Malpresentations

In face presentation (0.3 of presentations at or near term), the fetal neck is sharply extended so the occiput is in contact with the fetal back. The face is the presenting part. Diagnosis is made by palpation of the fetal face on vaginal exam. The fetal head assumes a position between vertex presentation and face presentation so that the anterior fontanel presents first. The fetal head assumes a position such that the eyebrows present first. This forces a large diameter through the pelvis...

HELLP Syndrome

HELLP syndrome is a manifestation of preeclampsia with hemolysis, elevated liver enzymes, and low platelets. In contrast to typical presentations of preeclampsia, it is associated with Less than 36 weeks' gestation Once preeclampsia is suspected, the following tests should be done Blood Electrolytes, blood urea nitrogen (BUN), creatinine, liver function tests (LFTs) (ALT, AST), complete blood count (CBC), uric acid, and platelet count Urine Sediment, 24-hour protein, 24-hour creatinine Fetal...

Androgens

Androgens are steroid hormones produced in the gonads (ovaries in women, the testes in males) and in the adrenal glands. Effects of Androgen Excess Hirsutism and Virilization Androgens promote hair growth at puberty, although to different extents in each sex. Females, with low levels of androgens, develop visible pubic and axillary hair. Males, with greater concentrations of androgen, get additional hair g growth on the face and chest, as well as masculinization (i.e., increased mus cle mass,...

Ovarian Etiologies

PCOS is a common condition (affecting 5 of reproductive age women) and is characterized by hirsutism, virilization, amenorrhea, obesity, and diabetes (sometimes). Ovaries are found to have multiple inactive cysts with hyperplastic ovarian stroma. The LH FSH ratio is often greater than 3 1. The cause is unknown, and the treatment is oral contraceptives. Hyperthecosis is when an area of luteinization occurs in the ovary, along with stromal hyperplasia. The luteinized cells produce androgens and...

Sexual Arousal Disorder

A Partial or total lack of physical response as indicated by lack of lubrication and vasocongestion of genitals a Persistent lack of subjective sense of sexual excitement and pleasure during sex a Treat decreased lubrication with KY Jelly or Astroglide. a Menopausal symptoms may respond to oral or topical estrogen. a Sildenafil (Viagra) may be helpful. a Referral for psychosocial consultation or therapy if psychological issues exist Complaints of sexual arousal disorder are typically...

Integumentary System Skin

Many physiologic changes in the skin can occur during gestation. Some are believed to result from changes in the hormonal milieu of pregnancy (see Table 4-2). TABLE 4-2. Pruritic Dermatologie Disorders Unique to Pregnancy Melanocyte-Stimulating Hormone Effects Melanocyte-stimulating hormone increases can result in the following Linea nigra Black line discoloration of the abdomen that runs from above the umbilicus to the pubis may be seen during the latter part of gestation Darkening of nipple...

Cervical Dysplasia

Cervical dysplasia and cervical cancer lie on a continuum of conditions. Cervical dysplasia can take one of three paths 2. Remain the same and not progress RISK FACTORS FOR CERVICAL DYSPLASIA AND CERVICAL CANCER Human papillomavirus (HPV) infection 80 of cases Risk highest if infected > 6 months Types 16, 18, 31, 33, high oncogenic potential High sexual activity (increase risk of viral bacterial infections) Multiple sexual partners Intercourse at early age ( 17 years) Cigarette smoking...

Endometriosis

Endometriosis is the condition in which endometrial tissue is found outside of the uterus, often causing pain and or infertility. Five to 10 of women in reproductive age The ectopic endometrial tissue is functional. It responds to hormones and goes through cyclic changes, such as menstrual bleeding. The result of this ectopic tissue is ectopic menses, which causes peritoneal inflammation, pain, fibrosis, and, eventually, adhesions. Tissue in endometriosis is viable and behaves normally. Exam...

Cocaine

Pregnancy does not increase one's susceptibility to cocaine's toxic effects Complications of pregnancy Spontaneous abortion and fetal death in utero Preterm labor and delivery (25 ) Meconium-stained amniotic fluid (29 ) Neurobehavioral abnormalities motor function) (e.g., impairment in orientation and

Chronic Hypertension HTN and Pregnancy

Defined as hypertension that antecedes pregnancy Mild Systolic > 140 mm Hg and or diastolic > 90 mm Hg Severe Systolic > 160 mm Hg and or diastolic > 110 mm Hg If during pregnancy a chronic hypertensive patient's systolic blood pressure (BP) rises by 30 mm Hg or diastolic rises by 15 mm Hg, it is pregnancy-induced hypertension superimposed on chronic hypertension. Diagnose HTN BP > 140 90 at rest, measured at least twice, and > 6 hours apart. (sustained T in BP) Diagnose HTN BP >...

Follicular Cysts

Follicular cysts are the most common functional ovarian cysts. Failure of rupture or incomplete resorption of the ovarian follicle results in a cyst. Just like the original follicle, the ovarian cyst is granulosa cell lined and contains a clear to yellow estrogen-rich fluid. Acute pelvic pain usually signifies rupture Physical exam pelvic and abdominal exam Sonography if necessary to confirm diagnosis No treatment may be necessary, since most cysts resolve spontaneously within 2 months. Oral...

Classification of Pap Smear Abnormalities

Remember, Pap smear gives information about cervical cytology. Two different systems exist that describe the possible findings of a Pap smear 1. Modern Classification System A.K.A. CIN cervical intraepithelial neoplasia Describes the degree of abnormality of the cells 2. Bethesda system SIL, squamous intraepithelial lesion Describes three things 1 the adequacy of the Pap test performed, 2 the degree of abnormality, and 3 a description of the cells

Lutein Cysts

There are two types of lutein cysts Corpus luteum cysts and theca lutein cysts. The corpus luteum cyst is an enlarged and longer living, but otherwise normal, corpus luteum. It can produce progesterone for weeks longer than normal. Signs symptoms Unilateral tenderness amenorrhea Diagnosis History and physical pelvic exam once ectopic pregnancy has been ruled out , sonogram Treatment only if symptomatic Analgesics, oral contraceptives, laparot-omy scopy if ruptured Corpus hemorragicum is formed...

Terminology

G gravidity 3 total number of pregnancies, including normal and abnormal intrauterine pregnancies, abortions, ectopic pregnancies, and hy-datidiform moles Remember, if patient was pregnant with twins, Q 1. P parity 3 number of deliveries gt 500 grams or gt 24 weeks' gestation, stillborn dead or alive Remember, if patient was pregnant with twins, P 1. Ab abortion 0 number of pregnancies that terminate lt 24th gesta-tional week or in which the fetus weighs lt 500 grams LC living children 3 number...