Top 100 Secrets from Obstetrics and Gynecology Secrets

1. The ulcer of primary syphilis is usually single and painless, while the ulcer of herpes is more often multiple and painful. 2. Trichomoniasis and candidiasis are diagnosed by visualizing the organisms on microscopy of vaginal discharge; bacterial vaginosis is diagnosed by the "whiff test" and the appearance of "clue cells". 3. PID is often a polymicrobial infection but generally begins with infection with N. gonorrhoeae or C. trachomatis. 4. Midcycle surge of luteinizing hormone (LH) predicts impending ovulation. 5. In females, the order of puberty is thelarche, pubarche, maximum growth velocity, and menarche. 6. The three most common causes of primary amenorrhea are gonadal dysgenesis, mllerian agenesis, and androgen insensitivity. 7. The most common cause of secondary amenorrhea is pregnancy. 8. The two syndromes that are characterized by breast development and the absence of a uterus, androgen insensitivity and mllerian agenesis, can be differentiated by a karyotype. 9. Premenstrual syndrome (PMS) is defined as the emotional and physical symptoms that occur at the same time prior to the menstrual cycle each month. 10. Fibroids are estrogen-sensitive, fibromuscular benign tumors that are thought to originate from a monoclonal cell line. 11. There are no diagnostic criteria for polycystic ovarian syndrome (PCOS), but common findings include increased LH:FSH ratio, decreased fasting glucose:insulin ratio, polycystic ovaries on ultrasound, hirsutism, and obesity. 12. Endometriosis, or endometrial tissue outside the uterus, causes pelvic pain, dyspareunia, and infertility. 13. Adenomyosis, or endometrial tissue in the myometrium, causes menorrhagia and dysmenorrhea. 14. All pelvic pain is not gynecologic in origin. 15. Ovarian failure is normal at menopause (average 51 years old) and premature at > 40 years; it requires work-up in women < 30 years old. 16. Risks of ovulation induction include multiple gestation and ovarian hyperstimulation. 17. Initial evaluation of an infertile couple should include basal body temperature chart to assess ovulation, semen analysis, hysterosalpingogram to check tubal patency, then postcoital test to evaluate cervical mucus. 18. In vitro fertilization (IVF), a procedure used to overcome tubal or male factor infertility, requires ovarian hyperstimulation with injectable gonadotropins, egg retrieval, fertilization, and embryo transfer. 19. Stress incontinence is loss of urine due to increased intra-abdominal pressure, and urge incontinence is due to detrusor instability. 20. Stress incontinence can be due to urethral hypermobility or, less commonly, intrinsic sphincter deficiency. 21. 15-20&percnt; of clinically recognized pregnancies end in miscarriage, but this risk is decreased to 6-8&percnt; once embryonic cardiac activity is seen. 22. The most common type of chromosomal abnormality in miscarriages is autosomal trisomies, but the single most common karyotype is monosomy X. 23. Legalization of abortion has significantly reduced the number of women hospitalized with complications of abortions. 24. Patients with ectopic pregnancies usually present with abdominal pain and abnormal vaginal bleeding. 25. In a normal pregnancy, beta-hCG levels approximately double every 48 hours.

26. Combination oral contraceptives (OCPs) work primarily by inhibiting ovulation through suppression of LH and FSH. 27. OCPs decrease the risk of ovarian and endometrial cancers. 28. The phases of the sexual response cycle are excitement, plateau, orgasm, and resolution. 29. Vaginismus is often associated with a history of sexual abuse or trauma. 30. Symptoms of menopause include irregular then absent menses, hot flashes, and vaginal atrophy or dryness. 31. Vulvar cancer is predominantly squamous cell and spreads via lymphatics to superficial inguinal nodes. 32. Paget's disease of the vulva may be associated with underlying adenocarcinoma; therefore, local excision is recommended. 33. Human papillomavirus (HPV) can trigger genital dysplasia and is linked to invasive cervical cancers. 34. The incidence of cervical cancer is decreasing secondary to regular screening with Pap smears. 35. Cervical cancer is staged clinically with exam under anesthesia, cystoscopy, and proctoscopy. 36. Important risk factors for endometrial cancer include obesity, anovulation, and tamoxifen use. 37. The most common presenting symptom of endometrial cancer is abnormal uterine bleeding, especially postmenopausal bleeding. 38. Sex cord and germ cell tumors are usually diagnosed early and are highly curable, while epithelial ovarian cancer presents late in the disease. 39. Meigs syndrome mimics advanced-stage ovarian cancer but actually involves benign ovarian fibroma associated with ascites and pleural effusion. 40. The highest risk for serious injury or death is when or after an abused woman leaves her abuser. 41. The incidence of domestic violence increases during pregnancy and postpartum. 42. A woman with a history of a child with a neural tube defect needs 4 mg of folic acid prenatally, but those without such a history need only 400 mcg. 43. Advanced maternal age is associated with increased chromosomal abnormalities, increased first-trimester losses, and increased risk of most obstetric complications. 44. An increase in plasma volume that is greater than the increase in red blood cell mass causes the dilutional physiologic anemia of pregnancy. 45. Pregnancy is a hypercoagulable state due to increased clotting factors and venous stasis. 46. To decrease group B streptococcal neonatal sepsis, the CDC recommends maternal screening for the bacteria via vaginal and rectal cultures in the late third trimester and prophylaxis with antibiotics in labor for those who test positive. 47. The nonfasting 1-hour, 50-gm glucose tolerance test is used to screen for gestational diabetes, and the fasting 3-hour, 100-gm glucose tolerance test confirms the diagnosis. 48. The recommended weight gain in pregnancy is 25-35 pounds for normal weight women. 49. Nausea and vomiting of pregnancy typically begin around the fourth to the seventh week and end by the twelfth week. 50. There is no method proven to prevent preeclampsia, and the only cure is delivery. 51. Magnesium sulfate is given to preeclamptic women during labor and for 24 hours after delivery to prevent seizures. 52. If a woman has a history of gestational diabetes, her lifetime risk of developing type 2 diabetes is 36&percnt;.

53. To decrease the malformation risk in patients with insulin-dependent diabetes mellitus (IDDM), good glycemic control should be achieved prior to conception. 54. Circulating T4 and T3 increase in pregnancy secondary to increased thyroid-binding globulin, but free levels are unchanged. 55. The risk of congenital anomalies is 2-3 times higher than baseline in women on anticonvulsants, but the risk is increased above baseline even in women with epilepsy not on medications. 56. Cardiac output increases in pregnancy, first by increased stroke volume, then by increased heart rate. 57. Women with cardiac valvular disease and ventricular septal defects should receive subacute bacterial endocarditis prophylaxis at the time of vaginal delivery. 58. Treatment of asthma in pregnancy is essentially the same as in nonpregnant women. 59. Pulmonary embolism is the leading cause of maternal mortality in the U.S. 60. During pregnancy, increased renal plasma flow and increased glomerular filtration rate lead to decreased serum BUN and creatinine. 61. Pregnancy increases the risk of pyelonephritis due to anatomic changes, changes in urine content, and increased progesterone affecting ureteral motility. 62. Maternal parvovirus infection can lead to fetal anemia, hydrops, and even IUFD. 63. Women with active HSV at the time of delivery should undergo cesarean section to prevent neonatal transmission. 64. Possible fetal effects of lupus include congenital heart block and neonatal lupus. 65. There is no safe level of alcohol consumption in pregnancy; the best advice is not to drink alcohol at all. 66. Placental abruption and stillbirth occur in 8&percnt; of pregnant cocaine users. 67. Lithium, a common treatment for bipolar disorder, has been associated with cardiac malformations, especially Ebstein's anomaly, but the extent of the risk is unclear. 68. Postpartum blues occur in 50-80&percnt; of women, depression in 8-15&percnt;, and psychosis in 1-2/1000. 69. Special considerations for general anesthesia in the pregnant woman include aspiration risk, physiologic respiratory changes, IVC compression by gravid uterus, and hypercoagulability. 70. Initial evaluation of a pregnant trauma patient is the same as in the nonpregnant woman; stabilize the mother before evaluating the fetus. 71. Perimortem cesarean section should be done after 4 minutes of CPR in a pregnant woman. 72. Preterm labor and delivery are much more common in multiple gestations; in fact, mean gestational length for twins is 35 weeks; for triplets, 33 weeks; and for quadruplets, 31 weeks. 73. Twin-to-twin transfusion syndrome of monozygotic pregnancies occurs due to a placental vascular anastomosis between the fetuses. 74. Fetal hemolytic disease can occur if the mother produces antibodies against fetal red blood cell antigens. 75. Rhogam, which is anti-D immunoglobulin, is given to Rh-negative women at 28 weeks, at other times when fetomaternal hemorrhage may occur, and postpartum if the newborn is Rh-positive. 76. The baseline risk of congenital anomalies is 2-3&percnt;. 77. The most common autosomal disorders are trisomy 21 in live births, trisomy 18 in stillbirths, and trisomy 16 in first-trimester losses. 78. The discriminatory zone is the -hCG level at which an intrauterine pregnancy should be seen on ultrasound.

79. Gestational dating is done using the crown-rump length in the first trimester and biparietal diameter, head circumference, femur length, and abdominal circumference in the second and third trimesters. 80. Although intrauterine growth restriction (IUGR) is defined as estimated fetal weight less than the tenth percentile, most adverse perinatal outcomes occur at less than the fifth percentile. 81. Fetal urine is the major source of amniotic fluid production while fetal swallowing is the major mode of resorption. 82. The majority of cases of polyhydramnios are idiopathic followed by maternal diabetes. 83. HCG is made by the syncytiotrophoblast to maintain the corpus luteum's production of progesterone. 84. Abnormal placental development may occur over the internal cervical os (previa), attached to the myometrium (accreta), into the myometrium (increta), or through the myometrium (percreta). 85. Placenta previa classically presents as painless third-trimester vaginal bleeding, but placental abruption presents as painful third-trimester vaginal bleeding. 86. Even after two consecutive mid-trimester losses due to premature cervical dilation, women have a 70-75&percnt; chance of carrying the next pregnancy to term. 87. Cervical cerclage is indicated for treatment of cervical incompetence, but its benefit is still controversial. 88. Premature rupture of membranes (PROM) is confirmed by pooling, positive nitrazine test, and ferning of vaginal fluid. 89. External cephalic version is a technique where one or two people attempt to maneuver a fetus from breech to cephalic presentation. 90. Non-stress tests assess fetal heart rate baseline, variability, and accelerations and are part of antepartum fetal surveillance to detect fetuses at risk secondary to uteroplacental insufficiency, but non-stress tests cannot predict sudden events. 91. Intrapartum fetal heart rate monitoring has decreased the number of intrapartum fetal deaths, but it has increased the number of cesarean sections without changing the rate of longterm neurologic sequelae or cerebral palsy. 92. Decelerations are characterized based on timing with contractions - early (head compression), late (uteroplacental insufficiency), and variable (cord compression). 93. The stages of labor are stage one (onset of contractions to complete dilation), stage two (complete dilation to delivery of fetus), and stage three (delivery of fetus to delivery of placenta). 94. The cardinal movements of labor are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. 95. The most common complication of cesarean section is infection, namely endometritis. 96. The main complication of vaginal birth after cesarean section (VBAC) is uterine rupture, and the level of risk depends on the type of previous uterine incision. 97. As in the adult, neonatal resuscitation utilizes the ABCs (airway, breathing, and circulation). 98. Postpartum hemorrhage is loosely defined as blood loss greater than 500 cc for a vaginal delivery and 1000 cc for a cesarean section. 99. The most common cause of postpartum hemorrhage is uterine atony. 100. The most common cause of postpartum fever is endometritis, and the greatest risk factor for this infection is cesarean section.