UWise Flashcards Preview

OB/GYN > UWise > Flashcards

Flashcards in UWise Deck (55)
Loading flashcards...

Anticoag of preference in pregnancy

Lovenox (LMWH)
-warfain contraindicated b/c teratogenic


What is included in first trimester screening?

Chlamydia/gonorrhea, HIV, Hep B, syphilis

dont forget about HepB and syphilis...


17 yo at 32 wks presents w/ colicky right flank pain and CVAT
-negative UA, normal white count
-Renal US: moderate right hydronephrosis


Compression of the right ovarian vein by the uterus
-R more than L due to cushioning to the left ureter by the sigmoid colon


What is acute salpingitis?

Just another way of saying PID


Agent besides OCPs that can help in the tx of hirsuitism

Spironolactone = aldo antagonist diuretic


42 yo G2P2 p/w pelvic pain, dysmenorrhea, menorrhagia
-pain used to be cyclic, now constant
-regular menses
-uterus soft and TTP
-not sexually active in past 10 yrs

Physical exam findings

Adenomyosis- typically in multiparous F over 40 yo
-presents w/ dysmenorrhea and heavy menstrual bleeding that progresses to chronic pelvic pain

PE: boggy, tender, uniformly enlarged uterus

-fibroids less likely to cause pelvic pain
-lack of sexual activity makes PID less likely


Common complications in twin-twin transfusion syndrome

Death in utero for both twins iscommon
-surviving infants: increased neurologic morbidity and CP
-excessive volume => cardiomegaly, tricuspid regurg, ventricular hypertrophy, hydrops fetalis for recipient twin


19 yo G1P0 p/w vaginal spotting at 6 weeks past LMP
-VS stable, PE unremarkable
-initial beta-hCG 2000 w/ 48 hr repeat 2100
-TVUS: empty uterus w/ thin endometrial stripe and no adnexal mass

(a) Dx
(b) Next step

(a) Ectopic
-insufficiently rising beta w/ thin endometrial stripe excludes intrauterine pregnancy

(b) Methotrexate
-ideal candidate: HDS, non-ruptured ectopic


22 yo G1P1 2 days s/p C-section, continually febrile since birth and despite broad spectrum abx
-breasts: no erythema, nipples intact
-abdomen: soft, NT, no adnexal masses or tenderness
-incision c/d/i
-normal lochia, unremarkable UA


Septic thrombophlebitis = thrombosis of the venous system in the pelvis
-often dx of exclusion after r/o: mastitis, cystitis, endometriosis, ovarian abscess


Standard management for molar pregnancy

Suction curretage


Next step after pap smear w/ atypical squamous cells of undetermined significance

Next step- reflex HPV testing

If HPV+ for high risk serotypes => colposcopy

If HPV neg => cotest w/ cytology and HPV repeated in 3 years


24 yo at 39 wks presents in active labor w/ T 102, FHR 180 w/ minimal variability

(a) Dx
(b) Expected appearance of baby at delivery

(a) Chorioamnionitis

(b) Septic infant: lethargic, pale (minimal variability suggesting hypoxia) and high temperature


Treponemal vs. non-treponemal testing

For syphilis:

Non-treponemal tests (VDRL or RPR) are non-specific,
Treponemal tests- use when high pretest probability to confirm dx


36 yo at 32 wks
-HTN and class F diabetes
-IUGR with weight below 10th percentile

Most likely etiology of this IUGR?

Uteroplacental insufficiency 2/2 vascular disease (diabetes and HTN)


36 yo G0 w/ desire to get pregnant p/w spotting x6 mo
-TVUS: 2cm endometrial polyp

Best step in management?

Hysteroscopic polypectomy- remove the polyp and preserve further fertility

If didn't want to get pregnant could try progestin or hysterecomy


Breastfeeding decreases risk of what cancer in mom?

Ovarian cancer


At what age should mammogram testing start

ACOG recommends that mammography start at age 40


List the normal and predictable sequence of female sexual maturation

1. thelarche (breast buds)
-average age 10
2. adrenarche (hair growth)
3. growth spurt
4. menarche
-average 12/13


30 yo desires removal of her IUD, pelvic exam shows no IUD string visible
-US: IUD in uterine cavity

Next step

Hysteroscopy to remove IUD under direct visualization


Which is the most concerning finding on colposcopy

-ectropion, acetowhite epithelium, disorderly atypical vessels

Most concerning = disorderly atypical vessels- indicating more angiogenesis (more irregular)
-ectropion = precursor to squamous metaplasia


Difference in complications btwn mothers w/ pre-existing vs. gestational diabetes

Pre-existing diabetes more likely to have IUGR

Gestational more associated w/ macrosomia, polyhydramnios, neonatal hypoglycemia, preeclampsia


Intervention to prevent risk of preterm, low birth weight infant in multigestation birth

Early, good weight gain
-aids in development and placenta

NOT: bed rest, cervical cerclage


Post-menopausal F undergoes THBSO, starts to re-experience hot flashes


2/2 Decreased circulating androgens
-ovaries produce androgens (androstenedione and testosterone) which peripherally get converted into estrogen
^also explains why obese F have fewer menopausal symptoms


28 yo G0 pap test w/ high-grade squamous intraepithelial lesion

Next step?


reflex HPV testing or repeat pap is not enough


Tx of septic thrombophlebitis

Transiently add anticoagulation to abx and fever should resolve quickly
-suspect septic thrombophlebitis as dx of exclusion for persisting fever
-sometimes CT scan will show thrombosed veins


Treating hyperthyroid during pregnancy

Use PTU (propylthiouracil)


30 yo w/ DM1 (Hgb A1C 9.7) presents at 10 wks, smokes 1/2 ppd

What structural abnormality is the fetus at highest risk of developing?

Uncontrolled diabetes during organogenesis => 4-8x increased risk of having a fetus w/ structural anomaly- usually CNS (neural tube defects) and cardiac


To confirm ROM, test cervical mucus or vaginal fluid

Important to test vaginal fluid (and not cervical mucus) b/c of false positive ferning patterns


When would an elective C-section for pain be performed?

At 39 weeks gestation

-NOT at 41 if labor has not already happened
-totally a women's choice to undergo elective C-section


Benefit of vacuum delivery vs. forceps assisted delivery to the mother

Vacuum deliveries associated w/ less maternal lacerations/discomfort