Flashcards in Ob/Gyn Deck (125)
Compare and contrast myomectomy to fibroid embolization
Uterine fibroid embolization requires a shorterhospitalization and less time off work. General anesthesia is not required, and a blood transfusion is unlikely to be needed. Myomectomy is recommended over fibroid embolization for patients who wish to become pregnant in the future. Uterine fibroids can occur or develop after either Myomectomy or embolization.
Which of the following drugs is contraindicated in the second and third trimester of pregnancy: amoxicillin, azithromycin, ceftriaxone, ciprofloxacin, or doxycycline?
Doxycycline due to the risk of permanent discoloration of tooth enamel
SSRIs in pregnancy
Generally safe except for paroxetine, which may cause congenital cardiac malformations with first trimester use, and is pregnancy category D
Benzodiazepines in pregnancy
Controversial due to a possible association with cleft lip/palate
Bupropion in pregnancy
Not well studied, but may cause increased risk of SAB.
When is maternal sero-positivity to CMV virus a contraindication to breast-feeding?
When it is of recent onset, or in mothers of low birth weight infants.
What is appropriate follow-up for a patient whose Pap smear indicates the presence of atypical squamous cells of undetermined significance, (ASC – US).
There are three appropriate follow-up options. Best is reflex testing for HPV. Another option is to repeat ttwp cytological exams performed at six-month intervals. The final option is a single colposcopy exam.
If the HPV test is negative, the Pap smear should be repeated at one year.
What is the first step in the evaluation of a woman over 35 with abnormal vaginal bleeding?
At what estimated fetal weight does ACOG recommend consideration of cesarean delivery without a trial of labor?
When the estimated fetal weight is 4500 g in a mother with diabetes, or 5000 g in the absence of diabetes.
What laboratory test should be done in a pregnant woman who has symptoms of flu and has been exposed to H1N1?
Real-time reverse transcript days PCR. Pregnant women are at greater risk for severe disease and complications from H1N1. Real-time PCR is the most definitive method to identify H1N1. Routine testing for H1N1 using rapid test is not recommended by the CDC because the sensitivities of the currently available rapid tests are quite poor.
What is the most common cause of abnormal vaginal discharge in a sexually active woman?
Bacterial vaginosis. It accounts for up to 50% of cases in some populations it is more common than either Candida albicans or trichomonas vaginalis infections.
What measurements are used to estimate just stational age during the first second and third trimester is a pregnancy?
Crown to rump length is the most accurate measurement of gestational age and is done at 7 to 14 weeks. After that other measurements are more reliable. In the second trimester, biparietal diameter and femur length are used. During the third trimester, biparietal diameter, abdominal circumference, and femur length are best for estimating gestational age.
What are the various types of decelerations seen on fetal monitoring and what do they represent?
Early deceleration's are thought to result from vagus nerve response to fetal head compression, and are not associated with increased fetal mortality or morbidity. Variable decelerations are thought to be due to acute intermittent compression of the umbilical cord between fetal parts and the contracting uterus. Late decelerations are thought to be associated with uteroplacental insufficiency and fetal hypoxia due to decreased blood flow in the placenta this pattern is a warning sign and is associated with increasing fetal compromise, worsening fetal acidosis, fetal central nervous system depression, and or direct myocardial hypoxia.
What are the signs of uterine rupture during labor?
The only reliable sign is fetal distress. That classic signs of uterine rupture such as sudden, tearing uterine pain, vaginal hemorrhage, and loss of uterine tone or cessation of uterine contractions are not reliable and are often absent. Pain and bleeding occur in as few as 10% of cases.
How can serum progesterone levels be used to evaluate viability or status of a pregnancy?
A single serum level of 25 ng/mL or higher indicates a healthy pregnancy and excludes ectopic pregnancy with a sensitivity of 98%. If the level is less than 5 ng per milliliter the pregnancy is nonviable. Assessment of fetal well-being is difficult if levels are in the intermediate range of 5 to 25 ng/mL.
What are the criteria for diagnosis of bacterial vaginosis?
Patients must have three of the four Amsel criteria to be diagnosed with bacterial vaginosis. These include a pH of greater than 4.5, which is the most sensitive; clue cells greater than 20%, which is the most specific; a homogeneous discharge, and a positive with test.
What are the chances of getting pregnant with intercourse in relationship to the days before or after ovulation?
There is a 30% probability of pregnancy resulting from unprotected intercourse 1 to 2 days before ovulation, 15% three days before, 12% the day of ovulation, and essentially 0% 1 to 2 days after ovulation.
What does the CDC recommend in terms of antenatal screening for group B streptococcal disease?
Cultures from the vaginal introitus and rectum are the most sensitive for detecting group B strep colonization. No speculum exam is necessary. The closest time to delivery that cultures can be performed and allow time for results to be available is 35 to 37 weeks gestation.
A strawberry cervix is a feature of what sexually-transmitted disease?
What is the definition of delayed or interrupted puberty in girls?
It is defined as failure to to develop any secondary sex characteristics by age 13, to have menarche by age 16, or to have menarche five or more years after the onset of pubertal development.
What is the most accurate test to determine whether a patient with contractions is at high risk for preterm labor?
Vaginal fetal fibronectin. In symptomatic women this is the most accurate test for predicting spontaneous preterm delivery within 7 to 10 days. It is less accurate in those who are asymptomatic. If the fetal fibronectin is negative it maybe possible to avoid interventions such as hospitalizations, tocolysis, and corticosteroid administration.
What is the best regimen for emergency contraception?
It is called plan B. It is a contraceptive package that contains 20.75 mg tablets of levonorgestrel to be taken 12 hours apart.
Which measurement by ultrasound determination during the second trimester provides the most accurate estimate of gestational age?
Biparietal diameter is the most accurate parameter during the second trimester it has a 95% confidence level of being within 5 to 10 days of the actual just additional age when used at the proper time.
What are the risk factors for endometrial cancer?
A history of anovulatory cycles, obesity, nulliparity, history of tamoxifen use, and diabetes mellitus.
What is the emergency management of dysfunctional uterine bleeding?
Intravenous conjugated estrogen – 25 mg Q4 hours until bleeding slows for 12 hours. This is believed to be a stimulus for clotting at the capillary level. It promotes rapid growth of endometrium to cover denuded endometrial surface and stop bleeding. 75% will be controlled in six hours. Another possibility is oral conjugated estrogen 10 mg per day in four divided doses.
Oral contraceptive pills or 10 days of progestin each month should be started after the bleeding stops to prevent recurrence.
What is the non-emergency management of dysfunctional uterine bleeding?
One combined hormonal oral contraceptive pill for seven days. If the flow stops within 12 to 24 hours, the diagnosis of dysfunctional uterine bleeding can be confidently made. The combined oral contraceptive should be stopped at seven days. Regular OCP's should be given for the next 3 to 6 months.
An alternative would be cyclic administration of progesterone for three months.
What patients tend to have thin endometrium?
They have heavy continuous uterine bleeding. They are often using a progestin dominant contraceptive pill, IUD, Depo-Provera, or minipill. They are excessively thin or have low body fat and may be hypoestrogenic. These include women with eating disorders and elite athletes.
Cyclic prolonged and/or excessive bleeding
Bleeding at irregular and frequent intervals. This typically involves ovulatory cycles.