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263 Cards in this Set
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PROM
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Premature rupture of membranes: at least 1 hr prior to onset of labor
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PPROM
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Preterm premature rupture of membranes: premature = 1 hr before labor; preterm = before 37 wks GA
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prolonged rupture of membranes
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more than 18 hrs. before labor
increased risk of infxn |
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ROM Diagnosis (4 criteria)
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1) gush of fluid -- can be confused with stress incontinence
2) Pooling of fluid in posterior fornix 3) +nitrazine - amniotic fluid is alkaline, positive for LOF if turns blue 4) +ferning - estrogens cause crystallization as fluid dries on a slide, looks like a fern |
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Cervical exam (5 components)
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1) Dilation
2) effacement 3) Station 4) Cervical position 5) Consistency |
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Bishops Score
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>8 = favorable for successful vaginal delivery (either spontaneous and induced labor)
<5 : induced or spontaneous vaginal delivery unlikely |
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anterior fontanelle
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junction between frontal and parietal bones, larger, diamond-shaped
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posterior fontanelle
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junction between parietal and occipital bones, smaller, triangular
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labor
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painful contractions + cervical change
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cervical ripening agents
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PGE2 gel
Cervadil -- PGE2 pessary PGE1M -- Misoprostol |
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Contraindications for use of prostaglandins (induction of labor)
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Maternal: asthma, glaucoma
OB: >1 previous c-sxn, non-reassuring fetal testing |
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fetal HR
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110-160
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fetal tachycardia
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>160 bpm
infxn, hypoxia, anemia |
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fetal bradycardia
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<90 (for > 2 mins)
OB emergency |
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Fetal HR tracing (4 characteristics)
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1) baseline
2) variability 3) accelerations / reactive 4) decelerations |
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Accelerations (at term)
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at least 15 bpm over baseline for at least 15 secs
-- 2 in 20 mins = reactive strip |
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Early decelerations
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begin and end at approx same time as uterine contraction
Increased vagal tone b/c of fetal head compression |
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Variable decelerations
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precipitous drop (at any time)
Umbilical cord compression |
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Late decelerations
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begin at peak of contraction, nadir is >30 secs after peak of contraction, slow return to baseline
placental insufficiency |
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Adequacy of uterine contractions
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measured in Montevideo units (via IUPC only)
= sum of peak-trough for all contractions in 10-min period. Adequate > 200 montevideo units |
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fetal scalp pH
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reassuring at pH > 7.25
nonreassuring at pH < 7.20 |
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cardinal movements of labor (6)
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1) engagement
2) flexion 3) descent 4) internal rotation 5) extension 6) external rotation / restitution / resolution |
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Stages of labor (3)
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1) Stage I -- onset of labor to complete dilation and effacement
2) full dilation to delivery of infant 3) delivery of infant to delivery of placenta |
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Stage I - duration
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Nulliparous -- 10-12 hrs
- nL = 6-20 hrs Multiparous -- 6-8 hrs - nL = 2-12 hrs |
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Latent phase (Stage I)
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from onset of labor to 4-5 cm
dilation - slow cervical change |
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Active phase (Stage I)
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4-5 cm dilation to full dilation
nulliparous -- 1.2 cm dilation per hr multiparous -- 1.5 cm per hr |
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Stage 2 - duration
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Prolonged:
Nulliparous > 2 hr (3 hr with epidural) Multiparous > 1 hr (2hr with epidural) |
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Signs of placental separation (3)
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1) cord lengthening
2) gush of blood 3) uterine firming and fundal rebound |
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Retained placenta
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placenta does not deliver within 30 mins
- preterm deliveries - placenta accreta |
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Placenta accreta
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placental invasion into or beyond endometrial stroma
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Perineal lacerations
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1st deg - mucosa or skin
2nd deg - extends to perineal body (not anal sphincter) 3rd deg - into / through anal sphincter 4th deg - involves anal mucosa |
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Signs of uterine rupture
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abdominal pain
fetal HR decelerations / bradycardia sudden pressure decrease on IUPC maternal sensation of a "pop" |
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Antepartum hemorrhage
Major causes |
1) placental abruption (30%)
2) placenta previa (20%) |
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Placenta previa
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abnormal implantation over internal cervical os
- bleeding from small disruptions in placental attachment |
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Placenta accreta
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abnormal invasion of placenta into uterine wall -- superficial invasion into uterine myometrium
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Placenta increta
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placenta invades myometrium
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Placenta percreta
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placenta invades through myometrium into serosa
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circumvallate placenta
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when membranes double back over edge of placenta -- forms dense ring around periphery of placenta.
A major cause of 2nd tri hemorrhage |
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vasa previa
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velamentous cord insertion causes fetal vessels to pass over internal cervical os
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velamentous placenta
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blood vessels insert between amnion and choirion away from margin of placenta.
Vessels unprotected, vulnerable to compression / injury |
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succenturiate placenta
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extra lobe of placenta implanted away from rest of placenta.
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Painless vaginal bleeding in 28th wk of gestation
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Sentinel bleed
placenta previa |
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Third trimester vaginal bleeding and severe abdominal pain
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placental abruption
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vaginal bleeding a/w sinusoidal variation in fetal HR
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fetal anemia, fetal vessel rupture
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preterm labor
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before 37 weeks
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incompetent cervix
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silent painless dilation of cervix
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low birth weight
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less than 2500 g
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Intrauterine growth restriction
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not growing appropriately for GA
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Ritodrine
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ONLY FDA-approved tocolytic
beta-mimetic |
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Tocolysis
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goal is to gain 48 hours for betamethasone / dexamethasone administration
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Tocolytic goal
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decrease / halt cervical change resulting from contraction
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beta-mimetics (for tocolysis)
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ritodrine
terbutaline |
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Tocolytics
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ritodrine
terbutaline Mg sulfate nifedipine indomethacin |
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Signs of chorioamnionitis
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maternal fever
elevated maternal WBCs uterine tenderness fetal tachycardia |
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maternal pelvis types
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1) gynecoid
2) android 3) anthropoid 4) platypelloid |
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obstetric conjugate
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distance between sacral promonotory and midpoint of symphysis pubis
Shortest AP diameter of pelvic inlet |
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McRoberts maneuver
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sharp flexion of the maternal hips -- decreases inclination of the pelvis
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Rubin maneuver
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pressure on accessible shoulder to push it toward anterior chest wall of fetus
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Zavanelli maneuver
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push the baby back in -- then do c-section
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Small for gestational age
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less than 10th percentile
symmetric -- proportionately small asymmetric -- some organs disproportionately small |
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large for gestational age
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greater than 90th percentile
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Fundal height
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approx equal to GA at greater than 20 wks
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Decreased growth potential
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Starts small, stays small
Genetic / chromosomal abnl intrauterine infxn teratogenic exposure substance abuse radiation exposure small maternal stature preg at high altitudes female fetus |
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Intrauterine growth restriction (IUGR)
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Falls off growth curve
Maternal factors: HTN, anemia, chronic renal dz, malnutrition, severe DM Placental factors: previa, chronic abruption, infarction, multiple gestations |
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Fetal macrosomia
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birth weight greater than 4500 g
- sometimes 4000g is used |
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max volume of amniotic fluid
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greatest at 28 wks, ~800mL
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Amniotic fluid index
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Sum of measurements (cm) of largest vertical pocket in each of the 4 quadrants of maternal abdomen.
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Oligohydramnios
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AFI<5
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polyhydramnios
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AFI>20
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Erythroblastosis fetalis
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hyperdynamic state
heart failure diffuse edema ascites pericardial effusion serious anemia |
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Kleihauer-Behtke test
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amount of fetal RBCs in maternal circulation
used to determine the amt of RhoGAM to administer if placental abruption or antepartum hemorrhage |
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Liley curve
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predicts severity of fetal hemolysis with red cell isoimmunization
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Liley curve - Zone 1
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mildly affected fetus
amniocentesis every 2-3wks |
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Liley curve - zone 2
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moderately affected fetus
amniocentesis every 1-2wks |
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Liley curve - zone 3
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severely affected fetus
weekly amniocentesis US assessment for hydrops |
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missed abortion
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intrauterine fetal demise before 20 weeks
lack of uterine growth cessation of sx of pregnancy serial falling hCG |
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TORCH infections
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Toxoplasma
RPR CMV HSV |
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postterm pregnancy
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past 42wks GA or > 294 days past LMP
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monozygotic twins
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fertilized ovum divides into two separate ova
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dizygotic twins
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ovulation produces two ova, both are fertilized
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DiDi twins
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separation before differentiation of trophoblast -- 2 chorions, 2 amnions
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MoDi twins
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days 3-8
after trophoblast differentiation, before amnion formation |
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MoMo
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days 8-13
after amnion formation --> single placenta, one chorion, one amnion |
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Conjoined / Siamese twins
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days 13-15
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Preeclampsia
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Edema
HTN proteinuria - Usually in nullips, 3rd trimester Can develop anytime after 20 wks |
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HELLP syndrome
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hemolytic anemia
elevated liver enzymes low platelets |
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early HTN (14-20 wks)
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hydatidiform mole or chronic HTN
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Preeclampsia Risk Factors
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nulliparity
maternal age <20 or >35 multiple gestation underlying chronic HTN |
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Mild preeclampsia
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140/90 - 160/110
or >30 incr SBP, >15 incr DBP >300 mg protein in 24 hrs or 1-2+ dipstick hands and/or face edema |
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severe preeclampsia
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>160/110
> 5,000 mg /24 hr or 3-4+ dipstick non-dependent edema |
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severe preeclampsia
other diagnostic factors |
mild preeclampsia +:
oligura (<400 mL/24hr) pulm edema RUQ pain HA/scotoma altered LFTs thrombocytopenia IUGR |
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trx of MgSO4 overdose
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give 10 mL of calcium chloride or calcium gluconate
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Class A1 DM
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gestational, diet controlled
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Class A2 DM
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gestational, insulin controlled
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Class B DM
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onset age 20 or older
duration less than 10 yrs |
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Class C DM
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onset: 10-19 yoa
duration: 10-19 yrs |
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Class D DM
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Onset: before age 10
Duration: > 20 yrs |
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Class F DM
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Diabetic nephropathy
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Class R DM
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Proliferative retinopathy
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Class RF DM
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Retinopathy and nephropathy
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Class H DM
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Ischemic heart dz
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Class T DM
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prior renal transplant
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Screening for GDM
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fasting glucose > 105
1 hr > 140 2 hr > 165 |
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Normal OGTT
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fasting 90 or 105 (plasma)
1 hr 165 or 190 2 hr 145 or 165 3 hr 125 or 145 Two or more elevated values, including fasting |
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Indications for GBS prophylaxis
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delivery < 37 wks
prolonged ROM Temp 100.4 or greater GBS bacteruria previous child with GBS dz |
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DES exposure
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Increased risk of clear cell adenocarcinoma of cervix and vagina
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Cervical mucous - ovulatory phase
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profuse, clear, thin
stretches to 6cm when lifted vertically (spinnbarkeit) more basic, pH 6.5 or greater +ferning on slide |
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Cervical mucous - early follicular phase
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Immediately following menstruation
thick, scant, acidic does not allow sperm penetration |
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Cervical mucous - luteal phase
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Progressive thickening, less stretching
inhospitable to sperm |
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chorionic villous sampling
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between 10-12 weeks
aspiration of small amt of chorionic villi from placenta detect fetal chromosomal anomalies in 1st tri |
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amniocentesis
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between 16-18 weeks
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endometriosis
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chronic low sacral back and pelvic pain, worse premenstrually, tender posterior vaginal fornix, uterine motion tenderness.
dysmenorrhea, dyspareunia, pain with defecation laparoscopy is gold std for dx |
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Endometritis - risk factors
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PROM (> 24 hrs)
prolonged labor (>12 hrs) c-section IUPCs or FSEs operative vaginal delivery |
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Endometritis - causal organism(s)
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usually polymicrobial
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Endometritis - clinical presentation
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foul-smelling lochia
fever leukocytosis uterine tenderness |
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Endometritis - treatment
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IV clindamycin and IV gentamycin
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OCPs - risks
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venous thromboembolism
stroke MI Breast Ca Cervical Ca increased triglycerides HTN worsening DM cholestasis / cholecystitis |
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OCPs - protective against
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ovarian cysts and cancer
endometrial cancer benign breast dz dysmenorrhea (anemia) |
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urethral hypermobility
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cotton swab in urethra
angle > 30 deg with increased intra-abdominal pressure (valsalva) |
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Pelvic inflammatory dz - diagnostic criteria
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fever > 38C
leukocytosis elevated ESR purulent cervical discharge adnexal tenderness cervical motion tenderness lower abdominal tenderness |
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lichen sclerosis et atrophicus
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chronic inflammatory condition
- most common in women - vulvar punch biopsy for dx - increased risk for vulvar squamous cell carcinoma - high potency topical steroids for tx |
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fibroids - clinical presentation
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dysmenorrhea
heavy menses enlarged uterus |
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Premature ovarian failure
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elevated FSH in the setting of 3 mos or more of amenorrhea in a women less than 40 yoa
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PCOS
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suspect in any woman with menstrual irregularities and signs of hyperandrogenism
- need OGTT in initial workup |
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asymtomatic bacteruria - treatment
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amoxicillin
nitrofurantoin (macrodantin) oral cephalosporin |
TMP-SMX (Bactrim) -- pregnancy class C
- may be used during 2nd tri - NOT during first tri b/c interferes with folic acid metabolism - NOT during 3rd tri --> increased risk of kernicterus |
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bacterial vaginosis
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malodorous discharge / vaginal irritation
increased risk for preterm delivery and LBW |
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GBS
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can cause UTIs, chorioamnionitis, endomyometrities, neonatal sepsis
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BV - diagnosis
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amine odor on whiff test
pH 5-6 clue cells on slide |
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BV - organisms
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Gardnerella vaginalis
Bacteroides Mycoplasma hominis |
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BV - treatment
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Metronidazole
500 mg BID for 1 week |
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VZV
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vertical transmission transplacentally
varicell zoster immune globulin can prevent transmission - any pt w/o h/o chickenpox with an exposure in pregnancy - give w/in 72 hrs of exposure |
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CMV
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maternal infxn - usually subclinical or mild viral illness
infants - 30% mortality - 90% have PERMANENT sequelae |
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Congenital rubella syndrome
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deafness, cardiac abnormalities, cataracts, mental retardation, blueberry muffin baby
IgM titers in infant indicative of infxn |
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Gonorrhoeae - tx
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ceftriaxone
PCN probenecid |
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Chlamydia - tx
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erythromycin
azithromycin NOT: tetracycline or doxycycline |
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onset of lactation
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24-72 hours postpartum
breasts firmer, warmer, tender |
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Postpartum hemorrhage
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vaginal delivery - blood loss > 500mL
c-sxn - blood loss > 1000 mL |
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postpartum hemorrhage - causes
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uterine atony
retained products of conception placenta accreta cervical lacerations vaginal lacerations |
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Methergen (methylergonovine)
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Given after oxytocin in uterine atony
- contraindication with HTN |
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Prostin (PGF2alpha)
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given after oxytocin and methergen in uterine atony
- contraindicated in asthma |
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Labial fusion
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excess androgens
usually 21-hydroxylase deficiency - may phenotypically be ambiguous genitalia |
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Puberty: primary amenorrhea with menstrual cramps
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Imperforate hymen or transvaginal septum
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Mayer-Rokitansky-Kuster-Hauser Syndrome
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- 46,XX
- mullerian agenesis or dysgenesis - normal ovaries |
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Testicular feminization syndrome
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- 46, XY
- insensitivity to testosterone - undescended testes |
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Fox-Fordyce disease
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puritic microcystic disease
- occlusion of apocrine sweat glands - if infxn and abscess formation --> hidradenitis suppurativa |
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HELLP Syndrome - tx
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Delivery is definitive tx beyond 34 wks when +fetal lung maturity or if fetal or maternal deterioration
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Galactorrhea
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BILATERAL nipple discharge, usually milky or clear, can be yellow, brown, or green
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Amsel criteria (for BV dx)
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Need 3 of 4:
1) thin gray-white vaginal discharge 2) pH > 4.5 3) amine odor with KOH = + whiff test 4) clue cells on wet mount |
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serum BUN and creatinine in pregnancy
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Decreased due to increased GFR and RPF
- Increased renal fcn begins early in 1st tri - reaches 40-50% above prepregnancy baseline |
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Hydaditiform mole - clinical triad
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1) enlarged uterus
2) hyperemesis 3) bhCG > 100,000 |
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Syphillis positive in pregnancy - tx
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1) PCN G
2) if PCN allergy -- PCN desensitization |
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amenorrhea
abdominal pain vaginal bleeding in a pt. of childbearing age |
ALWAYS r/o ectopic pregnancy
- pregnancy test is 1st diagnostic test |
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Tamoxifen
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SERM
- Estrogen receptor antagonist on breast -- tx/prevention of breast ca - Estrogen receptor agonist on endometrium -- increased risk of endometrial ca - decreased risk of osteoporosis |
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Threatened abortion
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Any hemorrhage before 20th week
- cervix closed - no passage of fetal tissue |
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incomplete abortion
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evacuation of some fetal tissue, remainder is retained
-vaginal discharge: blood / tissue - abdominal cramps ** cervical dilation |
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complete abortion
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entire conceptus passes through cervix
**cervical dilation - cervix closes after passage |
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inevitable abortion
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vaginal bleeding, lower abd cramps -- radiate to back and perineum, dilated cervix
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Biophysical profile - 5 components
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1) NST (reactive)
2) fetal tone (flexion / extension of extremity) 3) fetal movements (at least 2 in 30 mins) 4) fetal breathing movements (at least 20sec in 30 mins) 5) amniotic fluid volume (single vertical pocket > 2cm) |
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Biophysical profile - scoring
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Score two for each component when present.
Score zero when absent or abnormal 8-10 normal |
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BPP = 8, low amniotic fluid volume
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delivery, fetal compromise likely
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BPP = 6, no oligohydramnios
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delivery if > 37 wks or repeat BPP in 24 hrs -- delivery if not improved
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BPP = 6, low amniotic fluid volume
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delivery if over 32 weeks or daily monitoring
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BPP < 4
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Delivery if > 26 weeks
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hypotension with epidural - cause
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sympathetic fiber block causes blood pooling in venous system
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Raloxifene
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SERM
- used to prevent osteoporosis - increases risk of venous thromboembolism -- contraindicated if h/o DVT - SE: hot flushes, leg cramps |
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precocious puberty
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development of secondary sex characteristics before age 8 (girls) or 9 (boys).
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maternal quadruple screen
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1) bHCG
2) MSFAP 3) Inhibin A 4) estriol |
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Down's syndrome - quadruple screen results
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1) elevated bHCG
2) decreased MSAFP 3) decreased estriol 4) elevated inhibin A |
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1 hr OGTT -- cutoff value
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< 140 mg/dL
- rules out GDM - screen b/twn 24-28 wks |
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3 hr OGTT - cutoffs
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GDM if 2 of 3 are abnl:
fasting < 95 mg/dL 1 hr < 180 mg/dL 2 hr < 155 mg/dL 3 hr < 140 mg/dL |
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Endometrial hyperplasia
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abnormal proliferation of glandular and stromal elements with normal histologic appearance
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Simple hyperplasia
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abnormal proliferation of both stromal and glandular elements
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complex hyperplasia
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abnl proliferation of glandular elements w/o proliferation of stromal elements
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atypical simple hyperplasia
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cellular atypia and mitotic figures in addition to glandular crowding and complexity
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atypical complex hyperplasia
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progresses to carcinoma in 29%
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Follicular ovarian cysts
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most common functional cysts
from unruptured follicles asymptomatic, unilateral |
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Corpus lutein cyts
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during luteal phase of menses
from enlarged/hemorrhagic corpus luteum - can cause delayed menstruation, dull lower quadrant pain |
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Theca lutein cysts
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small bilateral filled with clear, straw-colored fluid
from stim with abnl high bHCG - molar pregnancy - choriocarcinoma - clomiphene |
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endometriosis
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presence of endometrial tissue (glands and stroma) outside endometrial cavity
- most common sites: ovary, pelvic peritoneum |
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endometrioma
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cystic collection of endometriosis in the ovary
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Halban theory (endometriosis)
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endometrial tissue is transported via lymphatic system to ectopic sites in pelvis
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Meyer theory (endometriosis)
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multipotential cells in peritoneal tissue undergo metaplastic transformation into functional endometrial tissue
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Sampson theory (endometriosis)
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endometrial tissue is transported throug the fallopian tubes during retrograde menstruation
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endometriosis - symptoms
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dysmenorrhea
dyspareunia infertility abnl bleeding cyclic pelvic pain - Sx severity does not correlate with amt of endometriosis |
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adenomyosis
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extension of endometrial glands and stroma into uterine musculature
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adenomyosis
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extension of endometrial glands and stroma into uterine musculature
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Syphillis
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Incubation: 7-14 days
Primary lesion: papule (chancre) Tx: PCN |
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Chancroid
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painful, demarcated, nonindurated ulcer located anywhere in anogenital region
Haemophilus ducreyi |
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lymphgranuloma venereum
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l-serotypes of chlamydia trachomatis
tx: doxycycline, 100mg PO BID for 21 days |
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endomyometritis
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uterine tenderness, fever, and elevated WBCs
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endomyometritis - tx
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clindamycin 900 mg IV Q8hrs
gentamycin 2mg/kg loading and 1.5 mg/kg Q8 hrs |
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Fitzhugh-Curtis Syndrome
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peri-hepatitis from ascending PID
RUQ pain and tenderness LFT elevations |
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Toxic Shock Syndrome
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high fever (>102)
erythematous rash hypotension desquamation of palms/soles (1-2 wks post-acute illness) |
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cystocele
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herniation of the bladder into vaginal vault
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urethrocele
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herniation of urethra into vaginal vault
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rectocele
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herniation of rectum into vaginal vault
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enterocele
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herniation of small bowel into vaginal vault
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1st degree pelvic relaxation
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structure in upper 2/3 of vagina
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2nd degree pelvic relaxation
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structure descended to level of introitus
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3rd degree pelvic relaxation
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structure protrudes outside of vagina
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Stress incontinence
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urine loss with exertion or straining
- pelvic relaxation - displacement of urethrovesical junction |
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Urge incontinence
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= detrusor instability
urine leakage due to involutary, uninhibited bladder contractions during filling phase |
UTIs
bladder stones bladder ca suburethral diverticula foreign bodies |
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Total incontinence
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continuous urine leakage
- urinary fistula |
diagnose with methylene blue or indigo carmine
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overflow incontinence
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urine loss due to poor / absent bladder contractions
frequent / constant urinary dribbling |
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mucosal coaptation
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estrogen-sensitive filling mechanism of urethral vasculature
- estrogen increases urethral resting pressure -> promotes continence |
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PNS bladder control
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allows micturition
S2, S3, S4 |
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SANS bladder control
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prevents micturition
contraction of bladder neck and internal sphincter hypogastic nerve from T10-L2 |
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cotton swab test
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used to diagnose hypermobile bladder neck -- stress incontinence
nL = change in angle < 30 deg hypermobile = 30-60 deg |
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Cystometrogram
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distinguish stress incontinence and detrusor instability
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Uroflowmetry
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measures rate of urine flow through urethra
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follicular phase
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FSH --> primary ovarian follicle develops --> produces estrogen --> proliferation of uterine lining
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endometrium in proliferative phase
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luteal phase
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after ovulation
corpus luteum develops --> secretes progesterone --> maintains endometrial lining (prep for fertilized ovum) |
endometrium in secretory phase
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theca interna cells
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produce androstenedione
respond to LH |
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granulosa cells
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convert androstenedione to estradiol
respond to FSH |
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climacteric
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termination of reproductive phase
perimenopause |
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Primary amenorrhea
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absence of menses in women who have not undergone menarche by age 16 or not by 4 years after thelarche
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Secondary amenorrhea
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absence of menses for 3 menstrual cycles or a total of 6 mos in women with previously nL menstruation
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Painful third trimester bleeding
normal ultrasound |
placental abruption
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placental abruption - risk factors
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Maternal HTN and preecclampsia
previous abruption trauma rapid hydramnios decompression short umbilical cord tobacco and cocaine folate deficiency |
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septic abortion - presentation
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fever, chills
abdominal pain bloddy / purulent vaginal discharge |
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emergency contraception
Plan B |
Levonorgestrel
- up to 120 hrs after intercourse |
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maternal fasting glucose
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75-90 mg/dL
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Gestational Diabetes - risks to fetus
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macrosomia
hypocalcemia hypoglycemia hyperviscosity (polycythemia) resp difficulties cardiomyopathy CHF |
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spontaneous abortion
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before 20th week
fetal weight < 500 g |
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central precocious puberty
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premature activation of hypothalamic-pituitary axis
- Administer GnRH agonist therapy to prevent premature epiphyseal plate closure |
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Turner syndrome - FSH level
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high
-- poor ovarian function --> low estrogen --> decreased feedback --> high FSH |
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primary dysmenorrhea
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usually before age 20
a/w increased tissue prostaglandins |
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secondary dysmenorrhea
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dysmenorrhea caused by:
endometriosis adenomyosis fibroids cervical stenosis pelvic adhesions |
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Abnormal uterine bleeding
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any irregularity in the menstrual cycle
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menorrhagia
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heavy / prolonged menstrual bleeding
> 80 mL |
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Metrorrhagia
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bleeding between periods
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hypomenorrhea
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periods with unusually light flow
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polymenorrhea
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frequent periods
similar bleeding episodes fewer than 21 days apart |
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oligomenorrhea
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periods greater than 35 days apart
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dysfunctional uterine bleeding
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diagnosis of exclusion for no known cause of menorrhagia, metrorrhagia, menometrorrhagia
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postmenopausal bleeding
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vaginal bleeding more than 12 months after menopause
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vaginal atrophy
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most common source of lower genital tract postmenopausal bleeding
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vellus hair
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nonpigmented
soft covers entire body |
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terminal hairs
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pigmented, thick
scalp, axilla, pubic areas |
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hirsutism
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increase in terminal hairs on face, chest, back, lower abdomen, inner thighs
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virilization
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development of male features
deepening of voice, frontal balding, increased muscle mass, clitoromegaly, breast atrophy, male body habitus |
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contraception - physiology-based methods
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periodic abstinence, coitus unterruptus, lactational amenorrhea
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well-rugated, moist vagina with abundant clear stretchable cervical mucous
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sign of current estrogen secretion
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evidence of ovulation
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track menstrual cycle
basal body temp cervical mucus midluteal progesterone premenstrual / ovulatory symptoms |
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clomiphene citrate - mechanism
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induction of ovulation - antiestrogen -- competitively binds to estrogen receptors in hypothalamus --> stims pulsatile release of GnRH --> increase FSH and LH
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ovarian hyperstimulation
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iatrogenic disorder (Pergonal) -- ovarian enlargement, torsion, rupture
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Direct role of HCG in pregnancy
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maintain corpus luteum (and therefore progesterone secretion) until the placenta is able to secrete progesterone on its own
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dyspareunia - medical causes
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endometriosis
local infections vulvar / vaginal growths estrogen deficiency |
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Kallman's syndrome
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congenital absence of GnRH
a/w anosmia |
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mittelschmerz
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midcycle pain caused by ovulation itself
common in women who are not on OCPs |
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% risks for endometrial cancer based on results of biopsy
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penny nickle dime quarter
1% simple hyperplasia without atypia 5% complex hyperplasia without atypia 10% simple hyeprplasia with atypia 25% (really 35-40) complex hyperplasia with atypia |
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indications for a pregnant woman to come into L&D
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contractions q5min for 1 hr
vaginal bleeding less than 10 fetal movts / 2 hours rupture of membranes |
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tocolysis: strategies
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ritodrine/terbutaline: beta mimetic
hydration: decreases ADH secretion (cross reacts with oxytocin receptors) MgSO4: calcium antagonist CCBs: nifedepine Indomethacin: prostaglandin inhibitor |
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preterm infants are at increased risk for:
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necrotizing enterocolitis
RDS ROP intraventricular hemorrhage sepsis |
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best way to check for MgSO4 toxicity
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serial reflex checks: mg causes decreased DTRs before reaching toxic levels
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how/when do you treat PPROM?
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before 32 weeks: risk of prematurity outweighs, give abx (tocolytics, corticosteroids and ampicillin w/ erythromycin)
after 36 weeks: risk of infection outweighs, def don't give tocolytics |
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postpartum diuresis requirements for women with preeclampsia treated with Mg?
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must be treated with Mg until the women diureses 200ml/hour for 4 consecutive hours
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partial vs. complete molar pregnancy: source of chromosomes
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partial: normal egg (23), fertilized by two sperm (23), trisomy of all chromosomes
complete: empty egg (0) fertilized by one sperm (23, usually X), which then doubles itself |
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partial vs. complete molar pregnancy: diagnostic differences
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partial: appears like a fetus, malformations, U/S: gestational sac, focal vesiculations on placenta
complete: no fetal tissue, no gestational sac, diffuse vesiculations on placenta. VERY high hCG levels (>100K) |
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when to deliver based on BPP
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BPP<4 : deliver >26wks
BPP=6 with oligo: deliver >32wks BPP=6 with nl AFI: deliver >37wks, if <37, repeat in 24hr deliver if no change BPP 8+: normal |
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normal vaginal pH
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3.8-4.5 during reproductive years
>4.7 premenarche and postmenopausal |
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vaginal wet mount: what are parabasal cells?
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smaller than squams, larger nuclei
ddx: atrophy, inflammation (infection or Lichen Planus) |
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trichomonas dx
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many wbcs
pH >5.0 motile trichomonads on wet prep |
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