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86 Cards in this Set
- Front
- Back
management of preterm labor
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- corticosteroids: betamethasone or dexamethasone (stimulates surfactant production, reduce risk of intraventricular hemorrhage)
- GIVE AS IM not IV (more stable [ ] of the drug) |
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preeclampsia
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- HELLP: H-emolytic anemia, E-levated LFTs, L-ow P-latelet count
- 50% occur prior to term, can also occur 24-48hrs after delivery - IV mag or plasma exchange if persistent |
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management of eclampsia
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- resp and CV resuscitation
- AES after two large bore needles placed - NEXT STEP: give Mg (can add phenytoin or diazepam) - most BENEFICIAL tx to prevent further complications is SPEEDY DELIVERY (over giving mg) |
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tx of hypertensive crisis vs moderate HTN in pregnancy
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- hydralazine or labetaolol
- moderate HTN: methyldopa |
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ominous sign of eclampsia?
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- retinal hemorrhage-- a sign that vascular damage has occurred in other organs
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renal injury in eclampsia?
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- glomerular capillary endotheliosis
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most common cause of postpartum hemorrhage?
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- uterine atony
- manage by fundal massage and oxytocin first; if doesn't work then think other causes: - other causes: perineal lac, uterine rupture, retained products of conception |
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first line med in post partum hemorrhage
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- oxytocin
- others: methylergonovine, carboprost, misoprostol |
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second twin doesn't deliver immediately?
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- give oxytocin (don't just observe)
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tx of heavy menses?
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- a sign of anovulation (no ovulation = no progesterone)
- given high dose estrogen followed by progestin - if not that bad then can give OCP 3-4x regular dose - dilation and curettage if hormones don't work or are C/I - or IV estrogen if need rapid hemostasis |
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ASCUS
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- get HPV testing
- if negative then f/u 1 yr - if positive then colposcopy - if CIN 2 or 3 then evaluate and tx - if CIN 1 or less either repeat pap in 6-12months or HPV test in 12 months - if negative pap x2 then f/u 1 yr - if +ASC-US or ASC-H then colposcopy - if + HPV again then colposcopy |
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tx of ASC-H
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- colposcopy
- if CIN 2 or 3, evaluate and tx - if CIN 1 or less either repeat pap in 6-12 months or HPV test in 12 months - if negative papx2 then f/u 1 yr - if +ASC-US or ASC-H then colposcopy - if +HPV again then colposcopy |
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colposcopy f/u
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- high grade neoplasia: treat
- low grade neoplasia or lower: serial pap smears or HPV testing per ASCUS |
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gestational diabetes screening
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- 24-28th weeks
- 2steps - 1. 50g glucose (no fasting), measure BS if >130-140 then do step 2 - 2. 100gm glucose while fasting --> measure at 0, 1, 2,3 hrs --> if greater than 95, 180, 55, 140 then + |
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BG goals in pregnant diabetics
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- < 95
- < 120 2 hours postprandial - if not then start on NPH (intermediate) w/ lispro/regular - avoid longer acting (teratogenic) |
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treatment of moderate PID versus severe PID
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- moderate: CTX + doxy
- severe: cefoxitin + doxy - can switch doxy with azithro |
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best IUD for sickle cell?
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- progestin IUD: little blood loss, less thromboembolic events
- progestin OCP: bad b/c of breakthrough bleeding = anemia - combined oral OCP: bad b/c of thrombogenic events - medroxyprogesterone shot: though progestin only, C/I in those with thromboembolic risk b/c of increased HDL |
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Nephrolithiasis in pregnant woman -- imaging?
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- U/S
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postpartum endometritis
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- polymicrobial infection of endometrium s/p delivery: uterine tenderness, foul-smelling discharge
- tx: broad spectrum abx-- glindamycin and gentamicin |
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which GI abx is c/i in breast feeding?
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- metronidazole
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risk of endometritis?
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- high risk is in route of delivery: cesarean > vaginal
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abx for pregnant woman with uti
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- cephalexin
- amox - macrobid - IV CTX for pyelo |
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uti abx to avoid in pregnancy
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- cipro: tendon
- tetracycline: decreased bone growth - bactrim: sulfonamides increase bili in fetus |
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pyelo in pregnant woman
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- IV CTX
- low dose macrobid of cephalexin for rest of pregnancy |
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anovulation work up
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- basal body temp
- progesterone in mid-luteal phase - serum prolactin - endometrial sampling |
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retroverted uterus
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- 11% population
- can be caused by PID - causes infertility, no abortion |
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greatest risk of limb reduction in chorionic villous sampling?
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- <9 weeks
- least in > 11wks |
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stress urinary incontinence
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- first line is pelvic floor exercises
- other: estrogen creams, alpha-receptor agonists (amitryptiline, impirimine) - NOTE: oxybutinin is for urge incontinence |
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pt with HSIL
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- no HPV testing, strait to colposcopy
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pregnant woman found to have BV: asympt vs sympt
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- fishy smell with KOH
- don't need to treat asympt though increased risk of preterm labor and such b/c treated doesn't decrease the risk - tx sympt |
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skin conditions in pregnancy
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- pruritus is very common
- papular urticarial papules and plaques of pregnancy: within the striae gravidarum - herpes gestationis: urticarial plaques and papules around the umbilicus |
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tx of herpes gestationis
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- topical triamcinolone (steroid)
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folic acid
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- gen pop 0.4mg
- women on AED or hx NTD: 4mg/day >= 1 month before conception |
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pt on OCP and synthroid?
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- may need to increase synthroid because estrogen increase TBG
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tx of chlamydia in pregnant woman?
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- erythromicin BASE (not estolate) or amox
- given husband azithromycin 1gmx1 |
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Suspect endometriosis, next step?
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- laparoscopy is required to confirm dx
- tx: NSAIDS, GnRH analogds, danazol, OCP |
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young sexually active female with UTI, next step?
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- get urine pregnancy test b/c if pregnant then don't use bactrim, use amox, cephalexin or macrobid
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teratogenic effects of gentamicin?
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- bilateral congenital deafness
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hematoma found on U/S in pregnant woman?
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- repeat U/s in one week
- subchorionic hematoma, causes first trimester bleeding - no tx - increased risk spontaneous abortions |
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Kleihauer-Betke test
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- measures fetal cells in maternal circulation
- use when large antepartum bleed in Rh negative mother |
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gestational trophoblastic disease
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- malignant cancer of uterus that occurs after pregnancy
- hx of continued vaginal bleeding after hydadtidiform mole, abortion, pregnancy |
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turner syndrome
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- XO, webbed neck, short stature, high palate, short forth metacarpal
- pregnancy can occur but very rare |
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signs of malignancy in nipple discharge
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- unilateral, guaiac positive, grossly bloody
- cytology study - get mammogram --> fine needle aspiration or open breast biopsy |
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treatment of PMDD?
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- SSRI: fluoxetine is the best, relieves behavioral and physical symptoms; more than 20mg /day is not effective
- 15% are resistant and alprazolam is a good alternative - if resistant than give GnRH or danazol (androgen) for ovulation suppression |
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what other disease is PMS associated with?
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- higher risk of depression- 80%
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highest risk factor for PID?
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1. multiple sexual partners
- less so: no barrier contraception, previous PID, age - IUD is only very minimal increase |
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Pregnancy risk category?
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- A: no increased risk
- B: animal studies showed no risk, but no studies in pregnant women; or 2) animal studies have shown an adverse effect but hasn't been confirmed in pregnant women - C: adverse effect in animal studies, or no studies in animals or pregnant women - D: evidence of human fetal risk but benefits from use may be acceptable (life threatenting, serious disease, no viable treatment alternatives) - X: don't use in pregnant women |
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AFP testing
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- do in weeks 16-20
- if + then f/u w/ U/S in wk 20 |
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what to measure in hyperTH? what is dx of hyperTH in pregnant woman?
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- TSH, total and free T4
- diagnosis: high serum free T4, serum TSH < 0.01 |
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gestation transient thyrotoxicosis
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- mildly increased free T4
- slightly decreased TSH at end of first trimester - in pregnant, a slight increase in T4 and t3 and decrease in TSH is normal |
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number one reasons girls don't use OCP?
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- weight gain
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woman is homosexual, does she need pap smears?
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- yes same risk and guidelines apply
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pap smear guidelines
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- start age 21 regardless of sexual activity (younger or older)
- q2 years until 30 - increase to 2-3 years if 3 neg or reached 30 years - only do HPV in >30y.o. |
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when to give anti-D immune globulin
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- at 28 weeks to RH (D) negative w/ negative ab women
- no need to do if father is RH (D) negative too |
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woman with right to left shunt heart defect?
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- e.g. eisenmenger syndrome: elective termination of pregnancy
- or surgery in 2nd trimester- heart and lung transplant |
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which two AEDs require high folate?
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- carbamazepine or depakote, other AEDs only need normal amount
- check AFP, amnio or U/S |
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AED during pregnancy?
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- if before pregnancy then switch depakote or carbamazepine to something else
- if middle of pregnancy, switching and overlapping with other AED is too much risk so continue with VPA - all other AEDs: lower to lowest dose possible - breast feeding is ok |
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adolescent pregnancy risks?
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- perinatal moratality, preterm delivery, preamture, low birth weight, future cognitive d/o
- no increased risk of congenital malformations |
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when to deliver in preeclampsia?
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- once they reach 32-34 wks gestation
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failure to progress?
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- cesarean
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when is parental consent not needed?
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- issues related to pregnancy, contraception, STD, substance use, emotional illness
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can you withhold treatment to a baby?
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- yes, if very poor prognosis and parent's wishes
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when to give td?
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- if dirty and last booster >5 years ago
- if clean and last booster >10 years ago |
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RH neg mother with bleeding?
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- do rosette test to determine feto-maternal hemorrhage and to give increased amount of anti-D immunization
- if don't given enough then may cause maternal alloimmunization e.g. mother will have anti-D ab titers |
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uterine prolapse
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- surgical intervention
- only use pessary if poor surgical candidate |
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woman with warts from conyloma acuminata during delivery?
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- vaginal delivery ok
- no intervention |
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pear shaped motile organisms on pap smear?
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- trich
- oral metronidazole |
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septic abortion
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- woman tries to self-abort
- 1. stabilize, 2. obtain blood and endometrial cultures, 3. Broad IV abx (clinda, gent and amp or single therapy of zosyn or imipenem), 4. surgically evacuate |
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OCPs and migraines?
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- migraines -- increased risk of stroke, if no aura then relative, if yes aura or focal sx then absolute
- esp if >35 y.o. |
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OCPs and endometrial cancer?
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- decreases risk
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baby with myelomeningocele?
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- emergent surgery in 24-48 hours, no need for imaging
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SAAG value in cirrhosis?
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- serum albumin - ascitic fluid albumin
>= 1.1: CHF, cirrhosis, alcoholic hepatitis < 1.1: peritoneal carcinomatosis, peritoneal tuberculosis, nephrotic syndrome, pancreatitis, serositis |
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shoulder dystocia?
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- tell mother not to push at next contraction -- > reposition baby or do McRoberts maneuver
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Zavanelli's maneuver
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- shoulder dystocia- put baby back in pelvis for preparation of C section -- have 7 min to deliver that baby
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breastfeeding and found to have trich
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- though abx is usually 7 days, given one dose metronidazole 2g PO for 1 dose and d/c breastfeeding for 12-24 hours after dose
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tests for first prenatal visit vs routinely
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- blood type and ab screen, rhesus type, Hct/Hg, rubella, syphilis, chlamydia and HIV, hepB, UA, Cx, culture
- routinely: BP, weight, uterine fundal height, fetal heart tones, fetal presentation and activity, urine glucose and protein |
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woman dx with preeclampsia?
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- give hydralazine and MgSO4, then initiate delivery
- brisk DTR are very ominous for eclampsia, so MgSO4! |
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breastfeeding and found to have trich
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- though abx is usually 7 days, given one dose metronidazole 2g PO for 1 dose and d/c breastfeeding for 12-24 hours after dose
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tests for first prenatal visit vs routinely
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- blood type and ab screen, rhesus type, Hct/Hg, rubella, syphilis, chlamydia and HIV, hepB, UA, Cx, culture
- routinely: BP, weight, uterine fundal height, fetal heart tones, fetal presentation and activity, urine glucose and protein |
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woman dx with preeclampsia?
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- give hydralazine and MgSO4, then initiate delivery
- brisk DTR are very ominous for eclampsia, so MgSO4! |
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pap smear results
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- 6 months if previous abnormal pap, or +HPV, or previous insufficient screening
- if unsatisfactory sampling then repeat smear in 2-4 months |
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woman on warfarin wants to get pregnant?
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- switch to subQ hep
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androgen insensitivity
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- XY genotype, female phenotype with undescended testicles
- have breasts b/c test to est conversion - no pubic or ax hair - blind pouch vagina |
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cysts in pelvis during pregnancy
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- if purely cystic pelvic mass < 10 cm then most will resolve
- if > 5cm and adnexal then remove in 2nd trimester b/c increased risk of complications |
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testing for down syndrome?
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- 2nd trimester: AFP, HCG, unconjugated estriol, dimeric inhibin A
- 10 weeks: U/S- nuchal translucency |
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pregnant and active TB
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- TB risks outweights fetal risk, treat with isoniazid, rifampin and ethambutol
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