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Abortion definition
termination of pregnancy less than 20 weeks from last menses or fetus less than 500g
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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
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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
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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
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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
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HGSIL (High Grade Squamous Intraepithelial Lesion)
- -Up to 95% have true high grade lesion
- -Colpo immediately
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Cervical PAP surgery modalities
- 1. Punch biopsy
- 2. Cryocautery
- 3. Laser vaporization
- 4. Loop electrode excision procedure (LEEP)
- 5. Hysterectomy
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Most common PID organisms
- 1. Chlamydia trachomatis
- 2. Neisseria gonorrhoeae
- 3. Bacteroides
- 4. Aerobic streptococci
- 5. Anaerobic cocci
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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
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Regimen A
- Cephalosporins for gonorrhea
- Cefoxitin
- Cefotetan
- For Chlamydia
- Doxycycline
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Regimen B
- Clindamycin
- Gentamicin
- Doxycycline
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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)
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Complications of PID
- 1. Infertility (adhesions)
- 2. Ectopic pregnancy
- 3. Endometritis
- 4. Chronic pelvic pain
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FHR early pregnancy and near term?
160's early pregnancy
120's-140's near term
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Pregnant weight gain amount?
25-35lbs
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