UW OB2 Flashcards
28yo Prego. NV, RUQ Pain, BP 160/94, 98.9 F, Hg 8.5, Platelets 96K, +3 protein, AST/ALT elevated. dx? tx?
HELLP Syndrome = systemic inflammation + platelet consumption.
tx: DELIVERY, MgSO4, Hydralazine
Whats the major benifit with transdermal estrogen?
no increased risk of DVT!
FHR monitoring: Nadir + contraction mirroring each other
What could this mean?
normal or fetal head compression
FHR monitoring: Nadir occurs slowly after contraction. as contraction subsides nadir is being reached.(late deceleration)
What could this mean?
uteroplacental insufficiency
FHR monitoring: Nadir is sharp and not related to contractions
What could this mean?
cord compression, oligohydraminose, cord prolapse
How do you manage cord compression? what would you see on FHR monitoring?
move mother onto left side to avoid compressing IVC, Amnioinfusion if ruptured membranes.
On FHR monitoring would see sharp decelerations not related to contractions.
describe the histology seen on bx of fat necrosis of the breast?
foamy macrophages w/fat.
*may see in women how had previous breast surgery
HTN meds safe in prego
methyldopa, labetalol, hydralazine, nifedipine
2nd line: clonidine, Thz
HELLP or Eclampsia…which do you deliver?
both! tx is immediate delivery!
Tx of chorioamnionitis?
- Abx(amp + genta +/- clinda if c-section)
2. delivery
Placenta previa vs Placeta abrution on presentation?
Previa = PAINLESS Abrution = PAINFUL
Gestational diabetes goals. Tx hierarchy?
Fasting <95, 1hr pp <140, 2h pp <120
tx: diet > insulin > metformin > glyburide
What labs do you need @ initial vists for prego?
- RhD type + ab
- Hg/Hct, MCV(CBC)
- HIV, VDRL/RPR, HBsAg
- Rubella + varcella immunity
- pap test
- chlamydia PCR
- urine cult + protein
What labs do you need for prego @ 24-28 wks?
- Hg/Hct, MCV(CBC)
- RhD type + ab
- 1hr Glucose tests
What labs do you need from prego @35-37 wks?
GBS Culture!
Genitourinary Syndrome of Menopause
sx? pe?
sx: dryness, itching, dysparuria, urinary incon,recurrent UTI, Pelvic pressure, VAGINAL BLEEDING
pe: narrow introitus, pale mucosa, dec elasticity, dec rugae, PETECHIA, FISSURES, loss of labial volume
Women w/painful ulcers on vaginal who also has feeling of not being able to empty her bladder completely. comes in to ER complaining of Fever + HA + dysuria.
how do you dx?
THIS IS HSV! dx w/ viral PCR
*lumbosacral neuropathy of HSV can cause urinary retention
24 F prego, LMP 9w ago, recently stopped OCP and now has heavier periods, feels “incomplete bladder emptying” which she has had for awhile. PE shows 15w uterus w/irregular contores. dx?
leiomyomata uteri = bitch got fibroids she aight
Women with skin colored papules on labias. dx?
Condylomata acuminata = HPV 6 & 11!
*smooth, flat, papules, or califlower like
Placental abrution risks factors? what are you worried about when thsi happens?
RF: HTN, trauma, Cocaine + tobacco
*DIC, hypovolemic shock, fetal hypoxia, preterm deliver
Weird shit tahts normally w/in first few hrs of delivery
Shivers, temp <100.4 is considered normal, bloody discharge up to 3 weeks afterward(will get lighter and ligher in color)
Modifiable Breast cancer risk factors
HRT, Null parity, increase in age of 1st brith, alcohol
nonmodifiable breast cancer risk factors
BRCA +, 1st degree relative, white, increase in age, early menarch/late meno
23 yo F w/FNV, LQ tenderness, RUQ pain w/inspiration, intermenstral spotting, pain that is worse w/menses. dx?
PID! *intermenstral spotting was prob cervicitis
cause of symmetrical IUGR(<10% for gestational age) in 1st trimester.
Chromosomal Abnormalities > infection
cause of asymmetrical IUGR(<10% for gestational age) in 2/3st trimester.
HTN, smoking,maternal malnurition, utero-placental insufficiency
T/F raloxifene has no risk of DVTs
FALSE! Raloxifene still has risks of DVTs + hot flashes
+bone & -breasts
When do u treat osteopenia?
- When they bc osteoportic
- When they have a fragility fracture
- When the FRAX score tells u to
15 yo girl with heavy heavy menstral bleeding. How do you stop bleeding?
IV estrogen + anti emetic bc it’s gonna make her sick
How do you explain post partum urinary retention? when shoudl you be able to pee?
regional anethesia can cause bladder atony. should be able to void 6h s/p deliver/cath removal
Hyperemesis Gravidarm dx vs regular NV in 1st trimester
presence of ketones in urine = hyperemesis!
RF for Shoulder Dystocia
big baby, mom obesity, increase weight gain in prego, gestational diabetes, post term prego
Sx in inflammatory breast carcinoma vs IDC or LBC
Inflammatory = Peau d’orange, edema + erythema
*erythema not seen in others.
What happens if you dont treat primary genital herpes?
resolves on its own and will decrease in freq over time. Meds will speed resolution.
Mittelschmerz syn?
pain on 1 side of lower abdomen around d10-14 of menstral cycle lasting 1 d = ovulation!
can you breastfeed w/hep C?
yup!
mom gets epidural then hypotension why? tx?
epidural causes vasodilation + venous pooling
tx: fluids, move onto Lside and give vasopressors
cervical insufficiency =
<2.5cm
progesterone
girl on period presetns with fever (102), diffuse macular rash on palsm + soles, hypotension, NV, diarrhea + AMS…dx? tx?
Toxic Shock Syndrome = will see desquamation 1-3 wks later
tx: remove foreign body, Clinda+Vanc
Usually due to GAS or S.Aureus
What must you do for a mom with hypothyroid in prego?
increase her dose of durgs bc TBG increases in prego and will further take up T4 resulting in low lvls if not.
