UW OB 1 Flashcards
Prego women w/HSIL(High grade squamous intraepithelial lesion) how do you F/U?
since shes pregnant you must do a colposcopy first & if invasive do cervical excision
@ what weeks is tocolytics C/I?
34 wks or more
before — wks you can give corticosteroids
37 wks
C/I to breastfeeding
Galactosemia, Untreated TB, HIV infection, Herpetic breast lesions, Active Varicella Infection, Chemo or Radiation, Active Substance Abuse
describe the normal changes in thyroid function during pregnancy
decreased TSH, Increased total T4 and mild increase in free T4
Pt has Hydatidiform mole removed. What will you see in b-hCG? How do you follow up?
b-hCG will slowly fall and be gone in 6 months. During this time she MUST BE ON CONTRACEPTION FOR 6 MONTHS
what type of cancer is mammary pagents dz?
adenocarcinoma
prego women w/hyperemesis gravidarum; confusion, fallen 2x while standing, nystagmus. dx?
wernicke encephalopathy(encephalopathy, oculomotor dysfunction/nystagmus, ataxia)
Risk factors for cervical cancer
tobacco use, low SES, Immunosup, oral contraceptive use, high risk sex partners, STI, HPV
inpatient PID tx
IV cefoxitin or cefotetan + doxycyclin If PCN allergy: clindamycin + gentamycin
outpatient PID tx
IM ceftriazone + oral doxy
Lichen Plantus v Lichen Simplex Chronicus v Lichen Sclerosus
Lichen Sclerosus = thin, white, wrinkled skin over the labia majora/minora + atrophic changes.Lichen Simplex Chronicus = hyperplastic response to repetitive scratching and irritation = thick leathery textured skin.*Lichen Planus = glassy bright red erosiuns and ulcerations of vulvovaginal area(purp papules assoc w/HEP C), wickham striae
Pathogenesis of ovarian torsion
ovary mass causes twisting of ovary = ischemia & necrosis
Why do you do a Biophysical Profile on a baby?
to asses fetal oxygenation through ultrasound observation and the nonstress test.
pt w/endometriosis are at greatest risk for….
infertility
what is Pseudocyesis?
woman who wants to be prego but cant basically believes shes prego = somatization stress!= somatization stress fx hypo-pit-ovar axis causing weight gain, amenorrhea and causes her to imagine a + prego test when its actually neg.dx: neg U/S, neg Prego tests + clinical
Tx of HELLP & Eclampsia?
delivery!
women in 3rd trimester comes in complaining of bleeding, PE shows bright red blood from cervix. dx?
placenta previa*shoudl always do U/S before PE
Tx of Hyperemesis Gravidarum
dietary modification > Diphenhydramine(anti-his) > Metoclopramide(D-antag) > Ondansetron(5HT antag)
What will you see with intra-amniotic Infection/Chorioamnionitis? tx?
PROM >18h, Uterine tenderness, maternal fever, fetal tach >160bpm maternal leukocytosistx: abx(ampicillin +gentamycin for vag +clindamycin if C) + delivery
Which Ig crosses the placenta?
IgG
Why is Rh incompatibility so much worse than ABO incompatibility?
Rh exposure takes time to develop so by end of 1st prego mom has recently started making IgG to baby = will make immediate attack on 2nd Rh + baby.*ABO incompatibility causes an acute response and will lyse RBCs. type O moms have large Anti A&B IgG = big hemolysis vs Type A&B moms have small O IgG & mostly IgM which doesnt really cross the membrane.
When is Rh screening done?
28 weeks
What do you do if mom is Rh- and baby is Rh+?
give Rogam @28wks and within 72 hr of birth
Presentation of Placenta Previa VS Placenta Abruption
Previa = painless vaginal bleeding in 3rd trimester, blood from cervixAbruption = Painful uterus w/bleeding in thrid trimester!
41w gestation. NST w/FHR 140. FHR decreased to 120 after contraction peak. BBP score of 4. no accelerations for >40 min dispite vibroacostic stimulation. dx?
Uteroplacental insufficiency
Itrauterine Fetal Demise(IUFD)How do you dx this?
fetal death at >20 weeks**can only dx w/lack of fetal cardiac activity(no heart movement) on transabdominal U/S*absent fetal movement or absence of fetal heart sounds on doppler could be bc baby is sleeping or not in the right position this is why you must visualize absence of heart movement w/U/S
Abortion vs Intrauterine fetal demise
Abortion is death before 20 wksIUFD comes after 20 wks
women cant get prego. she have regular menstral cycles and you have already worked up the dude and hes fine. what do you do next?
- Smush test for inhospitable Mucous2. check for ovulation(ovulation kit checking LH, Progesterone levels, BBT, Endometrial biopsy)
Managment of PPROM <34 wks; PPROM >34 wks
Preterm premature rupture of membbranes = <37 wks.if PPROM > 34 wks = deliery +abx + steroidsIf PPROM < 34 wks = managed expectantly if not infection +abx +steroids*if PPROM < 34 wks w/infection = delivery +abx + sterids**either way always give ABx + STEROIDS!
Presenation and tx of uterine rupture
sudden extreme abdominal pain, abnormal bump in abdoment, no contractions, regression of fetus as it is now floating in abdomen.tx: Laparotomy ASAP to get baby out then repair or hysterectomy
Uterine Inversion presentation and tx
lower abdominal pain, round mass protruding through the cervix, fundus not palpable, hemorragic shock.tx: fluid replacement, push uterus back in then remove placenta and give uterotonic drugs(helps uterus contract and stops bleeding)
treatment for overflow incont.
Anti-Cholinergic(betha) > cath
What is Pubic Symphysis Diastasis? cause? rf? tx?
progesterone & relaxin cause increased pelvic motility and widening, after tramatic delivery(fetal macrosomia, multiparity, precipitous labor, operative vag delivery) can present w/difficulty ambulating, RADIATING SUPRAPUBIC PAIN w/an intact neuro exam.tx: NSAIDs, PE, resolves 4-6 wks
define an acceleration on a NST (assume >35wks). whats a + NST?
acceleration: >15 bpm for >15s returning to normal w/in 2 min.+NST: >2 accel in 20 min each above 15bpm and >15s.
women reports pain with penitration. dx? tx?
genito-pelvic disorder = due to trauma, abuse or lack of knowledge.tx: kegals + desensitization
Hydralazin vs labetalol for HTN prego
cant give labetalol w/bradycardia
women with recurrent canidida inf…what shoudl you check?
a1c
baby born w/warm, moist skin, tachy, poor feeding, irritabliity, poor weight gain…dx?
neonatal thyrotoxicosis! mom prob has anti-TSHr ab! which cross the placenta causeing release of excessive TH in baby.tx: methimazol + BB = will resolve in 3 months
Young women tx for some cancer w/chemo now presents with menopause sx…wtf happened?
1 ovarian insufficiency due to chemo attacking ovaries.
