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OBGYN Flashcards

(102 cards)

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1
Q

Placenta previa

A

painless third trimester bleeding
implantation across cervical os
increased risk with multiple c-sections

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2
Q

Placentia abruptio

A

sudden onset PAINful 3rd trimester bleeding

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3
Q

uterine rupture

A

can feel fetal parts - painful with or without bleeding

contraction and sudden fetal distress followed by loss of contractions and loss of fetal station

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4
Q

vasa previa

A

painless 3rd trimester bleeding - fetal bradycardia after ROM

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5
Q

gestational Diabetes

A

24-28wks
1 hr glucose challenge
3 hr GTT (need 2+)

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6
Q

Normal latent phase

A

20hrs - nulliparity

14hrs - multiparity

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7
Q

how to augment labor

A 
oxytocin 
misoprostol 
dinoprostone
amniotomy 
balloon to stimulate engagement
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8
Q

prolonged and arrested active phase

A

no cervical change after 4hrs of adequate contractions or 6hrs of inadequate contractions

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9
Q

prolonged 2nd stage

A

2hrs pushing in multi

3hrs pushing in a nulli

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10
Q

test to monitor for fetal anemia

A

MCA Doppler showing increased flow

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11
Q

timeline of amniocentesis

A

15-20 wks

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12
Q

timeline of chorionic villous sampling

A

10-13wks

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13
Q

what test allows access for transfusion

A

Percutaneous Umbilical cord sampling only do if <32wks

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14
Q

rhogram timelines

A

28wks and 72hrs of fetal maternal mixing (including abortions)

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15
Q

accelerations on a NST

A

increased HR of 15 bpm that is sustained for 15 seconds that occurs twice in 20 min

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16
Q

VEAL

CHOP

A

variable decelerations- cord compression
Early decelerations - head compression
Late decelerations - placental insufficiency

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17
Q

NST categories

A

cat 1 - normal
cat 2 - variability but some minimal abnormal
cat 3 - absent variability get baby out

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18
Q

IUD types

A

levonorgestrel (initial spotting)

copper (best one - but can increase bleeding and cramping)

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19
Q

plan B pill

A

levonorgestrel within 72hrs of intercourse - delays ovulation until sperm are gone - will not harm existing pregnancy

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20
Q

depo shot

A

3 months

absence of periods or abnormal bleeding

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21
Q

chronic HTN in pregnant women

A

bp >140 / >90 before 20 wks

control with alpha methyldopa

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22
Q

gestational HTN

A

elevated BP after 20wks in the absence of proteinuria

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23
Q

pre eclampsia without severe features

A

BP >140/>90 after 20wks
proteinuria >300mg
deliver at 37wks

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24
Q

pre eclampsia with severe features

A 
BP >160/>110 
creatine >1.1 or 2x baseline 
platelets < 100 
increased AST or ALT 
RUQ or epigastric pain 
pulmonary edema
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25
eclampsia =
pre eclampsia with seizures
26
treatment of eclampsia
HTN - labetolol, hydralazine Sz- Magnesium and possibly benzos ultimate tx = deliver baby
27
down syndrome - hcg and inhibin A
increased hcg | increased inhibin A
28
elevated AFP
neural tube defects | abdominal wall defects
29
cell free DNA
10wks noninvasive
30
ROM
speculum exam - pool of fluid in the posterior vagina nitrazine test - turns blue ferning pattern when dry
31
premature ROM
>37wks prior to onset of labor in the absence of contractions (make sure to know GBS status)
32
preterm ROM
<37wks - if >34 wks - deliver - if <34 wks - corticosteroids and delay as much as you can - if <24wks nonviable
33
chorioamnionitis and endometritis
same (1 with baby in and other baby out) - maternal fever - maternal and/or fetal tachy - uterine tenderness - purulent amniotic fluid
34
treatment of chorioamnionitis and/or endometritis
IV ampicillin, gentamicin, and clindamycin
35
tocolytics
Magnesium - <32 wks neuroprotection Ca channel block - nifedipine PGE-i - not in >32 weeks (closes ductus) B-agonists - for tachysystole only
36
congenital hypothyroidism
low birth weight | neuropsychological impairment
37
hypothyroid patients
High TSH low T4 infertile secondary to annovulation tx - levothyroxine
38
hyperthyroidism
low TSH high t4 prior to preg - surgical resection or radioactive ablation during preg - PTU (blocks T4 --> t3) or methimazole
39
valproate (pregnancy class)
teratgenic - cardiac abnormalities - neural tube defects - craniofacial abnormalities
40
epilepsy drugs to avoid in pregnancy
valproate phenytoin carbamzepine
41
epilepsy drug thats OK for pregnancy
levetiracetam
42
First line Tx of UTI and backup
amoxicillin and nitrofurantoin backup | 1st line IV = ceftriaxone
43
other teratogenic meds
``` ACE-I ARBS lithium retinoic acid MTX ```
44
diagnosis of twins
Uterus is large for dates AFP is high on quad screen US = Dx
45
twins are at increased risk for
C-section | prematurity
46
dizygotic dichorionic diamnitotic
2 placentas 2 sacs 2 eggs = 2 genders
47
monozygotic dichorionic diamniotic
2 placentas 2 sacs 1 egg = 1 gender
48
monozygotic monochorionic diamnotic | increased risk for
1 placenta 2 sacs 1 egg = 1 gender twin twin transfusion (bigger twin at risk - small twin does better)
49
monozygotic monochorionic monoamniotic | increased risk for
1 placenta 1 sac 1 egg = 1 gender conjoined twins, cord entanglement
50
all multi gestations are at increased risk for
breech birth pre term placenta previa PPH
51
delivery decisions for cephalic - cephalic cephalic - breech breech - breech
vaginal clinical judgment c section
52
latent phase definition
cervix dilatioin up to 6cms
53
active phase of labor
6-10cm cervical dilation
54
cervical changes during labor and mechanism
changes from thick (nose) and firm to thin a short structure (lip) mechanism - breaking of disulfide bonds between collagen = collagen ripening
55
effacement of cervix
shortening
56
cervical changes can be stimulated by:
fetal head engagement and by the production of prostaglandin E2
57
fetal station numbers
-5 (uterus) 0 (ischial spine) +5 (out of vagina)
58
frank breech
knees extended | hips flexed
59
complete breech
knees flexed | hips flexed
60
footling breech
knees in any position | hips extended
61
external version
attempted 37wks
62
GPA | TPAL
term preterm abortions living
63
1st trimester labs
``` ABO type rh Ag hgb/hct rubella titers varicella titers HIV RPR Hep B gonorrhea chlamydia ```
64
C section incision name
pfannestiel incision bikini cut vertical (classic or emergent) transverse (planned)
65
risks of vacuum delivery
denuding vagina (inside out) cephalohematoma facial lacerations
66
risks of forcep delivery
maternal lacerations or hemorrhage facial nerve palsy skull fx intracranial hemorrhage
67
cervical insufficiency
she may begin to dilate very early in pregnancy
68
anesthesia stage I pain - stage II pain -
T10-T12 visceral pain | S2-S4 somatic pain
69
pudendal nerve block
block the somatic pain stage II performed by palpating the ischial tuberosity and injection is made towards the pudendal nerve near the sacrospinous ligament
70
epidural (DOC)
should be no pop no CSF return pain of contractions removed but not the pressure
71
excess epidural anesthesia risks
vasodilation and hypotension | paralysis of the diaphragm if its too high
72
cardio physiology of pregnancy
plasma volume increases RBC mass increases dilutional anemia increased CO
73
coagulation state of pregnant women
hypercoagulability clotting factor increase increased fibrinogen increased D-dimer
74
pulmonary changes of pregnancy
increased minute ventilation increased tidal volume decreased FRC
75
genitourinary changes
increased GFR | creatine will be lower
76
definition of PPH
500cc vaginal delivery | 1000cc c-section
77
uterine atony
MCC of pph tired uterus fails to contract - feels BOGGY (saturated oxytocin receptors)
78
tx of uterine atony
1) uterine massage 2) uterotonics (methlergonovine, oxytocin, carboprost) 3) mechanical tamponade with bakri baloon 4) sx
79
carboprost (hemabate) moa
PGF2alpha - smooth muscle contractions???? | C/I - in asthma
80
uterine inversion
- uterus cant be felt may come out of the vagina | - increased risk with oxytocin and umbilical cord traction
81
placenta accreta, increta, percreta
acreta - endometrium increta - myometrium percreta - serosa
82
hepatitis B exposed baby
Hep B vaccine | IV Ig hep B
83
HIV tx for a baby
AZT (zidovudine)
84
toxoplasmosis
``` mono like syndrome cat feces - uncooked meat exposure brain calcifications ventriculomegaly seizures ```
85
CMV
- jaundice - petechial - low platelets - intrauterine growth restriction - hearing loss - hepatosplenomegaly
86
herpes
- painful burning prodrome - vesicles on an erythematous base - PCR - c-section to avoid exposure - prophylaxis with acyclovir
87
diagnosis of rectovaginal fistula
dark red velvety (rectal mucosa) on the posterior vaginal wall
88
granulosa cell tumors
``` malignant stromal cord tumors large >10cm complex post menopausal bleeding juvenile - precocious puberty estrogen secreting ```
89
cause of granulosa cell tumors
endometrial hyperplasia from chronic unopposed estrogen exposure
90
candida on microscope
pseudohyphae
91
treatment of candida
fluconazole
92
HELLP syndrome
hemolytic anemia elevated LFTs low platelets due to systemic inflammation and platelet consumption
93
acute abdomen signs
guarding with decreased bowel sounds
94
implantation site of a gestational sac
upper fundal region | abnormal = outer quadrants (corneal arcus)
95
chadwick sign
blue discoloration of vagina and cervix (6-8wks)
96
hcg timeline
the 1st (4wks) doubles every 4hrs peaks at 10wks drops in 2nd trimester
97
BP lowest peak
23-28wks
98
virchow triad
hypercoagulability (increased fibrinogen) stasis (venous) endothelial damage
99
MCC of increased AFP
dating error
100
braxton hicks contractions
3rd trimister sporadic no cervical dilation
101
presentation of ectopic pregnancy
unilateral lower abdominal or pelvic pain vaginal bleeding if ruptured can be hypotensive with peritoneal irritation
102
exclusion criteria for MTX for ectopic
``` immunodeficiency non compliant liver disease (ADR - hepatotoxicity) greater >3.5cm fetal heart auscultated breast feeding coexisting viable pregnancy ```

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