women's health Flashcards
ectopic pregnancy RF
conception with IUD in place
ectopic pregnancy presentation
missed/delayed menses
vaginal bleeding
abdominal pain/discomfort
risk for fallopian tube rupture - bleeding out
ectopic pregnancy treatment
unstable - surgery - laparotomy
stable - med - MTX (CBC, creatinine, LFTs)
methotrexate CI
hemodynamic instability/fallopian tube rupture, unable to follow up
hepatic/renal disease
thrombocytopenia, anemia
ectopic pregnancy diagnosis
absence of intrauterine gestational sac with hcg levels of 1500 mlU/ml or greater via ultrasound
gestational HTN
SBP >140 or DBP >90 on 2 separate readings at least 4 hours apart, with no proteinuria or severe preeclampsia
most cases resolve postpartum
first line: PO a-methyldopa and PO labatalol
preeclampsia
BP 140/90 with proteinuria >300 for 24 hours (or other end organ damage) after 20th week of gestations in previously normotensive pt
may have HA, rapid weight gain, edema
mag sulfate for seizure prophylaxis
nicardipine/labetalol
HELLP
hemolysis, elevated liver enzymes, low platelet count
RUQ pain
deliver the baby if >34 weeks, otherwise steroids, BP mgmt, seizure mgmt, transfusion
HTN crisis
goal <160/110
labetalol, hydra, nifedipine
avoid nitroprusside - concern for cyanide and thiocyanate toxicity in mom/fetus
eclampsia
emergency - DELIVER THE BABY
BP control
Seizure mgmt w mag sulfate
amniotic fluid embolism
rapid decline in maternal or fetal status; hypotension w resp symptoms, coagulopathy, cardiac arrest
place in lateral decubitus position to minimize vena cava compression
permpartum cardiomyopathy
dilated cardiomyopathy
onset last month of pregnancy/5 months postpartum
treatment like CHF exac
VTE
treat w LMWH
infectious diseases
rubella
HSV
CMV
listeriosis - wisespread absecesses/granulomas in internal organs
pulmonary disease
SOB normal!!!
asthma
pneumothorax
renal disease
nephrolithiasis common
treat pyelonephritis
DM
normal DM - insulin req decrease 10–20% in first trimester
gest DM - lifestyle modifications, then metformin/glyburide
thyroid - hyperthyroid then hypothyroid. Synthroid. previous hypothyroid need Synthroid increase
depression
blues, depression, psychosis
SSRI or SNRI
neurocritical care
r/o venous sinus thrombosis -> stroke
consider for acute neuro changes
CT scan
EEG/TCD
seizure mgmt, BP mangt, reduction of ICP
bleeding in second half of pregnancy
abrupt placentae
placenta previa
premature labor
abrupt placentae
PAINFUL vaginal bleeding, abd pain, uterine tenderness
inquire about trauma, smoking hx, HTN, cocaine
MUST R/O in all patients w painful bleeding
placenta previa
do not do a digital exam
ultrasound to confirm
premature labor
bleeding
<37 weeks
steroid/abx
fever most common cause
endometritis
assume pelvic infection until proven otherwise
adnexal torsion
surgical emergency
potential ovarian ischemia
US w/wo doppler
FDA drug categories
A - relatively safe for use in preg
B - no known risks, not well confirmed in human trials
C - studies not available, given only if benefit>risk
D - definitive fetal risk
X - contraindicated risk to fetus
big physiologic change in preg
CO increases 50%
