Ob/Gyn

Multiple Gestations

Etiology Fertility drugs Presentation Exponential uterus growth Rapid wight gain ↑ hCG ↑ MSAFP Diagnosis Ultrasound Monozygotic (identical) Dizygotic (fraternal) Complications General Preterm delivery Placenta previa Breech presentation Post-partum hemorrhage Spontaneous abortion Anemia Monochorionic (one placenta) Twin-twin transfusion Monoamniotic (one amniotic sac) Conjoined twins Cord entanglement

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Abortion

Pregnancy that ends Before 20w gestation Fetus <500g Etiology Chromosomal abnormality (60-80%) Anatomical abnormality STDs Antiphospholipid syndrome Hyperthyroidism Diabetes Malnutrition Trauma Rh isoimmunization Symptoms Cramping abdominal pain Vaginal bleeding Hypotension Diagnosis CBC Blood type Ultrasound Treatment Type Findings Cervix Treatment Complete abortion No products found Closed Follow up Incomplete...

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Ectopic Pregnancy

70-80% in ampulla Risk Factors PID IUD Previous EP Symptoms Pelvic pain Vaginal bleeding Hypotension if ruptures Diagnosis hCG If hCH >2000 then pregnancy should be seen with U/S Ultrasound Laparoscopy Treatment Methotrexate Contraindications Immunodeficiency Non-compliance Liver disease EP > 3.5 cm hCG >5000 Fetal heart beat Surgery Salpingostomy...

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Prenatal Care

First Trimester Visit every 4 weeks First visit Blood tests CBC Rh/Blood type Rubella Ab HBsAb VDRL/RPR HIV ± HCV Varicella HbA1c Sickle cell U/A and UC PPD Pap smear → Dysplasia Cervical Gonorrhea/Chlamydia Discuss genetic screening Tay-Sachs CF 9-14 weeks First trimester genetic screening Ultrasound Confirm gestational age...

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Normal Pregnancy

Definitions Embryo → Fertilization – 8w Fetus → 8w – Birth Infant → Birth – 1y   Gravidity/Parity G-TPAL G (# of pregnancies) P (full term; preterm; abortion; living children)   Dating Methods Developmental Age (DA): since fertilization Gestational Age (GA): since LMP Nagele rule: Estimated deilvery = LMP...

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Polycystic Ovarian Syndrome

Risk Factors Familial Valproic acid Presentation Amenorrhea Irregular menses Infertility Hirsutism Androgenic alopecia Obesity Acne Metabolic syndrome Insulin resistance DM type 2 Acanthosis nigricans Atherogenic dyslipidemia Hypertension Diagnosis Rotterdam Criteria (2 out of 3) Polycystic ovaries on U/S Bilateral enlarged ovaries, multiple cysts Anovulation/Oligoovulation History of Amenorrhea Clinical/Biochemical hyperandrogenism...

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Uterine Abnormalities

Fibroids Etiology Leiomyoma → Smooth muscle and connective tissue Estrogen-responsive → Change with cycles Non-malignant Risk factors Estrogen-responsive Change with cycles Shrink with menopause Black > White Presentation Uterine bleeding Menometrorrhagia Anemia Mass effect Enlarged uterus Constipation Urinary retention/frequency Pain Dysmenorrhea Dyspareunia Diagnosis Physical exam Firm, nontender, irregular, enlarged...

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Contraception

Best Methods What’s in it? Duration The Good The Bad Implanon Progestin only 3 years Light period Breastfeeding Ok Irregular periods Weight gain IUD (Levonorgestrel) Progestin 5 years Light period ↓ cramps Breastfeeding Ok ↑ EP risk PID IUD (Copper) 10 years Breastfeeding Ok ↑ cramps/bleeds ↑ EP risk...

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Uterine Bleeding

PALM COEIN Structural Polyp Adenomyosis Leiomyoma (Fibroids) Malignancy Non-structural Coagulopathy Ovarian Dysfunction (AUB) Endometrium Iatrogenic (IUD) Not yet classified Abnormal Uterine Bleeding Type Description Etiology Menorrhagia Heavy bleeding Endometrial hyperplasia Uterine fibroid DUB IUD Hypomenorrhea Light bleeding/Spotting Hymen Cervical stenosis OCP Oligomenorrhea Menstrual cycle >35 d Pregnancy Menopause Anorexia...

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Menopause

Permanent loss of estrogen 48-52 years Average 12 months Symptoms Menstrual irregularity Sweating Hot flashes Mood changes Insomnia Anxiety/Irritability Poor concentration Dyspareunia Loss of libido Vaginal atrophy Vaginal pruritus Vaginal dryness Physical Exam Atrophic vaginitis ↓ Breast size Vaginal/cervical atrophy Diagnosis NO test needed! ↑FSH ↑LH ↑ Total cholesterol...

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PMS/PMDD

Symptoms Headache Breast tenderness Pelvic pain Bloating Irritability Low energy Diagnosis Menstrual Diary Premenstrual Dysphoric Disorder Symptomatic for 2 consecutive cycles First half symptom free; Second half with symptoms Dysfunction in life Treatment Limit coffee, alcohol, cigarettes, chocolate Exercise Severe → SSRI

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