WH Flashcards
What is an appropriate measure of FHR variability from baseline?
6-25 bpm
Normal baseline FHR?
110 - 160 bpm
What are some things that can cause minimal/absent variability in FHR?
Acidemia Fetal sleep Fetal tachycardia Meds (narcotics, anesthesia) Prematurity Cardiac arrhythmias Pre-existing neuro injury
Define an accel of FHR.
How frequently should these occur?
Rise over baseline of 15+ bpm for at least 15 seconds.
At least two should occur over 20 minute span.
Define recurrent late decels
Occur with 50%+ of contractions
Fetal decels that mirror the timing of maternal contractions are likely from what cause?
Fetal head compression - these are “early” decels and benign
VEAL CHOP: early = head
Decels that occur without contraction are likely from what cause?
Cord compression - these are “variable” decels
VEAL CHOP: variable = cord
Decels that are gradual, lasting 30 seconds to 2 minutes, with the nadir after the peak of contractions are likely from what cause?
Placental insufficiency - these are “late” decels and are a concerning finding
When is the fetal yolk sac usually visible?
From week 5 until ~week 10-12
When is fetal cardiac activity detectable?
Around week 6
When do weekly prenatal visits begin?
Week 36
When do bimonthly prenatal visits begin?
32 weeks, until 36 when weekly visits begin
When is a GBS swab collected in pregnancy?
37 weeks
When is TDAP offered to a pregnant patient?
28 weeks
When is a GTT performed on a pregnant patient?
28 weeks
Associate types of twinning with timing of embryonic cleavage
Early (days 1-3) = di/di
Mid (days 4-8) = mo/di
Late (days 8-13) = mo/mo
Very late (days 13/15) = conjoined
Naegle’s Rule?
(LMP) - 3 months + 7 days
What does a risk of Down’s look like on quad screen?
Low estriol, low AFP
High inhibin A
What quad screen finding is associated with higher risk of neural tube defects?
High AFP
If AFP, estriol, and BHcg and high and inhibin A is low on quad screen, what is this concerning for?
Trisomy 18
What are the age criteria for primary amenorrhea?
14YO w/NO pubertal development or
16 YO w/ pubertal development
What are some endocrine causes of primary amenorrhea?
HyperGnRH hypogonadism:
ex: Turners - high FSH, loss of oocytes
HypoGnRH hypogonadism:
ex: Kallman’s - low FSH, no small
ex: Sheehan’s: hypopituitarism = low FSH
Chronic illness
EuGnRH hypogonadism: PCOS, congenital adrenal hyperplasia, hyperprolactinemia, hypothyroidism
Basic, normal physiologic hormone cascade of menstruation
Hypothalamus releases GnRH –>
Pituitary releases FSH, LH –>
FSH/LH stimulates ovaries and uterus:
- FSH causes follicle to develop
- LH surge causes rupture of follicle/release of ovum
Estrogen from granulosa cells dominates during follicular phase and builds endometrium
Progesterone from corpus luteum stabilizes the uterine lining and promotes production of “uterine milk”
Giant multinucleated cells on Tzank smear - Dx and Tx?
HSV, give valcyclovir 1g BID x 10 days
Tx for chlamydia
Doxy 100 mg PO x 7 days
- If pregnant, use AZ
- Consider adding ceftriazone 250mg IM for gonorrhea
Tx for gonorrhea
Ceftriazone 250mg IM
- Consider adding doxy 100 mg PO x 7 days for chlamydia
HPV screening reccs
- Start at 21 with Pap/reflex
- Start co-testing at 30
- Stop at 65 or s/p hyst
Tx for chancroid
Ceftriaxone 250mg IM
Tx for lymphogranuloma venerum
Doxy 100mg PO BID x 21 days
Tx for PID
Outpatient:
- Ceftrixone 500mg IM
- Doxy x14 days
- Consider adding metro for BV coverage
Inpatient:
- Cefoxitin or cefotetan IV
- Doxy IV
Transition to doxy alone PO after 24 hours sustained improvement, and consider adding metro for BV coverage
Abx for fever presenting intrapartum with RF for chorio
- Amp + gent if vaginal delivery
- Amp + gent + clinda if C/S
Tylenol for fever, IVF for tachycardia, cooling blanket if needed
- If non-ana allergy to PCN, replace amp with cefazolin
- If ana allergy to PCN, replace amp with clinda or vanc as appropriate
What are latency antibiotics and when are they used?
Preterm labor (<37 weeks):
- Amp + erythro IV x 2 days
- Amox + erythro PO x 5 days
What is the normal regimen given to a woman presenting with preterm labor <32 weeks?
- Betamethasone (2 doses, 24 hrs apart)
- Mg Sulfate
- PCN (GBS proph)
- IV fluids
- Tocolytics if membranes have not ruptured: indomethacin for <48 hours
- Latency antibiotics (amp + erythro then amox + erythro)
Define oligo- and polyhydraminos
Oligo: Deepest pocket <2 cm or AFI 5cm or less
Poly: Deepest pocket 8+ cm, or AFI 24cm or more
Tx for pyelonephritis in pregnancy
Amp + gent, or zosyn (tazo+piperacillin) if severe
Outside of pregnancy, cipro
Treatments for p/p hemorrhage 2/2 atony
Pitocin!
Add if needed:
- Misoprostol (ass’d transient hyperthermia)
- Methylergonovine (methergine) - CIx in HTN
- Carbaprost/hemabate: CIx in asthma, AE = diarrhea
Tamponade if needed; hyst as last resort
Tx for endomyometritis
I&D + clinda + gent; add ampicillin if no response in 24 hours; add metro after that if needed
Name two meds for urge incontinence, their classes, and some AE
Oxybutinin: antimuscarinic, has anti-sludge effects
Mirabegron: B agonist, relaxes the detrusor and can cause HTN. CIx in HTN, ESRD, and liver dz
Other than NSAIDs, OCPs and surgery, what are some tx options for endometriosis?
GnRH agonists: ex, leuprolide + progesterone. Binds GnRH receptors in pituitary, causes down-regulation of HPG axis via negative feedback. Can cause menopause-like AE.
GnRH blockers: suppresses GnRH release, causing hypoestrogenic state. Dose-dependent AE. Example: elagolix.
How do COC pills work?
Provide negative FB to HPG axis to cause decrease in FSH, decrease in LH, and inhibit follicle development/ovulation
How does letrozole work and what is it used for?
Aromatase inhibitor - lowers estrogen, can increase FSH to stimulate ovulation.
Used post breast cx
Used in PCOS to help fertility
How does clomiphene work and what is it used for?
Causes release of GnRH- blocks and agonizes estrogen receptors. Increases FSH via blockade, stimulating ovulation
