Os closed
-All POC expelled
-Supportive, RhoGAM given

57
Q

Explain a missed abortion

A

-OS closed
-POC intact, non viable fetus
-D&C, Misoprostol

58
Q

Explain a septic abortion

A

-OS closed, Cervical motion tenderness
-POC retained, foul brown discharge
-D&C And ABX (Levo + Metro)

59
Q

What is vasa previa?

A

Complication of placenta previa
-Fetal vessels crossing over the os

60
Q

Symptoms of vasa previa

A

-painless vaginal bleeding + fetal distress (bradycardia) + rupture of membranes

61
Q

What should be done if you suspect vasa previa?

A

Deliver the baby

62
Q

MCC of postpartum hemorrhage

A

Uterine atony

63
Q

Symptoms of postpartum hemorrhage (what does the patient look like?)

A

-Soft, flaccid boggy uterus with dilated cervix
-Bleeding with hypovolemic shock

64
Q

Treatment for postpartum hemorrhage

A

-Bimanual uterine massage and compression (1st line)
-IV Oxytocin
-Artery embolization if ineffective

65
Q

Prelabor Rupture of Membranes (PROM) is? It occurs prior to when? Symptoms of this condition.

A

PROM: rupture of amniotic membranes prior to onset of labor

Occurs after to 37 weeks

Gush of fluid or persistent leakage

66
Q

What are some diagnostics that can be done for PROM?

A

-Nitrazine paper test: turns blue if pH > 6.5 (amniotic fluid)
-Fern test: amniotic fluid dries in a fern pattern
-NO DIGITAL EXAM!

67
Q

Treatment for PROM

A

-Admit and await spontaneous labor
-Induce labor with Oxytocin or Prostaglandin gel is no labor within 18 hours

68
Q

What is Preterm Prelabor Rupture of Membranes?

A

occurs prior to 37 weeks

68
Q

If under 34 weeks and you are dealing with PPROM, what should you do?

A

Give Betamethasone to improve fetal lung maturity

-Delivery if signs of maternal or fetus distress/infection

Pance Re-Up (76 decks)

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