Reproductive Pearls - Sheet1 Flashcards
Low-dose combination oral contraceptives must be stopped in a smoker at age
35: After age 35, the associated risks of smoking and oral contraceptive use for deep venous thrombosis, cerebral vascular accidents, and myocardial infarctions are increased significantly. The patient should be counseled on estrogen-free methods of contraception.
The “gold standard” for diagnosis of abnormal uterine bleeding is
Uterine Dilation and Curettage- Especially when done with hysteroscopy, uterine dilation and curettage can be diagnostic and therapeutic
what is the incidence for dizygotic (fraternal) twins in the United States?
1 in 90 - The incidence of dizygotic (fraternal) twins within the United States is approximately 1 in 90 pregnancies; it is slightly higher in African Americans and is lower in Caucasians
What is the incidence for monozygotic (identical) twins in the United States?
1 in 250 - The incidence for monozygotic (identical) twins is approximately 1 in 250 pregnancies.
A breastfeeding woman presents 3 weeks postpartum complaining of unilateral breast pain, fever of 102°F, and chills. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation. The most likely diagnosis is:
Infectious mastitis - Onset of infectious mastitis is >1 week postpartum. Treatment of choice is cloxacillin, dicloxacillin, nafcillin, or a cephalosporin. The mother should continue to nurse or pump and use warm soaks and oral pain relief
During which interval in pregnancy to should patients be screened for gestational diabetes?
Between 24 and 28 weeks gestation - The American College of Obstetricians and Gynecologists recommends that pregnant women at low risk for gestational diabetes mellitus have a glucose tolerance test between 24 and 28 weeks of gestation because, by this point, the condition has manifested and can be detected.
A woman presents to the emergency department 10 weeks after the first day of her last menstrual period complaining of bright red vaginal discharge. She denies abdominal cramping. Physical examination discloses blood in the vaginal vault, closed cervix, without evidence of passage of tissue. Which type of abortion does this represent?
Threatened abortion- A threatened abortion is characterized by bleeding ranging from spotting to profuse, brown to bright red, occurring before 20 weeks of gestation. Pelvic examination discloses blood in the vaginal vault with evidence of bleeding from the cervical opening, a closed and uneffaced cervix, and no evidence of the passage of tissue. – Inevitable abortion is characterized by rupture of membranes and cervical dilation before 20 weeks. – Completed abortion is characterized by spontaneous expulsion of the products of conception. – A missed abortion is defined as death of the fetus before 20 weeks of gestation without expulsion of the products of conception. – In an incomplete abortion, retained fetal tissue is present following a spontaneous, partial abortion.
Clinical breast examination should be performed by a clinician at what time of the menstrual cycle?
Days 5 to 7 of the menstrual cycle - Less fluid retention and hormonal influence is present in the breast tissue 5 to 7 days into the menstrual cycle, allowing for a better and more thorough examination. Breast tissue may retain fluid and therefore be more difficult to examine at the onset of menses. Hormonal influence may affect the breast tissue during ovulation and during days 8 to 25 of menstrual cycle. Hormonal influence and fluid retention may affect the breast tissue during days 16 to 25 of menstrual cycle.
Preterm labor is defined as occurring before _____ weeks gestation?
37 - Preterm labor is characterized by regular uterine contractions, abdominal examination disclosing a gravid abdomen before 37 weeks of gestation, cervical effacement, cervical dilation, and/or descent of the fetus into the pelvis.
A serum quantitative human chorionic gonadotropin (hCG) assay can detect the presence of hCG as early as ____ days after conception
5 days - A serum quantitative human chorionic gonadotropin (hCG) assay can detect the presence of hCG as early as 5 days after conception. A urinary pregnancy test detects hCG 14 days after conception
The best diagnostic study for management of uterine leiomyomas is:
Pelvic ultrasound
What are the classic clinical features of ectopic pregnancy?
Abdominal pain and bleeding - The typical presentation of a patient with an ectopic pregnancy is abdominal pain and vaginal bleeding.
When should Rh immune globulin (RhIG) be given to a mother
Administration of Rh immune globulin (RhIG) at 28 weeks or at times when there may be a transfer of blood with mother and fetus in the Rh-negative mother with Rh-positive father is used to prevent hemolytic disease of the newborn. – Prevention in mother: 200 ug RhoGam (RH immune globulin - pooled anti-D IgG binds to fetal RBCs to prevent maternal mixing). Given if Rh negative mother and father Rh positive or unknown. – Given at 28 weeks gestation after potential mixing of blood. Also given within 72 hours of delivery of Rh positive fetus.
Microscopic examination of vaginal discharge reveals clue cells on the wet mount. What is the most likely diagnosis?
Bacterial vaginosis presents with abnormal vaginal discharge with a slight odor. Clue cells are seen on a wet mount of the vaginal discharge. Candidias may present with similar symptoms but would reveal budding yeast on a KOH smear. Trichomoniasis would reveal the protozoan Trighomonas vaginalis and white cells with microscopic examination.
Treatment for Trichomonas vaginalis
Trichomoniasis is a protozoan infection and should be treated with a one-time dose of 2 grams of metronidazole
When should the pregnant patient be screened for Group B Streptococcus (GBS)?
35-37 weeks - GBS is caused by the pathogen Streptococcus agalactiae and is typically asymptomatic in the pregnant patient. Left untreated newborns can become infected and develop septicemia, pneumonia and meningitis. Women nearing delivery at 35-37 weeks should be tested and treated prophylacticaly for positive cultures to prevent neonatal infection. In the case of premature rupture of membranes and preterm labor, women should be treated prophylacticaly, ideally within 4 hours of labor.
Risk factor for fetal genetic disorders?
Maternal age greater than 35 years, previous pregnancies affected by abnormalities, history of early pregnancy loss and ethnicity have all been associated with increased risk of genetic abnormalities. Additionally, paternal age of greater the 50 years has been associated with higher risks.
When should a serum triple screen (AFP, hCG, PAPP-A) be offered to a pregnant female?
Between 15-18 weeks gestation
What genetic disorder does a serum triple screen test for?
Trisomy 21 (Downs Syndrome). - A serum triple screen includes assessment of Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A). This test is used to screen for Trisomy 21 (Downs Syndrome).
A pregnant female at 12 weeks gestation presents with a 7 day history of mild vaginal bleeding. Over the last 2 days she describes increased uterine cramping with vaginal discharge and bleeding. Denies passage of conceptus. Physical examination reveals ruptured membranes, moderate effacement of the cervix and cervical dilation of 4cm. What is the most likely diagnosis?
Inevitable abortion - Inevitable abortions present with a bleeding history of several days , uterine cramping, rupture of membranes, cervical dilation > 3cm and effacement with no expulsion of the products of conceptio
A pregnant female at 16 weeks gestation presents with an incomplete abortion and continued bleeding. What is the most appropriate clinical intervention for this patient?
Dilation and evacuation - An incomplete abortion is the expulsion of part of the products of conception. A dilation and evacuation is necessary to remove the remaining products.
The drug of choice for the medical management of unruptured ectopic pregnancies that are ≤ 4cm is:
Methotrexate - given as multiple dose, single dose or 2-dose therapy as medical treatment for the termination of unruptured ectopic pregnancies.
Tocolytic agent used in the treatment of pre-term labor to suppress uterine activity.
MgSO4 - Magnesium sulfate is a tocolytic agent used in the treatment of pre-term labor to suppress uterine activity.
Individuals presenting with pre-term labor should be managed with _________ therapy to suppress uterine activity and __________ to accelerate fetal lung maturity if there are no contraindications for use.
Tocolytics, corticosteroids - Pre-term labor should be managed with tocolytic therapy to suppress uterine activity. Magnesium Sulfate and β-adrenergic agonists (terbutaline) are most commonly used. In addition, a single course of antenatal corticosteroids (Betamethasone or Dexamethasone) can be administered to accelerate fetal lung maturity.
When should a patient be screened with a 50-g glucose challenge for gestational diabetes
between 24 and 28 weeks gestation
What constitutes a normal result after a 50-g glucose tolerance test
Results <140mg/dL are normal and require no further evaluation or treatment. If the results are >140mg/dL an OGTT should be obtained to confirm the diagnosis of gestational diabetes. If 2 out of 4 of the blood sugar levels are elevated in the OGTT, patients will require careful treatment to include dietetic counseling, exercise and many times, pharmacologic therapy. Pharmacologic therapy of choice is insulin.
A 28-year-old P1G0 pregnant female presents for a prenatal visit at 37 weeks. The pregnancy has been unremarkable thus far. Her blood pressure (BP) is 148/94 mm Hg, and urine dipstick shows +1 proteinuria. After further monitoring, her BP remains elevated. What would be the most appropriate treatment option?
Schedule the patient for an induced vaginal delivery – This patient has mild preeclampsia. Delivery is the only cure, and can be accomplished after 36 weeks.
A patient presents at 30 weeks gestation with a blood pressure of 164/118 mm Hg, and complains of nausea and upper abdominal pain. Lower extremity edema is present. No seizure activity has occurred. What is the most likely diagnosis? A. Eclampsia; B. Severe preeclampsia; C. Mild preeclampsia
Severe preeclampsia - This scenario meets the criteria for severe preeclampsia. Eclampsia is diagnosed upon development of seizure activity.
