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86 Cards in this Set

  • Front
  • Back
management of preterm labor
- corticosteroids: betamethasone or dexamethasone (stimulates surfactant production, reduce risk of intraventricular hemorrhage)
- GIVE AS IM not IV (more stable [ ] of the drug)
preeclampsia
- 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
management of eclampsia
- 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)
tx of hypertensive crisis vs moderate HTN in pregnancy
- hydralazine or labetaolol
- moderate HTN: methyldopa
ominous sign of eclampsia?
- retinal hemorrhage-- a sign that vascular damage has occurred in other organs
renal injury in eclampsia?
- glomerular capillary endotheliosis
most common cause of postpartum hemorrhage?
- 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
first line med in post partum hemorrhage
- oxytocin
- others: methylergonovine, carboprost, misoprostol
second twin doesn't deliver immediately?
- give oxytocin (don't just observe)
tx of heavy menses?
- 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
ASCUS
- 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
tx of ASC-H
- 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
colposcopy f/u
- high grade neoplasia: treat
- low grade neoplasia or lower: serial pap smears or HPV testing per ASCUS
gestational diabetes screening
- 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 +
BG goals in pregnant diabetics
- < 95
- < 120 2 hours postprandial
- if not then start on NPH (intermediate) w/ lispro/regular
- avoid longer acting (teratogenic)
treatment of moderate PID versus severe PID
- moderate: CTX + doxy
- severe: cefoxitin + doxy
- can switch doxy with azithro
best IUD for sickle cell?
- 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
Nephrolithiasis in pregnant woman -- imaging?
- U/S
postpartum endometritis
- polymicrobial infection of endometrium s/p delivery: uterine tenderness, foul-smelling discharge
- tx: broad spectrum abx-- glindamycin and gentamicin
which GI abx is c/i in breast feeding?
- metronidazole
risk of endometritis?
- high risk is in route of delivery: cesarean > vaginal
abx for pregnant woman with uti
- cephalexin
- amox
- macrobid
- IV CTX for pyelo
uti abx to avoid in pregnancy
- cipro: tendon
- tetracycline: decreased bone growth
- bactrim: sulfonamides increase bili in fetus
pyelo in pregnant woman
- IV CTX
- low dose macrobid of cephalexin for rest of pregnancy
anovulation work up
- basal body temp
- progesterone in mid-luteal phase
- serum prolactin
- endometrial sampling
retroverted uterus
- 11% population
- can be caused by PID
- causes infertility, no abortion
greatest risk of limb reduction in chorionic villous sampling?
- <9 weeks
- least in > 11wks
stress urinary incontinence
- first line is pelvic floor exercises
- other: estrogen creams, alpha-receptor agonists (amitryptiline, impirimine)
- NOTE: oxybutinin is for urge incontinence
pt with HSIL
- no HPV testing, strait to colposcopy
pregnant woman found to have BV: asympt vs sympt
- 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
skin conditions in pregnancy
- pruritus is very common
- papular urticarial papules and plaques of pregnancy: within the striae gravidarum
- herpes gestationis: urticarial plaques and papules around the umbilicus
tx of herpes gestationis
- topical triamcinolone (steroid)
folic acid
- gen pop 0.4mg
- women on AED or hx NTD: 4mg/day >= 1 month before conception
pt on OCP and synthroid?
- may need to increase synthroid because estrogen increase TBG
tx of chlamydia in pregnant woman?
- erythromicin BASE (not estolate) or amox
- given husband azithromycin 1gmx1
Suspect endometriosis, next step?
- laparoscopy is required to confirm dx
- tx: NSAIDS, GnRH analogds, danazol, OCP
young sexually active female with UTI, next step?
- get urine pregnancy test b/c if pregnant then don't use bactrim, use amox, cephalexin or macrobid
teratogenic effects of gentamicin?
- bilateral congenital deafness
hematoma found on U/S in pregnant woman?
- repeat U/s in one week
- subchorionic hematoma, causes first trimester bleeding
- no tx
- increased risk spontaneous abortions
Kleihauer-Betke test
- measures fetal cells in maternal circulation
- use when large antepartum bleed in Rh negative mother
gestational trophoblastic disease
- malignant cancer of uterus that occurs after pregnancy
- hx of continued vaginal bleeding after hydadtidiform mole, abortion, pregnancy
turner syndrome
- XO, webbed neck, short stature, high palate, short forth metacarpal
- pregnancy can occur but very rare
signs of malignancy in nipple discharge
- unilateral, guaiac positive, grossly bloody
- cytology study
- get mammogram --> fine needle aspiration or open breast biopsy
treatment of PMDD?
- 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
what other disease is PMS associated with?
- higher risk of depression- 80%
highest risk factor for PID?
1. multiple sexual partners
- less so: no barrier contraception, previous PID, age
- IUD is only very minimal increase
Pregnancy risk category?
- 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
AFP testing
- do in weeks 16-20
- if + then f/u w/ U/S in wk 20
what to measure in hyperTH? what is dx of hyperTH in pregnant woman?
- TSH, total and free T4
- diagnosis: high serum free T4, serum TSH < 0.01
gestation transient thyrotoxicosis
- 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
number one reasons girls don't use OCP?
- weight gain
woman is homosexual, does she need pap smears?
- yes same risk and guidelines apply
pap smear guidelines
- 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.
when to give anti-D immune globulin
- at 28 weeks to RH (D) negative w/ negative ab women
- no need to do if father is RH (D) negative too
woman with right to left shunt heart defect?
- e.g. eisenmenger syndrome: elective termination of pregnancy
- or surgery in 2nd trimester- heart and lung transplant
which two AEDs require high folate?
- carbamazepine or depakote, other AEDs only need normal amount
- check AFP, amnio or U/S
AED during pregnancy?
- 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
adolescent pregnancy risks?
- perinatal moratality, preterm delivery, preamture, low birth weight, future cognitive d/o
- no increased risk of congenital malformations
when to deliver in preeclampsia?
- once they reach 32-34 wks gestation
failure to progress?
- cesarean
when is parental consent not needed?
- issues related to pregnancy, contraception, STD, substance use, emotional illness
can you withhold treatment to a baby?
- yes, if very poor prognosis and parent's wishes
when to give td?
- if dirty and last booster >5 years ago
- if clean and last booster >10 years ago
RH neg mother with bleeding?
- 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
uterine prolapse
- surgical intervention
- only use pessary if poor surgical candidate
woman with warts from conyloma acuminata during delivery?
- vaginal delivery ok
- no intervention
pear shaped motile organisms on pap smear?
- trich
- oral metronidazole
septic abortion
- 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
OCPs and migraines?
- migraines -- increased risk of stroke, if no aura then relative, if yes aura or focal sx then absolute
- esp if >35 y.o.
OCPs and endometrial cancer?
- decreases risk
baby with myelomeningocele?
- emergent surgery in 24-48 hours, no need for imaging
SAAG value in cirrhosis?
- serum albumin - ascitic fluid albumin
>= 1.1: CHF, cirrhosis, alcoholic hepatitis
< 1.1: peritoneal carcinomatosis, peritoneal tuberculosis, nephrotic syndrome, pancreatitis, serositis
shoulder dystocia?
- tell mother not to push at next contraction -- > reposition baby or do McRoberts maneuver
Zavanelli's maneuver
- shoulder dystocia- put baby back in pelvis for preparation of C section -- have 7 min to deliver that baby
breastfeeding and found to have trich
- 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
tests for first prenatal visit vs routinely
- 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
woman dx with preeclampsia?
- give hydralazine and MgSO4, then initiate delivery
- brisk DTR are very ominous for eclampsia, so MgSO4!
breastfeeding and found to have trich
- 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
tests for first prenatal visit vs routinely
- 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
woman dx with preeclampsia?
- give hydralazine and MgSO4, then initiate delivery
- brisk DTR are very ominous for eclampsia, so MgSO4!
pap smear results
- 6 months if previous abnormal pap, or +HPV, or previous insufficient screening
- if unsatisfactory sampling then repeat smear in 2-4 months
woman on warfarin wants to get pregnant?
- switch to subQ hep
androgen insensitivity
- XY genotype, female phenotype with undescended testicles
- have breasts b/c test to est conversion
- no pubic or ax hair
- blind pouch vagina
cysts in pelvis during pregnancy
- 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
testing for down syndrome?
- 2nd trimester: AFP, HCG, unconjugated estriol, dimeric inhibin A
- 10 weeks: U/S- nuchal translucency
pregnant and active TB
- TB risks outweights fetal risk, treat with isoniazid, rifampin and ethambutol