UWorld 4 Flashcards
disorders of the active phase of labor
protraction
-clinical features: cervical change slower than expected +/- inadequate contractions. treat with oxytocin
arrest: no cervical change for >4 h with adequate contractions OR no cervical change for >6h with inadequate contractions. tx with cesarean
operative vaginal delivery (vacuum/forceps)
Indications
- protracted second stage of labor
- FHR abnormalities
- maternal contraindications to pushing
Fetal complications:
- laceration
- cephalohematoma
- facial nervy palsy
- ICH
- shoulder dystocia
maternal complications:
- GU tract injury
- urinary retention
- hemorrhage
three types of thryoiditis
- chronic ai thyroiditis (hashimoto)
- hypothyroid features, diffuse goiter, positive TPO ab, variable radioiodine uptake - painless thyroiditis (silent thyroiditis)
- small nontender goiter, mild brief hyperthyroid, positive TPO Ab, low radioiodine - subacute thyroiditis (de Quervain thyroiditis)
- prominent fever and hyperthyroid s/s, painful/tender goiter
-elevated ESR and CRP, low radioiodine uptake
common problems related to lactation
- engorgement: b/l, symmetric fullness, tenderness and warmth
- nipple injury: abrasion, bruising, cracking, and or blistering from poor latch
- plugged duct: focal tenderness and firmness and or erythema no fever
- galactocele: subareolar, mobile, well-circumscribed, nontender mass; no fever
- mastitis: tenderness/erythema + fever
abscess: s/s of mastitis + fluctuant mass
hemophilia
- X-linked recessive d/o
- on average carrier mothers and unaffected fathers have a 25% chance of having a son with hemophilia, a silent carrier daughter, an unaffected son, or an unaffected daughter
pelvic organ prolapse
cystocele-bladder rectocele-rectum enterocele-small intestine procidentia apical prolapse-uterus, vaginal vault
Rf: obesity, multiparity, hsterectomy, postmenopausal
CP: pelvic pressure, obstructed voiding, urinary retention, urinary incontinence, constipation, fecal urgency/incontinence, sexual dysfunction
management: weight loss, pelvic floor exercises, vaginal pessary, surgical repair
nonstress test
- external FHR monitoring for 20-40 mins
- nml: reactive:>2 accels
- abnml: nonrxv:<2 accels; reccurent variable or late decels
BPP
- NST + US assessment of: amniotic fluid volume, fetal breathing movement, fetal movement, fetal tone
- 2 pts per category if nml, 0 if abnnl (max: 10/10)
- equivocal 6, abnml 0 2 4 or oligo
contraction stress test
- external FHR monitoring d/r spontaneous or induced (eg oxytocin, nipple stim) uterine contractions
- nml: no late or recurrent variable decels
- abnml: late decels with >50% of contractions
doppler sonography of the umbilical artery
- eval of umbilical artery flow in fetal intrauterine growth restriction only
- nml: high velocity diastolic flow in umbilical artery
- abnml: dec, absent, or reversed end-diastolic flow
BPP in depth (nml findings)
- NST: rxv FHR monitoring
- amniotic fluid vol: single fluid pocket >2cmx1cm or amniotic fluidindex>5 (otherwise its oligo)
- fetal movements: >3 general body movements
- fetal tone: >1 episode of flexion/extension of fetal limbs or spine
- fetal breathing movements: >1 breathing episode for >30 seconds
RF for placental insufficiency
- advanced maternal age
- tobacco use
- HTN
- diabetes
abruptio placentae
- concealed vs visible bleeding
- separation of placenta from uterine wall prior to fetal delivery
- CP: abdo and/or back pain, FHR abnormalities, variable amt of sudden-onset vag bleeding, high freq low intensity contractions, hypertonic/tender uterus
RF:
- maternal HTN or preeclampsia/eclampsia
- abdominal trauma
- prior placental abruption
- cocaine and tobacco use
oxytocin
indications: induction or augmentation of labor, prevention and management of PPH
Adverse effects: hyponatremia, hypoTN, tachsystole
s/s of GU syndrome of menopause
- vulvovaginal dryness, irritation, pruritus
- dyspareunia
- vag bleeding
- urinary incontinence, recurrent UTI
- pelvic pressure
PE of GU syndrome of menopause and tx
PE: narrowed introitus, pale mucosa with dec elasticity and dec rugae; petechiae and fissues; loss of labial volume
Tx: vaginal moisturizer and lubricant, topical vaginal estrogen
estrogen and stuff with its receptors
bladder trigone, urethra, pelvic floor muscles, and endopelvic fascia possess estrogen receptors and are maintained by adequate estrogen levels
ectopic triad
- vaginal bleeding
- lower abdo pain
- adnexal tenderness
-diagnosis made by positive pregnancy test and TVUS showing gestational sac at an ectopic site, most commonly fallopian tube
what are three causes of abnml menstrual bleeding
- fibroids
- heavy prolonged menses
- pressure s/s: constipation, urinary freq, pelvic pain/heaviness
- ob complications: impaired fertility, pregnancy loss, preterm labor
- enlarged irregular uterus
- asx: observe, symptomatic: combined hormonal contraception, sx - adenomyosis
- dysmenorrhea, pelvic pain
- heavy menses
- bulky globular and tender uterus - endometrial ca/hyperplasia
- h/o obesity, nulliparity, or chronic anovulation
- irregular, intermenstrual, or postmenopausal bleeding
- nontender uterus
high grade squamous intraepithelial lesions pap test requires…
colposcopic exam and biopsy of cervical abnormalities d/t high risk of progression to cervical ca
colposcopy
evaluautes cervix and vagina under magnification and id abnml (acetowhite changes) from nml cells in addition to abnml vessels
-cervical neoplasia occurs at transformation zone or squamocolumnar jxn
vesicovaginal fistula
RF: pelvic sx, pelvic irradiation, prolonged labor/childbirth trauma, GU malignancy
CF: painless, continuous urine leakage from the vagina
diagnostic studies: PE (clear watery fluid in the vagina), dye test, cystourethroscopy
DDx of urinary incontinence
- stress-2/2 obesity, multiparity, pelvic sx
- dec urethral sphincter tone, urethral hypermobility (tx with kegel exercises, or urethral sling sx)
- s/s: leakage with coughing, lifting, sneezing - urge
- detrusor hyoeractivity
- s/s: sudden, overwhelming urge to urinate - overflow
- impaired detrusor contractility, BOO
- s/s: incomplete emptying and persistent involuntary dribbling
US assessment of gestational age
- gestational sac diameter at 4.5-6wk, +/-5-7d accuracy
- crown-rump length at 7-10d +/-3, at 11-14 +/- 5
- biparietal diameter, head circumference, femur length less accuracy as the gestational age increases
urinary stress incontinence
- can be a presenting symptom of leiomyomata uteri (fibroids) d/t direct pressure on the bladder from an irregularly enlarged uterus
- best imaging modality to diagnose fibroids: US of pelvis
uterine inversion
- uterine fundus that inverts and prolapses through the cervix or vagina
- results in smooth, round mass protruding through the cervix or vagina, a uterine fundus that in nonpalpable transabdominally, severe pain, and PPH
CP: hemorrhagic shock, lower abdo pain
pathophys: xs fundal pressure, xs umbilical cord traction
RF: nulliparity, fetal macrosomia, placenta accreta, rapid L&D
management: aggressive fluid replacement, manual replacement of the uterus, placental removal and uterotonic drugs after uterine replacement
intrauterine fetal demise
- fetal death at >20 wks
diagnosis: absence of fetal cardiac activity on US
management: 20-23 wks do D&E or vag delivery
24 wks: vag delivery
complication: coagulopathy after several weeks of fetal retention
different causes of amenorrhea
- ovarian failure-FSH and LH inc
- functional hypothalamic amenorrhea-FSH and LH dec
- asherman syndrome (FSH, LH, prolactin, TSh are nml)
- prolactinoma-fsh and lh down, prolactin up, tsh nml
- hypothyroidism-fsh and lh down, prolactin and tsh up
type 2 oi
pathophys: AD, Type 1 collagen defect
US: mulitple fractures, short femur, hypoplastic thoracic cavity, fetal growth restriction, intrauterine demise
prognosis: lethal
dermoid ovarian cyst (mature cystic teratoma)
- cmmon benign ovarian tumor in premenopausal women
- can be found incidentally d/r PE
- typical US: calcifications and hyperechoic nodules
- dangerous complication: ovarian torsion
initial menstrual cycles in adolescents
-irregular and anovulatory d/t hypothalamic-pituitary-gonadal axis immaturity and insufficient secretion of gonadotropin-releasing hormone
intraamniotic infection (chorioamnionitis) RF
- prom (>18h)
- preterm premature rupture of membranes
- prolonged labor
- internal fetal/uterine monitoring devices
- repetitive vaginale examinations
- presence of genital tract pathogens
intraamniotic infection (chorioamnionitis) diagnosis
maternal fevel PLUS >1 of the following:
- fetal tachy (>160/min)
- maternal leukocytosis
- purulent amniotic fluid
- maternal tachy (>100/min)
- uterine fundal tenderness
intraamniotic infection (chorioamnionitis) management and complications
management: broad spec Abx and delivery
complications for mom: PPH, endometritis
for neonatal: preterm birth, PNA, encephalopathy
non-classic (late onset) CAH
pathophys: ar, dec 21, nml gc and mineralcort, inc androgens
CF: early pubic/axillary hair growth, severe acne, hirsutism, and oligomenorrhea in girls; inc growth velocity and bone age; inc 17 hydroxyprogesterone level
tx: hydrocortisone
order of puberty in girls
- breast development (thelarche) 8-12 in resp to rising estrogen
- pubic hair (pubarche)
- six mo before menses get growth spurt
- menarche at tanner stage 4 2-2.5 yr after initial breast bud (avg age 12.5 for menses onset)
- considered nml at age <15 if development of secondary sex characteristics has been appropriate
