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150 Cards in this Set
- Front
- Back
Uterine Leiomyoma (Fibroids) -
What is it |
MC benign gyn lesion
MC in Blacks and pts. > 35 smooth muscle cell tumors responds to hormones inc. during pregnancy usu regresses after menopause transform to leiomyosarcoma is rare |
|
Uterine Leiomyoma (Fibroids) -
Hx/PE |
Usu asymp
may have - abnorm uterine bleeding pelvic pressure dysmenorrhea urinary freq. pain NT irreg enlarged uterus "lumpy bumpy" |
|
Uterine Leiomyoma (Fibroids) -
Dx |
US
|
|
Uterine Leiomyoma (Fibroids) -
Tx |
If asymp -
manage expectantly monitor growth serial exams US if severe Sxs or postmenopausal growth - myomectomy or hysterectomy med therapies - shrink tumors tumors grow when meds stopped use in perimenopausal |
|
Infertility -
What is it |
Inability after 1 year
female dysfunction (no. 1) male dysfunction female - no. 1 = endometriosis PID cervix uterine-tubal ovulation prob peritoneum multiple factors UNK |
|
Infertility -
Dx |
FSH
LH TSH prolactin hysterosalpingography semen analysis |
|
Infertility -
Tx |
Tx underlying cause
. endometriosis - lap removal of implants . clomiphene citrate . Pergonal - purified human FSH & LH . GIFT, IVF |
|
Menopause -
What is it |
Due to end-organ ovarian
resistance to gonadotropins median age 50-52 premature - < 40 idiopathic premature ovarian failure assoc. with cigarettes artificial - after removal of ovaries after irradiation of ovaries postmenopausal - lose protection from estrogen inc. risk for osteoporosis and heart dis. |
|
Menopause -
Hx/PE |
Menstrual irreg
sweating sleep disturb mood changes dec. libido dyspareunia dysuria vaginal dryness dec. breast size gen. tract atrophy |
|
Menopause -
Dx |
Inc. serum FSH - suggestive
1 yr without menses |
|
Menopause -
Tx |
HRT -
can relieve Sxs help prevent osteoporosis contraindications - unDx vag bleeding liver disease acute vas thrombosis h/o endometrial cancer h/o breast cancer progesterone/estrogen - if still have uterus estrogen alone - if had TAHBSO clonidine topical estrogens calcium vit D calcitonin bisphosphonates |
|
Contraception -
Rhythm Method What is it |
Use body temp and cervical
mucus consistency to predict time of fertility |
|
Contraception -
Rhythm Method Side Effect |
Unreliable
|
|
Contraception -
Coitus Interruptus What is it |
Withdraw before ejaculation
|
|
Contraception -
Coitus Interruptus Side Effect |
High failure rate
|
|
Contraception -
Diaphragm and Cervical Caps What is it |
Domed sheet of rubber or latex
placed over cervix must be fitted by physician must remain in vagina 6-8 hrs after intercourse |
|
Contraception -
Diaphragm and Cervical Caps Side Effects |
Possible allergy to latex
or spermicides risk of UTI, TSS |
|
Contraception -
Condoms What is it |
Latex sheath
|
|
Contraception -
Condoms Side Effects |
Possible allergy to latex
or spermicides |
|
Contraception -
IUD What is it |
Plastic and/or metal device
placed in uterus causes local sterile inflammatory reaction in uterine wall so that sperm engulfed and destroyed |
|
Contraception -
IUD Side Effects |
Inc. vag bleeding - copper IUD
uterine perforation IUD migration infection inc. risk of PID inc. risk of ectopic preg |
|
Contraception -
OCPs What is it |
Suppress ovulation by
inhibiting FSH/LH change consistency of cervical mucus make endometrium unsuitable for implantation |
|
Contraception -
OCPs Side Effects |
HTN
hepatic adenoma weight gain inc. risk of thromboembolism nausea acne breast tenderness mood changes |
|
Contraception -
Levonorgestrel (Norplant) - What is it |
Taken off market 2002
progestin subdermal implant suppresses ovulation thickens cervical mucus makes endometrium unsuitable for implantation effect lasts 5 yrs. |
|
Contraception -
Levonorgestrel (Norplant) - Side Effects |
Irreg vag bleeding
weight gain galactorrhea acne breast tenderness headache hard to remove |
|
Contraception -
Postcoital morning-after pill What is it |
Progesterone +/- estrogen
take within 72 hrs of unprotected sex suppresses ovulation discourages implantation |
|
Contraception -
Postcoital morning-after pill Side Effects |
N/V
fatigue breast tenderness headache dizziness |
|
Contraception -
Medroxyprogesterone (Depo-Provera) What is it |
IM injection given every 3 mos
suppresses ovulation thickens cervical mucus makes endometrium unsuitable for implantation |
|
Contraception -
Medroxyprogesterone (Depo-Provera) Side Effects |
Irreg vag bleeding
depression weight gain breast tenderness delayed restoration of ovulation after discontinue |
|
Contraception -
Surgical Sterilization (Tubal Ligation, Vasectomy) What is it |
Tubes ligated, cauterized or
mechanically occluded |
|
Contraception -
Surgical Sterilization (Tubal Ligation, Vasectomy) Side Effects |
Essentially irreversible
bleeding infection failure ectopic pregnancy |
|
Intraductal Papilloma -
What is it |
Common cause of
bloody nipple discharge |
|
Fibrocystic Change -
What is it |
Catchall term
spectrum of clinical findings mastalgia breast cysts fibroadenoma mastitis hyperplasia nodularity commonly seen in premenopause from exaggerated response of stroma to hormones & growth factors inc. cancer risk only if cellular atypia |
|
Fibrocystic Change -
Hx/PE |
Cyclic,
premenstrual, b/l breast pain, tenderness, swelling excessive tissue nodularity |
|
Fibrocystic Change -
Dx |
Fine-needle aspiration
cytologic exam |
|
Fibrocystic Change -
Tx |
Dec. caffeine and nicotine
vit E progestins danazol tamoxifen diuretics |
|
Fibroadenoma -
What is it |
MC breast lesion < 30
benign, slow-growing tumor epithelial & stroma components recurrence common phyllodes tumor - (cystosarcoma phylloides) grows fast large type of fibroadenoma rarely malignant |
|
Fibroadenoma -
Hx/PE |
Round
firm, NT mobile solitary mass, discrete |
|
Fibroadenoma -
Dx |
Surgical excision -
tissue for Dx |
|
Fibroadenoma -
Tx |
Surgical excision
|
|
Breast Cancer -
What is it |
MC cancer (incidence)
no. 2 in cancer death risk factors - gender age breast Ca 1st degree relatives h/o breast cancer 1st fullterm preg after 35 y/o h/o fibrocystic change with cellular atypia inc. exposure to estrogen - nullparity early menarche late menopause late menarche - dec. risk BRCA-1 & BRCA-2 mutations - early-onset familial breast and ovarian cancers |
|
Breast Cancer -
Hx/PE |
Lump -
hard irreg not mobile painless possible nipple discharge can be asymp and nonpalpable MC location - upper outer quad mets to - lymph nodes bones brain lung liver advanced disease - skin changes: dimpling redness ulceration edema axillary adenopathy |
|
Breast Cancer -
Dx |
■ Mammography -
↑ density microcalcifications irregular borders ■ US - solid mass vs. benign cyst ■ tumor markers for recurrent- CEA CA 15-3 CA 27-29 ■ estrogen receptor (ER) progesterone receptor (PR) HER2/neu status ■ metastatic disease - ↑ ESR ↑ alk phos ↑ calcium CXR - pulmonary metas CT - chest, abdomen, pelvis, brain bone scan |
|
Breast Cancer -
Tx |
■ All hormone receptor pos. -
tamoxifen ■ estrogen rec. neg - chemo ■ trastuzumab - HER2/neu-expressive cancers ■ partial mastectomy and axillary dissection followed by radiation ■ modified radical mastectomy (total mastectomy plus axillary dissection) ■ contraindications to breast-conserving therapy - large tumor multifocal tumors subareolar location fixation to chest wall nipple involved overlying skin involved ■ Invasive cancer requires axillary dissection ■ stage IV - radiation and hormones mastectomy may required ■ ER- and PR+ - favorable |
|
Ectopic Pregnancy -
What is it |
Implants outside uter. cavity
MC site - ampulla risk - h/o PID (most common) prior ectopic pregnancy tubal/pelvic surgery DES exposure in utero IUD |
|
Ectopic Pregnancy -
Hx/PE |
Classic triad -
amenorrhea light vag bleeding lwr abdom or pelvic pain tender pelvic or adnexal mass ruptured ectopic - surgical emergency sudden, sharp abdom pain orthostatic hypotension tachycardia shoulder pain shock generalized abdominal and adnexal tenderness with rebound tenderness |
|
Ectopic Pregnancy -
Dx |
■ B-hCG -
levels lwr than normal preg level takes > 2D to double ■ serum progesterone < normal ■ transabdom or transvag US Dx - empty uterine cavity and B-hCG of 6,500 ■ culdocentesis - > 5cc of nonclotting blood identifies hemoperitoneum not sensitive nor specific |
|
Ectopic Pregnancy -
Tx |
■ Serial B-hCG and US
■ expectant management if - asymp dec. B-hCG small mass no US evidence of bleeding ■ methotrexate - stable, unruptured ■ all others, surgery - salpingostomy salpingectomy salpingo-oophorectomy ■ RhoGAM if appropriate |
|
Ectopic Pregnancy -
Complications |
Inevitable loss of fetus
hemorrhagic shock future ectopic pregnancy infertility maternal death Rh sensitization |
|
Vaginitis -
What Causes it |
Vagina normally -
mixed bacterial flora acidic envi (pH 3.5-4.5) maintained by lactic acid- producing lactobacilli change in environment => overgrowth of other bacteria can be bact., fungi, protozoa |
|
Bacterial Vaginosis -
Hx/PE |
Gray, fishy-smelling discharge
often pruritus and irritation |
|
Bacterial Vaginosis -
Dx |
pH > 4.5
saline smear - clue cells KOH prep - positive whiff test |
|
Bacterial Vaginosis -
Tx |
PO metronidazole
|
|
Trichomonas -
Hx/PE |
Profuse, malodorous,
yellow-green discharge dysuria dyspareunia erythema strawberry petechiae in upper vagina/cervix |
|
Trichomonas -
Dx |
pH > 4.5
saline smear - motile trichomonads KOH prep - nothing |
|
Trichomonas -
Tx |
PO metronidazole
Tx partner test for other STDs |
|
Candidal Vaginitis -
Hx/PE |
Thick, white discharge -
cottage-cheese texture pruritus with or without burning erythematous, excoriated vulva/vagina |
|
Candidal Vaginitis -
Dx |
pH - normal
saline smear - nothing KOH prep - pseudohyphae |
|
Candidal Vaginitis -
Tx |
Topical antifungals
(miconazole) po fluconazole |
|
Vaginitis -
Dx |
■ Det. vag pH with
nitrazine paper ■ micro exam of discharge - saline (wet prep) KOH ■ r/o STDs - gram stain of discharge Chlamydia Ag test ■ r/o UTI - clean-catch UC and UA |
|
Vaginitis -
Complications |
Inc. risk of PID -
with bacterial vaginosis preterm labor ROM |
|
Cervicitis -
What is it |
N. gonorrhea
Chlamydia co-infection common infect cervical glandular epithelium cervix - red & bleeds easily yellowish-green mucopurulent discharge discharge can be seen exuding from endocervical canal |
|
Cervicitis -
Dx |
Cervical motion tenderness
(CMT) no other signs of PID |
|
Pelvic Inflammatory Disease -
What is it Risk Factors |
Microorg. ascend into:
endometrium - endometritis uterine wall - myometritis fallopian tubes - salpingitis ovaries - oophoritis parietal perit. - peritonitis most causes - gonorrhea & chlamydia risk factors - multiple sexual partners unprotected or freq. sex young age at 1st intercourse mucopurulent cervicitis prior PID IUD incidence decreases with - OCPs barrier contraception |
|
Pelvic Inflammatory Disease -
Hx/PE |
Lower abdominal pain
fever chills menstrual disturbances purulent cervical discharge cervical motion tenderness adnexal tenderness RUQ pain may indicate perihepatitis (Fitz-Hugh–Curtis syndrome) |
|
Pelvic Inflammatory Disease -
Dx |
Lower abdom, adnexal and
cervical motion tenderness fever inc. ESR inc. CRP WBC > 10,000 cervical swab pos. for chlamydia or gonorrhea US - pelvic abscess Def. Dx - laparoscopy consider - B-hCG RPR/VDRL HIV LFTs |
|
Pelvic Inflammatory Disease -
Tx |
Don't wait on culture results
treat partner outpatient (3 options) - cefoxitin + probenecid × 1dose ceftriaxone IM × 1 dose and doxycycline × 14 days ofloxacin × 14 days and metronidazole × 14 days admit - ■ if surgical emergency can't be ruled out ■ tubo-ovarian abscess - admit for at least 24 hours ■ pregnant ■ don't improve after 48-72 hrs. of outpt. Tx ■ severe illness, n/v, hi fvr ■ immunodeficient ■ noncompliant ■ cefoxitin or cefotetan and doxycycline × 14 days. |
|
Pelvic Inflammatory Disease -
Complications |
Ectopic pregnancy
chronic pelvic pain infertility repeated infections Fitz-Hugh-Curtis syndrome pelvic/tubo-ovarian abscess - severe pain hi fever n/v signs of sepsis peritoneal signs adnexal mass admit - IV ABx hydration drainage or TAHBSO |
|
Toxic Shock Syndrome -
What is it |
Acute illness
caused by preformed S. aureus toxin (TSST-1) 90% women of childbearing age in 5 days of onset of menses tampon use nonmenstrual almost as common- organisms from: nasopharynx, bones, vagina, rectum, wounds |
|
Toxic Shock Syndrome -
Hx/PE |
■ Abrupt onset -
fever, vomiting, diarrhea ■ can => hypotensive shock ■ diffuse macular erythematous rash (sunburn-like) ■ nonpurulent conjunctivitis ■ desquamation of palms and soles within 1–2 weeks |
|
Toxic Shock Syndrome -
Dx |
BC - neg
|
|
Toxic Shock Syndrome -
Tx |
Admit
rehydration remove source of toxin antistaph ABx - nafcillin, oxacillin manage renal or cardiac failure |
|
Menorrhagia -
What is it Cause |
↑ amount of flow
> 80 mL per cycle or prolonged bleeding flow lasts > 8 days causes - leiomyoma endometrial hyperplasia endometrial polyps endometrial cancer cervical cancer pregnancy complications |
|
Oligomenorrhea -
What is it MCC |
↑ length of time
between menses 35–90 days between cycles MCC - pregnancy |
|
Polymenorrhea -
What is it Cause |
Frequent menstruation
< 21-day cycle cause - anovulation |
|
Metrorrhagia -
What is it Causes |
Bleeding between periods
causes - endometrial polyps endometrial cancer cervical cancer pregnancy complications exogenous estrogen |
|
Menometrorrhagia -
What is it Causes |
Excessive and irregular
bleeding causes - endometrial polyps endometrial cancer cervical cancer pregnancy complications exogenous estrogen |
|
Postmenopausal Bleeding -
What is it Causes |
Uterine bleeding > 1 year
after menopause causes - vaginal atrophy exogenous hormones cancer |
|
Abnormal Uterine Bleeding -
Dx |
Distinguish ovulatory
from anovulatory d/o thorough menstrual Hx - bleeding freq., vol, duration bimanual exam pap smear ovulatory - transvag US sonohysterogram D&C with hysteroscopy anovulatory - B-hCG CBC coag profile FSH LH TSH prolactin endometrial Bx any postmenopausal woman with uterine bleeding - endometrial BX to r/o endometrial cancer |
|
Abnormal Uterine Bleeding -
Tx |
Treat underlying d/o
ovulatory - NSAIDs +/- OCPs anovulatory - OCPs cyclic progestin (medroxyprogesterone) high-dose IV estrogen D&C endometrial ablation hysterectomy - last resort |
|
Amenorrhea -
What is Primary Amenorrhea |
No menses by 16 y/o
no secondary sexual characteristics by 14 y/o |
|
Primary Amenorrhea -
Causes |
Mullerian anomalies
vaginal agenesis imperforate hymen testicular feminization ovarian failure Turner's Kallmann's anorexia excess exercise weight loss stress tumor infection |
|
Amenorrhea -
What is Secondary Amenorrhea |
No menses for 3 cycles
if h/o irreg cycles - no menses for 6 mos. |
|
Secondary Amenorrhea -
Causes |
Asherman's syndrome
cervical stenosis pregnancy polycystic ovarian syndrome anorexia excess exercise weight loss stress |
|
Amenorrhea -
Dx Explain |
PE
B-hCG primary - uterus? breast? secondary - prolactin TSH CT or MRI progestin challenge estrogen-progest. challenge FSH/LH ■ inc. prolactin? inhib rel. of FSH and LH causes - pituitary tumor, hypothyroidism, dopamine antag if neg. - progestin challenge ■ progestin challenge - bleeding - prob is anovulation causes - hypothalamic dysfunction polycystic ovarian syn ovarian tumor adrenal tumor no bleeding - estrogen-progest. challenge ■ est-progesterone challenge - bleeding - functional uterus, inadequate estrogen stim no bleeding - Asherman's ■ FSH/LH hypo - Sheehan's hyper - 17-hydroxylase def., gonadal agenesis |
|
Amenorrhea -
Tx |
Tx underlying cause
if low estrogen - HRT Ca2+ supplements |
|
Dysmenorrhea -
What is it |
Pain during menses that -
requires meds prevents normal activity primary - no structural gyn d/o start < 20 y/o tends to dec. with age due to uterine contractions probably mediated by PGE Tx - NSAIDs and OCPs secondary - pelvic pathology MC - endometriosis adenomyosis myomas pelvic congestion PID ovarian cysts cervical stenosis pelvic adhesions |
|
Endometriosis-
What is it |
Functional endometrial tissue
(glands and stroma) implanted outside uterus women of reproductive age common sites - ovaries cul-de-sac uterosacral ligament due to - implant via retrograde menses vascular and lymph dissem metaplasia risk factors - family Hx nulliparity infertility |
|
Endometriosis-
Hx/PE |
Hx -
premenstrual pain dyschezia chronic pelvic pain dyspareunia abnorm bleeding infertility PE - tender, nodularity along uterosacral ligament fixed, retroverted uterus tender, fixed adnexal masses |
|
Endometriosis-
Dx |
Definitive Dx -
direct visualization via laparoscopy or laparotomy implants - rust-colored dark brown "powder burns" raised blue raspberry lesions" severe - adhesions surround implants ovary may have - endometrioma (chocolate cysts) pain severity - doesn't always correlate with extent of disease |
|
Endometriosis-
Tx |
Options -
OCPs or progestin danazol or GnRH agonists lap ablation TAH-BSO lysis of adhesions |
|
Vulvar Cancer -
What is it Risk Factors |
4th MC gyn malignancy
usu occurs after menopause - (peaks in 60s) squamous cell ca (90%) risk factors - diabetes obesity HTN vulvar dystropy HPV-16 HPV-18 |
|
Vulvar Cancer -
Hx/PE |
Asymp in early stages
vulvar pruritis (MC) erythematous or ulcerated vulvar lesion palpable vulvar mass |
|
Vulvar Cancer -
Dx |
Definitive Dx -
Biopsy |
|
Vulvar Cancer -
Tx |
Wide local excision
regional lymph node dissection radiation - dec. tumor metas recurrence |
|
Cervical Cancer -
What is it Risk Factors |
3rd MC gyn malignancy
squamous cell ca (most) adenoca (most of remaining) results from cervical intraepithlial neoplasia (CIN) if untreated => invasive ca spreads - directly blood lymphatics to - pelvic lymph nodes para-aortic lymph nodes Risk factors - HPV 16, 18 and 31 early onset of sex multiple sex partners immune compromised tobacco STDs |
|
Cervical Cancer -
Hx/PE |
Hx -
usu asymp if asymp, usu Dx by - Pap smear, colposcopy and Bx if symp - postcoital bleeding is usu 1st Sx menorrhagia metrorrhagia pelvic pain vag discharge PE - cervical discharge cervical ulceration pelvic mass fistulas |
|
Cervical Cancer -
Dx |
■ Bx all lesions
■ colposcopy and endocervical curettage if - dysplasia (on Pap smear), squamous intraepithelial neoplasia (on Pap smear) or 2 consec findings of atyp squamous cells of undet signif (ASCUS) ■ pelvic exam under anesthesia ■ CXR ■ IVP ■ staging - clinical based on invasion into adjacent structures and metastases CT/MRI can't be used to stage |
|
Cervical Cancer -
Tx |
■ Carcinoma in situ -
finished childbearing - TAH wish to keep uterus - cervical conization ablation of lesion: cryotherapy laser ■ invasive - . all stages - radiation & chemo less radical surgeries . early stages - radical hysterectomy lymph node dissection ■ advanced disease or bulky tumors - radiation +/- chemo |
|
Cervical Cancer-
Staging of CIN |
CIN I -
mild dysplasia low-grade squamous intraepithelial lesion (LSIL) CIN II - moderate dysplasia high-grade squamous intraepithelial lesion (HSIL) CIN III - severe dysplasia or carcinoma in situ high-grade squamous intraepithelial lesion (HSIL) |
|
Endometrial Cancer -
What is it Risk Factors |
MC gyn malignancy
strong association with high levels of unopposed estrogen ages 50-70 usu adenoca mets to: direct - cervix intraperitoneal seeding blood - lungs, vagina lymphatics - aortic node pelvic node risk factors - unopposed estrogen diabetes HTN nulliparity family Hx |
|
Endometrial Cancer -
Examples of Unopposed Estrogen |
Estrogen replacement therapy
chronic anovulation early menarche late menopause ovarian granulosa cell tumors polycystic ovarian syndrome obesity tamoxifen |
|
Endometrial Cancer -
Hx/PE |
postmenopausal bleeding
menorrhagia metrorrhagia lwr abdom pain cramping uterus - fixed, immobile if spread to adnexa & peritoneum signs of mets - hepatosplenomegaly lymphadenopathy abdom masses |
|
Endometrial Cancer -
Dx |
Pap smear - not very sensitive
ECC EMB D&C - if sample inadeq US to r/o - fibroids polyps endometrial hyperplasia grade - key prognostic factor staging - surgical peritoneal fluid cytology abdom exploration TAH-BSO pelvic & para-aortic nodes |
|
Endometrial Cancer -
Tx |
High dose progestins - stage I
chemo - doxorubicin cisplatin advanced & recurrent dis. adjuvant radiation - cervical & extrauter. spread |
|
Ovarian Cancer -
What is it Risk Factors |
2nd MC gyn malignancy
leading cause of U.S. gyn ca deaths MC - postmenopausal OCPs - protective effect risk factors - fam h/o breast or ovarian ca chronic uninterrupted ovulate- nulliparity delayed childbearing infertility late menopause categorize by site of origin - ■ epithelial cell - MC serous cystadenoca ■ germ cell - dysgerminoma ■ sex cord-stromal tumors |
|
Ovarian Cancer -
Hx/PE |
Hx -
Usu asymp until advanced - abdom pain bloating pelvic pressure urinary freq. early satiety constipation vag bleeding systemic Sxs PE - solid, fixed nodular pelvic mass ascites pleural effusion |
|
Ovarian Cancer -
Dx |
Pelvic US
CT or MRI surgical staging - TAH-BSO omentectomy tumor debulking monitor - CA-125 aFP LDH hCG |
|
Ovarian Cancer -
Tx |
Radiation - dysgerminomas
postsurgical chemo - carboplatin paclitaxel epithelial cell tumors |
|
Ovarian Cancer -
Prevention |
■ 2 first degree relatives -
annual screening CA-125 transvag US ■ after childbearng - prophylactic oophorectomy ■ OCPs may help dec. risk |
|
Polycystic Ovarian Syndrome -
What is it |
Oligomenorrhea
cause unknown Sxs of - androgen overproduction inc. circulating androgens excess LH b/l polycystic ovaries chronic anovulation infertility obese hirsute ages 15-30 association - insulin resistance DM inc. risk of endometrial ca |
|
Polycystic Ovarian Syndrome -
Hx/PE |
Hx -
hirsutism obesity amenorrhea infertility May have - virilization acne DM HTN acanthosis nigricans PE - enlarged cystic ovaries |
|
Polycystic Ovarian Syndrome -
Dx |
Serum LH/FSH ratio > 3
inc. serum androstenedione inc. DHEA US |
|
Polycystic Ovarian Syndrome -
Tx |
weight reduction
clomiphene citrate metformin OCPs |
|
Spontaneous Abortion (SAB) -
What is it Risk Factors |
Nonelective termination
at < 20 wks. GA common cause of 1st tri blding most 1st tri - fetal factors most 2nd tri - mat. factors risk factors - advanced mat. age advanced pat. age increased gravidity prior SAB minority status |
|
Spontaneous Abortion (SAB) -
Hx/PE |
Hx -
ask h/o: abortions infections familial genetic abnorm PE - vaginal bleeding passage of tissue open or closed cervical os |
|
Spontaneous Abortion (SAB) -
Dx |
B-hCG
establish GA transvag US - assess viability CBC blood type |
|
Spontaneous Abortion (SAB) -
Tx |
Ensure hemodynamically stable
give Rhogam (if appropriate) uterine evacuation |
|
Threatened Abortion -
Sxs |
Minimal bleeding
possible abdom pain no POC expelled (POC= products of contraception) |
|
Threatened Abortion -
PE/US |
Closed internal cervical os
normal US |
|
Threatened Abortion -
Tx |
Avoid heavy activity
pelvic and bed rest |
|
Inevitable Abortion -
Sxs |
Profuse bleeding
severe cramping |
|
Inevitable Abortion -
PE/US |
Open internal cervical os
|
|
Inevitable Abortion -
Tx |
Emergent D&C
|
|
Incomplete Abortion -
Sxs |
Some POC expelled
|
|
Incomplete Abortion -
PE/US |
Open internal cervical os
retained fetal tissue on US |
|
Incomplete Abortion -
Tx |
Emergent D&C
|
|
Complete Abortion -
Sxs |
Minimal bleeding
minimal cramping all POC expelled |
|
Complete Abortion -
PE/US |
Closed internal cervical os
empty uterus on US |
|
Missed Abortion -
Sxs |
No uterine bleeding
no POC expelled |
|
Missed Abortion -
PE/US |
Closed internal cervical os
no fetal cardiac activity retained fetal tissue on US |
|
Missed Abortion -
Tx |
Evacuate uterus
D&C |
|
Septic abortion -
Sxs |
Fever
chills peritoneal signs often recent h/o therapeutic abortion |
|
Septic abortion -
PE/US |
Hypotension
hypothermia oliguria resp distress if in shock inc. WBC |
|
Septic abortion -
Tx |
Evacuate uterus
D&C IV ABx |
|
Intrauterine fetal demise -
Sxs |
Mom may report absence of
fetal movements |
|
Intrauterine fetal demise -
PE/US |
Uterus small for GA
no fetal heart tones or movement on US |
|
Intrauterine fetal demise -
Tx |
Induce labor
evacuate uterus to avoid DIC |
|
Urinary Incontinence -
Risk Factors |
Older age
pelvic relaxation obstructed labor traumatic delivery menopause chronic cough straining ascites large pelvic tumors |
|
Urinary Incontinence -
Causes |
DIAPPERS
Delirium Infection (UTI) Atrophic urethritis/vaginitis Pharmaceutical Psych causes (esp. depression) Excess urine output (hyperglycemia, hypercalcemia, CHF) Restricted mobility Stool impaction |
|
Urinary Incontinence -
Dx |
UA and UC -
to exclude UTI Serum Cr - to exclude renal dysfunction Cystogram - fistulas bladder neck abnorm |
|
Stress Incontinence -
What is it |
Sphincter insufficiency
laxity of pelvic floor muscles common in multiparous women or after pelvic surgery |
|
Stress Incontinence -
Hx |
Activities that
↑ intra-abdominal pressure - coughing, sneezing, lifting not common in supine position |
|
Stress Incontinence -
Tx |
Kegel exercises
surgery - place bladder neck in correct anatomical position |
|
Urge Incontinence -
What is it |
Detrusor hyperreflexia
or sphincter dysfunction due to bladder - inflammatory conditions neurogenic disorders |
|
Urge Incontinence -
Hx |
Preceded by strong,
unexpected urge to void unrelated to position or activity |
|
Urge Incontinence -
Tx |
Anticholinergics
TCAs |
|
Overflow Incontinence -
What is it |
Dribbling of urine from
overly full bladder Volume is usually small |
|
Overflow Incontinence -
Hx |
Chronic urinary retention
|
|
Overflow Incontinence -
Tx |
Catheter - if acute
Tx underlying disease timed voiding |