#9: Women's Health Flashcards
When should a pelvic exam not be performed
NO pelvic exams when pt is > 20 wks gestation
What should be at top of ddx for post menopausal women w/ vaginal bleeding
DDx for for post menopausal women w/ vaginal bleeding
think CANCER!
MC cause of maternal mortality in 1st 12 wks of pregnancy
Ectopic pregnancy
- MC cause of maternal mortality in 1st 12 wks of pregnancy
Vaginal Bleeding: Ectopic Pregnancy
- what is the MC site
- What is the biggest RF for it
Vaginal Bleeding: Ectopic Pregnancy
- MC site = fallopian tube
- biggest RF = PID (h/o G/C)
Pt presents w/ 1st trimester abd pain, vaginal bleeding, and adnexal mass
Dx?
Dx = Ectopic pregnancy
Dx: Ectopic Pregnancy (Vaginal Bleeding)
- what test is done serially to confirm pregnancy
- what is done to eval hemodynamic stability
- what test is done to assess location of preg (IUP, extrauterine, etc)
Dx: Ectopic Pregnancy (Vaginal Bleeding)
- b-HCG serially to confirm pregnancy (Q2 days)
- eval hemodynamic stability–> FAST exam
- assess location of preg (IUP, extrauterine, etc) –> TVUS
Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ TVUS
- what should be used if TVUS is non-diagnostic
Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ TVUS
- TVUS is non-diagnostic –> b-HCG discriminatory zone
Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ b-HCG discriminatory zone and TVUS
- what b-HCG value should the IUP be visible on US
- at how many wks should you see yolk sac (TVUS)
- at how many wks should you see cardiac activity (TVUS)
Dx: Ectopic Pregnancy (Vaginal Bleeding) w/ b-HCG discriminatory zone
- b-HCG value of 2000 –> IUP should be visible on US
- see yolk sac at 6 wks w/ TVUS
- see cardiac activity at 6.5 wks w/ TVUS
Management of Ectopic Pregnancy (Vaginal Bleeding)
- what are option(s) if pt is stable
- what are option(s) if pt is unstable
Management of Ectopic Pregnancy (Vaginal Bleeding)
- stable –> medical or surg
- unstable –> surg
Tx of Ectopic Pregnancy (Vaginal Bleeding): Medical
- what is the drug given
- other than stable/unruptured: what ectopic size and what level b-HCG qualifies for this tx
Tx of Ectopic Pregnancy (Vaginal Bleeding): Medical
- drug = MTX
- other than stable/unruptured: qualifies for this tx
- ectopic size < 3-4 cm
- b-HCG < 10, 000
Tx of Ectopic Pregnancy (Vaginal Bleeding): Surgical
- for stable pts
- for unruptured, future fertility desired
- for ruptured, future fertility not desired
Tx of Ectopic Pregnancy (Vaginal Bleeding): Surgical
- for stable pts –> laparoscopic
- for unruptured, future fertility desired –> salpingostomy
- for ruptured, future fertility not desired –> salpingectomy
f/u for Ectopic Pregnancy (Vaginal Bleeding): all methods
- when can you stop following b-HCG levels
- what med often given postop
f/u for Ectopic Pregnancy (Vaginal Bleeding): all methods
- stop following b-HCG levels once 0
- med given postop = MTX
implantation of placenta over the os
Placenta previa = implantation of placenta over the os
22 wk preg pt having twins presents w/ painless, bright red vaginal bleeding. She had prior c-sections with her last 2 pregnancies and is a smoker.
Dx?
Placenta previa
- RFs: c-section, multiple gestations, smoker, preg w/twins
partial or complete separation of placenta before delivery
placenta abruption
22 wk preg pt who uses cocaine, has HTN, smokes and has hx of fibroids presents w/ painful vaginal bleeding. She has had 1 c-section in past.
Dx?
Placenta abruption
- RFs: cocaine use, HTN, hx of fibroids, smoking, c-section
Dx: of Placenta previa and abruption
- how to Dx previa, what should not be done
- Placenta abruption
- what is the classic finding on US
Dx: of Placenta previa and abruption
- Dx previa w/US , DONT do pelvic exam
- Placenta abruption
- classic finding on US = retroplacental clot
Tx of Placenta previa
- what to do until bleed stabilizes
- what are the 3 indications for C-section
- post care
- what given for baby when 23-34 wks gestation
- who to give Rho-gam to
- when to schedule C-section
Tx of Placenta previa
- bedrest/hospitalize until bleed stabilizes
- 3 indications for C-section
- life threatening maternal hemorrhage
- non-reassuring fetal status
- signif bleed > 34 wks - post care
- 23-34 wks gestation–> CCS to mature lungs
- Rho-gam to Rh- mothers
- sched C-section for 36-37 wks
Tx of placenta abruption
- aggressive management of what?
- what procedure needed
Tx of placenta abruption
- aggressive management of hemodynamics
- need EMERGENT C-section
Post partum hemorrhage
- definition: how much blood loss w/vaginal delivery and w/ c-section
- MC cause and Tx
- 4 tx options
Post partum hemorrhage
- definition: > 500m ml blood loss w/vaginal delivery and > 1000 w/ c-section
- MC cause = uterine atony, Tx = oxytocin
- 4 tx options
- remove POC
- Uterine packing
- embolize pelvic vessels
- hysterectomy