Notes

Incontinence

Hypertonic bladder Motor urge Oxybutinin Amitriptyline Neurogenic bladder Hypotonic Overflow incontinence Bethanecol Intermittent catheterization

Gynecology Infections

Bartholin Gland Cyst Pain, tenderness, dyspareunia Mass Medial labia majora Lower vestibular area I&D → Culture fluid for STD Vaginitis ↑ pH of vagina Antibiotics → kills Lactobacillus Diabetes Normal flora overgrowth Douching Disease Bacterial Vaginosis Candidiasis Trichomoniasis Pathogen Gardnerella Candida albicans Trichomonas vaginalis Discharge Gray-white Fishy odor NO inflammation White...

Adnexal Mass

Ovarian Hyperthecosis Etiology Nests of luteinized theca cells scattered in the ovarian stroma ↑↑ production of androgens ↑ risk of endometrial hyperplasia/carcinoma Presentation Virilization in a postmenopausal woman Obesity More severe hirsutism than PCOS Shaving common Virilization Clitoral enlargement Temporal balding Deep voice Male habitus Amenorrhea/Irregular menses Severe insulin...

Pelvic Anatomy

Vulvar/Vaginal Problems

Pediatric Labial fusion Excess androgen (21-β hydroxylase deficiency) Sarcoma Botryoides Rhabdomyosarcoma Vaginal discharge Bunches of grapes within vagina Epithelial Abnormalities Lichen sclerosus White skin from labia to anus ↑ cancer risk postmenopause → Paget or Carcinoma Treatment → Topical steroid Squamous cell hyperplasia Chronic irritation results in hyperkeratosis In chronic...

Moles

Gestational Trophoblastic Disease Etiology Benign Complete Sperm + Empty egg 46 XX No fetal tissue Incomplete Sperm + 2 Eggs 69 XXY Contains fetal tissue Malignant Invasive Mole Choriocarcinoma Risk Factors Mom age <20y, >40y ↓ Folate ↓ β-carotene Presentation First trimester bleeding Hyperemesis gravidarum Preeclampsia/eslampsia <24w ↑↑ Uterus...

Endometrial Cancer

Etiology Type I (75%) Type II (25%) Endometrioid Estrogen exposure Preceded with hyperplasia Mean age 55y OCP is protective Serous Unrelated to estrogen p53 mutation Later age Poorer outcome Risk Factors ↑ Estrogen exposure Early menarche Late menopause PCOS Obesity Lynch syndrome Tamoxifen Estrogen only HRT OCP ⇒ ↓ Risk Presentation...

Gynecologic Cancers

→ IM-Oncology

3rd Trimester Bleeding

Placenta Previa Risk Factors Previous C-section Previous uterine surgery Multiple gestations Previous episode Presentation Painless vaginal bleeding Spontaneous detection on US before 28w Diagnosis Transabdominal ultrasound No vaginal exam before US! Types Complete Partial Marginal Low-lying placenta (0-2 cm away from cervical os) Vasa previa Treatment...

Prenatal Infections

Group B Strep The only time mother with a positive Group B strep screen doesn’t get intrapartum antibiotic is Planned C-section, NO ROM, NO start of delivery Prophylaxis → Ampicillin Allergic → Erythromycin Hep B Positive Ag C-Section Give baby IVIg and Hep B vaccine right after delivery Breastfeeding ok HIV 2...

OB Operations

C-Section Sodium Citrate → For all C-sections give Na citrate ↓ Gastric acidity Prevent Acid Aspiration Syndrome Indication Elective Previous C-section Classic Transverse Active genital herpes Cervical carcinoma HIV infection Placenta previa Breach Postterm pregnancy Desired Urgent Prolonged Arrest of labor Eclampsia Failed vaginal delivery Erythroblastosis fetalis Emergent Maternal...

Other Medical Disease in Pregnancy (UTI, Thyroid)