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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?
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)
Normal Gestation:
• Pre-term:
• Post-term: and tx
Normal Gestation: 40 wks
• Pre-term: <35 wks
• Post-term: >42 wks (Tx: oxytocin)
Newborn Exam:
(small for gestational age)
Newborn Exam: Symmetrical (baby problem):
chromosomal-abnormality or TORCH infection
Asymmetrical (mom problem):
poor blood supply spares brain=> small body, normal head
>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
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
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
how long does an egg last?
Eggs last 3 days in Fallopian tube (lose 1/month)
how long does an sperm last?
Sperm lasts 5 days in Fallopian tube (make 100 million/day)
Molar Pregnancy: what is it increased risk for?
increased risk of invasive mole and choriocarcinoma (2%)
• Increased placental villi => grape clusters
Molar Pregnancy: US and presentation
US: "snowstorm appearance"
• Fundus rising more than normal, very high β-HCG, 1st trimester bleeding or HTN
2 types of molar pregnancy and describe each
Incomplete Mole: 2 sperm + 1 egg (69, XXY), has embryo parts
Complete Mole: 2 sperm+ no egg (46, XX-both paternal), no embryo
Complete Mole
2 sperm+ no egg (46, XX-both paternal), no embryo
Incomplete Mole
2 sperms + 1 egg (69, XXY), has embryo parts
Molar Pregnancy Tx:
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
5 mo Gestation:
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)
Zona pellucida:
Fertilization: Ovum w/ 2nd polar body=> zygote
Zona pellucida: ring around ovum
Gametogenesis: mumps
Mumps kills leydig cells -> no testosterone, pancreatitis, orchitis
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
Theca externa: associated hormone
=>Progesterone (think pregnancy state)
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
Progesterone ⇨ Theca interna => E2
Uterus: E2 = >
Cervix: E2 =>
Breast: E2 =>
Uterus: E2 = > proliferation of decidua functionalis
Cervix: E2 =>thins mucus
Breast: E2 => ductal growth
Ovarian Hyperstimulation Syndrome:
weight gain, big ovaries (can rupture)
GnRH agonist=> multiple births
Progesterone: SE (eating habbits, face, pigmentation (2), vascular (4), uterus, brain.
⇧appetite, pica,⇧ acne, melasma, quiescent uterus, violence, (hyperpigmentation), dark areola, has Epo sequence in it, resorbs sodium/water (bloating), hypertension, dilutional anemia
Estrogen: SE (muscle, GI, liver (2), brain, vascular system (2), bone
muscle relaxant, constipation, ⇧protein production, increase HDL, irritability, varicose veins, hypotension, inhibits osteoclasts
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
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)
Bicornate Uterus
can cerclage if previous losses
Polycystic Ovarian Syndrome: presentation and hormone levels
⇧LH, ⇧testosterone, obese, hairy, acne, amenorrhea, DM
why do PCOS patients have increase risk of endometrial carcinoma?
⇧ Cysts: no ovulation ⇨ no progesterone (⇧endometrial CA) ⇨ can't inhibit LH
tx for PCOS
Tx: clomiphene (if pt wants to be pregnant), Metformin,
Spironolactone (tx hirsuitism)
Estrogen Effects:
Weight gain
Breast tenderness
Nausea, HA
Progesterone Effects:
Natural Planning:
75% effective Periodic abstinence during ovulation
Male Condoms:
protects against STDs (85% effective)
Diaphragms/Cervical caps:
UTIs/cervicitis/TSS, leave in 8hr postcoitus (80% effective)
lasts 1 hr (70% effective)
Hormonal Contraceptives: CI
don't give to smokers or SLE pts (92% effective)
Hormonal Contraceptives: Estrogen
what does it do to prevent pregnancy?
⇩FSH: can't select dominant follicle "Follicle Stimulator"
Hormonal Contraceptives:
what does it do to prevent pregnancy?
⇩LH: ⇩Ovulation, thick cervical mucus, inhospitable endometrium
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
Estrogen+ Progesterone, placed in vagina lasts 3 wk
Ortho Evra Patch
type of hormones
how long it lasts
Estrogen + Progesterone lasts 1 wk
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
what is it
who can use it?
long-acting Progesterone shot lasts 3mo,
use in sickle cell/ epilepsy/ smokers
Intrauterine Devices: used for what kind of patients
use for smokers or bleeding disorders
⇧PID /ectopic risk
(99% effective)
Progesterone IUD
how long it last
how does it work
"mirena"is an Intrauterine Device that lasts 5 yrs:
releases 20 mg/day Levonorgesterol
Copper T
how long it last
how does it work
menstrual cycle
is an Intrauterine Device lasts 10 yrs
inflammation kills sperm
(regular menses)
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)
when plan B can be used? how does it work?
Postcoital protection that uses 2 pills progesterone,
then 2 pills 12hr later, no prescription needed (<72hr)
Yuzpe: what is it? how is it used?
Postcoital protection high dose estrogen/progesterone,
repeat 12hr later (<72hr)
IUD insertion
Postcoital protection Copper T (<5days)
RU486: what is it? how does it work?
Postcoital protection that blocks progesterone receptor to slough lining, abortifacient (<7wk)
Menopause test
50 y/o ⇨ FSH > 30 + 6mo amenorrhea
Hot Flash tx
Tx: Clonidine
Hormone Replacement Therapy "HRT":
After 3yrs:
Post-menopause: E2 + Progesterone (to protect from endometrial CA)
After 3yrs: Stop E2 (b/c of clots), switch to Rolixifene
Post-hysterectomy: E2 alone
HRT Risks:
⇧Endometrial CA
⇧Breast CA
HRT Benefits
Fertilization: 3 sperm reactions
Capacitation Rxn
Acrosomal Rxn:
Crystalization Rxn
Crystalization Rxn:
wall formed after 1 sperm enters (to prevent polyspermy)
Capacitation Rxn
Zn used to peel semen off
Acrosomal Rxn:
sperm release enzymes to eat corona radiata
LH ⇨ Leydig cells ⇨ Testosterone ⇨ Spermatogenesis
Embryology Ducts:
Boy: Mesonephros = Wolffian duct (forms inside to out)
Girl: Paramesonephros = Mullerian duct (forms up to down)
Embryology genital anatomy
Boy: Testes, Vas deferens, Epididymis, Seminal vesicles

Girl: Ovaries, Fallopian tubes Uterus (w/ cervix), Upper vagina
Labioscrotal swelling:
boy: Scrotum
girl: Labia majora
Urogenital fold:
Boy: Prostate, Prostatic urethra, Bulbourethral glands
Girl: Labia minora, Lower vagina
Genital tubercle:
boy: Penis
girl: Clitoris
Assisted Reproduction: when is it used for? success rate? and describe its 3 types
used for inadequate spermatogenesis, 25% success rate

a) In Vitro Fertilization
b) Gamete Intrafallopian Transfer
c) Zygote Intrafallopian Transfer
In Vitro Fertilization
fertilize eggs in lab ~> uterus
Gamete Intrafallopian Transfer
put eggs + sperm~> Fallopian tube
Zygote Intrafallopian Transfer
put zygote ~> Fallopian tube
do not mix with what drugs
No nitrates or α1 blockers!
• Sildenafil "Viagra"
• Vardenafil "Levitra"
• Tadalafil "Cialis"
Premature ejaculation: what is the cause of it? and tx
: stress => sympathetics, females have slow
latent phase
• Tx: " squeeze technique" to cause sperm to turn around
define Infertility:
5 risk factors
inability to conceive after 12 months of unprotected sex
Risk Factors:
BMI >29
• 50% Male problem
• 30% Female problem (PID)
• 20% Other
Acute Bleeding Tx:
• Estrogen (high dose)
• Oral contraceptives (high dose)
• D&C
Male Infertility Workup:
measure signal to see if organ is OK
1) TSH ⇨ ⇩GnRH ⇨ ⇩LH
2) Testosterone
3) GnRH
4) PRL
Adrenal gland =>
Testicles =>
Adrenal gland => Testosterone
Testicles => DHT (at puberty)
Female Infertility Workup:
1) Peritoneal: endometriosis, adhesions
2) Ovulatory: hypothalamus-pituitary-ovary
3) Tubo-uterine: fibroids, tubal occlusion
4) Cervix: abnormal mucus
5) Unexplained: anti-sperm Ab
2 syndromes that can cause Precocious Puberty:
• Pineal tumor
• McCune-Albright
sexual contact without consent
• Erection/ ejaculation does not have to occur,
victim does not have to prove they resisted
oral/ anal penetration
Statutory rape
< 16 y/o or handicapped
Spousal rape:
sexual contact by husband w/o consent
Pathology: of being male or female
"male/female" is based on genotype
"It's what's on the inside that counts"
what are these hormones responsible for?
Miillerian Inhibiting Factor "MIF" =>
Testosterone =>
Miillerian Inhibiting Factor
"MIF" => internal genitalia
Testosterone => external genitalia
external genitalia problem
True Hermaphrodite
internal genitalia problem => has both sexes
Female Hermaphrodite:
impossible b/c the default is female
what diseases can cause Precocious Puberty, give 2
• Pineal tumor
• McCune-Albright
Female Pseudohermaphrodite:
XX with low 21-OHase = > high testosterone
Male Hermaphrodite:
XY with no MIF
Male Pseudohermaphrodite:
XY that has low 17-0Hase = > low testosterone
Testicular Feminization = Androgen Insensitivity Syndrome
• Bad DHT receptor ⇨ XY w/ blind pouch vagina
• No axillary/pubic hair
Testicular Feminization = Androgen Insensitivity Syndrome tx
Tx: Bilateral gonadectomy (to prevent cancer)
McCune-Albright: presentation
precocious sexual development
• Polyostotic fibrous dysplasia "whorls of CT"
• "Coast of Maine" pigmented skin macules
McCune-Albright: tx
Tx: Progesterone (anti-E2) or Flutamide (anti-androgen)
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)
Increased Estrogen States
• Pregnancy
• Liver failure
• p450 inhibition
Bleeding Disorders
Adenomyosis: define, DES effect in daughter and tx (3)
growth of endometrium ~> myometrium, enlarged "boggy" uterus w / cystic areas
DES => increased risk in daughters
• Tx: Oral contraceptives, Leuprolide, Hysterectomy
what are the effect of DES on daughters? presentation?
Adenomyosis ~> menorrhagia, Clear cell CA of vagina/cervix and Recurrent abortions
Kallman's sydrome: pathogenesis and tx
no GnRH can't smell. GnRH neurons fail to migrate from the old embroyonic olfactory epithelia to the hypothalamous
Tx:pulsatile GnRH
Savage's syndrome
ovarian resistance to FSH/LH
Turner's syndrome: chromosome, 2 hormone level, reproductive system.
(XO): high FSH, low E2, ovarian dysgenesis
1° Amenorrhea Workup:
1) ⇧PRL
2) ⇩TSH
3) ⇧E2
4) ⇧FSH ~>karyotype
Bleeding Most Commons:Post-coital
cervical cancer
Bleeding Most Commons: Post-menopause
endometrial cancer
Bleeding Most Commons: Post-coital pregnant
placenta previa
define 2° Amenorrhea and 3 examples
>>stop menstruating (>6mo)
Hypothalamic Dysfunction:
Sheehan syndrome:
what is the #1 2ndary cause of amenorrhea
Pregnancy: #1 cause
secondary amenorrhea Hypothalamic Dysfunction
exercise-induced, ⇩FSH/ ⇩LH/ ⇩E2
Sheehan syndrome: define and tx
post-partum hemorrhage~> pituitary
hyperplasia infarcts ~> no lactation
• Tx: Synthroid, Cortisol
Asherman's syndrome
previous D&C ~>uterine scars
Chronic Pelvic Pain
Endometriosis until proven otherwise
Dysfunctional Uterine Bleeding: define and tx
Diagnosis of exclusion, usually due to anovulation
• Tx: IV Estrogen (to stop bleeding), D&C
what hormone is responsible?
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)
Endometriosis: presentation. what does it mean when there is hemoptysis with each period?
painful heavy menstrual bleeding, infertility, ''powderburns, chocolate cysts". Blue ~> Brown ~> White
Ex: Hemoptysis with each period => endometriosis of nasopharynx or lung lesions
Endometriosis: Dx
Dx: Laparoscopy => biopsy those 3 areas (ovary, uterosacralligament, cul-de-sac of Pouch of Douglas)
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
Endometriosis: pathogenesis
Retrograde menses through Fallopian tube into:
o ovary, uterosacral ligament, cul-de-sac of Pouch of Douglas
Kleine regnung
scant bleeding at ovulation
heavy menstrual bleeding
menorrhagia + Obesity:
what hormone does fat make?
tx (3)
fat makes estrogen
(Tx: weight loss, Oral contraceptives, Leuprolide = GnRH analog)
Fibroids: define and 2 types
Leiomyoma: benign uterus SM tumor
subserosal type
submucosal type define and tx
Submucosal type=> bleeding
(Tx: hysterectomy)
Subserosal type: define and tx
(Tx: myomectomy) "serosal -> think surface"
bleeding or spotting in between periods
what does Postcoital bleeding in a child bearing age indicate? pathogen?
cervical CA (HPV 16,18,31,45)
Postcoital bleeding >40y/o:
cause and tx
endometrial CA
(Tx: TAH, BSO)
pain at ovulation
Adnexal Torsion
Gynecologic Emergencies.
mass with no Doppler flow
Ruptured Ectopic pregnancy
Gynecologic Emergencies.
free fluid in cul-de-sac
Syphilis: pathogen
Treponema pallidum (spirochete)
Syphilis: name 2 diagnosis test, in what 4 cases is it false (+)
FTA-ABS: (+) for life and RPR/VRDL (>1:16)
False +:SLE, HepC, Mono, recent vaccination
Syphilis: Tx:
when pregnant
Doxycyline, Penicillin G
(if pregnant)
Syphilis: symptoms
1°: painless chancre
(1-6 wks)
2°: rash, condyloma lata
(6 wks)
3°: neuro, cardia, bone
Herpes virus: 2 types
I= oral (palliative)
II= genital
Herpes virus: genetic make up
ds DNA
Herpes virus: 3 tests
Tzanck test
Herpes virus: tx
Herpes virus: symptoms
1° = fulminate grouped
vesicles on red
2° = painful solitary
HPV: tx
HPV: genetic make up
ds DNA virus
HPV: diagnosis
HPV: symptoms
HPV 6/11:
HPV 16 /18:
HPV 6/11: condyloma accuminata
HPV 16 /18: cervical cancer
Chlamydia: agent
Chlamydia: 3 ways to diagnose
Tissue culture, Nucleic acid probe, Elementary bodies
Chlamydia: tx
Chlamydia: symptoms
Cervicitis: yellow pus
90% asymptomatic
Gonorrhea: agent
Gram - diplococcus
Gonorrhea: 3 ways to diagnose
Gram stain
Thayer Martin culture
Nucleic acid probe
Gonorrhea: tx and pharyngeal gonorrhea
Ceftriaxone or Ofloxacin (if pharyngeal)
Gonorrhea: symptoms in male and female
Palmar pustules, Arthritis
90% male symptomatic 50% female symptomatic
Condyloma lata
2° Syphilis: = flat fleshy warts, ulcerate
Condyloma accuminata: describe and tx
HPV 6/11: = verrucous "cauliflower" warts, koilocytes
• Tx: Podophyllin, TCA, or freeze it off
Chancres: causes of increase of what kind of infection
⇧risk of HIV infection through breaks in skin barrier
painful vesicles, ulcerate, intranuclear inclusion bodies
Herpes (DNA virus):
painless chancre
Syphilis (T. pallidum ):
and tx
(H. ducrei): painful ulcer w/ irregular borders, necrotic center, Gram- rod, "school of fish"
pattern (Tx: Ciprofloxacin)
Lymphogranuloma Venereum: agent, clues and tx
(C. trachomatis): painless lymphadenopathy
(Tx: Doxycycline)
Granuloma Inguinale: pathogen, lesion, bodies and tx
(C. granulomatosis): oozing lesions, Donovan bodies
(Tx: Doxycyline)
Balanitis: clue and tx
itchy penis papules
(Tx: Fluconazole)
Congenital blindness
Neonatal blindness
Epididymitis: pathogen, describe, treatment and management
• Unilateral scrotal pain that is decreased by support
Tx: Doxycycline (must treat partner)
Painless STDs: what percentage and give 3 examples
80% is painless. The other 20% is not painless.
Syphilis, Lymphogranuloma Venereum, Granuloma Inguinale
Testicular Torsion: clues and tx
• No cremasteric reflex, odd angle
• Pain not decreased with elevation
• Tx: immediate operation
3 cause of Vaginitis and how does it do this?
Antibiotics: disrupt normal flora balance
Douche/ Sex: increases pH
Foreign Body: focus of infection -> pediatric discharge
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
non-bacterial fetal infections
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: 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 = 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:
• 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
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
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
Endocrine: ⇧total T4, normal free T4
Heme: ⇧RBC (30%), ⇧Vol (50%), telangiectasias, varicose veins
Musculoskeletal: Muscles relax
Pregnant Physiology:
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
estrogen crystallizes on slide
when is it false +
amniotic fluid is alkaline (False + : blood, semen, infection)
Chorionic Villus Sampling
what should one test for? and when?
⇧risk of fetal limb defects, test for Trisomy 21 (week 10)
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: 37wk
Triplets: 33wk
Quadruplets: 29wk
circular~> vaginal delivery
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
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
horizontal oval ⇨ C/S
heart ⇨ C/S
Pregnant Nutrition
Gain: lbs/wk, and calories
Gain 1 lb/wk (2800 cal/ day)
Pica: urge to eat ice, clay, starch
Pregnant Nutrition
Folic acid
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: 30 mg/day (erythropoiesis)
Zn: 20 mg/day (sperm, taste buds, hair)
Pregnant Nutrition
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:
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
Trisomy 18
⇩ ⇩ ⇩
Trisomy 21
⇩ ⇧ ⇩
3 Requirements For Labor:
Cervical Dilation
Water Broke
how often should they be?
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
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
1st Degree: Skin
2nd Degree: Muscle
3rd Degree: Anus
4th Degree: Rectum
Stage II of labor
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
Urgent C/S:
Emergent C/S:
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
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
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
Baby Presentations:
Double Footling Breech
describe and delivery
two feet sticking out of cervical os
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
fetal hypoxemia (Tx: C/S)
Decreased beat-to-beat variability
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
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
Elevated Liver enzymes
Low Platelets
HELLP syndrome, name the 4 steps of treatment
1) MgSO4
2) Labetalol (if SBP > 170)
3) Hydralazine
4) Delivery
= cheesy baby skin
= green baby poop
= 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:
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: Methotrexate, Surgery
Group B Strep Treatment and why?
PCN or Ampicillin during labor (prevent meningitis)
Hepatitis B Tx
Hep B vaccine + Ig to neonate
hormone +
fake pregnancy w / all the signs and symptoms
must consult Psych
can have a + beta HCG
Preterm Bleeding (<20 wks):
1st trimester abortions:
Chromosomal abnormalities
Preterm Bleeding (<20 wks):
2nd trimester abortions:
Cervical incompetence, bicornate uterus
Preterm Bleeding (<20 wks):
3rd trimester abortions:
Placenta problems, incompetent cervix
Preterm Bleeding (<20 wks): Threatened abortion: define and tx
cervix closed, baby intact (Tx: bed rest)
Preterm Bleeding (<20 wks): Inevitable abortion: define and tx
cervics open, baby intact (Tx: cerclage = sew cervix shut until term)
Incomplete abortion: define and tx
Preterm Bleeding (<20 wks). cervix open, fetal remnants
(Tx: D&C to prevent placenta infxn)
Complete abortion: define and management
Preterm Bleeding (<20 wks). cevix open, no fetal remnants (Test: β-HCG)
missed abortion:
what needs to be ruled out
Preterm Bleeding (<20 wks).
cervics closed, no fetal remnants
rule out ectopic w / β-HCG
(Tx: D&C)
Septic abortion:
signs and symptoms
Preterm Bleeding (<20 wks)
fever > 100°F,malodorous discharge
(x-ray to check for free air due to bacteria)
Placenta Previa:
Term Bleeding (>36 wks):
vaginal bleeding, placenta covers cervical os; ruptures placental aa.
Vasa Previa:
Term Bleeding (>36 wks):
placenta aa. hang out of cervix
Placenta Accreta: define and tx
Term Bleeding (>36 wks):
placenta attached to superficial lining
(Tx: hysterectomy after delivery)
Placenta lncreta: define and tx
Term Bleeding (>36 wks):
placenta invades into myometrium (Tx: hysterectomy after delivery)
Placenta Percreta: define and tx
Term Bleeding (>36 wks):
placenta perforates through myometrium
(Tx: hysterectomy after delivery)
Placenta Abruptio: define and tx
Term Bleeding (>36 wks):
severe pain, premature separation of placenta (Tx: FFP, emergency C/S)
Velamentous Cord Insertion: define
Term Bleeding (>36 wks):
fetal vessels insert between chorion and amnion
Uterus Rupture: define and tx
Term Bleeding (>36 wks):
tearing sensation, halt of delivery (Tx: hysterectomy after delivery)
Post-Partum Bleeding and its common causes
bleeding of how much is considered postpartum bleeding?
Trauma: Repair
Retained Placenta: D&C
Uterine Atony (soft, boggy):
management of uterine atony
• Uterine massage
• Fluid
• Oxytocin
Apt test:
mom vs baby. detects HbF in vagina (brown= Mom's, pink= baby's)
Wright's stain:
detects nucleated fetal RBC in Mom's vagina
Kleihauer-Betke test:
detects %fetal blood in maternal circulation ⇨ RhoGam dosage
Pre-Term Babies: <36wk management
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
Post-Term Babies: what to check (4)
Dating US (8-12wk) or LMP
Non-stress test: if non-reactive ⇨ do Biophysical Profile
AFI: 5-20
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
Gestational DM:
2 types
GoaL· Glucose=60-100
A1: diet controlled
A2: insulin controlled
Breast CA + Pregnancy:
2nd trimester:
Presentation: do mastectomy
2nd trimester: do chemo
Post-partum: do radiation
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
what 2 Antibiotics (cleared faster in pregnancy):
Amoxicillin, Erythromycin
anticoagulant used in pregnancy
must continue (Phenobarbital is least teratogenic)
Fluoxetine "Paxil"
(5) treatment for Asthma in pregnant women
Steroids, β-agonists, Theophylline, Isoproteranol, Albuterol
avoid Efavirenz
HTN (short-term)
Hydralazine, Labetalol
HTN (long-term)
Toxoplasmosis: when should this be administered?
Pyrimethamine+ Sulfadiazine (>2nd trimester)
Ulcerative Colitis:
pregnancy Vaccines: (5)
OPV, DT, Hep B, Yellow fever, Influenza
Teratogens:=> renal failure. due to kidney displasia.forms cyst on the baby's kidney
Teratogens: = > kill CN8
=> transposition of great arteries
=> neural tube defects
= > grey baby
=> CNS defects
=> clear cell CA of vagina in daughter
=> small stuff, mental retardation (fetal alcohol syndrome)
=> cartilage damage
=> Ebstein's anomaly
=>necrotizing enterocolitis
Retinoic acid
=> CNS defects
=> decrease bone growth
= > phocomelia (limb abnormalities)
=> NTD, teratogen