OB/Gyn clinical notes

Pap smear starts @ 21 or new onset intercourse

Abnormal pap, LEEP- surgery for dysplastic cervix, increased risk for prematurity on successive pregnancy, cervical shortening.

gonorrhea, chlamydia - test with urine

>30 years old? Pap + HPV is very sensitive (can rule you out), if -/- don't repeat for 3 yrs

vaginal pH - low, blood, semen, rupture of membrane increases pH

three major infections in GU

yeast - cottage cheese, no change in pH

trichomoniasis -erythema, greenish yellow frothy, increases pH

bacterial vaginosis - grey spilled milk, increases pH

-whiff test - KOH tx and smells bad, or have sex without condom and alkaline sperm create bad smell, clue cells

bacterial vaginosis, trichomonas treated with metronidazole

"chandelier sign" - moving the cervix causes great pain, sing of peritoneal tenderness

acute cystitis - UTI

chronic cystitis (interstitial) disease of lining of bladder, chronic UTI w/neg culture, avoid acidic, citric, spice, tylenol

fetal heart rate monitoring

keep track of

1. rate

2. variability

3. accels/decels

4. uterine contractions

reactive heart rate should accelerate to

<32>10 bpm for 10 seconds x2 within 20 minutes

>32 weeks gestation? fhr accelerate>15 bpm for 10 seconds x2 within 20 minutes

late decelerations happen after uterine contraction, very bad, sign of fetal hypoxia, possible uteroplacental insufficiency

4 questions to ask every antepartum mother every morning?

1. any contractions/cramping?

2. any vaginal bleeding?

3. any fluid leakage? water break?

4. any fetal movments?

actinomyces is associated with IUD's, treatment is penicillin

Endometrial Cancer

US 40,000 cases annually, 4-5,000 deaths

typical clinical presentation is post-menopausal bleeding

risk factors

obesity - adipose contains aromatase (converts estrogen)

nulliparity

smoking is protective because nicotine by products induce clearance of estrogen, ^ binding

globulin

tamoxifen

HNPCC - hereditary nonpolyposis colorectal cancer - in young presentations

atypical hyperplasia - 30% go on to develop cancer

Diagnostics

Ultrasound - $1,800 good negative predictive value

Biopsy - $100's, 80-90% sens/spec

D&C better but con is surgery

Woman >35yrs w/menorrhagia? Sample.

Prognosis - Grade very important, higher grade lower prognosis, more than stage

Stage

Ia <1/2cm>

Ib >1/2cm invasion into myometrium

II stromal invasion

IIIa - serosa/tube/adnexal

b - vagina

c - nodes (pelvic, periaortic)

IV a bladder/rectal mucosa

b Distant

Treatment

surgery (uterus, nodes, bilateral salpingoopherectomy)

low risk? no further tx

intermediate risk? radiation (pelvic vs intracavitary brachytherapy)

high risk? chemo + radiation

Anesthesia in Labor-

somatic vs visceral pain

visceral pain - hard to localize, first stage of labor, well treated w/opioids

somatic pain - stage two in labor,