Ovarian Pathology
This condition presents with sudden unilateral pelvic pain, often after intercourse or activity, and is usually self-limited.
Ovarian cyst
- TVUS/transabdominal in adolescents
- Supportive tx (NSAIDs)
This STI-related condition presents with cervical motion tenderness and lower abdominal pain.
Pelvic inflammatory disease
- Gonorrhea + chlamydia
- Complications: infertility, ectopic pregancy
Mucopurulent discharge and postcoital bleeding are classic for this condition. NO Cervical Motion Tenderness.
Cervicitis
- Friable cervix
- Gonorrhea: ceftriaxone 500 mg IM <150 kg and 1g if >150 kg
- Chlamydia: doxycycline x 7 days, azithromycin 1g PO if pregnant or concerns for compliance
Unilateral severe pain ± bleeding w/ elevated ß-HCG.
Ectopic pregnancy
- Risks shock, hypotension
- MC: Fallopian tube
Painless third-trimester bleeding is classic for this condition.
Placenta previa
- NO PELVIC EXAM!!!!
- OB consult, possible C-section
This type of ovarian cyst forms after ovulation and can bleed internally
Corpus luteum cyst
- Supportive (NSAIDs), unstable → surgery
- Risks hemorrhagic rupture
First-line outpatient treatment for mild-to-moderate PID includes these two antibiotics.
Doxycycline (14 days)+ Ceftriaxone ± Metronidazole (BV concern)
Severe: IV cephalosporin + doxycycline + gentamicin
First-line treatment for gonorrhea in cervicitis is this antibiotic.
Ceftriaxone 500 mg IM
- Add doxycycline if chlamydia is not excluded
This lab value is trended every 48 hours when pregnancy location is unknown.
ß-HCG
- ~1500 → should see IUP on TVUS
Painful vaginal bleeding with uterine tenderness suggests this diagnosis.
Placental abruption
- Emergency delivery/support
An ovarian mass containing multiple tissue types (like hair or teeth) is called this
Teratoma (Dermoid cyst)
- Surgical removal if large/symptomatic
- Can become malignant
A complication of PID presenting with unilateral adnexal mass and toxicity is called this.
Tuboovarian abscess
- PID treatment
- In patients who do not improve in 72 hours, may need percutaneous drainage of abscess vs laprascopic drainage
A painful mass at the 4 or 8 o’clock position of the vaginal introitus suggests this diagnosis.
Bartholin abscess
- Broad spectrum abx (TMP-SMX or cephalexin) with warm compress or sitz bath
- I&D if well-defined + Word catheter
Medical management of stable ectopic pregnancy commonly uses this drug.
Methotrexate
- Folate antagonist
- Use only if: stable, reliable f/u, no rupture
Hypertension after 20 weeks with proteinuria defines this condition.
Pre-ecclampsia
- Mild: labetalol/nifedipine
- Severe: magnesium + delivery
- Complications: HELLP, fetal growth restriction
This imaging modality is first-line for suspected ovarian cyst or torsion
TVUS w/ doppler
This condition presents with thin, gray, fishy-smelling discharge and clue cells on microscopy.
Bacterial vaginosis
- pH >4.5
- Metronidazole (PO or vaginal)
If cervical motion tenderness is present, the diagnosis is this instead of cervicitis.
Pelvic inflammatory disease
- Tx w/ Doxycycline + Ceftriaxone + Metronidazole
This hormone injection is given to Rh-negative patients with vaginal bleeding.
RhoGAM
Seizures in a pregnant patient with preeclampsia indicate this condition.
Ecclampsia
- Magnesium sulfate, control BP, deliver @34 weeks
An ovary larger than this size (in cm) raises concern for torsion.
>4 cm ovary
This type of vaginitis presents with normal pH and “cottage cheese” discharge.
Candida vaginitis
- Budding yeast
- Fluconazole PO x 1 (topical for pregnancy)
This bedside finding—bleeding upon swab contact—is called this and is seen in cervicitis.
Friability
Heavy bleeding with retained products of conception describes this type of miscarriage.
- Expectant/Misoprostol/D&C
Treatment of severe preeclampsia or eclampsia includes this IV medication to prevent seizures.
Magnesium sulfate
- 4-6g IV load → 2 g/hr