obstetrics and gyncology 2 Flashcards
Variable decelerations causes
ur Mx
pture of membranes and decrease in amniotic fluid volume, as they can result in umbilical cord compression and occlusion of the umbilical vessels, particularly during contractions
maternal repositioning
Fetal scalp stimulation
when to do
when to not do
performed to evaluate fetal acidosis in patients who have no accelerations on FHR monitoring.
** Fetal scalp stimulation is not performed in patients with decelerations, as it can exacerbate a parasympathetic response, resulting in a prolonged deceleration or fetal bradycardia.**
name most complication of chronic HTN in pregnant women
pre term delivery
not pre term rupture of membranes
prolonged rupture of membranes lead to polymicrobial infection {gram + and gram -} bacteria so Tx of choice is
clindamycin plus gentamicin;
post menopausal bleeding approach 1st and 2nd line Mx
1st line transvaginal Ultrasound if endometrium less < 4 no further evaluation is required
2nd if endometrium thickining is more than >4 go for endometrial biopsy
if bdnign»_space;observation
if atypia /neoplasia»progestins -surgery
pain with breastfeeding and bloody nipple discharge duo to it
most common cause
poor infant positioning and improper latch-on technique.
sexual harrasment Mx
Postexposure prophylaxis
Emergency contraception
Psychosocial counseling
amniotic fluid embolism syndrome (AFES), happens duo to ———-
which in turn lead to ————-
ur Mx **
amniotic fluid enters the maternal circulation through areas of disrupted maternofetal connections
Hypoxemic respiratory failure ,profound hypoxia can cause a coma or seizure, as seen in this patient.
Obstructive shock,cardiac arrest ,DIc
management is supportive not magnisium sulfate foe the seaziure not heparin for the emblism cause we already have DIC.
iagnostic criteria for antiphospholipid-antibody syndrome
(1 clinical & 1 laboratory criterion must be met)
Laboratory
Lupus anticoagulant
Anticardiolipin antibody
Anti-beta-2 glycoprotein antibody I
Clinical
Vascular thrombosis
Arterial or venous
Pregnancy morbidity
≥3 consecutive, unexplained fetal losses before 10th week
≥1 unexplained fetal losses after 10th week
≥1 premature births of normal neonates before 34th week due to preeclampsia, eclampsia, or placental insufficiency
Disorders of bladder outlet obstruction are treated ——
Other wise pregnant physiological bilateral hydronephroisis ***need no further Mx
with Foley catheter placement.
Intimate partner violence has a high prevalence and significant morbidity and mortality and is underreported. Therefore, screening is required in all women of childbearing age at routine medical visits.
screening is required in all women of childbearing age at routine medical visits.
typically occurs in patients with endometrial scarring from prior uterine surgery (eg, dilation and curettage, cesarean delivery); the scarred areas do not undergo normal endometrial decidualization in early pregnancy.
with prolonged abnormal postpartum hemorrage not responisve to uterotonic medications
and the Mx is ergent hysterectomy
placenta accreta
what a story to tell
Acute pancreatitis can be diagnosed in the presence of 2 of 3 classic features: classic symptoms (eg, severe epigastric pain radiating to the back); elevated amylase/lipase; or characteristic imaging findings. This patient with classic symptoms and laboratory findings does not require a CT scan, particularly given that she is pregnant and that imaging would not affect management at this time (vs lipid panel, which may indicate the need for insulin infusion or apheresis).
does not require a CT scan,
Triglyceride levels typically increase two- to four-fold in pregnancy, particularly in the third trimester (increased triglyceride-rich lipoprotein production and decreased lipoprotein lipase activity). In this patient with hypertriglyceridemia who discontinued fibrate therapy in pregnancy, this effect is likely compounded.
lipid panel showing a triglyceride level >1000 mg/dL is required for diagnosis of triglyceride-induced pancreatitis and has implications on patient management: In addition to intravenous fluid therapy and pain control (used in any case of acute pancreatitis), management of triglyceride-induced pancreatitis may include insulin infusion (limits fatty-acid release from adipocytes) or apheresis (removes triglyceride-rich plasma).
*****soooo fkin high yield
2nd time stupid
red macular rash
Toxic shock syndrome, caused by Staphylococcus aureus bacteremia and associated exotoxin release, typically presents with fever, hypotension, tachycardia, and a diffuse, red, macular rash. Treatment includes fluid replacement and antibiotic therapy with clindamycin plus vancomycin
Recurrent urinary tract infections (≥3 episodes in a year or ≥2 episodes in 6 months) commonly occur in postmenopausal patients due to——-
estrogen deficiency lead to
ulvovaginal atrophy, decreased bulk and elasticity of the bladder trigone and urethra, and increased vaginal pH. Treatment is with vaginal estrogen.
malignant sex cord–stromal tumors of the ovary that secrete estradiol. Patients typically present with a large ovarian mass and postmenopausal bleeding (due to associated endometrial hyperplasia from chronic unopposed estrogen exposure).
granulose cell tumors
so solid tumor that secretes estrogen
A uterine size–dates discrepancy exists when the fundal height measures larger or smaller than expected for gestational age. Gestational diabetes mellitus
gdm causes a uterine size–greater-than-dates discrepancy by promoting fetal macrosomia and/or increased amniotic fluid volumes (ie, polyhydramnios).
Septic pelvic thrombophlebitis can cause postpartum fever due to injury, thrombus, and hematogenous spread of infection to the pelvic veins (eg, ovarian veins). Patients are typically initially treated for suspected endometritis but have relapsing-remitting fevers and persistent abdominal pain despite antibiotics. Septic pelvic thrombophlebitis is not associated with incisional induration or erythema.
relapsing-remitting fevers its adiagnosis of execlusion
patients with an unsatisfactory colposcopy (ie, entire squamocolumnar junction cannot be visualized) require ———–
as well as pts high-grade squamous intraepithelial lesions on Pap testing
endocervical sampling (eg, endocervical curettage).
Management of vasa previa
of a ruptured fetal vessel is with emergency cesarean delivery because of the high risk of fetal exsanguination and demise.
bartholin gland Mx
1-Asymptomatic Bartholin duct cysts in young women do not require intervention as most of the cysts drain spontaneously and resolve on their own. Therefore, observation and expectant management are recommended for these patients.
2-symptomatic cysts or abscesses are treated with incision and drainage (Choice C)
** followed by placement of a Word catheter to reduce the risk of recurrence. Some women develop ******recurrent Bartholin cysts or abscesses and undergo a **marsupialization procedure, which creates another point of drainage for the Bartholin gland.
secondary amenorrhea, defined as———-
amenorrhea for ≥3 months in women with previously regular menses (or ≥6 months in women with previously irregular menses).
secondary amenorrhea, Mx
Initial evaluation includes a pregnancy test, followed by serum prolactin, TSH, and FSH level testing
intrahepatic cholestasis of pregnancy (ICP).
clinical features include
Development in 3rd trimester
Generalized pruritus
Pruritus worse on hands & feet
No associated rash
Right upper quadrant pain
intrahepatic cholestasis of pregnancy (ICP).
labaratory abnormalities
can lead to 4 obstetrics complications :
↑ Total bile acids (≥10 µmol/L)
↑ Liver transaminases (typically <2x normal, rarely >1000 U/L)
± ↑ Total & direct bilirubin
Intrauterine fetal demise
Preterm delivery
Meconium-stained amniotic fluid
Neonatal respiratory distress syndrome
intrahepatic cholestasis of pregnancy (ICP). Mx
Ursodeoxycholic acid
Antihistamines
Delivery at 37 weeks gestation
greatest risk factor for placenta previa is
previous cesarian delivery additional r.f previous placenta previa multiple gestation (ie, increased placental surface area), and advanced maternal age (age ≥35)
all sexually active women age <25 are recommended annual screening for ——–and the gold screening tets is
C trachomatis and N gonorrhoeae, including those with low-risk sexual behavior (eg, monogamous, condom use) such as this patient.
The nucleic acid amplification test (NAAT) is the gold standard for screening
risk factors for breach presentation and its not Tobacoo smocking {usually its causes growth restriction that might lead to breach presintation }
Advanced maternal age (≥35)
Multiparity
Uterine didelphys, septate uterus
Uterine leiomyomas{uworld love it }
Fetal anomalies (eg, anencephaly)
Preterm (<37 weeks gestation)
Oligohydramnios/polyhydramnios
Placenta previa
Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy that typically occurs during the first trimester. A common risk factor is a twin gestation due to elevated hCG and progesterone levels.
summury twin u get more Sx
the most common pain symptoms are dysmenorrhea and severe dyspareunia (ie, pain with intercourse), particularly with deep penetration, due to the proximity of the vagina to the uterus, bladder, and rectum.
ur Dx
ur MX
Endometriosis in contrast to
Vaginismus, also known as genitopelvic pain/penetration disorder
nonsteroidal anti-inflammatory drugs and/or combination oral contraceptives THAT SUPPRESS ENDOMETRIAL TISSUE PROLIFERATION
vaginismus Mx :multiple modalities, including cognitive-behavioral therapy, couples therapy and sex education, pelvic floor physical therapy, and vaginal dilators.
Patients with a prolapsed fibroid typically have labor-like pain due to cervical dilation as the fibroid passes through the cervix.
ectopic pregnency diffirntiate between appendicitis byyyy———–
doppler flow
patients typically have increased Doppler flow (ie, “ring of fire”) around the ectopic pregnancy. This patient’s pelvic ultrasound shows an intrauterine pregnancy and adnexa with normal Doppler flow
placenta previa as 20 w of gestation with no HX OF complication ur Mx
The majority (~90%) of cases resolve spontaneously due to lower uterine segment lengthening and/or placental growth toward the fundus; therefore, initial management is with ***routine obstetric care
Septic abortion Mx regardless time intervention
broad spectrum ABS and suction and curettage
presents with fever, heavy vaginal bleeding, purulent discharge, and uterine tenderness
most common risk factor for breast cancer is
age of the pt
not Hx of family breast cancer not estrogen therapy
Indications for prophylactic administration of anti-D
immunoglobulin for Rh(D)-negative patients*
At 28-32 weeks gestation
<72 hours after delivery of Rh(D)-positive infant
<72 hours after spontaneous abortion
Ectopic pregnancy
Threatened abortion
Hydatidiform mole
Chorionic villus sampling, amniocentesis
Abdominal trauma
2nd- & 3rd-trimester bleeding
External cephalic version
Lymphogranuloma venerum:very painful lympho nodes enlargement chlamudua trachomatis
Granuloma ingunalle:progressive ulceration without lymph nodes enlargement and without pain inguinill bill =0 Even without exudate (klebisiella granulamatosis)
Chancroid:hemophilia decuryaii: painful lesion with exudate
Negative rapid plasma regain in 1ry syphillus with positive Chanre ur Next Mx choose
A-observation and follow up
2-Empiric penicillin g
False-negative nontreponemal serology (eg, rapid plasma reagin) is common in primary syphilis. Patients with negative serology and strong clinical evidence (eg, chancre) of primary syphilis are treated empirically with intramuscular benzathine penicillin G.
Acute liver failure of pregnancy just look at ——-
Ur Mx ———
Low Glucose level it’s always indicative with low platelets count and elevated liver enzymes with signs of chile cystitis
Immediate delivery
Failure of progesterone inducing test exclude ——
Pcos wich leaves us with
Educational objective:
Functional hypothalamic amenorrhea is due to suppression of the hypothalamic-pituitary-ovarian axis by strenuous exercise, caloric restriction, or chronic illness. Patients are at risk for decreased bone mineral density due to estrogen deficiency
Lecithyroxine in pregnant women should be ur advice —-
their dose increased by approximately 30% at the time the pregnancy is detected
Stress urinary incontinence (SUI) is the intermittent, involuntary loss of urine with increased intraabdominal pressure (eg, coughing, laughing). SUI is due to either decreased urethral sphincter muscle tone or urethral hypermobility from weakened pelvic floor muscles. Although this patient’s multiparity puts her at risk for SUI, there is no urethral leakage with Valsalva on pelvic examination, making this diagnosis unlikely.
(Choices C and E) Overflow incontinence causes continuous, painless loss of urine due to chronic urinary retention. Underlying causes include diminished contractility of the bladder detrusor (ie, neurogenic bladder from diabetes mellitus) and external compression of the urethral outlet (eg, fibroids, prolapse), impeding bladder emptying. Urinary retention causes an elevated postvoid residual (≥150 mL), not seen in this patient.
Other wise if there urge it’s involountary cobtraction
R if it’s painless continuous leackage with Hx of surgeries and radiation devoloped over a period of time it’s fistula
So repeat the 6 causes champ 🤯
Symptoms include bilateral breast fullness, tenderness, and warmth, without fever. Improvement is expected as breastfeeding is established ur Dx
Breast engorgement
Rubella immunity is evaluated as part of the prenatal panel in pregnant women.
So do you give vaccination during pregnancy
Hell naaah
However, the measles-mumps-rubella live-attenuated vaccine is contraindicated during pregnancy. It should be administered postpartum to nonimmune women, such as this patient.
Y we do urine bacteria culture in a Sx pregnant women
Asymptomatic bacteriuria in pregnancy has a 40% risk of progressing to pyelonephritis because smooth muscle relaxation and ureteral dilation allow urine to ascend from the bladder to the kidneys.
should be suspected in postmenopausal women who have taken tamoxifen or have other risk factors (eg, pelvic radiation).
Tamoxifen use and it’s indistinguishable from uterine liomyoma fibroids
Uterine sarcoma irregular mass in the abdominal area above symphsis pupis in postmenopause women
If it’s regular and symmetrical think adenomyisus
If it’s mass in the vaginal area think of with pressure Sx think of pelvic organ prolapse
vaginal pH ≥5 may help confirm the hypoestrogenic state because reduced glycogen production reduces normal vaginal lactobacilli activity. Treatment includes vaginal moisturizers and vaginal estrogen.
The genitourinary syndrome of menopause, or atrophic vaginitis, causes vulvar and vaginal atrophy from loss of epithelial elasticity due to low estrogen levels
endometrial cells on Pap testing. is age based:
Women age <45 do not have endometrial cells reported on their Pap tests because this is a common, benign finding, particularly if Pap testing is performed during the first 10 days of the menstrual cycle.
In contrast, women age ≥45 do have endometrial cells reported on their Pap tests because this finding is more concerning for an abnormality. In this age group, particularly in postmenopausal women, endometrial shedding may be due to endometrial hyperplasia/cancer,
The risk of endometrial hyperplasia/cancer is further increased if the patient has additional risk factors (eg, obesity, prior chronic anovulation).
.
Therefore, postmenopausal women with endometrial cells on Pap testing require further evaluation with an endometrial biopsy
Cervical cancer screening
Age <21
———
Age 21-29
———-
Age 30-65
Age >65
risk
Hysterectomy
(with cervix removed)
No screening
Cytology every 3 years
Cytology every 3 years OR
Cytology plus HPV testing every 5 years
OR
Primary HPV testing every 5 years
No screening if negative prior screens & low
No screening if negative prior screens & low
Pts with introa amniotic fluid with heavy vaginal bleeding u suspect
Retained product if conception
If placenta retained product the pts will have immediate
postpartum urinary retention, definition
Causes ——-
Can lead to —-
Mx———
which is the inability to void ≥6 hours after vaginal delivery
regional neuraxial anesthesia (eg, epidural anesthesia), and pudendal nerve injury from prolonged labor
inability to sense the need to void, loss of the micturition reflex, bladder atony (eg, palpably overdistended bladder with suprapubic fullness and tenderness), and urinary retention. Overflow incontinence
Urethral catheterization is required for both diagnosis and treatment, particularly in patients who are unable to void
postvoid residual volume of ≥150 mL is consistent with urinary retention. Urethral catheterization decompresses the bladder,
Most common complication of using endomethacin
Indomethacin, a nonspecific cyclooxygenase inhibitor, decreases prostaglandin production and leads to fetal vasoconstriction (eg, premature closure of the ductus arteriosus). The subsequent decreased renal perfusion and fetal oliguria can result in oligohydramnios (ie, amniotic fluid index ≤5 cm)
((((Oligohydrominas)))))
PCI’s pts will be diagnosed in both ways
1st line Mx
clinically (eg, hirsutism, acne, alopecia) or biochemically with elevated serum testosterone levels
Weight loss
Absent flow to the ovary
Ovarian torsion
Mx of ovarian torsion
Laparoscopy with detorsion
Ovarian cystectomy
Oophorectomy if necrosis or malignancy
Pseudocyesis is a
persistent, nondelusional belief of being pregnant in a nonpregnant patient. A patient with pseudocyesis can have symptoms of early pregnancy (eg, morning sickness, abdominal distension), but pregnancy testing is negative and ultrasound examination reveals an empty uterus (eg, thin endometrial stripe).
Lied pregnancy
Cranial ultrasonography* indications :
Performed if symptomatic or as routine screening if <32 weeks gestational age
bulging fontanelle, a rapidly increasing head circumference, bradycardia in premature neonate ur Dx Ix
Intraventrucukar hemorrhage
Cranial. Ultrasonography if pts Is symptomatic or as routine clinical examination before the 32 w
Normal temperature ranges
36.1°C to 37.2°C (97°F to 99°F).
