Simmons studying Flashcards
What are the relative contraindications for methotrexate for abortifacient (4)
1) mass >4cm
2) fetal cardiac activity
3) b-hCG >5,000
4) refusal to accept blood products
what are the absolute contraindications for methotrexate use for abortive (10)
1) intrauterine pregnancy
2) elevated liver enzymes
3) decreased renal function
4) breast feeding
5) poor follow up
6) immunocompromise
7) pulmonary disease
8) peptic ulcer
9) ruptured cyst/ ectopic
10) sensitivity to metho
How do we give metho?
single dose IM injection
If ineffective, usually another dose given
if thats ineffective surgery is option
How to follow up with metho treatment for abortive
Need repeat beta in 4 and 7 days. from day 4-7 we expect 15% decrease to claim effectiveness.
What should the patient expect for metho treatment?
nausea, pain at the site of ectopic because of retraction of the mass, vaginal spotting.
what should the patient avoid after given metho treatment
vitamin C/prenatal vitamins and sunlight
Why avoid Folic acid after metho?
what about vitamin C?
The mechanism of action is deplete folic acid. thus it could counteract methotrexate’s mechanism of action.
Vitamin C may increase the metho action making it more toxic.
Discriminatory zone for ultrasound detection of ectopic pregnancy?
b-hCG >2,000
what are the most common causes for fetal meningitis
1) beta-strep
2) listeria
3) E. coli
what is the importance of Rh factor?
Rhesus factor is always tested. If mother is negative then she will produce antibodies to the red blood cell antigen causing hemolysis. If she has a baby that is Rh (+) then the baby will die of hydrops fetalis
increased number of pregnancies puts the mother at risk for what?
hemorrhage and prolapse.
How do we treat Rh negative mothersd
RhoGAM
what is rhogam
immunoglobulin
what is the definition of labor?
cervical change/time
When must you have placental delivery?
within 30 min
what is the normal dose of folic acid
400ug daily
what percentage of pregnancies are unplanned
50%
what age is too old for pregnancies?
34 for multiple pregnancies and 35 for single pregnancy
what is the most accurate way to determine pregnancy?
1st trimester ultrasound
what is the another way to determine pregnancy date?
Neagles rule: last menstrual period. add one week and 1 year and then subtract 3 months
Are serological tests used to determine gestational age?
No. They are GA non-specific
Whats the best indicator of gestational if only doing one test
second trimester ultrasound
What is fundal height
the length in cm from the pubic bone to the top of the uterus. Good indicator of the size fo the baby and how far along the pregnancy is.
The fundal height should be +/-2 of the weeks gestation. Thus, if 30 weeks along the fundal height should be 28/32.
what is APGAR
appearance, pulse, grimmace, activity, respiration
what are the causes of AUB?
structural and nonstructural. PALM-COEIN
polyp, adenomyoma, leimyoma, malignancy, cogulopathy, endometrial, iatrogenic, not-yet specified.
When do women feel fetal movements?>
usually around 20 weeks
Decelerations type and causes
variable-cord compression, early-head compression, accelerations-good, late decel-placental insufficiency
define early deceleration
If the decel occurs with contractions.
Variability at gestational ages –what do we expect to see?
28wks–any variability
28-32wks –10sec X 10bpm
>32wks –15sec X 15bpm
prolonged accelerations vs deceleration s
accels good. Decels bad –could indicate cord compression due to oligohydramnios
normal range of fetal heart beats
110-160
what can inhibit contractions
terbutaline
G and P
gravida and paragravida
Gravida is the number of pregnancies
para is the number of times the uterus is emptied.
how is para separated
full term, preterm, abortions, living.
how frequently does bHCG double?
every 48 hours
what is misoprostal used for (4)
1) abortifacient
2) postpartum hemorrhage
3) gastritis
4) induction of labor
What dose of miso do we give for postpartum hemorrhage>
large rectal dose (4-5 pills)
What dose of miso do we give for abortive
1/4 pill oral. 24-48 hours after mifepristone
what does misoprostal do
causes myometrial contractions
mefipristone type of drug and what does it do
progrestational glucocorticoid inhibits progresterone, induces bleeding.
what does progesterone do?
prepares the uterine lining for implantations and contributes to overall fetal health.
what do we give magnesium for?
to stop seizures in preeclampsia
how do we check for Mag toxicity
headache? vision changes? ringing in the ears? trouble breathing? upper right quardant pain? dizziness? then we check their heart, lungs, reflexes and dystonia.
preeclampsia definition
1) systolic blood pressure greater than equal to 140 and a diastolic greater than or equal to 90 on two occasions at least 4 hours apart or
2) a systolic greater than 160 or a diastolic greater than 110 or higher.
what is the anitdote for magnesium toxicityf
calcium gluconate
what is the therapeutic dose for magnesium
> 4
what are the risks of misoprostal overdose
uterine atony and rupturing of intact uterus
why not give a previous C-section pitocin?
rupture.
why not give a previous C-section misoprostol?
rupture
what labs do we order for preeclampsia work up and why
CBCd (schistocytes, platelets), LDH (cell rupture/tissue damage), comprehensive metabolic panel (for kidney and liver function), uric acid (cell breakdown)
how do we test if you have broken your water
ultrasound (AFI), alkaline pH testing, slide for test –slide test for ferning.
what is HELLP
hemolysis, elevated liver and low platelets
how do we treat for GBS
ampicillin
what tests do we perform at 28wks?
gestational diabetes, TDAP, RhoGAM
what tests do we preform at 35 wks?
GBS
How often do we do pap smears?
depends on age
21-30 every 3 years
30-65 3 years, or with cotest 5 years.
when can stop doing paps?
65 if the last 10 years have been adhered to.
when to start paps if immunocompromised?
immediately upon diagnosis and continue annually. If immunocompromised from birth (maternal transference) then begin screening at the onset of sexual activity
definition of hypersystolic uterus
> 5 contractions/10 min
questions for triage?
contractions? rush of fluid? bloody? fetal movements?
what are the criteria for administration of pitocin
<200 montevideo units (since 200 is sufficient)
how to calculate montevideo units?
sum of the amplitudes of contractions-baseline multiplied by the number of contractions at 10 min.
post op questions
how are you feeling? are you in any pain? tolerate food or drinking? gone to the bathroom? have you gotten up and moved, yet?
what are the types of leiomyomas
subserosal, submucosal, peduculated, intramural, abdominal
what are some of the non-medical causes of anovulation?
PCOS, pregnancy, hypothyroidism, pituitary dysfunction, turner’s syndrome
What are the treatments for AUB
IV equine estrogen, progesterone, combined contraceptives, tranexamic acid
what is the adenexal size that can cause torsion>
> 5cm
what ultrasound findings are suggestive of cancer
increased vascularity, multiceptated, papillary or solid component, ascites, >10cm
tumor markers for germline tumors
beta-hCG, LDH, AFP, inhibin A, CA-125
what is the mutation rate for a mature teratoma
0.2-3% low
list some non-malignant masses
teratoma, ectopic pregnancy, serous cystadenoma, endometrioma, corpus luteum
what is first line treatment of nausea in pregnancy
doxylamine and pyridoxine
what are the components of the quad screen?
Inhibin A, b-hCG, AFP, estriol
what are the bone related adverse side effects of bisphosphonates?
osteonecrosis of the jaw
what are the values and interpretations of progesterone in pregnancy?
> 20 normal, <5 abnormal, 5-20.
What is the rate of tubal ligation failure
1:300
What do oral contraceptives do to the ovary, endometrial lining and the cervix (cervical mucous)?
inhibit ovulation, thin the endometrial lining and thicken the cervical mucous
