repro Flashcards
when can you dx primary amenorrhea
13y w/o 2ndary sex characteristics
15y w/ 2ndary sex characteristics
primary amenorrhea. breasts and uterus are both present.
outflow obstruction
primary amenorrhea. breasts are absent, uterus is present.
- (if high FSH/LH) ovarian causes e.g. premature ovarian failure, Turners (XO)
- (if low FSH/LH) hypothalamus/pituitary failure or late puberty
primary amenorrhea. breasts present, uterus is absent
mullerian agenesis (46xx) androgen insensitivity (46xy)
primary amenorrhea, short stature, webbed neck, low hairline, low set ears, wide nipples
turners syndrome (45xo)
acquired endometrial scarring
ashermans syndrome
tender and “boggy uterus” on exam
adenomyosis (endometrial tissue within the myometrium)
what is the most effective therapy for adenomyosis
total abdominal hysterectomy
what are medical treatments for leiomyomas
progestins
leuprolide* (shrinks uterus by 50%)
what is the mgmt of leiomyomas to preserve fertility
myomectomy
what is the definitive tx for leiomyomas
hysterectomy
postpartum uterine infx due to retained products of conception
endometritis
postpartum fever, abdominal pain, and uterine tenderness, think this
endometritis
tx for endometritis
abx
cyclic premenstrual pelvic pain, dysmenorrhea, dyspareunia, think this
endometriosis
definitive dx for endometriosis
laparoscopy with bx
chocolate cyst
endometrioma of the ovaries
mgmt for endometriosis
- suppress ovulation w meds
- laparoscopy with ablation (if fertility desired)
- TAH with salpingoophorectomy
screening test for endometrial hyperplasia
transvaginal ultrasound
consider endometrial hyperplasia if endometrial lining is greater than ____
4mm
definitive dx for endometrial hyperplasia
endometrial bx
tx for endometrial hyperplasia w/o atypia
progestin, repeat bx in 3-6mo
tx for endometrial hyperplasion w/ atypia
hysterectomy +/- BSO, treat as previous card if not surgical candidate or wish for fertility
what if a pt has postmenopausal bleeding, you do US, and endometrial stripe is < 4mm?
repeat US in 4mo if continued bleeding, consider bx
pt presents with vaginal bleeding + abd pain + recent amenorrhea. think?
threatened abortion or nonviable pg
what drug induces ovulation and is often given in infertility
clomiphene
what size ovarian cyst is usually functional and resolves on its own
< 6-8cm
when should you repeat US for functional cyst
6 weeks
tx for ovarian cancer
TAH-BSO, lymphectomy, chemo
a pg woman has painless dilation and effacement of the cervix in her 2nd trimester. what is this
cervical incompetency
how to manage cervical incompetency
1) bed rest, weekly injections of 17 a-hydroxyprogesterone
2) cerclage if you wanna
older pt presents with vaginal itching and on exam you see red/white ulcerative, crusted lesions. suspect?
vulvar cancer
included in the mgmt for an ectopic pregnancy, you should give rhogam if the mother is RH_____
negative
painless vaginal bleeding. US shows snowstorm appearance
complete molar pregnancy
painless vaginal bleeding .US shows cluster of grapes appearance
partial molar pregnancy
US shows no products of conception (above scenario)
complete
US shows gestational sac
partial
mgmt of these trophoblastic diseases
uterine suction curretage asap, follow weekly Bhcg levels
when is the screening for gestational diabetes
24-28 weeks
what is a + result for the 50g oral glucose challenge test
> / 140mg/dl after 1h
if they fail the 50g oral glucose challenge, they go onto the 3-hour oral glucose tolerance test. what is a + result for this
1h > 180
2h > 155
3h > 140
what is the gold standard test for gestational dm
3h GTT
if a pt has gestational DM, when should they deliver
38 weeks
when do you give rhogam if indicated
28 weeks gestation
within 72h of delivery
tests for PROM
- Nitrazine
- Fern
- Speculum exam (infx)
mgmt of PROM
await spontaneous labor OR give oxytocin/prostaglandin gel to induce labor
what amount of cervical dilation + effacements indicates premature labor (before 37 weeks)
> 3cm dilation
> 80% effacement
what drugs are given to suppress uterine contractions
tocolytics (terbutaline, mag sulfate, nifedipine, indomethacin)
someone is going into premature labor. IDK what the L:S test is but it is less than 2:1. what is your management
give tocolytics to suppress ctx for 48 hours, give antenatal steroids for fetal lung development
when can a pt expect morning sickness to go away
16 weeks
what type of morning sickness is more severe and may persist past 16 weeks
hyperemesis gravidarum
what anti-emetics are first line in pregnancy
pyridoxine (B6) +/- doxylamine
what is the MC cause of 1st trimester bleeding
threatened abortion
pregnant pt has bloody vaginal discharge, cramping, uterine size is normal for gestation, no POC expelled, a closed cervical os, what is it and how do you manage
threatened abortion
tx: rest, serial Bhcg
pregnant pt has bleeding and cramping, uterine size is normal for gestation, there is progressive cervical dilation but no POC are expelled. what is it and how do you manage
inevitable abortion
tx: D&E, rhogam if indicated
pregnant pt has bleeding and cramping with a boggy uterus, some POC has been expelled, cervix is dilated. what is it and how do you tx
incomplete abortion
tx: D&C, rhogam if indicated
pregnant pt has bleeding and cramping, the size of her uterus is at a pre-pregnancy state. POC has been expelled. Cervix is closed. what is it and how do you tx
complete abortion
tx: rhogam if indicated
pregnant pt presents with bleeding and cramping, no POC has been expelled, her cervix is closed. what is it and how do you manage
missed abortion
tx: D&C/E
at what weeks do you perform a D&C
5-13 weeks
at what weeks do you perform a D&E
> 12 weeks
how do you dx placenta previa/placenta abrupta/vasa previa
pelvic US
mgmt for placental previa
hospitalize, stabilize fetus (tocolytics, steroids), deliver when stable
mgmt for abruptio placenta
hospitalize and immd delivery
mgmt for vasa previa
immd c section
after how many weeks can you dx gestation htn or pre eclampsia
after 20 weeks gestation
when should you deliver a baby for someone who has gestation htn
34-36 weeks
what should you give a pt with gestational htn (not a bp med, something else)
mg sulfate to prevent eclampsia
fetal heart can be detected at ____ weeks and ______ is normal HR
10-12 weeks
120-160bpm
pelvic US can detect fetus at ____ weeks
5-6 weeks
fetal movement can be detected at _____ weeks
16-20 weeks
what is triple screening and when is it done
1) a-feto protein
2) b-hcg
3) estradiol
done at 15-20 weeks
when is GBS screening done
32-37 weeks
components of apgar score
appearance/skin pulse grimace activity respiration done at 1 + 5 mins after birth
what qualities give a baby a perfect apgar score (2 pts per section = 10)
appears: pink
pulse: >100
grimace: cries or pulls away
activity: flexes arm and legs resist extension
respiration: strong cry
what qualities give a baby a 0 apgar score
appears: blue all over
pulse: 0
grimace: no response to stimulation
activity: none
respiration: none
MC cause of postpartum hemorrhage
uterine atony
mgmt of uterine atony
massage, oxytocin, misoprostol to get uterus to contract
