Obstetrics and Gynecology Flashcards
2 types of amenorrhea
primary
secondary
primary amenorrhea is no menses by _ yo with an absence of secondary sex characteristics
OR
by _ yo w. normal growth of secondary sex characteristis
13
15
causes of primary menses
pregnancy
imperforate hymen
turner syndrome (dysgenesis)
HPO axis abnl
anorexia
bulimia
wt loss
exercise
secondary amenorrhea is absence of menses for _ mo in women w. previously normal menstruation,
OR
_ mo in a woman w. a hx of irregular cyles
3
6
mc cause of amenorrhea
pregnancy
ascending infxn that ascends from the cervix or vagina to the endometrium and/or fallopian tubes
PID
2 mc pathogens associated w. PID
GC
CT
what is chandelier’s sign
cervical motion tenderness -> PID
3 complications of PID
infertility
ectopic
tubo-ovarian abscess
dx for PID
abdominal tenderness, cervical motion tenderness, and adnexal tenderness
PLUS 1 or more:
temp > 38
WBC > 10,000
pelvic abscess
tx for PID: inpt vs outpt
outpt: ceftriaxone + doxy +/- metro
inpt: doxy + cefoxitin OR cefotetan x 48 hr, followed by doxy
indications for inpt tx w. PID
severely ill/vomiting
dx uncertain
ectopic/appendicitis can’t be ruled out
pregnancy
pelvic abscess suspected
HIV
failed outpt tx
excessive uterine bleeding w. no organic cause
dysfunctional uterine bleeding
types of dysmenorrhea
menorrhagia
metorrhagia
menometrorrhagia
polymenorrhea
oligomenorrhea
prolonged/heavy uterine bleeding
regular intervals
menorrhagia
variable amt of bleeding
irregular, frequent intervals
metrorrhagia
more blood loss during menses
frequent irregular bleeding btw menses
menometrorrhagia
menses that occur more frequently (< 21 days)
polymenorrhea
menses that occur less frequently (> 35 days)
oligomenorrhea
what types of dysfunctional uterine bleeding to uterine lesions cause (2)
menorrhagia
metrorrhagia
uterine lesions include (6)
endometrial ca/sarcoma
endometrial hyperplasia
submucosal fibroid
endometrial polyps
endometritis
adenomyosis
blood disorders associated w. dysfunctional uterine bleeding (4)
vWD (von willebrand)
prothrombin deficiency
leukemia
severe sepsis
which types of dysfunctional uterine bleeding is hypothyroidism associated w. (2)
menorrhagia
metrorrhagia
which 2 types of dysfunctional uterine bleeding is hyperthyroidism associated w. (2)
oligomenorrhea
amenorrhea
continuous unopposed production of estradiol 17 beta causes
anovulatory dysfunctional uterine bleeding:
continuous proliferation of endometrium w.o corpus luteum -> sloughs off in irregular pattern
LH surge is associated w. what type of dysfunctional uterine bleeding
mid cycle spotting
gs dx for dysfunctional uterine bleeding
dilation and curettage
diagnostic and therapeutic
_ can be used acutely if pt presents w. hemorrhage due to DUB
IV estrogen
_ reduce menstrual blood loss
NSAIDs
dysmenorrhea prior to menses, not relieved by NSAIDs or OCPs
dyspareunia
endometriosis
2 types of dysmenorrhea
primary
secondary
primary menorrhea begins w.in _ to _ mos of menarche
6-12
dysmenorrhea is due to excess _ production (2)
PG
leukotriene
-> increased uterine contraction
describe pain w. dysmenorrhea
begins w. start of menses
lasts 2-3 days
worst on day 1
3 sx associated w. dysmenorrhea
ha
nausea
diarrhea
painful menstruation caused by clinical identifiable cause
secondary amenorrhea
causes of secondary amenorrhea (lots!)
endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis/lesions
psych
describe pain w. secondary menorrhea
pain begins mid cycle
increases in severity til the end
mc age for secondary dysmenorrhea
20-40
top 2 locations for ectopic pregnancy
- fallopian tubes
- ampulla of tube
3 hallmark findings of ectopic
abd pain
bleeding
adnexal mass
mc cause of ectopic
occlusion of tube 2/2 adhesions
6 rf for ectopic
previous ectopic
previous salpingitis
previous abd/tubal surgery
IUD
assisted reproduction
smoking
5 sx of ruptured ectopic
severe abd pain or shoulder pain
peritonitis
tachycardia
syncope
orthostatic hypotn
dx for ectopic
b hcg > 1,500 w. no fetus in utero on US
when bHCG > _ there should be evidence of developing intrauterine gestation on US
1,500
hallmark US finding of ectopic
ring of fire (ring of vascularity)
hypervascular lesion w. peripheral vascularity
what is this showing
ring of fire -> ectopic
indications for MTX for ectopic
b HCG < 5,000
ectopic mass < 3.5 cm
no FHR
hemodynamically stable
no blood d.o
no pulm. dz
no peptic ulcer
normal renal fxn
normal hepatic fxn
compliant pt
contraindications for MTX for ectopic (3)
bf’ing
active pulm dz
immunodeficiency
moa for MTX
folic acid antagonist -> inhibits DNA replication
indications for emergent laparoscopy salpingostomy for ectopic
rupture
MTX contraindicated
premature separation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks gestation
placental abruption
mc cause of third trimester bleeding
placental abruption
5 rf for placental abruption
trauma
smoking
HTN
preeclampsia
cocaine
painful 3rd trimester bleeding is always _ until proven otherwise
placental abruption
dx for placental abruption
clinical…always
US findings of placental abruption
retroplacental blood collection
PE finding of placental abruption
blood stained amniotic fluid in vagina
_ indicate fetal hypoxia/bradycardia
decelerations
tx for placental abruption (5)
delivery
type and match
coag studies
large bore IV
steroids
management of small placental abruptions
expectant management
endometriosis is mc found in the (2)
ovary
peritoneum
t/f: the severity of endometriosis sx does not equate to severity of dz
t!
endometriosis is most likely caused by
retrograde menstruation: endometrium floats back out of fallopian tubes into ovary