uwise studying Flashcards
what are the testing intervals for pap smears and cotests
begin testing at 21 regardless of sexual activity
21-65 every 3 years
30-65 every 5 years if cotest.
stop at 65 if never had abnormal and been compliant for 10 years
what do you do if you have an ASCUS on pap
reflex repeat pap with cotest
what do you do if you have a positive repeat pap with cotest
colposcopy –furhter investigation is required.
whats the next step for woman that have a positive pap for HSIL
Need further intervention. colposcopy or diagnostic excisional procedure.
what are the findings for PID
abdominal pain, adnexal tenderness, fever, cervical motion tenderness, vaginal discharge.
what is the classical presentation of gonorrhea
mucopurulent cervicitis with exacerbation of symptoms during cycles
what does chlamydia cause
frequently associated with gonorrhea and causes cervicitis and PID.
How does trichomonas present
yellow frothy discharge but not typically with fever or abdoinal pain
how does candida present
thick white cottage cheese like discharge. not typically associated with fever or abdominal pain
cervicitis presentation
increased vaginal discharge, dysuria, urinary frequency, postcoital bleeding
classical syphilis and what test to confirm
macular rash on palms and soles, described as copper penny lesions. need treponemal-specific antibody test to confirm. darkfield can be used but availability is low.
If a patient has an STI what should we do?
screen for all STIs/
what are clue cells indicative of
bacterial vaginosis. this does not usually cause irritation. clue cells are seen on a wet mount slide. they are adherent coccobacillary bacteria on the edges of the cells.
what is the presentation of trichomaniasis
yellow-green frothy discharge. these are protozoans and have flagella that allow them to spin across the slide. they also cause inflammation and irritation (strwberry cervix).
Does bacteria vaginanosis smell/
yes, fishy odor. KOH test reveals amines and a fishy odor.
when is it best to test for herpes?
very early in the outbreak. the vesicle is broken open and thr culture is taken.
Why can herpes tests come back negative
they are highly specific, but not very sensitive. 10-20% false negative rate.
what is the next step if ASCUS, then positive high-risk on reflex in a 21 yr old
21-24 is a special population, in that there is a high incidence of HPV in this group and typing is not recommended. the management would be expectant and repeat cytology in 12 months.
when do we start colon cancer screening and what are the screens
45-50. Annual hemoccult testing, flexible sigmoidoscopy 5 years, colonoscopy every ten years
when do we start DEXA scans?
onloy started <65 when the patient has risk factors.
when do we start mammograms
40 and annually.
when do we offer breast MRI?
when there is >20% risk of developing breast cnacer
when is a breast ultrasound used?
adjunct to mammography it is useful in evaluating inconclusive findings.
is ultrasound a primary screening tool for breast cancer
NO.
what are the criteria for BRCA testing
a combination of first and second degree relatives on the same side of the family
what are the most reliable methods of brith control
LARCs, DEPO, sterilization all have <1% failure rate
which birth control methods have a failure rate of 3-5%
OCPs,
what contraceptive method has a failure rate of 12%
male condomds
what is the failure rate of nuva ring? a contraceptive ring? how often do you have to change it?
8%.
once a month
what to test for in patient with fat and hyperpigmented regions on the skin
diabetes. this is highly indicative of acanthosis nigricans
why prescribe folate to vegetarians especially if hthey plan on pregnancy
because they do NOT get enough folate
Diet alone in people with normal diets is insufficient to ward off neural tube defects, which is why folic acid is prescribed.
what is the strongest predictor of osteoporosis, what are some other risk factors
family history.
age >50.
gender (women 4X more likely)
small, petite and thin women are at higher risk.
heavy alcohol consumption is also a risk factor
what is the best way to lower your risk for osteoporosis
exercising regularly weight-bearing exercises 3-4 a week are the best for preventing osteoporosis
physiologic dyspnea of pregnancy
present in up to 75% of pregnant women in the third trimester.
what are the signs of PE
tachycardia, tachypnea, hypoxia, chest pain, signs of DVT
what are the signs of mitral stenosis
diastolic murmur, signs of heart failure
what happens to the respiratory system during pregnancy
1) inspiratory capacity increases (15%)
2) increases in tidal volume and inspiratory reserve capacity.
3) respiratory rate does not change
4) there is increased minute ventilation and this causes compensated respiratory alkalosis.
5) functional residual capacity is reduced to 80%.
this leads to shortness of breath often experienced in the third trimester.
what happens to the plasma osmolality in pregnancy
it is reduced.
what happens when we fluid overload pregnancy women
their osmolality becomes normalized and they begin to have pulmonary edema
what type of murmur is always abnormal
diastolic
how much does the cardiac output increase in pregnancy
33%
what happens to the SVR
it falls
why does the cardiac output increase in pregnancy
due to both HR and SV.
what percentage of women have a systolic murmur in pregnancy and why
95%. because of the increased volume.
is the systemic vascular resistance more or less than the pulmonary vascular resistance
the systemic vascular resistance is always greater than the pulmonary. if the opposite then there is a right to left shunt and cyanosis will develop in the context of a VSD.
what happens to the ureters in pregnancy
come degree of dilation in the ureters and renal pelvis occurs in a majority of women. the dilation is often unequal due to the cushioning of the sigmoid colon on the left and greater on the right due tothe dextrorotation of the uterus.
this can cause mild hydronephrosis
what happens to the thyroid axis in pregnancy
the thyroid binding globulin is increased due to increases in circulating estrogen and this causes an increase in the total thyroxine levels, but t4 free will remain the same. similar effects occur for T3. the thyroid also increases in size by approx 10% in pregnancy
If someone has a molar pregnancy on ultrasound what is the next step?
chest X ray is indicated because the lungs are the most common site of metastatic trophoblastic disease.
what screening measures do you take for african american couples? Even when non-symptomatic
screening for alpha and beta thalassemia is possible by RBC indices. hemoglobin electrophoresis is the best for hemoglobin C and thalassemia minor
what genetic diseases are important for Jewish populations
fanconic anemia, tay-sachs, cystic fibrosis, niemann-pick
what population is affected by thalassemia
mediterranean population
what populations are at risk for cystic fibrosis
non-hispanic whites, Jews.
which populations are at risk for tay-sachs
ashkenazi jews, french-canadians
what other diseases are Ashkenazi Jews at risk for?
Gaucher’s, Canavan, and Bloom. cystic fibrosis, tay sachs.
what does valproic acid put the fetus at risk for
neural tube defects, hydrocephalus, craniofacial abnormalities.
are insulin and methyldopa linked to fetal anomalies
NO.
what are women with poorly controlled diabetes putting fetus at risk for?
4-8-fold risk of structural anomaly, neural tube defects, and cardiovascular defects. genitourinary and limb deefects have been reported
what is chorionic villus sampling able to dtect?
karyotype. but the sample can be used for biochemical, DNA-based studies, including cystic fibrosis testing
what test has the highest detection rate for T21
cell free DNA screen has a detection rate of 99% at a 0.2% fasle-positive rate.
the other tests have a 5% false positive rate.
what are the tests for T21 and T18
cell-free DNA screen,
quad test, triple test, sequential screen and serum integrated screen with nucal translucency
first trimester combined test T21
nucal translucency, PAPP-A (pregnancy associated protein A), beta-hCG. has an 85% detection rate.
triple screen test for T21
second trimester AFP, beta-hCG, uE3 (estriol test), 69% detection rate.
quad screen for T21
triple screen with inhibin A, 81% detection rate
sequential screen for T21
first trimester NT andPAPP-A with second trimester quad 93% detection rate
serum integrated screen when unable to determine nucal translucency
first trimester PAPP-A and second trimester quad screen 88% detection rate
what is the most common cause of inherited intellectual disability
fragile X
what is the most effective screening tool for down syndrome
cell free DNA. performed as early as nine weeks.
when a patient fails a blood glucose test in pregnancy what is the first step
counseling on diet and glucose monitoring
Is IUGR seen in women with gestational diabetes?
NO. it is seen in pre-existing diabetes however.
what are the risks associateed with gestational diabetes
shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia
what is the recommended dose of folic acid
4mg daily before conception and through the first trimester
valproic acid can cause what?
1-2% incidence of neural tube defects, specifically lumbar meningiomyelocele. spina bifida, cardiac defects, facial clefts, hypospadius, craniosynostosis, limb defects. lung hypoplasia and omphalacele
what is the most common cause of an elevated maternal serum AFP
90-95% of cases of elevated AFP are due to things other than neural tube defects, including, underestimation of gestational age, fetal demise, multiple gestations, ventral wall defects and tumor or liver disease in the paitent.
Is warfarin okay during pregnancy
No. it is a known teratogen. low molecular weight heparin the drug of choice during pregnancy
what aneuploidy test is offered for women of normal risk
quad screen
when is amniocentesis offered
for women over 35 and in the setting of an abnormal screening test.
when is chorionic villus sampling offered
during the first trimester
what are the first trimester screens
nuchal translucency, serum hCG, and PAPP-A.
is serum AFP offered for aneuploidy
NO. this is insufficient for aneuploidy. it is good for neuroal tube or abdominal wall
what are braxton-hicks
short duration, less intense contractions that cause bearable pain in the lower abdomen and groin region. they can cause some nausea and discomfort.
what are some clinical findings for trisomy 21 p
flattened nasal bridge, small and rotated ears, sandal gap toes, hypotonia, protruding tongue, short broad hands, epicanthic folds, and oblique palpebral fissures
what is the most likely finding for a baby born to a type 1 diabetic
small and hypoglycemic
NOTE: gestational diabetics are bigger!
what are the warning signs for fetal sepsis
tachycardia and minimal variability. septic infants appear pale, lethargic and with high temperature
what is a common complication of twin-twin transfusion syndrome
polycythemia of the plethoric twin. (the bigger more robust twin)
the smaller one is usually at risk for IUGR and oligohydramnios while the plethoric twin is at risk for volume overload and polyhydramnios that may lead to heart failure and hydrops.
what are babies born to diabetic mothers at risk for in the context of blood diseases
hypoglycemia, polycythemia, hyperbilirunbinemia, hypocalcemia, and respiratory distress. isolated anemia and thrombocytopenia are not risks.
Do you use naloxone on infants?
No. any substance abuse/use at all is a contraindication for naloxone use since it could put the baby in life-threatening withdrawal.
when an infant is born to a mother that is HIV positive what is the next step?
immediately upon delivery begin zidovudine (AZT). HIV testing begins at 24 hours. breast feeding is NOT encouraged.
how to calculate APGAR
activity respiration pulse grimmace appearance all get two points each
how does sheehan’s syndrome present
significant blood loss causes anterior pituitary hypoperfusion and ischemic necrosis leading to loss of gonadotropin, TSH, and ACTH. signs are slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension and amenorrhea
what is the most common cause of postpartem fever
endometritis
what is the most common causal agent of endometritis
polymicrobial. both aerobic and anaerobic species. staphylococcus and strep are the most common.
what is postpartem blues
feelings of depression with symptoms that only last less than two weeks.
what symptom is useful in deciphering between postpartem blues and depression
inability to connect with family or ambivalence to the newborn is indicative of postpartem depression.
what is the most significant risk factor for postpartem depression
personal history of depression
what are the risk factors of postpartem depression
history of depression, social isolation, lack of support, marital conflict, considering termination, stressful life situations,
what is the safest way to suppress lactation
breast binding, ice packs and analgesics.
what cancer does breast feeding reduce the risk of?
ovarian cancer and a decreased incidence of breast cancer
why do we not prescribe EP contraception postpartem
can increase difficulties in lactation and breast feeding.
what is the proper positioning for breast feeding
belly to belly is the most effective position
what causes mastitis and how do we treat
strep from babies mouth causes it. antibiotics easily trats it
Do you stop breast feeding for mastitis?
No.
how dos simple mastitis presetn
breast feeding mother with pain and mild fever and redness in the breast
what can help mothers that want to exclusively breast feed
getting baby on breast within 20 min of delivery and rooming with the baby (unlimited access)
what hormones increase on birth of the baby that effect milk production
profound increase of progesterone and estrogen. this inhibits alpha-lactalbumin.
what does candida of the nipple present like
pink, shiny, nipples that are irritated when breast feeding. have flaking skin on the periphery. usually no fever since this is superficial. this should prompt inspection of the babies mouth. the nipple fissures can also become infected with bacteria and thus anitbiotics should be apart of the treatment plan.
how many stools should an adequately fed baby have
3-4 in 24 hours
how many times should an adequately fed baby urinate
4-6 times in 24 hours
what strategies should be considered for breast engorgement
frequent nursing, warm shower, compresses, massaging and hand expressing the milk wearing a good support bra. using analgesics 20 min before feeding.
which hormone is responsible for milk production
prolactin
which hormone is responsible for milk ejection
oxytocin
what is the best first step to diagnosing a breast feeding mother who’s baby is losing weight
assess breast feeding technique directly.
what the increase in risk for someone that has had an ectopic
10-fold
what two things do we look at to decipher between intrauterine and ectopic pregnancy on ultrasound
the level to rise by 50% (or double ) in 24hrs and be greater than the discriminatory zone. >2,000
what is standard of care for a ruptured ectopic in the fallopian tube
salpingectomy
how does uterine perforation present
abdominal pain, nausea, scant bleeding, fever, immediately after a surgical procedure
what is the most common abnormal karyotype encountered in spontaneous abortions
autosomal trisomy
what diseases are assocaited with early pregnancy loss
systemic diseases, such as diabetes, lupus, chronic renal disease
is it safe for patient’s experiencing early pregnancy loss to be managed expectant
Yes. You can manage them expectantly
women experiencing first trimester losses should be tested for what?
systemic diseases, such as lupus, diabetes, thyroid diseases
what is a benefit of misoprostol in the use of abortifacient
it reduces the time to expulsion for pregnancy
what will oxytocin do?
increase the strength and frequency of contractions
do you ever wait until 42 weeks of gestation?
no. this may increase the risk of perinatal mortality
If full term is it reasonable to induce labor if the patient is in back pain?
yes/
when is misoprostol used prior to oxytocin
when the cervix is unfavorable.
what is associated with breech presentation
prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencaphaly, placenta previa. unterine anomalies, and fibroids
what are the risk factors for shoulder dystocia
fetal macrosomia, maternal obesity, diabetes mellitus, post-term pregnancy, a prior delivery, complicated by shoulder,
what is backup transverse lie presentation associated with?
cord prolapse
what are the risk factors for cord prolapse
rupture of membranes, polyhyramnios, premature or small fetus
what is turtle sign indicative of
shoulder dystocia.
what is the first maneuver in shoulder
McRoberts maneuver –hyperflexing her legs to her abdomen
what is contraindicated in shoulder
fundal pressure and operative vaginal delivery
what is the major symptom of uterine fibroids
heavy menstrual bleeding secondary to increase in uterine size and/or obstructive effect on uterrine vasculature that ultimately leads to more bleeding. other symptoms are pain and pressure which may cause pressure against bladder bowel and pelvic floor.
what do we do about fibroids in pregnancy
nothing. no need to treat.
what type of fibroid is associated with miscarriage
In general, fibroids are infrequent cause of miscarriage or subfertility, but submucosal or intracavitary myomas are most likely to cause lower pregnancy and implantation rate.
what are the mechanisms of fibroid miscarriage
focal endometrial vascular disturbance, endometrial inflammation, secretion of vasoactive substances.
When you have a patient that has AUB and a uterus that is oversized, what is the next step for treatment? e
endometrial sampling
A patient with fibroids that needs conservative therapy for fertility should get what management
First treat with NSAIDs and OCPs. GnRH agonists (leurpolide) are a great management tool.
how long for GnRH treatment for maximal response from fibroids
3 months. if treatment is discontinued then the fibroid will return to its pretreatment size in 3-4 months.
what is the typically presentation for uterine fibroids
progressively heavier periods and longer menstrual periods over the past year with increased uterine size.
when is GnRH treatment indicated
before surgery to shrink the tumor or when the onset of menopause is expected.
If a younger patient with fertility issues presents with intramural fibroids what is the management
myomectomy is warranted in younger patients with infertility if the fibroid is sufficient in size or location to be a probable cause of infertility, including distorting the uterine cavity
what is the risk for isoimmunization
> 20% —2% antepartem, 7% after full term delivery, 7% with subsequent pregnancy loss.
what ultrasound is indicative of fetal hydrops
it is defined as a collection of fluid in two or more body cavities, such as ascites, pericardial, and or pleural fluid and scalp edema.
what volume of fetal blood is neutralized by the standard dose of RhoGAM?
the standard dose is 300mcg, 30cc of fetal blood.
how do we detect Rh-D
indirect coomb’s test
what measurement is needed to scale the severity of fetal anemia and disease for Rh-isoimmunization
amniotic billirubin.
in the presence of severe erythroblastic fetus, the amniotic fluid will become stained yellow. this is billirubin and can be quantified by spectrophotometric measurements of optical density 420-460. if there is a deviation from linearity this indicates the presence of severe hemolysis.
what does zone three of the Liley curve indicate
this is severe hemolytic disease with hydrops and fetal death likely within 10 days. the baby needs a transfusion
what is the most common cause of post partem hemorrhage
uterine atony.
what are the risk factors for post partem hemorrhage
macrosomia, precipitous labor, multiparity, general anesthsia, oxytocin use, prolonged labor, twins, and chorioamnitis
what medications are used to increase uterine contractions and reduce post partem hemorrhage
methergine, prostaglandins, misoprostol, oxytocin,
what is prostaglandin E1
misoprostol
what is prostaglandin E2
dinoprost, avoid use in hypotensive patients
what is prostaglandin F2-alpha
“hemabate”, avoid using in asthmatic patients
another name for methregine
methylergonovine
How is oxytocin delivered
IV with fluids. NO IV PUSH
what do methergine, oxytocin, prostaglandins all do
contract the uterus
If post partem bleeding is an issue but you find no atony or retained placenta then what do you look for and what do you do?
look for lacerations first. then potentially move to uterine artery embolization.
what to look for with placenta that is low-lying and anterior with multiple C-sections
placenta accreta
what is a B-Lynch suture
this is a uterine compression suture used to control bleeding in the context of retractable atony
what is delayed postpartem hemorrhage
when bleeding begins 48-72 hours after delivery.
what are common findings for abruption
vaginal bleeding, painful contractions with rapid progression of labor, clotting on the placenta
how does a septic abortion present
fever, bleeding and a dilated cervix.
what is the management for septic abortion
broad spectrum antibiotics and uterine evacuation.
why not use single-agent antibiotics for septic abortion
because there are typically a wide-range of organisms that are involved in septic abortions
which has more blood loss, surgical or medical abortion
medical abortions have more blood loss.
What is the upper limit of gestational age for manual vacuum aspiration
8 weeks
when do you use mifepristone and misoprostol
can use up to 9 weeks of pregnancy.
if a patient is experiencing heavy bleeding after medical abortion what is the next management
D and C
what do we do after a surgical abortion
always give broad spec antibiotics. there is a 42% reduction in infections when antibiotics are administered
Why do oral contraceptives reduce dysmenorrhea
because the progestrin in the OCP will induce endometrial atrophy. prostaglandins are produced in the endometrium and thus would be reduced. which should improve dysmenorrhea
when should we test for G/C?
in all sexually active patients that are 25 and younger
what are the contraindications for OCPs
older than 35 and smokers.
How effective is hysterectomy for relieving dysmenorrhea
> 80%
what needs to be performed in any woman over age 45 with AUB
endometrial sampling or biopsy to rule out carcinoma.
What needs to be done for the diagnosis of leiomyomata uteri
endometrial biopsy to rule out cancer
what is the exact definition of a fibroid
well-circumscribed, non-encapsulated myometrium
what is the definition of endometrial polyps.
localized hyperplastic overgrowth of glands/stroma
what is the definition of endometrial hyperplasia
crowding of endometrial glands with an increase in the gald to stroma ratio
definition of endometriosis
endometrial glands/stroma and hemosiderin-laden macrophages outside of the uterine cavity.
adenomyosis definition
invasion of the endometrial glands into the myometrium
how do uterine polyps present
heavy menstruation, intermenstrual bleeding, dysmenorrhea, increased cramping
what is the first line therapy for dysmenorrhea
NSAIDs
secondary dysmenorrhea causes
endometriosis, adenomyosis, uterine fibroids, infection.
Restricted uterine motion on exam can be due to what
endometriosis, scarring
what are some signs of magnesium toxicity
respiratory depression, muscle weakness, loss of deep tendon reflexes, nausea, and if given in really high doses cardiac arrest.
what level of magnesium is therapeutic and what levels cause issues?
therapeutic: 4-7mEq/L
loss of deep tendon reflexes: 7-10
cardiac arrest: 15
IN the context of preeclampsia and HELLP, what is the indication to deliver immediately
low platelets is the contraindication to expectant management. uncontrolled hypertension, non-reassuring fetal traces, liver function tests > 2X, eclampsia, persistent CNS symptoms and oliguria.
what are the most serious risk factors for preeclampsia
Chronic renal disease (20:1), chronic hypertension (10:1), family history (5:1), nullparity, BMI > 30 and age>40 all have 3:1. odds ratios.
what is the most common abnormal karyotype encountered in spontaneous abortions
autosomal trisomy 40-50% of cases.
monosomy X (45X,O) 15-25%
triploidy -15%
tetraploidy -5%
what is the most common chromosomal aneuploidy
trisomy 16
what is the most accurate measurement of the fetus for assessing dates?
femur length or long-bone length
factor V Leiden is associated with what in pregnancy
still birth, preeclampsia, placental abruption, IUGR…remember look for a history of clots/DVT/PE (even if taking oral contraceptives, etc)
what should be checked on all women that have vaginal bleeding during pregnancy
maternal blood type for Rh factors
what are some risks for placental abruption
polyhydramnios with rapid decompression of uterine, cavity. smoking
what are risk factors for placenta acreta
(this occurs when the placenta grows into the myometrium) previous C-sections and a low anterior placenta. the scar tissue prevents proper implantation, so it grows into the myometrium….thus acreta can be caused by previous c-sections
what is the bloody show
during pregnancy the cervix becomes vascular and when it dilates bleeding can occur.
what trimester does threatened abortion occur
first trimester
what is the most common cause of preterm labor
idiopathic.
other causes are dehydration, uterine distortion
what is nifedipine
a tocolytic
do we use tocolytics for amniotic fluid infection?
no.
what is a contraindication for magnesium
myastenia gravis
should we use terbutaline on diabetic patients?
no.
why is indomethacin contraindicated >33 weeks
because it closes the ductus arteriosis
what is associated with betamethasone treatment of the newborn
decreased risk of intracerebral hemorrhage and necrotizing enterocolitis.
how does magnesium affect uterine contractions
it competes with calcium
if ascus and hpv negative then
resume 3 years
if ascus then what
HPV testing or repeat cytology in 12 months
Do we ever use a pap smear for excluding cancer
NO. this is a screening test, not a diagnostic test. If cancer is suspected, need a biopsy.
what do obvious cervical lesions require?
biopsy.
what is the diagnosis and what do you do if you find a white plaque on the cervical os
this is leukoplakia and should be biopsied directly or under colposcopy as soon as possible, regardless of pap test outcome.
what is the false-negative rate of pap tests
20-30%
what do you do if you have taken a biopsy and pap test and they come back normal
resume normal testing
what is an ectropion
an area of columnar epithelium that has not yet undergone squamous metaplasia.
what do punctuations and mosaicism represent
they are representative of new blood vessels on end and on their sides. this represents angiogenesis and typically a more aggressive lesion.
what is more important to consider acetowhite findings or vascular changes
vascular changes.
what is the sensitivity of endocervical curettage
low. not that good of a test.
how llong does it take for HPV exposure to cause cancer
15 years
is cervical cancer genetically inherited
no
microinvasive cancer is defined how
cancer that invades less than 3mm
if a patient has a positive endocervical curettage, what is the next step
conization
what is an expected side effect of the DEPO shot
bleeding
who are the ideal candidates for progestin-only contraceptive
women that have had thromboembolic disease and estrogen-sensitive cancers, women who are lactating, women over 35 who smoke or who develop nausea with combined pills
what do copper IUDs do to mensuration
they can make them worse. but they last longer…
what do progesterone IUD do to periods
they make them better or stop them all together.
which contraceptives reduce the risk for ovarian cancer
OCPs.
what is the strongest predictor of regret of sterilization
age
levonorgestral IUD is what and does what
it is a progestrin-IUD. it has less of a failure rate than oral contraceptives and will eventually cause amenorrhea in most women (although the periods are heavier to start). it is protective against endometrial cancers
the patch is what? what is the contraindication
the patch is a transdermal application that releases estradiol and is contraindicated in woman over 198 lbs.
what form of emergency contraception can be used in a person with a history of DVT
NOT PLAN B. this person should get copper IUD. it can act as emergency contraception is applied up to five days after intercourse.
from where do you take a swab for assessing nitrazine test
the vagina, NOT the cervix
if someone presents with PPROM do you give tocolysis
yes. in order to give a round of steroids in hopes of improving the outcomes for the baby’s lungs;
what causes variable decelerations and what is a common context
cord compression and this can occur in PROM due to a lack of amniotic fluid.
what is ruptured membranes and a tender fundus indicate
chrioamnionitis
what is the greatest risk associated with delivering a baby before 24 weeks?
pulmonary hypoplasia
what medication can reduce the risk of PPROM
17-alpha-hydroxyprogresterone
how common is PROM
occurs in approximately 10-15 percent of all pregnancies
what can give a false positive nitrazine test?
sperm
when do you give magnesium for neuroprotection
<32 weeks and PPROM WITH LABOR that will occur within 24 hours
what signs are indicative of abruption
painful contractions and bleeding and PPROM.
what is the relationship between abruption and PPROM
2-5% of PPROM involve abruption
what do we give for PPROM
antibiotic therapy with ampicillin and erythromycin has been shown to prolong the latency period by 5-7 days as well as reduce the risk of maternal chorioanionitis and neonatal sepsis
what antibiotics do we give for endometritis
gentamycin and ampicillin
what is the most likely cause of cystitis
e. coli. other causes are klebsiellia and proteus mirabilis
what is breast engorement and what can it cause
it is an exaggerated response to the lymphatic and venous congestion associated with lactation. when the baby is not feeding well the breast become overfilled and can cause a fever.
when does milk let-down usually occur
during postpartem day two or three
how are C-section incisions managed
open drainage of the wound is appropriate
septic pelvic thrombophlebitis
thrombosis of the venous system of the pelvis. this is a diagnosis of exclusion. treatment is anticoagulants and antibiotics
what do you consider for a patient that was under general anasthesia?
aspiration pneumonia –always look to the lungs
what is the gold standard for treating post-cesarean endometritis
clindamycin and gentamycin
why dont we give cefalosporins or doxycyclines postpartem
they would provide great coverage for the organisms of post partem infection, but wee dont give them to nursing mothers
Do we give prostaglandins to VBACs
No. These are mainly used for cervical ripening, but can increase the risk of uterine rupture.
what does prostaglandin E1 do?
this is misoprostol and it is used for induction of labor based on uterine tonics and cervical ripening
fetal tachycardia is indicative of what
fetal distress, can be caused by maternal infection
what is prostaglandin E2
this is dinoprostol or CERVIDIL. this is a ripening agent
what is the initial measure to treat fetal hypoperfusion (late decels).
changing maternal position to the left lateral can help perfuse the fetus
what do we do if the fetal tracing has reduced variability and no accelerations during labor
digital fetal scalp stimulation. If an acceleration results then this is highly correlated with a fetal pH greater than 7.20 in over 90% of cases.
what is the next step in attempting to elicit an acceleration if the digital fetal scalp test fails
then further assessment such as allis clamp or fetal scalp pH is required
what are the findings for postdates and uteroplacental insufficiency
growth restriction, oligohydramnios, placental calcifications, and fetal demise
what are late term pregnancies associated with
macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency, and dysmaturity
what is amnioinfusion and what does it accomplish?
this is saline infusion into the uterine cavity. this is a reasonable approach to treat variable decelerations.
what is the presentation for fetal dysmaturity
10% over 43 weeks. the fetus has peeling skin, long finger nails, thin and long body, meconium stained skin and small placenta
