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Breast Cancer
Risk Factors Family history HRT in menopause Most common → Adenocarcinoma Presentation Early findings Asymptomatic Sudden mammography finding Mass Single Nontender Immovable Hard to touch Ill-defined margins Unilateral bloody nipple discharge → Intraductal papilloma Locally advanced findings Axillary lymphadenopathy Breast enlargement Pain Peau d’orange → Suggests inflammation Redness Thickening...
Read morePrimary Amenorrhea
First pregnancy test! Definition No 2º sexual characteristics by 13y 2º sexual characteristics present but no menses by 15y Etiology 2º sexual characteristics ABSENT Gonadal dysgenesis Turner syndrome Swyer syndrome Premature ovarian failure Radiation/Chemo to ovary Central hypogonadism Hypothalamic/Pituitary insufficiency Constitutional growth delay Undernourishment Stress Hyperprolactinemia Exercise Cranial radiation...
Read morePostpartum Hemorrhage
Definition Bleeding >500ml after vaginal delivery >1000ml after C-section Early PPH → within 24h Late PPH → 24h-6w Etiology Atony Risk Factors Anesthesia Uterine overdistension Multiple gestations Polyhydramnios Prolonged labor Laceration Retained parts Placenta accreta Coagulopathy Diagnosis Enlarged, soft boggy uterus Laceration Retained parts Placenta Accreta (75%) To superficial uterine wall...
Read moreLabor Complications
Prolonged Latent Stage Prolonged latent phase Primipara: >20h Multipara: >14h Etiology Sedation Unfavorable cervix Uterine dysfunction (irregular/weak contractions) Treatment Rest Hydration Most convert to spontaneous delivery in 6-12h Protracted Cervical Dilation Slow cervical dilation Active stage No change for 4h >5h long Primipara: <1.2 cm/h Multipara: <1.5 cm/h Etiology Power...
Read moreNormal Labor
Electronic Fetal Monitoring (external tacometer) FHR Normal: 110-160 bpm Tachycardia: >160 bpm Hypoxia Maternal fever Fetal anemia Bradycardia: <110 bpm Congenital heart disease Severe hypoxia Uterine hyperstimulation Cord prolapse Rapid fetal decent Variability Absent variability Minimal variability Normal variability Marked variability Sinusoidal variability Acceleration 2 increases in FHR >15...
Read moreFetal Testing
Nonstress Test (NST) 20 mins Mother in lateral tilt position Result Reactive → 15/15. 2 in 20 Fetal movements ≥ 2 FHR acceleration ≥ 2 >15 bpm Lasts 15-20 secs Nonreassuring Fetus asleep → Vibroacoustic stimulation Biophysical Profile (BPP) 30 mins 5 categories (2 point each) NST Chest expansion ≥ 1 Movement...
Read moreFetal and Amniotic Size
Fetus IUGR Fetus weight in bottom 10% for GA Symmetric Before 20w Brain in proportion to body Asymmetric After 20w Brain bigger that body Etiology First trimester Chromosomal abnormality Uterine Infection 2/3 trimester Maternal HTN → Asymmetric Maternal smoking → Asymmetric Maternal substance abuse Maternal malnutrition Maternal anemia Placenta...
Read moreDiabetes in Pregnancy
Pregestational Diabetes Diagnosis DM type 1/2 before pregnancy Complications Mother Preterm labor 4x preeclampsia 2x spontaneous abortion ↑ infection ↑ postpartum hemorrhage Fetus ↑ congenital anomalies Heart Neural tube Macrosomia Shoulder dystocia Additional evaluations needed Mother EKG 24h urine Cr clearance Protein HbA1c Ophthalmologic exam Fetus 22-24w → Fetal...
Read moreHypertension in Pregnancy
Chronic Hypertension Diagnosis BP > 140/90 before 20w Treatment Methyldopa Labetalol Hydralazine Nifedipine ACEi and Diuretics ⇒ Uterine ischemia Gestational Hypertension Diagnosis BP > 140/90 after 20w No edema No proteinuria Treatment Metyldopa Labetalol Hydralazine Nifedipine Preeclampsia Risk Factors Chronic HTN Renal disease Mild Diagnosis BP > 140/90 Proteinuria...
Read moreRh Incompatibility
Hemolytic Disease of Newborn Fetal anemia Extramedullary hematopoiesis Billirubin neurotoxicity High output CHF Erythroblastosis fetalis Screening Algorithm Initial prenatal visit → Antibody screening Mother Rh Positive → No further workup Mother Rh Negative Dad Rh Negative → No further workup Dad UNKNOWN and high-risk pregnancy → Amniocentesis PCR for fetal blood type (16-20w) Fetus...
Read moreRupture of Membranes
Spontaneous ROM → After or at the labor onset Premature ROM → >1h before labor onset Preterm Premature ROM (PPROM) → <37w gestation Prolonged Premature ROM (Prolonged ROM) → >24h prior to delivery Premature ROM Presentation Gush of fluid Diagnosis Sterile speculum exam Fluid in posterior fornix Nitrazine paper → blue Ferning...
Read morePreterm Labor
Risk Factors Previous episode Multiple gestations Cervical surgery PROM Placental abruption Uterine abnormality Chorioamnionitis Preeclampsia Abdominal surgery Polyhydramnios Poor maternal nutrition Low SES Presentation Contraction Cervix dilation 20-37w Complications RDS Intraventricular hemorrhage PDA Necrotizing enterocolitis Retinopathy of prematurity Bronchopulmonary dysplasia Death Treatment High risk for preterm labor → Vaginal/IM progesterone during...
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