Obs/Gyne Focus Flashcards
Define meconium
first intestinal discharge of a newborn infant
when does meconium stained amniotic fluid occur? (Green)
fetus looses sphinter control bc (1) hypoxia stimulating vagus nerve
Preterm labor occurs btw which weeks? Signs of it?
20-37 weeks
Uterine contraction
Effacement of cervix and dilation
4 causes of preterm labor
uterine distension (if multiple gestation e.g. triplets or polyhydramnios)
stress
infection/inflammation
placental abruption
Tests for preterm labor
fetal fibronectin
CBC
urinalysis
Digital cervix check
US of cervix lenght
Preterm labor general TX
corticosteroids for sufactant production in baby lungs
tocolytics (to supress contractons) - nifedipine
MgSO4 - to help baby brain
Antibiotics - ampicillin/gentamicin (to avoid group B strep)
What are leopold manuvers
4 abdominal assessment maneuvers to determine position of fetus
What are the stages of labor
Stage 1 (latent, active, transition phases) - goal is to dilate and efface cervix
Stage 2 (complete cervical dilation finished and delivery of fetus)
Stage 3 (baby is out and delivery of placenta)
Stage 4 (placenta out, 2 hours of observation)
What is an umbilical cord prolapse?
umbilical cord prolapses through cervix - EMERGENCY
uterine rupture lineage of development
window - myometrium thinned
dehiscence: endo and myo are ruptured
rupture: endo, myo and perimetrium are ruputred
what is abruptio placentae
premature detachment of the placenta from the uterine wall
DX of ectopic pregnant
urine HCG
serum progesterone
TX for ectopic pregnancy
methotrexate (inhibits growth of embryo)
salpingostomy (salvage fallopian tubes if unruptured)
salpingectomy (removal of tube)
Define HELLP syndrome
is a form of pre-eclampsia that develops in 3rd trimester
Hemolysis Elevated liver enzymes Low Platelets
T/F GnRH is released by the hypothalamus in a pulsatile manner
T
What is the Graffian follicle
the one dominant follicle that becomes chosen for ovulation
The graffian follicle, once stimulated by FSH, releases what and to what effect?
It releases estrogen.
Estrogen goes back to the adenohypophysis and inhibits the release of more FSH.
The estrogen also stimulates the increase in LH to peak.
Estrogen causes proliferation of the endometrium.
once the dominant follicle has ovulated, the remaining cells in the ovary are called? They release what and why?
Corpus luteum
releases progesterone.
Tells endometrium to stop proliferate, and to differentiate instead into softer/be more nutritious
main risk for endometrial carcinoma?
Overproduction of estrogen
what triggeres menses?
fall in progesterone levels and consequent ischemia of endometrial layer
before the placenta can produce progesterone on its own (at 8 weeks), who keeps up the progesterone levels necessary to maintain the pregnancy?
the trophoblastic cells in the embryo produce hCG
days of follicular phase in menstrual cycle
day 1 - 14
LH stimulated the teca cells to do what?
to activate production of androgens
FSH acts on granulosa cells to do what?
to take the androgens produced by the teca cells and activate aromatase to change androgens into estrogens
T/F the ovary can produce cholesterol ex novo
T
Where is AMH produced? What does it signify in females?
is produced by granulosa cells in women and sertoli cells in men.
It signifies the reserve of ovarian follicles
Progesterone secretion causes firm mucus or soft, permeable mucus?
Firm
Inhibin A is only in women, and its purpose is to stop the further release of FSH from the hypophysis when a dominant follicle has already been selected
T
accorciate cycle is called
polimenorrhea (cycle <21 days)
allungato cycle is
oligomenorrhea (>35 days)
Metrorragia means?
hemorrage irregular outside of the cycle
Metrorrhagia examples according to ages
Before menarcha: lesions from external bodies or abuse
Menopause: endometrial cancer (<= 5mm is the cut off width for not cancer)
First trimester: ectopic pregnancy, aborto, mola
Third trimester: placental detachment and placenta previa
Primary amenorrhea defintion
lack of menses at 14 y/o + no secondary characteristics
secondary amenorrhea definition
loss of menses for 6 months in a woman that previously had a normal cycle
causes of primary amenorrhea
Cromosomico: Turners syndrome (X0 - female-ish), Klinfelters syndrome (XXY - male-ish)
Gonadico: Sawyer syndrome (gonadic disgenesis pura - appears female-ish)
Fenotipici: Pseudohermapfroitisim; Morris syndrome (XY - insensibile to androgens), Rokistansky (XX - congential aplasia of uterus and 2/3 superior of vagina)
if a woman has PCOS and is amenorrhoic, will she have her mensis if you administer progesterone only?
yes
Asherman syndrome
occurs when scar tissue forms inside the uterus and/or the cervix. These adhesions occur after surgery of the uterus or after a dilatation and curettage with tuberculosis and schistosomiasis being a less common cause
PCOS hormone elevated is
LH
How to diagnose PCOS?
prove : (1) ovarian dysfunction (amenorrha/oligomenorrhea, echo)
(2) hyperandrogenism (hirsutism, acne, calvizia or increase testosterone in blood)
PCOS issue is?
doesnt have aromatase enzymes.
Give metformin, give estrogen and progesterone pills
what is the scale of hirsutism?
Score of Ferrimana nd Gallwey
if >8 points its positive
metaplastic theory of endometriosis
in the presence of an inflammatory estrogenic stimulus it produces endometrial tissue
Chocolate cysts for endometriosis is seen on
not on echo (is seen ground glass)
on laparoscopy
right and left ovarian arteries originate from
aorta
the uterine arteries originate from
anterior visceral branch of the internal iliac artery
the lymphatic vessels of the superior third of the vagina drain directly into
iliac lymph nodes
order of incidence of gynecological tumors
MECOV
mamella
endometrium
cervix
ovary
vulva
Types of endometrial cancer
Type 1: adenoK, 85% of cases, hormone dependant, has endometrial hyperplasia, good prognosis
Type 2: most commonly serous or serous papillary, bad prognosis
risk factors for endometrial cancer
estrogens (precocious puberty, late menopause)
obesity
tamoxifene
levels of prevention
priamry: vaccinations (avoid entire pop from encountering the RF)
Secondary: screening (for the pop already exposed to the RF)
Third: follow up
Does endometrium cancer have screening? How to diagnose?
no screening
DX: hysteroscopy with biopsy
stages of endometrial cancer
Stage 1: only uterus
- 1a: with myometrium infiltration <50% (ONLY STAGE WHERE YOU CAN GIVE CONSERVATIVE TX)
-1b: >50%
Stage 2: uterus and cervix
Stage 3: local invasion
Stage 4: metastatis to bladder and rectum
what histotype of ovarian tumor is most frequently correlated to ovarian endometriosis
clear cell tumor and endometriod tumor
most common RF for cervical cancer
HPV 16 18
E6 E7 virus changes
screening of cervical cancer
from 25 years - 30 years: pap test ogni 3 anni
above 30 -65: HPV test ogni 5 anni
If HPV positive: PAP test next. PAP positive: go to colposcopia with biospy
LSIL or CIN1 regrades by itself or HSIL (CIN2/CIN3) needs conisation. – Bethesda systme for reading
most common ovarian cancer
epithelial
what is IOTA
international ovarian tumor analysis
A system to classify ovarian cysts according to echography
RMI or risk of malignancy index for ovarian cancer includes
age
ecography (IOTA)
Ca125