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  1. Who is responsible for infertility?
    40-65% female, 20-40% male, 15-20% idiopathic
  2. Define infertility
    • <35yo inability to conceive after 1 year
    • >35yo inability to conceive after 6mo
  3. Secondary Infertility
    Have conceived in the past, but currently cannot.
  4. Hx Questions for 27yo c/o inability to conceive
    • LMP? characteristics of menses..regularity, flow,
    • STIs, PID, PAP smears
    • ROS-->thyroid disease, hirsuitism, pelvic or abd pain, 
    • Fam Hx--> infertility, birth defects, mutations, retardation, fragil X
    • Life style-->occupation, exercise, stress, smoking EtOH
  5. PE findings for infertility
    • Incomplete secondary sex characteristics
    • Turner syndrome appearance (hypogonadism)
    • Tenderness of the pouch of Douglas (PID endometriosis)
    • Adenexal masses
    • Hyper
  6. Evaluation of filopian tubes and pelvis structure?
    • U/S
    • hysterosalpingography
  7. Male Infertility approach considerations
    • Seman analysis--90% normal seaman excludes male as cause for infertility
    • Hypothalamic or pituitary tumor
    • Drugs affecting the CNS
    • Klinefelter's syndorm
    • Prolactomas
    • Anabolic steroid use
  8. Male Sperm Issues (MMAAL sperm)
    • Motility issues--sperm antibodies, obstruction, infection
    • Morphology issues--cryptochidism, toxins, varicocele
    • Acidic sperm--ejac dysfunction, abscess of vas defrense
    • Azzoospermia--genetic endo infection
    • Low volume--hypogonad, ejac dysfunction
  9. The probability of achieving a pregnancy in menstrual cycles is...
  10. Braxton Hicks Contractions are
    • shorter in duration than labor
    • not as intense as real labor
    • not associated with cervical dilation

    active labor begins when cervix is dilated 4 cm
  11. Initial prenatal visit includes...
    • H&P-->Gp status, GYN Hx, Fam Hx, Chronic conditions
    • Labs-->type and screen/CBC/UA/STI/HIV/Hep B
    • Pt. Education
  12. EDD
    • Estimated Delivery Date
    • Three months back from the start of the LMP + 7 days
  13. Normal time for a single gestation?
    Multiple gestations?
    • 40 weeks
    • 35 weeks
  14. Pregnancy catagoires
    • A--safe in humans
    • B--safe in animals, but unknown in humans
    • C--risk/benefit?
    • X--not safe
  15. Prenatal care should include regular updates on...
    • BP
    • Weight (normal is 25-35lbs or 3-4lbs/month)
    • Fundal height
    • FHR
    • Uterine palpation
    • Fetal presentation (Leupold maneuvers)
    • U/A
  16. PE finding consistent with pregnancy
    • Increased uterine size 1cm/wk after 4 wks gestation
    • Chadwick sign--blueish discoloration of vagina
    • Hegar sign--softening of the cervix
    • Fuller and tender breasts
    • areolar darkens
    • increased visibility of breast veins
    • Fetal heart sounds at 10-12 weeks gestation
  17. Stages of labor
    • 1st--time of regular contractions to 10cm dilation two phases latent (up to 4 cm dilation) active (4cm-10cm)
    • 2nd--time of full dilation to expulsion of fetus
    • 3rd--expulsion of fetus to expulsion of placenta
  18. Goal of Intrapartum Fetal Surveillance
    Recognize changes in fetal oxygenation which may result in complications--asses fetal stress
  19. Internal monitoring
    • More specific--can tell us if contractions are adequate to cause cervical dilation
    • can measure the intrauterine pressure
  20. Cardiovascular changes during normal pregnancy
    • heart displaced up and out
    • normal second heart sound
    • systolic end murmur
    • Diastolic murmur--->BAD
    • Increased CO 30-50% (1/5 of CO goes to placenta increasing the risk of postpartum bleeding)
  21. Respiratory Changes in pregnancy
    • increased total O2 consumption by 20%
    • compensated respiratory alkalosis
  22. Hematologic changes in pregnancy
    • increased plasma volume
    • increased RBCs
    • increased coagulation factors-->doubled risk for thromboembolism
    • 5x the risk during peurperium (approx 6-8wks postpartum)
  23. Endocrine changes during pregnancy
    • Euthryroid--
    • -gland enlargement
    • -placental Hcg-->stimulation of T4
    • Estrogen-->hepatic synthesis of TBG-->increased levels of total T3 and T4
    • Thyroid is working normally, but other hormones are affecting serum levels
  24. Description of the fetus during labor
    • Stations--0=presenting part is level with ischial spine
    • (-) values are superior to ischial spines
    • (+) values are inferior to ischial spines
  25. Placenta Previa defined
    placental location near the cervical os
  26. Placenta previa signs and symptoms, risk factors, Dx, Tx
    • painless bleeding in 3rd trimester
    • Dx-->transvag US
    • RF-->smoking, previous placenta previa, advanced age, multiparty, cocaine use, prior cesarean or other uterine surgery
    • Tx-->cesarean
  27. Placental abruption defined
    abnormal preseperation of the placenta
  28. placental abruption signs and symptoms, risk factors, Tx & complications of
    • SS-->vag bleeding with PAIN
    • RF-->HTN, preecclampsia, multiple gestation, smoking, cocaine use, multiparty, PRIOR abruption
    • Tx--immediate delivery
    • MC cause of coagulopathy in pregnancy
  29. Preeclampsia
    • HTN
    • proteninura
    • or 
    • platelet <100K, creatinine 2x, AST or ALT 2x, pulmonary edema
  30. Eclampsia
    preeclampsia + seizures
  31. Gestational diabetes risk factors
    • Hx of gestational diabetes
    • AA, Pacific islander, native american, hispanic american, asian
    • Fam Hx of diabetes in 1st degree relative
    • BMI >30
    • previous delivery of baby >9lbs
    • glycosuria at 1st prenatal visit
    • PCOS, current use of glucocoticoids
  32. Gestational diabetes effects on newborn
    • baby produces high insulin in response to high sugar from mother, when born the transfer of sugar to baby ceases and the newborn experiences a transient hypoglycemic episode b/c of the insulin overload
    • additionally it cause babies to be born with large heads and overall heavier babies as the unused glucose in converted to fat
  33. Routine glucose testing is done when..
    • 24-28 weeks gestation w/o risk factors
    • fasting not required--ingest 50g and check after 1 hour
    • 3 hour glucose test if inital is >140
    • need two abnormals for Dx
  34. Other complications of GDM
    • macrosomia
    • excessive weight gain for mom
    • shoulder dystocia
    • need for cesarean
    • preeclampsia
  35. HELLP syndrome
    • Hemolysis
    • Elevated Liver enzymes
    • Low Platelet counts
    • occurs in 4-12% or pts with preeclampsia
    • Tx platelet transfusions, delivery
    • Schistocytes
  36. Risk Factors for HELLP
    • Hx of preeclampsia or ecclampsia
    • FHx of HELLP
    • nulliparity
    • multigestations
    • >35yo
    • HTN
    • DM
    • Vascular, connective tissue, antiphospholipid
    • AA & obesity
  37. Threatened abortion...
    bleeding with a viable pregnancy
  38. Missed abortion..
    nonviable intrauterin gestation less than 20 weeks with the cervical os closed
  39. Incomplete abortion
    intrauterine gestation less than 20 weeks with the os open and some tissue already passed
  40. Inevitable abortion...
    cervix is open but no tissue has passed
  41. Complete spontaneous abortion..
    passage of all tissue and an empty uterus
  42. Septic abortion...
    is abortion with retained products f conception with symptoms and signs of infection
  43. Suspected abortion work up
    • US
    • HCG levels (should be doubeling every 48 hours with an intrauterine fetus)
  44. Five Cardinal Movements of Labor
    • Flexion
    • Descent
    • Internal rotation
    • Extension
    • External rotation
  45. Post Partum Hemorrhage PPH
    primary vs secondary
    MC cause
    Risk factors
    • primary 1st 24 hours after delivery
    • secondary after 24 hours
    • MC cause--uterine atony
    • Occurs in 1-5% of deliveries
    • Risk factors-->prolonger labor, augmented labor, Hx of PPH, episiotomy, operative delivery
    • Oxytocin 10-40 units/L of saline
Card Set:
2015-04-02 01:06:24
obstetrics medical PA

OB for physician assistants
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