OB Flashcards
No vaginal bleeding, closed cervical os, no fetal cardiac activity, empty sac
Missed
Vaginal bleeding, closed cervical os, fetal cardiac activity
Threatened
Vaginal bleeding, dilated cervical os, products of conception may be seen or felt at or above cervical os
Inevitable
Vaginal bleeding, dilated cervical os, some products of conception expelled & some remain
Incomplete
Vaginal bleeding or none, closed cervical os, products of conception completely expelled
Complete
Heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus
Fibroids
Dysmenorrhea, pelvic pain, heavy menses, bulky, globular & tender uterus
Adenomyosis
Obesity, no kids, chronic anovulation, irregular bleeding, intermenstrual bleeding, or postmenopausal bleeding, nontender uterus
Endometrial cancer/ hyperplasia
No cervical change for > or = 4 hours with adequate contractions
Labor arrest get a C-section
No cervical change for > or = 6 hours with inadequate contractions
Labor arrest get a C-section
Cervical change slower than expected?
Oxytocin
MC cause of labor protraction
contraction inadequacy
MC ovarian cancer in postmenopausal women? Tx?
Epithelial ovarian carcinoma. Vague sx. Pleural effusion and rectovaginal nodularity = mets. Tx: Ex Lap
Nagle Rule
Subtract 3 months from last period and add 7 days = date of birth.
Preterm
25-37 weeks
Early term
37 wks - 38 wk and 6 days
Full Term
39 weeks - 40 wks and 6 days
Late Term
41wks - 41wks and 6 days
Post Term
after 42 weeks
Previabile
before 24 weeks
First sign of pregnancy on physical exam. Where cervix softens.
Goodell’s Sign happens at 4 weeks
Ladin Sign
Midline uterus softens at 6 weeks
Chadwick Sign
Blue discoloration of vagina and cervix 6-8wks
the “mask of pregnancy” hyperpigmentation of the face. Can worsen with sun exposure
Cholasma 16 weeks
When does a pregnant women develop telangiectasias
First Trimester - develop in palms
Fist trimester
14 wks GA 12 weeks DA
2nd trimester
24 weeks DA and 26 weeks GA
When can a gestational sack be seen on US? What’s the Beta HCG
5 weeks or Beta-HCG of 1000-1500 or higher. (go with 1500 if have to pick)
Beta HCG has increased to 20,000-30,000 what trimester is it
3rd
Beta HCG is dropping, what trimester is it
2nd
Changes in Cardiology when pregnant?
Increased CO (increased HR) and decreased BP (slightly)
GI changes when pregnant?
Morning sickness (from incerased E and P, and HCG from placenta), GERD, and Constipation (Decreased colon motility)
Renal changes when pregnant
Increased risk of pyelo due to increase in kidney and ureter size. Bigger uterus can compress ureters. Increases GFR
Hematology when prego
Anemic (from increased plasma), Hypercoaguable
First Trimester… What happens?
See pt every 4-6 weeks. Get a US between 11 and 14wks. Hear heart at end of trimester. Get bloodwork, pap, and gonorrhea/chlamydia. Screening if desired.
Most precise time to get fetus age?
US first trimester
2nd Trimester… what happens?
Screen for genetic and congenital problems at 15-20weeks (triple or quad screen). Auscultate fetal heart rate. 16-20wks quickening (feel fetal movement 1st time), multiparous may feel sooner. 18-20wks routine US for malformation.
Quad Screen
Use MSAFP, Beta-HCG, Estriol, and Inhibin A(neural tube or abdominal wall defect) Looking for Downs.
Third Trimester… what happens?
Visits every 2-3 weeks. After 36 weeks you visit every week. Get a CBC at week 27 (replace Fe orally as needed). Get a glucose load (at 24-28wk) if high confirm with oral glucose tolerance test. Cervical cultures for Chlamydia/ Gonorrhea and GBS at 36 weeks.
3rd Trimester contractions. Sporadic and no cervical dilation
Braxton Hicks contractions
If Braxton Hicks Contractions become regular, what do you do?
Check cervix to rule out preterm labor before 37 weeks. If preterm labor, cervix will be open.
How do you treat GBS
Prophylactic abx during labor
When do you treat Chlamydia and Gonorrhea when prego
Treat it when you see it. Get it out of there!
A test done at 10-13 weeks in advanced maternal age or known genetic disease in parent.
Chorionic Villus Sampling
Chorionic Villus Sampling
10-13wks, obtains Karyotype, catheter into intrauterine cavity to aspirate chorionic villi from placenta (transabdominally or transvaginally)
Done after 11-14 weeks for advanced maternal age or known genetic disease in parent
Amniocentesis (gives fetal karyotype. Needle transabdominally into amniotic sac
When do you get a fetal blood sample?
Patients w/ Rh isoimmunization and when a fetal CBC is needed. Needle transabdominally into uterus to get blood from umbilical cord
Where does ectopic pregnancy usually implant?
Ampulla of the fallopian tube
Ectopic pregnancy risk factors?
PID, Intrauterine Devices, Previous ectopic pregnancies
Strongest risk factor for Ectopic Pregnancy?
Previous Ectopic Pregnancies
test for ectopic pregnancy?
Beta-HCG, US (location), Laparoscopy (removal)
If suspect Ectopic, what meds?
1 dose of methotrexate (follow for 4-7 days). Watch for a 15% decrease. If no decrease give another dose. If no decrease… surgerize. Follow until Beta-HCG is zero.
If giving methotrexate… what labs should you follow
Transaminases to detet changes indicating hepatotoxicity
When to avoid methotrexate for ectopic treatment?
Immunodeficient, noncompliant, Liver problems, If ectopic is 3.5cm or larger. If you can auscultate a fetal heartbeat.
Surgery treatment for ectopic pregnancy?
Salpingostomy (cut whole in fallopian tube to preserve it). Do a salpingectomy if needed and just remove it all. If mom is Rh negative, give her Rhogam so that other pregnancies won’t be affected.
Pregnancy that ends before 20 weeks or a fetus <500g
Abortion
When do most spontaneous abortions occur?
before 12 weeks (60-80% due to chromosomal problems)
Maternal factors that increase risk of abortion?
Anatomic abnormalities, STDs, Antiphospholipid Syndrome, Endocrine (DM or Hyperthyroid), Malnutrition, Trauma, Rh isoimmunization
Prego with crampy abdominal pain and vaginal bleeding. What do you need to be thinking about?
Abortion
How do you distinguish the different types of abortions?
GET A US!!! MUST GET IT!!! need to get a CBC for blood loss and Blood type for Rh, but US makes the diagnosis.
Complete Abortion treatment
F/U in office
Incomplete Abortion treatment
Dilation and curettage (D&C/medical)
Inevitable Abortion treatment
D&C/ medical
Threatened Abortion
Bed rest, pelvic rest
Missed Abortion
D&C/ medical
Septic Abortion
D&C and IV antibiotics, such as levofloxacin and metronidazole
Mom has big uterus, rapid weight gain, and incresed beta-HCG and MSAFP (higher than expected for gestational age)
CONGRATULATIONS! You have twins! Drinks for everyone!!! Except you, cause you’re pregnant.
Monozygotic
1 egg and 1 sperm that split. Identical Twins
Dizygotic
2 eggs and 2 sperm. Fraternal Twins
Complications/ Risks for twins (or more) in utero
Spontaneous abortion of one fetus, premature labor and delivery, placenta previa, anemia
Number 1 risk factor for preterm labor
Other preterm labor
Contractions, dilation of cervix, (between 20-37wks)
Preterm Labor
Evaluation of fetus in preterm labor?
weight, GA, and presenting part (Cephalic vs. breech)
When do you not stop preterm labor?
Preeclampsia/eclampsia, Maternal cardiac disease, cervical dilation >4cm, Maternal hemorrhage (abruptio placenta, DIC), fetal death, or chroioamnionitis
When do you stop preterm delivery?
If 24-33 Estimated GA and 600-2500g
How do you stop preterm delivery?
Betamethasone and Tocolytics
When do you not stop preterm labor?
34-37wk estimated GA and/or >2500g
What does betamethasone do for preterm labor/ fetus?
matures fetus’s lungs (effect starts at 24 hours, peaks at 48 hours and lasts for 7 days)
What do tocolytics do for preterm labor/ fetus?
Administer after steroids. Slow progression of surgical dilation by decreasing uterine contractions.
Common tocolytics?
Mg, CCBs, Terbutaline
What’s most common tocolytic, what are it’s side effects?
MG sulfate. SE: flushing, Head aches, diplopia, and fatigue. Toxicity can cause respiratory depression and cardiac arrest. Check via deep tendon reflexes.
Terbutaline
causes myometrial relaxation. SE: increased HR leading to palpitations and hypotension
CCB
SE: Head ache, flushing, and dizziness
Indomethacin can be used as a tocolytic. When do you use it?
NEVER!!! DONT YOU DARE F’ING PUT IT AS AN ANSWER!!!!! IT’S ONLY USED TO CLOSE A PDA.
Gush of fluid from vagina in pregnant woman, what happened?
Premature Rupture of Membranes
How do you diagnose Preterm Rupture of Membranes
Speculums: fluid in posterior fornix, fluid turns nitrazine paper blue, fluid has a ferning pattern when allowed to air dry (WTF?)
When is premature rupture of membranes a problem?
When it becomes prolonged. 24 hours before delivery.
Premature rupture of membranes leads to?
Premature labor, cord relapse, placental abruption, chroioamnionitis
Premature rupture of membranes treatment
Chorioamnitis = delivery now. If fetus is term then deliver. Preterm fetus (betamethasone, tocolytics, ampicillin and 1 dose azithromycin.
Abnormal implantation of placenta over the internal cervical os
Placenta Previa (cause of 20% of prenatal hemorrhages)
Increased risk of placenta previa
Previous c section, previous uterine surgery, multiple gestations, previous placenta previa
when is digital vaginal exam or transabdominal US contraindicated?
Third trimester vaginal bleeding. May cause increased separation between placenta and uterus = sever hemorrhage. (Placenta Previa)
Painless vaginal bleeding in pregnant woman, >28 weeks
Placenta Previa (can detect on US)
Diagnose placenta previa
transabdominal US
Types of placenta previa
Complete, Partial, Marginal, Vasa Previa, Low-Lying Placenta
Placenta Previa - Complete
Complete covering of internal cercial os
Placenta Previa - Partial
Partial covering of the cercial os
Placenta Previa - Marginal
Placenta is adjacent to the internal os (often touching he edge of os)
Placenta Previa - Vasa Previa
Fetal vessel is present of the cervical os
Placenta Previa - Low Lying Placenta
Placenta that is implanted in the lower segments of the uterus, but not covering the internal cervical os (more than 0cm, but less than 2cm away)
Placenta Previa Tx
Treat if lots of bleeding or decreased hematocrit. Treatment is strict pelvic rest (with no sexy time!!!)
When do you deliver with Placenta Previa?
Unstaoppable labor (cervix dilated more than 4cm), Severe hemorrhage, Fetal distress. Give betamethasone, If have to deliver, you’re headed to Rome get that C-Section!!!
Placenta Acreta
abnormally adheres to the superficial uterine wall
placenta attaches to the myometrium
Placenta Increta
Placenta invades into the uterine serosa, bladder wall, or rectum wall
Placenta percreta
Why is placenta acreta bad?
When it’s time for he placenta to detach, it can’t. Results in hemorrhage and shock. Patient will likely need a hysterectomy.
Placental Abruption
premature separation of the placenta form the uterus
Why is placental abruption bad?
tears the placental blood vessels and results in hemorrhaging into separated space.
What can placental abruption result in?
life-threatening bleeding, premature delivery, uterine tetany, DIC, and hypovolemic shock
Risk factors for placental abruption
Maternal HTN, prior placental abruption, cocaine, exgternal trauma, smoking
Placental abruption presentation?
Third trimester vaginal bleeding, severe abdominal pain, contractions, fetal distress
Tx for placental abruption
Immediate laparotomy w/ delivery of fetus. They don’t do a c-section because the baby might not be in the uterus.
Patient had placental abruption and their uterus was repaired after delivery. How does this affect subsequent pregnancies
All new pregnancies will be delivered at 36 weeks by c-section
Mom is Rh - and baby Rh +… what happens
Not a problem in first pregnancy. Mom antibodies attach baby. Causing hemolysis of fetus’s RBCs or hemolytic disease of the new born.
Fetal anemia and extramedulary production of RBCs. Can result in Kernicterus.
Hemolytic disease of the Newborn (hemolysis increses released heme and bili)
When do you test mom’s Rh?
Initial prenatal visit
Mom initially tests Rh-, what’s next?
get an Rh antibody titer done. if it’s negative, then mom is unsensitized.
What is the antibody screen of mom for?
see if mom is Rh- or +
What is the antibody titer of mom for?
see how many antibodies to Rh+ blood mom has
If mom is unsensitzed how do you keep her that way?
Give RhoGam anytime fetal antibodies might cross the placenta: (amniocentesis, abortion, vaginal bleeding, placental abruption, delivery)
Prenatal antibody screening done at 28 and 35 weeks… Mom is still unsenstized, what next?
Give RhoGam to mom
Mom is unsensitized and baby is Rh+ at delivery. What next?
Give RhoGam to mom
Mom is sensitized if titer is > 1.4. What happens if it rises to above 1.16?
She gets RhoGam if it’s 1.4 or more. If its above 1.16 she gets amniocentesis to check fetal bilirubin level.
Chronic HTN?
BP above 140/90 before the patient became pregnant or before 20 weeks gestation.
What do you use to treat Chronic HTN?
Methyldopa, Labetalol, or Nifedipine
BP > 140/90 that starts after 20 weeks gestation. (no proteinuria and no edema)
Gestational HTN, treat with methyldopa, labetalol, or nifedeipine
Risk Factors for preeclampsia
Chronic HTN, Renal disease
Severe Preeclampsia
3+ protein on dipstick, mental status changes, changes in vision, impaired liver function. (you have end organ damage sort of)
What med prevents eclampsia
Mg Sulfate
Patient with history of preeclampsia has a tonic clonic seizure
It’s eclampsia
Eclampsia tx?
stabilize mom, then deliver baby. Control seizure with mg sulfate and bp with hydralazine
HELLP
Hemolysis, Elevated LIver enzymes, Low Platelets
How do you treat HELLP?
Same as eclampsia: stabilize mom then deliver baby
Complications of pregestational DM (Type 1 or 2)
4x more likely preeclampsia, 2x more likely spontaneous abortion, increased rate of infection, increased postpartum hemorrhage
Fetal complications of Moms pregestational DM (Type 1 or 2)
Increase in congenital anomalies (heart and neural tube defects), Macrosomnia
Macrosomnia complications
Shoulder dystocia (shoulder gets stuck under the symphysis pubis during delivery)
How do you evaluate mom with pregestation DM
EKG, 24 hour urine (creatine clearance and protein), HbA1C, Opthalmological exam
How do you evaluate fetus when mom has pregestation DM
32-36wk (weekly nonstress test w/ US; >36wk twice weekly testing (one NST and one Biophysical Profile); 37wk Lesithin/sphingomyelin ration; 38-39wk just induce labor
Gestational DM Complications
Preterm birth, Fetal Macrosomnia (etc.), Neonatal hypoglycemia. 2-4x more likely to develop type 2 dm after delivery
Gestaional DM evaluated?
Screen between 24 and 28 weeks. Glucose load test first, if above 140 then do glucose tolerance test. If any of the 3 measurements in glucose tolerance test are elevated then you have gestational diabetes.
Gestational DM treatment
Diet and exercise. then insulin (never tell a pregnant woman to lose weight)
Fetus <10% for gestational age?
Fetal Growth Restriction
Symmetric Intrauterine Fetal Growth Restriction
Brain in proportion to rest of body. Happens before 20 weeks gestation
Brain weight is not decreased, Abdomen is smaller than head. Occurs after 20 weeks
Asymmetric Intrauterine Fetal Growth Restriction
Number 1 preventable cause of Intrauterine Fetal Growth Restriction in US
Smoking
Intrauterine Fetal Growth Restriction Dx:
US to confirm weight and gestational age
Intrauterine Fetal Growth Restriction Complications
Premature labor, stillbirth, fetal hypoxia, low IQ, seizures, mental retardation
Intrauterine Fetal Growth Restriction Treatment
Quit smoking, and get immunized to prevent infections, but no live immunizations when pregnant
Fetus with an estimated birth weight >4500g
Macrosomia
Macrosomia Risk Factors?
Maternal DM or Obesity, advanced maternal age, Postterm pregnancy
Macrosomia Dx:
Fundal height > 3cm gestation age. Then get a US. US confirms gestational age
How does a US confirm gestational age?
Mesaure femul length, abdominal circumference, and head diameter
Macrosomia complications
Shoulder dystocia, Birth injuries (clavical fracture), low apgar, hypoglycemia
Macrosomia tx:
Induction of labor if lungs are mature before fetus is >4500g
If fetus is > 4500g what do you?
All Roads Lead to Rome, get a Cesarean Section
Non Stress Test
Measures fetal movements and assesses the HR.
Reactive Non Stress Test
Detection of 2 fetal movements, and acceleration of HR greater than 15bpm lasting 15-20s over a 20 min period
If non stress test is reactive…
Fetus doing well
if non stress test is nonreassuring…
Fetus could be sleeping. Use Vibroacoustic stimulation to wake up the baby.
Biophysical Profile consists of?
NST, Fetal chest expansions (normal is 1/ 30 min), Fetal movement (normal is 3/30 min), Fetal muscle tone, & Amniotic fluid index (volume based on US). Each category is worth 2 points.
Score Ranges of a Biophysical Profile?
8-10 = normal; 4-8 = inconclusive; 4 = below normal (consider delivery)
Normal fetal HR
110-160BPM
What’s a normal acceleration of fetal HR?
increase in HR of 15 or more bpm for longer than 15-20s. Twice in 20 minures is normal
What is an early deceleration and what causes it?
Decrease in HR that occurs with contractions. Head Compression
What is a variable deceleration and what causes it?
Decrease in HR and return to baseline with no relationship to contractions. Umbilical Cord Compression
What is a late Deceleration? is it serious? what causes it?
Decrease in HR after contraction started. No return to baseline until contractions ends. Most serious. Fetal Hypoxia
Fetal descent into the pelvic brim?
Lightening
Benign contractions that don’t result in cervical dilation?
Braxton Hicks
Blood tinged mucus from vagina, released with cervical effacement?
Bloody Show
Stage 1 of Labor
Onset to full dilation of cervix. Primipara = 6-18 hours. Multiparious: 2-10 hours
Latent Phase of Labor
Onset to 4cm dilation. Primipara = 6-7 hours. Multiparious: 4-5 hours
Active Phase of Labor
4cm dilation to full dilation. Primipara = 1cm/hour. Multipara: 1.2cm/hour
Stage 2 of Labor
Full dilation of cervix to delivery. Primipara: 30 minutes-3 hours. Multipara: 5-30minutes. This is where fetal descent happens.
Stage 3 of Labor
Delivery of neonate to delivery of placenta. 30 minutes
While waiting for the placental separation in stage 3, what should you do?
inspect and repair any lacerations of the vagina
Medications used to induce labor?
Prostaglandin E2 (cerivical ripening). Oxytocin (increases uterine contractions). Amniotomy (puncture the amniotic sac via an amnio hook)
Arrest of Cervical Dilation
no cervical dilation for more than 2 hours
Prolonged latent stage
latent phase lasts longer than 20 hours for primipara or 14 hours multipara.
Prolonged latent stage tx
Hydration and rest. Most will convert to spontaneous labor in 6-12 hours.
Protracted Cervical Dilation
Slow dilation during active phase of labor. <1.2cm for primipara and <1.5cm for multipara
3 Ps of Protracted Cervical Dilation
Power (contraction strength and frequency), Passenger (size and position of fetus), and Passage (fetus is larger than pelvis (cephalopelvic disproportion)
Protracted Cervical Dilation - Cephalopelvic Disproportion Tx?
C-Section, all roads lead to Rome
Protracted Cervical Dilation - Weak contractions Tx?
Oxytocin
Types of Arrest Disorders
Cervical Dilation (no dilation for 2 hours) and Fetal Descent (no fetal descent for 1 hour)
Etiology of Arrest Disorders?
Fetal presentation, , Cephalopelvic Disproportion, Excessive sedation/anesthesia
Malpresentation (arrest disorder) what do you feel on vaginal exam?
a soft mass instead of the normal hard surface of the skull. Confirm with US
Fetus’s hips are flexed and extended knees bilaterally?
Frank Breech
Complete breech
Fetus hips and knees are flexed bilaterally
Fetus’s feet are first: one leg (single footling) or both legs (double footling)
Footling Breech
When do you perform an external cephalic version for breech?
After 36 weeks. Fetus will likely maneuver itself before 36 weeks.
Shoulder Dystocia
Anterior shoulder is stuck behind the pubic symphysis.
Risk Factors of Shoulder Dystocia
maternal DM and obesity, postterm pregnancy, hx of prior shoulder dystocia
Treatment of Shoulder Dystocia
In this order!!! 1. McRoberts Maneuver. 2. Rubin Maneuver. 3. Woods maneuver. 4. Deliberate fetal clavicle fracture. 5. Zavanelli maneuver
McRoberts Maneuver?
Mom Knees to chest to increase suprapubic pressure
Bleeding more than 500ml after delivery
Postpartum hemorrhage
Early postpartum hemorrhage timeline?
w/in 24 hours after delivery
Late postpartum hemorrhage timeline?
w/in 24hrs-6 weeks after delivery
Most common cause of postpartum hemorrhage?
Uterine Atony
Inability to breastfeed after postpartum hemorrhage?
Sheehan Syndrome
Tx of postpartum bleeding?
Check for rupture. If the exam is normal then do a bimanual compression and massage. If that doesn’t work give oxytocin.
When do Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) begin?
When women are in their 20-30s
PMDD is a more severe version of?
PMS. It will disrupt daily activities
PMS and PMDD sx
Head Ache, Breast Tenderness, Pelvic Pain and bloating, Irritability and Lack of energy.
PMS and PMDD Dx
Sx for 2 consecutive cycles, sx free period of 1 week in first part of the cycle (follicular phase). Sx must be present in the 2nd half of the cycle (luteal phase) and dysfunction in life
PMS and PMDD Tx:
Decrease caffeine consumption and smoking. Give SSRI’s if sx are severe
Menopause Age
48-52
How does menopause start?
Irregular menstrual bleeding. Oocytes produce less estrogen and progesterone, both have LH and FSH start to rise. Women are asymptomatic for 12 months. Some women experience symptoms for years.
Menopause Sx
menstrual irregularity, sweats and hot flashes (vasospasms), Mood changes, dyspareunia (pain in sex)
Physical Exam findings of Menopause
Atropic vaginitis, decreased breast size, vaginal and cervical atrophy
Menopause Dx
Increased FSH is diagnostic of menopause
Tx of menopause
HRT for short term symptom relief and prevention of osteoporosis
HRT is associated with ________________ and can lead to ________________.
Endometrial hyperplasia and endometrial carcinoma
Contraindications to HRT in menopause
Estrogen dependent carcinoma (breast or endometrial cancer). History PE or DVT.
Postcoital bleeding is….
Cervical Cancer until proven otherwise
Menorrhagia, what is it?
Heavy and prolonged menstrual bleeding
Hypomenorrhea, what is it?
Light menstrual flow. May only have spotting
Metrorrhagia, what is it?
Intermenstrual bleeding
Menometrorrhagia, what is it?
Irregual bleeding (time intervals, duration, amount of bleeding).
Oligomenorrhea
Menstrual cycles >35 days long
Postcoital bleeding
Bleeding after sexy times (cervical cancer till proven otherwise)
Menorrhaia causes
Endometrial hyperplasia, uterine fibroids, dysfunctional uterine bleeding, IUD
Hypomenorrhea causes
Obstruction (hymen, cervical stenosis), OCP
Metrorrhagia causes
Endometrial polyps, endometrail/cervical cancer, exogenous E administration
Menometrorrhagia causes
Endometrial polyps, endometrial/cervical cancer, Exogenous E administration, Malignant Tumors
Oligomenorrhea causes
Pregnancy, Menopause, Significant weight loss (anorexia), Tumor secreting E
Postcoital bleeding
Cervical Cancer, Cervical Polyps. Atrophic Vaginitis
Dysfunctional Uterine Bleeding (DUB)
Unexplained or abnormal bleeding. Happens with anovulation. Ovaries make E but no corpus luteum is formed, so no progesterone. Endometrium will out grow blood supply and result in bleeding.
Dx DUB ?
Endometrial biopsy for women over 35 to exclude carcinoma
Any patient older than 35 with DUB should get what?
Endometrial biopsy to rule out carcinoma
DUB Tx?
OCPs. D&C can be done to stop bleeding.
DUB Severe Tx?
when patients are anemic, can’t be controlled by OCPs, or compromised lifestyle. Tx endometrial ablation or hysterectomy
OCPs reduce risk of:
Ovarian carcinoma, endometrial carcinoma, and ectopic pregnancy.
OCP risk?
Thromboembolism and Hepatocellular Adenoma
IUD SE?
PID when placed. Must do genital cultures before they are placed.
When does labial fusion occur?
Presence of excess androgens. MC cause is 21-B-hydroxylase deficiency.
Labial fusion treatment?
Reconstructive surgery
Who does Lichen Sclerosis affect?
affects any age. Postmenopause is increased risk of cancer
Lichen Sclerosis and treatment?
White, thin skin extending from labia to perianal area. Tx is topical steroids.
Who does Squamous Cell Carcinoma affect?
Any age, patients who have had chronic vulvar pruritus
Squamous Cell Carcinoma and treatment?
Patients with chronic irritation develop hyperkeratosis (raised white lesion). Ts: sitz baths or lubricants (relieve the pruritis)
Who does Lichen Planus affect?
30s-60s
Lichen Planus and treatment?
Viole, flat papules. Tx: Topical Steroids
where are Bartholin Glands?
Lateral sides of the vulva at 4 and 8 o’clock
Bartholin Gland cysts/ abscess treatment?
I&D with cultures for gonorrhea and chlamydia
Recurrent Bartholin Gland cyst/abscess tx?
Marsupialization (I&D where space is kept open with sutures)
Vaginitis Risk Factors?
Antibioitcs, DM, Overgrowth of normal flora. Any factor that will increase the pH of the vagina
Vaginitis sx?
itching, pain, abdominal odor, and discharge
Saline wet mount shows clue cells
Bacterial Vaginosis = Gardnerella
KOH shows psuedohyphae
Candida
White cheesy vaginal discharge
Candida
Candida tx
Pick an “azole” or nystatin
Gardnerella Tx
Metronidazole or Clindamycin
Profuse, green, frothy vaginal discharge
Trichomonas
Saline wet mount shows motile flagellates
Trichomonas
Trichomonas treatment
patient and partner with metronidazole
Vulvar soreness and pruritis appearing as a red lesion with a superficial white coating
Pagets
Who does Pagets affect
postmenopausal caucasion women
Treatment of Pagets
vulvectomy
Most common type of vulvar cancer
Squamous Cell Carcinoma
Pruritis, bloody vaginal discharge, and postmenopausal bleeding
Squamous Cell Carcinoma
How do you diagnose pagets or squamous cell carcinoma? When is staging done?
Biopsy. staging done in surgery
Tx of unilateral squamous cell lesions w/out lymph node invovlement
modified radical vulvectomy. If lymph nodes are involved they must be excised (lymphadenectomy)
Adenomyosis
invasion of endometrial glands into myometrium
What age does adenomyosis affect?
Women age 35-65
Endometriosis and uterine fibroids are risk factors for what?
Adenomyosis
How do you diagnose adenomyosis definitively?
Hysterectomy
Large, globular, and boggy uterus
Likely adenomyosis
What is endometriosis
implantation of endeometrial tissue outside of the endometrium
What sites are most common for endometriosis
ovary and pelvic peritoneum
Who does endometriosis affect?
Women of reproductive age
Endometriosis presentation
Cyclical pelvic pain that starts 1-2 weeks before menstruation and peaks 1 to 2 days before menstruation. Pain ends with menstruation. Abdnormal bleeding, and nodular uterus and adnexal mass are common!!!
Endometriosis dx
Visualization via laparoscopy. Will look dark and rusty. Potentially described as chocolate cyst on ovary
Endometriosis tx
NSAIDs, OCPs for mild. Moderate to severe = Danazole or Leuprolide (Decrease FSH)
Androgen derivative that is associated with acne, oily skin, weight gain, and hirsutism
Danazol
GnRH agonist and when given continuously suppresses E. Ass/ w/ hot flashes and decreased bone density.
Leuprolide
When to surgerize for Endometriosis?
Severe or infertile. Goal is to restore pelvic anatomy and remove endometrial implants. May receive total hysterectomy and bilateral salpingo-oophorectomy
PCOS Sx
Amenorrhea, or irregular menses, hirsutism and obesity. Acne, DM type 2
Dx PCOS?
Bilaterally enlarged ovaries with multiple cysts on US. Increased T and obese. Increased LSH and decreased FSH. LSH/ FSH ration of 3:1
Tx of PCOS
Weight loss. OCPs (controls androgens and prevents endometrial hyperplasia) Use OCPs if they don’t want kids
PCOS and want to conceive?
Clomiphene and metformin
Vaccines Contraindicated in Pregnancy
HPV, MMR, Live Attenuated Influenza, Varicella
Recommended Vaccines during Pregnancy
TDAP, Inactivated Influenza, Rho(D) Immunoglobulin
Vaccines indicated if high risk Pregnancy
Hep B, and Hep A, Pneumococcus, H. Influenza, Meningococcus, Varicella Zoster Immunoglobulin
