OB Flashcards
What are the symptoms of Menopause and what causes them?
*Primary Symptoms: related to fluctuating hormones. Vasomotor instability: hot flashes and night sweats. Menstrual irregularity due to fluctuating levels of estrogen and progesterone. Vaginal Dryness.
*Secondary symptoms: related to primary symptoms and prolonged. lowered levels of estrogen. Insomnia, irritability, labile moods and increased risk of osteopenia, osteoporosis and heart disease.
What are some discomforts of menopause and what can I suggest?
*Hot flashes: light, layerable clothing, regular exercise (walking included), set thermostat lower.
*Osteoporosis: Calcium & Vit D supplements, Weight bear everyday, decrease caffine.
- Falls: Decrease clutter, slippers with treads, night lights, and low beds.
*Vaginal Dryness: Use water soluble lube with sexual activity.
*Pelvic floor issues: Hydrate well & urinate often, Kegal Exercises.
What are Uterine Fibroids?
Bengin, estrogen tumors of the uterine wall (Do not migrate to other parts of the body)
What can be done about Uterine Fibroids?
Medications: gonadotropins (FSH, LH) may decrease the size of fibroids.
Surgery:
*Myomectomy- remove fibroids (can still get pregnant)
*Hysterectomy- remove uterus
What causes Uterine Fibroids?
Age over 45
Genetics
Hypertension
African Americans
Nulliparity - a woman who hasn’t given birth to a child.
Obesity
What are the life long complications of Uterine Fibroids?
*Pain: Pelvic pain prior to menses, pain with menses, pain with micturition, low back pain.
*Infertility
What is Endometriosis?
A disorder in which tissue similar to the tissue that lines the uterus grows outside the uterus in places where it doesn’t belong.
What causes Endometriosis?
Increased age
Family history
Short menstrual cycle <28 days
long menstrual cycle >1 week
Nulliparous or one to two pregnancies
High dietary fat content
How can we manage Endometriosis?
CAN’T BE CURED
Suppress estrogen level: danazol - pseudo menopause, OCPS - pseudo pregnancy, Euproolide/ Lupron - antineoplastic hormones to decrease levels of estradiol.
Surgery to reduce the number of cyst
NSAIDs - pain
Excisions or ablation of lesions
Hysterectomy
Cycle of violence
Phase 1: Tension building- the first and sometimes the longest phase of the cycle. Tension builds in the relationship. May be accelerated with drinking, drugs, and strained relations.
Phase 2: Acute Battering- the explosion and the actual violence. May abuse physically or emotionally. The victim refuses to believe it happened, often deny the episode and will often refuse medical help.
Phase 3: Honeymoon stage- the recovery period where they are apologetic, calm, and loving. May be extremely sorry for his/her actions. The victim hopes that he/she changes, sometimes believes it is her/his fault.
Who is at risk for abuse?
All women are at risk for IPV (no discrimination on age, weight, marital status)
IPV against women causes more injuries or deaths than automobile accidents, rapes or assaults combined!
Crosses all boundaries (races, sexual orientation)
LGBT are often the neglected victims due to targeting screenings and interventions toward the heterosexual community.
IPV can occur in men as well and is often under reported due to social stigma involved.
What to look out for signs of abuse?
*Overuse of health services
*Vague, nonspecific complaints
*Repeated missed appointments
*Unexplained injuries
*Untreated serious injuries
*Significant delay between the injury and the presentation for care
*Injuries that do not match the patient’s description of how they were incurred
*Evidence or a history of previous injuries
*Bilateral or multiple injuries in various stages of healing
*Intimate partner who refuses to leave the patient’s side
*Intimate partner who insists on explaining how the injury was incurred
*Not speaking when talked to
*Bruising in hidden spots
*Poor or little eye contact
How to take care of someone who has been absued?
Goal: reduce incidence/severity of abuse/trauma related to violence and injury
*Remain with victim at all times
*Obtain consents for care and evidence retrieval
*Complete History and Physical
*Assess verbal and non-verbal components of interactions
*Collect forensic specimens
*Labs – cultures, RPR, HIV, UA/C&S, hCG
*Antibiotic prophylaxis
*Emergency contraception
Discomforts during pregnancy and how to manage them?
*Nausea & Vomiting: dry crackers before arising, avoid
fried, greasy, spicy foods
*Heartburn: several small meals, antacids
*Backache: good body mechanics/ exercise
*Urinary Frequency: kegel’s exercises
*Varicosities: avoid constricting clothes/support hose, leg elevation
*Constipation: >fluid intake, >fiber in diet, >activity
*Leg Cramps: Exercise/ stretching, Calcium/ phosphate balance
*Edema: Elevation, Watch high sodium intake
Hyperemesis Gravidarum
*Frequent emesis, persistent beyond first trimester.
*Leads to hypovolemia and electrolyte imbalance which can cause:
Tachycardia,
Hypotension,
Decrease urinary output
Increased BUN,
Protein and vitamin deficiencies
*Treatment: antiemetics, rehydration, TPN
Pregnancy induced Hypertension
*Most often seen in primigravidas, adolescents, diabetics, and multiple pregnancy
*Progressive hypertension, vasoconstriction, decreased urine production, edema
*Mild to severe preeclampsia as condition progresses
Pre-eclampsia
*Mild – B/P greater than 140/90, edema above the waist, weight gain > 1 lb/wk, Urine protein 1+ or greater
*Severe – B/P > 160/110, anasarca, weight gain > 2 lb/wk, proteinuria, headache, blurred vision, epigastric pain, hyperreflexia, irritability
*May progress rapidly to eclampsia and/or HELLP syndrome
*Can lead to placental infarction – IUGR, acute hypoxia, preterm delivery and possible fetal death
Eclampsia we are worried about?
Seizures
Coma
Uterine contractions
Reduce BP, prevent seizures and deliver
HELLP Syndrome
Liver damage
H – hemolysis
EL – elevated liver function tests
LP – low platelets
Results in ischemia, tissue damage and potential post delivery hemorrhage
Mild management of Preeclampsia
Mild preeclampsia – home management, modified bedrest, high protein and moderate sodium diet, antihypertensives may be used
