Ob-gyn board notes

OB-GYN Board Notes

Dysfunctional uterine bleeding:
 Most common cause is fibroids and can be dx by pelvic utz.
 Most common cause of iron deficiency anemia in females
 Get worse after menopause and reduce in size with OCPs.
Endometrial cancer
 Any type of dysfunctional uterine bleeding in a post menopausal female
is endometrial ca till proven otherwise. Dx by endometrial bx  Commonly presents as irregular bleeding in post menopausal females  most patients are aged 50-59 years
 will see thickened endometrium on utz
 Next step in management endometrial Bx

Endometriosis/adenomyosis
 Pieces of the endometrium break off and attach to the abdominal wall
and tissue since it is endometrium is will cycle in size so the pain is cyclic
as well

Leiomyoma
 Uterine fibroids are leiomyomata of thesmooth muscle. As other
leiomyomata, they abut may lead to excessive menstrual
blee often causeand may lead to

Metritis

 Endometritis is divided into obstetric and non-obstetric endometritis. It is the most common cause of fever during the postpartum period.
 Fever in a post-partum patient is metritis until proven otherwise.

Prolapse
Prolapse uterus and bladder are common events in a post-menopausal patient
and present with the feeling of a mass in the lower areas and bladder specifically
presents with urinary sxs such as frequency, urgency, and incontinence.

Ovary Cyst
 An ovarian cyst is a sac filled with liquid or semi-liquid material arising in an ovary. The number of diagnoses of ovarian cysts has increased with the widespread implementation of regular physical examinations and ultrasound technology.  the vast majority of ovarian cysts are benign  Most commonly presents with lower abdominal pain with radiation to
the back area
 DX: UTZ

Neoplasms
 Primary lesions include epithelial ovarian carcinoma (70% of all
ovarian malignancies), germ-cell tumors, sex-cord stromal tumors, and
other more rare types. Metastases to the ovaries are relatively frequent,
with the most common being from the endometrium, breast, colon,
stomach, and cervix.
 the mean age is 56 years
 Mutation in the BRCA1 or BRCA2 gene is present
 CA125 is a glycoprotein antigen detected by using mouse monoclonal
antibody OC125 raised from an ovarian cancer cell line.  CA125 is elevated in other benign and malignant conditions, including
menstruation; endometriosis; pelvic inflammation; liver, renal, and lung
disease; and cancer of the endometrium, breast, colon, pancreas, lung,
stomach, and liver.
 spreads initially within the peritoneal cavity= Ascites the most
common presentation
 Ultrasound reveals ovarian cancer tumors more accurately than
blood tests, study finds. "A new study finds ultrasound is more
accurate than blood test[s] when determining if an ovarian tumor is
cancerous," according to a report appearing in the Nov. 13 issue of
Journal of the National Cancer Institute.
Raloxifene (Evista) and Tamoxifen commonly used in treatment Cervix Cancer
 Cervical cancer is the second most common malignancy in women
 abnormal vaginal bleeding, usually postcoital
 Major risk factors observed include sex at a young age, multiple sexual partners, promiscuous male partners, and history of STDs  HPV viral DNA has been detected in more than 90% of squamous
 TX: colposcopy, direct biopsies, and endocervical curettage  Papillomavirus vaccine (Gardasil®) -- Quadrivalent HPV recombinant
vaccine. 3 doses 1st dose/ 2nd dose 2 months later/ 3rd dose 6 months after
1st dose
First vaccine indicated to prevent cervical cancer, genital warts
(condyloma acuminata) HPV 6 and 11
 Cervarix® same dosing frequency

PAP Smears Guidelines
Age of 1st Pap = 21 then every 2 years until 30 then every 3 years
Age of final Pap= 65 if at least 3 normal results in the preceding 10 years
Dysplasia
 PAP smear must be done as well as a culture for HPV
 Stage I repeat pap smear
 Stage II dysplasia (atypical squamous, low-grade squamous, high grade
squamous intraepithelial lesion or atypical glandular cells )= colposcopy
 HPV 16 and 18 most common cause for cervical CA

Cervicitis
 Cervicitis is an inflammation of the cervix secondary to Chlamydia trachomatis clear scant d/c cause of PID
 TX: azithromycin or doxycycline
Neisseria gonorrhoeae purulent copious d/c
 TX: Ceftriaxone
Trichomonas vaginalis green frothy d/c strawberry cervix
 TX: Flagyl
Herpes simplex virus (HSV) clear vesicular lesions
 TX: acyclovir
 human papillomavirus (HPV).
 Noninfectious cervicitis might be caused by local trauma, radiation, or
Cystocele/Prolapse/Rectocele
Uterine prolapse is a descent or herniation of the uterus into or beyond the
vagina. Uterine prolapse is best considered under the broader heading of "pelvic
organ prolapse," which also includes cystocele, urethrocele, enterocele, and
rectocele. Anatomically, the vaginal vault has 3 compartments: an anterior
compartment (consisting of the anterior vaginal wall), a middle compartment
(cervix), and a posterior compartment (posterior vaginal wall). Uterine prolapse
involves the middle compartment. Uterine prolapse always is accompanied
by some degree of vaginal wall prolapse.

Amenorrhea:
most common cause is pregnancy otherwise it is secondary to a hormonal
issues (lack of estrogen) and lack of weight
Menopause most commonly occurs female after 50
Bone density scan are needed after age 65
Breast Carcinoma
 most common is ductal located upper outer quadrant  Mutation in the BRCA1 or BRCA2 gene is present Raloxifene (Evista) and Tamoxifen commonly used in treatment Study suggests annual combined screening may increase life
expectancy for patients with BRCA1 gene mutations.
(2/27, Brown) reports that based on data from the Surveillance Epidemiology and End Results Program and the Breast Cancer Surveillance Consortium, researchers say that "[a]mong women with BRCA1 gene mutations, which are known to increase the risk of breast cancer, annual screening with both mammography and MRI is associated with better survival when compared with screening with either method
Postpartum hemorrhage:
 Usually secondary to retained products DX: UTZ
Premature rupture of membranes
Nitrazine test

Placenta previa
 The classic presentation of placenta previa is painless vaginal
bleeding
 A leading cause of third trimester hemorrhage Bleeding is thought to occur in association with the development of the lower uterine segment in the third trimester. Placental attachment is disrupted as this area gradually thins in preparation for the onset of labor
Abruptio placentae
 Abruptio placentae is defined as the premature separation of the placenta from the uterus. Patients with abruptio placentae typically present
with bleeding, uterine contractions, and fetal distress. A significant
cause of third-trimester bleeding associated with both fetal and maternal
morbidity and mortality, abruptio placentae must be considered whenever bleeding is encountered in the second half of pregnancy  Bleeding may be profuse and come in “waves” as the patient's uterus Dystocia
 Dystocia is considered the result of any of the following during labor: (1) abnormalities of expulsive forces; (2) abnormalities of presentation, position, or development of the fetus; and (3) abnormalities of the maternal bony pelvis or birth canal. Frequently, combinations of these 3 interact to produce a dysfunctional labor.
Ectopic pregnancy
 Any lower abdominal pain in a pregnant patient 12 weeks or less is an  TX: Methotrexate stable 8 weeks or less

Gestational diabetes
 Infants of mothers with preexisting diabetes experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit admission.  Hyaline membrane disease, large birth weight, ??CP, Erb’s palsy
Gestational trophoblastic disease
 Gestational trophoblastic disease (GTD) can be benign or malignant. Histologically, it is classified into hydatidiform mole, invasive mole
(chorioadenoma destruens), choriocarcinoma
 Hydatidiform mole is the most common form of gestational
trophoblastic neoplasia In hydatidiform moles, beta-hCG levels greatly
exceed those produced in normal pregnancy

Infusing pregnant women with magnesium sulfate may decrease
cerebral palsy risk, study suggests.
 "one-third of cerebral palsy cases are caused by early preterm birth," researchers at the University of North Carolina-Chapel Hill found that administering magnesium sulfate intravenously could not only "halt [early] contractions" and preeclampsia, but it is also believed to reduce blood vessel constriction in the infants' brains.
Folic acid may reduce a woman's risk of delivering prematurely,
study suggests
 Moreover, the group found that taking supplemental folic acid -- either by itself or in a multivitamin - - for at least a year before conceiving was tied to a 70 percent lower risk of delivering between 20 and 28 weeks' gestation and a 50 percent lower risk of delivering between 28 and 32 weeks."

Source: http://paboardreview.org/uploads/OB-GYN_Notes.pdf