Repro V Flashcards
gestational HTN
BP >140/90 after 20th week gestation
no proteinuria
tx - a-methyldopa, labetalol, hydralazine, mifedipine
preeclampsia
HTN with proteinuria or end organ damage
-after 20 weeks gestation
abnormal placental spiral artery
- endo dysfxn
- vasoconstriction
- ischemia
higher risk - HTN, DM, chronic renal disease, autoimmune disorder
complication - placental abruption, coagulopathy, renal failure, uteroplacental insufficient, eclampsia
tx preeclampsia
antihypertensives
IV mag sulfate - prevent seizure
delivery of fetus
eclampsia
preeclampsia and seizures
can lead to maternal death
tx of eclampsia
IV mag sulfate - seizure
antiHTN
immediate delivery
HELLP syndrome
hemolysis
elevated liver enzyme
low platelet
severe preeclampsia
-schistocytes on blood smear
can get hepatic subcapsular hematoma - rupture - severe hypotension
tx - immediate delivery
placental abruption
risk fx - trauma, smoking, HTN, preeclampsia, cocaine
abrupt painful bleeding in third trimester
pcomplication - DIC, shock, fetal distress
placenta accreta
placenta attach myometrium without penetrating
MC
placenta increta
placenta penetrate into myometrium
placental percreta
placenta penetrates through myometrium into uterine serosa
placental attach to rectum/bladder
placenta previa
placenta attached over or within 2cm of cervical os
risk fx - multiparous, prior C section
with painless third trimester bleeding
vasa previa
fetal vessels over cervical os
vessel rupture, exsanguination, death
membrane rupture, painless vaginal bleeding, fetal bradycardia ( less than 110/min)
tx - emergency C section
often unprotected by wharton jelly
ectopic pregnancy
risk fx - hx of infertility, PID, rupture appendix, tubal surgery
hx of amenorrhea
lower than expected risk in hCG
sudden lower abdomen pain
diagnosis - U/S
look like appendicitis
gyn cancer in US incidence
endometrial highest - ovarian - cervical
cervical - highest worldwide - bc no screening or HPV vaccine
prognosis -ovarian worst - cervical - endometrial
clear cell adenocarcinoma of vagina
women exposed DES in utero
sarcoma botryoides
girls less than 4yo
aka rhabdomyosarcoma variant
spindle shaped cells
desmin positive
clear grape like polypoid mass from vagina
cervical dysplasia
classify - CIN 1, 2, 3
with HPV 16,18
- E6 - inhibit p53
- E7 - inhibit Rb
risk fx - multi sex partners, smoking, sex at young age, HIV
invasive carcinoma of cervix
SCC
pap smear to catch precursor - koilocyte change
koilocytes
cervical dysplasia - seen on pap
premature ovarian failure
atresia ovarian follicle
-low estrogen, high LH, high FSH
menopause before age 40
polycystic ovary syndrome
stein leventhal syndrome
hyperinsulin or insulin resistance
-alter HPA feedback
high LH and FSH
- high androgen from theca internal
- decreased rate follicle maturation
unruptured follicle - form cyst - anovulation
presentation of PCOS
amenorrhea, oligomenorrhea, hirsutism, acne, subfertility
assocation with obesity
risk of endometrial cancer due to unopposed estrogen from anovulatory cycle
tx PCOS
weight reduction OCP clomiphene citrate ketoconazole spironolactone
follicular ovarian cyst
upruptured graafian follicle
hyperestrogen
endometrial hyperplasia
MCC ovarian mass young woman
