inpatient medicine 2
Terms
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Women of reproductive age who are sexually active
HIV-positive women
Immunocompromised women
During prenatal care workup -
Pap Smear
Indications -
Active vaginal, cervical, or uterine infection
Relative Contraindication
Blood contamination, especially if heavy - pap smear CI
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Vaginal discharge
Vulvar or vaginal pain, itchiness, or odor
Abnormal vaginal secretions -
Cervical-Vaginal Sampling
Indications - Heavy bleeding with blood contamination of sample
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Cervical-Vaginal Sampling
CI -
Single cervical polyp (easiest)
Multiple cervical polyps: may best be treated with curettage of the cervical canal
Endometrial polyps: require at least a dilation and curettage (D&C), possibly hysteroscopy
Postmenopausal women with cer -
Cervical Polyp Removal
Indications -
Active cervical or uterine infection
Oral anticoagulation, which may require electrosurgical removal and coagulation in surgery suite
Uncooperative patient - cervical polyp removal CI
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Failed Word catheter treatment in the acute setting
Recurrent infections or reaccumulation of Bartholin’s gland cyst fluid. -
Bartholin’s Marsupialization
Indications -
Cysts that could be adequately treated with a Word catheter
Coagulation defect (either medication related, congenital, or acquired) that is uncorrected
Patient who is unable to comply with wound care - Bartholin’s Marsupialization CI
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Acute infections
Pain from cyst enlargement
Obstructive Bartholin’s gland cyst affecting the patient’s sexual activity or obstructing the vaginal orifice. -
Bartholin’s Cyst Word Catheter Placement
Indications -
Cysts that should be treated by marsupializtion
Coagulation defect (either medication related, congenital, or acquired) that is uncorrected -
Bartholin’s Cyst Word Catheter Placement
contraindications -
Abnormal Pap smear indicating any degree of dysplasia
Pap smear indicating atypical glandular cells
Pap smear indicating persistent atypical cells of undetermined significance
Prior intrauterine DES exposure
Abnormal-appearing or palp -
Colposcopy
Indications -
Inflammatory or infectious cervicitis
Acute pelvic inflammatory disease (PID)
Active uterine bleeding
Uncooperative patient -
Colposcopy
contraindications -
Treatment of cervical dysplasia, colposcopy performed first
Treatment of cervical dysplasia involving the canal, cone excision
Significantly abnormal Pap smear in a noncompliant patient -
Loop Electrosurgical Excision
Indications -
Active cervical, endometrial, or pelvic infection
Uncontrolled and/or characterized bleeding disorder
Noncooperative patient
Extreme caution in patients on anticoagulation -
Loop Electrosurgical Excision
contraindications -
Any unidentifiable or concerning lesion
Lesion that does not respond to conventional therapy
Pigmented lesions
Atypical nevi
Vulvar ulceration of uncertain etiology
Leukoplakia
Acetowhite epithelium
Vulvodynia with acet -
Vulvar Biopsy
Indications -
Poorly controlled infection over biopsy site (treat then biopsy)
Caution with large excisional biopsies with anti-coagulation -
Vulvar Biopsy
ContraIndications -
Evaluation of the causes of abnormal uterine bleeding: postmenopausal bleeding, malignancy/hyperplasia, ovulation/anovulation, and hormone replacement therapy
Evaluation of women with bleeding after 1 year of presumed menopausal amenorrhea
Asse -
Endometrial Biopsy
Indications -
Positive pregnancy test
Pelvic inflammatory disease
Unreducible cervical stenosis
Ambiguous uterine anatomy form pelvic examination
Noncooperative patient - endometrial bx Contraindications
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Patient in active labor
Fetus in no distress -
Vaginal Delivery
Indications -
Vasa previa or placenta previa
Abnormal fetal lie
Cord prolapse
Prior classical cesarean section
Active genital herpes infection
Fetal deformities -
Vaginal Delivery
contraIndications -
Previous cesarean delivery and patient declines vaginal birth after cesarean (VBAC)
Previous cesarean, classical or unknown surgery
Maternal emergencies requiring the fastes mode of delivery: severe preeclampsia, uterine rupture, cardiova -
Cesarean Section
Indications - pt refusal
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Amniotic Fluid Index Ultrasound
contraIndications -
Instumented delivery
Shoulder dystocia
Perineal barrier to effective delivery
Fetal prematurity
Breech presentation -
Episiotomy-Laceration Repair
Indications - Extensive vulvar varices
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Episiotomy-Laceration Repair
contraIndications -
Estimation of gestational age
Determination of interval fetal growth
Determination of presenting part
Suspected multiple gestation
Significant uterine size/dates discrepancy
Confirmation of fetal viability
Suspected uterine -
Obstetric Ultrasound
Indications - Unstable fetal/maternal medical status when immediate surgical delivery is necessary
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Obstetric Ultrasound
contraIndications -
An element in the induction of labor
An element in the augmentation of labor
To diagnose meconium-stained amniotic fluid
To place fetal scalp electrodes
To start amnioinfusion -
Amniotomy
Indications -
High presenting part, with risk of cord prolapse
Presenting part unknown
Vaginal delivery contraindicated
Cervix not favorable for induction or less than 3 cm
Group B streptococcus colonization and antibiotics not available -
Amniotomy
contraIndications -
Size inconsistent with dates
Maternal diabetes
Hypertensive diseases of pregnancy
High-risk pregnancy
Post dates pregnancy -
Amniotic Fluid Index Ultrasound
Indications