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69 Cards in this Set
- Front
- Back
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How can you measure fetal lung maturity?
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lecithin: sphingomyelin ration
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Round ligament syndrome
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-Round ligament supports the top of the uterus
-Right one can mimic appendicitis pain -Pain associated with activity -usually happens about 18 wks/early first trimester |
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What is the most important supplement to give a pregnant woman and why?
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-folic acid
-decreases incidence of neural tube defects |
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physiologic anemia
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moms have low hemoglobin concentration bc plasma volume increase faster than red cell volume
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fetal heart rate
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normal: 120-160
Tachy: >160 Brady: <120 (moderate=70-89 and severe= <70) Should be variability (HR increases at least 15 beats per minute for less than 30 seconds) |
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What does a saw tooth pattern on an EKG mean?
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Fetal hydrops
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Most accurate way to asses the date of pregnancy?
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Crown Rump Length (CRL)
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ancenephaly
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failure of brain and skull to form
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exencephaly
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exterioration of abnormally formed brain
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encephalocele
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cystic extention of the brain through skull and scalp defects
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spina bifida
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malformations resulting from failure of fusion of vertebral bodies
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meningiocele
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extension of meninges through defect
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meningiomylocele
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spinal cord extends through the defect
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How much folic acid should a woman take?
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400 micrograms with no hx of NTD
4 mg if hx of NTD |
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Most common chromosomal abnormality causing mental retardation? What are the screening tests?
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Down's syndrome
Quad screen: MSAFP, hCG, estriol and inhibin |
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How does estrogen affect the lining of the endometrium?
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Makes it grow
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How does progesterone affect the lining of the endometrium?
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stops the multiplication of cells
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unopposed estrogen?
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estrogen w/o progesterone-inhibited growth of the endometrium
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most important factor for malignant potential in the endometrium?
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atypia
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What is the hallmark of both endometrial hyperpasia and endometrial carcinoma?
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AUB
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Triad of risk factors for endometrial carcinoma?
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Obesity, HTN and diabetes
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3 types of endometrial hyperplasia without atypia? How would you tx?
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-simple hyperplasia, compex hyperplasia, and adenomatous hyperplasia.
-tx medically with progesterone |
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How is atypical hyperplasia treated?
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hysterectomy
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Main symptom of polyps?
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abnormal bleeding
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Grades of differentiation of endometrium?
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Grade 1) Highly differentiated
2) moderately differentiated 3) entirely undifferentiated |
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Invasion of endometrial cancer? Good vs bad prognosis?
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-First two layers of invasion are the muscle and into the cervix (can access lymph nodes if it gets worse)
-Once tumor gets into cervix it acts like cervical cancer and this is BAD NEWS |
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T or F abnormal bleeding in a postmenopausal women is likely to be benign
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T (only 15-20% have cancer)
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follicular cysts
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-clear, thin walled, solitary
-1-5 cm -if greater than 5 then there is a problem -often resolve spontaneously |
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Benign ovarian neoplasms
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-only 25% are neoplastic (not cancer just growth)
-epithelial cell origin |
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serous cystadenomas
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-MC of epithelial tumors
-85% unilateral -b/l serous cysts have increased potential for malignancy |
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Mucinous cystadenomas
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-95% unilateral
-May be huge |
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Germ cell tumors
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-Benign cystic teratoma (dermoid) (MC)
-80% of neoplasms under age 20 -Derived from one or more primary germ layers |
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Benign cystic teratoma
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-Most common ovarian neoplasm (all ages)
-All have malignant potential -10-20% b/l |
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stroma cell origin
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-made up of theca and granulosa cells
-granulosa-theca cell tumors -sertoli leydig cell tumors -fibromas |
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granulosa theca cell tumors
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-make estrogen
-older women who have this will function like pre-menopausal women |
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Fibromas
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-not fibroids of muscle tissue
-most common benign solid tumor -large fibromas may be associated with meigs' syndrome |
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important factors for malignant potential?
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size, simple/complex and u/l vs b/l
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Which ovarian neoplasm will give a positive preggers test?
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Dysgerminoma
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Risk factors for ovarian neoplasms?
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-family hx
-BRCA1 or BRCA2 -age: 60% btwn 40-60 yo -OCPs decrease risk (cancer is proliferative and the pill shuts the ovary down. It reduces the tendancy to proliferate) |
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pathogenesis of ovarian neoplasms?
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primary spread by direct extension within peritoneal cavity by cells sloughing from ovarian surface
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Staging of ovarian cancer
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stage when surgery is done
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tx of ovarian cancer
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-debulk the tumor
-remove as much of the tumor as you can. Then give chemo. -most imporatant part is to remove as much of the tumor as possible |
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Krukenber tumors
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-from GI tract
-stomach primary site in 80% -mostly b/l -characteristic cell is signet ring |
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Which breech to deliver vaginally?
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Frank breech
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3 Ps?
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Passenger (is the baby too big or in a difficult position?)
Passage (is the pelvis big enough for the baby) Powers (are contractions forceful enough? give oxytocin) |
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latent vs active phase of labor?
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Latent: onset of contractions but no dilation or effacement (just contractions)
active: sharp/abrupt upward turn in graphic pattern of labor bc of dilation |
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How do you evaluate abnormal labor?
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-Serial pelvic exams 2 hrs during active phase
-look for effacement (in percentage 100% meas no different between internal and external os) -look for station in relation to ischial spines (breech presentation or vertex) |
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Mastits vs engorgement?
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Engorge: B/L, no redness, diffuse, distended, firm, nodular, low grade fever
Mastitis: u/l, red, high fever and flu like sx, main agent: staph aureus |
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Tx of mastitis vs engorgement
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mastitis: allow nursing/pump, pump and dump when on meds (oral penicillinase) tylenol/motrin
engorge: support, ice, analgesics |
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risk factors for post-partum anxiety and depressionm?
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personal family hx, prior PPD, family hx of psychiatric disorder, depression during pregnancy, martial instability, lack of support, younger maternal age, unwanted pregnancy, victim of violence and abuse, low self-esteem, high levels of anxiety, stressful during preggers
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What immunizations are needed post-partum?
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Rubella, anti-D immune globulin (rhogam), hepatitis B, TDaP (tetanus, diptheria, pertussis)
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Uterine atony
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if uterus is not well contracted and there is hemorrhage
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Uterine atony tx
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-fundal compression and massage (entire fist the vagina and put pressure on the uterus)
-empty bladder -oxytocin infusion -methylergonavine maleate (methergine C/I in pre-clampsia) -prostaglandins F2 alpha (hemabate), E1 analogue (cytotec) -B-lynch suture -Manual compression |
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If the uterus is firm but there is still hemorrhaging what should you do?
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look for lacerations
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Risk factors for endometritis?
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c-section, duration of labor, duration of ruptured membranes (greater than 18 hrs), choiroamniontits, preterm labor, multiple exams, internal monitoring, bacterial vaginosis
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Threatened vs inevitable abortion
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Threatened: painless bleeding < 20wks cervix is closed
inevtable abortion: significant bleeding/ and or ruptured membranes < 20wks with cervical dilation |
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Anti-phospholipid syndrome
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Anti-phospholipids antibiodies + recurrent pregnancy lost
Causes thrombosis which targets utero-placental circulation and can lead to fetal loss or intrauterine growth retardation |
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Causes of spontaneous abortion
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-immune dysfunction, anatomic abnormalities (late 1st timester and early 2nd), Chromosomal abnormalities (1st trimester), Maternal problems (infx, thrombophilia), Horomanal
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Preeclampsia
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HTN, edema, proteinuria
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severe preeclampsia
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-HTN, edema, proteinuria (severe)
-headache/ visual disturbances -thrombocytopenia -oliguria -oligohydramnios |
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Chronic HTN in preggers
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-IUGR: chronic starvation of the fetus throughout the entire pregnanacy
-Mild if systolic <180 and diastolic <110 -DO NOT USE ACE INHIBITORS (use CaCBs) -elevated bc increased resistance (vasoconstriction) or increased flow |
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Physical exam for preeclampisa
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-rapid weight gain
-edema of UE or face -BP siting and supine high -Liver tenderness (subcapsular hemorrhages, section of liver will have periportal necrosis -herreflexia -Monitor kick count |
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Tx for preeclampsia
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-Prevent convulsions
-DELIVER -Mg Sulfate (at time of diagnosis) -Do cesarean section unless there are other problems with labor |
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How would you establish the estimated date of confinement
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-280 days from first day of last menstrual period and also looking at ultrasound
-if EDC of U/S and FDLMP is less than 7 days apart then use the FDLMP -If there is greater than a 7 day different between the two then use U/S |
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post-maturity or dysmaturity syndrome
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-Dx made by pediatrician
-"little oldman" look (loss of subQ fat, parchment type skin) -meconium staining -baby stops growing |
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Macrosomia
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->4500g
-birth trauma -poor nutrition (oligohydramnios, meconium aspiration syndrome, placental dysfunction) -Deliver trauma, Brachial plexus injury |
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effacement
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shortening of cervical length
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engagement
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baby's head is lowering
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Bishop score
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90-15 = cervical ripening, <8 is not easy to induce
-position -effacement -dilation -sofness -baby's head |
