Womens Health/Pregnancy Flashcards
What is gestational thrombocytopenia- clinical features, typical platelet range
benign
self-limiting
5-7% pregnancies
discovered late in gestation, usually at delivery. incidental, no symptoms
usually 100-150,000
Management of gestational thrombocytopenia
continue routine prenatal management
Management of ectopic pregnancy
In hemodynamically stable patients with:
- BHCG <200 and no adnexal mass, can do expectant management
- BHCG <5,000 (can use methotrexate in patients with no contraindications to therapy - immunodef, renal failure, active pulm disease)
hemodynamically unstable patients require surgery (ruptured ectopic –> intraabdo bleeding –> HD instability)
epidemiology and clinical pres of interstitial cystitis/bladder pain syndrome
more common in women
assoc with psychiatric and pain disorders (ex fibromyalgia)
clinical sx: bladder pain with filling, relief with voiding. increased urinary freq, urgency. dyspareunia
diagnosis of interstitial cystitis/bladder pain syndrome
bladder pain with no other cause for >6 weeks
normal urinalysis
management of interstitial cystitis/bladder pain syndrome
improve qual of life
amitriptyline or pentosan polysulfate sodium w/c repairs the urothelium
behav modification, avoid triggers, pt
analgesics
Definition of pre-eclampsia
new onset HTN at >20 wks gestation
PLUS
proteinuria and/or end-organ damage
Severe features of pre-eclampsia
- SBP >=160 or DBP >= 110 (2 times >4 apart)
- thrombocytopenia
- elevated cr
- elevated LFTs
- pulm edema
- visual or cerebral sx
Management of pre-eclampsia
without severe features: delivery at >=37 wks with severe fx: delivery at >=34 wks Mag sulfate (seizure ppx) antihypertensives
How do you treat pregnant women with anti-phospholipid syndrome?
aspirin and/or LMWH depending on prior pregnancy complications ex. fetal loss, pre-eclampsia
Is hydroxychloroquine (plaquenil) safe in pregnancy?
yes
is methotrexate safe in pregnancy?
no
What are anti-Ro/SSA and anti-La/SSB antibodies in pregnant women associated with in neonates?
neonatal lupus and congenital heart block
Treatment of mild menopausal symptoms
behavioral/lifestyle modifications
Treatment of mod/severe menopausal/vasomotor symptoms
In patients w/ contraindications to estrogen –> SSRI
if no contraindication to estrogen –>
intact uterus: estrogen and progestin
absent uterus: estrogen only
HRT is given for <5 years
Condyloma acuminata
HPV- types 6 and 11
non-friable, non-tender, fungating lesions
treatment: trichloroacetic acid, podophyllotoxin
What are examples of selective estrogen receptor modulators? When do you use each of them?
Tamoxifen- used in adjuvant breast ca therapy in patients with non-metastatic, estrogen positive br ca. first line in pre-menopausal pts. can also be used in post-menopausal pts who dont tolerate aromatase inhibitors
Raloxifene- used in post menopausal osteoporosis
How do selective estrogen receptor modulators work? What are their adverse effects?
They are competitive inhibitors of estrogen binding. Mixed agonist/antagonist activity
Adverse effects: Hot flashes VTE Endometrial hyperplasia and carcinoma- tamoxifen only Uterine sarcoma- tamoxifen only
UTI treatment in pregnancy:
abx for asymptomatic bacteriuria and cystitis
Amox-clav Fosfomycin Cephalosporin (ex. cefpodoxime, keflex) Nitrofurantoin- avoid in 1st trimester TMP-SMX- avoid in 1st trimester and at term
UTI tx in pregnancy
abx for mild-mod pyelo:
- inpatient admission
- 3rd or 4th gen cephalosporin- ceftriaxone or cefepime
- aztreonam
- ampicillin & gentamycin
UTI tx in pregnancy:
abx for severe pyelo (immunocompromised, urinary retention):
zosyn
carbapenems
complications associated w/ pyelonephritis in pregnancy
ARDS in mother, preterm labor
How to manage hyperthyroidism in pregnancy; which drug to use in each trimester?
1st: propylthiouracil b/c methimazole assoc w/ congenital defects
2nd/3rd: methimazole b/c PTU assoc with hepatotoxicity
can use beta blockers as well, and thyroidectomy also option
how often do you monitor thyroid labs in hyperthyroid pregnant pt?
every 4 weeks
goal for managing hyperthyroidism in pregnancy?
maintain slightly hyperthyroid state
what hyperthyroid treatment is contraindicated in pregnancy?
radioactive iodine
primary ovarian insufficiency clinical features
age <40
- amenorrhea
- menopausal sx: hot flashes, pain during sex
- often idiopathic, however can be related to autoimmune disorders, previous chemo/rad, or genetic abnormalities - turners, fragile x
- lab: elevated FSH, low estradiol
most effective emergency contraceptive
copper IUD 99%
second most is levenogestrel pill / Plan B- 95% effective within 24h, then decreases to 85%
treatment of urge incontinence
first line: bladder training and behavioral modifications like pelvic muscle exercises
if this fails, can try antimuscarinics- oxybutinin, tolterodine, and beta3 agonists ex. mirabegron
when do you screen for GDM?
third-trimester for low risk pts
first-trimester for high risk/patients who had it previously
then repeat 2 weeks post partum if they had GDM to see if they have persistent T2DM
PCOS diagnostic criteria
need 2 of 3:
- irregular or absent ovulation/menses
- clinical (hirsutism, acne) or biochemical (elevated testosterone) hyperandrogenism
- polycystic ovaries on ultrasound
normal vaginal ph
3.8-4.5
criteria for BV
3 out of 4 of the following:
thin,grey vaginal discharge
vaginal pH >4.5
odor after KOH whiff test
clue cells
tx of BV (first and second line)
oral or vaginal metronidazole
alternatively, clindamycin
glycemic targets during pregnancy:
- fasting
- 1 hour post-prandial
- 2 hours post-prandial
fasting: <=95
1 hour post prandial <=140
2 hours <= 120
second line treatment for GDM, after lifestyle/dietary changes (1st line)
basal bolus insulin
new diagnosis of HIV in pregnant pt. when do you start HAART?
right away
at what HIV viral load do you need to do a c-section and intrapartum zidovudine (AZT)?
> 1000
if viral load is optimal, <1000, can still deliver vaginally, without AZT
can you do amniocentesis in a pregnant HIV pt?
yes if viral load is <1000
postpartum, do you treat the infant born to a mother with HIV? with what?
if viral load <1000, zidovudine (AZT)
if viral load >1000, multi drug ART
What do you do with thyroid replacement in hypothyroid pts during pregnancy?
- at sign of positive pregnancy test, increase dose by 30%
- monitor every 4 weeks, adjust to trimester specific norms
what vaccine do all pregnant pts need, in each pregnancy, regardless of vaccination history?
TDAP
if given in third trimester, it provides passive immunity to infant
prolactinoma management
if causing hypogonadism/amenorrhea or neuro sx (headache, visual changes) due to mass effect, tx with dopamine agonists (cabergoline, bromocriptine) and follow with serial MRIs.
surgery (transsphenoidal resection) is only reserved for refractory cases
