EOR - OB Flashcards
1
Q
what are contraindications to estrogen use for birth control? (4)
A
Migraines with aura, DVT, Uncontrolled HTN, Smoking >35
2
Q
DVT, PE, CVA, MI, Seizure meds can decrease effectiveness.. all are ADRs of what kind of birth control?
A
COCs - estrogen/progesterone pills + NuvaRing
3
Q
Irregular bleeding, Weight gain, Length of time to resume ovulation (5 months)… all are ADRs of what kind of birth control?
A
Depot shot
4
Q
how long does the nexplanon implant last?
A
3 years
5
Q
what is the timeframe for taking plan b?
A
72 hrs (3 days)
6
Q
what are three ways to Dx infertility?
A
semen analysis, ovarian reserve evaluation, tubal evaluation
7
Q
what are medication options for infertility? (7)
A
clomiphene citrate (MC for PCOS), letrozole (aromatase inhibitor), human menopausal gonadotropin, FSH, GnRH, metformin, dopamine agonists (bromocriptine or cabergoline)
8
Q
normal changes in pregnancy: cardiac
A
increased blood volume, CO, HR (by 10-15 bpm). increase plasma and RBC volume = anemia
increase clotting factors = hypercoaguable
decreased systemic vascular resistance, BP (in 2nd trimester - normalizes in third)
9
Q
normal changes in pregnancy: pulmonary
A
increased tidal volume and minute ventilation = respiratory alkalosis
10
Q
normal changes in pregnancy: renal
A
increase GFR, decreased urea + creatinine
11
Q
normal changes in pregnancy: GI
A
constipation, increase GERD,
changes in bile composition = increase risk of cholestasis, hyperbilirubinemia + jaundice
12
Q
normal changes in pregnancy: genital
A
vaginal pH decreases and increase glycogen in vaginal epithelium= increased risk chorioamnionitis
13
Q
when is fundal height at the pubic symphysis ?
A
12 wks
14
Q
when are doppler heart tones heard?
A
10 wks -12 wks
15
Q
what is the rate of serum beta-HcG increase in pregnancy?
A
doubles every 2 days in early pregnancy
16
Q
how many days after conception is serum and urine BhCG detected?
A
Serum HcG detect 5days after conception
Urine HcG detects 14days after conception
17
Q
when is “quickening” felt? (fetal movement by mom)
A
16-20 wks (earlier in multigravida moms)
18
Q
when is fetus able to detect on pelvic US
A
5-6 wks
19
Q
“signs” of changes in pregnancy: ladins, hegars, piskaceks, goodell’s, chadwicks
A
Uterus changes: ladin’s sign (uterus softens after 6 wks); hegar’s sign (uterine isthmus softens after 6-8wks); Piskacek’s sign (palpable lateral bulge or softening of uterine corneus 7-8wks)
Cervix changes: goodell’s sign (cervical softening 4-5wks), chadwick’s sign (blue cervix/vulva 8-12 wks)
20
Q
EDD (Naegele’s rule)
A
1st day of LMP + 7 days - 3 months.
21
Q
when is 50g GTT for DM checked if pt HAS risk factors? if they dont? when level indicates a second test?
A
risk factors: prenatal screen
none: 28 wks.
50gm glucola on ALL pts, if >130-140 at 1hr → do 100g 3hr GTT w/in a week.
GDM is Dx if 3hr test shows 2 of the following. >95 fasting, >180 1hr, >155 2hr >140 3hrs
22
Q
what infectious diseases are screen in prenatal visit?
A
HepB, HIV, Syphilis, rubella titer
23
Q
what are the first, second and third trimesters?
A
1-12, 13-27, 28-42 (or birth)
24
Q
what is included in the “first trimester screening” ? what levels would increase risk? when is it done?
A
done @ 10-13wks
abnormal high or low HcG level, low PAPP-A + thickened nuchal translucency (10-13wks w/ US), combined with maternal age = patient-specific risk level or anueoploidy (trisomy 18, down syndrome)
25
IF there is increased risk for genetic abnormality of the baby, when is chorionic villus sampling done?
10-13wks.
26
what does NIPT look for and when is it done?
10 wks, cell-free DNA looks for increased risk of aneuoploidy, extra or missing X, Y.
27
when is the "quad screen" done and what do abnormal levels indicate?
15-20 :check alpha fetoprotein, B-hCG, estradiol + inhibin A
High BhCG and others low = down syndrome
All low = trisomy 18
High alpha fetoprotein = open neural tube defect (spina bifida)
Inhibin A: high levels = chromosomal abnormalities
28
when is Rh tested and when is Rhogam given (if needed) ?
tested prenatal and @ 28wks
| given @ 28 wks + 72hrs after birth (or if blood mixing)
29
when is GBS screen done? what is the txt if positive?
screen 32-37wks (vaginal/rectal culture); Txt with PCN G when in labor
30
when are these tested? HgB/Hct, Antibody Screen, VDRL, RPR, HIV
prenatal + again at 28 wks
31
what is a BPP ?
Fetal breathing, fetal tones, amniotic fluid level/index (AFI) [weekly], NST + gross fetal movements [2 points for each]
< 4 is abnormal, 8-10 is ideal
32
when do twice weekly NSTs start (w/ AFI once per week)?
41 wks
33
why and when would a BPP be ordered?
if you are a high risk pregnancy, typically starting after week 24 or 32 wks
34
what is considered a "high risk" pregnancy? and reason for a BPP? (9)
```
have a history of pregnancy complications
have high blood pressure, diabetes, or heart disease
are at least 2 weeks past your due date
have a history of pregnancy loss
have abnormal amniotic fluid levels
have obesity (BMI greater than 30)
are older than 35
are carrying multiples
are Rh negative
```
35
reactive vs nonreactive NST
Reactive (good): >2 accelerations in 20min, increased FHR >15bpm from baseline lasting >15second → repeat weekly
Non Reactive (bad): no accelerations or <15bpm <15seconds. = sleeping/immature/compromised → vibratory stimulation, may try contraction stress test
36
what is the routine followup schedule in pregnancy?
Q4wks until 28wks, Q2 wks 28-36wks, Qweek 36-41 wks.
37
what are the 3 stages of birth?
I: onset of labor (true contractions) → full dilation of cervix: latent + active (rapid dilation at 5-6cm) phase
II: full dilation → delivery of fetus: passive + active phase (active maternal expulsive efforts)
III: delivery of fetus → delivery of placenta: lasts 0-30min.
38
define a spontaneous abortion + give the MC cause
Termination of pregnancy <20wks. Caused MC by fetal chromosome abnormality
39
threatened abortion: define + txt
ONLY ONE ASSOC. W/ VIABLE FETUS= possibly salvageable . MC cause of 1st trimester bleeding. No POC expelled, Closed os, blood vaginal discharge.
Txt: supportive, serial bhCG to see if doubling
40
inevitable abortion: define + txt
no POC, pregressive cervix dilation >3cm, effaced. +/- rupture of membranes.
Txt: D+C or D+E
41
incomplete abortion: define + txt
some POC expelled, cervix DILATED, heavy bleeding, retained tissue + boggy uterus.
Txt:D+C or D+E, pitocin
42
complete abortion: define + txt
complete passage of all products, closed os.
| Txt: none needed
43
missed abortion: define + txt
fetal demise but still retained in uterus, no POC expelled, closed os.
Txt: D+E, misoprostol
44
septic abortion: define + txt
retained POC becomes infected → infection of uterus + organs. Closed os w/ cervical motion tenderness. foul/brown discharge, fever chills
Txt: D+E to remove POC, broad spectrum abx
45
when can a medical vs surgical elective abortion be performed?
medical: <9wks, surgical 9-24 wks
46
options for elective medical abortion (3)
1. Mifepristone (blocks progesterone = thin endometrial lining) and misoprostol (stimulates uterine contraction) - up to a week to abort
2. Methotrexate (folic antagonist- for ectopics) and misoprostol - may take up to a month to abort
3. Vaginal misoprostol alone
47
options for elective surgical abortion (2)
D+C (4-12 wks) or D + suction (>12 wks)
48
MC cause of abruptio placenta + txt?
delivery ( C-section preferred) +/- observation and meds for baby to protect heart and lungs until delivery .
*MC cause- maternal HTN
49
what can placenta previa progress to?
May separate (abruptio) from the uterus as the cervix dilates --> so NEED C-section delivery @ 36 wks!
50
Dx and txt for placenta previa
Dx: painless third trimester bleeding + US
txt: stabilize the fetus → tocolytics (Mg sulfate-inhibits uterine contraction for preterm labor) . Delivery when stable
51
MC cause of bleeding in early pregnancy
early pregnancy loss (MC- threatened abortion)
| others- infection, ectopic
52
placenta accreta
part of placenta invades and is inseparable from uterine wall = risk of life threatening blood loss during delivery for mom
53
3 most common indications for c-section
Failure to progress during labor
Nonreassuring fetal status
Fetal malpresentation
54
if C-section is by maternal request, what GA is it at?
40 wks
55
Abx prophylaxis options for C-section
| if PCN allergic, if already on some for GBS, if already on for chorioamnionitis
cephazolin 60min before incision (PCN allergy - clindamycin or gentamicin) +azithromycin for those in labor or PROM
OR if GBS prophylaxis is on board (PCN G) only need to add Azithromycin
OR if chorioamnionitis prophylaxis is on board (ampicillin + gentamicin) we add clindamycin or metronidazole
56
MC cause of cord prolapse
MC cause is premature rupture of membrane.
57
what is erb's palsy?
brachial plexus injury from shoulder dystocia
58
“turtle head” retraction of baby’s head back into the vagina - this is a sign of what?
shoulder dystocia
59
what are two maneuvers you can do for shoulder dystocia?
non-manipulative =McRoberts Maneuver (hyperflex mom’s legs into abd) or manipulative = woods “corkscrew” (180 degree shoulder rotation)
60
Dx of ectopic
TVUS absence of gestational sac w/ bhCG level >2,000,
61
txt options for ectopic
methotrexate (contraindicated if ruptured or h/o TB) → would then need laparoscopic salpingostomy
62
fetal bradycardia signaling oxidative distress.. what are your next steps?
give mom O2, increase IV fluids, turn woman on her side. +/- Stop oxytocin and give terbutaline to slow contractions. If these don’t work → emergent delivery
63
complications that come with gestational DM
large baby, preterm delivery, breathing difficulties, HYPOGLYCEMIA OF BABY, stillbirth, obesity + type II DM later in life of baby.
64
GDM - what is the schedule for blood glucose checks and what are the target levels?
Take BS 4 times daily with target levels of 90-95 fasting and <120 two hours after a meal.
65
first and second line txt options for GDM
First line is insulin (metformin as an alternate)
| Insulin: NPH dosed am and bedtime + a short acting at mealtime
66
what is gestational trophoblastic dz and what are the four types?
nonviable fertilized egg implants in uterus → ABNORMAL PLACENTAL DEVELOPMENT 4 types
1. Molar (benign) 2. Invasive mole 3. Choriocarcinoma 4. Placental site trophoblastic tumor.
67
what is a hyatidiform mole (molar pregnancy) ?
neoplasm due to abnormal placental development with trophoblastic tissue proliferation arising from gestational tissue (not maternal in origin). MC type, 80% benign. - complete (egg w/ no DNA- all paternal chromosomes) or partial (some fetal development but not viable)
68
dx of gestational trophoblastic dz/molar pregnancy?
bhCG MARKEDLY elevated (>100,000) + US = “snowstorm” or “cluster of grapes”
69
txt of gestational trophoblastic dz/molar pregnancy ?
suction curettage +/- chemo/hysterectomy if METS
70
hyperemesis gravidarum S+S, what metabolic manifestations can it lead to?
severe, excessive N/V, weight loss 5%, electrolyte imbalance (metabolic acidosis from starvation, hypochloremic alkalosis from vomiting).
71
how is the Dx of incompetent cervix made?
Hx painless cervical dilation + 2nd trimester deliveries.Advanced cervical dilation and effacement before week 24 of pregnancy without painful contractions, vaginal bleeding, water breaking (ruptured membranes) or infection
72
txt for incompetent cervix
: progesterone, cervical cerclage <14wks (stitches removed in last month of labor)
73
define postpartum hemorrhage. what is early vs late?
Blood loss >500ml if vaginal delivery. >1000mL if C-section.
Early 24hrs postpartum, late >24hrs up to 8wks postpartum.
74
beside bleeding, what are other signs of postpartum hemorrhage ?
signs of hypovolemic shock, uterine atony = soft/boggy uterus
75
txt options for postpartum hemorrhage
bimanual uterine massage, txt underlying cause, IV access. + uterotonic agents (IV oxytocin, methylergonovine) prostaglandin analogs (IM carboprost tromethamine, Misoprostol).
76
dx chronic htn before pregnancy vs gestational htn vs preclampsia vs chronic HTN w/ superimposed preclampsia
Chronic htn in pregnancy: >140/90 BEFORE 20wks and no proteinuria
Gestational HTN: new HTN >20wks w/out systemic findings
Preclampsia: newly elevated BP and proteinuria in pregnancy after 20wks.
chronic HTN w/ superimposed preclampsia: S+S of d/o along with chronic HTN
77
when do kick counts start?
20 wks
78
who does not need GBS screen?
C-section delivery
79
leading cause of morbidity/mortality in pregnancy?
preclampsia/eclampsia
80
Dx of preclampsia (BP, what if severe?)
BP >140/90 (>160/110 if severe) on 2 separate occasions at least 6hrs apart w/ Proteinuria >300mg/24hr or end organ damage.
81
what is HELLP syndrome?
complication of preclampsia: Hemolytic anemia, Elevated Liver enzymes, Low Platelets
82
what 3 fetal complications can arise from preclampsia?
growth restriction, preterm labor, placenta abruption
83
txt for preclampsia + preclampsia w/ severe features
delivery at 37wks, steroids (betamethasone) to mature lungs if <34wks
Monitor: BP, UA/dipstick, 2x-week NST,
Severe = prompt delivery (at 34 wks) + Mg Sulfate (seizure prevention) + BP meds (labetalol, nifedipine, hydralazine)
84
S+S eclampsia
preclampsia + abrupt tonic-clonic seizure 1-2min → post-ictal state. Hyperreflexive → resp distress → coma
85
txt for eclampsia
Mg sulfate(seizure prevention/txt) (+lorazepam if refractory), delivery (once stable), + hydralazine or labetalol.
86
what is the concern with Rh incompatibility ?
if another Rh+ fetus, antibodies may cross placentae and attack fetal RBCs. =fetal hemolytic dz -->
hemolytic anemia, jaundice, kernicterus (brain damage from bilirubin), hepatosplenomegaly, fetal hydrops (fluid accumulation in two spaces - pericardial effusion, ascites, pleural effusion, subcutaneous edema), CHF.
87
hemolytic dz of newborn = erythroblastosis fetalis, what is the txt?
antigen-negative RBCs through US guided umbilical vein transfusion.
88
why are UTIs common in pregnancy? what does it increase risk of?
Common b/c uterus puts pressure on the bladder and urinary tract + ureteral dilation.
= increased risk of premature labor. Screen pregnant pts for asymp bacteriuria.
89
txt of UTI in pregnancy
amoxicillin,Nitrofurantoin (macrobid), augmentin, keflex, cefpodoxime, Fosfomycin. 7-14days
90
what are the two classifications for common birth defects and what are included in them ?
Structural: heart defects, cleft lip/palate, spina bifida, club foot
Functional/developmental: down syndrome, sickle cell, cystic fibrosis
91
chorionic villus sampling: when and why is it done? risk/benefit versus amniocentesis?
Done in 1st trimester (>10wks)- available earlier than amniocentesis but has higher diagnostic uncertainty and is more dangerous.
Available to all women, regardless of risk. MC done if >35yo or prior pregnancy w/ genetic abnormality, etc.
92
risk assoc. with chorionic villus sampling and amniocentesis?
miscarriage
93
what are the indications for amniocentesis ?
MC evaluate for genetic abnormalities, also fetal infection, degree of hemolytic anemia, blood/plt type, neural tube defects.
Also used as therapeutic txt for polyhydramnios or twin-twin transfusion syndrome or prolapsed fetal membrane.
94
when is amniocentesis done?
15-17wks
95
which abnormal pap test results are the ONLY ones that dont need colposcopy?
Atypical squamous cells of undetermined significance (ASC-US):
Under 30 years repeat in one year
Over 30 years: Acceptable to repeat cotesting at 1 year.
HPV positive colposcopy
HPV negative repeat in 3 years
*all others (ASC-H, LSIL, HSIL, and AGC need colposcopy)
96
what are tocolytic options (to slow labor) ?
"Its Not My Time"
| indomethacin, nifedipine, Mg sulfate, terbutaline
97
when is tocolysis of preterm labor contraindicated?
When the maternal and fetal risks of prolonging pregnancy or the risks associated with these drugs are greater than the risks associated with preterm birth (e.g. pre-eclampsia and intra-amniotic infection).
98
what are risk factors for placenta previa?
increased maternal age, multiparity, prior placenta previa, and prior cesarean delivery.
99
what are fetal complications of placenta previa (other than perpartum hemorrhage)?
The rate of congenital malformations (namely neurologic, cardiovascular, gastrointestinal, and respiratory) doubles with placenta previa.
100
nitrazine test (swab changes with orange to blue) is to confirm what?
presence of amniotic fluid - PROM
101
when checking for PROM - what pH will indicate a positive finding?
pH >6.5 (normal vaginal fluid is 3.5-6)
102
clinical manifestations of molar pregnancy (5)
vaginal bleeding, pelvic pain/pressure, uterine size >GA, hyperemesis gravidarum, preclampsia <20wks
103
dietary deficiency of what vitamin increases risk of molar pregnancy?
vitamin A
