OG Flashcards
embryo
fertilization to 8 weeks
fetus
8 weeks to birth
developmental age
number of days since fertilization
gestational age
number of days/weeks since LMP
naegle rule
subtract 3 months, add 7 days
first trimester dates
12 weeks DA
14 weeks GA
second trimester dates
24 weeks DA
26 weeks GA
pre-viable
born before 24 weeks
post term
greater than 42 weeks
F-PAL
full term
preterm
abortions
living children
goodell sign
FIRST sign of pregnancy,
4 weeks
= softening of the cervix
ladin sign
softening of the midline of the uterus,
6 weeks
chadwick sign
blue discolouration of vagina and cervix
6-8 weeks
when does palmar erythema present
first trimester
when does chloasma present
16 weeks
when does linea nigra present
second trimester
US in pregnancy
CONFIRMS INTRAUTERINE
PREGNANCY=
beta hCG greater than 1500 OR
5 weeks= gestational sac on ultrasound
morning sickness caused by
increase in estrogen, progesterone, hCG
other GI complication of pregnancy
constipation
renal in pregnancy
INCREASE GFR–> decrease BUN/cr
haem in pregnancy
- anaemia
- hypercoagulable
most accurate way of establishing gestational age at 11-14 weeks
ULTRASOUND
triple screen
MSAFP, estriol, beta hCG
quad screen
+ INHIBIN A
triple and quad screening done when
15-20 weeks
after 36 weeks how often does the mum come to see the doctor
every week
braxton hicks that are continued
CHECK THE CERVIX
since real contractions will have a dilated cervix, vs. BH contractions= closed cervix
CBC done when
27 weeks,
if Hb less than 11 replace iron orally
glucose load
24-28 weeks, fasting or non fasting ingestion of 50g glucose and serum glucose checked 1 hr later
glucose tolerance test
FBG, 100g glucose and serum glucose check 1,2,3hrs
GDM if….
either glucose load or GTT is positive
postive glucose load
glucose greater than 140 send for OGTT
if gave them pregnant woman iron—>
give stool softener
CVS done during
10-13wks
Amniocentesis done during
11-14wks
strongest risk factor for ectopic pregnancy
PREVIOUS HISTORY of ectopic
contraindications to MTX
- immmunosuppressed
- liver disease
- non compliant
- greater than or equal to 3.5cm
- fetal heart
MCC spontaneous abortions
chromosomal abnormalities
work up for spontaneous miscarriage
- CBC
- blood type– RH
- US*******
what must be done for a miscarriage
ULTRASOUND– to determine what type of misacarriage
missed miscarriage
death of fetus, but all products of conception present in uterus
tx of threatened abrtion
bed rest,
pelvic rest
septic abortion
infection of uterus and surrounding areas
medical tx of misacarriages
PGE1 to dilate cervix for expulsion of products
when to stop delivery if….
24-33 EGA
600-2500g
when to deliver
34-37 EGA
greater than 2500g
list of conditions where you should NOT NOT NOT NOT NOT stop with tocolytics
- PET/ eclampsia
- maternal cardiac disease
- greater than 4 cm cervical dilation
- maternal haemorrhage
- fetal death
- chorioamnionitis
most commonly used tocolytic
magnesium sulfate
side effects of magnesium sulfate
- RESPIRATORY DEPRESSION
and cardiac arrest— thus nb to check DTRs often
commonly used tocolytics
- magnesium sulfate
- CCBs
- terbutaline
- NOT NOT NOT NOT NOT NOT NOT indomethacin
preterm fetuses WITHOUT chorioamnionitis
tx= betamethasone
what type of US for placenta previa
TRANSABDOMINAL
complete previa
completely covers the internal cervical os
partial previa
partially covers the internal cervical os
marginal previa
on the MARGIN, adjacent to internal os, touching the edge of os
low lying placenta
NOT covering the internal os– more than 0cm, but less than 2cm away; implanted in the lower uterine segment
tx for placenta previa
STRICT PELVIC REST– NOTHING INTO VAGINA
risk factors for abruption
- HTN
- previous hx
- cocaine
- external trauma
- smoking
MCC DIC in pregnancy
placenta abruption
complications of concealed placental abruption
- DIC
- uterine tetany
- fetal hypoxia
- fetal death
- sheehan syndrome
tx of uterine rupture
LAPAROTOMY ASAP– since baby could be outside of the uterus floating around in the abdomen
gestational HTN
bp greater than 140/90mmHg without proteinuria or edema
mild preclampsia
greater than 140/90
dipstick 1+-2+
24hr urine greater than 300mg
edema in mild PET
hands, feet, face
edema in severe PET
GENERALIZED
32-36 weeks test needed
NST: fetal well being
US: fetal size
greater than 36 weeks test needed
twice weekly testing
1 NST
1 BPP: AF and fetal well being
37 weeks test needed
L/S ratio
38-39 weeks if patient refuses L/S ratio
NO TEST– INDUCE LABOUR
tx for GDM
diet and exercise
do NOT NOT NOT NOT tell them to lose weight
macrosomia, when should US be done
if fundal height is greater than 3cm
earl deceleration
decrease in HR that occurs with contractions
HEAD COMPRESSION
variable decelerations
decrease in HR and return to baseline with no relationship to contractions
UMBILICAL CORD COMPRESSION
late decelerations
decrease in HR after contraction started. no return to baseline until contractions ends
FETAL HYPOXIA
lightening
fetal descent into pelvic brim
stage 1
labor–> cervical dilation
primi: 6-18hrs
multi: 2-10hrs
latent phase
labor–> 4cm
primi: 6-7hrs
multi: 4-5hrs
active phase
4cm–> full
primi: 1cm/hr
multi: 1.2cm/hr
stage 2
cervical dilation–> delivery neonate
primi: 30-3hrs
multi: 5-30 minutes
stage 3
delivery neonate–> delivery placenta
30 minutes
what not to give asthmatic pregnant women
PROSTAGLANDINS–> bronchospasm
protracted cervical dilation causes
3P’s
- power: strength and frequency of uterine contractions
- passenger: size and position of fetus
- passage: passenger larger than pelvis= cpd
TX OF cpd
CS
arrest disorders
- cervical dilation
- fetal descent
cervical dilation arrest
no cervical dilation for past 2 hrs
fetal descent arrest
no fetal descent for 1 hour
frank breech
hips F
knees E
complete breech
hips F
knees F
footling breech
feet first
- complete= both feet
- incomplete= 1 foot
up until what point is it okay for baby to be breech
36 weeks
PPH extra side note
assure there is no rupture of the uterus
premenstural dysphoric disorder
PSYCHIATRIC DISORDER
vaginal diaphragm…
USELESS without the jelly
6hrs before
6hrs after
labial fusion
21 beta hydroxylase deficiency
- excess androgens
- reconstructive surgery
chronic irritation of vulva with hyperkeratosis (Raised white lesion)
squamous cell hyperplasia
tx squamous cell hyperplasia of vulva
sitz baths or lubricants
PC bartholins
- PAIN PAIN PAIN
- dyspareunia
tx bartholins
incision and drainage
–> MARSUPIALIZATION= allow the space to remain open
bilateral pagets of vulva
radical vulvectomy
unilteral pagets of vulva
modified vulvectomy
PC SCC of vulva
PRURITUS
stage 0 SCC vulva
CIS
stage 1 SCC vulva
vaginal wall, less than 2 cm
stage 2 SCC vulva
vulva or perineum more than 2 cm
stage 3 SCC vulva
tumor spreading to lower urethra or anus, unilateral lymph nodes present
stage 4 SCC vulva
tumor invasion into bladder, rectum, or bilateral lymph nodes
stage 4a SCC vulva
distant mets
unilateral LNs SCC vulva tx
modified radical vulvectomy
bilateral LNs SCC vulva tx
radical vulvectomy
PC adenomyosis
- dysmenorrhea
- menorrhagia
dx of adenomyosis
CLINICAL
- large, globular, boggy uterus
most accurate dx of adenomyosis
MRI
definitive dx of adenomyosis
hyterectomy
tx of adenomyosis
HYSTERECTOMY
rf for endometriosis
FDR with endometriosis
pain in endometriosis
cyclical– 1-2 weeks before menses
exam for endometriosis
nodular uterus and adnexal mass
SE’s danazol
- acene
- oily skin
- weight gain
- hirsuitism
