OB-GYN Flashcards
Noonan syndrome
- an autosomal dominant genetic disorder of congenital malformations.
The characteristic phenotypic features of Noonan syndrome are:
- characteristic facial dysmorphic features: hypertelorism, downward slanting eyelid slits, ptosis, low-set ears with a thickened rim, wide short neck, sometimes with fluff features
- organ abnormalities: defects of the cardiovascular system (especially pulmonary valve stenosis), kidney defects, cryptorchidism in boys,
- abnormalities of the skeletal system: short stature, deformities of the sternum (shoemaker’s or chicken’s chest), valgus of the elbows, scoliosis, vertebral defects (semi-circles), rib defects,
- usually a light blue color of the irises
- disorders of the lymphatic system
- tendency to ecchymosis,
- blood clotting disordershearing loss,
- deafness.
Prader-Willi syndrome (PWS)
is a birth defect syndrome caused by a deletion in the long arm of the father’s chromosome 15.
The disease occurs with a frequency of 1: 10 thousand. up to 1: 50,000 live births. In older sources, the acronym -HHHO was used, derived from the words: hypotonia-hypomentia-hypogonadism-obesity, that is: muscle hypotonia, mental retardation, underdevelopment of the genital organs, obesity
. The characteristic morphological features include: bulging forehead, amygdala eyes, narrow face, small lower jaw, small hands and feet.
Angelman syndrome
is a neurogenetic disorder that is caused by the inactivation of the UBE3A gene (E3 ubiquitin ligase), the product of which combines ubiquitin with a protein product to be degraded. As a result of the mutation, pathologically large amounts of protein accumulate, which disrupts the development and function of the CNS.
The syndrome is manifested by intellectual disability, seizures that are difficult to control, impaired speech development, uncontrolled bouts of laughter and movement stereotypes (the so-called happy puppet syndrome).
Klinefelter’s syndrome
is a genetically determined genetic disease that belongs to numerical aberrations with at least one additional copy of the X chromosome (47 XXY).
Klinefelter’s syndrome is the most common cause of male hypogonadism, with a frequency of 1: 500-1: 1,000 live-born male newborns.
The most typical features of these patients are tall stature, feminine silhouette, long limbs and small testicles.
Alport syndrome
genetically conditioned disease (type IV collagen defect)
revealed in childhood
Clinical picture of the disease:
progressive nephropathy
micro/macrohematuria
later, increasing proteinuria appears
may be accompanied by hypertension
the disease leads to end-stage renal disease
bilateral sensorineural hearing loss
eye changes:
- lenticonus
- pigmented retinal changes
- corneal ulcers
leiomiomatosis
aneurysms
Magnesium Sulfate MOA
decreases uterine tone and contractions by acting as a calcium antagonist and a membrane stabilizer.
Terbutaline MOA
acts by increasing conversion of ATP to cAMP, which decreases free calcium ions through sequestration in the sarcoplasmic reticulum.
Calcium channel blockers
decrease intracellular calcium, which reduces uterine contractility
Indomethacin MOA
blocks the enzyme cyclooxygenase and decreases the level of prostaglandins, which decreases intracellular levels of calcium and therefore decreases myometrial contractions.
Flushing, diplopia, and headache are common side effects of
magnesium sulfate
Women taking terbutaline often note
headache, tachycardia, and anxiety.
Calcium channel blockers such as nifedipine can cause
headache, flushing, and dizziness.
indomethacin has been associated with
the premature closure of the ductus arteriosus in the neonate.
The most effective test to monitor patients for magnesium toxicity is through
serial DTR examination. DTRs are diminished and then lost with magnesium serum levels between 6 and 10 mg/dL.
Toxic levels of magnesium (>10 mg/dL) result in respiratory depression, hypoxia, and cardiac arrest.
Serial DTR examination is therefore a cost-effective screening test for magnesium toxicity.
Serum levels are not necessary unless there is concern for absent DTRs or patients show symptoms of respiratory depression.
Rubin maneuver.
This maneuver involves pressure on either fetal shoulder to diminish the biacromial diameter in an effort to free the anterior shoulder and allow delivery of the fetus.
McRoberts maneuver is described first and involves
flexing the maternal hips, which results in ventral rotation of the maternal pelvis and an increase in the size of the pelvic outlet.
It is the least invasive of maneuvers.
Next, suprapubic pressure is applied by directing force just above the pubic symphysis in an oblique direction.
The goal of this maneuver is to disimpact the anterior shoulder.
It is very important that pressure be applied obliquely to free the shoulder, because downward pressure will not change the biacromial diameter.
Wood cork maneuver involves
placing a hand behind either the anterior or posterior fetal shoulder and rotating the fetus 180 degrees to lead to descent and delivery of the shoulders.
Papillary cancer -
accounts for about 80% of thyroid cancers (the most common malignant thyroid cancer). Metastasis mainly through lymphathic system.
Its only symptom can be an enlarged lymph node nearby the trachea or lateral neck (this is the metastasis of occult papillary cancer).
Follicular cancer -
represents about 20% of thyroid cancers, grows slowly as a single tumor.
Unlike papillary carcinoma, it rarely spreads via the lymphatic pathway (much more frequently through the bloodstream to the lungs and bones).
Anaplastic cancer
- i.e. undifferentiated - accounts for about 5% of thyroid cancers and is usually present in elderly people (over 60 years of age).
It occurs on the basis of differentiated, papillary or follicular cancer, usually infiltrates surrounding tissues.
Medullary cancer
- it accounts for about 5% of thyroid cancers and may be genetically conditioned (tumors usually occur bilaterally, may co-occur with parathyroid adenoma and phaeochromocytoma of the adrenal medulla).
It is metastasized by both the lymphathic and blood pathways. It grows slowly, produces and secretes CEA and calcitonin.
The second most common thyroid cancer is:
Follicular cancer
Some facts about thyroid cancer:
6 pts
A characteristic symptom of medullary cancer is diarrhea .
Frequent in medullary cancer is family occurrence ( RET mutation ).
Rapid progression is characteristic of anaplastic cancer.
In anaplastic cancer, the characteristic symptom is dyspnea .
Differentiated cancers can be treated with radioactive iodine .
Thyroid cancer is 4 times more common in women .
general symptoms:
in the case of an advanced stage of the cancer, symptoms associated with infiltration of other organs or the presence of distant metastases may occur
fever
lack of appetite
weight loss
iron deficiency anemia
presence of blood in / on the stool
right colon cancer (including caecum)
Symptoms depend on the location of the cancer
dull ache in the area of the abdomen on the right side, near the navel or abdomen
stool dark, brown or mixed with blood, anemia
tumor perceptible in the middle/ lower abdomen on the right side
cancer of the left half of the colon (including the sigmoid colon):
Symptoms depend on the location of the cancer
flatulence
often painful colic
fresh admixture of blood in the stool
change of the defecation rhythm
obstruction (bloating, pain, nausea, vomiting, constipation)
rectal cancer
Symptoms depend on the location of the cancer
admixture of bright red blood
feeling of incomplete defecation, diarrhea impossible to suspend
an intestinal colic causing the need to defecate
abdominal pain, crotch
Blood group A increases the risk of
stomach cancer
Antiphospholipid Syndrome (APS) is an autoimmune disorder associated with the presence of antiphospholipid antibodies, which include:
- anti-cardiolipin antibodies*
- antibodies against β2-glycoprotein I*
- lupus anticoagulant*
Recurrent miscarriages always require careful diagnostic evaluation.
Causes of recurrent miscarriages include:
Anatomical factors (uterine fibroids, intrauterine adhesions, birth defects)
Corpus luteum dysfunction
Antiphospholipid syndrome
Thyroid dysfunction
Diabetes mellitus
Most miscarriages in women with APS occur in the _______ of pregnancy.
Treatment:
The recommended therapy for pregnant women with APS consists of ?
Most miscarriages in women with APS occur in the first trimester of pregnancy.
Treatment:
The recommended therapy for pregnant women with APS consists of acetylsalicylic acid and heparin, which increases the chance of giving birth to a healthy child.
Which of the following changes in blood morphology occurs in the second trimester of normal pregnancy?
physiological hemodilution in pregnancy.
Thus we can observe during morphological analysis:
- a decrease in hematocrit value*
- a decrease in hemoglobin*
- a decrease in platelets*
- leukocytes may be normal or slightly elevated*
During pregnancy, there is also an increase in the production of the coagulation factors:
Name
- and*
- we observe a decrease in the concentation of* endogenous anticoagulants such as
___ ___ and ___
This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of_____
I, II, V, VII, VIII, X, XII
and
we may observe a decrease in the concentration of endogenous anticoagulants such as protein C and S.
This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of thromboembolism.
Symptoms depend on the location of the cancer:
right half of the colon -
left half of the colon -
rectum -
right half of the colon - increasing anemia and abdominal pain.
left half of the colon - change in bowel habits, diarrhea with lots of mucus or constipation, blood in the stool.
rectum - a tumor palpable during per rectum examination.
The most important examination in the diagnosis of colorectal cancer is ______, which allows to visualize the tumor growing in the intestine and enables the collection of biopsies for histopathological examination.
Based on the hist-pat examination, the TNM classification is assessed.
the “T” characteristic means:
colonoscopy
Based on the hist-pat examination, the TNM classification is assessed.
Tis - infiltration of the mucosa,
T1 - infiltration of the submucosa,
T2 - muscle membrane infiltration,
T3 - infiltration of periocecal / perianal tissues,
T4 - infiltration of adjacent organs / structures or visceral peritoneum.
Colorectal cancer - most of the procedures are performed using the classic method, but laparoscopic operations are becoming more common
depending on the location of the tumor, there are:
- segmental resections:* transverse colon tumors, sigmoid tumors
- right hemicolectomy:* caecum tumors, ascending colon tumors
- left hemicolectomy:* descending colon tumors, sigmoid tumors
- dilated hemicolectomy*
- Hartman’s operation:* tumors of the left half of the large intestine (including sigmoid colon).
fetal lie-
the ratio of the long axis of the fetus to the long axis of the uterus and birth canal
Possible position types:
longitudinal
transverse
oblique
position-
the ratio of individual parts of the fetus to the uterus
for the longitudinal position, the ratio of the fetal back to the uterus is determined
in the case of transverse and oblique position - the ratio of the head of the fetus to the uterus
setting I- fetal back / head on the left side
setting II - fetal spine / head on the right side
attitude-
the ratio of parts of the fetus to each other
Depending on the ratio of the head to the torso while passing through the birth canal, the following arrangement can be distinguished:
well-flexed
deflexed
engagement -
ratio of the leading part to the plane of the pelvic brim (measured in centimeters)
Tay-Sachs disease (GM2 gangliosidosis)
- a genetically determined disease from the group of storage diseases consisting in the accumulation of fatty substance - GM2 ganglioside in nerve cells of the brain.
- a rare genetic disorder passed from parents to child. It’s caused by the absence of an enzyme that helps break down fatty substances.
These fatty substances, called gangliosides, build up to toxic levels in the brain and spinal cord and affect the function of the nerve cells
Phakomatoses
group of developmental disorders of tissues from three germ layers, which are manifested by changes in
the skin, nervous and vascular systems and co-occurring defects of internal organs.
Asherman’s syndrome is
adhesions in the uterine cavity that completely or partially close its lumen.
This is manifested by either little or no bleeding.
The most common causes of Asherman’s syndrome are: curettage of the uterine cavity, endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.
The Mayer-Rokitansky-Küster-Hauser syndrome
congenital syndrome characterized by aplasia of structures originating in the Muller’s ducts, i.e. the uterus and vagina.
Primary amenorrhea is the most common cause of medical reports.
Couvelaire syndrome (uteroplacental stroke)
is a rare, life-threatening complication of pregnancy in which the detachment of the placenta is accompanied by an infiltration of the uterine muscle with blood that almost reaches the serosa.
dehiscence
the splitting or bursting open of a pod or wound.
Conditions in which the occipital softening may occur :
Name 2
What leads to Rickets?
rickets
excessive supply of phosphates in the diet
→ phosphates bind with ionized calcium and accumulate in soft tissues → low level of calcium in the serum stimulates the secretion of PTH (secondary hyperparathyroidism) → bone calcium release → rickets
The Ehlers-Danlos syndrome
the following occur in the course of the disease:
related to, among others, abnormalities in morphology of collagen
- excessive mobility in the joints (subluxation, dislocations, joint deformities, exudates)
- excessive skin stretching (formation of hernia)
- fragility of blood vessels (easy bruising)
- problems associated with sight (myopia, retinal detachment)
- no softening of the bones is found
Craniotabes
Define:
(softening and thinning of occipital and parietal bones)
A dizygotic pregnancy
is one in which two separate eggs were fertilized (for this to occur, polyovulation must happen) at one time. As a result, two genetically different fetuses develop.
They differ in the same way as siblings from two separate pregnancies.
This pregnancy will always be dichorionic and diamniotic
A monozygotic pregnancy
is a more complicated process. It is a pregnancy in which as a result of fertilization of one egg cell by one sperm, 2 identical embryos are formed.
This is done by splitting of the initially single zygote.
A very important element of this division is the time from fertilization in which this division takes place:
A very important element of this division is the time from fertilization in which this division takes place:
- if within 4 days of fertilization:*
- if between 4 and 7 days after fertilization:*
- if after day 7:*
- if after 13 days:*
- if within 4 days of fertilization* - it will be a dichorionic, diamniotic pregnancy
- if between 4 and 7 days after fertilization* - it will be a monochorionic, diamniotic pregnancy
- if after day 7* - it will be a monochorionic monoamniotic pregnancy
- if after 13 days* - there is a very high risk that the fetuses will be somehow connected to each other (conjoined twins)
chorion
- is one of the membranes that is involved in the creation of the placenta -
- it is quite significant and is related to serious consequences (which were explained in discussion under the question about TTTS)
amnion
is also one of the fetal membranes that, when filled with fluid, creates a safe environment for the development of the embryo.
- diaphragmatic hernia (define)*
- Name two types:*
. This disease happens when the abdominal organs are displaced into the chest cavity through a hole in the diaphragm.
2 types of diaphragmatic hernias:
anterior - Morgagni - usually on the right side
postero-lateral - Bochdalek - 90% of cases, usually on the left side
Anemia is common in pregnant women.
It is diagnosed at the level of
hemoglobin <11g / dl
non-pregnant women who have anemia diagnosed at
Hb <12 g / dl
In the course of pregnancy,
the volume of blood is?
This uneven growth leads to a ?
In the course of pregnancy, the volume of blood is increased by as much as 40-45%, and the mass of erythrocytes by 18-25%.
This uneven growth leads to a decrease in hematocrit and the occurrence of anemia.
Prader-Willi syndrome
is a multisystemic congenital disease, associated with genetic imprinting.
The cause of the syndrome is the deletion of a Chromosome 15 fragment from the father. In the clinical picture during the neonatal period, hypotonia, lack of sucking reflex (hence feeding problems) dominate, while starting at the age of 2 years the phenotype is dominated by increased appetite, which results in the rapid development of obesity.
There is also hypogonadism and intellectual disability.
Prader-Willi syndrome.
Characteristic features of the syndrome
short stature, small hands and feet, facial dysmorphia (amygdala eyelids, narrow upper lip, small lips, hypopigmentation of the skin and hair) and behavioral disorders (in this patient it may be skin picking).
All these features speak for Prader-Willi syndrome.
Klinefelter syndrome characterized by
delayed puberty - the most common cause of hypergonadotrophic hypogonadism.
Other symptoms include tall stature, female physique, gynecomastia, no voice mutation, and erection problems.
Alström syndrome
is a rare genetic disease.
The disease is caused by an autosomal recessive inherited mutation in the ALMS1 gene located on Chromosome 2.
The main disorder is congenital retinal dystrophy which causes blindness, deafness and obesity.
Photophobia and nystagmus are most commonly seen as the first symptoms of the syndrome. There is no reduced muscle tone or feeding problems.
Carpenter syndrome
is one of the forms of APS-2,
i.e. polyglandular (hypofunction) autoimmune syndrome type 2.
It consists of: primary hypoadrenocorticism, autoimmune thyroid disease and type 1 diabetes. It manifests most often at the age of 20-40.
The first node to drain the lymph from the tumor is called?
the sentinel node
Invasive breast cancer can also spread through the so-called?
Rotter route,
i.e. the intermuscular route, then it metastases directly to the second and third degree axillary nodes
The most common type of malignant breast cancer?
common location?
is adenocarcinoma,
its most common location is the superior external quadrant.
The two main types of adenocarcinomas are:
Ductal cancer - which occurs in the cells lining the milk ducts of the breast (as in the case of the patient in the question)
lobular carcinoma - arising in the cells of the mammary glands.
Malignant Primary
Germ Cell Tumors
name 6
Dysgerminoma
Yolk sac tumor
Embryonal carcinoma
Polyembryoma
Nongestational choriocarcinoma
Mixed germ cells
Biphasic or Triphasic
Teratomas
name 2
Immature teratoma
Mature teratoma
Monodermal Teratomas and
somatic-type Tumors
associated with Dermoid Cysts
Name 6
Thyroid tumor
Struma ovarii
Carcinoid
Neuroectodermal-type tumors
Glioblastoma
Melanoma
treatment of stress urinary incontinence (SUI) is
duloxetine.
Duloxetine (similar to venlafaxine) belongs to the drug group of ___and ___-
MOA?
Duloxetine (similar to venlafaxine) belongs to the drug group of serotonin and noradrenaline reuptake inhibitors (SNRIs).
The proposed mechanism for its action is probably the increase in bladder capacity and contractility of the urinary sphincter (via the noradrenergic mechanism -> α1-adrenergic and serotonin stimulation -> stimulation of 5HT2 receptors in the pudendal nerve).
Clinical studies have shown it is highly effective compared to placebo groups. The recommended dose is 40 mg/day.
However, application in depression and anxiety disorders, as well as neuropathic pain in the course of diabetes, remain the main indications for duloxetine.
Other groups of drugs used in the treatment of stress urinary incontinence include:
estrogens, α2-adrenergic agonists, cholinolytics (e.g. oxybutynin).
test interpretation
down syndrome
low AFP, low estriol, increased hCG
test interpretation
Edwards syndrome
low AFP, low estriol, low hCG
Test interpretation
neural tube defects
high concentration of AFP
malignant non-epithelial tumors of the ovary
Germinal tumors:
name 7
dysgerminoma
yolk sac tumor
embryonic tumors
polyembryoma
choriocarcinoma
teratomas: immature & mature
mixed germinal tumors
malignant non-epithelial tumors of the ovary
Gonadal tumors:
name 5
- folliculoma*
- thecoma*
- fibroma*
- Sertoli and Leydig cell tumors*
- mixed tumors*
Hormonal changes in polycystic ovary syndrome (PCOS):
↑ LH secretion ->
↑ LH secretion → stimulation of theecal cells → ↑ androgen production
Hormonal changes in polycystic ovary syndrome (PCOS):
↑ androgen levels →
↑ androgen levels → dysfunction of the hypothalamic-pituitary-ovarian axis → ↑ pulsatile GnRH secretion → ↑ LH levels → premature follicular maturation → premature estradiol peak → FSH inhibition → ↓ FSH levels
Hormonal changes in polycystic ovary syndrome (PCOS):
LH: FSH ratio?
ratio> 2
Hormonal changes in polycystic ovary syndrome (PCOS):
increased aromatization of androgens →
increased aromatization of androgens → relative hyperestrogenism
Mitochondrial diseases include:
Name 9
A syndrome of chronic progressive external ophthalmoplegia,
Kearns-Sayre syndrome
Mitochondrial encephalomyopathy syndrome involving the nervous system, stomach and intestines,
Pearson’s marrow-pancreas syndrome
Myoclonic epilepsy with ragged red fibers in the muscles (MERRF syndrome)
MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, occurrence of stroke-like incidents)
Leber’s hereditary neuropathy of optic nerve,
Neurogenic myopathy with ataxia and retinal pigment degeneration,
Aplastic anemia caused by chloramphenicol
Kearns-Sayre syndrome
Kearns–Sayre syndrome (KSS), oculocraniosomatic disorder or oculocranionsomatic neuromuscular disorder with ragged red fibers is a mitochondrial myopathy with a typical onset before 20 years of age.
KSS is a more severe syndromic variant of chronic progressive external ophthalmoplegia (abbreviated CPEO), a syndrome that is characterized by isolated involvement of the muscles controlling movement of the eyelid (levator palpebrae, orbicularis oculi) and eye (extra-ocular muscles). This results in ptosis and ophthalmoplegia respectively.
KSS involves a combination of the already described CPEO as well as pigmentary retinopathy in both eyes and cardiac conduction abnormalities. Other symptoms may include cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism, and other endocrinopathies. In both of these diseases, muscle involvement may begin unilaterally but always develops into a bilateral deficit, and the course is progressive. .
The Lust sign
is one of the symptoms characteristic of tetany.
In order to observe it, you should hit a neurological hammer in the region of the common peroneal nerve.
We can consider it as positive if there is sagittal muscle contraction and abduction of the foot.
Landau reflex
appears at around 5 months of age and disappears up to 3 years old.
It is examined as follows - the child should be held in the air facing the ground - the reflex can be considered present if the child lifts his head up, then bends his back and straightens the lower limbs in the hip joints.
Levine’s sign means
showing the clenched fist on the sternum depicting the feeling of tightening while the patient describes the symptoms of angina pectoris.
Laseque sign
is the inability to raise the lower limb in a lying position. Its presence indicates the compression of the sciatic nerve.
The test is performed in a lying position on the back, the person examining lifts the lower limb of the patient by bending it in the hip joint.
The occurrence of non-physiological pain (should be distinguished with pain associated with muscle contraction!) Indicates a positive sign
Leigh syndrome
(also called Leigh disease and subacute necrotizing encephalomyelopathy) is an inherited neurometabolic disorder that affects the central nervous system.
Normal levels of thiamine, thiamine monophosphate, and thiamine diphosphate are commonly found but there is a reduced or absent level of thiamine triphosphate. This is thought to be caused by a blockage in the enzyme thiamine-diphosphate kinase, and therefore treatment in some patients would be to take thiamine triphosphate daily.
With Leigh’s name you should associate Leigh disease, or necrotic subacute encephalopathy caused by mutations in mitochondrial DNA
pancreatic neuroendocrine tumor - VIP-oma
→ severe diarrhea is typical, leading to electrolyte disturbances in the patient, such as hypochloridia, hypokalemia with arrhythmias and asthenia, non-respiratory acidosis.
pancreatic neuroendocrine tumor - glucagonoma
→ it is a tumor originating from pancreatic alpha cells and secreting glucagon. Symptoms are related to the hormone secreted and include diabetes mellitus, weight loss, mucositis, diarrhea, anemia, necrolytic migratory erythema.
. pancreatic neuroendocrine tumor - insulinoma
→ it is a neoplasm originating from β cells of the pancreatic islets. It secretes insulin, and therefore in the course of this cancer, we can expect hypoglycemic episodes in the patient and the associated disturbances of consciousness and behavior.
pancreatic neuroendocrine tumor - gastrinoma
→ a tumor that secretes gastrin, which stimulates the production of gastric juice. The symptoms cause Zollinger-Ellison syndrome.
normospermia include:
ejaculate volume: 1.5-6ml
sperm concentration: 15-250mln / ml
motility: Type A and B (progressive, rapid and slow motion)> 32%
morphology: > 4% sperm with normal structure
viability: > 58% live sperm.
Aspermia -
decreased volume of ejaculate: 0-0.5ml
Oligospermia -
reduced sperm count <15ml / ml
Asthenozoospemia -
decreased sperm motility <32% shows progressive movement
Teratozoospermia -
abnormal sperm morphology: <4% sperm with normal structure.
Cancer of the vulva:
Accounts for what %
accounts for 3-8% of all malignant neoplasms of female genital organs
more than 50% of cases are diagnosed after the age of 70.
Cancer of the Vulva:
There are 2 precancerous states
hyperplastic lichen sclerosus (precedes keratotic cancer)
VIN (vulvar intraepithelial neoplasia) (precedes squamous cell carcinoma associated with HIV infection)
Cancer of the Vulva:
histological types
squamous cell carcinoma (90%)
Bartholin gland cancer
basal cell carcinoma
adenocarcinoma
melanoma
sarcomas
metastatic tumors
Cancer of the Vulva:
risk factors
lichen sclerosus of the vulva
intraepithelial neoplasia (VIN)
a large number of sexual partners
early age of sexual intercourse
HIV and HPV infection
nicotinism
low socioeconomic status
Cancer of the Vulva:
treatment
surgery
radiotherapy
chemotherapy
the most common method is radical vulvectomy with inguinal lymph nodes removal
in the case of inoperable neoplasms, systemic treatment and/or radiotherapy are used
Cancer of the Vulva:
prognosis
tumor recurrences occur in up to 30% of patients
five-year survival of patients with stage FIGO I vulvar cancer is 98%, FIGO II- 85%, FIGO III- 74%, FIGO IV- 31%
Mechanism of action of the estrogen component:
- FSH suppression*
- inhibiting the selection and growth of the dominant follicle*
- prevention of bleeding*
- intensification of progestational activity*
Mechanism of action of the gestagen component:
LH suppression
effect on the endometrium
thickening of cervical mucus
effect on the fallopian tubes
menometrorrhagia
- abundant, irregular, prolonged bleedings, linked to an increase estrogens blood concentration, particularly in the perimenopausal period
hypermenorrhoea
- blood loss >100 ml
hypomenorrhoea
- blood loss <30 ml
dysmenorrhoea
- severe pain in perimenstrual period and during bleeding itself
algomenorrhoea
- menstrual pains are accompanied by vegetative symptoms
metrorrhagiea
- abundant, prolonged bleedings not on the time of expected menstruation
- juvenilis - acyclic bleeding in young women >10 days
- -climacteria* - bleeding in a woman 6-12 months after menopause
menorrhagia
- regular, cyclic, abundant, prolonged bleeding in menstruation time
amenorrhoea intermittens
- rare bleedings in intervals lasting from 43 days to 6 months, most often, but not always, are anovulatory cycles and typically occur in women with polycystic ovary syndrome.
Definition
Endometriosis
- the occurrence of the endometrium (glandular cells and stroma) outside the uterine cavity.
Endometriosis
Surgical Treatment options:
- removal of isolated foci
- removal of endometrial cysts
- removal of the entire ovary
- removal of the entire uterus with adnexa
Endometriosis
Pharmacological Tx options:
-
hormonal therapy:
- gonadoliberin analogs (goserelin) and their antagonists, e.g. danazole
- progesterone preparations (dienogest , progesterone)
- estrogen-progesterone preparations
- intrauterine device with levonorgestrol
- aromatase inhibitors
- selective progesterone receptor modulators (SPRMs)
- painkillers:
- NSAIDs
Symptoms
Endometriosis Symptoms
- restriction of fertility.
- lower pelvic pain syndrome, painful examination, and nodular lesions palpable in the projection of the uterosacral ligaments.
- painful menstruation (dysmenorrhoea), pains start a few days before the onset of menstruation
- dyspareunia.
- enlarged, tender, poorly mobile appendages.
Name 3 drugs
Dopamine D2 receptor agonists
(bromocriptine, quinagolide, cabergoline)
Dopamine D2 receptor agonists (bromocriptine, quinagolide, cabergoline) are used for:
Treatment of Pituitary tumors producing Prolactin
Dopamine is a neurotransmitter responsible for:
- motor drive
- emotional processes
- hormone secretion
The hormonal effect of dopamine is
antagonistic to prolactin → hence the other name for dopamine (prolactostatin). Dopamine agonists cause an increase in dopamine secretion, thereby enhancing its prolactin antagonism.
- Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) → ↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia.
Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) →
↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia
in the diagnosis of hyperprolactinemia-what is used as a functional test →
- metoclopradmide is used as the functional test.
Metoclopramide acts as a dopamine receptor?
MOA
Metoclopramide acts as a dopamine receptor antagonist→ action, ↑ stimulates prolactin secretion
Physiological changes in the circulatory system during pregnancy?
- ↑ cardiac output and increase in sodium and water retention → ↑ blood volume → ↓ peripheral vascular resistance → ↓ blood pressure (most prominent in the 2nd trimester)
- displacement of the apex of the heart upwards and to the left (lifting the diaphragm by the enlarging uterus)
- increase in heart size by about 12%
- ↑ blood volume
- I trimester: ↑ volume by approx. 10-15%
- maximum volume is reached at 28-34. week of pregnancy (increase by 40-45% compared to the state before pregnancy)
- ↑ red blood cell mass: by 20% (Bręborowicz 2010), by 30% (Bręborowicz 2015)
- mean value of hemoglobin in women at delivery - 12.5 g/dl
- pathological anemia is diagnosed at hemoglobin concentration <11 g/dl
- increased erythropoiesis → ↑ reticulocyte count
- ↑ stroke volume
- I trimester: ↑ by 30-40%
- the maximum value is reached about 20 tc
- ↑ cardiac output (cardiac output) by 30-50%
Define
Acute pyelonephritis
is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems
Define
Acute pyelonephritis
is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney.
Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems
Define
- also known as 46, XY complete (pure) gonadal dysgenesis (CGD), is a rare congenital disorder of sex development. It is characterized by the failed development of the sex glands (i.e. testicles or ovaries)
- have an XY genetic makeup, or genotype, but develop a vagina, uterus, and Fallopian tubes instead of a penis and scrotum.
- because dysgenetic gonads do not secrete testosterone (hypogonadism) nor anti-Müllerian hormone, Müllerian ducts’ derived organs develop (female)
- is characterized by a female phenotype , female internal sexual organs , normal or high growth, sexual infantilism and primary amenorrhea
Granulosa cell tumor
ex?
Belongs to?
Folliculoma:
- belongs to the gonadal tumors of the ovary
- it can occur in women of any age (only 5% are diagnosed before puberty)
- most often it occurs unilaterally (only 2% of tumors are bilateral)
granulomas secrete?
estrogens and inhibin
Folliculoma symptoms
- premature puberty in girls
- change in the nature of menstruation (irregular, heavy)
- coexistence of hyperplasia (25-50%) or endometrial cancer (5%)
- ascites (10%)
- symptoms of “acute abdomen” due to tumor rupture
- premature puberty, change in the nature of menstruation and coexisting endometrial hyperplasia result from increased estrogen levels (granulomas secrete estrogens and inhibin)
- determination of inhibin concentration is useful in monitoring treatment and detecting relapses
malignant non-epithelial tumors of the ovary
Gonadal tumors
Name 5
- folliculoma
- thecoma
- fibroma
- Sertoli and Leydig cell tumors
- mixed tumors
malignant non-epithelial tumors of the ovary
Germinal tumors
Name 7
- dysgerminoma
- yolk sac tumor
- embryonic tumors
- polyembryoma
- choriocarcinoma
- teratomas
- immature
- mature
- mixed germinal tumors
Explain CTG-Fetal
CTG:
Acceleration- explain
-
short-term, transient FHR acceleration by at least 15 beats per minute, lasting 15 seconds or longer
- periodic
- episodic
Explain CTG-Fetal
CTG
Deceleration - explain
short-term slowdown of the basic FHR by at least 15 beats per minute, lasting 10 seconds or longer
- early - the effect of central stimulation of the X nerve by compression of the head in the birth canal (Gaussian reflex)
- late
- variable
- complex
Define
Hypothalamic-pituitary insufficiency:
(classification, takes form of, causes)
- in the classification of menstrual disorders according to WHO, it is classified as group I
- takes the form of hypogonadotrophic hypogonadism
- There are pituitary and hypothalamic causes
causes of hypothalamic-pituitary insufficiency
Hypothalamic:
Congenital-name 3
- Kallmann’s syndrome
- isolated hypogonadotrophic hypogonadism
- GnRH receptor mutation
causes of hypothalamic-pituitary insufficiency
Hypothalamic:
Acquired- name 3
- functional hypothalamic amenorrhoea - FHA
- hypothalamic psychiatric amenorrhea
- organic hypothalamic amenorrhea (post-traumatic or inflammatory tumors, damage to the hypothalamic-pituitary area)
causes of hypothalamic-pituitary insufficiency
Pituitary:
Name 4
- post-traumatic or post-inflammatory tumors, damage to the hypothalamic-pituitary area
- Sheehan’s syndrome
- empty saddle syndrome
- lymphocytic pituitary inflammation
diagnostics of hypogonadotrophic hypogonadism
Symptoms
- congenital and pre-pubertal disorders: primary amenorrhea, failure to develop secondary sex characteristics
- disorders acquired after puberty: secondary amenorrhea, presence of secondary sex characteristics
diagnostics of hypogonadotrophic hypogonadism
Hormone concentration
↓ levels of FSH, LH and estradiol
diagnostics of hypogonadotrophic hypogonadism
progesterone test ?
estrogen-progesterone test ?
negative
Positive
diagnostics of hypogonadotrophic hypogonadism
gonadoliberin test ?
- positive for hypothalamic disorders
- negative in the case of pituitary disorders
The disulfiram-like reaction?
- symptoms induced by alcohol consumption resulting from the aldehyde dehydrogenase block, which results in the accumulation of toxic acetaldehyde.
- The name comes from ‘disulfiram’, a drug used to treat alcoholism.
- It blocks the aldehyde dehydrogenase
In the disulfiram-like reaction -
In the disulfiram-like reaction -
Symptoms:
- vasodilation (facial redness)
- hypotension
- increased heart rate
- excessive sweating
- breathing disorders
- dyspnea
- nausea
- vomiting
- anxiety
In the disulfiram-like reaction -
Description:
Long list of drugs with a disulfiram-like effect includes?
which we use to treat?
metronidazole
-which we use to treat genital infections
e.g. T. vaginalis infection and bacterial vaginosis.
Drug TX
Drug treatment of urinary tract infections in pregnant or lactating women:
“NAAC” most common
- nitrofurantoin
- furazidine - do not use in the first trimester of pregnancy
- co-trimoxazole
- trimethoprim
- fosfomycin (cat. B)
- amoxicillin (cat. B)
- amoxicillin with clavulanate (cat. B)
- cephalexin (cat. B)
- ampicillin
- cefuroxime (cat. B)
Drug TX
Pregnant women should not use:
name 5
“My TTSF”
- Tetracyclines (damage fetal teeth and bones)
- Trimethoprim (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus)
- Sulfamethoxazole (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice)
- Fluoroquinolones (completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)
- Macrolides (should not be used as first-line drugs).
define
The triple marker?
test is a non-invasive test that assesses AFP, hCG and estriol in mother’s blood serum between weeks 14 and 20 of pregnancy
Due to the low sensitivity (65%) and the late diagnostic period, it is used less frequently than the double test.
The double test?
- is a non-invasive test carried out between 11 and 14 weeks of pregnancy
- It evaluates 2 biochemical markers:
pregnancy plasma protein (PAPP-A) and placental gonadotropin (hCG)
-It is characterized by early diagnosis and high sensitivity (95%).
The basic parameters assessed in the spermiogram are:
name 10
- Ejaculate volume (N >1.5 ml)
- Total sperm count (N >39 x 10^6/ejaculate)
- Sperm concentration (N >15x10^6/ml)
- Total sperm motility (N >40%)
- Progressive movement of spermatozoa (N >32%)
- Vitality (live spermatozoa) (N >58%)
- Percentage of sperm with normal morphology (N >4%)
- pH (N ≥7.2)
- Liquefaction time of the ejaculate (N <60 min.)
- Presence of leukocytes (N <1x10^6/ml) and erythrocytes (N =none)
Nomenclature related to semen quality:
Teratozoospermia
- - Spermatozoa percentage with normal morphology below 4%
Nomenclature related to semen quality:
Asthenozoospermia
- Percentage of progressively motile (PR) spermatozoa below <32%
Nomenclature related to semen quality:
Asthenoteratozoospermia
- Sperm percentage with progressive movement <32% and normal morphology <4%
Nomenclature related to semen quality:
Azoospermia -
- No sperm in ejaculate
Nomenclature related to semen quality:
Cryptozoospermia -
- Spermatozoa absent from fresh preparations but observed in a centrifuged pellet
Nomenclature related to semen quality:
Hemospermia (hematospermia) -
- The presence of erythrocytes in the semen
Nomenclature related to semen quality:
Leukospermia (leukocytospermia, pyospermia) -
- The presence of leukocytes in the ejaculate above the limit value (N = <1x10^6/ml)
Nomenclature related to semen quality:
Necrosoospermia -
- A low percentage of live, and high percentage of immotile, spermatozoa in the ejaculate
Nomenclature related to semen quality:
Oligozoospermia -
- Total sperm count below 39x10^6/ejaculate
Nomenclature related to semen quality:
Aspermia -
- No semen due to lack of ejaculation or retrograde ejaculation
TX Meds
What is the “golden standard” for ovarian cancer
- The combination of carboplatin and paclitaxel
%of cases, location, TX,
Recurrences of ovarian cancer:
- Despite the high sensitivity to chemical treatment of ovarian cancer, in about ¾ cases it recurs
- The recurrence usually occurs again in the abdomen and is often multifocal
- The basic method of treatment of recurrent ovarian cancer is chemotherapy. It is usually used as palliative treatment
- Due to the usually diffuse nature of the disease, radiotherapy does not allow to effectively destroy all foci of the disease.
Fetus lie (situs)
- the relation of the long axis of the fetus to the long axis of the uterus and the birth canal
- longitudinal
- transverse
- oblique
Fetal position (positio)-
- the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal
- position I - spine (head) on the left side of uterus
- position II - spine (head) on the right side of uterus
Fetal attitude (habitus)-
- the relation between the parts of the fetus
- flexed
- extension
Insertion (immissio) -
- relation of the leading part to the interspinal line
The most important systemic changes in the course of pregnancy:
cardiovascular system:
- increase in the output and the heart rate
- reduction of peripheral resistance
- increase in stroke volume
- decrease in blood pressure
-
increase in blood volume:
- 40-45% compared to a non-pregnant woman
- about 50% (the word “about” suggests that the maximum increase in blood volume is even more than 50%) in relation to the pre-pregnancy value
- by 40% compared to non-pregnant women
- decrease in hematocrit, hemoglobin, platelets,
The most important systemic changes in the course of pregnancy:
coagulation system:
- acceleration of blood coagulation
- increase in concentration of most coagulation factors
- increased tendency to thrombi
The most important systemic changes in the course of pregnancy:
respiratory system:
- increased infrasternal angle
- the diaphragm is raised by 4 cm
- increased lateral dimension of chest
- increased circumference of chest
- respiratory rate, vital capacity (VC) of the lungs do not change
- increased tidal volume (TV)
- decreased total lung capacity (TLC)
- alveolar ventilation increases by 70%
- reduction of resistance in the airways
- swelling of the mucosa of upper respiratory tract and greater predisposition to nosebleeds
The most important systemic changes in the course of pregnancy:
urinary tract:
- increase the length and volume of the kidneys
- widening of the kidney calyces
- swelling of the mucous membrane of the bladder
- reduction of bladder capacity
- widening of the ureters
- greater risk of acute pyelonephritis
- increased renal perfusion and GFR (even by half)
- higher frequency of urination
- reduction in creatinine
- reduction in Na + and K + concentrations
- reduction in reabsorption of some substances from the urine (eg glucose)
The most important systemic changes in the course of pregnancy:
digestive system:
- heartburn
- change in the oral flora, but the increase in the incidence of caries is debatable
- constipation
- hemorrhoids
- dilation of the portal vein
- increase in ALP
- decrease in GGTP
- reduced gallbladder contractility - increased risk of urolithiasis
The most important systemic changes in the course of pregnancy:
endocrine system:
- goiter
- increase in T4 and T3 concentrations
- decrease in TSH
- 3-fold enlargement of the pituitary gland
- increased concentration of PRL and MSH
- increase in RAA activity and cortisol productio
The most important systemic changes in the course of pregnancy:
musculoskeletal system:
- Increasing the mobility of joints and pelvis cartilage
- increase in lumbar lordosis and thoracic kyphosis
The most important systemic changes in the course of pregnancy:
eye:
- lowered intraocular pressure
- thickening of the cornea
- problems with accommodation
The most important systemic changes in the course of pregnancy:
metabolism:
- additional energy expenditure
- hypertrophy of pancreatic islets
- increased insulin secretion
- insulin resistance
- postprandial hyperglycemia
- fasting hypoglycemia
- positive nitrogen balance
- increased concentration of proteins in the blood
- increase in total cholesterol, phospholipid and TAG concentrations
- increase in leptin concentration
- increased appetite
- water accumulation
The most important systemic changes in the course of pregnancy:
uterus:
- increase in blood flow
Polycystic ovary syndrome is:
known as / characterized by / excessive production of ?
(PCOS - polycystic ovary syndrome), also known as the the Stein-Leventhal syndrome is characterized by menstrual disturbances, infertility and androgenization.
It affects 4-12% of women of childbearing age, can run in families. The underlying disorder is excessive LH secretion, which leads to stimulation of tissue cells to increase androgen production.
To diagnose PCOS it is necessary to meet min. 2 of 3 Rotterdam criteria:
To diagnose PCOS
2 of 3 Rotterdam criteria:
- oligomenorrhoea or amenorrhoea
- clinical and / or biochemical features of hyperandrogenism
- image of polycystic ovaries on ultrasound:
- > 12 follicles in the ovary and / or
- ovarian volume> 10 mlTo diagnose PCOS it is necessary to meet min. 2 of 3 Rotterdam criteria:
- oligomenorrhoea or amenorrhoea
- clinical and / or biochemical features of hyperandrogenism
- image of polycystic ovaries on ultrasound:
- > 12 follicles in the ovary and / or
- ovarian volume> 10 ml
Polycystic ovary syndrome (PCOS - polycystic ovary syndrome)
Laboratory tests:
- ↑ LH concentration
- LH: FSH ratio> 2
- ↑ testosterone levels (total and free) and androstenedione
Polycystic ovary syndrome (PCOS - polycystic ovary syndrome)
symptoms:
- menstrual disorders (oligomenorrhoea or amenorrhoea)
- hyperandrogenization (acne, hirsutism, alopecia)
- overweight and obesity
- hyperinsulinemia, insulin resistance, type 2 diabetes
- sterility
Polycystic ovary syndrome (PCOS - polycystic ovary syndrome)
Complications:
- hypertension
- increased risk of cardiovascular disease
- 3-fold increase in the risk of endometrial cancer (PCOS is a state of relative hyperestrogenism due to insufficient progesterone synthesis due to lack of ovulation)
PCOS does not affect the incidence of breast and rectal cancers
Neoplastic ovarian tumours
tumors producing steroid hormones:
- name hormones -4*
- name tumors-6*
Hormones:
estrogens, testosterone, androstendione, DHEA
Tumors include:
dysgerminoma, embryonal carcinoma, immature teratoma, gonadoblastoma, foliculliculoma, Sertoli-Leydig cell tumor.
Neoplastic ovarian tumours
Germ cell tumors
arise from?
Name 7
(arise from multipotent reproductive cells or stem cells present in the ovary):
- Dysgerminoma
- Embryonal carcinoma
- Immature teratoma
- Choriocacrinoma
- Endodermal sinus tumor; Yolk sac tumor
- Gonadoblastoma
- Polyembryoma
Neoplastic ovarian tumours
Gonadal tumors
arise from?
Name 4
(arise from sex cords and ovarian stroma, produce steroids):
- Thecofibroma
- Folliculoma - (also called granulosa cell tumor)
- Sertoli-Leydig cell tumor - a tumor from Sertoli and Leydig cells
- Androblastoma
serious complications in the newborn and child:
Sabin-Pinkerton’s triad due to?
name:
- retinitis and chorioretinitis
- intracranial calcifications
- microcephaly or hydrocephalus
Toxoplasmosis during pregnancy:
Definition
Kallmann’s syndrome
- genetic disorder that prevents a person from starting or fully completing puberty.
- Kallmann syndrome is a form of a group of conditions termed hypogonadotropic hypogonadism.
- Kallmann syndrome has the additional symptom of a total lack of sense of smell (anosmia) or a reduced sense of smell
- If left untreated, people will have poorly defined secondary sexual characteristics, show signs of hypogonadism, almost invariably are infertile and are at increased risk of developing osteoporosis
Definition
Sheehan’s syndrome
- is postpartum pituitary necrosis caused by perinatal hemorrhagic shock.
- The most characteristic symptom is the lack of lactation resulting from a sudden decrease in the secretion of prolactin by the pituitary gland
- Other symptoms of this syndrome include: no return of menstruation after delivery, secondary adrenal and thyroid insufficiency - they develop gradually over many months.
Definition
Couvelaire syndrome
(uteroplacental stroke) is a rare, life-threatening complication of pregnancy in which the detachment of the placenta is accompanied by an infiltration of the uterine muscle with blood that almost reaches the serosa.
Definitoin
The Mayer-Rokitansky-Küster-Hauser
- syndrome is a congenital syndrome characterized by aplasia of structures originating in the Muller’s ducts, i.e. the uterus and vagina.
- Primary amenorrhea is the most common cause of medical reports
Definition
Asherman’s syndrome
- is adhesions in the uterine cavity that completely or partially close its lumen.
- This is manifested by either little or no bleeding.
- The most common causes of Asherman’s syndrome are: curettage of the uterine cavity, endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.
Anti-RhD immunoglobulin is given
How?
intramuscularly to a RhD-negative women in less than 72 hours
Anti-RhD immunoglobulin is given intramuscularly to a RhD-negative women in less than 72 hours:
- delivery was physiological
- delivery was pathological
Provide dose:
a. 150 μg, if the delivery was physiological,
b. 300 μg, if the delivery was pathological, e.g. Caesarean section, delivery of a dead fetus or multiple pregnancy, using Crede’s method or manual extraction of the placenta.
Dose
After spontaneous miscarriage or termination of pregnancy, invasive prenatal diagnosis (amniocentesis, chorion biopsy, cordocentesis), removal of ectopic pregnancy, in the case of a threatened miscarriage or preterm delivery, with bleeding from the genital tract and after external cephalic version:
a. 50 μg until the 20th week of pregnancy,
b. 150 μg after the 20th week of pregnancy.After the birth of a RhD-positive child:
Definition and who is affected
Endometrial cancer
- belongs to the most common malignancies affecting women and is simultaneously the most common gynecological cancer (except for breast cancer).
- Postmenopausal women are typically affected. The exact etiology of this disease is still unknown, but it is known to be closely related to hyperestrogenism (especially unopposed by progestins).
Known risk factors for endometrial cancer
Known risk factors for endometrial cancer include:
- Metabolic syndrome and its components (overweight, obesity, diabetes, dyslipidemia)
- Tamoxifen (drug used in breast cancer)
- Polycystic ovary syndrome
- The single-use of estrogens unopposed by progestins in hormone replacement therapy or contraception
- Early first menstruation and/or late menopause
- Nulliparity, infertility
- Low physical activity
- Estrogen-producing tumors
- Liver failure (impaired estrogen metabolism)
- Genetic conditions (mutations of the PTEN, P53, HER2/neu genes)
Factors that reduce the risk of endometrial cancer
Factors that reduce the risk of endometrial cancer include:
- Smoking
- Multiparity
- The use of combined therapy of progestins and estrogen in contraception and hormone replacement therapy
- Late first menstrual period and/or early menopause
- Acetylsalicylic acid intake
Histological types of endometrial cancer:
- Type I - is the most common (80%), estrogen-dependent type of adenocarcinoma. It is characterized by slow progression and good prognosis
- Type II - is unrelated to hyperestrogenism, progresses aggressively and has a poor prognosis.
- delivery was physiological
- delivery was pathological
Provide dose:
a. 150 μg, if the delivery was physiological,
b. 300 μg, if the delivery was pathological, e.g. Caesarean section, delivery of a dead fetus or multiple pregnancy, using Crede’s method or manual extraction of the placenta.
classification of endometrial cancer stages FIGO classification
classification of endometrial cancer stages
Stage 1
Endometrial cancer IA No infiltration or infiltration ≤50% of the thickness of the
myometrium IB Infiltration >50% of myometrium thickness
classification of endometrial cancer stages FIGO classification
classification of endometrial cancer stages
Stage 2
- *Infiltration of the cervical stroma but does not extend outside the**
- *uterus**
classification of endometrial cancer stages FIGO classification
classification of endometrial cancer stages
Stage 3
Local and regional infiltration IIIA Infiltration of the uterine serum and/or adnexa IIIB Vaginal or parametrial involvement IIIC1 Pelvic lymph node involvement IIIC2 Para-aortic lymph node involvement
classification of endometrial cancer stages FIGO classification
classification of endometrial cancer stages
Stage 4
Infiltration of the bladder and/or rectal mucosa and/or distant
metastases IVA Infiltrate the bladder and/or rectal mucosa IVB Distant metastases (including metastases to inguinal lymph
nodes)
Dimensions of the fetal head:
What are the Dimensions of the fetal head:
- Dimensions:
- diameter suboccipitobregmaticus: 9.5 cm
- diameter frontooccipitalis: 12 cm
- diameter mentooccipitalis: 13.5 cm
circumferences of the fetal head:
- Circumferences:
- suboccipitobregmatic: 32 cm (it is the most advantageous circumference for passing through the small pelvis)
- occipitofrontal: 34 cm
- occipitomental: 35 cm
definition
Premature thelarche
development of small amount of breast tissue (typically 1” or less across), typically before the age of 3 years.
The breasts do not get larger and the girl does not have a growth spurt
Premature puberty (pubertas praecox)
Tertiary sexual characteristics appear before the age of 8.
The pathomechanism is associated with too early central GnRH secretion.
The clinical picture includes:
- premature development of mammary glands
- increased pigmentation of the nipple
- premature development of pubic and axillary hair
- swelling, thickening and bruising of the hymen
GnRH analogues are used in the treatment
Definition
delayed puberty:
Conditions that can lead to this include?
when menarche does not occur until the age of 16, or until the age of 14,
there are no signs of mammary gland development.
States that can lead to this include:
- Gonadal dysgenesis
- Congenital adrenal hyperplasia
- Polycystic ovary syndrome
- Androgen insensitivity syndrome
Define
Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome
TX and Procedures include ?
- is a defect in the inborn absence of the uterus and vagina.
- Surgical treatment :* creating a vagina to enable the patient to have sexual intercourse
Procedures include:
- vaginoplasty
- traction methods (e.g. Veccheti’s method)
- vulvovaginoplasty
Causes:
Recurrent miscarriages
Causes of recurrent miscarriages include:
- Anatomical factors (uterine fibroids, intrauterine adhesions, birth defects)
- Corpus luteum dysfunction
- Antiphospholipid syndrome
- Thyroid dysfunction
- Diabetes mellitus
Definition
Antiphospholipid syndrome (APS)
- sometimes known as Hughes syndrome
Antiphospholipid Syndrome (APS) is an autoimmune disorder associated with the presence of antiphospholipid antibodies, which include:
- anti-cardiolipin antibodies
- antibodies against β2-glycoprotein I
- lupus anticoagulant
- disorder of the immune system that causes an increased risk of blood clots:
Conditions:
- DVT (deep vein thrombosis, a blood clot that usually develops in the leg
- arterial thrombosis (a clot in an artery), which can cause a stroke or heart attack
- blood clots in the brain, leading to problems with balance, mobility, vision, speech and memory
Antiphospholipid syndrome (APS)
TX and time of occurrence?
Most miscarriages in women with APS occur in the first trimester of pregnancy.
Treatment:
- The recommended therapy for pregnant women with APS consists of acetylsalicylic acid and heparin, which increases the chance of giving birth to a healthy child.
The occurrence of endometriosis should be taken into account in the following conditions:
- Reduced fertility,
- Pelvic pain syndrome
- Painful menstruation
- Pain complaints related to intercourse (dyspareunia)
definition
Bacterial vaginosis (BV)
- vaginal infection caused by a disturbed natural balance between bacterial populations.
- The lactobacilli are gradually replaced by pathogenic strains:
Gardnerella vaginalis, Mobiluncus, Bacteroides, Prevotella, Mycoplasms.
Amsel criteria
helpful in diagnosing bacterial vaginosis (BV): (3 out of 4 criteria must be met)
- homogeneous, white and gray vaginal discharge
- vaginal pH > 4.5
- fishy odor, increased after sexual intercourse and after alkalising vaginal secretion with 10% potassium hydroxide (KOH)
- clue cells under the microscope (clue cells are epithelial cells coated with bacteria)
Bacterial vaginosis (BV)
BV treatment:
- Metronidazole (the first-line drug)
- clindamycin
Risk factors for endometrial cancer:
- hyperestrogenism, e.g. PCOS, childlessness, long menstrual period, use of tamoxifen, hormonally active ovarian tumors
- taking estrogens without balancing action of the gestagens,
- obesity
- hypertension
- diabetes
- mutations in DNA repair genes (Lynch syndrome- lifetime risk is 30-60%)
- early menarche
- late menopause
- infertility or the birth of only one child
Factors that may reduce the risk of endometrial cancer:
- oral contraceptives with two-component preparations
- multiparous
- smoking (leads to earlier menopause, which reduces the risk of disease)
- taking aspirin
Definition
Choriocarcinoma
Choriocarcinoma is a malignant, gestational trophoblastic cancer, usually of the placenta.
- It is characterized by early hematogenous spread to the lungs.
- It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD).
It is also classified as a germ cell tumor and may arise in the testis or ovary.
Definition
MENORRHAGIA
that is, prolonged heavy menstrual bleeding regularly occurring, volumetric symptoms - pollakiuria resulting from pressure on the bladder and pain.
Definition
Polyuria
Excessive urine production
- Adults usually make about 3 liters of urine per day
- polyuria- up to 15 liters per day
- classic sign of diabetes
Define/Symptoms
Uterine fibroids
- are the most common tumors of the female genital organs
-Symptoms:
MENORRHAGIA - that is, prolonged heavy menstrual bleeding regularly occurring, volumetric symptoms - pollakiuria resulting from pressure on the bladder and pain
-profuse acyclic uterine bleeding (metrorrhagia), frequent urge to urinate, urinary retention, nocturia, constipation, incomplete defecation, dyschezia (unable to defecate) , primary or secondary infertility, inability to deliver pregnancy, increased risk of fetal malposition during pregnancy.
Definition
Premenstrual syndrome (PMS)
is a recurrent, disrupting mental (mood swings, irritability) and somatic symptoms (abdominal pain, headache, fatigue, swelling of the limbs) of moderate intensity that occur in the premenstrual phase of the cycle and disappear with the onset of menstrual bleeding
Definition
unicornate uterus
- congenital defect of the uterus that results from unilateral agenesis / aplasia of the Müller’s duct.
- The course may be asymptomatic or cause secondary dysmenorrhea.
- It is associated with an increased risk of infertility, premature delivery and misplacement of the fetus
Definition
Dysmenorrhea
Primary dysmenorrhea
- medical term for painful menstrual periods which are caused by uterine contractions.
- refers to recurrent pain
Pain can typically last 12 to 72 hours, and you might have other symptoms, such as nausea and vomiting, fatigue, and even diarrhea.
symptoms of (PBM)
symptoms of primary dysmenorrhea (PBM)
appear about 6-12 months after the menarche. This is due to the onset of ovulatory cycles and increased prostaglandin levels. PBM is manifested by painful contractions of the lower abdomen and lumbosacral area, which appear a few hours before or immediately after menstruation and last for 48-72 hours. Over-secretion of prostaglandins can cause systemic symptoms such as headache, nausea and vomiting, dizziness, diarrhea, irritability, fatigue and somnolence. The general examination and gynecological examination did not reveal any organic cause of the symptoms.v
Definition
Asherman’s syndrome
a secondary amenorrhea caused by intrauterine adhesions following curettage of the uterine cavity.
Definition
Cytology is a
test used in the secondary prevention of cervical cancer.
The purpose of this study is to detect pre-cancerous conditions that already exist.
Active prophylaxis by cytological examination in Poland covers women aged 25-65 and is performed every 3 years.
Definiton
Colposcopy is a
diagnostic examination of intraepithelial lesions of the cervix (SIL), vagina (VAIN), vulva (VIN) and invasive forms in these locations.
It is not a primary prevention method.
Define Test
HPV DNA genotyping
used in screening for cervical cancer, and these are secondary prevention.
Definition
Cervical conization / LLETZ is a
diagnostic and therapeutic method that consists in excising a suspicious lesion with a margin of healthy tissues and subjecting the material to histological evaluation.
Define
The Mayer-Rokitansky-Küstner-Hauser defect syndrome (also known as)?
The Mayer-Rokitansky-Küstner-Hauser defect syndrome (also known congenital deficiency of the vagina and uterus or Müllerian agenesis) affects phenotypic women with 46XX karyotype and is characterized by:
- congenital absence of the vagina and uterus
- primary amenorrhea
- the rudimentary horns of the uterus
- properly developed ovaries and fallopian tubes with normal function
- well-developed second- and third-order female sex characteristics
- normal mammary glands
- with female type hair
The main causes of postmenopausal bleeding are:
atrophic changes in the uterine or vaginal mucosa (40-50%),
endometrial cancer (10%), polyps (3%).
Gestational Diabetes Criteria
Criteria for diagnosis of gestational diabetes:
Test duration
Venous plasma glucose concentration
Fasting
⩾ 92 mg / dL
⩾ 5.1 mmol / 1
in 60 min.
⩾ 180 mg / dL
⩾ 10 mmol / 1
in 120 min.
⩾ 153 mg / dL
⩾ 8.5 mmol / 1
Symptoms of endometriosis include:
-
pain (66%):
- chronic (often> 6 months),
- located in the lower abdomen,
- in the peri-menstrual period,
- dyspareunia,
- irregular / excessive bleeding,
-
fertility disorders:
- failure of the fallopian tubes,
- disorder of folliculogenesis,
- lack of ovulation,
- luteinization of an unbroken follicle,
- digestive system ailments (nausea, vomiting, satiety, flatulence, pain during defecation).
The gynecological causes of pelvic pain syndrome include:
- Painful bladder syndrome,
- Endometriosis,
- Adenomyosis,
- Muscle,
- Benign tumors of the appendages,
- Pelvic inflammation,
- Adhesions in the smaller pelvis.
Markumaran is a drug whose active ingredient is ?
MOA?
SE?
Phenprocoumon.
It belongs to coumarin derivatives, which is a long-acting oral anticoagulant.
It works by inhibiting vitamin K reductase, reducing the synthesis of vitamin K-dependent coagulation factors II, VII, IX and X, and the anticoagulant proteins C and S.
As a side effect of anticoagulant therapy is an increased bleeding predisposition.
Definition
Mayer-Rokitansky ‘ego-Klister-Hauser syndrome (Rokitansky syndrome, MRKH syndrome) is
the most common cause of congenital absence of the uterus and the upper part of the vagina. Patients with this syndrome have properly developed secondary sex characteristics, normal ovaries and a normal female karyotype 46, XX.
Definition
Patients with pure gonadal dysgenesis;
46XX
46XY
Patients with pure gonadal dysgenesis with 46XX karyotype show normal growth and no development of secondary and tertiary sexual characteristics.
*Pure gonadal dysgenesis with 46XY karyotype (Sweyer syndrome) is caused by a mutation in the SRY gene.
Patients have a female phenotype, female gender identification, and normal development of the mammary glands, pubic and axillary hair with a properly developed uterus.
Define
Constitutional growth retardation and maturation
Constitutional growth retardation and maturation is a variant of growth with a strong family tendency, associated with
a) delay in maturation of the hypothalamic-pituitary-gonadal axis, accompanied by growth retardation,
b) lack of somatic and hormonal characteristics of puberty in girls >13 years of age. and boys> 14 years old In most cases, this condition does not require treatment as children eventually achieve normal growth and sexual development.
Define
androgen insensitivity syndrome;
In the syndrome of total androgen resistance in adolescence, it is the cause of primary amenorrhea, sparse axillary and pubic hair.
At the same time, growth is normal and the development of the mammary glands is only partially inhibited.
Physical examination shows a short, blind vagina, no uterus, and presence of testicles.
Define
Partial androgen resistance syndrome
- Virilization features (micropenis, cryptorchidism, hypospadias), a hypoplastic or aplastic uterus, are noteworthy in childhood, although breast development is usually normal.
Definition
Virilization
is a condition in which a female develops characteristics associated with male hormones (androgens), or when a newborn has characteristics of male hormone exposure at birth
Name 2
Two groups of tocolytic drugs are used in Poland:
- oxytocin receptor antagonists; Tractocile - the drugs of choice, used for 48 hours. The patients tolerate it well and it is a safe drug. Contraindication to its use are symptoms of a threat to the life of the mother or the fetus
- short-acting beta-adrenoreceptor agonists (fenoterol)– is much less tolerated and has more contraindications, such as: heart and circulatory system diseases, glaucoma, kidney or liver failure.
define
Tocolytic therapy is
treatment aimed at suppressing the contractile function of the uterine muscle and thus delaying labor
This therapy helps to prevent complications related to preterm labor, such as: respiratory distress syndrome or bleeding into the plexuses of the lateral ventricles of the brain.
Drugs administered in steroid therapy include 2 administration of 12 mg of betamethasone intramuscularly within 24 hours.
Such treatment is used in premature rupture of membranes, which is the cause of 1/3 of preterm labor.
Name 5
Relative contraindications for reproduction in women with diabetes
- Severe nephropathy (creatinine clearance <40 ml / min, serum creatinine> 2.5 mg / dl)
- Uncontrolled refractory hypertension
- Untreated proliferative retinopathy
- Active, advanced ischemic heart disease or a history of myocardial infarction
- Autonomic neuropathy with involvement of the conduction and stimulus system of the heart or the gastrointestinal tract
Define
The triple test
is one of the non-invasive methods of prenatal diagnosis - it is a screening test used to detect fetal genetic and developmental defects.
The concentration of alpha-fetoprotein (AFP), hCG and estriol between 14 and 20 weeks of pregnancy is assessed
test interpretation Type of defect
down syndrome
low AFP, low estriol, increased hCG
test interpretation Type of defect
Edwards syndrome
low AFP, low estriol, low hCG
test interpretation Type of defect
neural tube defects
high concentration of AFP
name 8
The result of the triple test is influenced by many factors:
- race (higher AFP levels in black than in white)
- multiple pregnancy eg. twins/triplets etc. (↑ AFP)
- body weight
- insulin dependent diabetes (↑ AFP)
- smoking
- mother’s age
- examination using radioactive markers within the 2 weeks preceding the examination
- incorrect indication of gestational age.
Name 4
High FSH serum levels accompanied by low estradiol levels are characteristic of:?
Turner syndrome;
premature ovarian failure (POF);
pure gonadal dysgenesis;
postmenopausal period.
Fetus lie (situs)-
- relationship between the longitudinal axis of fetus and the long axis of the uterus and the birth canal
- longitudinal
- transverse
- oblique
Fetal position (positio)-
relation of particular parts of the fetus to the uterus
- position I - dorsal column (occiput) on the left side
- position II - dorsal column (occiput) on the right side
Fetal position (positio)-
relation of particular parts of the fetus to the uterus
- position I - dorsal column (occiput) on the left side
- position II - dorsal column (occiput) on the right side
Station (immissio) -
- relationship of the fetal presenting part to the level of the ischial spines
Incorrect head position:
- low occipito-transverse position
- straight occipito-posterior/anterior position above the level of the ischial spines
- occipitoposterior position
Occiput anterior position
(occiput faces towards pubic symphysis) is a physiological position.
Langerhans cell histiocytosis
abnormal clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes.
Symptoms range from isolated bone lesions to multisystem disease.
- caused by the growth of histiocytes and Langerhans cells
- causes the appearance of an excessive amount of cytokines and prostaglandins that lead to the formation of infiltrates
- generalized form - most often in children before 2 years.
- localized character - mostly in older children
Name
Langerhans cell histiocytosis Clinical Symptoms
- bulging of the skull
- difficult to remove cradle cap
-
a papular effusionon the trunk or head
- red or yellow-brown
- does not respond to antibacterial treatment
- unresolving leaks from the ear
- gum infiltrations, pain and teeth loss, premature teething
- bulging eye / eyes
- diabetes insipidus
- effort dyspnoea
- hemoptysis
- hemorrhagic diathesis
- enlargement of lymph nodes
- hepato-, splenomegaly
- fever
- lack of appetite, weight loss
- change of behavior
Define
Carcinoid:
-
gastrointestinal tumor,
- most often located in the appendix : 90% according to Noszczyk,
- usually less than 2 cm, too small to give metastases to the liver
- other location: small intestine (terminal ileum - much more often metastasizes to the liver), esophagus, stomach, large intestine, bronchi
- most often located in the appendix : 90% according to Noszczyk,
- neuroendocrine tumor: it secretes mainly serotonin
The triple marker
test is a non-invasive test that assesses AFP, hCG and estriol in mother’s blood serum between weeks 14 and 20 of pregnancy.
Due to the low sensitivity (65%) and the late diagnostic period, it is used less frequently than the double test.
Cell free fetal DNA in the mother’s blood test
A non-invasive prenatal test with the highest sensitivity, as much as 99% in the diagnosis of chromosomal defects in the fetus is the assessment of free fetal DNA in the mother’s blood.
This test can be performed from the 10th week of pregnancy
The double test
is a non-invasive test carried out between 11 and 14 weeks of pregnancy.
It evaluates 2 biochemical markers: pregnancy plasma protein (PAPP-A) and placental gonadotropin (hCG).
It is characterized by early diagnosis and high sensitivity (95%).
Ultrasound examination during pregnancy:
- using the Doppler function assesses the flows in:
- middle cerebral artery,
- umbilical artery,
- ductus venous,
- uterine arteries,
- tricuspid valve
- Doppler function is also used during the diagnostics of preeclampsia, fetal distress, hemolytic anemia, IUGR, postterm pregnancy, haemorrhage during pregnancy, twin pregnancy, during NSAID treatment in pregnancy and fetal echocardiography.
- it is obligatorily performed 4 or 5 times during pregnancy:
Double test:
- performed between the 11th and the 14th week of pregnancy
- we measure: PAPP-A and hCG
Triple test:
- performed between the 14th and 20th week of pregnancy
- we measure: AFP, hCG, E3
Quadruple test:
- performed like a triple test,
- measure: AFP, hCG, E3
- but additionally the concentration of inhibin A is measured
The proper management of Pap smear grade 3 is:
PAPA I
Normal stratified squamous epithelial cells in the smear.
The proper management of Pap smear grade 3 is:
PAPA II
Apart from the normal stratified squamous epithelial cells, there are cells of deep layers of this epithelium, glandular epithelium or elements of inflammatory exudate.
The proper management of Pap smear grade 3 is:
PAPA III A
Increased inflammation without atypia. (case from the question, since the test showed inflammation, it should be repeated after the end of anti-inflammatory treatment)
The proper management of Pap smear grade 3 is:
PAPA III B
Presence of dysplastic cells associated with cervical intraepithelial neoplasia.
The proper management of Pap smear grade 3 is:
PAPA IV
The probability of pre-invasive cancer (the current pathomorphological classification does not distinguish it).
The proper management of Pap smear grade 3 is:
PAPA V
Cell morphology is altered enough that there is a high probability of cancer.
The term „sterilitas primaria” describes:
inability to achieve pregnancy
The primary cancer for metastatic ovarian cancer occurs in:
- The digestive tract (usually the stomach) - the most common source of metastases
- breast
- lungs
- second ovary
- endometrium (rare)
- melanoma (rare)
- pancreas (rare)
- carcinoid (rare)
The best known steroid therapy used in RDS (respiratory distress syndrome) prophylaxis is:
- Intramuscular administration of 2 doses of 12 mg betamethasone at 24-hour intervals
- Intramuscular administration of 4 doses of 6 mg dexamethasone at 12-hour intervals.
Pearl Index
- the number of pregnancies per 100 women using a given method of contraception for 1 year.
The Actual Pearl Index is the lowest for:
IUD with lewonorgestrel 0,20,2
IUD Cooper T 0,80,8
The normal sperm count (for 1mL) is:
20 million
Volume:
Normospermia:
1.5-6 ml
Volume:
Aspermia:
- 0-0.5 ml
Volume:
Hypospermia:
- 0.5-1.5 ml
Volume:
Hyperspermia:
> 6 ml
Sideropenic anemia
- (iron deficiency anemia) is the most common type of anemia occurring in pregnancy.
- It is diagnosed if the concentration of Hb is lower than 11 g / dl.
- Anemia during pregnancy can contribute to:*
- The basic treatment is oral iron preparations in a dose of ?*
- miscarriage
- premature delivery
- IUGR
- Intrauterine death of the fetus
- disturbed uterine contraction function
The basic treatment is oral iron preparations in a dose of 100-300 mg / 24 hours
In the natural course of the third stage of delivery, the blood loss is
150-250 ml.
volume
postpartum haemorrhage (PPH)
- defined as the loss of at least 500 ml of blood from the genital tract within 24 hours of delivery.
- PPH:*
- small - 500-1000 ml
- large -> 1000ml:
- moderate (1000-2000 ml)
- heavy (> 2000ml)
Functions of folic acid:
- role in purine synthesis
- role in the synthesis of pyrimidines
- involved in the transformation of amino acids
- regulation of normal erythropoiesis
length of time/dosage
the efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy has been confirmed as
- efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy
- it is recommended that each woman planning pregnancy should begin folic acid supplementation at least a month before planned fertilization and continue it until the end of the first trimester
-recommendation to use a constant substitution (regular intake) of 400 μg folic acid should include all women in childbearing age, regardless of whether they plan to become pregnant.
length of time/dosage
the efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy has been confirmed as
- efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy
- it is recommended that each woman planning pregnancy should begin folic acid supplementation at least a month before planned fertilization and continue it until the end of the first trimester
-recommendation to use a constant substitution (regular intake) of 400 μg folic acid should include all women in childbearing age, regardless of whether they plan to become pregnant.
Conditions in which the standard dose (400 μg) should be increased to 4 mg. These are:
- the patient gave birth in the past to a child with a neural tube defect, a cleft palate
- The predicted beneficial effect of using folic acid on other pregnancy results, including preventing premature birth, increasing birth weight and placenta mass, reducing the incidence of other congenital malformations (including heart defects) has not been explicitly confirmed in well-planned clinical trials
- the patient is using anti-epileptic medicines
- BMI of the mother> 30 kg / m2
- hyperhomocysteinemia
- Diabetes
- Haemolytic anemia
Bacterial vaginosis (nonspecific bacterial vaginosis )
- vaginal infection caused by a disturbed natural balance between bacterial populations.
- The lactobacilli are gradually replaced by pathogenic strains, e.g. Gardnerella vaginalis, Mobiluncus, Bacteroides, Prevotella, mycoplasmas.
- The lactobacilli are gradually replaced by pathogenic strains
e. g.
Gardnerella vaginalis,
Mobiluncus,
Bacteroides,
Prevotella,
mycoplasmas.
The HELLP syndrome is an acronym for English words:
- H - hemolysis
- E - elevated
- L - liver enzymes
- L - low
- P - platelets
The HELLP syndrome is more precisely defined by the Tennessee classification:
- hemolysis (LDH> 600 U / l, elevated total bilirubin)
- elevated liver enzymes (AST> 70 U / l)
- reduced number of platelets (<150,000)
define, secrete, SOM, symptoms diag
Choriocarcinoma
(choriocarcinoma) - aggressive, highly vascularized trophoblast tumor containing tissue very similar to the syncytiotrophoblast and cytotrophoblast.
- One of the most aggressive cancers
- It releases large amounts of beta-hCG
- Symptoms: Vomiting, hand tremors, hyperthyroidism, uterine bleeding (rare), signs of metastatic foci
- The main site of metastasis: lungs
- Metastasis through the bloodstream
- Diagnosis based on an interview, subject examination, physical examination, ultrasound
define-value
Amniotic fluid index (AFI) is a
- quantitative estimate of amniotic fluid
- AFI is normally 7 to 25 cm.
- each individual pocket of fluid should be 2 to 8 cm.
- Fluctuations outside of this range define oligohydramnios (too little amniotic fluid) or polyhydramnios (too much amniotic fluid).
In the treatment of hypertension in pregnancy what medication is absolutely contraindicated?
Causing?
-ACE inhibitors and ARBs are absolutely contraindicated
-cause oligohydramnios, kidney damage and skull hypoplasia
- Diuretics should also be avoided.
name 6 meds….include First line drug
Pharmacological treatment of hypertension in pregnancy:
- Methyldopa (first line drug)
- beta-blockers: labetalol, metoprolol
- calcium channel blockers: nifedipine
- alpha1-blockers: prazosin
- dihydralazine
- magnesium sulfate
define
congenital toxoplasmosis:
-hydrocephalus, retinitis, choroiditis and intracranial calcifications (the Sabin–Pinkerton triad).
Woman -Men
Frequency of malignant tumours - ordered from the most common ones
Women -“BCLE OCT”
Men -“LPCU SKL”
Frequency of deaths from malignant tumours - ranked from the most common ones
Women - “LBCO PSC”
Men - “LCPS UPK”
Causes of hyperprolactinemia:
Physiological:
- pregnancy
- first months of breastfeeding
- physical stress, e.g. pain, illness
- psychological stress, e.g. difficult experiences
- sleep
- physical effort
- protein meal
- examination of mammary glands
- stimulation of the nipples
Causes of hyperprolactinemia:
Pathological:
- prolactinoma
- damage to the pituitary stalk
- lymphocytic hypophysitis
- pituitary injury
- hypothyroidism
- liver failure
- kidney failure
- chest wall injury
- shingles
- epilepsy
- drugs:antipsychotics, antidepressants, prokinetics, antihypertensives, drugs used in peptic ulcer disease
Lasts- division
Menstrual cycle:
- it lasts 28 days
- division:
- ovarian
- uterine:
Menstrual cycle:
uterine:
- menstruation
- 1st-5th day of the cycle
- exfoliation of the functional layer of the endometrium, the remaining basal layer is equal to 0.5mm
- effect of prostaglandins
Menstrual cycle:
- proliferative phase
- 6th-13th day of the cycle
-
dependent on the growth of follicles in the ovary and the follicular secretion of estrogens
- FSH stimulates the proliferation of ovarian granulosa cells and their ability to produce estrogens by increasing aromatase activity → further stimulation of granulosa cell proliferation under the influence of FSH and estrogens → ↑ the number of FSH receptors
- thickening of the endometrium
- increased number of glands in the endometrium
- increased endometrial vascularization
Menstrual cycle:
ovulation:
- 14th day of the cycle
- further thickening of the endometrium
Menstrual cycle:
secretory phase:
- 15th-28th day of the cycle
- effect of the action of progesterone secreted by the corpus luteum
- further thickening of the endometrium
- glands in the endometrium become corrugated
- cells accumulate glycogen, lipids and proteins
- cervical
Fetus and afterbirth:
Stages of prenatal development:
- germinal
- embryonic
- fetal:
- at the beginning of the fetal stage, the CRL is 33 mm
Afterbirth (adnexa fetalia) :
placenta:
- common organ of mother and fetus
- weighs 500g
- the largest dimension: 20-25 cm
- thickness: 2-3 cm
- placenta is fully developed at the end of the first trimester
- lobule is the basic functional unit of the placenta
Afterbirth (adnexa fetalia) :
umbilical cord (funiculus umbilicalis):
- length: 60 cm
- It includes:
- one umbilical vein (because the right umbilical vein disappears at an early stage of fetal life)
- two umbilical arteries
- Wharton’s jelly
Afterbirth (adnexa fetalia) :
fetal membranes:
- amnion
- chorion
- allantois
- yolk sac (saccus vitellinus)
Prolactinoma:
- The most common pituitary adenoma
- it is derived from lactotropic cells
- autonomously secretes prolactin (PRL), which released in excessive amount leads to hypogonadism
- hyperprolactinemia impairs pulsatile secretion of GnRH from the hypothalamus, and thus - pituitary gonadotropins (LH and FSH)
Prolactinoma Symptoms:
- in women:
- abnormal menstrual bleeding (oligomenorrhoea or amenorrhoea)
- corpus luteum insufficiency
- infertility
- galactorrhoea
- low libido
- hypogonadism
- visual impairment (pressure on the optic chiasm)
- headache
Prolactinoma Symptoms:
- in men:
- low libido
- erectile dysfunction
- infertility
- gynecomastia
- hypogonadism (reduction of facial hair and pubic hair, reduction of muscle mass)
- impaired vision (pressure on the optic chiasm)
- headache
Polycystic ovary syndrome and Cushing’s syndrome may have similar symptoms. The most commonly used screening test for Cushing’s syndrome
- screening test for Cushing’s syndrome is a dexamethasone suppression test.
- This will be the most appropriate test to differentiate these medical conditions.
1 mg dexamethasone suppression test (overnight dexamethasone suppression test, low-dose dexamethasone suppression test):
- administer 1 mg of dexamethasone orally before going to sleep (at 22.00-23.00)
- determine the serum cortisol concentration in the morning on an empty stomach between 8:00 and 9:00
- a cortisol concentration <1.8 μg / dl (50 nmol / L) excludes Cushing’s syndrome
define
Placental abruption (ablatio placentae)
- complete or partial separation of a correctly located placenta from the uterine wall with forming a retroplacental hematoma.
*
indications for caesarean section:
Placental abruption (ablatio placentae)
- This is a direct threat to the life of the fetus
- Placental abruption is one of several (according to the Polish Gynecological Society) emergency indications for caesarean section:
- umbilical cord prolapse
- suspected internal haemorrhage due to uterine rupture
- placental abruption
- eclampsia
- risk of eclampsia
- fetal heart dysfunction
Gonadotropin-Releasing Hormone analogues
- a group of drugs formed by the modification of the natural Gonadotropin-releasing hormone (GnRH) amino acid chain, which prolonged its half-life.
MOA
Gonadotropin-Releasing Hormone analogues- MOA
- Mechanism of action: they bind to the receptors in the anterior pituitary gland, initially increasing gonadotrophin secretion, and then after about 10 days, due to down-regulation of the number of GnRH receptors, they cause a strong hypogonadotropic effect
Name 7
Gonadotropin-Releasing Hormone analogues
Group representatives
- leuprolide
- goserelin
- buserelin
- nafarelin
- deslorelin
- histrelin
- triptorelin
Gonadotropin-Releasing Hormone analogues
Indications:
- breast cancer
- prostate cancer
- endometriosis
- uterine myomas
- inhibition of precocious puberty
- protocols for assisted reproduction
SE
Gonadotropin-Releasing Hormone analogues-
(due to hypogonadotropic hypogonadism)
- hot flushes
- night sweats
- mood and sleep disorders
- atrophic changes in the reproductive system
- reduction in bone mineral density
- increased risk of cardiovascular diseases
define
PCOS ( polycystic ovary syndrome) :
- also known as Stein-Leventhal syndrome
- affects 4-12% of women
- familial incidence
- diagnosis after excluding other diseases with similar symptoms (Cushing’s syndrome, hyperprolactinemia, CAH, hypothyroidism or hyperthyroidism, acromegaly, androgen secreting tumors)
- increases the risk of endometrial cancer
PCOS
Clinical and biochemical symptoms:
- increase in LH concentration
- insulin resistance
- hyperinsulinemia
- hyperandrogenemia:
- and its clinical consequences: hirsutism, acne, baldness
- overweight or obesity
- menstrual cycle disorders
- infertility
- carbohydrate metabolism disorders
- increased estrogen concentration
Diagnosis of PCOS:
(Rotterdam Criteria, minimum 2/3)
- oligoovulation or anovulation
- clinical symptoms of hyperandrogenism or hyperandrogenemia
- image of polycystic ovaries in ultrasound (at least 12 follicles with a diameter of 2-9 mm, volume of ovary> 10 ml)
PCOS
Treatment:
- Lifestyle modification
- body weight normalization is a basic recommendation for patients with PCOS
- permanent change of eating habits
- diet
- physical exercises
- Pharmacotherapy:
- combined oral contraceptive pill
- metformin
- antiandrogens: spironolactone
- Infertility treatment:
- clomiphene citrate (the first-line therapy in the treatment of infertility)
- stimulation protocol using gonadotrophins and GnRH analogues (second-line therapy in the treatment of infertility)
- laparoscopic treatment (third-line therapy in the treatment of infertility):
- electrocautery
- laser technique
- in vitro fertilization (fourth-line therapy in the treatment of infertility)
Diameters and circumferences of the fetal head:
Diameters :
- suboccipitobregmatic diameter: 9.5 cm
- occipitofrontal diameter: 12 cm
- occipitomental diameter: 13.5 cm
combined contraceptive pill
Mechanism of action of the estrogen component:
- FSH suppression
- inhibiting the selection and growth of the dominant follicle
- prevention of bleeding
- intensification of progestational activity
combined contraceptive pill
Mechanism of action of the gestagen component:
- LH suppression
- effect on the endometrium
- thickening of cervical mucus
- effect on the fallopian tubes
Postpartum pituitary gland necrosis
(Sheehan’s syndrome) - deficiency of hormones of the anterior pituitary gland as a result of necrosis caused by hemorrhage and hypovolemic shock during or after delivery.
a set of symptoms caused by a deficiency of one or more pituitary hormones:
ACTH:
- orthostatic hypotension
- fainting
- nausea and vomiting
- anorexia
- weight loss
- increased body temperature
- reduced skin pigmentation
- a tendency to hypoglycemia (especially when GH deficiency coexists)
a set of symptoms caused by a deficiency of one or more pituitary hormones:
GH: (symptoms of deficiency that occurred in an adult are not clear)
- reduction in muscle mass
- fat gain (mainly visceral)
- reduction in bone mineral density
- hypoglycemia
- hyperlipidemia
a set of symptoms caused by a deficiency of one or more pituitary hormones:
TSH:
- secondary hypothyroidism - symptoms less pronounced than in primary hypothyroidism, there is no goitre
a set of symptoms caused by a deficiency of one or more pituitary hormones:
LH and FSH:
-
hypogonadotropic hypogonadism (answer B):
- amenorrhea
- low libido
- disappearance or lack of tertiary sexual characteristics (pubic hair)
a set of symptoms caused by a deficiency of one or more pituitary hormones:
PRL:
- no lactation after delivery
Magnesium sulfate: Antidote
calcium gluconate
“B” Bracht for “Breech” birth
The Bracht maneuver
- is used in case of breech birth.
- It consists in directing the trunk of the fetus in the direction corresponding to the pelvis leading line and applying pressure on the uterine fundus by an assisting person.
- Some authors resign from applying pressure on the uterine fundus and at the final stage of delivery administer iv 5 oxytocin units.
Swyer syndrome:
- a variant of the XY gonadal dysgenesis (male genotype)
- because dysgenetic gonads do not secrete testosterone (hypogonadism) nor anti-Müllerian hormone, Müllerian ducts’ derived organs develop (female)
- is characterized by a female phenotype , female internal sexual organs , normal or high growth, sexual infantilism and primary amenorrhea
indications
Mirabegron
is a strong and selective b3- adrenergic receptors agonist.
Indications: emergency treatment of urinary urgency, pollakiuria and / or incontinence caused by urinary urgency, which may occur in adult patients with overactive bladder syndrome (OAB).
disulfiram-like effect includes metronidazole, which we use to treat
treat genital infections,
e.g. T. vaginalis infection and bacterial vaginosis.
Indications for Caesarean section in twin pregnancy (based on Bręborowicz):
- Elective (absolute) indications: name 6
- first fetus in a non-cephalic position (presentation)
- twin B>A by 25%
- monoamniotic pregnancy (c-section in 34 wk of pregnancy)
- conjoined twins (c-section in 36-38 wk of pregnancy)
- pregnancy ≥3 fetuses
- other, see below - indications for Caesarean section
Indications for Caesarean section in twin pregnancy (based on Bręborowicz):
- Relative indications:
- monochorionic-diamniotic pregnancy
- TTTS
- history of cesarean section
- twin pregnancy <32 week of pregnancy
- primipara - despite the cephalic position of the first fetus, if the second fetus’ position is non-cephalic
- death of the first fetus in the third trimester
Indications for Caesarean section in twin pregnancy (based on Bręborowicz):
- Emergency indications:
- “locked twins” (interlocked)
- breech presentation with born lower limbs of both fetuses, with no delivery progress. (even when the fetuses are dead)
- see below, indications for Caesarean section
Indications for caesarean section: Bręborowicz groups these indications into three stages of urgency: elective, urgent, emergent)
- Elective (planned) indications:
- incorrect fetal position
- cephalopelvic disproportion (anatomical defects of pelvis)
- macrosomia >4500g, big fetus in diabetic mother >4250g)
- thin uterine scar <2mm
- non-obstetric indications (neurological, ophthalmic, orthopedic, hematological, cardiological, psychiatrical, other)
Indications for caesarean section:
- Slightly urgent indications:
- incorrect head position
- abnormal fetal position with ongoing uterine contractions
- cervical dystocia
- severe pre-eclampsia
- preterm delivery of a fetus for which birth via the reproductive tract is a serious risk of injury or death
Indications for caesarean section:
- Urgent indications:
- recurrent episodes of bradycardia
- late or variable decelerations with ineffective contractions that do not ensure the proper progress of delivery
- deep fetal bradycardia that does not respond to conservative treatment
Indications for caesarean section:
- Emergency indications:
- umbilical cord prolapse
- suspected internal haemorrhage due to uterine rupture
- premature placental abruption
- eclampsia
- threatening eclampsia
- fetal heart dysfunction
menometrorrhagia
- abundant, irregular, prolonged bleedings, linked to an increase estrogens blood concentration, particularly in the perimenopausal period
hypermenorrhoea
- - blood loss >100 ml
hypomenorrhoea -
- blood loss <30 ml
dysmenorrhoea -
- severe pain in perimenstrual period and during bleeding itself
algomenorrhoea -
- menstrual pains are accompanied by vegetative symptoms
metrorrhagiea -
- abundant, prolonged bleedings not on the time of expected menstruation
juvenilis -
- acyclic bleeding in young women >10 days
climacteria -
- bleeding in a woman 6-12 months after menopause
menorrhagia -
- regular, cyclic, abundant, prolonged bleeding in menstruation time
amenorrhoea intermittens -
rare bleedings in intervals lasting from 43 days to 6 months, most often, but not always, are anovulatory cycles and typically occur in women with polycystic ovary syndrome.
Anemia during pregnancy can contribute to:
- miscarriage
- premature delivery
- IUGR
- intrauterine fetal death and stillbirth
- disturbed uterine contractility and prolonged labour.
- delayed child development
The most common type of anemia in pregnancy:
syderopenic (iron deficiency anemia)
how is it recognized - tested
syderopenic (iron deficiency anemia)
- It is recognized if Hgb concentration is lower than 11 g / dl
- The longer the pregnancy lasts, the greater the risk of anemia is
- The blood count is the screening test:
- MCV <80 mm3
- decreased ferritin concentration
- TIBC increase
- elevated transferrin
- elevated sTfR
Treatment of preeclampsia: it is necessary to prevent convulsions -
- intravenous administration of MgSO4 Zuspan method:
- initial dose 4-6g, within 20 minutes
- maintenance dose 1-2g / h for> 24h
- frequent side effects, the need to monitor patellar reflex, respiratory rate and diuresis
- antidote: 1g of calcium gluconate
in order to prevent convulsions in Preeclampsia - Via
Zuspan method: intravenous administration of MgSO4 = antidote?
antidote: 1g of calcium gluconate
tumors producing steroid hormones are
name the steroid hormones being produced: 4
(estrogens, testosterone, androstendione, DHEA) include:
Dehydroepiandrosterone (DHEA), known as androstenolone, is an endogenous steroid hormone precursor.
DHEA is produced in the adrenal glands, the gonads, and the brain
DHEA helps produce other hormones, including testosterone and estrogen.
Natural DHEA levels peak in early adulthood and then slowly fall as you age.
tumors producing steroid hormones are
name the tumors producing the steroids: 6
dysgerminoma,
embryonal carcinoma,
immature teratoma,
gonadoblastoma,
foliculliculoma,
Sertoli-Leydig cell tumor.
7 “ICE D PEG”
Germ cell tumors (from multipotent reproductive cells or stem cells present in the ovary):
- Dysgerminoma
- Embryonal carcinoma
- Immature teratoma
- Choriocacrinoma
- Endodermal sinus tumor; Yolk sac tumor
- Gonadoblastoma
- Polyembryoma
4
Gonadal tumors (arise from sex cords and ovarian stroma, produce steroids):
- Thecofibroma
- Folliculoma - (also called granulosa cell tumor)
- Sertoli-Leydig cell tumor - a tumor from Sertoli and Leydig cells
- Androblastoma
Kallmann syndrome
- is the lack of smell sense present in over 80% of patients.
- Other symptoms include hypogonadotropic hypogonadism (delayed puberty, incomplete development of sexual characteristics), bone system abnormalities, disturbances in the middle line, gynecomastia.
explain
decreased sperm count in the semen analysis, gynecomastia was found and laboratory tests showed decreased follicle-stimulating hormone levels and increased testosterone levels.
The most probable cause of the?
The use of Anabolic steroids
-Exogenous testosterone will inhibit the nuclear axis of the pituitary gland, resulting in a decrease in endogenous testosterone production, suppression of spermatogenesis, and testicular atrophy.
name & descrive
- the most common gonadal tumor
Folliculoma: (arise from sex cords and ovarian stromal cells)
- the most common gonadal tumor
- applies to women of all ages
- usually one-sided
-
secretes:
-
estrogens:
- may cause early puberty symptoms in girls
- they can cause excessive menstruation or abnormal bleeding
- they increase the risk of endometrial hyperplasia and endometrial cancer
- they are not used to monitor treatment and detect relapses
-
inhibin:
- a useful indicator for monitoring treatment and relapse detection
- can stop menstruation
-
estrogens:
- basic treatment: surgery
- characterized by late relapses (on average 4-6 years, but even after 30 years)
- it easily breaks, causing peritoneal symptoms. Immediate surgery is required
10
Drug treatment of urinary tract infections in pregnant or lactating women:
- nitrofurantoin
- furazidine - do not use in the first trimester of pregnancy
- co-trimoxazole
- trimethoprim
- fosfomycin
- amoxicillin
- amoxicillin with clavulanate
- cephalexin
- ampicillin
- cefuroxime
5
Pregnant women should not use:
- Tetracyclines (damage fetal teeth and bones)
- Trimethoprim (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus)
- Sulfamethoxazole (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice)
- Fluoroquinolones (completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)
- Macrolides (should not be used as first-line drugs).
Pregnant women should not use: symptoms
Tetracyclines
- (damage fetal teeth and bones)
Pregnant women should not use: cause symptoms
Trimethoprim
- (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus)
Pregnant women should not use: causing symptoms
Sulfamethoxazole
- (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice)
Pregnant women should not use: causing symptoms
Fluoroquinolones
- (completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)
Pregnant women should not use: causing symptoms
Macrolides
(should not be used as first-line drugs).
-Macrolide antibiotics are used for the treatment of common bacterial infections, such as upper and lower respiratory infections and sexually transmitted diseases, and are frequently used as alternatives for patients allergic to penicillin.
Macrolides (such as azithromycin, clarithromycin, and erythromycin) are among the most commonly prescribed antibiotics during pregnancy
Double test:
- performed between the what week/weeks of pregnancy?
- evaluates two biochemical markers in pregnant blood: Name
-performed between the 11th and the 14th week of pregnancy
-evaluates two biochemical markers in pregnant blood: PAPP-A and β-hCG
Triple test:
- performed between the 14th and 20th week of pregnancy
- we measure:
- AFP
- hCG
- E3
druple test:
- performed as a triple test, but additionally the concentration of inhibin A is determined
- Triple test measure:
- AFP
- hCG
- E3
Placenta previa - placenta nested within the lower part of the uterus
risk factors:
Placenta previa -
- placenta nested within the lower part of the uterus
- multiparity, age, multiple pregnancy, cigarette smoking, fetal defects, cesarean sectio
-Placenta previa
gold standard Diagnosis, time of diagnosis, examination : name all
- the final diagnosis is made only in the second half of pregnancy, when the placenta is fully developed.
- Internal examination is strictly contraindicated, even during labor.
- the golden diagnostic standard is transvaginal ultrasonography.
- its diagnosis is an indication for hospitalization and intensive supervision of the pregnant woman and the fetus.
- perinatal mortality rate is 10 times higher than normal
- the prognosis for the mother is usually good
- the first bleeding is usually painless and rather harmless
Define
Lie of the fetus
(situs) - the relationship of the _l_ong axis of the fetus to the _l_ong axis of the uterus and the birth canal
- longitudinal
- transverse
- oblique
Position of the fetus
-
(positio) - the relationship of particular parts of the fetus to the uterus
- position I - back (head) on the left side
- position II - back (head) on the right side
Attitude of the fetus
-
(habitus) - the relationship of part of the fetus relative to self
- flexed
- extended
Presentation of the fetus
- (immissio) - relationship of the presenting part to the intercostal line
Ovarian cancer is very sensitive to chemotherapy, especially if the surgery did not leave many leftovers of the disease.
treatment regimens use & drugs with the highest activity against ovarian cancer:
- platinum derivatives: cisplatin and carboplatin - drugs with the highest activity against ovarian cancer.
- paclitaxel
- The combination of carboplatin and paclitaxel is currently the “golden standard” for ovarian cancer.
- platinum derivatives: cisplatin and carboplatin - drugs with the highest activity against ovarian cancer.
define
serological tests
- determination of specific antibodies in serum in immunocompetent patients:
serological tests - determination of specific antibodies in serum in immunocompetent patients:
IgM
- they appear 1 week after the invasion, reach a maximal concentration after 1 month and usually disappear after 6-9 months, they can persist for many months or years after infection
serological tests - determination of specific antibodies in serum in immunocompetent patients:
IgA
- testify to the recent infection, disappear earlier than IgM (less accessible test, especially useful in the diagnosis of infection in pregnant women and in innate form)
serological tests - determination of specific antibodies in serum in immunocompetent patients:
IgG
- maximal concentration 2-3 months after infection, last a lifetime.
- When it is necessary to determine the time of infection (eg in pregnant women), the so-called avidity (strength of binding to antigen) IgG antibodies (low avidity antibodies → acute phase toxoplasmosis, antibodies with high avidity → invasion before ≥20 weeks)
A pap smear is a cervical cancer screening test used in many countries, including Poland. In Poland, it is addressed to women aged 25-59 who have not had a pap smear examination performed in the last 3 years. The sensitivity of the test is about 65-70%
The group of patients included in the screening every 12 months include:
- HIV-positive patients
- patients taking immunosuppressants
- HPV-infected patients - a high-risk type
What is not a risk factor for cervical cancer
-Obesity is not a risk factor for cervical cancer**,
-while it increases the risk (2-4 times) of endometrial cancer.
Biological effects:
- estrogen:
- the development of secondary and tertiary sexual characteristics
- increased uterine muscle mass
- stimulation of endometrial proliferation
- increasing the amount of transparent mucus
- stimulating the growth and exfoliation of the vaginal epithelium
- increase in libido
- stimulating the growth and proliferation of tubules and follicles in the mammary gland
- pro-thrombotic
- increase in synthesis:
- SHBG
- CBG
- TBG
- inhibition of osteolysis
- water retention in the body
- beneficial effect on the emotional state
Biological effects:
gestagens
- growth and congestion of the uterine muscle
- reduction in uterine contractility and tubal peristalsis
- increasing the density of cervical mucus
- increasing the synthesis of glucagon
- lowering the hypoglycemic effect of insulin
- increase in body temperature
- diuretic action
- antiandrogenic effect
- synergistic effect with estrogens on the nipple: stimulation of the growth and proliferation of tubules and follicles in the mammary gland
HELLP
(Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia.
clinical picture of Kallmann’s syndrome includes
- an olfactory disorder and isolated hypogonadotropic hypogonadism- loss of sense of smell
- Diagnosis is possible already in the neonatal period due to the early manifestation of symptoms such as micropenis, cryptorchidism (the absence of at least one testicle from the scrotum), and a small volume of testicles.
- Sexual maturation usually does not occur or is stopped.
- The silhouette is eunuchoidal and bone age is delayed.
Asherman’s syndrome is
- adhesions in the uterine cavity that completely or partially close its lumen.
- This is manifested by either little or no bleeding.
- The most common causes of Asherman’s syndrome are: curettage of the uterine cavity, endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.
Sheehan’s syndrome is
-postpartum pituitary necrosiscaused byperinatal hemorrhagic shock.
- The most characteristic symptom is the lack of lactation resulting from a sudden decrease in the secretion of prolactin by the pituitary gland.
- Other symptoms of this syndrome include: no return of menstruation after delivery, secondary adrenal and thyroid insufficiency - they develop gradually over many months.
5
cardiovascular system:
- increase in the output and the heart rate
- reduction of peripheral resistance
- increase in stroke volume
- decrease in blood pressure
- increase in blood volume:
Location of the uterine fundus:
at the end of 16th week:
- 1 -2 fingers above the pubic symphysis
Location of the uterine fundus:
at the end of 20th week:
- 2-3 fingers below the navel
Location of the uterine fundus:
at the end of 24th week:
- at the level of the navel
Location of the uterine fundus:
at the end of 28th week:
- 2-3 fingers above the navel
Location of the uterine fundus:
at the end of 32th week:
- halfway between the navel and the xiphoid process
Location of the uterine fundus:
at 36th week:
- adjacent to ribs (the highest location)
Location of the uterine fundus:
at 40th week:
- 1-2 fingers below the ribs
Pfannenstiel-Kerr incision or pubic incision
-type of abdominal surgical incision that allows access to the abdomen.
-It is used for gynecologic and orthopedics surgeries, and it is the most common method for performing Caesarian sections today.
Wolff channel cells
→ These are cells that transform into the vas deferens in men, while in women they are atrophied.
luteal corpuscle
→ lutein-granular cysts are sent with a layer of luteinized granular cells surrounded by a thick connective tissue wall. —Their content is usually bloody.
-They can cause pain in the lower abdomen, producing hormones - estrogens and / or progesterone lead to disorders of the menstrual cycle.
fibroblast tumor
-(fibroma) is a gonadal tumor that originates from the stroma of the ovary.
- Occurs mainly in postmenopausal women and is hormonally inactive.
- Often however, it can be a component of Meigs syndrome (ovarian tumor + ascites + pleural fluid).
Urinary Incontinence Forms:
- stress urinary incontinence (WNM)
- urgent urinary incontinence (NNM)
- overflow incontinence
- non-sphincter urinary incontinence
stress urinary incontinence (WNM)
- excessive mobility of the bladder neck
- sphincter mechanism failure
urgent urinary incontinence (NNM)
- detrusor muscle hyperactivity
- low bladder wall compliance
overflow incontinence
- detrusor muscle insufficiency
- obstacle to outflow
non-sphincter urinary incontinence
- fistula
- developmental defects
The Bishop’s scale is used to:
Scale:
Parameters:
- assess the degree of cervical ripening.
- Score on a scale of 0 to 3 points. is subject to 5 parameters:
- dilatation
- shortening
- consistency
- ratio of the cervix to the vaginal axis
- position of the presenting part
Hormonal changes in polycystic ovary syndrome (PCOS):
- ↑ LH secretion → stimulation of theecal cells → ↑ androgen production
- ↑ androgen levels → dysfunction of the hypothalamic-pituitary-ovarian axis → ↑ pulsatile GnRH secretion → ↑ LH levels → premature follicular maturation → premature estradiol peak → FSH inhibition → ↓ FSH levels
- LH: FSH ratio> 2
- increased aromatization of androgens → relative hyperestrogenism
treatment is used in premature rupture of membranes
Drugs administered in steroid therapy include:
- two administration of 12 mg of betamethasone intramuscularly within 24 hours
Two groups of tocolytic drugs are used in Poland:
- oxytocin receptor antagonists;
- short-acting beta-adrenoreceptor agonists (fenoterol).
Adenocarcinoma is the most common histological type of
endometrial cancer.
There are two types of endometrial cancer:
**Type I **- estrogen-dependent – glandular (Latin: adenocarcinoma endometroides ) ,
Type I occurs in 80% of cases
type II - occurring without any connection with hyperestrogenism.
Type II in 20% .
What type of cell is a choriocarcinoma?
- Choriocarcinoma is a true malignant neoplasm of trophoblastic cells.
- Approximately 50% of choriocarcinomas follow molar pregnancies, and the remainder occur after spontaneous abortions or ectopic or intrauterine pregnancies.
Choriocarcinoma is a
- malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs.
- It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD).
- It is also classified as a germ cell tumor and may arise in the testis or ovary.
Choriocarcinoma of the placenta during pregnancy is preceded by:
- hydatidiform mole (50% of cases)
- spontaneous abortion (20% of cases)
- ectopic pregnancy (2% of cases)
- normal term pregnancy (20–30% of cases)
- hyperemesis gravidarum
name 10 conditions
Increased CA 125 concentrations are observed in
- endometriosis
- uterine fibroids ,
- liver cirrhosis,
- pelvic inflammatory diseases (PID),
- endometrial,
- breast,
- lung
- pancreatic cancer
- during pregnancy
- menstruation
Hyperandrogenism is characterized by the following symptoms:
hirsutism, acne, alopecia .
Tumors arising from the cells of the female gonad are:
- folliculloma
- granulosa cell tumor
- areoblastoma
- fibroma
tumors arising from cells from the male gonad are:
- Sertoli cell tumor
- Leydig cell tumor
Trophoblast hyperplasias include :
- complete mole
- partial prismatic mole
Germinoma ( dysgerminoma )
- large tumor (over 10 cm) with a capsule
- In 90% of cases, it occurs unilaterally , but it is the only germ cell tumor that can also occur bilaterally
- is the most frequently diagnosed malignant ovarian tumor in pregnant women
- may develop from gonadoblastoma
- the marker used to diagnose germinomas is LDH (lactate dehydrogenase)
- treatment includes adnexectomy and adjuvant chemotherapy
Teratomas
There are two subgroups of teratomas:
- Immature teratoma ( teratoma immaturum )
- Mature teratoma ( teratoma maturum )
7 facts
Immature teratoma ( teratoma immaturum )
- malignant tumor
- elements of the tumor resemble embryonic (embryonic) tissues
- 1% of all malignant ovarian tumors
- accounts for 10–20% of malignant ovarian tumors diagnosed before the age of 20
- it practically does not occur in postmenopausal women
- it usually occurs unilaterally
- less sensitive to chemotherapy than germinoma ( complete removal of all tumor foci is very important )
Mature teratoma ( teratoma maturum )
- most often mild
- composed of elements of three germ layers (if one tissue dominates, it may differentiate, e.g. towards ovarian goiter and cause symptoms of hyperthyroidism )
- the most common form is a dermoid cyst (ectodermal elements dominate)
- usually in women of reproductive age (20–30 years)
- sometimes diagnosed during pregnancy (if it is large, it may constitute an obstacle to childbirth)
- treated surgically
Yolk sac tumor
- malignant epithelial tumor arising from the primary yolk sac
- grows very quickly (average tumor size is about 15 cm)
- it develops unilaterally
- it is solid, brittle and has a thin capsule
- the average age of patients is 18 years (1/3 of girls are prepubescent)
- secretes α-fetoprotein (AFP) - a sensitive marker used to monitor treatment
Embryonic cancer ( carcinoma embryonale )
- occurs very rarely
- the average age of patients is 14 years
- can secrete estrogens , AFP (α-fetoprotein) and β-hCG (chorionic gonadotropin)
Asherman’s syndrome
- develops as a result of a single or repeated injury to the uterine lining in the course of abrasion , infection or hysteroscopic surgery
- currently, one of the most common causes of Asherman’s syndrome is curettage of the uterine cavity in the early postpartum period
- Typical symptoms include intrauterine adhesions, scanty menstruation, amenorrhea and infertility.
Antiphospholipid syndrome ( APS) is a
- systemic autoimmune disease in which the clinical picture is most important thrombotic complications and obstetric failures .
- Up to 25% of unexplained recurrent miscarriages may be related to the presence of antiphospholipid antibodies (aPL).
- These antibodies include:
- lupus anticoagulant (LA),
- anticardiolipin antibodies (aCL)
- anti-B2-glycoprotein I anti bodies (aB2GPI).
- aPL antibodies occur in about 5% of healthy women and in 5-50% of women with pregnancy losses
Classification according to ASRM ( American Society for Reproductive Medicine ) – divides uterine defects into 7 classes:
Type 1 – agenesis or hypoplasia of structures derived from the Müllerian ducts, e.g. Mayer–Rokitansky–Küster–Hauser syndrome,
Type 2 – unicornuate uterus ( uterus unicornis ),
Type 3 – double uterus (uterus didelphys),
Type 4 – bicornuate uterus ( uterus bicornis ),
Type 5 – single uterus divided by a complete or partial septum,
Type 6 – arcuate uterus ( uterus arcuatus ),
Type 7 – developmental abnormalities associated with intrauterine exposure to DES (diethylstilbestrol).
Gynecological oncology
Chorionic Villus Cancer – Treatment and Monitoring
chorionic carcinoma
1) Chemotherapy (even in advanced stages) – methotrexate.
2) β-hCG
determination :
– every month for the first 2 years,
– then every 6 months for the rest of your life.
3) Hormonal contraception is recommended.
4) Patients should not get pregnant during the first 2 years.
Gynecological oncology Ovarian tumors – Germ cell tumors of the ovary
There are two subgroups of teratomas:
- Mature
- Immature
Ovarian tumors – Germ cell tumors of the ovary
Immature teratoma ( teratoma immaturum )
- Malignant tumor ,
- the tumor elements resemble embryonic (germinal) tissues,
- 1% of all malignant ovarian tumors,
- constitutes 10–20% of malignant ovarian tumors diagnosed before the age of 20 ,
- it is practically non-existent in postmenopausal women,
- it usually occurs on one side ,
- less sensitive to chemotherapy than germinomas (complete excision of all tumor foci is very important).
Ovarian tumors – Germ cell tumors of the ovary
Mature teratoma ( teratoma maturum )
- Mostly mild ,
- include dermoid cysts and are generally benign
- may be composed of elements from three germ layers (ecto-, endo- and mesoderm) – most often it has hair, fat or teeth,
- in the case of the presence of neuroectodermal tissue, it may cause symptoms, such as carcinoid syndrome in the case of serotonin production, and when thyroid tissue is present, the patient may experience symptoms of hyperthyroidism ,
- usually in women of reproductive age (20–30 years old),
- sometimes diagnosed during pregnancy (if large, it may constitute an obstacle to delivery),
- treated surgically.
Ovarian tumors – Germ cell tumors of the ovary
germinoma ( dysgerminoma )
- The second most common germ cell tumor (after teratoma) but the most common malignant tumor in this group.
- Large tumor (over 10 cm) with a capsule.
- In 90% of cases it occurs unilaterally , but as the only germ cell tumor it can also occur bilaterally .
- It is the most frequently diagnosed malignant ovarian tumor in pregnant women .
- It may occur in dysgenetic gonads (e.g. in Turner syndrome) – then it often develops on the basis of gonadoblastoma .
- The marker used to diagnose germinomas is LDH (lactate dehydrogenase) and beta-HCG .
- Treatment includes adnexectomy and adjuvant chemotherapy.
Ovarian tumors – Germ cell tumors of the ovary
Yolk sac tumor
- The second most common malignant tumor in this group develops from cells of the primary yolk sac.
- It most often occurs in children and young women – the average age of patients is 18 years (⅓ of girls are pre-pubertal).
- It grows very quickly (the average size of the tumor is about 15 cm).
- It develops one-sidedly .
- It is solid, fragile and has a thin capsule.
- Secretes α-fetoprotein (AFP) – a sensitive marker used to monitor treatment; or LDH.
- May co-occur with germinomas.
- All patients, in addition to surgical treatment, should also undergo chemotherapy.
Ovarian tumors – Germ cell tumors of the ovary
Embryonic cancer ( carcinoma embryonale )
- It occurs very rarely .
- Mainly in children and young women – the average age of patients is 14 years.
- It may secrete AFP (α-fetoprotein) and β-hCG (chorionic gonadotropin), LDH and estrogens (producing symptoms of premature puberty).
- It is associated with a much worse prognosis than other cancers in this group.
- Treatment involves surgery and chemotherapy.
Ovarian tumors – Germ cell tumors of the ovary
Mixed Germ Cell Tumors
- They contain two or more germ cell tumor elements.
- The most common combination is germinomas and yolk sac cancer .
Ovarian tumors – Germ cell tumors of the ovary
Chorionic carcinoma
- Most choriocarcinomas are diagnosed in the 2nd–3rd decade of life,
- Chorionic carcinoma that develops unrelated to pregnancy is extremely rare – then it occurs mainly as a component of a mixed germ cell tumor .
Ovarian tumors – Germ cell tumors of the ovary
Germ cell tumors: name 6
- teratoma
– germinoma ( dysgerminoma )
– yolk sac cancer
– embryonic cancer
– mixed germ cell tumors
– choriocarcinoma primarily developing in the ovary
loooook up!!
Gynecological oncology
Ovarian tumors – Gonadal ovarian tumors
Gonadal tumors:
– folliculoma – the most common!
– thecoma ,
– nucleoblastoma ( androblastoma ),
- sertolioma ,
- leydigoma ,
– gyneblastoma ,
– gynandroblastoma .
Diagram - uterine fibroids
