OBGYN Flashcards
How does hormonal contraception work?
Disrupts the negative feedback loops of the anterior pituitary gland which stops FSH from being produced which therefore stops ovulation
Dysfunctional uterine bleeding in a post-menopausal woman
Almost always related to cancer of varying degrees of aggressiveness
Could also be caused by UTI
Clinical management of dysfunctional uterine bleeding
Order hCG to determine if pregnant
Order basic labs: CBC, BMP
Pelvic exam to determine if bleed is coming from the os or from lesion in the vagina
Pelvic ultrasound to examine the endometrium (thickness, presence of masses, presence of products of conception)
Ovarian Torsion: Causes, presentation, Diagnosis, treatment
Gynecological emergency
Caused by ovarian enlargement due to a cyst or tumor
Presents with severe abdominal pain, vomiting, pre-syncope
Could intermittent pain as it untorses
Diagnosed with ultrasound
Treatment is urgent surgery hopefully within 4 hours of time of onset
What does a strawberry cervix indicate
Trichomoniasis
- Usually accompanied with a frothy greenish discharge and a musty smell
- Treated with metronidazole 2g PO x1
Pelvic Inflammatory Disease: Causes, presentation, diagnosis, treatment
Caused generally by gonorrhea or chlamydia that pass the cervix and enter the endocervical canal and travel to the uterus or fallopian tubes
Usually sxs begin with vaginitis/cervicitis and then progress to lower abd pain and fever
- –Pain is much worse with movement and often causes difficulty walking
- –Usually significant cervical motion tenderness
Treatment:
Mild: Ceftriaxone 250mg IM and Doxycycline 100mg PO BID x14 days
Severe: Usual care for sepsis
Cefoxitin 2gm IV every 6 hours and Doxycycline 100mg IV every 12 hours (“Foxy Doxy”)
Most common female reproductive cancers
Dermoid Cysts: Teratomas
Cystadenomas: Benign tumors
Mullerian cysts: Almost always malignant and usually appear post-menopausal - CA 125 will be elevated
Risk factors for ectopic pregnancy
Prior ectopic Tubal pathology or surgery Tubal Ligation STD (usually PID from chlamydia, causing stenosis of the fallopian tubes) IUD Smoking Advanced maternal age
Know the different types of abortion
Spontaneous abortion:
- Loss of pregnancy before 20 weeks
- Fetal death after the age of viability (24 weeks) is labeled “still birth”
- Most common sxs is bleeding
Inevitable abortion:
- Patient has vaginal bleeding and crampy abd pain with notable cervix dilation.
- Products of conception can be seen through cervical os.
Incomplete abortion:
- Vaginal bleeding and pain present
- Cervix is dilated and products of conception are noted in the cervix.
Missed abortion:
-Spontaneous abortion in a pt with or without sxs and a closed cervical os - can cause infection and DIC
When is Rhogam given?
In all women with vaginal bleeding with Rh negative blood type
Prevents hemolytic anemia in the next baby
Pregnancy-related hypertensive disorders: Clinical presentation
Preeclampsia:
- Most common
- Causes hypertension, proteinuria and end-organ dysfunction (usually liver or kidney)
HELLP (hemolysis, transaminitis, thrombocytopenia):
- Thought to be related to preeclampsia but up to 15% of patients with HELLP do not have an elevated BP
- Can have elevated uric acid
Eclampsia:
- Medical emergency
- HTN with the development of seizures
Treatment of Preeclampsia/HELLP
- Reduction in the BP is the priority
- Usually done with labetalol, nifedipine or hydralazine
- —Remember ACE-I and ARBs are contraindicated in pregnancy
Magnesium Sulfate given IV to treat recalcitrant HTN and prevent seizure
Treatment of Eclampsia
Delivery of the fetus is the priority
Treatment with Magnesium Sulfate is the treatment of choice
—check Mg level every few hours and keep below 10
Management of postpartum hemorrhage
Usually caused by the 4 T's Tone: Atonic uterus Trauma: From birth Tissue: Retained products of conception Thrombin deficiency: Usually diagnosed at this time but was not known prior
Treatment:
Best treatment is prevention
—Administration of oxytocin postpartum
-Start massive infusion protocol
-Pack vagina or cervical os to help stop bleeding that could be in vagina or cervix
-Suture any wounds
-Obtain ultrasound to assess for RPOC
-Give uterotonics if indicated
-Urgent OBGYN consult
—-Can consider a Bakri Balloon into the uterus to tamponade bleeding
—Can also consider hysterectomy if all else fails
Resuscitation of the pregnant patient in cardiac arrest - physical resuscitation
- Intubation becomes more of a priority to provide enough O2 for mom and baby
- Faster respiratory rate is provided
- Smaller ET tube sometimes needed d/t edema
- NG/OG tube should be placed to decompress the stomach to make room for the uterus
- Manual uterine displacement to the patient’s left is needed to assure adequate perfusion and venous return
