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1

Anticoag of preference in pregnancy

Lovenox (LMWH)
-warfain contraindicated b/c teratogenic

2

What is included in first trimester screening?

Chlamydia/gonorrhea, HIV, Hep B, syphilis

dont forget about HepB and syphilis...

3

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

Mechanism

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

4

What is acute salpingitis?

Just another way of saying PID

5

Agent besides OCPs that can help in the tx of hirsuitism

Spironolactone = aldo antagonist diuretic

6

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

Dx
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

7

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

8

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

9

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

Dx?

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

10

Standard management for molar pregnancy

Suction curretage

11

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

12

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

13

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

14

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)

15

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

16

Breastfeeding decreases risk of what cancer in mom?

Ovarian cancer

17

At what age should mammogram testing start

ACOG recommends that mammography start at age 40

18

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

19

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

20

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

21

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

22

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

23

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

Why?

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

24

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

Next step?

Colposcopy

reflex HPV testing or repeat pap is not enough

25

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

26

Treating hyperthyroid during pregnancy

Use PTU (propylthiouracil)

27

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

28

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

29

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

30

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

Vacuum deliveries associated w/ less maternal lacerations/discomfort