Term
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Definition
Endometrial stroma and glands found in areas other than endometrium, respond to hormonal changes just as endometrium does: proliferating, bleeding
Cause may be from retrograde menstrual flow
lymphatic & vascular metastasis
deficient cell mediated immunity |
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Term
| Where can endometriosis lesions develop? |
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Definition
| Implants may be found in/on intestinal tract, urinary tract, lungs, thorax, peripheral nerves, central nervous system, surgical scars |
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Term
| Incidence of Endometriosis |
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Definition
Increased risk: short cycles <27 days, long flow >7 days, spotting before menses, family history
15 to 70% of infertility and chronic pelvic pain patients have endometriosis
50% of premenopausal women |
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Term
| What is the gold standard for diagnosing Endometriosis? |
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Definition
| Direct visualization with histologic examination is gold standard |
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Term
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Definition
History: timing of pain and/or bleeding, other associated symptoms, family history
not unusual for little or no dysmenorrhea after menarche then develops later, progresses
Physical exam: may be normal, tender nodules to masses, unless obvious takes experienced examiner
May be helpful to examine while bleeding, implant areas will be more tender, swollen
Imaging/lab
Empiric therapy |
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Term
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Definition
Ultrasound could detect endometromas
MRI may see implants and adhesions
CT can reveal lesions outside of pelvis
Barium enema/Colonoscopy for bowel infiltration
CA 125 elevated - used for ovarian screening but not ovarian ca specific |
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Term
| Treatment for Endometriosis |
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Definition
NSAIDS
Combination hormone therapy
Cyclic
Continuous
Progestin-only therapy
GnRH agonists
Danazol
Surgery |
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Term
| Etiology & Incidence of Uterine Fibroids |
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Definition
25-50% of women, may be as high as 80%
Most common solid pelvic tumor
Pathogenesis: Initial trigger unknown, but cells overgrow forming tumor
Signs/Symptoms dependent on size and location of tumor |
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Term
| Diagnosing Uterine Fibroids |
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Definition
Menstrual history: develops later in reproductive years, not likely diagnosis in adolescents
Abdomen: If tumor large enough may feel in abd
Ultrasound usually effective, cost effective too, when differential diagnosis is not clear MRI or CT may be helpful, may not palpate submucosal tumors
CBC: Assess for anemia, if surgery needed, correct anemia if possible, if only symptom is heavy bleeding, consider bleeding disorders |
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Term
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Definition
OCP’s progestin dominant, use lowest dose possible, may not work, Depo-Provera may work
GnRH agonists: same as endometriosis
Surgery: Embolization-radiologist usually performs, catheterization to uterine arteries, fibroids have increased vasculariztion, foreign body injected into artery, blocks blood flow, tumor dies (UVa and Martha Jefferson)
Risks-decreased ovarian function-some of foreign material may drift into ovarian arteries-ischemic injury, infection
Myomectomy-removal of fibroid only- increased risk of blood loss, long procedure, needs to be done by someone with experience, retain fertility, but often subfertile and increased risk of spontaneous abortion and uterine rupture at delivery
Hysterectomy-Curative, ovaries can remain |
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Term
| Chronic Pelvic Pain Etiology & Incidence |
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Definition
No accepted definition but generally considered duration of longer than 6 months
Source may be reproductive, urinary, GI, musculoskeletal or neurologic
Approximately 15-20% of women 15-50 yo have pain greater than 1 year
More common in women who have been physically or sexually assaulted |
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Term
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Definition
Testing dependent on H&P
History: Timing, associated symptoms
Abdominal and pelvic exam
Tenderness or restricted movement
Ultrasound/MRI/CT
Lab: CBC, UA, STD’s
X-ray: Barium enema, spinal
Laparoscopy, colonoscopy, cystoscopy |
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Term
| Treatment for Pelvic Pain |
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Definition
Antidepressants
Analgesics
Antibiotics
OCP’s/progestins
GnRH agonists
Exercise
Referral for:
Physical Therapy
Surgery
Pain management |
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Term
| Pregnancy drug classifications |
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Definition
A thru X
A: vitamins insulin, thyroxin
B: many antibiotics
C: Most drugs, no controlled studies, but frequently used and seem OK
D: DANGER, risk known but may needed to preserve life
X: NO use in pregnancy, applies to both parents, stop 6 mos before pregnancy |
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Term
| When can the embryo be harmed? |
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Definition
| Prior to day 31 no organs to disrupt either the embryo is destroyed or unharmed, after day 81-formation complete |
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Term
| Hypertension and Pregnancy |
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Definition
Increased risk for pre-eclampsia, placental insufficiency, growth restriction, fetal hypoxia
Labetalol most used, nifedipine also used (can also treat preterm labor)
ACE inhibiters increase risk for fetal anomalies, diuretics not recommended
Proteinuria associated with increasing blood pressure indicates pre-eclampsia
Evaluating for kidney function prior to pregnancy helpful, can be baseline if develops pre-eclampsia |
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Term
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Definition
Tight control of glucose at time of conception and first trimester can decrease the risk of fetal malformation
Oral meds generally not used, type 2 DM usually need to use insulin
Insulin demands vary by trimester
Increased risk for renal damage, pre-eclampsia, hydramnios, preterm labor, macrosomia |
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Term
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Definition
Worsens in 1/3, improves in 1/3
Risk of fetal hypoxia if asthma not treated greater risk than medication exposure
Inhaled medications (corticosteroids, beta agonists) little systemic absorption
Antihistamines, leukotriene antagonists safe
Bronchospasm may worsen third trimester because of acid reflux
If decreased pulmonary function in labor, may be indication for Cesarean Section |
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Term
| Rheumatic disorders and pregnancy |
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Definition
Most problematic: Rheumatoid Arthritis and Systemic Lupus
Arthritis pain may improve during pregnancy but recur and worsen postpartum
NSAIDs, glucocorticoids useful and safer than gold, Plaquenil or Imuran
Lupus with antiphospholipid antibodies increase the risk of thrombosis-maternal and placental
Anticoagulants often used: Heparin, Lovenox
Fetal monitoring essential |
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Term
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Definition
Stress of pregnancy/delivery/postpartum may trigger increase in symptoms
Increased risk of postpartum depression and psychosis
SSRI’s (C) frequently used, seem safe, Wellbutrin (B)
Lithium increases risk for congenital heart malformations
Benzodiazepines may increase cleft lip/palate
Newborns may have drug withdrawal/sedation if medications used near delivery |
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Term
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Definition
Tension headache more common than migraine
Preexisting migraine may improve or worsen
Triptans not frequently used, vasoconstriction may also occur in uterine vessels, oral is probably better than injectable
Tylenol (B), NSAIDs (B until 32 weeks then D) |
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Term
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Definition
Untreated thyroid disorders may decrease fertility
Undiagnosed or undertreated can increase risk for miscarriage, preterm birth, pre-eclampsia, Thyroid storm, CHF
Pregnancy places varying demands on the thyroid.
Monitor TSH &/or T4 at beginning and every 6 weeks to adjust dosage
Levothyroxine (A), PTU (D)
Postpartum: Increased risk for new and temporary thyroid disorder.
Check thyroid function in postpartum depression
May affect breast milk if not euthyroid |
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Term
| Substance Abuse & Pregnancy |
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Definition
No safe amounts of tobacco, etoh or illegal drugs known. Probably better to use nicotine replacement than tobacco-not getting all the tars, carbon monoxide, etc
Excessive caffeine >2-3 sources /day=increased infertility, miscarriage, fetal overstimulation ? Placental injury
Many of these cause premature placental aging, doesn’t provide good vascular supply to fetus.
Meth, Coke increase risk of placental abruption, PTL, neonatal withdrawal |
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