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Obstetrics and Gynecology > Obstetrics and Gynecology > Flashcards

Obstetrics and Gynecology Flashcards

1
Q

What is the most common detrimental consequence of prolonged membrane rupture?

A

Chorioamnionitis

  • increasing risk of fetal and maternal sepsis
  • this prompts effort to effect delivery immediately
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2
Q

What is chorioamnionitis?

A

Also known as IAI or intra-amniotic infection. It is an inflammation of the fetal membrances (amnion and chorion) due to a bacterial infection probably from bacteria ascending from the vagina into the uterus.

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3
Q

What is the benefit/significance of antimicrobial therapy in mothers with premature rupture of membrane associated with chorioamnionitis?

A

antimicrobial therapy had significantly reduces the number of newborns with RDS, NEC, and other adverse outcomes of bacterial sepsis.

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4
Q

What are the available choice of management for preterm ruptured membranes?

A

Delivery by induction of labor
Expectant management

other ancillary includes:
GBS prophylaxis
corticosteroids
tocolytics for expectant management
antimicrobials
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5
Q

What are the available choice of management for preterm labor without rupture of membrane?

A

almost the same with PROM

Delivery by induction of labor
Expectant management

other ancillary includes:
GBS prophylaxis
corticosteroids
tocolytics for expectant management
antimicrobials
amniocentesis
corticosteroids
bed rest
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6
Q

How do you detect infection in amniotic fluid of a preterm labor without rupture of membrane? what are its criteria to diagnose infection?

A

amniocentesis

criteria for positive infection:
elevated leukocyte count
low glucose level
high IL-6
or positive gram stain results
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7
Q

What is the rationale in administering corticosteroid in a mother undergoing premature labor? What are the corticosteroids of choice?

A

corticosteroid were found to accelerate lung maturation in fetus.
-it is effective in lowering the incidence of RDS and neonatal mortality

Betamethasone or dexamethasone

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8
Q

What is a cervical pessaries?

A

It is a medical device used to treat an incompetent or short cervix. Early in pregnancy, a rounf silicone pessary is placed at the opening of the cervix to close it, and then removed later in the pregnancy if the risk of preterm labor has passed.

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9
Q

What is a cervical cerclage?

A

Also known as cervical stitch. It is a treatment for cervical weakness, when the cervix starts to shorten and open too early during pregnancy causing either a late miscarriage or preterm birth.

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10
Q

what is the significance of tocolytic agents?

A

Tocolytic agents do not markedly prolonged the gestation but may only delay the delivery up to 48 hrs. This may allow transport to a regional obstetrics center and permit time for corticosteroid therapy to take effect.

Beta-adrenergic agonist (ritodrine), calcium channel blockers or indomethacin are recommended tocolytics that last up to 48 hrs,

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11
Q

What are the drugs used as tocolytics?

A 
B-adrenergic agonists (reduced intracelullar calcium thus preventing activation of myometrial contractile proteins)
magnesium sulfates (alter myometric contratility)
calcium channel blockers
prostaglandin inhibitors (indomethacin)
Atosiban (competitive antagonists of oxytocin-induced contractions)
NO donors (muscle relaxant)
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12
Q

How do you classify newborn as SGA?

A

if its birth weight is less than the 10th percentile for gestational age

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13
Q

How do you classify newborn as LGA?

A

if its birth weight is more than the 90th percentile for gestational age

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14
Q

How do you classify newborn as AGA?

A

if its birth weight is lbetween 10th and 90th percentile for gestational age

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15
Q

What are the PRESUMPTIVE SIGNS of pregnancy?

meaning signs that are unrelated to fetus and mother

A
  • Amenorrhea
  • Breast tenderness
  • Nausea and vomiting
  • Increased skin pigmentation
  • Skin striae
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16
Q

What are the PROBABLE SIGNS of pregnancy?

meaning signs that are related to mother

A
  • Enlargement of the uterus
  • Maternal sensation of uterine contractions and fetal movements
  • Hegar sign (or the softening of the junction between corpus and cervix)
  • Positive urine and serum B-HCG
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17
Q

What are the POSITIVE SIGNS of pregnancy?

meaning signs that are related to fetus

A
  • Fetal heart tones
  • Sonographic visualization of fetus
  • Perception of fetal movements by examiner
  • X-ray showing fetal skeleton
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18
Q

What is the normal duration of pregnancy postconception? from LMP?

A

266 days or 38 weeks (postconception)

280 days or 40 wks (from LMP)

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19
Q

How do you establish gestational age?

A

through conception dating, mestrual dating and naegele’s rule

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20
Q

How to use Naegele’s rule?

A

Get LMP, then minus 3 months and add 7 days from it,

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21
Q

The last few hours of human pregnancy are characterized by?

A

forceful and painful uterine contractions that effect cervical dilations and cause the fetus to descend through the birth canal

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22
Q

What are the four phases of parturition?

A

Phase 1-Uterine quiescence and cervical softening
Phase 2 -preparation
Phase 3 -parturition or the clinical stages of labor
Phase 4 - Recovery

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23
Q

What are Braxton-Hicks contractions or false labor contractions?

A

These are some low intensity myometrial contractions that are felt during the quiescent phase, but they do not normally cause cervical dilatation. These contractions become more common toward the end of pregnancy.

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24
Q

What are the first trimester methods to induce abortion?

A

Vacuum curettage-Dilation and curettage (D&C)

Medical abortion- Mifepristone and Misoprostol

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25
Q

What are the second trimester methods to induce abortion?

A

Dilation and Evacuation (D&E)

Labor induction methods (hypertonic solutions like urea or saline, prostaglandins, vaginal pge like disoprostone)

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26
Q

What is the immediate complication of induced abortion using labor induction method at 2nd semester pregnancy?

A

Retained placenta

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27
Q

What is the most common problem with all PG abortions during 2nd semester?

A

Retained placenta

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28
Q

What are the immediate complications of dilation and curettage in induced abortion of a 2nd semester pregnancy?

A 
uterine perforation
retained tissue
hemorrhage
infection
DIC
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29
Q

How can you ensure of a complete evacuation of pregnancy after abortion?

A

sonogram (look for retained pregnancy tissues)

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30
Q

What is the limitation of using medical drugs like misoprostol (cytotec), mifepristone (mifiprex), etc?

A

can only be used in women within first 63 days of amenorrhea

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31
Q

What are other ancillary procedures used in abortion?

A

prophylactic antibiotics and pain relief

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32
Q

Define spontaneous abortion.

A

bleeding within 12 weeks of gestation (first trimester)

the most common cause of early pregnancy loss is fetal in origin (chromosomal, mendelian abnormalities, antiphospholipid syndrome)

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33
Q

Majority of early pregnancy loss is caused by what etiology?

A

chromosomal abnormalities

Followed by:

  • mendelian abnormalities (autosomal or x-linked dominant and recessive)
  • antiphospholipid syndrome (rare)
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34
Q

What is a missed abortion?

A

sonogram finding of NONVIABLE pregnancy WITHOUT vaginal bleeding, uterine cramping or cervical dilation.

Mgt: scheduled suction D&C, induce contractions with misoprostol, or conservative management

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35
Q

What is a threatened abortion?

A

sonogram finding of VIABLE pregnancy WITH vaginal bleeding, but NO cervical dilation.

Mgt: No intervention, pregnancy may continue to term

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36
Q

What is an inevitable abortion?

A

has VAGINAL BLEEDING, UTERINE CRAMPING, CERVICAL DILATION but NO passage of POC yet.

mgt: emergency suction D&C to prevent further blood loss and anemia

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37
Q

What is an incomplete abortion?

A

VAGINAL BLEEDING, UTERINE CRAMPING, CERVICAL DILATION with PARTIAL passage of POC.

mgt: emergency suction D&C to prevent further blood loss and anemia

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38
Q

What is a complete abortion?

A

VAGINAL BLEEDING, UTERINE CRAMPING, CERVICAL DILATION with ALL POC being passed.

mgt:
- confirm with sonogram to ensure no intrauterine debris left
- weekly hCG titers to ensure negative pregnancy and rule out ectopic pregnancy

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39
Q

What is fetal demise?

A

In-utero death of a fetus after 20 weeks gestation before birth

Antenatal demise-before labor
Intrapartum demise-during onset of labor

40
Q

What is the most serious consequence of fetal demise to mother?

A

DIC

41
Q

What are the presentations to suspect fetal demise?

A

Fundus less than date (before 20 wks)

Absence of fetal movements (after 20 wks)

42
Q

What are the risk factors causing fetal demise?

A 
fetal infection
maternal trauma
over diabetes
antiphospholipid syndrome
severe maternal isoimmunization
fetal aneuploidy
43
Q

How to confirm diagnosis of fetal demise?

A

Ultrasound doppler showing ABSENCE OF CARDIAC ACTIVITY/ FETAL HEART BEAT

44
Q

What is the appropriate management for fetal demise presenting with DIC?
How would you know the presence of DIC?

A

Immediate delivery and seldective transfusion of blood products

Order laboratory tests like plateletcount, d-dimer, fibrinogen, PTT, aPTT

45
Q

What is an ectopic pregnancy? common location?

A

Pregnancy outside the uterine cavity

The most common site is in the distal ampulla of oviduct

46
Q

What are the risk factors for the occurrence of ectopic pregnancy?

A

previous pelvic inflammatory diseases that can cause scarring or adhesions that prevent normal migration of zygote into the uterine cavity.

Risk factors are:
Infectious (pelvic inflammatory disease)
Postsurgical (tuboplasty/ligation)
Congenital (DES use)
Idiopathic
47
Q

Classic triad of unruptured ectopic pregnancy? What happens when it ruptures?

A

Amenorrhea
Vaginal bleeding
Unilateral pelvic abdominal pain

Ruptured ectopic pregnancy symptoms will vary depending on the extent of intraperitoneal bleeding and irritation. Sometimes indicates HYPOTENSION, indicative of hypovolemia

48
Q

What are the classic signs of unruptured ectopic pregnancy?

A

Unilateral adnexal and cervical motion TENDERNESS

Uterine enlargement and fever are usually absent

Tachycardia and hypotension (indicates ruptured ectopic pregnancy)

abdominal guarding and rigidity

49
Q

What diagnostic tests/tools are used to diagnose ectopic pregnancy?
What results from these tests highly suggest of an ectopic pregnancy?

A

Serum beta-hCG levels
and vaginal sonogram

Failure to see a normal intrauterine gestational sac when the serum beta-hCG titer is >1500 mIU

if less than <1500 mIU and does not reveal IUP, it may suggest possible ectopic. Advise for a repeat serum hcg titer level every 2-3 days until levels exceed 1500 mIU and still no IUP

50
Q

Management for a ruptured ectopic pregnancy

A

Exploratory laparotomy

Signs/Symptoms of Rupture: amenorrhea, vaginal bleeding, abdominal pain, hemodynamically unstable

51
Q

What is the management for threatened abortion?

A

preferably bed rest and avoid stressful activities

52
Q

Treatment for hydatidiform mole?

A

suction curettage

follow-up beta-hCG titer weekly

53
Q

Management for unruptured ectopic pregnancy?

A 
medical treatment (METHROTREXATE)
surgical treatment (LAPAROSCOPY)
54
Q

Rationale for usage of methotrexate for medical treatment of unruptured ectopic pregnancy?

A

methotrexate is a folate antagonist that attacks rapidly proliferating tissue including the trophoblastic villi, This is also used in treating cancer that kills rapidly dividing cancer cells.

55
Q

What are the criteria to use methotrexate for treatment of unruptured ectopic pregnancy?

A

pregnancy mass <3.5 cm diameter
absence of fetal heart motion
beta-hCG levels <6000 mIU
no history of folic supplementation

if does not meet criteria, proceed to laparoscopy

56
Q

Limitation of transabdominal ultrasound in obstetrics?

A

affected by maternal habitus. Not usually used in obese patients.

transvaginal are utilized in first trimester, producing high resolution images that are not influenced by maternal BMI

57
Q

What is chorionic villus sampling and what is it for?

A

CVS biopsy is a prenatal test that involves taking a sample of tissue from the placenta villi to test for chromosomal abnormalities and certain genetic problem. the placenta and the fetus have similar genetic make-up.

58
Q

What is amniocentesis?

A

direct ultrasound guided aspiration of amniotic fluid containing amniocytes. This is used for neural tube defect screening. It involves biochemical analysis of AF-AFP and acetylcholinesterase.

59
Q

What is a percutaneous umbilical cord sampling (PUBS) and what is it for?

A

Ultrasound-guided aspiration of fetal blood from the umbilical vein after 20 wks gestation.

Used to test blood gases, karyotype, IgG and IgM antibodies.

Also used as therapeutic procedure for intrauterine transfusion with fetal anemia.

60
Q

What is a fetoscopy?

A

a transabdominal procedure performed with a fiberoptic scope in the operating room after 20 wks under general or regional anesthesia.

Indications: Intrauterine surgery and fetal skin biopsy.

61
Q

What is a cervical cerclage? purpose?

A

placing a suture the encircles the cervix to hold the cervical canal from dilating.

It is performed under regional or general anesthesia.

Purpose: Treatment for cervical insufficiency

62
Q

What is the frequent complication in first trimester of pregnancy?

A

spontaneous abortion?

63
Q

What is quickening? lightening?

A

quickening- maternal awareness of fetal movements detected around 16-20 wks

lightening-descent of the fetal head into the pelvis resulting in easier maternal breathing and pelvic pressure

64
Q

What are the common pregnancy danger signs?

A 
vaginal bleeding
vaginal fluid leakage
epigastric pain
uterine cramping
decreased fetal movements
persistent vomiting
headaches/visual changes
pain with urination
chills and fevers
65
Q

Possible diagnosis for a pregnancy complaint of VAGINAL BLEEDING

A

early (spontaneous abortion)

later (placental abruptio or previa)

66
Q

Possible diagnosis for a pregnancy complaint of VAGINAL FLUID LEAKAGE

A

membrane rupture

urinary incontinence

67
Q

Possible diagnosis for a pregnancy complaint of EPIGASTRIC PAIN

A

severe preeclampsia (enlarged liver with proteinuria)

68
Q

Possible diagnosis for a pregnancy complaint of UTERINE CRAMPING

A

preterm labor

preterm contractions

69
Q

Possible diagnosis for a pregnancy complaint of DECREASED FETAL MOVEMENTS

A

fetal demise/compromise

70
Q

Possible diagnosis for a pregnancy complaint of PERSISTENT VOMITING

A

hyperemesis (early)
hepatitis
pyelonephritis

71
Q

Possible diagnosis for a pregnancy complaint of HEADACHES/VISUAL CHANGES

A

severe preeclampsia

72
Q

Possible diagnosis for a pregnancy complaint of SEIZURES

A

eclampsia

73
Q

Possible diagnosis for a pregnancy complaint of PAIN WITH URINATION

A

cystitis

pyelonephritis

74
Q

Possible diagnosis for a pregnancy complaint of CHILLS AND FEVER

A

pyelonephritis

chorioamnionitis

75
Q

What are UNSAFE immunizations or vaccines for pregnant women?

A

live attenuated vaccines:

Measles, Mumps, Rubella (MMR)
Varicella
Polio (oral)
Yellow Fever

*intramuscular polio (IPV) is inactivated type of vaccine

76
Q

What are SAFE immunizations or vaccine for pregnant women?

A

killed or inactivated organisms

Influenza (all pregnant women in flu season)
Hepatitis B (pre- and postexposure)
Hepatitis A (pre- and postexposure)
Pneumococcus (for high risk women)
Meningococcus
Typhoid
77
Q

Differential diagnosis of LATE PREGNANCY BLEEDING

A

can be vaginal, cervical, or placental causes

Cervical erosion, polyps, carcinoma
Vaginal varicosities, laceration
Placental abruptio, previa, accreta, vasa previa

78
Q

Initial needed work-up for a pregnant who presents with late pregnancy bleeding

Initial management?

A

CBC
platelets, PTT, aPTT, fibrinogen, d-dimer
type and cross-match
sonogram

Insert IV line with large bore needle (isotonic without desxtrose if mother is unstable)
Insert urinary catheter to monitor urine output

79
Q

Define abruptio placenta

A

a normally implanted placenta separates from the uterine wall before delivery of the fetus.

partial or complete.

overt/external or concealed/internal

80
Q

Risk factors for occurrence of placental abruption

A 
hypertensive
cocaine abuse
maternal trauma
previous placental abruption
premature membrane rupture
81
Q

Management for placental abruption when mother or fetus is jeopardized or unstable?

A

emergency cesarean delivery

as long as there is jeopardy, do cesarean
Avoid cesarean delivery if the fetus is dead.

82
Q

Management for placental abruption when mother has heavy bleeding but the bleeding is well controlled or pregnancy is >36 weeks

A

Perform amniotimy and induce labor. Place external monitor to assess fetal heart rate pattern and contractions.

Avoid cesarean delivery if the fetus is dead.

83
Q

Complications of severe placental abruptio

A

hemorrhagic shock with acute tubular necrosis (hypotension)

DIC (release of tissue thromboplastin into the general circulation from disrupted placenta)

Couvelaire uterus (extravasating blood in the myometrial fibers)

84
Q

Define placenta previa

A

placenta is imppanted in the lower uterine segment.

common in early pregnancy but most often not associated with bleeding

85
Q

most likely diagnosis for a late trimester bleeding that is painless

A

placental previa

86
Q

Different classifications of placenta previa?

A

complete/total/central
partial
marginal or low-lying previa

87
Q

OB triad for placental previa

A

late trimester bleeding
painless
lower segment placental implantation

88
Q

What is a possible consequence of a placnta previa implanted in a previous uterine scar? management?

A

The villi may invade into the deeper layers of the desidua basalis and myometrium resulting to intractable placenta (accreta)

Management:esarean hysterectomy

89
Q

What do you call to a condition where the villi invade deeper than the superficial layers of decidua basalis?

A

placental accreta, increta, percreta

90
Q

Difference between accreta, increta, percreta

A

accreta invades the deepest layer of the desidua basalis but does not reach the myometrium yet

increta reaches the myometrium

percreta reaches the serosal layer

91
Q

What is vasa previa?

A

A condition in which fetal blood vessels cross or run near the internal opening of the uterus.

These vessels are at risk o rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.

92
Q

What is the classic triad for vasa previa?

A

Rupture of membrane,
painless vaginal bleeding,
fetal bradycardia

93
Q

What is the immediate management for a confirmed vasa previa?

A

Immediate/emergency cesarean delivery

Rationale: to prevent fetal death secondary to fetal hypovolemia

94
Q

What is an uterine rupture? What are its risk factors?

A

Spontaneous tearing of the uterus that may results in the fetus being expelled into the peritoneal cavity

RF are:
prior cesarean delivery (incision site)
myomectomy
excessive oxytoxin stimulation
grand multiparity
marked uterine distension
95
Q

Common presentation of a uterine rupture

A

vaginal bleeding
loss of electronic fetal heart rate signal
loss of station of fetal head (may be expelled to peritoneal cavity)
may occur before or during labor

Obstetrics and Gynecology (1 decks)

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