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238 Cards in this Set
- Front
- Back
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What is the most common reason why AFP is elevated?
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inaccurate dating
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Where is the uterus found at about 20 weeks gestation?
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level of the umbilicus
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What makes alpha fetoprotein
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the fetal liver
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What is the first trimester screen for Down syndrome?
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nuchal translucency
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What effect does Down syndrome have on estriol and AfP?
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decreases both
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What is increased in Down syndrome?
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hCG and inhibin A
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What is the common reason for abrnomal serum screening?
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wrong dates
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So what do you do to evaluate these serum abnormalities?
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do an U/S
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What are some other things associated with high AFP?
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abdominal wall defects
polyhydramnios fetal skin defects |
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What is the fetal loss rate of amniocentesis?
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about 0.5%
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What is the double bubble sign?
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it's a sign of Down syndrome that is linked to "cystic masses in the abdomen"
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What is the etiology of cleft liip?
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multifactorial
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How do you interpret a high AFP result with no real identifiable etiology?
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high risk of still birth
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Genetic counseling is used for patinets that have a possible hereditry syndrome
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ok
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How do you tx Candida?
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clotrimazole- pt only
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steps for pprom
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abx,
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if premature labor+ incompatible with life
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expectant labor mgmt
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primary amenorrhea + high fSH
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Turner syndrome, get a karyotype
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what are first line for endometriosis?
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OCPs
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hypertrophic dystrophy= lichen sclerosis ****
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do steroids
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what else?
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you have to get a biopsy
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Behcet's disease looks like herpes
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should have negative HSV cultures or titers
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variable decels= umbilical cord compression
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ok
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for some weird reason
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HRT actually increases risk of CAD
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progesterone deficiency
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short luteal phase with short cycles, recurrent SABs
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dx of luteal phase defect
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endometrial biopsy showing lag in endometrium
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CVS can be done early
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if the woman is trying to decide what to do
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amniocentesis is done
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to assess lung maturity and between 16 and 18 weeks
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endometritis
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puerperal fever over 2 days, tender uterus
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if no response to antibiotics
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consider septic pelvic thrombophlebitis and treat with heparin
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anaerobes like Bacteroides are the most common
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to cause endometritis
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3 D's of endometriosis
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treat with OCPs or lysis of adhesions
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major cause of death in pre-eclampsia is
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ICH
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2 most common antepartum hemorrhage
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previa
abruption |
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bright red VB
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just means it's one of these two
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big complication of abruption
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DIC- monitor fibrinogen
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risks for abruption
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traumahtn
previous hx cocaine tobacco folate short umbilical cord |
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most accurate fetal weight parameter
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abdominal circumference
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2 types of iugr
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symm or asymm
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symmetric iugr means
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tht the damage occurred before 28 weeks
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asymm means after 28 weeks
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y
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bilteral edema in pregnancy is
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benign
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MRKH syndrome=
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is mullerian agenesis
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46 XX
no uterus normal secondary sex char's |
renal anomalies
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before 34 weeks
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is steroid benefit
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pmof occurs
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before age 40
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usual cause of pmof
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autoimmune disease
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autoimmunities that could give pmof
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hashimoto
addison's type 1 dm |
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what is the tx for pmof?
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egg donation
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what is bpp?
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sonography + heart monitoring
counting fetal movements |
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measures of NST reactivity
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extremity tone
brething gross movements amniotic fluid index |
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scores of 8 to 10 are
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reassuring
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BPP can be repeated once or twice weekly until term for high risk pregnancies
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nst it based on tracing of the fetal heart
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reactive= + 15x15 accels
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ok
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nonreactive=
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no accels are seen
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definition of oligo
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afi under 5
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risk factors for candida
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antibiotics
ocp's diabetes pregnancy immunosuppressants |
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post menopausal women rely on
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aromatization
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obese women have mild menopause because
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of their adipose tissue volume aromatizing the **** out of stuff
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pseudocyesis= imaginary pregnancy
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that occurs in women with strong desire to get pregnant
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tx for pseudocyesis
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psychiatric
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which hormone for menopause or pmof?
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fsh
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lichen sclerosis tx
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super potent steroids
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itch spots after menopause=
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get a biopsy
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have to r/o vulvar CA with a lichen sclerosis picture
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ok
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dx of iufd is made with
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real time u/s
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iufd=
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death of fetus after 20 weeks
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complete placenta previa requires
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scheduled C section
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mgmt of TOAs
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triple abx therapy
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do they ever drain a TOA?
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yes after 48 hours of no response
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again remember the fevers with no response after 48 hours=
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septic pelvic thrombo
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any woman with amenorrhea
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hcG
tsh prl |
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mgmt of inevitable or incomplete abortions
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admit nd consider D&C or suc curettage
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what do you do after the abortion?
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Rhogam
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you only deliver previa by
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Cs
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elevated androgen in pcos
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T and DHEA
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is leukocytosis normal postpartum?
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yes and it can be significant
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what is lochia rubra?
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the first bright red discharge to occur after preganncy
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what is an incomplete abortion?
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when you have some retained poc's
cervix is open |
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similar to inevitable abortion
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except that inevitable usually means that they still have retained all the Pocs
none have passed yet |
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rsk factors for abortion
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chromosomal anomalies are most common
infection tobacco etoh hypothryoidism sle DM cervical incompetence uterine anomalies |
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rhogam is given when
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at 28 weeks
and within 72 hours of any event or procedure |
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tx for chlamydia
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single dose of 1 g oral az-max
or 7 to 10 days doxycycline |
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tx fr gonorrhea
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im ceftriaxone 250 mg + oral doxy or azithro
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criteria for delivering vaginally breech
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frank or complete
fetal weight between 2500 adn 3800*** flexed fetal head adequately large pelvis no fetal indications for C/S |
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what diseases are good to be pregnant with?
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peptic ulcers and MS
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breast mass in young woman
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FNA and ultrasound
NOT mammography |
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check what with hyperprolactinemia symtoms?
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TSH
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what is trichotillomania?
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compulsively pulling hair out
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tx of graves in pregnancy
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ptu
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definition of iugr
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birth weight below 10th percentile
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most common cause of iugr
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htn
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what bpp score necessittes immediate delivery for the mgmt?
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under 4
over 8 is reassuring |
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what about between 4 and 8?
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consider lung maturity
if not mature reassess bpp in 24 hours |
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so summary of bpp interpretation
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over 8 = nothing
between 4 and 8= can deliver with fetal lung maturity, consider contraction nst |
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presentation of lymphogranuloma v
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painless ulcer but PAINFUL lymphadenitis
classic groove sign= linear fibrosis parallel to inguinal ligament |
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when does hemodilutional anemia reach its peak?
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34 weeks
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when is most common for phys dyspnea?
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third trimester
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cause?
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increased minute ventilation causes comp'd resp alkalosis
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does RR increase in pregnancy?
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no only the tidal volume
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so remember about the breathing
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phsyiolgoic dyspnea= comp'd resp alkalosis with increased tV, no change in RR, worst in third trimester
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CO also increases in pregnancy due to
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both high SV and hr
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how does thyroid hormone change?
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its total levels are increased
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most common site of metastasis for chorioca?
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lungs
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get a CXR and give
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methotrexatet
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tx for molar pregnancy
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suction curettage
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diseases in ashkenazi jews
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fanconi
tay sachs CF Niemann pick |
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most common anomaly in poorly controlled dm
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cardiac
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does cvs detect NTDS?
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no it only does karyotyping and biochem anomalies
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quad screen
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inhibin a
afp hcg unconj'd estriol |
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what is the down syndrome screen for frist trimester?
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nuchal translucency
papp a double bubble sign on U/S |
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risk of sab while doing cvs
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1%
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pres of uterine rupture
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intense abdominal pain ass'd with a vaginal bleed
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tx for uterine rupture
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TAH
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however some women if they still desire fertility
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can get debridement and closure of the wound
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cervix is dilated but there is no passage of the POC
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inevitable ab
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VB, lower abdominal cramps that radiate and a dilated cervix
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inevitable abortion
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cevical mucous at ovulation
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thin watery and profuse
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first step for decreased fetal movements-->
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get an NST
if non reactive look at an U/S to dx IUFD or do vibroacoustic stim |
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most common reason for non reactive nst?
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sleeping baby- stim them and see if they move
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so when do you get bpp in non reactive stress test?
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if it's deemed a high risk pregnancy like with htn etc
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so again decreased fm--> get a NST--> if reactive don't worry
if not reactive--> do stimulation or BPP if high risk dx iufd with u/s |
remember bpp
0 to 4- deliver now 4 to 8- consider contraction st consider fetal lung maturity and current status for delivery 8 to 10 nothing |
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painless indurated ulcer with a punched out base and rolled edges
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a chancre of primary syph
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hw long before the chancre appears
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takes a few weeks
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gold std for dx of syph
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df microscopy
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how do you dx renal colic in pregnancy?
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don't do KUB
do an ultrasound to avoid radiation |
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suppress lactation with
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ice packs
tight binders |
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kallmann
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anosmia
lack of sex traits no GnRH low FSH |
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if far from term how do you tx severe preeclampsia?
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you do IV hydralazine, Mag sulfate and steroids and then deliver later
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otherwise just know tht
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severe= deliver now
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change in thyroid hormone
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high total thyroxine
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tx of preterm labor
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hydration and bed rest
tocolysis and steroids |
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3 tests for secondary amen
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tsh
prl hcg |
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how do you assess estrogen?
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progestin withdrawal
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with fetal maternal hemorrhage (Kleihauer betke test)
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you need to give rhogam
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also you give rhogam postpartum
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wthin 72 hours
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what drugs worsen edema of pregnancy?
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B agonists
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how often can we figure out the cause for iufd?
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half the time
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how do you manage lithium?
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wean them off but don't stop them cold or they will have mood disorder swings
ebstein's anomaly is the big risk |
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isotretinoin mgmt?
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stop immed
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primary cause of recurrent SAB in SLE pt?
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lupus anticoagulant
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how do you manage breech before 37 weeks?
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expectantly
you only do version after 37 weeks as this is more successful |
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abdominal pain with normal cycle in young females
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think mittelschmerz aka mid cycle pain
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pres of abrution
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painful contractions and VB
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however what sx is not requried for a clinical suspicion of abrutpion?
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the bleeding- it can be a concealed abruption
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does us diagnose abrutpion?
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no
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greatest risk factor for abruption
|
htn
don't go immediately to cocaine or tobacco just know these associations |
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htn htn htn
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for abruption
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what can be given to relax the uterus for replacement?
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halothane
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two stimulants of prl
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trh and serotonin
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dopamine inhibits
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yep
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do you treat asx bacteriuria ? why?
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because it gives pyelonephritis and sepsis
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std of care for threatened abortion
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reassurance and follow up
only half of these will progress |
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definition of threatened abortion
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any VB before week 20
closed cervix and live fetus |
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looks quite similar to
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complete ab- closed cervi but no fetus
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tx for idiopathic precocious puberty
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GnRH agonist to prevent premature fusion of the epiphyseal plates
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so relly the concern with precocious puberty is
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musculoskeletal problems
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gold std for endometriosis dx
|
laparoscopy
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drug of choice for htn crisis in pregnancy
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labetalol
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why labetalol?
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because it reduces proteinuria and diabetic nephropathy
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ace and arbs are contra
|
ok
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advanced PTL requires
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tocolysis immediately with MgSo4
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ocp for lactation
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progestin only because it does not affect milk production
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why can't iud's be placed immediately postpartum?
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because th uterus has not involuted yet
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tx for missed ab
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can be expectant but you might want to encourage D&C to avoid retained POC and infection/DIC
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usual pres of a missed abortion
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lack of pregnancy symptoms
negative ultrasoune arrest of uterine growth |
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when is D&C then made difficult for missed AB?
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when the fetus is large after 16 weeks
this may require prostaglandin induction |
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use 3 hour GTT to confirm
|
gestational diabetes
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most effective DS screen in 2nd trimester
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quad screen
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first trimester screen for DXS
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nuchal trans
papp a hcg |
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so again
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quad= second trim
papp a, hcg, and nuchal trans= first trimester |
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risks of gest dm
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dystocia
macrosomia polyhydramnios cardiac anomalies caudal regression abortions |
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dose of folic acid
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0.4 g
or 4 g if previous hx of NTD |
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ideal weight gain for obese woman
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11 to 20 lb
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normal weight gain
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15 to 25
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underweight
|
i think they get 25 lbs of weight gain
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critical period
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3 to 8 weeks gestation
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|
braxton hicks
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short irregular non-intense contractions
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labor precautions
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contractions every 5 min for a whole hour
rom fetal movement less than 10 per 120 min vb |
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if fetal hr not confirmed
|
place a scalp electrode
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can you do an epidrual with fetal brady?
|
no
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what happened if you placed an iupc and now there's bleeding?
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uterine perforation occurred
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tx of the uterine perf?
|
withdraw the cath and reinsert and if fetal heart tracing is reassuring don't worry about it
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most common cause of PPH
|
uterine atony
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time frame for postpartum blues
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less than 2 weeks
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symptom of post partum depression
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newborn ambivalence
also lasts more than 2 weeks |
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if they have abdominal pain with VB
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it's an ectopic vs. threatened ab
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what is the mgmt
|
get an hcg and if over 1500 get an u/s
if not and they are stable then get a follow u/s in 48 hours if they are not stable then take them to the OR for lap |
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if it's a woman who is unstable with abdominal pain and vb
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then do ex lap
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what is the treatment for confirmed ectopic (hcg over 2000 and no intrauterine gestational sac) if they are stable?
|
methotrexate
|
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sxs of ectopic
|
peritoneal signs
hypovolemia abdominal pain + hcg |
|
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big risk of oligohydramnios
|
IUGR
|
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risks for babies born to diabetic mothers
|
hypoglycemia
polycythemia hyperbilirubinemia hypocalc respiratory distress |
|
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do you flex the neck for venting a newborn?
|
no
|
|
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big risk of type 1 dm
|
iugr and sab
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if the patient is stable and doing well, then you can do what for missed ab
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expectant mgmt
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tx for cerv incompetence?
|
cerclage in T2
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asthma usually gets better or worse in pregnancy?
|
wors
|
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therapy for syphillis in a pcn allergic pregnant patient?
|
desensitization and still give PCNG
|
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tx for syphillis otherwise
|
penicillin
or doxy |
|
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biggest risk of death in pregnancy disease
|
pulmonary htn
there is up to a 50% mortality rate in these patients |
|
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definition of severe preeclamp
|
>160/110
>5 g proteinuria per 24 symptomatic |
|
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mg so4 prevents eclampsia
|
yep
|
|
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signs of Mg toxicity
|
yep
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therapeutic mg level is between
|
4 and 7
|
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what is the first sign of Mg toxicity?
|
loss of DTrs
|
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|
biggest risk of MgSo4?
|
resp depression and cardiac arrest
|
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tx for severe pre-E
|
delivery
|
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|
sinusoidal heart pattern means...
|
fetal anemia or abruption usually
|
|
|
side effect of depo provera
|
irregular bleeding but this generally goes away
|
|
|
when do you use urethral bulking?
|
for loss of sphincter tone
|
|
|
when do you use urethropexy
|
GSUI
|
|
|
tx of urge incont
|
oxybutynin or tolterodine
|
|
|
tx for uterine prolapse?
|
Sacrocolpopexy
or vaginal hysterectomy |
|
|
what is colpocleisis?
|
when you surgically obliterate the vagina under local anesthesia
|
|
|
pessary fitting is best for..
|
bad surg candidates
|
|
|
first line for sx endometroisis?
|
OCPs
|
|
|
second line?
|
GnRH agonists to shrink the implants
|
|
|
sudden onset of pain and nausea a well as presence of ovarian cyst on U/S means
|
torsion from a hemorrhagic cyst
|
|
|
hemorrhagic cyst should go away on its own
|
ok
|
|
|
tx of endometriosis patient who desires fertiltiy
|
GnRH agonists and/or laparoscopy for lysis of adhesions
|
|
|
Asians have the highest rate of molar pregnancy
|
ok
|
|
|
wht nutritional deficiency for molar pregnancy?
|
folate
|
|
|
std mgmt for molar pregnancy?
|
suction curettage
|
|
|
follow up for molar pregnancy
|
weekly for hcg levels- also get baseline CXR and place them on OCPs
|
|
|
complete vs partial mole
|
complete= 46 XX, no parts, high risk of chorio, larger uterus than by dates
partial= 69XXX etc and have low risk f chorio |
|
|
is there a persistent risk for moles?
|
not really
|
|
|
presentation of complete moles
|
larger uterus than dates, early ealy preeclampsai, and high risk of chorio
|
|
|
partial mole
|
smaller uterus for dates
|
|
|
what is teh hcg value for a mole?
|
like 10000000000000
not in the 2000s |
|
|
mgmt of lsil
|
colposcopy with biopsies
|
|
|
best tx option for cervical dysplasia
|
LEEP
|
|
|
when do you do cone knife?
|
when you're not entirely certain you got the whole lesion
|
|
|
do you do excision for LSIL/CIN 1 to 2?
|
no just do leep
|
|
|
incidental adnexal mass workup
|
U/S- if functional cyst it probably just requires OCPs/expectant mgmt
|
|
|
biggest risk for endometritis
|
C/S
|
|
|
tx of SPT
|
heparin + antibiotics
|
|
|
big risk factor for PPROM
|
genital tract infections like BV
|
