Repro Flashcards
which hormone rises day 0 to day 14 in the menstrual cycle
estrogen
which hormone rises day 14 to day 28 in the menstrual cycle
progesterone
what hormone spikes on day 14 in the menstrual cycle to trigger ovulation
LH
how do you treat cystitis in pregnancy
amoxicillin or macrobid x 7-14 days
sulfisoxazole unless the last week of pg
describe the pap screening guidelines
start at 21
q3y age 21-29
q5y age 30-65 with hpv
discontinue at 65+
what are 4 reasons you wouldn’t discontinue paps at age 65+
hx CIN2
hx CIN3
hx adenocarcinoma in situ
recent + screening
patient is age 21-24
pap comes back + for ASCUS or LSIL
what is the management
repeat pap in 12 mos
if negative, repeat pap in another 12 pos
if negative then - routine screening
if positive then - colposcopy
patient is age 21-24
pap comes back + for HSIL, ASC-H, AGC
what is the management
colposcopy
patient is age >/ 25
pap is negative
hpv is positive
what is the mgmt
repeat pap in 12 mos
if both negative - routine screening
if either are positive - colposcopy
patient is age >/ 25
pap shows ASCUS
hpv is negative
what is the mgmt
repeat hpv cotest every 3 years
patient is age >/ 25
pap shows ASCUS
hpv is positive
what is the mgmt
colposcopy
patient is age >/ 25
pap shows LSIL
hpv is negative
what is the mgmt
repeat hpv cotest every 1 year
patient is age >/25
pap shows LSIL, HSIL, AGC, or ASC-H
hpv is positive
what is the management
colposcopy
in ectopic pg what happens to hcg
it fails to double every 24-48 hours
at what point in pregnancy does a molar pg occur
from 6 weeks to 4-5 months
what are the symptoms are molar pregnancy
painless bleeding
uterus size discrepancy
hyperemeis
what does US show with molar pregnancy
cluster of grapes
or
snowstorm appearance
how to treat molar pregnancy
curettage
what can molar pregnancy lead to?
choriocarcinoma
1st trimester bleeding no POC expelled os is closed bloody vaginal discharge \+/- ctx
what is it, and whats the tx
threatened abortion
tx = rest and follow hcg
pregnancy bleeding
bleeding is > 7 days with cramping
cervix dilated >3cm, +/- membrane rupture
no POC expelled
what is it and what’s the tx
inevitable abortion
tx = D+E
pregnancy bleeding bleeding is heavy, cramping, with retained tissue boggy uterus cervix is dilated some POC expelled
what is it and what’s the tx
incomplete abortion
tx = D+C, pitocin
pregnancy bleeding
pain, cramping, bleeding that stops
os is closed
uterus is pre-preg size
what is it and what’s the tx
complete abortion
tx = none
pregnancy bleeding
brown discharge, no pregnancy sx
os closed, no POC expelled
embryo not viable but is retained
what is it and whats the tx
missed abortion
tx = D+C/E
as a general rule when do you do D+C versus D+E
D+C is 1st trimester
D+E is 2nd trimester
3 causes of 3rd trimester bleeding
placenta previa
abruptio placenta
vasa previa
3rd trim: sudden painless bright red bleeding and soft, nt fetal HR normal pelvis US shows placenta implanted near to os, partially or completely covering fetus' head
dx and tx?
placenta previa
hospitalize for bedrest
stabilize w tocolytics (mag sulfate) to stop ctx
perform amniocentesis to check lung maturity
then deliver baby
when can you give steroids for lung maturity
24-34 weeks
3rd trim: continuous, painful, dark red bleeding severe abd pain, rigid uterus \+/- sx of shock fetal distress w/ bradycardia pelvis US shows placenta prematurely separated from the uterus
dx and tx?
abruptio placenta
hospitalize to stabilize
immediate delivery
what MC causes abruptio placenta?
what can abruptio placenta lead to?
MC cause HTN
can lead to DIC
3rd trim:
painless vaginal bleeding with rupture of membranes
fetal distress with bradycardia
US shows fetal vessels crossing over the os
dx and tx?
vasa previa
immediate C section
when is the prenatal screen for gestational DM
24-28 weeks
two diagnostic tests for gestational DM and results?
- Screening
50g oral glucose test
Fail test if 140+ after 1 hour
2. Gold standard 3 hour oral glucose tolerance test Fail test if 180+ after 1 hour 155+ after 2 hours 140+ after 3 hours
management / birth plan of gestational DM
insulin
deliver at 38 weeks
when does mom need rhogam
if she is rh negative
what are signs of a rh incompatible baby
hemolytic anemia, jaundice, kernicterus, hsm, fetal hydrops
where does fluid build up in fetal hydrops
heart - CHF
pericardium - pericardial effusion
lungs - pleural effusion
liver - ascites
when do you give RhoGam
at 28 weeks gestation
and within 72 hours p birth of Rh + fetus
tests for PROM? (3)
NITRAZINE test to check ph
FERN test to check amniotic fluid pattern
speculum test
management for PROM?
wait for labor and monitor for infx
what is premature labor defined as
before 37 weeks
patient is before 37 weeks gestation with sx of labor
explain the 3 categories of cervical dilation/effacement and how likely labor is
- dilated < 2cm, effaced < 80%, labor unlikely
- dilated 2-3cm, effaced <80%, labor likely
- dilated > 3cm, effaced >80%, labor definite
management of premature labor (3)
- tocolytics to suppress ctx x 48h
- steroids for lungs
- abx maybe - GBS
when can you dx gestational HTN
after 20 weeks
what is HELLP syndrome
pre-eclampsia can cause HELLP syndrome
Hemolytic Anemia, Elevated Lft’s, Low Platelets
management of pre-eclampsia
plan for delivery at 34-36 weeks
+/- BP meds
management of eclampsia
mag sulfate for seizures
deliver as soon as pt is stable
definite BP meds
