OB/GYN Study Guide #1

1. OB/GYN Study Guide #1 Class 44

2. 1) Type & parts of Pelvis –Difference b/w Male & Female pelvis. (Batiste Linden) Abassi Abdomen ppt: Slide 16 of 87 • Four types of female pelvis were described. Actually, the majority of pelvis are of mixed types: • (I) Gynecoid pelvis(50%) : • It is the normal female type. • 1.     Inlet is slightly transverse oval. • 2.     Sacrum is wide with average concavity and inclination. • 3.     Side walls are straight with blunt ischial spines. • 4.     Sacro- sciatic notch is wide. • 5.     Subpubic angle is 90-100o. Abassi Abdomen ppt: Slide 17 of 87 • (II) Anthropoid pelvis (25%): • It is ape-like type. • 1.     All anteroposterior diameters are long. • 2.     All transverse diameters are short. • 3.     Sacrum is long and narrow. • 4.     Sacro-sciatic notch is wide. • 5.     Subpubic angle is narrow.

3. 3rd & 4th Types of Pelvis Abassi Abdomen ppt: Slide 18 of 87 • (III) Android pelvis (20%): • It is a male type. • 1.     Inlet is triangular or heart-shaped with anterior narrow apex. • 2.     Side walls are converging (funnel pelvis) with projecting ischial spines. • 3.     Sacro-sciatic notch is narrow. • 4.     Subpubic angle is narrow <900 Abassi Abdomen ppt: Slide 19 of 87 • (IV) Platypelloid pelvis (5%): • It is a flat female type. • 1.     All anteroposterior diameters are short. • 2.     All transverse diameters are long. • 3.     Sacro-sciatic notch is narrow. • 4.     Subpubic angle is wide.

4. What is Pelvimetry & Cephalo Pelvic Disproportion-CPD? Tabers 2009 • Pelvimetry: Measurement of the diameters of the pelvis. • CT pelvimetry. procedure for measurement of the bony pelvis and fetal head through use of CT images; currently the more accurate imaging technique. • manual pelvimetry. measurement of the essential diameters of the bony pelvis using the hands. • radiographic pelvimetry. procedure for measurement of the bony pelvis and fetal head using anteroposterior and lateral radiographs, with a device for the correction of magnification. Wikipedia • Cephalo-pelvic disproportion exists when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal. This may be due to a small pelvis, a nongynecoid (see below) pelvic formation, or a large fetus, and combinations of these. Certain medical conditions may distort pelvic bones, such as rickets or a pelvic fracture, and lead to CPD.

5. Ovulation is the release of a single, mature egg from a follicle that developed in the ovary. It usually occurs regularly, around day 14 of a 28-day menstrual cycle. Once released, the egg is capable of being fertilized for 12 to 48 hours before it begins to disintegrate. Signs of ovulation can be any of the following, although many women may only notice 1 or 2 of these:• Change in cervical fluid• Change in cervical position and cervical firmness• Brief twinge of pain or dull ache that is felt on one side of the abdomen• Light spotting• Increase in sex drive• Elevated level of the luteinizing hormone which can be detected on a test• Body temperature chart that shows a consistent change: Just after ovulation, there should be a rise of approximately 0.4-0.6 F (about 0.2 Celsius). The day of ovulation there will be a slight rise. The following two days will climb progressively higher. The rise on the day of ovulation is not distinguishable from the normal ups and downs in the entire pre-ovulatory phase. It is only recognized in retrospect when it forms an upward line with the two days afterward. The post-ovulatory tempertures remain at this new, higher level, until menses when they drop and start the cycle over again. Again, it is only useful when a woman tracks several of her cycles and (if they are regular) she will be able to determine when she will ovulate. • Breast tenderness• Abdominal bloating• Heightened sense of vision, smell or taste #4 Physiology of Menstruation. Ovulation LH/FSH surge ,signs of ovulation. What is corpus luteum & its significance.(Espinoza Celia)

6. #4 Corpus luteum (continued) • The corpus luteum: is a temporary endocrine structure involved in production of progestogen, which is needed to maintain the endometrium. • The corpus luteum develops from an ovarian follicle during the luteal phase of the menstrual cycle or estrous cycle, following the release of a secondary oocyte from the follicle during ovulation. The follicle first forms a corpus hemorrhagicum before it becomes a corpus luteum, but the term simply refers to the visible collection of blood left after rupture of the follicle and has no functional significance. While the oocyte (later the zygote) traverses the Fallopian tube into the uterus, the corpus luteum remains in the ovary. • The corpus luteum is typically very large relative to the size of the ovary; in humans, the size of the structure ranges from under 2 mm to 5 mm in diameter. • The corpus luteum is essential for establishing and maintaining pregnancy in females. • In the ovary, the corpus luteum secretes estrogens and progesterone, which are responsible for the thickening of the endometrium and its development and maintenance, respectively. • The corpus luteum secretes estrogen and progesterone that inhibit LH and FSH • If the egg is not fertilized, the corpus luteum stops secreting progesterone and decays (after approximately 14 days in humans). It then degenerates into a corpus albicans, which is a mass of fibrous scar tissue. • The uterine lining sloughs off without progesterone and is expelled through the vagina. In an estrus cycle (sexually receptive) , the lining degenerates back to normal size. • If the egg is fertilized and implantation occurs, the trophoblast cells of the blastocyst secrete the hormone human chorionic gonadotropin (hCG). • hCG signals the corpus luteum to continue progesterone secretion, thereby maintaining the thick lining (endometrium) of the uterus and providing an area rich in blood vessels in which the zygote(s) can develop. From this point on, the corpus luteum is called the corpus luteum graviditatis. • The introduction of prostaglandins at this point causes the degeneration of the corpus luteum and the abortion of the fetus. However, the placenta eventually takes over progesterone production and the corpus luteum degrades into a corpus albicans without embryo/fetus loss.

7. 5. Fibroadenoma • The typical case is the presence of a painless, firm, solitary, mobile, slowly growing lump in the breast of a woman of childbearing years. • Fibroadenomas arise in the terminal duct lobular unit of the breast. They are the most common breast tumor in adolescent women. They also occur in a small number of post-menopausal women. Their incidence declines with increasing age, and they generally appear before the age of thirty years, probably partly as a result of normal estrogenic hormonal fluctuation. Although fibroadenoma is considered a neoplasm, some authors believe fibroadenoma arises from hyperplasia of normal breast lobule components. • Most fibroadenomas are treated by surgical excision. They are removed with a small margin of normal breast tissue if the preoperative clinical investigations are suggestive of the diagnosis. A small amount of normal tissue must be removed in case the lesion turns out to be a phyllodes tumour on microscopic examination. • Fibroadenomas have not been shown to recur following complete excision or transform into phyllodes tumours following partial or incomplete excision.

8. 5. Fibrocystic Diseases • It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out. • The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different. • Puerperal mastitis • Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. It is caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess. • Nonpuerperal mastitis • The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. Skin related conditions like dermatitis and foliculitis are a separate entity. Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska's Disease and others.

9. 5. Carcinoma of Breast • Breast cancer is a cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. • The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the surrounding breast tissue. • Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. • When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange. • In a clinical setting, breast cancer is commonly diagnosed using a "triple test" of clinical breast examination (breast examination by a trained medical practitioner), mammography, and fine needle aspiration cytology. Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also identify any other lesions. Fine Needle Aspiration and Cytology (FNAC), which may be done in a GP's office using local anesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.

10. #19 What is the relationship of OCPs with STDs and why? • Many of the contraceptives that have the greatest efficacy in preventing pregnancy provide no protection against STDs, and methods (specifically condoms) that protect against STDs have higher contraceptive failure rates in typical users. • In patients at risk for STDs, greater emphasis should be placed on use of a barrier method of contraception, either alone or in combination with another contraceptive method.

11. 50. Pap Smear in low risk vs. High risk population. Explain • What is a Pap Smear • A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for pre-malignant (before-cancer) or malignant (cancer) changes.

12. 50. (cont.) Low Risk Patients • When to start • 3 years after vaginal intercourse, no later than age 21 • Frequency of Pap smear testing • Yearly with exceptions: • every 2 years if liquid-based kit • every 2-3 years if three normal tests in a row in women >30 years old • At what age to stop having Pap smears • Total hysterectomy for benign disease • > 70 years old with at least three normal Pap smear results and no abnormal Pap results in the last 10 years (American Cancer Society 2004)

13. 50. (cont.) High Risk Patients HPV: The principal risk factor is infection with the genital wart virus, also called the human papillomavirus (HPV), although most women with HPV infection do not get cervical cancer. About 95%-100% of cervical cancers are related to HPV infection. Some women are more likely to have abnormal Pap smears than other women. Smoking: One common risk factor for premalignant and malignant changes in the cervix is smoking. Although smoking is associated with many different cancers, many women do not realize that smoking is strongly linked to cervical cancer. Smoking increased the risk of cervical cancer about two to four fold. Weakened immune system: Women whose immune systems are weakened or have become weakened by medications (for example, those taken after an organ transplant) also have a higher risk of precancerous changes in the cervix. Medications: Women whose mothers took the drug diethylstilbestrol (DES) during pregnancy also are at increased risk. Other risk factors: Other risk factors for precancerous changes in the cervix and an abnormal Pap testing include having multiple sexual partners and becoming sexually active at a young age.