Obstetrics Flashcards
1
Q
Name the 7 cardinal movements of labor.
A
- Engagement = fetal head enters pelvic inlet
- Descent = head begins to pass through pelvis (lightening)
- Flexion = head flexion so the smallest point exits first
- Internal rotation = rotates to face down (parallel with sagittal suture)
- Extension = head extends as it passes through the vaginal canal/pubic symphysis
- Restitution = turn head left or right to deliver anterior shoulder first
- Expulsion (delivery)
2
Q
What are Braxton-Hicks Contractions?
A
Spontaneous uterine contractions that occur late in pregnancy but are NOT associated with cervical dilation
3
Q
What are the 4 most common causes of postpartum hemorrhage?
A
4 T’s:
- Tone (atony of uterus)
- Trauma (cervical/perineal lacerations)
- Tissue (retained placenta)
- Thrombosis (VWF or other clotting disorder)
4
Q
APGAR score
A
Appearance, Pulse, Grimace, Activity, Respirations: Respirations = 2 HR = 2 Responsiveness = 2 Tone = 2 Color = 1
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
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
7
Q
Complete abortion: define, dx, treat
A
- POC completely expelled from uterus. Cervical os is closed
- Rhogam if needed and serial hCGs
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)
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)
10
Q
Pt presents for miscarriage. Blood type is Rh -. What do you give?
A
anti-D Rh immunoglobulin
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
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
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.
14
Q
What advice to you give someone after a molar pregnancy?
A
Contraception for 6-12 months!
15
Q
What is the MC site for an ectopic pregnancy?
A
Fallopian/uterine tube
16
Q
What is the MC cause of an ectopic pregnancy?
A
Occlusion of the tubes due to adhesions
17
Q
What are the risk factors for an ectopic pregnancy
A
- Previous ectopic (MC)
- PID
- IUD use
- Tubal ligation, endometriosis, IVF
18
Q
What is the classic triad of ectopic pregnancy?
A
- Unilateral pelvic or lower abd pain
- Vaginal bleeding
- pregnancy/amenorrhea
19
Q
What is Kehr sign?
A
Severe abd pain and left should pain from a ruptured ectopic
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
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
22
Q
What are the MC fetal complication of gestational diabetes?
A
- Macrosomia (baby gets too big) –MC
- Preterm labor
- Neonatal hypoglycemia
- Hypocalcemia
23
Q
What is the first line med for gestational diabetes?
A
- Insulin (only if they fail the GTT after diet and exercise changes)
- Metformin or glyburide
24
Q
What is the blood glucose goal of a fasting diabetic?
A
95mg/dL
25
Mom with gestational diabetes and on insulin should have what tested weekly and when should she deliver?
- NSTs or FHTs collected weekly
| - Deliver at 38 weeks
26
The 1 hour GTT consists of how much glucose and what does mom's BGL need to be in one hour?
- 50g of glucose
| - 1 hr glucose should be <130mg/dL; if greater = 3hr GTT
27
Name the levels for the 3 hr GTT
<95 fasting
<180 @ 1 hr
<155 @ 2 hrs
<140 @ 3 hrs
If mom is + for any of these at 2 time points = diagnostic
28
MC cause of painful third trimester bleeding
Placental abruption
29
Painful vaginal bleeding in third trimester in a mother with preeclampsia and or abd trauma
Placental abruption
30
Painless vaginal bleeding in third trimester
Placenta previa
31
Define and explain HELLP syndrome
```
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
When does preeclampsia occur?
After 20 weeks of gestation
33
What 4 drugs can you give for severe gestational HTN/preeclampsia?
Hydralazine
Methyldopa
Labetalol
Nifedipine
34
What classifies preeclampsia?
- New onset HTN >140/90 at 20 weeks
| - Proteinuria (300mg in 24 hr or 1-2+ on dipstick
35
What do we give IV in preeclamptic mothers to prevent seizures?
Magnesium sulfate
36
When should mom deliver if she has HTN during pregnancy?
38 weeks
37
What HTN meds are contraindicated in pregnancy?
ACEi and ARBs
38
What are severe features of preeclampsia and what is the treatment?
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
What defines mild preeclampsia?
- BP at or >140/90
| - proteinuria at or >3g
40
32 y/o G3P2 female presents at 30 weeks pregnant with BP reading 150/97 and proteinuria 3g. What is the treatment?
- Daily weights
- Weekly BP measures and urine dipstick
- Antenatal corticosteroid shots in the gluteal muscle
41
What is the definitive diagnosis for ovarian torsion?
Surgical visualization
42
MC cause of ovarian torsion?
Adnexal cysts
43
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?
Ultrasound.
| Definitive dx is surgical visualization
44
What is the drug of choice to treat postpartum atony?
Oxytocin
45
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?
```
Bacterial vaginosis, clue cells
+ amine KOH
>4.5 vaginal pH
Thin white discharge
Tx: metronidazole/Flagyl
```
46
What lab results do you expect to see on a 52y/o woman with 12 months of amenorrhea?
Elevated FSH/LH
| Decreased estrogen/progesterone
47
What do you treat vaginal atrophy with?
Vaginal estrogen cream
48
What is the differential for a woman with postmenopausal bleeding?
1. Endometrial cancer
2. Polyps or fibroids
First line test: TVUS; endometrial stripe should be <3-4mm
49
35y/o females wishes to retain the ability to become fertile but has a leiomyoma. What is the treatment of choice?
Myomectomy
50
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?
Leiomyoma
| Definitive tx: hysterectomy
51
What is cervical insufficiency/an incompetent cervix?
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
What is ASCUS and what do we do with this result?
Atypical squamous cells of undetermined significance
Pap in 1 year + HPV testing
53
What is LSIL and HSIL?
Low grade vs high grade squamous intraepithelial lesion
54
When are normal cervical cancer screenings done?
21-29y/o every 3 years + reflex HPV
| 30-65y/o = HPV and pap every Q5 yrs
55
What HPV strains are associated with cervical cancer?
16, 18, 31, 33
56
What is the MC type of cervical cancer?
Squamous cell carcinoma
57
What is the treatment for chorioamnionitis?
Ampicillin and Gentamicin (may need Clinda)
58
What are the Amsel Criteria?
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
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?
-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
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?
- Umbilical cord prolapse
| - Knees to chest and emergency C-section
61
What 4 drugs should you think of when a pregnant mom is in acute preterm labor?
```
Tocolytic Drugs: "It's Not My Time"
Indomethacin
Nifedipine
Magnesium Sulfate
Terbutaline
```
62
MC cause of PID?
Chlamydia
63
PID treatment for a non pregnant woman?
Ceftriaxzone + Doxycycline + Metronidazole
64
PID treatment for a pregnant woman?
IV cefotetan (2nd gen) + 1mg Azithromycin PO
65
What is a CI of methergin/methylergonovine?
HTN + CAD/PAD/Raynaud's
66
What drugs can be used to treat postpartum hemorrhage from atony?
Oxytocin
Methylergonovine/Methergen
Carboprost
