Term
| 1st trimester vaginal bleeding |
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Definition
| miscarriage, ectopic pregnancy, gestational trophoblastic disease |
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Term
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Definition
Weeks that have been completed since the first day of last menstrual period
Problems: irregular menstrual cycles
variable timing of ovulation ( days 10 - 21) |
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Term
| Estimated Date of Delivery (EDD) |
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Definition
"Due Date"
- Estimated Date of Confinement (EDC)
-90% of pregnancies end +/- 3 weeks |
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Term
| Average length of human pregnancy |
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Definition
266 days after fertilization
280 days after 1st day of last menstrual period (lMP)
- 40 weeks |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
affects about 0.5-2%
-causes severe dehydration
- pregnancy complication: multiple gestation or trophoblastic disease
- requires hospitalization: hyperalimentation
- pregnancy termination is necessary in rare cases |
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Term
| Typical time course of morning sickness |
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Definition
begins 5-7 weeks of gestation
peaks 8-10 weaks
abates >12 weeks |
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Term
| What is nausea and vomiting triggered by? |
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Definition
Rapdily rising HCG
- worse in multiple pregnancy
- prior motion sickness, migraines, PMH of family with it |
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Term
| What are some treatments for nausea |
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Definition
| rest, avoidance of triggers, diet, hydration, anti-emitc drugs, ginger, accupressure |
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Term
| Most common cause of bleeding in first trimester |
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Definition
| Benign bleeding of early pregnancy = OK |
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Term
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Definition
Common = 20% of all gestation
- diagnosis of exclusion = we try and exclude everything else |
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Term
| What does a first trimester ultrasound do? |
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Definition
Confirms location (IUP and Ectopic)
-viability of embryo
-detects molar pregnancy
- therapeutic effects |
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Term
| SAB= spontaneous abortion |
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Definition
*Miscarriage*
15-20% of clinical pregnancies and occurs in 1st trimester
risk increases with maternal age (egg health and qulaity) |
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Term
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Definition
- *UNHEALTHY EMBRYO* = egg health and chromosomal genetic abnormality
-hormone imbalances, uterine malformations, infections, immunological |
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Term
Clinical Course of Miscarriage
3 phases |
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Definition
1st phase: 6-9 weeks = intermittent bleeding and cramping
2nd phase : 1-3 weeks later= heavy bleeding and cramps
3rd phase : few hours later: gestational sack expelled
D & C is sometimes required
*EMBRYO DEATH PRECEDES THE MISCARRIAGE BY 2-6 WEEKS** |
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Term
| Location of Ectopic Pregnancy |
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Definition
95% in fallopian tube
5% in cervix |
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Term
| Risk factors for ectopic pregnancy |
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Definition
tubal infection (salpingitis)
prior ectopic pregnancy
tubal sterilization
IUD
cigarette smokes |
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Term
| How do you diagnose ectopic pregnancy |
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Definition
vaginal bleeding 6-10 weeks
pelvic pain:lateralizes then goes right to the middle
ULTRASOUND IS ESSENTIAL TO DX
*crucial to make diagnosis before rupture* |
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Term
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Definition
most occur between 8-12 weeks
- massive intraabdominal blood loss
- severe pain, ER**
*requires salphingectomy |
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Term
What can you do for an unruptured ectopic
what's the surgery called? |
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Definition
Chemotherapy
or surgery: conserve tube or remove it
salpingostomy |
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Term
Gestational Trophoblastic Disease (GTD)
most common form |
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Definition
Choriocarcinoma (life threatening) or hydatidiform mole
molar pregnancy |
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Term
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Definition
trophoblastic neoplasm
more common in old and very young
low folic acid diet
egg got fertelized in 2 sperms... but the maternal nucleus is inactivated and now there are 2 sperm nucleus |
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Term
| What does a molar present like? |
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Definition
NO embryo!
high HCG Levels
preeclampsia, ovarian cysts, and hyperemesis gravidarum
uterine bleeding |
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Term
| How do you treat a molar pregnancy |
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Definition
monitor HCG levels
evacuate the uterus
rising HCG levels could lead to an invasive GTD |
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Term
| Late Pregnancy problems (4) |
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Definition
Supine Hypotension
hypertensive syndromes
placental disorder
premature labor |
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Term
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Definition
| after 20 weeks... pregnant women should lay on side |
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Term
| Pregnancy Induced Hypertension |
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Definition
Makes up for 70% of hypertensive states of pregnancy
30% makes up for pre-existing hypertension
- Gestational hypertension
- preeclampsia-eclampsia
- superimposed preeclampsia |
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Term
| What antihypertensive drugs are contraindicated in pregnancy? |
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Definition
ACE inhibitors
Angiotensin Receptor Blockers (ARBs) |
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Term
Preeclampsia
what are complications for mom and baby? |
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Definition
Hypertesion (BP > 140/90)
Proteinuria
Complications:
Maternal: seizures (eclampsia), stroke, renal failure, death
fetal: poor growth and intrauterine death |
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Term
| What's the difference between Preeclampsia and Eclampsia? |
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Definition
Eclampsi is preeclampsia with grand mal seizures
mostly happens in antepartum, then intrapartum/postpartum is 25% both |
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Term
| What are the causes of preeclampsia/eclampsia? |
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Definition
not really sure!
Best guess: alteration of placental physiology that mediates vascular dilation normally seen throughout pregnancy |
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Term
| Mild Preeclampsia treatment |
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Definition
prevent eclampsia = bed rest and MgSO4
deliver if greater than 37 weeks and hospitalize if before that |
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Term
| Severe Preeclampsia treatment |
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Definition
Prevent eclampsia
deliver regardless of gestational age
take steroids if less than 34 weeks and delay deliver for 24-48 hours |
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Term
| Whats most popular medicine to prevent seizures |
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Definition
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Term
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Definition
Placenta previa
Abruptio Placenta
*BOTH PRESENT AS 3RD TRIMESTER VAGINAL BLEEDING* |
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Term
Placenta previa
Types of previa (3) |
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Definition
*PAINLESS 3rd trimester vaginal bleeding**
placenta has implanted low in cervical canal *covers cervix*
.. risk factors are increased by uterine scar (C-section)
- hypoperfused endometrium
- enlarged placenta (multiple pregnancy)
marginal, complete, low-lying |
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Term
| How do you manage placenta previa? |
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Definition
Deliver the baby! total will require a c-section
- Delay delivery if they are less than 35 weeks, bleeding is minimal and pt. is NOT in labor |
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Term
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Definition
*PREMATURE SEPERATION OF THE PLACENTA*
PLACENTA ABRUPTION
PAINFUL*** 3RD TRIMESTER BLEEDING
-pain at seperation site and Labor contractions
- happen from blunt trauma or car rash or idiopathic |
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Term
| Premature Labor *Preterm* |
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Definition
labor between 21-36 weeks
MOST IMPORTANT CAUSE OF NEONATAL DEATHS AND MORBIDITY*
- acute respiratory disease, chronic lung disease, CP, necrotizing enterocolitis, retinitis, blindness |
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Term
| Risk factors of premature labor |
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Definition
1. prior premature labor
2. multiples
3. african american
4. socioeconomic
other factors: poor weight gain, anemia, smoking, bacterial vainosis |
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Term
| Glucocorticoid for preterm labor |
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Definition
given less than 34 weeks to mother systemically
*Increases amount of surfactant production*
stimulates maturation of fetal lung |
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Term
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Definition
drug to delay delivery 1-2 days
- allows time for glucocoriticoid
- ca++ blockers, MgSO4, Beta-2 sympathomimetics |
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Term
Endometriosis
incidence of disease
Symptoms |
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Definition
Endometrial glands and stroma cells outside of the uterus
*Most common in infertile women... found in normal fertile women too.. 1-10%
*PELVIC PAIN* dysmenorrhea, dyspareunia, deep seated pelvic pain
Infertility |
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Term
| How do you Diagnose endometriosus |
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Definition
| Visualize the lesions via laparoscopy or open surgery... or by diagnostic imaging |
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Term
Causes of endometriosis
Treatment |
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Definition
Retrograde menstruation
endometrial cells implant on somewhere else
- like blood or lymph
ovarian suppresion or surgery |
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Term
| Uterine Leiomyoma = "Fibroids" |
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Definition
benign tumor or uterine smooth muscle
- rarely becomes malignant
*KEY FACTOR based on symptoms on SIZE AND LOCATION*
Location most typical= INTRAMURAL
Very common 40-50% of women by age 50!!!
Estrogen Dependent |
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Term
| Whats treatment for fibroid |
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Definition
Meds that block/reduce estrogen = GnRH
or Antiprogestational
- Radiological EMBOLIZATION THERAPY
- Surgery: Myomectomy or hysteroctomy |
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Term
| Ovarian Cysts: Functional Cysts |
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Definition
common
ovulation abnormality
go away spontaneously |
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Term
| Ovarian Cysts: Polycystic Ovarian Syndrome |
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Definition
ANOVULATION
- excessive ovarian androgen production (ELEVATED TESTOSTERONE PRODUCTION)
could lead to Type 2 Diabetes |
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Term
| Ovarian Cysts: Benign Ovarian Neoplasms |
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Definition
Benign cystic teratoma*** = Dermoid
*can be serous or mucous*
*Results from growth of unfertilized egg** |
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Term
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Definition
unknown benign tumors
serous and mucinous: discomfort, bloating, GI disturbances |
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Term
| What is a special risk for all cysts? |
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Definition
| TORSION... could cause twisting of ovaries and could trigger ischemia and acute pain |
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Term
Breast Cancer
screening
Treatment |
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Definition
*PRESENTED AS PAINLESS LUMP*- discovered by patient
Most cancer is associated with the ducts than glandular elements
- rare before 40
risk increases with early menarche and late menopause
screened by mammography during annual breast exam
surgery, radiation, chemo, anti-estrogen drugs, immune modulation |
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Term
| What increases lifetime risk for breast cancer |
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Definition
presence of tumor suppressor gene mutations
BRCA 1 and BRCA 2
increases to 50-85% with presence of gene |
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Term
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Definition
Factors that lower risk: pregnancy and oral contraceptive use
*EPITHELIAL ORIGIN (90%)*: serous or mucinous
Germ cell origin, or stromal/sex cord origin
most likely for intra-abdominal spread* and cause gastrointestinal compromise
Surgery: remove uterus, ovaries, omentum,
chemo |
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Term
Cervical Cancer
PREVENTION |
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Definition
Main Cause: HPV - human papillomavirus
also synergism with cigarette and immunosuppression (HIV)
High Risk HPV: Types 16, 18, 33, 35, 45
prevented by HPV vaccine: Gardasil... attacks strains 6, 11, 16, 18 |
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Term
How do you screen for cervical cancer?
How do you treat cervical cancer? |
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Definition
pap smear...
Hysterectomy and lymph node disection GYN oncologist
radiation therapy, chemotherapy |
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Term
| How can cervical cancer cause death? |
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Definition
| cancer can block ureters and cause renal failure |
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Term
Endometrial "Uterine" Cancer
how is it diagnosed?
How is it treated? |
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Definition
cancer that can spread to myometrium
quite common but not terribly lethal
Risk: estrogen exposure, not enough progesterone, genetics
decreased risk: oral contraceptive or progestin
POST MENOPAUSAL BLEEDING***
biopsy... D&C
Radiation, surgery: removing uterus, ovaries, and fallopian tubes, give progestins and anti-estrogens, chemo |
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Term
| Oral Contraceptives and Cancer |
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Definition
DECREASES RISK OF OVARIAN CANCER
DECREASES RISK OF ENDOMETRIAL CANCER
no impact on cervical or breast cancer |
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Term
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Definition
Key Triggering event: OVARIAN EGG SUPPLY REACHES ZERO
KEY CONSEQUENCE: ESTROGEN PRODUCTION DECREASES
- so they will have increased levels of FSH
Cessation of menses for 6-12 months
age of onset: mean is 51
obese women's fat cells make more estrogens = longer onset of periods |
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Term
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Definition
amenorrhea
vasomotor flushes
sleep disruption
decreased vaginal lubrication
reduced pelvic support for bladder and uterus
accelerated calcium loss* |
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Term
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Definition
this disrupts sleep
*error in thermoregulation= hypotahlamus thinks the body has elevated body temp
*peak incidence is 3-5 years after menopause |
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Term
| Treatement for menopause/hot flushes |
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Definition
SSRI's, Progestin, estrogen
Hormone Replacement Therapy: give the estrogen thats missing |
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Term
Estrogen Replacement
*What's the key to taking estrogen* |
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Definition
Estradiol
conjugated estrogens,
or combined with progestins
IF UTERUS IS STILL PRESENT PROGESTERONE MUST BE TAKEN WITH ESTROGEN |
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