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PANRE > GYN-Contraceptives/Pregnancy > Flashcards

GYN-Contraceptives/Pregnancy Flashcards

1
Q

How does Hormonal Contraception function?

A

Inhibits ovulation by inhibiting mid-cycle luteinizing hormone (LH) surge

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2
Q

Does hormonal contraception protects against STI?

A

No

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3
Q

Oral Contraceptive pills schedule or how to use?

A

Start on 1st day of menses

§ Take daily on schedule, 21-day pill pack + 7-day sugar

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4
Q

Types of OCP?

A

Estrogen + progestin or progestin alone (very compliant-becasue has to be taken at same time daily as ovulation can occur)
• Progestin alone safe in breastfeeding, ↓ side effects because
no estrogen

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5
Q

Pro’s of OCP’s

A 
dysmenorrhea & menorrhagia
• improves acne
• ↓ PID, ectopic pregnancy
• protection against ovarian cancer, endometrial cancer &
osteoporosis
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6
Q

Cons of OCPs:

A

↑ risk of thromboembolism
• weight gain, nausea, headaches
• ↑ risk of gallstones, hypertension (HTN

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7
Q

Implants

A

Etonogestrel (Nexplanon)
• Lasts 3 years
Failure rate 0.05%

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8
Q

Injectable

A

Medroxyprogesterone (Depo Provera)
• Q3mo IM injection
• Failure rate 5%

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9
Q

Transdermal

A

Norelgestromin (Ortho Evra)
• On 3 weeks, off 1 week
• Failure rate 10%

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10
Q

Intravaginal

A

Etonogestrel/Ethinyl estradiol (Nuvaring)
• In 3 weeks, out 1 week
• Failure rate 7%
• Must be removed during intercourse & replaced within 3 hrs
• Must be a very compliant & comfortable with body

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11
Q

What is Intrauterine device (IUD)?

A

Mechanism not completely understood; spermicidal, elicits sterile
inflammatory response
o Does not affect ovulation
o Most effective method after sterilization & abstinence

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12
Q

What is the increase risk of an IUD?

A

↑ risk insertion-related PID (uterus is sterile but vagina is not sterile?)

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13
Q

Does IUD protects against sTI?

A

NO

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14
Q

Most effective method after sterilization & abstinence

A

Intrauterine device (IUD)

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15
Q

Types of IUD

A

Hormonal and Copper

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16
Q

Hormonal IUD?

A

Mirena, Kyleena, Liletta, Skyla)

• 3-6 years of protection depending on type

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17
Q

Copper IUD?

A

Paraguard-not hormonal

• 10 years of protection

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18
Q

Barrier methods?

A

Male & female condoms; Intravaginal device (diaphragm, sponge)

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19
Q

Male & female condoms

A

Female not very widely used
§ STI protection
§ Failure rate average 20%
§ Must know how to properly use

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20
Q

Intravaginal device (diaphragm, sponge)?

A 
Must be left in place 6-24 hrs post-intercourse
§ ± STI protection
§ Failure rate 15%
§ Used with spermicide nonoxynol-9
§ ↑ risk of toxic shock syndrome
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21
Q

Emergency Contraception?

A

Progestin-only
Ulipristol acetate
Copper IUD

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22
Q

When is progestin hormonal contraception prefer?

A

After pregnancy, estrogen may affect breast milk production and increases risk of thromboemolism (remember pregnancy alone is a risk)

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23
Q

Copper IUD

A

Most effective within 5 days of unprotected intercourse

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24
Q

Ulipristol acetate

A

30 mg dose
o Prescription only
o Most effective within 5 days of unprotected intercourse

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25
Q

Progestin-only

A 
1.5 mg dose
o Available over-the-counter (OTC)
o No age restriction
o Most effective within 72 hrs of unprotected intercourse
o Side effect: nausea & vomiting
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26
Q

Definition of Infertility

A

failure to conceive after 1 year of regular unprotected intercourse

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27
Q

Female causes of Infertility

A

Anovulatory cycles
● Ovarian dysfunction
● Structural issues

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28
Q

Male causes of Infertility

A

40%

● Abnormal spermatogenesis/motility issues

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29
Q

Work-up & management of Infertility?

A 
Semen analysis
● Endocrine evaluation (thyroid stimulating hormone [TSH], follicle stimulating
hormone [FSH], prolactin)
● Anatomical evaluation (hysterosalpingogram)
● Reproductive assistance
o Clomiphene to induce ovulation
o Intrauterine insemination (IUI)
o In-vitro fertilization (IVF)
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30
Q

Diagnosis of pregnancy

A

Serum human chorionic gonadotropin (hCG) can detect pregnancy as early as 5
days post-conception
● Serum levels double every 48 hours in normal pregnancy
● Urine hCG can detect as early as 14 days post-conception
● Naegele rule
o Expected date of delivery (EDD) = 1st day of last menstrual period (LMP) +
1 year - 3 months + 7 days

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31
Q

Serum levels hCG doubles every?

A

48 hrs

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32
Q

Maternal physiologic changes

A

Cardiovascular: ↑ heart rate (HR), ↑ cardiac output (CO), ↑ stroke volume (SV), ↓
blood pressure (BP), ↓ peripheral vascular resistance (PVR)
● Pulmonary: ↑ tidal volume, ↓ expiratory reserve
● Hematologic: ↑ blood volume, ↑ fibrinogen, ↓ hematocrit
● GI: ↑ gastric emptying time, ↓ sphincter tone

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33
Q 
When is (Prenatal care)
First appointment schedule during pregnancy?
A

6-8 weeks, then Q monthly

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34
Q

Initial labs of pregnancy for mom? Baby?

A

Mom: CBC, Rh factor, U/A, STI swab, HIV, Rubella & Hep B titers

Baby; Fetal heart tones by doppler: 10-12 weeks

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35
Q

Naegele rule

A

Expected date of delivery (EDD) = 1st day of last menstrual period (LMP) +
1 year - 3 months + 7 days

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36
Q

Pregnancy nutrition?

A

Prenatal vitamin with folic acid + iron, dietary
calcium, smoking
& alcohol cessation; avoid mercury-containing fish, uncooked food
(goodbye sushi🍣) & unpasteurized cheese (goodbye fancy cheeses

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37
Q

When is genetic testing recommended?

A

Recommended at 9-14 weeks

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38
Q

What is tested in genetic testing?

A

Pregnancy-associated plasma protein A (PAPP-A); Along with nuchal scan & b-hCG levels, can detect genetic disorders

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39
Q

Every visit of pregnancy what will be done?

A

weight, fetal heart tones, fundal height, urine dip for

glucose and protein

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40
Q

When is quad screen done? What is check during quad screen?

A

15-20 weeks: 𝛂-fetoprotein, 𝛃HCG, estriol, inhibin A

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41
Q

Trisomy 21

A

“2 up, 2 down”: ↑𝛃HCG, ↑ inhibin A ↓ 𝛂FP, ↓estriol

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42
Q

Trisomy 18

A

Trisomy 18 “still underage”: All four low

43
Q

Open neural tube defect:

A

↑ 𝛂FP

44
Q

Prenatal care at 10 weeks?

A

Fetal Heart Tones by doppler

45
Q

Prenatal care at 18 weeks?

A

Quickening

46
Q

Prenatal care at 18-20 weeks?

A

Ultrasound for full anatomic screen

47
Q

Prenatal care at 20 weeks?

A

Fundal height at umbilicus

48
Q

Prenatal care at 24-28 weeks?

A

Glucose Tolerance Test

49
Q

Prenatal care at 18 weeks?

A

RhoGAM if mom (-) and dad (+/unknown)

50
Q

Prenatal care at 36-37 weeks?

A

Group B strep screen

51
Q

Rh incompatibility (Level 1)?

A

Rh (-) mom carrying Rh (+) baby may develop anti-Rh antibodies with any
fetal blood leak into maternal circulation.
● Ab then can attack fetal RBC of subsequent Rh(+) pregnancies causing
hemolysis

52
Q

Prevention of RH incompatibility?

A

Prevention: Give RhoGAM at 28 weeks with Rh(-) mom, Rh(+)/unknown dad
● Give second RhoGAM at birth if baby is indeed Rh(+)
● Give RhoGAM after abortion, ectopic pregnancy, vaginal bleeding,
amniocentesis or any suspicion of blood mixing in Rh(-) moms

53
Q

Sexual/physical abuse in pregnancy (Level 1)

A

Psychosocial discussions of support, safety at all prenatal appointments
● Women at higher risk for physical abuse during pregnancy

54
Q

Abruptio Placentae (Level 1)?

A

Definition: Premature separation of a normally implanted placenta

55
Q

S/S of Abruptio Placentae (Level 1)

A

S/S: Painful, dark red vaginal bleeding, abd pain, fetal distress
○ Remember symptoms from the name→ an “abrupt” ripping of the
placenta would be painful

56
Q

DX of Abruptio Placentae (Level 1)

A

U/s, no pelvic exam

57
Q

Tx of Abruptio Placentae (Level 1)

A

Mild: Inpatient monitoring

○ Moderate to severe: Deliver that baby

58
Q

Breast Cancer (Level 1)?

A 
#1 non-skin cancer in women, #2 most common cause of cancer deaths in
women. Two main variants: Ductal and lobular
59
Q

Risks of Breast Cancer (Level 1)?

A

↑ exposure to estrogen (early menarche, late menopause,

nulliparity), BRCA 1&2, 1º FH, age >65yr

60
Q

S/s of Breast Cancer (Level 1)?

A

Painless, hard, non-mobile lump, most in upper outer quadrant

61
Q

Late findings of reast Cancer (Level 1)?

A

Nipple retraction, nipple discharge, peau d’orange skin

thickening, axillary lymphadenopathy

62
Q

DX of Breast Cancer (Level 1)?

A

Mammogram, U/S, biopsy

63
Q

What % is breast Ca found by patient

A

90%

64
Q

What age to a female pt being for the following : Screening: Mammogram, self breast exam, yearly clinical exam

A

> or - to 40

65
Q

Screening: Mammogram guidelines, self breast exam, yearly clinical exam

A

ACS: Annual mammogram ≥ 40yo
● USPSTF: Mammograms q2y 50-74yo; q2y at 40yo if ↑risk; 10y prior to age
of 1º relative’s diagnosis

66
Q

What is Ectopic pregnancy (Level 2)

A

Definition: Implantation of fertilized ovum outside uterus
● Areas of implant – Fallopian tube > abdomen > ovary, cervix; Top of “Do not miss” list of every woman of reproductive age presenting
with abdominal pain

67
Q

Risks of Ectopic pregnancy (Level 2)

A

PID, IUD use, endometriosis

68
Q

S/S Ectopic pregnancy (Level 2)

A

Classic triad of unilateral abdominal pain + vaginal bleeding +
amenorrhea (d/t pregnancy)
● If ruptured: syncope, signs of hemorrhagic shock

69
Q

DX of Ectopic pregnancy (Level 2)

A

(+) pregnancy test, transvaginal U/S showing empty uterus

● Confirm with serial HCGs not doubling as expected

70
Q

TX Ectopic pregnancy (Level 2)

A

Small, non-ruptured: Methotrexate (disrupts cell multiplication)
○ Ruptured, complicated: Surgery
○ Don’t forget RhoGAM for Rh negative mothers
○ Follow up 𝛃HCG is key!

71
Q

Risks of Gestational diabetes (Level 1)

A

Prior h/o GD, multiple gestations, obesity, non-white ethnicity, prior
delivery of baby >9lb

72
Q

DX of Gestational diabetes (Level 1)

A

Dx: 1h Glucose Challenge Test at 24-28wk

○ If BS ≥140mg/dL, confirm with 3h 100g Glucose Tolerance Test

73
Q

TX of Gestational diabetes (Level 1)

A

Tx: Diet, exercise, meds to keep FBS <95 mg/dL (metformin, insulin)

74
Q

If HTN < 20 weeks

A

→considered Chronic Hypertension
o Treat BP; monitor BP, urine for protein, and other symptoms as
pregnancy progresses

75
Q

If HTN > 20 weeks + other symptoms

A

→considered Preeclampsia/Eclampsia

76
Q

If HTN >20 weeks + no other symptoms

A

considered pregnancy induced

77
Q

Preeclampsia

A

Occurs >20 weeks to 6 weeks postpartum
● Triad: HTN + proteinuria +/- edema
○ BP ≥ 140/90 on 2 occasions >4 hours apart AND
○ Proteinuria >300 mg/24hr or >1+ on dipstick
● Or in the absence of proteinuria, new-onset hypertension + new onset of:
○ Thrombocytopenia (platelets <100,000/microL)
○ Renal insufficiency (serum creatinine >1.1mg/dL)
○ Impaired liver function (elevated LFTs)
○ Pulmonary edema
○ Cerebral or visual changes

78
Q

Severe Preeclampsia

A 
Two severe BP values SBP ≥ 160 or DBP ≥ 110 obtained 15-60 minutes
apart
● End-organs affected
○ Persistent oliguria <500mL/24hr
○ Progressive renal insufficiency
○ Unremitting headache/visual disturbances
○ Pulmonary edema
○ Epigastric /RUQ pain
○ LFTs 2x normal
79
Q

Management Severe Preeclampsia

A

If GA ≥ 37 weeks → Deliver that baby
○ If GA < 37 weeks → Bedrest, daily weights, BP and proteinuria
monitoring
○ If <34 week, steroids for lungs
○ Magnesium to prevent seizures
○ Labetalol and/or hydralazine to lower BP (goal <160/110)

80
Q

HELLP syndrome:

A

Severe pre-eclampsia + Hemolysis, Elevated LFTS, Low

Platelets

81
Q

Eclampsia ?

A

Preeclampsia criteria + abrupt onset tonic-clonic seizures
Seizure timing: 25% antepartum, 50% intrapartum, 25% postpartum (most
within 48 hours but can be up to weeks postpartum)

82
Q

S/S Eclampsia

A

Headache, visual changes, RUQ pain

83
Q

Eclampsia TX?

A 
Definitive treatment is delivery
○ ABCDs
○ Magnesium for seizures
○ Fetal monitoring while stabilizing mom
○ BP control with labetalol and/or hydralazine
○ Deliver that baby when mom is stable
84
Q

What is Placenta previa (Level 1)

A

Placental implantation on or close to cervical os

● May be complete, partial or marginal

85
Q

S/S Placenta previa (Level 1)

A

Painless bright red 3rd trimester bleeding, no fetal distress
o Remember 3 Ps - 3 rd trimester P ainless P lacenta P revia

86
Q

DX of Placenta previa (Level 1)

A

U/S, no pelvic exam

87
Q

Tx Placenta previa (Level 1)

A

Bed rest, stabilize baby (tocolytics, steroids), delivery

88
Q

What is Postpartum hemorrhage (Level 1)

A

Bleeding >500 cc after vaginal delivery or >1000 cc after

c-section; Common reason for maternal death in first 24 hours after delivery

89
Q

Causes of Postpartum hemorrhage (Level 1)

A

Uterine atony, uterine rupture, genital tract trauma, retained
placental tissues, infection

90
Q

S/S Postpartum hemorrhage (Level 1)

A

Hypovolemic shock, soft boggy uterus with dilated cervix

91
Q

tx Postpartum hemorrhage (Level 1)

A 
Uterotonic agents (Oxytocin, Misoprostol), bimanual massage, artery
embolization
92
Q

Common reason for maternal death in first 24 hours after delivery

A

Postpartum hemorrhage

93
Q

What is Premature rupture of membranes (PROM) (Level 1)

A

Premature (PROM): >1 hour before onset of labor

● Preterm Premature (PPROM): <37 weeks gestation

94
Q

Risks of Premature rupture of membranes (PROM) (Level 1)

A

Smoking, STIs, multiple gestations

95
Q

s/s of Premature rupture of membranes (PROM) (Level 1)

A

Gush or leak of fluid, vaginal discharge

96
Q

DX of Premature rupture of membranes (PROM) (Level 1)

A

Sterile speculum exam for visual inspection
■ NO digital exam
○ Nitrazine paper test (turns blue if pH >6.5)
○ Fern test

97
Q

TX of Premature rupture of membranes (PROM) (Level 1)

A

Depends on GA and fetal lung maturity
○ Steroids for lung maturity <34 weeks
○ If infection present or fetal distress: Abx and deliver that baby

98
Q

Def of Cord Prolapse

A

Abnormal positioning of umbilical cord during labor → cord compression & fetal
hypoxemia (obstetrical emergency!)

99
Q

Overt Cord Prolapse

A

Cord moves in front (ahead) of fetal presenting part & protrudes thru
cervical canal, into or out of, vagina

100
Q

Occult Cord Prolapse

A

Cord is positioned alongside the presenting part

101
Q

Presentation: Cord Prolapse

A

Abrupt severe, prolonged fetal bradycardia or new onset severe
variable decelerations in a labor that was previously progressing with normal
tracings

102
Q

DX: Cord Prolapse

A

clinical; visualization or palpation of cord

103
Q

Tx: Cord Prolapse

A

Prompt cesarean section delivery
o Temporizing measures: manually elevating the presenting part off the cord,
placing pt in Trendelenburg or knee-chest position, retrofilling bladder with
500-700 mL saline, administering tocolytic agent (eg. terbutaline

PANRE (15 decks)

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