ob/gyn Flashcards
follicular phase
1-14 days- endometrium thickens under influence of estogren- in the ovaries- dominant follicle matures leading to ovlulation
luteal phase
after ovulation, ruptured follicle becomes corpus luteum- segretes progesterone and some estrogen- progesterone enhances lining of the uterus- prepares it for implantation- no implantation- corpus luteum degerenates- STEEP DECREAse iN ESTROgen and progesterone- this leads to MENSTRUATION
menstrual cycle
FSH - egg mature
LH: mature follice to produce estrogen
LH in charge of all hormones
estrogen negative feedback- stops LH AND FSH if too much estrogen- inhibits the GRH so that less LH And FSH
then positve feed back switch from estrogen= then the surge
ovluation : due to increase in LH SURGE: leads to egg release: day 12-14
if preg
blastrocyst- keeps the corpus luteum functional- estrogen and progesterone— keeps endo from sloughimg
dub
normal cycle is 24-38 days lasting 4-8 days
average loss is up to 80 ml
def
menorhage : heavy or prolonged
metrorrhagia: between expected metnrusal cycles
menometrorrhagia: irregularly, bleed between expected menstrual cycles
oligomen: infrequent menstruation
polymen: frequent cycle interval
chronic anovluation (90%)
problems with hPA
extreemes of age- teenagers, or perimeno
unopposed ESTROGEN!!- when blood supply runs out- it sheds- but thats irregularly
ovulatory anovulation
regular cyclical shedding- prolonged progesterone secretion- because there is less estrogen!!!!–> lots of bleeding as a result
diagnosis of exclusion OF DUB
reproductive, systemic, everything ruled out- negative pelvic- DUB IS DX
hormone levels, trasvag, endo biopsy stripe is fine and less than 4 mm,
management of DUB
high dose IV estrogens on high dose OCP
anovulatory DUB: OCP- first line- decreases endometrial cancer!! by reducing ounopposed estrogen
progesterone: if estrogen is contraindicated
GNRH agonists- leurolide- temporary amenhorrhea- if given CONTINUOUSLY!
ovulatory DUB: OCP, proesterone, GNRH agonists like leuprolide, surgery
dynsemorrhea
painful menstruation
Primary: not due to pelvic path- due to increased prostaglandin
secondary: due to pelvic path- endometriosis, adenomyosis, leiomyomas, pid, adhensions
right before or with menses- diffuse pelvic pain
NSAIDS- inhibits prostaglandin mediated uterine activity, ovluation suppression with OCP/depo
laparoscopy
premenstrual syndrome
physical, behavioral mood changes with LUTEAl phase of the MENSTRUAL CYCLE!
bloat, breast swell, headache, fatigue, muscle pain, depressed, hostile, irritable, aggressive, food cravings
starts 1-2 weeks before menses- relieved within 2-3 days of menses- 7 days symptom free during follicular phase!!!
SSRI, SNRI, COP, GNRH, spirnolactone for bloating and breast tenderness,
Amenorrhea
no menses
preg test, prolactin, FSH, LH, TSH
primary amenorrhea
failure of menarch onset- by age 15y (With sex characteristics )or 13y (no 2ndry sex characteristics)
breast and uterus present: utflow obstruction
uterus absent but breast preasnt: muellerian agenesis, androgen insens
breast absent and uterus present: ELEVATED FSH AND LH is ovarian cause (means HPA is working)- turner’s (45 x)premature ovarian failure
NORMAL/low: fsh AND LH Are low: hpa failure puberty delay (athelete, illness, anroexia)
secondary amenorrhea!!
absense of menses formore than 3 months in a patient with previously normal menstruation or more than 6 months for someone who was previously oligo
preg: MOST COMMON CAUSE OF SECONDARY AMENORRHEA!!!
hypothalamus: decreased fsh and lh because problems with GNRH: anoreia, exercise, stress, nutrtitional deficiency, celiac, hypothalamic disorders
pitutitary dysfunction: prolactin secreting pitutary adenoma- prolactin inhibits GNRH!!!- less FSH, LH, increased prolactin
ovarian dysfunction: pcos: premature ovarian failure, turner’s- - lack of estrogen- they have symptoms of menopause: DUE TO ESTROGEN DEFICIENCY11! - hot flash, sleep problems, dry thin skin, vaginal dryness
increased FSH AND LH, decreased estradiol- means ovarian problem
prosterone challenge: given them progesterone and if they bleed- its ovarian–no ovulation and there is enough estrogen present
NO BLEEd; hypoestrogenic (HPA failure to release estrogen) OR uterine outflow issue cuz of outflow tract block or hpa failure
menopause
ovarian failure for more than 1 year no menses- average is 50-52
premature menopause- before 40
estrogen deficiency- hot flash, osteoporosis, skin/nail/hair changes, increased cardiovasc events, hyperlipedieia, vaginal atroph, atrophic vaginitis (ellow discharge)
INCREASED FSH!, increased LH but no estrogen!!! - no more ovarian follicles!!
management: estrogen cream, calicum, vitamin d, bisphosphonates, SERM (tamoxifen, raloxfine)
HRT!!: estrogen only or - risk of endo cancer but not breast cancer, because of the estrogen- often used for people with no uterus!!, CVA, DVT< PE!!
estrogen and progesterone:protects against endo cancer- use for those with uterus
uterine fibroids (LEIOMYOMA)
benign smooth muscle tumor in uterus
REGRESSES AFTER MENOPAUSE
GROWTH IS RELATED TO eSTROGEN!!
african american
menorrhea most common, dysnmen
abd pressure, bladder issues
IRREGULAR, LARGE HARD PALPABLE in abd pelvis!!
most dont need TX
medical: inbhits estrogen!!: leuprolide- GNRH AGONIST-shrinks the uterus- but only if given continuously=used if near menopause!
surgery: hysterectomy- def treatment- most common cause of hysterectomy is fbiroids
myomectomy: preserve firtility
adenomyosis
islands of endometrial tissue within the M”YOMETRIUM!! (mucular layer of uterin wall)!!!
MENORrhagia, dysmehorrhea
tender, SYMMETRICAL, BOGGY UTERUS!!
FIBROIDS ARE assymmetrical and hard but adenomyosis is not!!
TOTAL ABDOMINAL hysterectomy is the only effective therapy
endometritis
infection of uterine endometrium
postpartum or postlaboral uterine infection- biggest risk factor is C sECTION!!!
tachy, abd pain, uterine tenderness after c section, postABORTAL!
clinda and gentamycin as treatment!!
proplyalsix:S 1st gen cephalo X 1 dose during c-section to avoid this
endometriosis
ectopic endometrial tissue- RESPONDS TO hormaonl changes!!
OVARIES- MC SITE!!!
nulliparity is a risk factor!!- usually less than 35 years old when it starts
cyclic premenstrual pelvvic pain, dysmenorrhea, dyspareunia, dyzcchezia (painful defectation)
INFERTILITY!!1
laparoscopy with biopsy- def
endometiromas- chocolate cysts
TX: combined ocps and nsaids
progesterone: suppresses GNRH- atrophy of endometriosiis, suppresses ovulation
leurpolide- GNRH analog causes pitutary fsh//lh suppression
DANAZOL!!!! testosterone-induces pseudomenopause- suppresses FSH and LH !!!
feritility wants: conservative laparoscopy
total abd hysterecomy- no babies
endometrial hyperplasia
due to continuous unopposed estrogen- no progesterone
CHRONic anovulation- too much estrogen, but no eggs to ovulate!!
endo strip more than 4 mm- screen test
endometrial biopsy- def test– check if more than 35 with stripe, tamoxifen, ags on pap
TX:
PROGESTIN!!!
hysteretomy if ATipia with endo hyperplasai
endo cancer
mc gyn malig
mc postmenopausal
estrogn dependent CANCER!
too much estrogen exposure, tamoxifen, pcos, obesity, late menopause
COMBINED OCPS- protective against endometrial cancer and OVARIAN
adenocarcinoma mc
hysterectomy- tx
postmenopausal beleed
mc benign, but check for endo cancer
pelvic organ prolapse: uteriner herniation into the vagina
MC after childbirth!!
bladder into the anterior vagina- CYSTOCELE
small bowel into UPPER VAGINA: enterocecele
rectocele: posterior distal vagina with distal sigmoid colon
vaginal fullness
vaginal bleed purulent discharge
urinary frequency, urgency, stress incontiennce
KEGAL exercises strengthen pelvic muscles- prevention
pessaries!!!!
hysterecomy- surgery
functional ovarian cysts
follicular cysts- when follicsles don’t rupture and just grow
corpus luteal cycstS: fail to degenerate after ovulation
asymptomatic until rpture- unilateral RLQ or LLQ pain
pelvic US- smooth, thin walled unilocular
luteal- complex, thicker walled with peripheral vascularitiy
r/o pregnancny
most cysts less than 8 cm spontaneously reoslve- repeat ultrasound after 6 weeks
ovarian cancer
ocps are protective- decreases ovulatry cycles
HIGHEST MORTALITY in all gyn cancers
less ovulatry cycles put u at risk- inferitlity, nulliparity
BRCA1/BRcA2, turner’s, peutz jehgrers
rarely symptomatic, constipation, abd fullness/distentions
abd or ovarian mass, ascites, METS TO UMBilical lymph nodes (sister mary joseph’s nodeS_
biopsy- 90% EPITHELIAL!!!!- serum CA-124 levels used to monitor TREATMENT PROGRESS!
benign ovarian neoplasmas
dermoid cystic teratomas- mc enign ovarian neoplasma
pcos
amenorrhea, obesity, hirsuitism, insulin resistance
LH DRIVEN, in ovaries- androgen production increased!!!, increased insulin!!
oligomenorrhea, amenorrhea secondary
hirsuitms is from too much androgen
type II DM, obesity
bilateral ENLARGED, smooth mobile ovaries- acanthosis nigricans
increased testosterone in labs, LH AND FSH ration: 3 to 1, LH IS REALLY HIGH!!!
string of pearls in pelvic- peripheral cysts
OCP is treatment- noramlizes bleed- suppresses androgen, spirnolactone for hirsuitism- but teratogenic
leuprolide, finasteride
clomiphene for inferitlity
metformin for reducing insulin
management of abrnomal paps in adult women more than 25
Management of Abnormal PAPs in Adult Women > 25 years
• ASC-US:
• If HPV negative – rescreen in 3 years with co-testing
• If HPV positive – colposcopy
• ASC-H: colposcopy
• LSIL (mild dysplasia): colposcopy, if pt > 30 yrs and HPV negative - repeat co- testing in 1 year is acceptable
• HSIL (mod/severe dysplasia CIS-carcinoma in situ): colposcopy or immediate LEEP excision (diagnostic excisional biopsy)
• AGC: endometrial biopsy/ECC (endocervical curettage) /colposcopy
ab paps in women younger than 25
ASC-H and HSIL = colposcopy
ASC-US, LSIL: repeat cytology in 12 months most of the times!
Management of Abnormal Pap Women 21-24
• ASC-US: repeat cytology in 12 months, HPV testing (positive hpv: repeat cytology in 12 months, negative go back to routine screening)
• ASC-H: colposcopy
• **LSIL: repeat cytology in 12 months, no HPV testing ** - MORE LENIANT!
• HSIL: colposcopy, no excisional biopsy option
cervgical biopsy
LSIL: 1/3 thickeness affected
HSIL: CIN 2: moderate dysplasia- 2/3 thickness
CIN 3: full thickness- carcinoma en situ
cervical carcinoma
human papilloma virus- 16,18!!!!!, 31,33,45,
endomet cancer, ovarian cance, THEN cervical is mc
hpv, DES exposure!!
SQUAMOUS is MOST COMMON TYPE!!
clear cell carcinoma- DES exposures
post coital bleed/spotting- MC
colpo with biopsy!!
GARDASIL!!=-11 to 26 years old
gardasil 9 covers for more!
less than 15- 2 dose, more than 15-3 doses
incomp cervix
can’t maintain pregnancy-
DES exposure- risk factor, previous cervical trauma
CERCLAGE AND BED REST!!!- to prevent premature cervical dilation!!
bartholin cyst/abscess
e.coli, staph,gonorrhea!
tender if infectious
I AND D with abx
vaginal cancer
squamous cell MOST of the times- clear cell if DES exposure!!
asymtomatic- ab vaginal bleed, vag discharge
vulvar cancer
squamous
pruritis is MOST COMMON SYMPTOM!!
red/white/ulcerative, crusted LESIONS!- biopsy
vulvular atrophy
decreased estrogen- dryness, painful sex, infection and recurrent uti!
vaginal estrogen, vaginal moisturizers
mastitis
mostly in laactating women, s. AURESU!! MC
infectious: unilateral!, tender, warmth, swelling, nipple discharge- mother can continue to nurse or breast pump!!
congestive: bilateral
breast abscess: fluctuance with induration,
infectious: dicloxacillin, nafcillin,
breast abscess: I AND D- discontinue from the affected BREAST!
fibrocystic brest disorder
exaggeraetd response to HORMONEs- fluid filled!!
Most COMMON breast d/o
multiple, mobile, lumps in breast- tender, BILATERAL no axillary involvement or nipple discharge
breast cysts- INCREASE OR DECREASE WITH MENSTRUAL hromonal changes
FNA- straw colored fuluid no blood
fibroadenoma of the breast
2nd MC benign breast disorder
smooth wellcircumscribed, non tender- freely mobile, rubbery lump- DOES NOT WAX OR WANE WITH MENSTURATION!! no axillary invovlement or nipple discharge!
observation
breast cancer
BRCA and BRCA2, age more than 65 years old, too many menstrual cycles!- nulliparity, prolonged uonpposed estrogen, never breastfed, increased estrogen
infiltrative ductal carcinoma- MC
painless, hard, fixed, non mobile lump- mc in UPPER OUTER QUADRANT, skin changes- skin retraction!!!, discoloration, ulceration, nipple INVERSION!!
pagets disease of nippe: chronic eczematous itchy, scaling rash on the nipples and areola!
inflmattory: red, swollen, warm, itchy brest
peud’orange, lymphatic obstruction caause peu’d oranges, peud orange is poor prognonsis
mamogram shows microcalcification and spiculated masses!!- ultrasound- for less than 40 y, biopsy
lumpectomy, mastectomy, rmoeval of axillary lymph nodes, radiation therapy/chemo, OR ANTI-ESTROGEN!— TAMOXIFEN!- useful for those dependent on the estrogen!!- blocks receptors of estrogen in breast tissue
mammogram: every 2 years- 50 to 74 years old- start at 40 if increased risk factors every 2 years
check breast: immediately after mesnturation ro on days 5-7 of mesnutral cycle.
fitz-hugh curtis syndrome
hepatic fibrosis, uq pain due to perihepatitis- liver capsule involvement- complicatino from PID!
toxic shock
S. AUREUS cause- tampon use, diaphragm or sponge
high fever, ertyheatmous macular rash, hypotension!
TX: CLINDA and VANCO!
vaginitis
bv: mc: gardnella vaginaliis, anareobes , fish, grey-white watery, fishy odor with koh prep, clue celols, metro X 7 days, clinda
no douching,
trich: frothy, yellow green discharge, strawberry cervix, metro 2 g x 1 dose cervical petechiae,
candida: thick crud like- coattage cheese, hyphae, yeast on koh, flucoazole or intravaginal antifungals, keep vagina dry
chalmydia
painLESS genital ulcer, anjd PAINFUL inguinal LAD , nucleic acid, azithro and doxy
chacnroid
hamephilus ducreyi- gram neg BACILLUS
genital ulcer is painful and painful inguinal LAD- AZITHRO
uncomp pregnancy
5 days after conception- beta hcg increases in SERUM
urine- 14 days after conception
hega’s sign: softening after 6-8 weeks gestation
chadwick’s : bluish discoloration 8-12 weeks!
10-12 weeks- fetal heart sound heard!!!
pelvic ultrasound sees fetus in 5-6 weeks!
16-20 weeks: fetal movement
fundal heigh measurement
12 weeks- above pubic symphysis
16 weeks: midway between pubis and umbilicus
20 weeks: at the umbilicus
38 weeks: 2-3 cm below the xiphoid process
prenatal care
nagel’s: 1st day of last menstural period plus 7 days and minus 3 montsh
first visit: CBC, ua, glucose, protein, blood type and rh, random glucose, hep b, hiv, syphillis, rubella, sickle cell and cystic fibrois,s pap smear
first trimester screen
1-12 weeks free beta hcg papp-a nuchal traslucency!! - thickness is bad uterine size and gestation- IF ABNormal; CVS or amniocentesis- 10-13 weeks
ultrasound
CVS: 10-13 weeks- offered to those with chromosal abnromality before , maternal age more than 35, 1st or 2nd trimesterer maternal screen abnormalities, abnormal utlrasound, prior preg loss
INCREASES RISK OF SPONTAENOUS abortion!!
second trimester screening
13-27 weeks
15-20 weeks- tripple screen for fetoprotien, beta hcg and estradiol
low estradiol and low alpha feta BUT HIGH beta hcg!- down syndrome- 21
high alpah feta- open neural tube defects
LOW EVERYTHING- trisomy 18!
inhibin A: high levels is abnormal chromosome
amnicoentesis: - for those at risk- 15-18 weeks
GESTATIONAL DIAbETES: 24-28 weeks
trimester
28 to birth
rhogam- 29 weeks and within 72 horus after childbirth
group b strep checked- 32-37 weeks
h and h
biophysical: breath, tone, fluid, NST, movement!: CHECKED ON FETUS!
non-stress testing
mroe than 2 accelerations in 20 mins, 15 bpm increae in heart rate from baseline- lasting more than 15 seconds is acceleration
non reactive: no fetal heart rate acceleration or elss than 15 bpm in less than 15 seconds (sleeping abyb, or immature or compromised vetus)- fibratory stimulation used
CONTRACTION STRESS TEST
CONTRACTION STRESS TEST: response to STRESS @ uterus contraction
negative: no late deceelrations in the prescence of 3 c oontractions in 10 mins
repetive LATE DECELERATIONS = in the presence of 3 contractions in 10 mins- DELIVERY of baby should be done!!
variable deceleration: cord compression- which is not HORRIBLE but late decelerations are bad!
infertility
can’t concieve fater a year!
hysterosalpingography
clomiphene- induces ovluation
ectopic
mc in fallpian tube-
risk factor: due to adhesions from surgery, pid
cmt, adnexal mass
serial b hcg should double in 24 to 48 hours
trans vag- no sac with more than 2000 strongly suggests ectopic !!
METROtrexate!!i s treatment!!- for stable, early gestation ones but not for ruptured
rhogham if mother is rh neg
ruptured: laparsocopic salpingotomy
spontaneous abortion
Spontaneous Abortion
• Pregnancy terminating before the 20th completed week
• Bleeding, cramping, abdominal pain
• 20% of pregnancies terminate in abortion
• Majority (62%) occur prior to 8 weeks
• 60% result from major chromosomal abnormalities
• Diagnosis-ultrasound, serial beta-HCG (should double every 48 hours)
Definitions of Abortion
• Threatened Ab – Bleeding with or without cramping with a closed cervix
• Inevitable Ab – Above with dilatation of cervix
• Complete Ab – All products have been expelled
• Missed Ab – Embryo or fetus dies but the products of conception are retained
• Incomplete Abortion – Some portion of the products of conception remain in the uterus
• Anembryonic pregnancy – blighted ovum
• Habitual Ab – three or more abortions in succession; think SLE, thyroid
htn pregnancy
• Blood pressure greater or equal to 140/90
• Occurs at or after 20 weeks of gestation
• No proteinuria
• Treatment
• Usually refrain from using anti-hypertensives
• Treatment indicated for systolic > 160 mmHg or diastolic > 105-110 mmHg
• NO ACE inhibitors/ARBs
• Preferred drugs
▪ Labetalol, Hydralazine, Methyldopa, Nifedipine
pre-eclampsia
htn and proteinuria and EDEMA
mild: 140/90 more than that, with prtoein like 300 mg/24 hours
severe: 160/110 with more than 5 g of protein, thrombocytopenia, dic, hellp syndroem!!! headache, visual!
mild: delivery at 36 weeks
steroids to mature lungs if less than 34 weeks
severe: prompt delivery only cue plus hsop and mag sulfate- hydralazine and labetalol
eclampsia
seizures or coma- tonic-clonic seizures
hyperrreflexia
mag sulfate, delivery of fetus once stable,
htn before 20 weeks
methyldopa, labetalol
abruptio placetae
painful, vaginal bleed, dark red, abd pain, tender, rigid uterus, fetal distress!!
PROMPT DELIVERY!!! mya lead to DIC
placenta previa
no abd pain, soft non tender uterus, no fetal distress
give tocolytics- mag sulfate, steroids given 24-34 weeks for lung maturity! and deliver when stable!
gestational diabetes
/DM only present during pregnancy
risk: infant was heavy before, multiple gestations, obesity
screen: 50- g oral glucose challenge test at 24-28 gestation= if more than 140 mg/dl after 1 hour- do 3 hour
3 hour 10 g- gold standard: fasting more than 95, 1 hour more than 180, 2 hour more than 155, 3 hour more than 140
give insulin
glyburide
labor indution at 38 weeks!!if uncontrolled
40 weeks if controlled
psot partum
mdd 2 weeks to 12 weeks postpartum
blues: just 2-3 days postpartum- resolves in 10 days, no thoughts of harming baby
depression : 3-14 months!!!!!- thoughts of harming baby!
molar pregnancy
Gestational Trophoblastic Disease: Molar (Hydatidiform) Pregnancy
• Presentation
• Bleeding
• Hyperemesis
• Large for dates uterus
• hCG markedly high for LMP
• Pre-eclampsia in 1st or 2nd trimester pathognomonic for molar pregnancy
• Snowstorm or cluster of grapes appearance in uterus on US
Molar Pregnancy
• Complications:
• Metastasize to lung
• Choriocarcinoma
• Uterus needs to be evacuated, tissue sent to pathology
• Effective birth control
• No pregnancy for 1 year. . .follow serial HCG weekly to zero, then repeat monthly for one year
labor and delivery
Labor and Delivery
• First stage – onset of labor to complete dilation of cervix
• Latent – 6 hours
• Active – 3-7 hours
• Second stage – complete dilation of cervix to delivery of fetus – 2 hours
• Third stage – delivery of placenta – 5-30 min
shoulder dystochia
Shoulder Dystocia
• Occurs when fetal anterior shoulder impacts against maternal symphysis following delivery of head
• “Turtle sign”
• Risks: Fetal macrosomia (>4500 g at most risk)
• Maternal diabetes
• Complications: Maternal – post-partum hemorrhage, 4th degree lacerations, fetal- brachial plexus palsies, fracture of clavicle, fetal death
• Management: Maneuvers to increase the functional size of pelvis, decrease the shoulder width of fetus and change the orientation of the fetus (McRoberts-flex, flex, suprapubic pressure)
post partum hemorrhage
Post-Partum Hemorrhage
• Loss of >500 mL of blood after vaginal delivery
• Common: 4% of vaginal deliveries
• Risk Factors: prolonged 3rd stage of labor, multiple deliveries, episiotomy, hx of post- partum hemorrhage, fetal macrosomia
• Causes:
▪ Tone: uterine atony - MOST COMMON CAUSE!!!!! - soft boggy uterus!
▪ Trauma: lacerations
▪ Tissue: retained placenta
▪ Thrombin: coagulopathies
• Management: Active management of 3rd stage of labor, Oxytocin (Pitocin), Early cord clamping and cutting with controlled traction on cord, Hysterectomy
menses
returns 6-8 weeks after postpartum
uterus: at umbilicus afterdelivery, then shrinks after 2 days- descents into pelvis in 2 weeks
lochia serosa: vag bleed after delivery 4-10 days- brownish/pinkish- done by 4 weeks
Premature rupture of membrane
- Rupture of membranes during pregnancy before 37 weeks gestation and before the onset of labor
- 3% of pregnancies; responsible for 1/3 of preterm deliveries
- Complications: umbilical cord prolapse, respiratory distress syndrome, neonatal sepsis, placental abruption, fetal death
- Evaluation:
- Speculum exam (no digital cervical exam) pooling of fluid, nitrazine paper, ferning
- Observation of fluid leakage from cervical os with valsalva
- Treatment: Antibiotics, Corticosteroids, Short-term tocolysis, Delivery
premature labor
before 36 weeks gestation
antenatal steroids!!!- MOST IMPORTANT- to mature the lungs of baby
tocolytics: indometacin, nifedipine, mag sulfate, beta agonists- TERUtaline!!- given for 48 hours to delay delivery so that steroids can take full effecT!!!
abx: group B strep- ampicillin and amoxicillin and azithro
induction
prostagland gle for early induction
later induction: after some cervix dilationiv oxytocin
amniotomy!
early deceleration
due to head compression
variable: due to cord compression
danazol
for someone with fibrocystic breast disease and endometriosis
Danazol is both a weak progestin and androgen which helps to inhibit ovarian function. It is indicated in both the treatment of endometriosis as well as mastalgias secondary to fibrocystic disease and represents the best drug of choice for this patient.
what test should you order for someone with molar pregnancy after you see the clusters on the ultrasound
Gestational trophoblastic neoplasia may range from a simple molar pregnancy to metastatic choriocarcinoma. These conditions are generally associated with first trimester bleeding and hyperemesis gravidarum. Physical exam usually shows an abnormally large uterus, abdominal tenderness, and pelvic exam may reveal abnormalities. Choriocarcinoma may become metastatic, with a high affinity for lung metastasis; therefore, CXR is an essential imaging study to order in these patients.
adnexal mass more than 5 cm
can cause torsion!
