Reproductive (Male + Female) - 7% Flashcards
(46 cards)
1
Q
Amenorrhea (Primary)
A
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
2
Q
Amenorrhea (Secondary)
A
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
3
Q
Atrophic Vaginitis
A
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
4
Q
Bacterial Vaginosis
A
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
5
Q
Fibroadenomas
Benign Breast Disease
A
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
6
Q
Fibrocystic
Benign Breast Disease
A
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
7
Q
Galactorrhea
A
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)
8
Q
Gynecomastia
A
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
9
Q
Breast Abscess
A
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
10
Q
Breast Carcinoma
Screening, dx
A
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
11
Q
Breast Carcinoma
tx
A
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
12
Q
Breast Carcinoma
RF, Tumor types
A
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 +
13
Q
Mastitis
A
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
14
Q
Breech Presentation
Complicated Pregnancy
A
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
15
Q
Candiasis Vaginitis
A
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
16
Q
Cervical Dysplasia
A
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
17
Q
Cesarean Delivery
Complicated Pregnancy
A
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
18
Q
Cord Prolapse
Complicated Pregnancy
A
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
19
Q
Dysfunctional Uterine Bleeding
Eti, sxs
A
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
20
Q
DUB
Dx, tx
A
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
21
Q
Ectopic Pregnancy
Dx, tx
A
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
22
Q
Ectopic Pregnancy
eti, sxs
A
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
23
Q
Endometriosis
A
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
24
Q
Fetal Distress
A
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
25
**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
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
26
**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
27
**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
28
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
29
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
30
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
31
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
32
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**
33
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
34
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
35
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)
36
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**
37
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
38
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
39
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
40
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-
41
**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**
42
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
43
**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
44
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
45
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
46
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**
