OB- GYN Objectives. OB- GYN HISTORY. I. Age, gravidity, parity. A. Age: age- related risks, young- prematurity, older- syndromes. B. Gravidity: total # of pregnancies. C. Parity: number of Full- term deliveries, Preterm, Abortions/miscarriages, Living children (Florida. Power And Light). II. Chief Complaint: reasons for the pt visit expressed in their own words (COLDEARR or LMNOPQRST). Don't cut to chase on entering room. III. Present illness. A. Dysmenorrhea: painful menstruation (primary or secondary)2. Dyspareunia: painful intercourse. Pelvic pressure. 4. Acute pelvic pain: direct or rebound. ![]() Chronic pelvic pain. Vulvar pain or pruritus. Menorrhagia: excessive bleeding. Metrorrhagia: light or heavy bleeding at irregular intervals (like any metro train)3. Menometrorrhagia: heavy and irregular timing. ![]() ![]() ![]() Identification of serious underlying disorders is the primary purpose of laboratory testing and should be individualized. About 95 percent of these patients have PCOS. Learn about Yaz (Drospirenone and Ethinyl Estradiol) may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related. Dianette (cyproterone acetate and ethinylestradiol) Dianette tablets contain cyproterone acetate and ethinylestradiol. This combination of medicines is also known as. Although the exact. Polymenorrhea: < 2. Oligomenorrhea: few periods. ![]() ![]() What is hidradenitis suppurativa hs? Learn about hidradenitis suppurativa hs symptoms, hidradenitis. Rio aprova PL sobre pagamento de serviços ambientais realizado por catadores. MNCR A Alerj aprovou no dia 10 de dezembro o projeto de lei que cria o Programa. PATHOGENESIS OF HIRSUTISM. Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women. Hair appears in a masculine. What is premenstrual dysphoric disorder (PMDD)? Learn about premenstrual dysphoric disorder (PMDD), a severe form of PMS. Discover the symptoms of PMDD, include mood. Hypomenorrhea: little menstrual bleeding. Abnormal discharge. Leukorrhea. 2. Nipple discharge. D. Bowel symptoms. Constipation. 3. Proctorrhagia. E. Urinary symptoms. Incontinence. 4. Sensations of incomplete voiding. F. Menstruation. 1. Flow (duration and amount)4. Date of last menstrual period (LMP)5. Date of preceding LMP6. Premenstrual tension. Breast tenderness. Irritability. 9. Dysmenorrhea. G. Past obstetrical history. Gravidity- -total # of pregnancies. Parity- -# of deliveries (FPAL)3. Length of gestation. Complication during prenatal periods. Method of deliveries, complications, outcomes. Indications for operative deliveries. Characteristics anbd conditions of offsprings. Puerperal complications. H. Gynecologic history. Prior diagnosis of gynecologic dz. Gynecologic surgery. Pelvic pain. 5. Vulvar or vaginal lesions. Bleeding problems. Pap smear history. Infertility. I. Contraceptive history. Actual feelings about contraception. Current method. 3. Length of use and any problems? If contraceptive method is used, is it well accepted? Well comprehended? Is change desired? Complaints related to the method. Prior methods and complications. J. Sexual history. Age at first intercourse. Number of partners. Know exposure to STDs. Feelings about sexual function. Current problems. Orgasmic function. Dyspareunia. 9. Vaginismus. History of sexual abuse. K. Past medical history. Medications. 2. Other medical diagnosis. L. Past surgical history. M. Family history. CA: colon, breast, ovarian, uterus. N. Social history. Habits: social, sexual. O. PE: include thyroid and lymphatics (axillary, groin, supraclavicular). ANTEPARTUM CARE. I. Important factors in the patient's past Medical/Surgical/Obstetrical Hx in assessing current pregnancy. A. Medical: DM, HTN/CV dz, thyroid dz, infectious dz. B. Surgical: prior abdominal surgeries in case of a CS (possible adhesions)C. OB: date & location of delivery, gestational ages, type of delivery or termination, duration of labor. Important factors in the Family and Socio- economic Hx. A. FHx DM, HTN/PIH/CV dz, thyroid dz, congenital malformations, genetic disorders. B. SE: insurance, prenatal care, alcohol or tobacco, drug use, father in home, exposure to pets. PNV, etc. III. Complete Physical. A. HEENT (check for thyroid status), CV, lungs, abdomen (gravid? Evaluate uterine size and determine heart beats. A. From the pubic symphisis to height of fundus. Basic lab data obtained on all pregnant patients, value of each test, normal values for pregnancy. A. Blood type including Rh & Ab screen. B. Rubella immune. C. CBC- -hct, WBC, plt. D UA- -protein, sugar. E. Glucola at 2. 4- 2. NL< 1. 30- 1. 40: 1 hour), do 3- hr of abnormal. F. RPR, GC, HBs. Ag, GBS, TB skin test. H. AFP (1. 5- 2. 0 Wks): high (open defect of neural tube: anencephaly, open spinal bifida) indication. US; low (Down, etc.)I. US (1. 0- 2. 0 wks): EGA, gender. VI. High- risk Factors. A. Medical/obstetrical disorders. Specific infections. Heart disease. 5. Chronic HTN6. Thyroid dysfunction. Isoimmunization. 9. Other significant maternal disease. Nutrition: vitamins & minerals, folate, iron. Emotional disturbance: poor coping skills etc. Discuss with the Pt. A. Common complaints. Heartburn (especially late in pregnancy)2. Constipation. 3. Sialorrhea. E. Use of drugs: avoid drugs of any kind if possible & clear with physician before using. H. Outline frequency, number, and clinical factors to be assessed in prenatal visits. Every 4 weeks up to 2. Prenatal Visits. 1. Initial labs: CBC, blood group with Rh type, serologic test for syphilis, rubella, hepatitis B. MSAFP), review prenatallabs. EGA, US5. 2. 4 weeks: begin maternal education. Rh immune globulin as indicated, GDM screen, risk assessment. Hb, fetal surveillance as indicated. DIAGNOSIS OF PREGNANCY. I. Four positive signs of pregnancy. A. Use of Ultrasonography in Early Diagnosis. A. Confirm pregnancy dating. B. Measurements of the gestational sac & crown- rump length (CRL)in cm plus 6. GA. III. 6. 6% every 2 days). Presumptive Signs of Pregnancy. A. Probable signs: enlargement of the abdomen, uterine changes (size, shape, consistency), cervical changes. Braxton- Hicks contractions, Endocrine tests. PHYSIOLOGIC CHANGES IN NORMAL PREGNANCY. I. Uterine Changes. Enlargement. 2. Pelvic and ligament pain, weight gain. Uterine anomalies, leiomyoma enlargement. B. Uterine blood flow. Enlarging uterus compresses iliac veins and IVC; venous return, and thus CO dec. Ovarian changes. A. Anatomy and physiology of the corpus luteum of pregnancy. CL made up of granulosa cells of the ruptured follicle & theca cells of ovarian stroma. Vaginal and perineal changes. A. Abdominal wall and skin changes. A. MSH and because some melanomas contain estrogen receptors. Breast changes. A. Macroscopic. 1. Size and nodularity inc., nipple hypertrophy & pigmentation; areolar hypertrophy and. Ig. A. after 3- 6 days, replaced by mature milk. VI. Metabolism changes. A. Water metabolism (normal distribution of water in the pregnant pt.) in relation to dependent. ECF increases and mom is in a state of physiological extracellular hypervolemia. Protein metabolism: active transport of aa across placenta means inc. Fasting blood sugar levels and response to oral glucose load: should be lower sugar levels. Lipolysis, maternal levels of free fatty acids: in first 1/2 of pregnancy, dec. Insulin response to carbohydrate intake in pregnancy: In first 1/2 of pregnancy, the. F. Fat metabolism. Starvation effect in pregnancy. VII. Hematologic changes. A. ESR, PT/PTT dec. Cardiovascular system. A. Heart rate. B. Cardiac silhouette. C. Cardiac volume. D. Heart sounds (heart murmurs)E. Cardiac output. F. Arterial blood pressure. Changes according to trimester. Changes according to maternal posture. Upper and lower extremities venous pressures. IX. Respiratory tract. A. Anatomic (chest) changes. B. Respiratory rate and tidal volume. C. Minute ventilation. D. Vital capacity. E. Residual volume. F. Lung compliance. X. Urinary system. A. Renal plasma flow. C. Importance of maternal position in renal function at term; i. D. Renal function tests in pregnancy. E. Glycosuria of pregnancy. F. Ureters. XI. Gastrointestinal tract. A. Displacements: Appendix. B. Pyrosis (esophagitis- gastritis)C. Gastric emptying in labor. E. Gums: Epulis of pregnancy. F. Hemorrhoids and constipation. XII. Liver and gallbladder. A. Liver laboratory studies in pregnancy. B. Alkaline phosphatase activity. C. Serum albumin. D. ALB/globulin ratio. E. Gallbladder function and propensity to stone formation. XIII. Endocrine glands. A. Pituitary: Enlargement, role in pregnancy, labor, and delivery. Growth hormone. 2. Prolactin: Serum levels in pregnancy; serum levels during. Puerperiumb. Non- lactating mothers. Progesterone effect on lactation. B. Enlargement. 2. Thyroid hormone concentration in pregnancy. Thyroid- binding globulin (estrogen effect)b. Serum thyroxin (T4)c. Triiodothryonine resin uptake (T3. U)d. Free thyroxin index (FTI)PLACENTAL DEVELOPMENT AND PHYSIOLOGY. I. Characteristics of placental villi. II. Characteristics of placental circulation. A. Single vein carries oxygenated blood to fetus, paired arteries branches of hypogastric carrying. III. Histologic concept of placental . Description of the amnion. A. Chorion and amnion have different anatomic origins. V. Description of the umbilical cord. A. 3. 0- 1. 00 cm long, 2 cm diameter, three vessels. VI. Placental hormonal production. A. Human chorionic gonadotrophin (h. CG)B. Human placental lactogen (HPL)C. Estrogens (role of the fetal adrenal). VII. Basic mechanisms of placental transfer. A. Selective transfer.
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