but you CANNOT give methotrexate if-
baby has heartbeat
mom has severe pain
baby is >3cm
vulvar pain differential will mostly likely be
folliculitis
vulvovaginitis
bartholin's cyst
treatment for recurrent bartholin's
1. salt water bath
2. glandectomy
3. marsupialization (sewing it open)
do not use KY jelly for exam lubricant in an REI clinic because its spermicidal
getting an accutane prescription in NYS requires a pledge that you will not become pregnant or evidence you are on OCP
episiotomies - two types (midline and mediolateral)
mediolateral - worse healing more nerve damage
midline - faster better healing
LATEST ACOG GUIDELINES INDICATE EPISIOTOMIES ARE NOT HELPFUL, DO NOT CUT THEM.
Retained placenta - >30minutes and placenta has not delivered.
problem- could bleed to death
how to get it out?
-manual
-DnC
transfusion - 1 unit of pRBC increases Hct3points, Hgb1point
How to put in an IUD
obtain consent
insert speculum visualize cervix/os
clean w/betadyne
grasp cervix w/tenaculum
sound uterus (figure out how deep)
cock the IUD and put it in gently
cuts strings and foxswabs for any bleeding
>35 years old and metro/menorrhagia = endometrial biopsy
Hypertensive emergency in the OR?
1. labetalol push 20mg wait 10min, still high? 20mg push wait 10min still high?, 40mg wait 10min still high?, 40mg wait 10 still high?, 80mg push wait 10min still high?
2. hydralazine 5mg wait 5min, still high? 5mg wait 5min still high? 10mg, wait 5min still high? 20mg wait 5min still high?
3. call ICU need drip w/Ca channel blocker
1:370 is the risk for fetal loss during amniocentesis so when the risk of down's becomes greater than 1:370 amnio is indicated otherwise risk of loss of fetus supercedes
advice on marriage from patient
1. never take each other for granted
2. no sundown on anger
3. take care of yourself (keep looking good/attractive)
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