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Fetal macrosomia
4 mg of folic acid is the recommended dose for women with previous pregnancycomplicated by neural tube defects
Braxton Hicks contraction are short in duration, less intense than true labor and thediscomfort as being in the lower abdomen and groin.
Labor precautions
Rupture of membranes
Vaginal bleeding
Fetal scalp electrode should be placed if the heart rate cannot be confirmed using externalmethods
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Don't place an epidural unless fetal heart rate can be confirmed
If an intrauterine pressure catheter is placed and a significant amount of vaginal bleeding isnoted, then uterine perforation may have occurred
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Tx: with the catheter, monitor the fetus and observe signs of fetal compromise
s/s of depression less than 2 weeks after delivery are called postpartum blues
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self limited
Ectopic pregnancy must be diagnosed by follow up hCG (< 50% increase in 48 hours).Then methotrexate can be used
The discriminatory zone for beta-hCG is 2000 mIU/ml. This is the level when fetuses can be seen by US
Methotrexate is used for ectopic pregnancy if there is hemodynamic stability, no rupture,ectopic mass < 4cm w/o heart tone or < 3.5 cm w/
heart tone, normal liver enzymes, normalwhite count
S/s of ruptured ectopic pregnancy: hypovolemia, peritoneal signs, and positive pregnancytest
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Chronic hypertension
Babies born to diabetic mothers are at risk for hypoglycemia, polycythemia,hyperbilirubinemia, hypocalcemia and respiratory distress.
Sniffing is the correct position for application of positive pressure ventilation in a newborninfant. Flex neck is not necessary. Just for adults.
The majority of first trimester spontaneous abortions is due to chromosomal abnormalitiesin the conceptus
In women with insulin-dependent diabetes, the rates of spontaneous abortion and major congenital malformations are both increased.
Provided the patient is hemodynamically stable and reliable for follow-up, expectantmanagement is appropriate therapy for missed abortion
in the first trimester
The use of angiotensin converting enzyme inhibitors, such as Lisinopril, beyond the firsttrimester of pregnancy has been associated with
oligohydramnios, fetal growth retardationand neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures anddeath.
There are no proven alternatives to penicillin therapy during pregnancy and Penicillin G isthe therapy of choice to treat syphilis in pregnancy.
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Tx: Desensitization to pencillin and subsequent penicillin G therapy
Among women with cardiac disease, patients with pulmonary hypertension are among thehighest risk for mortality with pregnancy. These
women have a 25-50% risk for death with pregnancy.
Magnesium sulfate is the mainstay of therapy during labor and for 24 hours postpartum tolower the seizure threshold in preeclampsia
Thrombocytopenia <100,000 is a contraindication to expectant management of severe preeclampsia remote from term (<32
weeks)
tachycardia and sinusoidal heart rate pattern are consistent with abruptio placenta
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Use artificial sphincter as a last resort
Central and lateral cystoceles are repaired by fixing defects in the pubocervical fascia or reattaching it to the sidewall, if separated from the
white line
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Uterine prolapse is treated by vaginal hysterectomy
Stress incontinence is caused by an increase in intra-abdominal pressure (coughing,sneezing) when the patient is in the upright position.
urge incontinence is caused by overactivity of the detrusor muscle resulting in uninhibitedcontractions, which cause an increase in the bladder
pressure over urethral pressureresulting in urine leakage
Colpocleisis is a procedure where the vagina is surgically obliterated and can be performedunder local anesthesia
The sudden onset of pain and nausea, as well as the presence of a cyst on ultrasoundsuggest ovarian torsion
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Exploratory surgery is indicated for an ovarian torsion
A patient with a known history of endometriosis who is unable to conceive and has anotherwise negative workup for infertility, benefits from
ovarian stimulation withClomiphene Citrate, with or without intrauterine insemination.
After suction curretage for molar pregnancy, pregnancy should be avoided in the f/u periodand 6 months thereafter
Partial moles are 69 XXY/XXX/XYY triploid and have lower risk of GTD post-molar pregnancy than complete moles
Complete moles usually present with larger uteri, preeclampsia and higher likelihood of developing into post-molar GTD.
Because metastatic choriocarcinoma is quite vascular, suspicious lesions should never be biopsied.
The most recent consensus guidelines (2006) state that management of LGSIL (unless thewoman is pregnant, postmenopausal or an
adolescent) is initial colposcopic examination.
A hysterectomy with bilateral salpingo-oophorectomy is the definitive treatment for a patient with pelvic pain due to endometriosis.
A transvaginal ultrasound would be the best way to begin a workup for an incidentalfinding of an adnexal mass.
The primary risk factor for preterm rupture of membranes is genital tract infection,especially associated with bacterial vaginosis.
Similar To 102247212-OBgyn-Shelf
If premature labor occurs and the fetus has an anomaly incompatible w/ life, let the fetus be born
All patients w/ primary amenorrhea and high FSH need to have a karyotype determination
GBS screening occurs at 36-37 weeks. Women should be treated with penicillin G duringlabor, even in the absence of frank chorioamnionitis
Untreated asymptomatic bacteriuria of pregnancy can lead to pyelonephritis or cystitis.Treat with nitrofurantoin (or ampicillin or 1st gen
cephalosporin) for 7 to 10 days
OCPs are first line therapy for endometriosis in younger women desiring future fertility
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Laser treatment is appropriate if the patient is actively trying to conceive
Hypertrophic dystrophy of the vulva is seen in postmenopausal women. Treat w/corticosteroid topically. Biopsy is required to distinguish from
vulvar carcinoma
Behcets disease can present like herpes or syphillis w/ recurrent ulcers and uveitis.
Fetal heart decelerations are the most common encountered anomaly. Associated withumbilical cord compression.
HRT can actually increase the risk of coronary heart disease and stroke rather than reduce
Puerperal fever is an increase in temperature > 38C for more than 2 consecutive days in thefirst 10 days postpartum
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Most common etiology - endometritis
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Spiking fevers in the puerperal period that do not respond to fevers are likely due to pelvic thrombophlebitis -> give heparin
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Most common pathogens causing endometrisis in the puerperal period: anaerobes
Abruptio placenta and placenta previa are the most common causes of antepartumhemorrhage
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Most common sx is bright red third trimester bleeding
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DIC is a major complication of abruptio placenta
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Risk factors for abruptio placenta are
trauma
maternal hypertension
folate deficiency
Abdominal circumference is the most accurate parameter for estimating fetal weight byU/S
Steroids are used to enhance fetal lung maturity when premature rupture of membranesoccur less than 34-weeks gestation
Premature ovarian failure refers to failure of estrogen production by the ovaries that occur in women less than 35 years
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Autoimmune origin
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Associated with Hashimotos, Addison's type I diabetes
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Tx = egg donation
Risk factors for candida vaginitis are DM, OCPs, pregnancy and immunosuppressivetherapy
Pseudocyeis is an imaginary pregnancy that occurs in women with a strong desire to become pregnant
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Needs psych eval
In any woman of childbearing age with secondary amenorrhea, first rule out pregnancywith beta-hCG
Patients with inevitable or incomplete abortions should be hospitalized and monitored to prevent complications
For all types of abortions, RhoGAM has to be administered in all women without anti-Rhantibodies
Patients with PCOS have elevated DHEA. ACTH stimulation produces exaggersted DHEAresponse due to increased sensitivity.
Lochia rubra is the first vagina discharge after pregnancy. It is bright red.
In incomplete abortion, the cervix is dilated and there is incomplete evacuation of theconceptus with fragments retained in the uterine cavity
RhoGaM is indicated in previously unsensitized Rh-negative women at 28 weeks gestationand within 72 hours of any procedure or incident
Single dose azithromycin is used to treat chlamydial infection. But gonococcal infectionsare treated with empiric abx for both gonorrhea and
chlamydia (ceftriaxone + doxycycline).7 days of doxy can also be used for chlamydia.