Approach To Urinary Tract Infections Definitions

Cystitis Bacterial infection of the bladder defined as having greater than 100.000 colony-forming units of a single pathogenic organism on a midstream voided specimen. Urethritis Infection of the urethra commonly caused by C. trachomatis. Urethral syndrome Urgency and dysuria caused by urethral inflammation of unknown etiology urine cultures are negative. UTI's may involve the kidneys (pyelonephritis), bladder (cystitis), and urethra (urethritis). One in live women will acquire a UTI sometime...

Clinical Approach

PID, or salpingitis, usually involves Chlamydia, gonorrhea, and other vaginal organisms, such as anaerobic bacteria. The mechanism usually is ascending infection. A common presentation is a young, nulliparous female complaining of lower abdominal or pelvic pain and vaginal discharge. The patient may also have fever and nausea and vomiting if the upper abdomen is involved. The cervix is inflamed therefore, the patient often complains of dyspareunia. The diagnosis of acute salpingitis is made...

Approach To Vaginal Infections

The three most common types of vaginal infections are BV. trichomonal vaginitis, and candidal vulvovaginitis (Table 58-1). BV is not a true infection but rather an overgrowth of anaerobic bacteria, which replaces the normal lactobacilli of the vagina. Although it may be sexually transmitted, this is not always the case. The most common symptom is a fishy or musty odor, often exacerbated by menses or intercourse because both of these situations introduce an alkaline substance. The vaginal pH is...

Clinical Pearls

An endometrial sampling should be performed in a woman with postmenopausal bleeding to assess for endometrial carcinoma. Unopposed estrogen is generally the biggest risk factor for development of endometrial cancer. Endometrial cancer is staged surgically, and surgery is a fundamental part of its treatment. Persistent postmenopausal bleeding warrants further investigation (e.g., hysteroscopy) even after a normal endometrial sampling. American College of Obstetricians and Gynecologists....

Approach To Pruritus In Pregnancy Definitions

Cholestasis in pregnancy Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash. Pruritic urticarial papules and plaques of pregnancy (PUPPP) Common skin condition of unknown etiology unique to pregnancy, characterized by intense pruritus and erythematous papules on the abdomen and extremities. Herpes gestationalis Rare skin condition seen only in pregnancy, characterized by intense itching and...

Considerations

This patient has postmenopausal vaginal bleeding, which always should be investigated, because it can indicate malignant or premalignant conditions. The biggest concern should be endometrial cancer. She also has numerous risk factors for endometrial cancer, including obesity, diabetes, hypertension, prior anovulation (irregular menses), late menopause, and nulliparity. The endometrial sampling or aspiration can be performed in the office by placing a thin, flexible catheter through the cervix....

Approach To Adolescent Health Maintenance

Anorexia nervosa Eating disorder usually affecting adolescent females in which the affected person has a distorted body image, thinking of herself as overweight when in reality her weight is less than her ideal body weight. Bulimia Eating disorder in which the affected individual goes through binges of eating and then induces emesis, uses laxatives, or reduces caloric intake. Health risks to adolescents more likely are behavioral rather than caused by illnesses. Three fourths of deaths in the...

Comprehension Questions

58.1 A 22-year-old woman is seen for vaginal discharge. The presumptive diagnosis is bacterial vaginosis. Which of the following most likely is present B. Heterogenous vaginal discharge D. Positive Kleihauer-Betke test 58.2 A 26-year-old woman taking antibiotics for cystitis complains of itching, burning, and a yellowish vaginal discharge. Which of the following is the best therapy 58.3 Which of the following organisms may be isolated from a wet surface 6 hr after inoculation 58.4 A...

Intrauterine Adhesions Ashermans Syndrome

Intrauterine scarring leading to an unresponsive endometrium is most commonly due to injury to the pregnant or recently pregnant uterus. However, any mechanical, infectious, or radiation factor can produce endometrial sclerosis and adhesion formation. The sine qua non for development of IUA is endometrial trauma, especially to the basalis layer. The adhesions usually are strands of avascular fibrous tissue, but they also may consist of inactive endometrium or myometrium. Myometrial adhesions...

Approach To Cervical Cancer Definitions

Cervical intraepithelial neoplasia Preinvasive lesions of the cervix with abnormal cellular maturation, nuclear enlargement, and atypia. Human papilloma virus (HPV) Circular, double-stranded DNA virus that can become incorporated into cervical squamous epithelium, predisposing the cells to dysplasia and or cancer. Radical hysterectomy Removal of the uterus, cervix, and supportive ligaments, such as the cardinal ligament, uterosacral ligament, and proximal vagina. Radiation brachytherapy...

Mechanisms of Incontinence

Genuine stress incontinence Following trauma and or other causes of weakness of the pelvic diaphragm (such as childbearing), the proximal urethra may fall below the pelvic diaphragm. When the patient coughs, intra-abdominal pressure is exerted to the bladder but not to the proximal urethra. When the bladder pressure equals or exceeds the maximal urethral pressure, then urinary flow occurs. Because this is a mechanical problem, the patient feels no urge to void, and the loss of urine occurs...

Answers To Case 19 Galactorrhea due to Hypothyroidism

Summary A 30-year-old parous woman with irregular menses notes a watery breast discharge of 6 months' duration. She had been treated previously with radioactive iodine for Graves' disease. The pregnancy test is negative. Most likely diagnosis Galactorrhea due to hypothyroidism. Next step Check serum prolactin and thyroid-stimulating hormone (TSH) levels. Likely mechanism Hypothyroidism is associated with an elevated thyroid-releasing hormone (TRH) level, which acts as a prolactin-releasing...

Answers To Case 52 Chlamydial Cervicitis and HIV in Pregnancy

Summary An 18-year-old G1 PO at 22 weeks' gestation has a positive Chlamydia DNA assay of the endocervix. She denies lower abdominal pain and is afebrile. Her abdomen is nontender and gravid. The gonorrhea culture is negative, and the HIV ELISA test is positive. Next step in therapy Oral erythromycin, azithromycin, or amoxicillin. Next diagnostic step for HIV Either western blot confirmation or polymerase chain reaction (PCR) confirmation. Optimal treatment of HIV infection in pregnancy...

Approach To Hirsutism

Hirsutism should be viewed as both an endocrine and a cosmetic problem. It is most commonly associated with anovulation however, other causes of increased androgen levels must be ruled out, such as adrenal and ovarian diseases. The most sensitive marker of excess androgen production is hirsutism. followed by acne, oily skin, increased libido, and virilization. Virilization consists of clitoromegaly. deepening of the voice, balding, increased muscle mass, and male body habitus. Adrenal...

Approach To Fetal Bradycardia Definitions

Fetal Bradycardia During Labor

Engagement Largest transverse biparietal diameter of the fetal head has negotiated the bony pelvic inlet. Fetal Bradycardia Baseline fetal heart less than 110 bpm for more than 10 min. Umbilical cord prolapse Umbilical cord enters through the cervical os appears in front of the presenting part. Artificial rupture of membranes Maneuver used to cause a rent in the fetal chorioamniotic membranes. The onset of fetal bradycardia should be confirmed by either internal fetal scalp electrode or...

Approach To Wound Disruptions Definitions

Wound dehiscence Separation of part of the surgical incision but with an intact peritoneum. Fascial disruption Separation of the fascial layer, usually leading to a communication of the peritoneal cavity with the skin. Serosanguineous Blood-tinged drainage. Evisceration A disruption of all layers of the incision with omentum or bowel protruding through the incision. Surgical Site Infection SSI Infection related to the operative procedure that occurs at or near the surgical incision within 30...

Approach To Ureteral Injuries Definitions

Ivu Ureteric Injuries

Cardinal ligament Attachments of the uterine cervix to the pelvic side walls through which the uterine arteries traverse. Intravenous pyelogram IVP Radiologic study in which intravenous dye is injected and radiographs are taken of the kidneys, ureters, and bladder. Hydronephrosis Dilation of the renal collecting system, which gives evidence of urinary obstruction. Cystoscopy Procedure whereby a scope is placed into the bladder via the urethra. Various procedures, such as placement of stents...

Approach To Anemia In Pregnancy Definitions

Anemia Hemoglobin level less than 10.5 g dL in the pregnant woman. Iron deficiency anemia Fall in hemoglobin level due to insufficient iron to meet the increased iron requirements during pregnancy. Hemolytic anemia Abnormally low hemoglobin level, due to red blood cell destruction, which may be divided into congenital causes and acquired causes. Glucose-6-phosphate dehydrogenase G6PD deficiency X-linked condition whereby the red blood cell may have a decreased capacity for anaerobic glucose...

Physiology

At approximately 47 years of age, most women experience peri menopausal symptoms due to impending failure of the ovaries. Symptoms include irregular menses due to anovulatory cycles vasomotor symptoms, such as hot flushes and decreased estrogen and androgen levels. Because ovarian inhibin levels are decreased, FSH levels rise even before estradiol levels fall. The decreased estradiol concentrations lead to vaginal atrophy, bone loss, and vasomotor symptoms. Although most clinicians agree that...

Ruptured Corpus Luteum

Corpus luteum cysts develop from mature graafian follicles and are associated with normal endocrine function or prolonged secretion of progesterone. They usually are smaller than 3 cm in diameter. There can be intrafollicular bleeding because of thin-walled capillaries that invade the granulosa cells from the theca interna. When the hemorrhage is excessive, the cyst can enlarge, and there is an increased risk of rupture. Cysts tend to rupture more during pregnancy, probably due to the increased...

Definitions

Leiomyomata Smooth muscle, benign tumors, usually of the uterus. Leiomyosarcoma Malignant, smooth muscle tumor, with numerous mitoses. based on their location in the uterus. based on their location in the uterus. Submucous fibroid Leiomyomata that are primarily on the endometrial side of the uterus and impinge on the uterine cavity Figure 24-1 . Intramural fibroid Leiomyomata that are primarily in the uterine muscle. Subserosal fibroid Leiomyomata that are primarily on the outside of the...

Contributors

University of Texas Medical School at Houston University of Texas Medical School at Houston Resident in Obstetrics and Gynecology The Methodist Ob Gyn Residency Houston. Texas Norma Labor Pulmonary Embolism Resident in Obstetrics and Gynecology The Methodist Ob Gyn Residency Houston. Texas Gonococcal cervicitis Herpes simplex virus Fellow in Maternal-Fetal Medicine Department of Obstetrics and Gynecology University of Texas Medical School at Houston Houston. Texas Pubertal Delay Amenorrhea,...

Tubal Factor Infertility

Tubal infertility is due to damage or obstruction of the fallopian tubes. The changes or obstruction are associated with previous pelvic inflammatory disease PID , previous pelvic or tubal surgery, and peritoneal factors. Tubal and peritoneal factor infertility often occur concurrently, and their treatments are often similar. Tubal and peritoneal factors account for 30 to 40 of female infertility cases. Salpingitis is the most important etiologic factor in tubal infertility. The risk of...

Approach To Suspected Placental Abruption Definitions

Concealed abruption When the bleeding occurs completely behind the placenta and no external bleeding is noted this condition is less common than overt hemorrhage but is more dangerous. Fetomaternal hemorrhage Fetal blood that enters into the maternal circulation. Couvelaire uterus Bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface. Compared to placenta previa, abruptio placentae is more dangerous and unpredictable. Furthermore, the diagnosis is much...

Approach To Antepartum Vaginal Bleeding Definitions

Placenta Previa

Antepartum vaginal bleeding Vaginal bleeding occurring after 20 weeks' gestation. Complete placenta previa Placenta completely covers the internal os of the uterine cervix Figure 14-1 . Partial placenta previa Placenta partially covers the internal cervical os. Marginal placenta previa Placenta abuts against the internal os of the cervix see Figure 14-1 . Figure 14 1. Types of placenta previa. Complete placenta previa A , marginal placenta previa B , and low-lying placentation C are depicted....

Teratomas

Mature benign cystic teratomas dermoid cysts constitute more than 95 of all ovarian teratomas. They make up 15 to 25 of all ovarian tumors, especially in the second and third decades of life. The most common elements are ectodermal derivatives, such as skin, hair follicles, and sebaceous Dysgerminoma Endodermal sinus tumor Embryonal carcinoma Polyembryoma Choriocarcinoma Teratoma or sweat glands. However, they can also contain tissues of the three embryonic layers, including mesoderm and...

Approach To Inverted Uterus Definitions

Inverted Uterus

Third stage of labor From delivery of infant to delivery of the placenta upper limit of normal is 30 min . Abnormally retained placenta Third stage of labor that has exceeded 30 min. Uterine inversion Turning inside out of the uterus, whereupon the fundus of the uterus moves through the cervix, into the vagina Figure 3-1 . Signs of placental separation Cord lengthening, gush of blood, globular uterine shape, and uterus lifting up to the anterior abdominal wall. Figure 3-1. Inverted uterus....

Lifespan Of Galactocele

Core-needle biopsy Use of a 14- to 16-gauge needle to extract tissue from a breast mass, which preserves cellular architecture. Fine-needle aspiration FNA Use of a small-gauge needle with associated vacuum via a syringe to aspirate fluid or some cells from a breast mass and or cyst. Fibroadenoma Benign, smooth muscle tumor of the breast, usually occurring in young women. Fibrocystic changes, the most common of the benign breast conditions, are described as multiple, irregular, lumpiness of the...

Clinical Pearl

Normal Size Endometrial Stripe

The vaginal examination assesses the anterior pelvis, whereas the rectal examination is directed at the posterior pelvis. 12. Laboratory assessment for obstetric patients a. Prenatal laboratory tests usually include i. Complete blood count CBC to assess for anemia and thrombocytopenia. ii. Blood type, Rh. and antibody screen are of paramount importance for all pregnant women for women who are Rh negative, Rho D immune globulin RhoGAM is administered at 28 weeks' gestation and at delivery if the...

Physical Examination

Abdominal Examination Pregnant Lady

General appearance Cachetic versus well-nourished, anxious versus calm, alert versus obtunded. 2. Vital signs Temperature, blood pressure, heart rate, and respiratory rate. Height and weight are often placed here. 3. Head and neck examination Evidence of trauma, tumors, facial edema, goiter, and carotid bruits should be sought. Cervical and supraclavicular nodes should be palpated. 4. Breast examination Inspection for symmetry, skin or nipple retraction with the patient's hands on her hips...