Term
| Bleeding after intercourse is __ __ until proven otherwise. |
|
Definition
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Term
| Children with vaginal bleeding is either __ __ or __. |
|
Definition
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|
Term
| __ consecutive months without a period is menopause. Any bleeding after this is always __ and possibly __. |
|
Definition
- 12
- abnormal
- precancerous |
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Term
36 year old woman presents to the ER complaining of light spotting for two days. She had a positive pregnancy test 4 days ago. Her LMP is 4 ½ weeks ago.
What tests do you want to order? |
|
Definition
- Urine hcg (quantitative)
- CBC to make sure hemodynamically stable
- Blood type
- Ultrasound |
|
|
Term
| normal hemoglobin and hematocrit levels in women? |
|
Definition
- hemoglobin: 12-16
- hematocrit- 38-46% |
|
|
Term
| When should the gestational sac appear on OB ultrasound? |
|
Definition
|
|
Term
| When should the yolk sac appear on ultrasound? |
|
Definition
|
|
Term
| When should the fetal pole or embryo appear on OB ultrasound? |
|
Definition
|
|
Term
| When should cardiac activity show up on OB ultrasound? |
|
Definition
| - around 6 weeks, definitely by 7 weeks |
|
|
Term
| When is Crown to Rump Length (CRL) assessed? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Which ultrasound is most accurate at determining how far along the pregnancy is? |
|
Definition
|
|
Term
| 3 measurements of the pregnancy assessed at the 20 week ultrasound: |
|
Definition
- Biparietal Diameter (BPD)
- Femur Length (FL)
- Abdominal Circumference (AC) |
|
|
Term
| What is the most important measurement used to monitor fetal growth? |
|
Definition
|
|
Term
| A Biophysical Profile (BPP)combines an __ with a __ __ __ to determine fetal health in the third trimester. This test is performed if there is a question about fetal health and well being resulting from either an examination, maternal/fetal symptoms, or if the pregnancy is considered high risk. |
|
Definition
| - ultrasound with a non-stress test |
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Term
| The NST portion of the BPP measures the baby's __ __, ___, and __ __ reactivity to __ for 20-30 minutes. Then an ultrasound is done. |
|
Definition
- heart rate
- movement
- heart rate reactivity to movement |
|
|
Term
| 5 fetal attributes scored during a BPP: |
|
Definition
- Breathing (normal: 1 breathing episode in 30 mintues, abnormal: 0 breathing episodes in 30 minutes)
- Movement (normal: 2 or more movements in 30 minutes, abnormal: less than 2 movements in 30 minutes)
- Muscle tone (normal: 1 or more movements of active flexion or extension, abnormal: slow extension/flexion or partially open fetal hand)
- Heart Rate (normal: 2 or more episodes or reactive heart rate acceleration w/in 2o minutes, abnormal: 1 or more episode of unreactive heart rate acceleration)
- Amniotic fluid (normal: 1 or more adequant pockets of amniotic fluid, abnormal: no/inadequate pockets of fluid) |
|
|
Term
| List 5 aspects assessed during BPP: |
|
Definition
- Breathing
- Movement
- Muscle tone
- Heart Rate
- Amniotic fluid |
|
|
Term
|
Definition
| usually after 32 weeks gestation |
|
|
Term
| The BPP gives you an __ __ __. If there is excessive amniotic fluid, it is called ___. If there is decreased amniotic fluid, it is called ___. |
|
Definition
- Amniotic Fluid Index
- polyhydramnios
- oligohydramnios |
|
|
Term
| What type of ultrasound is best when pregnancy is still early on? |
|
Definition
|
|
Term
| how do you assess placental location? |
|
Definition
|
|
Term
36 year old woman presents to the ER complaining of light spotting for two days. She had a positive pregnancy test 4 days ago. Her LMP is 4 ½ weeks ago.
Most likely dx? |
|
Definition
- threatened abortion
- implantation bleeding |
|
|
Term
| considering previous flashcard, what would be the next test you order? |
|
Definition
| Quantitative hcg, repeat in 48 hours |
|
|
Term
| considering previous flashcard, what would be the next test you order? |
|
Definition
| Quantitative hcg, repeat in 48 hours |
|
|
Term
A 23 year old G2P1 woman presents to the ER complaining of some crampy pain and bleeding x 2 days which stopped this morning. Her LMP was 10 weeks ago.
On exam: ~8 week uterus with diffuse mild tenderness of pelvis
SSE: brownish discharge in cervical os, no pooling noted
US: irregularly shaped gestational sac with 8 week fetal pole visualized, no cardiac activity
What is her most likely dx? |
|
Definition
|
|
Term
| With an abortion, what are the patient's options? |
|
Definition
- wait and see approach
- D&C |
|
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Term
| Even if mother has abortion, if she is Rh negative, give her ___. |
|
Definition
|
|
Term
| At what gestational age do you give Rhogam prophylactically? |
|
Definition
|
|
Term
Implantation bleeding
Common
Minimal, at time of the first missed period
1-2 days, spotting to menstrual flow
20% to 25% of all pregnant women spot or bleed in the first trimester
Must always consider:
threatened, inevitable, complete, or incomplete abortion
ectopic pregnancy
molar pregnancy |
|
Definition
|
|
Term
|
Definition
- bleeding
- closed cervix
- uterus appropriate size
- +/- uterine tenderness |
|
|
Term
|
Definition
- some products of conception are expelled while some remain
- cervix usually dilated
- bleeding (may be profuse)
- enlarged uterus
- uterine cramping
- more common at greater than 6 weeks gestation |
|
|
Term
|
Definition
- uterus has expelled its contents
- cervical os is closed
- minimal bleeding
- uterus is near normal size
- little/no uterine pain/cramping |
|
|
Term
| Missed abortion findings: |
|
Definition
- pregnancy is lost but products not expelled
- uterus involutes so it is small for dates
- minimal dark red/brown vaginal bleeding
- pregnancy tests may remain positive for some time |
|
|
Term
| Septic abortion findings: |
|
Definition
- infection occurs concurently with abortion
- temperature elevation
- elevated WBC and ESR |
|
|
Term
| If patient is having an abortion and bleeding profusely in the ER what could you give them? |
|
Definition
- Uretotonic agent
also probably need a D&C if bleeding profusely |
|
|
Term
| what are some uretotonic agents? |
|
Definition
- Ergonovine maleate (Ergotrate)
- Methylergonovine maleate (Methergine) |
|
|
Term
| Anyone past __ to __ weeks, should have fetal heart tones done. Normal fetal heart tones are __ to __. |
|
Definition
- 10-12 weeks
- 120-160 bpm |
|
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Term
A 27 year old G2P1 with previous C/S, presents to your rural ER at 32 weeks on the way back from Christmas vacation with complaints of vaginal bleeding. She reports that she had a gush of bright red blood at a nearby Dairy Queen prior to her arrival.
BP 120/80, P 92
Fetal status is reassuring with FHT 140’s
No contractions noted
A small amount of bright red blood is noted in the introitus and there is no free bleeding.
Hb 9.2, Hct 27
The next step in her evaluation should be? |
|
Definition
|
|
Term
| with placenta previa, do not do SSE |
|
Definition
|
|
Term
Placenta previa
Often bright red blood in vagina usually in 3rd trimester
Instrumentation, digital examination of the cervix, and speculum examination can provoke severe hemorrhage
1/3 of placenta previa cases are <30wks
admission and obstetric consultation are indicated |
|
Definition
|
|
Term
| With placenta accreta, anchoring placental villi attach to the ___, rather than being contained in the decidual cells. Thus, the placenta is abnormally adherent to the uterus. This can cause life threatening __ __ _ and increases the need for immediate hysterectomy. |
|
Definition
- myometrium
- post-partum hemorrhage |
|
|
Term
| Placenta Increta occurs when the placenta invades __ the __. |
|
Definition
|
|
Term
| Placenta percreta occurs when the placenta invades through the __ with possible invasion to surrounding __ like the __. |
|
Definition
- through the serosa
- tissues
- bladder |
|
|
Term
| If pt in 3rd trimester is bleeding, what do you do first? |
|
Definition
| ultrasound, do NOT do SSE |
|
|
Term
| UTERINE TENDERNESS IS KEY HERE TO PLACENAL ABRUPTION. This is really easy to miss. Pts may be really sick and vomiting , bleeding a lot, or they may be feeling fine after a car accident. ANY CAR ACCIDENT SUSPECT THIS WITH PREGNANT WOMEN, EVEN IF FEEL FINE, MONITOR THEM, PUT THEM ON FETAL MONITOR, ESPECIALLY IN 2ND AND 3RD TRIMESTER. Shearing force from MVA separates placenta. Sometimes even the u/s won’t show this, so MONITOR. |
|
Definition
|
|
Term
| Pts with placental abruption will usually have __ __ and may or may not have vaginal bleeding, if they do have bleeding it tends to be __ ___. |
|
Definition
- uterine tenderness
- dark red/brown |
|
|
Term
| MCC of intrapartum fetal death: |
|
Definition
| Abruptio Placentae (placental abruption) |
|
|
Term
| With placental abruption there tends to be __ __ in the vaginal vault. The amount of bleeding does NOT correlate with severity. This is distinguished from placenta previa by presene of __ __. |
|
Definition
- dark blood and clots
- abdominal tenderness |
|
|
Term
| Dx studies to be done with placental abruption? |
|
Definition
- US
- fetal monitoring
- fibrin
- platelet count
- PTT to make sure don't slip into DIC |
|
|
Term
| Placental abruption is associated with __. |
|
Definition
|
|
Term
| Risk factors for ectopic pregnancy: |
|
Definition
- Non-white race
- Older age
- h/o STD or PID
- Infertility tmt
- IUD
- BTL or tubal repair
- Previous ectopic pregnancy
- DES exposure |
|
|
Term
| If anyone has a hx of ectopic pregnancy, never give them an __. |
|
Definition
|
|
Term
Ectopic pregnancy S/Sx: (?Intraperitoneal hemorrhage, ?Infection)
severe, sharp constant pain at affected side
more diffuse abdominal pain with intraperitoneal hemorrhage
shock may be present (hypovolemia due to hemorrhage)
+/- cervical motion tenderness
+/- vaginal bleeding (Ectopic pregnancies cause vaginal bleeding because of the separation of the decidua from the endometrium as the ectopic pregnancy dies ) |
|
Definition
|
|
Term
| In a normal pregnancy, beta hcg doubles every ___ hours. |
|
Definition
|
|
Term
| Dx for ectopic pregnancy: |
|
Definition
- UPT positive
- US transvaginal
- Culdocentesis- to determine if there is a hemorrhage- put needle in posterior fornyx of vagina and see if there is blood or not |
|
|
Term
| possible locations for ectopic pregnancies to occur: |
|
Definition
- cervical
- interstitial
- tubal (isthmus)
- ovarian
- tubal (ampular)
- infundibular (ostial)
- ovarian |
|
|
Term
| 83% of ectopic pregnancies are ___. |
|
Definition
|
|
Term
| when does the placenta take over the pregnancy? |
|
Definition
|
|
Term
| with total placenta previa, cannot have intercourse |
|
Definition
|
|
Term
| Placenta previa presentation: |
|
Definition
bright red bleeding
no abdominal tenderness |
|
|
Term
| Ectopic pregnancies usually cause pain around weeks __ to __. If they are going to rputure its around weeks __ to __. If the ectopic is discovered around weeks 4-6, __ can be used. |
|
Definition
- 4 to 8 weeks
- 8 to 10 weeks
- methotrexate |
|
|
Term
A 32 year old G4P3 woman presents to the ER with bleeding and clots. She thinks she is miscarrying. Her LMP was 9 weeks ago. She also reports n/v daily x 3 weeks.
Vital signs are stable
Physical exam reveals 10-12 week nontender uterus, and on SSE you note grape like clots oozing out of the cervical os.
UPT positive, CBC WNL, Type AB+
What is ddx? What tests would you order to confirm your suspicion? |
|
Definition
DDx: molar pregnancy or partial mole
Tests: US, quantitative hcg |
|
|
Term
| US of a molar pregnancy aka trophoblastic disease would show: |
|
Definition
|
|
Term
| Most trophoblastic tumors are __ __. This occurs in one of every 1000 gestations in non-oriental women. |
|
Definition
|
|
Term
| SSx of trophoblastic disease: |
|
Definition
- vaginal bleeding
- enlarged uterus for dates
- passage of grapelike structures
- HTN, edema, and proteinuria can occur |
|
|
Term
| Dx of trophoblastic disease: |
|
Definition
- US: snow storm appearance
- elevated quantitative hcg greater than 100,000 mIU/ml |
|
|
Term
| With trophoblastic disease in ddx, be sure to rule out: |
|
Definition
- normal gestation
- multiple gestation
- uterine enlargement due to other reasons like myoma
- hydramnios |
|
|
Term
| Molar pregnancies are suggested by: |
|
Definition
- vaginal bleeding
- uterus large for dates
- serum hcg levels greater than 100,000 mIU/ml |
|
|
Term
| When measure the fundus, anything within 2 cm +/- is normal. |
|
Definition
|
|
Term
33 year old G1P0 woman at 33 weeks EGA presents to your ER c/o contractions Q10 minutes for the past 3 hours. She states she has had ctx every few hours for the past week. Her OB put her on bedrest two days ago but is out of town for the next week.
FHT 150’s and S=D
Toco/NST reveals regular contractions at Q9 minutes.
What is most likely Dx? |
|
Definition
|
|
Term
| What could be given in the ER to stop contractions? |
|
Definition
Terbutaline or Ritodrine (beta mimetics)
Magnesium sulfate
(both have horrible side effects- respiratory depression, HA, decreased DTRs) |
|
|
Term
| What are two drugs that increase contractions? |
|
Definition
|
|
Term
| What does HELLP syndrome stand for? |
|
Definition
- Hemolysis
- Elevated Liver Enzymes
- Low Platelets |
|
|
Term
| Premature labor is defined as uterine contractions with __ __ before __ weeks gestation. |
|
Definition
- cervical changes
- before 37 weeks |
|
|
Term
| Leading cause of neonatal mortality : |
|
Definition
|
|
Term
| Risk factors for premature labor: |
|
Definition
- Lower SES
- Extremes of age
- Tobacco, cocaine use
- h/o preterm delivery
- Infections (UTI, genital tract, other) |
|
|
Term
|
Definition
|
|
Term
| Criteria for delivery with premature labor: |
|
Definition
- Eclampsia: PIH, proteinuria, grand mal seizures
- Fetal demise
- Congenital anomalies |
|
|
Term
| Premature Rupture of Membranes (PROM) is aka ___. This refers to rupture before labor, not to fetal prematurity. |
|
Definition
|
|
Term
|
Definition
SSE:
- Nitrazine paper testing- turns blue with ph of 7.1-7.3- amniotic fluid (normal vaginal pH pregnancy is 3.5 to 6.0)
- Ferning- amniotic fliuid turns white and crystalizes on slide when heated and dried
( Vaginal secretions carmelize and turn brown on slide ) |
|
|
Term
| with PROM you should avoid: |
|
Definition
| direct digital exam of cervix |
|
|
Term
| With PROM, what cultures should be obtained? |
|
Definition
- group B streptococci
- Chlamydia
- gonorrhea |
|
|
Term
| Nitrazine paper- blue- amniotic fliud, yellow= negative, green- not sure b/c blood can cause this. |
|
Definition
|
|
Term
Delivery complications: For the passenger (Baby)
Chorioamniotitis
Shoulder dystocia
Breech presentation
Face/brow presentation
Umbilical cord prolapse
Multiple Gestations |
|
Definition
|
|
Term
|
Definition
| Cephtriaxone 250 mg IM once + Doxycycline 100 mg bid for 14 days po + Metronidazole 500 mg bid for 15 days po |
|
|
Term
|
Definition
- Cefoxitin 2 g IV q6h + Docycline 100 mg PO/IV q12h (do this for 24 hours or until patient is stable)
- then ouput docycylcine 100 mg po bid for 14 days. |
|
|
Term
| PID with a tubo-ovarian abscess tmt: |
|
Definition
- Clindamycin + Aminoglycoside
OR
- Clindamycin + Metronidazole/Doxycycline |
|
|
Term
|
Definition
250 mg IM Ceftriaxone
if they have an IUD, remove it after starting abx |
|
|
Term
| PID indications for hospitalization: |
|
Definition
TAPHIPUG:
- Tubo-ovarian abscess
- Adolescents
- Pregnancy
- Hx of operative/dx procedures
- Inadequate response to outpatient treatment
- Peritonitis in upper quandrants
- Uncertain dx
- GI symptoms |
|
|
Term
|
Definition
- recurrent acute PID
- ectopic pregnancy
- chronic pelvic pain |
|
|
Term
| Tmt for tubo-ovarian abscess if enterococcus is suspected: |
|
Definition
| Clindamycin + Aminoglycoside + Ampicillin (for enterococcus) |
|
|
Term
| For the treatment of tubo-ovarian abscesses, metronidazole is an effective replacement for anaerobic infections, but Metronidazole does NOT cover ___ ___ organisms. |
|
Definition
| does NOT cover gram negative organisms |
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|
