OBG part 3 Flashcards by Stephanie Escobar

___ is used to treat osteoporosis in patients who also require breast cancer prophylaxis.

Raloxifene

selective estrogen receptor modulator (SERM)
Increases risk of DVT/PE/hyper-coagulation

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Prolactin, which is high in breastfeeding individuals, inhibits the release of ___

GnRH & Gonadotropins

resulting in low estrogen levels (dyspareunia)

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The __ nodes are the primary lymphatic draining site for the distal vagina, vulva, and penis.

superficial inguinal

→ deep inguinal → ext iliac → para-aortic nodes

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The ___ lymph nodes are the primary draining site for the cervix.

internal iliac

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The ___ lymph nodes are the primary draining site for the body of the uterus.

external iliac

cervix= interenal iliac

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The ___ lymph nodes are the primary draining site for the ovaries & testes.

para-aortic

blood supply directly from aorta

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Lower abdominal pain (typically bilateral), cervical motion tenderness, and purulent vaginal discharge
Diagnosis is ___

PID

*can also px/w: dyspareunia, dysuria, ↑ WBC/ESR

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Common causes of infectious vulvovaginitis (3)

inflammation/infection of vagina

Bacterial vaginosis
Vaginal yeast infection
Trichomoniasis
*other STDs & atrophic vaginitis

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Complications associated with PID include (4)

pelvic peritonitis/sepsis

infertility (tubal scarring)
TOA
ectopic pregnancy

Fitz-Hugh-Curtis syndrome

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Placenta previa risk factors (4)

h/o placenta previa

h/o cesarean delivery
h/o curettage
> 35 years
multiparity

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How to work up suspected placenta previa?

Transvaginal ultrasound

*Digital vaginal examinations are c/i in case of hemorrhage of unknown cause

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Management of Placenta Previa:
Asymptomatic patients (EGA: ≤20w)
Asymptomatic patients (EGA< 37w)
Symptomatic stable pt (EGA< 37w) 
Severe, active bleeding (EGA< 37w) 
Regardless of sxs if gestational age > 37w

Asymptomatic patients (EGA: 18–20w) → f/u TVUS at 32 w (to monitor placement)

Asymptomatic patients (EGA< 37w) → expectant management* + admit

Symptomatic stable pt (EGA< 37w) → expectant management* + admit for Observation

Severe, active bleeding (EGA< 37w) → emergent cesarean

Gestational age > 37 weeks →immediate cesarean

*Expectant management
< 36w: corticosteroids
If mild uterine contractions: tocolysis & magnesium if <32

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Painless (3T) vaginal bleeding (fetal blood) that occurs suddenly after ROM with Fetal distress ( like bradycardia) on FHT.

Fetal death can occur quickly through exsanguination or asphyxiation

VASA PREVIA

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How to work up suspected vasa previa? (1)

Treatment

Transabdominal or TVUS with color Doppler

Emergency cesarean delivery

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A NEGATIVE fetal fibronectin from cervical secretions rules of

Premature Labor

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When is a vaginal exam contraindicated?

Vasa Previa
Placenta Previa
Placental Abruption

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Sudden-onset abdominal or back PAIN (+/- between contractions)
uterine tenderness
Continuous vaginal bleeding
Fetal distress: Decelerations (60% of cases)
Vaginal Bleeding

Placental Abruption

Cx: DIC 2/2 fetal thromboplastin release

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Work up for suspected placental abruption (3)

Transabdominal Ultrasound* 
Coagulation factors (DIC r/o)
CBC (H&H)

*possible retroplacental hematoma

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Treatment for placental abruption

Hemodynamic control
RhD ppx in RhD negative mothers

≤33w (HDS mom & baby)

corticosteroids (betamethasone)
tocolysis PRN
Aim for a normal delivery

≥34w
Bleeding + contractions→ vaginal delivery
No bleeding + No contractions + ok baby → expectant management (steroids, tocolysis)

≥37w
Deliver

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Placental Abruption complications

IUFD
DIC (thromboplastin)
Retro-placental hemorrhage into peritoneum
Uterine rupture

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Vaginal bleeding with regular uterine contractions and cervical changes in laboring woman.

Bloody show

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vaginal bleeding typically after sex with some pelvic pain

+/- Bruised and tender cervix without evidence of active bleeding

Cervical trauma

reassurance

Sudden pause in contractions
Fetal distress (deteriorating FHR)
Vaginal bleeding
Hemodynamic instability
Suspected diagnosis:

Uterine rupture

Risk factors
h/o c-section, Transmyometrial surgery

____ is associated with FEVER, abdominal pain, recent h/o PID, and LEUKOCYTOSIS

tuboovarian abscess

___ is the recommended treatment for breast abscesses with INTACT overlying skin

Ultrasound-guided fine needle aspiration

___ is the treatment of choice for breast abscesses that are complicated by overlying skin necrosis (purple, thin skin) or those that fail to respond to less invasive treatment attempts. After, pts are tx w/ cephalexin or dicloxacillin

Surgical incision and drainage

Nausea and vomiting treatment escalation in pregnancy

pyridoxine (B6) → doxylamine → (anti-emetics) diphenhydramine, or promethazine/odansetrone/metoclopromide

Estrogen found within OCPs decreases ___ levels.

protein S

Anovulatory cycles are the mcc of AUB in otherwise healthy adolescents & typically occur up to ___ after menarche due to an immature hypothalamic-pituitary-ovarian axis.

2 years *Anovulation→ deficit in progesterone→ unopposed estrogen→ negative feedback in HPA→ long menses

A death of a fetus before 20 weeks' gestation. | The cervical os is closed and U/S shows a gestational sac w/ POC and absent fetal cardiac activity.

Missed abortion

Gravid uterus with closed cervical os, and U/S evidence of intrauterine pregnancy (double decidual sac sign) w/ vaginal bleeding and/or abdominal cramping, preserved fetal cardiac activity and appropriate serum β-hCG

Threatened abortion

Fever, Leukocytosis, cervical motion tenderness, bloody cervical discharge, positive ESR, and multiloculated adnexal mass points to

TOA 2/2 pelvic inflammatory disease

The intrauterine fetal demise before it attains viability (< 20 weeks) U/S shows an empty gestational sac or a fetus without fetal heart activity within the first 12 weeks.

Spontaneous abortion (Miscarriage) Dilation and curettage (D&C) is the treatment of choice for spontaneous abortion complicated by heavy vaginal bleeding.

Vaginal bleeding and lower abdominal cramping in combination with an open cervical os, a solid mass in the cervical canal, and absent fetal heart tones suggest an ____.

incomplete abortion

Incomplete abortion with foul-smelling vaginal discharge, cervical tenderness, and fever raise concern for intrauterine infection, indicating ___. Tx:

septic abortion IV clindamycin & gentamicin w/ suction & curettage

Dyspareunia and pruritus in a postmenopausal woman with a white vulvar plaque (+/- malignancy on bx) on pelvic examination are consistent with __.

Lichen sclerosus tx: superpotent topical glucocorticoids( betamethasone or CLObetasol)

How to tell apart systemic bacterial infection (sepsis) from AF embolism?

Both can have hypotension, DIC, AMS etc. However: Bacterial sepsis→ Fever + sxs develop progressively over hours/days AFE → NO FEVER + sxs develop within an hour or so

Elevation of serum LH levels after stimulation with a GnRH agonist indicates ___

central precocious puberty (CPP)

Adverse effects include: ``` HYPOKALEMIA→ fatigue, proximal muscle weakness, and decreased deep tendon reflexes. Tremor headache anxiety tachycardia/palpitations ```

Terbutaline (Beta-2 receptor agonists)

___ is indicated in patients with HELLP syndrome at ≥ 34 weeks' gestation or at any gestational age if the maternal or fetal status deteriorates.

Immediate delivery

Risk of infection is high following P-PROM thus antibiotic prophylaxis with __ & __ is administered >34 weeks of gestation give ____ is given to induce fetal lung maturation. To ensure fetal lung maturity, delivery can be delayed for up to 48 hours through administration of ___

ampicillin & azithromycin betamethasone Tocolytics (NSAIDs/Indomethacin, beta2-adrenergic agonists/Terbutaline, calcium-channel blockers/Nifedipine) *provided vital signs of both mother and child remain stable

Delete

___ is the best management option for women with cervical insufficiency, who are < 24 weeks' gestation of a singleton pregnancy with a cervical length of <25mm

Transvaginal cervical cerclage

__ is the antidote for heparin overdose which has a prolonged aPTT

Protamine sulfate

``` Increased or Decreased in Sheehan syndrome: ACTH Aldosterone Cortisol TSH ```

decreased Increased decreased decreased

__ trauma is more common in forceps delivery. __ and __ injuries are more common in vacuum delivery.

External ear cephalo-hematomas brachial plexus

A small, concentric, hypoechoic myometrial mass in a nulliparous woman of reproductive age is suggestive of ___ , for which a history of early menarche and obesity are risk factors.

uterine leiomyoma

A nonstress test (NST) is considered reactive if there are ≥ _ fetal heart rate accelerations that last for at least 15 seconds and are > 15 bpm above the baseline within a __-minute period.

2 | 20

Placental abruption, retained fetal products, amniotic fluid embolism, and preeclampsia are risk factors for the development of __ in pregnant women

DIC DIC is due to systemic release of thromboplastin resulting in an over activation of the coagulation cascade which causes a systemic consumption/depletion of both procoagulant and anticoagulant clotting factors, usually resulting in abnormal bleeding. Labs: thrombocytopenia, increased PT and PTT, increased bleeding time, increased D-dimer, and decreased FIBRINOGEN and factor V concentrations.

___ are the first-line hormone-therapy for estrogen-positive and progesterone-positive breast cancers in POST-menopausal women.

Aromatase inhibitors (exemestane, anastrozole, letrozole) Side effects: decreased estrogen & decreased bone density

__ is a humanized antibody that is used against HER2 receptor-positive breast cancer.

Trastuzumab side effects: flu-like sxs & HF

___ can be used to treat estrogen-positive breast cancer.

Selective estrogen receptor modulators (SERM) like Tamoxifen/Raloxifene Tamoxifen: decreases bone density in pre-monpausal women

__ is a mitotic inhibitor that is a first-line treatment for triple-negative breast cancer and ovarian cancer.

Paclitaxel