OBGYN #3 Flashcards
What pregnancies are at risk for Rh Alloimmunization
-Rh negative mother + Rh positive father (or unknown)
Explain what happens in Rh alloimmunization
When a Rh-negative mother carries a Rh-positive fetus. During subsequent pregnancies, if she carries another Rh positive fetus, antibodies cross placenta and attack the fetal RBC’s, leading to hemolysis of the fetal RBCs
In Rh-negative women, when is Rhogam given? 3 instances
- 28 weeks gestation
- within 72 hours of delivery of Rh-positive baby
- After any potential mixing of blood
What is placenta previa?
Abnormal placenta placement over or close to internal cervical os
Risk factors for placenta previa
-Multiple gestations, previous C-section, previous placenta previa
Symptoms of placenta previa
- Painless vaginal bleeding in third trimester
- Absence of abdominal pain or uterine tenderness
- Soft, nontender uterus
- DO NOT PERFORM PELVIC EXAM (may cause hemorrhage)
How is placenta previa diagnosed?
-Transabdominal US performed initially, then confirmed by transvaginal US
Treatment for placenta previa
- Watchful waiting if patient is stable
- Pelvic rest
- Delivery if > 36 weeks. C section preferred most times.
Primary Amenorrhea is defined as
Primary: failure of menarche onset by 15 (in presence of secondary sexy characteristics) or age 13 (in absence of secondary sex characteristics)
secondary amenorrhea is defined as
Absence of menses for > 3 months in a patient with previously normal menstruation (or > 6 months with previous oligomenorrhea)
MCC of secondary amenorrhea
Pregnancy
Bacterial vaginosis is due to
Overgrowth of Gardnerella Vaginalis
-Decreased Lactobacillus acidophilus
Symptoms of BV
- Malodorous vaginal discharge worse after sex
- Vaginal itching, burning, dyspareunia
- May be asymptomatic
Regarding Amsel’s Criteria, what are the 5 criteria for BV
- 1) Clue cells on microscopic saline smear
- 2) pH > 4.5
- 3) few WBCs
- 4) copious, thin, homogenous, gray-white discharge
- 5) Positive whiff-amine test (fishy odor)
On a saline wet mount, what is seen in BV besides clue cells.
-Mobile protozoan trophozoites
Treatment for BV
- Metronidazole 2g oral x 1 dose or Clindamycin
- Partners do not need to be treated
MC type of vulvar cancer
Squamous Cell Carcinoma
Symptoms of vulvar cancer
- Red or white ulcerative or raised crusted lesion
- Vulvar pruritus, bleeding, or pain
Diagnostic for vulvar cancer
Biopsy - 90% squamous
Symptoms of ovarian torsion
- Unilateral pelvic pain (acute)
- N/V
- Abdominal tenderness or adnexal mass
Diagnostic for ovarian torsion
- US with Doppler (initial): decreased ovarian blood flow
- Surgical exploration: definitive diagnosis
Treatment for ovarian torsion
-Laparoscopy with detorsion to restore blood flow
What is preeclampsia defined as
-New onset of hypertension (>140/90) occurring after 20 weeks gestation + proteinuria or end-organ dysfunction in a previously normotensive female
Mild preeclampsia is defined as
-BP > 140/90 + proteinuria of at least 300 mg in 24-hour urine specimen (or dipstick 1+ to 2+)
Severe Preeclampsia is defined as
- Blood pressure 160/110 or greater
- Proteinuria 5g in 24-hour urine (3+ on dipstick)
- End organ symptoms (Cerebral or visual symptoms)
- HELLP (Hemolytic anemia, elevated liver enzymes, low platelets)
Management of Mild Preeclampsia
- > 37 weeks: delivery
- < 37 weeks: expectant management
Management of severe preeclampsia
- > 37 weeks: prompt delivery, hospitalization, Magnesium sulfate to prevent seizures, BP control
- < 37 weeks: Hypertensives and delivery
Eclampsia is
Preeclampsia + seizures or coma
Symptoms of Eclampsia
Abrupt onset of tonic-clonic seizures
Treatment for eclampsia
- IV Mag Sulfate for seizures and BP stabilization
- Delivery of the fetus
What medications for BP control should be used in Eclampsia
-IV Labetalol or Hydralazine
Risk factors for endometrial hyperplasia
-Prolonged unopposed estrogen (chronic anovulation, estrogen only therapy, PCOS, obesity, early menarche, late menopause, Tamoxifen use)
Diagnostic of endometrial hyperplasia
-Transvaginal US screening test - thickened endometrial stripe > 4 mm
What is the definitive diagnostic for endometrial hyperplasia?
Endometrial biopsy
Symptoms of endometrial hyperplasia and endometrial cancer
-Abnormal uterine bleeding (postmenopausal bleeding)
MC type of endometrial cancer
Adenocarcinoma
Treatment for Endometrial Cancer
- Stage 1: total abdominal hysterectomy with bilateral salpingo-oophorectomy
- Stage 2/3: TAH-BSO + lymph node excision w/wo radiation
- Stage 4: systemic chemotherapy
What lab is seen in both endometrial cancer and ovarian cancer
CA-125
