obstetrics and gyncology 2 Flashcards
Variable decelerations causes
ur Mx
pture of membranes and decrease in amniotic fluid volume, as they can result in umbilical cord compression and occlusion of the umbilical vessels, particularly during contractions
maternal repositioning
Fetal scalp stimulation
when to do
when to not do
performed to evaluate fetal acidosis in patients who have no accelerations on FHR monitoring.
** Fetal scalp stimulation is not performed in patients with decelerations, as it can exacerbate a parasympathetic response, resulting in a prolonged deceleration or fetal bradycardia.**
name most complication of chronic HTN in pregnant women
pre term delivery
not pre term rupture of membranes
prolonged rupture of membranes lead to polymicrobial infection {gram + and gram -} bacteria so Tx of choice is
clindamycin plus gentamicin;
post menopausal bleeding approach 1st and 2nd line Mx
1st line transvaginal Ultrasound if endometrium less < 4 no further evaluation is required
2nd if endometrium thickining is more than >4 go for endometrial biopsy
if bdnign»_space;observation
if atypia /neoplasia»progestins -surgery
pain with breastfeeding and bloody nipple discharge duo to it
most common cause
poor infant positioning and improper latch-on technique.
sexual harrasment Mx
Postexposure prophylaxis
Emergency contraception
Psychosocial counseling
amniotic fluid embolism syndrome (AFES), happens duo to ———-
which in turn lead to ————-
ur Mx **
amniotic fluid enters the maternal circulation through areas of disrupted maternofetal connections
Hypoxemic respiratory failure ,profound hypoxia can cause a coma or seizure, as seen in this patient.
Obstructive shock,cardiac arrest ,DIc
management is supportive not magnisium sulfate foe the seaziure not heparin for the emblism cause we already have DIC.
iagnostic criteria for antiphospholipid-antibody syndrome
(1 clinical & 1 laboratory criterion must be met)
Laboratory
Lupus anticoagulant
Anticardiolipin antibody
Anti-beta-2 glycoprotein antibody I
Clinical
Vascular thrombosis
Arterial or venous
Pregnancy morbidity
≥3 consecutive, unexplained fetal losses before 10th week
≥1 unexplained fetal losses after 10th week
≥1 premature births of normal neonates before 34th week due to preeclampsia, eclampsia, or placental insufficiency
Disorders of bladder outlet obstruction are treated ——
Other wise pregnant physiological bilateral hydronephroisis ***need no further Mx
with Foley catheter placement.
Intimate partner violence has a high prevalence and significant morbidity and mortality and is underreported. Therefore, screening is required in all women of childbearing age at routine medical visits.
screening is required in all women of childbearing age at routine medical visits.
typically occurs in patients with endometrial scarring from prior uterine surgery (eg, dilation and curettage, cesarean delivery); the scarred areas do not undergo normal endometrial decidualization in early pregnancy.
with prolonged abnormal postpartum hemorrage not responisve to uterotonic medications
and the Mx is ergent hysterectomy
placenta accreta
what a story to tell
Acute pancreatitis can be diagnosed in the presence of 2 of 3 classic features: classic symptoms (eg, severe epigastric pain radiating to the back); elevated amylase/lipase; or characteristic imaging findings. This patient with classic symptoms and laboratory findings does not require a CT scan, particularly given that she is pregnant and that imaging would not affect management at this time (vs lipid panel, which may indicate the need for insulin infusion or apheresis).
does not require a CT scan,
Triglyceride levels typically increase two- to four-fold in pregnancy, particularly in the third trimester (increased triglyceride-rich lipoprotein production and decreased lipoprotein lipase activity). In this patient with hypertriglyceridemia who discontinued fibrate therapy in pregnancy, this effect is likely compounded.
lipid panel showing a triglyceride level >1000 mg/dL is required for diagnosis of triglyceride-induced pancreatitis and has implications on patient management: In addition to intravenous fluid therapy and pain control (used in any case of acute pancreatitis), management of triglyceride-induced pancreatitis may include insulin infusion (limits fatty-acid release from adipocytes) or apheresis (removes triglyceride-rich plasma).
*****soooo fkin high yield
2nd time stupid
red macular rash
Toxic shock syndrome, caused by Staphylococcus aureus bacteremia and associated exotoxin release, typically presents with fever, hypotension, tachycardia, and a diffuse, red, macular rash. Treatment includes fluid replacement and antibiotic therapy with clindamycin plus vancomycin
Recurrent urinary tract infections (≥3 episodes in a year or ≥2 episodes in 6 months) commonly occur in postmenopausal patients due to——-
estrogen deficiency lead to
ulvovaginal atrophy, decreased bulk and elasticity of the bladder trigone and urethra, and increased vaginal pH. Treatment is with vaginal estrogen.
malignant sex cord–stromal tumors of the ovary that secrete estradiol. Patients typically present with a large ovarian mass and postmenopausal bleeding (due to associated endometrial hyperplasia from chronic unopposed estrogen exposure).
granulose cell tumors
so solid tumor that secretes estrogen
A uterine size–dates discrepancy exists when the fundal height measures larger or smaller than expected for gestational age. Gestational diabetes mellitus
gdm causes a uterine size–greater-than-dates discrepancy by promoting fetal macrosomia and/or increased amniotic fluid volumes (ie, polyhydramnios).
Septic pelvic thrombophlebitis can cause postpartum fever due to injury, thrombus, and hematogenous spread of infection to the pelvic veins (eg, ovarian veins). Patients are typically initially treated for suspected endometritis but have relapsing-remitting fevers and persistent abdominal pain despite antibiotics. Septic pelvic thrombophlebitis is not associated with incisional induration or erythema.
relapsing-remitting fevers its adiagnosis of execlusion
patients with an unsatisfactory colposcopy (ie, entire squamocolumnar junction cannot be visualized) require ———–
as well as pts high-grade squamous intraepithelial lesions on Pap testing
endocervical sampling (eg, endocervical curettage).
Management of vasa previa
of a ruptured fetal vessel is with emergency cesarean delivery because of the high risk of fetal exsanguination and demise.
bartholin gland Mx
1-Asymptomatic Bartholin duct cysts in young women do not require intervention as most of the cysts drain spontaneously and resolve on their own. Therefore, observation and expectant management are recommended for these patients.
2-symptomatic cysts or abscesses are treated with incision and drainage (Choice C)
** followed by placement of a Word catheter to reduce the risk of recurrence. Some women develop ******recurrent Bartholin cysts or abscesses and undergo a **marsupialization procedure, which creates another point of drainage for the Bartholin gland.
secondary amenorrhea, defined as———-
amenorrhea for ≥3 months in women with previously regular menses (or ≥6 months in women with previously irregular menses).
secondary amenorrhea, Mx
Initial evaluation includes a pregnancy test, followed by serum prolactin, TSH, and FSH level testing
intrahepatic cholestasis of pregnancy (ICP).
clinical features include
Development in 3rd trimester
Generalized pruritus
Pruritus worse on hands & feet
No associated rash
Right upper quadrant pain
greatest risk factor for placenta previa is
previous cesarian delivery additional r.f previous placenta previa multiple gestation (ie, increased placental surface area), and advanced maternal age (age ≥35)
Patients with a prolapsed fibroid typically have labor-like pain due to cervical dilation as the fibroid passes through the cervix.
Lymphogranuloma venerum:very painful lympho nodes enlargement chlamudua trachomatis
Granuloma ingunalle:progressive ulceration without lymph nodes enlargement and without pain inguinill bill =0 Even without exudate (klebisiella granulamatosis)
Chancroid:hemophilia decuryaii: painful lesion with exudate
