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31 Cards in this Set
- Front
- Back
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Risk factors for shoulder dystocia…
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Obese, multiparous, gestational diabetes, post-term, prolonged 2nd stage of labor
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Management of baby w/ shoulder dystocia…
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McRoberts (straightens sacrum relative to lumbar spine and rotates symph pubis anteriorly), suprapubic pressure (brings shoulders into an oblique plane), delivery of posterior arm, Woodscrew maneuver, Zavanelli (push back and C-sxn)
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With shoulder dystocia, what is mechanism of delivery of post fetal arm…
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Decreases fetal bony diameter from shoulder to axilla
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Woman post TAH is having fever and flank pain, what is first test to get…
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IVP or CT of abdomen and pelvis to look for ureteral obstrxn
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Cardinal ligament attachments and vessels…
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Attaches cervix to pelvic wall, uterine vessels transverse
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RFs for ureteral injury in pelvic surgery… most common location…
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Cancer, extensive adhesions, endometriosis, tubo-ovarian abscess, residual ovaries, interligamentous leiomyomata. Cardinal ligament is most common location…
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Locations of ureteral injury in pelvic surgery and when they might happen…
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Cardinal ligament in hysterectomy, pelvic brim in ligation of ovarian vessels, vesicoureteral junction when vaginal cuff ligated in hysterectomy
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Management of ureteral obstrxn…
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Antibiotics + cystoscopy to attempt retrograde stent passage (work out the kink)
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Patient undergoing TAH develops nausea, vomiting, and ascites several days post-op…
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Overdisection of ureter causing devascularization and urine leak into abdomen which aggravates the intestines.
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RFs for endometrial cancer…
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Early menarche, late menopause, estrogen secreting ovarian tumors, hx or fam hx of breast or ovarian cancer, Obesity, diabetes, HTN, prior anovulation (irregular menses), late menopause, nulliparity, unopposed estrogen replacement**
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Test for diagnosis of endometrial cancer…
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aspiration or sample with catheter (95% sensitivity) and/or hysteroscopy (esp if persistent)
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Causes of postmenopausal bleeding…
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Endometrial polyps, atrophic endometrium (most common- friable tissue due to low estrogen levels), vaginitis, hormone replacement therapy, and endometrial cancer
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Endometrial stripe and what is abnormal on it…
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Transvaginal sonograph of endometrial thickness. >5 mm is abnorm in post menopausal women
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On endometrial biopsy, what is notable for premalignancy and what is statistics..
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Complex hyperplasia w/ atypia is malignant in 30-50% of cases
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What percent of postmenopausal women not on hormone therapy who have vaginal bleeding will have endometrial cancer…
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1/5
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Staging procedure for endometrial cancer…
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TAH BOS, omentectomy, lymph node sampling, peritoneal washings
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When does endometrial cancer tend to be more aggressive..
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When presenting in an atypical patient (thin) w/o hx of anovulation
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Vasa previa…
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Umbilical cord vessels overlying internal cervical os thus vulnerable to fetal exsanguinations upon ROM
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Test to r/o placenta previa…
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US, avoid looking thru vagina as it may induce bleeding
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Natural history of placenta previa…
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Usually first episode is small and does not require immediate delivery but later on it does.
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Differences between placenta previa and abruption…
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Previa is painless and does not lead to coagulopathy where abruption is painful and can have coagulopathy
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RFs for placenta previa…
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Grand multiparity, prior c-sxn, prior curettage, previous previa, multiple gestation
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RFs for placental abruption…
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Polyhydramnios, HTN,
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Complications of placental abruption…
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Hemorrhage, fetal to maternal bleeding, coagulopathy, preterm delivery
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RFs for placental abruption…
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HTN, cocaine, short umbilical cord, trauma, uteroplacental insufficiency, submucous leiomyomata, sudden uterine decompression (hydramnios), cigarettes, preterm PROM
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Couvelaire uterus…
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Bleeding into the myometrium of the uterus giving a discolored appearance to the surface
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how does one make the diagnosis of placental abruption...
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there is no one test, clinical picture taken as a whole. US not a good test. Look for Hx findings, pain, Couvelaire
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complications of placental abruption...
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uterine atony, postpartum hemorrhage, coagulopathy (in 1/3 of cases where abruption causes fetal death), fetal-maternal hemorrhage (test w/ Klei-Betke elution method)
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helpful signs and findings of placental abruption...
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serial Hgb levels, following fundal height and assessment of FHR pattern
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when might expectant managment be exercised in pt w/ abruption...
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patient is stable w/ no active bleeding or signs of fetal compromise
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what is managemnt of abruption when assoc with fetal death and coagulopathy...
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vaginal delivery route w/ IV fluids and blood to maintain hct > 25% and UO >30ml/h and possible Mg sulfate for seizure due to development of preeclampsia in many
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