CPP LAB M3 OVERVIEW

Obstetrics and Gynecology

is a branch of medicine that specializes in the care of women especially during pregnancy and childbirth.

Obstetrics and Gynecology Practitioners

diagnose and treat diseases of the female reproductive organs, specializing in women's health issues, like menopause, hormone problems, contraception (birth control), and infertility.

menopause, hormone problems, contraception (birth control), and infertility.

Obstetrics and Gynecology Practitioners diagnose and treat diseases of the female reproductive organs, specializing in women's health issues, like _____ [4]

Gynecologist

[TYPE OF PHYSISCIAN]
This is a specialist in women's reproductive health

Obstetricians

[TYPE OF PHYSISCIAN]
They care for women during their pregnancy and just after the baby is born.

Obstetricians

[TYPE OF PHYSISCIAN]
They deliver babies.

Gynecologic diseases

In general they are diseases involving the female reproductive tract.

• benign and malignant tumors

• pregnancy-related diseases

• infection

• endocrine diseases

Gynecologic diseases include ___ [4]

Malignant tumour

Among Gynecologic diseases the ____ is the most common cause of death.

Human Papilloma virus (HPV) infection

[ Gynecologic diseases ]
___ has been shown to be one of the major etiological factors associated with cervical cancer.

BRCA1 tumor suppressor gene

[ Gynecologic diseases ]
Inactivation of the _____ gene has been implicated in hereditary ovarian cancer.

• Strangury

• Abdominal Pain

• Vaginal Itching

• Muscle or Body Aches

• Unexplained Weight Loss

• Fever

• Menstrual Disorders

• Vomiting

• Ectopic Pregnancy

• Cervical Erosion

• Ovarian Cyst

• Bleeding and Discharge

GYNECOLOGICAL DISEASES SYMPTOMS [12]

Stage I

[What Stage of Ovarian Cancer ]

The cancer is confined to the ovaries.

Stage II

[What Stage of Ovarian Cancer ]

The cancer is in one or both ovaries and has spread to the pelvic region

Stage III

[What Stage of Ovarian Cancer ]
The cancer is in one or both ovaries, and the cancer has either spread to the lining of the abdomen or to the lymph nodes in the back of the abdomen.

Stage IV

[What Stage of Ovarian Cancer ]
The cancer has metastasized to distant sites or other organs outside the abdomen and pelvic region.

• Ovarian cysts.

• Pelvic pain.

• Endometriosis.

• Uterine fibroids.

• Polycystic ovarian syndrome(PCOS)

• Acne and abnormal female hair distribution.

• Genital tract infections.

• Vulva and vagina skin disorders

In general the Common Gynecological Disorders are the following, [8]

[REVIEW IN NOTES]

Hormone Replacement Therapy (HRT)

Menopause

This is sometimes called as “ The Change of Life “

Menopause

___is a normal time in a woman’s life when her period stops

Menopause

During _______ , a woman’s body makes less of the hormones estrogen and progesterone

estrogen and progesterone

During MENOPAUSE , a woman’s body makes less of the hormones ___and _______

• night sweats

• hot flashes

• vaginal dryness

• thin bones

[MENOPAUSE]
Lower hormone levels may lead to symptoms like ____ [4]

• Irregular periods

• Vaginal dryness

• Hot flashes

• Sore or tender breasts

• Chills

• Night sweats

• Sleep problems

• Headaches

• Weight gain and slowed metabolism

• Mood changes

• Thinning hair and dry skin

• Memory problems

SYMPTOMS OF MENOPAUSE [12]

Menostar

This Estrogen- Only Medicines is only used to prevent osteoporosis

Osphena

This Estrogen- Only Medicines is not estrogen only

Progestin-only medicines

Estrogen-only medicines are usually taken with _____ medicine to lower the chance of getting endometrial cancer in women who still have their uterus

Estrogen-only medicines

___ medicine are usually taken with progestin-only medicines to lower the chance of getting endometrial cancer in women who still have their uterus.

endometrial cancer

Estrogen-only medicines are usually taken with progestin-only medicines to lower the chance of getting______ cancer in women who still have their uterus.

Contraception

______ is the prevention of pregnancy by inhibiting sperm from reaching a mature ovum or by preventing a fertilized ovum from implanting in the endometrium

• Condom

• Female condom

• Oral contracepion

• Hormonal ring

• UID

• Contraceptive injection

• Surgical sterilization

• Implant

• Coitus interruptus

• Calendar rhythm method

• Vaginal douche

• Contraceptive patch

• Diaphragm/cap

Contarception Methods [13]

prevention of pregnancy following sexual intercourse

GOAL OF TREATMENT in CONTRACEPTION :

___ ?

• 99%

• 8%

[Contraception]
With perfect use, their efficacy is more than ___%, but with typical use, up to___% of women may experience unintended pregnancy

Monophasic OCs

[Contracepton Treatment]

___ contain a constant amount of estrogen and progestin for 21 days, followed by 7 days of placebo.

• 21 days

• 7 days

[Contracepton Treatment]

Monophasic OCs contain a constant amount of estrogen and progestin for____ days, followed by ___days of placebo.

Biphasic and triphasic pills

[Contracepton Treatment]
______ pills contain variable amounts of estrogen and progestin for 21 days and are followed by a 7-day placebo phase.

• 21 days

• 7 days

[Contracepton Treatment]
Biphasic and triphasic pills contain variable amounts of estrogen and progestin for -___ days and are followed by a ____-day placebo phase.

Third-generation OCs c

[Contracepton Treatment]
_____ contain newer progestins (eg, desogestrel, drospirenone, gestodene, and norgestimate).

Third-generation OCs contain newer progestins (eg, desogestrel, drospirenone, gestodene, and norgestimate).

[Contracepton Treatment]
These potent progestins have no estrogenic effects

Third-generation OCs contain newer progestins (eg, desogestrel, drospirenone, gestodene, and norgestimate).

[Contracepton Treatment]
These are less androgenic than levonorgestrel and thus are thought to have fewer side effects (eg, less likelihood or severity of acne).

Drospirenone

[Contracepton Treatment]
This may also cause less weight gain compared with levonorgestrel

progestin-only “minipills”

[Contracepton Treatment]
The _____ tend to be less effective than combination OCs

progestin-only “minipills

[Contracepton Treatment]
They are associated with irregular and unpredictable menstrual bleeding.

progestin-only “minipills

[Contracepton Treatment]
They must be taken every day of the menstrual cycle at approximately the same time of day to maintain contraceptive efficacy.

contraceptive efficacy.

[Contracepton Treatment]
Progestin-only “minipills must be taken every day of the menstrual cycle at approximately the same time of day to maintain ____

Progestin-only “minipills'“

[Contracepton Treatment]
They are associated with more ectopic pregnancies than other hormonal contraceptives.

“quick start method

[Contracepton Treatment]
In the _____” method for initiating OCs, the woman takes the first pill on the day of her office visit (after a negative urine pregnancy test).

first day start method

[Contracepton Treatment]
In the ______ method, women take the first pill on the first day of the next menstrual cycle.

Sunday start method

[Contracepton Treatment]
The ______ method was used for many years, whereby the first pill was taken on the first Sunday after starting the menstrual cycle.

• Monitor blood pressure annually in all CHC users.

• Monitor glucose levels closely when Combined Hormonal contraceptives or CHCs are started or stopped in women with a history of glucose intolerance or diabetes mellitus.

• For all contraceptive users do annual cytologic screening (more often if they are at risk for STDs), pelvic and breast examination, and well woman consultation. Also, regularly evaluate for problems that may relate to the CHCs (eg, breakthrough bleeding, amenorrhea, weight gain, and acne).

• Annually monitor women using Nexplanon for menstrual cycle disturbances, weight gain, local inflammation or infection at the implant site, acne, breast tenderness, headaches, and hair loss.

• Evaluate women using depot medroxyprogesterone acetate or DMPA (an injectable progestin) every 3 months for weight gain, menstrual cycle disturbances, and fractures.

• Monitor women with Intrauterine device or IUDs at 1 to 3 month intervals for proper positioning of the IUD, changes in menstrual bleeding patterns, upper genital tract infection, and protection against STDs.

CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES [6]

CHC users

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Monitor blood pressure annually in all __ users.

Combined Hormonal contraceptives or CHC

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Monitor glucose levels closely when ______are started or stopped in women with a history of glucose intolerance or diabetes mellitus.

cytologic screening

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
For all contraceptive users do annual______ screening (more often if they are at risk for STDs), pelvic and breast examination, and well woman consultation

CHCs (eg, breakthrough bleeding, amenorrhea, weight gain, and acne)

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Regularly evaluate for problems that may relate to the ______

Nexplanon

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Annually monitor women using _____ for menstrual cycle disturbances, weight gain, local inflammation or infection at the implant site, acne, breast tenderness, headaches, and hair loss

Depot Medroxyprogesterone Acetate or DMPA (an injectable progestin)

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Evaluate women using ____ every 3 months for weight gain, menstrual cycle disturbances, and fractures

Depot medroxyprogesterone acetate or DMPA

This is an injectable progestin

Intrauterine device or IUDs

[ CONTRACEPTION EVALUATION OF THERAPEUTIC OUTCOMES]
Monitor women with______ at 1 to 3 month intervals for proper positioning of the IUD, changes in menstrual bleeding patterns, upper genital tract infection, and protection against STDs.

nonhormonal contraception

[NON-PHARMACOLOGIC THERAPY]
A comparison of methods of ______ contraception

abstinence (rhythm) method

[NON-PHARMACOLOGIC THERAPY]
The ______ is associated with relatively high pregnancy rates

• Barrier Techniques

• Diaphragms are effective because they are barriers and because of the spermicide

• placed in the diaphragm before insertion. It should be inserted up to 6 hours before

• intercourse and must be left in place for at least 6 hours after. It should not be left in place for more than 24 hours because of the risk of TOXIC SHOCK SYNDROME (TSS).

NON-PHARMACOLOGIC THERAPY [4]

[NON-PHARMACOLOGIC THERAPY]
Barrier Techniques

Diaphragms

[NON-PHARMACOLOGIC THERAPY]
____are effective because they are barriers and because of the spermicide

• 6 hours before

• 6 hours after

[NON-PHARMACOLOGIC THERAPY]
Diaphragms are effective because they are barriers and because of the spermicide ; Placed in the diaphragm before insertion. It should be inserted up to _____ hours before intercourse and must be left in place for at least ____ hours after.

• 24 hours

• TOXIC SHOCK SYNDROME (TSS)

[NON-PHARMACOLOGIC THERAPY]
Diaphragms should not be left in place for more than ___ hours because of the risk of _____

28 days (range 21–40 days).

[ MENSTRUAL CYCLE]
An average length of the menstrual cycle is_____days

day 1.

[ MENSTRUAL CYCLE]
The first day of menses is _____

Ovulation

[ MENSTRUAL CYCLE]
____ usually occurs on day 14

day 14

[ MENSTRUAL CYCLE]
Ovulation usually occurs on _____

luteal phase

[ MENSTRUAL CYCLE]
After ovulation, the______ lasts until the beginning of the next cycle

hypothalamus

[ MENSTRUAL CYCLE]
The ____ secretes gonadotropinreleasing hormone (GnRH), which stimulates the anterior pituitary to secrete gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

gonadotropinreleasing hormone (GnRH)

[ MENSTRUAL CYCLE]
The hypothalamus secretes_____, which stimulates the anterior pituitary to secrete gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

• gonadotropin

• follicle-stimulating hormone (FSH)

• luteinizing hormone (LH).

[ MENSTRUAL CYCLE]
The hypothalamus secretes gonadotropinreleasing hormone (GnRH), which stimulates the anterior pituitary to secrete ____ [3]

follicular phase

[ MENSTRUAL CYCLE]
• In the _____ phase , FSH levels increase and cause recruitment of a small group of follicles for continued growth.

• days 5 and 7

• oocyte.

[ MENSTRUAL CYCLE]
• In the follicular phase, FSH levels increase and cause recruitment of a small group of follicles for continued growth. Between days ____ , one of these becomes the dominant follicle, which later ruptures to release the _____

estradiol and inhibin

[ MENSTRUAL CYCLE]
The dominant follicle develops, increasing amounts of ____ and _____, providing a negative feedback on the secretion of gonadotropinreleasing hormone and FSH

negative feedback

[ MENSTRUAL CYCLE]
The dominant follicle develops, increasing amounts of estradiol and inhibin, providing a ______feedback on the secretion of gonadotropinreleasing hormone and FSH.

estradiol, progesterone, and androgen.

[ MENSTRUAL CYCLE ]
The dominant follicle continues to grow and synthesizes _______ [3]

Estradiol

[ MENSTRUAL CYCLE ]
___ stops the menstrual flow from the previous cycle, thickens the endometrial lining, and produces thin, watery cervical mucus.

FSH

[ MENSTRUAL CYCLE ]
_____regulates aromatase enzymes that induce conversion of androgens to estrogens in the follicle

aromatase enzymes

[ MENSTRUAL CYCLE ]
FSH regulates_____ enzymes that induce conversion of androgens to estrogens in the follicle

mid cycle LH

[ MENSTRUAL CYCLE ]
• The pituitary releases a______ surge that stimulates the final stages of follicular maturation and ovulation

Ovulation

[ MENSTRUAL CYCLE ]
______ occurs 24 to 36 hours after the estradiol peak and 10 to 16 hours after the LH peak.

LH surge

[ MENSTRUAL CYCLE ]
The____ surge is the most clinically useful predictor of approaching ovulation.

luteal phase

[ MENSTRUAL CYCLE ]
___ phase is the third and final phase of the ovarian cycle.

luteal phase

[ MENSTRUAL CYCLE ]
It typically lasts about 14 days in a 28- day menstrual cycle.

FSH and LH

[ MENSTRUAL CYCLE ]
At the beginning of the luteal phase_____ cause the Graafian follicle that ovulated the egg to transform into a structure called a corpus luteum.

Graafian follicle

[ MENSTRUAL CYCLE ]
At the beginning of the luteal phase, FSH and LH cause the ____ that ovulated the egg to transform into a structure called a corpus luteum.

corpus luteum

[ MENSTRUAL CYCLE ]
At the beginning of the luteal phase, FSH and LH cause the Graafian follicle that ovulated the egg to transform into a structure called a _______

progesterone

[ MENSTRUAL CYCLE ]
• The corpus luteum secretes _____, which in turn suppresses FSH and LH production by the pituitary and stimulates the continued buildup of the endometrium in the uterus

fertilized

[ MENSTRUAL CYCLE ]
How this phase ends depends on whether or not the egg has been ___ ?

Conception

____is most successful when intercourse takes place from 2 days before ovulation to the day of ovulation.

corpus luteum

In CONCEPTION:
After ovulation, the remaining luteinized follicles become the______, which synthesizes androgen, estrogen, and progesterone.

androgen, estrogen, and progesterone

In CONCEPTION:
After ovulation, the remaining luteinized follicles become the corpus luteum, which synthesizes _______ [3]

human chorionic gonadotropin (HCG)

In CONCEPTION:
If pregnancy occurs, _____ prevents regression of the corpus luteum and stimulates continued production of estrogen and progesterone

• corpus luteum

• progesterone

• menstruation

In CONCEPTION:
If pregnancy does not occur, the

____ degenerates,

___declines and

_____ occurs

Pregnancy

This is a complex physiology which surrounds the process of fertilization and pregnancy progression

pharmacokinetics

In PREGNANCY :
Drug characteristics and physiologic changes modify drug ______

Absorption, Protein binding, Distribution, and Elimination

In PREGNANCY :
• Drug characteristics and physiologic changes modify drug pharmacokinetics during pregnancy, including changes in ____[4] requiring individualized drug selection and dosing.

drug-induced teratogenicity

In PREGNANCY :
____ is a serious concern during pregnancy