Cervix and Uterus Disorders

Describe each 1. when is an intrauterine pregnancy seen on transvaginal ultrasound 2. When is an intrauterine pregnancy seen on abdominal ultrasound 3. describe the yolk sac seen on ultrasound 4. what is the double decidual sign

IUP seen on transvaginal ultrasound > 38 days after LMP or beta-hCG > 1500 IUP seen on abdominal ultrasound > 45 days after LMP or beta-hCG > 4000 YS: Present at 5 to 6 weeks with b-hCG > 2000; first definitive sign of IUP Double decidual sign helps distinguish between IUP and a pseudogestational sac (sac of fluid)

Next step for testing in women over 30 is positive for HPV but have a negative PAP smear

If the Pap smear test is negative and HPV test is positive, providers may either repeat Pap smear and HPV co-testing in one year or order HPV DNA typing to detect HPV subtypes 16 or 18.

What is unilateral midcycle pelvic pain related to ovulation

Mittelschmerz

First line diagnostic test for pelvic pain

Pelvic ultrasound

What is a corpus luteum cyst?

The corpus luteum of the ovary supports the pregnancy by secreting progesterone during the first 6-7 weeks. It often becomes cystic.

A 32-year-old woman presents with vaginal bleeding for two weeks. She states she has had to change her pad every 2-3 hours with the bleeding. Vital signs are stable and physical exam only reveals blood coming from the cervical os. The patient's hemoglobin is 12 g/dL and her pregnancy test is negative. What treatment is indicated for this patient?

This patient presents with non-life threatening abnormal uterine bleeding (previously called dysfunctional uterine bleeding), which can initially be managed with combination oral contraceptives. Bleeding is typically split into anovulatory (90%) and ovulatory (10%). In patients with vaginal bleeding of childbearing age, the most important first step in diagnosis is to rule out pregnancy. In anovulatory bleeding, combination oral contraceptive pills can aid in regulating the menstrual cycle and counteract the effects of unopposed estrogen. Typically, patients are instructed to take combination oral contraceptive pills twice a day for 5-7 days or until the bleeding stops followed by once daily dosing.

What does postcoital (post sexual intercourse) bleeding suggest?

cervical cancer which must be ruled out

A 55-year-old postmenopausal woman presents to your office with a complaint of vaginal bleeding. Which of the following is the most appropriate next step in management?

endometrial biopsy

A 32-year-old G0P0 woman presents with dull, crampy pelvic pain that has been intermittent over the last six months. She is currently menstruating and notes the pain seems to worsen with menses. She also reports pain with intercourse but denies any vaginal discharge. On examination, she is in no acute distress and is afebrile. She has scant blood in the vaginal vault and no significant focal tenderness. No masses are appreciated. Her pregnancy test is negative. What is the most likely diagnosis?

endometriosis

Patient will be a woman 2 - 3 days post c-section Complaining of fever, abdominal pain,foul smelling lochia PE will show purulent vaginal discharge, cervical motion tenderness, uterine tenderness Labs will show leukocytosis

endometritis

classically occurs 2-3 days post-partum and is characterized by fever, foul-smelling lochia, abdominal and pelvic pain, abnormal vaginal bleeding, uterine tenderness and leukocytosis

endometritis

Women with risk factors for endometrial hyperplasia and consequently endometrial cancer can reduce their risk by using ...

oral contraceptives or cyclic progestin therapy

A 33-year-old woman presents to the clinic for obstetric care. She reports a history of two consecutive, painless second-trimester miscarriages. Her past medical history is remarkable for previous conization for cervical intraepithelial neoplasia. She is currently twelve weeks pregnant. Which of the following is the most appropriate next step in management in this patient?

A cervical cerclage, performed at 12-14 weeks, is indicated for this woman who is likely suffering from cervical insufficiency secondary to iatrogenic causes. Cervical insufficiency describes a presumed physical weakness of cervical tissue that causes or contributes to the early delivery of an otherwise healthy pregnancy, usually in the second trimester. It can be the result of genetic weakness of the cervix, extreme stretching of or severe lacerations to the cervix during previous deliveries, an extensive cone biopsy done for precancerous cervical cells, cervical surgery, and cervical laser therapy. It is usually diagnosed when a woman miscarries in the second trimester after experiencing progressive painless effacement and dilation of the cervix without apparent uterine contractions or vaginal bleeding. Risk factors for cervical insufficiency support the diagnosis. Congenital and acquired cervical abnormalities increase the risk of cervical insufficiency. Acquired risk factors are more common. A diagnosis can also be made with cervical length < 25 mm on transvaginal ultrasound or advanced cervical changes on physical examination before 24 weeks of gestation.

what is the pathophysiology of anovulatory abnormal uterine bleeding

Anovulatory bleeding is caused by the failure of the corpus luteal cyst to form leading to absence of progesterone and unopposed estrogen stimulation on the endometrium.

biggest risk factor for endometritis

C section

A G2P2 46-year-old woman presents to her gynecologist's office with a six month history of irregular, heavy menses. She states her cramps are no worse than usual and she does not have dyspareunia or postcoital bleeding. On physical exam, she has a body mass index of 32 kg/m2. A bimanual examination reveals a normal-appearing cervix and a smooth, regularly-shaped uterus that is not enlarged. Which of the following is the most likely diagnosis?

Endometrial hyperplasia is the most common cause of abnormal uterine bleeding in older, obese women. Hyperplasia, or proliferation of the endometrium, is the result of unopposed estrogen over a period of time. Risk factors for hyperplasia include older age, obesity, diabetes, polycystic ovarian syndrome, and certain genetic mutations. A patient who experiences abnormal uterine bleeding should undergo an endometrial biopsy. A pelvic and transvaginal ultrasound can be used in the evaluation, but is more useful in a postmenopausal female as the endometrium is still dynamic in a premenopausal patient. An endometrial biopsy can help determine if the hyperplastic cells are with or without atypia; the latter has a lower chance of progressing to carcinoma and can be treated with progestin-based therapies and endometrial biopsies every three to six months until the hyperplasia has resolved. Hyperplasia with atypia has a higher likelihood of transitioning to carcinoma. If the patient does not wish to preserve fertility, she should undergo a hysterectomy. If the patient does wish to retain her fertility, she can be treated with megestrol acetate, the more potent progestin therapy, and repeat endometrial biopsy at three months, adjusting the dose upwards if atypia persists.