Section 8 - OB/GYN Flashcards
First step when a vaginal bleeder comes to the ED
pregnancy status/test
causes of vaginal bleeding in prepubertal female
sexual assault needs to be excluded, vulvovaginitis most common
causes of prepubertal vulvovaginitis
candidiasis, strep, e coli, shigella, viruses, pinworms
Cause of bleeding and vaginal discharge
foreign bodies
most common cause of vaginal bleeding in women of reproductive age
anovulation
most common cause of vaginal bleeding in postmenopausal women
exogenous estrogens, atrophic vaginitis, endometrial lesions (ca), tumors
treatment of patients with severe vaginal bleeding
conjugated estrogen 25 mg IV q2-6 hours, medroxyprogesterone when bleeding subsides
stable patients, treatment of DUB with a clear diagnosis
oral contraceptive, medroxyprogesterone, tranexamic acid
mittelschmerz
self-limited, unilateral, dull aching pain that occurs mid cycle from leakage of prostaglandin containing follicular fluid
image modality for pelvic cyst ruptured
pelvic/transvaginal ultrasound
image modality of choice for ovarian torsion
ultrasound with Doppler flow imaging
symptoms of endometriosus
recurrent pelvic pain with menstrual cycle, dysmenorrhea, dyspareunia
risk factors of ectopic pregnancies
PID hx, surgical procedures on tubes, previous ectopic pregnancy, IUD, assisted fertility.
classic triad of ectopic pregnancy
abdominal pain, vaginal bleeding, amenorrhea
definitive diagnosis for ectopic pregnancy
US or direct through surgery
labs for treatment of ectopic pregnancy
type and cross, call ob/gyn, give fluids
threatened abortion
vaginal bleeding in first 20 weeks, closed cervical os, benign exam, no passage of tissue
inevitable abortion
vaginal bleeding in first 20 weeks, dilated cervical os, benign exam, no passage of tissue
incomplete abortion
partial passage of conceptus
complete abortion
passage of all fetal tissue before 20 weeks gestation
missed abortion
fetal death at less than 20 weeks without passage of fetal tissue for 4 weeks after fetal death
septic abortion
infection during abortion with pelvic pain, fever, CMT, uterine tenderness, foul-smelling
differential diagnosis with ectopic pregnancy
implantation bleeding, gestational trophoblastic disease
gestational trophoblastic disease
hydatidiform mole, partial mole, trophoblastic tumor, choriocarcinoma
nausea and vomiting of pregnancy normally seen…
first 12 weeks of pregnancy
treatment of n/v with pregnant patients
- 5% dextrose in nl saline or LR
- metoclopramide, promethazine, odansetron
- doxylamine with pyridoxine at home
UTI in pregnancy treatment
- nitrofurantoin 100 mg PO twice daily
- amox 500 PO 3 times daily
- cephalexin 500 mg PO 4 times daily
time period when fetus is most at risk
2nd-8th week post conception
abruption placentae
premature separation of placenta from uterine wall
sx: vaginal bleeding, abd pain, uterine tenderness, hypertonic contractions, increased uterine tone, fetal distress, DIC
placenta previa
implantation of placenta over cervical os
sx: bright red vaginal bleeding, painless
diagnosis of abruption placentae vs placenta previa
transabdominal ultrasound before SSE or bimanual exam
clinical presentation of PROM
rush of fluid or continuous leakage of fluid from the vagina, pH greater than 7.0 and ferning pattern
what should you avoid if patient has PROM
no digital pelvic examination! - increase rate of infection, can do sterile speculum
what tests should be run for preterm labor (
GC, bacterial vaginosis, GBS, ultrasound
what meds should be used for preterm labor?
tocolytics with glucocorticoids, dex 6 mg IM
diagnosis of HTN in pregnancy?
systolic blood pressure > 140 or diastolic > 90 with two measrements prior to 20 weeks gestation
diagnosis of preclampsia?
HTN > 140/90 and proteinuria in patients 20 weeks gestion to 4-6 weeks after delivery
severe preeclampsia symptoms?
end organ involvement: HA, visual disturbances, metnal status changes, edema, oliguria, dyspnea, abdominal pain
symptoms of eclampsia?
HTN > 140/90 and proteinuria and seizures in patients 20 weeks gestation to 4-6 weeks after delivery
HELLP syndrome symptoms?
epigastric and RUQ abdominal pain
lab findings for severe preclampsia?
anemia, thrombocytopenia, elevated creatinine, elevated liver enzymes, elevated LDH
HELLP lab findings?
schistocytes on peripheral smear, platelet count lower than 150000, elevated AST/ALT
tx of severe preeclampsia or eclampsia?
mg sulftate 4-6 g over 20 min followed by maintenance infusion
- monitor reflexes
severe HTN tx?
labetalol 20 mg IV bolus with repeat boluses of 40-80 mg to max 300 mg or hydralazine 5.0 mg followed by 5 and 10 mg every 10 min
Diff diagnosis of postpartum hemorrhage?
uterine atony, uterine rupture, lac of lower genital tract, retained placental tissue, uterine inversion, coagulopathy
tx of uterine atony?
oxytocin 20 units NS at 200 mL/h, uterine massage
sx of postpartum endometritis? Time frame?
fever, lower abdominal pain, foul-smelling lochia
- several days after delivery
phys exam findings of endometritis?
CMT and discharge
labs for endometritis?
CBC, UA, cervical cx
tx for postpartum endometritis?
abx, clinda plus gent or cefoxitin
sx of mastitis?
swelling, redness, tender engorgement of breast
tx of mastitis?
diclox or cephalexin or clinda if PCN allergy
- continue nursing, pump if purulent discharge
sx of amniotic fluid embolism?
CV collapse with hypoxemia, seizures, DIC
braxton hicks contraction diagnosis?
false labor with irregular in intensity and duration contractions
what do you do if you have a palpable pulsating cord on bimanual examination?
keep hand on presenting fetal part and elevate, get in touch with ob right away –> CSECTION INDICATED
types of breech presentation with tx?
frank/complete - can deliver vaginally
incomplete/footling - cannot deliver vaginally, need csection
normal vaginal flora pH
3.8-4.5
sx of bacterial vaginosis
malodorous fishy smelling vaginal discharge
- vaginal irritation, excoriation, fissures
dx of BV
vaginal discharge, pH greater than 4.5, positive amine test, clue cells
tx of BV
metronidazole 500 mg PO 2 times daily for 7 days, clinda 300 mg PO 2 times daily for 7 days
pt susceptible to candida vaginitis?
DM, systemic abx, pregnancy, BCP
sx of candida vaginitis?
pruritus, vaginal discharge, external dysuria, dyspareunia, thick cottage cheese discharge
tx of candida vaginitis?
azoles vaginal tablets
trichomoniasis sx
frothy, malodorous vaginal discharge, vaginal erythema, vulvur irritation
trichomoniasis tx
metronidazole 2 g single dose or tinidazole 2 g single dose
