Shared Flashcard Set

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Clinical Medicine - OB/GYN
N/A
126
Medical
Graduate
07/20/2011

Additional Medical Flashcards

 


 

Cards

Term
Suggestive signs of pregnancy
Definition


amenorrhea

breast tenderness/enlargement
fatigue
syncope/vertigo
urinary frequency

nausea (6-8 wks)




Term
presumptive signs of pregnancy
Definition

palpable fetal movements

uterine enlargement

softening of uterus

cervical vascular changes

Term
Softening of isthmus = ??? sign
softening of anterior wall of uterus = ??? sign
blue discoloration of cervix = ??? sign
softening of cervix = ??? sign
Definition

Isthmus = hegar's

anterior wall = ladin's

blue cervix = Chadwick's

cervix softening = Goodell's

Term
Dodge take home message:


If you think a woman might be pregnant and it's important to know, order what test?


If it is CRUCIAL to know if a woman is pregnant, order what test?

ex of this situation?
Definition

important: serum or urine qualitative pregnancy test

crucial: serum quantitiative HCG

 

ex: accutane

 

Term
other tests to diagnose pregnancy (other than HCG)
Definition

xrays: fetal bones show up at about 14 weeks gestation

 

US: vaginal probe 1st trimester, abdominal >12 weeks

 

 

Term
at what gestational age can you detect:

gestational sac
2mm embryo
cardiac activity
movement
Definition

gestational sac: shows up at 5-5.5 weeks (3 weeks after conception)

 

2mm embryo - at 5.5-6 weeks

 

cardiac activity: 5.5-6 weeks

 

movement: 7.5-8.5 weeks

Term
Gold Standard for diagnosing pregnancy
Definition

Quantitative (NOT qualitative) HCG test

 

Absolute: if >5mIU/ml

possible if >2mIU/ml

 

Typical post-fertilization 14 days: >30mIU/ml

Term
1. dyspareunia
2. episiotomy
Definition

dyspareunia - pain during sexual intercourse

most common cause: vulvodynia

 

episiotomy: surgical incision of the vulva to prevent laceration at the time of delivery or to facilitate vaginal surgery

Term
What dz?

Cause: uncertain. not an STD but associated with sexual activity

Sx: Thin, white, milky discharge and characteristic "fishy smell"

dx?

complications?

tx?
Definition

bacterial vaginosis (gardnerella vaginalis)

 

dx: look for clue cells on saline wet mount slide. sniff test

 

complications: increased risk of premature labor, increased risk of PID if exposed to chlamydia, increased risk of post-GYN surgery infection

 

tx: oral or topical metronidazole, topical clindamycin

Term
epithelial cells will punctated inclusions, making a speckled pattern
Definition
clue cells
Term
first 28 days of life is considered the ___ period
Definition
neonatal/newborn
Term
1. cystocele

2. nullipara


3. macrosomia - definition, cause, complications

4. primigravida
Definition

cystocele: herniation of urinary bladder into vagina

 

nullipara: never had a child

 

macrosomia: large fetal size (>10 lbs). most commonly seen in moms with type II or gestational diabetes. baby at risk for metabolic problems after birth as well as birth trauma

 

primigravida: woman who's pregnant for the first timek

Term
term, preterm, and postterm
Definition

 

term: 37-42 weeks

preterm: <37 - greater risk for death, resp problems, sequela

Post term: >42

Term
post-partum time frame: delivery - 6 weeks

uterus regresses to 20 weeks size on postpartum day ___


rapid cardiovascular and metabolic changes: such as?
Definition

puerperium

 

20 weeks size by day 1

 

weight loss: 4 kg over 6 weeks

blood loss: 500-1,000 ml. normalized after 3 weeks

rapid fall in insulin resistance

coagulation: rapid fall in fibrinogen and platelets

lipid chemistry; normal <1week

Term
3 measures of how "ready" a woman is to deliver
Definition

 
dilation

- 1 finger = 1-2 cm dilated

- 2 fingers = 2-3 cm dilated

 

effacement

- usually an inch thick

- needs to be paper thin


station - how far down the birth canal is the head?

- 0 = at ischial spine

- -1,2,3 = above the ischial spine

- +1,2,3 = below ischial spine

 

Term
average length of human pregnancy:

___ days after conception (fertilization)

___ dayas after 1st day of last menstrual period

"due date" = ____ = 40 weeks
Definition

266

280

estimated date of delivery (EDD)

Term
trimesters:

1st: ___ - ___
2nd: ___ - ___
3rd: ___ - ___
Definition

1st: conception to 14 weeks

2nd: 15-27 weeks

3rd: 28-40 weeks

Term
a baby is considered a "fetus" at ___ weeks becuase all organ systems have been started
Definition
10
Term
Nagele's rule of dating the EDD
Definition

LMP + 7 days - 3 mos

 

LMP of July 1 = EDD of april 8

Term
what is quickening?
when would it first be noticed?
Definition

 

 

first fetal movement

 

nulliparus: 18-22 weeks

multiparas: 14-18 weeks

Term
when does a baby first start to move?

when can fetal heart beat first be heard?

when does cardiac activity begin?
Definition

movement: 7-8 weeks

HB: 10 weeks via doppler, 16-20 weeks via fetoscope

cardiac: 5 weeks

Term
Uterine growth marks:


___: size of your fist
___: palpable at or slightly above pubic symphisis
___: palpable at umbilicus
___: palpable at xiphoid
Definition

non-pregnant

12 weeks

20 weeks

36 weeks

 

in general, height in cm = weeks gestation

Term
Pregnancy terms:


___: 37-42 weeks
___: >42 weeks
___: 28-36 weeks
___: 22-27 weeks
___: <22 weeks
___: loss before 20 weeks or <500 g
Definition

term

post term

premature

immature

non-viable

abortion

Term
____: trophoblastic proliferation with no embryo
Definition
gestational trophoblastic disaese
Term
___: intrauterine fetal death before or during labor
___: death in the first 28 days of life
___: # of stillbirths and neonatal losses per 1,000 births. Rational goal <10/1,000
___: pregnant woman who dies during pregnancy or within 6 weeks of delivery/termination. rational goal 11-12/100,000
Definition

stillbirth

neonatal death

perinatal death (mortality) rate

maternal mortality

Term
direct v. indirect maternal mortality
Definition

direct: specifically related to pregnancy (bleeding, infection)

 

indirect: somewhat related to pregnancy (pregnant woman who gets swine flu is more likely to die than general public)

Term
___: # of pregnancies
___: # of births

4 digit parity system: what does each # stand for?
Definition

gravity

parity

 

1st digit: # of full term pregnancies

2nd digit: number of preterm deliveries

3rd digit: # of pregnancies that ended before 20 weeks

4th digit: # of kids currently alive

Term
G3P1101

G4P0030

G1P1002

G1P1000
Definition

G3P1101: 3 pregnancies, pregnant now, one full term, 1 pre-term,  1 baby at home

 

G4P0030: 4 pregnancies, pregnant now, 3 early pregnancies ended

 

G1P1002: 1 pregnancy, 1 full term birth, 2 kids at home = twins

 

G1P1000: 1 pregnancy, 1 full term birth, 0 kids at home

Term
Normal fetal heart rate compared to maternal HR
Definition

fetal: 120-160 bpm

maternal: <100 bpm

Term
How often should mom come in for prenatal visits?
Definition

2nd trimester: every 4 weeks

third trimester: every 2 weeks

36 weeks and beyond: every week

Term
DDX for fluid loss through vagina late in pregnancy

how do you decide which it is?
Definition

amniotic fluid (rupture of membrane)

urine

blood

 

determine which it is via STERILE speculum exam

 

determined by pH via nitrazine strip:

acidic (yellow): <7 = probably urine

basic (blue) + ferning: >7 = probably amniotic fluid = "nitrazine positive"

red = blood

Term
1. rupture of membanes before labor
2. rupture of membranes before 37 weeks
3. rupture of membranes latent phase > 24 hours (?)


risk factors of these?
Definition

1. premature rupture of membranes (PROM)

2. preterm rupture of membranes

3. prolonged rupture of membranes

 

risk: similar to preterm labor

Term
___ is THE single most importnat cause of neonatal death, perinatal death, and neonatal morbidity
Definition
preterm labor
Term
risk factors for ____:

prior preterm labor
multiple gestation
african americans
low SES
Definition
preterm labor
Term
___

used 1027- 1968 to treat or prevent miscarriage, lbw, poor ob outcome

shown by 1952 not to be helpful

show by 1968 to cause increased risk of vaginal cancer for female fetus, miscarriages, ectopic pregnancy for female fetus, premature labor, infertility due to "T-shaped" uterus
Definition
DES - diethylstilbesterol
Term
what dose fetal fibronectin in the maternal serum indicate?
Definition

preterm labor

 

cervical legth is only other thing that is useful in predicting preterm labor. >25 mm = very low risk

Term
___: regular contractions that cause a change in the cervix (effacement + dilation)


___: warm up contractions
Definition

labor

 

braxton-hicks contractions

Term
tx for preterm labor
Definition
tocolysis usually via magnesium sulfate
Term
tx for preterm labor
Definition

tocolysis to delay delivery a day or two

 

transport to appropriate premie center

 

glucocorticoids (betamethasone or dexamethasone) when <34 weeks to help mature surfactant in fetus

Term
neonatal survival estimates:

<22 weeks
22-24 weeks
26-28 weeks
28-34 weeks
>34 weeks
Definition

<22 = <1%

22-24 = 5-10%

26-28 = 50-90%

28-34 = 90-99%

>34 = 99%

Term
risks & tx of PROM
Definition

risks: infection (chorioamnionitis) - risk to baby and mom

 

tx: NO vaginal exams to limit bacteria, abx

Term
diabetic obstetrical issues
Definition

birth defecs - related to glucose control at conception and early pregnancy

 

late pregnancy intrauterine fetal death (stillbirth)

 

large fetal size (macrosomia) >10lbs - risk of birth trauma

Term
tx of diabetes in pregnancy
Definition

TIGHT glucose control

early delivery: 37-38 weeks

Term
Changes in insulin/glucose in pregnancy
Definition

first trimester: insulin secretion & sensitivity rise, fasting glucose falls

 

2nd & 3rd trimester: insulin sensitivity falls, fasting glucose rises, due to HPL

 

--> ULTIMATELY 2-3x as much insulin may be needed during 3rd trimester than before pregnancy

Term
ddx for first trimester bleeding
Definition

1. benign bleeding of early pregnancy - dx of exclusion

- due to luteal-placental shift or cervix

2. threatened spontaneous abortion

3. ectopic pregnancy

4. gestational trophoblastic dz

Term
High HCG + no gestational sac in uterus = ?
Definition
ectopic
Term
1. ___: bleeding during any pregnancy <14 weeks
2. ___: some plaenta remains in uterus after abortion. all products of conception (POC) are not expelled.
3. ___: luteum dries but embryo doesn't get the message
4. ___: infection during miscarriage. common during elective abortions
5. ___: consistent miscarriages
Definition

threatened abortion

incomplete abortion

missed abortion

septic abortion

recurrent abortion

Term
most notable risk factor for spontaneous abortion (miscarriage)
Definition
intrinsic embryo health (unhealthy egg/sperm, egg that's too old)
Term
___ - a gestational sac with no embryo - represents VERY early abortion
Definition
blighted ovum
Term
spontaneous abortion: embryo death precedes uterine evacuation by __-__ weeks
Definition
2-6
Term
abortion usually >10 weeks where products of conception are not completely expelled. mom can bleed to death. has heavy cramping "like Labor"

tx?
Definition

incomplete spontaneous abortion

 

requires uterine currettage

Term
fever, discharge, pelvic pain
leukocytosis, elevated sed rate

after elective abortion/uterine instrumentation

requires hospitalization, IV abx, and curettage to evacuate uterus

can occasionally occur with incomplete abortion
Definition
septic abortion
Term
recurrent sab evaluation
Definition

chromosomal analysis

thyroid screen

evaluate uterus

Term
Typical time course of morning sickness

beings __-__ weeks of gestation
Peaks at __-__ weeks
Abates (usually) after about ___ weeks

in rare cases, can persist into the 3rd trimester
Definition

5-7

8-10

12

 

women who make it 8-9 weeks w/o n/v probably won't have any

Term
cause of n/v in pregnancy
Definition
probably related to HCG levels
Term
tx for n/v during pregnancy
Definition

anti-emetics

B6 and doxylmaine (unisom) are first line

Term
severe form of n/v during pregnancy
can be life threatening due to severe dehydration
consider multiple pregnancy or gestastional trophoblastic disease as a cuase

usually requires hospitalization: IV hydration + anti-emetics
hyperalimentation
pregnancy termination necessary in rare cases

corticosteroids may help prevent
Definition
hyperemesis gravidarum
Term
CV changes during pregnancy
Definition

increase in blood volume by 8 weeks, +45% by 34 weeks

 

CO: +30-50% during pregnancy, +30% uring labor, +45% during pushing

 

Vascular resistance: falls during 1st and 2nd trimester.

 

BP: falls due to increased CO and decreased PVR

Term
Normal physiologic CV changes during pregnancy (other than blood volume, TPR, and CO)
Definition

systolic flow murmur (grade 1 & 2)

Split in S1

Distended neck veins (in late pregnancy)

dyspnea

tachypnea

shift in PMI due to uterus size

 

Normal pregnancy does NOT cuase:

diastolic murmurs

grade 3-4 systolic murmurs

pleural edema

Term
supine hypotension syndrome
Definition

after about 20 weeks:

woman's uterus compresses her vena cava when she lies flat on her back which can result in syncope

 

thus, a woman past 20 weeks should lay on her side or at 30 deg head

Term
monitoring fetal health
Definition

growth measurements

biochemical markers - is placenta producing the right hormones?

biophysical assessments - US assessment of fetal activity

placental assessment: placental aging (tends to be exaggerated in diabetics)

Term
methods of measuring biophysical assessment in fetus
Definition

fetal movement - daily kick count

non-stress test

vibroacoustic timulation "Wake up" tests

contraction stress test (CST or Stress test) to measure blood flow through uterine artery

US assessment of amniotic fluid volume and respiratory movement

Term
Normal v. abnormal fetal heart beat as recorded by a non-stress test
Definition

FHR is fluctuant. HR increases when baby kicks

 

abnormal: no variation of HR

Term
how are contractions induced for a contraction stimulation test
Definition
IV oxytocin or breast nipple stimulation
Term
What would a positive (worrisome) CST show?
Definition
no variability in FHR with contractions or decreased FHR after contractions. indicates fetal hypoxia.
Term
causes of htn during pregnancy
Definition

chronic htn

 

pregnancy-induced:

- gestiational htn

-preeclampsia-eclampsia

- superimposed preeclampsia (preeclampsia in a pt who already has htn)

Term
risks associated with chronic htn during pregnancy
Definition

preeclampsia

palcenta abruption

preterm labor

intrauterine growth retardation

 

discontinue ACE and ARBs because they are associated wtih fetal abnormalities

Term
pregnant pt wtih bp >140/90 wiht NO proteinuria

dx?

tx?
Definition

gestational htn

no tx unless bp > 160/110

Term
pregnant >140/90 + proteinuria (300-2,000 mg/24 hours or 1+/2+

edema common but not required for dx
Definition

preeclampsia

 

Term
BP >160/110 OR
proteinuria >2g/24 hours OR
oliguria (<500 ml/24 hours) OR
liver abnormalities/RUQ pain OR
pulmonary edema OR
thrombocytopenia (<100,000/mm3)
Definition
severe preeclampsia
Term
preeclampsia wtih grand mal seizures

fetal mortality: 13-30%
Maternal mortality: 4-5%
Definition

eclampsia

 

can occur before, during, or after labor

Term
preeclampsia tx
Definition

mild: deliver if >37 weeks, hospitalize if <37 weeks

 

severe: deliver regardless of gestational age, delay 24-48 hours with steroids if <34 weeks

 

for both, main goal is preventing eclampsia with:

IV magnesium sulfate

Term
HELLP syndrome
Definition

H: hemolysis

EL: elevated liver enzymes

LP: low platelet counts

 

10% incidence in severe preeclampsia

Term
lactation:

estrogen, progesterone, placental lactogen suppresses lactation during pregnancy

initial lactation secretion is ___: low on fat and CHO and high in vitamines and Igs

___ is essential for ongoing lactation

Milk "let down" reflex loop is critical - involves ___
Definition

colostrum

 

prolactin

 

oxytocin

Term
how do you suppress lactation in a new mother?
Definition

mainly: avoid nipple stimulation

 

Drugs (estrogen and bromocriptine) used to be used but aren't anymore because of increased risk for stroke

Term
types of gestational trophoblastic disease (GTD)
Definition

hydatidiform mole ("molar pregnancy") - most common

choriocarcinoma: life threatening but treatable

 

intermediate forms: chorioadenoma destruans, placental site-trophoblastic tumor (PSTT)

Term
trophoblastic neoplasia that is common in mexicans and asians
associatd wtih dispermic fertilization, maternal pronucleus inactivation

non-viable pregnancy

produces lots of HCG

Pt presents with high HCG, hyperemesis gravidarum, preeclampsia, ovarian cysts, large uterus, uterine bleeding

US shows absent embryo and distinctive pattern of small lucent areas in a large uterus

tx?
Definition

molar pregnancy

 

tx: suction curettage

monitor HCG levels for one year - put pt on contraception for a year

if HCG continues to rise, will cause invasive disease and increased risk for choriocarcinoma

Term
24 y/o woman presents with pos home pregnancy test
Knife-like LLQ pain for 12 hours
LMP 9 weeks ago
first trimester bleeding
Serum HCG is normal or low
hx of right tubal pregnancy 3 years ago

dx? made via?
tx?
complications?
Definition

ectopic pregnancy dx made via US - will show empty uterus and bulge in one fallopian tube

tx: chemo (methotrexate) + extensive follow up to make sure serum HCG returns to normal

or surgery (laparoscopy/laparotomy)

 

complications - rupture:

- life-threatening event with massive blood loss, severe pain or syncope. requires laparotomy

Term
pregnancy with two gestations: one IUP and the other ectopic

vary rare except after IVF
Definition
heterotopic pregnancy
Term
rare pregnancy with high fetal and maternal mortality rates

requires surgery
Definition
abdominal pregnancy
Term
signs that labor is imminent
Definition

"dropping" of fetus - can be up to 4 weeks before delivery

 

Braxton Hicks contractions/false labor

 

"Show" - mucusy/bloody plug comes out + rupture of membranes

 

true contractions 2-2.5 min apart = ready to deliver

Term
Stages of labor
Definition

1. begins when contractions begin to achieve dilation and effacement and ends with complete dilation (10 cm)

 

2. latent phase: irregular to regular contractions wiht little or no progress

 

3. active phase: regular progress expected, failure to progress a potential problem

 

4. Second stage: full dilation to delivery of baby

 

5. third stage - delivery of placenta

Term
average length of labor for nullip and multip pts
Definition

nullip: 10.1 hour mean

 

multip: 8.2 hour mean

Term
Y-shaped indentation felt when examining station on a normal vertex delivery is the ____


4 pronged indentation felt when examining station is the ____ and means the baby's head is not flexed down yet.
Definition

posteiror fontanelle

 

anterior fontanelle

Term
when can an epidural be given?
Definition
around 5cm dilation
Term
___ - when uterus doesn't contract like it should post-labor and there is excessive bleeding when the placenta is delivered.

how can this be prevented?
Definition

uterine atony

 

give mom oxytocin to help uterine contractions

Term
Any time you want to make contractions stronger, eating during birth or during delivery of placenta, give mom ___
Definition
oxytocin
Term
cephalopelvic disproportion
Definition

when baby's head is too big for a woman's pelvis

 

needs C-section

 

often seen in babies >10 lbs

Term
FHR reaction to contractions
Definition

normal: HR slows before contraction and speeds up after, probably due to pressure on baby's head

 

late deceleration: deceleration of baby's hr begins after the peak of contraction. indicates hypoxia. needs stat c-section

 

variable deceleration: FHR varies dramatically with contractions. common. usually indicates cord compression. OK as long as it's not too deep

Term
methods of extracting a baby without doing c section. this is done when:

head is engaged
position of head is known
position must be a deliverable one
cervix completly dilated
membranes rupturd
no cephalopelvic disproportion (CPD)
Definition

outlet, low, mid forceps

vacuum extractor

Term
Preparation for forceps delivery
Definition

adequate anesthesia (numb pudendal nerve at ischial spine)

 

cath in and out for mid forceps

 

episiotomy

Term
Malpresentation of baby during labor:

OT
OP
Face, Brow
Breech: frank, complete, incomplete (footling)
transverse lie
Definition

OT: occiput transverse. probably need to rotate baby with forceps

 

OP: occiput posterior. probably need assisted delivery

 

Frank breech: legs extended and feet are by baby's head. butt is presenting part. can cause compresion of umbilical cord and cause hypoxia or trapping of head

 

complete breech: butt is presenting part and baby is sitting indian style

 

incomplete/footling breech: anything that's not frank or complete. may just be one foot that is presenting part

 

transverse lie: must be delivered via c-section

Term
2 incisions during c section

skin - can be midline vertical or pfannensteil transverse

uterine incision - low transverse, low vertical, classical, t-shaped

which uterine incision is preferred?
Definition
low transverse - due to much lower rupture rate in future pregnancies
Term
What is the major organ you need to get out of the way during a c section?
Definition
bladder
Term
3 P's of progression of baby during delivery
Definition

Passenger: baby. how big the baby is or the baby's head

 

Passage: birth canal

 

Powers: force of contraction

Term
large baby + obese mom --> baby's brachial plexus is injured during delivery

result?
Definition
erb's palsy
Term
dystocia
Definition
abnormal or difficult childbirth
Term
when placenta gets stuck in uterus after birth
Definition
placenta accreda
Term
abruptio placenta
Definition

premature separation of placenta

 

high parity

htn

hx of previous abrutpion

Term
post-partum complications
Definition

postpartum endometritis - esp with long labor and lots of vaginal exams. increased cramping, discomfort, fever

 

DVT

Term
28 y/o, 10 weeks pregnant, with hx of several first trimester spontaneous abortions. what should we be concerned about?
Definition

cervical incompetence - painless, gradual dilation of cervix between 14-27 weeks.

 

complications: SROM, expulsion, feeling vaginal pressure due to bulging of amniotic fluid

 

risk factos: D&C, conization, LEEP (surgical procedures to cervix), congenital

 

tx: Cerclage - putting stitch around cervix

Term
causes of third trimester bleeding:

cervical sources: cervical plug/"bloody show", postcoital, placental pathology (polyp, tumor)

placenta previa or abruptio

iatrogenic
Definition

cervical causes tend to be benign and don't produce much blood

 

placental causes can produce a lot of blood - a cup or more

Term
placenta within zone of cervical effacement and dilation.

classical presentation: painless third trimester bleeding due to effacement and dilation


what are some risk factors for this?

3 types?

complications?
Definition

placenta previa

 

 

risk factors: uterine scarring (previous c section), hypoperfused endometrium (age, multiparity), enlarged placenta (multiple pregnancy)

 

complications: torrential bleeding - pt can bleed out in 5 min

3 types:marginal (partial), complete, low-lying

Term
pt with placenta previa at 20 weeks.. should we be concerned?
Definition
yes, need to watch it, but good chance that it will be normal by delivery date
Term
never ever ever ever do ____ when there is vaginal bleeding until you know for sure that there is not a placenta previa
Definition
cervical exam
Term
management of placenta previa:

total
partial
low lying
Definition

total: c-section

partial: vaginal delivery may be possible

low-lying: vaginal delivery may be possible

Term
vasa previa
Definition

when the fetus is the source of the bleeding during a placenta previa (not usually the case).

 

amniotomy is the only issue with this. happens when umbilical artery/vein is not protected like normal by umbilical cord (velamentous cord) and vessels are crossing the internal os

 

risk of fetal death is very high

 

 

Term
amniotomy is followed by fetal tachycardia and bleeding. what happened?
Definition
vasa previa
Term
succenturiate placenta
Definition
"extra" placenta
Term
complication of 0.5-1% of pregnancies

main sx: bleeding and pain at placental separation site + labor contractions during third trimester
PAINFUL third trimester bleeding

can be due to trauma or ischemia/necrosis due to HTN

tx?
Definition

placental abruption

 

tx: emergency delivery (either c-section or vaginal), tocolysis for fetal distress, volume replacement (blood transufision), watch for DIC (falling platelet count, elevated fibrin split products)

Term
pt with painless, extensive third trimester bleeding. US shows placenta low on posterior wall

dx?
tx?
Definition

placenta previa (marginal, possibly partial)

 

tx: delivery, expectant management if bleeding stops, double setup vaginal exam

Term
double set up exam
Definition
pt taken to operating room for very careful vaginal exam (usually following extensive bleeding) with room set up for emergency C-section if need be
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