1. mesonephric ducts (wolffian)

2. paramesonephric (mullerian) duct

3. yolk sac

4. gonadal ridge

5. urogenital sinus

6. urogenital ridge

1. incision: transverse abdominal most common, others: midline suprapubic

2. classical vertical incision

3. low-transverse incision

4. indications: when vag delivery is not feasible or would impose undue risk, repeat c/s, cephalopelvic disproportion/dystocia, malposition/presentation, fetal distress, placenta previa, preeclampsia, multiple gestation, fetal abnormalities, cervical cancer, active herpes

5. complications: pospartum hemorrhage, endometritis, wound infection, dehiscence

1. indications: tx of gynecological cancer, benign gyn conditions, obstetrical complications

2. pre-op: baseline eval to detect cancer - pap smear w/in 3 mos, bimanual exam, pelvic US, IVP, bowel prep, IV abx before procedure, compression stockings for VTE pro

3. TAH: sx or pelvic findings suggesting adnexal disease, older pts with significant GI complaints, pts wanting additional procedures (liposuction)

4. Supracervical: difficulty dissecting cervix, distorted atatomy due to PID or endometriosis, compromised medical condition. less chance of nerve damage and therefore bladder/orgasmic problems

5. vaginal: gynecoid pelvis w/ wide pubic arch and vaginal apex >2 fingerbreadths, uterine size <280g, significant heart/lung disease

6. LAVH: decreased length of hospital stay, decreased postop analgesia, decrased convalescence, lower complications

7. after c/s: hemorrhage, abnormal placental implantation, uterine atony, inability to repair ruptured uterus, large myomas

1. abnormal grwoth of uterine tissue in places other than uterine lining. found almost exclusively in women of reproductive age

2. s/s: red petechial lesions on peritoneal surfaces of pelvic organs - dark brown/blue/black in appearance, pelvic pain during menstrual cycle, infertility, dysmenorrhea, dyspareunia, pelvic pain, premenstrual spotting, uterine motion pain, tender adnexa, abnormal uterine position

3. ovary

4. "choclate cysts", "powder burns"

5. complications: catamenial pneumothorax

6. treatment: expectant management, analgesia, OCPs, progestins, GnRH agonists, aromatase inhibitors, surgery, IVF

1. CIN II and III (moderate and severe dysplasia)

2. s/s: usually non. dx based on bx after abnormal pap

3. labs/tests: repeat cervical cytology q 6 mos until 2 consecutive normals, HPV test, schiller test, colposcopic exam,

4. colposcopy: leukoplakia, hyperkaratosis (white/thickened epithelium), acetowhite epithelium after acetic acid aplication, abnromal vasculature

5. diagnostic conization: unsatisfactory coploscopy, lesions extending into cervical cancal, dysplasia on endocervical curettage, adenocarcinoma, microinvasive carcinoma

6. tx:

- cryotherapy & laswer ablation - cannot produce tissue specimen for histology

- LEEP, cold knife conization, laser cone excision - can do histology

1. 7-14 cm

2. isthmus (narrow and straight portion imediately adjoining uterus), ampulla (wider, more tortuous), infundibulum (funnel-like dilation)

3. ovarian and uterine arteries

4. suspensory ligament of ovary suspends infundibulum from pelvic brim

1. blastocyst

2. blastocyst

3. trophoblast

4. maternal blood

5. amnion

6. mesoblast

7. chorionic plate

8. cotyledon

9. 8 weeks - head is half the bulk, hepatic lobes, RBCs, kidneys, ears/eye/nose/mouth/digits, tail almost gone

10. 12 weeks: skin pink, head still large, brain roughly complete, ossification of sarcal arches and bodies

11.16 weeks: sex discernible, hemoglobin F present, hemoglobin A begins, fetus active, heart well developed, lobulated kidneys, meconium in bowel

12. 20 weeks: moving a lot, uterus at umbilicus, sternum ossified

13. 24 weeks: fat deposits, 50% viable, vernix/os/pubis ossifies

14. 28 weeks: lungs functional, low surfactant, nails appear, testes at inguinal ring, talus ossifies

15. 32 weeks: 99% viable

16. 36 weeks: lanugo disappearing, testes in inguinal canal, scrotum small w/ few ruggae, distal femoral ossification centers

17. 40 weeks: silky hair, full testes, pendulous/rugous scrutum, proximal tibia ossificaiton

1. day 6

2. day 14

3. corpus luteum

4. proliferative

5. secretory

1. contains arterial blood, tissue debris, prostaglandins, fibrinolysin. shouldn't have clots unless excessive flow

2. usual duration: 3-5 days

3. avg blood loss: 30 ml. ranges from spotting to 80 ml

1. around day 14, follicular rupture occurs, ovum extruded into abdomen and picked up by fembriated ends of fallopian tubes and transported to uterus

2. rise in basal body tempt

3. urinary LH

4. 48 hrs before ovulation

secrete mullerian inhibiting substances to prevent development of uterus, fallopian tubes, and vagina

secrete testosterone to form internal and external genitalia

1. turner's (45x) or anything with streak gonads

2. s/s: newborns: edema of hands and feet

adolescents: short stature, sexual infantilism, webbed neck, growth retardation

3. labs: elevated gonadotropin, serum FSH >50, LH >90, low estrogen

4. tx: estrogen to assist in development of secondary sex characteristic, growth hormone for height, surgical removal of streak gonads

1. presence of ovarian and testicular tissue

2. s/s: ambiguous genitalia, female-type breasts, menstruation, chimeric sex chromosomes (46XY/XX)

3. tx: surgical removal of contradictory organs, reconstruction of external genitalia

klinefelter's

tx: usually none for infertility and gynecomastia

surgery, testosterone, donor sperm

s/s: greatly enlarged clitoris may be mistaken for penis, no gonads w/in scrotolabial folds

- growth: grow more rapidly early in life but then stop growth about age 10

- virilization begins age 2 - pubic/axillary/body hair, beard, acne, no puberty

- electrolyte imbalance

- no ovulation

labs: high androgens and 17-hydroxyprogesterone

tx: high doses of hydrocortisone + surgical correction of external genitalia

cause: defect in action of testosterone or fxn of testis

s/s: ambiguous genitalia

labs: deficiency in biosynthesis of testosterone

tx: endocrine, surgery, and psych consults

1. definition: cessation of menses <40 y/o

2. vasomotor flushes, atrophic vaginitis, decreased cervical mucus, osteoporosis

3. labs:

- increase in: LH and FSH

- decrease in : testosterone, estradiol, estrogen, progesterone

4. tx:

- atrophic vaginitis: lubricants, topical estrogens

- vasomotor flushes: estrogens, progestins, clonidine, SSRIs, gabapentin

- osteoporosis: 1200 mg Ca, 400-800 mg vit D, smoking cessation, avoid alcohol, weight-bearing exercise, bisphosphonates (alendronate, risedronate, ibandronate), calcitonin, estrogens, parathyroid hormone, SERMs (raloxifene), progestines

OCPS: relieve hot flashes and regulate menstrual cycles during perimenopause

Indications: prevention of osteoporosis, tx of hot flashes and vaginal atrophy

Complications: all due to estrogen -endometrial cancer, breast cancer, DVT, stroke, vaginal bleeding, gallbladder dz, dyslipidemia,

Contraindications: undiagnosed abnormal vaginal bleeding, hx breast cancer, hx estrogen-dependent neoplasia, hx DVT/PE, hx MI or CVA, liver disease

osteoporosis: low dose (0.014 mg/d) transderman estrogen

hot flashes: standard dose conjugated estrogen (0.3-0.625 mg/d), 0.025 mg/d transdermal estrogen, or 0.5 mg/d oral estrogen

atrophic vaginitis: 0.25-0.2 g topical estrogen for 2 weeks, then 25 ug estradiol PO for 2 weeks, then weekly, then estradiol ring for 3 months

combined, continuous estrogen + progestin is most common

long term OCP no longer recommended due to cardiovascular risk

symptoms: amenorrhea, n/v, breast tenderness (mastodynia), breast discharge (colostrum), enlargement of sebaceous glands in areola, quickening, bladder irritability/frequency/nocturia, UTI

signs: increased basal body temp, chloasma (darkening of skin over forehead/cheeks), linea nigra (darkening of nipples and linea alba), stretch marks, spider telangiectaisas

primi: 18-20 weeks

multi: 14-16 weeks

amenorrhea: estrogen/progesterone by corpus luteum

n/v: rapidly rising hCG

1. chadwick's sign

2. leukorrhea

3. hegar's sign

4. relaxation of pelvic joints

5. abdominal enlargement

6. uterine contractions

7. Ladin's sign

8. Goodell's sign

1. FHT: 10 weeks. 120-160

2. Palpation of fetus: 22 weeks

3. cardiac: 5-6 weeks

4. limb buds 7-8 weeks

5. finger movements: 9-10 weeks

6. 10-12 weeks, 1 week

perinatal period: 28 weeks - first 7 days of life

deaths = first 40 years of life

1/2 occur in utero

70% occur in first 28 days

1. 50%

2. s/s: uterine contractions > 2/hr, dilation/effacement, vaginal bleeding, bloody show

3. tests: US - gestational age, fetal weight, presenting part, fetal monitoring

CBC w/ diff

UA

amniocentesis - fetal lung maturity

cervical culture: GC/chlamydia

fetal fibronectin - neg test r/o delivery w/in 2 weeks

4. cervical incompetence, preterm uterine contractions

5. tx: bed rest, hydration, corticosterones, tocolysis

purpose: delay labor to allow corticosteroids to mature fetal lungs

drugs:

- beta mimetics (terbutaline)

- magnesium sulfate

- calcium channel blockers

- prostaglandin synthase inhibtiors (indomethacin)

try multiple drugs if one fails

1. 24 hr

2. chorioamnionitis

3. s/s: hx of gush of fluid from vagina or watery vaginal d/c, sterile speculum exam looking for pooling amniotic  fluid in posterior fornix, nitrazine test demonstrating an alkaline pH, presence of ferning when placing fluid on slide and allowed to air dry

4. labs/tests:

CBC w/ diff

UA

US - fetal size, amniotic fluid index

amniocentesis - fetal lung maturity, infection

chorioamnionitis

tx: delivery, regardless of gestational age
broad spectrum abx
oxytocin to induce labor
24-32 weeks: abx, corticosteroids, tocolytics for 48 hrs, then deliver

1. definition: 42 weeks from first day of LMP or 40 weeks from time of conception

2. most common cuase: incorrect dating

3. maternal risks: fetal size, birth injury, placental insufficiency, olioghydramnios, cord compromise

4. labs/tests:

NST 2x/week

US 2x/week for biophysical profile and amniotic fluid

Mother does fetal movement counts daily

5. tx: expectant managemnet - induction does not decrease c/s rate

Rh-neg mom gives birth to Rh-pos baby. fetal RBC pass to mom. mom makes abs against Rh antigen.

future pregnancies may develop hemolysis due to maternal antibodies

s/s:

fetal: anemia, immature rbc, high bilirubin, erythroblastosis fetalis

neonate: anemia, hyperbilirubinemia

tx:

screen for ABO and Rh group

28 week visit: ab screening performed, if neg - give 300 ug RhIgG or Rhogam

35 week: repeat ab screening. if pos - manage pt as rh-sensitized

postpartum: if baby is Rh-pos or Du-pos, give Rhogam

hemorrhage

tx:

ABC's

trendelenburg

fetal monitoring

blood transfusion, Ca, K

1. concealed: hemorrhae confied within uterine cavity

external: blood drains through cervix

2. risk factors: previous separation, HTN, advanced maternal age, multiparity, vascular disease, smoking, alcohol, cocaine

3. US often inconclusive

4. tx: IV, PRBC, vaginal delivery, c/s if fetal distress

1. risks: multiparity, advanced age, previous c/s, mechanical separation, placentitis, rupture of venous lakes

2. complete: completely covers internal os

marginal: w/in 2 cm of internal os

3. s/s: painless hemorrhage, usually around 28 weeks

4. US

5. tx: expectant - transfusions, tocolysis, test fetal maturity

delivery - c/s is method of choice

6. complications: hemorrhage, shokc, death, bleeding, operative trauma, infection, embolism, prematurity

1. definition: onset of labor to full cervical dilation

2. duration: primi - 6-18 hr, multi - 2-10 hr

3. sips and ice chips

4. maternal pulse and bp q 2-4 hr

fetal hr q 30 min

uterine contractions q 30 min

cervical dilation

1. fullcervical dilation to delivery of baby

2. duration: primi - 30 min-3 hr

multi: 5-30 min

3. monitor fetal hr q 15 min

fetal progression:

§  Engagement of presenting part: head enters pelvis

§  Flexion: aids in engagement and descent

§  Descent: continues progressively

§  Internal Rotation: rotate to pass the ischial spines

§  Extension: must occur to allow head to bass through vaginal outlet

§  External Rotation: rotates to position it occupied at engagement

·       Delivery anterior shoulder: gentle traction downward

·       Delivery posterior shoulder: gentle traction upward

1. definition: delivery of baby - delivery of placenta

2. duration: 0-30 min

3. placental separation: fresh show of blood from vagina, umbilical cord lengthens

fundus raises up

uterus firm and globular

1. bone density

2. normal: T score >-1.0 SD

osteopenic: T score -1.0-(-2.5)

Osteoporotic: T score <-2.5

3. recommendations: postmenopausal <65 y/o

all women >65 y/o

women considering osteoporosis therapy

women on HRT for prolonged therapy

1. killed viruses, toxoid, recombinant

2. flu

3. diphtheria, tetanus, hep b, killed polio

4. MMR, polio, varicella

definition: spontaeous cessation of menses before 40 y/o

complications & tx:

atrophic vaginitis - topical estrogens

hot flashes - estrogens & progestins

osteoporosis - calcium, vit D, smoking cessation

vaginal dryness/dysparuenia

atrophic cystitis

urethral caruncle w/ dysuria

breast regression

1. lightening

2. weeks

3. bloody show

1. 25%

2. >20 hr. tx with bedrest, sedation, or oxytocin

3. cervical protraction: <1.2 cm/hr in nulliparous, <1.5 cm/hr in multiparous

4.protracted descent: <1 cm/h in nulliparous or <2 cm/h in multiparous

5. arrest of dilation: 2 hr

6. arrest of descent: 1 hr

7. precipitate labor: <3 hr

8. precipitate dilation: >5 cm/h primi or >10 cm/hr multi - can cause placental abruption, uterine rupture, PP hemorrhage - tx: stop oxytocin, give terbutaline/ritrodine

1. gynecoid

2. android

3. anthopoid

4. platypelloid

1. occiput posterior and occiput transverse

2. brow presentaiton

3. face presentation

4. abnormal fetal lie

macrosomia

risk factors: maternal DM, obesity, excessive maternal weight gain, postdate pregnancy

risk for shoulder dystocia

shoulder dystocia

fetal compromise

placenta previa

fetal blood loss

vasa previa

1. decreased fhr or decrease in variability

2.

a. vaginal exam

b. mom to lateral position for intrauterine resuscitation

c. correct maternal hypotension

d. stop oxytocin

e. deliver

placenta previa

DO NOT DO CERVICAL EXAM

needs c/s

250-500 ml

fetal tachy, recurrent decels, prolonged brady, sinusoid pattern

kleihauer-betke test

vasa previa

tx: emergency c/s

spontaneous abortion

congenital anomalies

macrosomia

shoulder dystocia

operative delivery

birth trauma

neonatal hypoglycemia

resp distress syndrome

hypocalcemia

hyperbilirubinemia

fetal malformations due to hyperglycemia occur in first 8 weeks of pregnancy, so all DM pts should recieve periconceptional care

1st trimester: estrogen and progesterone cause decreased fasting glucose

2nd/3rd: decreased insulin sensitivity

>36 weeks - external cephalic version

c/s if not corrected

uterine, adnexal, or cervical motion tenderness and absence of competing dx

PLUS one of these:

>38.3C or 101F

increased ESR

increased WBC

inflammatory mass

gram neg intracellular diplococci

1. gonorrhea or chlamydia

2. r/o ectopic and appy

3. pelvic US, UPT, CBC, ESR, genital cultures, UA

4. risk factors: multiple partners, young, nulliparous, non-white, douching, smoking, IUD

5. cefoxitin IM + probenecid PO + ceftriaxone IM

1. lactobacilli

2. homogeneous white d/c, microscopic presence of >20% clue cells, vaginal d/c with pH > 4.5, fish odor

3. Flagyl PO, clinda cream, or flagyl cream

1. benign: smooth, mobile, <10 cm, calcium, painless

2. malignant: fixed, solid, septation >3mm, ascites, abd pain, bloating, nausea, early satiety, munstraul abnormalities

3. workup: US, CBC, CMP, hCG, CA-125, AFP, LDH

1. 85%

2. 40%

3. screening: dx with breast ca <40 y/o, 1st deg relative with breast ca <50, women w/ family hx of male or multiple breast cancers, sngnificant neoplasms (ovarian, colon, pancreatic)

PCOS

workup: FSH, LH, prolactin, TSH - to r/o other causes

testosterone, 17-hydroxyprogesterone

tx:

exercise, weight loss, metformin

clomiphene: infertility

OCPs: hirsutism

less frequent ovulation + lower quality eggs

estrogen, progesterone, prolactin, GH, insulin, cortisol, epithelial growth factor

prolactin is stimulated by suckling, nipple stimulation, crying infant, positive attitude

ovarian teratoma

immature teratomas are malignant, mature are benign

ectopic

ovarian tumors: dysgerminoma, mixed germ cell tumor, choriocarcinoma, embryonal carcinoma

1. staph

2. fissured, red, warm, sore nipple

3. tx: dicloxacillin or cephalosporin, keep nursing, stop if abscess

4. recurrent = neonatal strep infx

1. 7-14 d before menstruation - should quit w/ menstruation

2. pt chart sx, diet and avoid triggers, Ca/Mg/B6/Vit E/NSAIDS, SSRI, OCP

3. PMDD

1. 2nd

2. 1/8

3. risk: delayed childbearing (>35), fm hx, BRCA 1 or 2, personal hx of breast cancer, mecarch <12, menopause >50

4. early: single, nontender, firm mass with ill defined margins; mammogram abn w/ no palpable mass

5. late: skin/nipple retraction, axillary adenopathy, breast enlargment, erythema, edema, pain, fixation of mass to skin or chest wall

6. breast exam: 20-40 y/o every 2-3 years, >40 yearly

7. mammogram: >40 1-2 years, >50 yearly

8. lump - diagnostic mammogram

9. most malignant: inflammatory

10. tx: surgery + adjunctive therapy. just palliative if stage IV, mammogram q 6 mos for 2 yr

1. infertility/subfertility: inability of a couple to conceive w/in 1 year
2. sterility: those who have never conceived
3. fecundity: probability of achieving live birth w/in 1 menstrual cycle
4. fecundibility: likelihood of conception per month of exposure

90%

male sperm analysis

oocytes

egg stransport

implantation of ova

1. testicular pathology - varicocele

2. count: >20M/ml

motility: >50%

volume: >2 ml

Morphology: >30% normal

1. pelvic US, urinary LH, basal body temp, endometrial bx, cervical mucus, hysterosalpingogram, sonohysterogram, laparoscopy w/ chromointubation (gold standard for assessing tubes)

2. FSH/estradiol: day 3, progesterone day 21

3. hx abnormal pap, post-coital bleeding, cryotherapy, conization, DES exposure

4. clomid (starting day 3-5 of cycle for 5 days) --> hCG + IUI --> IVF

1. C

2. A

3. X

4. D

5. B

1. not pregnant

2. nulliparous

3. 12 weeks

4. 20 weeks

36 weeks

1. spontaneous abortion

2. implantation bleed

3. inevitable abortion

4. incomplete abortion

bloody show

placenta previa

vasa previa

placental abruption

DIC

uterine rupture

non-OB (cervical pathology, vaginal pathology)

MVA

death of mother, placental abruption

1. htn, edema, proteinuria, PE: brisk patellar reflexes, clonus

2. young nulliparous and >35 multiparous

3. kidneys: glomeruloendotheliosis

4. mild: <37 weeks: corticosteroids + bed rest

>37 weeks - induction

5. severe: <24-34 weeks: corticosteroids + mag sulfate

>34 weeks: delivery

risks: tonic clonic seizure

tx: ABCs, diazepam/lorazepam, deliver baby!

1. variant of pre-eclampsia characterized by: Hemolysis, Elevated Liver enzymes, and Low Platelets

2. sx: RUQ pain, malaise, n/v

3. tx: delivery then dexamethasone

protein: 1 g/kg/d + 20 g/d --> appx 80 g/day

calcium: 1.5 g/day

iron: 30 mg/day

folic acid: 4 mg/d if prior NTD, 0.4 mg/d if not

cause: HPV

incubation: >3 mos

lesions: papillary growths that coalsece into cauliflower masses, tend to proliferate during pregnancy

sx: pruritis, vaginal d/c, post-coital bleeding

bx: koliocytes

tx: trichloracetic or bichloracetic acid (TCA or BCA), podophyllin gel, cryosurgery/electrocoagulation

1. testicular feminization with 46.XY genotype due to deficeincy in androgen-binding protein --> creates male hermaphroditisim

2. presents as amenorrhea

3. has vulva and breasts secondary to unopposed estrogen but no uterus or vagina or body hair bc body is not responseive to testosterone. testes made by mullerian inhibiting factor = mullerian agenesiis

4. tx: address gender identification and remove undescended testes

converts testosterone to estrogen

aromatase inhibitors (anastrozole, etrozole) and inactivators (exemestane) block conversion of androgens to estrogens --> good for breast cancer

multiple partners, early onset of sexual activity, high risk sexual partners, HPV infection, hx STDs, smoking, HIV, AIDS, multiparity, long term OCP use

condoms do not entirely protect against HPV - can be transmitted from scrotal-labial contact

1.  any degree of glucose intolerance w/ onset during pregnancy

2. complications: macrosomia, polyhydramnia, miscarriage, fetal malformation, hypoglycemia in baby, preterm birth, pyelo, preeclampsia, in utero meconium, fetal hr abn, c/s, still birth

3. tx: BG control, non-weight bearing/low-impact exercise, diet 1800-2400 cal/day, insulin, birth 38-39 weeks

1. 70-95 fasting

2, <140 1 hr pp

3. <120 2 hr pp

1. progesterone

2. hypothalamic pituitary axis

3. thyroid/adrenal dysfunction

4. irregular bleeding, absence of ovulatory temp changes, low serum progesterone

NTD: high maternal serum levels

Down's: decreased levels + increased hCG

1. hypothalamic-pitutiary axis, endometrium responsive to horomes, outflow tract from internal to external genitalia

2. absence of menses by age 15

3. absence of menses for 3 cycles or 6 mos

4. pregnancy

5. PREGNANCY TEST, TSH, prolactin, pelvic exam (establish presence of organs), US, serum testosterone

tumor

myoma

pregnancy complication

IUD

hyperplasia

dysfunctional bleeding

1. carcinoma, intraductal papilloma, fibrocystic changes

a. intraductal papilloma or malignancy

b. fibrocystic changes

c. prolactinemia or OCP

d. subareolar abscess

chlamydia

tx: doxy or azithromycin

pregnancy: erythromycin or amoxicillin

gonorrhea

reportable

tx: ceftriazone/cefixime + doxy or azithromycin

DM, HIV, obesity, pregnancy, abx, steroids, OCP, debilitation

pruritus, white/cheesy d/c, vulvuar erythema, burning w/ urination

KOH prep

culture is gold standard

tx: nystatin PO or cream, clotrimazole/ketoconazole/fluconazole

trichomonas

tx: metronidazole x 1

primary syphilis

tx: benzathine pcn G IM x 1, tetracycline or doxy for 14d for PCN allergy

secondary syphilis

tx: benzathine PCN G

latent syphilis

tx: benzathine PCN G

late latent syphilis

get CSF study to r/o neurosyphilis

always systemic disease - organomegaly, osteochondritis, anemia, jaundice, skin lesions, rhinitis, adenopathy, CNS disease

baby's test is reactive

tx: put baby in isolation, treat if rising titer

treat mom before 18 weeks to prevent transmission

lymphogranuloma venereum

tx: REPORT

- doxy or erythrombycin for 21 days

granuloma inguinale (donovanosis)

tx: bactrim or doxy x 3 weeks --> NOT PCN

chancroid

tx: report

r/o syphilis

sitz baths, azithromycin + ceftriaxone + erythromycin + cipro

incubation: 2-7 d

lasts 2-6 weeks

tzanck smear

1. 40-50%

2. 60%

2. 50%

4. 36 weeks

condyloma acuminate

tx: trichloaracetic or bichloracetic acid (TCA or BCA), podophyllin gel, cryosurgery/electrocautery

1. leukorrhea of pregnancy

2. CO increase by 30-50%, SEM

3. 20% increased need for O2

4. 35% increase in blood volume

5. decreased bladder tone and capacity, NOT proteinuria

6. n/v/pica/gerd/constipation

7. progesterone = laxity of ligaments, pubic symphysis at 28-30 weeks

8. 16 weeks

repeat

cephalopelvic disproportion/dystocia

 malposition/malpresentation

fetal distress

placenta previa/multiple gestation/fetal abnormalities, cervical cancer, active herpes

treatment of cancer

benign GYN conditions (endometriosis, dysmenorrhea, menorrhagia)

obstetric complications

1. early: red petechial lesions. later: dark brown/blue endometriomas or "chocolate cysts"

2. ovary

3. infertility, dysmenorrhea, dyspareunia

4. expectant management, nsaids, OCP, progestins, danazol, GnRH agnoists (leuprolide), hysterectomy

serous cystadenocarcinoma

tx: surgery

1. first stage

2. latent phase

3. active phase

4. second stage

5. third stage

1. placenta previa -- do not do cervical exam

2. abruptio placentae

1. chlamydia

2. gonorrhea

3. trichomonas

4. yeast

5. bacterial vaginosis

sperm

Tubal and pelvic pathology make up 35%

a tocolytic

started if hx of preterm birth, positive fibronectin, short cervix, changing dilation

allows for corticosteroid administration for 48 hrs

ACE and ARBs

1. hydatidiform more. tx: suction curettage, monitor hCG for 1 year

2. choriocarcinoma

ectopic

get US

tx: methotrexate IM, laparotomy for rupture

high parity

hypertension

hx previous abruption

hypothalamic/pituitary level

hypthalamic/pituitary axis

ovarian

uterine

metabolic

fibroids (leiomyoma)

PCOS

coagulopathy

ovarian torsion

tx: knee-chest position

laparoscopy

endometriosis

adenomyosis

leiomyoma

outflow obstruction

adenomyosis

tx: nsaids, ovarian suppression, surgery

monilia (Candida)

trichomonas

Bacterial vaginosis (gardnerella)

supress gonadotropin

oral contraceptives

steroids (depo)

GnRH analogs (Lupron)

day 3: estradiol (should be <80) and FSH (Should be <10)

day 21: progesterone should be >9