Preg causes DIC:
Retained products Abruption Severe Pre-Eclampsia Amniotic fluid embolism Sepsis
Six characteristics of Hypovolemic Shock:
Hypotension Tachycardia Narrow pulse pressure (<25 mmHg) Altered mental status Weak peripheral pulses Cool extremities
Anatomic vs. Endocrine causes for secondary amenorrhea?
Anatomic:
- Asherman’s (adhesions due to repeated D and C)
- Cervical stenosis
Endocrine:
- Premature ovarian insufficiency < 40
- PCOS - obese + excess androgen and LH/FSH ratio increases and follicles don’t develop normally = involution
Give penicillin for syphilis and 2 hours later pt has ctx + fever + hypotension + tachycardia. Process?
Jarish-Herxheimer rxn: death of treponemal spirochetes and release of large amounts of lipopolysaccharides from dead treponomas. Self-resolve in 24-48 hrs.
Supportive Tx: IV fluids + Acetaminophen
Causes IUGR:
- diabetes - but when?
- others…
Diabetes w/ vascular/renal disease
Smoking
HTN
Renal insufficiency
Risk factors predisposing to PPROM?
Smoking Substance abuse Socioeconomic status Extremes of maternal age <18 >40 Hx PPROM Infections
Diabetes in preg:
Diabetic fetopathy (fetal hyperglycemia, hyperinsulinemia, macrosomia) Shoulder dystocia Prematurity Perinatal respiratory distress Hypoglycemia after delivery Hyperbilirubinemia Congenital heart defects & cardiomyopathies hPL causes insulin resistance
Pregnancy drug categories
A-E
A - human trials = not shown risk any trimester
B - animal trial = no harm to fetus, no human trials
C - animal shows risk; human no good studies; benefit may outweigh risk
D - human, good studies, known risk to fetus;
X - don’t use; positive evidence fetal abnormalities
Causes of primary dysmenorrhea?
Adolescent/young adult
- nulliparity
- heavy menstrual flow
- smoking
- depression
R/o pelvic anatomy abnormality
Steps for treating uterine atony:
1 - bimanual uterine massage
2 - oxytocin (encourage contraction)
3 - Uterotonics (ergots, prostaglandin F2-a, misoprostol)
4 - Surgery: intrauterine balloon, embolization, compression stitches
5 - Ultimate - hysterectomy
Post-coital bleeding vs. menorrhagia vs. post-menopausal bleeding?
post-coital = cervical cancer
menorrhagia = endometrial polyps, fibroids, adenomyosis
PMP bleed = endometrial carcinoma (remember tamoxifen & unopposed E)
Polyp vs. Fibroid
Polyp: menorrhagia + menometrorrhagia (bleed btwn periods); benign overgrowths of tissue; 40-50yo’s; NOT palpable, but can prolapse
Fibroid: benign prolif myometrium; reproductive aged women; menorrhagia + pelvic pain/pressure + infertility; AFRICAN AMERICAN; lumpy enlarged uterus
1st Stage of Labor Timeline
2nd Stage of Labor Timeline
1st Stage: latent up to 6cm
- > 20 G0 or > 14 G1+ = prolonged latent
- treat w/ IV oxytocin
2nd Stage: active 6cm to delivery
- failure to descend after 10cm for 2 hours G0 or 1 hour G1+ (add 1 hour for epidural) = prolonged second stage. Give oxytocin.
- arrest of 2nd stage = only after 6cm, 4+ hours adequate ctx w/ no cervical change or oxytocin for 6+ hrs w/ no cervical change.
Mullerian agenesis vs. Androgen Insensitive Syndrome
If ovaries present = mullein agenesis; 46 X, X; also will have pubic hair and breasts.
AIS = 46 X,Y that looks like female but no ovaries, no uterus, breasts yes, and vagina in blind pouch. Defect in androgen receptor.
Very high Testosterone levels.
Causes for uterine atony?
- ) Increased uterine dissension
- multiple gestation, macrosomia, polyhdraminos
- ) Chorioamnionitis
- ) Long induction of labor
- ) Use of Mag
- ) Uterine inversion
- ) Retained placenta
Brenner vs. Granulosa vs. Teratoma tumor?
Brenner: nests of transitional epithelium
Granulosa: produce estradiol so uterine stimulation + hyperplasia + cancer; increased Inhibin; complex mass
Teratoma: calcification on CT scan due to teeth!
Contraindications to using Oxytocin?
- Hx uterine rupture
- Active herpes
- Placenta previa / vasa previa
- Umbilical cord prolapse
- Transverse fetal lie
PMP woman w/ vulvar pruritus, not better w/ OTC moisturizers or antifungals.
Smoker 35 pack year hx
White plaque 1.5cm
Next best step? Dx? Tx?
Do vulvar biopsy Cancer - lichen sclerosis, smoker, HPV - hx cervical neoplasia, cancer - hx vulvar intraepithelial neoplasia 1st line treat lichen sclerosis after biopsy = clobetasol propionate
Suspect CMV, how diagnose/follow?
Amniocentesis to dx w/ PCR testing for CMV DNA in amniotic fluid. Then follow w/ serial U/S every 2-4 weeks - microcephaly - ventriculomegaly - intracerebral calcifications - fetal hydrops - IUGR - oligohydraminos
Etiology of Endometriosis?
Retrograde menstruation: endometrial tissue outside of the uterus Clinical - dysparunia - dyschezia - dysmenorrhea
Middleschmerz vs. Ovarian Torsion
Middleschmerz: dull pain 5/10, mid-cycle
Ovarian Torsion: sharp pain, 9/10 + N/V
- U/S show absent blood flow to ovary
(risk increased w/ enlarged ovaries/adnexal masses)
Painless vaginal bleeding 35 weeks, next step? Why?
Transvaginal U/S
Don’t want to disrupt a potential placenta previa so no SVE
IUGR diagnosed
- threshold for this?
- next diagnostic step?
- pathophys?
Below 10th percentile
Do doppler of umbilical artery
- measuring end-diastolic flow
- if reduced or absent = fetus not doing well
