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9 Cards in this Set
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workup secondary amenorrhea:
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so this means no bleeding in previous bleeder.
first step = PREGNANCY TEST. second = PROGESTERONE. if withdrawl bleeding = plenty of estrogen around, so LH level. If HIGH, think PCOS. if LOW, maybe tumor - check PROLACTIN, TSH (remember that hypothyroidism = high TSH = turn on prolactin). if no bleeding = not enough estrogen = do FSH. If high = ovaries failed early = maybe karyotype, autoimmune, drugs.. if LOW, check brain for tumors. |
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what's DUB? how do you treat it?
what about endometriosis? |
both are treated with OCP's and NSAIDS as first line.
DUB = weird bleeding not caused by cancer or pregnancy. Usually ANOVULATORY cycles responsible (like PCOS). endometriosis - second line = GnRH agonists/danazol. Also surgery if causing infertility. |
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what are the drugs for infertility?
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clomiphene causes ovulation. but this requires adequate estrogen.
if not enough estrogen, give hMG (human menopausal gonadotropin = combo LH/FSH). |
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what antibiotics are OK in pregnancy? Anti-htn? DM?
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penicillin, nitrofurantoin, erythromycin, cephalosporins.
remember hydralazine and methyldopa okay. insulin fine, NO oral hypoglycemics |
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what's a BPP? what do you do if it's not good?
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biophysical profile: consists of NST (watch for 30 minutes: should have 2 accels of 15bpm for >15 seconds each).
Amniotic fluid index: >25 = too much, <5 = bad. Breathing movements: 30 in 10 minutes Movements: 3 body movements in 10 mintutes. If bad, do contraction stress test = give oxytocin, look at monitor. Late decels = cesarian. |
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what are the stages of labor? how long?
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first stage: primi = <20h, multi = <14. Divided into latent (up to 4 cm) - this is variable.
active part of 1st stage in primi = 4cm to full, should go >1cm/hr. Multi = >1.2cm/hr Second stage = fully dilated to baby out. 30 min to 3 h in nuli, under 30 min in multi. 3rd stage: baby out to placenta out, <30 min 4th stage = after placenta 'till mom stable = <48 hrs. |
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decels - what do they mean? do what?
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early decels = fine, this is head compression/vagal stimulation.
late decels = uteroplacental insufficency - put in lateral decub, STOP oxytocin, fluids, 02, scalp pH. variable decels = cord compression. same plan (lat decub, o2, stop oxytocin). |
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postpartum fever that doesn't go away with antibiotics - what should you do?
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if it goes away with broad spectrum, think endometritis.
if not better with abx, probably THROMBOPHLEBITIS - give heparin. |
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postpartum hemorrhage - what's the main cause, what do you do?
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main cause = uterine atony. risks = large babies/fluid/multiple babies/giving oxytocin too much.
cure = little bit of oxytocin to encourage squeezing, followed by ergotavine, followed by PGF2. |
