11,12,13 Vaginal bleeding Flashcards
Woman presents with severe vaginal bleeding that is life-threatening. Do what?
- IV estrogen to stop bleeding
- if medical tx doesn’t work, ex-lap to ligate arteries/do TAH.
Abortion:
-do what after contents have passed? (3)
- U/S to check for retained parts (may need D&C)
- B-HCG: track to 0. High risk of gestational trophoblastic disease. give OCPs so mom can’t get pregnant.
- Give Rhogam if mom Rh-
DUB: dysfunctional uterine bleeding
- what is this
- when is it normal
- tx (2)
- dx of exclusion. most DUB is caused by anovulation. (w/o ovulation, progesterone not made, and endometrium grows until it outgrows its blood supply and then sheds/bleeds)
- anovulation is normal near menarche and menopause
- NSAIDs (its effect on prostaglandins to constrict vessels is stronger than platelet action), OCPs/contraception (prostaglandins)
PCOS
- mech/path
- sx
- dx
- tx (4)
- ovaries replaced by atretic follicles, which don’t ovulate. So high estrogen, low progesterone. estrogen converts to T
- Hirsutism, Irregular menses, anemia, Infertile
- endocrine dx: LH/FSH >3. elevated T
U/S shows 1000s of follicles, but not needed to dx
- OCPs–reset axis, reduce anovulation
Spironolactone–androgen blocking
clomiphene–induce ovulation to get pregnant
Metformin–treats DM and also lowers androgens
Precocious puberty:
-diagnostic steps, and diagnoses/tx
screen all girls with development of breasts/ax-pubic hair <8 yo.
- do wrist X-ray to determine bone age. If bone age is >2 yrs above average, proceed.
- Leuprolide stim test (stim HPO axis–is problem in axis or not)
If LH/FSH rise, then must be central precocious puberty. Do MRI to find tumor and resect. If no tumor, this is ‘constitutional’ so give Leuprolide continuous.
If LF/FSH no change, there are exogenous hormones. Look for it: (U/S adrenal, U/S abdomen, T, DHEAS, urine 17-OH pro). Can be ovarian/adrenal tumor (resect), CAH (use steroids), or Cyst
Uterine bleeding caused by anatomic defects
- what are they (3)
- sx, dx, and tx
- fibroids: estrogen-responsive growths in myometrium. Dx with U/S or MRI. Give leuoprolide (continuous) to shrink fibroids, then resect (myomectomy)
- adenomyosis: (endometriosis of myometrium) glandular tissue inside muscle. Dx: PE shows enlarged, smooth uterus. Use U/S or MRI. Tx with contraceptives, leuprolide, ablation, resection
- polyps: Dx with hysteroscopy, tx with polypectomy
Puberty in females: order of events (4) and what ages
“Boobs pubes, grow flow”
Breast development–8
Axillary/pubic hair–9
growth spurt–10
menarche–11
vaginal bleeding in postmenopausal woman
-what can cause it, do what
- vaginal atrophy
- endometrial cancer
- hormone replacement therapy
- Do endometrial sampling to r/o CA
Vaginal bleeding in premenarchal girl
-suspect what, do what
Suspect foreign bodies and sexual abuse.
Do a speculum exam under anesthesia (scary for girl)
Precocious puberty
- what to be concerned about
- what is the first sign to screen
- growth spurt will be missed if menarche is too early.
- Look at development of axillary-pubic hair/breast buds. If they develop at <8 yo, investigate. Start with wrist X-ray for bone age.
Abortion:
Describe stages (5)
threatened–live baby
inevitable–dead baby, no passage of contents, open os
incomplete–passage of contents, open os
complete–complete passage of contents, closed os
missed–dead baby, closed cervix
What does menarche mean regarding entire puberty process?
It’s the last step of puberty. Once menarche reached, this signals the fusion of growth plates.
So, if menarche too early, growth spurt is lost
