Ob/Gyn

Obstetrics Times

Prenatal Care First Trimester → Visit every 4 weeks First visit Many tests 9-14 weeks First trimester genetic screening Ultrasound Confirm gestational age Nuchal translucency (↑ in Down Syndrome) PAPP-A (Pregnancy-Associated Plasma Protein A) hCG ± Chorionic villus sampling (10-13w) Second Trimester → Visit every 4 weeks 15-20 weeks Triple/Quad test ± Amniocentesis (11-14w) 16-20...

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Breast Disorders

Breast Mass Approach Return after menstruation ↓ in size → Fibrocystic changes No change <35y → U/S Clear fluid → FNA Relieved → Follow-up q 3m Not completely gone → Excisional biopsy Bloody fluid → Excisional biopsy Mass → Excisional biopsy >35 → Mammography/core or excisional biopsy Not Proliferative...

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Estrogens

Estrone (E1) → Estrogen of adipose tissue Estradiol (E2) → Main estrogen Estriol (E3) → Estrogen of pregnancy (placenta) Estetrol (E4)

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Postpartum Infection

Definition Temperature ≥38℃ Day 2-10 postpartum ≥2 days Etiology The 7 W’s Womb Endomyometritis Wind Atelectasis Pneumonia Water UTI Walk DVT Pulmonary embolism Wound Incision Episiotomy Weaning Breast engorgement Abscess Mastitis Wonder drugs Drug fever Postpartum Endometritis Risk Factors Emergent C-section PROM Prolonged labor Multiple vaginal exams Intrauterine manipulation...

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Hyperemesis Gravidarum

Morning sickness past first trimester Due to ↑ hCG and ↑ Estradiol R/O Molar pregnancy Starvation, Ketonuria, Weight loss Treatment Vitamin B6 Doxilamine Promethazine/Dimenhydrinate Severe Metochlopramide Ondansetron Prochlorperazine Promethazine IM Treat dehydration

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Virilization

CAH → ⬆︎Urinary 17-OH Progesterone

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Infertility

Ovarian reserve → Early follicular FSH ± Estradiol Order for workup Penis Sildenafil Counseling Semen ICSI Mucus Estrogen Artificial Insemination Ovulation Clomiphene Pergonal (Menotropin, hMG) Anatomy ICSI IVF Tuboplasty Surrogate Endometriosis Laser ablation Idiopathic Adoption

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Secondary Amenorrhea

Secondary Amenorrhea Definition → No menses for 6 months Etiology Pregnancy Breastfeeding Anovulation PCOS Pituitary adenoma ↑Prolactin ↑TRH PRIMARY hypothyroidism SECONDARY hyperthyroidism Hyperthyroidism Medications Antidepressants OCP Estrogen deficiency Ovarian failure Menopause Premature ovarian failure Hypothalamic pituitary insufficiency Outflow obstruction/stenosis Asherman’s syndrome Stress Extreme weight loss Excessive exercise

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Puberty

Precocious Puberty Types Central → GnRH dependent Peripheral → GnRH independent Diagnosis Wrist X-ray → Bone age GnRH stimulation test Give leuprolide (GnRH agonist) ↑ LH → Central No change in LH → Peripheral

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Incontinence

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

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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...

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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...

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