OBGYN Flashcards
1
Q
How to estimate delivery date?
A
LMP - 3 months + 7 days
2
Q
DA vs GA
A
DA = days since fertilization= shorter GA= days since LMP= longer than DA
3
Q
When does first trimester end? second?
A
12 weeks DA or 14 wks GA
24 weeks DA or 26 weeks GA
4
Q
Define lengths: pre- viability: pre-term: early term: full term: late term:
A
pre- viability: before 24 wks pre-term: 25-37 early term: 37-38.6 full term:39-40.6 late term: 41-41.6 postterm: 42+
5
Q
When is fetal movement felt?
Whats this called?
A
starts 16-20 wks GA
quickening
6
Q
When should anatomy scan be done?
A
18-20 wks GA
7
Q
What are the following signs?
Goodell sign
Ladin Sign
Chadwick Sign
A
Goodell- softened cervix (first)
Ladin- softened uterine midline
Chadwick- blue discoloration vagina/cervix
all first trimester
8
Q
When is “cholasma” seen? linea nigra?
A
second trimester ~16 wks; linea also second trimester
9
Q
Describe BHCG trend?
A
rises and peaks @ 10 wks
drops during 2nd trimester
rises again 3rd trimester to 20-30k
10
Q
How often should BHCG double in early pregnancy?
A
q48 hours for first month
11
Q
At what BHCG should a gestational sac be seen on scan?
A
10-15k/ or 5 wks
12
Q
Cards changes in pregnancy
A
^HR/CO
lower BP
13
Q
GI changes in pregnancy
A
GERD and constipation due to LES decreased tone and decreased colonic motility
14
Q
Renal changes in pregnancy
A
increased GFR, decreased BUN/Cr
increased risk pyelo due to uterine compression of GU tract
15
Q
Heme changes in pregnancy
A
anemia, hypercoagulable (fibrinogen ^ but no PT/PTT, INR change)
16
Q
Important prenatal testing done:
- early as possible
- 11-14 wks
- 16 wks
- 15-20 wks:
- 18-20 wks
A
- early: blood tests, pap, GC
- 11-14: gestational age, nuchal translucency
- 16 wks: fetal heart sounds
- 15-20 wks: triple or quad screen
- 18-20 wks: anatomy scan
17
Q
Third trimester testing done at
27 wks
24-28 wks
36 wks
A
27 wks CBC
24-28 GTT
36 wks repeat GC, GBS
18
Q
When to give iron supplements in pregnancy
A
Hgb 11 or less
19
Q
How often are visits early in pregnancy?
3rd trimester?
36?
A
early- 4-6 wks
3rd trimester- 2-3 weeks
36+- weekly visits w/ cervical cks at each
20
Q
When is chorionic villus sampling/amniocentesis a reasonable idea and when can it be done?
A
10-13 wks CVS; 11-14 amnio
advanced maternal age
known genetic disease in parent
21
Q
MC location ectopic pregnancy
A
ampulla of fallopian tube
22
Q
How to manage ectopic?
A
ruptured: stabilized –> surgery
not ruptured: medical or surgical treatment
23
Q
Medication used to abort ectopic?
A
MTX (folate receptor antagonist)
24
Q
Important followup for MTX treatment of ectopic?
A
follow BHCG to zero
25
Exclusion criteria
large or heart beat
liver disease
noncompliant
immune deficient
26
surg for ectopic
salpingostomy/ectomy
| *need rhogam if Rh negative
27
SAB is inevitable when?
bleeding + dilated cervix
28
Abortion is before what GA?
| MCC?
20 wks
(80% in first 12)
chromosomal abnl
29
Threatened abortion def
bleeding without dilation
30
Missed abortion def
abortion but all POC in uterus
31
Treatment of septic abortion
D&C + IV levo or metro
32
Difference between preterm labor and cervical incompetence?
contractions
33
Contraindication to tocolytics in preterm labor?
```
BP ^
cardiac disease
dilated more than 4
DIC
fetal death
chorio
```
34
At what GA is preterm labor not stopped?
34-37
| earlier give steroids and tocolytics
35
MC used tocolytic
magnesium sulfate... can also use CCB or terbutaline
36
Define PROM + risks
ruptured more than 24 hours before delivery
| = PTL, cord prolapse, abruption, chorio
37
Management of PROM
chorio- always deliver
term- wait 6-12 hours for spontaneous this induce
preterm- abx, steroids, tocolytics,
38
Abx used in PROM
azithro 1 g and ampicillin
39
What is CI in all cases of third trimester bleeding?
digital exam
40
Presentation placenta previa
painless bleeding
41
Three types of placental invasion
accreta, increta, percreta
42
Risk assc with placental invasion
PPH (type and cross)
43
Treatment of bleeding assc with placenta accreta
hysterectomy
44
Define placental abruption
Separation of the placenta from the uterus
45
Risk factors for abruption
smoking, cocaine, HTN, trauma, prior hx
46
MC incision type for Csection modern
low transverse
47
Two types of abruption
concealed vs external
| (concealed = bleeding into uterine cavity) * concealed in worse... DIC/hypoxia/ tetany etc
48
Clues to uterine rupture
fetus withdraws into abdomen during delivery
bump in abdomen
pain
no contractions
49
Treatment of uterine rupture
life threating... always immediate laparotomy
50
Management of future pregnancies after uterine rupture
IF uterus can be repaired.... deliver all future pregnancies by cesarean at 36 wks
51
Cause of hemolytic disease of newborn
Rh - mom, second pregnancies, develops ab's to fetal RBCs
52
Result of hemolytic disease newborn
erythroblastosis fetalis --> high output CHF
53
Screens for Rh factor (2)
Ab SCREEN to see if momma is + or -
| Antibody titer to see how many antibodies to Rh+ blood momma has (at initial visit and 28-35 wks)
54
Management of Rh - momma at 28-35 wks
- rhogam if unsensitized and again at birth if babe is acutally Rh+
- sensitized but less than 1:16- nothing
- sensitized more than 1:16- serial amnio
55
What if fetal hgb is low and bili is high?.
can perform intrauterine transfusion
56
Define pre-eclampsia and eclampsia
pre-eclampsia: HTN + proteinuria
| eclampsia: ^ + seizures
57
Define chronic HTN of pregnancy
above 140/90 before 20 wks GA
58
Define gestational HTN of pregnancy
BP above 140/90 after 20 wks GA without proteinuria or edema
59
Treatment of HTN in pregnancy
methyldopa, nifedipine, labetalol
60
ACE/ARBs in preggos?
no... malformations.
61
Define "severe preeclampsia"
more than 160/110; dipstick 3+; more than 5g protein in 24 hrs; generalized edema; mental status/ vision change; impaired LF.
62
Treatment of mild preeclampsia
if preterm: steroids + Mag Sulfate
| if term: induce delivery
63
Treatment of severe preeclampsia
Same as mild but add hydral
64
Maternal risks with pregestational DM
preeclampsia, SAB, infection, PPH
65
Fetal risks with pregestational DM
heart defects, NTDs, macrosomia, preterm
66
Maternal testing incase of pregestational DM
EKG, renal function, a1c, eye exam
67
Fetal testing needed in case of pregestational DM
32-26 wks: weekly NST and US
36+: weekly BPP and NST
37+: L/S ratio (can deliver now if mature)
38-39: induce delivery
68
Glucose testing at 24-28 wks...
| describe steps
- 50g gluc load test (+ if above 140)
- if + then ingest 100g while fasting and measure glucs at 1,2,3 hours.
- load --> tolerance
69
Treatment of GDM
diet and exercise (not weight loss) --> metformin/glyburide --> insulin
*pregestational type 2 will likely need insulin
70
Define IUGR
less than 10th percentile
71
Two types of IUGR
symmetric: brain = rest of body, starts before 20 GA
asymmetric: brain weight better than rest of body, after 20 GA
72
Prevention of IUGR
stop smoking, get vaccines (but not live)
73
Define macrosomia
babes greater than 4500 grams
74
Appropriate fundal height compared to GA
fundal height in cm should equal GA in wks... do US if off by 3 cm or more
75
What are the three STAGES of labor?
| How is stage one divided?
Stage 1: labor onset --> full dilation (latent + active starting at 4cm)
Stage 2: full dilation --> delivery
Stage 3: delivery babe --> delivery placenta
76
Upper limit normal stage 1 labor for primip vs multip
primip: 18 hours
multip: 10 hours
77
How fast should dilation go during active phase for primp/multip?
primip: 1cm/hr
multip: 1.2 cm/hr
78
Upper limit normal stage 2 labor for primip vs multip
primip: 3 hours
multip: 30 mins
79
Upper limit normal for stage 3 labor
30 mins
80
Stations of fetal head
-3 --> 0 --> +3
| 0 is pelvic brim
81
Chemicals for labor induction
oxytocin, PGE2
| *avoid PGE in asthmatics
82
3P's for evaluation of protracted cervical dilation
Power (contractions)
Passenger (babys head size)
Passage (pelvis size)
* can give oxytocin if power is the issue
83
Define arrest disorders
of cervical dilation: no change x 2 hours
| of fetal descent: no change x 1 hour
84
At what age is ECV appropriate
after 36 wks GA
85
Define early vs late PPH and what amt of blood constitutes hemorrhage?
early first 24 hours; late after
| must be more than 500 mL blood
86
Common causes PPH
#1 atony, then lacs/retained products/ etc
87
Management of PPH
massage and oxytocin
88
Dx criteria for PMD
2 + cycles
sx absent in follicular phase
sx present in luteal phase
interferes with life
89
Treatment for PMDD
SSRIs/ stop caffeine, alcohol, cigarettes chocolate
90
Menopause age + length
48-52, must have no periods x 1 year for dx
91
Problem with no estrogen? problem with estrogen replacement?
no estrogen- osteoporosis
| estrogen- endometrial carcinoma
92
Define menorrhagia? metrorrhagia?
meno- too much
| metro- irregular
93
Causes of excess bleeding?
polyps/cancer/fibroids/estrogen excess/ etc
94
Postcoital bleeding is ____ until proven otherwise
cervical cancer
95
Dx tests for menorrhagia/abnormal bleeding
CBC, PT/PTT, pelvic US
96
What produces progesterone during normal cycle?
corpus luteum, dies when pt does become pregnant, then prog withdraw= bleeding
97
Systemic reasons for anovulation
hypothyroid
| hyperprolactinoma
98
At what age is abnormal bleeding concerning for cancer?
35+
99
What three risks are decreased by OCPs
endometrial cancer, ovarian cancer, ectopics
100
Vaginal ring works the same way as? Patches?
OCPs same hormones, take out or off for 7 days to bleed
101
Depot medroxyprogesterone is effect for how long?
3 months, must get shot q3 months
102
Cause of labial fusion
high androgens as in 21 B hydroxylase def
103
Lichen sclerosis vs planus appearance + treatment of both
sclerosis is white; planus is purple
| both get steroids
104
Appearance of squamous hyperplasia on vagina + treatment
RAISED white lesion that itches
| treat with sitz bath
105
Treatment of Bartholin gland cyst ?
I&D + culture drainage to R/O G&C
106
Normal vaginal pH
lower than 4.5
107
Treatment of bacterial vaginosis?
metro or clinda
108
Treatment of trich
patient and partner with metro
109
Pagets disease appearance and treatment?
Rasied red lesion with white coating.... need vulvectomy
110
Common type of vulvar cancer + presentation?
squamous cell, often itchy
111
Adenomysosis appearance and treatment
endometrial glands grow into myometrium..... large boggy uterus. Treatment is hysterectomy
112
Treatment for severe endometriosis not managed by NSAIDs/ OCPs
danazol (test effects), leuprolide (induces reversible menopause)
extreme= surgery
113
Chemical dx of PCOS
LH:FSH more than 3:1
114
Drugs to help pt with PCOS conceive
metformin and clomiphene
