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82 Cards in this Set
- Front
- Back
4 signs of placental separation
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1. gush of blood - coincides with placenta separating from uterus
2. cord lengthening - placenta has dropped to lower portion of the uterus 3. globular uterus 4. uterus ascends to anterior abdominal wall |
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what can cause uterine inversion
complication from inversion |
if cord doesn't separate from uterus and excessive force is used to cause the separation --> uterine inversion
massive hemorrhage |
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appearance of uterine inversion
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shaggy mass, red and bulging
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definition of abnormally retained placenta
tx |
labor of placenta exceeds 30 mins
try manual extraction |
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risk factors for uterine inversion
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grand-multip
placental implantation in fundus |
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tx of uterine inversion
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halothane, terbutiline, and mgso4 to cause uterine relaxation
emergent surgery |
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what is protective of uterine inversion
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attenuated umbilical cord: it will separate easily and cause cord severing
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definition of premature ovarian failure
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cessation of ovulation younger than 40 yo
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what causes ovarian failure in turner's syndrome
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ovarian failure
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relationship between tsh and prl and menstrual cycle
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low tsh and high prl both inhibit gnrh pulsations --> fsh/lh inhibition
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sx of tss
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myalgias
n/v hypotension confusion sunburnlike rash --> maculopapular rash --> desquamation with palm/sole involvment (by 10th day) --> increased serum bili |
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what MAP is required to perfuse vital organs
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65 mmhg
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what is the organism in tss
best way to culture it |
staph
exotoxin-1 enters body vaginal cx |
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tx of tss
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iv nafcillin or methicillin + amnioglycosides
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definition of latent labor
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cervix mainly effaces and cervical dilation
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time limit of latent labor
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<18-20 hrs in prime
<14 hrs in multip |
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arrest of active labor
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no cervical change during 2h of active labor
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protracted active labor
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decreased cervical change over 2 hrs
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causes of prolonged latent phase
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decreased power, pelvis, or passenger
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definition of clinically adequate ctx
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q2-3 mins
firm abdomen 40-60 s OR >200 montevideo units over 10 mins |
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bloody show
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loss of cervical mucous plug
sign of impending labor |
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1st thing to consider in a woman with lower abdominal pain and vaginal spotting
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ectopic pregnancy, until proven otherwise
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progesterone levels for nml uterine pregnancy
progesterone levels for nonviable pregnancy |
>25
<5 |
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if non-viable pregnancy is dx, what is next step to determine etiology
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d&c to assess miscarriage (will see chorionic villi) or ectopic pregnancy (will see no villi)
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when should mtx be given to tx miscarriage
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if pts are asx and fetus is <3.5 cm
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what is cutoff in wks for a pregnancy loss to be considered a spontaneous abortion
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20w wks
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definition of pprom
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rom prior to onset of labor <37 wks
50% will labor w/i 48 hrs and 90% w/i 1 week |
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sx of chorioamnionitis
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maternal fever, tachy, uterine tenderness, and malodorous d/c
fetal tachy >160 is also an early sign |
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tx of pprom
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if <32 wks, steroids and broad-spectrum abx
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dx of chorioamnionitis
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see gm stained bacteria on amniocentesis
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time-frame of pre-term labor
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20-37 wks
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complication of vbac
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uterine rupture
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how to manage arrest of active phase of labor
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if ctx are not strong enough, give pit, then place iucp if there is still no dilation
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what things are included in the bishop score
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dilation
effacement station consistency cervical position |
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what bishop score is favorable for induction
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>8
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what are the cardinal movements of labor
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engagement (oociput transverse)
internal rotation (to occiput anterior) complete rotation extension of neck external rotation anterior shoulder posterior shoulder |
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what is the most common type of breech presentation
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frank breech
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what are the 3 types of breech and how do they differ
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frank: flexed hips with knees extended, feet are under fetal head
footling: one or both hips not flexed and foot or knee is in birth canal complete: flexed hips and knees, with 1 foot near the breech |
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when can external version of breech be performed
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after 37 weeks b/c of risk of abruption or rom secondary to external maneuvering
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#1 cause of post-partum hemorrhage
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uterine atony
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definition of post-partum hemorrhage
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>500 cc blood loss after vaginal birth
>1000 cc blood loss after c/s |
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orgs involved in endometritis
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anaerobes and aerobes
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why is bromocriptine no longer given to prevent galactorrhea post-partum
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sz and htn can result (uncommonly)
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what causes prolonged fetal tachy
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maternal fever
chorioamnionitis |
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cause of early decels
morphology |
head compression during ctx
mirror images of ctx tracing |
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cause of late decels
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placental insufficiency
chronic htn post-date pregnancy |
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causes of variable decels
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cord compression
cord around fetal parts fetal anomolies oligohydramnios |
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causes of sinusoidal fht
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severe fetal anemia
maternal drugs |
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causes of prolonged brady in fht
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uterine hyperstimulation
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when is an amnioinfusion performed
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to tx variable decels or meconium stained amniotic fluid
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which pg is contraindicated in asthma
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pg f2
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what is used to decrease uterine bleeding post-partum
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ergots
oxytocin pgs |
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which 2 placental problems often go together
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accreta and previa
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what effect does pregnancy have on peptid ulcer dz
on ms |
makes both of them better
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dx of endometriosis
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laparoscopy
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management of placental abruption in setting of painful bleeding in 3rd trimester
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can progress rapidly so pt should be carefully monitored
ensure rapid vaginal delivery c/s only if there is rapid deterioration in early stages of labor |
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when is rhogam given
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at 28 wks
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after 1h gtt, what is the threshold for gdm
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>140
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after the 3hr gtt what is the threshold for gdm
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at 1h >180
at 2h >155 at 3h >140 |
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what can be done to decrease utis in sexually active women
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void after sex
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what is the most common genetic mutation associated with ovarian ca
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p53 (much more common than brca)
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consistency of granulosa theca cells
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solid
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appearance of a serous cystadenoma
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larger than a functional cyst
pt has increased abdominal girth |
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what determines prognosis in ca
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tumor stage
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standard of care for advanced ovarian ca in a pt s/p oopherectomy and surgical staging
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post-op chemo
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definition of anemia in pregnancy
most common cause |
hb <10.5
fe deficiency |
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tx of hellp
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delivery
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what happens to haptoglobin lvls in hemolysis
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they decrease b/c they are bound by hb
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side effects of mgso4
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decreased dtr
pulmonary edema respiratory depression |
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when should antenatal steroids be given in ptl
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between 24-34 wks, after that not needed
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should tocolysis be given to pts with suspected abruption
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no they should be delivered, b/c if tocolysis is used the abruption can continue
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what effect do b-agonists have on k
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hypokalemia
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complication of pyelonephritis in pregnancy
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2-5% --> ards (usually endotoxin related)
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what is the most common reason for septic shock in pregnancy
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pyelo
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how is incidence of pyelo reduced
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at 1st pnv urine cx is done to id asx bacteriuria
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tx of dvt in pregnancy
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heparin x 5-7 days then subq heparin to keep ptt 1.5-2.5 x nml limit x 3 mo
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stages of pelvic relaxation
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first degree:structure has descended into the upper 2/3 of the vagina
2nd degree: structure descends into the introitus 3rd degree: structure protrudes outside the vagina |
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stress incontinence
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urine loss with exertion ro straining
caused by pelvic relzxation and displacement of urethrovesical junction |
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urge incontinence
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detrusor instability
urine leakage is 2ndary to involuntary and uninhibited bladder contractions |
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total incontinence
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continuous urine leakage 2ndary to urinary fistulas (usually 2ndary to pelvic surgery or pelvic radiation)
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overflow incontinence
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incomplete voiding
urinary retention and overdistension of the bladder |
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treatment of bv
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metronidazole
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