GU-2

• 1. Hot flashes
• 2. Atrophic vaginitis (dry pussy)
• 3. Bone density loss
• 4. Interrupted sleep
• 5. Urinary symptoms
•     -atrophic changes = stress and urge incontinence
•     -dysuria, urgency and frequency

• 1. Lifestyle mods
• 2. Estrogen (most effective, highest risk)
• 3. Progestins (synthetic estrogen)
• 4. SSRI anti-depressants
•    -decrease incidence and severity
•    -dosage less than needed for depression
•    -side effect: sexual dysfunction, dry mouth, nausea
• 5. Gabapentin
• 6. Biologic agents
•    -phytoestrogens (soy, chick peas, lentils, red clover)
•    -black cohosh (plant)
•    -evening primrose (flower)

• 1. decrease vaginal elasticity, shorted vaginal canal
• 2. appears pale
• 3. can become irritated, dry
• 4. increase pH of vagina --> increase bacterial vaginitis

• 1. Weight bearing exercise
• 2. Adequate daily calcium and vit D
• 3. Treat vit D deficiency, which is common
• 4. decrease smoking
• 5. decrease excessive alcohol
• 6. counsel if amenorrhea due to low body weight

• 1. Biphosphonates - decreases osteoclastic activity
• 2. Denosumab - osteoclast inhibitor
• 3. Teriparatide - parathyroid hormone

• 1. Additional progestins cause headache, fatigue, fbloating, cramps, bleeding
• 2. Cyclical progestins cause cyclical bleeding
• 3. Continuous progestins causees unpredictable light bleeding x6 months

Combo therapy INCREASES risk for heart disease and breast cancer; risk arises 5-7 yrs after start

• -If menopausal Sx are severe, disabling
•      *limit use to short term (1-2 years)
•      *before prescribing, obtain med hx, breast exam, pap, mammo

• 1. Uterine leiomyoma
• 2. Endometriosis
• 3. History of migraine
• 4. History of pregnancy-related or OCP-related thrombosis

• 1. Undiagnosed vaginal bleeding
• 2. Suspicion or hx of breast CA
• 3. Suspicion or hx of endometrial CA
• 4. Active venous thrombosis
• 5. Malignant melanoma

• 1. Folic acid - supplement reduce neural tube defects by 50%
• 2. Rubella status - need vaccine to baby doesn't get it
• 3. Diabetes (preconception) - causes high birth defects
• 4. Hypothyroidism - can be treated w/ Levothyroxine, which promotes proper neurologic development

• 1. Every 4 weeks until 28 weeks
• 2. Every 2 weeks 28-36 weeks
• 3. Every week after 36 weeks

• 1. irregular intervals
• 2. intensity unchanged
• 3. no change in cervical dilation
• 4. discomfort mainly in lower abdomen
• 5. relieved by sedation

• 1. Regular intervals
• 2. Interval gradually shortens
• 3. Intensity gradually increases
• 4. Cervix dilates
• 5. Discomfort in back and entire abdomen
• 6. no relief with sedation

• 1. Dilation (expressed in cms)
• 2. Effacement (process of thinning out; expressed in percentage from 0% to 100% = paper thin)
• 3. Station (-3 to +3 = baby head coming out)

• 1. First stage = onset of contractions to fully dilated
• 2. Second stage = fully dilated to delivery of baby
• 3. Third stage = birth to delivery of placenta
• 4. Fourth stage = post partem care (recovery of mom)

• 1. First stage
•    -regional: epidurals, spinal, combined
•    -systemic: opoids (morphine, fentanyl, meperidine)
• 2. Second stage
•    -local for episiotomy
•    -pudendal block for episiotomy, instrumentation

• 1. facilitate delivery
• 2. inevitable tear
• 3. forceps/vacuum/breech delivery

• 1. 1st degree - vaginal mucosa or perineal skin
• 2. 2nd degree - subepithelial tissues of the vagina with or without perineal body
• 3. 3rd degree - anal sphincter
• 4. 4th degree - rectal mucosa exposin the lumen of the rectum