OB/GYN EOR Exam

granulosa cells

FSH stimulates what cells?

follicle growth

↑ aromatase → estrogen production

Actions of FSH

theca cells---> androgen production

LH stimulates what cells?

LH

what hormone triggers ovulation?

LH

hormone that maintains corpus luteum

FSH

hormone that increases aromatase --> estrogen production

negative feedback on GnRH/FSH/LH

how does low estrogen effect the HPO axis?

positive feedback → LH surge → ovulation

how does high sustained estrogen impact the HPO axis?

progesterone

______ has a negative feedback on GnRH

FSH

follicular phase is dominated by what hormone?

Begins with menses

Dominated by FSH

Ovarian follicles mature

Granulosa cells ↑ estrogen

main events of the follicular phase

LH surge --> ovulation

what does the follicular phase end with?

progesterone

what hormone dominates luteal phase?

Dominated by progesterone

CL forms

Prepares uterus for implantation

Fixed length (~14 days)

main events of the luteal phase

CL regresses → progesterone drops → menses

what causes menses if there is no pregnancy?

follicular and luteal

what are the phases of the menstrual cycle?

-proliferative phase (coincides with follicular)

-secretory phase (coincides with luteal)

what are the phases of the endometrium?

estrogen

the proliferative phase of the endometrium is driven by

Endometrium thickens

Glands are straight

Prepares for ovulation

main events of the proliferative phase

progesterone

the secretory phase is driven by

Endometrium becomes glandular & vascular

Glands become coiled

Ideal for implantation

main events of secretory phase

estrogen, progesterone

______ builds the endometrium, _______ stabilizes it

110-160 bpm

what is a normal baseline fetal heart rate?

<110 bpm

what is a bradycardia fetal heart rate?

>160 bpm

what is a tach fetal heart rate?

1. determine baseline fetal heart rate

2. determine HR variability (MOST IMPORTANT)

3. evaluate for accelerations

4. evaluate for decels

5. overall category

steps to interpreting a EFM pattern

0 bpm change

define absent variability on EFM

<5 bpm change

define minimal variability on EFM

moderate (6-25 bpm)

what is a reassuring variability on EFM?

>25 bpm

define a marked variability on EFM

reassuring

the presence of accelerations is

↑ ≥15 bpm for ≥15 sec

define an appropriate acceleration in a fetus >32 weeks

↑ ≥10 bpm for ≥10 sec

define an appropriate acceleration in a fetus <32 weeks

head compression (benign)

early decels indicate

cord compression

variable decels indicate

uteroplacental insufficiency

late decels indicate

≥2 min, <10 min

define a prolonged decel

Normal

a Category I EFM is

Indeterminate

a Category II EFM strip is

abnormal (requires immediate action)

a category III strip is

Baseline rate

Variability

Presence/absence of accelerations

Type & timing of decelerations

Category (I, II, or III)

Interventions and response

required documentation elements of a EFM strip

Normal baseline

Moderate variability

No late or variable decels

findings associated with a category I EFM pattern

Continue routine monitoring

No intervention needed

management of category I tracing

Category III: Abnormal

most common EFM category

Minimal variability

Recurrent variables

Tachycardia without decels

findings associated with Category II tracing

left lateral

maternal positioning indicated for category II tracing

Maternal repositioning (left lateral)

IV fluids

Stop oxytocin

O₂ if indicated

Consider amnioinfusion (for recurrent variables)

management options (intrauterine resuscitation) for category II tracing

Absent variability plus:

• Recurrent late decels OR

• Recurrent variable decels OR

• Bradycardia OR

• sinusoidal pattern

findings associated with a category III tracing

Immediate intrauterine resuscitation

Prepare for urgent delivery (C-section if unresolved)

management of category III tracing

maternal repositioning, amnioinfusion

management of variable decels d/t cord compression

O2, fluids, stop pitocin

management of late decels d/t placental insufficiency

Resuscitate, consider delivery

management of prolonged decels d/t hypoxia

Amnioinfusion

introduction of a solution into the amniotic sac; an isotonic solution is most commonly used to relieve fetal distress

late decels

d/t placental failure---> think oxygen delivery problem

amnioinfusion

key treatment of variable decels

O2 and fluids

key treatment of late decels

stop oxytocin

initial treatment of late decels

variable decels

name the decel

late decels

name the decel

early decels

name the decel

Gravida: pregnancies

Term

Preterm

Abortions/miscarriages

Living children

define GTPAL

Term/preterm deliveries

Miscarriages/abortions

Complications (PPH, preeclampsia, gestational diabetes)

Mode of delivery (vaginal vs C-section)

Neonatal outcomes

components of a thorough obstetric history

Menstrual history (LMP, cycle length, regularity, flow)

Contraceptive use (current/past)

Sexual history (partners, STI risk, pain with intercourse)

Pap smear history & results

STI history

Gynecologic surgeries or diagnoses (fibroids, endometriosis)

components of a thorough gynecologic history

Inspection → palpation (pads of fingers, circular motion)

Assess for masses, skin changes, nipple discharge

components of a breast exam

-pt supine

-locate symphysis pubis

-palpate top of the uterine fundus using the ulnar border of your hand

-measure with tape measure (in cm)

how to assess fundal height

45 degrees

insert the speculum at what angle?

monthly, ideally after menses

when is the ideal time to perform self exams?

left lateral tilt (esp after 20 weeks)

how do you avoid supine hypotension in pregnant patients?

gestational age (weeks) ± 2 cm

interpretation of fundal height (after 20 weeks only)

just above symphysis pubis

expected fundal height at 12 weeks

at umbilicus

expected fundal height at 20 weeks

xiphoid process

expected fundal height at 36 weeks

Multiple gestation

Polyhydramnios

Macrosomia

Incorrect dating

reasons why fundal height may be larger than expected

Fetal growth restriction (IUGR)

Oligohydramnios

Incorrect dating

reasons why fundal height may be smaller than expected

>2 cm discrepancy to dates

when does a fundal height result in reflex ultrasound?

anteverted, anteflexed

most common uterus position

cardinal (transverse cervical) and uterosacral ligaments

ligaments that support the uterus

Bladder – anterior to uterus

Rectum – posterior to uterus

organs anterior and posterior to the uterus

Blood supply from ovarian arteries (aorta)

blood supply of the ovaries

ureter

runs under the uterine artery

internal iliac

the uterine artery is a branch off of

broad ligament

The ligament extending from the lateral margins of the uterus to the pelvic wall; keeps the uterus centrally placed and provides stability within the pelvic cavity.

-peritoneal fold, not a true ligament

vesicouterine pouch (anterior cul-de-sac)

anterior to fundus between uterus and bladder

Rectouterine pouch (of Douglas)

-lowest point of female abdominal cavity

-accumulates blood/ascites

-drained from posterior fornix of vagina

3-8 weeks

critical period of embryonic development

urogenital ridge

the gonads originate from what embryonic structure?

the development of ovaries

absence of SRY leads to

Fallopian tubes

Uterus

Cervix

Upper ⅔ of vagina

structures that develop from the Mullerian (paramesonephric) ducts

Mullerian agenesis

Everything is normal except no uterus and upper vagina

Have ovaries, normal hair distribution, and are 46XX

uterine didelphys

Complete duplication of the uterus, cervix, and vagina

bicornuate uterus

a common uterine anomaly in which the endometrium divides into two horns

T10-L2

sympathetic innervation of the pelvic organs

Thoracolumbar soft tissue

Rib raising

Lumbar HVLA

main techniques to treat the sympathetics of the pelvic organs

S2-4, pelvic splanchnic

parasympthetics of the pelvic organs

motility, secretion

the parasymphathetics of the pelvic organs regulates

Sacral rocking

Sacral decompression

Pelvic diaphragm release

mainstays of parasympathetic treatment of pelvic organs

Levator ani (iliococcygeus, pubococcygeus, puborectalis)

Coccygeus

muscles of the pelvic diaphragm

pelvic diaphragm

Structure that separates pelvis and perineum

Cardiac enlargement (↑ LV mass)

Upward displacement of the heart

Anatomic cardiac changes in pregnancy

↑ CO, HR, SV

↓ Systemic vascular resistance (SVR)

cardiac output and SVR changes in pregnancy