OBGYN 9 Flashcards by Giselle McIntyre

1 hour glucose results positive for GDM

> /= 140

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Positive results for 3 hour GTT

Fasting positive > 90
1 hour > 180
2 hour > 155
3 hour > 140

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Define arrest of labor

• No progress in the active phase of labor (>6 cm) with ruptured membranes for 4 hours without adequate contractions, or 6 hours of inadequate contractions

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Managent of PROM

GBS status and deliver

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Management of PPROM

Deliver after 34 weeks

Give steroids

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Give the full name of a mono/di twin

Monochorionic/diamniotic

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Time frame of twinning

♣ 0-4 days – dichorionic/diamniotic
♣ 4-8 days – monochorionic/diamniotic
♣ 8-12 days – monochorionic/monoamniotic
♣ >13 days – conjoined twins

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Tx of uterine atony

♣ First line
• Dilute IV oxytocin + bedside uterine massage
♣ If first line is ineffective:
• Prostaglandin F2-alpha (Hemabate aka Carbaprost)
o Prostaglandin compound that stimulates myometrial contraction
o Contraindicated in asthmatic patients due to potential for bronchoconstriction
• Rectal misoprostol
• Methylergonovine Maleate (Methergine)
o An ergot alkaloid agent that induces myometrial contraction as a treatment of uterine atony
o Contraindicated in hypertension due to risk of stroke

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Management of chorioamnionitis

♣ Broad spectrum IV antibiotics (e.g. ampicillin, gentamicin, clindamycin)
♣ Induction of labor - Caesarean is not necessary unless indicated

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What is a threatened abortion

Pregnancy with vaginal spotting during the first half of pregnancy; but fetus is still viable

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What is an incomplete abortion

Pregnancy <20 weeks associated with cramping, vaginal bleeding, open cervical os, and some passage of tissue but also retained tissue in utero

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What is a missed abortion

Pregnancy <20 weeks with embryonic or fetal demise but no sx such as bleeding or cramping

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What is an inevitable abortion

o Bleeding and cramping in the presence of a dilated cervix; indicates that passage of the conceptus is unavoidable

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Management of septic abortion

Broad spectrum abx + uterine evacuation

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What is the disease associated with recurrent pregnancy loss

Antiphospholipid syndrome

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Tx of antiphospholipid syndrome

Anticoagulation = Aspirin + Heparin

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What are the drugs used for medical abortion

Mifepristone (terminates pregnancy)

Followed by Misoprostol (Uterine cramping + expulsion of POC)

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Next step in management of Rh- mom with +antibodies

Transcranial doppler - increased flow means that mom is attacking baby and baby is increasing flow to compensate for anemia

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Describe the 3 antibodies that you worry about in pregnancy

Lewis (lives)
Duffy/Rh(D) (dies)
Kell (kills)

At what gestational age do you deliver Rh alloimmunization anemic baby

Deliver if > 32 weeks

what if baby is <32 weeks

transfusion

Intrapartum tx of mom with HIV

♣ Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery
♣ Viral load <1000 copies = ART + vaginal delivery
♣ Viral load >1000 copies = ART + zidovudine + cesarean section

Postpartum tx of baby with HIV+ mom

♣ maternal viral load <1000 copies = Zidovudine

♣ maternal viral load >1000 copies = multi-drug ART

Most likely diagnosis/organism: vaginal discharge with friable cervix that bleeds with manipulation

Acute cervicitis - usually caused by gonorrhea/chlamydia

When (timing) is chorionic villus sampling vs. amniocentesis indicated

Chorionic villus sampling = 10-13 weeks Amniocentesis = 15-20 weeks

Describe likely complication of baby born to mom with preeclampsia with severe features

Fetal growth restriction/low birth weight Preeclampsia is caused by abnormal placental development which puts the fetus at risk for chronic uteroplacental insufficiency

Describe the difference in management of PPROM based on gestational age, signs of infection/fetal distress

34-37 weeks: o Antibiotics o +/- corticosteroids o Delivery ``` <34 weeks: -- No signs of infection or fetal compromise ♣ Antibiotics ♣ Corticosteroids -- Signs of infection or fetal compromise ♣ Antibiotics ♣ Corticosteroids ♣ Magnesium if <32 weeks ♣ Delivery ```

Describe the pathogenesis of hypotension secondary to epidural

Hypotension occurs when the sympathetic nerve fibers responsible for vascular tone are blocked, resulting in vasodilation (venous pooling), decreased venous return, and decreased cardiac output

Prevention and tx of hypotension secondary to epidural

Prevention = IV fluid expansion prior to epidural Tx = IV fluid bolus, L uterine displacement (mom on L side) to improve venous return, or vasopressor

What happens to pH, PCO2, and HCO3 in normal pregnancy

Primary respiratory alkalosis with partial metabolic compensation (pH increased - 7.45; PCO2 decreased, HCO3 decreased)

What happen kidney function in pregnancy

Increased GFR leads to lower Creatinine

Management of ASCUS in pregnancy

re-Pap postpartum

Management of HSIL in pregnancy

Colposcopy

What are risks of hormone replacement therapy in menopausal women

o Venous thrombosis o Stroke o CHD (combined therapy) o Breast cancer (combined therapy)

What are contraindications to OCPs

``` o Uncontrolled HTN o DM with end organ disease o Smokers o Age > 35 o Migraine HA with aura ```

Describe interstitial cystitis

A chronic inflammatory condition of the bladder, clinically characterized by recurrent irritative voiding sx of urgency and frequency. Etiology is unknown

How often should mammograms be perfomed

Bi-annually Or annually according to ACOG

How often should colonoscopies be performed

q10 years

What is a common exacerbating factor of cyclic mastalgia

caffeine

Next step in managment of breast lump with bloody needle aspiration

Mammogram + excisional biopsy

Next step in management of breast lump with clear needle aspiration

Reexamination in 2 months

Order of pubertal events

``` (Think: Tits, pits, mits, and lips) ♣ Thelarche (Breasts) (8) ♣ Pubarche (Axillary and pubic hair) (9) ♣ Growth (10) ♣ Menarche (11) ```

What are the components of McCune Albright

o Precocious puberty o Café-au-lait spots o Polyostotic fibrous dysplasia

Diagnose: Normal ovaries with absent uterus and fallopian tubes

Mullerian agenesis

Describe GnRH, LH, FSH, Prolactin, and TSH in hypothalamic amenorrhea

``` o Functional hypothalamic amenorrhea (aka low GnRH) ♣ FSH low ♣ LH low ♣ Prolactin normal ♣ TSH normal ```

Most common locations for ureteral injury during hysterectomy

1. Cardinal ligament - when ligating the uterine arteries 2. During ligation of ovarian vessels 3. At uterovesicular junction (where ureters enter the bladder) - when vaginal cuff is ligated