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OBGYN > Blueprints > Flashcards

Blueprints Flashcards

1
Q

Gravida

A

number of times a woman has been pregnant

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2
Q

Para

A

number of pregnancies that led to a birth (> or equal to 20 weeks GA or > 500g)

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3
Q

Gestational age

A

age in weeks and days measured from last menstrual period

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4
Q

Developmental age (aka conceptional/embryonic age)

A

number of weeks and days since fertilization

-usually 2 wks off from GA (egg fertilized 14 days after first day of prior menstrual period)

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5
Q

a-subunit of hCG is identical to…

A

alpha subunits of LH, FSH, and TSH

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6
Q

Placenta produces… (4)

A

1) ESTROGEN (from circulating plasma-borne precursors produced by maternal adrenal glands
2) hCG (peaks 10-12 wks) –> maintains corpus luteum in early pregnancy
3) PROGESTERONE - after corpus luteum degrades
4) Human placental lactogen (hPL) –> maintain nutrient supply to fetus - induces lipolysis, insulin antagonist = DIABETOGENIC

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7
Q

Why are women at increased risk for complicated UTI during pregnancy?

A
  • increased urinary stasis from mechanical compression of the ureters
  • progesterone mediated smooth muscle relaxation
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8
Q

Third trimester tests (4)

A

1) Hct
2) RPR/VDRL
3) GLT (glucose loading test) -50g glucose –> check 1 hr later (<140)
4) GBS culture

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9
Q

NST (nonstress test)

A

normal is at least two accelerations of the FHR in 20 min that are at least 15 beats above baseline HR and last for at least 15 seconds

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10
Q

Braxton-Hicks contractions

A

occasional, irregular contractions that do not lead to cervical change - can occur several times per day, up to several times per hour

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11
Q

BPP (biophysical profile)

A

assesses fetal well-being using amniotic fluid volume, fetal tone, activity, breathing movements, and a nonstress test either 0 or 2 points for each of the five categories.

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12
Q

L/S ratio

A

L/S ratio > 2 is a good sign that RDS is unlikely

  • Type II pneumocytes secrete surfactant
  • Lecithin increases as the lung matures, and sphingomyelin decreases beyond 32 weeks
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13
Q

Ectopic pregnancy

A

pregnancy that implants outside the uterine cavity

-typically fallopian tube (ampulla 70%, isthmus 12%, fimbriae 11%)

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14
Q

Presentation of incompetent cercix

A

painless dilation and effacement of the cervix, often in the 2nd trimester

VS. preterm labor which begins with contractions –> cervical change

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15
Q

When should MTX be used in ectopic pregnancy

A

patients with a small ectopic pregnancy ( <4cm, bHCG<5,000 and without a fetal hearbeat

+ pt must have reliable follow up for recheck of B-hcg at 7 days. (B-hcg should be falling by 10-15% by then)

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16
Q

Missed abortion

A

death of an embryo with retention of all POCs

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17
Q

incomplete abortion

A

partial expulsion of POC prior to 20 weeks

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18
Q

inevitable abortion

A

pregnancy complicated by vaginal bleeding with a dilated cervic

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19
Q

Cervical ripening agents

A

PGE2, cervidil, PGE1M (misoprostol) –> dilate cervix and reduce risk of cesarian delivery

Maternal contraindications to PG = asthma, glaucoma

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20
Q

Fetal scalp electrode

A

better at getting more sensitive beat-to-beat HR variability readings

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21
Q

Normal fetal pH and pulse ox readings

A

pH = 7.2-7.25

O2 sat = above 30%

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22
Q

Cardinal movements of labor

A
  • engagement
  • descent
  • flexion (allows smallest diameter of head through pelvis)
  • internal rotation
  • extension
  • external rotation
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23
Q

Hypertonus

A

single contraction lasting 2 minutes or longer

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24
Q

tachysystole

A

more than 5 contractions in a 10 minute period

–> can tx with terbutaline to help relax the uterus

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25
Q

three signs of placental seperation

A

1) gush of blood
2) lengthening of cord
3) uterine fundal rebound as placenta detaches from uterine wall

26
Q

Risks of c-section

A

increased mortality vs. vaginal
increased morbidity from - infection, thrombotic events, wound dehiscence, recovery time

-increased risk future deliveries have to be c-section, increased risk for placenta accreta and previa

27
Q

Indications for c-section

A
  • failure to progress in labor (e.g. no cervical change over 2-4 hours)
  • breech presentation
  • transverse lie
  • shoulder presentation
  • placenta previa
  • placental abruption
  • fetal intolerance of labor
  • non-reassuring fetal status
  • cord prolapse
  • prolonged second stage
  • failed operative vaginal delivery
  • active herpes lesions
  • PRIOR C SECTION
28
Q

VBAC (vaginal birth after cesarian)

A

prior incision must be low transverse incision (kerr) or low vertical incision (kronig)

29
Q

Trial of labor after cesarean (TOLAC)

A

biggest risk is rupture of prior uterine scar

*prior classical hysterotomy or other vertical uterine incisions is an absolute contraindication to TOLAC

30
Q

3 types of placenta previa

A

1) complete previa = placenta completely covers internal os
2) partial previa = covers part of internal os
3) marginal previa = edge of placenta reaches the margin of the os

31
Q

Placental abruption

  • risks?
  • complications?
A

risks = maternal HTN, preeclampsia, maternal use of cocaine or meth, trauma

complications = DIC, hypovolemic shock

32
Q

Vasa previa

A

unprotected vessels cross over the internal cervical os, making them vulnerable to compression or tearing when membranes rupture

vasa previa is rare, but perinatal mortality is high (40-60%) because baby can bleed out very quickly

33
Q

Velamentous cord insertion

A

blood vessels insert between the amnion and chorion away from the placenta instead of inserting directly into the chorionic plate

-cause of most pregnancies complicated by rupture of fetal vessels

34
Q

sinusoidal pattern on fetal heart monitoring indicates what?

A

fetal anemia

35
Q

UTIs in pregnancy:

asymptomatic bacteruria in early pregnancy causes an increased risk of…

A

1) 20-30x increased risk acute pyelonephritis in pregnancy –> maternal sepsis/ARDS
2) preterm birth
3) low birth weight infants

36
Q

Treatment of maternal pyelonephritis

A 
IVF
IV abx (cephalosporin  or amp+gent) until asx for 24-48 hrs

-transition to oral abx

37
Q

Bacterial vaginosis in pregnancy

A

increases risk of PPROM, preterm delivery, chorioamnionitis/endometritis

38
Q

GBS in pregnancy

A

responsible for: UTIs, chorio, endomyometritis, neonatal sepsis

get rectovaginal swap between 35-37 weeks

TX with ampicillin/penicillin, or clinda if penicillin allergic

39
Q

Signs/symptoms of choria

A

1) fetal tachycardia (>160bpm)
2) maternal tachycardia
3) foul-smelling amniotic fluid
4) fever (>38)
5) WBC > 15
6) uterine tenderness
7) low amniotic fluid glucose
8) elevated IL-6 in amnionitic fluid

40
Q

Genital herpes

A

primary infection during pregnancy has higher risk of perinatal transmission

Can result in neonatal disease:
-disseminated disease, CNS disease, disease limited to eyes, skin, or mouth –> viral sepsis, pneumonia, or herpes encephalitis

41
Q

Varicella neonatal infection

A

occurs transplacentally via vertical transmission

congenital varicella syndrome –> skin scarring, limb hypoplasia, chorioretinitis, microcephaly

42
Q

Parvovirus B19

A

In MOM: erythema infectiousum = low grade fever, malaise, myalgias, arthralgias, red macular “slapped cheek” facial rash

In BABY: fetal infection, death, miscarriage, fetal hydrops

43
Q

Congenital rubella

A

virus crosses placenta hematogenously

sx:

1) deafness
2) cataracts/retinitis
3) CNS defect
4) cardiac malformations (e.g. PDA)

44
Q

Hyperemesis gravidarium

A

persistent vomiting
weight loss >5%
ketonuria

*common in setting of MOLAR PREGNANCIES

45
Q

Tx of DVT in pregnancy

A

LMWH (preferred) or unfractionated heparin (goal of PTT of 2.5x normal)

-if using LMWH, must initial start with IV heparin, and be transitioned to SQ heparin

WARFARIN is CONTRAINDICATED

46
Q

Vaginal delivery, common complications (6)

A

1) PPH
2) vaginal hematoma
3) cervical lacerations
4) retained POCs
5) Mastitis
6) Postpartum depression

Rare complications:

  • endomyometritis
  • episiotomy infections
  • episiotomy breakdown
47
Q

Cesarean delivery, common complications

A

1) PPH
2) Surgical blood loss
3) wound infection
4) Endomyometritis
5) Mastitis
6) postpartum depression

Rare complications:

  • Wound separation
  • Wound dehiscence
48
Q

Progression of uterine atony treatment

A

1) uterine massage
2) IV oxytocin (Pitocin)
3) methylergonovine (Methergine)
4) Hemabate (PGF2)
5) Misoprostol (PGE1)
6) D+C to r/o retained POCs
7) If bleeding rate is mild –> Bakri ballon (uterine tambonade)
8) Uterine artery embolization
9) Exploratory laparotomy with ligation of pelvic vessels and possible hysterectomy

Other surgical options:

  • O’leary sutures (tie off uterine arteries)
  • Ligation of hypogastric or internal iliac arteries
  • B-Lynch sutures
49
Q

Postpartum blues

A

rapid mood swings
changes in appetite
changes in concentration and sleep

occur within 2-3 days after delivery - resolve within 2 wks

50
Q

Postpartum depression

A

sx of sadness and disinterest
-low energy, anhedonia, anorexia, apathy, sleep disturbances, extreme sadness

persist after 2 wks.

TX with SSRIs

51
Q

Menorrhagia

A

regularly timed menstrual cycles, but abnormally heavy flow or duration
-Most commonly due to uterine fibroids, adenomyosis, endometrial polyps, cancer, endometrial hyperplasia, cancer, or cervical polyps

52
Q

hypomenorrhea

A

regularly timed menses but an unusually light amount of flow

53
Q

Metrorrhagia

A

characterized by bleeding that occurs between regular menstrual periods

54
Q

Polymenorrhea

A

frequent periods that occur less than 21 days apart

55
Q

oligomenorrhea

A

periods > 35 days apart

56
Q

Nabothian cyst vs. Bartholin gland cyst vs. Skene’s gland cyst

A

Nabothian = bubble uder the surface of the cervix, often bluish in color

Bartholin’s gland cysts = found in the labia majora

Skene’s gland cysts = located near the urethral meatus

57
Q

Fitzhugh Curtis sx

A

perihepatitis from ascending PID infection

associated with GC/CT

RUQ pain or pleuritic pain in context of PID

elevated LFTs (sometimes)

laparoscopy is gold standard for dx (violin string adhesions)

58
Q

HIV pt pap smear schedule

A

Pap smear 6 months apart x2 –> if normal, can do yearly pap smears

continue pap smears every 6 months with prior HPC infection, CIN, or symptomatic HIV disease

59
Q

Voiding:

  • parasympathetic
  • sympathetic
  • voluntary
A
  • parasympathetic = pelvic nerve, results in voiding (S2-S4)
  • sympathetic = hypogastric nerve (T10-L2)
  • voluntary = pudendal nerve (external sphincter contraction)
60
Q

Labs in PCOS

A 
Elevated LH
normal/low FSH
nml estrogen
elevated testosterone
nml/increased inhibin

OBGYN (3 decks)

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