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