Ob and Female Reproduction

Endometrial CA is the most common gynecologic malignancy in the US. p2398 St Louis

ASCCP colposcopy guidelines REF

All oral agents cross the placenta (in contrast to insulin) leading to the potential for severe neonatal hypoglycemia. Use insulin in pregnant diabetics. REF 

DUB treatment option ? A levonorgestrel-releasing intrauterine device. REF

A single progesterone lvl of 25 ng/mL or higher indicates a healthy pregnancy and excludes ectopic pregnancy with a sensitivity of 98%.  
At an hCG lvl of 17,000 mIU/ml cardiac activity can be detected.

The classic triad of missed menses, pain, and bleeding - think ectopic pregnancy. REF

Cigarette smoking is the only nonsexual behavior strongly correlated with cervical dysplasia and cancer, independently increasing the risk two- to fourfold. REF

All combo OCPs raise SHBG and decrease testosterone - can lead to improvement in acne. REF

Screening for GBS is done by obtaining cultures from the rectum and vaginal introitus at 35–37 weeks' gestation. REF

Patients with persistent hyperestrogenic states are at heightened risk for the development of endometrial cancer. REF

Fetal distress with prolonged, variable, or late decelerations and bradycardia is the most common, and often only, sign of uterine rupture. 

BV - Amsel criteria - must have 3 of 4 to dx:
1. pH > 4.5 - most sensitive
2. clue cells (> 20%) - most specific.
3. homogenous discharge.
4. positive whiff test (amine odor with addition of KOH).

BV - another questions.

Great stuff - at 16 weeks: 
1. AFP - if it is up (2.5 X) then US.
2. Amniocentesis if US does not explain the elevated AFP.
3. Chorionic Villus Sampling offered in eval of chromosomal abnormalities as adjunct to AFP.
4. hCG is used in working up Down syndrome (expect 2.5 NL in DS), AFP is decreased in DS.

A 16-week visit is advised for all pregnant women to offer alpha-fetoprotein (AFP) screening for neural tube defects and Down syndrome. 

With epidural anesthesia an increase in the rate of cesarean sections has not been shown. 

The usual recommendation is to treat postpartum endometritis with clindamycin and gentamicin. Keep your "cins" together in endometritis.

While no single diagnostic imaging procedure would result in a radiation dose that would threaten the well-being of a developing embryo or fetus, and fetal risk is considered to be negligible at 5 rad or less, certain imaging procedures do carry a higher radiation dose than others: Fluoroscopic barium enema 3.986 rad IVP 1.395 rad Lumbosacral spine films 0.359 rad V/Q lung scan 0.215 rad Chest film, two views 0.00007 rad

Adnexal masses in women under 45 years of age are benign in 80%–85% of cases.

Infants of hypertensive mothers have a threefold increase in perinatal mortality compared to infants with IUGR who are born to normotensive mothers. 

Perinatal mortality doubles at 42 weeks gestational age. REF

Down syndrome REF

Ovarian cancer is the deadliest gynecologic malignancy in the U.S. REF

Currently in elderly women at average risk there is no screening method for ovarian CA. REF

Work up for secondary amenorrhea. REF

Bacterial Vaginosis (BV) - tx with oral or vaginal clindamycin or Flagyl. REF
- In BV there is no documented need to tx the male partner.

Fetal distress has proven to be the most reliable clinical symptom of uterine rupture. REF

Injectable medroxyprogesterone acetate REF
-  is not causally linked with thromboembolic events
- MC SE is menstrual irregularities
- weight gain is also a SE
- there may be a decrease in HDL-cholesterol and an increase in LDL

Define fetal tachycardia and state the DDX. REF