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Step 2 CK Obs Gyn > obs > Flashcards

obs Flashcards

(61 cards)

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1
Q

Nageles rule

A

due date = LMP + 9 mo +7 days

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2
Q

fundal height

A

20 weeks: uterus at umbilicus, grows @ 1 cm/week

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3
Q

fetal heart tones

A

10-12 weeks by doppler

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4
Q

quad screen

A

MSAFP, PAPP-A, CVS, amniocentesis

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5
Q

MSAFP

A

elevated (over 2.5 MoM) : open neural tube defects (anen, spina bifida), abdo wall defects (gastroschsis, omphalocele), multiple gestation, incorrect gestational dating, fetal death, placental abnormalities

decreased msafp (

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6
Q

trisomy 18

A

all 4 quad (afp, b-hcg, estriol, inhibin A) are down

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7
Q

trisomy 21

A

dec AFP and estriol, inc b-hCG and inhibin A

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8
Q

fetal heart rate

A

160 bpm tachy, hypoxia, maternal fever, fetal anemia

normal variability is 6-25 bpm. fetal distress

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9
Q

contraindic to anesethesia (epidural, spinal)

A

refractory maternal hypo, maternal cogulopathy, use of a once daily LMWH within 12 h, skin infection, increased ICP

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10
Q

bishop score (favorability of delivery)

A

0-4: 45-50 failure, give PGE to induce
5-9: points to 10% failure, give pitocin
10-13: sucess!!

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11
Q

hyperemesis gravidum

A

persistent vomiting, (post 1st trimester), starvation (ketonuria), weight loss (5% decrease from prepregnancy),

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12
Q

hyperemesis grav labs

A

inc b hcg, inc estradiol

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13
Q

hyperemesis grav hx

A

morning sickness, reflux, gastro, hyperthyroidism, neuro

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14
Q

hyperemesis diagnosis

A

b-hcg level, ultrasound. ketonemia, ketonuria, hyponatremia, hypokalemia, hypochloremic metabolic alk Liver enzymes, serum bili, amylase/lipase

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15
Q

hyperemesis treatment

A

1- admin B6,
2-doxylamine PO,
3-promethazine/dimehydrinate.
Severe: metoclopramide, ondansetron, prochlorperazine, promethazine im/po

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16
Q

gestational DM hx/s, complications

A

late preg, over 90% / large for GA, edema, polyhydramnios

over half of mums get glu intolerance or DM2 later

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17
Q

gestational dm dx

A

1- one hr 50 g glucose challenge: venous plasma glu

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18
Q

gestational dm rx

A

mom:
fetus:

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19
Q

pregestational diabetes Rx mom

A

renal, opthal, cardiac

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20
Q

pregestational diabetes Rx fetus

A

18-20 w; u/s

32-4 w:

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21
Q

pregestational Rx delivery, postpartum

A

early delivery, c section

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22
Q

htn in preggers

A

gestational htn:

chronic htn:

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23
Q

gestational Rx

A

monitor bp, do not give ACEs, diuretics (causes uterine ischemia, exacerbates low plasma volume)

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24
Q

preeclampsia definition

A

new onset htn, proteinuria (over 300mg protein in 24 hr period), at >20 w gestation

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25
eclampsia
new onset grand mal seizures in preeclampsia pts
26
HELLP
vasospasm-->bleeds, organ necrosis
27
preeclampsia Rx
induce delivery with IV oxytocin, PGE, amniotomy
28
severe preeclampsia Rx
1-control BP (labetalol, hydralazine) 2-prevent seizures with IV mag sulfate (beware DTR loss, resp paralysis, coma) 3-deliver by induction/c section when stable
29
eclampsia Rx
1-ABCs with O2 supp/mask 2-seizure control/prophylaxis with Mg. Give IV diazepam. control bpp, limit fluids/foley 3-deliver
30
preeclampsia complications
premature, fetal distreess, stillbirth, placental abruption, seizure, DIC, cerebral hemm, serous retinal detachment, fetal/maternal death
31
eclampsia complications
after 20 w. MC causes are placental abruption, placenta previa. placenta accreta, ruptured uterus, genital tract lesions, trauma
32
ectopic preg hx/pe
abdo pain, spotting, no sx. PMHx scarred fallopain tubes-hx of PID, pelvic surgery, DES, endometirosis
33
ectopic preg dx
repro age female with abdo pain..!!! 1-pregnancy test, transvag u/s showing empty uterus 2-confirm with serial hCG (without appropriate hCG doubling)
34
ectopic preg Rx
mtx for small tubal ones, salpingectomy (laparoscopy) or salpingostomy w evacuation (laparotomy)
35
ectopic preg complications
tubal rupture, hemoperitoneum
36
IUGR def, complications
FW
37
IUGR hx, ex
systemic dz like uteroplacental insufficiency | RFs: substance abuse, placenta previa, multiple gestations
38
IUGR Dx
1-serial fundal height with u/s | 2-ultrasound for EFW
39
IUGR for Tx
if near due date, give steroids/betamethasone to speed up fetal lung maturity then: monitor fetus with NST
40
fetal macrosomia
weight >90%, C section for EFW>5k g for those without diabetes and >4500 for those with diabetes. inc risk of shoulder dystocia (erb duchenne or brachial plexus injury)
41
polyhydramnios
afi>20 on us etio: maternal DM, multipple gestations, isoimmuniz, pulm abormalities, fetal anomalies, twin twin Cx: preterm labor, detal
42
oligohydramnios
afi
43
Rh isoimmunization
fetal RBCS leak into mum's circulation, antiRh IgG can form and cross placenta, leading to hemolysis of fetal Rh RBCs (erythroblastosis fetalis)
44
Rh isoimm Rx
prevention: Tx:
45
Rh isoimm Cx
hydrops when fetal Hg
46
gestational trophoblastic dz
complete moles: | incomplete / partial moles:
47
gestational tropho hx, ex
uterine bleeding in 1st trimester, hyperemesis grav, (pre)eclampsia at 40. diet def in folate/b-carotene
48
gestational tropho dx
enlarged ovaries (bilateral theca-lutein cysts), expulsion of grapelike molar clusters, no fetal heartbeat increased serum b-HCG (usu>100 mIU/mL), snostorm on pelvic u/s lung mets on CXR cluster of grapes on D&C
49
gestational tropho Tx
evacuate uterus, weeky b-hCG. | Rx malignant with mtx, dactinomycin, residual dz with hysterectomy, chemo, irrad
50
gestational tropho Cx
malignant GTD: invasive moles, chorioc with ulm or CNS mets. trophoblastic pulm emboli
51
multiple gestations hx,ex
rapid uterine growth/mum weight gain, palpaitng 3+ large fetal parts on leopolds maneuver's
52
multiple preg Dx
us, hcg, hpl, msafpfor GA
53
multiple preg Tx
multifetal reduction, selective fetal termination for higher-order multiple preg, antepartum fetal surveillance for IUGR
54
multiple preg Cx
maternal : preeclampsia, preterm labor or PROM, pyeloneph, placental abruption, postpartum hemm fetal: twin to twin transfusion syndrome, iugr, preterm labor
55
shoulder dystocia RFs, dx, tx
Tx HELPER
56
failing to progress Dx
1st stage | 2nd stage: nulliparous __, multiparous
57
failing to progress Cx
chorioamnio to fetal infection, pneumonia, bacteremia
58
ROM types
spontaneous: PPROM: prolonged ROM
59
ROM hx, ex
gus of clear/blood-tinged amniotic fluid | uterine contractions
60
ROM dx
1- 2 no digital vag Ex for those not in labor etc
61
ROM Tx
depends on GA, fetal lung maturity: | Abx (amp, gent), antenatal steroids (betamethasone or dexx48 hrs)

Step 2 CK Obs Gyn (2 decks)

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