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228 Cards in this Set
- Front
- Back
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Why do pregnant women get anemia?
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Dilutional effect (RBCM rises 30% but volume rises 50 %)
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What are the degrees of vaginal lacerations?
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1st degree: skin
2nd degree: muscle 3rd degree: anus 4th degree: rectum |
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What is vernix?
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Cheesy baby skin
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What is meconium?
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Green baby poop
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What is lochia?
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Endometrial slough
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What is normal blood loss during a vaginal delivery?
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500 mL
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What is normal blood loss during a C-section
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1000 mL
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How do you treat A2 gestational DM?
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Insulin
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What are identical twins?
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-Egg split into perfect halves.
-Monochorionic |
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What are fraternal twins?
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Multiple eggs fertilized by different sperm.
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What is ovarian hyperstimulation syndrome?
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Weight gain and enlarged ovaries after clomiphene use.
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Who makes the trophoblast?
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Baby
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Who makes the cytotrophoblast?
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Mom (due to GnRH, CRH, TRH, inhibin)
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Who makes the syncytiotrophoblast?
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Mom and baby (hCG, HPL)
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When does implantation occur?
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1 week after fertilization
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When is beta-hCG found in urine?
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12-14 days after conception
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When is beta-hCG detectable in blood?
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8-11 days after conception
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What are some effects of estrogen?
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-Muscle relaxant
-Constipation -increased protein production -irritability -varicose veins |
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What are some effects of progesterone?
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-increased appetite
-increased acne -dilutional anemia -quiescent uterus -pica -hypotension -melasma |
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What make progesterone <10 weeks post-fertilization?
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Corpus luteum
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What makes progesterone >10 weeks post-fertilization?
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Placenta
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What is the function of beta-hCG?
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-maintains corpus luteum
-sensitizes TSHr to increase BMR |
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What makes beta-hCG?
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Placenta
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How fast should beta-hCG rise?
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Doubles every 2 days until 10 weeks (when placenta is fully formed)
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What is the function of AFP (alpha fetoprotein)?
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Regulates fetal intravascular volume
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What is the function HPL (human placental lactogen)?
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Blocks insulin receptors so sugar stays high (increases baby's sugar stores)
- increased throughout pregnancy |
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What is the function of inhibin?
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Inhibits FSH (no menstruation)
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What is the function of oxytocin?
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-milk ejection
-baby ejection/uterine contractions |
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What is the function of cortisol in pregnancy?
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-decreases immune rejection of baby
-lung maturation |
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What are the thyroid hormone levels during pregnancy?
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Increased TBG (increase in bound T4, normal free-T4)
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What is a normal biophysical profile?
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>7
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What is a biophysical profile?
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"Test the Baby, MAN!"
Tones of the heart Breathing Movement AFI Non-stress test |
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What pelvis types are better for vaginal delivery?
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Gynecoid or Anthropoid
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What pelvis types will need C/S?
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Platypelloid or Android
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How do you predict a due date with Nagele's Rule?
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9 mo from start of last menses + 1 week
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How do you correct Nagele's Rule for cycles >28 days?
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Add x days if cycle is x days longer
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How much weight should a pregnant woman gain?
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1 lb/wk
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When should intercourse be avoided during pregnancy?
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3rd trimester b/c PG-F in semen may cause uterine contractions
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What is a Leopold maneuver?
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1) Feel fundus
2) Feel baby's back 3) Feel pelvis inlet 4) Feel baby's head |
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What is Stage I of labor?
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Up to full dilation
1) Latent phase (<20h): contractions, up to 4 cm dilation 2) Active phase (<12h): 4- 10 cm dilation (1 cm/hr) |
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What is Stage II of labor?
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Full dilation to delivery
Stage 0 - Baby above pelvic rim 1 - Engage 2 - Descend 3 - Flex head 4 - Internal rotation 5 - Extend head 6 - Externally rotate 7 - Expulsion |
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What is Stage III labor?
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-Delivery of placenta (due to PG-F)
-Blood gush, cord lengthens, fundus firms |
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How do you monitor baby's HR?
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-Doppler
-Scalp electrode |
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How do you monitor uterus?
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-Otodynamics
-Uterine pressure catheter |
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What Bishop's score predicts delivery will be soon?
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>8
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What are Braxton-Hicks contractions?
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Irregular contractions w/ closed cervix
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What is a vertex presentation?
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Normal; posterior fontanel presents first
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What is a sinciput presentation?
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Anterior fontanel presents first
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What is a face presentation?
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Mentum anterior -> forceps delivery
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What is a compound presentation?
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Arm of hand on head -> vaginal delivery
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What is a complete breech?
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Butt down, thighs and legs flexed
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What is a frank breech?
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Butt down, thigh flexed, legs extended (pancake)
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What is a footling breech?
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Butt down, thigh flexed, one toe is sticking out of cervical os
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What is a double footling breech?
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Two feet sticking out of cervical os
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What is a transverse lie?
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Head is on one side, butt on the other
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What is shoulder dystocia?
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Head out, shoulder stuck
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Can you try vaginal delivery on a woman who has had a classic vertical C/S previously?
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No. C/S for all future deliveries
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Can you try vaginal delivery on a woman who has had a low transverse C/S previously?
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Yes
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What is early deceleration?
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Normal; due to head compression
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What is late deceleration?
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Uteroplacental insufficiency b/c placenta can't provide O2 & nutrients.
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What is variable deceleration?
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Cord compression
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What is increased beat-to-beat variability?
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Fetal hypoxemia
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What is decreased beat-to-beat variability?
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Acidemia
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What is pre-eclampsia?
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HTN, proteinuria, gestation >20 wks (often present w/ edema also)
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What is the treatment for pre-eclampsia?
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Delivery
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What is HELLP syndrome?
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Hepatic injury causing
-Hemolysis -Elevated Liver enzymes -Low Platelets |
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What is eclampsia?
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Pre-eclampsia + Seizures
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What are the symptoms of eclampsia?
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H/A, changes in vision, epigastric pain
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What is the treatment of eclampsia?
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5mg MgSO4 to stop the seizures, then 2mg drip of MgSO4
-MUST DELIVER |
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What is chorioamnionitis?
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-Fever
-Uterine tenderness -Decreased fetal HR |
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What are the symptoms of amniotic fluid emboli?
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Mom just delivered baby and has SOB, PE, death
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What is endometriitis?
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Post-partum uterine tenderness
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What is an incomplete molar pregnancy?
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-2 sperm + 1 egg (69, XXY)
-has embryo parts |
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What is a complete molar pregnancy?
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-2 sperm + no egg (46, XX -both paternal)
-no embryo |
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What is pseudocyesis?
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Fake pregnancy w/ all the signs and symptoms
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What is the MCC of 1st trimester maternal death?
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Ectopic pregnancy
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What is the MCC of 1st trimester spontaneous abortions?
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Chromosomal abnormalities
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What are the MCC of 3rd trimester spontaneous abortions?
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-Anti-cardiolipin Ab
-Placenta problems -Infection -Incompetent cervix |
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What is a threatened abortion?
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-Cervix closed
-Baby intact -Tx: bed rest |
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What is an inevitable abortion?
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-Cervix open
-Baby intact -Tx: Cerclage (sew cervix shut until term) |
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What is an incomplete abortion?
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-Cervix open
-Fetal remnants -Tx: D&C to prevent placental infection |
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What is a complete abortion?
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-Cervix open
-No fetal remnants -Test: beta-hCG |
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What is a missed abortion?
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-Cervix closed
-No fetal remnants -Tx: D&C |
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What is a septic abortion?
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-Fever >100F
-Malodorous discharge |
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What is placenta previa?
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-Post-coital bleeding
-Placenta covers cervical os -Ruptures placental arteries |
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What is vasa previa?
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Placenta vessel crosses the internal os and gets damaged on AROM
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What is placenta accreta?
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Placenta attached to superficial lining
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What is placenta increta?
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Placenta invades into myometrium
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What is placenta abruptio?
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-Severe pain
-Premature separation of placenta |
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What is velamentous cord insertion?
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Fetal vessels insert between chorion and amnion
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What is a uterus rupture?
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-Tearing sensation
-Halt of delivery, head floating |
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What is an APT test?
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Detects HbF in vagina vs. maternal blood (+ test = fetal blood)
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What is Wright's stain?
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Detects nucleated fetal RBC's in mom's vagina
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What is a Kleihauer-Betke test?
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Detects % of fetal blood in maternal circulation (dilution test)
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What are the maternity blues?
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Post-partum crying, irritability
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What is post-partum depression?
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Depression after 2 weeks post-partum
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What is post-partum psychosis?
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Hallucinations, suicidal, infanticidal
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What causes high levels of HCG?
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twins
gydatiform mole choriocarcinoma |
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If a female had a hydatiform mole and then a D&C but still bHCG rising what is the diagnosis?
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Choriocarcinoma
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Low levels of hCG caused by?
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ectopic
threatened or missed abortion |
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Skin changes in pregancy include?
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line nigra
cholasma (morning glow) Chadwicks sign Stria gravidarum Spider angiomata/palmar erythema |
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Cardiovascular changes in pregancy?
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Blood pressure
Plasma volume Femoral venous pressure (Inc causes haemorrhoides and varcosie veins) CO INC 50% Peripheral vascular resistance (PVR) |
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Murmurs in pregnancy include?
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systolic (is normal)
diastolic pathogenic |
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Haematological variations in pregnancy?
RBC’sPlasma volumeWBC’sPlateletsCoagulation |
RBCs inc
Plasma volume inc by 50% WBCs Platelets no change Coagulations (2,7,9,10..) |
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Gastrointestal Changes in pregnancy
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stomach DEC. emptying leads to GORD
large bowel INC transit time = constipation |
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Pulmonary changes in pregancy?
TV minute volume respiratory volume blood gases |
TV increases
resp volume decreases blood gases (alkaline, inc pH of urine..) |
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Renal changes in pregnancy?
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increase in size
glucosuria (HSL, HPL) proteinuria |
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Endocrine changes in pregnancy?
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pituatiry increase
thyroid increased vascularity |
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Types of estrogen in a female?
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Estridiol (E2): granulosa cells
Estrone (E1): adipose Estridoil (E3): fetal adrenals |
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What are the 1st trimester changes?
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< 13 weeks
N/V Spotting/ bleeding Wt gain 5-8 lbs Complication: spontaneousabortion (Chromosomal abnormality: most common one is 16) |
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What are the 2nd trimester changes in pregnancy?
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13-26 weeks
round ligament pain braxton-Hicks contractions quickening Wt gain 0.5kg a week complications: INCOMPETENT CERVIX |
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Cerclage
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stictching the cervix shut if a women has a history of cone biopsy or a history of abortion due to incompetent cervix
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Changes in 3rd trimester pregnancy?
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Decreased libido,
back pain, (due to excessive lordosis) urinaryfrequency (mechanical pressure) Lightening (the fetus engages and so it drops and the female sudden instantly realse thus can get a full breath of air in) Bloody show Wt gain 1 lb/week Complication: PROM |
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Haemoglobing labe values in pregant vs non-preganant women?
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diltuitonal effect drops it from 12-14 to 10-12
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The MCV level is therefore more specific than Hb in pregnacy. Therefore what causes an MCV <80 or >100?
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<80 fe
>100 folic acid (rapidly growing cells like the fetus, and not really a B12 thing) |
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Rubella antigen testing in pregnancy?
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cant vaccinate in preganncy
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What is a usual HepB prenatal immune screen like?
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HBV Ab: successful vaccination
HBV surface antigen (therefore an infection) E antigen: means shes in an infective state |
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Direct and indirect coombs testing prenatal results?
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Direct: patient blood type and Rh (A,B,C,D,E.. D is most common)
Indirect: atypical antibody test |
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What are the STD screening criteria in pregnancy?
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chlamydia
gonnorhea syphillis |
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What would you look for on a urine screen in pregnancy?
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Urinalysis:
Proteinuria Ketones Glucose Bacteria Culture: asymptomatic bacteruria(ASB) |
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Tb treatment in high risk patients
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CXR negative then Isnozaid and B6
CXR postive: Rifampicin, INH, Pyrazinamide (crosses the megninges), Ethambutal (6-9 months) |
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HIV testing is recommedned in all pregnant women therefore they have to....?
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opt out
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Testing of HIV with ELISA what is the Ab lag?
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Detectable HIV antibodies (3 month lag) and baby will have Ab for 6months (corsses placenta)
Babies born to an HIV + mothers Western Blot Zidovudine |
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Causes of high alpha fetal protein?
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twins
ventral wall defects placental bleeding sacrococcygeal teratoma MOST COMMON CAUSE: dating errors |
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Triple marker screening
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MS-AFP
hCG Estriol |
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Blood glucose screening in pregnancy in AUS?
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high risk pregnacy then screen at intial visit
otherwise 26-28 weeks 75g glucose load fasting <5.1 1h <=10 2hr <=8.4 |
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Non stress testing in pregnancy purpose and normal values?
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purpose is to detect fetal movement
Check frequency of fetal movement External fetal HR monitor Accelerations < 32 wks: > 10 or more BPM,lasting >10 sec > 32 wks: > 15 or more BPM,lasting > 15 sec |
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Biophysical profile
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5 components of fetal wellbeing:
1. NST: scores 0-2 for each 2. Amniotic fluid volume 3. Fetal gross body movement 4. Fetal extremity tone 5. Fetal breathing movements2-5 assessed through Utz. |
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BBP scoring and what they mean?
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8-10 = reassuring (weekly BPP)
4-6 = worrisome> 36 wks- deliver< 36 wks- BPP every 12-24 hours 0-2 = fetal hypoxia (deliver ASAP) |
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What is a Contraction stress test?
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Testing fetus response to toleratetransitory decreases in blood flow
Presence or absence of latedeceleration MEANS there is uteroplacental def. and thus NEED TO Induce with IV oxytocin Negative test is good- no late Dcells |
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Umbilical artery dopplers
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Measures ratio of Systolic andDiastolic blood flow in umbilicalarteryIncreased throughout pregnancy,since diastolic pressure falls more
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What is GBS?
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Normal GI tract flora
30% of women are asymptomatic carriers Vertical transmission Early onset (pneumonia or sepesis) Late onset (mengitis) Mgt: IV penicillin: if allergic- Clindamycinand Erythromycin |
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Normal managment of GBS?
Indications for treatment |
Positive urine culture GBBS
Previous baby had GBBS Screening by vaginal cultures:3rd trimesterIf + then prophylaxis IV PCN Preterm or Membrane rupture > 18hrs,or maternal fever…… Mgt.Prophylaxis IV PCN |
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Toxoplasma Gondii in pregnancy
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60-80% of the population already have toxoplasmosis
Parasite associated with cat feces Raw goat milk Under cooked infected meat Vertical transmission Lethal if first trimester Third trimester- asymptomatic Intracranial calcification Mgt: Pyrimethamine Sulfadiazine |
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Varicella infections
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Chicken Pox
Herpes Zoster Spread via respiratory droplets ZIG ZAG skin lesion Maternal varicella pneumonia Mgt: administer VZIG to suspectedgravid within 96 hrs of exposure |
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Rubella
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RNA virus spread throughrespiratory dropletsTransmission only if primaryinfectionFetus= VSDNeonate= congenital deafnessPrevention: rubella IgG antibodyscreeningLive attenuated virus- avoidpregnancy for 1 month afterimmunization
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CMV
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Spread via body secretionsLife long latency, so fetus can getit on reactivation
Periventricular calcification MCC of congenital deafnessMgt: Ganciclovir |
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HSV
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Multinucleated Giant CellsMaternal genital lesion is MC routefor fetal infectionDx: + culture from ruptured vesiclePrevention: C-sectionIf membrane already ruptured and ithas been >8-12 hours- too late todo a C-sectionMgt: Acyclovir
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HIV
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HIV + mothers take zidovudinestarting at 14 wks until deliveryC-section for deliveryBreast feeding contraindicatedNeonate gets AZT for 6 wks, thencheck again
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Maternal Sypgillis Infections
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Primary- painless ulcer with rolled upedges (chancre)- gone in 2-3 wksSecondary- 2-3 months after contact,maculopapular skin rash andcondyloma lataTertiary- organs affectedHeart- aortitisDorsal column- tabes dorsalisCSF +Mgt: Vaginal delivery: Benzathine PCN and if allergicdesensitization to PCN
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Painful bleeding in third trimester
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Abruptio placenta until proven otherwise
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Types of abruptio placenta and severity
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overt (bleeding) vs
concealed (can see inc in fundal height) Mild- no fetal abnormalityModerate- 25 – 50% surfaceseparationMonitor for late D-cellsSevere- abrupt, knife like uterinepain> 50% placental separationDIC may occurSevere late D-cells |
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What is the managment of Abruptio
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Emergency Cesarean if mother orfetal jeopardy
Vaginal delivery if bleeding iscontrolled or > 36 wks Conservative (in hospital)Stable and remote from term Confirm placental location on sono Replace fluids |
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Placenta migration
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placenta hypertrophies on top end and atrophies on the lower end
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3 types of placenta previa
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Total, complete or central- covers osPartial- partial cover of osMarginal, low lying- near os
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Mx of placenta previa
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Emergency Cesarean if mother orfetal jeopardyVaginal delivery- lower placentaledge must be > 2cm of osScheduled C-sectionFetal lung maturity by amniocentesisConservative (in hospital)Bed rest, preterm, confirm placentallocation
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Placenta acreta
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villi implants on a scar ofrom DC or something, that placenta may never separte and then need to do a hysrterectomy
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Vasa Previa
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fetal vessels in front of the internal os, thus if you artifically rupture the membrane you can get rapid fetoplacental circulation (FETAL brady cardia..)
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Uterine rupture triad
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painful bleed
loss of FHT CAUSES: MCC- classical (or vertical) incision myomectomy excessive oxytocin Mgt: Surgical |
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Defining abortions
- Missed - Threatened - Inevitable - Incomplete - Complete |
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Most serious consequence of fetal demise >20 weeks?
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Most serious consequence…DIC (disseminated intravascularcoagulation)Usually takes 3-4 wks to occurRelease of thromboplastin fromdeteriorating fetal organsDo not deliver until mom is ready aslong as there is no DIC
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Expected lab results in a fetal demise
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low plts, and fibrinogen
high PT, PTT, D-dimers |
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Anti-D antibodies
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passive Ab IM
the IgG antibodies attaching to the foregin RBC and lysis before the mother can develop an immune response |
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When is Anti-D given?
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Give to Rh(D) negative mothers at28 weeksWithin 72 hours ofChorionic villus samplingAmniocentesisRh+ deliveryD & CGive 300 micrograms (1 vial) controls for up to 30ml of fetal blood crossing into mother
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Kleihauer Betke Test
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Quantitates fetal RBC’s in mom’sbloodLooks at a peripheral smearWill access if more than one vial isneeded
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PROM risks
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Risk of ascending infectionHistory of sudden gush of copiousvaginal fluidsOligohydramnios on Utz.
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Diagnosis of PROM
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Sterile speculumPooling – clear fluid in posteriorvaginal fornixNitrazine positive (turns paper blue)
Fern test- on microslide to DDx the blue colour change from urine or amnio (looks like a fern tree) Chorioamnionitis:Maternal feverUterine tendernessConfirmed PROM |
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Mx of PROM
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Uterine contractions present(don’t use tocolysis)Chorioamnionitis- IV antibiotics,deliveryNo infection< 24 wks- dismal outcome>24- bed rest, IM (to avoid the peak and get a gradual increase in steroids) betamethasone, 7 dayprophylaxis of ampicillin anderythromycin
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Preterm labour
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3 criteria:Between 20 and 37 weeksUterine contractions (3 in 30 min.)Cervical changes(dilation changes > 2cm)
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Tocolytic agents
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Prolong pregnancy for up to 72 hrsIM betamethasone to workTransport mother/fetus to neonatalintensive careGiven parenteral
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Types of tocolytics
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MgSO4- blocks Ca2+Monitor: DTR (deep tendon reflexes) Antidote: IV calcium gluconateContraindications: renal insufficiency, MG (myastheina gravis)
Beta adrenergic agonist- terbutaline,ritodrineCa2+ blockers- Nifedipine, ProcardiaPG inhibitors- Indomethacin |
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Risks of post date pregnancy
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Worried about placental breakdownFetus not getting the O2 it needsMeconium risk42 wks maximum time in uterusShoulder dystocia
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Managment of Post dates
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favourable: induce labour
unfavourable: cervix not dilated |
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Managment of meconium
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in labour: amnioinfusion to dilute meconium
after head is delivered: suction nose and pharynx after body is delivered: laryngoscope and suction to remove meconium from below the vocal cords |
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Mild preeclampsi
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140/90
>0.3g/dl urine >20 weeks gestation Mg >36 deliver |
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Severe preeclampsia
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160/110
>0.6g/dl urine >20 wks Mx: MgSO4 to avoid seizures then followed byanti-hypertensives |
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Eclampsia
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Unexplained grand mal seizureswith…HTNProteinuria> 20 wks gestationSevere diffuse cerebralvasospasms
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Mx of eclampsia
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First protect the mothers airwayIV MgSO4, with IV bolus of 5g to stopseizureMaintenance dose 2g/hrDeliver at any gestational ageLower diastolic B/P to 90-100mmHg
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HELLP Syndrome
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5-10% of preeclamptic patientsH- hemolysisEL- elevated liver enzymesLP- low plateletsMgt. prompt delivery at any age
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Process of cervical effacement
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Cervical effacement:Thinning due to oxytocin and PGE2breaking disulfide bonds in collagenfibersNormal cervix: 2cm long/ 2cm wide
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normal cervix lengths
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2cm long and 2 cm wide
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Cardinal movements in labour
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EngagementDescentFlexionInternal rotationExtensionExternal rotationExpulsion
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Stages of labour
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Stage 1: onset of uterine contractionand ends with complete dilationLatent- cervical dilation up to 20 hrs (3-4 cm)Active – rapid cervical dilation (1.2 cm/hr)Stage 2: complete cervical dilation todelivery (2 hrs)Stage 3: delivery to placental expulsion(30 min)Stage 4: observation of mother forpreeclampsia and post partumhemorrhage
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Prolonged latent phase
- MCC -Mx |
Prolonged Latent PhaseCervical dilation <3cm for…> 20hrs primipara> 14 hrs multipara
- MCC injudicious analgesia - Mgt. Therapeutic rest |
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Prolonged Active Phase or ArrestCervical dilation > 3cm…
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Prolonged dilation < 1.2 cm for > 2hPassenger problem: size ororientationPower problem: inadequate uterinecontractionHypotonic muscle- IV oxytocinContraction normal- go to C-section
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Prolonged 3rd stage
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Placenta has not delivered within 30minIf it does not remove with IVoxytocin, then think accreta (etc.)Mgt. manual removal orHysterectomy
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Prolapsed Umbilical Cord
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Obstetric emergencyCord gets compressed affectingfetal oxygenationOccult- head and uterine wallPartial- head and cervical osComplete- protruding into vaginaMgt. Knee-chest positionElevate presenting partImmediate C-section
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Shoulder Dystocia
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Delivery of fetal shoulder isdelayed after delivery of headImpacted of pubic symphysisMgt. suprapubic pressureMcRoberts maneuver- thigh flexedWoods corkscrew- internal rotationManual delivery of posterior arm
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Early decelerations
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due to head compressions
- and the deccleration is at the same time of the uterine compressions |
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Variable decelerations
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cord compression
- abruot decclerations that dont coincede with uterine contractions - thus rotate the mother a little bit |
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Late decelerations
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uteroplacental def.
- i.e fetal acidosis - the heart reate goes down very slow then comes up to baseline with mums contractions happening just before that |
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Caesarian section risks
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Maternal mortality and morbidity ishigher than vaginal deliveryHemorrhage : > 1000 mlInfectionVisceral injury: bowel, bladderThrombosis- DVT
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V-BAC
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vaginal birth after C-section
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Cervical ceretage
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Pt’s with incompetent cervixShirodkar- beneath cervicalmucosa- left in place with deliverof C-sectionMcDonald- removed by 36 wks forvaginal deliveryPlaced at 14 wks, before cervicaldilation and effacement occur
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Post partum fever
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PP day 0: AtelectasisPP
day 1-2: UTIPP day 2-3: EndometritisPP day 4-5: Wound infection(antibiotics and drain)PP day 5-6: Septic thrombophlebitis(IV heparin 7-10 days)PP day 7-21: Infectious mastitis(oral cloxacillin and continuebreast feeding) |
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Cervical dysplasia
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assymptomatic
takes 8-10 yrs to become cancer most regress |
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HPV
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16, 18, 31, 33 and 35PremalignantCancerous6,11Benign condyloma acuminata
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Pap smears
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Screening for premalignant lesionsTransformation zone (T-zone)squamous/columnar3 years after onset of sexualactivity or 21 y/oDiscontinued >70 with 3 negativepap’s< 30 y/o annually (2 yrs liquid based)> 30 every 2-3 yrs after 3 (-) pap’s
by 21 sexually active or not because people are abused when they are young and sometimes they dont remeber |
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Bethesda System
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Negative- no malignancyASC- atypical squamous cellsLSIL- low grade squamous intraepitheliallesion (HPV or CIN I)HSIL – high grade squamous intraepitheliallesion ( CIN 2,3, moderate dysplasia)Cancer- invasive
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Diagnostic approach
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Accelerated repeat PAP: ASC-USHPV-DNA testing: ASC-USColposcopy- abnormal pap(acetic acid)Endocervical curettage (ECC)- r/oendocervical lesion [not in pregnancy]Cone biopsy- PAP worse than histological
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Mx of cervical cancer in relation to histology
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Observation: CIN I, repeat pap 6-12monthsAblative: CIN 1, 2, 3: CryotherapyExcisional: CIN 1, 2, 3: LEEP (loopelectrosurgical excision), coldknifeHysterectomy- recurrent CIN 1,2,3
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Invasive cervical CA
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Penetrated through basementmembranePostcoital vaginal bleedingDx. Cervical biopsy- sq. cell CAMgt. Hysterectomy
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Cervical neoplasia in pregnancy
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Pregnancy does not changeprogressionTest female same as non-pregnantSkip ECC- cervix more vascularInvasive CA:<24 wks: hysterectomy> 24 wks: wait until 32-33 wks, thenC-section and hysterectomy
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Post menopausal bleeding
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Menopause- after 3mo or cessationof mensesEndometrial carcinoma (MCC)Unopposed estrogenDx: Endometrial samplingMgt: Positive histology: TAH & BSO
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Leiomyoma
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Benign smooth muscle of themyometriumMore common in black femalesMgt. ObservationPresurgical shrinkage 3-6 mo GnRH analogMyomectomyEmbolizationHysterectomy
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Enlarged uterus causes
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leiomyoma
adenomyosis |
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Adenomyosis
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Ectopic endometrial glands and stromalocated within the myometrium of theuterine wallTender uterus in absence of pregnancyDx. Utz or MRIMgt. Levonorgestrel intrauterine systemDefinitive : Hysterectomy
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premenopausal adnexal mass
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Simple Cyst- luteal or follicularComplex cyst- dermoid (germ layers)Dx. hCG levels to rule out pregnancy:SonogramMgt.Simple cyst- observation, OCP’s,(>7cm laparoscopic)Complex cyst- surgical removal
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Adnexal Mass With Pain
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Sudden onset of severe lowerabdominal pain in presence ofadnexal mass….”Ovarian torsion”Mgt. untwistObservation to assure revitalizationRoutine exam annually
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Prepubertal Adnexal Mass
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Functional ovarian cyst notpossible because ovarianfollicles are not functioningSuspicious of neoplasmDx. Tumor markers…LDH- dysgerminomaBeta HCG- ChoriocarcinomaAlpha fetal protein- endodermal sinustumor
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Postmenopausal adnexal mass
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Ovaries should be atrophicAny enlargement, should drawsuspicion of ovarian cancerBRCA-1
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Classification of ovarian tumors
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Epithelial tumor (80%)- post menopausalMC serousGerm Cell tumor (15%)- teenagersMC dysgerminomaStromal tumor (5%)Granulosa cell tumor- increased estrogenMetastatic tumor- Krukenbergstomach to ovary
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Vulvar Neoplasia
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Vulvar lesion with pruritusVulvar itchingSquamous hyperplasia(whitish focal area)Mgt. corticosteroidsLichen Sclerosis(bluish-white papule)Parchment likeMgt. testosterone cream
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Vulvar Intraepithelial Neoplasia(VIN)
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Squamous dysplasiaMgt. surgical excision
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Gestational trophoblastic neoplasia (GTN)
|
complete mole: 46XX
Incomplete mole: 69XXY, rare to have a viable baby here too |
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Molar pregnancy 3 types
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hydatiform mole (2% become choriocarcinoma)
choriocarcinoma invasive mole |
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Nuchal translucency
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10-14 wks
Thick area you should of cystic hydroma (downs syndrome) |
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CVS
|
Aspiration of placentatissue (9-12 wks)Sono guidedKaryotypingPregnancy loss rate 0.7%
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Amniocentesis
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Transabdominal needle to withdrawamniotic fluid under sono (15-20 wks)Looking at DNA from fetal cellsNot enough fluid prior to 15 weeksPregnancy loss rate (0.5%)24 weeks- Rh isoimmunization(bilirubin levels)34 weeks- Lecithin-sphingomyelin
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Percutaneous umbilical blood sampling
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Fetal blood from umbilical vein(> 20 weeks)Fetal karyotypingIgM antibodyBlood typingIntrauterine Blood TransfusionPregnancy loss rate 1-2%
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cyclops baby
|
patau
|
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clenched fist baby
|
edwards
|
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Spina bifida occulte does it have high AFP
|
no because its a vertebral problem and not a spinal problem
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Porters syndrome
|
flat faces
- doesnt matter how many weeks pregnant they are discontinue the pregnancy |
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Cell phase at implantation
|
meiosis II in the tubes
meiosis I @ ovulation prophase immature eggs |
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Week 2-3
|
Bilaminar germ disk:- Epiblast- HypoblastCytotrophoblastSynchotrophoblastPrimitive streak
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Week 4-8
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Major organs formingTeratogenic risk- Ectoderm- Mesoderm- EndodermMust have all 3 in order to ateratogen to cause problems
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Ectoderm
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CNS, PNS, sensory, skin, hair
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Mesoderm
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muscle, cartilage, heart
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Endoderm
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GI, Resp
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Female cycle
|
FSH stimulates the granulosa cells that convert the androgens from theca cells to estrogen and inhibin via aromatase.
Initally E is inhibitory on GnRH and +ve on the granulosa cells, and also inhibin is -ve on FSH. When E peaks, the feedback loop reverses and it now becomes +ve and you get the LH surge day 14 and FSH rises but not as much (due to inhibin still being there). The granulosa cell then develops a LH receptor and now can make progesterone, therefore it becomes the corpus letum |
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Male fertility
|
Leydig cells: testosrone 95% goes to the sertoli cells to makes inhibn, sperm and maintains TBB (testes blood barrier)
the other 5% gets convert to DHT and is more active |
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ionising radiation levels
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<5 Rad no problem
5-10 Rads small effect >10 Rad = dangerous X-ray= 0.1 |
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Chemotherapy
|
risk is 1st trimester
2nd & 3rd OKAY |
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Tobacco
|
IUGR
preterm |
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EtOH
|
facial hypoplasia
microcephaly mental retardation |
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Cocaine
|
intraventricular haemorraghe
placenta abruptio |
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|
FDA Pregnancy catergories for drugs
|
A: no risk
B; no risk to humans C; cannot rule out D: some risk but need to balance the risk to benfit ratio X: contraindicated |
