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Gynecology Kaplan

Step 2 CS Gynecology

When does hCG peak in the maternal blood? 9-10 weeks
When does hCG plateu in the maternal blood? 20-22 weeks
What is the function of hCG? *Maintain corpus luteum production of progesterone until the placenta can take over maintenance of the pregnancy *Regulate steroid biosynthesis in the placenta and fetal adrenal gland as well *Stimulate testosterone production in the fetal male testes
What do high levels of hCG indicate? Hydatiform mole, twin pregnancy, or choriocarcinoma
What do low levels of hCG indicate? Ectopic pregnancy or abortion
What is the function of hPL? Antagonize the cellular action of insulin, decreasing insulin utilization and thereby contributing to the predisposition of pregnancy to glucose intolerance and diabetes
What is the source of progesterone production? 6–7 weeks: Corpus luteum 7-9 weeks: Corpus Luteum and placenta 9 weeks: the placenta.
What is the function of progesterone? During early pregnancy, the function is to maintain the endometrium and induce secretory changes for blastocyst implantation During late pregnancy, the function is to induce immune tolerance for the pregnancy and prevent myometrial contractions
What are the three forms of estrogen and which stages of a woman's life do they predominate? Estradiol --> nonpregnant reproductive years Estriol -->Pregnancy( precursor is DHEAS) Estrione--> Menopause
What are the skin changes that occur during pregnancy? Striae gravidarum, spider angiomata, palmar erythema, Chadwick sign,linea nigra, and chloasma
What cardiovascular changes occur during pregnancy? BP decreases until 24-28 weeks, then gradually increases Plasma volume increases up to 50% SVR decreases by 30% CO increases by 50% Systolic ejection murmur along the left sternal border
What are the hematologic changes in pregnancy? RBC mass increases by 30% WBC count increases up to 16,000 ESR increases Factors 5,7,8,9,12 and vWF increase
What are the GI changes in pregnancy? Gastric motility decreases and emptying time increases Upward displacement of intestinal contents by the gravid uterus increases the risk of aspiration pneumonia Increased colonic reabsorption leading to constipation
What are the pulmonary changes in pregnancy? Tidal volume and minute ventilation increase RV decreases Respiratory alkalosis
What are the renal changes in pregnancy? Kidneys increase in size Uretral diameter increases due to progesterone GFR increases, and urinary glucose increases
What are the endocrine changes in pregnancy? Pituitary size increases up to threefold due to lactotroph hyperplasia and hypertrophy Cortisol increases two- to threefold Thyroid binding globulin (TBG) increases, resulting in increased total T3 and T4
What are the fetal circulation shunts? *Ductus venosus carries blood from umbilical vein to the inferior vena cava. *Foramen ovale carries blood from right to left atrium. *Ductus arteriosus shunts blood from pulmonary artery to descending aorta.
Describe the tissue of the breast Lobes of glandular tissue (15-20) arranged in a spoke-wheel pattern around the nipple with ducts running through them About 80-85% of breast is fat tissue during reproductive tissue
Which hormone, when released, leads to contraction of the muscle around the alveoli and expression of milk? Oxytocin
What ligaments keep the breast in shape? Cooper's ligaments
What events stimulates milk production? The expulsion of the placenta at delivery initiates milk production and causes the drop in circulating estrogens and progesterone. Estrogen antagonizes the positive effect of prolactin on milk production
What is the most common cause of early pregnancy loss? Chromosomal fetal abnormalities
What is the treatment for Anti-phospholipid syndrome in pregnancy? SubQ heparin
What is a missed abortion? U/S findings of a nonviable fetus with no bleeding, cervical dilation, or cramping
What is a threatened abortion? U/S findings of a viable fetus with vaginal bleeding and no cervical dilation
What is an inevitable abortion? U/S findings show POC in lower uterine segment Vaginal bleeding and cramping with no passage of POC
What is an incomplete abortion? Vaginal bleeding and cramping with some POC passing
What is a complete abortion? Vaginal bleeding, cramping, and all POC passed
What is the most concerning complication of IUFD? DIC
What is the classical triad of ectopic pregnancy? Secondary amenorrhea, abdominal pain, and vaginal spotting
What are the predisposing factors for ectopic pregnancy? PID, IUCD, previous ectopic pregnancy, tubal surgery, and DES exposure
What is the discriminatory bhCG level for U/S findings? 6,500--> Abdominal 1,500 --> Intravaginal
How do you diagnose an ectopic pregnancy based on bhCG findings? bhCG will not double at the rate that it does, it will be lower than expected
What are the criteria for methotrexate treatment in ectopic pregnancy pregnancy mass <3.5 cm diameter, absence of fetal heart motion, β-hCG level <6,000 mIU, and no history of folic supplementation
Created by: Ulaisl