Ob/gyn - Step Up To Step 2 Part 2

Front 1

Ectopic pregnancy
-implantation usually where
-RFs
-labs
-US findings
-Tx

Back 1

-ampulla
-RF: PID, prior ectopic, gyn surgery
-Labs: elevated beta-hcg but low for time of gestation
-US findings should be able to see IUP
-transabdominal at beta of 6500
-TVUS at beta of 1500
-Tx: MTX if not ruptured and good follow up
Ruptured: IV fluids and surgical excision

Front 2

Spontaneous abortion
-define
-first TM causes
-Second TM causes
-RFs

Back 2

-<20 weeks nonelective termination
-First TM: chromosomal abnormalities (trisomy)
-Second TM: infxn, cervical incompetence, uterine abnormalities, poor health or drug use
-RFs: *increased maternal age* prior SAB, smoking, alcohol, NSAIDs, cocaine, caffeine

Front 3

Intrauterine fetal demise
-define
-caused by
-tx
-complications

Back 3

-IUFD occurs after 20 weeks gestation
-caused by placental or cord abnormalities due to maternal conditions (*collagen vasc dz*), htn, infection, poor health, fetal abnormalities
-tx: oxytocin, misoprostol, D&E if <24 weeks
-cx: DIC

Front 4

IUGR - define

Back 4

< 10th percentile

Front 5

IUGR - symmetric

Back 5

<20 weeks, 20% of cases
decrease in fetal size
caused by:
*chromosomal abnormalities*
*congenital infection*

Front 6

IUGR - asymmetric

Back 6

> 20 weeks, 80% of cases
caused by: multi gestation, poor maternal health, placental insufficiency

fundal ht at least 3 cm smaller

Front 7

threatened abortion

Back 7

bleeding <20 weeks, closed os, viable fetus

Front 8

missed abortion

Back 8

bleeding present, nonviable fetus

Front 9

inevitable abortion

Back 9

<20 weeks with painful bleeding, open os

Front 10

incomplete abortion

Back 10

<20 weeks bleeding with open os and some uterine contents expelled

Front 11

complete abortion

Back 11

< 20 weeks bleeding open os, all uterine contents expelled

Front 12

normal AFI

Back 12

5-25

Front 13

Oligohydramnios
-associated with
-First TM
-second TM
-third TM

Back 13

AFI < 5
-IUGR, fetal stress, renal abnormalities
-1st TM: results in SAB
-2nd TM: fetal renal abnormalities, maternal causes, placental thrombosis
-3rd TM: PROM, preeclampsia, abruption

Front 14

Polyhydramnios
-can result from
-tx < 32 weeks
-tx > 32 weeks

Back 14

AFI> 25
-can result from:
-insufficient swallowing - esophageal atresia
-increased urination - maternal diabetes
-multi gest, anemia, chromosomal abnormalities

TX if maternal discomfort or threat of PTL:
-Tx < 32 weeks
amnioreduction and indomethacin
-tx > 32
amnioreduction only

Front 15

PROM
-RFs

Back 15

vaginal infxn cervical incompetence poor nutrition prior PROM

Front 16

PROM management 25-34 weeks

Back 16

1) hospital - bedrest

2) betamethasone

3) latency abx: amp and azithromycin
(2 days IV, 5 days po)

Also:
-Monitor: for fetal stress, labor abruption, do NSTs BID
-GBS swab
-UDS

Front 17

Preterm labor
-RFs
-Tx <34 weeks

Back 17

-multi gest, PROM, smoking, etc etc
-<34 weeks: tocolytic therapy for 48 hrs to give time for glucocorticoid induced lung maturity (MgSO4, terbutaline)
->34 weeks: empiric amp if delivery imminent

Front 18

RFs for placenta previa

Back 18

prior, multip, prior C/S, maternal age, fibroids, hx of abortion, smoking

Front 19

managing placenta previa

Back 19

bed rest
rhogam
c/s if delivery indicated
cx: hemorrhage, IUGR, maternal death

Front 20

Abruption
-RFs
-H/P
-tx
-cx

Back 20

-RFs: HTN, prior abruption, SMOKING, COCAINE, PROM, multigest
-Painful 3rd TM bleeding
- delivery happens quickly if hemodynamically unstable do C/S
-cx: DIC and severe hemorrhage

Front 21

C/I to inducing labor

Back 21

c/s
prior uterine surgery
fetal lung immaturity
active herpes
placenta previa

Front 22

Bishop score components

Back 22

Cervical dilation
Cervical effacement
Cervical consistency
Cervical position
Station

Front 23

Breech: frank vs complete vs footling

Back 23

frank: 75%, thighs flexed, knees extended
complete: thighs and knees flexed
footling: one or both legs extended

Front 24

Managing breech

Back 24

most reposition before delivery
external cephalic version 75% effective
often ends in c/section

Front 25

Active phase of labor

Back 25

4 cm dilation until near 10 cm

Front 26

Active phase how many cm/hr for nullip vs multip

Back 26

nullip: 1.2 cm/hr
multip: 1.5 cm/hr

Front 27

First stage of labor length nullip vs multip

Back 27

nullip <20 hrs (2/3 latent 1/3 active)
multip < 14 hr

Front 28

Second stage of labor, duration for nullip vs multip epidural vs not

Back 28

nullip:
<2 hrs, <3 hrs with epidural
multip:
<1 hr, <2 hrs with epidural

Front 29

Most common indications for a cesarean

Back 29

*prior c/s
*dystocia/failure to progress
*breech/malpresentation
placenta previa

Front 30

Highly suspect molar pregnancy if

Back 30

preeclampsia in first half of pregnancy

Front 31

Complete vs incomplete hydatidiform mole

Back 31

complete 46 XX/XY (empty egg penetrated by sperm)
incomplete 69 XXY/XXX, XYY (fertilization of egg by two sperm)

Front 32

RFs for mole

Back 32

older, low SES, prior molar, asian, smoking

Front 33

mole: US findings? tx?

Back 33

snowstorm pattern
expulsion of grape like mass
tx: d&c, follow bhcg for 1 yr and avoid pregnancy during that time

Front 34

choriocarcinoma

Back 34

arises from hydatidiform moles 50% of the time or after abortion, ectopic, or normal 0.o

increased beta

US: uterine mass with hemorrhagic and necrotic areas

cx: mets to lung brain liver kidneys GI