U-Wise 2 Flashcards
IUPC measures?
If contractions are adequate
What makes a good acceleration
More than 15 bpm lasting more than 15 seconds
Prolonged fetal tachycardia seen with
Maternal fever or chorioamnionitis
Variable deceleration shape
Rapid fall and variable upslope
Initial measurement to treat fetal hypoperfusion
Move patient to left lateral decubitus position, discontinue tocolytics, fluids
Why no methylgonovine in pt’s with pre-eclampsia or HTN
Vasodilator, can cause bleeding
Who can’t get Prostaglandin F2
Asthmatics, has a bronchoconstrictive effect
Low lying placenta w/ hx of c-section worry
Placenta accreta
Risks for retained placenta
Prior C section
Uterine leiomyomas
Prior uterine curettage
Succenturiate lobe of placenta
How is oxytocin administered to prevent uterine atony
Rapid infusion of a dilute solution (20-80 units)
Not an IV push
Suture to prevent uterine atony in surgery
B-lynch suture (uterine compression suture)
Complications of epidural
Spinal headache, localized back pain, and meningitis
Gentamicin gets what kind of bugs
Gram negs
Erythromycin good for
URIs
What increases risk of UTI post delivery
Indwelling catheter
What causes breast engorgement
Exaggerated response to lymphatic and venous congestion associated with lactation
Post partum fever spikes and normal exam, suspect?
Septic pelvic thromboembolus
First step in fever day 1 post c section
Chest xray (atelectasis)
What does preg class C mean
Animal studies have shown hard but no human studies have been done
Hx of psychiatric illness risk factor for
Post-partum depression (up to 1/3 of patients report a problem)
Most common SSRI adverse effect
Insomnia
SSRIs in breastfeeding
OK, is in breast milk but no detectable levels in infant
AE of SSRIs in 3rd trimester use
Agitation and poor feeding of newborn
When are symptoms of PMDD found
In luteal phase, absent in beginning of follicular phase
Post-partum pyschosis feature
Visual or auditory hallucinations
Tests to do in post term patients
NST and assessment of amniotic fluid volume
Post term pregnancies associated with
Placental sulfatase def, fetal adrenal HYPOplasia, anencephaly
Dx of post-term pregnancy based on
Establishment of an accurate gestational age
Amnioinfusion for
Repetitive variable decelerations
What do fetal dysmaturity babies look like
Withered, meconium stained, long nailed and fragile
Associated small placenta
Cardiac defects most common in what trisomy
21 (up to 50%)
Most commonly used cervical ripening agents
Prostaglandins
Maternal vascular diseases lead to
Uteroplacental insufficiency (asymmetric IUGR)
What do you do after IUGR is diagnosed
Antenatal testing of fetal well being
US of fetal well being not useful when
If used more than once every 2 weeks
NST based on the principle that
When fetus moves, its HR accelerates
1st trimester crown-rump length dates how accurate
+/- 4-5 days
Macrosomia definition
> 4000 grams in a diabetic and >4500 in a non diabetic
Lacerations more common in forceps or vacuum?
Forceps
Most likely complication with tubal ligation
Unplanned pregnancy
When should irregular bleeding end after depo shot
2-3 months
OCPs decrease risk of
Ovarian and endometrial cancer
Tubal ligation reduces the risk of what cancer
Ovarian
Strongest predictor of regret for permanent sterilization
Age (under 25 biggest risk)
Fever and bleeding with a dilated cervix is? Tx?
Septic abortion
Surgical abortion and antibiotics
Two lupus anticoagulant Ab? Prevention?
Anticardiolipin and beta-2 glycoprotein antibody
Help prevent with heparin
Why mifepristone and then misoprostol in medical abortion
Misoprostol – antiprogestin
Misoprosol – prostaglandin that induces uterine contractions
Gestational age limit for vacuum abortion
First step in heavy bleeding after termination of pregnancy
Dilation and curettage
Most common cause of vaginitis
BV
Chronic pruritus with vagina not involved is
Lichen sclerosis
Sever pain of vestibular touch or attempted vaginal entry
Vulvar vestibulitis
What causes lichen simplex chronicus
Chronic scratching and rubbing
Tx: steroids and antihistamines
GC mixed tx
Ceftriaxone and azithromycin
Least invasive tx for pelvic organ prolapse
Pessary fitting
Exposure to hep B regimen
HBIG and start hep B vaccination series
Mucopurulent cervicitis + bi adnexal and uterine tenderness? tx?
Salpingitis
IV cefotetan and doxy + gent
What causes overflow incontinence
Underactive detrusor muscle or obstruction (prolapse)
What type of urinary incontinence is due to detrusor instability? Tx?
Urge (uninhibited contraction of the bladder with filling)
Tx: Oxybutynin
What type of incontenence is caused by urethral hypermobility
Stress incontinence
Stress incontinence best surgery
Retropubic urethropexy
Tx for urethral intrinsic sphincteric def
Urethral bulking procedure
What is colpoclesis
Vagina is surgically obliterated –> good for severe prolapse in elderly
First step when US shows complex cyst in an older woman
Surgical exploration
First and 2nd line endometriosis drugs
- COC
2. Danazol (synthetic estrogen but lots of AE)
Definitive dx for endometriosis
Diagnostic laparoscopy (surgery and biopsy)
First step for hemhorragic cyst
repeat US in 2 months as should resolve
Sudden onset of pain and nausea and cyst on US likely?
Ovarian torsion
Good workup for unknown chronic pelvic pain
Laparoscopy (endometriosis present even in the youngens)
What is interstitial cystitis
Chronic inflammation of the bladder –> recurrent voiding symptoms and frequency in absence of evidence of any other disease
How do GnRH agonists work
Down-Regular hypothalamic pituitary gland production
New onset of pelvic pain often associated with
Abuse (up to 40% of pelvic pain)
Pelvic adhesions think
Chronic PID
Pelvic congestion features
worse during periods and pregnancy, aggravated by standing, fatigue, and coitus
Iilohypogastric nerve senstation
sensation to skin and groin overlying pubis
What nerve damage would keep patient from being able to adduct thigh
Obturator
Best time to get a prolactin level
Not during physical exam, which may stimulate prolactin
Tx for cervical dysplasia
LEEP
Complications from LEEP
Cervical stenosis, preterm delivery
LSIL in youngen
Repeat pap in 1 yer
Vulvar lesion unresponsive to medical therapy needs
Biopsy
Best way to begin workup for an incidental mass
Pelvic US