U World Concepts Flashcards
rare polymorphonuclear leukocytes = microscopy
discharge post menses = copious white, mucoid, odorless
Physiologic Leukorrhea
Candidiasis = would be pruitic + erythemic
New onset of HTN (140/90+)
Protein in urine =
Pre-eclampsia
Pre-eclampsia risk factors
Nulliparity
Obesity
Preexisting medical condition (SLE, chronic HTN)
Multiple gestation
Advanced maternal age
Pre-eclampsia management
Labetalol = IV + Hydralazine = IV - 160/110+
Nifedipine = PO
Mg Sulfate = Prophlyxis Seziures (block Ca++ channel → higher seizure threshold)
Pre-eclampsia severe sx
160/110
Platelet <100,000
Creatinine 1.1+ or 2x normal
↑ transaminases
Pulmonary edema
Visionor cerebral sx (headache)
Fever 24 hr+ postpartum
Uterine fundal tenderness
Purulent lochia = malodorous discharge
Postpartum endometritis
Clindamycin + gentamicin
Amniotic fluid embolism vs Anaphylaxis
Amniotic fluid embolism = bleeding (DIC) + crackles due to pulmonary edema
Anaphylaxis = acute onset (dyspnea + HoTN + tachy) + wheezing - Hypersensitivity rxn 1
Fever postpartum
HoTN
Diffuse macular rash
Altered mentation
Staphylococcal toxic shock syndrome
Vancomycin + Cefepime + clindamycin
+/- Vaginal bleeding
Ab pain
High-frequency contraction
Tender uterus
PMHx = tobacco + drug use (cocaine)
Abruptio placentae = remature placental separation from uterus
Nausea + flushing + headache + ↓reflexes
Pre-eclampsia
Magnesium toxicity
Tx: Calcium gluconate (stablizes cardiac membranes)
Uterine atony managment
- Uterine massage
- high-dose oxytocin
- Tranexamic acid
- Carboprost tromethamine (prostaglandins) - C/I in pts w/ asthma (causes bronchospasm)
Progesterone effects on the kidney
Kidney Stones
↑ Ca++ excretion
↑ ureteral dilation
↓ peristalsis
Abruptio placentae vs Uterine rupture
Ab pain + vag bleeding + abnormal fetal heart rate tracing
Abruptio placentae = Similar to uterine rupture
Uterine rupture = irregulat ab protuberance (palpable fetal parts)
Fibrocystic changes vs Fibroadenoma
Fibrocystic changes = multiple small TENDER masses
Fibroadenoma = small, firm, wel-circumscrribed mobule mass
Painless cervical dilation
2+ painless 2nd trimester losses
Cervical insufficiency
Cerclage = suture to reinforce + add tensile strength to cervix
Lichen sclerosus dx & management
dx: Thin, white, wrinkled skin over the labia majora/minora; atrophic
∆ that may extend over the perineum & around the anus
Excoriations, erosions, fissures from severe pruritus
Dysuria, dyspareunia, painful defecation
Management: topical steroids
Parvo B19 infection
Hydrops Fetalis
- ascites
- pleural effusion
Rubella
hepatomegaly
growth restriction
Cytomegalovirus infection
Periventricular calcifications
Ventriculomegaly
Microcephaly
Intrahepatic calcifications
Fetal growth restriction
Hydrops fetalis = edema in 2+ regions
U/L Bloody nipple discharge
Intraductal papilloma
ulceration + crusting + sclaing nipple-areolar complexes
Invasive ductal carcinoma
Nausea + vomiting
RUQ pain/epigastric pain
hypoglycemia + hyperbilirubinema + thrombocytopenia = fulminant liver failure
Acute Fatty Liver
Magnesium Sulfate C/I
myasthenia gravis
severe renal failure = soley excreted in the kidney
cardiac ischemia
heart block
pulmonary edema = ADR made worse
Blocks Ca++
Infertility Workup
- Semen analysis
- Hysterosalpingogram
- Midluteal phase progesterone level = confirms ovulation
Increase progesterone level after ovulation causes molimina sx
fatigue
bloating
premenstrual breast tenderness
When is Terbutaline used
tocolytic = inhibit contractions of myometrial smooth muscle cells
recurrent late decelerations when 5+ contractions/ 10 min
When is amnioinfusion used
during variable decelerations = cord compression
when is Phenylephrine
Vasopressor =
late decelerations + maternal HoTN
Breast abscess vs Lactational mastitis
Breast absecess = axillary lymphadenopathy
Lactational mastitis = U/L breast pain + flulike sx
Galactocele vs Plugged duct
palpable mass
bladder filling pain + relief w/ voiding
↑ frequency + urgency - urinary
Dyspareunia = pain w/ sex + exercise
Interstitial cystitis = bladder pain syndrome
Parvovirus B19 vs Toxoplasma gondii
Ascites
Toxoplasma = intracranial calcification w/n basal ganglia (gray-white matter junction)
1st line tx for migraine headaches in pregos
BB
Post epidural
positional headache
Postdural puncture headache
Managment =
self-limiting = laying down
Epidural blood patch
Normal urterine contractions
5 or less in 10 mins
200 Montevideo units (MVU)
Tachysystole uterine contractions
5+ contractions
Montevideo units
SERM role in infertility in PCOS
SERM inhibits estradiol negative feedback at the pituitary → ↑ GnRH pulse frequency → ↑ secretion of FSH & LH = ovulation
Oxytocin toxicity
Postpartum hemorrhage
Wt loss = (↓ATCH & GH)
Amenorrhea = ↓FH/LH
Lactation failure = (↓ prolactin)
↓HR + fatigue = (↓ TSH)
blood loss
Sheehans Syndrome = Pituitary Ischemic Necrosis
SLE flare vs Pre-eclampsia
Look for sx of SLE flare = macular rash + joint pain + swelling
Pre-eclampsia
Vaginal discharge
vaginal pooling or granulation tissue
Vesicovaginal fistula
Dx: bladder dye
Tx: surgical repair
Primary Ovarian Insuffiency
depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years
- hot flushes
- vaginal sx = dryness + dyspareunia + AUB
FMR1 gene for fragile X + Turner syndrome
Mass on the anterior vaginal wall
tender to palpation
expresses a purulent discharge from the urethra
urethral diverticulum
Dx: MRI
Tx: Surgical excision
gestational trophoblastic neoplasia (GTN) management
- Suction
- Surveillance w/ OCP for 6 months
Category 3
- Absent variability + recurrent late decelerations
- Absent variability + recurrent variable decelerations
- Absent variability + bradycardia
- Sinusoidal pattern
GET c-section
No uterus or ovaries
Blind vagina pouch
breast
androgen insensitivity syndrome (AIS)
46, XY (no ovaries)
No uterus + cervix + upper 1/3 vagina
Has ovaries + pubic hair + breast
Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)
46,XX (ovaries)
Vesicovaginal fistula vs urethral diverticulum
Vesicovaginal fistula = constant leakage + clear fluid collection
urethral diverticulum = dripple + associated anterior vaginal wall mass or purulent urethral discharge
STI tx
Empiric: ceftriaxone + doxycycline*
Confirmed chlamydia: doxycycline*
Confirmed gonorrhea: ceftriaxone
biophysical profile
Points given if:
Fetal movement = 3+ movements w/n 30 min
Fetal breathing = 1+ episodes of rhythmic breathing for 30+ secs
Fetal tone = 1+ episodes of extension w/ return to flexion or opening + closing hand
Volume = deepest vertical pocket 2+ cm & horizontal dimension 1+ cm
NST = 2+ acceleration
Ectopic Management
Stable: Methotrexate
Unstable: Surgery
Bishop Score
0: 0cm + < 30% effaced + -3 station + Firm consistency + OP
1: <2cm + < 50% effaced + -2 station + Medium consistency + Mid position
2: <4cm + < 70% effaced + -1/0 station + Soft consistency + OA
3: <6cm + 80% effaced + 2+ station
8+ = vaginal birth
GBS prophylaxic if allergic to penicillin?
clindamycin or vancomycin
carboprost tromethamine C/I
asthma
methylergonovine maleate C/I
HTN
stress incontinence (cough + sneeze) + urge incontinence (leaked on the way to the bathroom)
Mixed incontinence
Voiding dairy = to determine the predominant type of incontinence
Emergency contraception up to 5 days
IUDs
Ulipristal acetate
Indications for CVS include
- maternal age > 35 years
- abnormal 1st-trimester screen
- abnormal US findings
- FH of a chromosomal or genetic disorder
- parents who are known carriers for a genetic disease
Amniocentesis purpose
performed between 15–17 weeks’ gestation to detect fetal chromosomal abnormalities
Amniocentesis indications
- females aged > 35 years (at the time of delivery)
- abnormal MSAFP, triple, or quad screen
Completed AFTER US
Uteroplacental blood flow and gas exchange are maintained by
Using inhalational agents
Using inhalational agents
- uterine relaxation
- amnioinfusion
to maintain uterine volume and avoid uterine collapse that could result in placental separation and/or cord compression
nonsinusoidal category III patterns interventions
- Maternal repositioning
- Administer an intravenous (IV) fluid bolus
- Discontinue uterotonic drugs = Oxytocin + Misoprostol
Complete
No products of conception
Closed cervix
before 20 weeks
Incomplete
Vaginal bleeidng
Opened Cervix
Some product of conception expelled & some remain
before 20 weeks
Inevitable
Vaginal bleeding
Dilated cervix
POC seen or felt at or above os
before 20 weeks
Missed Abortion
No vaginal bleeding
Closed cervical os
No fetal cardiac activity or empty sac
before 20 weeks
Threatened
Vaginal bleeding
Closed cervix
Fetal cardiac activity
before 20 weeks
2nd trimester painless bleeding
Placenta previa
Vasa previa
Soft boggy uterus (atony)
Postpartum bleeding
postpartum hemorrhage due to retained placenta or membranes
Nipple discharge is considered pathologic if
- spontaneous
- U/L
- persistent
Mammogram > US > MRI
Late and post-term pregnancy
fetal complications
Macrosomia
Dysmaturity syndrome
Oligohydramnios
Demise
Late and post-term pregnancy
maternal complications
Severe obstetric laceration
Cesarean delivery
Postpartum hemorrhage
enlarged kidneys with thin renal cortices
hydronephrosis = posterior valve
Risk factors for breech position
Advanced maternal age (≥35)
Uterine didelphys, septate uterus
Uterine leiomyomas
Fetal anomalies = anencephaly
Preterm (<37 weeks gestation)
Oligohydramnios/polyhydramnios
Placenta previa
Polyhydramnios
Amniotic fluid index = ≥24 cm
indomethacin as a tocolytic
not given after 32 weeks
MOA: cyclooxygenase inhibitor = ↓ prostaglandin production → fetal vasoconstriction
↓ renal perfusion + fetal oliguria can result in oligohydramnios = amniotic fluid index ≤5 cm
AFI = asses the amount of amniotic fluid by dividing the uterus in 4 quadrants
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Tocolytics =
Given up to 34 weeks = slow or stop the contractions of a woman’s uterus during pregnancy
Indomethacin = C/I after 32 due to potential closure of the ductus arteriosus
Nifedipine = C/I after 34 weeks due to material hypotension + tachycardia
Magnesium sulfate = weaker and good for neuroprotection up to 32 weeks
Routine Lab test
Prenatal visit =
Rh(D) type & antibody screen
Hbg/Hct, MCV, ferritin
HIV, VDRL/RPR, HBsAg, anti-HCV Ab
Rubella & varicella immunity
Urine culture
Urine dipstick for protein
Chlamydia PCR (if risk factors are present)
Pap test (if screening indicated)
24-28 weeks =
Hbg/Hct
Antibody screen if Rh(D)-negative
1-hr 50-g GCT
36-38 = GBS cultures
Cell-free fetal DNA testing indications
Maternal age ≥35
Abnormal maternal serum screening test
Sonographic findings associated with fetal aneuploidy
Prior pregnancy with fetal aneuploidy
Parental-balanced robertsonian translocation
bupivacaine
local anesthetic = epidural
toxicity = metallic taste + tinnitis + Seizure
brown rash palms + soles
plaques w/ rolled edges on the vulva
Syphilis
Management in the presence of 1 STI
screening should be offered for other STIs
Dx Chorioamnionitis
Fever + maternal leukocytosis + Fetal tachycardia + purulent fluid
46 XX, 46XY
paternal disomy
Complete Mole = sperm fertilizes empty ovum
No fetal tissue
69 XXY, 69 XXX, 69 XYY
Triploidy
Partial Mole = normal ovum fertilized by 2 sperm
Fetal tissue present
a history of genital HSV receive antiviral prophylaxis w/ prego
beginning at 36 weeks gestation until delivery
anti-D antibody titer of 1:32
Pt is alloimmunized = sensitized
Risk factors for Vesicovaginal fistula
immediately following intraoperative bladder injury = cesarean delivery + hysterectomy
weeks or months following surgery or childbirth (eg, obstructed labor) due to tissue necrosis and sloughing
years after pelvic radiotherapy as a delayed presentation of radiation-induced microvascular injury (ie, endarteritis) and progressive tissue ischemia and breakdown (as seen in this patient)
no dividing intertwin membrane
single amniotic sac
Raloxifene C/I
deep venous thrombosis, renal vein thrombosis, pulmonary embolism, malignancy, active smoking, or any thrombophilia
Fetal Growth Restriction management
Regular nonstress testing
Weekly biophysical profiles
Serial umbilical artery Doppler sonography
Serial growth ultrasounds
