Reproductive (Male + Female) - 7% Flashcards
Amenorrhea (Primary)
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
Amenorrhea (Secondary)
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
Atrophic Vaginitis
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
Bacterial Vaginosis
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
Fibroadenomas
Benign Breast Disease
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
Fibrocystic
Benign Breast Disease
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
Galactorrhea
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)
Gynecomastia
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
Breast Abscess
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
Breast Carcinoma
Screening, dx
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
Breast Carcinoma
tx
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
Breast Carcinoma
RF, Tumor types
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 +
Mastitis
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
Breech Presentation
Complicated Pregnancy
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
Candiasis Vaginitis
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
Cervical Dysplasia
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
Cesarean Delivery
Complicated Pregnancy
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
Cord Prolapse
Complicated Pregnancy
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
Dysfunctional Uterine Bleeding
Eti, sxs
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
DUB
Dx, tx
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
Ectopic Pregnancy
Dx, tx
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
Ectopic Pregnancy
eti, sxs
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
Endometriosis
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
Fetal Distress
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
Gestational Diabetes
Complicated Pregnancy
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
-
nonfasting 50 g glucose challenge test => serum glucose 1 hr later
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
Gestational Trophoblastic Disease
Complicated Pregnancy
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
Hypertension in Pregnancy
Complicated Pregnancy
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
Intrauterine Pregnancy
labs for PN visit
weight gain
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
Intrauterine Pregnancy
Prenatal labs
- 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
Intrauterine Pregnancy
- Signs of pregnancy
- Physical Exam
- Lab changes
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
Intrauterine Pregnancy
- Fetal/Infant Nomenclature
- GTPAL
- Uterine growth
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
Menopause
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
Ovarian Cancer
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
Ovarian Cysts
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
PCOS
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)
Pelvic Inflammatory Disease
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
Pelvic Pain/Dysmenorrhea
(secondary)
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
Pelvic Pain/Dysmenorrhea
(Primary)
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
Placenta Abruption
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
Placenta Previa
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-
Post partum Hemorrhage
Complicated Pregnancy
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
Pre-Eclampsia and Eclampsia
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
Premature Rupture of Membranes (PROM)
Complicated Pregnancy
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
Spontaneous Abortion
eti, sxs
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
Spontaneous Abortions
dx, tx
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
Trichomoniasis
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
