Medical abortion
what is the recommended pain management for medication abortion
NSAIDs as needed
Smoking is associated with an increased risk of type 1 endometrial cancer. T/F
F (increased risk of type 2 endometrial cancer)
Define postpartum hemorrhage (2)
blood loss >=1000mL
OR
blood loss accompanied by signs and sxs of hypovolemia within 24hrs after birth
what is a normal period (duration and cycle)
duration 5 days. cycles 21-35 days
What are the last names of Megan and Meghan?
Meghan Born and Megan Kaiser
when is medication abortion preferrable to uterine aspiration? (3) (assume intrauterine pregnancy is confirmed and is <10wks/70days)
uterine fibroids that significantly distort cervical canal/uterine cavity
congenital uterine anomalies
introital scarring related to infibulation
how to diagnose endometrial cancer?
D&C (higher accuracy) or outpatient endometrial sampling
Name 3 causes of postpartum hemorrhage
Uterine atony, Lacerations, Retained placenta/products of conception, Placenta accreta, Coagulopathy/DIC, Uterine inversion, Infection
4Ts (tone, trauma, tissue, thrombin)
what is PALM-COEIN?
Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
Where are the interns from? (where they grew up?)
Megan: Colorado
Meghan: Wisconsin
Thu: Vietnam
When is medication abortion not recommended? (name 3)
confirmed/suspected ectopic pregnancy
IUD in place (can be removed prior to medication abortion)
current long-term systemic corticosteroid therapy
chronic renal failure
known coagulopathy/anticoagulant therapy
inherited porphyria
intolerance/allergy to medication
type 1: endometrioid adenocarcinoma (precursor is endometrial intraepithelial hyperplasia)
type 2: clear cell and papillary serous
Recommended management at 3rd stage of labor to prevent PPH
oxytocin (bolus of 10U or 10U IM), uterine massage, umbilical cord traction
NOTE: oxytocin + methylergonovine or oxytocin + misoprostol NOT superior to oxytocin alone
Name recommended lab assessments for AUB (3)
pregnancy test, CBC, TSH, pap, screening for bleeding disorders (PT, PTT)
NOTE: Chlamydia if high risk, may consider TSH
What was the procedure that Thu got to do on her very first day as a resident?
Below-the-knee amputation (literally breaking a leg on her very first day)
what are mifepristone and misoprostol? (drug types, mechanisms of action and effects- name 3 for mifepristone and 2 for misoprostol)
misoprostol: PGE1 analog. Effects: uterine contractions and cervical softening
Name 3 risk factors for type 1 uterine cancer
older age
residency in North America or Northern Europe
Higher level of education or income
White
Nulliparity
Hx infertility
Menstrual irregularities
Estrogen: Late age at menopause, early age at menarche, long-term use of unopposed estrogen, tamoxifen, obesity,
Hx T2DM, HTN, galbladder disease or thyroid disease
Lynch syndrome
Tx options for PPH (5)
uterotonics, tamponade (intrauterine balloons), surgical (B-Lynch procedure), embolization of uterine artery, hysterectomy
define menorrhagia, metrorrhagia, polymenorrhea and oligomenorrhea
menorrhagia: heavy menstrual bleeding (>80mL)
metrorrhagia: bleeding between periods
polymenorrhea: bleeding more often than 21 days
oligomenorrhea: bleeding less frequently than 35 days
What medical schools did the interns go to?
Megan: ATSU KCOM
Meghan: Des Moines University COM
Thu: MSUCOM
Give the medication names, dosage and dosing regimen for medication abortion (combination and monotherapy) AND how to manage incomplete medication abortion
mifepristone 200mg PO then misoprostol 800mcg (buccally, vaginally or sublingual) 24-48hrs later
OR
misoprostol 800mcg (buccally, vaginally or sublingual) q3h up to 3 doses
Incomplete medication abortion: repeat dose of misoprostol 1 week after, uterine aspiration or expectant (if retained sac at 2 weeks after medication abortion, usually expulsion the following weeks)
How to stage endometrial cancer?
remove uterus, cervix, adnexa, pelvic and para-aorta lymph nodes and pelvic washings
List the medications used for acute management of PPH and their contraindications (at least 3)
oxytocin: hypersensitivity (rare)
methylergonovine: HTN, preE, cardiovascular disease, hypersensitivity
15-methyl PGF2alpha (carboprost): asthma, relative contraindications to HTN, active hepatic, pulm or cardiac disease
misoprostol: hypersensitivity (rare)
NOTE: transexamic acid is to be considered after initial medical therapy fails
how to diagnose adenomyosis (screening and definitive) and name 2 findings on imaging indicative of it
transvaginal US or MRI
definitive dx by histopathology
findings: heterogenous myometrium, myometrial cysts, asymmetric myometrial thickness, subendometrial echogenic linear striations
What were the intern's first rotations in residency?
Megan: EM
Meghan: ICU
Thu: gen surg