obgyn revalida review 2013 for printing

5/22/2018 Obgyn Revalida Review 2013 for Printing

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Protocol for the Evaluation of

Diabetes in Pregnant Filipino Women

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Diabetes in HIGH RISK Pregnant Filipino Women

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Vaginal Discharge

o Physiologic


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lactobacilli

estrogen

glycogen

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lactobacilli;inhibits growth

of pathogenicorganisms

pH 3.8-4.2*

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OligomenorrheaBleeding occurs at intervals of > 35 days and usually is caused by aprolonged follicular phase.

PolymenorrheaBleeding occurs at intervals of < 21 days and may be caused by a luteal-phase defect.

MenorrhagiaBleeding occurs at normal intervals (21 to 35 days) but with heavy flow(>=80 mL) or duration (>=7 days).

MenometrorrhagiaBleeding occurs at irregular, noncyclic intervals and with heavy flow(>=80 mL) or duration (>=7 days).

Amenorrhea Bleeding is absent for 6 months or more in a nonmenopausal woman.

Metrorrhagia or bleeding

intermenstrual

Irregular bleeding occurs between ovulatory cycles; causes to considerinclude cervical disease, intrauterine device, endometritis, polyps,

submucous myomas, endometrial hyperplasia, and cancer.

Midcycle spottingSpotting occurs just before ovulation, usually because of a decline in theestrogen level.

Postmenopausal

bleeding

Bleeding recurs in a menopausal woman at least 1 year after cessation ofcycles.

Acute emergent

abnormal uterine

bleeding

Bleeding is characterized by significant blood loss that results inhypovolemia (hypotension or tachycardia) or shock.

Dysfunctional uterine

bleeding

This ovulatory or anovulatory bleeding is diagnosed after the exclusion ofpregnancy or pregnancy-related disorders, medications, iatrogenic

causes, obvious genital tract pathology, and systemic conditions.


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1990 National

Institutes of HealthCriteria (NIH):

Requires both criteria

2003ESHRE/ASRM

(Rotterdam):

Requires 2 of 3 criteria

2006 Androgen Excess

Society (AES):

Requires all 3 criteria

1 Chronic anovulation 1 Oligo-and/or

anovulation

1 Ovarian dysfunction

(oligo-ovulation and/orpolycystic ovaries)

2 Clinical and/or

biochemical signs of

hyperandrogenism

2 Clinical and/or

biochemical signs of

hyperandrogenism

2 Hyperandrogenism

(hirsutism and/or

hyperandrogenemia)

3 Polycystic ovaries 3 Exclusion of otherandrogen excess

disorders

Exclusion of other androgen excess disorders

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70/96

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o12 or more folliclesmeasuring 10 cm3)

oonly one ovary fitting thedefinition is required fordiagnosis


71/96

Lifestyle modification, targeting a

weight loss of 5-10% of initial body

weight, significantly improvemenstrual regularity and rate of

ovulation. Target BMI 20-25

G=D=HCGCD!


72/96

G=D=HCGCD!

Metforminshould be used as an adjunctto general lifestyle modification but not

as a replacement for weight loss,improved diet and increased exercise in

treating abnormal uterine bleeding in

women with PCOS.

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The use of oral contraceptive pills for 21-day

period followed by a 7-day pill free intervalimproves menstrual regularity among women

with PCOS, regardless of body mass index.

G=D=HCGCD!


75/96

G=D=HCGCD!

The use of oral contraceptives is thefirst choice in the treatment of hirsutism

in PCOS.

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o!7&U ,1)23-.-9 -.9;?-,*)5? g d??oC.9;?-,*)/0 >);6+A ;* 25*-,,/8-


82/96

$K@ICM@?IF

+D


83/96

-.+%(!/!-.

7.6!-*#$&'(6*'+

(*-a5-.2A ;K =25,- #-0L)2 #/). M)/8.;+)+


84/96

(*-a5-.2A ;K =25,- #-0L)2 #/). M)/8.;+)+

@A6;8/+,*)2 #/).


85/96

A6 8

F!$

C.9;?-,*);+)+ #-0L)2 ).h0/??/,;*A 9)+-/+- "L/*)/. .-Y8*;Y,1 Y),1 2;?60)2/,);. ],Y)+,).8 ;* 0-/3).8 ;* *56,5*-9

C.9;?-,*);+)+


86/96

o&A?6,;?+" #*;8*-++)L- 9A+?-.;**1-/" MA+6/*-5.)/" MA+21-`)/" $.K-*,)0),A

o#C h).9).8+" $CU h)


87/96

A

N. gonorrhea has

arapid onset

,and the pelvicpain usuallybegins a fewdays after the

onset of amenstrual period.

C. trachomatisalone often may

have an indolentcourse with slowonset, less pain,

and less fever.

B)+3 (/2,;*+


88/96

B)+3 (/2,;*+

Age at firstintercourse

Multiplepartners

High

frequencyof sex

Coitus

duringmenses

Lack ofcontraception

Douching

B)+3 (/2,;*+


89/96

B)+3 (/2,;*+

Previous PID -25%

IUD occursonly at the timeof insertion and

in the first 3

weeks afterplacement

Smoking /substance

abuse

Lower genitaltract infections

%M% H5)9-0).-+ K;* M)/8.;+)+ ;K =25,- #$M %0).)2/0

%*),-*)/ K;* $.),)/,).8 !1-*/6A


90/96

%*),-*)/ K;* $.),)/,).8 !1-*/6A

Empiric treatment should be initiated

if one or more of the minimum criteria are presentand no other cause(s) for the illness can beidentified

Sexually active young women and those at risk forSTDs if they present with lower abdominal pain

Minimum criteria

Cervical motion tenderness Uterine tenderness

Adnexal tenderness

=99),);./0 %*),-*)/ ,; $.2*-/+-&6-2)h)2),A ;K M)/8.;+)+


91/96

&6-2)h)2),A ;K M)/8.;+)+

Temperature >38.3C (101F)

Abnormal cervical or vaginalmucopurulentdischarge

WBCs on saline wet prep

Elevated ESR

Elevated CRP

Gonorrhea or chlamydia testpositive

G ,


92/96

G/./8-?-.,

Medical

Out patient In patient

Surgical

Conservative Radical

"5,6/,)-., B-8)?-. =


93/96

Ceftriaxone 250 mg IM once

Doxycycline 100 mg orally twice a day for 14days, with or without Metronidazole 500 mg

orally twice a day for 14 days.

PLUS

%*),-*)/ K;* @;+6),/0)`/,);.


94/96

6

Surgicalemergencies

PregnancyNon-response to

oral therapy

Inability to toleratean outpatient oral

regimen

Severe illness,nausea and

vomiting, high feveror tubo-ovarian

abscess

HIV infection withlow CD4 count

$.6/,)-., B-8)?-.+


95/96

$.6/,)-., B-8)?-.+

6IK@M@< *

v%-K;,-,/.Z 8 $7 a VZ 1;5*v%-K;


96/96

6IK@M@< "

v %0).9/?A2). c[[ ?8 $7 a X 1;5* 5678v H-.,/?)2). 0;/9).8 9;+- $7i$G IZ ?8i38J

K;00;Y-9 >A ?/).,-./.2- 9;+- IV^d ?8i38J a X1;5*+^ &).80- 9/)0A 9;+).8 ?/A >- +5>+,),5,-9^

Continue either of these regimens for at least 24 hoursafter substantial clinical improvement

Complete a total of 14 days therapy with

Doxycycline (100 mg orally twice a day) OR

obgyn revalida review 2013 for printing

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