OB Exam #1 Flashcards
Absence of menses
- normal in prepubertal, pregnant, postpartum, and postmenopausal females
- primary vs. secondary
- treatment is dependent on type (correct underlying factors)
- Causes: weight loss/gain, excessively exercising, stress, depression, PCOS, etc.
- Dx: draw labs to identify cause; pregnancy test
amenorrhea
Painful menstruation
- common in adolescence & caused by increased prostaglandin production causing increased uterine contractions
- can also be secondary to other pelvic or uterine issues (most commonly endometriosis)
- goal is to provide adequate pain control to maintain ADLs
- Tx: pain relief, contraceptive (hormones), OTC remedies
- Dx: CBC (anemia), UA, pregnancy test, pap smear (STDs), pelvic/vaginal US, laparotomy
dysmenorrhea
painless endometrial bleeding that is prolonged, excessive, & irregular
- most common at the beginning and end of reproductive years & is related to hormone disturbance
- Common causes: polyp, endometrial tissue growing in uterine wall, fibroids, cancer, coagulation issues
- Tx: treat & normalize bleeding; correct anemia; prevent or diagnose cancer; restore quality of life; contraceptives; NSAIDs; D&C; ablation; biopsy; hysterectomy (last resort)
abnormal uterine bleeding (AUB)
recurrent symptoms that occur during the last half of menstruation
- wide variety of S&S: dysphoria, breast pain, bloating, weight gain, tension headache, retain fluid, social withdrawal, interruptions w/ sleep or want to sleep more
- difficult to define & hard to diagnose
- exact cause = unknown
- Tx: lifestyle changes & meds (NSAIDs, contraceptives, antidepressants, diuretics); vitamins
premenstrual syndrome (PMS)
functional endometrial tissue implants in areas other than the uterine cavity such as the ovaries, fallopian tubes, outer surface of uterus, bowels, anal verge, pelvic wall
- this tissue responds the same way as endometrial lining during the menstrual cycle
- S&S begin as early as adolescence & stop after menopause
- cause = unknown
- Tx: surgical removal or ovarian suppressive agents; NSAIDs; hormonal suppression
endometriosis
inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception – secondary is the inability to conceive after previous pregnancies
- impacts emotional, social, and economic well-being of couples
- Female causes: ovarian dysfunction or tubal/pelvic pathology; anovulation, tubal damage, endometriosis, ovarian failure
- Male causes: low or absent numbers of motile sperm in the ejaculate; erectile dysfunction
- Tx: lifestyle changes; medication to promote ovulation; intrauterine insemination; IVF
infertility
refraining from sexual activity
- Failure rate: none
- Pros: costs nothing
- Cons: difficult to maintain
- STI protection, unless, body fluids are exchanged in other ways
abstinence
refrain from sex during fertile period
- Failure rate: 25%
- Pros: no side effects, acceptable to most religions
- Cons: high failure rate w/ incorrect use
- STI protection: none
- Methods: cervical mucus ovulation; basal body temperature; symptothermal; standard days
fertility awareness-based methods
male withdraws before ejaculation occurs
- Failure rate: 27%
- STI protection: none
- oldest & most widely used means of preventing pregnancy in the world
- one of the least effective ways of preventing pregnancy
withdrawal (coitus interruptus)
continuous breastfeeding can usually postpone ovulation & prevent pregnancy
- only works for about 6 months [must be exclusively breastfeeding– this is when kids are introduced to solid foods]
- important to educate women that pumping or manual milk expression can reduce effectiveness
- common method for postpartum women
lactational amenorrhea method
thin sheath placed over penis or into the vagina to block sperm
- Failure rate: 15%
- Pros: widely available, low cost, physiologically safe
- Cons: breakage risk, decreased sensation & spontaneity
- STI protection: provides protection
- made of latex (allergy alert) or polyurethane
condom [barrier method]
shallow latex cup that is placed in the vagina
- Failure rate: 16%
- Pros: no hormones, medically safe, cervical cancer prevention
- Cons: requires accurate fitting by healthcare professional, increased UTIs
- STI protection: none
diaphragm [barrier method]
pill that suppresses ovulation by combined action of estrogen & progestin
- most common and used by millions of women
- needs to be taken at same time everyday to be most effective
- can be used for Tx of acne, PMS, endometriosis, reduce risk of endometrial cancer & protects from PID
- Failure rate: 8%
- Pros: easy to use, high rate of effectiveness
- Cons: must take pill at exact same time everyday, possible undesirable effects, prescription needed
- STI protection: none
- ACHES: abdominal pain (liver or gallbladder issues); chest pain/SOB (PE); headache (HTN, impending stroke); eye problems (HTN); severe leg pain (DVT)
oral contraceptives [hormonal method]
injectable progestin that inhibits ovulation
- Failure rate: 3%
- Pros: long duration (3-MOS), highly effective, estrogen-free, can be used by smokers & lactating women
- Cons: menstrual irregularities, return visits every 12 weeks, return to fertility up to 12 months
- STI protection: none
Depo-Provera [hormonal method]
transdermal patch that releases estrogen and progestin into circulation
- Failure rate: 8%
- Pros: easy system to remember, very effective – once they stop using, fertility is restored pretty quickly
- Cons: skin irritation possible, may fall off and not be noticed providing no protection
- STI protection: none
Ortho Evra [hormonal method]
vaginal contraceptive ring about 2” in diameter that is inserted into the vagina; releases estrogen and progestin
- Failure rate: 8%
- Pros: easy system to remember, very effective
- Cons: may cause vaginal discharge; can be expelled w/o noticing and not offer protection
- STI protection: none
NuvaRing [hormonal method]
a time-release implant (one rod) of levonorgestrel for 3 yrs
- Failure rate: 0.05%
- Pros: long duration of action; low dose of hormones; reversible; estrogen-free
- Cons: irregular bleeding; weight gain; breast tenderness; headaches; difficulty in removal
- STI protection: none
Nexplanon [hormonal method]
a T-shaped device inserted into the uterus that releases copper or progesterone or levonorgestrel
- Failure rate: 1%
- Pros: immediately & highly effective; allows for sexual spontaneity; can be used during lactation; return to fertility not impaired; requires no motivation by user after insertion
- Cons: insertion requires skilled professional; menstrual irregularities; prolonged amenorrhea; can be unknowingly expelled; may increase the risk of pelvic infection
- STI protection: none
intrauterine devices (IUD) [hormonal method]
combo of levonorgestrel-only pills; combined estrogen & progestin pills
- used within 72-120 hours of unprotected sex, more effective the quicker they take it
- reduce risk of pregnancy by almost 90%
- Pros: provides a last chance to prevent a pregnancy
- Cons: risk of ectopic pregnancy if EC fails
- STI protection: none
emergency contraceptives (Plan-B) [hormonal methods]
- occur in older women around 30-50
- caused by overgrowth of fibrous tissue, in response to the monthly progesterone & estrogen levels
- rare in postmenopausal women
- S&S: palpable, movable lump; nipple discharge; breast tenderness
- Tx: supportive bra; decrease caffeine; ibuprofen; biopsy/aspiration
fibrocystic changes
- occurs in women age 15-30
- caused by hormone replacements (birth control), pregnancy, lactation
- benign, solid breast tumors
- S&S: round, movable lump; may have tenderness
- Tx: monitor; lump aspiration/biopsy; surgical removal
fibroadenomas
- caused by bacteria and result in inflammation/infection in breast tissues
- S&S: localized swelling, redness, warmth, tenderness of breast, flu-like symptoms
- Tx: warm compress; pain meds; antibiotics; expressing breastmilk
mastitis
- Types: ductal, tubular, colloid, medullary
- 2nd leading cause of cancer in women, much rarer in men
- Non-modifiable risk factors: female, age, genetics, history, race, timing of menarche/menopause
- Modifiable risk factors: hormone therapy; childbirth; non-breastfeeding; alcohol consumption; smoking; obesity
- Early S&S: none – why self breast exam & mammograms are important
- S&S: changes in color of breast, shape/contour of breast, lump in breast in one, changes in nipple-discharge, retraction, inverted, tenderness
- Dx: mammograms, needle aspiration, biopsy
- Tx: mastectomy, chemo, radiation, hormonal therapy
invasive breast cancers
bladder drops into the vagina
cystocele
rectum sags/bulges into the vagina
rectocele
small intestine bulges into the vagina
enterocele
uterus drops into the vagina
uterine prolapse
any organ that is herniated or protruding into or outside the vaginal canal affecting urination, defecation, sexual activity, and quality of life
- non-life threatening
- Risk factors: obesity; atrophy/weakening of pelvic floor; pregnancy/childbirth; hysterectomy; family Hx; increased abdominal pressure
- Tx: Kegels; hormone replacement therapy; diet & lifestyle modifications; pessaries devices; surgical interventions
pelvic organ prolapse
- small growth, usually benign
- results from infection, chronic inflammation, high levels of estrogen, or local congestion of cervical vasculature
- malignancy is higher in perimenopausal or postmenopausal women, common in middle age women and those who have bared children
- S&S: asymptomatic; abnormal vaginal bleeding after intercourse
- Appearance: endocervical = cherry red; closer to cervix = grayish white
- Dx: pap smear, US, hysteroscopy
- Tx: removal & biopsy
polyps
- benign tumor made up of composed smooth muscle & fibrous C.T., found in uterus
- slow-growing, vary in size
- highly evident during child-bearing years
- S&S: chronic pelvic pain; low back pain/sciatic; constipation/bloating; dysmenorrhea; dyspareunia; menorrhagia
- Predisposing factors: age, genetics/ethnicity, HTN, obesity, PCOS, diabetes
- Tx: hormone replacement, myomectomy, laser surgery, hysterectomy
uterine fibroid
- occurs more often than thought of as Bartholin glands are in the labia minora and produce lubrication during sexual arousal can be occluded and lead to infected abscess
- S&S: swollen, redness, painful, fluid-filled abscess on labia
- Dx: physical exam
- Tx: sitz bath, analgesics, antibiotics, I&D, word catheter placement
Bartholin cyst
most common endocrine syndrome in women
- cyst-like follicle within the ovary, interfering w/ ovarian function
- eggs never mature & no ovulation occurs
- multifaceted disorder – hyperandrogenemia; hyperinsulinemia; other issues (sleep apnea, obesity, elevated BP, etc.)
- most common cause for infertility
- Dx: hyperandrogenism, ovarian dysfunction
- Tx: contraceptive; antihyperglycemic drugs; ovulation agents; lifestyle changes
polycystic ovary syndrome (PCOS)
malignancy in uterine cervix and most common cause is HPV
- 3rd most frequently diagnosed cancer in women & most treatable cancers when detected early
- Risk factors: age of menarche; age of first intercourse; # of sexual partners; contraceptive use; unprotected sex; family Hx; smoking
- S&S: asymptomatic
- Dx: pap smear, colposcopy
- Tx: cryotherapy; cone biopsy; LEEP; hysterectomy; chemotherapy; radiation
- Preventive care: Gardasil vaccine
cervical cancer
abnormal growth of cells within uterine lining & high incidence of metastasis – the 4th most common cancer in women
- Risk factors: nulligravida; Hx; Hx of uterine fibroids; infertility; obesity; timing of menarche/menopause; diabetes; HTN; PCOS
- S&S: dyspareunia; back/pelvic pain; weight loss; change in GU/GI patterns; vaginal bleeding
- Dx: pelvic exams; transvaginal US; endometrial biopsy
- Tx: total hysterectomy; radiation; chemo
uterine/endometrial cancer
abnormal growth of ovarian cells occurring in women older than 63 & is the 5th most common cancer and deaths of women due to being undiagnosed & metastasizing
- develops slowly & advances before the women experiences symptoms
- Risk factors: age, genetics, Hx, infertility, nulligravida, timing of menarche/menopause, hormonal therapy, obesity
- S&S: pelvic/abdominal pain; urinary issues; increased abdominal size
- Dx: labs & US
- Tx: total hysterectomy, radiation, chemo
ovarian cancer
fertilization through 2nd week
- includes the zygotic & blastocyst stage
Pre Embryonic/Germinal Stage
End of 2nd week through 8th week
- not an embryo until week 2
Embryonic Stage
