OB/GYN Flashcards
Placenta previa
What? painless or painful?RF? Dx? CI? Comp
PAINLESS vaginal bleeding >20 weeks
Blood is maternal so FHR is normal
RF: prior c-sec, multiparity, multi gestation, tobacco use
Dx: transvaginal US
CI: digital cervical examine
Comp: Hemorrhage, preterm delivery
Amniotic fluid embolism
RF? MOA? Presentation? Tx
RF: C-section, placenta previa or abruption, preeclampsia
MOA: amniotic fluid enters circulation –> triggers massive anaphylactoid reaction
Presentation: shock, respiratory failure, DIC, coma, seizure
TX: support plus transfusion
Subchorionic hemorrhage
What, Presentation, Tx, Comp
Collection of blood between gestational sac and uterine wall
Presentation: Asx or vaginal bleeding
Tx: Expectant management
Comp: Nothing (most common), spontaneous abortion, placenta abruption, preterm premature ROM, preterm delivery, death
Abruptio placentae
RF, Sx, Dx, Comp
Placental detachment from the uterus before a fetal delivery
RF:
- Hypertension, preeclampsia
- Abdominal trauma
- Prior abrupt placenta
- Cocaine & tobacco use
SX:
- Sudden PAINFUL vaginal bleeding
- Abdominal or back pain
- High frequency, low intensity contractions
- Rigid, tender uterus
DX:
- Clinical
- Ultrasound +/- retroplacental hematoma
Complications:
- Fetal hypoxia, preterm delivery, mortality, - Maternal hemorrhage, DIC
Choriocarcinoma
What is it, Tx
Malignancy transformation of chorionic villi or trophoblast
Tx: Chemotherapy (MTX) and hysterectomy
Ovarian tumors
Sertoli leydig features
Sertoli-Leydig: androgen-secreting –> rapid onset of hirsutism, acne, male pattern balding, voice deepening, clitoromegaly, increased muscle mass, vulvovaginal atrophy, breast atrophy, oligomenorrhea
PCOS
1st line tx, Tx menstrual regulation,Tx ovulation, Tx hirsutism
High androgen –> high estrogen conversion in adipose tissue
- 1st line: weight loss
- Oral contraception for menstrual regulation
- 1st line for ovulation induction: Letrozole or Clomiphene
- 2nd line ovulation: Gonadotropins (LH, FSH)
- Spironolactone to treat hirsutism
Endometriosis (Sx, PE, Dx if needed, Tx)
Adenomyosis (RF, Patho, PE, Tx)
Endometriosis:
Non-neoplastic endometrium-like glands/stroma outside endometrial cavity
Sx: Cyclic Pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, infertility
PE: fixed, immobile uterus, rectovaginal nodularity, and adnexal mass
If needed, Dx: –> Laparoscopy
Tx: NSAID + oral contraception (decrease endometrial implant shedding)
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Adenomyosis
Abnormal collection of endometrial glands and stroma within the uterine myometrium.
RF:
- Multiparous women
- Prior uterine surgery (C-section)
Patho:
- Endometrial gland proliferation and cyclic bleeding within the myometrium —> dysmenorrhea and uterine tenderness
- Abnormal myometrial hyperplasia and hypertrophy —> concentric uniformly enlarged uterus
- Uterine enlargement —> Increased endometrial surface area —> regular, heavy menstrual bleeding
PE: Uniformly enlarged mobile uterus
TX: Progestin , then hysterectomy
Urethral diverticulum
RF, Sx, Dx, Tx
RF: repeat infection, inflammation and trauma (vaginal delivery or surgery).
Sx: dysuria, postvoid dribbling, dyspareunia, anterior vaginal mass, hematuria
Dx: UA, Ucx, MRI of pelvis, Transvaginal US
Tx: Manual decompression, needle aspiration, surgical repair
Physiologic changes in pregnancy
Cardio, Pulm, Renal, Heme, Endo
Cardio: Increase blood volume (plasma > RBC), decrease SVR/afterload, increase preload Increase HR and SV –>increased CO
Pulm: Increase central respiratory drive, decrease PaCO2 (resp alk), and increase PaO2, Increase tidal volume, decrease functional residual capacity (elevated diaphragm)
Renal: Increase renal blood flow and urine output. Increase GFR, decrease BUN and creatinine. Increase HCO3 excretion (metabolic compensation). Decrease Na concentration (high ADH)
Heme: Increase prothrombotic coagulation factors. Decrease Hgb concentration (dilutional anemia)
Endo: Increase thyroid hormone demand. Estrogen increases thyroxine-binding globulin —> increased total T4 & T3 levels. hCG stimulates thyroid follicles for increased T4 and T3 production —> decreased TSH. Therefore, check, free T4 and total T4/T3 if TSH is significantly suppressed,
Pregnancy and Thyroid
Normal changes: Path, Dx, tx
Hypothyroidism in pregnancy (Path, tx)
Tx for hyperthyroidism in pregnancy
Postpartum thyroiditis (Sx, Labs, Uptake, Path, Tx)
Normal changes:
- Elevated estrogen levels increased synthesis of T4-binding globulin (TBG)
- Concurrently, hCG also stimulate TSH receptors –> increase thyroid hormone release–> TSH declines d/t negative feedback
- People with normal thyroid function can increase thyroid hormone production to saturate increased TBG
- As hCG falls later in pregnancy –> TSH rises
Dx: TSH level, if suppressed –> free or total T4
Tx: self resolved
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Hypothyroidism in pregnancy
People with hypothyroidism are unable to increase thyroid hormone production.
Tx: increase levothyroxine dose 30% at time for positive pregnancy test
- Measure TSH every 4 weeks and adjusted levothyroxine dose to trimester-specific TSH
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Tx:
- PTU used in first trimester of pregnancy (due to methimazole teratogenicity)
- Methimazole used in second and third trimesters of pregnancy (due to risk of PTU-induced hepatotoxicity).
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Postpartum thryroiditis
- Onset <12 months after pregnancy
- Painless
- Transient hyperthyroid sx d/t release thyroid hormones followed by brief hypothyroid state –> return to euthyroid state
- Anti-TPO + High thyroglobulin
- Decrease radioiodine uptake
- Lympocytic infiltrates +/- germinal centers
CI of pregnancy
Cases and management
- Pulmonary arterial hypertension
- Peripartum cardiomyopathy with residual LV dysfunction
- HF with LVEF <30%
- Severe coarctation
- Severe mitral stenosis
- Severe symptomatic aortic stenosis
- Severe aortic dilation (Marfan syndrome)
Management:
- Recommend again pregnancy
- If pregnancy, discuss abortion
- If abortion decline, regular cardio follow up
- High recurrence if LVEF <20
Neonatal polycythemia
3 main causes categories, Tx, Comp
Hematocrit >65%
Cause:
1. Erythropoiesis from intrauterine hypoxia: gDM, HTN, Smoking. IUGR.
2. Erythrocyte transfusion: delayed cord clamping, twin-twin transfusion
3. Genetic/metabolic disease: hypo/hyperthyroid, trisomies
Tx: IVF, Glucose, partial exchange transfusion
Comp: vascular sludging and thrombosis (renal vein thrombosis)
Pregnancy and Sz meds
Most common cause of secondary amenorrhea is pregnancy.
Many commonly used anti-seizure meds (phenytoin, carbamazepine, ethosuximide, phenobarbital, topiramate) decrease efficacy of OCP by inducing cytochrome P-450 –> increase metabolism.
Those that don’t increase OCP metabolism are gabapentin and valproate.
IUD or etonogestrel implant are less affected by P-450 induction and are better for patients with seizure disorders.
- Although anti-seizures meds are teratogenic, majority of women with epilepsy have normal pregnancies.
- Valproate have the highest risk of teratogenicty therefore, change to an alternative (LEVETIRACETAM) 6 months prior is preferred.
- NO CHANGES in anti-epileptic meds should be made after conception, esp since there is little benefit (organogenesis occurrs between weeks 3-8). Should take high-dose folic acid and screen for neural tube defects (alpha fetoprotein and anatomy US).
- Abrupt changes can trigger seizures.
Breastfeeding should continue (benefits outweigh the risk)
Pregnancy and vaccines
Recommended vs CI
Recommended
- Tdap, influenza, Rho(D) immunoglobulin
High risk patients:
- Hep A, Hep B, Pneuococus, H.influenza, Meingicoccus, Varicella-zoster immunoglobulin
CI:
- HPV
- MMR
- Varicella
- Liver attenuated influenza
**risk of contracting infection from recipients of live vaccine is very low so give vaccine.
Pregnancy and exercise
Recommendations: walking, cycling, yoga, swimming, LIGHT-weight strength training.
- Patients who are already conditioned for long-durations, can continue high-intensity exercise.
Not recommended: scuba diving, contact sports, exercise with fall risk, skydiving
Abortions
Medial abortion meds
Ectopic pregnancy RF and Tx
Septic abortion: Sx, Tx, Comp
Intrauterine pregnancy can be seen on US once B-hCG >3,500
Medical abortion:
1. Mifepristone: anti-progesterone agent that primes uterus.
2. Misoprostol: prostaglandin that causes uterine contractions and expulsion of productions.
Ectopic:
RF: Previous ectopic, pelvic/tubal surgery, PID, tobacco use, infertility, in vitro fertilization
Tx: Methotrexate
Septic abortion
Sx: Fever, lower abd pain, purulent discharge, boggy tender uterus, dilated cervix
Tx: Cx, Abx, Suction and curettage, Hysterectomy
Comp: Myometrial infection/necrosis, sepsis, ARDS, DIC, Death
Contraception (different option, and reliability)
CI for combined hormone contraception
Implant >99%
IUD >99%
- Progestin releasing: less bleeding
- Copper: more bleeding but no hormones
Injection 94%
Pills, patch, ring 91%
Condoms 80%
Withdrawal 75%
Long-acting reversible contraception (IUD and implants) are 1st-line for adolescents
CI for combined hormone contraception :
- Migraines with aura
- Severe hypertension
- Ischemic heart, disease, stroke
- Age >35 & smoking >15 cigarettes/day
- <3 weeks postpartum
- Thromboembolism
- Thrombophilia (Factor 5 Leiden, antiphospholipid antibody syndrome)
- Active breast cancer
- Active or severe liver disease
- Progesterone receptor-positive breast cancer
Pregnancy labs
1st, 2nd, 3rd trimester
Initial:
- Rh D type and Ab screen
- H/H, MCV, Ferritin
- HIV, VDRL/RPR, HBsAg, Anti- HCV Ab
- Chlamydia PCR (if RF are present)
- Rubella & Varicella immuity
- Urine culture
- Urine dipstick for protein
- Pap smear (if screening indicated)
24-28 weeks:
- H/H
- Ab screen if Rh D negative
- 1 hr 50g GCT
36-38 weeks:
- Group B Strep
gDM
Screening and Tx
Comp
Screen at 24-28 weeks
1. Glucose challenge test
- 50g glucose –> check in 1hr. Want it to be <140
If elevated
- Glucose tolerarance test
Check fasting glucose (<95)
Give 100g oral glucose
Check each hour after for 3 hrs (<140, <120) - Postpartum
- Fasting glucose at 24-72hrs then GTT 6-12 weeks later: Give 75g and test for 2 hrs
Tx:
1st line: Insulin
2nd line: metformin and glyburide
Comp:
- Congenital heart defect
- Neural tube defect
- Small left colon syndrome
- Spontaneous abortion
- Fetal hyperglycemia & hyperinsulinemia
- Polycythemia (Increase metabolism demand –> hypoxia –> increased EPO)
- Organomegaly
- Neonatal hypoglycemia
- Brachial plexopathy, clavicle fracture, perinatal asphyxia (macrosomi –> should dystocia)
- Hypertrophic intraventricular septum (increased glycogen synthesis –> glycogen deposition in interventricular septum). Can be treated with IVF and beta blockers to increase LV blood volume. Regression by age 1y/o.
gThrombocytopenia
Criteria, Cause, Tx, CI
- Asx
- 2nd / 3rd trimester
- Pl 70,000-150,000
- No Hx of thrombocytopenia
- No association with fetal thrombocytopenia
- Resolve after delivery
Cause: Hemodilution and accelerated destruction of platelets
Tx:
- Serial CBC
- Repeat evaluation postpartum to ensure resolution
CI: neuroaxial analgesia if plt <70K or rapidly dropping plt d/t increased risk of spinal epidural hematoma
PID
RF, Tx
Most common organisms: N. gonorrhoeae and C trachamatis
RF
- Multiple sex partners (HIGHEST RF)
- Age 15-25
- Previous PIC
- Inconsistent barrier contraception use
- Partner with STI
Tx
A cephalosporin + Doxycycline (covers gonorrhoeae and chlmydia)
Hyperemesis gravidarum
Order of treatment
Order of treatment
- Dietary changes
- Vit B6 and H1 antihistamines
- Oral dopamine and serotonin antagonist
- IVF and IV anti-emetics
- Corticosteroids
- TPN or tube feeding
Preterm Labor Managment
GA and Tx
<32 weeks
- Steroids (IM betamethasone)
- Penicillin (GBS unknown or +)
- Tocolysis: indomethacin
- Magnesium sulfate (neuroprotection)
32-34 weeks
- Steroids
- Penicillin
- Tocolysis: Nifedipine (not indomethacin d/t risk of oligohydramniois and premature closure of PDA.
34-36+6 weeks (later preterm)
- Steroids
- Penicillin
Cervical insufficiency
Tx, CI
Cervical weakness associated with painless 2nd-trimester pregnancy loss
Tx:
- In patients with history-based dx: prophylactic cerclage placed prior to cervical shortening or dilation.
- In patient with US or PE based dx: Emergency cerclage. However, prolapsing amniotic membranes is a predictor for imminent delivery and indicates poor prognosis.
CI: exercise
High vs Low AFP (causes and further evaluation steps)
High:
- Open neural tube defect ( anencephaly, open spina bifida)
- Ventral wall defects (omphalocele, gastroschisis)
- Multiple gestation
Low:
- Aneuploidies (trisomy 18 & 21)
If abnormal
- 1st: repeat serum AFP
- 2nd: US
- 3rd: Amniocentesis to obtain amniotic fluid AFP, acetylcholinesterase.
Acute Cervicitis
Cause, Sx, Dx, Tx
Causes: Chlamydia, Neisseria , foreign object, latex, douching
Sx: Asx, Mucopurulent discharge, postcoital/intermenstrual bleeding, friable cervix
Dx: NAAT, Wet mount
Tx: Empiric tx with Ceftriaxone and Doxycycline. If pregnancy, CTX & Azithromycin
Pyelonephritis
Tx plan
- Requires hospitalization with IV hydration and IV antibiotic therapy (CTX, Cefapime).
- Once afebrile for 48 hours, patient placed on oral antibiotics for 10–14 days.
- Patient then continues on daily suppressive therapy until 6 weeks postpartum.
GBS infection
Screen at 36-38 weeks
Indication for intrapartum ppx:
- GBS bacteriuria or UTI in current pregnancy
- GBS + culture
- Unknown GBS PLUS <37 weeks, fever or ROM >18hrs
- Prior infant with early onset GBS infection
Management:
- If deterred early in pregnancy –> treat immediately with amoxicillin & cephalexin.
- Repeat test 1 week after finishing abx. - Regardless of results, treat with intrapartum Abx ppx (penicillin)
Postpartum Hemorrhage
RF, Cause, Tx
RF
-Prolonged or induced labor
- Chorioamnionitis
- Multiple gestations
- Polyhydramnios
- Grand multiparity
- Operative delivery
Causes:
- Uterine atony (most common)
- Retained placenta
- Genital tract laceration
- Uterine rupture
- Coagulopathy
Tx:
- Bimanual uterine massage, oxytocin
- IVF, oxygen.
- Uterotonic (methylergonovine, carboprost, misoprostol)
- Intrauterine balloon tamponade
- Uterine artery embolization
- Hysterectomy
Mastitis
Path,RF ,Bug, Sx, Tx
Lactation Mastitis:
Path: Bacteria from skin enter the milk ducts, and proliferate in stagnant milk —> infection
- Most likely to develop in the first 3 months.
- RF: Difficult breast-feeding —> prolonged engorement, inadequate milk, drainage, clogged milk ducts.
- Bug: most commonly Staph aureus
- Sx: Fever, breast pain, focal inflammation.Can also have myalgia, chills, malaise.
- Tx: Dicloaxacillin and cephalexin
Comp: Abscess
Sx: Fever, focal inflammation, flutuant tender mass
Dx: US
Tx: US guided fine needle aspiration
Pregnancy and renal colic
Dx
Dx:
1. Renal and Pelvic US
2. transvaginal US
3. Treat empirically OR MRI OR low-dose CT
Labor
Stages and phases
1st stage: beginning of contractions and end at 10cm dilated.
—– Latent phase: beginning of contractions to 6cm (slow cervical changes)
—– Active phase: 6cm to 10cm (rapid cervical changes ~ 1cm/2hrs)
Tx: Oxytocin and amniotomy
Post term pregnancy
After 40 weeks gestation, the placenta function deteriorates, and is no longer able to supply adequate oxygen and nutrition to the fetus, leading to fetal malnutrition and wasting.
Sx:
- Small for gestational age
- Wrinkled peeling skin
- Long thin body
- Decreased subcutaneous fat
- Long fingernails
- Lanugo hair
- Increase scalp hair
- Meconium stained placenta
Complications
- Oligohydramnios
- Umbilical cord compression
- Fetal heart rate abnormalities
- Meconium aspiration
- Respiratory distress
- Hypoglycemia
- Seizures
Pregnancy and appendicitis
Sx, Dx, Comp
Upward displacement of appendix
Atypical presentation: no peritoneal signs and no McBurney point tenderness
Dx: graded compression abd US. If inconclusive –> abd MRI
If untreated, patients can develop pylephlebitis: inflammation and thrombus of the portal veins.
Should dystocia
B: Breathe: do not push
E: elevate legs and flex hips (thighs against abdomen)
C: Call for help
A: Apply suprapubic pressure
L: enLarge vaginal opening with episiotomy
M: Maneuvers
- Delivery posterior arm
- Rotate posterior shoulder: apply pressure to the anterior aspect of the posterior shoulder
- Adduct posterior fetal shoulder: apply pressure to the posterior aspect of the posterior shoulder
- Mother on hands & knees: “all fours”
- Replace fetal head into pelvis for C-section
Uterine sarcoma
Ultrasound appearance is indistinguishable from leiomyomas
Should be suspected in postmenopausal patients
RF: tamoxifen use and pelvic radiation
Tx: hysterectomy
Aggressive tumor with a high risk of recurrence and poor prognosis
Pregnancy and Sickle cell
Prenatal care:
- baseline 24hrs urine collection/testing for total protein
—worsening chronic HTN doesn’t have sig change in proteinuria
—superimposed preeclampsia have progressive proteinuria
- Baseline chemistry panel
- Serial urine culture
- Pneumococcal vaccination
- Folic acid
- Aspirin
- Series fetal growth US exams
Obstetric complications:
- Spontaneous abortion
- Preeclampsia, eclampsia
- Abruptio placentae
- Antepartum bleeding
Fetal complications:
- Fetal growth restriction
- Oligohydramnios
- Preterm birth
Acute sickle hepatic crisis
- Episodes can be more severe during pregnancy with increasing gestational age.
- Repetitive RBC sickling cause destruction of erythrocytes and intra-extravascular hemolysis. - Repetitive episodes are associated with increased fetal and maternal morbidity.
Ovarian Hyperstimulation syndrome
Cause, path, Sx, Dx, Tx
Complication of ovulation induction therapy for infertility
Path:
- high hCG enhances ovarian
- acute fluid shift to extravascular space (third spacing)
Sx:
- N/V/abd pain
- Ascites
- Respiratory distress
- Hemoconcentration
- Hypercoagulabiltiy
- Electrolyte imbalance
- Multiorgan failure (renal failure)
- DIC
-Rapid weight gain
Dx:
- Fluid balance monitoring
- Serial CBG, electrolytes
- Serum hCG
- Pelvic US: bilateral enlarge ovaries with multiple follicles
- Chest xray: pleural effusion
- Echo: pericardial effusion
Tx:
- Corrected electrolyte imbalance
- Paracentesis and/or thoracentesis
- Thromboembolism prophylaxis
Vaginal delivery criteria
acceptable presentations
- Presentation: fetal body part close to birth canal
- Position:
—–Occipital anterior is best
—–chin anterior is possible
—–chin poster (next to sacrum) is not - Station
Primary ovarian insufficient
Sx, Labs, Imaging, Additional testing, Tx
Sx:
infertility, hot flashes, night sweats, vaginal atrophy
Labs: Elevated FSH but low estrogen before 40
Pelvic US: thin endometrial and small ovaries
Additional testing to find underlying cause: adrenal antibodies, TSH and karyotype analysis
Tx: estrogen replacement
Ovarian cancer (RF, protective factors, Sx, Labs, Tx)
Most common type is Epithelial ovarian carcinoma
RF: Family hx, genetic mutation (BRCA1/BRCA2), age >50, endometriosis, infertility, early menarche/late menopause
Protective factors: OCP, multiparty, breastfeeding
Sx:
- Asx: incidental adnexal mass
- Pelvic/abd pain, bloating, early satiety
- Dyspnea, obstipation/constipation, abd distension
Labs:
- High CA-125
- US: solid complex mass, thick separations, ascites
- If US is suspicion –> CT
Tx:
- Surgical exploration, chemotherapy
Cervical cancer
RF, Sx, Dx
RF :
HPV (strains 16,18), history of STI, early onset of sexual activity, multiple or high-risk sexual partners, immunosuppression, oral contraception use, low socioeconomic status, tobacco use
Sx:
- Mostly asymptomatic
- Irregular vaginal bleeding and a friable exophytic cervical mass
- Postcoital bleeding; watery, mucoid vaginal discharge; and ulcerative cervical lesions
Dx:
- Suspicious cervical lesions require a cervical punch biopsy
Pregnancy and skin changes
Melasma (Cause, RF, Tx)
Melasma:
- Acquire hyperpigmentation on sun-exposed areas of face
- RF: darker skin, family hx, thyroid dysfunction, medications (antiepileptics, oral contraception)
- Most common in women, esp during pregnancy, when elevated estrogen, progesterone, and melanocytes-stimulating hormone levels caused melanocyte stimulation
- mostly resolved within 1 year of giving birth but some areas stay.
Tx:
- Try to minimize sun exposure, using sunscreen
- skin-lightning agents and topical retinoid cream
Preeclampsiad
Def, cause,PPX
new onset HTN, proteinuria and/or end organ damage at >20 weeks
Thought to be caused by abnormal increase in platelet aggregation and vasoconstriction –> placenta infarction and ischemia.
In high risk patients, daily low-dose aspirin therapy initiated between 12 - 16 weeks
Breast mass (Dx by age and management)
Gynecomastia (physiologic vs pathologic features)
Nipple discharge
Breast mass:
Age <30: US
——-Simple cyst –> Needle aspiration
——-Complex cyst/mass –> Biopsy
Age 30-39: Mammogram or US
Age >40: Mammogram + US
——-Suspicous? Biopsy
—-If aspiration is non bloody (clear, green, straw-colored) and the cyst resolves: no additional testing
—-if blood and/or mass persist: biopsy
Gynecomastia:
Physiologic: imbalance in hormones - Androgens are converted to estrogen –> unilateral/bilateral, asymmetric or tender for boys at Tanner stage 3-4.
Pathologic:
Occuring before or after mid-puberty (Tanner stage 1 or 5), rapid progression or size >4cm, around nipple or persistence for >3 years.
Can order CMP (to r/o hepatic or renal disease) and hormonal studies (TSH, testosterone, estrogen, prolactin, LG, beta-hcg).
Nipple discharge
Pathologic: unilateral, bloody, spontaneous –> imaging
Physiologic: bilateral, multi-ductal expressed only with manipulation –> galactorrhea work up
Breast cancer
Screening
2 RF in men, Tx (2 routes)
Lobular carcioma in situ (management)
Intraductal papilloma (sx,dx, tx)
Mammary duct ectasia (sx)
Screen:
- Age 50-74 every 2 years
- age 40-49 based on shared decision making and RF’s
- Gene testing for high risk patients. High risk is two 1st-degree family members or 3+ 2nd-degree family members
RF:
1. Tumor suppressor gene mutation: BRCA1 and BRCA2 are tumor suppressor genes that repair dsDNA breaks. Mutations are inherited in AD manner
2. Klinefelter syndrome: extra X increases estrogen/androgen ratio. Sporadic error so family history does not increase risk.
Breast-conserving therapy: lumpectomy, lymphadenectomy, radiation
CI: multifocal disease (>2 tumors in separate quadrants), inflammatory breast cancer, prior therapeutic chest wall radiation therapy
Other treatment: chemo, mastectomy w/axillary LN dissection, and radiation
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Lobular carcioma in situ:
- Classically has no pleomorphic changes, consistent with non-invasive lesions. Usually observed with surveillance.
- Nonclassical LCIS does have suggestions of possible malignancy, and increased risk of developing invasive carcinoma.
- Tx: If core needle biopsy is concerning –> Excisional biopsy
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Intraductal papilloma
- Benign papillary tumor arising from breast duct lining
- Dx: unilateral, bloody discharge (can be non-bloody), no associated breast mass (nonpalpable d/t to size and location), no lymphadenopathy.
Tx: Mammography but if negative: US or MRI
Biopsy +/- excision
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Mammary duct ectasia:
- Causes fibrosis and inflammation of subareolar ducts –> multicolored discharge (blue or green-brown) and breast mass.
Uterine Rupture
What is it, RF, Sx, Tx
Full thickness disruption of the uterine wall
RF:
- Prior uterine surgery
- Induction of labor/prolonged labor
- Congenital uterine anomalies
- Fetal macrosomia
- Interpregnancy interval <18mo
Sx:
- PAINFUL Vaginal bleeding
- Intraabdominal bleeding (hypotension, tachyardia)
- Fetal heart rate: late deceleration
- Loss of fetal station
- Palpable fetal parts on abdominal exam
- Loss of intrauterine pressure
Tx:
Laparotomy for delivery and uterine repair
