Random Flashcards
Vaginismus treatment
Relaxatin, Kegels, insertion of dilators/fingres to desensitize
Risks to fetus with GDM (6)
Macrosomia Hypocalcemia Hypoglycemia Hyperviscosity/polycythemia: Hyperglycemia induces increased BMR which leads to fetal hypoxia and increased EPO production Respiratory problems Cardiomyopathy and CHF
Management of LSIL on pap
Premenopausal women
-at higher risk of CIN 2/3 so always follow up with colpo
Postmenopausal women -immediate colpo or -reflex HPV testing; colpo if positive or -repeat pap at 6 and 12 mos; colpo if abnormal
Management of CIN1 found on colpo
CIN1 preceded by low grade abnormalities
-repeat pap at 6 and 12 mos with colpo if pos
or
-HPV test in 12 mos and colpo if pos
CIN1 preceded by high grade abnormalities
-diagnostic excisional procedure (LEEP or cold knife)
or
-repeat pap and colpo at 6 and 12 mos with diagnostic excisional procedure or continued abnormlities
Work up of primary amenorrhea, uterus present
1) FSH level: distinguishes hypothalamic/pituitary (central) prolbem from gonadal problem
- if FSH elevated, gonadal, go to karyotype
- if FSH low, central, go to pituitary MRI
BPP: five parameters
1) NST - reactive
2) fetal tone - flexing or extending extremity
3) fetal movements - 2/30mins
4) fetal breathing movements - 20s/30m
5) amniotic fluid volume - pocket with greater than 2cm vertical diameter
BPP: management
8-10: normal
6without oligo: delivery if over 37 wks, repeat in 24 hours with delivery if unimproved if less than 37 wks
6 with loligo: delivery if over 32 weeks; daily monitoring if less than 32 weeks
4 or less: delivery if over 28 weeks
Management of excess N/V in pregnancy
1) measure beta hCG
2) if very high, ultrasound
Pathophys of stress incontinence
Weakened pelvic floor - urethral hypermobility with angle over 30% with increaesed intraabdominal pressure
Best rx is urethropexy to restore urethrovesicular angle
Physiologic leukorrhea
Copious white or yellow discharge without other symptoms
Management of symptoms of hyperprolactinemia
Measure both PRL and TSH beause hypothyroid can cause elevation of PRL; if isolated high PRL then MRI pituitary
Ruptured corpus luteum cyst in pregnancy
Causes hemoperitoneum in pregnancy: blood in abdomin irritates peritoneal lining resulting in severe pain, distension, and rebound. Can be confused with ectopic which is the most common cause of hemoperitoneum in setting of pos UPT.
If cyst is removed prior to 10-12 wks gestation, need to supplement progesterone
Surgical site infections
Fascial disruption: see copious peritoneal fluid escaping wound 7-10 days out; requires immediate surgical closure and broad spec antibiotics; usually caused by suture tearing through fascia
Superficial separation: open woun and drain purulence, broad spec antibiotic
Evisceration: protrusion of bowel or omentum through incision
Treatment of pyelonephritis
Treatment with antibiotics can cause bacterial lysis and endotoxemia, which can cause ARDS or preterm labor. Put on suppressive oral therapy for remainder of pregnancy due to high recurrence rate. Lack of improvement within 48 hrs of antibiotics suggests a urinary tract obstruction
CIs to mirena
recent STI, high risk for STI, anormal size/shape of uterus
Early HTN in pregnancy
HTN less than 20 wks either molar preg or chronic HTN
Third tri back pain etiology
Lumbar lordosis
Turner syndrome labs
Poor ovarian fx causes high FSH due to lack of neg feedback
PRemature ovarian failure/menopause labs
Elevated FSH and LH with FSH greater than LH due to slower clearance
BV vs trich presentation
Trich more associated with pruritus and inflammation
UTerine rupture presentation and distinguishing from previa
Presents with intesnse abdominal pain and vaginal bleeding. Pain progresses from acute pain of rupture to slight relief to diffuse pain. See retraction of presenting part and easier palpation of fetal limbs at abdomen, distinguishing from previa. Hypovolemia
Management of vaginal cancer
Stage I/II less than 2cm: surgery
Stage I/II greater than 2cm: radiation
Primary dysmenorrhea: presentation, pathophys, and treatment
Presentation: lower abdominal pain radiating to thighs and back; begins hours prior to menstruation
Pathophys: release of PGs during breakdown of endometrium (higher PG levels in women with primary dysmenorrhea)
Rx: NSAIDs to lower PGs
Treatment of AI
Gonadectomy to decrease testicular cancer risk AFTER completion of breast development and attainment of full adult height
Ruptured fetal umbilical vessels: presentation, diagnosis, pathophys, treatment
Presentation: antepartum hemorrhage with characteristic sinusoidal (bradycardia to tachycardia) FHR tracing
Diagnosis: Apt test which differentiates maternal and fetal blood
Pathophys: vaso previa (fetal vessels located between baby and cervical os) leaving them vulnerable to tearing during SROM or AROM
Treatment: crash section due to high fetal mortality rate
Arrest of descent def
Lack of change in 2hours for nullip/1 hour for multip (add 1 hr if epidural)
Hypotension with epidural
Caused by symp fiber block that leads to vasodilation in lower extremities and venous pooling
Postterm pregnancy monitoring
twice weekly US to monitor for oligo
Risk factors for uterine inversion
Anything that overextends uterus (grand multiparity, multiple gestation, poly, macrosomia)
Number one risk factor is iatrogenic- excess cord traction
Betamethasone effects on fetus
1) increases lung maturity and decreases resp distress syndrome
2) decreases ICH risk
3) decreases necrotizing enterocolitis risk
NO increased risk of infection in newborn
IUGR management
If accompanied by oligo, induce labor
If reassuring fetal testing, deliver at 37 weeks
Folate dose in women with prior NTD
4mg
Amniotic fluid parameters in chorio
Decreased glucose
Increased IL-6
Increased leukocytes but low pos predictive value
Weight gain recommendations
Underweight: 28 to 40 pounds
Normal weight: 25-35 pounds
Overweight: 15-25 pounds
Obese to any degree: 11-20 pounds
Pelvic congestion syndrome
CPP in setting of pelvic varicosities; presents with pelvic fullness/heaviness
Tamoxifen therapy monitoring for endometriosis
Annual exams. Only do endometrial biopsy if symptoms (bleeding or abnormal discharge) present because not used for screening
Copocleisis
Surgical obliteration of the vaginal to treat severe prolapse. Good for those with comorbidities because can be done quickly without any general anesthesia
Management of newborns with mec-stained amniotic fluid
Don’t suction routinely. If newborn depressed, intubate trachea and suction mec from beneath glottis
Cervical lesions: polyp vs cancer vs cyst
Cervical polyp: soft, bleeds
Cervical cancer: hard/nodular, bleeds
Nabothian cyst: doesn’t bleed
Fetal dysmaturity
Associated with advanced gestational age and small placenta. Withered, mec-stained, long-neailed, fragile infant. High risk for stillbirth
Highest risk cardiac conditions in pregnancy
Pulm HTN, aortic coarct with valve involvement, and Marfan with aortic involvement have 25-50% mortality rate
Tocolytics
CCBs (nifedipine) Beta agonists (terbutaline and ritodrine): contraindicated in diabetics, not usually used Indomethacin: CI after 32 weeks due to risk of PDA closure
Pruritus gravidarum
Mild version of cholestasis of pregnancy. Retention of bile salts resulting in bile salt deposition in dermis.
Initial rx: antihistamines and topical emollients
If ineffective, ursodeoxycholic acid or naltrexone
Pre-e urine protein
Over 300mg for diagnosis
Over 5000mg for severe pre e
ABG in pregnancy
Compensated resp alkalosis due to increased minute ventilation
Lewis antibodies
IgM; don’t cross placenta
IUGR complications
Fetal/perinatal demise
Meconium aspiration
Polycythemia
Preterm labor rx
Tocolytic + betamethasone + ampicillin if GBS status unknown
Lichen planus
Chronic derm disorder affecting hair-bearing skin, scalp, nails, oral mucosa, and vulva. Flares and remits. Vulvar irritation, burning, pruritus, burning, pain. Lacy reticulated pattern of labia and perineum. Can get scarring, erosions, adhesions
Lichen sclerosus
Whitening and thinning of perineal tissue seen in postmenopausal women, precursor to SCC. Extreme vulvar pruritus, burning, pain, dysparenunia
Management of heavy bleeding after medical abortion
Most likely due to retained products of conception. Manage with D&C
Indications for cold knife conization
Pos endocervical curretage; HSIL too large for LEEP; intolerance of exam; lesion beyond vision; rule out invasive cancer
Imipramine
TCAD that can increase prolactin level
Indications for colpo
Any pap abnormality (including ASCUS) associated with pos HPV
Cervical incompetance management
Progesterone can be used by not evidence based
Place cerclage at 14 weeks
Ovarian cyst management
Repeat US. Hemorrhagic cyst should self-resolve
Cystocele repair
Fix defects in pubocervical fascia or reattach it to sidewall if separated from white line
External cephalic version requirements
- reactive NST
- no contraindications to vaginal delivery
- 37wks to onset of labor
Amniotic fluid embolism presentation and management
Pres: sudden resp failure, cardiogenic shock, seizures, can lead to DIC
Management: adequate resp support number one priority
Methyldopa
Centrally acting alpha agonist used for HTN in pregnancy
Indications for endometrial biopsy in women with dysfunctional bleeding
Age over 35, obesity, chronic HTN, diabetes
Fetal hydantoin syndrome
Caused by exposure to anticonvulsants in utero - most often phenytoin and carbamazepine. Midface hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, developmental delay
Septic abortion management
Obtain blood and cervical cultures, then start antibiotics immediately. Gentle suction curretage - risk of uterine ruptur if aggressive
3Ds of endo
Dyspareunia
Dysmenorrhea
Dyschezia
Treatment of dysfunctional uterine bleeding in adolescent
Mild - iron supplement
Mod to severe: iron + high dose estrogen
Graves disease in pregnancy
Thyroid stimulating antibody can persist for several months following thyroidectomy. Can cross placenta (IgG) and cause thyrotoxicosis in fetus. Levo does not cross
Luteoma of pregnancy
Benign bilateral solid ovarian masses. Can cause hirsutism and virilization. No treatment needed
L/S ratio
Greater than 2 indicates fetal lung maturity
