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