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Women's Health > Women's Health Exam 1 > Flashcards

Women's Health Exam 1 Flashcards

1
Q

Non-endocrine tissue in the body that produces estrogen

A

Fat tissue

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2
Q

Role of LH and FSH

A

Cause secretion of Estrogen, Progesterone and other hormones from ovaries
Stimulate thecal and follicular cells to mature an egg

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3
Q

Roles of estrogen

A

Growth of endometrium
Breast in largement
Induces LH surge
Assists in libido

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4
Q

Roles of progesterone

A

Decreases uterine contractility
Promotes breast development and differentiation
Signals lactation as it falls
Maintaining pregnancy

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5
Q

Activins

A

Stimulate FSH secretion
Involved in WBC production and embryo development

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6
Q

Inhibins

A

Inhibit FSH so we don’t use all out follicles at once

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7
Q

Follistatins

A

Inhibit activins
Regulate gonadotropin secretion

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8
Q

Relaxin

A

Relaxes pubic symphisis and pelvic joints in pregnancy
Inhibits uterine contractions
Mammary and follicular development

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9
Q

Positive feedback on the HPO

A

Estrogen at high levels increases GnRH and LH secretion
Activin promotes gonadotropic cell function

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10
Q

Ad===Thelarche

A

Beginning of breast development
First sign of puberty in females

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11
Q

Pubarche

A

Onset of pubic and axillary hair, after breasts and before menstruation

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12
Q

Day one of a period

A

The first day of bleeding

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13
Q

Normal menstrual cycle

A

28 days on average

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14
Q

Follicular phase

A

Length varies - getting a new follicle ready

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15
Q

Hormones of the follicular phase

A

FSH stimulates a few follicles and then realease inhibin to stop more follicles
One grows and secretes Estrogen
Estrogen causes LH surge, triggering ovulation

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16
Q

Typical ovulation day

A

Day 14

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17
Q

Mittelschmerz

A

Pain upon ovulation

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18
Q

Corpus hemorrhagicum

A

Ruptured follicle fills with blood

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19
Q

Luteal phage

A

consistently 14 days
Corpus luteum forms from corpus hemmorrhagicum

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20
Q

Hormones of luteal phase

A

FSH drops
Corpus luteum produces estrogen which inhibits LH which is stimulating the corpus luteum
CL scars up if no pregnancy

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21
Q

Proliferative phase of the uterus

A

Estrogen forms the stratum functionale about days 5-16 - endometrium growth
Glands are made bu don’t work yet

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22
Q

Secretory phase of the uterus

A

About 14 days
CL is formed
Progesterone from the CL decorates the uterus
Glands become coiled and secrete fluid

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23
Q

Menstrual phase

A

Loss of blood flow results in the death of the stratum functionale

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24
Q

Cervical changes during the menstrual cycle

A

Estrogen makes cervicle mucus thinner and more hospitable to sperm - fern like pattern on slide first half of cycle

Progesterone makes the muscous THICK and impenatrable

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25
Q

Cervical ectopy

A

Caused by opening of cervical opening/unrolling exposing columnar epithelium of the inner cervix
Darker area of tissue - looks like an infection

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26
Q

Birth control and cervical ectopy

A

Stays around longer with birth control

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27
Q

Falopian tube cilia and hormones

A

Estrogen - beat faster
Progesterone - beat slower

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28
Q

Muscle and hormones

A

Progesterone - reduces spasms, relaxes smooth muscle, antagonizes insulin
Estrogen - Improves skeletal muscle contractility

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29
Q

Fat skin and Sodium/Water effect of progesterone

A

Maintains skin
Fat gain in pregnancy
Excretion of sodium and water

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30
Q

Cardiovascular changes of pregnancy

A

Laterally displaced PMI
Supine hypotensive syndrome from uterus compressing IVC
Larger heart and HR increase by 15bpm
Drop in BP w/ increase in volume
May see some murmur, SVT, Left shift, ST depression

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31
Q

Pulmonary changes in pregnancy

A

Congested upper respiratory tract from vasodilation
Higher and wider ribcage
Less dead space in lungs with increased tidal volume
Mild respiratory alkalosis

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32
Q

Renal changes during pregnanacy

A

Transient renal hypertrophy
Dilated ureters, hydronephrosis
Risk of UTI
Increased load on kidneys
Increased GFR
Some leakage of protein and glucose but not to excess
Increased renin

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33
Q

GI changes in pregnancy

A

Increased salivation
Gum hypertrophy
Increased transit times
Slow gallbladder emptying
Increased heartburn
NO worsening dental health is normal

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34
Q

Heme/Onc and Fluid changes in pregnancy

A

Increased in blood volume by 50%
More RBCs
Increased WBCs
More blood clots
Less immune function

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35
Q

When is prolactin highest

A

During pregnancy to help mammary glands develop

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36
Q

Thyroid and pregnancy

A

Increase in production
PTH decreases in 1st trimester and increases in 2 and 3

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37
Q

Eye changes in pregnancy

A

Glaucoma gets better, cornea can thicken

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38
Q

Skin changes in pregnancy

A

Increased skin pigmentation
Linea nigra - black line down midline of abdomen
Melasma - Brown butterfly rash on cheeks
Stretch marks -Red to Brown

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39
Q

Other skin changes that may be seen in pregnancy

A

Spider angiomas
Palmar erythema
Cutis marmorata
Varicosities in legs
Brittle nails
Thickening of hair

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40
Q

Metabolic changes in pregnancy

A

Increased fatigue
Increased appetite, weight, thirst

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41
Q

Weight increase during pregnancy

A

Average increase of 25-35 lbs
Loose about 20 lbs at delivery and thereafeter

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42
Q

Calories per day recommended for pregnancy and lactation

A

300 per day during pregnancy
500 per day during lactation

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43
Q

Protein intake recommendation for pregnancy

A

1g/kg/day
Plus 20 g/d in 2nd half

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44
Q

Pregnancy calcium recommendation

A

1200 mg/d

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45
Q

Iron recommendation for pregnancy

A

60-120 mg/day if defficient

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46
Q

Folic acid supplementation in pregnancy

A

.4 mg/day 1 month before conception and first 3 months
1g/d for insulin dependant diabetics, Valproate, or Carbamazepime
4mg/d if hx of tube defects

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47
Q

B6 for pregnancy

A

Helps with nausea

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48
Q

Placenta

A

Part of the fetus - takes up most of the blood brought to the uterus
Eats into the wall
Uterus needs to contract to prevent bleeding

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49
Q

SUbstances that don’t cross the placenta

A

Only very large
Heparin and Insulin

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50
Q

Initial evolution of fertilized egg

A

Zygote, morula, blastocyst

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51
Q

Week at which organ development begins

A

Weeks 5

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52
Q

Landmarks at weeks 6-7

A

Limb buds and heart beat

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53
Q

Week 9 landmarks

A

All essentail organs have begun to form

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54
Q

Week 10 landmarks

A

Fetal heart tones heard on US
End of embryonic period - fetal period begins

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55
Q

Lanugo development

A

Weeks 15-18

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56
Q

Weeks 19-22 landmarks

A

Fetus can hear
Feel movement of fetus

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57
Q

Threshold of survivability

A

Weeks 23-25 some survive
Week 26+ most survive

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58
Q

Week 26

A

Hands and startle reflex

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59
Q

Weeks 27-30

A

Surfactant production begins to occur

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60
Q

Mesonephric ducts

A

Turn into male structures

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61
Q

Paramesonephric ducts

A

Turn into female structures

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62
Q

Time of testes descending

A

About week 28, should be there by week 32

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63
Q

Term baby

A

Born at 37+ weeks

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64
Q

Preterm baby

A

20-37 weeks

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65
Q

Abortion baby

A

ALL pregnancy losses before 20 weeks

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66
Q

Living children

A

Any infant who lives for 30+ days

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67
Q

Primipara

A

Has delivered once AFTER 20 weeks

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68
Q

1st trimester

A

1-14 weeks

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69
Q

2nd trimester

A

15-28

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70
Q

3rd trimester

A

29-42

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71
Q

Amount of pregnancies that are unplanned

A

Up to half

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72
Q

Pre-conceptual care

A

Help modify risk factors before conception to improve pregnancy outcome

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73
Q

Presentation of pregnancy

A

Amenorrhea - May have conception bleeding
Chadwick sign - Bluish red uterus, soft
Breast enlargement and tenderness
Areolar enlargement

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74
Q

Fetal movement

A

May not feel until 20 weeks first time
May feel 16-18 weeks after first time

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75
Q

Pregnancy diagnosis

A

Urine hCG detectable 8-9 days after ovulation, can also detect in blood

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76
Q

3 hormones similar to hCG

A

LH, FSH, TSH

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77
Q

How rapidly should hCG increase?

A

Value doubles every 1.4-2 days

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78
Q

95% detection level for hCG

A

12.3 mIU/mL

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79
Q

First US evidence of pregnancy

A

4-5 weeks
Gestational sack seen
Transvaginal US

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80
Q

Yolk sac on US

A

Seen at 5-6 weeks
COnfirms location in the uterus (r/o ectopic)
Echogenic ring with anechoic center

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81
Q

Fetal Pole/Embryo

A

Seen after 6 weeks, looks like a hole in the muscle

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82
Q

Crown Rump length

A

Measure from head to butt can be done 6-12 weeks
More reliable estimate of age than LMP
Most accurate at 12 weeks

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83
Q

Naegele’s rule

A

LMP+7 days-3 months

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84
Q

Hx for pregnancy

A

Prior pregnancies
Contraceptive use/desires
Menses interval
Depression
Abuse
Drug/Alcohol use/Drugs

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85
Q

PE for pregnancy

A

Pap smear over 21
Chlamydia and Gonoirrhea testing
Cervical dilation, length, consistency
Bony pelvic architecture

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86
Q

Uterine sizes over time

A

6 week - Small orange
8 week - Large orange
12 week - Grapefruit

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87
Q

When should a Rho gam shot be given

A

at 28 weeks to negative mothers with positive babies
Also for vaginal bleeding intrapartum
Post delivery of neg mothers with positive babies

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88
Q

Kleihauer-Betke

A

Tests for number of fetal RBCs in circulation, in cases of trauma may need to test and give Rho gam

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89
Q

Rh IgG attack rate on fetal RBCs

A

.3 mg will eradicate 15mL Fetal RBCs (eq. to 30 mL fetal blood)

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90
Q

Rubella

A

MCC of fetal growth restriction
Infection in first trimester can cause abortion
Vaccine needs to be taken 1 month BEFORE getting pregnant

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91
Q

Syphillis

A

T. pallidum
Treat with PCN-G - desensitization recommended if allergic

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92
Q

Prenatal counseling recommendations

A

Prenatal vitamin - 400mcg folic acid and Iron
May work but should not do intense or hazardous work

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93
Q

Pregnancy weight gain

A

25-35 lbs if okay weight
Less if they weigh more

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94
Q

Risks associated with obesity while pregnant

A

Hypertension/Preeclampsia
Gestational diabetes
Macrosomia and C section

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95
Q

Additional diet for pregnancy

A

Increase by 100-300 calories per day
Avoid FISH/SEAFOOD

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96
Q

4 risk factors for lead exposure in mothers

A

Immigrant
Remodeling home with lead
Live near lead source
Contaminated water

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97
Q

Air travel and pregnancy

A

Safe up to 35 weeks
Need to ambulate

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98
Q

Dental treatment and pregnancy

A

Okay to get radiographs
Recommended to have done

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99
Q

Caffeine and pregnancy

A

5+ cups of coffee per day can increase risk
Under 200mg/day is okay

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100
Q

Exercise and pregnancy

A

Do not usually need to limit exercise
Encourage mild to moderate exercise - don’t ramp it up
10 lb lifting is the general rule
Don’t scuba dive, etc.

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101
Q

Smoking and alcohol and pregnancy

A

Need to avoid including vaping
Binge drinking is especially problematic

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102
Q

Breastfeeding recommendations

A

6 months is preferred
2 years by WHO (also recommedning ofr Africa)
8-12 times daily with 15 minutes per session
Helps with weight loss, child obesity, chronic disease, bonding

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103
Q

CI to breastfeeding

A

HIV
Drug/Alcohol use
Galactosemia
Hep C with broken skin
Active TB
Medications
Undergoing breast cancer tx
Active herpes lesions on breast

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104
Q

Pregnancy visit spacing

A

Every 4 weeks until 28
Every 2 until 36
Every week until delivery

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105
Q

Prenatal surveillance

A

Fetal HR
Height of the fundus

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106
Q

Fundus height benchmarks

A

12 weeks -emerging from bony pelvis
16 weeks - Between pubic symphysis and umbilicus
20 weeks - Fundus at the umbilicus
20-34 - correlates with gest age
+/- 2cm

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107
Q

Timing of gestational diabetes screening

A

24-28 weeks
50 g glucose with test right after

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108
Q

Lab tests during pregnancy

A

CBC at 28 weeks
Syphillis and HIV 28 weeks for high risk
Rh testing 28-29 weeks
Group B strep testing 35-37 weeks

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109
Q

Vaccines and pregnancy

A

Hep A and B
Flu vaccine
Tdap
RSV between 32 and 36 weeks
COVID

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110
Q

Tx for nausea and vomiting in pregnancy

A

Small meals
BRAT diet
Ginger
B6
Prochlorperazine
Metoclopramide
Odansetron

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111
Q

Hyperemesis gravidarum

A

Vomiting severe enough to produce weight loss, electrolyte disturbances, ketosis, dehydration, etc.

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112
Q

Tx for back pain in pregnancy

A

Shoes, maternity belt
Tylenol
Muscle relaxers

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113
Q

Hemorrhoid tx in pregnancy

A

Topical anesthetics
Warm bath
Compression socks for varcosities

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114
Q

Tx for heartburn in pregnancy

A

Antacids
H2 blockers
PPIs

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115
Q

Pica in pregnancy

A

Craving for dirt, ice, starch
Assoc. with iron deficiency

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116
Q

Tx for sleep issues with pregnancy

A

Benadryl and naps

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117
Q

Leukorrhea

A

Increased vaginal discharge during pregnancy - generally not pathologic

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118
Q

2 MC congenital abnormalities

A

Heart and Cleft palate

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119
Q

Threshold for downs risk

A

35years

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120
Q

Marker for neural tube defects

A

Alpha feto protein
May screen 15-18 weeks

Can use a US for it (more common)

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121
Q

Down syndrome screening recommendation

A

Offer to everyone regardless of risk
Screening NOT diagnostic
NUchal translucency and PAPP-A value

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122
Q

Second trimester down screening

A

hCG
AFP
Unconjugated estriol

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123
Q

Cell free DNA

A

Check for genetic abnormalities and gender
99% detection rate
Blood draw at 9-10 weeks

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124
Q

Amniocentesis

A

15-20 weeks
20 cc of fluid
Assess karytype, can be done for comfort
Evaluate for fetal lung maturity
Chance of fetal loss 1 in 300-500

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125
Q

Chorionic villus sampling

A

10-13 weeks
Assess fetal karyotype
Transabdominal or transcervical

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126
Q

CI to CVS

A

Vaginal bleeding
Higher risk of pregnancy loss - 2%
Uterine ante or retro flexion

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127
Q

Fetal blood sampling

A

For fetal anemia
Cord blood sampling
Perfromed at cord insertion

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128
Q

s/s of fetal stress

A

Low HR
Low fetal movement

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129
Q

Recommendations for antepartum testing

A

Every week starting weeks 32-34 (26-28 if high risk)

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130
Q

Factors effecting fetal movement

A

Diminished by increased movement
Sleeping
Placement of the placenta

Should be consistent in its habits

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131
Q

Non-stress test

A

For a baby not moving Measure heartbeat of fetus - should see 2+ accelerations in a 20 minute time span

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132
Q

What to do to wake baby up for a nonstress test

A

Acoustic stimulator up to three times - should have a positive result after

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133
Q

Biophysical profile

A

Score 0 or 2 in five categories
Non stress test
Breathing
Movement
Tone
Amniotic fluid volume (2x2 pocket)

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134
Q

BPP interpretation 8

A

Normal - deliver if abnormal amniotic fluid index

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135
Q

BPP interpretation 6

A

Deliver if over 36 weeks
Repeat within 24 hours
Deliver if still 6 or lower, observe if above 6

136
Q

BPP interpretation 4

A

Probably asphyxia repeat or deliver

137
Q

BPP interpretation 2

A

DELIVER!!

138
Q

Doppler velocitrimetry

A

Looks at fetal blood flow
Umbilical artery - Shows lack of blood to flow to fetus = growth restriction
Middle cerebral artery - Fetal anemia and growth restriction

139
Q

Complete dilation

A

10cm - max amount

140
Q

Effacement

A

How thick the cervix is - 0% is 4cm, 100% is no cervix left

141
Q

Braxton Hicks contractions

A

False contractions - more likely with more pregnancies, dehydration

142
Q

Bishop score favorable for labor

A

Greater than 8

143
Q

Diagnoses for labor

A

Water breaking
Ferning
AFI - Amniotic fluid
Nitrazine

144
Q

Vaginal bleeding in labor

A

A small amount can be okay

145
Q

Tx for group be strep vaginal colonization

A

PCN
Erythromycin or Clinda for allergies

146
Q

IV pain medication for labor

A

Usually avoided in later stages of labor to avoid fetal respiratory distress
Epidural anesthesia preferred

147
Q

Where is an epidural given

A

L3-L4 intercostal space

148
Q

CI to an epidural

A

Bleeding disorder or recent heparin use
Patient preference
Thrombocytopenia

149
Q

Regional anesthesia

A

One time dose for C section
Pudendal block - less common for pregnancy today

150
Q

General anesthesia for deliver

A

Usually only used in emergencies and C sections
Danger of maternal aspiration

151
Q

Bishop score that indicates likely failure of induction and what can be done

A

Less than 5
Cervical ripening

152
Q

Cervical ripening medication

A

Prostaglandins - Cervidil or Cytotec Both vaginal, Cytotec is oral as well
Can cause tachysystole, fever, vomiting, diarrhea, uterine rupture
CI - C-section, Hysterotomy, Myomectomy

153
Q

Induction of labor

A

Pitocin IV infusion that increases over time
Danger of tachysystole and rupture
Stop if fetal distress occurs

154
Q

Manual induction of labor

A

Balloon catheter or laminaria
More effective with ptosin
Inserted vagnially
Amnio hook to break water

155
Q

Augmentation of labor

A

Strengthen contractions - Use ptocin

156
Q

Operative vaginal delivery

A

Forceps or vacuum
Can cause lacerations (forceps - vaginally) (Vaccuum -Perineal)
Use for fetal compromise or if a C section can no longer be done

157
Q

First stage of labor

A

Onset to complete cervical dilation
1st 6 cms are much slower

158
Q

Second stage of labor

A

Cervial dilation to fetal expulsion

159
Q

Third stage of labor

A

Fetal delivery to placental delivery

160
Q

Fourth stage of labor

A

Placental delivery to one hour postpartum

161
Q

Adequate labor

A

Over 200 Montevideo unites in 10min as measured by intrauterine catheter
Start ptosin if inadequate

162
Q

Fetal variabilities that affect labor

A

Fetal size and alignment

163
Q

Vertex

A

Head first delivery

164
Q

Breech

A

Butt first delivery

165
Q

Shoulder/compound

A

Something in front of baby arm

166
Q

Funic

A

Umbilical cord first - C SECTION!!

167
Q

Direction baby should be looking when born

A

Down to the floor (posteriorly)

168
Q

Determinationof fetal position in Uterus

A

Mother lies supine
Leopolds maneuver:
Evaluate fetal lie, weight, position and presentation
Difficult with obesity, multiples, excess amniotic fluid

US is best bet though

169
Q

C-section indication

A

More than two fetuses
Any non vertex position
5,000+grams
4,500+ grams and diabetic mother

170
Q

Pelvic shapes

A

Gynecoid - best
Antropoid - Narrow front to back
Android - Triangular
Platypelloid - Narrow side to side

171
Q

Active phase arrest labor

A

No progression in cervical dilation in 6cm dilated patients despite four hours of adequate contractions or 6 hours of inadequate contraction with augmentation

C-section indicated

172
Q

Prolonged second stage labor

A

More than 3 hours pushing for nulliparous and 2 hours in multiparous
Indication for C section

173
Q

IUDC

A

Catheter to measure strength of contractions

174
Q

Umbilical cord prolapse

A

Emergency if cord get pinched - needs to be propped up manually
Indication for immediate C section while holding baby off the cord

175
Q

Indications of second stage

A

Pelvic/rectal pressure
Mother has active role in pushing out fetus

176
Q

Molding

A

Fetal head shaping to shape of pelvis as it works its way out

177
Q

Perineal laceration first degree

A

Injury to perineal skin and vaginal mucosa only

178
Q

Second degree perineal laceration

A

Injury to perineal body (space between vagina and rectum)

179
Q

Third degree perineal laceration

A

Injury through external anal sphincter

180
Q

Fourth degree perineal laceration

A

Injury through rectal mucosa

181
Q

Episotomy

A

Intentionally making a perineal laceration
Usually causes problems - not popular
Midline or Mediolateral - more painful to the side

182
Q

Shoulder dystocia

A

Fetal shoulder impaction on the pubic symphysis
Macrosomia, Diabetes, Obesity, Operative deliver are risk factors

183
Q

Dangers to the fetus in shoulder dystocia

A

Humerus or clavicle fracture, Brachial plexus injury, Death

184
Q

Management of shoulder dystocia

A

Episiotomy
Mcroberts maneuver - sharp flexion of maternal hips
Suprapubic pressure
Rubin, Wood’s corkscrew - rotate baby
Symphisiotomy

185
Q

Delivery of the placenta

A

Done with one hand on the umbilical cord with gentle downward traction

186
Q

Uterine inversion

A

Uterus is pulled out through the vagina
Replace uterus - use NOX or terbutylline to relax so it can go back inside

187
Q

Fourth stage of labor risk and definition

A

Postpartum hemorrhage - Uterine atony, Lacerations, retained placental fragments

Defines as 500+cc’s in a vaginal deliver or 1000+cc’s in a c-section

188
Q

Tx for uterine atony
Four Meds

A

Pitocin, Methergine, Cytotec, Hemabate

189
Q

Engagement

A

First movement of delivery
Passage of the widest aspect of the fetal presenting part (typically the head) below the plane of the pelvic inlet (level of ischial spines)

190
Q

Descent

A

Second maneuver of labor
Moving down into the bony pelvis

191
Q

Flexion

A

Head flexes to fit through the birth canal

192
Q

Internal rotation

A

Head of baby either rotates from transverse to anterior or posterior position

193
Q

Extesnsion

A

Head extends out as the baby passes into the vaginal

194
Q

External rotation / Restitution

A

Head rotates back to its original position prior to internal rotation - aligns with fetal torso

195
Q

Expulsion

A

Rest of baby comes out

196
Q

7 Cardinal movements of labor

A

Engagement
Flexion
Descent
Internal rotation
Extension
External rotation/Restitution
Expulsion

197
Q

Normal fetal HR

A

110-160

198
Q

Fetal bradycardia

A

Under 110 bpm
May be due to lupus heart block or maternal hypotension

199
Q

Absent fetal HR variability

A

Absent - worrisome

200
Q

Minimal fetal HR variability

A

1-5bmp variation
Fetus asleep or inactive

201
Q

Moderate fetal HR variability

A

5-25bpm variation
Considered normal

202
Q

Marek fetal HR variability

A

25+ bpm variation
Worrisome

203
Q

Normal acceleration of fetal HR

A

15bpm for 15s after 32 weeks
10bpm for 10s before 32 weeks

204
Q

Early decelerations

A

Begin and end with contractions
Result of head compression
No intervention required

205
Q

Late decelerations

A

Begin at peak of contraction and slowly return to baseline after contraction is finished
Result of compromised bloodflow during contractions - uteroplacental insufficiency

206
Q

Tx for late decelerations

A

Position, Oxygen, Stop Pitocin, Check cervix, consider C section or assisted vaginal delivery

207
Q

Variable decelerations

A

V shaped at any time due to cord compression
The deeper and longer, the more concerning
Reposition
Infuse water into the uterus

208
Q

Sinusoidal fetal HR

A

Most often fetal anemia - always concerning

209
Q

Category I fetal heart tracing

A

FHR 110-160
Moderate FHR variability
No late or variable decelerations

210
Q

Category II fetal heart tracing

A

Neither category I or III

211
Q

Category III fetal heart tracing

A

Absent FHR variability with any of the following
Recurrent late decelerations
Recurrent variable decelerations
Bradycardia
Sinusiodal waveform

212
Q

Contraction stress test

A

Use pitocin to trigger 3 contractions in ten minutes
Test for poor fetal HR patterns during contractions
Recurrent late decelerations - Positive - Bad
Good looking - Negative test
Equivocal (maybe one deceleration - Wait and see

213
Q

MC site of ectopic pregnancy

A

Ampulla of fallopian tube

Can also occur in C-section scar (becoming more frequent

214
Q

Risk factors for ectopic pregnancy

A

Prior
STDs
PID
Endometriosis
IUD
Assistive reproductive technology

215
Q

Presentation of ectopic pregnancy

A

Vaginal bleeding
Lower abdominal pain
Adnexal mass
Abdominal pain on rupture
Hemodynamic instability

216
Q

beta hCG at which pregnancy should be visible in the uterus

A

1500-2000mIU/mL
Should be increasing at a steady rate if pregnancy is normal

217
Q

US for ectopic pregnancy

A

No yolk sac seen in uterus with pseudo gestational sack
Donut sign - thick walls

218
Q

HCg monitoring if you dont see an intrauterine pregnancy

A

Check every other day

219
Q

Ectopic pregnancy treatment

A

Methotrexate - Patient needs to be compliant, no fetal cardiac activity, under 3.5 cm, beta hCG under 5000
Check hCG decrease by day 7
Increased abdominal pain afterwards, N/V/D

220
Q

Surgery for ectopic pregnancy

A

Salpinostomy - open up and remove - creates higher risk of ectopic pregnancy
Salpingectomy - Preferred

221
Q

Complete abortion

A

Expulsion of all products of conception before 20 weeks - can do analysis of products

222
Q

Incomplete abortion

A

Not all of the products of conception are expelled
Vaginal bleeding and abdominal cramping
May see protruding POC through cervical os
Curettage, Prostaglandins and removal of tissue for tx

223
Q

Inevitable abortion

A

No expulsion but vaginal bleeding and dilation of the cervix such that viability is unlikely
Treat with prostaglandins - keep pregnancy if fetal heartbeat

224
Q

Missed abortion

A

Death of embryo or fetus before 20 weeks with complete retention of products of conception
US shows nonviable pregnancy
Wait to pass or prostaglandins, Curettage, Expectant management

225
Q

Threatened abortion

A

Any bleeding before 20 weeks
Cervical os closed
Pelvic rest and close monitoring

226
Q

Complete Molar pregnancy

A

Excessive growth of placenta
Large for dates
2 sets of paternal chromosomes
Very high hcg
Excessive placental tissue
No POC

227
Q

Incomplete molar pregnancy

A

Two paternal and one half maternal set of chromosomes
Small for dates
Missed abortion
Fetal parts present

228
Q

Diagnostics for Molar pregnancy

A

Snowstorm appearance on US
Thickened multicystic placenta
Confirm via pathology
Vomiting
preeclampsia before 20 weeks

229
Q

Management of molar pregnancy

A

CXR for cancer
CBC
Thyroid
EKG
Suction, dilation and curettage
Pitosin to evacuate uterus
Rhogam if Rh negative
Watch for cancer with serial hCG - should decrease - birth control for some time

230
Q

Questions to ask about Antepartum bleeding

A

Check where it is coming from (could be UTI or hemorrhoids)
Sexual activity - ask

231
Q

Placental abruption

A

Separation of the placenta either partially or totally from its implantation site
Concealed or revealed
Usually early in pregnancy - monitor
Can cause hypovolemic shock - deliver immediately

232
Q

Revealed placental abruption

A

Presents with vaginal bleeding

233
Q

Diagnosis of placental abruption

A

Exclusion diagnosis - pay attention if mother has experienced trauma

234
Q

Couvelaire uterus

A

Purplr/Blue uterus from blood infiltration

235
Q

Management of placental abruption

A

Deliver -Vaginal preferred for dead fetus; C-section is quicker with bleed risk

236
Q

Placenta previa
Four Risk Factors

A

Placenta covering cervix
Increases with age, parity, c-section, smoking

237
Q

Presentation of placenta previa

A

Painless vaginal bleeding seen after second trimester

238
Q

Diagnosis of placenta previa

A

Should be excluded in any bleeding patient who presents after the 2nd trimester
Transvaginal US to visualize
NO DIGITAL EXAM ONCE CONFIRMED!!!

239
Q

Point before which previa is unlikely to persist

A

23 weeks

240
Q

Management for placenta previa

A

Delivery via C-section as late as possible
Deliver sooner if persistently bleeding
Goal to keep pt pregnant as long as possible

241
Q

Placenta accrete

A

Abnormally adhered
Accreta - Attached to myometrium
Increta - Attached into myometrium
Percreta - Goes through myometrium

242
Q

Risk factors for placenta accrete syndromes

A

C section or placenta previa

243
Q

Presentation of pracenta accrete

A

Found on US
Hard to deliver placenta
Recommended early delivery at 34-36 weeks
May consider leaving placenta insode or hysterectomy -MC

244
Q

Cervical insufficiency

A

Painless cervical dilation during the second trimester
d/t prior cervical trauma

245
Q

Eval and management of cervical insufficiency

A

US to confirm
Swab for infection
Trendelenburg psoition
Pelvic rest
Cerclage - stitch in the uterus kept in until week 36
Delivery

246
Q

Tx of cervical insufficiency for next pregnancy

A

US to measure
Preventative Cerclage - Rescue (wait) or Elective (don’t wait)

247
Q

Cerclage

A

Stitch in the uterus - what Mary Crawley got

248
Q

Preterm birth - 4 reasons

A

Delivery of infant before 37 weeks
Spontaneous
Idiopathic
Maternal or fetal indication
Twins+

249
Q

Fetal fibronectin and early labor

A

Sensitive but not specific for preterm labor - can rule it OUT

250
Q

Workup for preterm labor

A

Tocolysis - Stops contractions for 48 hours max
Administer steroids for fetal development
Nifedipine
Mag Sulfate
Prostaglandin inhibitors
Beta agonists - Terbutaline

251
Q

Management for preterm labor

A

Steroid for fetal lung maturation
Betamethazone indicated 24-34 weeks
Cerclage to help prevent
Progesterone NOT helpful unless vaginal

252
Q

Reason for magnesium sulfate in preterm labor

A

Prevents neonatal intercranial hemorrhage weeks 24-32 for at least 12 hours

253
Q

Preterm premature rupture of membranes

A

Check for pooling, nitrazine swab, ferning of vaginal mucosa to confirm
Risk of cord prolapse - don’t send home

254
Q

Managementof preterm premature rupture of membranes

A

Patient hospitalized for remainder of pregnancy
Corticosteroids for fetal lung maturity
Tocolysis
Ampicillin or Erythromycin can extedn time before delivery

255
Q

Intrauterine growth restriction

A

Stick with original due date
May be due to alcohol, smoking, young patients, TORCH infections

256
Q

Dangers with IUGR

A

Stillbirth
Encephalopathy
Palsy
Still monitor even if parents are small

257
Q

Diagnosis for IUGR

A

Less then 10th percentile overall growth OR less than 10th percentile abdominal circumference is indicative
US

258
Q

Management of IUGR

A

Amiotic fluid volume management
US for circumference and weight
Umbillical artery doppler monitor
Serial growth scans
Plan for delivery at 38 weeks

259
Q

Fetal death risk factors

A

Age
AA race
Smoking diabetes

260
Q

Dx and management of fetal death

A

Usually incidental - US
Plan for delivery
Karyotyping, Autopsy

261
Q

Management for future pregnancies after a fetal death

A

Control modifiable risk factors
Offer genetic testing
Anatomy scan at 18 weeks growth US at 32 weeks
Begin antepartum surveillance 1-2 weeks prior to when stillbirth happened
Elective induction or C section at 39 weeks

262
Q

Hypertension in pregnancy

A

Over 140/90 on two occasions at leat 2 hours apart

263
Q

Chronic hypertension and pregnancy

A

Present before 20 weeks or persistent 12 weeks after delivery is an underlying chronic HTN
ACEIs and Angiotensin receptor agonists are CI

264
Q

Prenatal care for chronic HTN

A

EKG, Echo (at risk for cardiomyopathy)
Baseline labs

265
Q

Medications for HTN in pregnancy

A

Labetolol or Calcium channel blockers
Aspirin reduced preeclampsia risk

266
Q

Management for chronic hypertension in pregnancy

A

Close observation
Deliver early at 37-39 weeks

267
Q

Gestational HTN

A

After 20 weeks BP becomes 14/90+
Resolves by 12 weeks postpartum
Treat and manage like chronic HTN in pregnancy

268
Q

Preeclampsia

A

Hypertension and proteinuria after 20 weeks gestation
0.3g+ urine protein on dipstick
Can also present with: Thrombocytopenia, Renal insufficiency, Liver disease, Pulm edema

269
Q

Risk factors for preeclampsia

A

Young age
First pregnancy
Multifetal
Obesity
Other vascular disorders

270
Q

Dx of preeclampsia

A

140/90+ BP
Proteinuria dipstick of 2+
300mg or more in a 24 hour urine collection
Could also be with thrombocytopenia

271
Q

Eclampsia

A

Occurence of generalized convulsion and or coma in the setting of preeclampsia with no other neuro condition
Before, during, or after labor - hold in hospital after birth

272
Q

Preeclampsia superimposed on chronic HTN

A

Need to have close monitoring of labs and home blood pressure so that it can be caught

273
Q

HELLP

A

Hemolysis, Elevated Liver Enzymes, and Low Platelet Count
RUQ pain because liver bleeds and distends capsule
Risk of hepatic hematoma and rupture
Indicates SEVERE preeclampsia

274
Q

Tx for preeclampsia

A

Delivery
Monitor closely if mild
HTN therapy if 160/110 or greater
Labetolol (IV), Hydralazine (IV), or nifedipine (PO) can be used

275
Q

Magnesium sulfate and preeclampsia

A

To prevent seizure, NOT BP
Continued after delivery until the patient diureses

276
Q

Pregestational diabetes

A

Check hemoglobin A1c first trimester
A1c over 6.5%
Higher A1c = More fetal anomalies - significant risk over 12%
Fasting glucose over 125, nonfasting over 200

277
Q

Complications of pregestational diabetics

A

Spontaneous abortion
Preterm birth
IUGR
Cardiac defects
Hydramnios
Macrosomia

278
Q

Neonatal effects of pregestational diabetes

A

Baby born with overproduction of insulin - hypoglycemia
Hypocalcemia
Diabetes and Obesity later in life

279
Q

Preconception care for diabetes

A

Glucose 70-110 mg/dL
A1c 7% or lower
Folic acid supplementation

280
Q

First trimester care for DM

A

Careful glucose monitoring
HGA1c under 6
81 mg Aspirin for preeclampsia prevention
24 hour urine

281
Q

Second and third trimester care for diabetic mothers

A

US at 18-20 weeks
Fetal echo at 20-24
Antepartum testing at weeks 32-34
Deliver 36-40 weeks
Vaginal or C section delivery

282
Q

Postpartum diabetes management

A

Insulin may need to be decreased - mom needs more insulin during gestation

283
Q

Gestational diabetes

A

Commonly recurrence
Diabetes after the first 20 weeks
Ethnic populations are at higher risk
Increased risk of DM later in life

284
Q

Screening for Gestational Diabetes

A

50g one hour glucose challenge followed by 100g 3 hour test - fasting

285
Q

Limits for 3 hour GTT

A

Fasting 95
1 hour 180
2 hours 155
3 hours 140

286
Q

Management of rgestational diabetes

A

Keep fasting BS under 95 and postprandial under 120
Diet modification - 40-20-40 diet
Insulin - First line
Metformin - also good
May consider early induction or not with vaginal delivery depending on size

Same risk factors as pregestational diabetes

287
Q

Postpartum management of gestational diabetes

A

All should receive a 75g 2 hour OGTT at 6-12 weeks postpartum

288
Q

Vanishing twin

A

Twin vanishes or is lost before the second trimester
10-40% of all twin pregnancy

289
Q

Diagnosis of multifetal gestation

A

Uterus larger than expected
Determine chorionicity in the first trimester with US

290
Q

Dichorionic twins

A

Two separate placentas with a thick 2mm+ dividing membrane
Twin peak sign aka lambda or delta sign

291
Q

Monochorionic twins

A

Thin under 2mm dividing membrane
T sign on US - right angle relationship between membranes

292
Q

Monoamniotic twins

A

One amniotic sac - the later the split the more the twins share
High risk of fetal death - deliver 32-24 weeks, steroids at 24-28 weeks with antepartum testing

293
Q

Complications of multifetal pregnancies

A

Congenital malformations
Spontaneous abortions
Low birth weight
HTN
Size dischordance

294
Q

Twin-Twin Transfusion syndrome

A

In monochorionic twins
One twin gets all the nutrients, one gives all the nutrients
May be able to ablate vascular abnormalities causing TTTS
May need selective abortions
Harms both twins -One anemic, one congested

295
Q

Weight gain expectation for multifetal pregnancies

A

37-54lbs. weight gain

296
Q

Labor management for DD twins

A

38 weeks, can be vaginal - first twin should be vertex!!

297
Q

Labor management for MD or MM twins

A

Usually C section at 34-37 weeks and 32-34 weeks respectively - first twin should be vertex!!

298
Q

Maternal hypothyroidism

A

Fetus does not produce own thyroid before 12 weeks
Check TSH every trimester
Cold, Fatigue, Muscle Cramps, Hair loss
MC - Hashimotos thyroiditis
Treat with levothyroxine

299
Q

Screening for maternal depression

A

Screen for in patients in initial visit and at every visit if at risk

300
Q

Tx for depression during pregnancy

A

Counselling
SSRI or SNRI are first line
If mother is stable on current antidepressant - don’t change

301
Q

Zuranlone

A

For post partum depression with and SSRI or SNRI

302
Q

Substance abuse among pregnant women

A

7.2% abused pain relievers
12% Drank
25+% Smoked including marijuana

303
Q

Screen for substance abuse in pregnancy

A

Try to screen all patients if possible - tend to use for those with risk factors

304
Q

Opioid substitution for pregnancy

A

Methadone, Suboxone, Subutex
All associated with neonatal withdrawal
Subutex does not cross the placenta as early

305
Q

UTI dx and tx in pregnancy

A

Always do a urine screen when first presenting as pregnant
Can cause preterm birth
Macrobid or Keflex and recheck urine a week after

306
Q

Suppressive UTI therapy in pregnancy

A

Macrobid 100mg PO daily

307
Q

Pyelonephritis in pregnancy

A

Flank pain
Admit w/ IV abx and prophylaxis
Assess for kidney stone

308
Q

Definition of infertility

A

1 year of unprtected intercourse of reasonable frequency in under 35
6 months for those over 35

309
Q

Primary v. Secondary infertility

A

Primary no prior pregnancies
Secondary - prior pregnancy

310
Q

How often is reasonable to have sex for fertility

A

Once every other day
Make sure you’re having it during the right time

311
Q

Workup for many pregnancy losses

A

Do genetic testing to see if there is a problem
Look for uterine septum on US

312
Q

Dx for ovulatory dysfunction

A

Use menstual hx as a predictor
Ask about mittleschmirtz
TSH, Weight over or under
Basal body temperature
US to look at ovarian reserve
Urine LH sticks

313
Q

Serum progesterone

A

Check around 21 days for ovulation
Relatively cheap

314
Q

Serum FSH

A

Predictor of ovarian reserve - less inhibin
Check on day 3 of cycle
Estradiol compensation (elevation) indicates a depleated ovarian reserve

315
Q

Antimullerian hormone testing

A

Expressed by granulosa cells
Possible role in dominant follicle recruitment
Under 1ng/mL can indicate depleated ovaries
High in PCOS

316
Q

Tx for ovulatory dysfunction

A

Check hyperprolactinemia
Treat any adenoma
Levothyroxine for hypothyroid
Ovulation induction

317
Q

Clomiphene for ovulation dysfunction

A

Clomiphene - Estrogen antagonist results in increased FSH given around day 3 of cycle
PO

318
Q

Aromatase inhibitors for ovulation induction

A

Letrozole
Inhibits estrogen and increases FSH
PO
High BMI and PCOS

319
Q

Gonadotropins

A

Variety of IM formulations
Expensive

320
Q

COmplications of ovulation induction

A

Multifetal gestation
Ovarian hyperstimulation syndrome - enlarged ovary with cysts - causing abdominal pain, distention

321
Q

Intrauterine insemination

A

Sperm washed and concentrated and inserted into the uterus - less expensive than and tried before IVF

322
Q

IVF

A

Sperm and ova combine seperately and inserted into uterus

323
Q

Tubal and pelvic factors that can lead to infertility

A

Endometriosis
Surgery such as appendectomy
Pelvic infection

324
Q

Dx for tubal issues

A

Hyerosalpingogram on days 5-10 - uses radio-opaque medium in uterus
Chromopertubation - Methylene blue for tube patency with laparoscopy

Expensive

325
Q

Tx for tubal and pelvic factors

A

Cannulation to create patency
Reconstruction post op
Removal if dyfunctional tube causing issues
IVF with removal of adhesions

326
Q

Uterine factors that cause infertility

A

Polyps, Uterine septum, Fibroids
Dx with US or Hysteroscopy, endometrial biopsy before IUI or IVF

327
Q

Asherman’s syndrome

A

Intrauterine adhesions that can resemble a fetus on US
Form after dilation and curettage

328
Q

Cervical factors that cause infertility

A

Infection
Thick mucous d/t high estrogen

329
Q

Dx and tx for cervical factors

A

Postcoital test - how many sperm got through
Bypass with IUI

330
Q

Male hx for infertility

A

Testosterone use!!
Get a semen analysis
Mumps, ED, Hx of infection

331
Q

Lag time for sperm to be impacted

A

Takes 3 months for effects to be felt - look at that in hx

332
Q

Semen analysis

A

Refrain from ejaculation for 2-3 days
Too much sex can reduce sperm count per time
f/u analyze for antisperm antibodies
f/u low volume with urology

333
Q

Tx for low sperm count

A

IUI - Under 20 million per mL

334
Q

Azoospermia

A

Congenital absence of vas deferens d/t cystic fibrosis

335
Q

Asthenospermia

A

Decreased sperm motility
Prolonged abstinence
Infection
Varicocele
IUI to treat

336
Q

Antisperm antibodies

A

Can be d/t vasectomy, infection, testicular torsion

337
Q

Hormonal evaluation of male infertility

A

Look for low FSH and or Testosterone
Giving testosterone can actually suppress sperm production

Women's Health (3 decks)

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