|
|---|
|
|
|
|
|
|
e****0
发帖数: 678 | 1 Screening
Pap smear for vervical cancer is 21 yo
DM
24-28 weeks
One hour 50 grams oral glucose tolerance test. BG > 140
Three hours glucose tolerance test (if two or more are positive)
1. Fasting BG > 95
2. One hour BG > 180
3. Two hours BG> 155
4. Three hours BG > 140
• Dysfunctional uterine bleeding (DUB)
Heavy vaginal bleeding occurs in the absence of structural or
organic disease
Endometrial biopsy is required to rule out endometrial
hyperplasia or carcinoma
If in pt with>35, obese, HTN, DM.
If biopsy is negative,
1. Mild DUB—iron
2. Moderate DUB and no active bleeding-- treat with cyclic progestins
3. Moderate DUB with active bleeding, or severe bleeding—high dose
estrogen
If progestins failed, endometrial ablation or hysterectomy
• IUFD – intrauterine fetal demise
Fetal death >20 weeks
The diagnosis requires confirmation with U/S before any further
action can be taken.
After the diagnosis is confirmed, a coagulation profile should
be drawn for DIC.
Due to tissure thromboplastin from the placenta.
Fibrinogen in the low normal range is the early sign because its
level is higher in pregnancy.
HCG may continue to rise
Management-fetus delivery
1. If fibrinogen is normal, spontaneous delivery
Autopsy should be performed
• Deceleration
Variable decelerations Early deceleration Late deceleration
Non-reassuring FHR Assuring FHR
Erratic onset of abrupt slowing of FHR in a/c uterine contraction A drop
in HR of 15 /minx15 sec. HR depression at or after the peak of the
uterine contraction
Most commonly encountered FHR deceleration in pregnancy
Due to umbilical cord compression Fetal head compression Uteroplcenta
insufficiency
Persistant deceleration <70 and long durationfetal hypoxia
Management
Oxygen and change in maternal position
d/c oxytocin
If persistence,
Fetal scalp PH hypoxia
trendelenburg position,
amnioinfusion
C-section at last
• The first step in the presence of any nonreassuring HR is to give
O2 and change position
• Fetal sleep presents with decreased long term variability
• Ectopic pregnancy
Dx--Transvaginal U/S is more accurate than transabd U/S
Transvaginal U/S when HCG 1500-6500
Transabd U/S when HCG >6500
If transvaginal U/S failed, then serial HCG measurement (
doubling every 48 hours in normal pregnancy).
Laparoscopy is a last resort
• Pubertal female
Immature HPG axisirregular cycle anovulatory&#
61664;the cue to slough endometrial is lacking and menstrual –like bleeding
occurs due to estrogen breakthrough bleeding.
Add progesterone will regulate the above
• Bacterial vaginosis
Three of four Amsel criteria
1. Thin, gray-white vaginal discharge
2. Vaginal PH >4.5
3. Positive “whiff” test upon addition of KOH (amine-like fishy odor)
4. Clue cell on wet mount.
• NST
Most common cause is the sleeping baby.
Reactive (Normal)
If in 20 minutes 2 accelerations of the fetal HR of at least 15 beats per
minutes above the baseline lasting at least 15 seconds each are noted.
• Contraction stress test (Oxytocin challenge test)
Infusion of oxytocin3 contractions/minute
Record fetal heart activity
Positive—late deceleration is notedat each contraction,
delivery.
• BPP
Indicated when decreased fetal movement or following a
nonreactive NST
Five parameters
1. NST
2. Fetal tone (flexion or extension of an extremity)
3. Fetal movement (3/10)( at least 2 in 30 minutes)
4. Fetal breathing movement ( 30/10)(at least 20 secs in 30 minutes)
5. Amniotic fluid volume( 5-20)( single pocket greater than 2 cm in
vertical axis)
Score 8-10 is normal and should be repeated 1-2 /week until term
for high risk pregnancy
Score 8 with oligohydramnos—delivery
Score 6 without oligohydramnios, >37 weeks—delivery
If <37 wks,
repeat BPP in 24 hrs and delivery
Score 6 with oligohydramnios, > 32 wks—delivery
< 32 wks—daily
monitoring
Score 4 or less, delivery if >26 wks
When BPP is 6 w/or w/o oligohydramnios or 4 without
oligohydramnios
corticosteroids and repeat BPP in 24 hours
If oligohydramnios—delivery
BPP< 6 without oligohydramnios, contraction stress test ordered
If latter—non-reassuring results—delivery
If latter—suspicious results—repeat next day
BPP =4 without oligohydramnios
If lung mature—delivery
If lung not mature—steroids and BPP within 24 hours.
BPP<4, delivery
• amniotic fluid index
normal 8-18
oligohydramnios 5-6
>20-24 polyhydramnios
• Test for pregnancy
1. Rubella and varicella
2. HBV, HIV, Chlamydia, syphilis,
3. Influenza.
4. CF and downs.
Screening for Chlamydia in all woman < 24 yo and those with
increased risk
Nucleic acid amplification test is screening.
HIV rescreening at 36 weeks
• Asymptomatic bacteriuria
Amoxicillin, ampicillin, nitrofurantoin, cephalexin x 7 days
(3 days maybe ok for non pregnant pt)
• Ciprofloxacin is a first line agent in the treatment of
pyelonephritis., not for pregnancy
• Septra
Interfere with folic acid metabolism in 1st trimester
Increased kernicterus in 3rd trimester.
• HPV (genital warts/ condyloma acuminate)
Treatment—
Small--trichoroacetic acid or podophyllin
Large—excision or fuguration
High recurrence
Condyloma acuminata Condyloma lata Vulvar cancer Lichen sclerosus
(LS&A) Vulvar lichen planus
Pink, teardrop Flat, velvety Singular, fleshy lesion Porcelain-
white polygonal macules and patches with an atrophic “cigarette paper”
quality
White, thin, wrinkled skin over labia
Chronic inflammatory Hyperkeratotic, erosive, papulisquamous
pruiritis
Postmenopause
Pruritis
Dyspareunia
Dysuria
Painful defecation middleaged
steroids steroids
• Lichen sclerosus (Lichen sclerosus et atrophicus LS&A)
Porcelain-white polygonal macules and patches with an atrophic
“cigarette paper” quality
White, thin, wrinkled skin over labia
Chronic inflammatory
Postmenopause Pruritis, Dyspareunia, Dysuria, Painful defecation
Sclerosus and scarring can lead to obliteration of the labia
minora and clitoris and a decrease in the diameter of the introitus.
Vulvar squamous cell carcinoma (SCC) occurs more commonly in
women with LS&A
Dx-- Vulvar Punch Biopsy
Tx—high potency topical corticosteroids
A class I topical corticosteroids BIDx 4 weeks
Less potent topical steroids or topical calcineurin inhibitor
• IUGR
Fetal weight < 10 %
Suspect if fetal height is 3 cm less than actual gestational
age in weeks.
Asymmetric IUGR has a better prognosis than symmetric IUGR
Abd circumference is the most effecetive parameter for estimate
the fetal weight. Because it is affected in both.
Symmetric cause (fetal factors < 28 wks) Asymmetric causes ( Maternal
factors)
(normal head and reduced abd circumference)
Chromosomal abnl
Congenital anomality
Congenital infection (TORCH) HTN
Preeclampsia
Uterine anomalies
Antiphospholipid syndrome
Collagen vascular disease
smoking
smoking is the most preventable cause of IUGR
• SCC of vaginal
Most common vaginal cancer
Increased with aging
The most common symptoms are vaginal bleeding and malodorous
vaginal discharge.
Treatment
Stage I and II ( no extension to pelvis )
< 2cm surgery
> 2 cm radiation
Radiation is highly effective for squamous cell carcinoma.
Trichomonas vaginitis Gardnerella vaginitis
Malodous, gray-green, thin, frothy discharge Malodous, Profuse ivory-gray
, amine or fishy odor, clue cell
Pruiritis,dysuria, dyspareunia No inflammation
Edematous and hyperemic
PH↑5-6 PH 5-6.5
• Metronidazole and fluconazole is ok to be used in pregnancy
Oral fluconazole is for candida vulvovaginitis
Metronidazole is for trichomonos and bacterial vaginosis
Disulfiram-like reaction if alcohol is taken
Pt should avoid alcohol intake
• Azithromycin is safe, but erythromycin is not.
• C section in all woman in labor with active HSV lesions
• RH (D)
First prenatal visit
28 weeks
Rh (D) negative should be treated with anti-D IG at 28 weeks and
delivery, and with 72 hours of any procedure or incident where there is a
chance of feto-maternal blood mixing
If mother mot sensitized, Anti-D is given
If mother is sensitized (1:8 to 1:32), anti-D not given, close
fetal monitoring
Rinne Result Weber normal Weber lateralizes to right Weber
lateralizes to left
Positive (normal) bilaterally Normal Left sensorineaural loss Right
sensorineural loss
Rinne negative on left Left conductive loss Left mixed hearing loss
Left conductive loss
Rinne negative on right Right conductive loss Right conductive loss
Right mixed hearing loss
• Preterm laborsitis is Chlamydia trachomatis
Occur before 20 weeks and after 37 weeks
Systemic corticosteroids given between 24-34 weeks
Tocolysis should be attempted to maintain the pregnancy for at
least 48 hours.
Long term goal to reach 34-36 weeks
• Menorrhagia
Prolonged or heavy menstruation
Last longer than 7 days or > 80 ml
• Most menstrual cycles in the first one to two years following
menarche are anovulatory. Typically irregular and menorrhagia.
• Most common cause of mucopurulent cervicitis -chlamydia
ABO Hemolytic anemia Rh(D) hemolytic dx
Ig M and Ig G IgG
mild severe
Occur in 1st pregnancy due to A and B antigen in food and bateria Occur
in 2nd pregnancy
• HCG
Begins at 8 days, double every 48 hours until 6-8 wks
Alpha unit—HCG, LH, FSH, TSH
Beta unit
Preserve the corpus liteumprogesterone until the
placenta is able to produce on its own.
Promote male sexual differentiation and maternal thyroid gland
•
• Premature ovarian failure
< 40 yo,marked elevated FSH,x 3 months
a/c autoimmune disorder such as hashimoto thyroiditis, addison
disease, type I DM, pernicious anemia
increased FSH and LH, decreased estrogen level.
Infertility of POF is treated with IVF
FSH/LH>1. Due to slower clearance of FSH from circulation
• Primary dysmenorrheal
Lower abd pain that radiates to thigh and begin hours before
period
Endometrium break downprostaglandins
NSAIDS.
• Primary amenorrhea #2388
FSH if no breast development
Pituitary MRI if ↓ FSH
Karyotyping if ↑FSH | e****0
发帖数: 678 | 2 Endometrial hyperplasia types. Risk of cancer treatment
simple 1% Cyclic progestin
complex 3% Cyclic progestin
Simple atypical 8% THA or progestins
Complex atypical 29% THA or progestins
• Prolatinoma and hypothyroidism galactorrhea
• Anesthesia can reduce uterine activity if in the latent phase
• Contraceptive for lactating mother
Progestin-only oral contraceptive
• Pregnancy luteoma
African-american
Bilateral solid ovarian mass due to HCG
Hirsutism and virilization
Benign, self-limiting
• Placental abruption
The role of U/S in the evaluation of antepartum hemorrhage is
primarily to rule out placenta previa and not to diagnose abruption
placentae.
Risk
HTN, preeclampsia
Placenta abruption in a previous pregnancy
Trauma
Rapid decompression of a hydramnios
Short umbilical cord
Tobacco use and cocaine use
Folate deficiency
Pt with placental abruption in labor must be managed
aggressively to insure a rapid vaginal delivery.
C section is used only when there are obstetric indication, or
when there is a rapid deterioration of the state of either the mother or
fetus and labor is in early stage.
• Placenta previa
Pelvic exam is contraindicated in any pt with antepartum
hemorrhage until placenta previa is r/o by U/S.
If both stable scheduled C section, at 36 weeks,
amniocentesis id done to
Evaluate.
If massive bleeding, emergency C section is done.
• Atrophic vaginitis
Mild—lubricant
Moderate-severe—low dose vaginal estrogen
• PCOS
Anovulation (amenorrhea or oligomenorrhea)
androgen excess,
ovarian cysts (string of pearls)
OGTT is recommended—2 hour OGTT
> 140 insulin resistance
> 200 DM
At risk developing dyslipidemia, insulin resistance, type II DM
Should be treated with metformin
Prevent type II DM
Losing weight
Induce ovulation
Suppressing androgen production
• Young woman has high density of breast tissue
Mammography is not helpful.
Androgen insensitivity syndrome
(testicular feminization) Mullerian agenesis
46 XY 46 XX
Absent androgen receptor
Female phenotype Female phenotype
TestesMIF…..
Breast due to peripheral conversion
NO Axillary and pubic hair (dependent on testosterone) Primary
amenorrhea and nondevevloped internal reproductive organs
Normal axillary and pubic hair
Tx—testicular resection due to potential cancer and creation of neo vagina
Gonadectomy is done in the 2nd or 3rd decade after completion of breast
development and attainment of adult height.
After removal of the gonads, estrogen therapy is indicated. Not progesterone
therapy as there is no uterus.
Immediate gonadectomy is indicated in XY gonadal dysgenesis (Swyer syndrome)
as malignant change can occur at any age.
• OCP
Weight gain is not a/c OCP
Risk of combination OCP benefit
Breakthrough bleeding
Amenorrhea
↑TG
HTN
Stroke
MI
Worsening DM
Venous thromboembolic dx
↑breast cancer and cervical cancer
Liver dx( hepatic adenoma) ↓endometrial cancer and ovarian
cancer
↓PID
↓ectopic pregnancy
↓benign breast disease
↓dysmenorrhea( anemia)
• AFP
NTDs
Abd wall defect
Multiple gestation
Inaccurate gestation age
Down syn Edward syn
Low AFP Low AFP
Loe estriol Low estriol
Elevated beta-HCG Low beta-HCG
Elevated inhibin A Nomrla inhibin
• Tumors
Granulose cell tumor Dysgernminomas Leydig cell tumor Teratoma
Bimodal age 20 yo Dermoid cyst
Prepubertyprecocious puberty unilateral
Postmenopausalbleeding, hypertrophy breast and absence
postmenopausal s/s Neutral, no secreting hormones Androgen
masculinization No secretion
• Ovarian torsion
Medical emergency
• Ovarian hyperstimulation syndrome
Is an iatrogenic complication of ovulation-inducing drugs. It is
characterized by abdominal pain due to ovarian enlargement and may be
accompanied by ascites, respiratory difficulty and other systemic findings.
• PID
Caused by N. gono, C. tracho, Mycoplasma
Hospitalization and parental antibiotics
1. High fever
2. Failure to respond to oral antibiotics
3. N/V
4. Pregnancy
5. Noncompliants
Treatment
1. Hospital pt ,IV
Cefoxitin/doxycycline
Cefotetan/doxycycline
Clindamycin/gentamicin
2. Out pt
Cefoxitin (IM) + probenecid (PO) + Doxycycline (PO)
Ceftriaxone (IM) + Doxycycline (PO)
• Aromatase deficiency
In utero—masculinization of the mother that resolve after
delivery due to placenta will not be able to make estrogens.
Clitoromegaly
Delayed puberty, osteoporosis, undetectable circulating estrogen
, high gonadotropins, polycystic ovaries.
• Syphilis in pregnancy
Allergy should be confirmed with skin test
PCN desensitization—incremental dose of oral PCN
• Steroid –induced folliculitis
Steroid acne
monomorphous pink papules and absence of comedones.
• Levonorgestrel (plan B)
Emergency contraception
Progestin-only and up to 120 hours
• Medroxyprogesterone (Depo-provera) IM
Every 3 month
• Stress incontinence
Weakening of the pelvic floor muscleurethral
hypermobility (inserting a cotton-swab into urethral orifice and angle> 30
upon an increase in intra-abdominal pressure.
Kegel exercise
Most benefitial treatment is restoration of the urethrovesical
angle by urethropexy.
Pessaries
Estrogen replacement
Burch procedure
Sling procedure
• Urge incontinence
Detrusor instability, bladder irritation, interstitial cystitis
Sundden and frequent loss of large urine
Nocturia and frequency
Treatment--oxybutynin
• Overflow incontinence
DM
Bathanechol and alpha-blockers
• Urodynamic testing
DDX overflow incontinence of BPH from acontractile bladder.
• Precocious puberty
Secondary sex before age of 8 in girls and 9 in boys
1. Central
Early activation of PHO axis↑FSH and LH
Brain MRI
Managed with GnRH agonist to prevent premature fusion of the
epiphyseal plates
2. Peripheral
Gonadal or adrenal excess↓FSH and LH
• Endometriosis
Definitively diagnosis is laparoscopy
Treatment
1. OCP
2. GnRH analogs
3. Danazol
Progestin-like medication
Treatment of endometriosis and fibrotic breast disease.
• PPROM
Before 37 weeks
Normal amniotic fluid PH 7.0-7.5; Normal vaginal PH 3.8-4.5
Management
1. Amniotic fluid measure fetal lung indices
2. U/S AFI ( normal 5-25)
3. Steroids between 24-34 weeks
4. Most common complication of PROM—pulmonary hypoplasia
5. Antibiotics is recommended in pt whose GBS is unknown. PCN prophylaxis.
Indications for GBS prophylaxis when GBS is unknown
• Delivery at < 37 weeks
• Duration of membrane rupture > 18 hr
• GBS bacteriuria in any concentration during the current pregnancy
• Prioe history of delivery of an infant with GBS
C section reserved for fetal distress
Amnio dye test
Only used when rupture of membrane is difficult to confirm
Most useful at early gestational ages
• Pay attention to menopause vs hyperthyroidism
s/s same
• endometriosis
definite dx is laparoscopy
CA 125 is elevated and levels tend to correlate with the
severity of endometriosis.
infertility
• mild preeclampsia
HTN> 140/90
Proteinuria> 300mg/24hr
After 20 weeks
• severe preeclampsia
vasospasm is the primary pathophysiology cause of preeclampsia
s/s
HTN > 160/110
Proteinuria >5 g/24 hr
Oliguria
P.edema
Thromboctopenia
↑liver enzymes swelling of liver with distension of
hepatic capdule (Glisson’s)RUQ pain.
Increased reflex irritability is a worrisome sign in pt with
preeclampsia ( seizure)
Treatmet
Hydralazine and labetalol control BP
Mg sulfate prevent further seizure.
• Interstitial cystitis
Painful bladder syndrome
Chronic condition a/c pelvic pain worsened by bladder filling or
intercourse accompanied by urinary frequency , urgency and nocturia.
Pain is relieved by voiding
Cytoscopy—submucosal petechiae or ulceration.
• Magnesium sulfate toxicity
The earliest sign is sepressed deep tendon reflexes
2nd sign—R. depression
Treatment
1. Stop
2. Calcium gluconate
• Aromatase only in ovary and fat , not in adrenal gland.
• Excessive feto-maternal hemorrhage
1. Rosette test—qualitative test
2. If negative standard dose of anti-D should be given
3. If positiveKleihauer-Betke stain to evaluate the amount of
bleedingthe dose of anti-D should be corrected accordingly
4. Failure to correct the dose of anti-D maternal
alloimmunization
• Premenstrual syndrome
Menstrual diary x 3 cycles
• #2530
• GBS infection
Screen for colonization with vaginal and rectal swab at 35-37
weeks
If positive, prophylactic antibodies (PCN orAmpicillin)
History of GBS bacteriuria or previous delivery of GBS child are
automatically given prophylactic antibics regardless of the results of a
rectovaginal culture.
• HIV
AZT throughout the pregnancy and labor and newborn for first 6
weeks
C section
No breastfeeding
• Pseudocyesis
Conversion disorder
Psych Tx
• Oligohydramnio
No vertical pocket of amniotic fluid greater than 2 cm, or
amniotic fluid index of 5 cm or less.
Posttrem pregnancy monitored for oligohydramnios twice weekly.
• Abortion
Inevitable abortion—treatment of choiceSuction
curettage
Missed abortion—surgically with D&C, medically with misoprostol
or mifepristone
All abortion—anti-D must be given to Rh-Negative woman who do
not have anti-Rh AB
Serial testing of HCG is for complete abortion to ascertain that
nothing remains in the uterus. It is not necessary in the case of
inevitable abortions as curettage is sufficient to remove the expired
product.
• Apt test
The Apt test is most commonly used in cases of vaginal bleeding late during
pregnancy (antepartum haemorrhage) to determine if the bleeding is from the
mother or the fetus.
A positive test would indicate that blood is of fetal origin,
and could be due to vasa previa.
A negative test indicates that the blood is of maternal origin.
In practice, the Apt test may not be done when there is
suspicion of vasa previa, because the time to fetal collapse with bleeding
from vasa previa is often very short.
The Apt test can also be used to detect the presence of fetal
blood in the maternal circulation in cases of suspected fetal-maternal
hemorrhage. Since the test is only a qualitative determination of the
presence of fetal hemoglobin in maternal blood, the quantitative Kleihauer-
Betke test is more commonly used.
Finally, the Apt test can be used after birth (postpartum
hemorrhage) if the newborn has bloody vomiting, bloody stool, or active
bleeding from the nasogastric tube. A positive apt test would mean that the
blood is either due to gastrointestinal or pulmonary bleeding from the
neonate. A negative Apt test would indicate that the blood is of maternal
origin, suggesting that the neonate swallowed or aspirated maternal blood,
either during delivery or during breastfeeding (e.g., from breast fissures).
• Adenomyosis
> 40
severe dysmenorrheal and menorrhagia
enlarged symmetrical uterus
DDX leiomyoma and endometrial carcinoma
For woman above 35 yo, it is mandatory to perform an endometrial
curettage to rule out endometrial carcinoma.
• Bilateral renal agenesis will not survive outside the uterus&#
61664;oligohydramnios
pulmonary hypoplasia.
• Graph
aminocentesis 16-20 weeks
Chorionic villus sampling 10-12 wks
cordocentesis Rapid karyotype analysis, fetal blood dyscrasias
• Cervical mucus
Ovulatory phase—ph 6.5
Ferning
• Polyhydramnios
Fetal malformation, genetic disorders, maternal DM, Multiple
gestation, fetal anemia
• Cervical incompetence
Gold standard—transvaginal ultrasound
Should be more than 25 mm at 24 weeks
Cervical length below 10% percentile for the gestational age is
considered a short cervix
• Fetal hydantoin syndrome
Phenytoin and carbamazepine
Midfacial hypoplasia, microcephaly, cleft lip and palate,
digital hypoplasia, hirsutism, developmental delay.
• Congenital syphilis
Rhinitis, hepatosplenomegaly, skin lesion
• Fetal alcohol syndrome
Midfacial hypoplasia, microcephaly and stunted growth
Mental retartdation
• Postpartum hemorrhage—most common reason is uterine atony.
• Epidural anesthesia
vasodilation and blood venous pooling
Hypotension
Transient Urinary retention caused by bladder denervation
Treat with in and out cath
• Corticosteroid treatment
Only used in 24-34 weeks
Require 24-48 hours to have benefit
• Ectopic pregnancy triad
Amenorrhea
Abd pain
Vaginal bleeding
• Graves disease mother
↑↑TSI level even after thyroidectomy
These IgG autoantibodies cross the placenta
thyrotoxicosis in the fetus and neonate
s/s—goiter, tachypnea, tachycardia, CM, restless, diarrhea,
poor weight gain.
• A mid-luteal serum progesterone level is used to test for
ovulation.
Progesterone > 10 ( normal < 2)
• A serum inhibin B level can be used to determine ovulatory
reserve
• Human placental lactogen HPL
Produced by the placenta
Quickly decrease after the delivery
Insulin antagonist effectmaternal lipolysis and insulin
resistanceincreasing delivery of fatty acids and glucose to the
fetus.
• Isotretinoin in pregnancy
Two effective forms of contraception 1 month prior to initiating
tx
Contraception must be continued during the treatment and for 1
month after isotretinoin is discontinued.
Must have a pregnancy test the week before treatment.
• A sinusoidal fetal HR
Uniform oscillation of 3-5 cycles per minute
A sign of fetal distress and inability of CNS to control HR
• Postpartum
Low grade fever and leukocytosis are common during the first 24
hours of the postpartum
Intrapartum and postpartum chills are also common
• SLE vs preeclampsia
Both has HTN, Proteinura, edema
• Prolactin
Inhibited by dopamine
Stimulated by serotonin and TRH (due to hypothyroidism)
Prolatininhibit GnRHamonorrhea
• Zavanell maneuver
A lst resort in case of shoulder dystocia
Pushing baby back into uterine cavity followed by a C section
Stage
Characteristics
nulligravida multigravida
First
Onset of true labor to full cervical dilation < 20 hours <14 hours
Latent phase 0-3-4cm Highly variable Higly variable
Active phase 3-4cm—10cm >1cm/hr >1.2cm/hr
Second Full dilation to birth of baby 30 minutes -3 hours 5-30
minutes
Third Delivery placenta 0-30 minutes 0-30 minutes
• Pap smear in pregnancy
If HSILcolposcopy and biopsynegative
repeat colposcopy and biopsy at 6-8 weeks after delivery.
LEEP procedure
An excisional therapy and is recommended for all pt except adolescent
and pregnant woman with HSIL on pap smear but without CINII or greater on
biopsy.
• Syphilis
syphilis Painless papule ulceration, forming a chancre with punched out
base and raised ,indurated margins.
Painless inguinal adenopathy.
Heals spontaneous in 1-3 months.
chancroid Deep purulent base and painful lymphadenopathy
Granuloma inguinale
(donovanosis) Painless genital ulcer. Red, beefy base without adenopathy
Not resolve without ABX.
• CVS
10-12 weeks
Risk—fetal death and limb reduction defects
The most important influential factor for reducing the incident
of limb reduction defects ----gestational age ( high risk before 9-10 wks)
• Ischemic optic neuropathy is a/c sildenafil and vardenafil.
• The requirement for L-thyroxine in pt receiving estrogen
replacement therapy increases.
• Osteoporosis
Risk—smoking and alcohol both
• Hyperemesis gravidarum
Presence of ketonuria
Loss > 5% of weight
Mild increase in ALT, AST, bilirubin, amylase, lipase
Measure HCG
• Triad of Hydatidiform mole
Enlarged uterus, hyperemesis, HCG> 100,000
• Breech presentation
External cephalic version if NST normal
> 37 weeks
Should be performed when emergent C section can be done
• Internal podalic version
Twin delivery
Cnovert the second twin froma transverse position to a breech
presentation for subsequent delivery
• Piper forceps
In breech delivery to extract the gead following delivery of the
body.
• Endometritis
T>38 outside of the 1st 24 hours postpartum
Fever, uterine tenderness, foul smelling lochia and leukocytosis
Treatment—clindamycin and gentamicin
• Uterine fibroids
Dysmenorrheal
Heavy menses
Enlarged uterus
Estrogen dependent tumor
• Secondary amenorrhea
In any woman of childbearing age with secondary amemorrhea,
first rule out pregnancy. | e****0
发帖数: 678 | | D******D
发帖数: 1159 | | j*******6
发帖数: 85 | | a**********e
发帖数: 310 | | s*********e
发帖数: 116 | | d*****x
发帖数: 96 | | a*****n
发帖数: 154 | | d******g
发帖数: 258 | |
|
|
|
|
|
|
|
