OB readings Flashcards
Estrogen in OCPs suppress what pituitary hormone?
FSH
Progestin in OCPs suppress which pituitary hormone?
LH
Which hormone in OCPs increased cervical mucus thickness?
Progesterone
Which hormone in OCPs provides most of the contraceptive effect, vs which decreases menstrual cycle?
Estrogen = decreases menstruation Progestin = majority of contraceptive effect
What is the classic regimen for OCPs?
21 days of hormones, 7 days of placebos
What are the two major disadvantages of the progestin only pill?
- Must be taken nearly exact time each day
- No control over cycle
Who should progestin only pills be prescribed to?
- H/o thromboembolism
- Breastfeeding mothers
What are the metabolic impacts of OCPs?
Increase lipids and stimulate p450
What is the treatment for breakthrough bleeding associated with combination OCPs?
1.25 mg of estradiol for 7 days, on top of OCPs
NOT double up on pills since progesterone effect will win out, and nothing will change
How long does the initial menstrual irregularity last with combination OCPs?
3 ish months
What percent of women using OCPs will develop amenorrhea?
1% in first year
Who is more likely to have post OCP amenorrhea?
Those pts who had irregular menstruation beforehand and younger women
What is the regimen for transdermal patch use?
The patient should start the patch during the first 5 days of her menstrual period and replace it weekly for 3 weeks. The fourth week is patch-free to allow a withdrawal bleed.
What is a major risk of transdermal patches that may decrease its efficacy?
fat
How often is the DEPO shot given? HOw long does it last?
q3 months (although lasts 14 weeks)
When in the menstrual cycle should the DEPO shot be given?
The injection should be given within the first 5 days of the current menstrual period, and, if not, a back-up method of contraception is necessary for 2 weeks.
Why should the DEPO shot not be given for longer than two years?
Lower estrogen levels increased the risk for osteoporosis
What are the contraindications to DEPO?
- unevaluated vaginal bleeding
- pregnancy
- Malignancy of the breast
- Liver dysfunction
True or false: the depo shot is an alternative to OCPs in women over 35 that smoke
True
What is the most common side effect of implant contraception?
Irregular, unpredictable bleeding
What is a major downside to diaphragm use?
Increased incidence of UTIs
The sponge should be left in place for at least (__) hours after intercourse, but wearing it for more than (__) hours is not recommended because of the risk of TSS.
The sponge should be left in place for at least 6 hours after intercourse, but wearing it for more than 30 hours is not recommended because of the risk of TSS.
Why is IUD insertion best inserted during menstruation?
it confirms the patient is not pregnant and her cervix is usually slightly open.
What is the role of abx and IUD placement?
Not shown to be effective in preventing infx
True or false: the copper IUD works by inhibiting implantation and and can function as an abortifacient in normal use
False–The copper ions from the copper-containing device primarily work as a spermicide, inhibiting sperm motility and the acrosomal reaction necessary for fertilization. It rarely works by inhibiting implantation and does not function as an abortifacient in normal use.
Why is the fertility awareness method not a good method postpartum?
Menstruation is still irregular postpartum
How does the calendar method work?
She charts her periods for 6 months to calculate this fertile period. The first day of the fertile period is determined by subtracting 18 days from the total length of her shortest menstrual cycle. The last day of the fertile period is calculated by subtracting 11 days from the total length of her longest cycle
What amount of breastfeeding is enough to provide contraception?
Exclusive breastfeeding (i.e., intervals between feedings not more than 4 hours during the day and 6 hours at night with supplemental feedings limited to less than 5%–10% of total feeding)
What is the plan B contraceptive?
Lots of progesterone
What are the components of the basic menstrual history?
- Age at first menarche
- LMP
- Length of periods
- Number of days between periods
- Any recent changes to periods
What are the basic questions that should be obtained at a new OB visit?
- Menstrual questions
- Sex question + contraceptives
- Gravidity/parity
- h/o vaginal issues/surgeries
- Family history
- Shx
What are the recommendations regarding clinical breast exams from the USPSTF and the american cancer society?
USPSTF = I rating ACS = q3 years in women 20-39, and annually for 40+
What are the recommendations regarding mammograms s from the USPSTF and the american cancer society?
USPSTF = q2 years from 50-74 ACS = 45-54 annually, then 55 q2 years
Premenopausal women need how much Ca per day? post?
1000 mg fpr pre
1200 mg for postmenopausal
When does the quickening occur?
18-20 weeks
When in gestation does the uterus become palpable in the lower abdomen?
12 weeks
What other hormone has a similar subunit to hCG?
LH
What time of day should a UPT be obtained? Why?
Morning since hCG highest after sleeping
When does a UPT become positive?
4 weeks after LMP
When can FHR be heard with doppler?
12 weeks
What is the technical definition of gestational age?
Number of weeks that have elapsed between the first day of the LMP
How many weeks after the LMP can the baby be visualized by TVUS and TAUS? What hCG levels are these?
TVUS = 4 weeks, 1500 hCG TAUS = 6 weeks, 5000 hCG
What are the three components of the first trimester screen, and when is it done?
at 12 weeks:
- PAPP-A
- bHCG
- US for NT
What are the three components of the second trimester quadruple screen, and when is it done?
15-20 weeks
- afp
- estriol
- hCG
What are the three components of the second trimester triple screen, and when is it done?
15-20 weeks
- afp
- estriol
- hCG
- inhibin
When is the glucose tolerance test indicated?
24-28 weeks
When is screening for GBS indicated?
35-37 weeks
What sort of exercises are contraindicated in pregnancy?
Supine ones, since this puts more pressure on the vena cava
What is the cause of primary dysmenorrhea?
Excess prostaglandin F2a produced by the endometrium
What ages does primary dysmenorrhea affect?
Late adolescents and 20s
What are the four major causes of secondary dysmenorrhea?
- Endometriosis
- Adenomyosis
- Leiomyoma
- PID
True or false: dyspareunia commonly occurs in pts with primary dysmenorrhea
false–suggests a secondary cause of pain
What are the s/sx of dysmenorrhea?
abdominal cramp
n/v/d
What is the therapy for primary dysmenorrhea?
NSAIDs and heat application
OCPs
True or false: NSAIDs commonly do not work in treating the pain with primary dysmenorrhea?
False–so successful that if no response, then should reevaluate the dx of primary dysmenorrhea
What is the surgical treatment for primary dysmenorrhea (hint: it’s not a hysterectomy)?
Presacral neurectomy–surgical disruption of the presacral nerves
What are the diagnostic criteria for IBS?
Abd discomfort for at least 6 months, with symptoms at least 3 days for 3 months
What is the proposed etiology of interstitial cystitis?
Disruption of the GAG layer that coats the mucosa of the bladder
What is a pharmacotherapy for endometriosis?
GnRH agonists (leuprolide)
What is the drug that is used to treat interstitial cystitis?
Dimethyl sulfoxide
What is the defintion or primary amenorrhea?
Never menstruated by age 13 without secondary sexual characteristics
OR
Not menstruated by age 15, but with secondary sex characteristics
What is the defintion of secondary amenorrhea?
Not menstruated for 3-6 months
What is asherman syndrome?
Amenorrhea 2/2 destruction of endometrium after D+C or PID
What are the two dopamine agonists that can be used to decrease prolactin secretion to encourage estrogen secretion?
Cabergoline
Bromocriptine
What is the MOA and use of clomiphene?
GnRH agonist that can be used to suppress or induce the HPA axis for sex hormones
What is the cause for irregular bleeding with a lack of progesterone?
Build up of endometrium from estrogen continues until outgrows blood supply
What is a luteal phase defect?
Corpus luteum is not secreting enough progesterone
What are the components for the PALM mnemonic for structural causes of dysfunctional uterine bleeding?
Polyps
Adenomyosis
Leiomyomas
Malignancy
What are the components for the COEIN mnemonic for non-structural causes of dysfunctional uterine bleeding?
Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified
By what factors does cigarette smoking increase the risk for cervical neoplasia?
3.5x
What are the two major branches of neoplasia of the cervix?
Glandular vs squamous
What are the typical s/sx of vulvar cancer? (4)
- Pruritus
- Burning
- Nonspecific irritation
- Appreciation of a mass
What are the effects of untreated lichen sclerosis?
May distort labial and periclitoral architecture, and fuse the normal labial and periclitoral folds
What is the initial symptom of lichen simplex chronicus?
Itching–“the itch that rashes”
What is the supposed etiology of the pruritus of lichen simplex chronicus?
Detergents, fabric softeners, etc
What is lichen planus? S/sx?
Rare inflammatory skin condition of the vagina/vulva
- May present with areas of whitish, lacy bands of keratosis
- Insertional dyspareunia
- pruritus
- burning
- d/c
menorrhagia, defined as menstrual blood loss of over how many mL?
80
What is complex endometrial hyperplasia vs simple?
Simple = both glandular and stromal elements proliferate Complex = Glandular elements proliferate without concomitant proliferation of stromal elements
Abnormal uterine bleeding in a pt over what age necessitates the workup for endometrial cancer?
35
What is the treatment for endometrial hyperplasia?
progestin therapy
How often should pts with endometrial hyperplasia with atypia be followed for after treatment?
q3 months
