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Abortion definition
termination of pregnancy less than 20 weeks from last menses or fetus less than 500g
Categories of Spontaneous Abortion
1. Threatened - cervix is closed but bleeding
2. Inevitable - cervix open and bleeding
3. Incomplete - same as inevitable except fetus is half out of uterus
4. Complete - whole dead product of conception comes out
5. Missed - baby dies and mom doesn't expel it
6. Habitual - 3 or more spontaneous abortions
7. Infectious - any of previous 6 but w/ fever and sepsis
Indications for initiating pelvic exam in precoital adolescent
1. delayed menarche
2. secondary amenorrhea
3. unusual vaginal discharge
4. abnormal bleeding
5. dysmennorhea unresponsive to first-line therapy
ASCUS (Atypical Cells of Undertermined Significance) pap procedure
1. Repeat pap at 6 & 12 months
-if ASC increases --> colposcopy
2. HPV DNA testing and triage
-if high risk HPV --> colposcopy
3. Adolescents 20yr or younger, repeat @ 12/24 months
LGSIL (Low Grade Squamous Intraepithelial Lesion)
-60% will resolve spontaneously
1. HPV DNA testing and repeat pap every 4-6 mo for 3 intervals
2. immediate colpo
HGSIL (High Grade Squamous Intraepithelial Lesion)
-Up to 95% have true high grade lesion
-Colpo immediately
Cervical PAP surgery modalities
1. Punch biopsy
2. Cryocautery
3. Laser vaporization
4. Loop electrode excision procedure (LEEP)
5. Hysterectomy
Most common PID organisms
1. Chlamydia trachomatis
2. Neisseria gonorrhoeae
3. Bacteroides
4. Aerobic streptococci
5. Anaerobic cocci
Criteria for Dx PID
Need these 3:
1. abdominal tenderness + rebound
2. adnexal tenderness
3. cervical motion tenderness
Plus 1 or more of following
1. gram stain of endocervic + for gram- diplococci
2. temp > 101F
3. WBC > 10k
4. elevated ESR or CRP
5. documented cervical infection of gonorrhea or chlamydia
6. pus on culdocenteses or laporoscopy
7. pelvic abcess on U/S or bimanual exam
Regimen A
Cephalosporins for gonorrhea
Cefoxitin
Cefotetan
For Chlamydia
Doxycycline
Regimen B
Clindamycin
Gentamicin
Doxycycline
Tubo-Ovarian Abcess
-Complicatino of PID and occurs in 10% of those infected
-Sx
: tender, inflammatory adnexal mass
Image w/ U/S, CT, or MRI
-Tx
: drainage by laparascopy or laparotomy; broad spectrum IV antibiotics (Clindamycin or Metronidazole, then Doxycycline)
Complications of PID
1. Infertility (adhesions)
2. Ectopic pregnancy
3. Endometritis
4. Chronic pelvic pain
FHR early pregnancy and near term?
160's early pregnancy
120's-140's near term
Pregnant weight gain amount?
25-35lbs
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Author
atmu
ID
174018
Card Set
GU-3
Description
Test 2 - GU3
Updated
2012-09-29T01:56:28Z
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