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OBGYN Flashcards

1
Q

indication for endometrial biopsy

A

> 4mm endometrial stripe on TV-US

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2
Q

indications for D+C

A
  • molar pregnancies
  • termination 4-12 wks gestation
  • may be used post-miscarriage to ensure empty
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3
Q

medical abortion meds / timeline

A

MIFEPRISTONE + MISOPROSTOL - safe up to 9 wks

  • mifepristone given first (progestin antagonist)
  • misoprostol 24-72 after (prostaglandin analog –> contract)

METHOTREXATE + MISOPROSTOL - safe up to 7 wks

  • methotrexate, misoprostol 3-7 days after
  • methotrexate is folic acid antagonist
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4
Q

follicular phase

A

Days 1-14 Follicular (Proliferative) Phase

ESTROGEN PREDOMINATES
-pulsatile GnRH from hypothalamus –> inc FSH and LH from pituitary to stimulate ovaries

Ovaries

  • inc FSH causes FOLLICLE AND EGG MATURATION
  • inc LH STIMULATES maturing follicle to MAKE ESTROGEN

Endometrium
-ESTROGEN CAUSES THICKENING (PROLIFERATIVE)

  • ESTROGEN CAUSES NEGATIVE FEEDBACK IN HPO system (hypothalamus-pituitary-ovarian)
  • inc levels of estrogen inhibit hypothalamic GnRH release as well as pituitary release of LH and FSH so no new follicles mature
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5
Q

menstruation

A

First days of Follicular phase

  • if egg not fertilized, the corpus luteum soon deteriorates
  • FALL OF PROGESTERONE AND ESTROGEN
  • endometrium no longer supported –> sloughs
  • negative feedback on GnRH subsides causing inc pulsatile GnRH secretion –> inc FSH and LH wich starts follicle maturation process over
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6
Q

ovulation

A

Days 12-14 (part of follicular phase)

  • inc estrogen being released from mature follicle switches from NEGATIVE –> POSITIVE FEEDBACK on GnRH causing mutual INC ESTROGEN, FSH, LH
  • sudden LH SURGE CAUSES OVULATION
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7
Q

luteal phase

A

Days 14-28 (aka Secretory Phase)

PROGESTERONE PREDOMINATES
-LH surge also causes ruptured follicle to become the CORPUS LUTEUM –> SECRETES PROGESTERONE and estrogen to maintain endometrial lining

If pregnancy occurs:

  • blastocyst keeps the corpus luteum functional (secreting estrogen and progesterone, which keeps endometrium from sloughing)
  • if no implantation, corpus luteum degenerates, leading to steep decreases in estrogen and progesterone –> leads to menstruation
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8
Q

GnRH pulses

A

> 1 per hour favors LH secretion

less frequent pulses favor FSH secretion

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9
Q

abnormal (dysfunctional) uterine bleeding

A

ABNORMAL FREQ/INTENSITY OF MENSES DUE TO NONORGANIC CAUSES (dx of exclusion)

Etiologies:
CHRONIC ANOVULATION (90%) 
-due to disruption of HPA
-esp w/ EXTREMES OF AGE
-UNOPPOSED ESTROGEN  - w/out ovulation there is no progesterone = unopposed estrogen --> endometrial overgrowth w/ IRREGULAR, UNPREDICTABLE SHEDDING

OVULATORY (10%)
-REGULAR CYCLICAL SHEDDING
+ovulation with prolonged progesterone secretion (due to low estrogen levels) –> inc blood loss from endometrial vessel dilation and prostaglandins

  • dx-
  • DIAGNOSIS OF EXCLUSION - r/o reproductive, systemic, iatrogenic causes (no evid of organic cause and negative pelvic exam)
  • W/U: hormone levels, TV US, endometrial bx if stripe >4mm or women >35y to rule out hyperplasia or CA
  • tx-
  • ACUTE SEVERE BLEEDING –> HIGH DOSE IV ESTROGENS OR HIGH DOSE OCP (reduce as bleeding improves)
  • ANNOVULATORY –> OCP 1ST LINE
  • regulates cycle, thins endometrial lining and reduces flow)
  • progesterone if estrogen c/i; GnRH agonists cause tempory amenorrhea
  • OVULATORY –> OCP, progesterone (orally or IUD), GnRH agonists
  • SURGERY - if no response (hysterectomy definitive), ablation
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10
Q

dysmenorrhea

A

PAINFUL MENSTRUATION, affects normal activities

PRIMARY - NOT DUE TO PELVIC PATHOLOGY
-INC PROSTAGLANDINS –> painful uterine muscle wall activity

SECONDARY - DUE TO PELVIC PATHOLOGY
-endometriosis, adenomyosis, leiomyomas, adhesions, PID

  • tx-
  • NSAIDS 1ST LINE (inhibits prostaglandin-mediated uterine activity) - best to start before onset of sx
  • local heat, vit E started 2 days prior
  • OVULATION SUPPRESSION: OCP
  • Laparoscopy (r/o secondary causes)
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11
Q

PMS

A
  • cluster of physical, behavioral and mood changes w/ cyclical occurance in LUTEAL PHASE
  • sx in 75-85% patients, significant disruption in 5-10%
  • sx-
  • physical, emotional, behavioral
  • dx-
  • SX INITIATE DURING LUTEAL PHASE (1-2 WKS BEFORE MENSES), RELIEVED W/IN 2-3 DAYS OF THE ONSET, PLUS AT LEAST 7 SX FREE DAYS DURING FOLLICULAR PHASE
  • tx-
  • lifestyle: stress reduce, caffiene reduce, NSAIDs, vit B6, E
  • SSRIs
  • OCPs (DROSPERINONE-CONTAINING OCPs for PMDD)
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12
Q

amenorrhea

A

W/U: pregnancy test, serum prolactin, FSH, LH, TSH

PRIMARY - FAILURE OF MENARCHE ONSET by 15yo (w/ 2ry char) or 13yo (w/ absence of 2ry char)

  • Breast + Uterus: OUTFLOW OBSTX –> transverse vaginal septum, imperforate hymen
  • Breasts no Uterus: MULLERIAN AGENESIS, ANDROGEN INSENSITIVITY
  • Uterus no Breasts: ELEVATED FSH/LH = OVARIAN CAUSES; NORMAL/LOW FSH/LH = HPA AXIS FAILURE

SECONDARY - ABSENCE OF MENSES FOR >3 MO IN PT W/ PREVIOUSLY NORMAL MENSTRUATION
-PREGNANCY MC

  • HYPOTHALAMUS DYSFX
  • disruption of normal pulsatile hypothalamic secretions of GnRH that lead to dec FSH/LH (anorexia, exercise, stress, nutritional, systemic disease)
  • dx- NORMAL/LOW FSH + LH, low estrodial, norm prolactin
  • tx- CLOMIPHENE (stim gonadotropin secretion)
  • PITUITARY DYSFX
  • ex. prolactin-secreting pituitary adenoma
  • dx- DEC FSH + LH, INC PROLACTIN (inhibits GnRH)
  • tx- surgery
  • OVARIAN DISORDERS
  • PCOS, PREMATURE OVARIAN FAILURE, follicular failure or resistance to LH or FSH, TURNER’S SYNDROME
  • dx- INC FSH + LH, DEC ESTRADIOL –> OVARIAN ABNORMALITIES
  • PROGESTERONE CHALLENGE TEST (pos w/drawl bleeding –> ovarian)
  • UTERINE DISORDER
  • SCARRING OF UTERINE CAVITY (ASHERMAN’S SYNDROME = ACQUIRED ENDO SCAR)
  • dx- pelvic US, absence of normal endo stripe
  • tx- estrogen tx to stimulate endometrial regeneration
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13
Q

menopause

A

CESSSATION >1 YEAR DUE TO LOSS OF OVARIAN FX
-premature before 40yo (mc in DM, smokers, vegetarians, malnourished)

-sx- ESTROGEN DEFICIENCY CHANGES

-dx- FSH ASSAY MOST SENSITIVE INITIAL TEST
(INC SERUM FSH >30)…x3
-INC SERUM FSH, LH, DEC ESTROGEN (due to depletion of ovarian follicles)
-Estrone is primary estrogen after menopause

-loss of estrogen’s protection –> inc osteoporosis, inc cardiovascular risks, inc lipids

  • tx-
  • ESTROGEN ONLY - most effective, inc risk endometrial cancer (unopposed) so GOOD FOR PT W/OUT UTERUS
  • risk of THROMBOEMBOLISM
  • ESTROGEN + PROGESTERONE - pt w/ uterus
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14
Q

leiomyoma (uterine fibroids) fibromyoma

A

LEIOMYOMA: BENIGN UTERUS SMOOTH MUSCLE TUMOR

  • GROWTH RELATED TO ESTROGEN PRODUCTION
  • 5X MC AFRICAN AMER, ESP >35
  • sx-
  • BLEEDING MC PRESENTATION
  • pressure/pain related to size, bladder sx
  • LARGE, IRREGULAR, HARD MASS DURING BI-MANUAL
  • dx-
  • PELVIC US
  • tx-
  • OBSERVATION, tx determined by sx, desire for fertility
  • LEUPROLIDE (GnRH inhibition –> dec estrogen = dec endometrial growth) shrinks uterus 50% but will return
  • SX - MYOMECTOMY (PRESERVE FERTILITY) OR HYSTERECTOMY DEFINITIVE; ablation
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15
Q

adenomyosis

A

ISLANDS OF ENDOMETRIAL TISSUE W/IN MYOMETRIUM
-mc later in repro years

  • sx-
  • MENORRHAGIA, DYSMENORRHEA, +/- infertility
  • TENDER, SYMMETRICALLY, BOGGY UTERUS
  • dx-
  • exclusion of 2ry amenorrhea, MRI
  • definitive: post-total abdominal hysterectomy examination
  • tx-
  • TOTAL ABDOMINAL HYSTERECTOMY - ONLY EFFECTIVE
  • conservative/fertility: analgesics, low dose OCPs
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16
Q

endometritis

A

INFECTION OF UTERINE ENDOMETRIUM

  • chorioamnionitis (fetal membrane infx)
  • RF: POSTPARTUM OR POSTABORTAL INFX (C-SECTION BIGGEST RF), prolonged rupture of membranes >24h, vag delivery, D+C
  • dx-
  • FEVER, TACHY, ABD PAIN AND UTERINE TENDERNESS AFTER C-SECTION, 2-3 days post-abortal
  • tx-
  • POST-C-SECTION or VAG DELIVERY –> CLINDA + GENT (may add amp for group B strep coverage)
  • PROPHYLAXIS W/ 1ST GEN CEPHALOSPORIN X 1 DOSE DURING C-SECTION
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17
Q

endometriosis

A

ECTOPIC ENDOMETRIAL TISSUE

  • OVARIES MC SITE, posterior cul de sac
  • RF: NULLIPARITY, ONSET <35y
  • sx-
  • TRIAD: CYCLIC PREMENSTRUAL PELVIC PAIN, DYSMENORRHEA, DYSPAREUNIA, DYSCHEZIA
  • Infertility >25% cause of female
  • dx-
  • LAPROSCOPY W/ BIOPSY DEFINITIVE
  • ENDOMETRIOMA “CHOCOLATE CYST”
  • tx-
  • OVULATION SUPPRESSION VIA OCPs
  • progesterone, leuprolide, danazol
  • sx-
  • CONSERVATIVE LAPAROSCOPY W/ ABLATION
  • TAH-BSO
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18
Q

endometrial hyperplasia

A

ENDOMETRIAL GLAND PROLIFERATION –> precursor to endometrial cancer, MC POST-MENOPAUSE

-HYPERPLASIA DUE TO CONTINUOUS INC UNOPPOSED ESTROGEN –> chronic anovulation, PCOS, perimenopause, obesity (androgen converts to estrogen in fat)

  • sx-
  • POST-MENOPAUSAL BLEEDING
  • dx-
  • TV-US, ENDO STRIPE >4MM
  • ENDO BX DEFINITIVE
  • tx-
  • w/out atypica –> PROGESTIN, repeat bx in 3-6 mo
  • w/ atypica –> TAH +/-BSO
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19
Q

endometrial cancer

A

MC GYNECOLOGIC MALIGNANCY IN US!

  • MC POSTMENOPAUSAL, 50-60Y PEAK
  • ESTROGEN-DEPENDENT –> RF: INC ESTRO EXPOSURE (nulliparity, chonic anovulation, PCOS, obesity, ERT, late menopause, tamoxifen)

-COMBO OCP PROTECTIVE AGAINST BOTH OVARIAN AND ENDOMETRIAL CA

  • sx-
  • POSTMENOPAUSAL / ABNORMAL BLEEDING
  • dx-
  • ENDO BX –> ADENOCARCINOMA MC
  • US –> STRIPE >4MM
  • tx-
  • Stage I: HYSTERECTOMY (TAH-BSO) +/- radiation
  • Stage II, III: TAH-BSO + lymph node excision +/- radiation
  • Stage IV: systemic chemo
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20
Q

postmenopausal bleeding

A

etiologies:
- MC BENIGN: vaginal/endometrial atrophy, cervical polyps, submucosal fibroids, 10% ENDO CA

  • dx-
  • any post-meno bleeding not on HRT should raise suspicion for endo ca, hyperplasia or leiomyosarcoma
  • TV-US –> <4mm, repeat in 4 mo, if continues –> bx
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21
Q

pelvic organ prolapse

A

RF: weakness of pelvic support structures, MC after childbirth, inc pelvic floor pressure (multiple vag births, obesity, heavy lifting)

CYSTOCELE: POSTERIOR BLADDER HERNIATING INTO ANTERIOR VAGINA

ENTEROCELE: POUCH OF DOUGLAS (SMALL BOWEL) INTO UPPER VAGINA

RECTOCELE: DISTAL SIGMOID COLON/RECTUM INTO POSTERIOR DISTAL VAGINA

  • sx-
  • PELVIC OR VAG FULLNESS, HEAVINESS “FALLING OUT” SENSATION
  • low back pain, vag bleed, purulent discharge, urinary sx
  • BULGING MASS ESP W/ INC ABD PRESSURE / VALSALVA
  • tx-
  • PROPHYLACTIC –> KEGALS, wt control
  • pessaries, estrogen tx (improves atrophy)
  • surgical: hysterectomy; uterosacral or sacrospinous ligament fixation
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22
Q

functional ovarian cysts

A

FOLLICULAR CYSTS - when follicles fail to rupture and continue to grow
CORPUS LUTEAL CYSTS - fail to degenerate after ovulation

  • sx-
  • most asymptomatic until rupture, undergo torsion or become hemorrhagit –> UNILATERAL RLQ OR LLQ PAIN
  • dx-
  • PELVIC US
  • tx-
  • SUPPORTIVE: most <8cm are functional and usually spontaneously resolve –> rest, NSAIDs, repeat US in 6 wks
  • OCPs prevent but don’t treat existing ones
  • if >8cm or postmenopause –> +/-laparoscopy/laparotomy
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23
Q

ovarian cancer

A

2ND MC GYNECOLOGIC CANCER

  • HIGHEST MORTALITY OF ALL GYNECOLOGIC CA
  • RF: FAM HX, INC NUMBER OVULATORY CYCLES, BRCA1/2, peutz-jehgers, turner’s syndrome
  • sx-
  • rarely sx until late in disease (extensive mets)
  • presents usually 40-60s
  • abd fullness/distention, back/abd pain, urinary freq
  • irregular menses, menorrhagia, postmeno bleed, constipation
  • palpable abdominal or ovarian mass (solid, fixed) ASCITES
  • SISTER MARY JOSEPH’S NODE = METS UMBILICAL
  • dx-
  • BIOPSY –> 90% EPITHELIAL, germ cell in pt <30y
  • TV-US useful screen in high-risk patients, mammography to look at 1ry in breast
  • tx-
  • Early: TAH-BSO + selective lymphadenectomy
  • Sx: tumor debulking; SERUM CA-125 USED TO MONITOR TX PROGRESS
  • Chemo
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24
Q

dermoid cystic teratomas

A

mc benign ovarian neoplasms

-remove due to potential risk of torsion or malig transform

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25
Q

PCOS

A

Triad: AMENORRHEA, OBESITY, HIRSUTISM (androgen excess)

  • PCOS due to insulin resistance; 10% of pop
  • assoc w/ abnormal fx of HPO-axis –> inc insulin and inc LH-driven in ovarian androgen production
  • sx-
  • MENSTRUAL IRREGULARITY
  • INC ANDROGEN –> HIRSUTISM, acne, male pattern bald
  • INSULIN RESISTANCE –> DM2, OBESITY
  • BILAT ENLARGED, SMOOTH, MOBILE OVARIES, ACANTHOSIS NIGRICANS
  • dx-
  • exclude: thyroid, pituitary adenoma (prolactin), ovarian tumors, cushing’s (dexa suppress test)
  • labs: INC TT, LH:FSH RATIO >3:1 (normal 1.5:1)
  • GnRH agonist stimulation test –> rise in serum hydroxyprogesterone
  • lipid panel, GTT
  • PELVIC US –> STRING OF PEARLS, ENLARGED OVARIES W/ PERIPH CYSTS
  • tx-
  • COMBO OCP –> NORMALIZE BLEEDING AND SUPPRESS ANDROGEN
  • SPIRONOLACTONE (BLOCKS TT RECEPTORS)
  • Infertility –> Clomiphene, metformin
  • complications:
  • chronic anovulation –> inc risk infertility and endometrial hyperplasia or cancer
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26
Q

pap smear cervical cytology

A

ASC-US - atypical squamous of undetermined significance

  • if >25yo can do HPV test (negative, repeat PAP/HPV in 3 years; if positive –> colposcopy w/ bx)
  • or no HPV test and repeat PAP in 1y (also for <21yo)

ASC-H - atypical squamous cells, can’t exclude HSIL

  • higher chance of ca than ASCUS
  • COLPOSCOPY

LSIL - low grade squamous intraepithelial lesion

  • mc seen w/ TRANSIENT HPV INFECTION
  • 50% regress in 2y, may progress to ca in 7y
  • 25-29yo –> COLPOSCOPY W/ BX
  • > 30y –> TEST HPV (neg, repeat in 1y)

HSIL - high grade squamous intraepithelial lesion

  • include CIN II, CIN III, + CARCINOMA IN SITU
  • COLPO W/ BX FOR ALL AGES
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27
Q

cervical biopsy histology results

A
  • MC ASSOC W/ HPV (CIN = cervical intraepithelial neoplasia) is precursor to cervical ca
  • TRANSFORMATION ZONE (SQUAMOCOLUMNAR JX) OF CERVIX IS HIGHEST RISK FOR MALIG

LSIL

  • changes seen w/ HPV
  • CIN I = MILD DYSPLASIA
  • OBSERVE (75% resolve 1 y) or EXCISION VIA LEEP OR COLD KNIFE CONE

HSIL

  • usualy from persistent HPV infx, often P-16 pos
  • CIN II + CIN III (MOD - SEV), FULL THICKNESS –> IN SITU
  • EXCISION (LEEP OR COLD KNIFE CONE) or ABLATION (CRYOCAUTERY, LASER CAUTERY OR ELECTROCAUTERY)
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28
Q

cervical cancer

A
  • HPV ASSOC W/ 99.7% ESP 16, 18 (70%), 31, 33, 45
  • 3rd mc gyn cancer
  • 45y ave age diagnosis, local mets
  • RF: smoking, CIN, DES exposure (diethylstilbestrol was synthetic estrogen used in OCP), immunosuppressed
  • takes 2-10 yrs for ca to penetrate basement membrane
  • sx-
  • POST COITAL BLEEDING/SPOTTING MC, metrorrhagia, pelvic pain +/- watery discharge
  • dx-
  • COLPO W/ BX
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29
Q

Gardasil

A

-Rec: given at 11 up to 26y

  • Gardasil Quad: 6, 11, 16, 18
  • Gardasil 9: same + 31, 33, 45, 52, 58

-Schedule:
-<15y, receive 2 doses at least 6 mo apart
->15y, receive 3 doses over minimum of 6 mo (0, 2, 6mo)
minimal is 0, 1, 4mo

-c/i if immunosuppressed, pregnant or lactating

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30
Q

ACOG screen guidelines

A
  • initiate: 21
  • discontinue: 65
  • age 21-29 –> pap every 3y
  • can consider primary HPV testing q3y for >25y
  • age >30 –> pap + HPV (co-testing) q5y preferred
  • pap every 3y
  • can consider primary HPV testing q3y for >25y
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31
Q

cervical insufficiency (incomplete cervix)

A
  • inability to maintain pregnancy 2ry to PREMATURE CERVICAL DILATION (ESP IN 2ND TRI)
  • RF: prev cervical trauma or procedure, uterus defects, DES exposure in utero, multiple gestations
  • sx-
  • bleeding, vag discharge, esp in 2nd tri
  • PAINLESS DILATION + EFFACEMENT OF CERVIX

-tx-
-CERCLAGE AND BED REST
+/- weekly injection of 17 a-hydroxyprogesterone in some women w/ preterm birth hx

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32
Q

Bartholin cyst/abscess

A
  • bartholin duct obstx –> retained secretions –> gland enlargement
  • may be infectious
  • sx-
  • INFECTED: TENDER, unilateral vulvar mass, edema/inflam
  • NON-INFECTED: NONTENDER, unilateral at duct location
  • dx-
  • CBC, cultures
  • tx-
  • infected –> I+D w/ antibiotics
  • non-infected –> no intervention needed if asymptomatic
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33
Q

vaginal cancer

A
  • rare (usually 2ry to another cancer)
  • peak 60-65y, SQUAMOUS CELL 95%, CLEAR CELL IF DES EXPOSURE IN UTERO

-asymptomatic, changes in period, abnormal bleed/discharge

  • tx-
  • radiation
34
Q

vulvar cancer

A
  • 90% SAUAMOUS (RISK INCLUDES HPV 16, 18, 31)
  • peak at 50y, linked to DES exposure
  • sx-
  • PRURITUS MC, asmyptomatic, post-coital bleeding
  • dx-
  • RED/WHITE ULCERATIVE, CRUSTED LESIONS –> BX
  • tx-
  • surgical excision, radiation tx, chemo
35
Q

vaginitis

A

INFECTIOUS: BACTERIAL VAGINOSIS, TRICHOMONIASIS, CANDIDA, CYTOLYTIC

ATROPHIC: postmenopausal, allergic rx

36
Q

vulvovaginal atrophy

A

-seen w/ dec estrogen states (post-meno)

  • sx-
  • vaginal dryness, dyspareunia, vaginal inflammation, infx, recurrent UTIs w/ inc pH (loss of lactobacilli which normally converts glucose to lactic acid)
  • tx-
  • VAGINAL ESTROGENS
  • Ospemifene
37
Q

mastitis + breast abscess

A

Mastitis

  • INFECTION: MOSTLY IN LACTATING WOMEN 2ry nipple trauma (esp PRIMAGRAVIDA); S. AUREUS MC
  • UNILATERAL pain w/ tenderness, warmth, swelling, discharge
  • CONGESTIVE: BILATERAL breast enlargement 2-3d postpartum
  • may have low-grade fever and axillary lymphadenopathy
  • tx-
  • Infx –> SUPPORTIVE (warm compress, breast pump) + ANTI-STAPH ABX (MAY CONTINUE TO FEED)
  • Congestive:
  • if doesn’t want to breastfeed –> ice, tight bras, analgesic
  • if breastfeeding –> manually empty after baby is done eating, local heat, analgesics

-Abscess: I+D, discontinue breastfeeding from affected

38
Q

fibrocystic breast disorder

A
  • MC breast disorder, esp 30-50y
  • FLUID-FILLED BREAST CYST DUE TO EXAGGERATED RESPONSE TO HORMONES (esp 30-50y)
  • sx-
  • multiple, mobile, well-demarcated lumps in breast
  • TENDER, OFTEN BILATERAL
  • usually no axillary involvement or nipple discharge
  • BREAST CYSTS MAY INC OR DEC IN SIZE W/ MENSTRUAL HORMONE CHANGES
  • dx-
  • US, FNA reveals STRAW-COLORED FLUID, NO BLOOD
  • tx-
  • most spontaneously, +FNA removal of fluid if sx
39
Q

fibroadenoma of the breast

A
  • mc in late teens, early 20s
  • made of glandular + fibrous tissue (collagen in swirls)
  • sx-
  • smooth, nontender, freely mobile, rubbery lump in breast
  • gradually grows over time, DOESN’T WAX + WANE W/ MENSTRUATION
  • may enlarge in pregnancy, no axillary involvement
  • tx-
  • observation - most reabsorb w/ time +/-excision
40
Q

breast cancer

A

malig primarily of the milk ducts or lobules

  • RF: BRCA 1+2, AGE >65Y, INC NUMBER MENSTRUAL CYCLES, INC ESTROGEN, 1st degree relative, obesity, etoh
  • 75% have no RF

Types:

  • DUCTAL: INFILTRATIVE CARCINOMA MC (75%) DCIS
  • assoc w/ lymphatic mets esp axillary

-LOBULAR: infiltrative lobular carcinoma in situ (may not progress but assoc w/ inc risk of invasive breast ca)

  • sx-
  • BREAST MASS, PAINLESS, HARD, FIXED LUMP
  • MC UPPER OUTER QUADRANT (65%) areola 18%
  • UNILATERAL NIPPLE DISCHARGE +/-BLOODY, purulent or green
  • SKIN: ASYMMETRIC REDNESS, dimpling (cooper’s ligament), nipple inversion
  • PAGET’S DISEASE OF NIP: CHRONIC EXZEMATOUS, ITCHY, SCALING RASH ON NIPPLES AND AREOLA
  • INFLAMMATORY BREAST CA: RED, SWOLLEN, WARM, ITCHY BREAST
  • dx-
  • MAMMOGRAM: MICROCALCIFICATIONS AND SPICULATED
  • ULTRASOUND: rec initial modality to eval breast masses in women <40y
  • BIOPSY: fine needle, large needle core, open/excision
41
Q

breast cancer stage/treat

A

Stage: based on T (size), N (nodes), M (metastasis)

  • Stage 0: precancerous, DCIS or LCIS
  • Stage I-III: w/in breast/regional lymph nodes
  • Stage IV: metastatic bc
  • tx-
  • lumpectomy, mastectomy, removal of regional LN

-Adjunctive:

RADIATION THERAPY
-after lumpectomy
CHEMO
-used in stage II-IV and inoperable disease, esp ER neg dz

NEOADJUVANT ENDOCRINE TX

  • ANTI-ESTROGEN (TAMOXIFEN): useful w/ ESTRO POS (blocks estrogen receptor)
  • AROMATASE INHIBITORS (LETROZOLE, ANASTROZOLE): useful postmeno ER-pos patients (reduces production of estrogen)
  • MONOCLONAL AB TX (TRASTUZUMAB): useful w/ HER2 POS (human epidermal growth factor receptor)
42
Q

breast cancer screening

A

MAMMOGRAM - detects as early as 2 yrs before palpated

  • ACS screen: annually age 45-54y, and q2y age >55
  • ACOG: annually >/=40
  • USPSTF: baseline mammogram q2y 50-74y; every 2y at age 40 if increase risk factors

CLINICAL BREAST EXAM: at least q3y in 20-39y (annually after 40y)

BREAST SELF EXAMINATION: monthly >20y of age IMMEDIATELY AFTER MENSTRUATION OR ON DAYS 5-7 OF MENSTRUAL CYCLE (less fluid retention)

Prevention in High-Risk pt:
TAMOXIFEN OR RALOXIFENE CAN BE USED IN POSTMENO OR WOMEN >35Y W/ HIGH RISK
-treatment usually for 5 yrs
-increased risk of DVT or endometrial cancer

43
Q

pelvic inflammatory disease

A

-usually mixed, MC GONORRHOEAE + CHLAMYDIA

  • sx-
  • pelvic/lower abdominal pain, dysuria, dyspareunia, vag discharge, nausea, vomiting
  • dx-
  • ABDOMINAL TENDERNESS (+REBOUND IF SEVERE), CERVICAL MOTION TENDERNESS, ADNEXAL TENDERNESS
  • pelvic ultrasound
  • laparoscopy
  • tx-
  • out-pt: DOXY (14d) + CEFTRIAXONE IM +/- flagyl
  • in-pt: IV DOXY + 2ND GEN CEPH (CEFOXITIN OR CEFOTETAN) or clinda + genta
  • complications:
  • FITZ-HUGH CURTIS SYNDROME: hepatic scarring and peritoneal involvement RUQ PAIN
44
Q

toxic shock syndrome

A
  • exotoxins made by STAPH AUREUS
  • seen in tampons, diaphragm or sponge, esp >24h
  • sx-
  • HIGH FEVER, tachy, n/v/d, pharyngitis
  • DIFFUSE, ERYTHEMATOUS MACULAR RASH (looks like sunburn, includes palms and soles), desquamation;
    severe: ulcerations, petechiae, vesicles, bullae
  • HYPOTENSION
  • dx-
  • CBC, CULTURES, CLINICAL (isolation not required)
  • tx-
  • hospital admission, supportive measures (fluid replace), clinda + vanc
45
Q

bacterial vaginosis

A
  • decreased lactobacilli (maintains pH) –> overgrowth of normal flora GARDNERELLA VAGINALIS, ANAEROBES
  • MC CAUSE VAGINITIS
  • sx-
  • ODOR, itching, asymptomatic, discharge
  • THIN, WATERY, GREY-WHITE, ROTTEN FISH SMELL
  • pH > 5
  • dx-
  • WHIFF TEST = FISH W/ KOH PREP
  • CLUE CELLS
  • tx-
  • METRONIDAZOLE X 7d OR CLINDA
  • don’t need to tx partner
  • complications: PROM, preterm labor, chorioamnionitis
46
Q

trichomoniasis

A
  • PEAR SHAPED FLAGELLATED PROTOZOA
  • sexually transmitted
  • FROTHY YELLOW-GREEN DISCHARGE
  • STRAWBERRY CERVIX (CERVICAL PETECHIAE)
  • pH >5
  • tx-
  • METRONIDAZOLE (2G X 1 DOSE) - PO PREFERRED
  • MUST TREAT PARTNER
  • spermicides reduce transmission

-perinatal complications, inc HIV transmission

47
Q

combo OCP

A

-prevent ovulation by inhibiting mid-cycle LH surge, thickens cervical mucosa, thins endometrium

  • improves dysmenorrhea, controls menstrual cycle
  • protects vs. osteoporosis, ovarian cysts, ovarian cancer and endometrium cancer
  • NOT FOR SMOKERS >35Y
  • INC GALLSTONES, FLUID RETENTION, THROMBOEMOLISM
48
Q

progestin only “mini pill”

A
  • SAFE DURING LACTATION
  • no estrogen side effects (ha, htn, nausea)
  • dec ovarian and endometrial cancer
  • less PID
  • menstrual irregularities
  • slightly less effective than combo OCPs
49
Q

long-acting progestins

A 
Depo provera (inject)
-last 3 months

Implanon (rod)

  • lasts 3 years
  • SE: OSTEOPOROSIS
50
Q

ortho evra

A

transdermal patch

-applied q 3wks –> 1 wk off

51
Q

NuvaRing

A
  • 3 weeks on, 1 week off

- remove during intercourse, replace w/in 3 hours

52
Q

uncomplicated pregnancy

A

Uterus changes:

  • LADIN’S SIGN: uterus softening after 6 wks
  • HEGAR’S SIGN: uterine isthmus softening after 6-8 wks
  • PISKACEK’S SIGN: palpable lateral bulge or softening of uterine cornus 7-8 wks

Cervix changes:

  • GOODELL’S SIGN: cervical softening due to inc vascularization (about 4-5wks)
  • CHADWICK’S SIGN: bluish color of cervix and vulva at 8-12 wks

Fetal heart tones –> 10-12 wks (120-160 bpm)
Pelvic US –> detects fetus 5-6 wks
Fetal movement –> 16-20 wks

53
Q

fundal height

A

12 wks –> above pubic symphysis

16 wks –> midway btw pubis and umbilicus

20 wks –> at umbilicus

38 wks –> 2-3 cm below the xiphoid process

54
Q

routine lab tests at first prenatal visit

A

blood type, Rh, CBC, UA (glucose + protein), random glucose, HBsAg, HIV, syphilis, rubella titer, screening for sickle cell and CF, pap smear

55
Q

1st trimester: maternal blood screen tests

A

Down syndrome:

  • Free B-hCG - abnormally high or low may be indicative of abnormalities
  • PAPP-A: usually low w/ down synd
  • Nuchal translucency: US at 10-13 wks, inc thickness abn

+/- chorionic villus sampling (risk of spont abortion)

56
Q

2nd trimester: screening/tests (13-27)

A

Triple Screen at 15-20 wks: a-fetoprotein, B-hCG, estradiol

  • Down Synd: low a-FP, high B-hCG, low Estradiol
  • Open neural tube defects: high a-FB
  • Trisomy 18 (stillborn or die in 1 yr): all low

Gestational Diabetes Screen: 24-28 wks

+/- amniocentesis

57
Q

3rd trimester: screening/tests (28-birth)

A

Gestational Diabetes Screen: 24-28 wks

Repeat Rh titers
-RhoGAM AT 28 WKS AND W/IN 72 HRS AFTER BIRTH

Group B Strep at 32-37 wks

Hemoglobin + Hematocrit at 35 wks

Biophysical profile: look at fetal breathing, fetal tones, amniotic fluid, NST and gross fetal movements (2 pts ea)

NON STRESS TESTING: baseline hr is 120-160

  • REACTIVE: FETAL WELLBEING >/= 2 accelerations in 20 minutes, inc fetal hr >/= 15 bpm from baseline lasting >/= 15 sec
  • Non-reactive: no fetal hr accelerations (maybe sleeping, immature or compromised fetus)

CONTRACTION STRESS TEST: measures fetal response to stress at times of uterus contraction

  • NEGATIVE: FETAL WELLBEING - no late decelerations in the presence of 3 contractions in 10 minutes
  • Positive: repetitive late decelerations in presence of 3 contractions in 10 minutes –> worrisome, prompt delivery
58
Q

ectopic pregnancy

A

-FALLOPIAN TUBE MC (ESP AMPULLA)

  • sx-
  • Triad: UNILATERAL PELVIC/ABD PAIN, VAG BLEEDING, AMENORRHEA
  • CERVICAL MOTION TENDERNESS, ADNEXAL MASS
  • dx-
  • SERIAL QUANTITATIVE B-HCG (fails to double 24-48h)
  • TVUS - absence of gest sac w/ B-hCG levels >2000
  • tx-
  • UNRUPTURED: METHOTREXATE
  • RUPTURED: LAPAROSCOPIC SALPINGOSTOMY
59
Q

spontaneous abortion

A
  • termination BEFORE 20 WKS
  • FETAL CHROM ABNORMAL MC (50%), infx, uterine defects, endocrine, malnutrition, immunologic, trauma, smoking, drugs

Threatened

  • MAY BE VIABLE
  • MC CAUSE OF 1ST TRI BLEEDING
  • SUPPORTIVE CARE, REST

Inevitable

  • PROGRESSIVE CERVIX DILATION +/- RUPTURE MEMB
  • D+E IN 2ND TRI

Incomplete

  • SOME POC EXPELLED (SOME RETAINED)
  • DILATED CERVIX
  • D+E IN 2ND TRI, PITOCIN

Complete
-ALL POC EXPELLED

Missed

  • FETAL DEMISE BUT STILL RETAINED IN UTERUS
  • NO POC EXPELLED
  • D+E (2ND TRI), D+C (1ST TRI)

Septic

  • RETAINED POC BECOMES INFECTED –> INFX OF UTERUS; SOME POC RETAINED
  • CERVICAL MOTION TENDERNESS
  • FOUL BROWN DISCHARGE, FEVER, CHILLS
  • D+E, BROAD SPECTRUM ABX
60
Q

D+C vs. D+E

A

Dilation + Curettage (including suction curettage)
-used 4-12 weeks gestation

Dilation + Evacuation
-used >12 weeks gestation

61
Q

transitional (gestational) HTN

A
  • HTN w/ NO PROTEINURIA AFTER 20 WKS
  • RESOLVES 12 WKS POST-PARTUM

-tx-
+/- hydralazine or labetalol

62
Q

preeclampsia

A

-HTN W/ PROTEINURIA +/- EDEMA AFTER 20 WKS
+/- earlier with multiples or molar pregnancy

  • sx-
  • ha, visual sx, fetal growth restriction, edema (bc proteinuria)
  • dx-
  • Mild: BP >140/90, PROTEINURIA >300mg/24h (>1+)
  • BP at 2 separate occasions at least 6h apart and no >1 wk

-Severe: BP >160/110, PROTEINURIA >5000mg/24h, THROMBOCYTOPENIA, +/-DIC, HELLP SYNDROME (hemolytic anemia, elevated liver enzymes, low platelets)

  • tx-
  • Mild: DELIVER AT >/= 37 WKS, conservative <34 wks (BP and dipstick weekly, bedrest), STEROIDS TO MATURE LUNGS
  • Severe: PROMPT DELIVERY ONLY CURE
  • HOSPITALIZATION + MAGNESIUM SULFATE (prevent eclampsia/seizures)
  • HYDRALAZINE, LABETALOL
63
Q

eclampsia

A

SEIZURES OR COMA in pt who meet preeclampsia criteria

  • sx-
  • SAME AS PREECLAMPSIA PLUS:
  • ABRUPT TONIC-CLONIC SEIZURES 1-2 MIN –> POSTICTAL STATE
  • HYPERREFLEXIA

-tx-
-ABCD’S
-MAGNESIUM SULFATE FOR SEIZURES (LORAZEPAM 2ND LINE)
-DELIVERY OF FETUS ONCE PT STABILIZED
HYDRALAZINE, LABETALOL

64
Q

chronic/preexisting HTN

A
  • HTN BEFORE 20 WKS GESTATION or before pregnancy
  • persists >6 wks post-partum
  • dx-
  • Mild: BP >140/90, NO PROTEINURIA
  • Moderate: >150/100
  • Severe: >160/110
  • tx-
  • Mild: monitor q2-4 wks, weekly 34-36 wks, deliver at 37
  • weekly NST during 3rd tri, serial BP and urnie protein
  • Mod/Severe: meds if BP >150/100 (METHYLDOPA TX OF CHOICE, LABETALOL)
  • AVOID ACEI AND DIURETICS
65
Q

placenta previa

A

ABNORMAL PLACENTA PLACEMENT ON OR CLOSE TO CERVICAL OS

  • partial: covering part of cervix
  • complete: total coverage of cervical os
  • marginal: w/in 2-3 cm of cervical os
  • sx-
  • 3RD TRI BLEEDING, PAINLESS, UTERUS NON-TENDER
  • no fetal distress
  • dx-
  • PELVIC ULTRASOUND - NO PELVIC EXAM!
  • tx-
  • hospitalization for stabilization
  • TOCOLYTICS: MAG SULFATE - inhibits labor preterm
  • AMNIOCENTESIS - to see fetal lung maturity (steroids btw 24-34 wks)
  • delivery when stable (vaginal if partial/marginal)
66
Q

abruptio placentae

A

PREMATURE SEPARATION OF PLACENTA FROM UTERINE WALL after 20 wks

  • sx-
  • 3RD TRI BLEEDING (CONTINUOUS, DARK RED), SEVERE ABDOMINAL PAIN, CONTRACTIONS, RIGID UTERUS
  • FETAL BRADYCARDIA/DISTRESS
  • dx-
  • PELVIC ULTRASOUND - NO PELVIC EXAM!
  • tx-
  • hospitalization
  • IMMEDIATE DELIVERY (C-SECTION PREFERRED)
  • MAY LEAD TO DIC

*MATERNAL HTN MC CAUSE (smoking, etoh, cocaine, folate deficiency, high parity, increased age, trauma, chorioamnionitis)

67
Q

vasa previa

A

FETAL VESSELS TRAVERSE THE FETAL MEMBRANES OVER THE CERVICAL OS

  • sx-
  • rupture of membranes PAINLESS VAGINAL BLEEDING
  • FETAL DISTRESS / BRADYCARDIA
  • dx-
  • PELVIC ULTRASOUND
  • tx-
  • IMMEDIATE C-SECTION
68
Q

gestational diabetes

A

RF: family or prior hx of gestational diabetes, spontaneous abortion, hx of infant >4000g at birth, multiple gestations, obesity, >25y, AA, Hisp, Asian/Pacific, Native

-caused by placental release of GH, corticotropin-releasing hormone and human placental lactogen (HPL) which antagonizes insulin

  • dx-
  • screen w/ 50G ORAL GLUCOSE CHALLENGE TEST AT 24-28 WKS –> IF >140 AFTER 1 HR –> 3HR GTT
-CONFIRMATORY (GOLD STD): 3 HR 100G GTT
In am after overnight fast, positive if:
-fasting >95
-1 hr >180
-2 hr >155
-3 hr >140
  • tx-
  • daily fingersticks overnight and after each meal, diet and exercise
  • INSULIN TX OF CHOICE (DOESN’T CROSS PLACENTA)
  • glyburide doesn’t cross placenta (higher risk eclampsia), metformin also safe
  • LABOR/INDUCTION AT 35 WKS IF UNCONTROLLED / MACROSOMIA

*50% chance of devo Dm after pregnancy, >50% chnce of recurrence w/ subsequent pregnancies

69
Q

postpartum blues

A

onset: 2-4 wks postpartum
- resolves w/in 10 days
- mild insomnia, anhedonia, fatigue, depressed mood, irritable, NO THOUGHTS OF HARM TO BABY

70
Q

postpartum depression

A

onset: 2 WKS - 2 MONTHS POSTPARTUM
- duration 3-14 months
- irritability, sleep and mood disturbances, eating changes, anxiety
- MAY HAVE THOUGHTS OF HARMING BABY

71
Q

gestational trophoblastic disease (molar pregnancy)

A

Abnormal placental trophoblastic tissue, 4 types:

  • molar pregnancy (benign)
  • invasive mole
  • choriocarcinoma
  • placental site trophoblastic tumor

-Abnormal pregnancy in which a nonviable fertilized egg implants –> abnormal placenta devo

HYDATIDIFORM MOLE: NEOPLASM DUE TO ABNORMAL PLACENTAL DEVO W/ TROPHOBLASTIC TISSUE PROLIFERATION ARISING FROM GESTATIONAL TISSUE
-MC TYPE, 80% BENIGN

  • COMPLETE MOLAR PREGNANCY: egg w/ no DNA fertilized by 1 or 2 sperm (46XX all paternal chromes) assoc w/ higher risk of malignant devo
  • PARTIAL MOLAR PREGNANCY: egg fertilized by 2 sperm (or 1 that duplicates its chromes), there may be devo of fetus but never viable; RF: EXTREMES OF MATERNAL AGE
  • sx-
  • PAINLESS VAG BLEEDING, +/- begin at 6wks - 4/5mo
  • UTERINE SIZE / DATE DISCREPANCIES (larger than expected)
  • HYPEREMESIS GRAVIDARUM (inc hormones)
  • CHORIOCARCINOMA - mets to lungs mc, lower genital tract
  • dx-
  • B-hCG MARKEDLY ELEVATED (>100,000), LOW A-FETO
  • US: “SNOWSTORM” OR “CLUSTER OF GRAPES” APPEARANCE, absence of fetal parts and heart sounds; cluster of grapes = enlarged cystic chorionic villi
  • tx-
  • SURGICAL EVACUATION: SUCTION CURETTAGE MAINSTAY ASAP, follow pt until B-hCG falls to undetectable, avoid preg for 1 yr after
  • METS: CHEMO (METHOTREXATE) DESTROYS TROHPH TISSUE AND/OR HYSTERECTOMY
72
Q

RH alloimmunization

A

Maternal AB that bind to fetal RBCs –> neonate hemolytic disease

  • occurs if Rh neg mom carries Rh pos fetus w/ exposure to fetal blood mixing (causes maternal immunization –> maternal anti-Rh IgG antibodies)
  • if next time, mom carries a Rh pos fetus, the AB may cross the placenta and attack the fetal RBCs (hemolysis)

Preventative:

  • 300 mg RhoGAM (Rh immunoglobulin - pooled anti-D IgG vinds to fetal RBCs to prevent maternal mixing)
  • Given if Rh neg, Ab-neg in 3 indications:
    1. 28 weeks gestation
    2. w/in 72 h of delivery of Rh pos baby or
    3. after any potential mixing of blood
73
Q

morning sickness + hyperemesis gravidarum

A

Morning sickness: N/V up to 16 wks
HEG: SEVERE, EXCESSIVE FORM assoc w/ WL, electrolyte imbalance, develops during 1st/2nd tri (longer than 16wks)
-acidosis (from starvation) and alkalosis (from vomiting)

  • RF: primagravida, pervious hyperemesis in past pregnancy, multiple gestations, molar pregnancy
  • Pathophys: vomiting center oversensitivity to pregnancy hormones
  • tx-
  • fluids, electrolytes, vitamins, high protein foods, small/freq meals, avoid spicy/fatty; TPN if severe
  • PYRIDOXINE (VIT B6) +/- DOXYLAMINE 1ST LINE
  • promethazine, dimenhydrinate
74
Q

cardinal movements of labor

A

Engagement: fetal presenting part enters pelvic inlet

Flexion: flexion of the head to allow the smallest diameter to present to pelvis (tucks chin)

Descent: passage of the head into the pelvis (lightening)

Internal Rotation: fetal vertex moves from occiput transverse position to a position where the sagittal suture is parallel to the anteroposterior diameter of the pelvis

Extension: vertex extends as it passes beneath the pubic symphysis

Externa rotation: fetus externally rotates after the head is delivered so that the shoulder can be delivered

75
Q

stages of labor

A

Stage I: onset of labor (true regular contractions) to full dilation of cervix (10 cm)

  • Latent phase: cervix effacement w/ gradual dilation
  • Active phase: rapid cervical dilation (begins at 3-4 cm)

Stage II: time from full cervical dilation until delivery

  • Passive phase: complete cervical dilation to active maternal expulsive efforts
  • Active phase: from active maternal efforts to delivery

Stage III: postpartum until delivery of placenta (0-30 min, average 5 min)
-3 Signs of placental separation:
1. gush of blood
2. lengthening of umbilical cord
3. anterior-cephalad movement of the uterine fundus (becomes globular and firmer) after placenta detaches
Placental expulsion: due to downward pressure of retroplacental hematoma, uterine contractions

76
Q

apgar score

A
  • usually done at 1 and 5 min after birth, repeat at 10 min if abnormal
  • score 1-10: >/= 7 normal, 4-6 fairly low, = 3 critical low
Appearance (skin color changes)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
77
Q

postpartum (puerperium)

A

6 wk period after delivery

  • Uterus: at level of umbilicus after delivery, shrinks after 2 days, descends into pelvic cavity after 2 weeks, normal size at about 6 wks
  • Lochia serosa: pink/brown vag bleeding, esp days 4-10 (from decidual tissue), resolves 3-4 wks
  • Breasts/menstruation: breast milk in postpartum days 3-5 bluish-white. if lactating, mothers may remain anovulatory during that time (otherwise menses may return 6-8 wks postpartum)
78
Q

postpartum hemorrhage

A
  • bleeding >500ml if vaginal, >1000ml if c-section
  • early: 24 hrs post partum, delayed >24 hrs up to 8 wks
  • UTERINE ATONY MC CAUSE (unable to contract to stop bleeding), uterine rupture, congestion, bleeding disorder, DIC
  • RF: rapid, prolonged labor, overdistended uterus, c-sect
  • sx-
  • hypovolemic shock: hypoTN, tachy, pale, dec cap refill
  • SOFT, BOGGY UTERUS w/ dilated cervix
  • work up-
  • CBC for H+H, US
  • tx-
  • BIMANUAL UTERINE MASSAGE
  • UTEROTONIC AGENTS: OXYTOCIN IV, METHLERGONOVINE; prostaglandin analogs (carboprost, tromethamine, misoprostol) to enhance contractions
79
Q

PROM

A

premature rupture of membranes
-RF: STDs, smoking, prior preterm delivery, multiple gestations

  • dx-
  • STERILE SPECULUM EXAM - VISUAL INSPECTION –> POOLING OF SECRETIONS
  • NITRAZINE PAPER TEST –> BLUE IF PH > 6.5 (amniotic fluid pH 7-7.3, vaginal pH 3.8-4.2)
  • FERN TEST –> AMNIOTIC FLUID FERN PATTERN
  • ultrasound
  • tx-
  • wait for spontaneous labor, monitor for infection
80
Q

PPROM

A 
premature labor (preterm labor)
-Labor: regular uterine contractions (>4-6/hr) with progressive cervical changes before 37 weeks
  • dx-
  • cervical dilation >3cm, >80% effacement
  • NITRAZINE PAPER TEST, FERN TEST
  • PRESENCE OF FETAL FIBRONECTIN btw 20-34 weeks strongly suggests preterm labor
  • L:S ration <2:1 = fetal lung immaturity
  • tx-
  • ANTENATAL STEROIDS (BETAMETHASONE) FOR LUNGS
  • TOCOLYTICS TO SUPPRESS CONTRACTIONS (INDOMETHACIN, NIFEDIPINE, MAG SULFATE)
  • abx prophylaxis (group b strep)
81
Q

dystocia

A

abnormal labor progression

  • 3 categories:
  • Power: contraction
  • Passenger: presentation or size of fetus (shoulder dystocia)
  • Passage: uterus or soft tissue abnormalities
  • TX SHOULDER DYSTOCIA:
  • NONMANIPULATIVE 1ST LINE: MCROBERT’S MANEUVER (inc pelvic opening w/ hip hyperflexion)
  • MANIPULATIVE: WOODS “CORKSCREW” MANEUVER 180 shoulder rotation
82
Q

induction of labor

A
  • Ind: vaginal delivery when prolonged labor may lead to complications
  • C/I: situations where risk of induction of vag delivery greater than c-section (prior uterine rupture, prior c-section, active herpes, umbilical cord prolapse, placenta previa, transverse fetal lie)
  • tx-
  • EARLY INDUCTION –> PROSTAGLANDIN GEL ON CERVIX (CERVIDIL), balloon catheter or laminaria
  • LATER INDUCTION –> when cervix is dilated <1cm w/ some effacement –> IV OXYTOCIN (PITOCIN)
  • AMNIOTOMY (artificial rupture of membranes w/ hook)

Concepts / Lists (16 decks)

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