SHELF Flashcards
Best screening for trisomy 21
Cell-free DNA testing
Preventing Meconium Aspiration Syndrome
Newborn depression with present meconium
=»Intubate the trachea and suction meconium from beneath the glottis
Infant appearance from a maternal Type I Diabetic
Small and hypoglycemic
Septic baby appearance
Pale, elevated temperature, and lethargic
RFs for babies born to diabetic mothers
Hypoglycemia
Polycythemia
Hyperbilirubinemia
Hypocalcemia
Respiratory distress
Safest method to suppress lactation
Breast binding, ice packs, and analgesics
Signs of adequate feeding in an infant
3-4 stools/24hrs
6 wet diapers/24hrs
Weight gain
Swallowing sounds
First evaluation in suspected ectopic
Repeat B-hCG in 48 hrs
Uterine perforation signs
2-3 days post D/C:
N/V
Abdoinal pain
Scant bleeding
Fever
Immediate management of unstable spontaneous abortion
D/C
Tx for respiratory depression due to Mag therapy
Calcium gluconate
Greatest gestational concern for obese women
Development of HTN
SLE outbreak tx.
Corticosteroids
Teratogenic SSRI
Paroxetine
Diagnostic test for appendicitis in pregnant ladies
Graded Compression Ultrasound
Hydrops fetalis signs
Can be identified by the collection of fluid in 2 or more body cavities (pleural/pericardial effusion, ascites, cerebral edema)
- Due to failure of liver to produce protein
- Can also see hepatosplenomegaly
Prevention of preterm delivery in multifetal gestation
Adequate weight gain
Sequelae of TTS in surviving twin
Neurologic sequelae
Cytotec
Misoprostol; used to induce labor
Terbutaline
B-agonist used to decrease uterine intracellular cAMP and decrease contraction rate
ADRs: Tachycardia
Hypotension
Anxiety
Chest pain
-Do not use this drug for more than 48 hrs
Greatest RF for PROM
Genital tract infxns
Decreased amniotic glucose in amniocentesis may indicate what?
Chorioamnionitis
CI’d drugs after PPH
Ergot alkaloids
PPH management
- Uterine massage
- Oxytocin
- If necessary, a Bakri Balloon
Most common source of fever on post partum Day 1
Lungs
Post term pt. testings
Biweekly NSTs and AFIs
Crown-rump length
Measured on transvaginal ultrasound to accurately date a pregnancy within 5-7 days
Most likely complication following BTL
Pregnancy
Hysteroscopic Tubal Occlusion
Essure
The placement of coils into the fallopian tubes that cause scarring to block the tubes
- must use back OCP for 3 months
- confirm blockage w/ HSG
Antiphospholipid antibody syndrome tx
Aspirin + Heparin
Lichen planus
Chronic dermatologic disorder manifesting as inflammatory mucocutaneous eruptions characterized by remissions and flare ups
Symptoms: irritation, burning, pruritis, bleeding, dyspareunia
-Pts. may also have extra vulvar lesions such as oral ulcers and alopecia
Urge incontinence tx.
Oxybutinin (anticholinergic)
RFs for pelvic organ prolapse
Increasing parity
Increasing age
Obesity
CT disorders
Chronic constipation
Urethral bulking procedure
Treats intrinsic urethral sphincter deficiencies
Tx. of hemorrhagic cyst
Ultrasound monitoring
Tx of ovarian torsion
Exploratory surgery
Precocious puberty tx
Clomiphene (GnRH agonist)
Imperforate hymen
Incomplete genital plate separation
Sx: Abdominal pain worse with periods; amenorrhea
Test indicated for amenorrhea
FSH
Postpartum Telogen Effusion
High E2 levels following delivery and during pregnancy that can potentially lead to hair loss
OCP mechanism of pain reduction in dysmenorrhea
Endometrial atrophy caused by the progestin reduces the amount of prostaglandins produced by the proliferating endometrium
Post-menopausal womens daily Ca2+ requirement
1200mg/day
Severe menopausal tx.
Lowest effective dose of OCP for the shortest time possible
Estrogen Hormone therapy effect on lipid levels
Increased: HDL, TGLs
Decreased: LDL
Imipramine
SSRI assoc. w/ hyperprolactinemia
-If pt. desires to be pregnant, they should be weened off this drug
Clomiphene Challenge Test
Helps to determine ovarian reserve in perimenopausal pts.
Vitamin Deficiencies assoc. w/ PMDD
Vitamin A, E, and B6
Most common location of vulvar adenocarcinoma beginning
Bartholin gland
-Be on the lookout for non-tender masses here
Multifocal VIN 2 tx.
CO2 laser ablation
Most common sx. w/ fibroids
Menorrhagia
Biggest RF for endometrial carcinoma
Complex atypical hyperplasia
Workup following endometrial cancer diagnosis
CXR
-Lungs are the most common site of metastasis
General Stress Incontinence tx.
Retropubic urethopexy (urethral bulking procedure)
-This fixes the urethral hypermobility
Tx of thyroid storm in pregnancy
Radioactive iodide
-Only use because it’s so dangerous
Bleeding in a woman > 40 yrs old
Always get an endometrial biopsy
RFs for FGR
CVD
HTN
COPD
Diabetes
Late deceleration
Alteration in uteroplacental diffusion that can be caused by any maternal disease that causes vascular damage
-Can progress to placental abruption
Tx for secondary arrest of acute phase of labor
Amniotomy
Initial tx. for fetal hypoperfusion (signaled by late decels)
Differentiate from maternal heart rate
Assess for umbilical cord prolapse
Change in maternal position to left lateral decubitis
***Also do this first for variable decels
Maternal O2 supplementation
Tx of HTN
Discontinue oxytocin
Lichen sclerosis
Chronic inflammatory skin condition presenting w/ extreme vulvar pruritis, burning, pain, resorption of the clitoris, and dyspareunia
- Skin changes include purple, polygonal papules or a waxy sheen on the labia
- Can progress to fissures and erosions secondary to the chronic itching
- Small increased risk for SCC
Tx: Topical corticosteroids
Precocious puberty tx
GnRH agonist
-Observation if pt. is nearly 10
Tamoxifen ADRs
Hot flashes (MC); works via antiestrogenic activity in the CNS causing anterior hypothalamic dysfnxn
DVTs
Endometrial hyperplasia/carcinoma
Hypothyroid pts. in pregnancy
Should have increased dosing of their levothyroxine
-These pts. are unable to adequately increase their prod. of thyroid hormone to meet the new levels of SHBG so they need some help
Management of Threatened Abortion
- US to determine fetal status
- Reassurance
- Return US in one week
Diagnosing ectopic pregnancies
B-hCG + transvaginal US
NAAT testing on gonorrhea and chlamydia
With this test, you only have to treat whatever comes back positive due to its high specificity
Placenta previa delivery date
36-37 weeks
Endometritis RFs
Prolonged ROM (>24 hrs)
Prolonged labor (>12 hrs)
C-sec
Use of IUPCs or fetal scalp electrodes
Endometritis Symptoms
Fever
Uterine tenderness
Foul-smelling lochia
Leukocytosis
Endometritis tx.
Clindamycin + Gentamicin
-is usually due to a broad-spectrum infxn
Mammary Paget Disease of the Breast
Persistent eczematous or ulcerating rash located around the nipple and areola that indicates an underlying adenocarcinoma
Sx: Bloody discharge
Nipple retraction
Scales
Pain
Itching
Burning
Uterine Rupture
Typically occurs in pts. w/ prior uterine surgery @ the site of the scar
Sx prior to rupture: Focal, intense abdominal pain
Hyperventilation
Agitation
Tachycardia
Sx after rupture: Retraction of fetal position (*Pathognomic)
Abnormal FHTs
Oxytocin ADRs
Uterine tachysystole ( > 5 contractions in 10 mins) =» possible fetal hypoxia
Tetanic contractions
Hypotension
Hyponatremia
Symmetric IUGR
“Fetal causes”
Genetic disorders (aneuploidy)
Congenital Heart Disease
Intrauterine infxn (CMV, rubella, toxo, malaria, varicella)
Intraductal papilloma
Benign breast condition of a single dilated breast duct usually found on biopsy or US
Sx: Unilateral blood discharge w/ no assoc. mass or lymphadenopathy
After confirming a benign breast cyst, what should be done?
Repeat breast exam in 2 months
Transverse fetal lie
Transient condition which spontaneously converts to vertex or breech; evaluate w/ US at 37 weeks to be sure
RFs: Prematurity
Uterine anomalies
Placenta previa
Multiple gestation
Pts. who have chronic HTN and OCPs
Discontinue OCPs if BPs are elevated on two separate occasions
First line test for adnexal mass
Pelvic US
Thin, clear cervical mucous around time of ovulation
Normal
Assymetric IUGR
“Maternal causes”
Vascular Disease (HTN, Pre-E, Diabetes)
Antiphospholipid antibody syndrome
AI disease
Cyanotic cardiac disease
Substance abuse
Endometrial thickness finding alongside a granulosa cell tumor
Biopsy the endometrium first because endometrial cancer is a more grave disease
HER-2
Is normally a bad prognostic factor for breast cancer BUT allows for tx. w/ Herceptin
-Can be determined via FISH or immunohistochemical staining
OCP ADRs
Breakthrough bleeding (MC; is assoc. w/ lower E2 doses)
Breast tenderness
Nausea
Bloating
Amenorrhea
HTN
DVT
Hepatic adenoma
Increased TGLs
Severe Pre-eclamptic features
> 160/>110 on 2 occasions at least 4 hrs apart
Thrombocytopenia
Increased serum Creatinine
Increase hepatic transaminases
Pulmonary edema
Visual changes/neurologic symptoms
Tx of Maternal Hypertensive Crisis
- IV hydralazine (vasodilator)
- IV labetalol (a1, B1, B2 blocker; CI’d w/ bradycardia tho)
- PO nifedipine (Ca2+ channel blocker)
Stress incontinence
Caused by a loss of urethral support and intrabdominal pressure exceeds urethral sphincter pressure causing loss of urine
Sx: Leaking w/ coughing, sneezing, laughing, lifting
Urge incontinence
Caused by detrusor muscle overactivity
Sx: Sudden, overwhelming or frequent needs to empty the bladder
Overflow incontinence
Impaired detrusor contractility or bladder outlet obstruction
Sx: Constant involuntary dribbling of urine and incomplete emptying of the bladder
Pseudocyesis
Conversion disorder where pts. who desire pregnancy present to the office with the signs of pregnancy (amenorrhea, positive test per their statement), however, all in-office testing is negative
-Requires psychiatric consult
IUD to use in breast cancer pts. about to start chemo
Copper IUD
-Progesterone is CI’d
Menopausal Genitourinary Syndrome
Hypoestrogenemia leads to atrophy of the urethral mucosal epithelium because it also possesses E2 receptors
-Loss of urethral compliance and closure pressure =» urgency, frequency, UTIs
Tx: 1st line - vaginal moisturizes and lubricant
2nd line- topical vaginal E2
Protective Modifiers from Breast Cancer
BSO - not routinely performed due to other consequences but definitely is a biggie
OCPs
Age
Bilateral renal agenesis
Condition that is incompatible with life due to the accompanying pulmonary hypoplasia; will see pockets of fluid on ultrasound
Quad Screen
AFP
Inhibin A
B-hCG
Conjugated estriol
-If this comes back abnormal, perform US to assess for abnormalities
CA-125 screening
Is not routinely recommended due to the large number of things that can cause an increased level
Bartholin Cyst
Mobile, soft, non-tender mass located behind the labium majora @ the 4 and 8 oclock positions
-Can caused discomfort during sex or while walking
NST
Fetal heart rate is recorded and monitored for spontaneous fetal movement; test is performed routinely on high-risk pregnancies
-Abnormal if
Breast engorgement tx
Ice and NSAIDs
Tx. of Grade 1 endometrial carcinoma in a woman who still desires pregnancy
High-dose progestin therapy and frequent endometrial sampling
Removal of postmenopausal ovaries
Still leads to further decrease in E2 due to loss of androgen prod. from the ovaries that can be converted peripherally to E2
Endometriosis pts. w/ infertility tx.
Clomiphene citrate (to stimulate the ovaries) and possible IUS
Lichen simplex chronicus
Result of chronic scratching and rubbing causing skin damage
=»Increased susceptibility for infxn and further itching
-Labia will appear thick, lichenified, and edematous
Tx: Topical corticosteroids
Recent ab therapy and vulvar itching
Candidiasis
Pts. w/ PPROM at 36 weeks
Augment labor and deliver
Preventing shoulder dystocia
Cant; it’s unpredictable but it is more likely in macrosomic infants
-Also, Cesarean delivery is not routinely recommended since it is unpredictable
Androgen Insensitivity Syndrome
X-linked mutation of androgen receptors
Findings: Normal breast development
46 XY karyotype
Minimal axillary and pubic hair
Absent uterus and upper vagina
Cryptorchid testes
Mullerian Agenesis
Hypoplastic/absent mullerian ductal system
Findings: Normal breast development
46 XX karyotype
Normal axillary and pubic hair
Absent uterus and upper vagina
Normal ovaries
IUFD follow-up
Placental and fetal autopsy to prevent reoccurrence
External Cephalic Version can be performed at…
> = 37 weeks
Tocolytic drugs
Indomethacin
Nifedipine
Terbutaline
Delivery at
Mag is also given to prevent neurologic complications in the infant alongside the usual corticosteroids and tocolytics
Ruptured Ectopic Pregnancy
Presents as amenorrhea, pelvic pain, and acute vaginal bleeding
Blood in the abdomen =» hypotension, syncope, tachycardia, diffuse abdominal pain, cervical motion tenderness, shoulder pain, and urge to defecate
Klumpke’s Palsy
Caused by Excessive traction on C8 and T1 during delivery; possibly due to shoulder dystocia
Sx: Extended wrist
Hyperextended metacarpophalangeal joints
Flexed intercarpalphalangeal joints
Absent grasp reflext
Horner syndrome
Intact macro and biceps reflexes
Fractured neonatal clavicle
Complication of shoulder dystocia
Sx: Clavicular crepitus/bony irregularity
Decreased macro reflx (due to pain; usually only on the fractured side)
Intact biceps and grasp reflexes
Endometriosis pain
Occurs 1 week before menses and peaks just before
-Also is associated with dysmenorrhea, dyspareunia, and dyschezia
UTI tx. in pregnancy
Amoxicillin
Nitrofurantoin
Cephalexin
Bactrim teratogenic effect
Kernicterus; due to folic acid antagonism
Anorexia and pregnancy complications
Infants: Prematurity
IUGR
Miscarriage
Poor growth
Intellectual disability
Mother: Hyperemesis gravidarum
Cesarean delivery
PPD
Genital warts tx.
Trichloroacetic acid
Podophyllin
Imiquimod
Women at age >35 should be offer what prenatal screening
Cell-free DNA testing
-If positive, follow-up with chorionic villus sampling or amniocentesis depending on the stage of pregnancy
MCC of PPH
Uterine atony; even during a c-sec
Most common cause of late postpartum hemorrhage 7-10 days after deliver
Sub involution of the uterus in which the placental i plantations site has not increased in size
Endometriosis appearance
Homogenous cystic mass on the adnexae
Mag excretion
Kidneys; therefore, dose should be altered for pts. w/ renal insufficiency
Modifiable Breast Cancer Risks
Hormone replacement therapy
Nulliparity
Age at first childbirth
Alcohol consumption
Chronic retention of products of conception
Consumptive coagulopathy due to chronic release of tissue factor from the placenta
- Fibrinogen levels may be in the low-normal range
- Deliver the stillborn child in any mother with signs of coagulopathy
Peripartum cardiomyopathy
Rapid onset of systolic HF @ 36 weeks or later
Amniotic fluid embolism
Presents as respiratory failure, cardiac shock, DIC, and coma/seizure
RFs: Advanced maternal age
Gravia >5
Cesarean/Instrumental delivery
Placenta previa/abruption
Preeclampsia
Tx: Respiratory and hemodynamic support
Placental abruption tx
IV fluid bolus and left lateral decubitus position
-Packed RBCs if necessary
Luteoma of pregnancy
Yellow-brown mass of large lutein cells; often bilateral
- Can be asymptomatic but on a test, likely hyperandrogenic
- Spontaneously regress post-partum
- Female fetus at GREAT risk of virilization
Post term pregnancy complications
Fetal: Oligohydramnios
Meconium aspiration
Stillbirth
Macrosomia
Convulsions
Maternal: C-sec
Infxn
PPH
Perineal trauma
Neonatal thyrotoxicosis
Transplacental passage of maternal anti-TSH abs causes transient hyperthyroidism in the neonate
Tx: Short term methimazole and BBs if necessary
-Resolves after 3 months
Mittelschmerz
Pain on ovulation
-Occurs due to the small amount of blood released into the peritonem w/ follicle rupture
Ovarian cancer diagnosis follow-up
Exploratory laparotomy
-Biopsy would cause seeding
Postpartum urinary retention
Presents as inability to void bladder w/ a sensation of fullness and dribbling
RFs: Nulliparity
Prolonged labor
Perineal injury
C-sec
Instrumental delivery
Regional injury =>> decreased sensory impulse =>> decreased microtuition reflex and detrusor tone
Tx: Analgesics
Ambulation
***Urinary catheterization
Pt. w/ spontaneous abortion who desires prompt treatment
D/C
HSV (+) pt at 36 weeks
Give prophylactic acyclovir
Palpable breast mass
> US
> 30 years old =» Mammogram
Intrahepatic cholestasis of pregnancy
Benign condition caused by idiopathic increased production of bile acids
-Presents w/ unbearable pruritis
Labs: Increased bile acids and bilirubin
Increased liver aminotransferases
MC ADR of epidural anesthesia
Hypotension; due to blockage of sympathetic nerve fibers
***Can lead to fetal acidemia from hypoxia
Tx: Left lateral decubitus position; IV fluids; vasopressors
Hyperemesis gravidarum pH
Metabolic alkalosis due to volume contraction
Placenta accreta tx.
Hysterectomy
Defect in the decidua basalis
Possible placenta accreta
Ectopic pregnancies needing surgical treatment
Unstable maternal vital signs, cardiac activity, or B-hCG > 5,000
Fetal manifestations of gestational diabetes
Congenital anomalies (cardiac/limb, sacral agenesis)
Increased risk of stillbirth
Macrosomia
Pulmonary hypoplasia
Polyhydramnios
Labor treatment of gestational diabetic
Begin IV dextrose; also do this if glucose
Chlamydia screening
All women under 25 and older women w/ risk factors, like a new sexual partner
C-sec viral load if mother is HIV pos
> 1,000
Pap smears post-hysterectomy
Only continue if the pt. Had a subtotal hysterectomy
ASC-US follow up
Repeat paps every 4-6 months until 2 consecutive negatives
Luteal phase defect
Insufficient amounts of progesterone produced by the corpus luteum =» early endometrial shedding
-However, ovulation is still occurring
Mild preeclampsia management
2x weekly NSTs and BPPs if suspected oligohydramnios or IUGR
US for fetal growth and amniotic fluid q3 weeks
Be on the lookout for rapid weight gain
Severe preeclampsia management
- Inpatient monitoring w/ daily lab values and fetal monitoring
- Stabilize w/ Mag and antihypertensives
Sclerosing adenosis
Firm, indurated, and ILL-DEFINED mass that is due to excessive tissue growth in the breast tissue lobules
-Painful, especially with the cycle
Dx: FNA; looks similar to carcinoma on mammogram
Duct ectasia
Inflammatory dilation of the breast ducts that may present w/ BILATERAL green or brown discharge
-Requires biopsy but once confirmed, management is conservative
Cystosarcoma phyllodes
Most common non-epithelial mass in the breast; is usually nontender and unilateral
- Presents pretty similar to a fibroadenoma with more rapid growth
- Slight chance for malignancy so removal is standard of care with monitor of recurrence
Tests at first pregnancy visit
CBC
UA
G/C
TB
VDRL/RPR
HIV
Rh status
Rubella titer and HBsAg test
Cardinal movments of labor
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
Pathogenesis of endometriosis
- Retrograde menstruation
- Lymphatic dissemination
- Coelomic metaplasia (explains endometriosis in pre-pubertal girls)
Infant of a mother with HBsAg (+) test
Receive vaccine within 12 hours of birth
Risks of hormone replacement therapy
***BREAST CANCER
Stroke
Blood clots
Heart disease
Thyroid Storm Treatment
B-blocker, PTU, and corticosteroids
Postpartum thyroiditis
Transient hyperthyroidism following delivery and is associated with anti-microsomal and TSO antibodies (just like w/ Hashimotos)
-Temporary management w/ antithyroid medications during the hyperthyroid phase
Hyperparathyroidism treatment in pregnancy
1 or 2nd trimester= surgery
3rd trimester= oral phosphates and a low calcium diet
Reverse doppler flow
Assoc. w/ fetal death in 48 hrs
=»DELIVER
Pt. w/ suspected pyelonephritis and no improvement after 48 hrs of antibiotics
Suspect urinary tract obstruction
-Getting a US will be helpful in this case
Dyspnea in a pregnant woman being treated for pyelonephritis
Possible ARDS
-Due to endotoxin release from gram negative bacteria
Septic pelvic thrombophlebitis
Bacterial infection at the placental implantation site spreads to thrombosed veins at the ovarian venous plexus or the common iliac veins
Sx: Recurrent high fever
Pelvic mass
Tx: Antibiotics + heparin
Most common organisms causing postpartum endometritis
Anaerobic bacteria
Treatment for breast engorgement
Wear a comfortable bra
Avoid nipple stimulation
Ice packs
NSAIDs
- DO NOT USE BREAST BINDING FOR LACTATION SUPPRESSION
- may lead to infection or plugged ducts
Test done to confirm ectopic pregnancy
Transvaginal US
Delivery of woman with previous abruption
36-37 weeks
TdAP vaccine and pregnancy
Give after 28 weeks regardless of when they last had it
Pap smears in HIV women
Annual
Most common location of a. Osteoporotic fracture
Thoracic spine
Most common STIs after sexual assault
Gonorrhea, chlamydia, Trichomonas, and HBV
- Go ahead and treat for these right off the bat
- Also screen for HIV and Syphilis
Woman complaining of flank pain and abdominal tenderness following a pelvic surgery
Probably ureteral damage, most likely at the cardinal ligament
-CT or IVP to confirm
RFs for fascial dehiscence
Obesity
Diabetes
Cancer
Vertical incision
-Usually will occur 7-10 days following surgery
Most common cause for suture dehiscence
Fascial disruption/breakdown by the suture
Diagnostic tests for Stress incontinence
Physical examination
Loss of bladder angle
Cystocele
Hypermobile urethra
Tx: Urethropexy (sling)
Pessary
Device that treats pelvic support problems and urinary incontinence; support the pelvic structures
-useful for women who do not want surgery for stress incontinence
Diabetes and the bladder
Can cause a nuerogenic bladder =» overflow incontinence
-Basically because of neuropathy
Most common cause of acute salpingitis
Multibacterial infxn
Fitz-hugh-curtis cause
Purulent tubal discharge which ascends to the RUQ
-Patients will complain of pain here
Most common cause of septic arthritis in young women
Gonorrhea; classically presents as migratory
Signs and symptoms of acute salpingitis
Abdominal tenderness
Cervical motion tenderness
Adnexal tenderness
Vaginal discharge
Fever
Pelvic mass on physical examination or US
IUD effect on PID
Increases risk
OCPs =» Lower
Adnexal mass w/ PID
Possible tubo-ovarian abscess
- US follow-up recommended
- Treated w/ IV antibiotics
Most common ADRs from metronidazole
N/V, abdominal bloating, diarrhea
-DO NOT CONFUSE W/ DISULFARIM RXN
=»headache, flushing, tachycardia, dizziness, N/V
Bartholin gland abscess
On the vestibule of the labium majora
-Significant problem could be Cancer; especially in women > 40
Greatest RF of multiple gestation
Premature or preterm labor
Tx of polyhydramnios
Amniocentesis; even if vitals are stable and baby looks good at the moment
Workup for Hyperemesis gravidarum
Work up for urine ketones
Medical management of an inevitable abortion
Prostaglandins for ️Bleeding control
Common history with cervical ectopic a
History of D/C
DD of PPH
Atony (can be due to twins, fibroids, polyhydramnios, macrosomia)
Lacerations
PLACENTAL RETENTION
DIC
Hematomas
Coagulopathy
Other drugs for uterine atony
Prostaglandin (Hemabate); don’t give to asthmatics
Ergot alkaloids; don’t give to HTN Pts.
Target glucose levels in gestational diabetes
Fasting:
RFs for placenta Previa
Previous PV
Previous c-sec
Uterine surgeries
Multiparity
Smoking
Cocaine
AMA
Assessment of HDN severity
Bilirubin in the amniotic fluid
Usually between 1:8-1:32
Increase in Doppler flow
Tx of HDN
Direct blood transfusion into the umbilical cord
Swelling lateral to the insertion of e round ligament and no intrauterine pregnancy but a positive test
Cornu ectopic pregnancy
Testes in Androgen Insensitivity Syndrome
Removed to prevent cancer development
Positive withdrawal bleeding after progesterone challenge test in secondary amenorrhea work up…what next?
Prolactin and TSH levels
Pts. May wind up needing Clomiphene treatment
Benefits to OCPS
Less heavy periods
Decreased risk of endometrial and ovarian cancer, PID, and benign Breast disease
Contraindications to IUD placement
Recent PID
STDs
Uterine tract malignancies
Breast cancer (preogesterone IUDs)
Fibroids
Rapid growth of a uterine fibroid
Possible Leiomyosarcoma; take that motherfucker out
Cervical cancer Tx.
Stages I and II = Hysterectomy
Stages III and IV = radiation therapy
Abnormal uterine bleeding unresponsive to OCP Tx.
Endometrial ablation or hysterectomy
Tx of fibrocystic changes in the breast
OCPs
Vitamin E
Decrease caffeine
FNA if you want I guess
Breast cancer treatments
Depends on its receptor positivity
Radiation given after simple lumpectomy
Chemo give with hormone therapy
Congenital syphilis
10 days after delivery: Maculopapular rash, snuffles, mucous patches on the pharynx, Hepatosplenomegaly,
Later in life: Hutchinson teeth, saddle nose, saber shin
Gestational CMV
Transmitted via saliva, secretions, Breast milk, semen
-can see IUGR, petechiae, Hepatosplenomegaly, Microcephaly, seizure, chorioretinitis, hydrops,
IgG in mom does not confer immunity and baby is still susceptible
Tx for congenital varicella
Give varicella Ig and check tigers
Delivery date for a gestational diabetic
38-39 weeks
Theory behind progesterone treatment for early endometrial changes
Converts estradiol to estrone and also decreases the number of E2 receptors on endometrial cells
MCCo prenatal death
Preterm labor
Antibiotics in PROM
Decrease likelihood of neonatal infection and also prolong the latent phase of labor
Postpartum fever with no uterine or Breast tenderness
Consider pelvic thrombophlebitis; is a diagnosis of exclusion
-Can sometimes see thrombosis on CT
Risk of HIV transmission without HAART
25%
Drug to give prior to administration of epidural
Antacids
If these were not given and a patient has the signs of respiratory distress, consider aspiration pneumonitis
Most common neonatal endocrine cause of death
Congenital adrenal hyperplasia
Management goals for delayed puberty
Intimate sexual maturation, prevent osteoporosis from Hypoestrogenemia, and promote full height potential
Start on unopposed estrogen first to promote normal
Breast development
Uterine septum
Incomplete dissolution of the fused midline septum of the Müllerian ducts; often presents with recurrent miscarriage
Dx: HSG, saline infusion sonohysterogram
Tx: Resection
What follow up should be performed on a woman with blocked tubes on HSG?
Laparoscopy; tubal spasm can cause this finding so we should identify the exact blockage
-Plus, it can also provide treatment
Persistent postmenopausal bleeding after a normal endometrial sampling
Perform hysteroscopy
-Even though the sample was negative, we gotta figure this shit out dont give up bruh
Granulosa cell and Sertoli-Leydig tumors on US
Completely solid mass
Pseudomyomaperitonei
Rupture of a large mucinous cystadenoma (can get VERY LARGE and can produce chronic pelvic symptoms (pain, constipation, bowel obstruction)
Tx for epithelial ovarian cancer
Debulking of the tumor with follow-up chemo
Follicular cyst size
Usually 5cm or less
-If bigger mass seen, follow-up is needed
Exercise-induced hypothalamic amenorrhea lab finding
Decreased estrogen w/ lower end normal FSH
