OB/GYN final Flashcards
advantages/disadvantages of radiation treatment in cervical cancer
advantage: able to use direct appliation of radiation
disadvantage: can damage the vaginal tissue so is reserved for older women
five tocolytic drugs
calcium channel blockers
magnesium sulfate
beta sympathomimetics
oxytocin
alcohol
why are submucosal fibroids concerning
because they interfere with the smooth muscle contraction of the uterus, preventing vasoconstriction and allowing for heavy bleeding
treatment of ovarian torsion
spontaneous revision with knee to chest position
laproscopy to untwist and fixate, oophorectomy if the ovary is necrotic
what is the effect of postmenopausal HRT on breast cancer
estrogen + progestin increases risk, estrogen alone does not
compare and contrast open, fine needle, and core needle biopsies for breast masses
open is the most reliable
fine needle is the least invasive but has a higher false negative rate and needs US or Xray guidance
core needle has fewer false negatives
what is the most common bone disorder in the US
involutional osteoporosis
gynecological menopause symptoms
amenorrhea
vaginal dryness
sexual dysfunction
patient presents with postive immunochemistry with an uneffaced cervix 1cm dilated and no regular contractions
what is the Dx
preterm PROM
mild preeclampsia
BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks
proteinura 300-2000 mg/24 hours
commonly have edema
four strategies to avoid hyperemesis
early intervention
outpatient IV hydration
corticosteroids (medrol)
antiemetics (compazine, zofran)
two characteristics of ovarian dysgenesis
early loss of oocytes
failure of germ cell migration
differentiate between CIN and CIS
CIN = cervical intrepithelial neoplasia, can be mild, moderate, or severe dysplasia
CIS = carcinoma in situ
menopause will cause a dramatic reduction in estrogen leading to an increase in FSH
what organ systems will this effect
reproductive
bone
CNS
CV
metabolic
skin
urinary tract
if estrogen is low, what other lab values should be high?
if they are low what is indicated
FSH and LH
there is a loss of GnRH from the hypothalamus
patient pregnant at 24 weeks complains of dyspnea. PE shows midsystolic murmur along the left sternal border, PMI displaced to the left, jugular venous distension
how concerned are you about this patient
only mildly concerned, all of these symptoms can be normal sequela of pregnancy
T/F quantitative HCG can help determine gestational age
false, HCG levels are too variable, unless the value is really low (indicates very early)
management of a threatened SAB
compassion
ultrasound
reassurance
arrange for follow up (1-2 weeks)
T/F screening is strong correlated with breast cancer survival
false, there is only a small increase in survival, a lot what we are picking out are not aggressively malignant similar to prostate cancer
what is the benefit treating bacterial vaginosis to manage preterm PROM
there isn’t any support
DES defined
uses
diethylstilbesterol, synthetic estrogen used to treat or prevent miscarriage, low birth weight, poor OB outcome
anencephaly
failure of the brain to develop
management options for hypothalamic amenorrhea
reduction in stress, gain weight, exogeneous GnRH pump, exogenous FSH and LH, birth control pills
cancer associated with BRCA2
breast cancer
ovarian cancer
pancreatic cancer
prostate
primary vs secondary amenorrhea
primary = none, never
secondary = had periods but stopped
nulliparous
never brought a pregnancy to term
patient 32wks G1P0 pregnant presents with borderline hypertension, trace protenuria, DTRs +2/4 at a bwt of 137.
what might you suspect?
two weeks later the patient presents with significant HTN, +2 proteinuria, hypereflexia, and 11lbs weight gain
what is indicated
beginings of a HTN disorder related to pregnancy
preeclampsia requiring hospitalization
nulligravida
never been pregnant
supplemental progesterone treatment for preterm labor
vaginal progesterone
injections of 17-OH progesterone
uterine prolapse
symptoms
incidence
pressure or heaviness, possible bowel and bladder symptoms
common 20-30%
intermediate forms of GTD
chorioadenoma destruans
placetal site-trophoblastic tumor
parous
how many couples will experience infertility in their lives
how many women
8-14%
25%
late deceleration
what do they indicate
bradycardia in response to a contraction
indicates that the baby is hypoxic
two highlights of the second trimester
time of rapid and major physiological adjustments
fetal viability happpens around 22 weeks
treatment for obesity associated with PCOS
diet and exercise along with metformin, possibly for life
examination of amenorrhea
pelvic exam
US
endoscopy *hysteroscope)
hysterosalpingogram
why does the risk of spontaneous abortion go up with age
because you have a higher risk for genetic abnormalities that will not produce a viable fetus
when is MRI mammography useful
high risk patients (BRCA1, 2, FHx)
best guess at a cause for preeclampisa
alteration of placental physiology that results in loss of substances that normally reduce vascular resistance
what is the trade off from mammography
reduce mortality by 8 per 100,000
increase false positives by 122 per 100,000
four types of emergency contraception
progestin only (plan B)
Yuzpe method
IUD insertion withine 5 days
Progesterone receptor blockers
T/F dermoids are maglignant
false, they are benign but they do destroy normal ovarian tissue if they grow
Rh hemolytic disease (Erythroblastosis Fetalis)
the reaction of anti-d IgG produced by the mother if exposed to Rh+ blood that can cross the placenta and cause hemoylsis
patient with narrow pelvic inlet and DMI is laboring with a fetus with a large biparietal diameter. The feus begins to experience late decelerations.
is oxytocin indicated
what if the presentation was breech
no to both
how common are abdominal pregnancies
what is the mortality rate
how is this managed
1/100,000 very rare
25% maternal, 90% fetal
delivery fetus, leave placenta in situ
acanthosis nigricans
dark, velvety skin in the folds and creases
what is the most significant risk factor for neural tube defects
folic acid deficiency
assessing preterm labor risk
cervical length by ultrasound
fetal fibronectin in maternal serum
general prognostic factors for breast cancer
best age is 40-70
preexisting conditions can limit treatment
staging
receptor status and genetic profile
placental abruption (abruptio placentae)
main symptoms
premature separation of the placenta
bleeding, pain at the sight of placental separation, labor pains
risk factors for involutional menopause
gender
genetics
smoking
low calcum intake
early menopause
four disadvantages of chemotherapy with methotrexate for ectopic pregnancy
mandatory follow up
frequent HCG testing (may take 2 months to go down)
works poorly on advanced gestations
what is the only cure for preeclampsia
T/F there can still be related issues up to 72 hrs later
delivery
true
preventing bladder atony
keep bladder empty during labor
watch for distended bladder post partum
catheterize as needed
which of the vaginitis big three is sexually transmitted
trichomonaisis
should EDD be revised when ultrasound indicated a different date than intial physical exam
yes, ultrasound is pretty accurate
what is the most common germ cell ovarian cancer
dysgerminoma
how is a breast cyst managed clincially
when should it be biopsied
outpatient aspiration
if its the first cyst, it is still present after aspriation, or the fluid aspirated is cloudy
types of estradiol used in HRT
tablets (estrace)
patch (estraderm)
spray (evamist)
differentiate between placenta accreta/increta/pancreta
accreta is less invasive, increta moderate, pancreta complete investion of the uterus and requires hysterectomy
dropping
descent of the baby’s head in to the pelvic inlet
what fetal measurements are taken during an OB ultrasound
skull
abdominal circumference
femur length
types of epithelial ovarian cancer
serous cystadenocarcinoma
mucinous cystadenocarcinoma
three ways to evaulate reccurreny SAB
chromosomal analysis of peripheral leukocytes from both partners
TSH and T4 screen
evaluate uterus (hysterosalpingogram, sonohysterography, hysteroscopy)
what causes a T shaped uterus when exposed to a fetus
DES
causes of osteoporosis
endocrine (cushings, hyperparathyroidism)
renal disease, esp ESRD
medication side effect
involutional
what suppresses lactation during pregnancy
what happens after delivery
estrogen, progesterone, placental lactogen
delivery ends suppression
complications of the third stage of labor (placenta delivery)
postpartum hemorrhage
PP infection (endometritis)
uterine inversion
hypothalamic/pituitary causes of amenorrhea
loss of GnRH from stress, low body fat, or congenital cause
hyperprolactinemia
biparietal diameter
a measurement of the skull through the septum pellucidum used to estimate gestational age accurately after 13 weeks
aglutination of enzmes lcan lead to what
hemoylsis and anemia, which can lead to heart failure
treatment of the big three vaginitis
oral or topical fungicides for monilia
oral or topical metronidazole for trichomoniasis and bacterial vaginosis
topical clindamycin for bacterial vaginosis
criteria for macrosomia
10lbs or more
premature rupture of membranes defined
how common is it?
risk factors
cause
rupture of membranes before labor
5-10%
similar to preterm labor
unknown
special risks associated with PCOS
unopposed estrogen increases risk of endometrial carcinoma
high androgens -> dyslipidemia
insulin resistance -> DMII
how will clue cells look like on a microscope slide
epithelial cells with granular bacterial inclusions
evaluation of a submucosal fibroid
pelvic exam may or may not reveal a submucosal mass, US is better
what is the most common cause of a septic abortion
diagnostic factors
contamination after uterine instrumentation following illegal abortions
fever; discharge; pelvic pain; leukocytosis; elevated SED rate
etiology and symptoms of cystadenomas
unknown, but they are benign
discomfort, bloating, constipation, gerd
T/F SERMs are useful for hot flashes but not osteoporosis
false, its the other way around
factors that increase risk for ovarian cancer
age
genetics (familial, BRCA1-2, ashkenazi)
high fat diet
PCOS
goals of HRT for menopause
reduce hot flashes
improve sleep to improve congition and reduce psychological symptoms
prevent bone loss
maintain health of the vagina, uterus, bladder
psychological menopause symptoms
mood changes
loss of concentration
irritability
three key assesment points during vaginal exam to determine if a laboring woman should be admitted
dilation
effacement
station
Whiff test for vaginosis
KOH on a vaginal secretion slide will produce a fishy smell with gardnerella vaginalis
treatment for ovarian cancer
surgery to cure stage 1-2, or debulk stage 3-4 for better chemo
chemo
DES increased risk for what four things in offspring
vaginal cancer in female offspring
miscarriage/ectopic pregnancy
premature labor
infertility
methods to suppress the ovaries in endometriosis treatment
how long should treatment last
pregnancy
steroid contraceptives
progestins
GnRH agonists
mild androgens
at least 6 months
three abruption risk factors
medical, gynlogical, other
30 yr old patient attempting to get pregnany comes to the clinic to seek infertility treatment after 1 month of unprotected sex.
how should be cancelled
what if she were 35+
40+
less than 35 should try 1 year of unprotected sex before attempting infertility treatment without obvious issues
6 months
immediately
what is the ultimate goal of infertility treatment
prenancy, adoption, or acceptance of life without children
causes of miscarriage
unhealthy embryo
hormone imbalances
uterine malformations
infections
immunologic problems
what is the goal of tocolysis to delay preterm labor
allow transport to appropriate place to deliver
allow time for glucocortcoid therapy
three types of surgical sterilization for women
postpartum “mini-laparotomy” tubal
laparoscopic coagulation or application of occlusive clips/rings
hysteroscopic
what might low amniotic fluid levels indicate
renal issues or an unhealthy fetus
what is the only method of breast cancer screening that is capable of finding non-palpable breast cancer
mammography
T/F hyper or hypo thyroid can cause reccurent abortion
true
what is the most common GYN problem in women from 15-45
symptoms
cervicitis/vaginitis/vulvovaginitis
vaginal discharge; vaginal or vulvar irritation; odor esp with bacterial vaginosis
21 y/o G0 presents with irregular menstrual cycles, hirsutism
Hx Menarche was at age 13, Periods always irregular (q 3-8 months), LMP 5 months ago
what might you suspect
polycystic ovarian syndrome
hyperprolactinemia
hyper/hypothyroid
define the perinatal death (mortality) rate
the number of still births and neonatal deaths per 1000 births
what constitutes complete cervical dilation
10cm
metabolic factors leading amenorrhea
hypothyroid
hyperprolactinemia
chronic illness
insulin resistance/anovulation (PCOS)
GI premature disease
necrotizing enterocolitis
what percentage of women have PCOS
what is the genetic transmission
4-6%
autosomal dominant transmission with variable pentrance
two types of epithelial carcinoma categorized as breast cancer
one special category
intermediate type ducts (ductal carcinoma)
terminal lobular ducts (lobular carcinoma)
carcinoma in-situ
patient with PCOS comes to clinic seeking to regulate periods and treat hirsutism
what is the best treatment option
birth control as long as she doesn’t want to get pregnany
patient G3P2002 presents at 33 weeks with bright red vaginal bleeding
DDx
loss of cervical plug
cervical bleeding from polyps or hyperemia
iatrogenic from digital cervical exams
placenta previa
placental abruption
two ways to augment labor and delivery
intravenous oxytocin and assisted fetal extraction
four ways to evaluate fetal health in late pregnancy
growth measurements
biochemical markers
biophysical assesments
placental assessment
cause of uterine prolapse
symptoms
incidence
weakening of uterine support caused by congenital causes, obstettrical causes, hypoestrogenism, or increased intraabdominal plressure
early deceleration
what does it indicate
are they concerning
transient bradycardia that looks to start when the contraction starts and ends when it ends
represents head compression
not really, it just means delivery is coming
two types of vertex malpresenstations
occiput transverse (OT)
occiput posterior (OP)
surgical treatment of mullarian agenesis
exicision of the transvaginal septum
inciision/resection of hymen
construction of a neovagina
hysteroscopic adhesiolysis
three accepted uterine causes of recurrent abortion
septum, scar, fibroids
common causes of oligomenorrhea
PCOS/PCOD
hyperprolactinemia
hyper/hypothyroid
treating hirsutism associated with PCOS
contraceptive steroids or antiandrogens (spirolactone/aldactone or finasteride/propecia)
apgar muscle tone scores
0 = none
1 = some flexion
2 = active movement
two indications of failed germ cell migration
streak or absent gonads
XX or XY chromosome
menstrual irregularity treatment
intermittent progestins (medroxyprogesterone acetate/provera 10mg x 10days every 1-3 months)
contraceptive steroids (birth control, contraceptive patch, nuva ring)
dermatologic menopause symptoms
dry skin
age spots
treatment for a molar pregnancy
suction curettage
monitor HCG for one year
2% risk of repeat molar pregnancy
three clinical forms of preeclampsia/eclampsia
mild preeclampsia
severe pre
eclampsia
menopause
cessation of menses for 6-12months due to natural, surgical or other causes
two methods of assisted fetal extraction
forceps
vacuum extraction
three distinctive presentations of a rupture ectopic pregnancy
massive blood loss
severe pain
syncope
why give glucocortcoids to someone in preterm labor
forces the development of the fetal respiratory system
clincal features of osteoporosis
wrist, hip, vertebra fracture
loss of height due to compression fractures
chronic back pain
treatment of abruption
delivery via emergency c section or expeditious vaginal deliver
tocolysis for fetal distress
volume replacement
treatment and hazards of cystadenomas
surgical excision
torsion, mucinous peritonitis if it ruptures, death due to size and pressure on other organs
how common is benign first trimester bleeding
where does it come from
what is a possible cause
common
from the cervix
possibly to the luteal-placental shift
can placenta previa be fatal
what is a major risk
yes
if an examining finger is inserted through the placenta
describe the process of engagement during labor
- head floating before engagement
- engagement (the lowest part of the fetus pressing against the pelvis) and flexion
- internal rotation (head turns anteriorly from transverse)
- begining extension of the neck
- complete extension (delivery of the head)
- external rotation (head turns transverse)
- delivery of the anterior shoulder with gentle downward traction
- delivery of the posterior shoulder with gental upward traction
methods of intrauterine contraception
IUD (Copper, mirena, Skyla, Liletta)
endometrial ablation
indications of supine hypotensive syndrome
treatment
anxiety, sympathetic discharge, syncope
lay on your side or on your back elevated 30 deg
pseudocyesis
false pregancy related to stress, bloating caused by gas
why are xrays not reccomended for imagining a fetus prior to 14 weeks
because the bones arent visible <14 weeks and the radiation is harmful
how long is a typically pregnancy from fertilization
from LMP
266 days after fertilization
40 weeks after LMP
why is the baby at risk for brain anoxia with shoulder dystocia
because it can take 5+ minutes to delivery the baby
33 y/o G2 P2002 presents with complaint of severe fatigue and shortness of breath. CBC shows severe anemia, Hgb = 6.2 g/dl. Menstrual cycles are regular (every 28-30 days) but increasingly heavy over the past 6 months
DDx
submucous leiomyoma
PCOS (but periods should not be regular)
coagulopathy
severe preeclampsia
BP 160/110 OR
severe proteinura (>2g/24hrs) OR
oliguria (<500mL/24hrs) OR
Liver abnormalities (RUQ pain) OR
thombocytopenia (<100,000/mm^3)
miscellaneous causes of placental abruption
trauma, heavy lifting, smoking
patient G3P2002 presents at 33 weeks with bright red vaginal bleeding, no recent cervical exams, normal painless uterus, low placenta
Dx
treatment options
probably placenta previa
Csection, expectant mangament if the bleeding stops
is there a value for mammography in ages below 40?
40-50
70+
no because the breast is more dense
maybe
no proven value after 70
two key lacatation hormones
prolactin
oxytocin
primipara
giving birth for the first time
respiratory premature disease
RDS
chronic lung disease
what is the anatomical landmark for a nonpregnant or nulliparous uterus
none, it is about the size of your fist or slightly smaller for nulliparous
prevention of cervical cancer
HPV vaccine
pap smear to detect cervical intraepithelial neoplasia
management of a total previa
partial
low lying
c section
vaginal delivery may be possible
vaginal delivery is usually possible
what would a cervical length of greater than 25mm indicate
very low risk for preterm labor
anesthetic options for the use of forceps
epidural
pudendal block
local anesthetic
surgical menopause
removal of both ovaries
Dx of ovarian torsion
ultrasound showing a mass with no arterial flow on doppler
four characteristics of a benign adnexal mass
unilateral, mobile, cystic, small (<5cm)
DDx for acute pelvic pain
PID
ovarian torsion
ruptured endometrioma
ectopic
SAB
surgical treatment of an unruptured ectopic
salpingostomy
salpingectomy
laparotomy
what is the anatomical landmark for a gravid uterus at 12 weeks
palpable at or just slightly above the pubic symphysis
two highlights of the first trimester
fetal stage of development starts at 10 weeks
most pregnancy losses happen here
preventing ecclampsia
what must be done during this time
IV magnesium sulfate
monitor for overdose (urine output, renal function, reflexs, mental status)
missed abortion
three patient issues associated
SAB where the uterus fails to evacuate the pregnancy within 8 weeks of embryo demise
patient anxiety; possible formation of a calcified mass; small risk of coagulopathy
is ovarian torsion common in a normal ovary
no, the ovary is usually enlarged from a benign cyst, dermoid, or hyperstimulation
what are the three most common causes of infertility
egg or ovulation
sperm
tubal or pelvic
PP CV and metabolic changes
weight loss
blood loss (500-1000mL), usually normal at PP wk3
rapid fall in insulin resistance
coagulation changes (rapid decrease in fibrinogen, secondary peaks of fibrinogen and platelets)
lipid chemistry normal <1week
what is the source of many idiopathic cases of infertility and treatment failure
infertility due to female age
prevention of Rh hemolytic disease
give Rhogam, coats the d antigen in artificial IgG so mom never has a change to react
risk factors for ectopic pregnancy
what percent will have at least one risk factor
previous salpingitis (PID)
previos ectopic pregnancy
prior tubal surgery
cigarette smoking
50%
alternative causes of PCOS that should be excluded
nonclassical congenital adrenal hyperplasia
androgen secreting tumor
cushing syndrome
usual criteria for admission of a laboring pregnant woman
active labor
rupture of membranes
abnormal bleeding
maternal or fetal health issues
if you aren’t sure, reevaluate in 1-2 hours
other types of GYN cancer
vulvar
vaginal
vulvar: squamous carcinoma, malignant melanoma
vaginal: clear cell adenocarcinoma (DES) esxposure
what is the general strategy for the use of clomid
use as much as necessary but as little as possible
expect rapid response (1st 3-4 months)
no effect in continuing beyond 6 months
etiology of PID
infection (gonorrhea, chlamydia, anaerobes) or STI that causes bilaterally inflammation of the fallopian tubes that can form a tubo-ovarian abscess
why are choriocarcinomas dangerous but treatable
they grow very fast and become lifethreatening, but respond well to treatment
what is Ondansetron (zofran) used for in early pregnancy
to treat nausea
three types of breast mass biopsy
open (excisional)
fine needle
core needle
disseminated intravascular coagulopathy is a risk factor with placental abruption
what should you look for in this
falling platelet count
elevated fibrin split products
what is the common cause of subclinical PID
what are the symptoms
what is the risk
chlamydia
mild cramping, no pain or fever
can cause infertility or ectopics due to tubal damage
vagina pessaries
a plastic ring inserted into the vagina to help support a prolapse uterus
why is rupture of membranes relevant
can trigger labor
infection (chorioamnioitis)
what two things would make asherman’s syndrome more likely
some kind of trauma, possibly surgical, that leads to infection
what is the goal of delaying preterm labor
to allow for the production of surfactant to prevent alveolar collapse
what percent of breast cancer is associated with BRCA1-2
5-10%
what risk is associated with gestational HTN
should it be treated
higher risk of HTN later on
only if it is severe >160/110
16 yr old patient presents with positive HCG and ultrasound indicating 16 wks.
What are four issues that might be of concern
school issues
nutrition
substance abuse
social support/newborn care
PCOS characterized by what
enlarged ovaries with multiple arrested cysts, oligomenorrhea/amenorrhea, and hyperandrogenism
patients commonly afflicted with primary dysmenorrhea
possible cause?
treatment
young women with ovulatory menstrual cycles
abnormal prostaglandin metabolism
treatment with antiprostaglandins or suppression of ovulation
what is the percent breakdown of HTN during pregnancy
30% is chronic, 70% is pregnancy induced
what is the most common symptom of endometrial cancer
abnormal uterine bleeding or postmenopausal bleeding
issues to look for in the health portion of the HEST workup
pelvic exam
look for infection (HIV, HepB/C)
changes to immune status (rubella, hepatitis)
TSH
Genetic screening
why is the low transverse uterine incision preferred for a C section
what is the disadvantage of the classical incision on the fundus
the uterus is thin, it easy to get to and heals well
high rupture rate
are self breast exams positively correlated to survival
are they still useful
no
useful in a diligent patient using good protocol during cycle day 6-10
what is necessary treatment for a ruptured ectopic
salpingectomy and blood transfusions
velamentous insertion
the umbilical cord inserts into the chorioaminotic membranes and travels from there to the placenta
first trimester
2nd
3rd
conception through 13 weeks
14-27
28-40
where is prolactin produced
what does it do
anterior pituitary
stimulates milk production by breast glandular tissue
etiology and symptoms of adenomyosis
unknown etiology, common in women 35-45 and abates at menopause
dysmenorrhea and menorrhagia
patient presents with 45X genome, short stature, coartation of the aorta
what GYN issue would you expect
early loss of oocytes (turner syndrome)
two types of episiotomy
midline
mediolateral
when is placenta previa usually seen
what is the cause
after 36wks
gradual cervical effacement and dilation is the trigger
describe the relationship between breast cancer and age
before what age is breast cancer less likely
what is the mean age at diagnosis
what is the time from origin to dianosis
risk increases with age
40 unless genetically predisposed
60-61
2-8 years
management of adenomysosi
diagnosis with MRI or ultrasound
supportive treatment with nsaids, analgesics, or ovarian suppression
surgical treatment with hysterectomy or segmental resection
classic presentation of placental abruption
painful third trimester bleeding
why are triple negative breast cancer the ones with the worse prognosis
because they are not receptive to anti-estrogen/progesterone/HER-2 drugs
types of tubal contraception
surgical
inflammatory occulsion
HTN drugs to stop during pregnancy
ACE inhibitors
ARBs
beta blockers
thiazides
describe lobular CIS
localized carcinoma that is not truly malignany but increase the risk of later malignancy by 20%
five characteristics of a maglignant adnexal mass
bilateral, fixed, solid or semi-cystic, larger than 5cm, ascities
big three causes of vaginitis
monilia (candida albicans)
trichomonaisis
bacterial vaginosis (gardnerella vaginalis)
precipitate labor
delivery with in 2 hours of the start of labor most often seen in multiparous women
three factors that would warrant infertility evaluation at any time
amenorrhea
known tubal Hx
male infertilty Hx
egg/ovulation test for HEST workup
FSH and estradiol (E2) testing on cycle day 2 or 3
serum progesterone
when would a laparotomy be necessary surgical treatment for ectopic pregnancy
ruptured ectopics, interstitial (cornual) ectopics, significant pelvic adhesions
PE findings associated with acute salpingitis
cervical motion tenderness
bilateral adnexal tenderness usually present
three stages of labor
1st: from beginning of labor to complete cervical dilation
2nd: from complete cervical dialtion to delivery
3rd: ends with delivery of placenta
uterine inversion
what is the treatment
when the placenta fails to detach from the uterus and pulls the organ out of the vagina
put it back in
what causes decreased insulin sensitivity in the second and third trimesters
human placental lactogen, prolactin, cortisol
management of a submucosal leiomyoma that is causing anemia
possible transfusion if hemodynamically unstable
additional folic acid and iron
GnRH agonists to decrease FSH and LH to stop menstruation (leupron)
surgical resection
what is the action of clomphene citrate
what are the possible side effects
inhibits estrogen, induces the release of FSH and LH
functional ovarian cysts; decrease cervical mucus; decreased endometrial growth; hot flashes
chemotheraputic agent for unruptured ectopic
methotrexate
treat ment of mild preeclampsia
prevention
deliver +37 weeks
admit <37 weeks
three uses of OB ultrasound
check for fetal anomalies
evaluate the placenta
take fetal measurements
treatment of invasive cervical cancer
radiacl hysterectomy with lymph node dissection
radiation therapy
chemo (adjunctive)
McRoberts manuver
hyperflexing the mother’s legs against the abdomen that allows for rotation of the pelvis and delivery of the anterior shoulder
The presence of which of the following distinguishes eclampsia from preeclampsia?
A. hypertension
B. proteinuria
C. seizure
D. thrombocytopenia
The answer is C [Ob/Gyn].
A. Preeclampsia and eclampsia both manifest with hypertension, proteinuria, and thrombocytopenia.
B. See A.
C. When seizure occurs, the patient goes from a diagnosis of preeclampsia to that of eclampsia.
D. See A.
pregnant patient G2P0010 presents with positive home pregnancy test, LMP 9 weeks ago, intermittent vaginal bleeding for 1 week, LLQ pain getting worse for 12 hours, Hx of right tubal pregnancy 3 yrs ago
what is suspected
how is she evaluated
ectopic pregnancy
confirm or exclude by vaginal ultrasound
what type of US is best in the first trimester
why
vaginal
confirms location of gestation; determine embryo viability; relief of anxiety
NY heart assocation classification
Class I: asymptomatic with ordinary activities
Class II: symptomatic with greater than normal activity
Class III: symptomatic with normal activities
Class IV: symptomatic at rest
gravidity
how many times someone has been pregnant
gestational HTN
BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks with no proteinuria
chronic HTN is associated with what four pregnancy risks
preeclampsia/eclampsia
placental abruption
preterm labor
intrauterine growth retardation
fibroid etiology
what determines the symptoms
a single myometrial cell mutation found in 20-50% of women that is estrogen dependent
symptoms are depedent on location
how often do hot flashes usually occur
when does the activity peak
what percent will have significant problems
1-12 hours, even during sleep
3-5 after onset of menopause then declining
5-10%
when is vaginal ultrasound used for imaging a fetus
abdominal
first trimester
>12 weeks
symptoms of endometriosis
when would it cause severe abdominal pain
none, infertility, dysmenorrhea, dyspareunia
when there is a ruptured endometrioma
Young sexually active patient on birth control presents with pelvic pain. She is afebrile and WBC count is normal. Serum HCG <5 mIU/ml. Pelvic exam unsatisfactory due to guarding and severe pain left adnexa. Ultrasound shows 6 cm fluid-filled mass in left adnexa
DDx?
ovarian torsion
sources of morbidity associated with ovarian cancer
intra-abdominal spread
obstruction or malabsorption in the GI tract
distant mets (liver, lung, bone)
will giving progesterone during pregnancy hurt a fetus
no, progesterone goes up during pregnancy
patient in the first trimester has an HCG greater than 2,000 but no IUP on vaginal ultrasound
what is the probable cause
ectopic pregnancy
apgar categories
color
pulse
reflex/irritability
muscle tone
breathing
three risk factors associated with endometritis
treatment
long labors, multiple vagina exams, failure of sterile technique
IV ABx
treatment of severe preeclampsia
prevention
deliver regardless of gestational age
delay for 24-48 hrs for glucocortcoids if <34 weeks
T/F delayed childbearing decreases risk of breast cancer
false, pregnancy after 35 increases risk by 1.5x
natural menopause
exhaustion of the ovarian supply of oocytes
during the first trimester insulin needs will ______
during the second and third they will _______
stay the same or go down
increase dramatically
musculoskeletal menopause symptoms
fractures/osteoporosis
how does bisphosphonates work against osteoporosis
disadvantages
blocks bone resorption
increases bone mass
reduces plasma calcium levels
needs to be taken on a empty stomach due to poor absorption, can often cause GI issues
integrated theory of endometriosis
high retrograde menstruation allows for endometrial cells to implant or grow
attenuated immune system allows for aggressive spread through blood or lymph
use of the word miscarriage vs abortion
abortion should not be used with patients
vaginal septum
a septum in the uterus that can cause dyspariena or dysmenorrhea
what age is mostly likely to present with acute salpingitis
typical symptoms and signs
teens and early 20s
bilateral lower abdominal cramping and pain with possible fever, purulent discharge that begin during or after menses
risks of Estrogen HRT
increased breast cancer risk
increased risk of CVD
increased risk of DVT (thromboembolism)
increased risk of uterine cancer unless prgesterone is added
primigravida
first pregnancy
clubbed fallopian tubes
hydrosalpinx
what is the major concern with hydrosalpinx
scarring and inflammation has destroyed the fimbria
blocked fallopian tube filled with fluid
the mucosa inside will be damaged and even with surgery to open the tube it may not be functional
SAB first phase
6-9 weeks of gestation, intermittent bleeding and cramping
A 30-year-old female who is 32 weeks pregnant begins to experience tremors, heat intolerance, and irritability along with some fatigue, tachycardia, hypertension, and lower abdominal pain.
Labs reveal the following:
Hct 33%;
Hgb 12.8 g/dL;
WBC 14,600/L
am cortisol 42 g/dL (normal 5 to 20 g/dL)
Total thyroxine 13.1 g/dL (normal 5 to 12 g/dL)
Total T3 225 ng/dL (normal 70 to 205 ng/dL)
TSH 0.4 U/mL (normal 2 to 10 U/mL)
Which of the following therapies is the treatment of choice?
A. amiodarone
B. propranolol
C. propylthiouracil
D. radioactive iodine
The answer is C
A. Amiodarone can be a cause of hyperthyroidism and is not used for the treatment.
B. beta Blockers may alleviate symptomatology of hyperthyroidism but may cause fetal growth retardation.
C. Hyperthyroidism results in low TSH and elevated T3 and thyroxine (free T4). It may cause intrauterine growth retardation, prematurity, or transient thyrotoxicosis in the newborn. Propylthiouracil is the only drug recommended for treatment of hyperthyroidism during pregnancy and lactation. This drug does cross the placenta and, although rare, may result in excess TSH secretion and goiter in the fetus. Therefore, the smallest dose possible should be used. Very little is secreted in breast milk; adverse effects in the fetus have not been demonstrated.
D. Radioactive iodine would be harmful to the fetus.
screening protocol for cervical cancer
begin 3 years after sexual activity or 21-25
q3yrs as long as results have been normal
q5yrs after 50
stop at 65 (or 70) with 5 normal paps
causes of oligohydramnios
signs
urethral stricture, kidney malformation
distended bladder on ultrasound
when would you suspect ectopic pregnancy
first trimester bleeding accompanied by cramping midpelvic pain intially progressing to knife-like localized pain
T/F episiotomy is reccomended for a routine non-operative delivery
false
guidelines to determine if salpingitis should be admitted
fever above 39C
WBC +20,000
guarding and rebound tenderness with severe pain
what would result in paternal genome 46yy in a hydatidiform mole
dispermic fertilization or maternal pronucleus inactivation
what is the main cuase of cervical cancer
two synergistic factors
HPV
smoking and immunosuppression
classic presentation of placenta previa
painless third trimester vaginal bleeding
which of the Rh genes are most important
D
DD - Rh positive
Dd- Rh positive
dd - Rh negative
evaluation of post menopausal bleeding
TV US to measure endometrial thickness, biospy if <3mm
endometrial biopsy >3mm
dilation and curettage in the case of cervical stenosis
staging endometriosis
when is aggressive treatment warranted
mild I and II
moderate III
severe IV
with stage III, IV, or with a patient less than 25
what is an effective treatment for HER-2 sensitive breast cancer
monoclonal antibodies against the receptors
what drug is in Plan B
when are the best given
what is the method of action
what is the main side effect
levonorgestrel pills
best results within 72 hours
blocks ovulation
nausea
puerperium
what happens to the uterus day 1 PP
what is a common procedure done at this time? why?
delivery to 6 weeks
it shrinks to size it was at during week 20 (palpable at the umbilicus
tubal ligation, because the uterus is right at the umbilicus for easy access
changes in menstrual cycle during perimenopause
regular cycles with less bleeding and cramping
irregular cycles
why would oral contraceptives stunt growth of a functional ovarian cyst
using the estrogen and progestone to decrease follical development through lower FSH and LH
what is the most common form of GTD
hydatiform mole
define adenomyosis
indicence
endometrial glands and stroma within the myometrium
8-40% of all hysterecyomes
what is secreted during lactation in the intiial 1-3 days PP
what makes it special
colostrum
low in fat and CHO, high in vitamins and immunoglobulins
5 minor risk factors for preterm labor
poor weight gain
working
smoking
anemia
infection
succenturiate lobe
accessory lobe of the placenta
T/F all the biochemical markers used to monitor fetal heatlh (estriol, human placental lactogen, HCG, etc) have not proved useful
true
what type of ovarian cancer can secrete steroid hormones
granulosa cell tumors
three types of PID
subclinical
acute salpingitis
chronic PID w/ sequlae
when is conservative treatment of ovarian cancer warranted
young people with no children or those with stage one disease with low malignany potential
three methods used to control pain during labor
controlled breathing during contractions
IV opiates
epidural anesthesia
one accepted genetic cause of recurrent abortion
balanced translocations
DDx for a breast mass
benign cyst (fibrocystic disease or cystic duct)
fibroadenoma (benign)
cancer
fat necrosis
lipoma
epidermal cyst
eclampsia
preeclampsia with grand mal seizures
management of HTN during pregnancy
keep blood pressure <140/90
reduce risks of preeclampsia
monitor fetal growth
patient who is 30 wks pregnant arrives at the ER after experiencing a rush of fluid from vagina with painless uterine contractions Q45-60 minutes
DDx
rupture of the amniotic sac
urine
blood
what triggers the let down reflex
nipple stimulation causes a release of oxytocin and prolactin from the pituitary, increasing milk production and letdown
two strategies to manage heart disease during pregnancy
controlling blood pressure
avoid additional cardiac stress of L&D
why are interstitial pregnancies dangerous
they can be mistaken for IUPs because they are in the uterus and the uterus has a much larger blood supply than the fallopian tubes
causes of infertility along with percent incidence
egg/ovulation (25%)
sperm problems (30%)
tubal/pelvic (30%)
unusual problems (5%)
Unexplaned (10%)
how is breast cancer usually discoved
90% are found as a painless lump in the breast
Gravida
being pregnant
six requirements to use forceps in augementation of delivery
completely dilated cervix
head engaged to pelvis (0 station or lower)
position of head must be known
position must be a deliverable one
membranes ruptured
no CPD
what happens on the first transfusion from an Rh positive person to an Rh negative person
subsequent transfusions
nothing will happpen
the body will have sensitized and produce antibodies against Rh factor leading to hemolysis
expectant management for preterm PROM
administer ABx, esp for group B streptococus
consider glucocorticoid if <32 weeks
how long before the miscarriage does embryo death occur
2-6 weeks
when are most people diagnosed with DM I
DM II
how many people
<25
>25
15-20 million, most with DM II
three risks associated with pelvic adhesions from PID
chronic pelvic pain
infertility
increased risk of ectopic
what is the racial and gender bias for involutional osteoporosis
more common in women
more common in caucasians than blacks
why is ferning useful for determining PROM
amniotic fluid will fern on slide due to proteins
what to look for on sterile speculum exam for PROM
pooling of fluid on the blade
pH of fluid
ferning on microscope
culture fluid of labor is not imminent or desirable
treatment for endometriosis
expectant management with nsaids for benign form
ovarian suppression
surgery
main fetal heart rate changes
normal variation
tachy/bradycardia
decelerations (late, early, variable)
what is the normal fetal presentation for labor
vertex, occiput anterior (OA)
what is the main endocrine changes associated with menopause
dramatic reduction in estrogen production resulting in an increase in FSH from the pituitary
what is considered a full term pregnancy
premature pregnancy
37-41 weeks
anything before 37 weeks
T/F total placenta previa will not change throughout the course of pregnancy
true, it can become marginal due to uterine growth
advantages of endometrial ablation
it will make conception much less likely and can reduce dysmenorrhea or endometrial pain to managable levels
preliminary signs of labor
dropping
false labor
loss of the mucus plug (ww/o bloody show)
what percent of sperm in semen are normally motile
what is considered mild asthenospermia
severe
very severe
+40%
20-39%
10-19%
<10%
are normally dosed birth control pills usually effective for adenomyosis
no, they need to be continuously dosed
two causes of intrauterine adhesions
theraputic ablation
asherman’s syndrome (scar tissue forming from repeat surgical procedures or trauam
changes in insulin needs during the first trimester
insulin secretion and sensitivity rise
fasting glucose falls (15mg/dL)
effect peaks at 12 weeks
what type of breast cancer is the most aggresive but uncommon
inflammatory breast cancer
divisions of first labor
prodromal: frequent irregular contractions with no cervical changes
latent: contracts become regular and cervix starts to change
active: strong, frequent contractions with fast progress
how large are typical functional ovarian cysts
will they resolve on their own
what might have happened if the patient has mild to moderate pain
<5cm in diamter
yes, usually with 1-3 months possibly faster with oral contraceptives
the cyst may have ruptured
factors the increase risk of endometrial cancer
decrease risk
estrogen exposure, genetic factors
oral contraceptives, progestin use
primary radiation therapy for endometrial cancer
implants in the endometrium or vagina
lymph nodes irradiation for mets
describe ductal CIS
a localized carcinoma with penetration of the basement membrane with 1-3% having + axillary nodes
non-communicating uterine horn
a malformation of the uterus where one side is closed off from the body of the uterus
apgar breathing scores
0 = none
1 = weak/irregular
2 = strong
indications that a pregnant women in labor should present
frequency of contractions
strength of contractions
vaginal fluid loss
patient pregnant at 12 weeks reports having one episode of syncope
what might be the cause?
as she is starting the second trimester blood pressure falls while blood volume is increased; can lead to positional or orthostatic hypotension
mullerian agenesis
what is this called when its idiopathic
how do both present
testicular feminization due to androgen receptor insensitivity
mayer-rokitanski-kuster-hauser syndrome
primary amenorrhea
two refuted causes of spontaneous abortion with exceptions
infection (except listeria and maybe ureaplasma)
luteal phase defects
GPA
Gravity Parity Abortions
G2 P1 A1
when are apgar scores taken
1 and 5 minutes post birth
treatment of CIN
loop electrosurgical excision procedure (LEEP)
cervical cryotherapy
cold knife cone biopsy
incidence of HELLP syndrome
10% incidence with severe preclampsia
what is premarin
what is it used for
conjugated estrogen used in HRT for menopause
T/F a positive HCG test doesn’t mean a patient is pregnant
true, but for OB/GYN purposes a positive HCG means pregnant
DDx for a benign cyst
functional (follicular or luteal cyst)
benign cystic teratoma (dermoids)
endometrioma
serous cystadenoma
mucinous cystadenomas
T/F you should inspect a placenta previa with a digital cervical exam
false, you should never examine a pregnany cervix when there is vaginal bleeding unless you know there is no placenta previa
where does amniotic fluid come from
what is its function
the fetus, particularly the kidneys
shock absorption, participates in the development of lungs
what is a double set up exam
what is it used for
a sterile speculum exam then a digital exam done in an OR prepped for c section when placenta previa is possible
maternal mortality
two division
Death of a pregnant woman during pregnancy or within 6 weeks of delivery or termination
direct and indirect
congenital abnormalities that would cause uterine amenorrhea
mullerian agenesis
transverse vaginal septum
imperforate hyman
risks associated with bisphosphonate use
osteonecrosis of the jaw
increase risk of esophageal cancer
increased risk of atrial fibrilation
what is the largest part of a normal fetus
what is the exception to this
the head
shoulders in large fetuses with macrosomia
in the case of mild oligiospermia or asthenospermia, what action can be taken
what about a severe issue
fertility without treatment is possible but intrauterine insemination (IUI) may help
fertility without treatment is very unlikely, IVF is the only option
when does normal labor occur
37-41 weeks gestational age
treatment of pregnant patient with DM I
tight insulin control (multidose insulin, diet, exercise)
early delivery (37-39 wks)
is there a benefit for performing an annual breast exam
important notes for the exam
yes, but a hurried or incomplete exam is useless
palpation supine with arm behind head, extra attention in the upper out quadrant, palpate axilla
the essential work up for infertility (HEST)
health, eggs, sperm, tubes
Apgar pulse scores
0 = absent
1 = <100/min
2 = >100 minute
where is zero station
when the biparietal diameter passed through the pelvis inlet
what is the anatomical landmark for a gravid uterus at 20 weeks
36 weeks
palpable at the umbilicus
palpable at the xiphoid
treatments for hot flashes
estrogen
clonidine (slightly effective)
progestin (moderately effective)
SSRI (moderate to good efficacy)
gabapentin (moderate)
how is carcinoma in situ usually diagnosed
mammography
T/F there is no way to know if a person with hypothalamic amenorrhea will resume normal estrogen production
no, which is worrisome for osteoporosis
criteria for a threatened spontaneous abortion
how will a person feel in regards to the pregnancy
any first trimester pregnancy with bleeding with or without cramping
some will still feel pregnant, others wont
when checking FSH and estradiol for HEST workup, what should the values be
what about serum progesterone
FSH <10
E2 <80
SP >9 if taken 7-10 days after LH surge
when will heterotopic pregnancy be more common
what will US show
in IVF
IUP with pelvic pain that mandates laparoscopy
treatment of uterine amenorhea caused my mullarian agenesis
supportive (vaginal dilators and careful counselling)
surgical
blind uterine horn (hematometra)
trapping of blood in the uterus due to a lack of opening
hyperemesis gravidarum
severe vomitting related to pregnancy
T/F the medical term for abortion as noted in the TPAL system G3 P0030 is always a medical abortion
false, it can be any reason why the fetus was not taken to term (ectopic pregnancy)
what is the usual presentation of ovarian cancer
screening tests
conclusion?
pelvic mass with ascites
pelvic exams, CA-125 assays, ultrasound
there is no cost effective protocol
treatment of fibroids
expectant
ovarian suppression
anti-progestational therapy
radiologica embolization
surgery (hysterectomy or myomectomy)
breech presentation
why might this be converted to a csection
posterior, leg, or foot presents instead of the head
because the head comes out last, if it gets stuck delivery might take too long
treatment of vasa previa
early recognition
c scetion is necessary, can be emergent if fetal bleeding occurs
what are the advantages of barrier contraception
three types
they are very effective with the right population and they may provide protection against STI
diaphram, cervical cap, condoms
an Rh negative wants to have a child with an Rh positive father after several SABs
can they have a kid
if the dad is Dd there is a 50/50 shot Rh factor won’t play a factor
if the dad is DD then the fetus will be 100% Rh+
HELLP syndrome associated with preeclampsia
H hemolysis
EL elevated liver enzymes
LP low platelet count
what is the risk associated with hyperemesis gravidarum
what is the treatment
what condition might you suspect to be associated with this
severe dehydration
IV hydration with anti-emetics; possible parenteral nutrition; pregnancy termination in severe cases
gestational trophoblastic disease
take away messages for PCOS
focus on the patients main complaint
make sure to test for dyslipidemia/CVD, insulin resistance, endometrial carcinoma
why is it important to maintain a high index of suspicion when symptoms point to ectopic pregnancy
1/200 have no risk factors, 20-50% result in high risk situations
gestational diabetes
glucose intolerance seend during pregnancy with no hx of DM and normal glucose tolerance after pregnancy
one factors that delays menopase
four factors that hasten menopause
obesity
cigarette smoking, chemo, pelvic radiation
why isn’t US used to screen for ovarian cancer
increased survival by 50% but lead to many false positives
three other producers of HCG
small cell lung cancer
testicular cancer
liver cancer
when would expectant management of placenta previa be indicated
significantly preterm with minimal bleed and the patient is not in labor
what is the effect of HRT for menopause on CV health
breast cancer risk
colon cancer risk
congition
not helpful, maybe harmful
slight increase in risk
maybe decrease risk
probably not useful
non-stress test for fetal monitoring
when is it most useful
comparison of FHR to fetal movement
most useful in late pregnancy
do theca-lutein cysts need to be removed
no, they will go away on their own when the molar pregnancy is removed
SAB second phase
7-12 weeks, heavy cramping and bleeding for several hours followed by expulsion of the gestational sac
in what age group does mammography increase survival
is it safe
what is the most common finding
50-70
yes there is fairly low radiation with modern equipment
microcalcification
breast cancer treatments
surgery
radiation
chemo
endocrine modulation
immune modulation
T/F oral contraceptives increase breast cancer risk
probably slightly
HTN drugs for use in pregnancy
calcium channel blockers
methyldopa
clonidine
hydralizine
treatment for infertility caused by PCOS
reduce insulin resistance (metformin)
induce ovulation (clomiphene citrate/clomid or aromatase inhibitor)
check for other fertility factors with no pregnacy after 3-4 normal ovulations or intially with risk factors
16 yr old patient presents with weight gain, LMP 6 months ago
DDx?
ovarian cyst
GI tumor
ascities
bowel obstruction
fibroid
patient presents with intermittent vaginal bleeding after three months of amenorrhea, persistant nausea and vomitting, high HCG, uterus palpable at the umbilicus
what might you suspect
molar pregnancy
OB issues with diabetics
birth defects
late pregnancy intrauterine fetal death (stillbirth)
large fetal size (macrosomia)
Diagnosis of PROM
immunochemistry (dipstick)
sterile speculum exam
T/F a fallopian tube having undergone a salpingostomy will not heal properly and probably not be effective
false, there is a 70% chance it will heal and be useful for pregnancy
types of breast reconstructuve surgery
saline implants
trans-rectus abdominis muscle flap
six types of spontaneous abortion
threatened
complete
incomplete
missed
septic
recurrent
three other types of fetal malpresentations for labor
face or brow
breech
transverse lie
why do SERMs work
because the estrogen receptors in bone are different that those found elsewhere in the body
multipara
given birth multiple times
treatment for unruptured ectopics
chemotherapy or surgery
why is it important tn HCG stay low after removal of a molar pregnancy
because the formation of a choriocarcinoma is likley
patient G4P0030, 1st electively terminated at 7 weeks, SAB at 18, SAB at 14 with normal appearing fetuses
what is the concern
cervical incompetence
26 yr old primigravid pt 7 weeks pregnant, DM I for 7 years
what happens to her insulin needs during pregnancy
what is the male risk of breast cancer
1/150 that of women with similar risk factors and treatment
four factors that cause conditions with prematurity
respiratory
GI
neurologic
visual
three less classic symptoms of PCOS
obesity
sleep apnea
skin changes (acanthosis nigiricans and skin tags)
two highlights of the third trimester
labor becomes increasingly likely
fetal viability increases rapidly
what causes bacterial vaginosis
incidence
s/s
treatment
gardnerella vaginalis in vaginal flora
common (15-40%)
asymptomatic or may cause vaginitis
metronidazole oral/cream, clindamycin vaginal cream
late decelerations
what do they mean
are the concerning
transient bradycardia that starts when the contraction is ending
indicates fetal hypoxia
if they don’t go away with position change or oxygen progress to c section
how is the placenta evaluated during an OB ultrasound
location and overall health
postmenopausal bleeding DDx
postcoital (cervical polyp or carcinoma)
ovulatory
abnormal (endometrial hyperplasia/carcinoma)
what is the estimated date of delivery
280 days after first day of the last menstrual cycle
primary infertility
a couple (particularly the woman) has never been pregnant together
at what gestational age is an incomplete SAB more common
what are two possible complications
what is required
more likely after 10 wks gestation
bleeding and cramping can be serious
requires uterine curettage
false labor
contractions with no cervial changes due to braxton hicks contractions or early labor (prodromal)
factors that lower ovarian cancer risk
pregnancy (-15% per pregnancy)
oral contraceptives (-50%)
pregnant patient with class II heart failure sudden experiences shortness of breath during normal daily activies
is this concerning
yes, increasing class during pregnancy is an ominous sign
ovarian causes of amenorrhea
primary ovarian failure
secondary ovarian failure caued by a pituitary issue or loss of GnRH
nulliparous
two complications with shoulder dystocia
brain anoxia
fetal trauma
perimenopause
the period of about 10 years prior to menopause characterized by changes in menstrual cycles and vasomotor flushes (hot flashes)
general menopause symptoms
vasomotor flushes
distinguish between third trimester bleeding caused by previa vs abruption
previa is painless, abruption is painful
what is the disadvantage of the transverse c section
when would you do a horizontal incision
it takes long because you have to separate the rectus from the rectus fascia
in the case of fetal distress
DDx of chronic pelvic pain
dysmenorrhea
dysparunia
natural course when not lactating
most will complain of engorgement, leaking, pain increasing over 2-3 days then subsiding
heterotropic pregnancy
two fertilized eggs implant, one in the uterus one ectopically
phases of a spontaneous abortion
first (6-9 weeks)
Second (7-12 weeks)
recovery
what is the long term survivability of breast cancer
two big take aways to maximize survival
old standard is 5 years
most studies are showing 10 years
early diagnosis is crucial and long term surveillance is needed
three types of endometrial hyperplasia
hyperplasia without atypia
hyperplasia with atypia
carcinoma in situ
vasomotor flushes
what causes them
the inability to regulate temperature
cause by misreading by the hypothalamus that triggers cooling mechanisms
what is in a gonadotropin fertility drug
what are the risks of treatment
FSH with or w/o LH
hyperstimulation, multiple births
culdocentesis
needle aspiration of the pelvic cul-de-sac to look for free blood
four examples of phosphonates
alendronate (fosamax)
risedronate (actonel)
etidronate (didronel)
pamidronate (aredia)
key symptoms of PCOS
oligomenorrhea (sometimes with heavy bleeding) or amenorrhea
hyperandrogenism (hirsutism, acne, alopecia)
T/F estrogen causes breast cancer
reasoning?
false, it opens the door to allow for breast cancer to form
women without esstrogen have a low risk, men with estrogen do, early menses + late menopause increases risk
pro/con for episiotomy midline vs mediolateral
midline is more comfortable during healing
mediolateral is less comfortable but less likely to extend into the rectum
hydatidform mole
risk factors
a neoplasm arising from trophoblastic cells
age (very old and very young)
diet/socioeconomic factors
paternal genome 46yy
evaluating abnormal pap smears (ASC-US, LGSIL, HGSIL)
ASC-US: treat any vaginal infections and repeat in 3-6 months
for any others colposcopy with directed biopsy
suspected cause of PCOS
prolonged anovulation caused by genetics, weight gain or stress that leads to hyperandrogenism, insulin resistance, which positively reinforces anovulation
morbidity associated with cervical cancer
local spread and destruction of ureters, bladder, rectum
lymphatic spread
rare distant metastasis
placenta previa
placenta within the zone of cervical effacment and dialtion
standard tests for all amenorrhea/oligomenorrhea
Gondatropins: FSH, LH
Prolactin
TSH
HCG
Test
two ways to evaluate fallopian tubes on a HEST workup
hysterosalpingogram
laparoscopy
what are two sequlae of PID that might cause chronic problems
tubo-ovarian abscess that requires surgical removal
pelvic adhesions
explain why coelemic metaplasia could be a cause of endometriosis
retrograde menstruation causea a metaplastic change in the peritoneum and ovarian lining
TPAL notation examples
G3 P1101
three pregnancies, 1 term delivery, 1 preterm delivery, 1 living child, no abortsion
advantages of SERM (raloxifene/Evista) over estrogen
action is limited to bone
safer than estrogen
side effects are mimicked by menopausal symptoms
may lower breast cancer risk
at what point does managing blood pressure during pregnancy become difficult
after 24 weeks
placenta accreta
treatment
why is this troublsome
an abnormality of placental attachment where the placenta is very tightly attached to the uterus
manual removal
there is no good dissection plane, may require hysterectomy
diagnostic difficulties in relation to heart failure and a pregnant patient
normal physiologic changes cause systolic murmurs and JVD
pseudo-dyspnea can mimic symptoms
PMI shifts due to the uterus
when evaluating a semen analysis for infertility what are three things to look at
what should happen if the results are abnormal
concentration, motility, volume
repeat at 4-8 weeks
the difference between primigravida and primipara
the first time being pregnant vs the first time giving birth
two medications that can cause osteoporosis
glucocorticoids and heparin
traditional reccomendations for threatened spontaneous abortion
bed rest
NPV (nothing per vaginum)(
managing the patient in premature labor
ABx (gram +)
glucocortcoids
bed rest
transport
risk factors or preeclampsia
more common in first pregnancies
more common in black women
more common with multiple pregnancies
more common in low socioeconomic groups
if the mother produces antibodies against the babies blood type can it effect the baby?
it might cause jaundice from hemolysis but AB antibodies are IgM and don’t pass the placenta
what to look for in HCG monitoring following GTD
effective contraception for one year
rising HCG levels indicating invasive GTD (20-30%)
if a mother is Rh negative and continues to have Rh positive children what is the effect
the mother’s anti-d reaction will become strong and stronger
two situations where dysmenorrhea might be caused by outflow obstruction
pain at or soon after menarche caused by mullerian fusion or vaginal formation problem
pain after surgical procedure due to cervical stenosis
why does gardnerella vaginalis cause bacterial vaginosis
unknown, but the bacteria is associated with sexual activity
two types of pseudodyspnea due to pregnancy
progesterone-induced tachypnea
upward displacement of the diaphragm
what happens during an incomplete SAB
how is it different from a normal SAB
products of conception ar not completely expelled
it is the same until expulsion (second phase)
lab test for amenorrhea
HCG
FSH/LH
TSH
Prolactin
Test (in cases of hirsuitism)
chromosomal analysis (to check for congenital abnormalities)
gardasil is most effective when
potential benefit
girls and boys 11-12, reccomended 9-26
prevent 70% of cervical cancer
90% genital warts
gynecologic causes of placental abruption
uterine malformation or fibroids
what other test might be considered for infertility treatment in the presense of oligomenorrhea or amenorrhea
what bout oligospermia
serum prolactin
chromosomal analysis
risk factors for shoulder dystocia
fetal macrosomia
maternal obesity
previous Hx
maternal diabetes
post dates
multiparity
why can “morning sickness” a misnomer
because it can last all day
apgar color points
0 = blue all over
1 = body pink, limbs blue
2 = pink all over
effects of estrogen that counter act osteoporosis
what is the result
stimulates estrogen receptors in bone
reduces the effect of parathyroid hormone
increases bone mass, reduces fractures
preeclampsia/eclampsia
BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks WITH proteinuria
TPAL
four classifications
gravidity plus four classifications of outcomes
Term deliveries, preterm deliveries, abortions, living children
risk factors for preterm labor
prior preterm labor (6-8X)
multiple gestation (6-8x)
african american (3-4x)
low socioeconomic status (1.9-2.6x)
what does the presence of fetal fibronectin in maternal serum indicate
increased risk for preterm labor
HPV types 6, 11, 42, 43 are low risk for cervical cancer but are asociated with what
condlyomata and CIN I
what is the treatment for cervical incompetence
cerclage (a band wrapped around the external os to keep it closed
when would leiomyosarcoma be high on the DDx
how are they treated
when there is a rapidly growing uterine mass or suspected fibroid
excision
causes for pelvic relaxation leading to uterine prolapse
obstetrical deliveries
decreased strength of connective tissue due to age
decreased estrogen
increased abdominal pressure from obesity, chronic cough, constipation
treatment for SAB
incomplete SAB
missed abortion
none
curettage
D & C or prostaglandin therapy
types of abnormal uterine bleeding
oligomenorrhea
amenorrhea (primary vs secondary)
menometrorrhagia
hypermenorrhea/menorrhagia
post menopauseal bleeding
medical cases of placental abruption
gestational diabetes or HTN
two immunochemistry test
amnisure (placental alpha microglobulin 1)
Actim prim (IGF bindining protein 1)
two phenothiazines used to treat nausea in early pregnancy
promethazine (phenergan)
prochlorperazine (compazine)
who does the blood from placenta previa come from
usually from the mom, but can be from the fetus in vasa previa
compare and contrast lumpectomy vs mastetcomy
similar survival studies with post op radiation
lumpectomy is under utilized, but not everyone is a candidate (small breast and large tumor size)
urinary menopause symptoms
frequency and incontinence
what is a normal semen concentration
what is considered mild oligospermia
severe
very severe
+20million
10-19 million
5-9 million
<5million
how do symptoms differ between submucosal and pedunculated fibroids
submucus will have menorrhagia and pressure discomfort from the mass
pedunculated will have acute pain due to infarct and dysmenorrhea
two advantages of chemotherapy with methotrexate for ectopic
convenient (single dose IM)
good success rate (90% optimum success)
two key incisions in a c section
two orientations of the skin incision
four orientations of the uterine incision
skin and uterine
midline verticle and pfannensteil (transverse suprapubic)
low transverse, low vertical, classical, T
SAB symptoms (cramping and bleeding) based on gestational age
5-7 weeks: mild
8-9: moderate
>10 weeks: moderate to severe
three types of placenta previa
marginal, complete, low lying
causes of hyperprolactiemia that might lead to amenorrhea
pituitary adenoma
hypothyroidism
drug induced
idiopathic
cervical incompetence
risks
when does it occur
painless gradual dilation of the cervix
surgery (D&C, conization, LEEP), trauma
14-27 weeks
variable deceleration
what is the cuase
are they concerning
transient bradycardia that can be during or after contractions
compression of the umbilical cord
can be if the bradycardia goes low enough
three ultrasound landmarks and when you would see them
gestational sack (5-5.5 wks)
2mm embryo (5.5-6wks)
cardiac activity (5.5-6 wks)
two types of abortsion
spontaneous and inducd
define gynecology
The study of… diseases & conditions that affect reproduction and the female reproductive system
adjunctive therapy associated with breast cancer
what is the goal
types
is chemo needed?
improve long term survival
endocrine modulation for estrogen sensitive patients (anti-estrogen and aromatase inhibitors)
chemo is not necessary for early stage cancer
rectocele vs cystocele
rectocele is posterior vaginal wall weakness
cystocele is anterior vaginal wall weakness
patient doing a hormone challenge for amenorrhea reports bleeding
what does that prove
that ovaries are producing estrogen and the uterus is intact
treatment options for primary ovarian failure
HRT
egg donation or stem cell gametes for fertility
how is it possible to have a full term pregnancy with a nulliparous cervix
cesarean
TNM
Tumor: size, Node: lymph node involvement, Metastasis: presence of distant metastasis
bethesda system to classify pap smears
normal: negative for CIN, CIS, cancer
atypical squamous cells, undetermined or cannot exclude (ASC)
low grade squamous intraepithelial lesion (LGSIL)
high grade squamous intraepthelial lesion (HGSIL)
two types of dysmenorrhea
secondary (due to pelvic pathology
primary
why are epidurals not reccomended during the latent phase of labor
because it can slow down cervical dilation if it occurs before 4cm dilation
is endometriosis diagnosed with ultrasound
no, endometriomas can be seen but endometriosis is confirmed with laprascopy
two step principle as it applies to breast cancer
make diagnosis with biopsy first, then treat
two uterine causes of amenorrhea
intrauterine adhesion (synchiae)
congenital abnormalities
patient no previous heart conditions presents with mitral reguritation and pleural edema on CXR
is this concerning?
yes, pregnancy will not normally cause diastolic murmurs, +gradeIII systolic murmurs, or pleural edema
three preparations before forceps should be used
adquate anesthesia
bladder not distended (may require catherization
episiotomy
glucocorticoid therapy for preterm labor treatment when less than 34 weeks
betamethasone 12 mg IM q24h x 2 doses
dexamethasone 6mg IM q6h x 4 doses
when is eclampsia diagnosed
50% antepartum
25% intrapartum
25% post partum
what is a likely cause of the hypothalamus causing vasomotor flushing
over production of FSH due to low estrogen stimulates the arcuate nucleus, which is near the thermoregulation center and causes spill over
changes in insulin needs during the second and third trimester
insulin sensitivity falls (33-50%)
fasting and postprandial glucose levels reise
hormonal challenge
progestin adminstered 10g x 5-7d, if bleeding starts that means that uterus and ovaries are intact
estrogen + progestin adminstered that leads too bleeding proves the uterus is intact
T/F fertility drugs are “fertility enhancers”
what conditions are not treatable with fertility drugs
false
sperm, tubal, uterine issues
three ovarian cancer origins
epithelial (90%)
germ cell origin
stromal/sex cord
diagnosis of vaginitis
wet mount on two slides
one with saline to look for flagellated trichomonads or clue cells (bacterial vaginosis)
one with potassium hydroxide to look for budding yeast
what are fertility drugs used for
two types
to cause or enhance ovulation
gonadotropins, clomiphene
classification for neonatal death
death with in the first 28 days
counselling for a patient experiencing nausea during pregnancy
rest/reduce stress
avoidance of triggers
small feedings with trial and error of foods
hydration
dangers associated with unopposed estrogen
strategy for dealing with infertility
discover the causes
correct the issue if possible
bypass if possible
provide support
three things associated with monilia causing vaginitis
hormonal changes, ABx, immune status in frequent infections
key lab finding for primary ovarian failure
very high FSH
why is vasa previa difficult to recognize
what is the usualy initial sign
often it doesn;t cause an issue until membranes rupture
fetal tachycardia
treatment of acute PID
remove IUD if present
admit toxic patient for IV ABx
outpatient with oral ABx
mean age for the onset of natural menopause
51
two types of placental abnormalities that can lead to postpartum hemorrhage
retained placental fragment or lobe
placenta accreta
two types of internal fetal monitoring
fetal scalp electrode for HR
intrauterine pressure catheter
managemnet of PCOS
screen for other causes of symptoms
screen for special health risks
treat main symptoms
imperforate hymen
a hymen that doesn;t open during development and can trap blood to cause dysmenorrhea
clinical factors to keep in mind when assessing a breast lump
most are benign (90% <20, 60-70>40)
is the mass solid vs cystic
mobile vs fixed
dimpling or nipple erosion
treatment of preterm labor
glucocorticoid therapy
tocolysis to delay 1-2 days
three aninotic fluid abnormailities
rupture of membranes
too much fluid (polyhydramnios)
too little fluid (oligohydramnios)
two main systems to indicate gravidity and parity when charting
GPA and TPAL
biohphysical assesments for to monitor the fetus
fetal movements (kick count)
non stress test
acoustic stimulation
contraction stress test
ultrasound assessment
what will happen to insulin needs after delivery
insulin resistance decreases, DMII can usually stop all meds, DMI greatly reduce
what types of patient would warrant vaginal ultrasounds and CA-125 assays every 6 months
BRCA1-2 positive patients with a first degree relative who had premenopausal ovarian cancer
typical course for morning sickness during pregnancy
begins at 5-7 weeks
peaks at 8-10 wks
usually ends >12wks but can persist into the third trimester
patient presents with
- BPs range from 140-155/85-95
- Reflexes +3/4
- C/o slight headache
- Mg SO4 started
- Platelet count 100,000
can you deliver or should you do c-section
in cases of preeclampsia labor progresses quickly and since unlikey to have SZ, trial labor for 8-12 hours unless HELLP syndrome is suggested by lab work
types of germ cell ovarian cancer
dysgerminoma
choriocarcinoma
embryonal cell carcinoma
four accepted causes of reccurrent abortion
maternal age
genetic
uterine
thyroid
24 y/0 gravida 1 para 1 complains of 10 days of progressive symptoms: Vaginal discharge, Vaginal itching and irritation, Good general health, Recently completed antibiotics for strep throat infection
DDx
vaginitis
44 y/o woman, gravida 3 para 3003 reports no menses for 7 months. Also has frequent hot flushes. FSH blood test = 100 mIU/ml with a negative pregnancy test.
Is she menopausal?
by clinical standard yes, but occasionally patients can spontaneous restart menses
prognosis of intraepithelial lesions
50% will regress to normal
25% will persist
25% will progress to invasive cancer
what percent of placenta previa are complete vs partial
20% complete, 80% partial
three ways to reduce risk of preeclampsia
BP control
rest
maybe diet
what causes pain with placental abruption
uterine contractions, uterine pain and tenderness at tthe sight of placental separation
SAB recovery phase
menstrual period like bleeding for up to 10 days
etiology and treatment of a dermoid
etiology: suspected cleavage/growth of an unfertilized oocyte
treatment: surgical excision with careful observation
criteria for reccurent abortion
incidence
3+ SABs especially with no live births
contraction stimulation test
add a uterine tocodynamometer to ultrasonic fetal heart monitor, cause 3 contractions over a 10 minute period and observe the FHR in response
treatment for uterine prolapse
reduce intraabdominal pressure
estrogen replacement
kegels
surgical repair
what is the minimum gestational age for survival
22 weeks
hydrops fetalis
fetal congestive heart failure
three risk factors for placenta previa
uterine scar from prior c section
hypoperfused endometrium (age, multipparity)
enlarged placenta (multiple pregnancy)
labor equals what
regular contractons that change the effacemtn and dilation of the cervix
define obstetrics
The branch of medicine that concerns the management of pregnancy, childbirth and the puerperium
complication common with fallope ring for laparoscopic sterlization
can cause cramping 12 hts post op
three other treatments for osteoporosis other than estrogen
calcium supplementation 1200-1500 mg/day
SERM
bisphosphonates
how to stimulate contractions for a contraction stimulation test
oxytocin/pitocin
breast stimulation
orgasm
miscellaneous causes of menopause
destruction of oocytes from chemotherapy or autoimmune process
endometritis signs
fever, cramping pain, malodorus discharge (lochia) often due to staph, strep, or E coli
why is it important that a pregnant patient not lay supine after 20 wks
the uterus is large enough compress the vena cava, reducing venous return and cardiac output
three causes of postpartum hemorrhage
uterine atony
cervical or vaginal lacerations
placental abnormalities
why is abnormal prostaglanding production suspected to be the cause of endometriosis
because NSAIDs, which block prostaglandins, tend to work well for endometriosis
what is prognosis of ovarian cancer dependent on
stage, age, health, tumor type, tumor grade
two forms of neural tube defects
anencephaly
spina bifida
in a patient with suspected PSOS what tests should be done to exclude alternative causes
early morning serum 17-hyrooxyprogesterone to rule out non-classical congenital adrenal hyperplasia
testosterone +2ng/mL to rule out androgen secreting tumor
cortisol levels to rule out cushings syndrome
treatment of endomettrial cancer
radiation therapy adjuct to surgery or primary
surgery (TAH, BSO)
progestin, tamoxifen
chemotherapy
shoulder dystocia
difficulty delivering the shoulders
primary surgical treatment for breast cancer
conservative (lumpectomy)
mastetctomy
axillary nodes
what is the genetic paradox in breast cancer
first degree relative with breast cancer increases risk by 3-4x
BUT
85% of patients have no family Hx
patient presents with early labor at 21 weeks
what is the reccomendation
it is up to the patient, but delaying labor will only buy so much time and there is good chance the baby will die
T/F most people in the world are Rh positive
true
special risk situation for placenta previa
amniotomy (artificial rupture of membranes) can rupture the umbilical cord
differentiate between benign and aggressive endometriosis
benign is usually dx at a later age with more superficial lesions and slower progression
aggressive with an early onset, more invasive lesions, and rapid progression
two types of external fetal monitoring
ultrasound for HR
tocodynamometer for detecting contractions
preterm labor
incidence
labor between 22-36 weeks
11-12&%
four types of forceps used for operative delivery
outlet
low
mid
vacuum extractor
fetal station
how high is the presenting part of the fetus in relation to the ischial tuberosities
pain associated with ovarian torsion
sudden, severe, unilateral pain with no positional relief and possible nausea
what is the risk of vasa previa
when would you suspect vasa previa
very high risk of fetal death +30%
vaginal bleeding with signs of fetal distress
suppression of lacatation
avoid nipple stimulation
where a very supportive bra
estrogen or dopaminergic drugs
two types of pregnany induced hypertension
gestational hypertension
preeclampsia/eclampsia
patient 10 wks pregnant presents with dark/black spotting especially after pap or sexual intercourse. IUP confirmed, fetal assessment via ultrasound shows no signs of fetal distress
what is the Dx? how can you be sure?
benign bleeding
because the most likely other answers have been excluded
why is pH used to determine PROM
if the fluid is acid it probably urine, basic probably amniotic fluid
secondary dysmenorrhea causes
endometriosis
adenomyosis
fibroids
outflow obstruction from congenital malformation or cervical stenosis
when is methotrexate prefered over surgical management of an ectopic
early on in the pregnancy
visual premature disease
retinopathy
weeks of pregnancy are calculated used what start date
the first day of the last menstrual period
why would a dopamine blocking drug cause hyperprolactinemia
dopamine inhibits release of prolactine from the anterior pituitary
apgar reflex/irritability scores
0 = no response
1 = grimace/feeble cry
2 = cough, pulls away
types of estrogens combined with progestin used in HRT
combipatch
prempro
fem HRT
what is the prognosis of endometrial hyperplasia w/o atypia
with atypia
carcinoma in situ
80% regress, 1% progress to cancer
considered premalignant, 8-29% progress to CA
considered the same as CA
risk factors for nausea and vomitting during pregnancy
multiple pregnancy
prior motion sickness or migraines
personal or family history of morning sickness
social factors
two things that can be assessed in the first trimester via vaginal ultrasound
IUP vs ectopic pregnancy
cardiac activity and size
when is fine needle biopsy the only reasonable method for breast cancerq
when assessing masses that are too small to palpate
three changes in cardiac output linked to pregnancy
30-50% increase during pregnancy
30% increase during labor
45% increase while pushing
three less common presentations of breast cancer
nipple erosion or discharge (pagets)
skin dimpling (retraction)
inflammatory breast cancer
where does oxytocin come from
what does it do
posterior pituitary
causes contraction of smooth muscle in the breast ducts (let down)
prevention of preterm labor
reduce risk factors
supplemental progesterone treatment
what should be monitored for labor progress
cervical changes
strenth and frequency of contractions
FHR
maternal vital signs, bladder status, discomfort
potential PP issues
bladder can be come edematous or atonic
rapid cardiovascular changes
intiation of lactation
what happens to blood volume during pregnancy
increase starting at 8 weeks progressing to a 45% increase in blood volume by weeks 34
how common is breech presentation
3-4% of all deliveries are breech
five indications for c section
failure to progress
fetal distress
abnormal fetal lie or presentation
prior c section
elective
T/F vascular resistance falls during the 1st and 2nd semester
true
risk of calcium supplementation for osteoporosis
people will overdose themselves thinking more is better and give themselves a kidney stone
two types of GTD
hydatidiform mole
choriocarcinoma
health risk screens for PCOS
endometrial biopsy after age 35 or 15+ years of PCOS
lipid profiule
screen for insulin resistance and glucose tolerance
two types of fetal trauma seen with shoulder dystocia
brachial plexus injury (Erb’s palsy)
clavicle fracture
T/F IUD can be used to treat menorrhagia
true
what prevents the uterus from becoming contaminated
cervical mucus plug
amniochorion membrane
how common are ovarian dermoids
what is the age bias
are the bilateral or unilateral
25% of all ovarian neoplasms
20-40
15% are bilateral
three key factors of labor
powers, pelvis, passenger
possible risk factor for polyhydramnios
diabetes, infections, mostly idiopathic
what is the single most important cause of perinatal deaths and neonatal morbidity
preterm labor
four causes for amenorrhea other than pregnancy
hypothalamic or pitiuitary problem
ovarian problem
uterine problem
metabolic/endocrine issue
T/F 50% of pregnancies end +/- 3 wks from LMP
false, 90%
HPV 16, 18, 33, 35, 45 are high risk and are associated with what
CIN II, III, cervical cancer
four growth measurements used to evaluate fetal health during late pregnancy
uterine size
biparietal diameter
abdominal circumference
femur length
three specialistst that should be part of the care team when dealing with a pregnant patient who has heart failure
obstetrician/perinatologist
cardiologist
anesthesiologist
environmental factors associated with breast cancer
high rate in developed nations related to fat intake
ETOH slightly increases risk
at what point in delivery is the brachial plexus at risk
why
delivery of the anterior shoulder
too much downward traction can stretch the nerves
25 y/o G2 P2002 returns for annual checkup and pap smear
On pelvic exam a 4-5 cm mass is palpated in the right adnexa
DDx
Benign ovarian cyst
ovarian cancer
pedunculated leiomyoma
causes of functional adnexal cysts
persistant follicle (follicular cyst)
persistant cystic corpus luteum (luteal cyst)
ovarian cancer stagin
stage one: tumor only in ovaries
stage II: tumor limited to pelvis
stage III: tumor limited to abdomen
Stage IV: distant mets
what is the goal of primary breast cancer treatment
intial recurrence
after that
surgical or medical therapy for a cure
still hope with endocrine, chemo, occasional surgical follow up
eventually palliative care
cephalopelvic disproportion
when the baby’s head is too large for the mother’s pelvis
macrosomia
risks
fetus >10lbs
birth trauma such as shoulder dystocia
describe the increase in maternal and fetal mortality related to eclampsia
increases maternal mortality 4-5%
fetal mortality 13-30%
labor defined
regular contractions with cervical effacement and dilation
spina bifida
a open defect of the spinal cord where the duramater is exposed
gestational diabetes treatment
diet
insulin if needed
metformin to increase sensitivity
definative surgical treatment for endometriosis
total abominal hystectomy with bilateral salpingo-oopherectomy via laparotomy
resection or ablation of endometroima laparoscopicly
how are breast cancers identified by their hormone receptor
estrogen positive or negative
HER-2 positive or negative
basal (“triple negative”)
treatment options for idiopathic infertility
IVF
egg donation
surrogate IVF
why would obesity delay the onset of menopause
adipocytes contain aromatase to convert androgens to estrogens
pharmaceutical treatment of nausea during pregnancy
pyridoxine (B6) + doxylamine (diclegis)
antihistamine (benadryl)
phenothiazines
serotonin antagonists
partiy
the number of times someone has successfully taken a pregnancy to term
what will happen if an Rh negative mom encounters and Rh positive fetus
they will produce IgG against the Rh factor and attack the fetus’ blood cells
what cllasses of heart failure are at severe risk of death during pregnancy
Class III: symptomatic with normal activies
Class IV: symptomatic at rest
when is the most common time for a ruptured ectopic pregnancy
between 9-11 weeks
stromal/sex cord ovarian cancer
granulosa cell tumor
health care issues with the big three vaginitis causes
frequent monilia: immunosuppression
trichomonaiasis: other STDs
bacterial vaginosis: increased risk of premature labor, increased risk of PID with clap, increased risk of post GYN surgery infection
immunologic therapy associated with breast cancer
trastuzumab for HER-2 sensitive cancer
trastuzumab emtansine is a chemo drug bonded to trastuzumab
how common are spontaneous abortions
what is the age bias
15-20% of clinical pregnancies end in spontaneous abortion
risk increases with age
menometrorrhagia
more frequent menstrual bleeding
describe the process of laparoscopic tubal sterlization
what are the advantages
coagulation, cutting, or binding the fallopian tube
no incisions, very effective, can be reversed, IVF still effective
treatment septic abortion
hospitalization with IV ABx and curettage to evacuate uterine contents
cancers associated with BRCA1
breast cancer
ovarian cancer
pancreatic cancer
fallopian tube
what is the most common cause of secondary ammenorrhea
pregnancy
vasa previa
what is needed for this to occur
when the fetal blood vessels run across the internal os
velamentous insertion or succenturiate lobe
breast cancer prognosis divided by receptor status
good: estrogen and progesterone receptors
neutral: HER-2
poor: tipple negative, HER-2 without monoclonal antibodies
how common is pregnancy related nausea and vomitting
70-85% will have some nausea
.5-2% will have severe form (hyperemesis gravidarum)
