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30 Cards in this Set

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Women of reproductive age who are sexually active
HIV-positive women
Immunocompromised women
During prenatal care workup
Pap Smear
Indications
Active vaginal, cervical, or uterine infection

Relative Contraindication
Blood contamination, especially if heavy
pap smear CI
Vaginal discharge
Vulvar or vaginal pain, itchiness, or odor
Abnormal vaginal secretions
Cervical-Vaginal Sampling
Indications
Heavy bleeding with blood contamination of sample
Cervical-Vaginal Sampling
CI
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
Active cervical or uterine infection
Oral anticoagulation, which may require electrosurgical removal and coagulation in surgery suite
Uncooperative patient
cervical polyp removal CI
Failed Word catheter treatment in the acute setting
Recurrent infections or reaccumulation of Bartholin’s gland cyst fluid.
Bartholin’s Marsupialization
Indications
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
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
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
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
Inflammatory or infectious cervicitis
Acute pelvic inflammatory disease (PID)
Active uterine bleeding
Uncooperative patient
Colposcopy
contraindications
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
Active cervical, endometrial, or pelvic infection
Uncontrolled and/or characterized bleeding disorder
Noncooperative patient
Extreme caution in patients on anticoagulation
Loop Electrosurgical Excision
contraindications
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
Poorly controlled infection over biopsy site (treat then biopsy)
Caution with large excisional biopsies with anti-coagulation
Vulvar Biopsy
ContraIndications
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
Positive pregnancy test
Pelvic inflammatory disease
Unreducible cervical stenosis
Ambiguous uterine anatomy form pelvic examination
Noncooperative patient
endometrial bx Contraindications
Patient in active labor
Fetus in no distress
Vaginal Delivery
Indications
Vasa previa or placenta previa
Abnormal fetal lie
Cord prolapse
Prior classical cesarean section
Active genital herpes infection
Fetal deformities
Vaginal Delivery
contraIndications
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
pt refusal
Cesarean Section
contraIndications
Instumented delivery
Shoulder dystocia
Perineal barrier to effective delivery
Fetal prematurity
Breech presentation
Episiotomy-Laceration Repair
Indications
Extensive vulvar varices
Episiotomy-Laceration Repair
contraIndications
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
Unstable fetal/maternal medical status when immediate surgical delivery is necessary
Obstetric Ultrasound
contraIndications
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
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
Size inconsistent with dates
Maternal diabetes
Hypertensive diseases of pregnancy
High-risk pregnancy
Post dates pregnancy
Amniotic Fluid Index Ultrasound
Indications
pt refusal
Amniotic Fluid Index Ultrasound
contraIndications