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Obstetrics topic list > Nagy's favorites > Flashcards

Nagy's favorites Flashcards

1
Q

Definition of
preeclampsia
eclampsia

A

After the 20th gestational week

Preeclampsia: BP > 140/90 mmHg
Proteinuria > 300mg/24 hours

Eclampsia: Tonic-clonic seizures

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2
Q

Gestational diabetes

A

screen at 24-28w

Fasting glucose < 5.3 mM, healthy
Fasting glucose 5.6-7.0mmol/l, Do OGTT
Fasting glucose > 7.0mmol/l on two separate measurements = DM

OGTT- 75g of glucose (fasting)
Normal
At 0 min < 7.0 mM
At 0 min 5.6-6.9 mM, Impaired fasting glucose
At 120 mins < 7.8 mM
At 120 min Impaired glucose tolerance 7.8-11.1 mM
If > 11.1 mM, DM.

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3
Q

Prophylactic Indications for C-section

A 
Prophylactic:
Maternal -
   prior C-section or myomectomy, 
   pelvic contractions
   fibroids or tumor
   herpes
   late primiparity >30 yrs

Fetal -
fetal scalp pH 7.21-6.25, threatened asphyxia
placental dysfunction or hypoxia
mother received infertility treatment

Maternal/Fetal -
   poor history of prior deliveries / poor gestational history
   dystocia/prolonged labor
   fetopelvic disproprotion / twins
   malpresentation
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4
Q

Vital Indications for C-section

A

Maternal -
Congestive heart failure, pulmonary edema
Severe bleeding or DIC

Fetal -
   fetal scalp pH < 7.20, asphyxia
   cord prolapse. 
   persistent transverse lie
   ascending infection
Maternal/Fetal -
   Ecclampsia
   Uterine rupture
   Placental previa
   Placental abruption
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5
Q

US in pregnancy

A

Zero: (6-7w) = Confirm pregnancy (gestational sac, HR)
Location and number of fetuses: Intra-/extrauterine

One: (11-13w) = Establish correct gestational age and check for chromosomal abnormalities.
Nuchal translucency (Down’s)
Neural tube defects, ductus venosus flow - heart
Biometrics

Two: (18-20w) = Congenital malformations and placentation.
GI defects, duodenal atresia, omphalocele, airway malformations
Locate the placental site and check fetal position

Three: (30-31w) = Fetal size, amniotic fluid, and late onset malformations
check growth pattern for IUGR or SGA
Late congenital malformations, agenesis of corpus callosum
Check AFI

Four: (36-38w) = Fetal presentation
Fetal weight, size, and position
To identify high-risk deliveries.

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6
Q

Diagnosing Placenta abruptio / placenta previa

A

Use hands to palpate the uterus

Abruptio: Painful, hard uterus, if rock hard –> emergency C-section

Previa: Painless, CTG normal

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7
Q

Causes of post-partum haemorrhage

A

Tissue: Retained placenta
Trauma: Vaginal lacerations
Thrombin: Coagulopathy (DIC)
Tone: Uterine atony (exclude other causes)

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8
Q

Stages of birth

A
  1. Onset of labor:
    a. Latent (3cm), ~8hours/5hours, regular contractions
    increasing in intensity and duration
    b. Active (3-10cm) ~5-7/2-4hours
    - active contractions are every 3 minutes, last 45s
  2. Delivering fetus: 30min/3hours/5-30min
    a. Propulsive phase (full dilation, descend to pelvic floor)
    b. Expulsion phase (ends with delivery of baby)
  3. Placenta: 5-30mins,
    a. Expulsion of placenta
    b. Expulsion of membranes
  4. Recovery: 2-6hours after expulsion of placenta
    a. Increased risk of bleeding
    b. Repair lacerations
    c. give RhoGAM to negative mothers with positive babies
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9
Q

Techniques of C-section incisions

A

Abdominal wall:
Transverse (Pfannenstiel) or Vertical (Midline)

Uterus:
Lower segment incision (Transverse) or Classical (Vertical)

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10
Q

Pearl index of different contraceptives

A

No. of pregnancies in 100 females/year with chosen contraceptive.

OCP: 0.1 - 2.5

Post-coital pill: 0.5 - 2.5

IUD: 0.5 - 5

Condom: 3 - 28

Surgical Sterilization: 0.3 - 6

Withdrawal: 4-22

Diaphragm: 6-12

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11
Q

Routine exams

A

Colposcopy
Cytology
Bimanual exam
Breast exam

Cytology -

  • between age 21 - 29 have a Pap test every 3 years. HPV testing should not be used in this age group unless it’s needed after an abnormal Pap test result.
  • 30 - 65 have Pap plus HPV co-testing every 5 years.
  • Over 65 years with no abnormal test results in the last 20 years should discontinue testing.

Breast exam -

  • over age 40 may begin screening mammograms if they wish
  • 45 thru 54 years annual mammorgrams
  • 55 and older, mammograms every 2 years, or yearly if they wish
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12
Q

Risks and benefits of Long-term OCP use

A 
Benefits: decreases all of the following
 Ovarian/endometrial cancer
 Bone loss
 Dysmenorrhea
 Acne
 Risk of trisomies in advanced maternal age
 Improves cycle regularity
Bad: increases these
 DVT/stroke
 Blood pressure
 Weight gain
 Depression
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13
Q

Endometriosis

A

Endometrial-like tissue outside the uterine cavity.
Dx: Gold standard = Laparoscopic visualization

Tx: Definitive is Surgery
Drugs, 
1st NSAIDS, combination OCPs or progestin only OCPs, 'pseudopregnancy' 
then, GnRH, leuprolide to suppress. 
GnRH analog side effects:
- Pseudomenopause 
- osteoperosis
- decreased HDL and increased cardiovascular disease
- vaginal atrophy
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14
Q

Urinary incontinence types (5)

A

Irritative:
Infection/Cystitis/tumor/urinary stone/foreign body,
frequency, urgency, and dysuria, but NO nocturia.

Urge:
Hypertonic, hyperactive detrusor muscle, also can be from cystitis, tumor, stones.
Associated with a sudden, strong, urgent desire to void and leak of urine with contractions.
Does have nocturia
Tx: Anticholinergics, botox injections to the detrusor every 6/9 months.

Stress:
Loss of bladder support, atrophy, birth. Coughing/increased pressure

Overflow incontinence, neurogenic bladder:
Hypotonic detrusor. No feelings of urge to void, with urine dribbling throughout day and night.
Tx: Cholinergics, intermittent self catherterization, indwelling catheter.

Bypass/Fistula

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15
Q

Main vaginal infections

A

Bacterial vaginosis - foul smell smell, no pain or itch. pH > 4.5. white discharge

Trichomonas - foul smell, itchy and inflamed, ph >4.5 green/yellow discharge. strawberry cervix

Mycosis (Candida) - no smell, itchy and inflamed. pH normal. thick white discharge.

Condyloma. HPV 6, 11.

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16
Q

Spontaneous abortion

A

Hx: Pain + bleeding, before 20th week.

Dx: Cervix, US, hCG

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17
Q

Contraindications to tocolysis

A 
Obstetric: 
   Severe abruption
   Ruptured membranes
   Chorioamnionitis
Fetal: 
   Fetal jeopardy
   Lethal anomaly
   Fetus is already dead

Maternal:
Eclampsia
Advanced dilation

18
Q

Leopold maneuvers

A
  1. Fundal grip = Palpate upper abdomen with
    both hands
  2. Umbilical grip = Palpate to localize fetal back.
    One palm to fix, while the other explores one
    side then change.
  3. Pelvic grip (1st pelvic grip) = Determine what
    fetal part is lying above the inlet. Grasp lower
    portion of abdomen just above the pubic
    symphysis with thumb and fingers of the right
    hand.
  4. Pawlick grip (2nd pelvic grip) = Face woman’s
    feet, attempt to locate fetus’ brow. Fingers of
    both hands moved gently down the sides of
    the uterus  Pubis. The side where there is
    resistance to the descent of the fingers is
    greatest where the brow is located.
  5. The Zangemeister meisterburger maneuver.
19
Q

Stopping excessive/intermenstrual uterine bleeding

A

Young: Progesterone –> Preserves fertility
Old: D&C

20
Q

Mayer-Rokitansky-Küster-Hauser Syndrome

A

Fancy word for Müllerian agenesis.
- Congenital malformation
- Failure of Müllerian duct to develop
o Missing uterus, cervix, upper 1/3rd of vagina
o Variable degree of upper vaginal hypoplasia (shortened)
- Causes 15% of primary amenorrhea
- Ovaries intact, ovulation usually occurs
- Will enter puberty and have secondary
sexual characteristics.

21
Q

Pap smear Papanicolau classification

A

P0: Improper sample
P1: Negative result, superficial squamous cells
P2: No dysplasia, but benign abnormal cells present. Superficial cells and WBCs
P3: Pathologic cells present, unclear if inflammation or dysplasia.
P4: Atypical cells, Suspected malignancy
P5: True malignancy

22
Q

Bethesda pap smear classification

A

Reporting cervical OR vaginal cytological Pap smear results.

Important steps:
1. Quality of the slide

  1. Whether the result is positive or negative
  2. Details of the slide
    a) abnormal squamous
    ASC-US
    ASC-H, cannot exclude high grade lesion
    LSIL - Low grade squamous intraepithelial lesion
    HSIL - High grade squamous iel
    b) abnormal glandular
    AGC - atypical glandular cells, endocervical, endometrial
    AIS - Adenocarcinoma in Situ
  3. Physician recommendation of how to proceed
23
Q

Prenatal care

A

Starts before conception.

400ug folate daily
avoid excess vitamin A and other teratogens,
control chronic diseases well and modify medications to not affect fetus.

24
Q

Puerperium

A

Period beginning immediately after delivery of a child extending for ~ 6w.

The maternal pregnancy changes return back to normal.
-cardiovascular system 1 week
-renal system 2-8 weeks, overflow
incontenence 3-6 months in 25%

lochia: rubra->serosa->alba
uterine involution 4 weeks total, placental site 6 weeks total.
vagina, cervix

menstruation 6-8 weeks without
breastfeeding, up to 18 months if feeding.
breast engorgement

perineum and abdominal wall
leukocytosis
weight loss

25
Q

Mortality Statistics

A

1) Neonatal Mortality Rate: No. of neonatal deaths during the 1st month/1,000 live births.
- Early NMR: 1st week
- Late NMR: 2-4th weeks

2) Perinatal Mortality Rate:
No. of perinatal deaths (stillbirths + neonatal deaths, from 24th gestational week to 1st week postpartum)/1,000 total births.

after 24th week or after the fetus >500g or 30cm in length.

26
Q

To exclude ectopic pregnancy

A

Measure Beta-hCG:

  • 1,000 U/L -> Gestational sac
  • 7,000 U/L -> Yolk sac
  • 10,000 U/L -> Embryo

Brown spotting and abdominal pain indicates ectopic pregnancy. Check fallopian tubes.

Beta-hCG doubles every 2nd day. If high but not doubling -> Ectopic pregnancy.

27
Q

Vitamin supplements

A

Preconception: Folic acid up to 6 weeks before 400ug/day

2nd trimester: Low dose Iron and Iodine 250ug/day

Calcium and vitamin D.

Avoid vitamin A.

28
Q

History taking

A
  • Previous operations
  • Allergy to medications
  • Obstetric anamnesis
  • Illness, drugs
  • First day of last menstrual period
    o Naegele’s rule: Can ONLY be applied if menses are REGULAR and cycle is 28 days.

E.g. If 1st day = 20th Sept.
+7 days = 27th Sept.
-3 months = June
Delivery date: 27th June

29
Q

Signs of pregnancy

A

Presumptive sign: Chadwick’s sign (6th week) -> Bluish discoloration of the cervix and vagina due to pelvic vasculature engorgement.

Probable signs:
- Positive home urine pregnancy test,
- Uterine enlargement, breast engorgement.
- Piskacek sign: Soft prominence over the
site of implantation
- Goodell’s sign: Softening of the cervix
- Hegar’s sign: Softening of the cervical
isthmus

Positive sign:
Detection of a fetal heart beat, recognition of fetal movement.

30
Q

Location of Bartholin’s Cyst

A

Lower 1/3 of labia major.

31
Q

Marsupialization of Bartholin’s Cyst

A

Cyst opened at the edges + sutured, forming an open pocket.

32
Q

Asherman’s syndrome

A

Adhesions/fibrosis of the uterine cavity, usually from D&C. Reversible infertility, via surgery to remove the scars and adhesions.

33
Q

Types of anaesthetics used in C-section

A

Spinal
Epidural -> Vaginal delivery
Intratracheal narcosis/anesthesia (ie. inhalational anesthetics) -> Emergency C-section

34
Q

What are the four questions to be answered during genetic counseling

A

What is the disease in question?
- clinical and laboratory diagnosis

How severe is it?
- what is the prognosis and available therapy

How is it inherited?
- What is the risk of recurrence

How can it be prevented?

  • Can it be diagnosed prenatally.
  • reproductive compensation, via screenings more healthy babies can be born than unhealthy babies aborted.
35
Q

Cervical cancer stages

A

0: CIN

I: Limited to cervix
Ia1: Stromal invasion < 3mm depth, < 7mm width
Ia2: Stromal invasion 3-5mm depth, < 7mm width

Ib: Clinically visible lesion
Ib1: < 4cm
Ib2: > 4cm

II: Beyond cervix, not in pelvic side walls, not in lower 1/3 of vagina
IIa: Beyond cervix or into upper 2/3 of vagina, no parametrium
IIa1: < 4cm
IIa2: > 4cm
IIb: Parametrial invasion

III: into lower vagina or pelvic wall.
IIIa: Lower 1/3 of vagina, no pelvic wall extension
IIIb: Pelvic side wall extension, obstructive uropathy

IV: Metastasis
IVa: Bladder, rectum
IVb: Distant organs

36
Q

Ovarian cancer staging

A

I: Ovary/fallopian tube
I/A - A single ovary/tube (capsule is intact)
I/B - Both ovaries/tubes are involved, but capsule is intact
I/C - Capsule is infiltrated or there is ascites.
Ic1: Surgical spill
Ic2: Capsule rupture before surgery, tumor
on ovary/fallopian tube surface
Ic3: Malignant cells in ascites/peritoneum

II: Pelvic extension/primary peritoneal cancer
II/A - Uterus or adnexa are involved
II/B - Other pelvic organs are involved
II/C - is II/A or II/B + ascites

III: Cytologically/histologically confirmed spread to peritoneum and retroperitoneal LN
III/A - microscopic peritoneal mets
III/B - macrocopic peritonal tumors, under 2cm.

IV: Metastasis
IVa: Pleural effusion with positive cytology
IVb: Distant metastasis

37
Q

Cervical cancer treatment

A

Stage 1A1: Transabdominal hysterectomy, or cone biopsy with clear margins.

Stage 1A2 thru 1B1: Radical Trachelectomy + PLND
Stage 1A2 thru 2A: Radical hysterectomy + PLND

Stage 2B thru 3B: Chemoradiation

Stage 4A or 4B: palliation chemoradio or surgery.

38
Q

Endometrial cancer staging

A

Endometrial cancer
0: CIS (Carcinoma in situ)

I: Limited to the uterus
Ia: < 50% myometrial invasion
Ib: > 50% myometrial invasion

2: Cervical involvement

3: Local spread
3a: Adnexa/uterine serosa
3b: Vagina/parametrium
3c1: Pelvic nodes
3c2: Paraaortic nodes

4: Metastasis
4a: Bladder/rectal mucosa
4b: Distant metastasis, ascites, peritoneum

39
Q

Indications for abortion

A

12th week: social indication, or when there is a 10% or greater chance of teratogenic exposure

18th week:

  • rape
  • legal incapacity
  • Missed diagnosis of pregnancy, hospital’s fault
  • Underage pregnancy

Maternal indication:
- if the mother’s life is in serious threat and abortion would alleviate it, at any time.

Fetal indication:

  • when there is a 50% or greater chance of serious genetic disease or fetal malformation.
  • Up to week 20, or week 24 if there was delayed diagnosis by hospital.

Fatal postnatal anomalies:
- termination at any point

40
Q

Benign ovarian tumors

A

Fibroma

Thecoma (NOT granulosa)

Serous or Mucinous Cystadenoma

Endometrioma (Endometiosis choclate cyst)

Mature teratoma

Brenner tumor

41
Q

Malignant ovarian tumors

A

Granulosa cell tumor

cystadenocarcinomas

Immature teratomas

Dysgerminoma

Yolk sac, endodermal sinus tumor

42
Q

Abortion techniques

A

Up to 6th week:
Suction curettage
Medical, Mifepristone, Misoprostol, MTX

Up to 12th week:
D and C

24th week:
Medical induction, Rivanolo, Laminaria, Prostaglandin, Oxytocin, then curettage

Obstetrics topic list (13 decks)

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