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PANCE > Reproductive (Male + Female) - 7% > Flashcards

Reproductive (Male + Female) - 7% Flashcards

1
Q

Amenorrhea (Primary)

A

No menses by 13 yo w/ no 2/2 sex characteristics or

No menses by 15 yo with normal 2/2 sex characteristics

Eti:

  • Pregnancy
  • Imperforate hymen
  • Gonadal dysgenesis (Turner’s syndrome)
  • HPO axis abnormalities (anorexia, bulimia, wt loss, excessive exercise)

Dx:

  • Quantitative B-HCG
  • FSH
  • prolactin
  • TSH, T3, Free T4
  • estrogen & progesterone

Risk of Osteoporosis in Primary Ovarian failure

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2
Q

Amenorrhea (Secondary)

A

Absence of Menses for 3 mos for those with regular menstruation

or for 6 mos for women with irregular cycles

MCC -

  • Pregnancy,
  • Endometrial atrophy ( Asherman’s syndrome, RXT),
  • Premature Ovarian Failure & PCOS (high FSH),
  • pitutiary dysfx (sheehan’s syndrome/necrosis of ant pitu)

Dx:

  • quant B-HCG, TSH, FSH, LH, Prolactin
  • TVUS
  • Prolactin if > 200 then get CT of Sella Turcica
  • Progresterone challenge

Tx:

underlying cause, use OCP, Ovarian dysfx = cyclic progesterone 10 mg for 10 days

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3
Q

Atrophic Vaginitis

A

atrophy of vaginal and vulvar tissues d/t hypoestrogenic state

MC in post menopausal women

Sxs

  • dryness
  • burning
  • irritation
  • low lubrication

Tx:

1st line therapy for sxs relieve - hormonal vaginal lubricants

Estrogen inserts - vaginal ring w/ 2mg estradiol q 3mos

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4
Q

Bacterial Vaginosis

A

MC of vaginitis

D/t Gardnerrella

Sxs

  • thin, copious, grey-white “fish” smell
  • pH > 5
  • clue cells
    • Whiff test

Tx Metronidazole PO 500 mg x 7 days or gel 0.75% 5g intravaginally for 5 days or

avoid alcohol - disulfram rx

Clindamycin gel 2% 5g intravaginally or 300mg PO BID x 7 days

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5
Q

Fibroadenomas

Benign Breast Disease

A

MC Benign breast condition = young adolescent women

Sxs:

  • painless, firm, smooth, well circumscribed, mobile nodule, gradually grows over time
  • No axillary or nipple invovlement

Dx

  • US +/- mammogram OR
  • FNA or excision bx

Tx - FNA bx or excisional bx

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6
Q

Fibrocystic

Benign Breast Disease

A

2nd MC benign breast lesions

Sxs

  • painful, swollen, lumpy, breast, bilaterally
  • well circumscribed, rubbery lumps, discrete, relatively moveable
  • Change in size correlates w/ menstrual cycle - resolves at start

Dx

  • breast cyst aspiration = straw color liquid w/ no blood
  • US +/- mammo

Tx

  • NSAID
  • heat/Ice, supportive bra
  • Resolves spontaneously
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7
Q

Galactorrhea

A

Prolactin secreting pituitary adenoma (usu < 10mm in diameter)

ETI - Meds (psychotropics, cimetidine, TCA’s, OCPs, depo)

CNS - pituitary microadenoma; hypothyroidism

Sxs

  • Bilateral
  • induced
  • clear/white/yellow nipple discharge

Dx

  • Prolactin level > 20 and usu x5x ULN
  • T4 and TSH
  • CT or MRI

Tx - Dopamine agonist - bromocriptine or cabergoline (longer acting)

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8
Q

Gynecomastia

A

Breast enlargement in males; breast tissue + glands

Sxs

  • Usu transient in puberty
  • bilateral, symmetric, smooth, firm and tender enlargment of breast under areola (kids)
  • MEN - MCC
    • persistent pubertal gynecomastia
    • idiopathic
    • Drugs - spironolactone, steroids, antiandrogens

Dx

  • Mammogram if cancer is suspected
  • LH, FSH, testosterone, estradiol, hcG

Tx

  • self limiting, tx underlying cause
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9
Q

Breast Abscess

A

Pocket of contained infection within the breast

Progression from mastitis - sxs same + localized mass and systemic signs of infection

MCC S. aureus

Tx:

  • I&D and anti-staph abx
  • Nafcillin/oxacillin IV or Cefazolin + Metronidazole
  • alternative is Vancomycin

​Stop breastfeeding on affected side - PUMP AND DUMP

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10
Q

Breast Carcinoma

Screening, dx

A

Mammogram Guidelines

  • age 40-44 - choice to start mammogram
  • 45-54yo - mammogram q 1 year
  • 55+ = mammogr q 2 years
  • no more screening 75+

Dx

  • Mammography - microcalcification (cant diff solid vs cystic)
  • US - delineating cysts vs solid
  • Breast bx** - gold std if solid
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11
Q

Breast Carcinoma

tx

A

Segmental mastectomy/lumpectomy => breast irradiation in all patients w/ adj chemo, with + nodes

  • Anti-estrogen (Tamoxifen)- ER+ tumors
  • Aromatase inhibitors (Anastrozole, letrozole) - post menopausal ER+ w/ breast cancer
  • Monoclonal AB (Trastuzumab) tx - HER2+
  • SERM
    • Tamoxifen or Raloxifene
    • post menopausal F > 35yo w/ high risk
    • treat for 5 years
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12
Q

Breast Carcinoma

RF, Tumor types

A

RF

  • Age
  • Nulliparity
  • early menarche < 12 or late >17
  • fam hx - BRCA1, BRCA2
  • incr estrogen exposure - postmeno HRT

Tumor types

  • MCC - Infiltrating Intraductal Carcinoma (DCIS)
    • classic painless, stony, hard unilateral mass
  • Infiltrating Lobular - bilateral
  • Inflammatory Breast cancer - , peau d’orange
    • mets early and faster
    • rapid enlargement of breast/ cellulitis
    • Padget’s disease of the breast - infiltrating intraducta carcinoma of nipple
  • ER + or PR + or HER +
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13
Q

Mastitis

A

Infection of breast from skin flora (MCC S aureus) d/t clogged milk ducts

Congestive (bilateral) vs Infectious (unilateral)

Sxs

  • cracked nipple
  • soreness/pain with breastfeeding - nipple trauma
  • unilateral erythema, tenderness, only 1 quadrant of breast affected
  • Fever/chills

Tx

  • dicloxacillin, cephalexin or erythromycin for staph
  • clinda as alternative
  • continue to breastfeed on infected side w/ warm heat QID
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14
Q

Breech Presentation

Complicated Pregnancy

A

Baby born bottom first; prevalence decreases with increasing GA

Three types

  • Frank - both legs in extension
  • Incomplete - one foot sticking out of pelvis
  • Complete - knees tucked

Dx

  • US with fetus in tranverse lie
  • if < 37 weeks, no intervention
  • observation + repeat US at 37 wks

Tx

  • External cephalic version
  • Trial vaginal deliveries, then planned C section
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15
Q

Candiasis Vaginitis

A

MC candida albicans

Sxs

  • vaginal burning, erythema
  • cottage cheese discharge
  • pH <4.5 (normal)
  • hyphae and yeast on KOH mount

Tx

  • Flucanozol/Diflucan 150mg PO x 1; another dose if sxs still bad
  • Miconazole/clotrimazole, terconazole x 7 days vaginal cream
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16
Q

Cervical Dysplasia

A

High risk HPV 16 and 18; early intercourse, childbearing, Multiple sex partners, hx of STI, LES, smoking

HPV 16 most carcinogenic, then 18; most HPV infx are transient becoming undetectable within 1-2 years

transformational zone MC affected

Dx - Cervical cancer screening

  • First PAP at 21 regardless of sexual activity
  • <30 yo - no HPV testing
  • 21 - 65yo - PAP q 3y
  • 30-65yo - PAP + cytology q 5y
  • >65yo - no screening
  • No cytology if total hysterectomy for benign; if surgery for CIN II-III, then annually 3 times before dc’ing

if ASC-US and up, require reflex HPV testing for high risk types

Tx

  • Quadrivalent HPV (Gardasil) vaccine =>11-12 years old, early s 9, catch up is 13-26
    • Male is 11-12, then catch up is 13-21
    • Male 22-26 = catch up for MSM or IMC
  • <15 - 2 dose series, 6 mos apart
  • >15 - 3 doses at 0, 1-2 mos, then 6 mos
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17
Q

Cesarean Delivery

Complicated Pregnancy

A

1/3 of all deliveries in US;

eti - previous CS, dystocia, failure to progress, breech, or fetal distress

Success of VBAC higher for breech, and lower for dystocia

Each subsequent C Section - infection, bleeding and thromboembolic event

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18
Q

Cord Prolapse

Complicated Pregnancy

A

Umbi cord comes out of uterus before or w/ presenting part of fetus

EMERGENCY - no O2 to fetus,

MCC - malpresentation or ROM

Three types

  • Overt - umbi descent before the fetal part
  • Funic - cord btwn presenting fetal part and fetal membrane; no ROM
  • Overt - cord presents with fetal; no ROM

Dx

  • sudden, severe decr in FHR
  • variable decelerations

Tx

  • Immediate CS
  • Manual elevation of fetal part
  • Mom head down w/ hips elevated
  • Tocolytics
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19
Q

Dysfunctional Uterine Bleeding

Eti, sxs

A

Excessive uterine bleeding w/ no organic cause

  • Menorrhagia - prolonged/heavy bleeding (>7d or >80mL[5.4 tbs}); regular intervals
  • Metrorrhagia - variable amt of bleedings at irregular, freq intvls
  • Menometrorrhagia - more blood loss during menses, freq and irregular bleeding btwn menses (heavy, freq, irregular)
  • Polymenorrhea - more freq <21 days
  • Oligomenorrhea - > 35 days

Eti:

PALM - Structural causes

  • Polyp - submucosal fibroid or polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy

COEIN - Nonstructural causes

  • Coagulopathy
  • Ovulatory dysfx
  • Endometrial
  • Iatrogenic
  • Not classified
20
Q

DUB

Dx, tx

A

Diagnosis of exclusion

  • r/o organic causes, reproductive, iatrogenic
  • R/o preg
  • med reconcilation

PE: thyromegaly , pelvic structural abns (polyps/fibroids)

Labs - FSH, LH, Prolactin, estradiol, testosterone, TSH/T3/T4, DHEAS, coags

Eval of uterus - EMB, hysterectomy, pelvic US

Uterine D&C (gold std) - diagnostic or therapeutic

21
Q

Ectopic Pregnancy

Dx, tx

A

Dx

  • Serial B-HcG - should double q24-48 hrs
    • initial <1500, repeat 2-3 day
  • Transvaginal US
    • if HcG > 2000 with no gestational sac = Ectopic

Tx

  • Unruptured/Stable

Methotrexate if

  • Hemodynamically stable
  • HcG < 5000
  • No fetal tones
  • Ectopic <3.5cm
  • no renal, hepatic, pulm
  • Successful if b-HcG >=15% 2 blood draws

Lap Salpingostomy if ruptured

22
Q

Ectopic Pregnancy

eti, sxs

A

implantation of fertilized ovum outside uterine cavity; MC implantation in Fallopian tube (Ampulla)

RF: previous abd sx, adhesions, PID, OCPs/IUD, tubal ligation

Sxs:

  • Triad
    • unilateral pelvic/abd pain
    • vaginal bleeding
    • amenorrhea/pregnancy
  • cervical motion tenderness/adnexal pain

Ruptured Ectopic - EMERGENCY

  • severe abd pain
  • dizziness
  • N/V
  • Shock signs - syncope, tachycardia, hypotension
23
Q

Endometriosis

A

Presence of endometrial tissues outside uterine cavity - MC in ovaries, fallopian

RFs: nulliparity; fam hx; early menarche

Sxs

  • 3 D’s
    • Dyspareunia
    • Dyschezia
    • Dysmenorrhea
  • Infertility
  • “tender nodularity in cul de sac”
  • Cyclic pelvic pain peak 1-2 d before menses onset

Lap with bx - definitive dx

Tx

  • OCPs + NSAID
  • Progesterone - endometrial tissue atrophy (surppresses GnRH)
  • Leuprolide - gnRH analog, pituitary and FSH/LH supprssion
  • Danazol /testosterone - suppresses mid surge LH –> only for 6 mos d/t bone loss
  • Conservative Lap w/ ablation - if desire to conceive
  • Total Abd Hysterectomy w/ Salpingo-oophorectomy - if no desire to conceive
24
Q

Fetal Distress

A

Non-Stress Test

  • Good - reactive NST > 2accelerations in 20 mins with increase FHR > 15bpm lasting 15 seconds
  • 2/20/15/15
  • Bad - nonreactive NST - no FHR accelerations or <15 bpm lasting < 15 secs, get contraction stress test

Contraction Stress Test

  • Good - Negative CST - no late decels in presence of 2 contractions in 10 mins
    • fetal well being, repeat CST as needed
  • Bad - Positive CST - repetitive late decels in presence of 2 contractions in 10 mins
    • worrisome esp if non reactive NST –> prompt delivery

APGAR

appearance, pulse, grimace, activity, respiration

  • score frm 1-10, > 7 is nl, 4-6 fairly low, < 3 critically low
  • test is done at 1 and 5 mins after birth
25
Q

Gestational Diabetes

Complicated Pregnancy

A

Glucose intolerance

screen 24-28 wks

Sxs

  • Fasting glucose > 92 = GDM
  • 18 wks - level 2 US for fetal cardiac abn
  • macrosomia - big baby

Dx

  • Random glucose test on first prenatal visit
  • Repeat screening at 24-28 wks
  • Screening
    • nonfasting 50 g glucose challenge test => serum glucose 1 hr later
      • if > 130 mg/dL,
      • then 100 g glucose challenge, fasting* 3 hour glucose performed (if 2x elevated then +)
        • Fasting 95
        • 1 hr > 180
        • 2 hr > 155
        • 3 hr > 140

Tx

  • If fasting glucose > 105 mg/dL or 2 hrs post prandial > 120 mg/dL = insulin
  • Early delivery by CS at 38 wks if macrosomic
26
Q

Gestational Trophoblastic Disease

Complicated Pregnancy

A

Proliferation of placental cells

Benign

  • Complete Mole
    • Huge amt of HCG, missed period, + preg test, vaginal bleeding, uterus larger than expected for GA
    • grape like mass or snow storm on TVUS
    • hyperemesis
    • preeclampsia in 1st or 2nd trimester ***

Malignant

  • Invasive Moles - from benign, can be choriocarcinoma** serial HcG weekly, then monthly
    • develops after molar pregnancy

Dx

  • HCG > 100,000
  • US - snow storm or cluster of grapes

Tx

  • Suction Curettage asap to avoid choriocarcinoma
  • Methotrexate to destroy trophoblastic dz, or hysterectomy
27
Q

Hypertension in Pregnancy

Complicated Pregnancy

A

Gestation Hypertension

  • BP >150/90 after 20 wks into pregnancy
  • resolves within 12 wks postpartum
  • elev BP and NO PROTEIN
  • Meds - hydralazine or labetalol safe

Chronic HTN

  • BP >140/90 prior to 20 wks GA
  • continues > 6wks post partum
  • HA + visual changes
  • No proteinuria
  • Severe - meds if >150/90
    • methyldopa**

Pre-eclampsia

  • HTN, +Proteinuria, edema, after 20 wks GA
  • Mild Preeclampsia
    • ​140/90 -160/110
    • Proteinuria > 300 mg/24 hrs or +1 on dipstick
    • DELIVERY
  • Severe Preeclampsia
    • ​>160/110
    • Proteinuria > 5g in 24 hrs or no urine or 3+ on dipstick
    • Cerebral visual change, pulm edema
    • HELLP syndrome - hemolysis, ele Liver enzymes, Low platelets
    • DELIVERY 24-26 wks
    • Mg Sulfate** + Hydralazine if >180/110

Eclampsia

  • Preeclampsia + seizures
  • Mg Sulfate for seizures, delivery once stable
  • Hydralazine for BP
28
Q

Intrauterine Pregnancy

labs for PN visit

weight gain

A

Every Prenatal Visit

  • Maternal Weight
  • BP
  • Fundal Height
  • Fetal Size and Presenting part
  • Urine Dipstick for protein
  • glucose
  • ketones

Rec’d weight gain during pregnancy

  • 10-15 for overweight
  • 20-35 lb for reg weight
  • 40-45 lbs for underweight

Avoid

  • Smoking
  • ETOH
  • Drugs - teratogens
  • Unpasteurized food (apple cider, soft cheese) - listeria
  • Raw meat, seafood, deli meat - listeria
  • King mackerel, shark, swordfish, tuna, tilefish - mercury
  • Farm salon - PCBs
29
Q

Intrauterine Pregnancy

Prenatal labs

A
  • CBC
  • Blood type, Rh factor,
  • random glucose
  • Urine
  • Pap smear (if < 1 year since last)
  • Immunology
    • VDRL
    • Hep B
    • Rubella
  • As indicated
    • CF
    • Tay Sachs
    • Sickle Cell
  • Group B Strep
30
Q

Intrauterine Pregnancy

  • Signs of pregnancy
  • Physical Exam
  • Lab changes
A

Diagnosis

  • Serum b-HcG - detect pregnancy as early as 5 days after conception
  • Urine b-HcG - detect a pregnancy 14 days after conception - incr Serum Progesterone

PE:

  • Increased basal body temp
  • Skin changes
    • Melasma/choasma - dark patches on face across bridge of nose or forehead
    • Linea Nigra - vertical line up abd
      • stimulation of melanocyte

Uterus changes

  • Ladin’s sign.- uterus softening after 6 wks
  • Hegar’s sign - uterine isthmus softening after 6-8 wks GA

Cervix changes

  • Goodell’s sign - cervical softening d/t increased vascularization - 4-5 wks GA
  • Chadwick’s sign - bluish coloration of cervic and vulva 8-12 wks

Lab changes

  • Cholesterol will increase
  • BUN and Cr will be decreased
31
Q

Intrauterine Pregnancy

  • Fetal/Infant Nomenclature
  • GTPAL
  • Uterine growth
A

Abortion - elective or spontaneous < 20 wks GA or wt <500g

Premature Infant - 20-36 wks or 1000-2500g

Full Term infant - 37-42 wks GA or >2500g

Postmature infant >42 wks GA

GPTPAL

  • Gravida - # of pregnancies woman has had
  • T - total # of full term pregnancies - 37-42 wks
  • P - total # of preterm pregnancies (20-36 wks)
  • A - # of abortions
  • L - # of living childrent
  • Twins - one prgenancy but 2 live children

Uterine Growth

  • 12 wks at pubic symphsis
  • 20 wks at umbilicus
  • > 20 wks - 1cm for every wk gestation
  • 36 wks at xiphoid
32
Q

Menopause

A

12 mos of amenorrhea, FSH>40

sxs

  • vasomotor - hot flashes
  • vaginal atrophy
  • depressive sxs, insomnia, irritability, lack of concentration
  • *concerns for osteoporosis, CVD

Dx - retroactively

Tx

  • Hormone replacement - tx PM symptoms, prevent Osteoporosis
  • transdermal delivery, lowest dose for shortest amt of time
  • estrogen only - if no uterus
  • estrogen + progesterone = if uterus
33
Q

Ovarian Cancer

A

Familian incidenct, nulliparity, first degree rel, brca

Sxs

  • Screening
    • pelvic exam
    • CA-125 > 35 abn
    • TVUS
  • asymp
  • GI/GU symp - bloating, increased abd girth, dysuria
  • Ascities, wt loss (late)

Tx

  • sx, chemo
34
Q

Ovarian Cysts

A

Fluid filled sac w/in ovary ; usu harmless and no sxs

Functional - 2-3cm, up to 10 cm, clear serous liquid, smooth internal lining

  • Follicular cyst MC - dominant follicule fails to rupture
  • Corpus luteum - dominant follicle rupture but closes again and doesn’t dissolve, seen in 1T of preg
  • Theca lutein cysts - overstimulation of HCG produced by placenta - only in pregnancy

Non functional cysts/neoplastic cysts -

  • PCOS (amenorrhea, hirsutism),
  • endometriomas (chocolate cysts),
  • dermoid cysts (Teratomas - teeth and skin) = can get v big causing ovarian torsion
  • > 10cm, irregular borders, internal septations

Sxs:

  • bloating, lower abd pain, LBP
  • dyspareunia

Normal menstruation cycle (functional) or non-functional

Dx

  • US guided aspiration & histological analysis - definitive​
  • MRI if US is indeterminate for sx resection eval
  • Serum CA-125 - in post/menopausal women - r/o Ovarian cancer

Tx

  • < 5 cm - observation
    • Uncomplicated cyst rupture - hemodyn stable - expectant mgmt and NSAIDs
  • > 5cm - cyst removal by laparoscopy
  • Surgery - symptomatic tumors, hemorrhaging severely, ovarian torsion
35
Q

PCOS

A

Ovulatory dysfx - constant release of GnRH (instead of pulsatile) => inc LH => bombards ovaries

Sxs

  • Oligomenorrhea/amenorrhea (menstrual irreg)
  • acne, hirsutism, male pattern alopecia (hyperandrogenism)
  • Central obesity, glucose intolerance, dyslipidemia (CVD risk)
  • Infertility

Dx

  • LH/FSH 3:1 (usu FSH is > LH)
  • Normal estrogen
  • Free testosterone > 50ng/mL
  • insulin resistance
  • large cystic ovaries (not always)

Tx

  • Weight loss***
  • OCPs, spironolactone (antiandrogens)
  • Metformin
  • clomiphene (ovulation induction)
36
Q

Pelvic Inflammatory Disease

A

Ascending infection of Upper genital Tract; MC GC, mixed anaerobes, Ecoli

RF:

  • multiple sex partners; unprotected sex
  • prev PID; iatrogenic causes IUD placement
  • age 15-19** adolescents

Sxs

  • pelvic pain, dyspareunia
  • chandlier sign - cervical motion tenderness
  • fever >101
  • presents around menses

Dx:

  • Abdominal/ Cervical motion tenderness
  • adnexal tenderness plus one of the following:
    • Fever >38C
    • WBC >10,000
    • Pelvic abscess via manual exam or US
    • ESR/CRP

Tx

  • Outpatient - Doxycycline 100mg BID x 4 d + Ceftriaxone 250mg IM x1
  • Inpatient - IV Doxycycline + 2nd gen Ceph (Cefoxitin or Cefotetan) OR Clindamycin + Gentamicin
37
Q

Pelvic Pain/Dysmenorrhea

(secondary)

A

D/t to an identifiable cause

Pain with menstruation that begin mid-cycle and increases in severity until end

Women age 20-40s

Eti

  • Endometriosis
  • adenomyosis
  • Polyps
  • fibroids
  • PID
  • IUD
  • tumors
  • adhesions
  • cervical stenosis/lesions , psych
38
Q

Pelvic Pain/Dysmenorrhea

(Primary)

A

Uterine pain around the time of menses - either 1ry or 2ry

  • usu lasts 1-2 days - relieved by NSAIDs and OCPs

Primary Dysmenorrhea

  • 6-12 mos of menarche. Patho - excessive prostaglandins and leukotriene production –> increased uterine contractions
    • Severe cramps that start w/ menses & lasts 2-3 days (highest pain in first day)
    • lower abd pain r-> back/thighs
    • HA, N, Diarrhea
  • PE - nl

Tx

  • NSAIDs - first line
  • OCPs
  • Menstrual suppression
  • surgical - endometrial resection
39
Q

Placenta Abruption

A

Premature separation of placenta from uterine wall after 20 wks

MCC of Painful, third trimester bleeding

RF:

  • maternal HTN MCC
  • High parity
  • Smoking/ETOH/Cocaine
  • Chorioamnionitis

Sxs:

  • dark red blood w/ severe abd pain and/or freq contractions
  • rigid uterus
  • Shock symptoms
  • Fetal bradycardia, fetal distress

Dx

Usually clinical, NO Pelvic exam, pelvic US

Tx

immediate delivery - CSection

40
Q

Placenta Previa

A

abnormal placement of placement, partially covering cervical OS

painLESS bleeding usu >28 wks gestation

suddent onset - BRB, no abd pain, No fetal distress

RF

  • increased age
  • multiparity
  • smoking
  • Prev CS

Dx

Pelvic US, no pelvic exam

Tx:

  • Bed rest - no intercourse, vigorous exercise
  • Tocolytics - to stop contractions - Mg Sulfate
  • Steroids - at 24-34 wks to incr lung maturity
  • Deliver if >36 wks, or blood loss >500mL
  • +/- Vaginal partial /marginal
  • blood transfusion
  • Rhogam if Rh-
41
Q

Post partum Hemorrhage

Complicated Pregnancy

A

Significant blood loss after giving birth; highest risk within first 24 hrs

Sxs

  • losing > 500mL of blood w/in 1st 24 hrs of vaginal delivery or 1L after CS
  • 4 T’s
    • Tone, Trauma, Tissue, Thrombin
    • MCC Uterine atony - 90%
    • Track trauma - preciptous labor/lacerations
    • Retained placental tissue
    • Coag disorder - DIC

Dx - Soft and boggy uterus

Tx

  • uterine fundus massage
  • Oxytocin for contractions, misoprostol
42
Q

Pre-Eclampsia and Eclampsia

A

Pre-eclampsia

  • HTN, +Proteinuria, edema, after 20 wks GA
  • Mild Preeclampsia
  • ​140/90 -160/110
  • New onset Proteinuria > 300 mg/24 hrs or +1 on dipstick OR end organ damage (thrombocytopenia, impaired LF, PE, Cerebral dysfx)
  • DELIVERY @ 37 wks
  • prevention - low dose aspirin 12-36 wks**

Severe Preeclampsia

  • ​>160/110
  • Proteinuria > 5g in 24 hrs or no urine or 3+ on dipstick
  • Cerebral visual change, pulm edema
  • HELLP syndrome - hemolysis, ele Liver enzymes, Low platelets
  • DELIVERY 24-26 wks
  • Mg Sulfate** + Hydralazine if >180/110

Eclampsia

  • Preeclampsia + grand mal seizures
  • Mg Sulfate for seizures, delivery once stable
  • Hydralazine for BP
43
Q

Premature Rupture of Membranes (PROM)

Complicated Pregnancy

A

Rupture of membranes at >/= 37 wks GA before contractions

Preterm PROM is < 37 wks GA

major risk - infection or cord prolapse

sxs

  • Sudden gush of clear or pale yellow fluid that occurs before 37 wks GA

Dx - need to confirm amniotic fluid

  • Speculum - fluid pooling in posterior fornix
  • Nitrazine test - blue d/t elevated pH >6.5 is positive
  • Microscopic examination - ferning crystalization of amniotic fluid

Tx based on GA

  • > 34 wks - induce labor
  • 32-34 wks - check lung maturity through fluid collection - induce
  • < 32 wks - stop contractions, start 2 doses of steroid injections, then deliver baby - give abx
44
Q

Spontaneous Abortion

eti, sxs

A

Termination of a pregnancy < 20 wks = 15-20% of pregnancies

  • most before 8 wks
  • MCC chromosomal abn

RF - smoking, infection, maternal systemic dz, immunologic parameters, drug use

SxS - variable, fundus of uterus may be boggy or tender

Dx - US and quant HcG

45
Q

Spontaneous Abortions

dx, tx

A

Early pregnancy bleeding and pain MUST r/o Ectopic

  • decreased b-HcG
    • should double q 48 hrs in viable preg
  • Transvaginal US - inappropriate development or intvl growth, poorly formed fetal pole, fetal demise
  • Blood type and Rh for Rh sensitization

Tx:

  • D&C
  • monitor B-HcG levels or US examinations
  • septic/infected abortion - complete evacuation of uterine contents, medical support, and abx
46
Q

Trichomoniasis

A

D/t Trichomonas vaginalis

Sxs

  • malodorous
  • frothy, yellow green dc
  • Strawberry cervic
  • pH > 5
  • mobile protozoa

Tx metronidazole 2g PO x1

partner also tx’ed

PANCE (15 decks)

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