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Gynae obs And Male Reproductive > Obs > Flashcards

Obs Flashcards

1
Q

How to assess GESTATIONAL AGE via US?

A

1st trimester—-> Gestational sac diameter

1st and 2nd—-> Crown rump length

2nd and 3rd—-> Biparietal diameter / head circumference/ femur length

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2
Q

Important point of gestational age assessment

A

If USG during 2nd and 3rd trimester shows discrepancy between EGA (calculated from 1st trimester crown rump length) and fetal measurements, growth problems should be considered (e.g. fetal macrosomia, fetal growth restriction)

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3
Q

Define Anemia in pregnancy

A

Anemia in pregnancy defined as: Hb <11 g/dl in 1st and 3rd trimester and <10.5 g/dl in 2nd trimester

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4
Q

What are the risk factors for HYPEREMESIS GRAVIDARUM?

A

Past hx of HYPEREMESIS GRAVIDARUM
Multiple gestation
Gestational trophoblastic disease

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5
Q

How to manage GESTATIONAL TROPHOBLASTIC DISEASE (GTD)?

A

D and C

F/u with Contraception and regular monitoring of B-HCG

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6
Q

Name the vaccine given in WOMEN OF CHILDBEARING POTENTIAL

A

Tdap

Inactivated influenza vaccine

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7
Q

Name the vaccine contraindicated during pregnancy

A

HPV
MMR

Varicella
Small pox

Intra nasal influenza vaccine

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8
Q

Name the general test done in first prenatal visit

A

Cervical cytology
Rh type and antibody screen

Cbc
Genetic testing for down syndrome and Cystic fibrosis

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9
Q

Name the the general infectious test done in first prenatal visit

A

Rubella and Varicella

Urine culture

Syphilis testing and HBV antigen
Chlamydia and HIV testing

Influenza

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10
Q

Consequences of syphilis in pregnancy

A

Pregnancy effects—–>preterm labor / Intrauterine fetal demise

Fetal effects—->Hepatomegaly and jaundice
H.anemia with low.PLTs
Long bones abnormalities

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11
Q

when to sample and how to t/m Group B.Strep?

A

Rectovaginal culture at 35-37 weeks gestation

Give Pencillin as a t/m

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12
Q

What are the indications of GBS treatment?

A

GBS bacteriauria OR UTI during pregnancy

GBS positive within 5 weeks of labor

Prior birth to an infant affected with early onset GBS disease

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13
Q

What are the indications of GBS treatment?part 2

A

Unknown GBS status status with;;
- less than 37 wk of gestation

  • Intra partum fever
  • Rupture of aminotic membrane for more than 24 hours
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14
Q

How to manage unvaccinated pregnant women with confirmed rubella exposure?

A

termination of pregnancy—->if pt do not wish termination—–> treat with IV immuno globulin—benefits unknown

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15
Q

Name the non invasive PRENATAL TESTING FOR FETAL ANEUPLOIDY?

A

First and 2nd trimester markers(9-13)///(15-20) both are non invasive and non dx

2nd trimester US and Cell free fetal DNA (18-20)///(>10wks)

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16
Q

Name the invasive test PRENATAL TESTING FOR FETAL ANEUPLOIDY

A

CVS and aminocentesis (10-30)(15-20wks)

Both test dx karo typic abnormalities

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17
Q

What are the indications for cell free fetal DNA testing?

A

Maternal age more than 35
Abnormal maternal serum screening test

Fetal ANEUPLOIDY on US and past hx
Parental based robertsonian translocation

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18
Q

What are the uses of Cell free fetal DNA TESTING?

A

Detection of ANEUPLOIDY

Fetal sex determination

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19
Q

Important point of Cell free Fetal DNA testing

A

Abnormal test: confirmed by chorionic villus sampling in 1st trimester and amniocentesis in 2nd trimester

Pts who do not meet high-risk criteria for cffDNA: can undergo 1st trimester combined test or 2nd trimester quadruple screen

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20
Q

When to Do OGTT test in pregnancy?

A

All pregnant women should have OGTT at 24-28 wks—high risk pts (e.g. marked obesity, FH od DM) may receive earlier

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21
Q

Risk Factors of CHORIOAMNIONITIS/INTRAAMNIOTIC INFECTION

A

Prolong labor
Prolong rupture of membrane

Presence of Genital tract pathogen
Internal fetal Or uterine monitoring devices

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22
Q

Triad of CHORIOAMNIONITIS/INTRAAMNIOTIC INFECTION

A

High grade maternal fever with maternal tachycardia

Malodorous / Purulent AMNIOTIC fluid Or vaginal discharge

Fetal tachycardia with increased WBC count

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23
Q
A

Maternal::
Uterine atony
Endometritis
PPH

-Neonate
Premature birth
Cerebral palsy
Infection encephalopathy

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24
Q

Name the tests for ANTEPARTUM FETAL SURVEILLANCE

A

Non stress test
BPP

Contractions stress test
Doppler US of the umbilical artery

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25
Q

When to call Non stress test “REACTIVE”?

A

HR 110-160 with moderate variability

More than 2 acceleration

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26
Q

When to call Non stress.test “Non Reactive “?

A

Less than 2 acceleration

Recurrent variable Or late deaccleration

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27
Q

What are the causes of Non Reactive stress test?

A

Fetal sleep cycle

Fetal hypoxia due to placental insufficiency fetal cardiac or neurologic abnormalities

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28
Q

Important point

A

FHR accelerations are the product of the fetal sympathetic nervous system, which matures at 26-28 weeks—extremely premature don’t demonstrate accelerations

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29
Q

Name the causes of Antepartum bleeding

A

Normal labour
Placental abruption / Previa / vasa
Uterine rupture

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30
Q

How to approach antepartum bleeding?

A

Start with speculum examination followed by TV.US

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31
Q

Triad of Normal labour

A

Intermittent pain

Contractions

Small amount of bloody tinged mucus (“bloody show”)

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32
Q

What are the risk factors of placental abruption?

A

Past hx
maternal HTN or Pre eclampsia / eclampsia

Abdominal trauma
Cocaine and tobacco use

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33
Q

How to dx placental abruption?

A

Clinically
Or
US to rule out P.Previa; would show retroplacental hematoma

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34
Q

What are the risk factors for Placental Previa?

A

Past hx
Past hx of C-sec Or any uterine surgery

Advance maternal age with multiparity
Smoking

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35
Q

How to manage Placental Previa?

A

TA.US followed by TV US
Plus
NO intercourse OR Digital vaginal Ex

Require C-Sec as a t/m

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36
Q

Important point

A

Fetal heart tracing usually unaffected as bleeding is maternal in origin

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37
Q

What are the risk factors of uterine rupture?

A

Past hx of Uterine surgery
Protracted Or Induced labour

Congenital uterine anomalies
Fetal macrosomia

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38
Q

Triad of Uterine rupture

A

Per vaginal bleeding with painful abdominal contraction

Loss of fetal station with palpation of fetal parts on abdominal Examination

Cessation of uterine contraction

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39
Q

Important point of Uterine rupture and P.abruption

A

No uterine contraction in U.RUPTURE

Tachysystole in placental abruption

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40
Q

How to prevent fetal and maternal exsanguination due to U.Rupture?

A

Prevention of fetal and maternal exsanguination: emergency laparotomy to confirm diagnosis and expedite delivery

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41
Q

Name type of UTERINE surgery in which trial of labour (vaginal delivery) is not contraindicate

A

Low transverse (Horizontal) C-section

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42
Q

Name type of UTERINE surgery in which trial of labour (vaginal delivery) is contraindicate

A

Classical C sec(vertical)
Abdominal myomectomy with uterine Cavity entry

Abdominal myomectomy without uterine Cavity entry

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43
Q

How to manage patient with hx of classical cesarean delivery or extensive myomectomy or myomectomy with uterine cavity entry?

A

Elective C section
If present in labor—>perform urgent laparotomy followed by hysterotomy (for fetus delivery if unruptured) or uterine repair (if rupture occurred)

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44
Q

Triad of Vasa Previa

A

Painless per vaginal bleeding with rupture of membrane

FHR shows bradycardia Or sinusoidal tracing

Bleeding causing fetal distress

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45
Q

How to dx and manage Vasa Previa?

A

Gold standard test is antenatal abdominal and transvaginal Doppler USG

Management is C section

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46
Q

What are the risk factors of PLACENTA ACCRETA?

A

Hx of C-Sec
Myomectomy

h/o dilatation and curettage, maternal age >35

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47
Q

US findings of Placental accreta

A

Antenatal ultrasound: an irregular or absent myometrial-placental interface and intraplacental villous lakes—typically diagnosed antenatally

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48
Q

Define Stage 1 ARRESTED of labor?

A

when dilation is >/=6 cm with ruptured membranes and 1 of the following

-No cervical change for >/=4 hours despite adequate contractions
OR
-No cervical change for >/= 6 hours with inadequate contractions

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49
Q

Define ADEQUATE CONTRACTIONS

A

Contractions summing to >/=200 Montevideo units for >/=2 hours

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50
Q

Define Latent Labor

A

Painful contractions causing cervical size change

Regular and Increase intensity/ frequency of contractions

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51
Q

Define false labor

A

No Or mild painful contractions without causing cervical size change

Irregular and weak intensity of contractions

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52
Q

How to manage false labor?

A

reassure and discharge with routine prenatal care

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53
Q

Define Precipitous labor

A

fetal delivery that occurs within 3 hours of the initiation of the contractions.

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54
Q

What causing Precipitous labor

A

risk factor for precipitous labor is multiparity.

It is spontaneous and not caused by oxytoci infusion

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55
Q

What are the S.E of oxytocin?

A

Low sodium
Low BP
Excessive Uterine contractions (tachysystole)

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56
Q

What are the S.E of EPIDRUAL ANESTHESIA?

A

Low BP
Depression of cervical spinal cord and brainstem activity
CSF leakage

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57
Q

Triad of CSF leakage due to Epidural ANESTHESIA

A

Due to dura is inadvertently punctured during epidural

postural headaches that are worse with sitting up

improved with lying down after delivery

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58
Q

Define Preterm labor

A

regular contractions at <37 wks of gestation that cause cervical dilatation and/or effacement

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59
Q

What are the risk factor of Preterm labor?

A

Past Hx
Multiple gestation

Short cervical length

Surgery of cervical
Cigarette use

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60
Q

How to Prevent Preterm labor with negative past Hx?

A

If No Past Hx—>check Cervical length on TVUS—>if normal—>routine pregnancy

If short length—>Vaginal progesterone and Check length till 24 weeks

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61
Q

How to prevent preterm labor with positive past Hx?

A

Give Progesterone injections and Do check Cervical length on TVUS

If short length—>Cerclage and serial US till 24 weeks
If normal cervix—->check length till 24 weeks

@What are the predictors of Preterm labor?
Short cervix

Positive fetal fibronectin test on 24-33 wk

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62
Q

Important point

A

Fetal fibronectin (FFN) in vaginal secretions is usually low from 22-33 weeks gestation

an elevated FFN concentration during this period is associated with an increased risk of preterm delivery.

Before and after 22-33 weeks gestation, FFN is normally high and therefore not a useful test

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63
Q

How to manage Preterm labor?

A

If before 32wk—>steroid / tocolytics
MgSO4 and Abx for GBS

If after 32 but before 33 wk—->same as above except MgSO4

If after 33 wks but before 37 wks—->only ABx for GBS and with OR without steroids

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64
Q

What are the indications of CESAREAN DELIVERY?

A

Fetal distress indicated by deceleration
Loss of FHR variability (occurs in fetal academia)

Breech presentation
Multiple prior cesarean deliveries

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65
Q

What are the risk factors of Breech presentation?

.

A

Risk factors:
prematurity
multiparity

multiple gestation
uterine anomalies

fetal anomalies
and abnormal placentation

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66
Q

Important point of ECV

A

It can be performed between 37 weeks gestation and the onset of labor and has been shown to reduce the rate of cesarean deliveries.

Before doing ECV, make sure no contraindications of VAGINAL delivery

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67
Q

What are the contraindications of ECV?

A

Indication of C-sec regardless of fetal lie
-placental abnormalities

  • Rupture membrane
  • Hyperextended neck
  • Fetal Or uterine anomaly
  • multiple gestation
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68
Q

D/F B/W ECV AND ICV

A

ECV done in singleton

ICV always in twin baby

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69
Q

How to manage PRETERM BREECH PRESENTATION?

A

Before 37 but after 34 weeks

Perform C section only.
No use of uterotonic agents

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70
Q

What are the risk factors ofTRANSVERSE LIE

A

prematurity,
uterine anomalies,
placenta previa
multiple gestations

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71
Q

How to manage TRANSVERSE LIE?

A

Give Trial of Labor if baby converts into Vertical position

Remain in traverse lie or converts to breech—> ECV (if not CI)—>successful—> trial of labor
unsuccessful ECV or ECV CI—> C.sec

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72
Q

Define SPONTANEOUS ABORTION (SAB)

A

fetal loss before the 20th week of gestation

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73
Q

How to approach spontaneous abortion?

A

US of abdomen OR TVUS

Serial B-HCG monitoring

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74
Q

Name the types of miscarriage in which cervix is open

A

Inevitable
Incomplete
Septic

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75
Q

Name the type of miscarriage in which cervix is closed

A

Threatened

Complete

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76
Q

Triad of Threatened miscarriage

A

Per vaginal bleeding with closed cervical Os

No issue in fetal cardiac activity

Expectant management if fetus is alive and repeat US

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77
Q

Triad of missed miscarriage

A

No vaginal bleeding
closed cervix
No fetal cardiac activity Or Empty sac

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78
Q

Triad of Inevitable miscarriage

A

Per vaginal bleeding
Open cervix
POC seen or felt at Or above cervical Os

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79
Q

Triad of Incomplete abortion

A

Vaginal bleeding
Open cervix
POC 50% seen in reproductive tract

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80
Q

Triad of complete abortion

A

No vaginal bleeding Or very minimal
Closed cervix
No POC left

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81
Q

How to manage Incomplete/ Inevitable and missed miscarriage?

A

If hemodynamic stable with minimal bleeding—–>Expectant management/ Prostaglandins Or surgical Evacuation

If unstable with heavy bleeding—-> D and C

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82
Q

Important point

A

Hospitalization and bed rest—not indicated in 1st trimester abortion spontaneous or threatened abortio
Oxytocin infusion—not used in 1st trimester (used in late 2nd or 3rd trimester)

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83
Q

How septic abortion occur?

A

Retained POC after elective abortion with non sterile technique

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84
Q

Triad of Septic abortion

A

Prodromal Sxs
Dilated cervix with Purulent Or bloody discharge
Boggy and tender uterus

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85
Q

Pelvic US finding of septic abortion

A

Retained POC
Increase vascularity

Echogenic material in the cavity
Thick endometrial stripe

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86
Q

How to manage septic abortion?

A

ABx and IV fluids
Suction curettage

Removal of uterus if no response to ABX OR develop abscess Or signs of clostridial infection

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87
Q

Important point

A

Misoprostol is a syntheticprostaglandin approved for use with mifepristone to terminate pregnancies of <49 days gestation

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88
Q

Triad of INTRAUTERINE FETAL DEMISE (IUFD)

A

Death of afetus in utero after 20 wks of gestation

absence of fetal movement and fetal cardiac activity On US

Cause is Unknown in 50% cases

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89
Q

Approach to Coagulopathy INTRAUTERINE FETAL DEMISE (IUFD)

A

Monitoring the coagulation profile: done after USG confirm IUFD

suspected coagulation derangement—> delivery without delay

coagulation parameters normal: expectant management Or induction of labor (patient preference)

90
Q

What are the t/m options of Still birth delivery in 2nd trimester?

A

D and C upto 24 weeks
Induction of labor
Spontaneous vaginal delivery

91
Q

What are the t/m options of Still birth delivery in 3rd trimester?

A

Do C-sec if past hx of it
Spontaneous vaginal delivery
Induction of labor with Or without cervical ripening

92
Q

What are the LATE TERM AND POSTTERM PREGNANCY COMPLICATIONS in fetus?

A 
C-SOM
Convulsion
Stillbirth
Oligohydramnios
Meconium aspiration /macrosomia
93
Q

What are the LATE TERM AND POSTTERM PREGNANCY COMPLICATIONS in mother?

A

PPH
Perineal trauma

Infection
C section

94
Q

Important point

A

Induction of labor ASAP in late and post term pregnancy as utero placental insufficiency would occur which causes Oligohydramnios

95
Q

What are the causes of Symmetrical fetal growth restriction?

A 
Due to fetal factors 
Viz 
Genetic disorder
CHD
TORCHss
96
Q

What are the causes of Asymmetric fetal growth restriction?

A

Due to maternal factors
Viz
Vascular dis like HTN related and DM
APLA

Autoimmune dis like SLE
Cyanotic cardiac disease
Drug abuse

97
Q

Important point of Macrosomia

A

No change in prognosis whether PPx C-sec or Vaginal delivery

98
Q

What are the risk factors for fetal macrosomia?

A

Maternal:::
Advance age with DM
Excessive Wt gain during pregnancy
Multiparty

Fetal:::
Post term pregnancy
Male sex
African American Or Hispanic

99
Q

What are the complications of Shoulder DYSTOCIA?

A

Fractured clavicle and humerus

Erb Duchene palsy and klumpke palsy

Perinatal asphyxia

100
Q

Important point of complications of shoulder DYSTOCIA

A

In both clavicle and humerus fracture, Moro reflex absent
And

Grasp reflex present and intact biceps

101
Q

What are the risk factors for the neonatal displaced clavicular fracture?

A

Fetal macrosomia

Instrumental delivery

Shoulder dystocia

102
Q

How to t/m Clavicular fracture?

A

Reassurance and Gentle handling
Analgesics

Place affected arm in a long sleeve garment and pin sleeve to chest with elbow flexed at 90*degree

103
Q

How to manage ERB-DUCHENNE PALSY?

A

Fortunately, up to 80% of patients have spontaneous recovery within 3 months

No improvement by 3-6 month surgical intervention can be considered but not necessarily curative

104
Q

Complications of 1st trimester Maternal hyperglycaemia

A

CHD
Neural tube defects
Small left colon syndrome

Spontaneous abortion

105
Q

Complications of 2nd and 3rd trimester of maternal hyperglycaemia

A

All due to fetal hyperglycaemic which results increase insulin

  • Polycythemia
  • Organomegaly
  • Macrosomia
  • Neonatal hypoglycaemia
106
Q

How Uterine Inversion occur?

A

Excessive Fundal pressure

Excessive umbilical cord traction

107
Q

Triad of Uterine Inversion

A

PPH with lower abdominal pain

Round mass protrude via cervix

Uterine fundus not palpable trans abdominal

108
Q

What are the risk factors for Uterine Inversion?

A

nulliparity

fetal macrosomia
placenta accreta

rapid labor and delivery

109
Q

What are the risk factor for the uterine atony?

A

Uterine fatigue from prolong or induce labor

Chorioamionitis
Over distend uterus

Retained placenta

110
Q

What are the contraindications of medicine use in uterine atony?

A

Methylergonovine in HTN

Carboprost in Asthma

111
Q

What are the normal findings in Postpartum period?

A

Transient rigors and chills
Peripheral Edema

Lochia rubra
Uterine contraction and involution

Breast engorgement

112
Q

What routine care to do in postpartum period?

A

Rooming in /Lactation support serial examination for uterine atony // bleeding

Perinatal care
voiding trail

Pain management

113
Q

Name the Lochia Occur first few days after delivery

A

lochia rubra

which is a red or reddish-brown vaginal

114
Q

Name the Lochia Occur after 3-4 days delivery

A

(lochia serosa)

discharge becomes thin and pink or brown colored

115
Q

Name the Lochia Occur after 2-3 weeks delivery

A

lochia alba::

After 2-3 weeks,the discharge becomes white or yellow

116
Q

Define Postpartum urine retention

A

inability to void by 6hours after vaginal delivery or 6 hours after removal of indwelling catheter after C. sec.

117
Q

Name the test which confirm the dx of postpartum urine retention

A

Bladder catheterization more accurate than bladder USG >/=150 mL of urine confirms diagnosis

118
Q

How Postpartum urine retention occur?

A

Regional anesthesia—->↓ motor and sensory impulses of sacral spinal cord——>suppression of micturition reflex and/or ↓ in bladder tone (↓ detrusor tone), pudendal nerve palsy from injury, or periurethral swelling

119
Q

Triad of POSTPARTUM ENDOMETRITIS

A

High grade fever outside the first 24 hours postpartum (less than 24 postpartum fever is normal)

Uterine tenderness with foul smelling lochia

Leukocytosis

120
Q

How to manage postpartum endometritis?

A

Causes are polymicrobial so IV clindamycin + IV aminoglycoside such as gentamicin

121
Q

What are the risk factor for Endometritis?

A

Risk factors for endometritis include,
Prolonged rupture of membranes (>24 hours)

Prolonged labor (>12 hours)

C. section

Use of intrauterine pressure catheters or fetal scalp electrodes

122
Q

Define Chronic HTN with superimposed Pre eclampsia

A

PRE EXISTING HTN with new onset proteinuria Or worsening of existing Proteinuria

Occur after or at 20wks

123
Q

What risk occur to mother due to HTN?

Remember sequence

A

GDM ——>placental abruption ——>C delivery ——>PPH

Superimposed pre eclampsia

124
Q

What risk occur to fetus due to HTN ?

A

FGR

Perinatal mortality
Preterm delivery

Oligohydraminos

125
Q

What are the risk factors of pre eclampsia?

A

maternal age <18 or >40
multiple gestation

nulliparity
preexisting DM

chronic kidney disease
and prior preeclampsia

126
Q

What features suggest SEVERE PRE ECLAMPSIA?

A

BP MORE THAN 160/110

Low PLTs with elevated LFT and creatinine

Pulmonary Edema
New onset visual Or cerebral SXS

127
Q

Important point of medication given in Pre eclampsia

A

Labetalol can’t be given in low pulse——>Give Hydralazine

Oral Nifedipine can’t be given in EMESIS

Loop diuretics if pulmonary Edema

128
Q

Name the 2nd line agent given in Eclampsia

A

diazepam more phenytoin would be indicated as 2nd line

129
Q

How to manage PULMONARY EDEMA IN PRE-ECLAMPSIA OR ECLAMPSIA?

A

supplemental oxygen
fluid restriction
diuresis in severe cases.

Fluid restriction and diuresis must be used with caution as plasma-volume is effectively ↓ed through third-spacing and placental perfusion can be compromised

130
Q

What are the causes of CAUSES OF HYPERANDROGENISM IN PREGNANCY ?

A

LUTEOMA

KRUKENBERG TUMOR

Theca luteum cyst (low Risk of fetal virilization)

131
Q

Triad of KRUKENBERG TUMOR

A

Mets from GIT cancer

US shows B/L ovarian mass

High risk of fetal virilization

132
Q

Triad of LUTEOMA

A

Yellow Or yellow brown masses of large lutein cells

B/L solid ovarian mass on US

High risk of fetal virilization

133
Q

Triad of Theca lutein cyst

A

B/L ovarian cyst on US

Associated with molar pregnancy And multiple gestation

Low risk of virilization

134
Q

How to manage ovarian mass causing hyperandrogenism?

A

Mostly regress after pregnancy

In case of pressure SXS do surgery

135
Q

INDICATIONS FOR PROPHYLACTIC ANTI-D IMMUNE GLOBULIN ADMINISTRATION FOR AN UNSENSITIZED Rh-NEGATIVE PREGNANT PATIENT

A

At 28 to 32 wk of gestation
With 72hrs of RH positive fetus delivery

Ectopic pregnancy/ Hydatidform Mole pregnancy / Abortion

2nd Or 3rd trimester bleeding
Abdominal Trauma

CVS sampling / amnioncentesis
ECV

136
Q

Consequences of Anorexic mother in fetus

A

1.Premature

  1. Small for gestational age (due to IUGR) or both
  2. Miscarriage
  3. Hyperemesis gravidarum
  4. C. sec
  5. Postpartum depression (not postpartum psychosis)
137
Q

Classified Genital Ulcer on the basis of Pain

A

If painless—> syphilis / chlamydia / klebsiella

If painful—>HSV / H.Ducreyi

138
Q

How the ulcer of HSV presents?

A

Multiple grouped ulcer

Shallow with erythematous base

139
Q

How the ulcer of h.ducreyi Present?

A

Single OR Multiple group ulcer With irregular boarder

Gray Or yellow exudate

Matted lymph nodes (suppurate / rupture)

140
Q

Important point of Chancroid

A

Organisms clump in long parallel strand (school.of fish)

141
Q

How the ulcer of klebsiella present?

A

Ulcerative lesion without LAD
Beefy appearing lesion with bleeding

Base has granulation like tissue

142
Q

How lymphogranuloma venerum Present?

A

Small shallow ulcer
Large painful inguinal LAD
Large painful fluctuant buboes
Sinus tract

143
Q

How the ulcer of syphilis presents?

A

Single painless ulcer which is indurated

Clean base

144
Q

Triad Bacterial vaginosis presents?

A

Thin white discharge with fishy odor
pH more than 4.5 with clue cells
metronidazole 500mg twice a day for 7 days

145
Q

Triad of TRICHOMONAS VAGINALIS

A

Thin frothy yellow green malodorous discharge
pH more than 4.5
metronidazole and tinidazole

146
Q

Triad of Candida vaginitis

A 
Thick cottage cheese discharge
Normal PH (3.8-4.5)
Fluconazole as a t/m
147
Q

Traid of PHYSIOLOGIC LEUKORRHEA

A

Copious white or yellow discharge non-malodorous

squamous cells and polymorphous leukocytes on microscope

No treatment needed

148
Q

How to manage PELVIC INFLAMMATORY DISEASE (PID)?

A

If no response Or unable to oral ABx /fever and pregnancy—–>cefoxitin or cefotetan/doxycycline and clindamycin/gentamicin

149
Q

How to manage non hospitalise PID?

A

non-hospitalized patients: IM cefoxitin + oral probenecid and oral doxycycline

or

IM ceftriaxone and oral doxycycline.

150
Q

What are the potential Complications of HEPATITIS -C IN PREGNANCY?

A

Gestational DM
Preterm pregnancy
Cholestasis of pregnancy

151
Q

How to manage mother if HEPATITIS C IN PREGNANCY?

A

No ribvairin

Vaccine against HBV AND HAV

152
Q

How to prevent vertical transmission of HCV?

A

Avoid C-section and scalp electrodes

No contraindications of breastfeeding unless blood present in nipples

153
Q

Antepartum management of HIV

A

If viral load less than 1k—->ART and vaginal delivery

If viral load more than 1k—->ART / zidovudine and C section

154
Q

Important point of HIV management in intrapartum

A

Avoid rupture of membrane
Avoid operative vaginal delivery
Avoid fe tal scalp electrode

155
Q

How to manage mother and baby postpartum?

A

Continue ART in mother

If viral load >1k give multi drug ART

IF viral load <1k zidovudine

156
Q

What are the risk factors of AMNIOTIC FLUID EMBOLISM?

REMEMBER C— GAP

A

C c section or Instrument delivery

G gravida more than 5
A advance mother age
P placenta previa / abruption / Pre eclampsia

157
Q

How to manage AMNIOTIC FLUID EMBOLISM?

A

Respiratory Or Hemodynamic support

With Or without transfusion

158
Q

Name the liver disorder in Pregnancy

A

INTRAHEPATIC CHOLESTASIS OF PREGNANCY

ACUTE FATTY LIVER OF PREGNANCY (AFLP)

HELLP

159
Q

Traid of INTRAHEPATIC CHOLESTASIS OF PREGNANCY

A

Intense generalised itching esp at night
Direct jaundice pattern in LFT
T/m as direct jaundice

160
Q

Triad of ACUTE FATTY LIVER OF PREGNANCY (AFLP)

A

RUQ pain with N/V
Low glucose with deranged LFT
Increase bilirubin

161
Q

Traid of PRURITIC URTICARIAL PAPULES AND PLAQUES OF PREGNANCY

A

Skin manifestation occur in 3rd trimester

red papules within striae with sparing around the umbilicus

No abnormalities in labs

162
Q

How to approach ACUTE APPENDICITIS IN PREGNANCY?

A

US»»MRI»»MRI not available»>only then CT can be performed»>diagnostic laparoscopy with last option (lower midline vertical laparotomy)

163
Q

How to dx RENAL STONES in pregnancy?

A

Renal and pelvic USG is the diagnostic study of choice

164
Q

Important point of Renal stones management in pregnancy

A

Shockwave lithotripsy—not done in pregnancy.

If a pregnant patient fails to improve with conservative measures, ureteroscopy or nephrostomy may be considered.

165
Q

D/F categories of URINARY TRACT INFECTION (UTI) IN PREGNANCY

A

Asymptomatic bacteriuria
Acute cystitis
Acute pyelonephritis

166
Q

Profile of thyroid hormone in pregnancy

A

Total T4 and Free T4 increase

TSH decrease

167
Q

At what week screening of GDM is conducted?

A

24-28 weeks

168
Q

How to screen for GDM?

A

Give 1hour 50g glucose and check after 1 hour—->if less than 140 No GDM
If more than 140—–>give 100g glucose and take 4 readings

169
Q

What is the target level of blood glucose in GDM?

A

Fasting should be less than 95
1 hours post meal should be less than 140
2 hours post meal should be less than 120

170
Q

Important Point of GDM

A

Usually screen test is done in 3rd trimester but if patient has risk factors for GDM, do screening test in first Trimester or First prenatal visit

171
Q

lmportant point

A

Small left colon syndrome—–>transient inability to pass meconium and resolves spontaneously.
Not related to intussusception

172
Q

Triad of Post Partum blues

A

Occur after 2-3 of pregnancy and resolve within 10 days

Mild depression with tearfulness

Reassurance and monitoring

173
Q

Triad of Post Partum depression

A

Occur within 4weeks after pregnancy

Sxs like Major depression disorders

Antidepressants and pyschotherapy

174
Q

Triad of Post Partum psychosis

A

Occur day to weeks after pregnancy

Sxs of pyschosis

Start anti psychotic and anti depressants without leaving infant with mother

175
Q

What are the complications of INAPPROPRIATE WT GAIN?

A

EXCESSIVE WT GAIN–> GDM / C-SEC / Fetal macrosomia

low wt gain–>FGR / Preterm delivery

176
Q

What are the consequences of mono placenta mono amniotic membrane?

A

Twin twin transfusion
umbilical cord enlargement
IU fetal demise
*stat preterm c-sec

177
Q

-Important point

A

single placenta with two amnion—> T-SIGN

two placenta with two amnion—>lamda sign

178
Q

What are the components of BPP?

A

Non stress test
Fetal movement

Fetal breathing movement
Fetal tone

Amniotic fluid volume

179
Q

What exactly BPP is assessing?

A

BPP is performed to assess fetal oxygenation which low in placental insufficiency

180
Q

What is the normal amniotic fluid volume?

A

Single fluid pocket more than 2*1cm
Or
Amniotic fluid index more than 5

181
Q

Name the conditions in which BPP is normal?

A

BPP is normal in: fetal malpresentation (causes fetal growth restriction or chronic fetal hypoxia but not abnormal BPP)

anterior placental location

182
Q

When to consider Contractions stress test normal?

A

No Late Or recurrent variable deceleration

183
Q

@ When to consider Contractions stress test abnormal?

A

Late deceleration even with more than 50 percent contractions

184
Q

What are the cause of fetal Tachycardia?

A

FHR >160 beats/min.
Common causes:
chorioamnionitis
maternal fever

maternal hyperthyroidism
medication use (e.g. terbutaline)

abruptio placenta

185
Q

Name the causes of Early fetal deceleration

A

Fetal head compression

But sometime this type of tracing considered normal

186
Q

How to manage early fetal deceleration due to head compression?

A

No treatment needed if normal baseline rate, moderate variability, no late or variable decelerations present as does not indicate fetal hypoxemia

187
Q

Triad of Post dural puncture headache

A

Occur after epidural anaesthesia

Headache increase increase with upright and decrease on supine

N/V and neck stiffness

188
Q

Triad of Congenital Zika virus

A

Fits with hypertonicity

Microcephaly with craniofacial disproportion

Ocular abnormalities

189
Q

Neuroimage finding of Zika virus

A

Calcification
Ventriculomegaly
Cortical thinning

190
Q

Name the Abx given for GBS if patient has allergy to penicillin

A

Cefazolin

191
Q

What are the warning signs of shoulder dystocia?

A

Prolonged labor

Turtle sign—–> Retraction of fetal head into perineum after delivery

192
Q

What are the cause of Fetal hydrops?

A

Immune—> Rh negative

Non immune--->
Parvo virus 
Fetal aneuploidy
CVS abnormalities
Thalassemia
193
Q

What breech position in which vaginal delivery possible and impossible?

A

Possible in —->Frank and complete

Impossible—->incomplete and footling

194
Q

What is the MCC cause 2nd stage arrest?

A

Fetal malposition (non occpitant

195
Q

How round ligament pain occur?

A

Sharp pain radiates to vagina

196
Q

What are the complications of Excessive weight gain and Inappropriate weight gain?

A

Excessive causes GDM + macrosomia + C sec

Inappropriate weight gain:
Fetal growth restriction + Preterm delivery

197
Q

Triad of Anembryonic gestation

A

No embryonic development

No uterine size discrepancy

198
Q

Important point

A

Down syndrome associated with VACTERAL

Diaphragmatic hernia associated with Edward syndrome

holoprosencephaly associated with pataue syndrome

199
Q

what are the causes of oligohydramnios in first Trimester?

A

Mostly due to fetal causes

200
Q

what are the causes of oligohydramnios in 2nd and 3rd Trimester?

A

Utero placental insufficiency

Rupture of membranes

201
Q

Name the medicine for bipolar disorder in pregnancy

A

Lamotrigine

202
Q

What are the consequence of short interpregnancy interval?

LAP

A

L LBW
A anemia
P PPROM / Preterm delivery

203
Q

US doppler finding of Ectopic pregnancy

A

Ring of fire around the ectopic pregnancy

204
Q

How to manage PPROM after 34 week but before 37 weeks?

A

Delivery
Abx like penicillin for GBS
±steriods

205
Q

How to manage uncomplicated PPROM before 34 weeks?

A

Steroid with ABx for GBS

Expectant management
If before 32 wk give magnesium

206
Q

What does mean by Complicated PPROM?

A

Infection

Fetal or maternal compromise

207
Q

How to managed Complicated PPROM before 34 weeks?

A

Magnesium if before 32 wk

Delivery
Abx like ampicillin and Gentamicin
Steroid

208
Q

What are the causes of Oligohydramnios in first trimester?

A

In first Trimester mostly due to fetal causes—>
Posterior uretheral valve
Renal agenesis
Aneuploidy

209
Q

What are the causes of Oligohydramnios in 2nd or 3rd trimester?

A

Utero placental insufficiency
(With FGR)

Maternal dehydration or Rupture of membranes (normal fetal growth)

210
Q

How thyroid hormone production increase to meet metabolic demand in pregnancy?

A

Estrogen increase TBG result increase only in bound hormones

B-HCG stimulates TSH receptor increase thryoid hormones

Both these suppress TSH

211
Q

TFT Pattern in Pregnancy

A

Increase Total 4

Mild Increase or unchanged free T3

Deceased TSH

212
Q

How to managed Perineal laceration after pregnancy?

A

If uncomplicated viz no fever or purulence—> NASIDS / Sitz bath

If fever or purulence or wound breakdown or non intact repair —->Abx / suture removal and surgical debridement

213
Q

What are the causes of Minimal Variability <5 Or absent Undetectable amplitude?

A

Prematurity

Fetal hypoxia or Sleep

CNS depressants like alcohol, narcotics and drugs

214
Q

What changes occur in Pulmonary patterns in Pregnancy?

A

Resp-alkalosis
Normal VC and FEV1

Increase Minute ventilation due to Tidal volume increase

Decrease RV and FRC

215
Q

Triad of Degenerating Uterine fibroid

A

Fundal tenderness with palpable mass

Increase WBCs count

Conservative management

216
Q

Important point of Cerclage

A

Patient with past hx of 2nd term pregnancy loss manage with prophylactic Cerclage placement ((doesn’t matter if cervical length is short or normal))

Procedure also done if patient has short cervical length

217
Q

Triad of Intrahepatic choletasis of pregnancy

A

RUQ pain

Whole body pruritis but more on hand and feet

Only LFT deranged without rash

218
Q

How to manage Intrahepatic choletasis of pregnancy?

A

1) Ursodeoxcholic acid
2) Antihistamine
3) delivery at 37th week of gestation

219
Q

What are the complications of Intrahepatic choletasis of pregnancy?
M-PIN

A

M. Meconium stained aminotic fluid

P preterm delivery

I intrauterine fetal demise

N Neonatal RDS

220
Q

How to Prevent and abort Migraine?
Abortive (TANE)
Preventive ABA

A

Abortive::
(Triptans, Antiemetic, Acetaminophen, NSAIDs, Ergotamine)

Prevent::
Anticonvulsant like topiramate Or Valproate
B BB (given in pregnancy unlike others )
A antidepressants ( TCA or Venlafaxine)

221
Q

What are the causes of Late (Secondary) PPH?

A

1) Placental Endometritis
2) Retained POC which present as boggy or tense uterus with heavy bleeding ± uterine atony

Rx via dilation and curettage

3) Placental site Sub involution which present as present as heavy bleeding with uterine atony

Rx via Uterotonics

222
Q

What are the CVS condition which are CI to pregnancy?

A

Symptomatic MS and AS
PAH

Symptomatic HF with LVeF less than 30%
Bicuspid AV with ascending aorta enlargement >50mm

Gynae obs And Male Reproductive (2 decks)

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