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410 Cards in this Set
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Nagele's Rule For Due Dates based on a 28 day cycle: what if the cycle is X days longer? why it is not accurate?
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based on 28-day cycle; add X days if cycle is X longer + 9 months from last menses -> add 1 wk (inaccurate b/ c not from ovulation date)
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Normal Gestation:
• Pre-term: • Post-term: and tx |
Normal Gestation: 40 wks
• Pre-term: <35 wks • Post-term: >42 wks (Tx: oxytocin) |
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Newborn Exam:
(small for gestational age) |
<2500g
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Newborn Exam: Symmetrical (baby problem):
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chromosomal-abnormality or TORCH infection
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Asymmetrical (mom problem):
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poor blood supply spares brain=> small body, normal head
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>4000g LGA: what are the etiologies
1st 24 hrs: what happens to the baby and why? 2nd 24 hrs: what happens to the baby and why? |
large for gestational age: DM or monochorionic twins
1st 24 hrs: Hypoglycemic (baby is used to hyperglycemic state) 2nd 24 hrs: Hypocalcemic immature parathyroids |
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what are the Menstrual Cycle stages? what happens on Day-0 and Day 1-10?
what hormone is elevated on days 1-10, decribe its endometrium. What phase in the menstrual cycle stages is most variable? |
''FOL" Follicular, Ovulatory, Luteal (Menstrual cycle stages)
Day-0: lining sloughs off, new follicles are starting Day 1-10 Follicular/Proliferative stage- high estrogen • proliferative endometrium, this phase is most variable |
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Menstrual Cycle:
Day 10-14: stage, hormone, temp, FSH and LH Day 10-28: stage, hormone, presentation, endometrium and biopsy |
Day 10-14: Ovulatory stage - high LH, highest temp
• E2 stim FSH (b/c pineal resets it), LH rises (LH higher b/c it was never inhibited) Day 10-28: Luteal Secretory stage- high progesterone, PMS • secrtetory-endometrium, deposition of lipids, proliferation of spiral aa |
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how long does an egg last?
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Eggs last 3 days in Fallopian tube (lose 1/month)
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how long does an sperm last?
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Sperm lasts 5 days in Fallopian tube (make 100 million/day)
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Molar Pregnancy: what is it increased risk for?
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increased risk of invasive mole and choriocarcinoma (2%)
• Increased placental villi => grape clusters |
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Molar Pregnancy: US and presentation
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US: "snowstorm appearance"
• Fundus rising more than normal, very high β-HCG, 1st trimester bleeding or HTN |
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2 types of molar pregnancy and describe each
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Incomplete Mole: 2 sperm + 1 egg (69, XXY), has embryo parts
Complete Mole: 2 sperm+ no egg (46, XX-both paternal), no embryo |
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Complete Mole
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2 sperm+ no egg (46, XX-both paternal), no embryo
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Incomplete Mole
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2 sperms + 1 egg (69, XXY), has embryo parts
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Molar Pregnancy Tx:
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D&C, use methotrexate to kill leftover tissue, follow β-HCG for 1-yr
Day 1: Methotrexate • Day 4: β-HCG should ⇩15% • Day 7: Repeat Methotrexate if needed |
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Oogenesis:
5 mo Gestation: Birth: Ovulation: |
5 mo Gestation: max #eggs (Girls have 400,000 eggs at birth)
Birth: 1° oocyte, Prophase I Ovulation: 2° oocyte w/ 1st polar body, Metaphase II (8-10 eggs develop per month, 1 ovulate) |
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Oogenesis:
Fertilization: Zona pellucida: |
Fertilization: Ovum w/ 2nd polar body=> zygote
Zona pellucida: ring around ovum |
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Gametogenesis: mumps
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Mumps kills leydig cells -> no testosterone, pancreatitis, orchitis
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who makes these estrogens?
E 1: Estrone => E 2: Estradiol=> E 3: Estriol = > |
Forms of Estrogen:
E 1: Estrone => menopause E 2: Estradiol=> female E 3: Estriol = > pregnancy |
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Theca externa: associated hormone
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=>Progesterone (think pregnancy state)
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Theca externa:
Uterus: Prog => Cervix: Prog = > Breast: Prog => |
Uterus: Prog => proliferation of spiral aa, lipid and glycogen deposition(vacuoles)
Cervix: Prog = >thickens mucus Breast: Prog => glandular growth |
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Progesterone ⇨ Theca interna => E2
Uterus: E2 = > Cervix: E2 => Breast: E2 => |
Uterus: E2 = > proliferation of decidua functionalis
Cervix: E2 =>thins mucus Breast: E2 => ductal growth |
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Ovarian Hyperstimulation Syndrome:
presentation complication |
weight gain, big ovaries (can rupture)
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Clomiphene:
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GnRH agonist=> multiple births
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Progesterone: SE (eating habbits, face, pigmentation (2), vascular (4), uterus, brain.
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⇧appetite, pica,⇧ acne, melasma, quiescent uterus, violence, (hyperpigmentation), dark areola, has Epo sequence in it, resorbs sodium/water (bloating), hypertension, dilutional anemia
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Estrogen: SE (muscle, GI, liver (2), brain, vascular system (2), bone
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muscle relaxant, constipation, ⇧protein production, increase HDL, irritability, varicose veins, hypotension, inhibits osteoclasts
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Amenorrhea Tests:
1) No uterus 2) No patent vagina 3) Povera challenge |
Amenorrhea Tests:
1) No uterus: Karyotype (Ex: testicular feminization) 2) No patent vagina: MRI (Ex: imperforate hymen /septal·defects) 3) Povera challenge |
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define the Provera Challenge:
• Bleeds=> • Not bleed=> Dx and next test |
Provera challenge: 5mg x 5 days and stop "5 for 5"
• Bleeds=> estrogen is normal (Ex: Normal/PCOS: ⇧LH) • Not bleed=> estrogen is abnormal or may have scarring (E-x: Asherman's) ⇧FSH ⇨ ovarian failure (Ex: turner's/Menopause) ⇩FSH ⇨ pituitary problem (Ex: Prolactinoma/Sheehan's/ Adenoma) |
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Bicornate Uterus
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can cerclage if previous losses
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Polycystic Ovarian Syndrome: presentation and hormone levels
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⇧LH, ⇧testosterone, obese, hairy, acne, amenorrhea, DM
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why do PCOS patients have increase risk of endometrial carcinoma?
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⇧ Cysts: no ovulation ⇨ no progesterone (⇧endometrial CA) ⇨ can't inhibit LH
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tx for PCOS
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Tx: clomiphene (if pt wants to be pregnant), Metformin,
Spironolactone (tx hirsuitism) |
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Estrogen Effects:
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Weight gain
Breast tenderness Nausea, HA |
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Progesterone Effects:
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Acne
Depression HTN |
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Natural Planning:
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75% effective Periodic abstinence during ovulation
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Male Condoms:
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protects against STDs (85% effective)
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Diaphragms/Cervical caps:
usage effectiveness complications |
UTIs/cervicitis/TSS, leave in 8hr postcoitus (80% effective)
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Spermicides
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lasts 1 hr (70% effective)
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Hormonal Contraceptives: CI
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don't give to smokers or SLE pts (92% effective)
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Hormonal Contraceptives: Estrogen
what does it do to prevent pregnancy? |
⇩FSH: can't select dominant follicle "Follicle Stimulator"
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Hormonal Contraceptives:
Progestin what does it do to prevent pregnancy? |
⇩LH: ⇩Ovulation, thick cervical mucus, inhospitable endometrium
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Combination Pill:
2 types and which is the most common form of progesterone/estrogen? |
• Norethindrone: most common form of progesterone
• Mestranol: most common form of estrogen |
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Nuvaring
hormone(s) usage |
Estrogen+ Progesterone, placed in vagina lasts 3 wk
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Ortho Evra Patch
type of hormones how long it lasts |
Estrogen + Progesterone lasts 1 wk
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Minipill
what hormone is in it what does it do during ovulation? when is it used? |
Progesterone only, does not block ovulation, use w/ breast feeding
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Depo-Provera
what is it who can use it? |
long-acting Progesterone shot lasts 3mo,
use in sickle cell/ epilepsy/ smokers |
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Intrauterine Devices: used for what kind of patients
complications effectiveness |
use for smokers or bleeding disorders
⇧PID /ectopic risk (99% effective) |
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Progesterone IUD
how long it last how does it work SE |
"mirena"is an Intrauterine Device that lasts 5 yrs:
releases 20 mg/day Levonorgesterol (amenorrhea) |
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Copper T
how long it last how does it work menstrual cycle |
is an Intrauterine Device lasts 10 yrs
inflammation kills sperm (regular menses) |
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Sterilization: what is it called in males/females? how effective is it?
Male: ejaculation, caution female: SE, procedures |
99% effective
Male: vasectomy- ejaculation still occurs, use caution in first 6 wks Female: tubal ligation- ⇧ectopic/pelvic-pain (Electrocautery > Banding> Clipping) |
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when plan B can be used? how does it work?
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Postcoital protection that uses 2 pills progesterone,
then 2 pills 12hr later, no prescription needed (<72hr) |
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Yuzpe: what is it? how is it used?
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Postcoital protection high dose estrogen/progesterone,
repeat 12hr later (<72hr) |
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IUD insertion
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Postcoital protection Copper T (<5days)
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RU486: what is it? how does it work?
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Postcoital protection that blocks progesterone receptor to slough lining, abortifacient (<7wk)
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Menopause test
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50 y/o ⇨ FSH > 30 + 6mo amenorrhea
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Hot Flash tx
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Tx: Clonidine
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Hormone Replacement Therapy "HRT":
Post-menopause: After 3yrs: Post-hysterectomy: |
Post-menopause: E2 + Progesterone (to protect from endometrial CA)
After 3yrs: Stop E2 (b/c of clots), switch to Rolixifene Post-hysterectomy: E2 alone |
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HRT Risks:
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⇧Endometrial CA
⇧Breast CA ⇧DVT |
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HRT Benefits
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⇩Osteoporosis
⇧HDL |
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Fertilization: 3 sperm reactions
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Capacitation Rxn
Acrosomal Rxn: Crystalization Rxn |
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Crystalization Rxn:
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wall formed after 1 sperm enters (to prevent polyspermy)
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Capacitation Rxn
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Zn used to peel semen off
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Acrosomal Rxn:
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sperm release enzymes to eat corona radiata
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Spermatogenesis
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LH ⇨ Leydig cells ⇨ Testosterone ⇨ Spermatogenesis
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Embryology Ducts:
Boy: Girl: |
Boy: Mesonephros = Wolffian duct (forms inside to out)
Girl: Paramesonephros = Mullerian duct (forms up to down) |
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Embryology genital anatomy
boy girl |
Boy: Testes, Vas deferens, Epididymis, Seminal vesicles
Girl: Ovaries, Fallopian tubes Uterus (w/ cervix), Upper vagina |
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Labioscrotal swelling:
boy girl |
boy: Scrotum
girl: Labia majora |
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Urogenital fold:
boy girl |
Boy: Prostate, Prostatic urethra, Bulbourethral glands
Girl: Labia minora, Lower vagina |
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Genital tubercle:
boy girl |
boy: Penis
girl: Clitoris |
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Assisted Reproduction: when is it used for? success rate? and describe its 3 types
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used for inadequate spermatogenesis, 25% success rate
a) In Vitro Fertilization b) Gamete Intrafallopian Transfer c) Zygote Intrafallopian Transfer |
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In Vitro Fertilization
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fertilize eggs in lab ~> uterus
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Gamete Intrafallopian Transfer
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put eggs + sperm~> Fallopian tube
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Zygote Intrafallopian Transfer
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put zygote ~> Fallopian tube
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Impotence
tx do not mix with what drugs |
No nitrates or α1 blockers!
• Sildenafil "Viagra" • Vardenafil "Levitra" • Tadalafil "Cialis" |
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Premature ejaculation: what is the cause of it? and tx
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: stress => sympathetics, females have slow
latent phase • Tx: " squeeze technique" to cause sperm to turn around |
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define Infertility:
5 risk factors |
inability to conceive after 12 months of unprotected sex
Risk Factors: Smoking BMI >29 • 50% Male problem • 30% Female problem (PID) • 20% Other |
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Acute Bleeding Tx:
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• Estrogen (high dose)
• Oral contraceptives (high dose) • D&C |
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Male Infertility Workup:
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measure signal to see if organ is OK
1) TSH ⇨ ⇩GnRH ⇨ ⇩LH 2) Testosterone 3) GnRH 4) PRL |
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Adrenal gland =>
Testicles => |
Adrenal gland => Testosterone
Testicles => DHT (at puberty) |
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Female Infertility Workup:
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1) Peritoneal: endometriosis, adhesions
2) Ovulatory: hypothalamus-pituitary-ovary 3) Tubo-uterine: fibroids, tubal occlusion 4) Cervix: abnormal mucus 5) Unexplained: anti-sperm Ab |
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2 syndromes that can cause Precocious Puberty:
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• Pineal tumor
• McCune-Albright |
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Rape:
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sexual contact without consent
• Erection/ ejaculation does not have to occur, victim does not have to prove they resisted |
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Sodomy
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oral/ anal penetration
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Statutory rape
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< 16 y/o or handicapped
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Spousal rape:
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sexual contact by husband w/o consent
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Pathology: of being male or female
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"male/female" is based on genotype
"It's what's on the inside that counts" |
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what are these hormones responsible for?
Miillerian Inhibiting Factor "MIF" => Testosterone => |
Miillerian Inhibiting Factor
"MIF" => internal genitalia Testosterone => external genitalia |
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Pseudohermaphrodite
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external genitalia problem
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True Hermaphrodite
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internal genitalia problem => has both sexes
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Female Hermaphrodite:
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impossible b/c the default is female
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what diseases can cause Precocious Puberty, give 2
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• Pineal tumor
• McCune-Albright |
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Female Pseudohermaphrodite:
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XX with low 21-OHase = > high testosterone
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Male Hermaphrodite:
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XY with no MIF
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Male Pseudohermaphrodite:
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XY that has low 17-0Hase = > low testosterone
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Testicular Feminization = Androgen Insensitivity Syndrome
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• Bad DHT receptor ⇨ XY w/ blind pouch vagina
• No axillary/pubic hair |
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Testicular Feminization = Androgen Insensitivity Syndrome tx
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Tx: Bilateral gonadectomy (to prevent cancer)
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Hirsutism:
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hairy
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Virilization
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man-like
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McCune-Albright: presentation
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precocious sexual development
• Polyostotic fibrous dysplasia "whorls of CT" • "Coast of Maine" pigmented skin macules |
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McCune-Albright: tx
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Tx: Progesterone (anti-E2) or Flutamide (anti-androgen)
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Cryptorchidism: tx and define
associated with what cancer? |
testes never descended=> sterility after 15mo, seminomas
• Tx: GnRH to pull testes down at 6mo, Orchiopexy at 1 y/o (staple testes to scrotum) |
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Increased Estrogen States
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• Pregnancy
• Liver failure • p450 inhibition |
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Bleeding Disorders
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>80mL
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Adenomyosis: define, DES effect in daughter and tx (3)
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growth of endometrium ~> myometrium, enlarged "boggy" uterus w / cystic areas
DES => increased risk in daughters • Tx: Oral contraceptives, Leuprolide, Hysterectomy |
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what are the effect of DES on daughters? presentation?
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Adenomyosis ~> menorrhagia, Clear cell CA of vagina/cervix and Recurrent abortions
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Kallman's sydrome: pathogenesis and tx
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no GnRH can't smell. GnRH neurons fail to migrate from the old embroyonic olfactory epithelia to the hypothalamous
Tx:pulsatile GnRH |
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Savage's syndrome
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ovarian resistance to FSH/LH
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Turner's syndrome: chromosome, 2 hormone level, reproductive system.
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(XO): high FSH, low E2, ovarian dysgenesis
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1° Amenorrhea Workup:
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1) ⇧PRL
2) ⇩TSH 3) ⇧E2 4) ⇧FSH ~>karyotype |
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Bleeding Most Commons:Post-coital
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cervical cancer
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Bleeding Most Commons: Post-menopause
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endometrial cancer
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Bleeding Most Commons: Post-coital pregnant
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placenta previa
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define 2° Amenorrhea and 3 examples
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>>stop menstruating (>6mo)
Pregnancy: Hypothalamic Dysfunction: Sheehan syndrome: |
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what is the #1 2ndary cause of amenorrhea
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Pregnancy: #1 cause
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secondary amenorrhea Hypothalamic Dysfunction
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exercise-induced, ⇩FSH/ ⇩LH/ ⇩E2
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Sheehan syndrome: define and tx
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post-partum hemorrhage~> pituitary
hyperplasia infarcts ~> no lactation • Tx: Synthroid, Cortisol |
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Asherman's syndrome
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previous D&C ~>uterine scars
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Chronic Pelvic Pain
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Endometriosis until proven otherwise
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Dysfunctional Uterine Bleeding: define and tx
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Diagnosis of exclusion, usually due to anovulation
• Tx: IV Estrogen (to stop bleeding), D&C |
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Dysmenorrhea:
define what hormone is responsible? tx? does the teen ager need parental consent to use OCP's? |
painful menstrual cramps (teenagers miss school/work)
• PG-F is responsible • Tx: Naproxen or Oral contraceptives (need parental consent for this use) |
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Endometriosis: presentation. what does it mean when there is hemoptysis with each period?
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painful heavy menstrual bleeding, infertility, ''powderburns, chocolate cysts". Blue ~> Brown ~> White
Ex: Hemoptysis with each period => endometriosis of nasopharynx or lung lesions |
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Endometriosis: Dx
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Dx: Laparoscopy => biopsy those 3 areas (ovary, uterosacralligament, cul-de-sac of Pouch of Douglas)
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Endometriosis: Tx
complications of endometriosis: MOA of Danazol |
Tx: Oral contraceptives, Leuprolide, Danazol = potent androgen (⇩FSH/ LH)
• Treatment-resistant Endometriosis: pelvic abscess or pelvic thrombophlebitis |
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Endometriosis: pathogenesis
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Retrograde menses through Fallopian tube into:
o ovary, uterosacral ligament, cul-de-sac of Pouch of Douglas |
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Kleine regnung
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scant bleeding at ovulation
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Menorrhagia
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heavy menstrual bleeding
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menorrhagia + Obesity:
what hormone does fat make? tx (3) |
fat makes estrogen
(Tx: weight loss, Oral contraceptives, Leuprolide = GnRH analog) |
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Fibroids: define and 2 types
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Leiomyoma: benign uterus SM tumor
submucosal subserosal type |
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submucosal type define and tx
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Submucosal type=> bleeding
(Tx: hysterectomy) |
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Subserosal type: define and tx
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=>pain
(Tx: myomectomy) "serosal -> think surface" |
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Metrorrhagia:
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bleeding or spotting in between periods
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what does Postcoital bleeding in a child bearing age indicate? pathogen?
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cervical CA (HPV 16,18,31,45)
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Postcoital bleeding >40y/o:
cause and tx |
endometrial CA
(Tx: TAH, BSO) |
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Mittelschmerz
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pain at ovulation
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Adnexal Torsion
management sign |
Gynecologic Emergencies.
mass with no Doppler flow |
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Ruptured Ectopic pregnancy
sign management |
Gynecologic Emergencies.
free fluid in cul-de-sac |
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Syphilis: pathogen
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Treponema pallidum (spirochete)
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Syphilis: name 2 diagnosis test, in what 4 cases is it false (+)
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FTA-ABS: (+) for life and RPR/VRDL (>1:16)
False +:SLE, HepC, Mono, recent vaccination |
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Syphilis: Tx:
when pregnant |
Doxycyline, Penicillin G
(if pregnant) |
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Syphilis: symptoms
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1°: painless chancre
(1-6 wks) 2°: rash, condyloma lata (6 wks) 3°: neuro, cardia, bone (6yrs) |
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Herpes virus: 2 types
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I= oral (palliative)
II= genital |
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Herpes virus: genetic make up
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ds DNA
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Herpes virus: 3 tests
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Tzanck test
Culture PCR |
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Herpes virus: tx
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Acyclovir
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Herpes virus: symptoms
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1° = fulminate grouped
vesicles on red base 2° = painful solitary lesion |
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HPV: tx
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Imiquimod
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HPV: genetic make up
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ds DNA virus
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HPV: diagnosis
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Koilocytes
Biopsy Serotype |
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HPV: symptoms
HPV 6/11: HPV 16 /18: |
HPV 6/11: condyloma accuminata
HPV 16 /18: cervical cancer |
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Chlamydia: agent
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obligate
intracellular parasite |
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Chlamydia: 3 ways to diagnose
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Tissue culture, Nucleic acid probe, Elementary bodies
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Chlamydia: tx
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Azithromycin
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Chlamydia: symptoms
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Cervicitis: yellow pus
Conjunctivitis 90% asymptomatic |
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Gonorrhea: agent
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Gram - diplococcus
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Gonorrhea: 3 ways to diagnose
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Gram stain
Thayer Martin culture Nucleic acid probe |
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Gonorrhea: tx and pharyngeal gonorrhea
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Ceftriaxone or Ofloxacin (if pharyngeal)
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Gonorrhea: symptoms in male and female
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Palmar pustules, Arthritis
90% male symptomatic 50% female symptomatic |
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Condyloma lata
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2° Syphilis: = flat fleshy warts, ulcerate
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Condyloma accuminata: describe and tx
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HPV 6/11: = verrucous "cauliflower" warts, koilocytes
• Tx: Podophyllin, TCA, or freeze it off |
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Chancres: causes of increase of what kind of infection
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⇧risk of HIV infection through breaks in skin barrier
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painful vesicles, ulcerate, intranuclear inclusion bodies
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Herpes (DNA virus):
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painless chancre
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Syphilis (T. pallidum ):
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Chancroid:
pathogen describe and tx |
(H. ducrei): painful ulcer w/ irregular borders, necrotic center, Gram- rod, "school of fish"
pattern (Tx: Ciprofloxacin) |
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Lymphogranuloma Venereum: agent, clues and tx
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(C. trachomatis): painless lymphadenopathy
(Tx: Doxycycline) |
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Granuloma Inguinale: pathogen, lesion, bodies and tx
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(C. granulomatosis): oozing lesions, Donovan bodies
(Tx: Doxycyline) |
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Balanitis: clue and tx
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itchy penis papules
(Tx: Fluconazole) |
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Congenital blindness
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CMV
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Neonatal blindness
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Chlamydia
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Epididymitis: pathogen, describe, treatment and management
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(Chlamydia)
• Unilateral scrotal pain that is decreased by support Tx: Doxycycline (must treat partner) |
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Painless STDs: what percentage and give 3 examples
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80% is painless. The other 20% is not painless.
Syphilis, Lymphogranuloma Venereum, Granuloma Inguinale |
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Testicular Torsion: clues and tx
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• No cremasteric reflex, odd angle
• Pain not decreased with elevation • Tx: immediate operation |
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3 cause of Vaginitis and how does it do this?
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Antibiotics: disrupt normal flora balance
Douche/ Sex: increases pH Foreign Body: focus of infection -> pediatric discharge |
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Candidiasis: discharge, presentation and how does it look like on a slide and treatment (2)
|
cottage cheese discharge, itchy, pseudohyphae
• Tx: 150mg Fluconazole or 1% Terconazole cream |
|
|
Trichomonas: discharge, cervix and movement of organism
treatment and management on situations is this a common infection of? |
green frothy discharge, strawberry cervix, flagellated
most common infxn s/p rape • Tx: 2g Metronidazole (tx partners) |
|
|
Bacterial (Gardnerella): discharge, cells, odor, shape of organism and diagnose
Tx: general and pregnancy |
clear discharge, clue cells, fishy odor, coccobacillus, KOH prep
• Tx: 2g Metronidazole or Clindamycin cream (if pregnant) |
|
|
Prolapse Progression:
1st Degree: 2nd Degree: 3rd Degree: |
1st Degree: Upper 2/3 vagina
2nd Degree: Near introitus 3rd Degree: Outside vagina |
|
|
Lichen simplex chronicus: describe and treatment
|
raised itchy red lesions of the vulva -> white
Tx: topical steroids |
|
|
Lichen sclerosis: vulva, rule out, and treatment
|
paperlike vulva, itchy white butterfly pattern from labia to anus,
r/o vulva CA Tx: Clobetasol - steroid cream |
|
|
Lichen planus: describe/oral lesions, associated with what disease? and treatment
|
pruritic polygonal purple papules, oral lesions (white lacy streaks on buccal mucosa),
assoc w / Hep C Tx: Betamethasone cream |
|
|
Cystocele: tx
|
• Colpocleisis (obliterate vaginal canal)
• Sling (elevate urethra) |
|
|
Uterine prolapse tx
|
"procidentia":
Hysterectomy |
|
|
TORCHS:
|
non-bacterial fetal infections
|
|
|
Toxoplasma:
how is it acquired where in the brain what would be seen? |
multiple ring-enhancing lesions, cat urine, parietal lobe
|
|
|
Rubella on baby (5)
|
cataracts, hearing loss, PDA, meningoencephalitis, "blueberry muffin" rash
|
|
|
CMV on baby (4)
|
spastic diplegia of legs, central calcifications, blind, most common congenital deafness
|
|
|
HSV -2:
causes what? what does it need to avoid this? |
temporal lobe hemorrhagic encephalitis, need C/S prophylaxis
|
|
|
Syphilis on baby (4)
|
(loves bone): Rhagade's (lip fissure), Hutchison's razor teeth, saber shin legs, mulberry molars
|
|
|
Types of Estrogen: where is each on made
E1: E2: E3: |
E1: Estrone (made by fat)
E2: Estradiol (made by ovaries) E3: Estriol (made by placenta) |
|
|
normal Pregnancy weight gain
|
gain -40 lbs
|
|
|
Zygote: how many cells and location
|
2 cells; in Fallopian tube (ampulla)
|
|
|
Morula: how many cells? where does it go?
|
16 cells, enters uterus
|
|
|
Blastula: number of cells, type of rxns, where does it stay
|
256-512 cells, blasts into posterior wall of uterus, "decidual rxn" = "Arias Stella rxn"
|
|
|
Identical twins:
|
split into perfect halves (monochorionic)
|
|
|
Fraternal twins:
|
multiple eggs fertilized by different sperm (dizygotic)
|
|
|
Trophoblast: who makes it? function?
|
Baby => feeds off spiral aa. and lipid/ glycogen
|
|
|
Cytotrophoblast: who makes it? 4 hormones that are made? simmilar to what structure?
|
Mom=> GnRH, CRH, TRH, Inhibin (similar to hypothalamus)
|
|
|
Synctiotrophoblast: who makes it? hormones that are made? simmilar to what structure?
|
Both mom and baby => HCG, HPL (similar to pituitary)
|
|
|
what does lacunar network mean?
|
Placenta inside: baby's
Placenta outside: mom's (villi grow toward mom) "lacunar network" |
|
|
what happens after 1 week of fertilization? after 2 weeks?
|
1 week after fertilization: Implantation
2 weeks after fertilization: β-HCG in urine |
|
|
Nomenclature: GxPxxxx
G PTAL |
G = Gestation
P =Pregnancies: Term, Preterm, Abortions, Live kids "TPAL" |
|
|
Gestational age
|
from last menstrual period
|
|
|
Developmental age
|
from fertilization
|
|
|
( +) Pregnancy test:
|
8 days after conception
|
|
|
Teenage pregnancy risks:
|
prematurity, perinatal mortality ( death of a fetus ), cognitive disorders
|
|
|
Herpes Gestationalis: clues and tx
|
itchy umbilical rash (Tx: topical Triamcinolone)
|
|
|
Telogen Effluvium:
|
post-partum hair loss
|
|
|
Pregnant Endocrinology:
Increased E:P ratio Decreased E:P ratio |
Increased E:P ratio ⇨ labor
Decreased E:P ratio ⇨ post-partum, breast feeding |
|
|
Estrogen: muscle, smooth muscle, liver, brain and vascular system (5)
|
muscle relaxant, constipation, ⇧protein production, irritability, varicose veins
|
|
|
Low E3: (4)
|
molar pregnancy, abortion, anencephaly, trisomies
|
|
|
Progesterone: 6 effect in the ff. diet, face, brain, uterus, BP
|
⇧appetite, pica, ⇧acne, dilutional anemia, quiescent uterus, violence
|
|
|
Progesterone: how is it made during the ff weeks
Wk 1-10: Wk 11-40 <10 ng/mL |
Wk 1-10: Placenta ⇨ β-HCG ⇨ corpus luteum ⇨ progesterone
Wk 11-40: Placenta ⇨ progesterone <10 ng/mL =>non-viable |
|
|
what does beta HCG do TSHr (2)
|
maintains corpus luteum, sensitizes TSHr =>act hyperthyroid (to ⇧BMR)
|
|
|
β-HCG: what makes it
how does it increase in amt. simmilar to what hormone |
Similar to LH
• Made by placenta • Doubles every 2 days until 10 wks (when placenta is fully formed) |
|
|
when is beta HCG false +/-
|
False (+): proteinuria, UTI
False(-): dilute urine |
|
|
what does it mean when beta HCG is low/high
|
Low: ectopic, abortion, anencephaly, Trisomy18 "lower number"
• High: twins, molar pregnancy, Trisomy 21 (small baby) |
|
|
AFP: function and where is it made from?
|
made by yolk sac/ liver, regulates fetal intravascular volume
|
|
|
Dx of low or high AFP, management for high AFP
|
Low: Trisomy 18, 21
High: twins, openings: anencephaly, spina bifida (do US anatomy scan) |
|
|
HPL function
|
blocks insulin receptors => sugar stays high
(baby's stocking up on stuff needed for the journey) |
|
|
Anemia of Pregnancy:
|
"dilutional"
• RBC rises 30% • Volume rises 50% |
|
|
what happens to PRL at birth ?
|
⇩progesterone => PRL acts unopposed
|
|
|
Inhibin function and what does it lead to?
|
inhibits FSH =>no menstruation
|
|
|
Oxytocin:
|
milk ejection, baby ejection
|
|
|
give 2 functions of Cortisol
|
decreases immune rejection of baby, lung development
|
|
|
Thyroid Hormones: TBG, bound T4 levels and free T4 levels
|
⇧TBG = ⇧bound T4, normal free T4 levels
|
|
|
Pregnant woman with new onset A Fib: Dx
|
think hyperthyroid
|
|
|
Pregnant Physiology
Brain: Cardiology: (3) |
Brain: ⇩migraines
Cardiology: ⇧CO, vasodilation "glow", hypotension |
|
|
Pregnant Physiology
Pulmonary: TV, V min, CO2 Renal: GFR, renin |
Pulmonary: ⇧TV, ⇧V min ⇩CO2 ⇨ relative hyperventilation to remove CO2 from baby to Mom
Renal: ⇧GFR, ⇩renin |
|
|
Pregnant Physiology
Liver: protein production ⇨ ? GI: (3) |
GI: ⇩PUD (⇩H+), constipation, GERD
Liver: ⇧protein production ⇨ ⇧TBG, hypercoagulable state |
|
|
Pregnant Physiology
Endocrine: total T4, free T4 Heme: RBC, Vol, veins Musculoskeletal: |
Endocrine: ⇧total T4, normal free T4
Heme: ⇧RBC (30%), ⇧Vol (50%), telangiectasias, varicose veins Musculoskeletal: Muscles relax |
|
|
Pregnant Physiology:
Skin: Immunology: |
Skin: Striae, linea nigra,
spider angiomas, acne, melasma hyperpigmentation "mask" Immunology: immunity=> autoimmune dz gets better (except SLE) post-partum silent thyroiditis |
|
|
Fibronectin test
|
increase delivery by 2wk
|
|
|
Chadwick's sign
|
blue vagina ( increase blood flow)
|
|
|
Hegar's sign
|
soft cervix
|
|
|
Fetal Heart tones
when is it developed? when is it detected? |
>8wk (we can't detect tilL 20wks)
|
|
|
when is it used: Ultrasound:
|
<20 wk
|
|
|
what would you see in a US at
16 wks? 20 weeks? |
week 16: can see if it's a girl/boy
Week 20: can feel baby move, baby fully formed/starting to grow |
|
|
when can one see the fetus
with a vaginal u/s and abdominal u/s? define crown- rump? |
• Can see with vaginal US when β-HCG >1,500
• Can see with abdominal US when β-HCG > 6,000 • Crown-rump: most accurate length |
|
|
Amniotic Fluid Index (AFI):
• <5: Dx and examples • >20: Dx and examples |
• <5: Oligohydramnios (cord compression or renal agenesis)
• >20: Polyhydramnios (DM or GI obstruction) |
|
|
how high should Fundal Heigh be at 12 weeks at 20 weeks
|
uterus should grow 1 cm/ 1wk
(bad if>4 difference from gestational age) • Pubic symphysis= week 12 • Umbilicus = week 20 (can feel baby kicking here, baby has been moving since week 8) |
|
|
Rupture of Membranes: 3 tests
|
• Pool test
• Fering • Nitrazine |
|
|
Pool test
|
look for fluid in vagina
|
|
|
Ferning
|
estrogen crystallizes on slide
|
|
|
Nitrazine
when is it false + |
amniotic fluid is alkaline (False + : blood, semen, infection)
|
|
|
Chorionic Villus Sampling
complication what should one test for? and when? |
⇧risk of fetal limb defects, test for Trisomy 21 (week 10)
|
|
|
Amniocentesis
complication when is it done? what is it for? |
(2% abortion rate): get fetal blood, test for Trisomies and NTD (week 16)
|
|
|
Percutaneous Umbilical Blood Sampling "cordocentesis"
when is this done? |
chromosomal analysis, transfusions
|
|
|
Radiation Levels: CXR, CT, barium
when should mom not air travel? |
CXR < CT < Barium
36wk: no air travel |
|
|
Multiple Gestations:
Twins: Triplets: Quadruplets: |
Twins: 37wk
Triplets: 33wk Quadruplets: 29wk |
|
|
Gynecoid
|
circular~> vaginal delivery
|
|
|
Anthropoid:
|
vertical oval ~> vaginal delivery
|
|
|
Biophysical Profile: normal
|
>8 = normal
|
|
|
Biophysical Profile: how is it done, qualifications for a good biophysical profile.
|
"Test the Baby, MAN"
Heart Tones Breathing Movement: BPD, HC, AC, FL Amniotic Fluid Index • Non-stress test (normal= "reactive") o Baby moves >32wk: ⇧HR 15bpm for 15sec, need 2 over 20min |
|
|
Platypelloid
|
horizontal oval ⇨ C/S
|
|
|
Android
|
heart ⇨ C/S
|
|
|
Pregnant Nutrition
Gain: lbs/wk, and calories Pica |
Gain 1 lb/wk (2800 cal/ day)
Pica: urge to eat ice, clay, starch |
|
|
Pregnant Nutrition
Folic acid Ca |
Folic acid: 0.4mg/day or 4mg/day if on Valproic Acid (avoid NTD)
Ca: 1500 mg/day (bone growth, SM contraction, mitosis) |
|
|
Pregnant Nutrition and explain why?
Fe: Zn: |
Fe: 30 mg/day (erythropoiesis)
Zn: 20 mg/day (sperm, taste buds, hair) |
|
|
Pregnant Nutrition
Vegans: Fish: |
Vegans: need protein, Vit B1
Fish: 1x/wk (no mercury: shark, swordfish, king mackerel) |
|
|
Pregnant Nutrition
No Alcohol No Tobacco |
No Alcohol: inhibits nuclear division of rapidly dividing cells ⇨ mental retardation
No Tobacco: IUGR, SIDS, prematurity, |
|
|
Pregnant Nutrition:
Cocaine Amphetamines Exercise: |
No Cocaine, Heroin, Amphetamines
Exercise: OK, stop if feel pain |
|
|
Gestational DM:
|
5O% will have DM type II later in life
|
|
|
why is glucose monitored closely during Pregnancy?
|
avoid fetal anomalies
|
|
|
Doctor Visits:
Month 1-7: Months 8-9: > 9 months: |
Month 1-7: Every month
Months 8-9: Every two weeks > 9 months: Every week until delivery |
|
|
Intercourse with a pregnant woman. what side should she be laying? what is the libido levels for each?
1st trimester: 2nd trimester: 3rd trimester: 6 weeks post-partum: |
woman on left side
• 1st trimester: ⇩libido (β-HCG's fault) • 2nd trimester: normal libido • 3rd trimester: may cause uterine contractions (PGF in semen) • 6 weeks post-partum: normal libido |
|
|
Prenatal Visits: test to be done
1st Visit: Week 16: Week 26: Week 36: |
1st Visit: Pap smear, GC/Rh screen
Week 16: US, Triple screen, Amniocentesis (if >35 y/o) Week 26: DM screen, Rho Gam Week 36: GBS screen (fx: Penicillin G during labor) |
|
|
Mom Chickenpox Exposure
|
Ck VZV titer, give Ig within 72hr
|
|
|
uE3 B-HCG AFP
Trisomy 18 |
uE3 B-HCG AFP
⇩ ⇩ ⇩ |
|
|
uE3 B-HCG AFP
Trisomy 21 |
uE3 B-HCG AFP
⇩ ⇧ ⇩ |
|
|
3 Requirements For Labor:
|
Contractions
Cervical Dilation Water Broke |
|
|
Contractions:
how often should they be? tx? |
q5min
Push Tx: Oxytocin |
|
|
Requirements For Labor:
Cervical Dilation: tx for incompetent cervix |
>4cm is irreversible
• Incompetent Cervix Tx: bedrest, then cerclage (12-36wk) |
|
|
Requirements For Labor:
If water is not broken, what is the tx? Dx of a water broken but no contractions? |
Water Broke:
• Not Broken Tx: PGE2 paper "Cervidil" if pt has good contractions • PROM: water broke, no contractions |
|
|
Labor Halt: Tocolytics
which ones decreases contractions? which one stops ADH? which one causes edema? what is mytocin? |
Hydration (stop ADH=mytocin)
Terbutaline- decrease contractions Ritodrine - ⇧ edema |
|
|
Leopold Maneuvers
|
1) Feel fundus
2) Feel baby's back 3) Feel pelvic inlet 4) Feel baby's head |
|
|
what does it mean when the bishop score is >8. when should mom come to the hospital?
|
Bishop's score >8 ~> delivery soon
Come to hospital when contractions are q5 min for > 1 hr |
|
|
Stage 1 of labor: 2 stages and when should an epidural be placed?
|
up to full dilation
1) Latent Phase ( <20h): 2) Active Phase (<12h): • 7cm: place Hydromorphone Epidural |
|
|
Latent Phase of labor: describe, how long is it? what makes the cervix dilate?
|
Stage 1: up to full dilation
( <20h): Contractions => 3cm cervical dilation |
|
|
Active Phase of labor: how long is it? how many cm/hr and describe
|
(<12h): 4-10cm cervical dilation (1cm/hr)
|
|
|
Monitor Baby HR:
normal HR what instruments used |
120-160=normal
1) Doppler 2) Scalp electrode |
|
|
how is the uterus monitored internally and externally? what do this instruments tell you?
|
Monitor Uterus:
1) External: Tocodynamics: frequency/duration of contractions 2) Internal: Uterine pressure catheter: intensity of contractions |
|
|
labor Induction: how does the contraction affects the baby?
give 3 things that can cause this? |
contraction leads to baby hypotension
• PGE2 • Oxytocin • Pitocin |
|
|
CI for PGE2 labor induction:
|
asthma and previous C/S
|
|
|
Vaginal Lacerations:
1st to 4th degree |
"SMARt"
1st Degree: Skin 2nd Degree: Muscle 3rd Degree: Anus 4th Degree: Rectum |
|
|
Stage II of labor
time what happens |
full dilation to delivery (< 2h)
|
|
|
Station 0: 7 stages
|
Baby above pelvic rim (most uteri are anteverted)
1. Engage 2. Descend 3. Flex head 4. Internal rotation 5. Extend head 6. Externally rotate 7. Expulsion: LDA most common presentation |
|
|
duration is determined by what
|
Duration determined by the 3 P's:
1. Power of contraction 2. Passenger size 3. Pelvis size |
|
|
what happens during Stage III of labor
due to what hormone? |
delivery of placenta (due to PG-F)
• blood gush ⇨ cord lengthens ⇨ fundus firms |
|
|
Braxton-Hicks contractions:
|
irregular contractions w / closed cervix
|
|
|
Stage IV of labor
|
6hrs post-partum
|
|
|
Post-partum hemorrhage define
|
> 5OO cc for vaginal delivery or >1L for C/ S
|
|
|
complications of stage 4
|
1) Atony:
2) Retained Placenta 3) Laceration |
|
|
if the uterus does not come down by 24 hrs, what is this called? management?
|
atony, uterus should come down to umbilicus by 24hr
(Tx: bimanual massage/ Pitocin) |
|
|
degrees of Episiotomy:
|
1⁰: through serosa
2°: through muscularis 3°: into perineal body |
|
|
Anesthesia:
Vaginal: Urgent C/S: Emergent C/S: Forceps/Vacuum: |
Vaginal: Epidural
Urgent C/S: Spinal anesthesia Emergent C/S: General sedation Forceps/Vacuum: Pudendal block |
|
|
Baby Presentations: Vertex:
describe and delivery |
posterior fontanel (triangle shape) presents first, normal delivery
|
|
|
Baby Presentations: Sinciput:
describe and delivery |
anterior fontanel (diamond shape) presents first
C/S |
|
|
Baby Presentations:Face:
describe and delivery |
if mentum anterior ⇨ forceps delivery
|
|
|
Baby Presentations: Compound
describe and delivery |
arm or hand on head ⇨ vaginal
|
|
|
Baby Presentations: Complete Breech
describe and delivery |
butt down, thighs and legs flexed
C-section |
|
|
Baby Presentations: Frank Breech
describe and delivery |
butt down, thigh flexed, legs extended (pancake)
⇨ delivery vaginally > 36 wks |
|
|
Baby Presentations:Footling Breech
describe and delivery |
butt down, thigh flexed, one toe is sticking out of cervical os
C-section |
|
|
Baby Presentations:
Double Footling Breech describe and delivery |
two feet sticking out of cervical os
C-section |
|
|
Baby Presentations:
Transverse Lie describe and delivery |
head is on one side, butt on the other ⇨ try Leopold manuver
|
|
|
Baby Presentations: delivery and define Shoulder Dystocia.
|
head out, shoulder stuck ⇨ try Leopold maneuver
|
|
|
Shoulder Dystocia Tx:
(7) in order |
1) Suprapubic pressure
2) McRobert's: move Mom's thighs to abdomen 3) Episiotomy 4) Wood's screw: try to rotate baby 5) Break clavicle 6) Zavanelli: push the head back in 7) C/S |
|
|
8 Reasons for C/S: what are the exceptions?
|
Arrest Disorder: adequate IUPC, no Δ dilation/2hr, no Δ descent/1hr, no contractions q3min
• Fetal Bleeding: (+) Apt test • Abruptio Placenta: painful bleeding • Placenta Previa: painless bleeding • Eclampsia • Twins: unless vertex-vertex • Breech: unless face/brow presents • Herpes: active lesions within 2wk |
|
|
2 types of C/S:
|
Classic Horizontal:
Low Transverse: |
|
|
Classic Horizontal
|
must have C/S for all future pregnancies
|
|
|
Low Transverse
|
can try vaginal delivery for future pregnancies w/ Foley bulb
|
|
|
Fetal HR Monitor: normal, what happens to the HR when the baby is stressed
|
Normal= 120-160 bpm (stress ⇨ ⇩baby HR)
|
|
|
what can fetal stress lead to?
|
Fetal stress =>sympathetics = > meconium aspiration
|
|
|
Montevideo units:
|
(increased pressure) x (contraction frequency/10 min) = 200/10min
|
|
|
Early Deceleration
|
normal, due to head compression
|
|
|
Late Deceleration: describe and tx
|
uteroplacental insufficiency b/c placenta can't provide 02/ nutrients (Tx: C/S)
|
|
|
Variable Deceleration and tx
|
cord compression (Tx: 02 +put Mom on side; amnioinfusion or C/S)
|
|
|
why does a baby get tachycardia and bradycardia during variable decelerations
|
Loss of blood => tachycardia (via carotid reflex)
Loss of 02 =>bradycardia |
|
|
Increased beat-to-beat variability
tx |
fetal hypoxemia (Tx: C/S)
|
|
|
Decreased beat-to-beat variability
tx |
acidemia (Tx: C/S)
|
|
|
Asymptomatic Bacteria:
management and why? |
must treat it b/c ⇧pyelonephritis risk ⇨ fetal mortality
|
|
|
Chronic HTN Tx:
|
1) Diet/Exercise
2) α-Me DOPA |
|
|
Rule of 60's
what should be done? |
=> immediate C/S
• HR below 60 bpm • HR ⇩>60bpm • HR <100 for 60 sec |
|
|
Most common cause of HTN:
1st trimester: 2nd semester: 3rd trimester: |
Most common cause ofHTN:
1st trimester: Mom 2nd semester: Molar pregnancy 3rd trimester: Pre-eclampsia |
|
|
Pre-Eclampsia:
pathogenesis criteria |
ischemia to placenta
HTN (>140/85) +Proteinuria (>5g/day) +Edema (face/hands) |
|
|
Pre-Eclampsia <20 wks: Dx
|
If <20 wks, think hydatidiform mole
|
|
|
complication of pre-eclampsia with mom
|
Mom gets cerebral hemorrhage/ ARDS ⇨ dies
|
|
|
define HELLP syndrome:
what do they usually die of? |
die of liver hematoma
Hemolysis Elevated Liver enzymes Low Platelets |
|
|
HELLP syndrome, name the 4 steps of treatment
|
Tx:
1) MgSO4 2) Labetalol (if SBP > 170) 3) Hydralazine 4) Delivery |
|
|
Vermix
|
= cheesy baby skin
|
|
|
Meconium
|
= green baby poop
|
|
|
Lochia
|
= endometrial slough
|
|
|
Eclampsia: define and Sx
|
HTN +seizures (shut down pump, Na is locked in cell but K can leak out)
Sx: Headache, blurry vision, epigastric pain |
|
|
eclampsia complication of seizures more than 10 minutes
|
If seizures > 10min ⇨ baby will die
|
|
|
eclampsia: management is to deliver the baby but if mom is seizing, what is the management?
|
Don't deliver baby while Mom is seizing
|
|
|
2 steps of treatment for eclampsia
|
Tx: 4g MgS04 (seizure prophylaxis) ⇨ C/S
|
|
|
Mg Toxicity at 5-7 mEq/mL:
signs and symptoms physiologically and tx |
less likely to depolarize (Tx: Ca Gluconate)
: ⇩Uterine contractions, ΔEKG |
|
|
Mg Toxicity: 8-12 mEq/mL
signs and symptoms |
⇩DTR, flushing, slurred speech
|
|
|
Mg Toxicity: 12-24 mEq/ mL
signs and symptoms |
⇩Respiratory paralysis
|
|
|
Mg Toxicity: 25-30 mEq/ mL
signs and symptoms |
Cardiac arrest
|
|
|
Chorioamnionitis: define and tx (2)
|
fever, uterine tenderness, ⇩fetal HR
Tx: 1) Immediate Ampicillin + Gentamycin, 2) C/S |
|
|
Amniotic fluid emboli
|
Mom just delivered baby and has SOB ⇨ PE, death (amniotic fluid ⇨ lungs)
|
|
|
Endometritis: define and tx
|
post-partum uterine tenderness (due to E. coli)
• Tx: Clindamycin + Gentamycin at time of cord clamping |
|
|
Normal Blood Loss:
Vaginal delivery: C-section: |
Vaginal delivery: 500 mL
C-section: 1,000 mL |
|
|
Ectopic Pregnancy: MCC place and Sx
|
no nausea
Ampulla of Fallopian tube |
|
|
Most common cause of 1st trimester maternal death?
|
ectopic pregnancy ⇨ MEDICAL EMERGENCY!
|
|
|
ectopic pregnancy
tx |
Tx: Methotrexate, Surgery
|
|
|
Group B Strep Treatment and why?
|
PCN or Ampicillin during labor (prevent meningitis)
|
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|
Hepatitis B Tx
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Hep B vaccine + Ig to neonate
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Pseudocyesis:
describe management hormone + |
fake pregnancy w / all the signs and symptoms
must consult Psych can have a + beta HCG |
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Preterm Bleeding (<20 wks):
1st trimester abortions: |
Chromosomal abnormalities
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Preterm Bleeding (<20 wks):
2nd trimester abortions: |
Cervical incompetence, bicornate uterus
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Preterm Bleeding (<20 wks):
3rd trimester abortions: |
Placenta problems, incompetent cervix
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Preterm Bleeding (<20 wks): Threatened abortion: define and tx
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cervix closed, baby intact (Tx: bed rest)
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Preterm Bleeding (<20 wks): Inevitable abortion: define and tx
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cervics open, baby intact (Tx: cerclage = sew cervix shut until term)
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Incomplete abortion: define and tx
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Preterm Bleeding (<20 wks). cervix open, fetal remnants
(Tx: D&C to prevent placenta infxn) |
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Complete abortion: define and management
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Preterm Bleeding (<20 wks). cevix open, no fetal remnants (Test: β-HCG)
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missed abortion:
define what needs to be ruled out tx |
Preterm Bleeding (<20 wks).
cervics closed, no fetal remnants rule out ectopic w / β-HCG (Tx: D&C) |
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Septic abortion:
define signs and symptoms xray |
Preterm Bleeding (<20 wks)
fever > 100°F,malodorous discharge (x-ray to check for free air due to bacteria) |
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Placenta Previa:
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Term Bleeding (>36 wks):
vaginal bleeding, placenta covers cervical os; ruptures placental aa. |
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Vasa Previa:
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Term Bleeding (>36 wks):
placenta aa. hang out of cervix |
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Placenta Accreta: define and tx
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Term Bleeding (>36 wks):
placenta attached to superficial lining (Tx: hysterectomy after delivery) |
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Placenta lncreta: define and tx
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Term Bleeding (>36 wks):
placenta invades into myometrium (Tx: hysterectomy after delivery) |
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Placenta Percreta: define and tx
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Term Bleeding (>36 wks):
placenta perforates through myometrium (Tx: hysterectomy after delivery) |
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Placenta Abruptio: define and tx
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Term Bleeding (>36 wks):
severe pain, premature separation of placenta (Tx: FFP, emergency C/S) |
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Velamentous Cord Insertion: define
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Term Bleeding (>36 wks):
fetal vessels insert between chorion and amnion |
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Uterus Rupture: define and tx
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Term Bleeding (>36 wks):
tearing sensation, halt of delivery (Tx: hysterectomy after delivery) |
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Post-Partum Bleeding and its common causes
bleeding of how much is considered postpartum bleeding? |
>5OOmL
Trauma: Repair Retained Placenta: D&C Uterine Atony (soft, boggy): |
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management of uterine atony
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• Uterine massage
• Fluid • Oxytocin |
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Apt test:
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mom vs baby. detects HbF in vagina (brown= Mom's, pink= baby's)
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Wright's stain:
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detects nucleated fetal RBC in Mom's vagina
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Kleihauer-Betke test:
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detects %fetal blood in maternal circulation ⇨ RhoGam dosage
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Pre-Term Babies: <36wk management
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1) MgS04 (tocolytic)
2) Amniotic Transfusion: flush NS continuously (max: 48hr) 3) "Window of Steroids": 28-32 wk 4) If <28wk ⇨ C/S to avoid IVH due to soft head |
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Post-Term Babies: what to check (4)
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Dating US (8-12wk) or LMP
Landmarks Non-stress test: if non-reactive ⇨ do Biophysical Profile AFI: 5-20 |
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Post-Term Babies: tx
what is a Favorable cervix and management? what is the management for Unfavorable Cervix: |
Favorable cervix means effaced >70%, dilation > 4cm: management is Oxytocin/ Amniostomy
Unfavorable Cervix: PGE1 cervical ripening |
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Gestational DM:
goal 2 types |
GoaL· Glucose=60-100
A1: diet controlled A2: insulin controlled |
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Breast CA + Pregnancy:
Presentation: 2nd trimester: Post-partum: |
Presentation: do mastectomy
2nd trimester: do chemo Post-partum: do radiation |
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FDA Pregnancy Drug Categories:
A = B = C = D = X = |
A = safe in humans
B = safe in animals C =unsafe in animals, no human studies D = unsafe X = very harmful |
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what 2 Antibiotics (cleared faster in pregnancy):
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Amoxicillin, Erythromycin
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anticoagulant used in pregnancy
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Heparin
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Anti-convulsant
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must continue (Phenobarbital is least teratogenic)
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Anti-depressant
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Fluoxetine "Paxil"
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Anti-inflammatory:
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Acetaminophen
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(5) treatment for Asthma in pregnant women
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"BATIS"
Steroids, β-agonists, Theophylline, Isoproteranol, Albuterol |
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Bactenuria:
|
Nitrofurantoin
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DM:
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Insulin
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HIV:
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avoid Efavirenz
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HTN (short-term)
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Hydralazine, Labetalol
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HTN (long-term)
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alpha-Methyldopa
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Hyperthyroid:
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PTU
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Pyelonephritis:
|
Ceftriaxone
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TB:
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Rifampin/INH/Ethambutol
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Toxoplasmosis: when should this be administered?
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Pyrimethamine+ Sulfadiazine (>2nd trimester)
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Ulcerative Colitis:
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Sulfasalazine
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pregnancy Vaccines: (5)
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"HI DOY"
OPV, DT, Hep B, Yellow fever, Influenza |
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ACE-I
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Teratogens:=> renal failure. due to kidney displasia.forms cyst on the baby's kidney
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Aminoglycosides
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Teratogens: = > kill CN8
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Amphetamines
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Teratogens:
=> transposition of great arteries |
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Carbamazepine
|
Teratogens:
=> neural tube defects |
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Chloramphenicol
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Teratogens:
= > grey baby |
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Coumadin
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Teratogens:
=> CNS defects |
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DES
|
Teratogens:
=> clear cell CA of vagina in daughter |
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EtOH
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Teratogens:
=> small stuff, mental retardation (fetal alcohol syndrome) |
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Fluoroquinolones
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Teratogens:
=> cartilage damage |
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Li
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Teratogens:
=> Ebstein's anomaly |
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NSAIDs
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Teratogens:
=>necrotizing enterocolitis |
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Retinoic acid
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Teratogens:
=> CNS defects |
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Sulfonamides
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Teratogens:
=>kernicterus |
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Tetracycline
|
Teratogens:
=> decrease bone growth |
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Thalidomide
|
Teratogens:
= > phocomelia (limb abnormalities) |
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Valproate
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=> NTD, teratogen
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