Uworld Flashcards
causes of oligohydraminos
preeclampsia, abruptio placenta, NSAIDs, uretoplacental insufficiency, renal anomalies
how does tocolitics like indomethacin cause oligohydraminos
closes ductus arteriosus which leads to vasoconstriction and under profusion of kidneys
complications of oligohydraminos
meconium aspiration, preterm delivery, umbilical cord compression
causes of polyhydraminos
esophageal/duodenal atresia, anencephaly, multiple gestations, congenital infection, DM
complications of polyhydraminos
fetal malposition, cord prolapse, preterm labor, PPROM
hormone levels in turners syndrome
low estrogen and progesterone, elevated FSH and LH
management of a pt with mild, asymptomatic polyhydraminos at term
expectant management
US findings of congenital CMV
periventricular calcifications ventriculomegaly microcephaly intrahepatic calcifications fetal growth restrictions hydros fatalis
long term effects of congenital CMV
sensorineural hearing loss
seizures
developmental delay
pathophysiology of ovarian hyper stimulation syndrome
increased hCG enhances ovarian vascular permeability which leads to fluid shift into extravascular space
clinical features of ovarian hyper stimulation syndrome
respiratory distress, ascites, hemoconcentration, hypercoaguable, DIC, electrolyte imbalance, multi organ failure
dx of ovarian hyper stimulation syndrome
serial CBC and electrolytes, manage fluid, serum hCG, pelvic US, CXR, echo
why are post menopausal women at increased risk of stress urinary incontinence
weakened pelvic floor muscles and decreased estrogen leading to urogenital mucosa atrophy
treatment of septic abortion
IV fluids, broad spectrum antibiotics, suction curettage
ABG disturbances in hyperemesis gravidarum
metabolic alkalosis with compensatory respiratory acidosis.
increased vomitting leads to decreased HCl which causes metabolic alkalosis
management of HIV + pregnant mom with viral load >1000
ART + zidovudine + c section
management of HIV + pregnant mom with viral load <1000
ART + vaginal delivery
dx of intra-amniotic infection
maternal fever + at least one of following: fetal tachycardia (>160) maternal leukocytosis maternal tachycardia purulent amniotic fluid
how can you decrease risk of preeclampsia in pts who are high risk
daily baby aspirin
high risk pts for preeclampsia
multiple gestations, DM, history of HTN
uterine aversion
abdominal pain, vaginal bleeding, shock
postmenopausal woman with endometrial cells on pap
must do endometrial biopsy to r/o endometrial hyperplasia
why does pregnancy increase risk of aspiration
increased progesterone leads to decreased gastric emptying and increased abdominal pressure leads to GERD
contraindications to contraction stress test
contraindications to labor: placenta previa, prior myomectomy
next step after a non reactive stress test
BPP or contraction stress test
BPP score of 0-4
fetal hypoxia due to placental insufficiency
normal findings of a BPP
> 3 fetal movements
single pocket of fluid >2 cm x1 or fluid index >5
1 episode of flexion/extension
1 breathing episode for >30 seconds
risk factors for active phase protraction
cephalopelvic disproportion, maternal obesity, nulliparity, advanced maternal age
presentation of choriocarcinoma
AUB pelvic pain symptoms from metastases (lungs) uterine mass elevated hCG
pathophysiology of primary dysmenorrhea
increased endometrial prostaglandin production which causes uterine hyper contractility
tx of primary dysmenorrhea
1st: NSAID
2nd: COC
clinical features of primary dysmenorrhea
pain first 2-3 days of menses, N/V, diarrhea, normal pelvic examination
cause of variable decelerations
cord compression, usually happens after rupture of membranes
first line management of recurrent variable decelerations
maternal repositioning
management of pts at high risk for preeclampsia
aspirin starting at 12 weeks
24 hour urine collection at initial visit
clinical presentation of vasa previa
painless vaginal bleeding with ROM or contractions
FHR abnormalities
fetal demise
intraductal papilloma
unilateral bloody discharge without mass
invasive ductal carcinoma
unilateral bloody discharge with mass
tx of group B strep
PCN
if allergic: cefazolin
fetal hydantoin syndrome
maternal use of anti epileptics
cleft lip and palate, distal phyalnge hypoplasia, widened frontonelle, cardiac abnormalities
management of spontaneous abortion
medical induction
expectant management
suction curetage if hemodynamically unstable or if infection
vesicovaginal fistula clinical symptoms
painless, watery discharge from vagina after recent pelvic surgery
diagnosis of intraamniotic infection
maternal fever plus at least one of following:
fetal tachycardia
maternal leukocytosis
purulent amniotic fluid
management of intraamniotic infection
broad spectrum antibiotics
induction of labor
contraindications to breast feeding
varicella infection HIV substance use active, untreated TB herpetic breast lesion chemo or radiation
treatment for patients with endometriosis who fail medical management
diagnostic laparoscopy
pregnancy related cause of wernikce encephalopathy
hyperemesis gravidarum
clinical features of wernickes encephalopathy
encephalopathy
ocular dysfunction (nystagmus, bl abducens palsy)
postural and gait ataxia
management of active phase arrest
C section
anencephaly management
fatal fetal anomally
reduce risk to mother
vaginal delivery best
preterm labor management if under 32 weeks
corticosteroids
PCN for GBS
mag sulfate
tocolysis: indomethacin
preterm labor management if 32-34 weeks
PCN for GBS
corticosteroids
tocolysis: nifedipine
preterm labor management if >34 weeks
corticosteroids
PCN for GBS
test to definitively diagnose preeclampsia
24 hour urine protein collection
late decelerations
fetal hypoxia and acidemia
due to urey-placental insufficiency.
can be due to uterine tachysystole
symptomatic pubic symphysis diastasis
suprapubic pain that radiates to the back, hips, legs, made worse by walking. point tenderness to palpation over pubic symphysis
causes of symmetric fetal growth restriction
chromosomal anomalies, infection
what are fibroids
proliferation of smooth muscle within the myometrium
clinical features of fetal hydrops
polyhydraminos pericardial effusion pleural effusion ascities skin edema placental edema
diagnosis of pt with cyclic dysuria and hematuria
endometriosis
mature cystic teratoma US findings
complex, cystic, calcifications, hyper echoic nodules
management of hydatiform mole
suction D&C –> weekly B-hCG tests until undetectable –> monthly B-hCG tests for 6 months (can’t get pregnant during this time)
complications of inadequate weight gain in pregnancy
low birth weight, preterm delivery
treatment for PCOS pt trying to get pregnant
letrozole
abnormal presentation of placental abruption
minimal bleeding bc it is contained within uterine cavity–> leads to focal pain (back pain), abnormally distended uterus, high frequency contractions
management of sinusoidal FHR
urgent C section
cause of sinusoidal FHR
fetal anemia - fetal blood loss from vasa previa
most serious complication of neonatal lupus
fetal AV block
first mutation in endometrioid endometrial carcinoma
PTEN
shiller-duval bodies
glomeruloid appearance, cancer cells lining up around a central capillary
