Gynecology Flashcards
Postpartum endometritis major risk factors
C-section (especially after onset of labor)
Prolonged labor and/or prolonged rupture of membranes
HIV
group B streptococcus colonization
Maternal diabetes.
C-section is still by far the most important, as the rate of endometritis following a C-section after onset of labor, even with antibiotic prophylaxis, is four times higher than with vaginal delivery!!
Prolonged rupture of membranes is defined as?
18-24 hours passing between rupture and delivery.
Acute fatty liver disease of pregnancy
3rd trimester
Acute liver failure secondary to extensive microvesicular fatty infiltration of the liver. It is due to failure of fatty acid beta-oxidation and presents with right upper quadrant pain, nausea, vomiting, and jaundice.
Elevated aminotransferases and a leukocytosis, hypoglycemia, thrombocytopenia.
Can decompensate quickly with multi-organ failure and fetal compromise.
Management is immediate delivery.
A young woman with no family history of malignancy and a nonpalpable mass in her breast in the setting of unilateral painless bloody discharge is likely suffering from?
An intraductal papilloma.
Letrozole
Aromatase inhibitor used to treat hormone receptor-positive breast cancer, also is the first-line treatment agent for restoring ovulation in women with PCOS and can cause decreased bone mineral density.
Infants of women with Sjögren’s are at risk for perinatal complications?,
As circulating anti-Ro(SSA) and anti-La (SSB) autoantibodies can cross the placenta and result in heart block. A pacemaker may be required for the affected infant.
Risk factors for placental abruption
Hypertension, previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40.
Menopause estrogen treatment indications
Estrogen alone for patients who do not have uterus.
Estrogen + progesterone for patients who have uterus avoiding dysplasia.
Different types of decelerations
Early: are slowing of the fetal heart rate in a pattern that is exactly synchronous with the contraction. They indicate fetal head compression within the birth canal.
Late decelerations are slowing of the heart rate that occurs towards the end of the contraction cycle. They signify utero-placental insufficiency.
Variable decelerations vary in onset, duration, and depth. They may occur between or with contractions, and they have an abrupt onset and rapid recovery. Represents umbilical cord compression.
Pap smear with atypical squamous cells of undetermined significance (ASCUS). Next best step?
HPV DNA test
patient >25 years: If DNA test is positive after ASCUS on Pap smear, colposcopy is recommended to biopsy cervical tissue.
If it is negative: however, if the HPV DNA test is negative, a Pap smear should be repeated in 3 years.
For patients under 25 years with a Pap smear showing ASCUS, a Pap smear should be repeated in 1 year.
Pap testing recommendations
Is recommended every 3 years for patients under 30 years of age.
For patients 30 years of age and over, screening may be either a Pap smear every 3 years or a combination Pap smear and HPV DNA test every 5 years.
Key findings for complete molar pregnancy
hyperemesis gravidarum, signs of hyperthyroidism, and a “snowstorm” appearance with theca-lutein cysts on ultrasound.
Risk factors for placental abruption
Hypertension, previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40.
When a mass is found in the breast, the next step in management is?
Imaging with an ultrasound being performed in young women (< 30 years of age) and a mammogram being performed in older women (> 30 years of age).
If a symptomatic (painful, skin changes, or breast discharge) benign and simple cyst is found on imaging, the next step in management is aspiration with an FNA.
If the mass disappears: the patient can follow up for an exam.
If an FNA yields insufficient or inconclusive results or the mass recurs: a follow-up core needle or surgical biopsy could be indicated.
FNA is preferred when there is a low pretest probability of cancer (such as in a young and otherwise healthy patient).
Adenoymosis.
Endometrial tissue within the myometrium.
Enlarged uterus
Heavy bleeding and pelvis pain.
Endometriosis
Presence of endometrial tissue outside of the uterus.
painful menstruation.
It typically does not cause the uterine enlargement or heavy bleeding.
A definitive diagnosis of endometriosis requires laparoscopic examination with biopsy.
Betamethasone and pregnancy
Should be administered to patients < 34 weeks gestation, or in any case < 36 weeks gestation with a L/S ratio < 2.0.
The L/S ratio suggests fetal lung maturity and should be greater than 2.0.
The most accurate method of dating a pregnancy in the first trimester is?
ultrasound measurement of the crown-rump length.
Premature activation of the adrenal glands can result in?
Premature adrenarche, isolated appearance of axillary hair before six years of age.
Meigs syndrome
Benign ovarian tumor (ovarian fibroma is the most common tumor), ascites, and pleural effusion.
post-menopausal women and has a broad and vague presentation including chronic illness, shortness of breath, weight change, increased abdominal girth, or even chest pain.
It is important to note that Meigs syndrome is a diagnosis of exclusion, and a malignant tumor should be ruled out first.
Tamoxifen
is a selective estrogen receptor modulator whose efficacy in treating breast cancer is due to antagonistic activity at estrogen receptors in the malignancy.
Also acts as an agonist in bone: decreased risks of osteoporosis.
Tamoxifen increases the risk of endometrial cancer, raloxifene is protective against endometrial cancer.
Pregnant women with diabetes follow up indications after 32 weeks?
They are at an increased risk of sudden intrauterine death.
Nonstress test, biophysical profile, or combination of these twice per week until delivery, should begin at 28-32 weeks gestation.
Biophysical profile
Fetal breathing movements
Gross body movements
Fetal tone
Reactive fetal heart rate
qualitative amniotic fluid volume
Hyperthyroidism and pregnancy
The treatment of choice is propylthiouracil.
In addition to PTU, propranolol can be used temporarily for hyperadrenergic symptoms such as tachycardia, atrial fibrillation, and hypertension.
Methimazole is avoided in the first trimester due to increased risk of teratogenicity. Aplasia cutis is classically associated with in utero exposure to methimazole.
After the first trimester, PTU is discontinued and substituted with methimazole due to the relatively greater risk of adverse effects with prolonged use of PTU.
A feared mother’s complication of placental abruption is?
Disseminated intravascular coagulation for which patients must be monitored.
< 30 years, pap smear result atypical squamous cells of undetermined significance, which is the most appropiate next step?
- HPV Testing (Preferred Option)
If HPV is negative, return to routine screening (repeat Pap smear in 3 years).
If HPV is positive, proceed to colposcopy. - Repeat Pap Smear in 1 Year (Alternative Option)
If HPV testing is unavailable, repeat Pap smear in 12 months.
If the repeat Pap is normal, return to routine screening.
If ASC-US or a more severe lesion persists, proceed to colposcopy.
Diagnosis of gestational diabetes mellitus
One or more plasma glucose values above of:
Fasting 92 mg/dl
1h glucose 180 mg/dl
2 h glucose 153 mg/dl
