AUB-O
Name three physiologic causes of AUB-O
Adolescence, perimenopause, lactation, pregnancy
What SSRI has the most pregnancy data to support its use?
Zoloft
What physical exam finding is seen with insulin resistance?
Acanthosis nigracans
What is reported pooled success rate of ECV according to the PB?
58%
Define PALM-COIN
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
Ego syntonic (thoughts are not upsetting or may be comforting to the pt)
Symptoms of psychosis (hallucinations, disorganized thinking, delusions)
Pt thinks harming infant would benefit infant/society in some way (due to dellusional beliefs)
Has other bizzare beliefs
Pt has history of trauma and expresses wanted to get revenge on baby's other parent
Features of psychosis or concominant severe personality disorders
In women with PCOS who are not attempting to conceive, what is the best medical maintenance therapy to treat menstrual disorders?
Combined hormonal contraception
Contraindication to external cephalic version
Contraindication to vaginal delivery
Placenta or vasa previa, HSV outbreak, NRFHTs...
What is the average length of a menstrual cycle
21-35 days
Buproprion! What presentation would you consider using this medication for? In what population is this medication contraindicated?
Depression with underlying anxiety (not great for anxiety predominant presentation)
Contraindicated in bullemia nervosa or underlying seizure disorder because it lowers the seizure threshold
Describe the diagnostic criteria of PCOS
Rotterdamn criteria:
> or = 12 follicles (2-9 mm) in a single follicle ovary and/or ovarian volume > 10 ml
An- or oligo- ovulation
Clinical or laboratory hyperandrogenism
Need 2 of 3 criteria
Describe the three reasons the PB gave for timing ECV at or after 37.0 weeks gestation.
1) if spontaneous version is going to occur, it is likely to have taken place by 37.0 weeks
2) Risk of a spontaneous reversion after ECV is decreased after 37.0 weeks compared with ECV at an earlier gestation
3) If complications arise during ECV you deliver a term infant
Why does anovulation lead to irregular uterine bleeding
No ovulation = no corpus luteum = low progesterone. Unopposed estrogen causes fragile endometrium with dyssyncrinous bleeding
In patients maintained on SSRIs during pregnancy, describe the most commonly seen neonatal side effects?
Poor neonatal adaptation syndrome - fussy.jittery babies that is generally mild and short lived
What is the gold standard test for glucose intolerance?
2 hour 75 gram oral glucose tolerance testing
Data supports the use of parenteral tocolysis for ECV
What diagnostic modalities are most useful in your evaluation of AUB-O?
Hysteroscopy
Transvaginal US
Saline infused sonohystogram
What rare but serious fetal condition can be seen with maternal SSRI use in pregnancy?
Persistent pulmonary hypertension
What medication for ovulation induction is recommended first line for women with PCOS desiring pregnancy?
Letrozole
Name the key requirements that should be included in a standard protocol for ECV (5).
1) US exam to confirm malpresentation and r/o presence of anomalies that would complicate a vaginal delivery
2) Informed consent
3) +/- tocolysis and neuraxial analgesia after pt counseling and informed decision making
4) NST and/or BPP before and after the procedure to establish fetal well being and contraction pattern
5) ECV should only be attempted in settings in which cesarean delivery is readily available