EOC Reproductive Review

preterm labor

<37 weeks

complicated by prelabor rupture of membranes

Once preterm prelabor rupture of membranes is confirmed, ampicillin, a penicillin antibiotic, is given to decrease infection in the mother and the infant, thereby delaying preterm labor. It is recommended that azithromycin 1 gram orally followed by ampicillin 2 grams intravenously every 6 hours for 48 hours be given. This is then followed by a course of oral amoxicillin for 5 days.

Paget disease

dermatitis in the nipple and areola areas

unilateral and associated with itching or burning in the area. The rash associated with Paget disease of the breast appears eczematous and erythematous

dx: intraepithelial adenocarcinoma cells on full-thickness punch or wedge biopsy of the nipple

tx: mastectomy

chronic HTN, woman planning PGY

The following medications are acceptable for the treatment of hypertension in pregnancy: methyldopa, nifedipine, and labetalol.

labetalol further reduces HR

threatened abortion

vaginal bleeding in the presence of a closed cervix without the passage of any products of conception before 20 weeks gestation

tx: expectant with reassurance and repeat outpatient ultrasound

ovarian torsion

enlarged cyst or mass that predisposes the ovary to torsion. Risk factors include ovarian cysts or masses ≥ 4 cm, prior pelvic surgery, history of tubal ligation, fertility treatments, and pregnancy.

sudden onset of severe U/L pelvic pain

def dx: surgical with direct visualization

AUB

Baseline treatment includes estrogen, progesterone, and combination hormone therapy. If hormones do not control bleeding and symptomatic anemia continues, practitioners consider surgical measures to control persistent, symptomatic, irregular bleeding. Options include endometrial ablation, and if this fails, hysterectomy may be considered.

uterine atony

1st line tx- uterine massage and compression and uterotonic agents

intraamniotic infection aka Triple I

ascending infection of normal vaginal flora.

purulent vaginal discharge on examination

tx: IV abx

uterine prolapse

reveals the uterus protruding out of the vaginal introitus.

pelvic pressure, heaviness, fullness, or falling out in the perineal area.

stage IV prolapse

tx: vaginal hysterectomy

normal ovulatory discharge

it develops the appearance and stretchy consistency of egg whites.

endometriosis

estrogen-dependent inflammatory disease marked by the growth of endometrial glands and stroma outside the uterine cavity.

RF: nulliparity

throbbing pelvic pain, dysmenorrhea, dyspareunia, infertility, heavy menstrual bleeding

vaginal tenderness, nodules in the posterior fornix, adnexal masses, and immobility of the cervix or uterus.

dx: endometrial glands and stroma on surgical bx

infective vaginitis

a change in vaginal discharge, burning, erythema, pruritus, dyspareunia, dysuria, and spotting.

dx: KOH whiff test

direct microscopic examination

ovarian torsion

Over half the cases of ovarian torsion are associated with an ovarian tumor or cyst. Benign tumors, particularly teratomas

Pelvic ultrasonography with Doppler imaging of the ovary is the initial diagnostic test of choice. Ultrasound findings are variable. Edema of the ovary is the most common finding.

dx lap

If clinical suspicion persists, patients need diagnostic laparoscopy to directly visualize the ovary in question.

breastfeeding fever, but flucutuant mass present= breast abscess

If clinical suspicion persists, patients need diagnostic laparoscopy to directly visualize the ovary in question.

incision and drainage or ultrasound-guided aspiration

breastfeeding still encouraged!

lactational mastitis

Dicloxacillin is used in patients without risk factors for methicillin-resistant Staphylococcus aureus (MRSA). For patients with MRSA risk factors, trimethoprim-sulfamethoxazole or clindamycin may be used.

primary amenorrhea

a lack of menarche by age 15 in a patient with apparently normal sexual development or by age 13 in a patient with no secondary sexual characteristics.

initial prenatal testing

Prenatal care is recommended within the first 10 weeks of pregnancy.

urine cx

placental abruption

complete or partial detachment of the placenta from the uterus before delivery of the fetus.

late pregnancy bleeding accompanied by uterine pain or contractions.

RF: maternal trauma, cocaine use, multiple gestation, hypertension, preeclampsia or eclampsia, cigarette smoking, and previous placental abruption.

fibrinogen levels < 200 mg/dL have the best correlation with severe maternal hemorrhage.

which confirms intrauterine pregnancy?

intrauterine fetal pole and yolk sac

Another way that increases the likelihood but does not confirm an intrauterine pregnancy is identifying the double ring, also known as the double decidual sign, which usually appears by 5.5–6 weeks gestation. The double ring helps distinguish a true gestational sac from an intrauterine fluid collection or pseudosac. Identifying intrauterine fetal heart activity

mastitis ans BF

continue BF b/l to avoid formation of breast abscess

mc cause of AUB

Ovulatory dysfunction and endometrial hyperplasia

physiologic leukorrhea

reassurance

prolonged menstrual bleeding

menstruation for more than 8 days.

endometriosis

dysmenorrhea, dyspareunia, and dyschezia.

def dx: laparoscopy with biopsy.

tx: combined oral contraceptives and NSAIDs for pain.

emergency contraception

A copper-containing intrauterine device (IUD) is the best option for this patient

fibroadenoma

well-defined, rubbery, nontender, MOBILE masses

A core-needle biopsy or excision can provide a definitive diagnosis

gonococcal cervicitis

dysuria and purulent discharge.

gram neg kidney bean-shaped diplococci

gestational trophoblastic disease/molar pregnancy

Hydatidiform moles are the result of aberrant fertilization and have the potential to become malignant.

Vaginal bleeding, pelvic discomfort, and hyperemesis gravidarum

uterus that is larger than expected for gestational age. Beta-human chorionic gonadotropin (hCG) is usually high.

On ultrasound, features of a complete mole include absence of an embryo or fetus and a central heterogeneous mass with numerous discrete anechoic spaces classically described as a snowstorm appearance.

tx: uterine evacuation with suction curettage

PPROM

rupture of fetal membranes before onset of labor

before 37 wks gestation

presence of amniotic fluid can be confirmed with nitrazine testing (a pH of 7.1–7.3 as opposed to a normal pH of 3.5–6.0), the presence of ferning on microscopic evaluation

endometrial CA

Risk factors of this condition include a body mass index ≥ 30 kg/m², nulliparity, diabetes, polycystic ovary syndrome (or any other condition characterized by prolonged anovulation), prolonged unopposed estrogen therapy, and long-term use of tamoxifen.

If it is > 4 mm or certain areas of the endometrium appear heterogeneous, there should be a high index of suspicion

tx: total hysterectomy and bilateral salpingo-oophorectomy

candidal vaginitis

pH of the discharge is < 4.5

rh ig

Negative Rh D on blood typing and antibody screen in a pregnant patient who is experiencing a spontaneous abortion is an indication to receive Rh D immune globulin.

28 weeks of gestation if they are Rh-negative and then again at delivery if the fetus is found to be Rh-positive

gestational DM

Insulin is the preferred pharmacological agent