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Pathognomonic of PID caused by C. Trachomatis
- Fitz-Hugh-Curtis syndrome ( typical violin string appearance)
- Adhesion b/w liver & peritoneal surface
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Risk factors that should avoid COCP
- 1. Uncontrolled HPT, DM, obese
- 2. Migraine w aura
- 3. Hx of VTE
- 4. > 35 y/o smokes > 15 cigs/day
- 5. Major surgery w prolonged immobility
- 6. Vascular dz / stroke
- 7. IHD, Cardiomyopathy, Afib
- 8. Liver cirrhosis & tumors
- 9. SLE & APL
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What is pearl index?
Number of contraceptive failure per 100 women years of exposure
- failure rate of contraception / used to summarize contraceptive effectiveness
- smaller the PI, the safer the method of contraception
- From safest > not safest
- - Subdermal implant
- - Male sterile
- - Mirena
- - Female sterile
- - Copper IUD
- - POP injx
- - POP
- - Male condom
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How to manage missed oill for COCP
- Missed 1 pill
- - take missed pill as soon as pt remembers followed by her regularly scheduled pill
- Missed 2 or more consecutive pills
- - remaining pills taken at usual time & backup contraception (ex: condom)
- - if missed in 1st week of cycle & unprotected sex - need emergency contraceptive
- Missed pill in 3rd week of active pills
- - finish that last week of hormone pills (week 3). Skip placebo pills. Immediately move to new pill pack the next day after finish week 3 hormonal pills
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Places to put combined transdermal patch on our body - 4
- Abdomen
- Upper outer arm
- Upper back (blkg bahu, not breast)
- Buttocks
- Diff side used each time
- Patch changed once/week for 3 weeks followed by 1 patch-free week
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MOA Mirena/hormone releasing IUD/Levonogestrel
- Foreign body effect
- 1. Uterus exposed to foreign body by the IUD frame
- 2. Sterile inflammation occur
- 3. This is toxic to sperm & ova
- 4. Impair implantation
+ local changes caused by released meds
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Important duration for contraceptives
Calender based method - avoid unprotected SI D8-D19
BBT, ovulation method - wait until 3 days after
Transdermal combined patch - for 3 weeks (change once/week), 1 week patch free
Vaginal ring - left 3 weeks
Progestin injectables - last 12 weeks/3 months
Subdermal implant - 3 years
IUD (Mirena) - 5 yrs, copper (10 yrs)
EC - LNG (w/in 1st 3 days), IUD & UPA (w/in 5 days)
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Anti-HPT drugs that can be used in pregnancy
- Labetalol
- Nifedipine
- Methyldopa
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What are the components of Rotterdam criteria to diagnose PCOS ?
- At least 2/3:
- 1) Polycystic ovaries (12 or more follicles/incteased ovarian volume)
- 2) Oligomenorrhea/Amenorrhea
- 3) Clinical/Biochemical signs of hyperandrogenism
- - clinical: acne, hirsutism
- - biochemical: raised serum testosterone
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Treatment of PCOS
1. COCP - to regulate menses and prevent endometrial hyperplasia from unopposed estrogen
- 2. Clomiphene citrate (Clomid)
- Anti-estrogenic effect (inhibit estrogen -ve feedback) cause increase GnRH and FSH for follicular growth so that ovulation can occur
3. Metformin - glucose intolerance
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Clinical features of PCOS
- HOSARA
- 1. Hirsutism
- 2. Obese
- 3. Subfertility
- 4. Acne
- 5. Recurrent miscarriage
- 6. Acanthosis nigricans
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What is Asherman syndrome?
- Aka intrauterine adhesion
- Common complication of dilation & curretage
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What is MRKH syndrome?
- Aka mullerian agenesis
- Absence of uterus, vagina or both. Ovaries preserve unlike in androgen insensitivity syndrome (AIS) - girl but genetically male who is resistant to male hormone who has no uterus, ovaries but has breast & pubic hair
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