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100 Cards in this Set
- Front
- Back
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Rx for advanced (Stages II+) ovarian cancer
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Surgical removal, followed by adjuvant chemo (taxane + carboplatin)
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When is magnesium sulfate given for preeclampsia?
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During delivery and 24 hours postpartum
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Therapeutic level of mag sulfate
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4-7
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Mag sulfate levels associated with respiratory depression and cardiac arrest
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>12 and >15
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Contraindications to expectant management of severe preeclampsia (e.g. indications for delivery)
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Thrombocytopenia < 100,000,
Inability to control BP w/ max doses of 2 antihypertensives, Non-reassuring fetal surveillance, LFTs < 2x nml, Eclampsia Persistent CNS Sx Oliguria |
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How fast should hCG rise in a normal pregnancy?
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Should double (or increase by 66%) every 48 hours
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Inappropriately rising (e.g. too low) beta-hCG levels indicate
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Abnormal pregnancy (e.g. ectopic, incomplete abortion, or resolving complete abortion)
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Distinction btwn a normal gestational sac and a pseudogestational sac
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Pseudo is located in the midline
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Serum progesterone <5 indicates
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Specific for nonviable pregnancy
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What is the Arias-Stella reaction?
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Hypersecretory endometrium of prengnacy on histology that occurs w/ BOTH ectopic and intrauterine pregnancies
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Culdocentesis is looking for
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Blood in peritoneal cavity, e.g. from ruptured ectopic (or purulent fluid from infection)
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Medical Rx for ectopic
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Methotrexate
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Relative contraindications to MTX for ectopic
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Cardiac activity
Mass >3.5cm (often correlates with b-hCG > 15,000) |
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Absolute contraindications to MTX
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Breastfeeding, immunodeficient, alcoholic, blood dyscrasia, pulmonary disease, PUD, hepatic/renal/hematology dysfxn
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When is more than one dose of MTX needed?
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If beta-hCG levels plateau or increase after 7 days
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Asherman's Syndrome includes the presence of what?
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Uterine synechiae (intrauterine adhesions)
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What is threatened abortion, what is the risk of subsequent spontaneous abortion, and what are the risks if carry to viability?
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Bleeding in the first trimester without tissue or fluid loss
50% Greater risk of preterm and low birth weight |
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What is inevitable abortion?
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Gross rupture of membranes w/ cervical dilation (contractions typically begin soon afterward)
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After what time are the fetus and placenta typically expelled separately?
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10wks
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After how many days should surgical abortion be performed instead of medical?
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49 days since LMP
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3 drugs for early medical abortion
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Mifepristone (antiprogestin), MTX (antimetabolite), misoprostol (prostaglandin)
All induce uterine contractility, either directly (misoprostol) or by decreasing progesterone inhibition |
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Rx for a septic abortion
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Broad spectrum IV Abx, IVF, prompt evacuation of uterus
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What is postabortal syndrome and how is it treated?
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Uterus fails to remain contracted after spontaneous abortion or elective abortion (pain, bleeding, open cervix, hematometra)
Suction curettage |
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At what beta-hCG level can an intrauterine pregnancy be appreciated?
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>2000
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Most common abnormal karyotope in aborted fetuses
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Autosomal trisomy
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Systemic maternal diseases associated w/ early pregnancy loss
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DM, SLE, CKD
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Rx for significant anemia during spontaneous abortion
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D&C
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Effect of single, prior first trimester surgical abortion on fertility/ likelihood of future early pregnancy losses
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No effect/ no increased risk
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Once pt at high risk for cervical cancer and has lesion, management option
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Cervical biopsy (can skip Pap smear, a screening test, as well as colposcopy since lesion can already be visualized)
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Screening tests for a normal African American couple wanting to conceive
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CBC and Hb electrophoresis
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Valproic acid is associated with an increased risk of these three abnormalities
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Neural tube defects, hydrocephalus and craniofacial malformations
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Women with poorly controlled DM during organogenesis are at risk for structural anomalies in these two systems
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CNS and CV
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Chorionic villus sampling is used to detect
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Chromosomal abnormalities
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Three components of triple screen + extra of quad screen
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AFP, hCG, unconjugated estriol
Inhibin A |
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Test for Down's in first trimester
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PAPP A (pregnancy associated plasma protein A)
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Risk of fetal loss with CVS
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1%
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Most sensitive screen for Down's in second trimester (and its sensitivity)
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Quad screen, 80-85%
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Risks of gestational diabetes
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Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios and fetal macrosomia
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Risk of pre-existing, but not gestational, diabetes
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IUGR
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Most common anomaly associated with valproic acid
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NTDs
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Definition of postpartum hemorrhage
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>500cc in a vaginal delivery or >1000cc in a C section
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Most common cause of postpartum hemorrhage
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Uterine atony
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Significant blood loss during delivery --> inability to breast feed, amenorrhea, constipation, slurred speech
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Sheehan Syndrome
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Cause of Sheehan Syndrome
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Anterior pituitary necrosis after significant blood loss
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Hormones affected by Sheehan Syndrome
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Gonadotropin, TSH, ACTH
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Increased risk of endometritis
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C section
With vaginal delivery: prolonged labor, prolonged ROM, multiple vaginal exams, internal fetal monitoring, manual removal of placenta, low SES |
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Most common cause of postpartum fever
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Endometritis
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Most common bacteria in postpartum endometritis
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Polymicrobial, aerobes + anaerobes (often staph and strep)
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Sign that can distinguish postpartum depression from postpartum blues
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Ambivalence toward newborn/ family
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Safest method of suppressing lactation
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Breast binding, ice packs and analgesics
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Cause of a normocytic anemia in pregnancy
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Hemodilution: maternal blood volume increases more than RBC volume
(iron deficiency would cause microcytic) |
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Physiologic respiratory/ acid base changes during pregnancy
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Increased minute ventilation --> compensated respiratory alkalosis
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Why does minute ventilation change in pregnancy?
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Because tidal volume increases (RR stays constant)
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Why are pregnant women susceptible to pulmonary edema?
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Decreased plasma osmolality
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Tocolysis with alpha agonists (e.g. terbutaline) increases the risk of this respiratory finding
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Pulmonary edema
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Hydronephrosis is more common on which side during pregnancy?
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Right
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Snowstorm pattern on ultrasound
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Gestational trophoblastic disease
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First step in the work-up of GTD
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CXR (will need weekly quants and a CBC as well)
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Substance that produces insulin resistance?
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Chorionic somatomammotropin (previously called human placental lactogen)
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Does insulin cross the placenta?
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No
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Normal PVR
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50-60cc
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PVR > 300cc indicates
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Overflow incontinence (due to underactive detrusor muscle or obstruction)
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Name for detrusor overactivity incontinence (e.g. when bladder is contracting too frequently)
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Urge incontinence
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Incontinence due to increased abdominal pressure in the absence of a detrusor contraction
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Genuine stress incontinence
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What is used for measurement of hypermobility in genuine stress incontinence?
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Straining Q-tip angle (if >30 degrees from horizon)
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Best surgical options (2) for pts with genuine stress incontinence w/ hypermobility
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Retropubic urethropexies or slings
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When are urethral bulking procedures effective for incontinence?
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When there is little to no mobility of the urethra
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Urethral bulking procedures are best for this type of incontinence
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Intrinsic sphincteric deficiency
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Best medical Rx for urge incontinence (detrusor overactivity)
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Anticholinergics, e.g. oxybutynin
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Kegel exercises are useful for this type of incontinence
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Stress urinary incontinence
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What does vaginal estrogen help with in terms of incontinence?
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Urgency, but NOT urge incontinence
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What is repaired in rectoceles?
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Defects in the rectovaginal fascia
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What is repaired in central and lateral cystoceles?
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Defects in pubocervical fascia
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Rx for uterine prolapse
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Vaginal hysterectomy
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Cause of stress incontinence
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Increase in intra-abdominal pressure (coughing, sneezing) when the patient is in the upright position
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What structural defects are associated w/ stress incontinence?
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Cystocele or urethrocele
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Continuous loss of urine
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Vesicovaginal fistula
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Cause of mixed incontinence
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Increased intra-abdominal pressure causes the urethral-vesical junction to descend causing the detrusor muscle to contract
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Small amt of continuous leaking
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Overflow incontinence
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What is colpocleisis and what is it used to treat?
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Surgical obliteration/ closure of the vaginal canal; vaginal prolapse
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Best least invasive option for prolapse
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Pessary
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Management of pt with FHR in the 60s and head at the introitus?
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IF patient cannot deliver vaginally with 1-2 pushes, go to assisted operative vaginal delivery
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Significant amt of vaginal bleeding after placement of an IUPC
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Presume uterine perforation–remove, monitor fetus; if reassuring, can reattempt
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Advantages of the midline episiotomy over the mediolateral episiotomy
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Less pain, less blood loss, ease of repair
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How long does the fourth stage of labor last?
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From delivery of the placenta until two hours afterward
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Abnormalities that may indicate Down's
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Flattened nasal bridge, small size, small rotated/ cup-shaped ears, andal gap toes, hypotonia, a protruding tongue, short broad hands, Simian creases, epicanthic folds, and oblique palpebral fissures
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Most likely fetal complication after maternal treatment with mag
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Respiratory distress
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Mom with T1DM will most likely have a baby that is small/large and hypo/hyperglycemic?
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Small
Hypoglycemic |
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Appearance of a septic infant
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Pale, lethargic, high temp
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Infants born to diabetic mothers are at increased risk of these 5 complications:
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Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, respiratory distress
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When to start treatment and testing in an infant born to an HIV+ mother
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Treatment immediately
Testing starts at 24hrs |
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2 growth issues in diabetic mothers
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Growth restriction
Macrosomia |
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Other risks in diabetics
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Polyhydramnios
Caudal regression syndrome CV defects NTDs Preterm birth Hypertensive complications |
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When should zidovudine be initiated in pregnancy?
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14wks (oral, switch to IV at delivery)
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Most common cause of sepsis in pregnancy
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Pyelo
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Drug for thyroid storm contraindicated in pregnancy
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Radioactive iodine (concentrates in fetus --> hypothyroidism)
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Rx for thyroid storm in pregnancy
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Thioamitdes, propanolol, sodium iodide, dexamethasone
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White classification for diabetes in pregnancy
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Class A1: gestational, diet controlled
Class A2: gestational, insulin controlled Class B: onset >20yo w/ duration <10yrs Class C: onset <20yo or duration >10yrs Class D: onset <10yo or duration >20yrs Class E: calcified pelvic vessels Class F: nephropathy Class R: retinopathy Class H: ischemic heart disease Class T: prior kidney transplant |
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Rx for bacterial vaginosis during pregnancy
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Immediate oral metronidazole to reduce risk of preterm delivery (no partner treatment needed)
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Highest mortality rates in pregnancy (>25-50%)
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Pulmonary hypertension, Marfan's syndrome, aortic coarctation w/ valve involvement
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