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35 yo G4P1021 at 7 wks p/w vaginal bleeding and cramping
-2 early first T losses
-s/p stroke
-US: empty uterus w/ slightly enlarged irregularly shaped uterus, beta-hCG 23

Most likely cause of this miscarriage?

Hypercoagulability- antiphospholipid syndrome


33 yo at 29 wks presents w/ PPROM, next step?

Latency abx- ampicillin and erythromycin
-shown to prolong latency period for 5-7 days, and to reduce maternal amnioitis and neonatal sepsis


2 signs of magnesium toxicity and levels at which they occur

High levels of magnesium sulfate can cause diminished or absent DTRS (around 10mg/dl) then respiratory depression (12-15) or cardiac depression (over 15)


35 yo G0 p/w 6 mo spotting btwn periods and desire for pregnancy
-menorrhagia w/ increased blood loss w/ past 3 menses
-TVUS: 2 cm endometrial polp


Hysteroscopic polypectomy

-Could do medical management w/ progestin but not if she wants to get pregnant


Describe the discharge seen in

(a) Trichomonas
(b) Candida

Vaginal discharge

(a) Trichomonas- yellow-green 'frothy" discharge
(b) Candida- thick white 'cottage-cheese' like discharge

-neither would cause fever/abdominal pain => think PID if present


20 yo at 28 wks presents w/ contractions q4min
-101F, HR 120, BP 110/65, white count 18k
-tender uterine fundus w/ otherwise normal exam
-1/50/-3, fetus in vertex
-FHT: category I tracing

Next step

Fever, tender fundus, white count- c/f intra-amniotic infection (chorio)- only thing is to get the baby out...

Next step = labor induction
-category I tracing => can induce labor instead of C-sxn


60 yo p/w urinary frequency and urge incontinence
-cystometrogram: uninhibited detrusor contractions upon filling
-normal post void ridicual

Best tx

Best tx = oxybutynin (anticholinergic/antimuscarinic)

Mechanism of urge incontinence = detrusor instability, overactive bladder (doesn't relax = uninhibited contractions)


At what age does a F w/ a hysterectomy no longer need pap smear?

Pap test screening is not indicated in pts who have had a hysterectomy, unless it was done for cervical cancer or a high-grade cervical dysplasia

women w/ a uterus can d/c pap smears after 65 if have had 3 consecutive negative smears w/ no hx cervical neoplasia/cancer


Tx of baby born to HIV+ mother

Baby gets zidovudine (AZT) immediately after delivery

-don't need to wait until 24 hrs of life, at 24 hrs of live HIV testing begins (not at time of delivery)


Contraindication to vacuum aspiration instead of D and C

Vacuum aspiration only for under 8 wks of gestation


Which type of leiomyomas have the highest risk of infertility

Submucosal and intracavitary

-very unlikely for fibroids to cause infertility, but if they do it'll probably be a submucsal or intracavitary: tx w/ hysteroscopic resection then should be able to conceive


Postterm pregnancies association w/

(a) placental sulfatase
(b) fetal adrenal gland function

Postterm pregnancies

(a) placental sulfatase deficiency
-placenta is the organ w/ an expiration date! not meant to last that long

(b) postterm associated w/ fetal adrenal hypoplasia


Risk factors that would indicate DEXA before age 65

-early menopause
-glucocorticoid therapy
-sedentary lifestyle
-hyperthryoid, hypereparathryoid
-anticonvulsant therapy
-vit D deficiency
-FHx for early or severe osteoporosis
-chronic liver or renal disease


Type 1 diabetic w/ A1C of 9.2% is at highest risk for what fetal complication?

Fetal growth restriction

-higher risk than macrosomia when this poorly controlled for this long
-thought to be 2/2 placental microvasculature disease


25 yo G1P1 p/w left breast pain and fever, currently breastfeeding her 2 1/2 week old infant
-erythema of the upper outer quadrant of left breast, TTP

(a) Dx
(b) Tx

(a) Puerperal (aka lactational- in a breastfeeding F) mastitis

(b) Tx = abx (oral vs. IV depending on severity) and ibuprophen/acetaminophen for pain relief
-don't have to stop breast feeding!!! encourage to keep breast feeding!!!


Describe classic presentation of gonorrhea induced PID

Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness
-mucopurulent vaginal discharge
-classically w/ exacerbation of symptoms during and after menstruation


Risks of phenytoin and carbamazepine in pregnancy

Clinical syndrome called fetal hydantoin syndrome with group of findings:
-hypoplasia of phalanges
-excess hair, cleft palate


What hormone is responsible for breastmilk production?


Prolactin is made throughout the pregnancy but its fxn is inhibited by estrogen and progesterone. Post-partum, inhibition of estrogen/progesterone is lifted, prolactin continues to be secreted- and milk is produced


28 yo G0 p/w severe endometriosis, failed conservative medical management

Best tx option?

Tx = laser ablation of adhesions- wouldn't do hysterectomy/salpingo-oophorectomy in young nulliparous F

Sidebar: conservative management is OCPs and analgesia


36 yo G0 p/w severe abdominal pain x2-3 days w/ N/D
-febrile to 102
-abdomen TTP w/ mild guarding and rebound, elevated white ct
-pelvic US: b/l 3-4cm complex masses


Dx = ascending infection causing salpingitis, ultrasound findings consistent w/ tubo-ovarian abscess

-most often sexually transmitted: gonorrhea, chlamydia, or any other thing ascending from the GU or GI tract


Uterotonic agents: contraindications for methylergonovine vs. prostaglandin F2-alpha

Methylergonovine = methergine, can't use in h/o HTN

Prostaglandin F2-alpha = hemabate, can't use in h/o asthma


Microscopic evaluation of discharge findings indicative of

(a) bacterial vaginosis
(b) trichomoniasis

(a) BV: clue cells on saline wet mount
-drop of KOH releases amines from the cells => fishy odor

(b) trichomoniasis = motile ovoid protozoa w/ flagella
trichomonads = unicellular protozoans


Use of amitriptyline in pregnancy

Used in pregnancy to treat migraine headaches


Associations with breech position

-multiple gestations
-placenta previa
-uterine anomalies and fibroids


Which features of severe preeclampsia are contraindications to expectant management

Need to deliver if:
-thrombocytopenia (plt under 100k)
-can't control BP on max doses of two antihypertensives
-non-reassuring FHT
-AST/ALT above 2x uln
-persistent CNS symptoms

Can wait if
-elevated uric acid and hemoconcentration