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Women's Health Flashcards

1
Q

layers of anterior abdominal wall

A 
skin
campers fascia
scarpas fascia
rectus abdominis
pyrimidalis
external oblique
internal oblique
transversus abdominis
rectus sheath
peritoneum
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2
Q

transversalis fascia location?

A

below arcuate: above and below rectus abdominis

above: below only (sheath above)

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3
Q

greater pelvis borders

A

(above pectinate line)
lumbar vert
iliac fossa
abd wall

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4
Q

lesser pelvis borders

A

(below pectinate line)
sacrum
ischium
pubis

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5
Q

pelvimetry definition

A

measurement of diameters of pelvic outlet, inlet and midpelvis

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6
Q

most important pelvimetry measurement

A

obstetric conjugate (shortest)

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7
Q

what do you actually measure?

A

diagonal conjugate

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8
Q

why cant you measure the obstetric conjugate?

A

bladder is in the way

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9
Q

pelvic outlet

A

bottom of pubis to bottom of coccyx

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10
Q

pelvic inlet

A

top of pubis to top of sacrum

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11
Q

obstetric conjugate

A

middle of pubis to top of sacrum

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12
Q

necessary obstetric conjugate for birth

A

> 10 cm (11)

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13
Q

types of female pelvis (MC to LC)

A

gynecoid (typical female) - 50%
anthropoid (narrow) - 25%
android (typical male) - 20%
platypelloid (wide) - 5%

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14
Q

diff btwn labia majora/minora

A

majora has fat and hair follicles, minora doesnt

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15
Q

blood supply for vagina

A

vaginal artery (branch of hypogastric - internal iliac)

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16
Q

blood supply for uterus

A

uterine art

ovarian art

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17
Q

blood supply for ovaries

A

fill

ovarian artery

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18
Q

vagina histo

A

stratified non keratinized squamous

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19
Q

cervix histo

A

outside: stratified non keratinized squamous
transitional zone
inside: columnar

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20
Q

cervix histo (@ diff ages)

A

younger: more squamous
older: more columnar

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21
Q

broad ligament attachments

A

fill

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22
Q

round ligament attachments

A

top of uterus

labia majora

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23
Q

ovarian ligament attachments

A

fill

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24
Q

suspensory ligament attachments

A

ovary

post abd wall

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25
vessels in suspensory ligaments | infundibulaopelvic?
ovarian a/v
26
vessels in round ligament
artery of samson
27
vessels in broad ligament
ureter | uterine vessels
28
ureter-uterine a/v relationship
ureter under a/v (water under the bridge)
29
movement of uterus in pregnancy
anteversion
30
layers of uterus
serosa (perimetrium) myometrium endometrium
31
abnormal uterus positions
retroversion anteflexion retroflexion
32
anteflexion
fundus over cervix
33
retroflexion
fundus folded posterior over cervix
34
parts of fallopian tubes
interstitial isthmus ampulla infundibulum (has fimbrae)
35
MC site of ectopic pregnancy
ampulla
36
fallopian size
7-14 cm
37
ovary size/size post menopause
3-5 cm/ decrease by 2/3
38
turner syndrome ovaries
streak ovaries need OCP to menstruate 45XO
39
what may accompany mullerian abnormalities
renal abnormalities
40
menstrual #s
menarche X cycle length X period length
41
coitarche
when first had sex
42
GP#s
G (pregnancies) P (full terms) (preterms) (abortion/miscarriage) (living)
43
vaccinations suggested preconceptionally
rubella varicella pertussis Hep B
44
vaccinations and getting pregnent
avoid conception 1 mo after live vaccine
45
folic acid levels
0.4 mgs/day usually | 4 mg/day with risk factors
46
genetic d/os to screen for
``` sickle cell B/A thalassemia Tay-sachs Canavan CF ```
47
confirmation visit
urine pregnancy test serum preg test gc/chl u/s
48
HCG levels in beginning of preg
doubling of quants every 48 hrs
49
symptoms of preg
N/V breast tenderness fatigue
50
signs of pregnancy
enlargement/softening of uterus chadwick sign Hegar sign fetal heart tones
51
time: softening of uterus
6 wks
52
time: fetal heart tones
12 wks
53
chadwick sign
congestion/bluish color to vagina
54
Hegar sign
softening of cervix
55
how to detect fetal heart tones
doppler
56
tests @ initial prenatal viist
``` pap gc/chla cultures uterine size cervix BP, height, weight T&S, Ab, CBC, RPR/VDRL, urine culture, HBsAg, HIV, CF varicella recommended ```
57
subsequent visits: when
every 4 wks till 28 wks every 2 wks till 36 wks weekly until delivery
58
fundal height @ 20 wks
20 cm
59
fundal height and gestation time
FH ~ gestation time till 36 wks
60
quickening (definition + time)
initial perception of fetal mvmt | 18-20 wks
61
recommended weight gain
normal BMI: 25-35 lbs | obese: 11-20
62
time for screening tests in preg
``` #1: 10-13 wks #2: 15-21 wks #3: 24-28 wks ```
63
tests @ 10-13 wks
serum PAPP-A, B-hCG, ultrasound measurement of nuchal translucency
64
tests @ 15-21 wks
``` serum MSAFP (AFP), hCG, estriol (uE3), inhibin A (quad screen) ```
65
cell free DNA tests for
tri13/18/21/XY | not NTDs
66
anatomy ultrasound time
18-20 wks
67
quad screen levels: NTDs
APF up
68
quad screen levels: Down syndrome
AFP down uE3 down hCG up inhibin A up
69
quad screen levels: tri 18
AFP down uE3 down hCG down
70
tests @ 24-28 wks
CBC, 1 hr GTT | Ab screen/Rhogam (lasts 14 wks)
71
3rd trimester screening
repeat RPR, HIV | group B strep culture
72
Leopold maneuvers
1. outline fundus 2. find back 3. fetus @ inlet 4. fetus in pelvis
73
absolute contraindications to aerobic exercise
``` sign heart disease restrictive lung dz cervical insufficiency mutiple gestation @ risk for PTL 2nd/3rd tri bleeding placenta previa post 26 wks ruptured membranes preeclampsia/gestational HTN ```
74
benefits of breastfeeding
cheap nutrition/immuno protection faster uterine involution/weight loss bonding
75
contraindications to breastfeeding
certain infections/medications
76
sex during preg contraindications
placenta previa premature membrane rupture PTL
77
fly till....
36 wks
78
cars and preg
walk every 1-2 hrs | seatbelt low, below gravid abd
79
med categories for preg
``` A - studied, no risk B - no known risk, studies may not be adequate C - risk cant be ruled out D - + evidence of risk X - contraindicated ```
80
sx of FAS
growth restriction facial abnormalities CNS dysfunction
81
FAS facial abnormalities
``` epicanthal folds flat nasal bridge railroad track ears smooth philtrum thin upper lip ```
82
common sx during pregnancy
``` HA edema n/v gerd round lig pain varicose veins vaginal discharge constipation fatigue leg cramps back pain ```
83
heart changes
``` location up CO BP down S3 gallop Systolic murmurs ```
84
abnormal heart changes
diastolic murmurs
85
ligament providing primary support ro uterus
uterosacral ligament
86
blood supply for fallopian tubes
ovarian and uterine arteries
87
tobacco risk to fetus
IUGR, low birth weight, mortality, SIDS
88
opiates in preg risks
withdrawal sx after birth/in utero
89
cocaine in preg risks
abruption | mortality
90
help w/ round lig pain
rest heating pad lateral recumbent belly band
91
true labor characteristics
contractions cause cervical change | Q5 min for @ least 1 hr
92
lightening
descent of fetal head into maternal pelvis
93
leopold maneuvers show you...
fetal lie fetal presentation fetal position
94
first stage of labor definition
onset of labor to 10 cm dilation
95
phases of first stage
latent and active
96
latent phase
cervical effacement and early dilation (
97
active phase
rapid cervical dilation (> 4 cm)
98
rate of active phase (nullip)
1.2 cm/hr
99
rate of active phase (multip)
1.5 cm/hr
100
second stage of labor definition
delivery of infact
101
third stage of labor definition
delivery of placenta
102
4th stage of labor definition
post placenta delivery (2-4 hrs)
103
first stage (no epidural) duration
n: 18 m: 13
104
first stage (epidural) duration
n: 19 m: 15
105
second stage (no epidural)
n: 2 m: 1
106
second stage (epidural)
n: 3 m: 1
107
average latent for nullip
8 hrs
108
7 cardinal labor mvmts
``` engagement flexion descent internal rot extension external rot expulsion ```
109
fetal eval -- how often (no RFs)
active: q30 min | 2nd stage: q15 min
110
fetal eval -- how often (RFs)
active: q15 min | 2nd stage: q5 min
111
levels: pain from dilation
T10-L1
112
levels: pain from vaginal/perineal distension
S2-S4 (pudendal)
113
pain management options
epidural spinal anesthesia local block general anesthesia
114
epidural
most effective continuous infusion used in vaginal or C-section
115
spinal anesthesia
``` single injections (2-3 hrs) C-sections ```
116
local block
inject perineum or vagina | pudendal block
117
general anesthesia
only c sections
118
caput succedaneum
edema of fetal scalp
119
episiotomy risks
up risk of 3rd/4th degree lacerations
120
Modified Ritgen Maneuver
support perineum and aid in fetal head extension
121
labor steps
``` head ant shoulder (downward P) post shoulder (upward P) ```
122
classic signs of 3rd stage (placenta)
uterus rises and becomes globular gush of blood lengthening of umbilical cord
123
time of 3rd stage
up to 30 min
124
1st deg lacerations
vaginal mucosa or perineal skin
125
2nd deg lacerations
underlying subq tissue, no rectal sphincter
126
3rd deg lacerations
thru rectal sphincter, no rectal mucosa
127
4th deg lacerations
thru rectal mucosa
128
4th stage management
massage fundus pitocin inspect placenta inspect cord for 3 vessels
129
cervical ripening: pharm
misoprostol: PGE1 analog cervidil: PGE2 analog
130
cervical ripening: c/i
hx of c section or uterine surgery
131
labor induction
stripping of membranes (release PGs) | oxytocin
132
disadvantages of cesarean
up risk hemorrhage, infection up maternal mortality long recovery/stay up pain
133
C-section indications
``` placenta previa hemorrhage from placental abruption prolapsed cord uterine rupture breech/malpresentation non-reassuring fetal tracing failed labor multiple gestation ```
134
TOLAC
trial of labor after cesarean
135
must have for TOLAC
``` 24 hr blood bank continuous fetal monitoring dr who can c section in house anesthesia ability to 30 min decision to incision ```
136
up prob of success in VBAC
precious vaginal birth | spontaneous labor
137
down prob of success in VBAC
``` recurrent indication (dystocia) > 40 wks materrnal obesity hi maternal age preeclampsia short interpreg interval up neonatal bbirth weight ```
138
tocodynamometry (TOCO)
freq/duration of contractions/pushing
139
intrauterine pressure catheter (IUPC)
freq, duration, P generated by contractions/maternal forces in mm Hg
140
necessary IUPC
>/= 25 mm Hg
141
adequate labor pattern
min 3 contractions in 10 min
142
MVUs
represent total intensity of contractions in 10 min period | MVU = P @ each contraction in 10 min
143
adequate MVUs
90% of labors need > 200 MVUs
144
normal labor pattern
= 5 in 10 min (averaged over 30 min)
145
tachysystole
> 5 in 10 min (averaged over 30 min)
146
baseline FHR
mean FHR during 10 min segment w/o epidosic changes, variability, segments that differ by > 25 bpm
147
baseline vs indeterminate
has to be at baseline for at least 2 min in any 10 min segment or its indeterminate
148
normal FHR baseline
110 - 160
149
tachycardia FHR baseline
> 160
150
bradycardia FHR baseline
151
baseline variability
``` fluctuations in baseline FHR that are irregular in amp and freq # = peak to trough ```
152
kinds of variability
absent minimal: 5 bpm or less moderate (normal): 6-25 bpm marked: >25 bpm
153
acceleration
abrupt increase in FHR (onset to peak
154
acceleration post 32 wks
peak of 15 bpm or more lasting 15 s or more (but less than 2 min)
155
acceleration pre 32 wks
peak of 10 bpm or more lasting 10 s or more (but less than 2 min)
156
prolonged acceleration
lasts 2 or more min but not as long as 10
157
acceleration or deceleration >/= 10 min
its a baseline change
158
early deceleration
gradual decrease + return to FHR (30s from onset to nadir) | nadir w/ peak of contraction
159
late deceleration
gradual decrease + return to FHR (30s from onset to nadir) | delayed: nadir is after peak of contraction
160
types of decelerations
early late variable prolonged
161
variable deceleration
abrupt decrease in FHR (
162
prolonged deceleration
decrease in FHR below baseline | decrease is 15+ bpm and lasts 2 or more min but not as long as 10
163
sinusoidal pattern
sine wave pattern in FHR baseline w/ freq of 3-5/min for 20+ minutes
164
reactive in non-stress test
up 15 bpm, lasting 15 s 2x in 20 min (32 wks)
165
modified reactivity in non-stress test
up 10 bpm lasting 10 or less s | 28-32 wks
166
nonreactive nonstress test
lack sufficient accelerations over a 40 min window | need mmore tests
167
category I FHRs
``` rate 110 - 160 moderate variability no late/variable decels maybe early dcels maybe accelerations ```
168
category III FHRs
absnet varability + (recurrent late, recurrent variable or brady) or sinusoidal
169
category II
all FHRs that arent I or III
170
steps to promote fetal oxygenation
``` lateral position IV fluid (lactated ringer) O2 slow pushing (everyother, evry 3rd contraction) down oxytocin/stop ```
171
to reduce uterine activity
IV fluid (lactated ringer) lateral position down/stop oxytocin if no response -- terbulatine
172
variable decels mean
cord compression
173
early decels mean
head compression
174
accelerations mean
youre ok
175
late dcels mean
placental insufficiency
176
prolonged decels mean
``` maternal hTN uterine hyperactivity cord prolapse/compression abruption maternal seizures rapid dilation/descent ```
177
high risk screen diseases in african americans
sickle cell CF beta thal
178
high risk screen diseases hispanics
CF | beta thal
179
high risk screen diseases in asians
alpha thal | beta thal
180
high risk screen diseases in ashkenazis
``` agaucher CF tay sachs dysautonomia canavan ```
181
birth weight @ risk fro dystocia
4000-4500 g
182
risks of labor dystocia
``` chorioamnionitis fetal infection c section port part hemorrhage operative vaginal delivery (mat/fetal trauma) ```
183
protraction d/o: latent phase
nullip: > 20 multip: > 14
184
protraction d/o: rate dilation in active phase
nullip: 1 cm/hr multip: 1.2-1.5 cm/hr
185
protraction d/o second stage duration
both: > 3hrs w/ epidural, > 2 w/o or id
186
arrest disorder affects which stages/phases
active | second
187
arrest d/o active phase
nullip: no dilation for > 2 hrs (> 4 w/ epid) multip: no dilation > 2 hrs
188
arrest d/o second stage
no descent after 1 hr pushing
189
manage prolonged latent
observe and sedate or discharge
190
manage prolonged active
observe, support, amniotomy or pitocin
191
manage arrest of active phase
observe, support, amniotomy or pitocin
192
shoulder dystocia maneuvers
McRoberts fetal clavicle fracture Zavanelli maneuver symphysiotomy
193
causes of PPH
``` atony retained POC rupture/inversion trauma/lacs coag d/os ```
194
RFs for atony
overdistended uterus abnormal labor things that mess with contraction (fibroids, meds)
195
Dx of atony
boggy uterus
196
management of uterine atony
``` intrauterine compression B-lynch stitch uterine artery ligation uterine artery embolization hysterectomy ```
197
RFs retatined placenta
previous C fibroids prior curettage accessory placental lobe
198
retained placenta management
inspect placenta, manually extract curettage hysterectomy
199
amniotic fluid embolism Sx
``` resp distress cyanosis CV collapse hemorrhage coma can lead to severe coag ```
200
amniotic fluid embolism management
CV and coag systems support
201
uterine inversion management
manual replacement uterine relaxation (NO, terbutaline, MgS) surgery if replacement fails
202
chronic HTN
HTN before preg or found
203
risks of CHTN
placental insuff IUGR preterm birth preeclampsia
204
CHTN goal BP
150/100
205
gest HTN
new onset HTN @ >20 wks BP 140/90+ (2x, 6hrs+apart) no proteinuria
206
when does gest HTN go back to normal
6-12 wks postpartum
207
when to give gest HTN meds
BP > 160/110
208
when to deliver gest HTN
39 wks or before EDD
209
preeclampsia
HTN >= 20 proteinuria or system probs >3000/24 hr or prt:crt >0.3
210
severe disease HTN
``` +160/110 thrombocytopenia LFTs RUQ pain renal insuff pulm edema cereb/visual problems ```
211
CHTN w/ preeclampsia goal BP
150/100
212
antiHTN meds for preggers
labetalol nifepipine methyldopa
213
management of preeclamp w/ severe
previable: stabalize and deliver | > 34 - deliver
214
risk of preeclampsia post part
4-6 wks
215
signs post part preeclamp
HA, visual changes --> MgS
216
preeclampsia predictors
ONLY Hx and ID RFs
217
preeclampsia prevention
NOT antiox, Ca, bed rest | only ASA in high risk
218
when to give MgS
severe, ecclampsia, HELLP (intra/post) | postpart preeclamp
219
MgS side effects
``` muscle weakness n/v HA, blurred vision areflexia resp depression pulm edema death ```
220
complications from placental abruption
``` couvelaire uterus coagulopathy isoimmunization hyterectomy fetal anemia/demise ```
221
RF for preterm (demographics)
``` non white low SES age extremes low pre-preg weight no prenatal care ```
222
avg twin delivery week
36
223
RF for preterm (medical/ob)
``` **prior preterm cone bx/LEEP polyhydramnios fibroids tobacco coccaine periodontal dz ```
224
cerebral palsy
non progressive dysfxn --> abnormal control of mvmt and posture (not necessarily retardation or seizures)

Clinical Medicine (9 decks)

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