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67 Cards in this Set
- Front
- Back
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pain menstruation caused by excess prostaglandin E2 secretion in menstual fluid, leading to painful uterine contractions
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primary dysmenorrhea
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typical ages of primary & secondary dysmenorrhea
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primary--peaks during late teens & early 20s. secondary--increases with age
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cramping in central lower abdomen or pelvis radiating to the back or thighs beginning before or at onset of menses lasting for 1-3 days
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primary dysmenorrhea
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symptoms of secondary dysmenorrhea
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bloating, menorrhagia, dyspareunia less related to first day of flow
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treatment for primary dysmenorrhea
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NSAIDs, oral contraceptives, heat, exercise
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incidence & treatment of PMS
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10-90% incidence, 10% debilitating, prevalence greatest during 4 & 5th decades; OCP +/- helpful spironolactone for fluid retention, NSAIDs for pain, SSRIs, Anxiolytics
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mean age of menopause
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51.5; 95% stop menstruating between 44-55
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clinical features of menopause
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insomnia tiredness irritability (usually resolves in 2-3 yrs; 3-6 weeks with estrogen therapy), bone loss skin thins & less elastic facial hair increases, hair loss increaes
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labs suggestive of menopause
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FSH >30
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drawbacks to treatment of menopause with combination hormone replacement therapy
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increase risk of heart disease, breast cancer, cognitive changes, migraines, gallbladder disease
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topical estrogens may improve urogenital symptoms in menopause, but unopposed estrogen increases risk of....
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endometrial cancer
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abnormal uterine bleeding in the absence of an anatomic lesion, usually caused by a problem with the hypothalamic-pituitary-ovarian hormonal axis
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DUB-dysfunctional uterine bleeding
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when are you most likely to see dysfunctional uterine bleeding
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shortly after menarche or during perimenopause
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what is leiomyomata
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uterine fibroids
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what pt might you expect to see uterine fibroids (leiomyomata) in?
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african american women with a family history, fibroids are dependent on estrogen
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most common gyn cancer in america
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endometrial cancer, median age 58, 75% of pts are postmenopausal
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most common symptom in endometrial cancer
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inappropriate uterine bleeding (90% of patients)
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condition in which endometrial glands and stroma r found outside the endometrial cavity
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endometriosis; most commonly found n nulliparous women n late 20s or early 30s, infertility is common
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dysmenorrhea, deep-thrust dyspareunia, dyschezia intermittent spotting, pelvic pain suggests
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endometriosis
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treatment of endometriosis
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surgery for large endometriosmas, danazol, OCPs, mifepristone
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treatment for ovarian cysts
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follow for 1-2 cycles in premenopausal women with cysts smaller than 8 cm, large or persistent cysts require laparoscopic eval, postmenopausal cysts are presumed to be malignant
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what is PCOS
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polycystic ovarian syndrome; pts have bilateral enlarged ovaries amenorrhea or oligomenorrhea, infertility
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cause of PCOS
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not clear, thought to be hypothalamic pituitary dysfunction & insulin resistance; pts at increased risk for endometrial hyperplasia & cancer
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this infection is strongly linked to cervical neoplasia
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HPV (human papilloma virus)
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persistent noncyclic breast pain suggests
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breast cancer
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breast tenderness, heat, fever, chills, flu like symptoms suggest
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mastitis & abscess
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when would u biopsy a fibroadenomatous mass
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<25 yo
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treatment of mastodynia (benign breast tenderness)
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reassurance, B6, bromocriptine, tamoxifen
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mean age of breast cancer
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60-61
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risk factors for breast cancer
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nulliparity, early menarche, leate menopause, long term estrogen or radiation exposure, delayed child bearing
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paget's disease
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ductal carcinoma presenting as an eczextous lesion of the nipple
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disadvantages of oral contraceptives
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increase risk of blood clots, abnormal lipids, possible increase in risk of breast cancer, HTN, cholelithiasis, benign liver tumors
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failure rates of OCPs
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<1% theoretically; actual rates are 4-6%
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definition of infertility
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failure to conceive after one year of unprotected intercourse, 15% of reproductive aged couples in US
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first test in evaluation of infertility
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semen analysis
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treatment success rate of infertility
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85%
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medical treatment of infertility
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clomiphen citrate 50-100 mg 5 days beginning day 3, 4, or 5 of cycle given to anovulatory women to promote ovaluation
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acute salpingitis, IUD-related cellulitis, tub-ovarian abscess, pelvic abscess are examples of
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pelvic inflammatory disease
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exam findings in pelvic inflammatory disease
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lower abdominal & pelvic pain, nausea, headache, lassistude
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how do you figure EDC (expected day of confinement)
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first day of last menstrual cycle minus three months plus seven days
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G_P_ _ _ _ stands for what
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G-total pregnancies, P is total deliveries, _ _ _ _ stands for term infants, premature deliveries (20-36wks) abortions (therapeutic/spontaneous <20wks), and living children
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wks of gestation for first heart tones
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10-12 wks, heartrate 120-160
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wks of gestation of first fetal movement
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18-20 wks primigravida, 14-18 wks for multigravida
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what does a triple screen test for
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alpha-fetoprotein, human chorionic gonadotropin )hcG) and unconjugated estriol
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what does high triple screen test or a low test suggests
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high-increased risk for neural tube defects; low-increased risk of down syndrome
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baseline fetal heartrate
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120-160
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A normal NST requires what
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2 accelerations of heart rate in 20 minutes of up to 15 bpm from baseline heart rate for a duration of 15 seconds and absence of decelerations
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definition of deceleration of fetal heart rate
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decline in HR of 15 bpm or lasting more than 15 seconds or slow return to baseline. persistent late decelerations which begin AFTER peak contraction warrant intervention
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what is an ectopic pregnancy
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implantation of pregnancy anywhere but the endometrium
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classic presentation of ectopic pregnancy
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unilateral adnexal pain, amenorrhea or spotting, tenderness or mass on pelvic exam
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evaluation for ectopic pregnancy
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hCG should double q 48 hours, if not suspect ectopic, transvaginal u/s id diagnostic 90% of time.
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treatment options for ectopic pregnancy
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methotrexate or surgery
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spontaneous abortion
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termination of pregnancy before 20 wks by any means, occurs n 15-20% of recognized pregnancies, 80% n first trimester of which 50% r secondary to chromosomal abnormalities
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what is gestational trophoblastic disease (GTD)
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spectrum of diseases arising from the placenta
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Hydatifdiform moles is a type of ........
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benign GTD (gestational trophoblastic disease
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incidence of twins
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1 in 94 births
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this is a carbohydrate intolerance of variable severity that is only present during pregnancy
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gestational diabetes
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incidence of diabetes after pregnancy if u have gestational diabetes
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50%
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when do u screen for gestational diabetes
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24-28 wks unless high risk then as soon as feasible
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what does PROM and PPROM stand for and what are the major risks involved
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premature rupture of membranes and preterm premature rupture of membranes; risk of infection
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triad of preeclampsia
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hypertension, edema, proteinuria
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what is HELLP syndrome in pregnancy
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severe preeclampsia, hemolysis, elevated liver enzymes, and low platelets
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this is a condition when mom and baby's blood type are not identical, mom may develop antibodies against infant's blood whcih can result in hemolysis
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Rh sensitization
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Why would you give Rho-gam (immunoglobulin)
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Rh neg mothers for prophylactic protection at 28 wks; if baby is Rh + give again after delivery to protect against subsequent pregnancies. Rhogam helps prevent development of antibodies to infant's blood
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this is the premature separation of a normally implanted placenta after wk 20 of gestation
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abruptio placentae; this is the most common cause of bleeding in the third trimester
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S&S of abruptio placentae
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painful vaginal bleeding, uterine, abdominal or back pain
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diagnosis of abruptio placentae
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clinical diagnosis, ultrsound is not reliable
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