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1

Parameters for normal menstrual cycle
(a) duration
(b) time btwn cycles
(c) blood loss

Normal menstrual cycles

(a) 2-7 days, average 5 days duration
(b) 21-35 days from day 1 to day 1
(c) average 30 cc blood loss, normal is under 80 cc
-not clotted w/ endometrial debris

2

Discharge instructions for postparum mothers to prevent postpartum depression

Good sleep and nutrition
-close monitoring/awareness and screening for symptoms (ex: symptom tracking)
-ensure good support

3

Differentiate timing of delivery btwn types of twins

Didi
Dimono
Mono-mono

Timing of delivery- earlier and earlier the more the twins are separated

Didi twins- 38 wks
Di-mono- 34-38 wks
Mono-mono: 32-34 wks and C-sxn 2/2 risk of cord entanglement

4

Ddx for postpartum fever

-endometritis
-UTI (cystitis or pyelo)
-wound infection
-mastitis (clogged ducts)
-HCAP PNA
-C. dif, pelvic thrombophlebitis

5

Steps to decrease risk for preterm PROM in a pt w/ h/o PROM

Can give progesterone for PROM ppx

6

Important reminder when transfusing blood products

Need to use 1:1:1 ratio of FFP to pRBC to plts after 2uRBC to prevent dilution

7

Meig's syndrome: triad of benign ovarian fibroma

Recall that most ovarian masses present w/ GI symptoms

Meig's syndrome = triad of benign ovarian fibroma + ascites + right pleural effusion
-typically pleural effusion on the right b/c the transdiaphragmatic lymphatic channels are larger in diameter on the right

8

What counts as a LARC?

LARC = long acting reversible contraception

1. IUD
2. Nexplanon

9

Most common etiology of postpartum hemorrhage

Uterine atony
-uterus feels boggy/soft

10

2 ways we can try to prevent uterine atony

-fundal massage
-IV/IM oxytocin

= active management of the 3rd stage of labor (delivery of the placenta)
-give 20 of ptosin (oxytcin) + cord traction via suprapubic pressure

11

Describe some surgical techniques to manage uterine atony

Ligate the uterine artery
UAE = embolize uterine artery (via IR)k
B. Lynch sutures

Last resort = hysterectomy

12

Workup for adnexal/mass

(a) First line, second line
(b) How different if post-menopausal

Workup for adnexal/mass

(a) First line: Pelvic ultrasound
(b) and if post-menopausal test CA-125 (not if premenopausal b/c can be falsely elevated by endometriosis, fibroids, PID)

Second line (and definitive tx) = surgical exploration

13

Primary source of amniotic fluid

Amniotic fluid produced mostly by fetal urine output

14

Risk factors for postpartum hemorrhage

C-section
prolonged labor, prolonged induction
-large baby (anything that over-distends the uterus- b/c then it needs to get much smaller much faster)
-polyhydramnios
-infection
-use of Mg during pregnancy (used to pervent seizures in preeclampsia

15

Differentiate Braxton-Hicks from true labor contractions

Braxton-Hicks: irregular, inconsistent
-usually in the third trimester
-often can be 'broken': stopped when change what you're doing or are distracted

True labor contractions: regular and consistent

16

Describe when estrogen peaks in the menstrual cycle

Estrogen produced by ovary and follicle (thing before ovulation causes corpus luteum), peaks at ovulation
-then LH peak comes shortly after

17

Define post-partum hemorrhage

Over 500 ccs after vaginal delivery
Over 1,000 cc after C-section

18

Serious consequence of persistent oligohydramnios

Pulmonary hypoplasia
-not enough pressure around the fetal lungs to allow for maturity

19

When do you deliver if pt has preeclampsia w/ severe features

34 wks

20

Define antepartum care

Care of pregnant mother before labor/delivery

21

Tox labs for preeclamspia

-CBC for plts
-BMP for Cr
-LFTs
-Uric acid (b/c builds up if kidneys can't excrete), LDH
-urine protein and creatinine for ratio (bad is over 3)

22

Name 3 meds that are well-established teratogens

-coumadin (warfarin)
-isotretin (acutane)
-ACEi

23

Most common cause of coagulopathy in pregnancy

Placental abruption

24

Tx for uterine atony: 3 steps

1. uterotonic meds
-methergine (contraindicated in HTN)
-hemabate (contraindicated in asthma)
-oxytocin (pit)
-mesoprostol

2. bakri baloon
-apply pressure to induce uterine tamponade to compress the spiral ateries

3. surgical management

25

Describe medical management of uterine atony

Give methergine (unless HTN, then use hemabate first), then give mesoprostol (takes 20 mins to work)- then add more pit (oxytocin)

26

Describe a possible physiologic mechanism of preeclampsia

Abnormal migration or structure of cytotrophoblasts lining the spiral arteries => there is not appropriate decrease in resistance of the vessels

Also a component of vasoconstriction

27

3 most common causes of neonatal death in preterm births

1. Respiratory distress
2. Infection
3. Interventricular hemorrhage

28

Describe diabetes screening during pregnancy

1-hr GCT (glucose control challenge) at 24-28 weeks

29

Tx for endometritis

IV gentamycin + clindamycin
-or can use single agent unasyn (piperacillin/tazobactam)

30

When can you detect fetal heart rate on transvaginal US

6 weeks