Repro Clincial Flashcards
bartholin’s cyst
- most common vulvovaginal tumor
- less than 3 cm = asympt
- usually unilat swelling
vaginal trauma
most common cause is sexual assault
cystocele
anterior vaginal prolapse
rectocele
posterior vaginal prolapse
VIN III/Squamous Cell Carcinoma in situ: Usual type
HPV16, smoking, immunocompromised status
VIN III/Squamous Cell Carcinoma in situ: Differentiated VIN
not associated with HPV, more commonly associated with Lichen Sclerosis
Paget’s Dz: vulva
Occurs in postmenopausal white F & can also occur in nipple areas of the breast
- have underlying carcinoma (breast or colon)
- Sx: itching & tenderness
- fiery red background with white plaque like lesions
Squamous Cell Vulvar Carcinoma
Postmenop. females bt 70-80 y/o
- pruritic, raised, ulcerated, pigmented or warty in appearance usually on labia majora
- Spread: direct extension, lymphatic embolization to regional LNs, hematogenous spread to distant sites (Lung, liver, bone)
Verrucous Carcinoma
- Lesions are cauliflower-like
- Radiation is contraindicated –> induce anaplastic transformation
Vaginal Intraepithelial Neoplasia (VAIN)
-HPV virus related
50-90% of pts with VAIN will have coexistent or prior neoplasia or cancer of the cervix or vulva
-Dx: asymptomatic, considered with an abnorm pap
Sarcoma Botryoides
- Presents as a mass of grape-like polyps protruding from the introitus
- tumor is embryonal rhabdomyosarcoma
- 2-3 y/o
- Tx: surgical resection, chemo, +/- radiation
Bacterial Vaginosis
-M.C. cause of vaginitis
-Gardnerella vaginalis
RFs: new/multiple sex partners, smoking, IUD, douching
-Sx: malodourous fishy amine odor especially after intercourse, profuse thin milky discharge often
-Dx: clue cells in saline wet mount, KOH + whiff test, vaginal fluid pH > 4.5
-Tx: Metronidazole BID x 7 days
Meyer-Rokitansky-Kuster-Hauser syndrome
complete lack of development of the paramesonephric system results in Mullerian agenesis = absence of the uterus and most of the vagina
Ovarian Torsion
complete or partial rotation of the ovary on its ligmentous supports, which often results in impedance of it’s blood supply
primary RF: ovarian mass > 5 cm
Adnexal torsion
ovary & fallopian tube both twist
Isolated torsion
torsion of just the FT or FT cysts are rare
Presentation of ovarian torsion
acute onset of u/L pain, nausea & possibly vomiting
-Dx: U/S
Threatened Abortion
vaginal bleeding & closed cervix
inevitable abortion
vaginal bleeding & the cervix is partially dilated
-loss in inevitable
incomplete abortion
- vaginal bleeding, cramping lower abd pain with dilated cervix
- passage of some but not all products of conception
Anembryonic gestation: blighted ovum
fertilized egg develops a placenta but no embryo
-U/S reveals empty gestational sac
Rh Isoimmunization
immunologic disorder that occurs in a preg, Rh-NEG women carrying an Rh-POS fetus
-RhoGAM - used to prevent maternal production of Abs
Single dose of RhoGAM
- Prevent isoimmunization after an exposure up to 30 mL of Rh D + whole blood or 15 mL of fetal red blood cells
- admin at 28 wks and within 72 hrs after delivery of a Rh D + infant
Kleinhauer-Betke Test
- identifies fetal RBCs in maternal blood
- will determine if additional RhoGAM is necessary
Fetal Hydrops
-ascites, pleural effusion, pericardial effusion, skin or scalp edema
Dystocia
- difficult labor
- dysfxnal labor characterizing that labor is not progressing normally
- Abnormalities of: power, passenger, passage
Consider augementing in active phase if
contractions are less than 3 in 10 min period and/or the intensity is less than 25 mm/Hg
-oxytocin is recommended
Power: Minimal effective uterine activity
- 3 contractions in a 10 min period averaging 25 mmHg above baseline
- > 200 MVU for at least 2 hrs
- document for 4 hrs before going to c-section
shoulder dystocia
delivery that required additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders
Cause of shoulder dystocia
impaction of the anterior fetal shoulder behind the maternal pubic symphysis or the impaction of the post shoulder on the sacral promontory
-turtle sign= retraction of the delivered fetal head against the maternal perineum (baby’s head comes out and retracts back)
