Section 8 - OB/GYN Flashcards by Cassie Newburg

First step when a vaginal bleeder comes to the ED

pregnancy status/test

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causes of vaginal bleeding in prepubertal female

sexual assault needs to be excluded, vulvovaginitis most common

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causes of prepubertal vulvovaginitis

candidiasis, strep, e coli, shigella, viruses, pinworms

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Cause of bleeding and vaginal discharge

foreign bodies

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most common cause of vaginal bleeding in women of reproductive age

anovulation

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most common cause of vaginal bleeding in postmenopausal women

exogenous estrogens, atrophic vaginitis, endometrial lesions (ca), tumors

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treatment of patients with severe vaginal bleeding

conjugated estrogen 25 mg IV q2-6 hours, medroxyprogesterone when bleeding subsides

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stable patients, treatment of DUB with a clear diagnosis

oral contraceptive, medroxyprogesterone, tranexamic acid

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mittelschmerz

self-limited, unilateral, dull aching pain that occurs mid cycle from leakage of prostaglandin containing follicular fluid

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image modality for pelvic cyst ruptured

pelvic/transvaginal ultrasound

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image modality of choice for ovarian torsion

ultrasound with Doppler flow imaging

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symptoms of endometriosus

recurrent pelvic pain with menstrual cycle, dysmenorrhea, dyspareunia

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risk factors of ectopic pregnancies

PID hx, surgical procedures on tubes, previous ectopic pregnancy, IUD, assisted fertility.

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classic triad of ectopic pregnancy

abdominal pain, vaginal bleeding, amenorrhea

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definitive diagnosis for ectopic pregnancy

US or direct through surgery

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labs for treatment of ectopic pregnancy

type and cross, call ob/gyn, give fluids

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threatened abortion

vaginal bleeding in first 20 weeks, closed cervical os, benign exam, no passage of tissue

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inevitable abortion

vaginal bleeding in first 20 weeks, dilated cervical os, benign exam, no passage of tissue

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incomplete abortion

partial passage of conceptus

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complete abortion

passage of all fetal tissue before 20 weeks gestation

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missed abortion

fetal death at less than 20 weeks without passage of fetal tissue for 4 weeks after fetal death

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septic abortion

infection during abortion with pelvic pain, fever, CMT, uterine tenderness, foul-smelling

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differential diagnosis with ectopic pregnancy

implantation bleeding, gestational trophoblastic disease

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gestational trophoblastic disease

hydatidiform mole, partial mole, trophoblastic tumor, choriocarcinoma

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nausea and vomiting of pregnancy normally seen...

first 12 weeks of pregnancy

treatment of n/v with pregnant patients

1. 5% dextrose in nl saline or LR 2. metoclopramide, promethazine, odansetron 3. doxylamine with pyridoxine at home

UTI in pregnancy treatment

1. nitrofurantoin 100 mg PO twice daily 2. amox 500 PO 3 times daily 3. cephalexin 500 mg PO 4 times daily

time period when fetus is most at risk

2nd-8th week post conception

abruption placentae

premature separation of placenta from uterine wall | sx: vaginal bleeding, abd pain, uterine tenderness, hypertonic contractions, increased uterine tone, fetal distress, DIC

placenta previa

implantation of placenta over cervical os | sx: bright red vaginal bleeding, painless

diagnosis of abruption placentae vs placenta previa

transabdominal ultrasound before SSE or bimanual exam

clinical presentation of PROM

rush of fluid or continuous leakage of fluid from the vagina, pH greater than 7.0 and ferning pattern

what should you avoid if patient has PROM

no digital pelvic examination! - increase rate of infection, can do sterile speculum

what tests should be run for preterm labor (

GC, bacterial vaginosis, GBS, ultrasound

what meds should be used for preterm labor?

tocolytics with glucocorticoids, dex 6 mg IM

diagnosis of HTN in pregnancy?

systolic blood pressure > 140 or diastolic > 90 with two measrements prior to 20 weeks gestation

diagnosis of preclampsia?

HTN > 140/90 and proteinuria in patients 20 weeks gestion to 4-6 weeks after delivery

severe preeclampsia symptoms?

end organ involvement: HA, visual disturbances, metnal status changes, edema, oliguria, dyspnea, abdominal pain

symptoms of eclampsia?

HTN > 140/90 and proteinuria and seizures in patients 20 weeks gestation to 4-6 weeks after delivery

HELLP syndrome symptoms?

epigastric and RUQ abdominal pain

lab findings for severe preclampsia?

anemia, thrombocytopenia, elevated creatinine, elevated liver enzymes, elevated LDH

HELLP lab findings?

schistocytes on peripheral smear, platelet count lower than 150000, elevated AST/ALT

tx of severe preeclampsia or eclampsia?

mg sulftate 4-6 g over 20 min followed by maintenance infusion - monitor reflexes

severe HTN tx?

labetalol 20 mg IV bolus with repeat boluses of 40-80 mg to max 300 mg or hydralazine 5.0 mg followed by 5 and 10 mg every 10 min

Diff diagnosis of postpartum hemorrhage?

uterine atony, uterine rupture, lac of lower genital tract, retained placental tissue, uterine inversion, coagulopathy

tx of uterine atony?

oxytocin 20 units NS at 200 mL/h, uterine massage

sx of postpartum endometritis? Time frame?

fever, lower abdominal pain, foul-smelling lochia - several days after delivery

phys exam findings of endometritis?

CMT and discharge

labs for endometritis?

CBC, UA, cervical cx

tx for postpartum endometritis?

abx, clinda plus gent or cefoxitin

sx of mastitis?

swelling, redness, tender engorgement of breast

tx of mastitis?

diclox or cephalexin or clinda if PCN allergy - continue nursing, pump if purulent discharge

sx of amniotic fluid embolism?

CV collapse with hypoxemia, seizures, DIC

braxton hicks contraction diagnosis?

false labor with irregular in intensity and duration contractions

what do you do if you have a palpable pulsating cord on bimanual examination?

keep hand on presenting fetal part and elevate, get in touch with ob right away --> CSECTION INDICATED

types of breech presentation with tx?

frank/complete - can deliver vaginally incomplete/footling - cannot deliver vaginally, need csection

normal vaginal flora pH

3.8-4.5

sx of bacterial vaginosis

malodorous fishy smelling vaginal discharge | - vaginal irritation, excoriation, fissures

dx of BV

vaginal discharge, pH greater than 4.5, positive amine test, clue cells

tx of BV

metronidazole 500 mg PO 2 times daily for 7 days, clinda 300 mg PO 2 times daily for 7 days

pt susceptible to candida vaginitis?

DM, systemic abx, pregnancy, BCP

sx of candida vaginitis?

pruritus, vaginal discharge, external dysuria, dyspareunia, thick cottage cheese discharge

tx of candida vaginitis?

azoles vaginal tablets

trichomoniasis sx

frothy, malodorous vaginal discharge, vaginal erythema, vulvur irritation

trichomoniasis tx

metronidazole 2 g single dose or tinidazole 2 g single dose