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30 Cards in this Set
- Front
- Back
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Women of reproductive age who are sexually active
HIV-positive women Immunocompromised women During prenatal care workup |
Pap Smear
Indications |
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Active vaginal, cervical, or uterine infection
Relative Contraindication Blood contamination, especially if heavy |
pap smear CI
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Vaginal discharge
Vulvar or vaginal pain, itchiness, or odor Abnormal vaginal secretions |
Cervical-Vaginal Sampling
Indications |
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Heavy bleeding with blood contamination of sample
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Cervical-Vaginal Sampling
CI |
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Single cervical polyp (easiest)
Multiple cervical polyps: may best be treated with curettage of the cervical canal Endometrial polyps: require at least a dilation and curettage (D&C), possibly hysteroscopy Postmenopausal women with cervical polyps have an increased incidence of coexisting endometrial polyps and may need hysteroscopy and/or D&C. High association of cervical polyps with tamoxifen therapy and menopause (with or without hormone replacement therapy): consider D&C with tamoxifen therapy. |
Cervical Polyp Removal
Indications |
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Active cervical or uterine infection
Oral anticoagulation, which may require electrosurgical removal and coagulation in surgery suite Uncooperative patient |
cervical polyp removal CI
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Failed Word catheter treatment in the acute setting
Recurrent infections or reaccumulation of Bartholin’s gland cyst fluid. |
Bartholin’s Marsupialization
Indications |
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Cysts that could be adequately treated with a Word catheter
Coagulation defect (either medication related, congenital, or acquired) that is uncorrected Patient who is unable to comply with wound care |
Bartholin’s Marsupialization CI
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Acute infections
Pain from cyst enlargement Obstructive Bartholin’s gland cyst affecting the patient’s sexual activity or obstructing the vaginal orifice. |
Bartholin’s Cyst Word Catheter Placement
Indications |
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Cysts that should be treated by marsupializtion
Coagulation defect (either medication related, congenital, or acquired) that is uncorrected |
Bartholin’s Cyst Word Catheter Placement
contraindications |
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Abnormal Pap smear indicating any degree of dysplasia
Pap smear indicating atypical glandular cells Pap smear indicating persistent atypical cells of undetermined significance Prior intrauterine DES exposure Abnormal-appearing or palpable cervix Persistent unexplained vaginal discharge Visible human papillomavirus (HPV) infection of the genital tract (condylomata) Unexplained vaginal bleeding Other sexually transmitted diseases HIV-positive status Intravenous drug abuse Cervical HPV-DNA screen positive for high-risk types Follow-up of previously treated cervical, vaginal, or vulvar dysplasia Evaluation of injuries resulting from sexual assault (special training necessary) |
Colposcopy
Indications |
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Inflammatory or infectious cervicitis
Acute pelvic inflammatory disease (PID) Active uterine bleeding Uncooperative patient |
Colposcopy
contraindications |
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Treatment of cervical dysplasia, colposcopy performed first
Treatment of cervical dysplasia involving the canal, cone excision Significantly abnormal Pap smear in a noncompliant patient |
Loop Electrosurgical Excision
Indications |
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Active cervical, endometrial, or pelvic infection
Uncontrolled and/or characterized bleeding disorder Noncooperative patient Extreme caution in patients on anticoagulation |
Loop Electrosurgical Excision
contraindications |
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Any unidentifiable or concerning lesion
Lesion that does not respond to conventional therapy Pigmented lesions Atypical nevi Vulvar ulceration of uncertain etiology Leukoplakia Acetowhite epithelium Vulvodynia with acetowhite epithelium (tissue that turns white after the application of vinegar) Presumed condylomata that are not responding to conventional therapy (following two treatment attempts of any kind) Postmenopausal woman with atrophic vaginitis that does not respond to estrogen therapy and no other cause is evident Any skin abnormality requiring definitive diagnosis |
Vulvar Biopsy
Indications |
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Poorly controlled infection over biopsy site (treat then biopsy)
Caution with large excisional biopsies with anti-coagulation |
Vulvar Biopsy
ContraIndications |
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Evaluation of the causes of abnormal uterine bleeding: postmenopausal bleeding, malignancy/hyperplasia, ovulation/anovulation, and hormone replacement therapy
Evaluation of women with bleeding after 1 year of presumed menopausal amenorrhea Assessment of enlarged uterus (combined with ultrasound) (negative pregnancy test) Monitoring adjuvant hormonal therapy (tamoxifen citrate) Infertility assessment: short luteal phase determination, ovulation/anovulation Evaluation prior to estrogen therapy in women who are at increased risk for uterine cancer Evaluation of endometrial cells or estrogen effect on Pap smears in postmenopausal women Evaluation of a Pap and atypical glandular cells of undetermined significance (AGUS) For screening women who are at gigher risk of uterine cancer, particularly associated with hereditary nonpolyposis colorectal carcinoma. This is the only true screening indication for endometrial biopsy Evaluation of an inappropriately thick endometrial stripe found on ultrasound Evaluation after progesterone therapy for adenomatous hyperplasia |
Endometrial Biopsy
Indications |
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Positive pregnancy test
Pelvic inflammatory disease Unreducible cervical stenosis Ambiguous uterine anatomy form pelvic examination Noncooperative patient |
endometrial bx Contraindications
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Patient in active labor
Fetus in no distress |
Vaginal Delivery
Indications |
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Vasa previa or placenta previa
Abnormal fetal lie Cord prolapse Prior classical cesarean section Active genital herpes infection Fetal deformities |
Vaginal Delivery
contraIndications |
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Previous cesarean delivery and patient declines vaginal birth after cesarean (VBAC)
Previous cesarean, classical or unknown surgery Maternal emergencies requiring the fastes mode of delivery: severe preeclampsia, uterine rupture, cardiovascular emergencies Cephalopelvic disproportion Fetal presentation or lie inconsistent with vaginal delivery Cord prolapse Cervical malignancy of other pelvic tumor Active genital herpes Arrest of labor Failed instrumented delivery Macrosomia Fetal prematurity, compromise, or distress |
Cesarean Section
Indications |
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pt refusal
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Cesarean Section
contraIndications |
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Instumented delivery
Shoulder dystocia Perineal barrier to effective delivery Fetal prematurity Breech presentation |
Episiotomy-Laceration Repair
Indications |
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Extensive vulvar varices
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Episiotomy-Laceration Repair
contraIndications |
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Estimation of gestational age
Determination of interval fetal growth Determination of presenting part Suspected multiple gestation Significant uterine size/dates discrepancy Confirmation of fetal viability Suspected uterine abnormality Biophysical profile (BPP) Suspected polyhydramnios or oligohydramnios Placental localization |
Obstetric Ultrasound
Indications |
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Unstable fetal/maternal medical status when immediate surgical delivery is necessary
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Obstetric Ultrasound
contraIndications |
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An element in the induction of labor
An element in the augmentation of labor To diagnose meconium-stained amniotic fluid To place fetal scalp electrodes To start amnioinfusion |
Amniotomy
Indications |
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High presenting part, with risk of cord prolapse
Presenting part unknown Vaginal delivery contraindicated Cervix not favorable for induction or less than 3 cm Group B streptococcus colonization and antibiotics not available |
Amniotomy
contraIndications |
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Size inconsistent with dates
Maternal diabetes Hypertensive diseases of pregnancy High-risk pregnancy Post dates pregnancy |
Amniotic Fluid Index Ultrasound
Indications |
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pt refusal
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Amniotic Fluid Index Ultrasound
contraIndications |
