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134 Cards in this Set

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What is most commonly the cause of labial fusion?
Excess androgens - exogenous or congenital adrenal hyperplasia
How is labial fusion treated?
Cortisol - which shuts down ACTH to inhibit the stimulation of the adrenal gland that is shunting all steroid precursors into androgens
Primary amenorrhea in the setting of cyclic pelvic pain?
Imperforate hymen, transverse vaginal septum, atresia, or agenesis
Vaginal agenesis occurs in which conditions?
MRKH syndrome and androgen insensitivity
MRKH syndrome?
Hypoplasia/absence of proximal vagina, cervix, uterus, and fallopian tubes
Androgen insensitivity...what causes it?
XY, nonfunctioning androgen (testosterone) receptors --> wolffian system never develops but mullerian inhibiting factor is still present: phenotypically female, with no uterus, hypoplasia of vagina, and undescended gonads
Lichen sclerosis
Vulvar skin changes that can cause atrophy
Lichen simplex chronicus
Chronic inflammatory process that can cause vulvar pruritus
Lichen planus
Shiny violaceous papules on flexor surfaces, mucous membranes, and vulva
Vaginal adenosis
Benign red grandular spots of the vaginal mucosa, often assoc. with DES exposure in utero
w/u of vulvar lesions?
Biopsy
Most common mass found on the vulva?
Epidermal inclusion cyst
Urethral caruncle?
Small fleshy tumors found at the distal urethral meatus, occuring mostly in postmenopausal women with vulvovaginal atrophy
Treatment of Bartholin's cysts?
if small - sitz baths, if large/abscess surgery... if woman >40, biopsy.
Most cervical cysts are..?
Nabothian cysts (dilated retention cysts)
Potential causes of cervical stenosis?
Congenital, post-op sarring, radiation, neoplasm, polyp, fibroid
Which reproductive structures do not arise from the mullerian system?
Ovaries and the lower 1/3 of the vagina
Most common anatomic uterine anomaly?
Septate uterus
Why are uterine septums and bicornuate/unicornuate uteri often incompatible with pregnancy?
Uterine septum - lack of adequate blood supply (first trimester loss)
Bicornuate/unicornuate - limited size of uterine horn (2nd trimester loss, preterm labor, etc.)
Fibroids - what age group?
Generally women of childbearing age; often regress during menopause
Fibroids can grow in response to which hormone?
Estrogen
Most common symptom of fibroids?
Abnormal uterine bleeding
Classic physical exam findings with fibroids?
Irregularly enlarged uterus with lumpy-bumpy / cobblestone protrusions
Medical management of fibroids and how does it work?
Provera, danazol, and GnRH agonists - decreasing circulating estrogen levels
Non-medical therapy of fibroids?
Uterine artery emnbolization, myomectomy, hysterectomy
Most severe form of endometrial hyperplasia?
Atypical complex hyperplasia
Risk factors for endometrial hyperplasia?
Obesity, nulliparity, late menopause, chronic anovulation, PCOS, and exogenous estrogen (without progesterone)
Treatment of endometrial hyperplasia?
Progestin therapy or D&C (if without atypia). Atypical complex is often treated with hysterectomy
Risk of developing EM CA with EM hyperplasia?
30%
Endometriosis
Presence of endometrial tissue outside the endometrial cavity
Name the common functional ovarian cysts
Follicular cysts, corpus luteum cysts, theca lutein cysts
Symptoms/presentations from ovarian cysts?
Often asymptomatic - occasionally menstrual disturbances, pelvic pain, dyspareunia, torsion, etc.
Palpable ovary or adnexal mass in a premenarchal or postmenopausal patient is suggestive of..?
Ovarian neoplasm
Most common sites of endometriosis?
Ovary and pelvic peritoneum
Endometriosis has been found with increased incidence in women with which systemic diseases?
Autoimmune diseases
Classical symptoms of endometriosis?
Cyclic pelvic pain begining 1-2 weeks pre-menses and resolving shortly after menses
Features of endometriosis intra-op?
"Powder burns" or "mulberry" lesions, often surrounded by reactive fibrosis, chocolate cysts
Medical regimens for endometriosis?
NSAIDs, OCPs, progestational agents, pseudomenopause (danazol, GnRH agonists, etc)
Side effects of danazol?
Androgen-related, anabolic side effects including acne, oily skin, weight gain, edema, hirsutism, and voice deepening
What is adenomyosis?
The extension of endometrial tissue into the uterine myometrium
Is adenomyosis responsive to OCPs or other medical treatments?
No
Physical exam of uterus in a patient with adenomyosis?
Soft, diffusely enlarged globular uterus
After US, what imaging can be used to diagnose adenoymosis?
MRI
Definitive treatment for adenomyosis?
Hysterectomy
Beta HCG rises to a peak of ____ by _______ weeks of gestation?
100,000 by 10 weeks of gestation
Ultrasound can confirm pregnancy as early as ___ weeks?
5
Simplest rule for estimating EDC from LMP?
Subtract 3 months and add 7 days
The decrease in systemic vascular resistance in pregnancy is most likely due to...?
Elevated progesterone leading to smooth muscle relaxation
How does hematocrit level change in pregnancy and why?
Plasma volume increases by 50%, but RBC volume increases by only 20-30%.
Levels of HCG double approximately every ____ hours during early pregnancy?
48 hours
List two pigmentation changes often seen in pregnancy?
Linea nigra, melasma/cholasma
First trimester tests in pregnancy?
CBC, Type and screen, RPR, rubella, HBVSa, UA, urine culture. Often PPD, toxoplasma titers, HIV, VZV titer if no h/o chickenpox
Doppler US can auscultate the fetal heart rate after ___ weeks?
10-14 weeks
Routine 2nd trimester tests?
MSAFP/triple screen, US, amnio in AMA patients
Vaginal bleeding in the first trimester could be a sign of..?
Ectopic, miscarriage
Vaginal bleeding in the 2nd trimester could be a sign of..?
Placental abruption or previa
increase in MSAFP can be seen in___? Decrease can be seen in ___?
Neural tube defects
Down syndrome
Components of quad screen?
BHCG, estriol, MSAFP, inhibin A
Patients who are Rh negative should receive RhoGAM at ___ weeks?
28
Third trimester tests?
Hct, RPR, GLT, Repeat GC/Chl, GBS
What are Braxton-Hicks contractions?
Irregular uterine contractions that are normal
Dependent edema in pregnancy is usually due to...?
IVC compression
How to monitor high-risk pregnancies in the third trimester?
BPP, fetal growth, fetal doppler studies, nonstress test
How is a NST considered formally reactive?
Two 15x15 accels in 20 mintues
What to do if the NST is nonreactive?
Assess the fetus by US. If there are any worrisome decels or the BPP is nonreassuring, an OCT is performed or delivery is considered
When is percutaneous umblilical blood sampling performed?
Setting of Rh isoimmunization, other causes of fetal anemia, and hydrops
How to predict fetal lung maturity?
Lecithin to sphingomyelin (L/S) ratio (if less than 1.5, high risk of RDS)
Where do most ectopics occur?
Tubes
Why has the incidence of ectopics been increasing?
increase in assisted fertility, STDs, and PID
Risk factors for ectopic pregnancy?
Prior ectopic, us of IUD, PID causing scarring or decreased peristalsis
Classical lab finding in ectopic pregnancy?
BHCG that is low for gestational age and does not increase at the expected rate
At what BHCG levels should an IUP be seen?
1500-2000
What therapy is frequently used for uncomplicated, nonthreatening ectopic pregnancy?
Methotrexate -
Spontaneous abortion defined as...?
Pregnancy that ends before 20 weeks gestation
Name the types of spontaneous abortion?
Complete, Incomplete, Inevitable, Thretened, Missed
Define inevitable abortion?
Bleeding and dilation of the cervix such that a viable pregnancy is unlikely
Most spontaneous abortion in the first trimester are due to...?
Xsomal abnormalities
How can an incomplete abortion be taken to completion?
expectant management, D&C, or prostaglandins
What is a threatened abortion?
Any intrauterine bleeding before 20 weeks without dilation of the cervix or expulsion of POC
Missed abortion?
death of the fetus before 20 weeks with complete retention of POC
Common etiologies of second trimester abortions?
Infection, uterine/cervical defects, maternal systemic disease, fetotoxins, trauma, preterm labor, incompetent cervix
Tx for incompetent cervix?
Betamethasone, strict bed rest, tocolysis if there's a component of PTL, possible cerclage
Recurrent pregnancy loss defined?
Three or more consecutive SABs
What conditions predispose to recurrent pregnancy loss?
Antiphospholipid syndrome, luteal phase defect, anatomic defects, other systemic conditions
Tx for APA syndrome?
low dose aspirin
Tx for luteal phase defect?
Progesterone
CF screening?
If mother has positive screen, test partner, if he's positive, do amnio or CVS
Sickle cell screening?
All african-americans, hemoglobin electrophoresis
How can thalassemias be screened in pregnant women?
Heterzygotes will have a mild hemolytic anemia and low MCV on routine CBC
Best way to diagnose prenatal xsome abnormalities?
Fetal karyotype
Down syndrome associated anomalies?
Cardiac defects, duodenal atresia or stenosis, short limbs, mental retardation
Screening for Down syn?
triple/quad screen
Defects in Edward syndrome?
Clenched fists, overlapping digits, rocker bottom feet, VSDs, tetralogy, and various defects such as omphalocele, NTDs
Patau syndrome has findings similar to....? Other defects? Prognosis? Detection?
Edward syndrome. Cleft lip, holoprosencephaly, cystic hygroma. Prognosis poor. Commonly dxd by routine US
Turner syndrome..?
45XO. Phenotypically female. Primary amennorhia, aortic coarctation, webbed neck, epicanthal folds, wide carrying angle
Klinefelter?
47XXY. Phenotypically male, infertility, gynecomastia, retardation
Endoderm forms? Mesoderm? Ectoderm?
GI and respiratory tracts
Cardiovascular, M/S, G/U
Skin, nervous system
US signs of spina bifida?
Lemon sign (concave frontal bones) and banana sign (flattened cerebellum)
Tetralogy of Fallot?
Overriding aorta, pulmonary stenosis, RVH
Potter syndrome
Renal failure leading to anhydramnios --> causing pulmonary hypoplasia and contractures
Potter disease
Bilateral renal agensis
US screening for aneuploiods and Down syndrome...look for?
Nuchal translucency
Triple screen is a good test for which anueploidies?
Trisomy 18 and 21
Describe the triple screen results in a trisomy 21 or 18 fetus?
Decreased MSAFP and estriol, increased BHCG in Downs / decreased in Edwards
Risk of complications from an amnio?
1 in 200
Standard Level I US is performed at ____ weeks?
18-22
PROM?
rupture of membranes at least 1 hour prior to onset of labor
PPROM?
Preterm, premature rupture of membranes
prolonged PROM?
PROM >18 hours prior to labor
diagnosing ROM?
pool, nitrazine, fern, rarely amnio dye test
Five components of the cervical examination in pregnancy?
Dilation, effacement, fetal station, cervical position, and consistency of the cervix make up the Bishop score
Strict definition of labor?
Regular uterine contractions that cause cervical change
How can labor be induced?
ROM, prostaglandins, oxytocin, mechanical dilation of the cervix
What are the common indications for induction of labor?
PROM, postterm pregnancy, preeclampsia, nonreassuring fetal testing, intrauterine growth restriction
The success of an induction is often correlated with..?
Favorable cervical status defined by Bishop score
Maternal contraindications for the use of prostaglandins? Obstetric contraindications?
Asthma, glaucoma
More than one prior C-section, nonreassuring fetal testing
Indications for augmentation of labor?
Inadequate ctx or a prolonged phase of labor
How can fetal hypoxia and acidemia be directly assessed?
Fetal scalp pH
List the cardinal movements of labor?
EDFIREER - engagement, descent, flexion, internal rotation, extension, external rotation
Second stage of labor?
Full dilation until delivery of the infant
First stage of labor lasts approx how long in a nulliparous woman?
10-12 hours
Transit time during the active phase of labor is affected by..?
Power, passenger, and pelvis
Second stage should be completed within..?
2-3 hours
Repetitive early and variable decels are common during what stage of labor?
Second stage
If uterine hypertonus causes fetal bradycardia, what tx can be given?
Terbutaline
Indications for episiotomy?
Need to hasten delivery, or impending shoulder dystocia
Retained placenta may be a sign of...?
Placenta accreta
Define the lacerations sustained during delivery?
1 - mucosa or skin
2 - perineal body, but not anal sphincter
3 - Extend into anal sphincter
4 - anal mucosa is entered
Most common indication for primary C section? Other common indications?
Failure to progress in labor.
Breech, transverse lie, shoulder presentation, previa, abruption, fetal intolerance of labor, cord prolapse, active herpes lesions.
What are risk factors for trials of labor after prior C section?
# of prior C sections, prior classical C section, IOL/use of prostaglandins, prior cephalopelvic disproportion
Common reasons for an emergent Csection?
Abruption, fetal brady, cord prolapse, uterine rupture, hemorrhage from a placenta previa
Differential dx of first-trimester bleeding?
Spontaneous abortion, postcoital bleeding, ectopic, vaginal/cervical lesions, extrusion of molar pregnancy, non-pregnancy causes
Differential of antepartum bleeding?
previa, abrutpion, vasa previa, uterine rupture, severe cervicitis, vaginal lesions, hemorrhoids, trauma, hematuria
Classic presentation of previa?
Painless profuse vaginal bleeding