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WH EOR > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Name the 7 cardinal movements of labor.

A
  1. Engagement = fetal head enters pelvic inlet
  2. Descent = head begins to pass through pelvis (lightening)
  3. Flexion = head flexion so the smallest point exits first
  4. Internal rotation = rotates to face down (parallel with sagittal suture)
  5. Extension = head extends as it passes through the vaginal canal/pubic symphysis
  6. Restitution = turn head left or right to deliver anterior shoulder first
  7. Expulsion (delivery)
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2
Q

What are Braxton-Hicks Contractions?

A

Spontaneous uterine contractions that occur late in pregnancy but are NOT associated with cervical dilation

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3
Q

What are the 4 most common causes of postpartum hemorrhage?

A

4 T’s:

  1. Tone (atony of uterus)
  2. Trauma (cervical/perineal lacerations)
  3. Tissue (retained placenta)
  4. Thrombosis (VWF or other clotting disorder)
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4
Q

APGAR score

A 
Appearance, Pulse, Grimace, Activity, Respirations:
Respirations = 2
HR = 2
Responsiveness = 2
Tone = 2 
Color = 1
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5
Q

Define threatened abortion and what is the management?

A

Pt presents with vaginal bleeding and cramping. The cervical os is CLOSED and the POC are intact. Observe at home, FU and get serial hCGs

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6
Q

Incomplete abortion: define, dx, and treat

A
  • POC partially intact, cervical os DILATED
  • Dx with US, b-hCG, progesterone, CBC, blood typing and Rh (for transfusion if necessary)
  • Medical tx: mifepristone first, misoprostol 24-48hrs following. Can also use just misoprostol
  • Surgical tx: 1st trimester = D&C; 2nd trimester = D&E
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7
Q

Complete abortion: define, dx, treat

A
  • POC completely expelled from uterus. Cervical os is closed

- Rhogam if needed and serial hCGs

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8
Q

Missed abortion: define, dx, treat

A
  • POC intact, cervical os closed
  • Order same labs and imagine
  • 1st line treatment is surgery (remember this depends on how many weeks along she is)
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9
Q

Septic abortion: what is unique about this presentation and how do we treat?

A
  • Pt will present with vaginal bleeding, cramping, cervical motion tenderness, fever, and chills
  • Tx: D&E regardless of dating and broad spectrum abx (levofloxacin + metronidazole)
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10
Q

Pt presents for miscarriage. Blood type is Rh -. What do you give?

A

anti-D Rh immunoglobulin

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11
Q

What is a complete molar pregnancy?

A
  • Empty egg with 2 sperm = all paternal chromosome (46XX) = no fetal tissues.
  • This is the MC type of gestational trophoblastic disease/molar pregnancy
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12
Q

You see a snowstorm or grape like appearance on US after pt presents with painless vaginal bleeding. Her uterus is much larger than it should be for only being 4 weeks along in pregnancy. What do you do?

A
  • get b-hCG levels; should be >100,000
  • Treat with surgical uterine evacuation. Send tissue to path
  • if choriocarcinoma present = get CXR to look for mets
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13
Q

What is a partial molar pregnancy?

A

-An egg is fertilized with 2 sperm (69 XXY or XXX) which results in fetal tissue that is not viable.

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14
Q

What advice to you give someone after a molar pregnancy?

A

Contraception for 6-12 months!

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15
Q

What is the MC site for an ectopic pregnancy?

A

Fallopian/uterine tube

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16
Q

What is the MC cause of an ectopic pregnancy?

A

Occlusion of the tubes due to adhesions

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17
Q

What are the risk factors for an ectopic pregnancy

A
  1. Previous ectopic (MC)
  2. PID
  3. IUD use
    - Tubal ligation, endometriosis, IVF
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18
Q

What is the classic triad of ectopic pregnancy?

A
  1. Unilateral pelvic or lower abd pain
  2. Vaginal bleeding
  3. pregnancy/amenorrhea
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19
Q

What is Kehr sign?

A

Severe abd pain and left should pain from a ruptured ectopic

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20
Q

When can you give meds for an ectopic and what med do you give?

A
  • Methotrexate can be given if the ectopic is measuring <4cm and hcg is <1500 without FHT and mom is hemodynamically stable.
  • Otherwise, the ectopic should be removed with a laparoscopic salpingostomy
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21
Q

A 28 y/o woman comes in with a missed period and sudden vaginal bleed and unilateral abd pain. What is in the workup?

A
  • TV ultrasound does not show yolk sac (if hcg is also <2000 = prob ectopic)
  • hcg will be declining
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22
Q

What are the MC fetal complication of gestational diabetes?

A
  1. Macrosomia (baby gets too big) –MC
  2. Preterm labor
  3. Neonatal hypoglycemia
  4. Hypocalcemia
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23
Q

What is the first line med for gestational diabetes?

A
  1. Insulin (only if they fail the GTT after diet and exercise changes)
  2. Metformin or glyburide
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24
Q

What is the blood glucose goal of a fasting diabetic?

A

95mg/dL

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25
Q

Mom with gestational diabetes and on insulin should have what tested weekly and when should she deliver?

A
  • NSTs or FHTs collected weekly

- Deliver at 38 weeks

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26
Q

The 1 hour GTT consists of how much glucose and what does mom’s BGL need to be in one hour?

A
  • 50g of glucose

- 1 hr glucose should be <130mg/dL; if greater = 3hr GTT

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27
Q

Name the levels for the 3 hr GTT

A

<95 fasting
<180 @ 1 hr
<155 @ 2 hrs
<140 @ 3 hrs

If mom is + for any of these at 2 time points = diagnostic

28
Q

MC cause of painful third trimester bleeding

A

Placental abruption

29
Q

Painful vaginal bleeding in third trimester in a mother with preeclampsia and or abd trauma

A

Placental abruption

30
Q

Painless vaginal bleeding in third trimester

A

Placenta previa

31
Q

Define and explain HELLP syndrome

A 
Hemolysis, elevated liver enzymes, low platelets = intravascular coagulation 
-increased pT and pTT
-decreased platelets
-shistocytes on blood smear
Thought to be due from the HTN
32
Q

When does preeclampsia occur?

A

After 20 weeks of gestation

33
Q

What 4 drugs can you give for severe gestational HTN/preeclampsia?

A

Hydralazine
Methyldopa
Labetalol
Nifedipine

34
Q

What classifies preeclampsia?

A
  • New onset HTN >140/90 at 20 weeks

- Proteinuria (300mg in 24 hr or 1-2+ on dipstick

35
Q

What do we give IV in preeclamptic mothers to prevent seizures?

A

Magnesium sulfate

36
Q

When should mom deliver if she has HTN during pregnancy?

A

38 weeks

37
Q

What HTN meds are contraindicated in pregnancy?

A

ACEi and ARBs

38
Q

What are severe features of preeclampsia and what is the treatment?

A

BP at or >160/110
Proteinuria of 5g
Signs of end organ damage: headaches, blurred vision, altered mental status, elevated creatinine, signs of DIC (shistocytes on smear and low platelets)/HELLP

Tx: If >37 weeks, immediate delivery + Mg sulfate + HMLN (htn meds)

39
Q

What defines mild preeclampsia?

A
  • BP at or >140/90

- proteinuria at or >3g

40
Q

32 y/o G3P2 female presents at 30 weeks pregnant with BP reading 150/97 and proteinuria 3g. What is the treatment?

A
  • Daily weights
  • Weekly BP measures and urine dipstick
  • Antenatal corticosteroid shots in the gluteal muscle
41
Q

What is the definitive diagnosis for ovarian torsion?

A

Surgical visualization

42
Q

MC cause of ovarian torsion?

A

Adnexal cysts

43
Q

28 y/o pt presents to the ED with sudden onset RLQ pain. She has hx of adnexal masses. What is the first line imaging that you should order?

A

Ultrasound.

Definitive dx is surgical visualization

44
Q

What is the drug of choice to treat postpartum atony?

A

Oxytocin

45
Q

22 y/o female presents with fishy odorous. gray/white vaginal discharge. Vaginal pH is 4.7, KOH is positive. What do you think this is? What’s pathopneumonic for this?

A 
Bacterial vaginosis, clue cells
\+ amine KOH
>4.5 vaginal pH
Thin white discharge
Tx: metronidazole/Flagyl
46
Q

What lab results do you expect to see on a 52y/o woman with 12 months of amenorrhea?

A

Elevated FSH/LH

Decreased estrogen/progesterone

47
Q

What do you treat vaginal atrophy with?

A

Vaginal estrogen cream

48
Q

What is the differential for a woman with postmenopausal bleeding?

A
  1. Endometrial cancer
  2. Polyps or fibroids
    First line test: TVUS; endometrial stripe should be <3-4mm
49
Q

35y/o females wishes to retain the ability to become fertile but has a leiomyoma. What is the treatment of choice?

A

Myomectomy

50
Q

28 y/o female presents with menorrhagia and dysmenorrhea. She has chronic abd/pelvic pain. On transvaginal US there appears to be a heterogenic hypoechoic mass with shadowing. What is the dx and definitive tx?

A

Leiomyoma

Definitive tx: hysterectomy

51
Q

What is cervical insufficiency/an incompetent cervix?

A

Painless dilation and effacement of the cervix in the late 2nd or early 3rd trimester.
RF: LEEP procedure (you saw this pt with this exact problem!)
Tx: Cervical cerclage if cervical length is 25mm or less + bedrest

52
Q

What is ASCUS and what do we do with this result?

A

Atypical squamous cells of undetermined significance

Pap in 1 year + HPV testing

53
Q

What is LSIL and HSIL?

A

Low grade vs high grade squamous intraepithelial lesion

54
Q

When are normal cervical cancer screenings done?

A

21-29y/o every 3 years + reflex HPV

30-65y/o = HPV and pap every Q5 yrs

55
Q

What HPV strains are associated with cervical cancer?

A

16, 18, 31, 33

56
Q

What is the MC type of cervical cancer?

A

Squamous cell carcinoma

57
Q

What is the treatment for chorioamnionitis?

A

Ampicillin and Gentamicin (may need Clinda)

58
Q

What are the Amsel Criteria?

A

Amsel criteria are used to dx BV (3/4):

  1. Thin gray/white discharge
  2. pH >4.5
  3. Postive Whiff Test on KOH
  4. Clue Cells
59
Q

23y/o pt presents 3 days post C-section due to PPROM with pelvic pain, foul smelling lochia, and fever. What is her most likely dx, what was the main RF, and what is the treatment?

A

-Endometritis = MC postpartum infection
-C-Section is the greatest RF
-Tx: Clinda+Gent; if GBS + add ampicillin
(can also be an extension of PID if pt is not pregnant)

60
Q

Baby suddenly has bradycardia and decels during labor. You reach in and feel a pulse at the cervix. What is this and how do we treat?

A
  • Umbilical cord prolapse

- Knees to chest and emergency C-section

61
Q

What 4 drugs should you think of when a pregnant mom is in acute preterm labor?

A 
Tocolytic Drugs: "It's Not My Time"
Indomethacin
Nifedipine
Magnesium Sulfate
Terbutaline
62
Q

MC cause of PID?

A

Chlamydia

63
Q

PID treatment for a non pregnant woman?

A

Ceftriaxzone + Doxycycline + Metronidazole

64
Q

PID treatment for a pregnant woman?

A

IV cefotetan (2nd gen) + 1mg Azithromycin PO

65
Q

What is a CI of methergin/methylergonovine?

A

HTN + CAD/PAD/Raynaud’s

66
Q

What drugs can be used to treat postpartum hemorrhage from atony?

A

Oxytocin
Methylergonovine/Methergen
Carboprost

WH EOR (3 decks)

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