OBGyn Flashcards
(31 cards)
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, Premature Ovarian Failure, pitutiary dysfx
Dx:
- quant B-HCG, TSH
- Prolactin if > 200 then get CT of Sella Turcica
- Progresterone challenge
- FSH
Tx:
underlying cause, use OCP, cyclic progesterone 10 mg for 10 days
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
eti, sxs
eti:
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
Ectopic Pregnancy
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
Ectopic Pregnancy
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
Endometriosis
eti, sxs
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
- Cyclic pelvic pain peak 1-2 d before menses onset
Endiometriosis
Dx, Tx
Lap with bx - definitive dx
Tx
- OCPs
- Leuprolide - gnRH analog
- 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
Pelvic Inflammatory Disease
eti, sxs
Ascending infection of Upper genital Tract
MC N gonorrhea, Chlamydia
RF:
- multiple sex partners
- abd pain
- unprotected sex
- prev PID
- age 15-19
- iatrogenic causes IUD placement
Sxs
- lower abd tenderness
- fever
- purulent cervical discharge
- chandlier sign - cervical motion tenderness
Pelvic Inflammatory Disease
dx, tx
Dx:
- Abdominal tenderness
- 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
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
Clindamycin gel 2% 5g intravaginally or 300mg PO BID x 7 days
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
Candiasis
MC candida albicans
Sxs
- vaginal burning, erythema
- cottage cheese discharge
- pH <4.5 (normal)
- hyphae and yeast on KOH mount
Tx with Flucanozol/Diflucan 150mg PO x 1; another dose if sxs still bad
Miconazole/clotrimazole, terconazole x 7 days vaginal cream
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
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-
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
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
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
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
first visit Prenatal labs
- CBC
- Blood type
- Rh factor
- Antibodies to blood group antigens
- 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
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
Spontaneous Abortion
eti, sxs
Termination of a pregnancy < 20 wks = 15-20% of pregnancies
RF - smoking, infection, maternal systemic dz, immunologic parameters, drug use
SxS - variable, fundus of uterus may be boggy or tender
