OBGYN general concepts Flashcards
1
Q
Estrogen from ovaries
A
Estradiol
2
Q
Estrogen from placenta
A
Estriol
3
Q
Estrogen from adrenal cortex and converted in thecal cell
A
Estrone
4
Q
Estrone and testosterone converted in theca cells
A
Estradiol
5
Q
2 cells in testes
A
Leydig and Sertoli
6
Q
2 cells in ovary
A
Theca cells and Granulosa cells
7
Q
Sequence of puberty
A
1 thelarche 2 pubic hair growth 3 growth spurt 4 menarche
8
Q
How many hours does the egg have to be fertilized
A
24 hours
9
Q
How many days does the sperm have to fertilize the egg
A
1 to 5 days
10
Q
Progesterone production in pregancy
A
1st trisem CORPUS LUTEUM 2nd and 3rd trisem PLACENTA
11
Q
Growth hormone of pregnancy
A
human placental lactogen or human chorionic somatotrophin
12
Q
Functional unit of ovary
A
ovarian follicle
13
Q
oocytes at fetal period at birth at onset of puberty
A
oocytes at fetal period 6 TO 7 MILLION at birth 1 TO 2 MILLION at onset of puberty 400 000
14
Q
2 arrests in fetal gameteogenesis
A
primary oocyte arrested ON 5th months AOG at PROPHASE I secondary oocyte arrested at METAPHASE II
15
Q
Mid cycle pain
A
Mittelschmerz caused by Corpus hemorrhagicum
16
Q
Luteal cells of the corpus luteum
A
Theca cells and Granulosa cells
17
Q
After ovulation we get 9 to 11 days of corpus luteum releasing progesterone to maintain anticipated pregnancy until
A
It notes the absence of pregnancy
18
Q
earliest histological sign of progesterone action
A
BASAL VACUOLATION
19
Q
Menstrual cycle phase with LOW progesteron SLOWLY RISING estrogen levels
A
early follicular phase
20
Q
Menstrual cycle phase with LOW progesteron RAPIDLY RISING estrogen levels
A
Late follicular phase
21
Q
Elevated level of progesterone
A
Luteal phase and pregnancy
22
Q
PREOVULATORY PHASE of ovarian cycle
A
follicular
23
Q
PREOVULATORY PHASE of endometrial cycle
A
proliferative
24
Q
PREOVULATORY PHASE length
A
variable 7 to 21 days
25
PREOVULATORY PHASE beginning and end
day 1 to ovulation
26
PREOVULATORY PHASE basal body temp
low basal
27
PREOVULATORY PHASE dominant hormone and source
estrogen from Follicular granulosa cells
28
PREOVULATORY PHASE histology
straight tubular glands
29
PREOVULATORY PHASE cervical mucus
thin and watery
30
PREOVULATORY PHASE function
replacement of the endometrial cells lost during menses
31
POSTOVULATORY PHASE of ovarian cycle
Luteal phase
32
POSTOVULATORY PHASE of endometrial cycle
Secretory
33
POSTOVULATORY PHASE length
constant 14 days
34
POSTOVULATORY PHASE beginning and end
day of ovulation til start of menses
35
POSTOVULATORY PHASE basal body temp
elevated over baseline
36
POSTOVULATORY PHASE dominant hormone and source
progesterone from Corpus luteum
37
POSTOVULATORY PHASE histology
tortuosus glands with secretions
38
POSTOVULATORY PHASE cervical mucus
thick and sticky
39
POSTOVULATORY PHASE function
prepares the uterus for implantation
40
what happens to the endometrium when you get pregnant
secretory endometrium turn into the DECIDUA the endometrium of pregnancy
41
Layers of decidua
1. decidua basalis 2 decidua capsularis 3 decidua parietalis
42
decidua that is part of the placenta invaded by trophoblasts with spiral arteries that are non responsive to vasoactive agents
Decidua basalis
43
decidua layer with spiral arteries and called the DECIDUA VERA lining the uterus
decidua parietalis
44
what enters uterine cavity blastocyst or morula
Morula on day 3 post conception AND this becomes the blastocyst
45
Blastocyst inner cell mass becomes
embryoblast
46
Blastocyst outer cell mass becomes
trophoblast with outer layer SYNCITIOTROPHOBLAST producing HCG and CYTOTROPHOBLAST
47
Implantation occurs on day ____ at _______________
day 7 at the posterior superior wall of uterus in the functional layer during the secretory phase
48
Embryoblast divides into ___ and ___ at week 2 post conception
EPIBLAST which will form the amniotic cavity and the HYPOBLAST which will form the yolk sac
49
Process establishing the 3 primary germ layers
gastrulation 1 ectoderm 2 endoderm 3 mesoderm
50
Ectoderm derivatives or outer layer
1 CNS neuroectoderm 2 PNS neural crest 3 SPECIAL SENSES hearing seeing 4 INTEGUMENT layer
51
Endoderm or internal layer
lining of Respiratory tract and Gastrointestinal tract
52
Mesoderm or middle layer 5
1 Muscles 2 Cartilages 3 CVS 4 Urogenital system 5 RBC
53
FDA category drug. Contraindicated in pregnancy. Fetal risk which outweighs any possible benefits
FDA CATEGORY X
54
FDA CATEGORY. No evidence of risk in humans. Controlled studies shows no risk to humans despite adverse findings in animals.
FDA CATEGORY B
55
FDA CATEGORY. Positive evidence of risk. Studies demonstrate risk but potential benefits may outweigh the risk.
FDA CATEGORY D
56
FDA CATEGORY. Controlled studies show no risk. Adequate studies show no risk to fetus in pregnancy.
FDA CATEGORY A
57
FDA CATEGORY. Risk cannot be ruled out. Control studies are lacking in humans and animals.
FDA CATEGORY C
58
Only part of fetus exposed to mothers blood
Syncitiotrophoblast
59
Abortion
20 weeks or less AOG with UTZ regardless of weight
60
What is the ovulation age of a fetus that is 8 weeks AOG
6 weeks. Subtract 2 weeks from AOG
61
Determine age of fetus 1st trisem
CRL
62
Determine age of fetus 2nd and 3rd t trisem
BPD
63
Functional closure of foramen ovale
minutes after birth
64
Anatomical closure of foramen ovale
1 year after birth
65
Functional closure of ductus arteriosus
10 to 12 hours after birth
66
Anatomical closure of ductus arteriosus
2 to 3 weeks after birth
67
Stage oflung development when surfactant detectible in amniotic fluid
Saccular stage 24 to 36 weeks
68
Completion of alveolar development
8 yrs old
69
Genetic or chromosomal sex dependent on
Y chromosome
70
Gonadal sex differentiation start at 6 weeks secondary to
SRY gene
71
Phenotypic sex
Hormones produced
72
Pregnancy hormone
HCG by syncitiotrophoblast. It maintains the corpus luteum.
73
HCG detectible at __ and doubles every
7 to 9 days post fertilization and doubles every 1.4 to 2 days
74
Progesteron production
Corpus luteum until 6 - 8 weeks PLACENTAL syncitiotrophoblast thereafter
75
Largest organ in fetus
adrenals
76
Softening and compressibility of isthmus at 6 to 8 wks AOG
Hegars sign PROBABLE EVIDENCE 6 to 8 wks AOG
77
softening of the cervix at 6 to 8 wks AOG
Goodels sign PROBABLE EVIDENCE 4-8 wks AOG
78
Bluish or purplish discooration of vagina at 6 wks aog due to inc vascularity
Chadwicks sign PRESUMPTIVE EVIDENCE 6 wks AOG
79
period when uterus is an abdominal organ and NOT a pelvic organ
2nd trisem ONLY becomes pelvic organ again near term
80
Are there gland in the vagina
None
81
Non STD female findings on cervical swab or pap smear
candidiasis and bacterial vaginosis. No need to treat partner
82
All coagulation factors increased during pregnancy except
Factor 11 and 13
83
unit similar between hCG and TSH
Alpha unit causing hyperplasia of thyroid gland during pregnancy
84
weight gain 1st 2nd and 3rd trimester
weight gain 1st T 2 LBS 2nd T 11 LBS 3rd T 11 LBS
85
Definitive evidence of pregnancy
1 identification of fetal heart action 2 perception of fetal movement by examiner 3 recognition of embryo or fetus by sonographic exam
86
Beading pattern
due to high PROGESTERONE during LUTEAL phase and PREGNANCY
87
Ferning pattern
due to high ESTROGEN during PRE OVULATORY phase of menstrual cycle
88
Phases of Ovarian cycle
1 Follicular or preovulatory phase 2 Ovulation 3 Luteal or postovulatory phase
89
Endometrial cycle
1 proliferative phase 2 secretory phase
90
What is detected by the pregnancy test
BETA subunit of B Hcg recall that it has the same alpha subunti as tsh
91
peak of B HCG at
8 to 10 weeks at 100 000
92
doubling of B Hcg
doubles every 1.5 to 2 days. Detected 8 to 9 days post ovulation.
93
Fetal heart action by ultrasound vaginal probe
5 weeks AOG
94
HR by doppler
10 wks AOG
95
HR by stethoscope
19 weeks AOG in all but can start at 17 wks
96
Quickening or fetal movement noted at
16 to 20 wks AOG OR 4 to 5 months
97
Braxton Hicks contractions
28 wks AOG
98
Oral glucose challenge test
75g OGCT at 24 to 28 wks AOG
99
Average weight gain during pregnancy
27.5 lbs
100
Variables to check for MATERNAL WELL BEING
1 BP 2 Weight gain 3 Uterine size
101
correlation of AOG to uterine size at
20 to 31 weeks AOG
102
12 weeks AOG at the level of
symphysis pubis
103
16 weeks AOG at the level of
midway between symphysis pubis and umbilicus
104
20 weeks AOG at the level of
umbilicus T10 dermatome
105
fetal kick counting
start of 28 weeks Normal is 8 to 10 kicks per 2 hours
106
screening for NTDs or chromosomal abn
18 to 18 wks BEFORE 20 wks AOG
107
Dilutional anemia at
28 TO 32 weeks AOG
108
GBS screening
35 to 37 wks AOG
109
Leupold maneuver
35 to 37 wks AOG
110
non stress test
GREATER than 41 wks
111
Test of fetal condition
NST
112
test of uteroplacental function
Contraction stress testing
113
What is Biophysical profile
UTZ plus electronic fetal tracing
114
test that measures reaction of fetal HR agains uterine contraction induced by oxytocin or nipple stimulation
Contraction stress testing
115
5 components of fetal well being BPP I Hear TAMBourines
FETAL 1 HR based on NST 2 tone flexion 3 AFI > 2 amniotic fluid index 4 movements 5 breathing
116
NST Acceleration
Fetal movement
117
NST Early deceleration
HEAD COMPRESSION. Deceleration simultanous with contraction duration. Vasovagal response.
118
NST Variable deceleration
UMBILICAL CORD COMPRESSION. Oligohydramnios or multiple pregnancy.
119
NST Late deceleration
UTEROPLACENTAL INSUFFICIENCY indicating comrpession of vessels. Delayed dec in HR in relation to uterine contraction.
120
Normall MSAFP
2 to 2.5 MoM
121
Prenatal test at 14 to 20 wks
amniocentesis for karyotyping
122
Prenatal test at 11 to 14 wks
early amniocentesis SE club foot
123
Prenatal test at 9 to 12 wks
chorionic villus sampling for karyotyping
124
Assessment of red cell anemia or alloimmunization at > 20 wks AOG
percutaneous umbilical cord sampling
125
Baterial vaginosis
Metronidazole 500mg tab_1 tab BID for 7 days
126
GBS prophylaxis intrapartum DOC and allergy alternative
DOC Pcn G IV. Alternative for allergy Cefazolin or Erythromycin or Clindamycin
127
Phases of parturition QASI
PHASE 1 Quiescence 2 Activation 3 Stimulation 4 Involution
128
prelude to parturition makes up 95 percent of pregnancy and refers to
Phase 1 Quiescence. PROGESTERONE high. From implantation to few wks before delivery.
129
preparation for labor
Phase 2 Activation. ESTROGEN high. Last 6 to 8 weeks of pregnancy. Prep for delivery.
130
process of labor
Phase 3 Stimulation
131
parturient recovery
Phase 4 Involution
132
Phase 3 or Stimulation refers to
Active Labor Stage I Stage II Stage III
133
Stage 1 of labor refers to
Latent LESS than 4cm. Active GREATER than 4 cm until 10 cm.
134
Stage 2 of labor refers to
10 cm to delivery of fetus
135
Stage 3 of labor refers to
from delivery of fetus to delivery of placenta lasting 5 minutes
136
Main hormone mediator of Phase III and IV
oxytocin
137
Source of PGE2 and OXYTOCIN during pregnancy
Amnion
138
Source of ENDOTHELUM 1 and PROSTAGLANDIN during pregnancy
Chorion
139
Most common fetal position
Occiput anterior left
140
FUNDAL GRIP
Leopolds Maeuver 1
141
Leopolds Maeuver 1
fetal part lying in the fundus
142
Leopolds Maeuver 2
location of fetal back or POSITION
143
Pawlicks maneuver
Leopolds Maeuver 3
144
Leopolds Maeuver 3
determine engagement of presenting part. ENGAGEMENT
145
Leopolds Maeuver 4
attitude or habitus of fetus. To determine the degree of flexion of fetal head.
146
BISHOP score criteria Cervix DEPS
1Consistency 2Dilatation 3Effacement 4Position 5Station GOOD SCORE at least 8
147
Cardinal movements of labor 7 EDFIEEE
1Engagement 2Descent 3Flexion 4Internal rotation 5Extension 6External rotation 7Expulsion
148
what movement is the PREREQUESITE for birth
Descent
149
CARDINAL MOVEMENT Allowing the narrowest fetal head diameter to pass through birth canal
Flexion
150
CARDINAL MOVEMENT allowing the fetal shoulder to present
External rotation
151
Duration of LATENT PHASE in Nullipara
LESS or EQUAL 20 hrs
152
Duration of LATENT PHASE in Multipara
LESS or EQUAL 14 hours
153
Duration CERVICAL DILATATION in ACTIVE PHASE Nullipara
LESS or EQUAL than 1.2 cm per hour
154
Duration of CERVICAL DILATATION in ACTIVE PHASE Multipara
LESS or EQUAL 1.5 cm per hour
155
Phases of ACTIVE PHASE
1 Acceleration phase 2 Phase of maximum slope 3 Deceleration phase
156
Descent begins at ___ cm
7 to 8 cm. fastest after 8 cm.
157
Duration of second stage of labor
Nulli 50 minutes. Multi 20 minutes.
158
predicts outcome of labor
Acceleration phase
159
measures overall efficiency of the machine
Phase of maximum slope
160
reflects fetopelvic relationship
Deceleration phase
161
Functional division oflabor parts 3
1preparatory 2 dilatational 3 pelvic
162
Preparatory
Latent phase PLUS acceleration phase of active labor
163
Dilatational
Phase of maximum slope of active labor
164
Pelvic
Fetopelvic relationship of active labor
165
laceration involving fourchette perineal skin vaginal mucous membrane
1st degree
166
laceration involving fascia and perineal muscles
2nd degree
167
laceration involving rectal mucosa
4th degree
168
laceration involving anal sphincter
3rd degree
169
Source of pain stage 1 of labor
Frankenhauser ganglion plexus T11 to T12
170
Location Frankenhauser ganglion plexus T11 to T12
Cervix 3 and 9 o clock pain fibers to uterus cervix and upper vagina
171
pain during the 2nd and 3rd stage
pudendal nerve S 2 to S 4
172
forceps used in nullipara delivery of fetus with molded head
sin son SIMPSON
173
forceps for deep transverse arrest of head
Kielland
174
forceps to deliver fetus with rounded head in multipara
Tucker mac lane
175
mc indication for primary CS
dystocia
176
mc indication for CS delivery
repeat CS
177
Causes of postpartum fever
Day PPD 0 wind 1 water 2_3 womb 4_5 wound 5_6 walk 7_21 mastitis
178
cause of 1st trisem abortion
fetus
179
2nd trisem abortion
maternal cause
180
Septic abortion etiology
clostridium serdeli
181
UTZ snow storm pattern
complete mole
182
UTZ swiss cheese pattern
incompelte mole
183
differentials for HTN prior to 20 wks AOG
H mole vs chronic HTN of pregnancy
184
differential for 1st trisem bleeding 3
abortion vs ectopic vs GTD
185
gestational trophoblastic tumor will follow
molar pregnancy more than normal pregnancy more than abortion
186
sites for GTT mets
lung then vagina
187
3 types of GTT gestational trophoblastic tumor
1 invasive mole 2 choriocarcinoma 3 placental site trophoblastic tumor
188
Rupture of tubal pregnancy isthmus vs ampulla vs cornual or interstitial
isthmus at LESS 2 mos AOG ampulla at GREATER than 2 mos cornua or interstitial at GREATER than 4 mos
189
predictor of spontaneous resoprtion
Hcg level LESS than 1000
190
MC risk factor of ecctopic pregnancy
tubal corrective surgery
191
Most identified risk factor
previous PID
192
presumptive evidence of ectopic pregnancy
b HCG of GREATER than 1500 miU per L with empty uterus
193
gestation sac in uterus seen at B HCG of
Greater than 1500
194
methrothrexate mgt of ectopic if
LESS than 6 wks AOG OR tubal mass LESS than 3.5 cm or B hCG LESS than 15000 OR no fetal heart sound
195
ectopic pregnanacy B HCG normalize in ___ days
20 days
196
UTZ retrochoreal hemorrhage
threatened or inevitable abortion
197
UTZ retroplacental blood clot
abruptio placenta
198
MCC 3rd trimester bleeding
abruptio placenta
199
MCC 3rd trimester painful bleeding
abruptio placenta
200
MCC 3rd trisemester painless bleeding
placenta previa
201
Placenta covers the internal os completely
Complete placenta previa
202
Placenta partially covers the internal os completely
Partial placenta previa
203
Edge of the placenta is at the margin of the placental os
Marginal placenta previa
204
Placenta is close to the opening of the cervical os but not touching it
low lying placenta previa. Vaginal possible
205
Bloody amniotic fluid
abruptio placenta
206
Anesthesia fo r stage II of labor
Pudendal block S2 to 4 using LIDOCAINE at ischial spine
207
Anesthesia for stage 1 labor AND gyne OPD
Paracervical block using lidocaine to 3 and 9 o clock position cervix
208
Anesthesia for eclampsia and pre eclampsia
Epidural anesthesia
209
Anesthesia for Stage I and II of labor
Epidural anesthesia
210
gold standard anesthesia in OB
Epidural anesthesia MC used
211
anesthesia of choice vaginal delivery
Epidural
212
anesthesia of choice in CS for complicated delivery
GA
213
MC uterine anomaly
septate uterus
214
MgSO4 dose hyporeflexic DTRs
6 to 12 mEq per ml
215
MgSO4 dose respiratory depression
15 mEq per ml
216
MC SE of MgSO4
flushing
217
Tocolytics used
Ca Blockers MgSO4, Nifedipine. B2 receptor agonist Ritrodrine and Terbutraline.
218
Dexamethasone dose
2 doses q12 hours apart DOS
219
post term pregnancy at
42 wks AOG
220
placental insufficiency due to aging and scarring
dysmaturity syndrome
221
BHcg vs Prolactin
B hCG same alpha unit as TSH, LH, FSH
Prolactin
- inhibited by Dopamine
- activated by TRH, serotonin
