disease

          + / - 

test +  a / b

test -   c / d

sens: a/(a+c) (+/+ (disease and test) over all with disease)

spec: d/(b+d) (-/- over all withOUT disease)

PPV: a/(a+b) (+/+ over all who TEST +)

NPV: d/(c+d) (-/- over all who TEST -)

(a + d)

---------------

(a + b + c + d)

(+/+ + -/-) - true postives and true negatives

-------------------------------------------------------

ALL with positive and neg tests and with/without disease- - all people who take the test

maternal: deaths per 100,000 live births

stillbirth rate/neonatal death rate/perinatal: per 1000 births (live vs total)

what embryologic origin?

labia - majora, minora

majora: genital swellings

minora: urethral folds

what embryologic origin?

clitoris

what embryologic origin?

vagina

upper 2/3: Mullerian ducts

-

-

-

-

lower 1/3: urogenital sinus

-

UPPER 2/3 vagina

cervix, uterus

fallopian tubes

Morula = embryo at 2-3 days post-fertilization

Blastocyst = 4-5 days post-fertilization

[image]

(5: insterstitial / isthmic / AMPULLA / infundib / fimb)

ANTERIOR: OISU VIMI

1. obturator O

2. Inferior gluteal I

3. umbilical --> superior vesical S

4. uterine U

5. vaginal V

6. inferior vesical I

7. Middle rectal M

8. Internal pudendal I

POSTERIOR: I-L/L-S/S-G
1. IlioLumbar

2. Lateral Sacral

3. Superior Gluteal

UPPER: cervical branch of UTERINE

MIDDLE: Inferior Vesical

LOWER: Inguinal

outer = theca

middle = granulosa

inner = zona pellucida

levator ani includes

(3)

ILIOcoccygeus

PUBOcoccygeus

PUBORECTALIS

injury to which nerve causes:

foot drop

sensation of 

1. vulva

2. anterior medial thigh

1.5 cm lateral to internal os

(#2 = at IP)

Type I = loss of posterior UV angle with NORMAL urethral inclination

Type II = BOTH loss of posterior UV angle AND abnormal angle of inclination

where internal pudendal nerve and vessels cross the ischio-rectal fossa

[image]

Acute Hemolytic

- destruction of transfused RBCs by pt's ab

- most commonly from ABO incompatibility

- starts within minutes or hours

- chills, fever, urticaria, N/V, hypoT, chest/back pain

- stop transfusion immediately, send blood for testing, IVF (can lead to ATN, DIC)

Nonhemolytic

- chills + > 1 degree C rise in temperature

- usually stop tf and rule out hemolytic rxn

TSH decreases in early pregnancy (1st tri) because of weak stimulation of TSH receptors by bHCG

then after 1st tri, TSH levels return to baseline

subclinical = no change in fT4

inc TSH, no change in fT4

1. SAB/IUFD

2. PTD

3. preE

4. abruption

1. First tri = PTU Propylthiouracyl (Primary) but hepatotoxicity.

- 50-150 mg TID

2. Second tri = Methimazole (Mehor for Mom)

- fetal risks: esophageal/choanal atresia + aplasia cutis

- 10-40 mg daily divided into 2-3 doses

2 proposed mechanisms

1. baroreceptors: chemoreceptor mediated vagal response --> decreased HR

2. myocardial depression caused by hypoxia --> deceased HR

nullip: > 20 hr

multip: > 14 hr

7 

1. engagement

2. descent

3. flexion

4. internal rotation

5. extension

6. external rotation

7. expulsion

EFW

when 500 g?

when 1000 g?

500 g at 20 wks

1000 g at 28 wks

BMT NST/AFI over 30 min - can start using at 28 wks

1. Breathing: > 30 s

2. Movement: 3 discrete mvmts

3. Tone: flexion + extension x 1

4. reactive NST

5. AFI: DVP 2 cm

2 for each.

8 with nl fluid = normal

8 with oligo  = suspect chronic asphyxia

6 = possible asphyxia

4 = probable "

2 = almost certain "

INTERVENE WITH SCORE OF 6 OR LESS

NST = earliest (heart is LAST to develop to is the FIRST to show signs of asphyxia)

TONE = last to disappear with fetal asphyxia (was the first to develop)

placenta --> umb Vein (lig teres) --> liver --> ductus venosum (lig. venosum) --> IVC --> RA --> RV --> pulm artery --> ductus arteriosus (lig arteriosum) --> aorta

RA also --> foramen ovale --> LA --> LV --> aorta --> hypogastrics --> umbilical arteries (umb ligaments) --> placenta

[image]

pH 7.26

pCO2 46

pO2 20

0/1/2/3 pts

closed / 1-2 /3-4 / 5+

0-30 / 40-50 / 60-70 / 80+

-3 / -2 / -1 / +1, +2

firm//

posterior//

<= 5 NEEDS CERVICAL RIPENING

>= 9 HIGH CHANCE OF SUCCESSFUL INDUCTION

TOTAL POSSIBLE SCORE: 13

[image]

Activity (=tone)

Pulse

Grimace (=reflex irritability)

Appearance (=color)

Respirations

0/1/2 pts

[image]

FRANK - most

hips flexed, knees extended (straight legs)

COMPLETE

hips and knees flexed (indian style)

INCOMPLETE

one or both hips is NOT completely flexed

MENTUM ANTERIOR CAN DELIVER VAGINALLY

[image]

7

1. T&S

2. KB

3. Syphillis screen

4. Tox screen

5. Viral titers - rubella, parvovirus

6. LAC, ACL

7. HbA1c

MTX for ectopic:

dose, protocol, success rate

50 mg/m2

check bHCG day 4 and 7

if <15% decrease from d 4 to 7 then give 2nd dose

90% success rate

absolute and relative contraindications to MTX therapy

Absolute:  B-I-A-H(eme) + lung/stomach/liver/kidney

[image]

1. myasthenia gravis

2. renal failure

3. hypocalcemia

at what mag level do you:

- lose patellar reflex

- respiratory arrest

- total paralysis

patellar: 10 meq/L

respiratory: 12 meq/L

paralysis: 25 meq/L

DYSPNEA

then angina? 

PHTN

Eisenmenger syndrome

Coarctation of aorta, complicated

Marfan syndrome with aortic involvement

25-50% mortality

Increase  "IC the TV"

1. Inspiratory Capacity

2. TV

(3. minute ventilatory volume 4. minute O2 uptake)

Decrease: "Take the RV (Residual Volume) down to the ER (Expiratory Reserve Volume) for some TLC (total lung capacity)because its FREE FRC (Functional Residual Capacity)"

1. Residual Volume

2. Expiratory Reserve Volume

3. Total lung capacity

4. Functional Residual Capacity

SAME: VC, IRV, FEV == "VERVE FEVer" 

1. sepsis

2. diffuse infectious pneumonia

HIV

Rubella

Rubeola

Hep CADE - A, C, D, E

(Hep B is DNA!)

Hep A

need to treat contacts? baby of recently pregnant mom?

contacts: within 2 weeks should received HAV immune globulin + formalin - inactivated HAV vaccine (SAFE in pregnancy)

infant: HAV immune globulin

measure maternal viral load at 30-34 weeks

if > 10^8 copies/ml, treat with Lamivudine 150 mg daily starting at 34 weeks

HBsAg + HBc IgM = acute infection

HBeAg = exceptionally high viral inoculum & active replication

Anti-C antibody (ELISA)

if positive then verify with recombinant immunoblot assay or nucleic acid test

Quantify HCV viral loads through PCR

Depends on viral load

<400 copies/ml: 1%

> 100,000 copies/ml: > 30%

CMV --> MCC

1. Microcephaly

2. Chorioretinitis

3. Cerebral calcifications

(and can cause mental retardation)

Risk of vertical transmission of toxoplasmosis goes up or down with increasing gestational age?

This is unlike what other congenital infection?

UP

15--30--60% (3rd tri)

(UNLIKE Rubella! <11 weeks 90% risk congen infection vs 0% after 16 weeks!)

primary infection in late pregnancy:

Pyrimethamine and sulfonamide

skin scarring

limb hypoplasia

CNS, eye abnormalities

0.5 / 0.7 / 0.9 x kg

2/3 in AM, 1/3 in PM then divide into long/short acting

- AM: 2/3 is long, 1/3 is short

- PM: 1/2 long, 1/2 short

Ex. 3rd tri 80 kg -  0.9 x 80 = 72 units.

- AM 2/3 = 48, PM 1/3 = 24

>> AM NPH = 2/3 48 = 32, AM Reg = 1/3 48 = 16

>> PM NPH = 1/2 24 = 12, PM Reg = 1/2 24 = 12

50% carb

30% fat

20% protein

105 - 190 - 165 - 145

if 2+ abnormal

day

0-3  = di/di

4-8 = mono/di

9-13 = mono/mono

>13 = conjoined

70% are mono/di.

CRL in cm + 6.5 = weeks gestation

(ex 3.5 cm + 6.5 = 10 weeks)

> 4500 g with DM 50%!

same without DM 25%

4000-4500 g without DM 10%, WITH 20%

1. deltoid

2. infraspinatus

3. flexor muscles of the forearm

C5-6 nerve roots most common

paralysis of the hand (lower than Erb)

C8-T1

Trimethoprim-sulfamethoxazole

160mg trimeth - 800 mg sulfa BID x 3 days

troponin-1

(not EKG)

breech

if fetal trunk has failed to rotate anterior

2 fingers grasp shoulders, other hand draws feet onto abdomen of mother

breech

delivers spontaneously to umbilicus then fetal body held against symphysis

30: 1/1000 

40: 1/100

35: 1/365

45: 1/36

days 29-72 postmenstrual

(weeks 4 - 10)

AFP / bHCG / E3

T21 vs T18 vs T13

             AFP       bHCG       E3

T21        DOWN    UP          DOWN

T18,T13  DOWN    DOWN    DOWN

T13 and 18 all down

endometrial cancer

and mild cognitive impairment

risk of accreta with precia and

1, 2, 3 prior CS

1 - 3%

2 - 11%

3 - 40%

4 - 61%

5 - 67%

ELEVATED in BV, trich, atrophic vaginitis, cervical mucus

NOT elevated in candidiasis

An elevated pH in a premenopausal woman suggests infections such as bacterial vaginosis (pH>4.5) or trichomoniasis (pH 5 to 6), and helps to exclude candida vulvovaginitis (pH 4 to 4.5). 

The pH of the normal vaginal secretions in premenopausal women is 4.0 to 4.5 because these women have relatively high estrogen levels. Under the influence of estrogen, the normal vaginal epithelium cornifies and produces glycogen, which is the substrate for lactic acid production by lactobacilli. In premenarchal and postmenopausal women in whom estrogen levels are low, the pH of the normal vaginal secretions is ≥4.7. The higher pH is due to less glycogen in epithelial cells, reduced colonization of lactobacilli, and reduced lactic acid production

 blood volume in pregnant women at term is about

100 mL/kg

carbs/protein = 4 cal/gm

fat = 9 cal/gm

upper vaginectomy

(not creams)

1. lung

2. vagina

25%

(NOT 30......!)

1. GROWTH SPURT

2. breast thelarche

3. pubarche

4. adrenarche

5. menarche

G-BPAM

In the United States, this corresponds to an upper limit of

12 to 13 years for girls (for breast development)

what's in FFP?

cryoprecipitate?

FFP - AT3, 5

1. fibrinogen

2. Antithrombin III

3. Factors V and VIII 

Cryoprecipitate - VW, 13

1. fibrinogen

2. Von Willebrand

3. Factors VIII and XIII

mode of inheritance:

Kallman's

3 modes - 

X-linked (MOST common)

auto Dominant

auto recessive

Klinefelter

- karyotype

- what causes?

47 XXY

nondisjunctional event involving sex chromosomes

1. cafe au lait spots

2. fibrous dysplasia

3. cysts of skull & long bones

can cause precocious puberty (in 40%) - but granulosa cell tumors more common cause

laminaria

(not Miso)

subQ drain

(closing subQ actually works!)

1:8

so if 1:2 or 1:4 that is LESS and you should repeat the titer in 4 weeks

ex. 1:32 (they diluted down more and still saw ab) then start MCA dopps

3

PDA

sensorineural deafness

cataracts

CNS defects

(remember effects are worst during organogenesis - different from toxo which is worst later in preg with more placenta)

(NO limb deformities)

testosterone 

(not DHEA)

primary care:

TSH

ovarian abnormality

(not familial)

MAB at 6 wks with no fetal pole

(IS indicated for ECV)

2 & 50

volume > 2 ml

sperm count > 49 million

motility > 50%

morphology > 50%

- 90% of CAH

- most frequent endocrine cause of neonatal death

- elevated 17 OHP 

- is salt-wasting

sides of forehead pulled in bc of pull on cisterna magna from SPINA BIFIDA

<O>

ARNOLD CHIARI

cerebellar vermis

4th ventricle

medulla oblongata

all herniate through cisterna magna

sounds like PUPPs but with bulla and vesicles

Herpes Gestationis

skin bx would show IgG and complement deposition in basement membrane

tx topical steroids