Syphillis tx in pregnancy
Penicillin, even if allergic
Thyroid studies in pregnancy
hCG increases TBG and stimulates TSH
Overall, this causes an increase in TOTAL T4, and FREE T4 stays the same as well TSH
Renal changes in pregnancy, effect on BUN and creatinine
Increased RPF and GFR lead to decreases in BUN, creatinine
Guideline for chronic vs obstetric HTN
Whether it's before or after 20 wks
HTN puts you at risk for what OB complication?
abruptio placenta
Causes of vomiting in pregnancy
Hyperemesis gravidarum
Hydatidiform mole
Hyperemesis gravidarum (sx, labs)
Severe N/V, ketonuria, elevated LFTs, amylase, lipase (from salivary glands)
External cephalic version
For breeches at 37 weeks+
Make sure you do it in a safe, prepared environment
Cardinal Movements
Engagement
Flexion
Internal rotation
Extension
External rotation
Lateral rotation
Most common twin types
Monochorion, diamnion
Dizygotic
Metastasis location for trophoblastic gestational disease and endometrial CA
Lungs
SE of tocolysis
Pulmonary edema
DM risk to fetus
Cardiac
Recommended weight gain for obese pregnant pt
11-20lbs
Fourth stage of labor
After placental delivery
When to go to the hospital during labor
ctx/5 min
ROM
Vaginal bleeding
How to treat infant from HIV+ mom
24 hrs zidovudine (AZT)
APGAR categories
Color
Activity
Breathing
Reflex
HR
GDM vs lifelong DM effect on fetus
Macro vs microsomia
Danger of one twin getting too much blood
Polycythemia
Mg + preeclampsia worry for fetus
RDS
How to suppress lactation
Breast binding, ice packs
NO MEDS
Most common cause of postpartum hemorrhage
Uterine atony
Uterine atony (RF, tx)
Chorio, multiple gestations, macrosomia, multiparous
Pitocin IV --> PGs --> D&C --> uterine balloon --> hysterectomy/surgery
Placenta accreta tx
Exploratory lap
PPH sources
Uterine atony (MC)
Cervical or vaginal lacerations
Placenta accreta
Retained POCs
Uterine rupture
Methylergonovine (Use, CI)
Used for uterus contraction if boggy after birth
CI in HTN pts
Chorio tx
Amoxicillin
Gentamicin
Septic pelvic thrombophlebitis (defn, sx, tx)
Thrombosis of pelvic veins
Fever, rule out other causes of postpartum infection
Anticoagulation, abx
Paroxetine in pregnancy can cause
Heart defects
PHTN
Placental sulfatase deficiency
Causes postterm gestations
Amnioinfusion indication
Repetitive variable decels
Assymetric growth restriction vs symmetric
Weight is decreased while height is fine
vs
Weight and height are proportionally decreased
Later vs earlier in pregnancy
pruritus gravidarum (tx, similar to)
Ursodeoxycholic acid
similar to intrahepatic cholestasis, where bile builds up in skin and itches
What is NST?
Non-stress test
Seeing if FHR responds to FM
Difference between mild and severe preeclampsia
3+ vs 5+ proteinuria
Sx of Mg toxicity
diminished reflexes, resp depression, and cardiac arrhythmias at worst
SSRI CI in pregancy?
paroxetine
Discriminatory zone
2000hCG (when pregnancy detectable on US)
Definition of recurrent abortions
3
Tests for recurrent abortions (3)
lupus, thyroid, DM
in early pregnancy what can cause abortion
Smoking, alcohol
What vaccine do you always give pregnant women
Flu
Osteoporosis in women is exacerbated by what substance?
EtOH
3 deceleration types and their etiology
Variable-cord compression
Early-head compression
Late-uteroplacental deficiency
Tx of decels
Change mom's position, give oxygen
First year or two of menarche is often...
anovulatory
irregular
Endometriosis (dx gold standard)
Laparotomy
Condyloma acuminata
HPV warts
6 + 11
Crabs (phthirus pubic) and Scabies tx
Anti-parasitics (ivermectin)
SEs of OCPs
Hypercoagulability
HTN
CI for contraceptive patch
Obesity
Lichen planus vs lichen sclerosis vs lichen simplex chronicus
Painful, extragenital rashes
vs
PRURITIC, old and young, consumes stuff
vs
Itching --> lichen buildup --> more itching, etc
Huge hint for endometritis
Foul smelling lochia
First steps in endometriosis tx, and tx for fertility
1) NSAIDs
2) OCPs
For fertility: Clomiphene
Key finding in ovarian torsion
N/V
Danazol mechanism
Blocks LH FSH midcycle surges
Testosterone-like
Most common pathogen in mastitis
Staph
First steps in breast mass
Mammogram
Fine needle aspiration
Excisional biopsy
Tx for molar pregnancy
D&C (first)
Methotrexate too
HSIL always means
Cone that ish
Epidural + BP
Lowers blood pressure by blocking sympathetic vasoconstrictive abilities
Signs of FAS
IUGR
Low ears
Flat philtrum
Thin lip
What causes AGR from the mom? Why is it assymetric?
Maternal blood restriction/vascular restriction, which can be caused by HTN, preeclampsia, smoking
Asymmetry because the baby reroutes the blood to the most important organs
Tx of endometriosis vs adenomyosis
Danazol, OCPs
vs
Hysterectomy
Estrogen replacement therapy means you need to supplement ? hormone
TH
Big difference between trichomonas and BV sx
Trichomonas presents with itching
Physiologic leukorrhea
Normal white discharge with no other sx
Can macrosomia or fibroids indicate for a CS?
Fibroids more so
Cervical insufficiency dx gold standard
Transvaginal US
When do you need to do steroids in preterm delivery?
<35 weeks. Afterwards you can assume the lungs are mature
Plan B generic name
Levonorgestrel
When do you disregard GBS culture results?
If pt has tested positive before, treat as if they still do no matter what
Fitz-Hugh-Curtis syndrome
PID danger
Perihepatitis from the infection ascending to liver
DUB (what it is, tx)
Vaginal bleeding after everything else is ruled out
Iron if mild, progesterone if medium, estrogen if heavy
Endometrial bx if over 35 yo
BPP Components (5)
Breathing
Heart
Moving
AFI
NST
Weight limit for a vaginal delivery
5000g
When do you give RhoGAM
28 wks
Postpartum
Sequelae of eclampsia in later life
CV dz
Emerging STD similar to G/C
Mycoplasma genitalium
Podofilox (use)
Genital warts (HPV)
Clomiphene citrate (M, T)
M-Antiestrogen, inhibiting E's negative feedback in pituitary
T-Because it blocks estrogen, can cause menopausal sx
When is cervical mucous clear and profuse?
Ovulation
Goal glc level in GDM pts
90
Down syndrome quad screen
Increased bHcg, inhibin
Decreased AFP, esriol
Big benefit of CVS over amniocentesis
Can be done earlier
Fibroid tx (meds vs preserving fertility vs definitive)
Danazol, leuprolide, OCPs
vs
Myomectomy
vs
Hysterectomy
Raloxifene's effect on organ systems
Breast - antag
Bone - agonist
Endometrium - antagonist
Hypercoagulability - agonist
Letrozole (M, similar drugs)
Aromatase inhibitor
Increases FSH, LH
Similar to anastrozole
BPP scores
8+ is great
<4 is delivery
PAPP-A
Low value can indicate Down syndrome
Inhibin (fxn)
Decreases FSH
17alpha hydroxylase def sx
This enzyme needed to divert stuff past aldosterone synthesis
No sex hormones, no cortisol, a lot of aldosterone
Females will have normal internal organs, lacking external secondary features