True Learn Wrongs Flashcards
increased risk for PPH
PreE w sF (cause for atony)
most common complex adnexal mass found during prgnancy
mature teratoma/dermoids
soft markers downs
NT (first tri only) cystic hygroma (first tri only)
Nuchal fold (second tri only) echogenic bowel echogenic focus mild ventriculomeglay chorioid plexus shortened femur
amount folic acid needed
4 mg if prior problem (4000ug)
4mcg if no prior prob (400ug)
APLS dx and treatment
one:
- vascular thrombosis
- preg morbility (death fetus >10w, premature delivery due to pre e shit, three unexplained losses
one:
- lupus anticoag 12w apart x2
- anticardiolipin antibody IgG or IgM 12w aparment x2
- anti-b2-glycoprotein IgG or IgM 12w apartmet x2
unfractionated heparin
tiem to wait for intercourse
unknown
most liekly outcome acute parvo virus infection
normal pregnancy
(most commonly pregoblematic if infected >20w
MLO of physical abuse in pregn
preterm labor
adequate contraction stress test
3 contractions, 40 seconds each, in a 10m period
echogenic bowel on US
- subchroinic collection can cause echogenic bowel because fetal injection of blood
- can’t be eval in first tri and is normal in third tri 9only matters in second tri)
- 80-90% have normal outcomes
US and LMP rules
<9w: >5 d off 9-15.6: >7d off 16-21.6: >10d 22-27.6: >14d 28w: >21d
perimortum
do it after 4 failed miutes of resusictation with hopes of delivery at 5 minutes
HIE dx:
- apgar <5 at 5 and 10
- fetul umbilical acidemia
- multisystem organ failure
- spastic quadripleegia and dyskinectic cerebral palsy
(seizures are not par tof this most commonly)
glyburide
reasonspible for more hypoglycemia in infants compared to insulin
leukorrhea in pregnancy due to which hormones
estrogen
FHT which mostly predictis acid/base status
- accelerations
scheudle CS for HIV+ high viral load
38w
MLO of fiboirds in pregnancy
pain due ot degradation
NOT assocaited with PPROM
reason to die from UAE
sepicemia
BPP negative and postitive predeictve values
high negative predictibe
low positive predictibe
this is true of all antepartum tests
NST false positive rate
55-90%
screen is anti-kell antibody positive
yo ushoudl do what
- check paternal antigen status
- causes severe hemolytic disease of fetus and newborn
- if dad antigen negative then no work up is necessary
rate of shoudler dystocias in vaginal deliveries
3%
ACE I side effects pregnancy
oligo and calvarium maldevleopement
danzol preg effects
virilization
US finding congenital rubella syndrome
- cafdiac anomlaies
- CNS defects
- heptosplenomegaly
- microcephaly
twinning is high and low in hwat countires
high : nigeria, united states > englahd, india, japan
obese weight gqin recs in preg
11-20 lbs
acute fatty liver in pregnancy - dx criteria that i cannot care aout rih now .
.
pp thyroiditis
- transient distruction of thyroid tissue
- autoimmune
- treatment includes beta blocker becuase it’s transient (and other meds wont help because its autoimmune and breaking down shit)
PTU SE
heptotoxicity
methimazone SE
aplasia cutis
cryopercipitate includes what factos
- factor 8, 13
- vWF
- fibrinogen
fetal heart arryhtmia with worst outcome
- atrial flutter
- difficult to treat
- often requries lots of meds to prevent fetal hydrops
which screen is not reliable in pregnancy
proetin S
shitty screen
ITP, you give IVIG, when shoudl the patlets start to go up?
1-3 d
peak response 2-7d
% of fetuses with increased NT will have aneupoloidly
50%
% twin gestations that go into PTB
60% before 37w
10% before 32w
MCC CS in US
failure to progress
steriliztion benefits
- reduce PID
- reduce ovarian cancer rates
normal fetal acid-base status at delivery
- pH 7.28
- PCO2= 498 (+- 8)
- PO2 18 (+- 6)
- HCO2 22 (+- 3)
asympotmatic BV in pregnancy
- no treatment rec
- is associated with low birth weight, PPROM, PTB
- treating asymptomatic women doesn’t help though
- treat asumptomatic if hx prior PTB
most sensitive test for chorio on amnio
- IL-6
- gold standard is fluid culture
% of neonates born 23w who will be normal afterwards
- 13%
endometritis
- how long abx after afebrile
- what abx:
run abx for 24h post fever
gent/clinda
methimzale
- SE
- MOA
SE: aplasia cutis (absence of skin, usually on top of head, possibly with no bone underneath)
risk of post term delivery
oligo, increase lacerations, operative deliveries, increased CS, increased PPH, inscreased infection
fetaL: convulsions, meconium aspiration, NICU admission, macrosomnia, low agars, post maturity syndrome (essentially malnourishment due to shitty placenta)
measurement used to diagnose FGR
- EFW
- or AC alone
MC cancer in pregnancy
second most common in preg
breast (common and diagnosed)
second: thyroid cancer
Vit D deficiency risks
- darker skin
- not outdoors
- malnutrition issues
- vegetarians
stress dose steroids during delivery indciations
- not indicated fr 7 day taper
- DONT need it if:
- taken any dose fr less than 3w
- <5mg morning dose for any amount of time
- <10mg every other day for any amount of time
neonatal alloimmune thrombocytopenia
- due to differences between maternal and paternal antigens
- first pregnancy at risk (different then Rh)
- MCC neonatal thrombocytopenia
MC congenital infection worldwide
CMV
- women can be asymptomatic
- fetus usually severely affected with IQ, hearing loss, visual impairment, cerebral calcifications, intraparaenchymal cysts, cerebellar abnormalities, microcephaly, bentriculomegaly, hepatospemomegaly, dydrops, FGR
MC thrmobophilia
Worse thrombophilis
Factor 5 Lieden
Antithrombyn 3 deficiency
tranfuse in PPH for
- 1500 blood loss with continued bleeding
- hemodynamic instability
- DIC needs more than just blood transfusion
MCC non-immune fetal hydrops
- cardiac issues (it’s CHF)
- also this is the MCC overall (immune isn’t that common)
BPP 6/10
- more monitoring and repeat testing tomorrow for <37w
BV diagnosis
- pH > gREATER than 4.5
- grey discharge
- > 20% clue cells
later term
post term
- 41
- 42
2h pp glucose test amount
75
LMWH vs Unfractionated heparin during delivery (w/wo epidural)
LMWH
- better tolerated dosing, less likely HIT, less bleeding problems, preferred
Unfractionated hep:
- shorter half life, can reverse, can monitor with PTT
REcs same for LMWH and Unfractionated heparin
- ppx: hold 12h prior to anticipated del
- thera: hold 24h prior to anticipated del
- pp: 4-6h after sVD
- pp: 6-12h after CS
Only different with epidural sp del
- Unfractionated:
- —-ppx: restart 1h after placement or removal of catheter
- —-thera: 1h after placement or removal of catheter
- LMWH:
- —ppx 12 after placement or 4 hours after removal
- —thera: 24h after placement or 4 hours after removal
the earlier you get PreE, what is the risk of next preg
higher. 26w = 50% 27-30: 40% 31-36: 30% term: 20%
risk accrete with previa
- primary CS: 3% > 11 > 40 > 61> 67 > 67
MCC genetic first trim abortion
- trisomy
- most specific kind is not tri, it’s XO
- most common trisomy is 16 however (but not more than XO when taken alone)
accertino def
10 increase over 10 sec
15 increase over 15 sec
post menopausal asymptomatic increased lining
no biopsy ever
goals BG after meals
fasting: <95
1h pp: <140
2h pp: <120
early onset infant group B infection s/sx
late onset infant group B infection s/sx
early:
<7d after birth
vertical transmission
sepsis, pneumonia, meningitis
late:
>7d - 3m after birth
horizontal transmission
bacteremia, meningitis, organ/soft tissue infection
(not caused by maternal status and ppx maternal does not prevent it)
erythema infectiosum is also called….
parvo virus
NTD prevalence
5 in 10,000 all deliveries
what % of women with preG diabetes also have cHTN
5-10%
estimated fetal weight for singleton breech del
2500
weed poor neonatal outcome
FGR mosty (less like is still birth, IQ deficients, behavioral changes)
uncontrolled hyperthyroidism increase your risk for ___
PreE
how long does it take for the uterus to get back to normal size after SVD
4w
twins with short cervix
no management required. no studies support giving anything
risk vertical transmission HIV >1000 not on treatment with SVD
25%
amount of Rh positive fetal blood needed to cause alloimmnization in Rh neg mother
0.1mL
negative CST means
no decels
treatment during pregnancy for latent TB (neg chest)
- begin after first trimester
- continue for 9 months
- treat with isoniazid for 9 months if reason to suspect will progress (immunosuppression, recent exposure <2 years ago, HIV infection)
cephalic presenting means
vertex
iron def anemia in pregnancy
- physiologic blood cell mass and volume expansion
macrosomnia is defined by
4000-4500
days opioid use after CS recommend
4d
hetero factor 5 lieden managment
survillence without intervention
after CNS infection with herpes, infants will have XX percent change long erm seuqele
- 20%
first tri screen
- NT
- PaPPA, free/total bhcg
sequential forceps/vaccum are problematic. because
- neonatal outcomes are poor
modi screenign for TTTS by US should be how frequently?
q14d
vasectomy truths
- wrose than nexplanon
- better, less expensive, safer than abodminal sterilizatoin of women
- 98% azospermia at 6m
herpes infection suppression doses
- acyclovir
- valacyclovir
acyclovir: 400 TID @36w
valacylovir: 500 BID @36w
eclampsi aMRI findings
parietal and occipital lobe edema
waht kind of fish are you not supposed to eat
king mackeral, marlin, tuna, bigeye, tilefish, orange roughe, swordfish
tranfusion associated citrate toxicity
calcium CHLORIDE (not carbonate)
rate of uteirne rupture one prior CS, vs 2 prior CS, vs classical
- 0.5%
- 1-2%
- 10%
greatest risk postterm dates
nulliparity
bishop score makes IOL same as spontaneous labor
8
recommended iodine intake for
- reproductive aged women
- pregnant women
- breast feedig woman
- 150
- 220 mcg
- 290 mcg
amniotic fluid embolisms
- avoid large scale volume resussitaiton
gas emobolism
left decubitus position
most accurate test for venous thrombus in pregnancy
- promthrombin G20210A mutation
PTL caused by vaginal infections
- BV before 16w
- gonorrhea
- asymptomatic bacteriuria
- clamydia
- trich
- urea plams
listeria monocytogenes findings
treatment
- foul smelling abscess placenta
- hispanic women at higher risk
- head ache, fatigue, myalgias, backache, gastrointestinal symptoms. (most common in third tri)
- spread hematogenously
- abcess of the fetus
treatment is nothing if asymptomatic
- expectedly manage if mildly sx but no fever
- febrile: blood cultures, high dose IV amp/gent (allergic penicillin: sulfamethoaxazole)
epidural placement location
L4-5
AFP sensitivty NTD
75%
nausea treatment in preg
B6 vitamen
partuition
Phase 1: quiescense of uterus
Phase 2: uterine preparedness of labor, cervical ripening
Phase 3: stimulation of uterus, cervical dilation, fetal and placental expulsion
Phase 4: uterine involution, cervical repair, breast feeding
prenatal testing and downs
hydral protocol
- 5/10, 10, 10 administration
varicella active in pregnancy, treatment
- oral acyclovir start 24h oral
- IV acyclovir if pneumonia
- VZIG given to neonates
Risk of still birth for FGR
- 1.5%
prolonged latent phase nullip vs multiparous
- 20 nullip, 14h multiparous
delivery rec for placenta previa
36-37.6w
toxo infection in first trimester work up
- check serologic toxoplasmosis IgG and IgM
vacuum cannot be placed belwo what GA
34 (but forceps can)
HIV course in pregnancy
- no change, no increase in viral load expected for associated diseases
heterozygous factor 5 lieden with personal hx of VTE (wht is chance of vTE in pregnancy)
10%
who needs to be screen for thyroid disease in preg
- people with personal hx of thyroid disease
- family hx of thryoid diesease
- type 1 diabetes pts
- clincal suspicion for thyroid dieaes (not include mild enlargement, but does include nodules etc)
things that are high while delivering (liek werid proteins called contraction - associated - proteins)
- oxytocin receptos
- calium receptos
- connexin 43
- PGF2 a receptors
possible effects of oxytocin bolus
- maternal hypotension (relaxation of smooth muscle)
- would then cause tachycardia
- hyponatremia can occur after long administrations of oxytocin
- can alos cause arrhythmias
- water intoxication
- analypyalsix
risk of verticel transmissino HSV primary outbreak at time of delivery
40-80%
personal hx of VTE raises risk for VTE in pregnancy by how much
3.5 times (3-4 fold)
CST satisfactory parameteres
negative, positive, equioval, unsat
- 3 ctx in 10 minutes at least
- each contrctions is 40 second long at least
- neg: no late or sig variables
- positive (bad): late after 50% even if ctx less than 3/10 m
- equivocal: intermittent late or sig variable decels
- unsat: fewer than 3 ctx in 10 minutes or uniterpretable strip
treatment ITP in pregnancy first line
definition
prednisone
- <150 x109
- treatment rec if <30, or if >30 and symptomatic
- if preg not helpful, then IVIG if plts <100,000
definition latent labor
maternal perception of regular contractions
NT that needs wu
- 3mm
TXA and PPH
helpful if within 3h of pph and if other meds fail
siezure meds are associated with what fetal anomaly
- NTD increased
- therefore need AFP measurements
- folic acid supplementation isn’t actually hepful
diagnose PE in pregnancy
- CT (angio)
outlet forceps
- fetal skull that has reached the pelvic floor, fetal sclap that is visible at teh introitus without spreading the labia
low forcepts
- lead poitn of fetal skull +2 station or more and not on the pelvic floor (modify with vs without rotation, which is related to 45 degrees)
mid forceps
station above +2 but head is engaged
vacuum related del compliqcations
brain bleeding (intracranial hem, subgaleal hematoma, hyperbilirubinemiia, retinal hemorrhage
shakling a pt may cause
fall problems delay in dx of abruption. seizure not safely treated in cuffs can't walk cna't be moved for emergency CS recommend baby remain wth mother after delivery for bonding
resusitat preg in cardiac arrest
left lateral decubiuts (same with gas embolis)
endometritis treatment
- gent/clinda
B lynch is doen with what sturue
1 chromic
TTTS US screenign starts when
16w + every 2w thereafter
4th degree repair meds
- abx x1 (ancef) or clinda
most commoon way to get toxo
pork and lamb undercooked
VTE is most likely when in preg
pp
when is uterus no longer palpible abdominally pp
2w sp del
TB test positive when how big for various diseases
HIV/organ transplant, recent contacts with active TB pt - 5mm
IV drug users, high risk setting resident, <4yo = 10 mm
everyone else without risk factors = 15
rates of NTD
- 1 parent ith NTD = 4.5 %
- 1 parents, 1 sibling NTD = 12%
- 2 parents with NTD = 30%
- 2 parents, 1 sibling NTD = 33%
endocarditis and pregnancy
- need ppx abx n preg and vaginal del with high risk features:
- prostetic cardiac valve
- previous episode of infective endocarditis
- unrepaired cyanoitc cardiac diease with palliative shunts
- cardiac tranplant with valve regurgitation due to structually abnoral valve
epidural and T6 spinal cord injury
- Up to T 10 level to prevent autonomic dysregulation.
- CS would be at T4 so taht doesn’t matter really
s/sx of amniotic fluid embolism
- DIC, hemodrynamic compromise, respiratory compromise
risk PPROM united states
3%
hemoglobinopathies wu
- black women should get CBC and electrophoresis
- South asian/medeterianian CBC and electrophoresis if needed
- all women CBC
HSV with recurrent herpes outbreaks, how likely get outbreak during pregnancy
75%
waht does mag prevent for fetus
CP
define IAI
- fetal tachy, maternal leukocytosis, maternal fever
what is most likely cause of fetal/maternal hemorrhage
delivery (SVD and CS)
dysmaturity syndrome
post dates risk
MCC of pyelso
anemia
Rec Vit D def during pregnancy
600 international units
clinical features of congenital varicella
LIMB ABNORMALITIES
- low birth weight
- IQ , hydrocephalus, microcephaly, seizures
- eye stuff
- GI: reflux, stenotic bowel, atretic bowel
- Skin: cutanoue scars
consequence of inadequatesly treated hypothyroidism in pregn
- PTB
- fetal demise, spontaneous abortion, low birth weight, IQ delays
sickle cell hgb goals
10.0 nad HbS 40% is what you transfuse up to once you decide to you need to tranfuse them
negative predictive value of neg nitrazine
99%
nucle transulcency is most sensitive at what gestation
13 w
available 11-14w
most likely verticle transmission hep C
prolonged rupture of membranes
TTP treatment pregnancy
plasma pheresis
stage 1-5 TTTS
1: oli/poly
3: ab dopplers
5 dead
Rh negative most likey race
white
endometritis treatment for extended fever
gent/clinda + amp for ENTEROCOCCUS
lwo risk maternal cardiac issue in pregnancy
mild pumonary stenosis
upper limit of safe to take Vit D in preg
4000 international units
increased calorie intake in pregnancy
1: none
2: 350
3: 450
syphilis screening
VDRL & RPR (and both have titers so you can tell if old infection and trated or new infection)
persistent locia 12w pp, first step wu is
TVUS (not a CBC, but should get a b-hcg)
- normal duration is 8w
- persistent locia could be PSTT
- you need to evlautat sp 8w
breast abscess for mastitis treatment
- I&D (some would suggest IV abx vanc 1g q12h
- normal mastitis is dicloxacillin 500 mg QID 10-14d
varicella worst outcomes when contract when
48h from del
- this is chicken pox
vaginal progesterone good for which pts to prevent PTD
- 16-24w
- current with singleton
- prior PTD spontaneous singleton
PPH can occur how far out from pregnancy
12w
severe range BP recheck for labetalol
10 minutes (not 20)
cerclage indications
acute appendicitis during prengnancy
give steriods and then do surgery without delay
tell between primary or recurrent HSV pock
- viral culture and HSV IgG antibody testing
- primary: +culture or PCR & NEGATIVE serologic tests
breakdown of 3rd or 4th degree repair NOT severely infected
- 1w outpt abx prior to surgery scheduled
expected weight gain for normal pregnancy
- 25-35lbs
- overweight BMI 25-30, (15-25)
- obese BMI 30 (11-20lbs)
alloimmunization and fetal hydrops is associated with which red blood cell antigens
- c, C, D, E, K, e
- MCA indicated for 1:8
BPP in order of disappearance for distress
First to disappear > last to disappear
- heart rate reactivity > breathing > gross movement > tone > amniotic fluid
active mangement of third stage of delv
- uterotonics
- uterine massage
- umbilical cord TRACTION
known complication of massive transfusion
HYPER kalemia
HYPO calcemia
metabolic aciodsis (from lactic acid and decreased removal of citrate)
CI of progesterone implants
- pregnancy
- pst hx of thrombosis
- liver tumors
- active liver lesions
- hx breast cancer
- allergic reaction to component of implant
meconium aspiration syndrome risk factor for it would be
- NRFHT
- the infant shits, aspirates it, causes respirtory distress
- occurs in 2-10% of infants with meconium
fetal growth slowing twins vs singelton
timing of twin delivery
Slowing:
twins 28w
singletons 32w
delivery:
di/di 38w
mo/di: 34-37w
mo/mo: 32-34w
postmaturity syndrome is seen in what percentage of post term deliveries
15-20%
NT 3.5mm at 11w. what is diagnostic testing to follow
CVS
massive transfusion infcludes
FFP, plts, RBC
ITP approaching del, when start treating
- CS/other surgical procedure : 50K
- Treat 30K even if unsymptomatic
- treat with steiods taper (IVIG if steriods not okay)
- treat with plts in emergency situation
- splenectomy only for refractory cases
rate of SAB if IUD is left in place
- 50%
earlierst you can use a vaccum
34w
appropriate time to resume anticoagulation after CS
6-12h
if epidural was used, then 24h afterwards
ITP if pregnisone is gong to work, plts shoudl start increasing when?
- 4-14d after administration
- max effect 2-3 w after admin
CMV recent vs old infection
IgM positive, IgG positive with low avidity
(IgM is immediate in first month, IgG comes in the months to follow)
(avidity
incidence of shoulder dystocia
3%
early pp IUD defined as
<10m after del to >1w pp
ovulation after del starts how many week pp
4
estrogen contraception can start how many weeks pp
3
mirena vs copper immediate pp IUD expulsion rates
mirena 2x expulsed more
most serious long term fetal vacuum complication
- intracranial hemorrhag (fetal daeth and brain damange)
- subgaleal hematoma can cause hemorrahgic shock cuase 1/2 fetal blood can collect, but with intervention resolves and doesnt have long term consequecnes
hep C risk inreased most with
IV drug use
penicillin rash and spyhilis dx in pregnancy
- treatment
- no desentiziatin needed for maculpapular rask, just give penicillin
- if uticaria, broncospams, angioedems then densit
- primary syph: 2.4 million uins IM x1
- latent syph 2.4 million units IM x3w
:which hemolobinpathies is assocated wtih fetal hydrops
- alpha thal deletion severe
varicilela findings
- fetal hydrops
- FGR
- microcephaly
- limb malformations
- hyperechogine foci bowel and liver
- cardiac malformations
featl hearting loss associatedw ith what infection
CMV
periventricular calcifications associatedw ith wht featl infection
toxo
wAth shoudl you use for anticognatulion if pt has HIT
fondaprinux (syntheitc pentasaccaride
waht hormone prevents lactations during pregnancy
progesterone
Rate PPH after
svd
cs
4%
6%
MCC secondary PPH
retained POC
iron requirement in pregnacy
1000 mg total
daily you take 27 mg to supplment cause 1000 isn’t found in food stores
2nd tri
most sensitive and specific US finding for DS
- thickened nuchal fold
twin chorioniscity
if the placenta is seen as one with a large piece going upwards towards the bags, then this is a lambda sign and it’s di/di
gold tandard for dx BV?
- gram stain
(MC way to dx is actually differet: two criteria of the following: thing/white/grey discharge, pH >4.5, KOH fishy oder, clue cell on microscopiy
PPV of fetal fibronectin
30%
annual percentage of PTB
10%
3rd tri IUFD IOL/TOLAC
- no prostaglindins beacuse rupture risk increased
IO- L vs spontaneous labor has increased rutpure risk but absolute risk is low
term PROM IOL method
pit
cytotec increases rate of chorio
GDM puts a woman at what percentage risk T2DM
70%
rate of twinning
3/1000 (0.3%)
reason to screen fro inherited thrombophilia
first degree relaive with thrombophilias
KB is 1.8% adn pt has 5000mL blood, standard does is 300 mcg, how many vials shoudl be given
1.8% x 5000 = 0.018 X 5000 = 90
ALso 300 mcg covers 30 mL fetal whole blood (or 15 featl red cells)
therefore 90 / 30 = 3 vials
GDM & >4500, the rate of shoulder dystocia is
20-50%
rubella non-immune and is exposed to rubella in pregnancy. what do you do
- expected management
- if symptoms then, IgG and IgM (IgM 7-10d, IgG for 1y)
- risk of brachial plexus injurty with current shoulder dystoochia
- % of brachial plexus injuries asociated with normal deliveries
- 10-20%
- 50% are just normal SVD
MCC acute pancreatitis
gallsteones, just like outside of pregnancy
which genetic disease is most associated with ashkenzi ancestry
- CF (1:29)
- tay-sachs (1:30)
CA-125 elevation
- protein found in many locations throughout the body including genitals, pancreas, gall bladder, stomach, kidney,lung, breast, heart.
- inflammation of these srufces causes elevations
- brain isnt’ one of these, likely a blood/brain barrier issue therefore primary brain cnacer wont elevate this.
cervical cancer and OCP assocaition
- long term use increases risk for cervical cancer
- risk also decreases with cessataion of use of OCPs
- those wtih HPV who have never used OCPs are at lower risk than women who HPV+ and HAVE used OCPs
association tumor markers and choriocarcinoma
+hcg
neg everything else
contains syncytiotrophoblasts (who make hcg)
association tumor markers and dysgerminoma
+hcg, +LDH
neg: AFP, CA-125
MCC germ cell tumor
10% associated wth gonadoblastomas
MCC tumor in peope lwith gonadal dysgenesis
association tumor markers and enbryonal carcinoma
+hcg, AFP
Neg: LDH, CA 125
- extremely rare seen in ovary, 14 cases every reported in last 30 years
- syncytiotrophoblasts cells may be present (therefore +hcg)
association tumor markers and endodermal sinus tumor
+AFP
neg: everything else
- germ cell tumor
- AKA yolk sac tumor, which makes AFP
- also contain schiller duval bodies
association tumor markers and immature teratoma
+AFP, LDH, CA 125
neg: hcg
chart of cancer tumors and assoicated markers
cervical cancer figo wu includes:
THIS CARD ISNT: ACTUALLY ACCURATE
SEeems that it can be clinically staged: exam, +biopsy + limited endoscopy and limited imaging but what this actually means is unclear to me. Catn’ get actual figo paper cause you have to pay for it.
Below is uptodate but this will give you the wrong answers too
- PE: palpate bimunual
- Biopsy: colpo, ECC, conization (extension is by visual assessment, biospy not needed)
- Endoscopy: hysteroscopy, cystoscopy, proctoscopy (and biopsy as needed)
- Imgaing: CT, MRI, or IVP (IV pyelogram) & CXR
risk GTN following evacuation of complete mole
15%
risk breast/ovarian cancer with BRCA types
BRCA 1: Breast 55-65%, ovarian 39%
BRCA 2: Breast 45%, ovarian 15%
BRCA 1/2: ovarian 85%
FIGO cervical cancer staging per review course
indications for onc referral
- post meno
- pre meno
post meno
- CA 125 >35
- US suggestive of malignancy
- ascities
- evidence abnormal distant mets
premeno
- fixed pelvic mass
- a very eleated CA 125 (there is no cut off for this, so
- US suggestive of malignancy
- ascites
- evdience of malignancy other places
Simple cysts <10cm do not need referral to gyn onc and can be monitored.
US signs concerning fro malignancy:
- ascites
- cyst larger than 10 cm
- papillary projections or solid components
- high color flow doppler
HPV strain for
- squamous cell cervical cancer
- adenocarcinoma with cervical cancer
16
18
MC cell in epithelial ovarian cancer
serous cells – serous cystadenocarcinoma
- epithelial cell cancer is the most common ovarian cancers
- serous tumors cause large ascites when progressed
- most epithelial cancers are diagnosed at stage III
vaginal cancer staging
- clinical staging (no hyst/LN etc for surgical staging)
- acceptible studies include: EUA, cysto, procto, CXR, IVP
- extremly rare cancer
- early stages are treated with surgery, however, most advnaced stages are treated with chemo/radiation
mature teratoma other name is
dermoid cyst
MC ovrian cancer diagnosed in pregnancy is
- dysgerminomas
- note: MC benign ovarian tumor is mature cystic teretoma (desmoid tumor)
- 5-10% are associated with gonadoblastoma
most importnat risk factor for epithelial ovarian cancers for the standard population
age
- increases after menopause (68% diagnosed after 55 years)
Risk underlying carcinoma in the surrounding areas of atypical ductal hyperplasia?
- 30%
- 5x higher risk of sugsequent breast cancer
- 30% of pts have either carinoma insitu or invasive carvinoma on excision of the mass of atypical ductal hyperplasia
Endometrial staging
-
DCIS is what
- precancerous or non-invasive cancerous lesions of the breast
- asymptomatic usually
- srugical removal w/wo radioation or tamoxifen is recommended
- lumpectomy or mastectomy are appropriate (neither is better)
GTN staging
- treat with methotrexate if lower rsk
- treat with EMA/CO if higher risk
- honeslty would need to memorize WHO grading criteria in addition to staging if you want ot ocrrectnly predict treatment needs
US findings adnexal mass concerning for malignancy
- 4 or more papillary strucutres
- irregular multilocular solid tumor with greast diamtere >10 CM
- very high color content on color doppler
BRCA carrier and risk reducing BSO and bilateral masterctomy, by how much is their risk reduced?
- bilateral mastectomy: 85-100% reduction in breast cancer
- BSO:
- –40-100% reduction breast cancer (50% if done before 50 yo)
- –80% for ovarian cancer
- –100% in HNPCC pt’s for ovrian cancer
- –r68% all cuase mortality reduction
mucinous adenocarcinoma
- rare cancer
- most important to removal appendix because it’s the most likley source of extra-mullerian origin. THis helpful to figure out how to treat them to make sure it’s gyn in origin.
- less common to have contralateral ovary (5%)
PSTT path finding
Treatment
- intermediate trophoblasts with syncytial elements, no villi (therefore low levels of hcg are expressed compared to chorio)
- treatment: hysterectomy
- slight elevation of hcg and placental lactogen
choriocarcinoma features on path
- abnormal tropholastic hyperplasia and anaplaisa
- no villi
- hemorrhage/necrosis
EIN treatment recs
- total hysterectomy if completed child bearing
- 40% EIN pts have concurrently early stage endometrial cancer, so hysterectomy is preferable when possible
- removal of ovaries is individualized and not required
- if not completed child bearing then can do progesterone oral, IM, or IU (nexplanon isnt’ approved yet)
common presneting symtpoms of fallopian tube cancer
- hydrops tubae profluens (copiuos serosangiunous vaginal discharge)
BRAC 1/2 recs on BSO
BRAC 1: 35-40 yo
BRCA 2: 40-45 yo
most comon type of uterine sarcoma
- leiomyosarcoma
simple or complex hyperplasia without atypica who want FUTURE (not now) feritlity should be treated with
progestine therapy
staging uterine SARCOMAs
chance of devleloping GTN after a
- complete mole
- partial mole
15-20%
1-5%
DCIS main treatment
- aka intraductal carcinoma
- most common non-invassive breast caancer currnetly
- 30% DCIS develops into breast cancer in 10 years if not treated
- treat with wide local excision
MC sym[tom of rhabdomyosarcoma
- embryonal rhabdomyosarcoma
- rare
- young girls
- presnting s/sx is VB
- treated with VAC chemo acronym
- usually no surgery and they can be fertile after treatment
inflammatory breast cancer details
- red, peau d’orange appearance
- biopsy will show thrombi in dermal lyphatic channels but often shows nothing therefore DIAGNOSIS IS CLINICAL
cervical cancer has three main types
- squamous (70%)
- adenocarcomina (25%)
- other (5%)
actual deinition of radical hysterectomy
- mainstay of cervical cancer treatment 1A2
- includes:
- –cardinal ligmenta to the pelvic side wall
- –complete resection of the USL to the insertin
- –resection of upper 1/3 of vagina
- –uterine artery at it’s origin afrom anterior dvision of th ehypogastric artery
(modified radical hysterectomy – parametrial tissue medial to the ureter)
waht % of mature teratomas will devlope in to squamous cell cancers?
- risk factors
0.2-2%
- risk factors for malignant transformation
- –older than 45yo
- –tumor size greater than 10cm
- –rapid growth
WHO scoring system GTN
0-6 low risk (methotrexate)
7-32 high risk (EAC/MO)
Pt wtih ER/PR+ breast cancer then goes into menopause and wants help. waht do you give her
Venlafaxine (SNRI). Dont give SSRI with tamoxifen for theroretchial concern that it wont work as well
- -note ER/PR+ means estrogen negative, progesterone positive
- these pts are usually on tamoxifen 5 years (for both pre/post menopausal)
MC partial mole karyotype
complete mole karyltyoe
partial: 69, XXX (XXY is second most common, note 47 XXY is kleinfelters and unrelated…. due to 47 not 69)
cmplete: 46 XX (90%)
ovarian recurrenace adn chemo
palliative only, no improvement in outcomes.
most common dx stage of endometrial cancer
1B
ancef flip dosage preop
120 kg
slapingostomy vs saplpingecotmy fertililty rates
same
ruptured ectopic is or is nto allowed to be treated with salpingostomy
contraindicated (
COPD LSC is acidotic because
- they have airflow limitation from scaring, inflammation, secretion in the lungs that isnt’ completely reversible wtih intubation.
- risk for HYPER CARBIA and respiratory acidsosi from OC2 gas absortion. beacuse they have fewer underlying abilities to compensate to eliminate CO2 dru to underlying diseased tiddue that reduces tissue for gas exchange. Hyperventilation to remove CO2 gas maybe not be possible due to need for prolonged expiraroty time patients with COPD
- also at risk for bradyarrhythmias and tacyarrhythmias
- alternative reason for resp acidosis in heavy pt is **obesity hypovbentilation syndrome OSH defined as daytime hypoventiliation (PaCO2 45) in pt without central, pulmonary, neuromuscular, or chest wall dieasese that expalins hypercarbia (BMI 30, OSA)
jehovah’s witness refusal of autologous blood. they will refuse and accept what
- their own blood (can be included in refusal of all blood)
- they will also refuse: RBC, plts, plasma, WBC, whole blood
they will accept:
- immunoglobulins, albumin, and coagulation factors concentrates and recombinant coagulation factors.
ectopic pregnancy due when
- hcg >3500, adnexal mass, empty uterus, (free fluid suggests rupture)
- lsc salpingectomy: prefered with severe rubal damange and sig bleeding
- lsc salpingostomy: preferred with desried future futurility and contralateral tube damage, coudl consider single ppx dose of methotrexate
- lapartomy: unstable pt, large amounts of intraperitoneal bleeding, compromised visualization
hysteroscopy removal polyp, with continued bleeding, how do you stop the bleeding intraop
- resection loop on coag (already usign resection loop)
- you can’t do rollerball coagulation (monopolar) with electrolyte rich medium like normal saline (which is true, i’ve never seen roller ball used on something other than cervix)
MC complication with LSC surgery
bleedign problems/anemia
lsc BTL approach that casues teh most tissue damage
- monopolar coagulation because doesn’t use a closed circuit like bipolar coagulation
risk PTB after CKC
- 2x as high PTB rates
suture types and tensile stregnth
- non-absorbable natural/synthetic
- absorbale natural/synthetic
- most tensile strenght initially is absorbable synthetic
- absorbable is the most, synthetic is the most. See chart
why do you close fat people fascia wtih PDS
absorbable synthetic – most initial tensile stregnth to prevent wound dehiscence
what suture is used for longest lasting tensile strength
PDS (polydioxanone) lasts forever. at 6m there is 25% tensile strength
submucosal fibroids and infertility
removal doubles fertility rates
abdominal prep in surgery
chlorhexidine
- requires 3 minutes to dry to have best decomtanination effects
chemical peritonitis
- chronic and acute abdominal pain
- sebaceous spill from mature teratomas
- those have hyperechoic lines, rokitansky protuberance (solid component that forms an acute angle with the cyst wall), tips of the iceberg (when solid compoennts in forground shadow on the background), point (colid complents lie hair, seen at orthoganal angle from hyperechoic points.
salpingectomy vs ostomy
- same fertility rates afterwards
- but higher ectopic rates afterwards with ostomy
suture used for cerclage placement
- need permanet suture
- uncoated polymer/polyester (ethibond)
- mersaline suture also permanent
gold standard for tubal patency test
chromo actually
ectopic hemodynamic INstability
- LSC + salpingectomy (ostomy not recommended)
CKC and LEEP risks
CKC
- PPROM 16%
- PTB 11%
- FG <2500g 10%
LEEP
- PPROM 8%
- PTB 5%
- FG <2500 6% at time of delivery
way to avoid inferior epigastric vessel injury with trochar placement
- driect visualizaiton tranperitoneally of inferior epiastric vessel (aka you look at the abodminal wall and figure out where teh inferior epigasric artery is
TLH with risk factors
needs SCDs and heparin started 2h before surgery and contineud until ambulating…
abx septic abortion
amp/gent/clinda
ectopic rate highest for process of sterilization
- bipolar coagulation
POP-Q where anterior prolpase extends 1cm below the hymen
stage II
