OBGYN: dz and treatment

Question 1

Menopause

Answer 1

1. Hormone replacement therapy–risks vs. benefits always considered
   * **estrogen ONLY if hysterectomy
   * ***estrogen + progestin if uterus

2nd line: SSRI or gabapentin

Post-menopause: suggest Vit D and Ca supplements

Question 2

Mastitis

Answer 2

Encourage BF still
Warm compresses
Dicloxacillin 500 mg PO QID x10-14 days

Question 3

Breast Abscess

Answer 3

I/D

Dicloxacillin, Cephalexin or Clindamycin

Question 4

Fibroadenoma of Breast

Answer 4

observation
reassurance
F/U

• excision for larger masses
• cryoblation is alternative to surgery only if <4cm

Question 5

Fibrocystic changes of breast

Answer 5

Analgesics–NSAIDS

Avoid caffeine

Combined hormonal contraceptives can help decrease severity

***most resolve spontaneously

Question 6

Placenta Previa

Answer 6

• dep on gestational age and amt of bleeding
  1. preterm: goal is allow fetal maturation W/O compromising mom’s health—–but if bleeding is excessive, prompt C-section must be done REGARDLESS of gestational age

Question 7

pre term labor
->34 weeks
<34 weeks

Answer 7

IF 34 weeks or later:
1. admit for delivery

• ***bed rest + fluids— contractions can cease in about 20% of patients
• **can be dicharged after 4-6 hours if no progressive cervical dilation or effacement

IF UNDER 34 weeks:

• admit and start fetal monitoring
• give BETAMETHASONE
• tocolytics–MAG SULFATE can be given to DELAY delivery up to 48 hrs—- allowing betamethasone to work
• ABX for GBS prophylaxis (usually no time to test mom)

Question 8

PROM

Answer 8

• admit
• fetal monitoring
• await spontaneous labor—- most go into labor within 24 hrs
• monitor for infection
• if labor or infection does not occur prior to 18 hours—— induce labor

Question 9

PPROM

Answer 9

• admit + fetal monitoring
• IF 34 weeks or less–>BETAMETHASONE
• tocolytics can delay delivery
• ampicillin + azithromycin to prevent infection
• prompt delivery is s/s of fetal infection/distress or materal

Question 10

arrest of labor

Answer 10

IV oxytocin

C-seciton if baby too big or abnormally positioned

Question 11

uterine cord prolapse

Answer 11

Preoperative intrauterine resuscitation to increase O2 delivery to the placenta, including manually elevating the fetal presenting part to prevent compression, placing the patient in trendelenberg, holding the cord above the mother’s belly.
If vaginal delivery is not pending, EMERGENCY C-SECTION to avoid fetal compromise or death.

Question 12

PP hemorrhage

Answer 12

1. bimanual uterine massage + compression
   1st drug= IV oxytocin
   2nd drug if 1st doesnt work–>Methylergonovine

**refractory= tamponade, surgical ligation of uterine artery, arterial embolization or hysterectomy

OTHER: IV infusions of RBCs and crystalloid fluids

Question 13

early pregnancy loss/spontaneous abortion

Answer 13

1. EXPECTANT MANAGEMENT
   - limited to first trimester
   - 80% body does it on its own
2. MEDICAL MANAGEMENT
   -mifepristone + misoprostol
   200 mg Mifepristone PO—- 24 hours later take 800 mcg of vaginal misoprostol
3. SURGICAL MANAGEMENT
   -for women who present with hemorrhage, hemodynamic instability or s/s infection
   -or women who prefer a more immediate completeion of abortion
   **surgical D&C (dilation and curettage) <16 weeks
   OR
   ***Dilation and Evacauation (D&E) >16 weeks

Question 14

probable ectopic pregnancy

Answer 14

1. IM methotrexate
2. PT returns on day 4 and 7 for HCG tests— should fall at lest 15% b/w these days– then PT is followed weekly until HCG not detected
   * ***if HCG is plateuing or not falling fast enough—- second dose of IM Methotrexate