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72 Cards in this Set

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NST
– normal is >15 bpm above paseline for al least 15 seconds over 20 minutes
CST
– positive is late decels for more than 50% of contractions and its bad
BPP componenets
– Test the Body MAN
– Tone, Breathing, Movement, AFI, NST
GDM
– if hyperglycemic during 1st trimester, its probably pre-existing
– don’t give oral hypoglycemics!
Pregnant and already have DM
– 20-22 weeks check for heart problems
– Insulin needs rapidly decrease after delivery
Gestational vs. Chronic HTN
– after 20 weeks and before 20 weeks
Symmetric vs. Asymmetric IUGR
– early insult from fetal problem (like infection or cytogenetics)
- late insult from HTN or smoking and good to do early delivery
Oligohydramnios
– AFI less than 5
– 40X mortality if no ROM
– from urinary tract abnormalities
– can do amnioinfusion
– can lead to clubfoot, pulmonary hypoplasia, cord compression
Polyhydramnios
– AFI greater than 20
– from GDM, Rh, cystic lung, GI problems, anencephaly and twin, twin
– can cause fetal malpresentation and cord prolapse
Mild vs. Severe preeclampsia
– modified bed rest
– antihypertensives and MgSO4 up until 24 hours postpartum
– treat Mg tox w/ Ca gluconate
Preeclampsia Tx
– HTN meds, MgSO4
– add diazepam if needed
– immediate delivery
Pregnancy and Cocaine
– Bowel atresia
Pregnancy and Streptomycin
– Auditory nerve damage
Pregnancy and Sulfonamides
– Kernicterus
Pregnancy and Quinolones
– Cartilage Damage
Pregnancy and Isotretinoin
– Heart and great vessel
– craniofacial
– deafness
Pregnancy and Methotrexate
– CNS, craniofacial, and IUGR
Pregnancy and Coumadin
– Stippling on bone epi
– IUGR and nasal hypoplasia
– MR
Pregnancy and ACEI’s
– Oligo and renal damage
Pregnancy and Carbamazepine
– nail hypoplasia
– IUGR and microcephaly
– NTDs
Pregnancy and Phenytoin
– nail hypoplasia
– IUGR and microcephaly
– MR and craniofacial
– increased risk of neuroblastoma
Pregnancy and Valproic Acid
– NTDs
– craniofacial and skeletal
GTD
– deficiency in folate of B-carotene
– type A mom and type O dad
– hyperthyroid
– bilateral theca-lutein cysts will resolve after treatment
– prevent pregnancy for 1 year
– chemo is methotrexate or dactinomycin
PPROM
– don’t do vaginal exam if less than 34 weeks
– give tocolytics and prophylactic ABx
– if infection or fetal distress, give Amp (or clinda) and Gent and induce
– can cause abruption or prolapse
Contraindications to tocolytics
– infection, nonreassuring, and abruption
– remember hydration and bed rest are first
Retained placental tissue
– accrete, previa, leiomyoma, previous C-section
– tx w/ manual removal and curettage w/ suctioning (careful not to perforate)
What do you seen on U/S at 5-7 weeks?
– 5 weeks sac, 6 weeks, pole, and 7 weeks cardiac activity
FNA of breast
– what you do w/ nonsuspicious mass
– go on to cytology if solid tumor and excitional biopsy if it doesn’t go away or the fluid is bloody
Fibrocystic Tx
– Danzol, but that causes acne, hirsutism, and edema
Fibrocystic vs. Fibroadenoma
– stromal vs. Epi and stromal
– neither found in menopause
Breast cancer staging
– 1 is < 2
– 2 is 2-5
– 3 is axillary
– 4 is distant mets (including supraclavicular)
Endometriosis pharm
– GnRH analogues (leuprolide or nafarelin)
– Danazol suppresses midcycle FSH and LH
– OCP
Dysfuctional uterine bleeding Tx
– Porgestins to stabilized
– for active bleeding, OCPs
– IV estrogen or Danazol for very heavy bleeding
– can also try GnRH analogues
Endometrial Hyperplasia Tx
– if simple or complex, give progestins then do repeat Bx
– many also consider aspiration curettage
– if atypia, TAH
PCOS Dx
– LH/FSH > 2
– ACTH stimulation increases an already increased DHEA
– pearl necklace sign
PCOS infertility
– clomiphene
– then try metformin, gonadotrophins, or ovarian drilling
– make sure OCP’s have progesterone b/c they don’t need any more unopposed estrogen
Ectopic Tx
– Surgery unless low B-HCG (expectant if < 200) or less than 3 cm (methotrexate)
Outpatient PID Tx
– Cefoxitin w/ probenecid X1
– Ceftriaxone IM + doxy for 14 days
– Oflaxacillin and metro for 14 days
Inpatient PID Tx
– Pregnant, high fever, abscess
– Cefoxitin or Cefotetal + doxy for 14 days
– clinda + gent for 14 days
Endometrial Cancer tx
– TAH/BSO w/ LN dissection
– progesterone radiotherapy
– chemo for advanced
Cervical Cancer Tx
– Stage 1 can just do TAH
– Early gets Radiotherapy, TAH, and LN removal
– Advanced gets rad and chemo
Vulvar Cancer Tx
– in situ gets wide margins
– invasive gets vulvectomy w/ LNs or wide excision w/ LNs and radiation
Fibroid Tx
– Medroxyprogesterone acetate or danzaol will slow bleeding
– GnRH analogues will decreased size
– can do surgery for torsion of pedunculated
CIN Tx
– 1 just do pap every 3 months
– Exocervix gets laser or cryo
– Endo gets LEEP
Premenopausal ovarian mass Tx
– if premenstrual, operate if > 2 cm
– otherwise, can watch if > 8 cm and cystic
– if menopause, 5 cm is cut-off
Ovarian dysgerminoma
– increased LDH
– needs radiation therapy
Glycosuria in pregnancy
– do one fasting and if there is still glycosuria, do a OGTT
Pseudocyesis
– imagined pregnancy with Sx
Ralosifene
– Estrogen agonist on bone and antagonist on breast and vagina
– increases DVTs
Lichen Sclerosis
– dry and itchy vulva postmenopausally
– do high dose topical steroids
Trichomonas tx
– Metro, uless preganat then do clotrimazole
Criteria for vaginal breech
– Complete or frank
– 36 weeks
– 2500-3600g
– flexed head
– large pelvis
– don’t try to convert outside of 37 weeks!
Idiopathic precocious puberty Tx
– GnRH analogues to prevent epiphysis fusion
Luteal phase defect
– a cause of infertility
– diagnosed w/ endometrial biopsy
– treat with progesterone supplement
– if that doesn’t work, try clomiphene or hMG
Mid-pelvis contraction
– prominent ischial spines
– need to do C-section
Infertility tests for ovulation
– BBT and mid-luteal phase progesterone level
Aromatase deficiency
– XX w/ normal internal but ambiguous external genitalia
– mom will be virilized during pregnancy
– no estrogens but very high FSH and LH
Kallman’s syndrome
– cant smell
– decreased FSH and LH
– hypogonadotropic hypogonadism
BV treatment
– metro unless pregnant, then do clinda
Pregnant w/ SLE and HTN
– the HTN is from glomerulonephritis
Clomiphene SE’s
– breast tenderness, hot flashes, and spotting
Placenta previa Tx
– schedule C-section at 36 weeks unless unstable, then do emergent
Amniotic fluid embolism
– can happen after amniocentesis
– can cause seizures!
– manage airway
Septic abortion management
– cervical and blood culture
– then IV abx
– then gentle suction curettage
Pregnant toxo tx
– elective abortion or spiramycin in 1st trimester
– after that do primethamine and sulfadiazine
Tocolytics SE’s (B-blockers)
– edema, tachy, increased myocardial workload
Pelvic thrombophlebitis
– Dx of exclusion
– give heparin 7 days after no response to ABx for fever postpartum
Missed abortion
– will have low fibrinogen
Ovulation induction complications
– OHSS can lead to ovarian torsion
Uterine rupture Tx
– TAH if not more kids
– primary closure if more kids
Major cause of death in eclampsia
– hemorrhagic stroke
What is the best way to estimate weight in IUGR
– abdominal circumference