CHILDBEARING EXAM #4

Primary amenorrhea

absence of menses at age 15 in presence of otherwise normal

Secondary amenorrhea

absence of menses for more than 3 cycles of 6 months in women who previously had mensesregular menstrual cycles

How to induce menses

Progesterone (Provera)

Primary dysmenorrhea

noticed 6-12 months after menarche, recurrent, crampy lower abdominal pain during menses

Secondary dysmenorrhea

begins later in life, associated with pelvic pathology/disease

Premenstrual syndrome (PMS)

mildly interfere with some aspects of a woman’s life, before/during menses

Premenstrual dysphoric disorder (PMDD)

severe form of PMS in which symptoms of anger, irritability and internal tension are prominent (must have 5 symptoms (1 psychological)), chart S+S over 2 consecutive cycles

Psychological symptoms of PMS and PMDD

anger, anxiety, depression, irritability, sense of being overwhelmed, sensitivity to rejection, social withdrawal

Behavioral symptoms of PMS and PMDD

forgetfulness, fatigue, poor concentration

Physical symptoms of PMS and PMDD

bloating, appetite changes, breast tenderness, headaches, lethargy/muscle fatigue, muscle aches/pain, sleep disturbances, swelling of extremities

Adenomyosis

thickening of uterus muscle

Endometriosis

uterine tissue grows outside the uterus

Dyspareunia

pain with penetration during sex

Hormonal (GnRH) antagonists

suppresses ovulation and reduces endogenous estrogen production — injection, use 6mo max

Chocolate cyst endometrioma

cyst filled with endometrial blood

Steroids

Damizol

Uterine fibroids

benign tumors of the smooth muscle of the uterus that can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms

Ablation

go in to burn area to make uterus smaller

GnRH agonists

puts patients in menopausal state so tumors shrink, then perform surgery

Myomectomy

removal of fibroids

Abnormal uterine bleeding (AUB)

umbrella term for many menstrual irregularities — differs in quantity or timing than usual menstrual flow

Dysfunctional uterine bleeding

related to hormones

Polycystic ovarian syndrome (PCOS)

enlarged ovaries with multiple cysts

Treatment for chlamydia

Doxycycline and Azithromycin

Friable cervix

inflammation or touch causes bleeding because it’s so tender

Tx for gonorrhea

Cetixime, Ceftriazone, Azithromycin AND Gentamicin

Primary syphilis

small, painless open sore or ulcer called a chancre — heals by itself in 3-6 weeks, enlarged lymphnodes, 1-12 weeks of infection

Secondary syphilis

skin rash, sores in or around mouth, vagina, fever, loss of appetite, muscle aches, joint pain, swollen lymph nodes, vision changes, hair loss, 2-8 weeks after the primary stage

Latent stage of syphilis

no signs of symptoms, may last for years, S+S may never come back or go to tertiary stage, years later

Tertiary stage of syphilis

heart aneurysms or valve disease, CNS disorders (neurosyphilis), tumors of skin, bones or liver, years later

Primary, secondary and latent syphillis treatment

Benzathine PCN G once

Late Latent/tertiary syphillis treatment

Benzathine PCN G for 3 weeks

HPV

viral sexually transmitted infection, transmitted through skin to skin contact, incubation 1-6mo, may remain dormant for up to 10 years

Can you get pregnant with HPV?

No, it is contraindicated

Coloscopy

large microscope that looks at cervical cells

Treatment of HPV

Podophyllin (kills wart cells) — contraindicated in pregnancy, liquid nitrogen, TCA, surgical excision

Patient controlled treatment

Podofilox gel, imiquimod — CONTRAINDICATED in pregnancy

Type 1 HSV

oro-facial lesions, cold sores, resides in trigeminal ganglion

Type 2 HSV

mostly genital lesions, resides in dorsal root ganglia

Primary outbreak of HSV

multiple painful lesions/blisters, flu-like symptoms, vulvar pain/swelling, dysuria and retention, S+S lasts 12-20 days

Secondary/recurrent outbreaks

prodrome of itching, burning, tingling, less severe outbreaks, shorter than primary, triggered by stress, sun exposure, menses, pregnancy, trauma, HIV

When is HSV infectious?

When the prodrome begins until lesions resolve — avoid sex

Treatment of primary and secondary HSV

Acyclovir, Famciclovir, Valacyclovir

What does the CDC recommend in pregnancy as HSV treatment?

Acyclovir or Valacyclovir

Hepatitis A virus

fecal-oral route

Hepatitis B virus

disease of liver, silent infection, transmitted through body contact

Hepatitis C virus

common blood-borne infection in US

Human immunodeficiency virus (HIV)

infection mainly by sexual contact and contaminated blood products

HIV Prophylaxis

Truvada, Descovy — helps reduce the risk

Scabies

sexually transmitted infection (doesn’t have to be), human and animal parasite, personal contact is most infectious

Treatment of scabies

Permethrin cream or Lindane cream

Indications for Lindane cream

not for use immediately after shower/bath, don’t use if pregnant or breastfeeding or with extensive dermatitis

Treatment of Trichomoniasis

Metronidazole 500mg BID x7 days

Treatment of Pediculosis

Permithrin cream, Malathion

Vaginitis

inflammation of vagina and possibly vulva

Bacterial vaginosis

vaginal infection, caused by bacteria Gardnerella vaginalis

Amine test

mix KOH with vaginal discharge and (+) = fishy smell

Clue cells

sprinkled cells, lots of little dots on vagina

Intravaginal treatment of bacterial vaginosis

Metronidazole, Clindamycin

Oral treatment of bacterial vaginosis

Metronidazole, Tinidazole, Clindamycin

Candida

yeast-like fungal infection of the vagina that results from change in vaginal flora

3 types of candida

C. albicans, C. tropicalis, C. galbrata

Intravaginal treatment for Candida

Gyne-Lotrimin, Monistat, Terconazole

Oral treatment for Candida

Diflucan (Fluconazole)

Pelvic inflammatory disease (PID)

most commonly involves fallopian tubes, uterus, caused by Chlamydia

Zika virus

arthropod-borne flavivirus, from mosquitos and semen

Fibroadenoma

most common benign breast condition, not cyclic

Galactorrhea

nipple discharge, elevated prolactin level

Mammary duct ectasia

inflammation of duct behind nipple

Simple (total) mastectomy

remove breast and nipple

Modified radical mastectomy

tissue, skin, areola, nipple, axillary lymphnodes

Radical mastectomy

everything plus chest wall and muscle

Urinary tract infections

Caused by E.coli

UTI treatments

Bactrim, Cipro, Floxin, Macrobid

Climacteric/Peri Menopause

transitional period, ovarian function and hormone production decline, may span 10-15 years

Menopause

woman’s menstrual periods permanently stop, result of decrease in estrogen, one full year without menses, average age 51.4

Infertility

inability of a couple of reproductive age to conceive after 12 months or more of regular intercourse without using contraception

Semen analysis

provides information about quantity and quality of seminal fluid, density, morphology, and motility of sperm

Normal sperm count

>20 million/mL

Normal semen length

2.0mL or more

Basal body temperature (BBT)

done in AM before getting out of bed, temp rise of 0.4 ×3 days = ovulation, doesn’t predict ovulation

Detection of LH in urine

predict ovulation, ovulation 24-36hr after LH surge when you pee on strip

Mid luteal phase progesterone concentration

7 days after ovulation, gives information about ovulation and luteal phase defect

Ovulation

>3.0ng/mL

Adequate luteal phase support

>10ng/mL, enough progesterone to support a pregnancy

Tubal patency hysterosalpingography

x-ray study of female genital tract, depicts tracts architecture and integrity, outlines uterine cavity, fallopian tubes, and peritoneal cavity

Tx for infertility

Clomiphene citrate (Clomid), can use for up to 5 cycles

AI/TDI

artificial insemination or therapeutic donor — done with own sperm, inject sperm into cervix at time of ovulation

IUI

intrauterine insemination — inject sperm inside the uterus and meet with egg at ovulation

IVF/ET

in vitro fertilization with embryo transfer — retrieve egg and sperm, grow in petri dish, put embryo in uterus so it implants

ZIFT

zygote intrafallopian transfer — take egg and sperm, fertilize in petri dish and put zygote in fallopian tube

Coitus interruptus (withdrawal)

22% failure, no STI/HIV prevention

What hormones stimulate ovulation?

FSH and LH

Calendar rhythm method

record number of days in each menstrual cycle for at least 6 months, subtract 18 from the length of shortest cycle and 11 days from longest cycle

Standard days method

days 8-19 are potentially fertile, use cycle beads, can only use in women with cycles between 26-32 days

Cycle beads

ring of 33 movable beads

Brown beads

safe days to have unprotected intercourse

White beads

fertile days

Basal body temperature

lowest body temperature in 24 hour period, take at the same time daily

BBT ranges

97.2-97.7