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obgyn > ObGyn4 DM,HTN,PEC, other complications > Flashcards

ObGyn4 DM,HTN,PEC, other complications Flashcards

1
Q

Chronic HTN (criteria)

A
  • Dx’d prior to pregnancy, or

- Dx’d before 20wks

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2
Q

Mild PEC (criteria)

A
  • 140/90
  • 0.3g/24hr (1+/2+ dipstick)
  • sxs absent (oliguria, LFTs, thrombocytopenia, HA, RUQ, vision, etc)
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3
Q

Severe PEC (criteria)

A
  • 160/110
  • 5g/24hr (3+/4+ dipstick)
  • sxs present (oliguria, LFTs, thrombocytopenia, HA, RUQ, vision, etc)
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4
Q

PEC (time)

A

after 20 wks

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5
Q

PEC superimposed on chronic HTN (definition)

A
  • chronic HTN w/o proteinuria w/ onset of proteinuria

- chronic HTN w/ proteinuria w/ onset of severe proteinuria, severe BP rise, thrombocytopenia, LFTs

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6
Q

Gestational HTN (criteria)

A
  • HTN w/o proteinuria after 20wks

- If returns to nl, then “transient HTN”

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7
Q

PEC (path x2)

A
  • Vasospasm (reduced perfusion)

- Capillary wall injury (leaky, coagulable)

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8
Q

Chronic HTN (monitoring)

A
  • Monthly US for IUGR

- If IUGR (+), weekly NSTs/BPPs

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9
Q

Chronic HTN (tx)

A
  • Methyldopa

- Labetalol

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10
Q

PEC/EC (tx)

A
  • Mg first

- Then consider delivery (vaginal preferred; c/s for maternal/fetal distress); term is OK with mild PEC

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11
Q

RUQ pain (path)

A

Stretching of hepatic (Glisson’s) capsule

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12
Q

Reason for Mg administration

A

To prevent FUTURE seizures, not control current one

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13
Q

Mg side effects and antidote

A
  • Depressed DTRs
  • Respiratory depression
  • Calcium gluconate
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14
Q

GDM (patho)

A

Insulin resistance d/t:

  • Increased human placental lactogen (hPL)
  • Increased insulinase
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15
Q

Class A1 vs A2 GDM

A

A1: managed by diet alone
A2: insulin

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16
Q

Class B DM

A
  • onset >20yo WITH duration <10yrs

- no vascular complications

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17
Q

Class C DM

A
  • onset 10-19 OR duration 10-19yrs

- no vascular complications

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18
Q

Class D DM

A
  • onset < 10yo OR duration > 20yrs

- vascular complications present

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19
Q

Class F DM

A

Diabetic nephropathy

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20
Q

Class R DM

A

Proliferative retinopathy

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21
Q

Class T DM

A

Renal transplant

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22
Q

Class H DM

A

Arteriosclerotic heart disease

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23
Q

DM (antepartum complications)

A
  • Polyhydramnios

- Increased risk for PEC

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24
Q

DM (intrapartum complications)

A
  • Dysfunctional labor (overdistended uterus)

- Traumatic/operative/cesarean delivery (fetal macrosomia)

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25
Q

DM (fetal/neonatal complications)

A
  • Hypoglycemia, hypocalcemia, polycythemia (hyperbili)
  • NTDs, sacral agenesis, cardiac anomalies
  • Macrosomia (shoulder dystocia, brachial plexus injury), IUGR, respiratory distress
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26
Q

Euglycemic goals for GDM and DM

A
  • FBS: < 90 mg/dl
  • 1hr: < 140 mg/dl
  • 2hr: < 120 mg/dl
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27
Q

Oral hypoglycemic agents (use?)

A

Contraindicated d/t fetal nephrotoxicity

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28
Q

GDM (initial screening: step 1)

A

1hr, 50mg OGTT @ 24-28wks

-NL: <140 mg/dl

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29
Q

GDM (confirmatory test: step 2)

A

3hr, 100mg OGTT (2/3 for dx):

  • FBS >95mg/dl
  • 1hr: >180mg/dl
  • 2hr: >155mg/dl
  • 3hr: >140mg/dl
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30
Q

GDM/DM (monitoring)

A

-weekly NSTs and AFI @ 32wks

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31
Q

EFW for c/s

A

4000-4500g or higher

32
Q

Detection of anomalies in DM(+) pregnancies

A
  • Sono 10-12 wks (anencephaly)
  • Triple marker 15-20 wks (NTDs)
  • Sono 18-20 wks (all anomalies)
  • Echo 22-24 wks (cardiac anomalies)
33
Q

Anemia (Hgb)

A

<10 g/dl

34
Q

Sickle cell trait (complication)

A

Increased risk of UTIs

35
Q

Asymptomatic bacteriuria increases risk of:

A

Pyelonephritis (also cystitis, preterm labor, and perinatal mortality)

36
Q

Asymptomatic bacteriuria in 3rd trimester (tx)

A
  • Amoxicillin, or
  • Nitrofurantoin, or
  • Cephalosporin
37
Q

Low back pain in 3rd trimester d/t:

A
  • Lumbar lordosis

- Relaxation of ligaments supporting joints of pelvic girdle

38
Q

Acute fatty liver of pregnancy (definition)

A

Acute liver failure w/ hypoglycemia and increased serum ammonia

39
Q

Pulmonary HTN w/ cor pulmonale (dx)

A

Amniotic fluid embolism

40
Q

Cholestasis of pregnancy (tx)

A
  • Ursodeoxycholic acid w/ cholestyramine

- Antihistamine

41
Q

Pruritic urticarial papules and plaques of pregnancy, PUPPP (presentation and tx)

A
  • Periumbilical rash spreads to extremities

- Antihistamines and corticosteroids

42
Q

RhoGAM (moa)

A

Binds to and hemolyses any D-positive RBCs in mom’s circulation

43
Q

Indications for RhoGAM (x6)

A
  • 28wks gestation
  • after Rh(+) delivery
  • after amniocentesis
  • ectopic pregnancy
  • 1st tri D&C
  • 3rd tri bleeding
44
Q

What is the abnormal titer load for atypical antibodies (eg, Rh)?

A

> /= 1:8

45
Q

Three ways to identify fetal anemia

A
  • OD450 (indirect)
  • PUBS (direct)
  • US velocity measurement of MCA (indirect)
46
Q

What does OD450 measure and indicated?

A
  • Measures bili level in amniotic fluid (amniocentesis)

- Fetal anemia

47
Q

Indications for intervention in the setting of anemia (x2)?

A
  • Liley zone III on OD450

- Hct <25%

48
Q

Modes of intervention in fetal anemia (x2)

A
  • Delivery (34wks or later)

- Intrauterine transfusion (< 34wks)

49
Q

Suspicious signs of a multiple gestation (x3)

A
  • Fundus larger than dates
  • High msAFP
  • High HCG
50
Q

Confirmatory test to confirm multiple gestation

A

Sono

51
Q

Associated risks in a multiple gestation (x5)

A
  • Premature delivery
  • Twin-twin transfusion (monochorionic)
  • Umbilical cord entanglement (monoamnionic) or anomalies
  • Vanishing twin syndrome
  • Fetal malformations (monoamnionic)
52
Q

Twinning classification by time of cleavage

A
  • Dichorionic diamnionic (0-3d morula)
  • Monochorionic diamnionic (4-8d blastocyst)
  • Monochorionic monoamnionic (9-12d)
  • Conjoined twins (> 12d)
53
Q

Twin deliveries based on presentation

A
  • Cephalic-cephalic: vaginal
  • Cephalic-breech: vaginal is possible but usually c/s
  • Breech-cephalic: c/s
54
Q

Maternal risks w/ twins (x4)

A
  • Nutritional anemias
  • PEC
  • Preterm
  • C/S
55
Q

Obstetrical risks w/ twins (x4)

A
  • Placenta previa
  • SROM
  • Malpresentation
  • PPH
56
Q

MC obstetric cause of DIC

A

Placental abruption

57
Q

First step in painless 3rd trimester bleeding

A

US to r/o placenta previa

58
Q

Algorithm for 3rd trimester bleeding

A

(-)Pain: Placenta previa, Vasa Previa

(+)Pain: Placental abruption, Uterine rupture

59
Q

Mgmt for different causes of 3rd trimester bleeding

A
  • Vasa previa, Uterine rupture: emergent c/s

- Previa, Abrpution: assess distress and age

60
Q

Induced abortion methods (x2 based on time)

A

< 12wks: Suction D&C, mefipristone (RU-486), MTX

12-24wks: D&E, IOL

61
Q

OCPs decrease risk of what kind of cancer? (x2)

A
  • Ovarian

- Endometrial

62
Q

Who loves Shahwesome?

A

:)

63
Q

Patch contraception (contents)

A
  • Estrogen and progesterone

- Not great in obese pts

64
Q

Tubal ligation reduces risk of what kind of cancer?

A

-Ovarian

65
Q

Depo shot can cause what? What’s the remedy?

A
  • Irregular bleeding, initially

- Resolves spontaneously in 2-3mo

66
Q

One disadvantage of medical abortion over surgical abortion

A

Greater blood loss

67
Q

First step medical mgmt for endometriosis, alternative, and confirmatory dx’c test

A
  • OCPs
  • GnRH agonist
  • Laparoscopy (though tx based on clinical pic)
68
Q

Next step in suspected ovarian torsion

A

ELAP

69
Q

Four pathologies of pelvic relaxation

A
  • Uterine prolapse
  • Cystocele
  • Rectocele
  • Entereocele
70
Q

Surgical mgmt of prolapse (x2)

A
  • Colporrhaphy (cystocele, rectocele)

- Hysterectomy (uterine prolapse)

71
Q

Medical mgmt of prolapse (x4)

A
  • Kegel
  • ERT
  • Pessaries
  • Electrical stimulation
72
Q

Urinary continence is under which CNS system? What are the two components?

A

Sympathetic:

  • Detrusor relaxation (beta)
  • Bladder neck contraction (alpha)
73
Q

Urinary incontinence is under which CNS system? What are the two components?

A

Parasympathetic:

  • Detrusor contraction (cholinergic)
  • Bladder neck relaxation (cholinergic)
74
Q

First step in urinary incontinence

A

UA

75
Q

Three types of urinary incontinence (x4)

A
  • Stress
  • Hypertonic urge
  • Hypotonic overflow
  • Fistula

obgyn (5 decks)

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