Obstetrics and Urological Conditions: Key Concepts and Diagnostic Approaches

What are the three categories of signs of pregnancy?

Positive signs, probable signs, and presumptive signs.

What are positive signs of pregnancy?

Definitive indicators such as palpation of the fetus, visualization via ultrasound, and detection of fetal heart tones.

What is Goodell's sign?

Softening of the cervix, indicative of pregnancy.

What is Chadwick's sign?

Bluish discoloration of the cervix and vagina, suggestive of pregnancy.

What is Hegar's sign?

Softening of the lower uterine segment during pregnancy.

At what gestational age can fetal heart tones be detected with a Doppler?

At 10-12 weeks.

What physiological changes occur in maternal cardiovascular adaptations during pregnancy?

Increased heart rate, cardiac output, plasma volume expansion, and louder heart sounds.

What is the normal doubling time for Beta HCG during early pregnancy?

HCG levels double every 48 hours during the first 12 weeks.

What does a rapid drop in HCG levels indicate?

It may indicate an inevitable abortion.

What is Gestational Diabetes Mellitus (GDM)?

Glucose intolerance first recognized during pregnancy, associated with various risks.

What screening method is used for GDM?

One-step method with a 50g non-fasting glucose test; if >140 mg/dL, proceed to a 100g 3-hour OGTT.

What are the diagnostic criteria for preeclampsia?

Hypertension (SBP >140 mm Hg or DBP >90 mm Hg) and proteinuria (>0.3 grams in 24-hour urine).

What is the definitive cure for preeclampsia?

Delivery of the baby.

What is the common presentation of acute cystitis in pregnancy?

Dysuria, frequency, urgency, and nocturia.

What is placenta previa?

A condition where the placenta partially or completely covers the cervix, leading to painless vaginal bleeding.

What is placental abruption?

Premature detachment of the placenta from the uterine wall, presenting with severe abdominal pain and vaginal bleeding.

What vaccines are recommended during pregnancy?

Tdap, influenza, hepatitis B and A, and RSV (Abrysvo) if due.

Which vaccines are contraindicated during pregnancy?

Live vaccines such as MMR, varicella, smallpox, and BCG due to teratogenic risks.

What is the significance of fundal height at 12 weeks?

It is above the synthesis pubis, indicating fetal growth.

What is the role of urinalysis in pregnancy screening?

To check for protein, leukocytes, nitrites, blood, and glucose, which can indicate complications.

What is the purpose of the quad screen during the second trimester?

To measure alpha-fetoprotein, beta HCG, estriol, and inhibin-A to help identify Down syndrome.

What is the management for severe hypertension in pregnancy?

Urgent IV therapy with labetalol, hydralazine, or nifedipine, targeting blood pressure of 130-150 systolic.

What lifestyle modifications are recommended for managing GDM?

Dietary control, physical activity, and blood glucose monitoring.

What is the significance of peripheral edema during pregnancy?

It is considered normal due to increased vascular permeability and fluid retention.

What is the common clinical feature of eclampsia?

Seizures occurring in a patient with preeclampsia.

What is the recommended management for urinary tract infections (UTIs) in pregnancy?

Treatment with safe antibiotics and monitoring to prevent complications.

What is the typical presentation of asymptomatic bacteriuria in pregnancy?

Requires treatment to prevent progression to pyelonephritis.

Which live vaccines are contraindicated during pregnancy?

MMR, varicella, smallpox, and BCG due to teratogenic risks.

What is the safe medication for pain and fever during pregnancy?

Acetaminophen.

What medication is preferred for managing diabetes in pregnant women?

Insulin.

Which vitamins are essential for fetal development during pregnancy?

Prenatal vitamins and folic acid.

What type of antacids are considered safe for reflux during pregnancy?

Tums and Maalox.

Which laxative is safe for use during pregnancy?

Colace.

What are the risks associated with NSAIDs during late pregnancy?

Risk of premature closure of fetal ductus arteriosus.

Which decongestant is preferred during pregnancy?

Intranasal oxymetazoline; pseudoephedrine should be avoided in the first trimester.

Which antihistamines are considered safest during pregnancy?

Chlorpheniramine and diphenhydramine.

What antibiotics are safe during pregnancy?

Penicillins (amoxicillin), cephalosporins, and macrolides (erythromycin, azithromycin), except clarithromycin.

What is the safety of nitrofurantoin during pregnancy?

Safe in the 1st and 2nd trimester; avoid in the 3rd trimester.

Which drugs are absolutely contraindicated during pregnancy due to high teratogenic risks?

Accutane, Proscar, Paxil, Prozac, Aminoglycosides, and Lithium.

What defines Asymptomatic Bacteriuria (ASB)?

Presence of at least 100,000 CFU/mL in urine without symptoms.

Which bacteria is most commonly responsible for ASB?

Escherichia coli.

What populations are primarily screened for ASB?

Pregnant women, kidney transplant recipients, children with vesicoureteral reflux, and post-urological surgery patients.

What is the prevalence of ASB in women over 80 years old?

Over 20%.

What is the recommended treatment for ASB in pregnant women?

Antibiotics such as amoxicillin, nitrofurantoin, or cephalosporins for 7 days.

What is hematuria?

Presence of red blood cells in urine, classified as microscopic or gross.

What are common causes of hematuria?

Infections, neoplasms, calculi, trauma, or strenuous exercise.

What is proteinuria and its significance?

Urinary protein excretion exceeding 150 mg/day, indicating renal damage.

What are common risk factors for proteinuria?

Age >60, obesity, and certain ethnic backgrounds.

What is the first-line treatment for uncomplicated urinary tract infections (UTIs)?

Nitrofurantoin (100 mg BID for 5-7 days).

What are the common symptoms of cystitis?

Dysuria, urgency, frequency, suprapubic discomfort, and hematuria.

What is the role of hydration in preventing UTIs?

Good hydration helps reduce the risk of urinary tract infections.

What imaging is recommended for recurrent or complicated UTIs?

Ultrasound or VCUG (voiding cystourethrogram).

What antibiotics are considered safe for use during pregnancy?

Penicillins, cephalosporins, and nitrofurantoin (avoiding third trimester).

What is Acute Pyelonephritis?

An acute bacterial infection of the renal parenchyma and pelvis, characterized by systemic toxicity, fever, flank pain, and urinary symptoms.

What is the most common causative organism of Acute Pyelonephritis?

E. coli, responsible for 75% of cases.

List some risk factors for Acute Pyelonephritis.

Urinary tract abnormalities, stones, indwelling catheters, diabetes, pregnancy, immunosuppression, recent UTI, and BPH.

What are common clinical features of Acute Pyelonephritis?

Fever >102°F, chills, flank tenderness, nausea, vomiting, dysuria, urgency, and malaise.

What is the recommended diagnostic workup for Acute Pyelonephritis?

Urinalysis, urine culture, blood tests for elevated WBC count, and imaging (ultrasound, CT).

What is the typical management for Acute Pyelonephritis?

Hydration, analgesics, and antibiotics; outpatient treatment with fluoroquinolones for mild cases.

What are kidney stones primarily composed of?

Calcium oxalate (80%), with other types including uric acid, cystine, and phosphate stones.

What is the classic presentation of nephrolithiasis?

Renal colic with severe, intermittent pain radiating to the groin, hematuria, nausea, and urinary urgency.

What is the gold standard imaging for diagnosing kidney stones?

Non-contrast CT scan.

What is the first-line management for small kidney stones?

Conservative treatment with hydration, pain control, and medical expulsive therapy.

What are the types of urinary incontinence?

Urge, stress, functional, and total incontinence.

What causes urge incontinence?

Sudden, strong urge to urinate followed by involuntary loss, often due to detrusor overactivity.

What is stress incontinence?

Involuntary leakage of small amounts of urine during activities that increase intra-abdominal pressure.

What is the typical assessment for urinary incontinence?

Detailed history, physical exam, voiding diary, and urinalysis.

What are some management options for urinary incontinence?

Behavioral strategies, pharmacologic treatments (anticholinergics, estrogen therapy), and surgical options.

What characterizes Chronic Kidney Disease (CKD)?

Gradual loss of renal function over more than three months, indicated by decreased GFR and/or persistent proteinuria.

What is the screening recommendation for CKD?

Annual screening in high-risk groups such as diabetics and hypertensives.

What are the stages of CKD based on GFR?

Stage 1: GFR >90; Stage 2: GFR 60-89; Stage 3: GFR 30-59; Stage 4: GFR 15-29; Stage 5: GFR <15.

What is the management goal for CKD?

Control blood pressure, manage diabetes, avoid nephrotoxins, and treat complications.

What is the role of IUDs in contraception?

IUDs are small, T-shaped devices inserted into the uterus to prevent pregnancy, highly effective and reversible.

What is the mechanism of action for progestin-releasing IUDs?

They release progestin, thickening cervical mucus and suppressing ovulation.

What is the typical failure rate of the Mirena IUD?

Ranges from 0.1% to 0.4%.

What is the primary mechanism of the Copper T IUD?

It prevents pregnancy by immobilizing sperm and disrupting sperm motility.

What are the contraindications for IUD use?

Active pelvic infections, pregnancy, and abnormal uterine bleeding.

What is the typical failure rate of the implant contraceptive method?

About 0.1%.

What is Depo-Provera?

An intramuscular injection of progestin administered every three months for contraception.

What are Combined Oral Contraceptives (The Pill)?

They contain estrogen and progestin, suppress ovulation, modify cervical mucus and uterine lining to prevent fertilization, and regulate menstrual cycles.

What are the contraindications for Combined Oral Contraceptives?

Contraindicated in women over 35 who smoke, with a history of blood clots, breast cancer, coronary artery disease, pregnancy, or abnormal uterine bleeding.

What are Progestin-Only Pills (Mini-Pill)?

Contain only progestin, suitable for women who cannot take estrogen, including breastfeeding women, with a typical failure rate of 7%.

How does the contraceptive Patch work?

Worn on the lower abdomen, buttocks, or upper body, releasing estrogen and progestin weekly for three weeks, with a patch-free week during menstruation.

What is the failure rate of the contraceptive Patch?

Approximately 7%.

What is the function of the Vaginal Ring?

Placed inside the vagina, it releases hormones over three weeks and is removed for a week, offering similar efficacy as the patch.

What are Barrier Methods of Contraception?

Methods that physically or chemically prevent sperm from reaching or fertilizing the egg.

What is the failure rate of the Diaphragm?

Approximately 17%, must be kept in place for at least 6 hours after intercourse.

What is the Sponge and its failure rate?

Contains spermicide and fits over the cervix, providing protection for up to 24 hours, with failure rates of about 14% for women who have never given birth and up to 27% for those who have.

What is the Male Condom?

Worn by the man, made of latex or synthetic materials, preventing sperm entry and providing protection against STDs, including HIV.

What is the failure rate of the Female Condom?

Approximately 21%, can be inserted up to 8 hours before intercourse.

What are Spermicides?

Chemical agents that kill sperm, available in various forms, must be inserted no more than an hour before intercourse and left in for at least 6-8 hours afterward.

What are the characteristics of Female Sterilization (Tubal Ligation)?

Involves surgically tying or sealing the fallopian tubes, highly effective immediately after the procedure with a failure rate of approximately 0.5%.

What is a Male Vasectomy?

The vas deferens are cut or sealed to prevent sperm from entering semen, with a failure rate of around 0.15%.

What is Emergency Contraception?

Prevents pregnancy after unprotected intercourse or contraceptive failure.

What are Emergency Contraceptive Pills (ECPs)?

Plan B One-Step and Ella can be taken up to 5 days after unprotected sex, primarily preventing fertilization or implantation.

What is the Copper IUD used for?

Inserted within five days of unprotected sex, it prevents fertilization and can serve as ongoing contraception.

What are the three most common breast lumps?

Fibroadenomas, fibrocystic breast changes, and breast carcinoma.

What are Fibroadenomas?

Benign, solid, usually solitary, and mobile breast tumors most frequently encountered in women under 30.

What characterizes Fibrocystic Breast Changes?

Nonproliferative alterations like ductal dilation and benign cyst formation, prevalent in women aged 30 to 50.

What is Breast Carcinoma?

The most common cancer in women and the second leading cause of cancer-related death.