U-World 1 Flashcards
Neonatal thyrotoxicosis results from
Transplacental passage of anti-TSH receptor antibodies during 3rd thrimester
Does thyroid hormone or exogenous levothyroxin cross placenta?
Not to significant degree
Tx for neonatal thyrotoxicosis
Methimazole + B blocker
When does Rh alloimmunization occur
When mother is Rh negative and baby is Rh positive
When to give two rho-gam doses
At 28 weeks and within 72 hours after delivery
What is the Kleihauer-Betke test
Used to determine whether higher dose of rho-gam is needed
If pt is on COC and has HTN, what do you do
d/c COC, usually causes resolution
Sheehan syndrome causes lack of what hormones
Anterior pituitary (Prolacting, GH, ACTH)
Epidural anesthesia effects on bladder
Over distention may cause loss of ability to contract causes overflow incontinence, tx short term with indwelling catheter
(don’t just observe because bladder needs to be decompressed)
First test on all women of childbearing age
Pregnancy test
What should be allowed to proceed in patients where fetus has been diagnosed with severe anomaly incompatible with life
Labor
Tx for pregnant woman w/ syphillis if pen allergy
Penicillin desensitization
Important AE of OCPs
Breakthrough bleeding, HTN, and increased risk of venous thromboembolism
Not weight gain
What is PMDD
Premenstrual dysphoric disorder - severe form of pMS with irritability and anger symptoms
4 rec Ab for UTI in pregnancy
- Nitrofurantoin
- Amoxicillin
- Amox-Clavulanate
- Cephalexin
TMP-SMX interferes with what in pregnancy
Folic acid metabolism –> contra in first trimester
3 things that usually cause symmetric fetal growth restriction
Fetal anomalies, fetal karyotype abnormality, and early maternal viral infection (MC)
Fetal factors
Most common fetal infection in US
CMV
Causes of asymmetric fetal growth
Maternal factors (Vascular disease, lupus Ab syndrome, autoimmune diseases, substance abuse)
When are elevated BP in pregnancy considered chronic HTN
> 20 weeks
Hyperaldosteronism causes
Hypernatremia and hypokalemia
Most common risk factor for placental abruption
Hypertension
Tx for variable compressions
Expectant management
2 recommended tx options for stress incontinence
Pelvic muscle exercises and urethropexy
Tx for BV
Metronidazole
same for Trich but tx patient also
What is pseudocyesis
Rare psychiatric condition in which a woman presents with nearly all signs and symptoms of pregnancy, but US reveals normal endometrial stripe and neg pregnancy test
US of missed abortion
Intrauterine collapsed gestational sac and absent fetal cardiac activity
in office preg test will still be positive
Tumor marker for ovarian cancer
CA125
cervical mucus in ovulatory phase
profuse, clear, and thin
will stretch to 6 cm
What is endometritis characterized by? Risk factors?
fever and uterine tenderness in postpartum period, often associated with foul-smelling loci
Risk factors include prolonged PROM, prolonged labor, operative vaginal delivery and C-section
MCC of postpartum endometritis? Tx?
Polymicrobial
Tx: IV clindamycin and gentamicin
MCC of mucupurulant cervicitis
Chlamydia
Side effects of depot shot
Weight gain, amenorrhea, nausea, breast tenderness
Contraindications to breast feeding
Active TB, Maternal HIV, herpetic breast lesions, varicella, chemo, active substance abuse
Infant contraindication to breast feeding
Galactosemia
What makes an abscess more likely than mastitis
Fluctuance
Tx for mastitis
Ab and breast feeding with both breasts
What is coitus interruptus
Pulling out
What causes infertility in PCOS
Anovulation
3 things to check in secondary amenorrhea after pregnancy test is negative? What does an increase in each mean?
Prolactin: Do brain MRI
TSH: Hypothyroidism
FSH: Premature ovarian failure
3 most common cause of secondary amenorrhea after preg
When do you give mag sulfate
Pre-term labor def
Regular uterine contractions at
GBS screen date
35-37 weeks
partial 21-hydroxylase def in females presents with
late adolescence as hyperandrogegism (hirsutism, acne) and elevated 17-hydroxyprogesterone
4 major risk factors for uterine rupture
Prior uterine surgery, induction of/prolonged labor, congenital uterine anomalies, fetal macrosomia
Presentation of vasa previa
painless antepartum hemorrhage associated with rapid deterioration of fetal heart tracing –> fetal blood is being lost
Why does pregnancy have mild hyponatremia
Hormones reset threshold to inc ADH release from pituitary
When does adenomyosis occur
When endometrium grows into the myometrium
Two drugs to induce ovulation in PCOS
Clomiphene citrate and metformin
Bulky, globular and tender uterus buzzword for
Adenomyosis
will also have menorrhagia and pelvic pain
Trisomy 21 quad screen
Low a-fp and estriol
Increased b-hCH and inhibin A
Abdominal pain in HELLP syndrome from
Liver swelling with distention of hepatic (Gisson’s) capsule
Extra-hepatic manifestations of AFLP
Leukocytosis, hypoglycemia, and acute kidney injury
What causes pulmonary edema in preeclampsia
generalized material vasospasm leading to inc. SVR and high cardiac afterload
Discharge in ovulation buzzword
“Egg white like” thickening or “spinnbarkeit”
3 causes of variable compressions
Chord compression, oligohydramnios, cord prolapse
What happens with the majority of breech presentations
Self-correct by 37 weeks gestation –> Don’t attempt to correct before then
3 contraindications to external cephalic conversion
Placental abnormalities, fetopelvic disproportion, or hyperextended fetal head
When should semen analysis be performed for infertility
Usually as initial screening test
Why should RPR be avoided in suspected cases of primary syphillis
High rate of false negatives (used for screening)
Breast mass biopsy showing foamy macrophages and fat globules is
Fat necrosis
Lichen sclerosis manifestations
Vulvar pruritus and discomfort, exam shows porcelain-white atrophy
Biopsy to rule out vulvar SCC
First line therapy for lichen sclerosis
High-potency topical steroids
Why should you deliver immediately in patients with intrauterine fetal demise
To prevent coagulation abnormalities (worry about DIC)
Elevated maternal afp could mean
Open neural tube defects, gastroschisis, and omphalocele
Tx for asymptomatic patients with pos Chlamydia DNA test
Single dose azithromycin or 7-day course of doxy
Neonatal drug to prevent HIV infection
Zidovudine
Why is carpal tunnel increased in pregnancy
Secondary to estrogen mediated depolymerization of ground substance, causes interstitial edema
What is Raloxifene? AE?
Estrogen antagonist in breast and vaginal tissue, agonist in bone tissue
DVT is AE
If B-HCG is less than
Repeat test and transvaginal US in 48 hours
*Pos cutoff in 1,500-2,000
Who should get Anti-D IG
Rh neg woman with neg Ab screen (means patient is not alloimunized)
Tx of intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid
2 initial tests for asymptomatic women with pelvic mass
Transvaginal US and CA-125 level
Arrest in the first stage of labor criteria
No cervical change for > 4 hours despite adequate contractions OR no cervical change for > 6 hours with inadequate contractions
Gestational DM target BG levels
- Fasting > 95
2. 1 hr post prandial -
Gestational DM screening dates
24-28 weeks
Odd complication of maternal hyperglycemia
Hyperviscosity due to polycythemia
How long to wait to get pregnant after MMR vacine
28 days (women who accidentally get in pregnancy are probs ok)
Vaccines not recommended in pregnancy
HPV, MMR, Varicella, Smallpox, live flu vaccine
Risk factors for uterine atony
Overdistension (twins, macrosomia) and uterine fatigue (prolonged labor)
Endometriosis description on US
Homogenous cystic-appearing mass
Hyperandrogenism during pregnancy is usually caused by
Ovarian masses (luteomas and theca lute cysts)
Management for spontaneous abortion in hemodynamically unstable patients
Surgical (suction curattage)
Loss of fetal station is a red flag for
Uterine rupture
Next test if pap smear comes back ASC-US
HPV testing
Tx for mag tox
Stop mag-sulfate and give Calcium-gluconate
TSH and T4 in pregnancy
TSH decreased
Total t4 increased
Free T4 unchanged
Prognosis for majority of babies born with Erbs palsy
Up to 80% have spontaneous recovery
Who is at increased risk for fetal macrosomia (race)
African american boys
When is laparoscopy indicated for endometriosis
When NSAIDS and COC have failed
What is HER2
Oncogene (gets overeexpressed)
