Obstetrics and Gynecology Flashcards

Flashcards covering key concepts from obstetrics and gynecology lecture notes.

What are typical signs and symptoms of endometriosis?

Bleeding into the peritoneal cavity, dysmenorrhea, and dyspareunia (often only during menstruation)

What are the treatment options for endometriosis?

NSAIDs +/- oral contraceptives, Mirena, GnRH agonists/antagonists, cauterization of adhesions or removal of ovaries

What are the characteristics of uterine polyps?

Light AUB, normal sized uterus, pedunculated fleshy growth that could be calcified, and hyperechoic appearance

What are the key characteristics of fibroids?

Irregular sized, bulky, enlarged uterus, proliferation of smooth muscle within myometrium, typically causing menorrhagia

What are key signs of adenomyosis?

Symmetrically (diffusely) enlarged, boggy (soft) uterus with endometrial glands within myometrium, leading to menorrhagia and dysmenorrhea

How do you initially treat AUB?

IV estrogen or high dose OCPs to stabilize endometrium; High dose progestin if estrogen is contraindicated

What occurs in placenta previa?

Placenta grown across the os leading to tearing when the cervix dilates

How is placenta previa managed?

No sex; No digital cervical exam; Inpatient admission for bleeding episodes; possible caesarean delivery at 36-37 weeks

What occurs in vasa previa?

Blood vessels connect uterus to accessory lobe lying across os, tearing when cervix dilates and causing fetal exsanguination

What is the treatment for vasa previa?

Urgent C-section

What are the risk factors for uterine rupture?

Previously scarred uterus (C-section); Oxytocin

What is the treatment for uterine rupture?

Crash C-section

What are the risk factors for vaginal hematoma?

Operative vaginal delivery; Infant > 8.8lb; Nulliparity; Prolonged 2nd stage of labor

What is the appropriate management for a vaginal hematoma?

Non-expanding: observation; Expanding: embolization or surgery

What are the risk factors for uterine inversion?

Nulliparity; macrosomia; placental accreta; rapid labor and delivery

How is uterine inversion managed?

Aggressive fluid replacement; manual replacement of uterus; placental removal and uterotonic drugs after replacement

What uterine presentation accompanies placental abruption?

Tender, hypertonic uterus

Which test can detect fetomaternal hemorrhage in placental abruption?

Kleihauer-Betke test

What do early, late, and variable decelerations indicate?

Early decelerations: head compression; Late decelerations: fetal hypoxemia and forceful contractions; Variable decelerations: cord compression/abnormal position

What is indicated by an abrupt, prolonged deceleration or bradycardia?

Umbilical cord prolapse

What are contraindications to IUD insertion?

Acute pelvic infection; Severe uterine cavity distortion; AUB; Wilson disease

What is a contraindication to a hormone releasing IUD insertion?

Currently diagnosed breast cancer

How long do injections provide contraception?

3 months

How does an OCP prevent pregnancy?

Inhibits LH surge -> no ovulation

What are contraindications to combined OCPs?

35 if smoking >15 cigarettes per day; SLE; Migraine w aura; breast cancer; cirrhosis

How does medroxyprogesterone acetate prevent pregnancy?

Thickens cervical mucus; decidualizes endometrium -> atrophy; impairs tubal peristalsis

What are options for emergency contraception?

Copper IUD, Ulipristal, Levonorgestrel, High dose OCPs

What are the benefits of estrogen-progestin contraception?

Endometrial and ovarian cancer risk reduction, menstrual regulation, hyperandrogenism treatment

What are the risks of estrogen-progestin contraception?

Thromboembolism, HTN, stroke, MI, hepatic adenoma, cervical cancer, moderate breast cancer risk

What are the causes of primary amenorrhea?

Genetic/anatomical

What is indicated by a high FSH measurement?

Primary ovarian insufficiency or Turners

What is the most common cause of abnormal development of uterus, cervix and upper 1/3 vagina?

Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser Syndrome):

What is the cause of androgen insensitivity syndrome?

A defect in androgen receptor (no DHT effect)

What is 5-alpha reductase deficiency?

Virilization at puberty d/t increased testosterone (impaired testosterone to DHT conversion)

What occurs in aromatase deficiency in fetus and what does it cause for the mother?

Inability to convert DHEAS to estrogen; mother gets excess androgens; hirsutism

What is a common cause of abnormal uterine bleeding in adolescents?

Immature HPO axis (after recent menarche)

How is AUB due to recent menarche is treated?

Progesterone to stabilize endometrium or combined oral pill to help regulate menses

What is signified by a negative progesterone challenge + withdrawal bleeding after estrogen challenge?

Lack of estrogen is the issue

What are two causes of primary amenorrhea with pelvic ultrasound showing an absent uterus?

Absent uterus: Karyotype: 46 XY AI ;46 XX Mullerian Agenesis

What uterine presentation are you more likely to see in adenomyosis vs fibroids?

Adenomysosis leads to a Symmetrically (diffusely) Enlarged, boggy (soft) uterus while Fibroids lead to Irregular sized, bulky, Enlarged Uterus

What are the differing presentations in a patient with Placenta Abruptio and Vasa Previa?

With Placenta Abruptio, pain can be in the back or abdomen; Vasa Previa does not typically affect the mother

How do you measure oligohydramnios and polyhydramnios?

amniotic fluid Index (AFI) <5cm is oligohydramnios, AFI >/= 24CM is polyhydramnios

What are key distinctions in a SGA infant vs a LGA infant?

SGA will have peeling skin and thin umbilical cord while LGA will have a risk of hip subluxation d/t intrauterine deformation

What is a key counseling point for patients that get a Etonogestel (progesterone) arm implant for contraception?

Etonogestel (progesterone) arm implant more effective than even IUD —> irregular bleeding/spotting for initial 6 months or more

What are the differing Complications in Gestational Diabetes and Oligohydramnios?

Gestational Diabetes will lead to neonatal hyperglycaemia—> increase insulin and IGF

Oligohydramnios leads to Meconium aspiration; Preterm delivery; Umbilical cord compression

What are the key issues for Polyhydramnios?

Multiple gestation, Congenital infection eg Parvo, Gestational diabetes leading to neonatal hyperglycaemia

What are the high risk factors involved in preeclampsia

Prior preeclampsia, Chronic HTN; DM; CKD, SLE, Multiple gestation

How is chronic hypertension treated during Preeclampsia

Treat with alpha methyl dopa

What is a physical exam and lab test distinguishing factor for preeclampsia

Hepatic swelling causes RUQ pain and that the Cr should be low in pregnancy eg 0.6 so norm Cr is high!

What are the top 4 risks associated with Oestrogen-progestin Contraception in order?

Thromboembolism, HTN, Stroke, MI

What are the top two Benefits of Oestrogen-progestin Contraception in order?

Endometrial and ovarian cancer risk reduction

Describe HELLP Syndrome

It is defined as having Hemolysis, elevated liver enzymes, low platelets.

These are all severe features of preeclampsia that can lead to serious complications for both the mother and the fetus if not identified and managed promptly.

What are the key signs and symptoms of intrahepatic cholestasis of pregnancy

1. Generalised pruritus worse on hands and feet

2. No rash but RUQ pain

Describe Acute fatty liver of pregnancy

This is microvesicular fatty infiltrate secondary to mitochondrial dysfunction of fatty acid beta-oxidation occurs

Will have RUQ pain, mildly elevated transaminases and resultant intrauterine demise, Fulminant liver failure (Platelets </= 100,000; poss DIC; INR increased etc)

scleral icterus, encephalopathy, Hyperbilirubinameia

What is needed to have an intraamniotic infection (IAI)

Fetal tachycardia (>160 bpm), Maternal fever of >/= 39 Celsius, leukocytosis and/or purulent amniotic fluid

What are the qualities of ABO Incompatabilty in Erythroblastosis fetalis?

Mother group O, baby A or B, First pregnancy can be affected as no sensitisation needed

What are the qualities of Rh Incompatabilty in Erythroblastosis fetalis?

First pregnancy is safe (needs sensitisation), Hepatosplenomegaly (as more severe) will occur

When is RhoD IgG given during a pregnancy?

1. When there is any miscarriage or evacuation of molar pregnancy, or ectopic pregnancy

2. CVS, Amniocentesis

3. placental abruption, maternal abdominal trauma,

4. all Rh negatives with vaginal bleeding

How is Recurrent Pregnancy Loss defined?

3 or more consecutive losses before 20 wks

What counts as cervical insufficiency and what some risk factors?

The cervix is <2 cm w/o hx preterm labour or <2.5 w a history; cervical conization is a risk factor

What are the common infections associated with the cause of recurrent pregnancy loss?

Toxoplasmosis, Listeria, HSV, CMV, Listeria

What key cell type has association with recurrent pregnancy loss?

Natural Killer cells (associated with preeclampsia and endometriosis also)

What are characteristics of a septic abortion?

Fevers, chills, Abdominal pain, vaginal bleeding and malodorous discharge

What is the cause of Postpartum Endometritis (infection of decidua)

Direct inoculation of uterus by vaginal Flora, but generally E.coli is a common cause

What are characteristics of Septic Pelvic Thrombophlebitis?

Persistent Fever unresponsive to Abs (>48hrs postpartum), No localising signs, Negative infectious evaluation, Hypercoagulability, Pelvic venous stasis & dilation, Vascular trauma, Infection

When to use a c-section to avoid vertical transmission of HIV?

Only if viral load high ie >1000

How often should a smear be done for cervical cancer prevention?

Every 3 years ages 21-65 years Ages 21-29 PAP smear only

What is current guidelines for HPV vaccinations

HPV Vaccination w/o HPV testing in unvaccinated F/M age 11-26 routine (can give ages 9-45)

What is used of for the HPV vaccine?

Gardasil: Highly purified virus like particles of L1 protein of HPVs

What are key findings of a Colposcopy

If the cervical epithelium contains an abnormal load of cellular proteins -> acetic acid coagulates the proteins -> opaque and white

What are common treatments for pelvic organ prolapse

Weight Loss, Pelvic Floor exercises, Vaginal Pessary for Pelvic Organ Prolapse, Surgery (if good candidate)

Where will you find a Bartholin Duct Cyst vs Gartner duct cyst and Skene gland cyst

1. Bartholin Duct Cyst is behind posterior labium majus

2. Gartner duct cyst and Skene (paraurethral/lesser vestibular) gland cysts are in Anterior vagina

What is the hallmark in evaluation of an ovarian tumor concerning malignancy

Malignant masses appear complex (solid & cystic) with irreg, thickened internal septations when evaluation Ovarian Tumours

What are key signs of Lutein cysts

Multiple and bilateral enlarged multicystic ovaries

What is key etiology for Pseudomyxoma Peritonnei

Cystadenomas of appendix and mucin producing tumours of ovary

What is the frequency for uterine tachysystole?

5 contractions/10min

What are the findings of moulding and captured, which are associated with cephalopelvic disproportion?

Moulding is change in fetal skull shape due to maternal expulsion efforts and captured is scalp edema due prolonged pressure

What is a key antibiotic used for PPROM <34wks

Latency antibiotics (ampicillin+azithromycin; prolong pregnancy)

What are two additional risk factors for an acute pyelonephritis infection

DM; Age <20

What is key finding of a Lochia rubra?

Bleeding due to shreds of tissue and decidua lasting until 3-4 days postpartum

What are key signs and symptoms of a polymorphic eruption of pregnancy?

Pruritic erythematous papules in the third trimester; it starts within abdominal striae but spares palms and soles

What are the risk factors for Hyperemesis Gravidarum

Hydatiform mole due to increased beta HCG, multifetal gestation, history of hyperemesis gravidarum

What 3 key secretions responsible for uteroplacental blood in the placenta

1. Placental Secretions

2. Oestrogen and progesterone

3. DHEAS Estriol

What is a short interpregnancy interval and the complications?

<6-18 months from delivery to next pregnancy; it can lead to maternal anemia; PPROM, Preterm delivery, and low birth weight (growth restriction)

What are the average measurements for labor and fetal station?

Labor generally progresses 2cm dilation every 2hrs or 1cm every hour in active labour to complete dilation; Fetal station +1 once the head is over ischial spine and moving toward delivery