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75 Cards in this Set
- Front
- Back
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Risk factors for poor prenatal care:
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Less Educated
Multiparous Substance abuse Young age (<20) Unmarried |
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Ideal time frame to have a pre-conception meeting:
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3-6 months before conception
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What percentage of pregnancies are unplanned in pregnant women.
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Approx 50% of adult women
Note that 95% of teen pregnancies are unplanned |
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What days are the most vulnerable for the developing fetus?
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Days 17-56 post conception.
Unfortunately, many women don't realize they are pregnant during this time. |
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For a planned pregnancy, when should a women start increasing folate consumption?
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1 month prior to pregnancy
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Most common early signs of pregnancy (4):
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Amenorrhea
Nausea Fatigue Breast Tenderness |
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Sudden reddish hyperpigmentation over the bridge of the nose in pregnancy:
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Cholasma
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Naegele's rule for estimating delivery date (EDD):
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EDD = (LMP - 3 months) + 7 day
Formula does not work for women who have irregular menstrual cycles |
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When do urine pregnancy tests first become positive?
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Around the time of the first missed period
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For a normal pregnancy, how much does beta HCG increase during the first trimester of pregnancy?
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Doubles every 1.4 to 2 days until the fetus is 8 to 10 weeks old.
At minimum, should increase by 66% every 48 hours |
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What is the best diagnostic choice for a woman with abnormal bleeding or abdominal pain and posiive pregnancy test:
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Transvaginal ultrasound.
Note that sonographic landmarks correlate strongly with HCG levels, and sonography can accurately predict delivery date within 4 days during first trimester |
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For a woman who has a questionable spontaneous abortion, what are poor prognostic signs on physical exam?
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Cervix is dilated or prognosis is poor.
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You are caring for a woman and there is concern of a possible loss of pregnancy during the first trimester. What are the lab tests you should order?
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Transvaginal ultrasound, or Beta-HCG
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#1 cause of maternal mortality during the first trimester:
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Ectopic Pregnancy
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What demographics have a higher rate of legal medical abortions?
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White women
Women < 20 Unmarried women |
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Which type of oral contraceptive is most efficacious in preventing pregnancy?
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In general all types of contraceptives are equally efficacious.
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Will an oral contraceptive harm an already developing fetus?
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No!
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What is the mechanism by which progestin blocks a pregnancy?
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Thicken cervical mucus,
Inhibits capacitation Endometrial changes Disrupts FSH |
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Other reasons to OCPs other than preventing pregnancy:
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Helps with dysmenorrhea, Improves acne, prevents osteoporosis, and cervical cancer, and atherosclerosis
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In a woman < 35 years old who smokes, is it okay to use oral contraceptives?
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yes! The risk of mortality from cardiovascular disease is less than the risk of mortality from pregnancy
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Women is at higher cardiovascular risk but wants to be on a birth control pill. Which type do you recommend?
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A third generation OC, or a progestrin only pill.
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What comorbid medical condition causes a higher risk of stroke in a woman using oral contraceptives?
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Migraine with auras
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What is the most common cardivascular risk associated with oral contraceptives
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VTE
Risk is highest during the first 2 years of OC use and when the woman smokes, or if they have an inherent coagulation defect |
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What is the risk of breast cancer in women using oral contraceptives
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Risk is unclear
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Discuss the risk of cancer and use of oral contraceptives:
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?Breast Cancer
?Cervical Cancer Helps reduce ovarian cancer In general higher cancer risk when started at a young age and used for a long time. Risk for cervical cancer declines after OC is stopped |
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ACHES mnemonic for potential health problems when using oral contraceptives:
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Abdominal pain
Chest Pain (AMI, PE) Headaches (Stroke, hypertension, migraines) Eye Problems (migraine, stroke/TIA) Severe Leg Pain (DVT) |
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Three strategies for when to start oral contraceptives:
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Immediately (although use a back-up method of protection for first 7 days)
Starting at the first day of menses Starting on a Sunday (will need a back-up for the first 7 days) |
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Why are many women dissatisfied with progesterone only pills?
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Cause menstrual irregularities, irregular bleeding.
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What is DMPA?
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A long acting progesterone only administered subcutaneously or IM.
Mechanism of action is to inhibit ovulation. |
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What is a good contraceptive choice for a woman taking isotretinoin (Accutane)?
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DMPA
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What does DMPA do to bone density:
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Causes bone loss!
Loss may not be reversible, although may improve with discontinuation. |
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What are the advantages of using a proesterone only pill compared to OCP?
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No estrogen risks
May also be used for breastfeeding |
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What do OCPs do to the endometrial wall?
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Estrogen thickens endometrial wall, while progestin can thin the wall.
Both OCP and POP can thicken mucus |
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How long does it take a woman on DMPA to become fertile
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Long time! 10 months
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Two types of emergency contraceptives
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Levonorgestrel (Plan B)
Oral contraceptives containing EE plus levonorgestrel / norgestrel |
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Primary mechanism of action of oral conraceptives
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Prevention of ovulation or fertilization.
Do not interfere with implantation of a fertilized egg to uterus, and do not harm a developing fetus. |
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Progestin only contraceptives (POPs) and Emergency contraceptives and breastfeeding:
When can you use? |
Can use 6 weeks after beginning breastfeeding
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Side effects of emergency contraceptives:
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Nausea and vomiting
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Are prophylactic antibiotics needed for women with IUDs?
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No evidence to say these are helpful if a woman does not have an infection.
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Woman is using an IUD and develops cramping and discharge in first three weeks.
What is your next step in the management of the patient? |
Remove the IUD and start antibiotic as the woman has an infection.
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What is the most common side effect when using a diaphragm?
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Colonization of the vagina with E. Coli.
May lead to increased infections |
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What is Mifepristone (RU-486)
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Derivative of noretindrone that acts as a progesterone antagonist.
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What is misoprostol
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Prostaglandin analogue that causes uterine contractions
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What is the gestational age for which you can administer mifepristone:
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Up to 49 days
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What is the gestational age for which you can administer mifepristone + Misoprostol:
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Up to 63 days
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Recommended laboratory testing prior to using medical induced abortion:
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Blood typing, H&H.
Ultrasound may be needed to confirm date of fetus |
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Mgmt of a patient with ASCUS on PAP, HPV negative:
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Repeat cytology in 12 months
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33 year old female was shown to be ASCUS on PAP, HPV positive, but colposcopy showed no CIN. Next step?
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Repeat cytology in 6-12 months. HPV testing in 12 months. If negative, can go to routine screening. If positive on recheck, repeat colposcopy.
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Pt is ASCUS on PAP, HPV positive. Next step?
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Colposcopy
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Woman found to have LSIL on PAP, HPV+. Colposcopy revealed no CIN.
What now? |
Repeat cytology in 6 & 12 months. Check HPV in 12 months. If either reveals potential problems, repeat colposcopy
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Woman is found to have high grade squamous intraepithelial lesion (HSIL) on routine PAP.
What are your two options? |
Immediate loop electrosurgical excision OR proceed with colposcopy.
If Colposcopy shows no CIN 2,3, repeat colposcopy in 6 months and 1 year. |
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Definition of perimenopause
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The period immediately prior to menopause up to 1 year post menopause
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Of the three types of estrogen, which one increases the most in proportion to the others after menopause:
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E1
Made by fat cells. Note that overall, estrogen levels decrease by 60% after menopause |
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Most common reason for hysterectomy in US women in their 40's:
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Fibroids
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By definition, premature menopause is cessation of menstrual periods before this age:
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40 years old
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Traditional way to diagnose menopause:
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Retrospectively.
ie., if woman hasn't had a menstrual period in one year |
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When using FSH to diagnose menopause, at what level would you expect to be correlated with menopause:
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Anything over 60
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Affect of obesity on hot flashes:
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Obesity increases chances of a woman having hot flashes
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Alternatives for treating hot flashes other than estrogen/testosterone:
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Gabapentin
Venlafaxine Clonidine Megestrol acetate Also consider relaxation techniques |
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For women who are perimenopausal and complaining of mood swings, does estrogen help?
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They are of limited use
However, hormone therapy may be better than antidepressants. |
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Treatment of choice for atrophic vaginitis:
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Low dose estrogen cream. Also consider vaginal lubricants.
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Histology review!
In menopause women lose 50% of cancellous bone. Where is cancellous bone mostly located? |
Mostly in the spine and ends of long bone.
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Least costly method for dealing with bone loss:
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Prevention during young adult years.
Smoking cessation, weight bearing exercise Adequate intake of calcium and vitamin D. |
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Does progesterone alone help prevent osteoporosis?
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No
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Hormone(s) of choice for fighting bone density loss:
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Estrogen + Testosterone
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Concerns about these two conditions have led to a reduction in the use of estrogen for treating osteoporosis:
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Cardiovascular risk
Breast Cancer |
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Common side effect of Alendronate:
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GERD
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This SERM can help prevent vertebral fractures:
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Raloxifene
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How can a woman who is taking hormone therapy help reduce her risk of endometrial cancer?
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By taking progesterone along with estrogen
Progesterone has a protective effect on the uterus |
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Most common cardiovascular effect on post-menopausal women taking hormone therapy:
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Venous thromboembolism
Occurs in 0.9% of patients |
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Which has more risk for breast cancer: Estrogen therapy or combined therapy:
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Combined hormone therapy carries a higher risk of breast cancer.
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Exoganous testosterone has two beneficial effects on a post-menopausal women.
Name them: |
Bone density
Libido Not that long-term safety data is lacking. |
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The FDA has approved this drug for the prevention of breast cancer in this high risk population:
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Tamoxifen (a SERM)
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Can Tamoxifen increase uterine cancer risk?
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Yes
Can also lead to hot flashes |
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What are phytoestrogens?
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Plant substances that function similarly to E2. They are not stored in tissues.
Women in countries that eat more phytoestrogens in their diet have fewer menopause symptoms. |
