OBGYN_6_Weeks

FA_2014
HTN in pregnancy think of Super Saiyan goku! - Goku is first form! G for Goku, G for gestational HTNBP
140/90
o Gestational HTN (pregnancy induced HTN)
BP is 140/90 after 20
th
week, no pre-exising HTN, no proteinuria, nor organ damage
TX is alpha methyl dopa, labetalol, hydralazine, nifedipine
Deliver at 39 weeks
o Preclampsia
BP is 140/90 and there is P for proteinuria which is >300 mg/24 hr after 20
th
week of gestation
to 6 weeks post partum
TX is deliver at 34 weeks severe, 37 weeks mild, IV magnesium to prevent seizure
o Eclampsia
Preclapsmpa + maternal sezirures ! E for electricity!
Maternal death d/t to stroke > intracranial hemorrhage or ARDS
Immediate delivery
o HELLP
Hemolysis, Elevated Liver enzymes, low platelet
USMLE RX 335
Women who are pregnant should expect to gain a 3-4 lb weight gain per month but would not expeed a total
of25-35 lb total women who are underweights should gain more and weomen are underweight should weigh
less.
Ashermanns syndrome- prevent endometrium from responding to hormones, dx is made in hysteroscopy
Periods resume after 3 months after birth who are not breastfeeding
Stres incontinence treat with surgery
Tamoxifen is a a SERM, inhibitor for estrogen and progesterone on breast tissue and agonist in the uterus
Treat pregnant UTI with 7 day course of nitrofurantoin or a 3-7 day course of amoxicillin or cephalexin
Pregnancy is a hypercoagubility state
Menpasue- amenorrhea for 1 year
Preeclampsia- new onset of HTN and protein uria (>.3 g in a 24 hr urine specimen)
Eclamsia- one ore more genralizezed convulsions and or coma in setting of preeclampsia
Amenorrhea for 3-5 months after OCs are common
Triple marker screening test- 1/200 is +tive. Next step is amniocentesis
o Maternal a fetoprotein MSAFP
o BcG
o Estriol
Quadruple Test done at 15-20 weeks gestation
o Elevated in presence of NT defects- anencephaly and spina bifida, adominal wall defects multiple
gestation, and fetal death
o Trisomy 18
o Trisomy 21- bHcG is high and MSAFP and estriol is low
o Has inhibition to the mix
Endometriosis = infertility do a laparoscopy
Fiborid- dx confirmed with US
UWORLD 211
MAFP is increased in neural tube defects, omphalocele, gastrochisis, but MC error.
o MAFP will be increased with acetylcholinesterase
Downs Syndrome will show low estriol and AFP but increased inhibin A and increased bHCG
Edwards will show decreased everything except for normal inhibiin
Metronidazole should not be taken with alcohol bc it causes disulfiram like reactions
Phenytoin and carbazapine- fetal hydanatoin syndrome- mid facial hypoplasia, hirsutidm, distal phalanges
abrupt growth, microcephaly, cleft lip
HPV vaccinated indication
o Age 9 26 for girls men 9-21
o HIV pts 9-26
o NOT INDICATED IN PREGNANT WOMEN
Chronic HTN
o Sys >140 and/or diastolic >90 : prior to conception or 20 weeks gestation
Gestational HTN
o New onset elevated BP > 20 weeks
o No proteinuria or end organ damage
Preclampsia
o New onset elevated BP at >20 weeks and proteinuria or signs of end organ damage
Elclampsia
o Preclampsia elevated BP >20 weeks, proteinuria or signs of end organ damage
o SEIZURES!!!! Grand mal
Chronic HTN with superimposed preeclampsia
o Chornic htn and 1 of the following
New onset proteinuria at >20 weeks gestation
o Sudden worsening of HTN
o Signs of end organ daage
o
TrueLearn 230
25Qs a Day

Kaplan Notes