Signs and symptoms of intrauterine pregnancy?
- Amenorrhea
- Nausea/Vomiting
- Breast tenderness/tingling
- Urinary frequency/urgency
- “Quickening”
- Weight gain
- Softening of cervix around 7 wks
- Uterine fundus palpable above pubic symphysis by 12-15 weeks
- Fetal heart tones on doppler by 8-10 weeks gestation
Imaging and referral for intrauterine pregnancy?
- Transvaginal US
- Obstetrics
- MEDEVAC
Pt education for pregnancy?
- Prenatal vitamins
- Avoid supplements
- Decrease caffeine intake
- Avoid eating raw/rare meat and fish high in mercury
- Eat fresh fruits and vegetables
- Only take medication prescribed by OB
- Encourage to abstain from alcohol, tobacco, and drugs
Signs and symptoms of threatened abortion (increased risk of miscarriage) pregnancy loss?
- Bleeding/cramping occurs
- Cervix not dilated
Signs and symptoms of complete abortion (complete miscarriage) pregnancy loss
- Products of contraception are completely expelled
- Pain ceases but spotting may persist
- Cervical os is closed, some blood on vaginal vault
Signs and symptoms of incomplete abortion?
- Cervix dilated
- Some portions of products of conception remains in uterus
- Only mild cramps reported
- Bleeding is persistent and often excessive
Signs and symptoms of missed abortion?
- Pregnancy ceased to develop but conceptus has not been expelled
- Symptoms of pregnancy disappear
- May be brownish vaginal discharge but no active bleeding
- Pain does not develop
- Uterus becomes smaller and irregularly softened
- Adnexa are normal
Treatment of pregnancy loss?
- Stabilize and resuscitate Pt
- MEDEVAC
- Gently remove visible products of conception
- Analgesics
- Follow up determined by obstetrics
A female with what is assumed to have ectopic pregnancy until proven otherwise with what symptoms?
- Vaginal bleeding
- Positive hCG
- Abdominal pain
What are risk factors of ectopic pregnancy?
- Infertility
- PID
- Ruptured appendix
- Prior tubal surgery
What is the most common cause of maternal death during the first trimester?
Undiagnosed or undetected ectopic pregnancy
What are signs and symptoms of ectopic pregnancy?
- Severe lower quadrant pain
- sudden onset, stabbing, intermittent, does not radiate
- Backache may be present during attacks
- Adnexal tenderness on exam
- At least 2/3’s have Hx:
- abnormal menstruation
- infertile
Treatment of ectopic pregnancy?
- MEDEVAC to OB
- Surgical Laparoscopy (unstable/rupture)
- Methotrexate IM IF stable with early ectopic
- Complications (shock, anemia)
General considerations for mastitis?
- Staph aureus most common
- Infecting non-lactating breast is rare
Signs and symptoms of mastitis?
- Frequently beings 3 months after delivery
- Starts with engorged breasts and sore or fissured nipple
- Cellulitis typically unilateral
- Fever and chills common
Lab findings mastitis?
- CBC - leukocytosis
Imaging mastitis?
Breast US
Antibiotic treatment for mastitis?
- MSSA:
- Cephalexin or clindamycin
- MRSA:
- Bactrim or clindamycin
- Regular emptying of breast
- Pain and inflammation management
Follow up for mastitis?
- Follow up within 48 hours
- Refer physician supervisor or gyno for absent improvement within 72 hours
General considerations for primary amenorrhea?
- Failure of menarche to appear
- Menarche generally occurs between 11-15 years
What is secondary amenorrhea?
Absence of menses for 3 months in woman who have passed menarche
What is menopause?
- Terminal episode of naturally occurring menses
- Retrospective Dx
- Usually after 6 months of amenorrhea
What is the most common cause of secondary amenorrhea in premenopausal women?
Pregnancy
What is the normal age of menopause? Early? Premature?
- Early: <45
- Premature: <40
- Normal 48-55
