OBGYN
Terms
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- Decreased fetal movement
- perform NST
- Non-reactive NST
- vibroacoustic stimulation
- Positive-reactive CST
- delivery if fetus is mature; repeat CST in 24 hours Perform BPP
- Positive nonreactive CST
- Delivery immediately, regardless of gestational age
- BPP score of 0 to 2
- deliver immediately, regardless of gestational age
- Biophysical profile score of 4 or 6
-
deliver if fetus mature' repeat CST in 24 hours
Perform BPP - BPP of 8 or 10
- Repeat BPP weekly or biweekly
- + HIGH MS-AFP
- obstetrical sonogram to rule out dating error
- + LOW MS-AFP
- obstetrical sonogram to rule out dating error
- uterus is SMALL for dates/FHT present
- obstetrical sonogram to rule out IUGR, oligohydramnios
- uterus is LARGE for dates
- obstetrical sonogram to rule out: twins, macrosomia, polyhydramnios
- Suspected postdates pregnancy
- establish how sure is gestational age
- Postdates pregnancy: dates firm and cervix favorable
- induce labor with AROM or oxytocin
- Post dates pregnancy: dates firm but cervix unfavorable
- induce labor with PG or twice weekly NSTs, AFIs
- Postdates pregnancy, dates unsure
- twice weekly NSTs, AFIs, and await onset of labor
- First trimester bleeding
- vital signs? Sonogram? Cramping? cervix openeind? passed tissue?
- threatened abortion
- conservative management
- missed abortion
- scheduled suction D&C
- Incomplete abortion
- emergency suction D&C
- Inevitable abortion
- emergency suction D&C
- Completed abortion
- serial beta-hCG titers
- septic abortion
- broad spectrum antibiotics and gentle suction D&C
- 3rd trimester bleeding
- vital signs? sonogram for placental localization
- 3rd trimester bleeding: vasa previa
- immediate cesarean section
- 3rd trimester bleeding: uterine rupture
- immediate cesarean section
- 3rd trimester bleeding: abruptio placenta with stable mom and fetus and rapid vaginal delivery expected
- allow vaginal delivery
- 3rd trimester bleeding: abruptio placenta with unstable mom and fetus with vaginal delivery unlikely
- immediate cesarean section
- 3rd trimester bleeding: abruptio placenta with stable mom and fetus, remote from term but no more bleeding, pain, or DIC
- conservative management
- 3rd trimester bleedinG": placenta previa with stable mom and fetus remote from tern
- conservative in-house management
- 3rd trimester bleeding: placenta previa with unstable mom or fetus, remote from term
- immediate cesarean delivery
- 3rd trimester bleeding" placenta previa with stable mom and fetus at term
- scheduled cesarean delivery
- twin pregnancy: cephalic-cephalic presentation
- vaginal delivery
- twin pregnancy: cephalic-breech presentation
- vaginal or cesarean delivery
- twin pregnancy: breech-cephalic presentation
- cesarean delivery
- suspected fetal demise
- obstetrical sonogram
- confirmed fetal demise
- rule out DIC
- confirmed fetal demise with evidence of DIC
- immediate delivery
- confirmed fetal demise duration unknown; Mom wants conservatice management
- assess for possible DIC
- just confirmed recent fetal demise
- assess psychological readiness for delivery
- isoimmunization: ∆OD450 in Liley zone I
- repeat amniocentesis in 3 weeks; deliver at term if ≥37 weeks
- isoimmunization: ∆OD450 in Liley zone II
-
repeat amniocentesis
in 1 week if HIGH zone 2
in 2 weeks if LOW zone 2
deliver at term if ≥37 weeks - isoimmunization: ∆OD450 in Liley zone
-
intrauterine transfusion: if <34 weeks
deliver if ≥34 weeks - sonographic findings suggestive of GTN
-
baseline b-hcg titer
baseline chest x-ray
suction d&c - histologically confirmed beign gtn
- weekly b-hcg titers until negative X 3; monthly b-hcg titers until negative X 12 months; effective contraception X 12 months
- histologically confirmed malignant GTN with good prognostic risk factors
- single agent chemo (methotrexate); weekly b-hcg titers until neg X 3; monthly b-hcg titers until neg X 12 months; effective contraception X 12 months
- histologically confirmed malignant GTN with poor prognostic risk factors
-
multiple agent chemo;
weekly b-hcg titers until neg X 3;
monthly b-hcg titers until neg X 2 years;
quarterly b-hcg titers until neg X 5 years;
effective contraception entire time - mild pre-eclampsia ≥ 36 weeks
- promt delivery; IV MgSO4
- severe pre-eclampsia, remote from term
- prompt deliver; IV MgSO4
- Severe pre-eclampsia ≥ 36 weeks
- prompt deliver; IV MgSO4
- Eclampsia; remote from term
- prompt deliver; IV MgSO4
- Eclampsia ≥ 36 weeks
- prompt deliver; IV MgSO4
- chronic hypertension, remote from term
- conservative management (methyl dopa is drug of choice)
- Chronic hypertenison ≥ 36 weeks
- evaluate fetal well being; deliver at term or with fetal lung maturity.
- chronic hypertension with superimposed pre-eclampsia remote from term
- prompt deliver; IV MgSO4
- Chronic HTN with superimposed pre-eclampsia ≥36 weeks
- prompt deliver; IV MgSO4
- HEELP syndrome, remote from term
- prompt deliver; IV MgSO4
- HEELP syndrome ≥36 weeks
- promt delivery, IV MgSO4
- Transient hypertension in pregnancy
- conservative management
- 1hr 50 g glucola screen ≥140 mg/dl
- 3 hr 100 g OGTT
- positive 3 hr 100 g OGTT
-
education: ADA diet
Education: importance of glucose controle
Home glucose monitoring - gestational diabetes: glucose values in target range, remote from tern, no risk factors
- conservative management
- gestational diabetes: glucose values NOT in target range, remote from term, no other risk factors.
- start insulin treatment; begin NST/AFIs at 32 weeks
- gestational diabetes; glucose values in target range at term
- consider delivery; start NSTs and AFIs
- Iron deficiency anemia in pregnancy
- FeSO4, 3 tablets per day
- folate deficiency in pregnancy
- folic acid, 1 mg per day
- culture proven asymptomatic bacteruria
- single agen oral antibiotic
- culture proven acute cystitis
- single agent oral antibiotic
- acute pyelnoephritis in pregnancy
- hospital admission; IV antibiotics; IV hydration
- patient in labor with history of acute toxoplasmosis in pregnancy
- vaginal delivery
- patient in labor with history of acute rubella in pregnancy
- vaginal delivery
- patient in labor with primary herpes in pregnancy and membranes ruptured 3 hours
- vaginal delivery regardless if genital lesions present or not
- patient in labor with secondary herpes during pregnancy and membranes intact
- vaginal delivery if no genital lesions; cesarean delivery if genital lesions
- patient in labor with secondary herpes during pregnancy and membranes ruptured 3 hours
-
vaginal delivery if no genital lesions;
c/s if genital lesions - patient in labor with secondary herpes during pregnancy and membranes ruptured 18 hours
- vaginal delivery regardless if genital lesions present or not
- patient in labor with history of treated syphilis in pregnancy
- vaginal delivery
- patient in labor with + hep BsAg in pregnancy
- vaginal delivery with active and passive immunizaton of baby
- patient in labor with + HIV in pregnancy
- vaginal delivery with AZT in labor
- patient in labor with + GBBS culture in pregnancy
- vaginal delivery with prophylactic IV penicillin
- prolonged latent phase of labor
- therapeutic rest or sedation
- prolonged active phase of labor
- access uterine contraction quality; IV oxytocin if inadequate
- arrest of dilation in active phase of labor
- assess uterine contraction quality; IV oxytocin if inadequate; c/s if no response
- arrest of descent in 2nd stage of labor
- assess uterine contraction quality; IV oxytocin if inadequate; vacuum extractor, forceps, or C/S
- prolonged 3rd stage of labor
- IV oxytocin; attempt manual placental removal; r/o abrnomal trophoblastic invasion
- repetitive accelerations on EFM in labor
- conservative management
- repetitive early decelerations on EFM in labor
- conservative management
- repetitive mild variable decelerations on EFM in labor
- conservative management
- repetitive moderate variable decelerations on EFM in labor
- conservative management
- repetitive severe variable decelerations on EFM in labor
- genericinterventions; rapid delivery if no response
- repetitive mild late decelerations on EFM in labor
- generic interventions; rapid delivery if no response
- repetitive severe late decelerations on EFM in labor
- generic interventions; rapid delivery if no response
- fetal blood sampling obtained in labor with pH 7.15
- immediate delivery
- fetal blood sampling obtained in labor with pH 7.25
- conservative management
- suspected PROM 21 weeks gestation without regular contractions
- speculum exam for pooling, nitrazine, ferning
- suspected PROM 31 weeks gestation without regular contractions
- speculum exam for pooling, nitrazine, ferning
- suspected PROM 37 weeks gestation without regular contractions
- speculum exam for pooling, nitrazine, ferning
- confirmed PROM 21 weeks gestation without regular contractions
- observation at hom/induce labor; servical cultures, prophylactic penicillin, steroids for fetal lung maturity
- confirmed PROM 27 weeks gestation without regular contractions
- observation in-hospital; cervical cultures, prophylactic penicillin
- confirmed PROM 37 weeks gestation without regular contractions
- deliver expeditiously or wait 24 hours if cervix unfavorable
- Confirmed PROM 21 with regular contractions
- conservative management without tocolytic therapy
- confirmed PROM 31 weeks gestation WITH regular contractions
- conservative management without tocolytic therapy
- confirmed PROM 37 wks gestation with regular contractions
- conservative management without tocolytic therapy
- confirmed PROM 21 weeks gestation with no contractions or chorioamnionitis
- home management
- confirmed PROM 31 weeks gestation with no contractions or chorioamnionitis
- observation at home/induce labor; cervical cultures, prophylactic penicillin, steroids for fetal lung maturity
- confirmed PROM 37 weeks gestation with fever and uterine tenderness
- deliver expeditiously or wait 24 hours if cervix unfavorable
- confirmed PROM 21 weeks gestation WITH fever and uterine tenderness
- deliver promptly; obtain cervical cultures; begin broad-spectrum antibiotics
- Confirmed PROM 31 weeks gestation with fever and uterine tenderness
- deliver promtpy; obtain cervical cultures; begin broad spectrum antibiotics
- confirmed PROM 37 weeks gestation with fevere and uterine tenderness
- deliver promptly; obtain cervical cultures; begin broad spectrum antibiotics
- regular uterine contractions, 28 weeks festation, fetal demise
- induce labor expeditiously
- regular uterine contractions, 28 weeks gestation, severe IUGR
- conservative management
- regular uterine contractions, 28 weeks gestation, severe fetus with renal agenesis
- conservative management
- regular uterine contractions, 28 weeks gestation, severe pre-eclampsia
- deliver expeditiously; start MgSO4; maintain BP 90-100 mm Hg
- regular uterine contractions, 28 weeks gestation, 8 cm dilated
- conservative management
- regular uterine contractions, 28 weeks gestation, 3 cm dilated
- tocolysis if no contraindications; obtain cervical cultures, prophylactic penicillin
- regular uterine contractions, 28 weeks gestation, cervix closed
- conservative management
- regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous classical c/s
- emergency repeat c/s
- Regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous transverse segment c/s
- emergency repeat c/s or attempt VBAC
- Regular uterine contractions, 36 weeks gestation, 3 cm dilated, previous low vertical c/s
- emergency repeat c/s or attempt VBAC
- regular uterine contractions, 36 weeks gestation, 3 cm dilated, frank breech presetation
- emergency c/s or attempt VBAC
- regular uterine contractions, 36 weeks gestation, 3 cm dilated, complete breech presentation
- emergency c/s
- regular uterine contractions, 36 weeks gestation, 3 cm dilated, footling breech presentation
- emergency c/s
- no uterine contractions, 27 weeks gestation, cervix closed, complete breech
- conservative management
- no uterine contractions, 37 weeks gestation, 2 cm dilation, complete breech
- attempt external version; discuss c/s
- no uterine contractions, 37 weeks gestation, 2 cm dilation, frank breech
- attempt extrenal version; discuss c/s; consider vaginal delivery
- postpartum bleeding due to uterine atony
- uterine massage, oxytocin, ergotamine, 15 methyl F2alpha
- postpartum bleeding due to genital lacerations
- repari lacerations.
- postpartum bleeding due to retained placental tissues
- manual uterine exploration; uterine curettage
- postpartum bleeding due to DIC
- remove all placental fragments; ICU of mom, selective blood product replacement
- postpartum bleeding due to uterine inversion
- elevate vaginal fornices; massage uterus; give oxytocic agents
- postpartum fever due to endometritis
- broad spectrum antibiotics to treat polymicrobial flora
- postpartum fever due to UTI
- urine culture and sensitivity; start single agent Antibiotic (unless pt is septic, then multiple agents)
- postpartum fever due to atelectasis
- pulmonary exercises; encourage ambulation
- postpartum fever due to wound infection
- obtain cultures; broad spectrum antibiotics; drain wound and pack
- pap smear: inflammation without atypia
- treat inflammation; no need to repeat Pap smear
- Pap smear: inflammation with atypia
- treat inflammation; repeat Pap smear
- Pap smear: low grade SIL
- colposcopy with directed biopsy
- pap smear: high grade SIL
- colposcopy with directed biopsy
- Pap smear: invasive carcinoma
- colposcopy with directed biopsy
- unsatisfactory colposcopy (T zone extends into endocervical canal); ap smear report: low grade SIL
- endocervical curettage
- unsatisfactory colposcopy (T zone extends into endocervical canal); pap smear report: low grade SIL
- cone biopsy
- unsatisfactory colposcopy (T zone extends into endocervical canal) pap smear report: high grade SIL
- cone biopsy
- satisfactory colposcopy; pap smear: low grade SIL; cervical biopsy: mild dysplasia (patient is pregnant)
- observation (look for spontaneous involution)
- satisfactory colposcopy; pap smear: low grade SIL; cervical biopsy: mild dysplasia
- epithelial destruction: cryotherapy, LEEP
- Satisfactory colposcopy; Pap smear: low grade SIL; cervical biopsy: severe dysplasia
- epithelial destruction: cryotherapy, leep, CO2, laser, cone biopsy
- Satisfactory colposcopy; Pap smear: high grade SIL: cervical biopsy: microinvasive carcinoma
- cone biopsy
- Satisfactory colposcopy; Pap smear: high grade SIL; cervical biopsy: mild dysplasia
- cone biopsy
- Satisfactory colposcopy; pap smear: high grade SIL; cervical biopsy: adenocarcinoma
- cone biopsy
- 35 y/o woman with cervical biopsy: CIS
- TOTAL HYSTERECTOMY (abdominal or vaginal) OR cone biopsy
- 55 y/o woman with cervical biopsy: CIS
- total hysterectomy (abdominal or vaginal)
- 35 y/o woman with cervical biopsy : invasive carcinoma, stage IA1
- total hysterectomy (abdominal or vaginal)
- 55 y/o woman with cervical biopsy: invasive carcinoma, stage IA1
- total hysterectomy (abdominal or vaginal)
- 35 y/o woman with cervical biopsy: invasive carcinoma, stage IA2
- extrafascial TAH
- 55 y/o woman with cervical biopsy: invasive carcinoma, stage IA2
- extrafascial TAH
- 35 y/o woman with cervical biopsy: invasive carcinoma, stage IB or II
- radical hysterectomy and bilateral lymphadenectomy or radiation therapy
- 55 year old woman with cervical biopsy: invasive cancer, stage IB or II
- radiation therapy
- 35 y/o woman with cervical biopsy: infasive cancer, stage III or IV
- radiation therapy
- 55 y/o woman with cervical biopsy: invasive cancer, stage III or IV
- radiation therapy
- 23 y/o with vaginal complaints: minimal discharge with "fishy" ordor
- vaginal pH; wet prep (look for clue cells)
- 23 y/o woman with significant discharge with itching and pain
- vaginal pH; wet/KOH prep (look for pseudohyphae and trichomonads)
- 23 y/o w/ diagnosis of bacterial vaginosis
- metrondiazole/clindamycin orally or vaginally
- 23 y/o woman with diagnosis of candida gainitis
- vaginal "azole" creams or single dose fluconazole
- 23 y/o woman with diagnosis of trichomonas vaginitis
- metronidazole cream/tablets, orally treating partner as well
- undiagnosed vulvar lesion
- vulvar biopsy
- vuvar biopsy: hyperplastic lesion
- fluorinated corticosteroids
- vulvar biopsu: lichen sclerosis
- testosterone cream
- vulvar biopsy: vulvar carcinoma, stage 0
- skinning vulvectomy OR laser ablation if younger patient
- vulvar biopsy: vulvar dysplasia
- surgical excision
- vulvar biopsy: pagets disease
- simple vulvectomy with lymphadenectomy (if invasive disease)
- vulvar biopsy: invasive carcinoma
- radical vulvectomy and bilateral lymphadenectomy
- 43 y/o woman with mild cystocele/rectocele
- kegel's exercises
- 57 y/o woman with mild cystocele/rectocele
- kegel's exercises
- 43 y/o woman with significant cystocele
- anterior colporrhaphy
- 57 y/o woman with significant cystocele
- anterior colporrhaphy and hormone replacement therapy
- 57 y/o woman with 2º uterine prolapse (not a surgical candidate)
- vaginal pessary and hormone replacement therapy
- 43 y/o woman with involuntary urine loss
- urinalysis and culture
- 43 y/o woman with involuntary urine loss & cannot suppress the urge to void
- anticholinergics, NSAIDs
- 43 y/o woman with involuntary yrine loss & + Q tip test
- elevate urethrovesical angle
- 43 y/o woman with involuntary yrine loss & residual volume of 450 cc
- intermiittent self catheterization; cholinergic agents, d/c systemic medications
- 43 y/o womane wtih involuntary urine loss with history of radical hysterectomy (indigo carmine leaks onto vaginal tampons_
- surgical repair of fistula
- 6 y/o girl with isolated pubic hair growth
- conservative observation
- 6 y/o girl with diopathic isosexual constitutional percocity
- GnRH agonist suppression
- 6 y/o girl with isosexual complete precocity and unilateral pelvic mass
- remove granulosa cell tumor/fibrothecoma
- 6 y/o firl with heterosexual precocity and inulateral pelvic mass
- remove Sertoli-Leydig tumor/hilar cell tumor
- 13 y/o girl with 1º amenorrhea and absent 2º sex characteristics
- conservative management
- 15 y/o girl with 1º amenorrhea and absent 2º sex characteristics
- FSH and karyotype
- 15 y/o girl with 1º amenorrhea WITH 2º sex characteristics
- conservative management
- 16 y/o with 1º amenorrhea no uterus but breast present
- serum testosterone and karyoptye
- 21 y/o no pregnant woman with 2º amenorrhea, progesterone challenge test +
- TSH; prolactin, periodic progestin cycline
- 21 y/o nonpregnanty woman with 2º amenorrhea; progesterone challenge test negative
- estrogen-progesterone challenge test
- 21 y/o non pregnant woman with 2º amenorrhea and + estrogen -progesterone challenge test
- FSH (CNS imaging if FSH low)
- 21 y/o non pregnant woman with 2º amenorrhea and - estrogen -progesterone challenge test
- hysterosalpingogram
- 17 y/o woman with primary dysmenorrhea and normal pelvic exam
- NSAIDS; combination OCPs
- 22 y/o woman with secondary dysmenorrhea (infertility, dyspareunia, dyschezia)
- diagnostic laparoscopy (look for endometriosis)
- 22 y/o woman with diagnosed endometriosis (requests medical management)
- steroid contraception; GnRH agonists; pregnancy
- 16 y/o woman with abnormal menstrual bleeding
- qualitative b-hcg test to r/o pregnancy
- 33 y/o woman with abnormal menstrual bleeding
- qualitative b-hcg test to r/o pregnancy
- 15 y/o adolescent with dysfunctional uterine bleeding
- periodic cycling with progestagens; no endometrial biopsy
- 30 y/o woman (normal weight and BP0 with dysfunctional uterine bleeding
- periodic cycling with progestagens; no endometrial biopsy
- 30 y/o woman (obese, hypertensive) with dysfunctional uterine bleeding
- endometrial biopsy with progestagen cyclinc if histology is normal
- 35 y/o woman (obese, htn) with dysfunctional uterine bleeding
- endometrial biopsy with progestagen cycling if histology is normal
- 55 y/o woman (obese, htn) with abnormal uterine bleeding
- endometrial biopsy to r/o endometrial cancer
- 30 y/o woman (normal weignt and BP) with dysfunctional uterine bleeding not normalized with progestagens
- hysteroscopy and D&C to look for endometrial pathology; consider hysterosonography
- 30 y/o woman with abnormal uterine bleeding with regular, predictable menses
- hysteroscopy and D&C to look for endometrial pathology, consider hystersonography
- 29 y/o woman with varied symptos exacerbated prior to menses
- keep a menstrual diary
- 29 y/o woman with confirmed PMS
- treatment directed at specific symptom cluster; consider SSRIs
- 30 y/o woman with hirsutism requests laboratory evaluation
- serum testosterone, DHEAS, 17-OH progesterone, cortisol, LH/FSH ratio
- 30 y/o woman with hirsutism due to androgen producing ovarian tumor
- surgical removal of tumor
- 30 y/o wih hirsutism due to androgen producing adrenal timor
- surgical removal of tumor
- 30 y/o wih hirsutism due to congenital adrenal hyperplasia
- glucocorticoid replacement
- 30 y/o wih hirsutism due to excessive hair follicle conversion of testosterone to DHT
- spironolactone
- 30 y/o woman with hirsutism due to PCO syndrome
- oral contraceptive pills
- 53 y/o postmenopausal woman after hysterectomy requests hormone replacement therapy
- continuous estrogen replacement
- 53 y/o postmenopausal woman with intact uterus requests hormone replacement therapy
- continue estrogen and progesterone replacement
- 59 y/o postmenopausal woman with undiagnosed vaginal bleeding
- hysteroscopy and fractional D&C after ruling out GI tract and lower reproductive tract causes
- 38 y/o premenopausal woman with complex hyperplasia without atypia desiring fertility preservation
- cyclic progestin and rebiopsy in 3-6 months
- 38 y/o premenopausal woman with complex hyperplasia without atypia not desiring fertility preservation
- cyclic progestin and rebiopsy in 3-6 months
- 38 y/o premenopausal woman with complex hyperplasia with atypia desiring fertility preservation
- cyclic progestin and rebiopsy in 3-6 months
- 38 y/o premenopausal woman with complex hyperplasia with atypia not desiring fertility preservation
- TVH or TAH
- 52 y/o postmenopausal woman with complex hyperplasia without atypia
- TVH or TAH
- 52 y/o postmenopausal woman with complex hyperplasia with atypia
- TVH or TAH
- 52 y/o woman with STAGE 1, GRADE 1, endometrial cancer
- TAH and BSO with peritoneal washing cytology
- 50 y/o woman with stage 1, grade 3 endometrial cancer
- TAH, BSO, peritoneal cytology and lymph node sampling
- 50 y/o woman with stage II endometrial carcinoma
- TAH, BSO after preoperative whole pelvis radiation
- 50 y/o woman with stage III or stage IV endometrial cancer
- TAH, BSO, progetin therapy, chemotherapy, and radiation therapy
- 25 y/o with a pelvic mass
- qualitative b-hcg to r/o pregnancy
- 25 y/o nonpregnant woman with a unilateral 5 cm cystic pelvic mas using diaphragm for contraception
- observation or place on combination oral contraceptives to suppress a functional cyst
- 25 y/o nonpregnant woman with a unilateral 5 cm cystic pelvic mass on combination oral contraceptive pills
- scheduled pelvic laparoscopy
- 25 y/o pregnant woman with bilateral 7 cm ovarian masses, partiall y solid and partially cystic
- observation of theca-lutein cysts or luteomas of pregnancy
- 25 y/o nonpregnant woman with a unilateral 5 cm solid pelvic mass
- scheduled pelvic laparoscopy
- 25 y/o nonpregnant woman with a unilateral 9 cm cystic pelvic mass complaining of sudden onset of RLQ pain
- EMERGENCY EXPLORATORY LAPAROTOMY
- 55 y/o postmenopausal woman with a unilateral 5 cm cstic pelvic mass
- stagin exploratory laparotomy
- 55 y/o postmenopausal woman with a unilateral 5 cm solid pelvic mass
- staging exploratory laparotomy
- 26 y/o woman G1P1 with stage Ia ovarian serous cystadenocarcinoma desiring retention of fertility
- unilateral salpingo-oophorectomy
- 38 y/o woman G4P3A1 with stage Ia ovarian serous cystadenocarcinoma not desiring retention of fertility
- TAH, BSO
- 38 y/o woman G1P1 with stage II ovarian serous cystadenocarcinoma
- TAH, BSO, chemo
- 52 y/o wman G1P1 with stage II ovarian serous cystadenocarcinoma
- TAH, BSO, CHEMO
- 25 y/o woman with a diffusely enlarged uterus
- qualitative b-hcg test to r/o pregnancy
- 25 y/o woman with a uterine submucous leiomyoma causing intermenstrual bleeding
- hysteroscopic resection
- 25 y/o woman with an asymmptomatic 7 cm uterine subserosal leiomyoma
- conservative management w/ observation
- 25 y/o infertile woman with multiple 5-7 cm uterine intramural leiomyomata
- preoperative involution by GnRH agonist suppresion followed by myomectomy
- 36 y/o woman G3P3 with multiple 5-7 cm uterine intramural leiomyomata not desiring fertility
- TAH
- 22 y/o woman G3P2A1, afebrile, with mucopurulent vervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
- outpatient antibiotic therapy with IM cephalosporin plus oral doxycycline/tetracycline
- 22 y/o woman G0P0, afebrile, with mucopurulent cervical discharge, cervical motion tenderness and bilateral adnexal tenderness
- inpatient antibiotic therapy with IV cephalosporin plus doxycyclin or clindamycin plus gentamycin
- 22 y/o woman G3P2ab1, T 102ºF with mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness
- inpatient antibiotic therapy with IV cephalosporing plus doxycycline or clindamycin plus gentamycin
- 22 y/o woman G3P2AB1, T 102º, with mucopurulent cervical discharge, cervical motion tenderness and bialteral fluctuant adnexal masses
- INPATIENT ANTIBIOTIC THERAPY WITH PERCUTANEOUS DRAINAGE/EMERGENCY LAPAROTOMY IF INADEQUATE RESPONSE TO MEDICAL TREATMENT
- 22 y/o woman G3P2A1, afebrile, with no cervical discharge, but with cervical motion tenderness and bilateral adnexal masses
- Qualitative b-hcg to r/o pregnancy, then conservative management. TAH, BSO if unsatisfactory response (remember ERT).
- 19 y/o woman with unilateral adnexal tenderness, and quantitative b-hcg of 800.
- transvaginal sonogram to look for intrauterine gestational sac.
- 29 y/o woman with unilateral adnexal tenderness and quantitative b-hcg of 800 and no intrauterine gestation sac or pelvic masses on tv sonogram
- observationand repeat b-hcg and tv sono in 2-3 days
- 19 yo woman with unilateral adnexal tenderness, and quantitative b-hcg of 2500 and no intrauterine gestation sac but possible left adnexal mass on tv sonogram
- pelvic laparoscopy or methotrexate therapy
- 19 y/o woman with 7 weeks of amenorrhea, now presenting with vaginal bleeding, sudden onset of abdominal pain, BP 70/40 and pulse 150/min
- emergency exploratoy laparotomy