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What are the risks of these procedures
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Section II: Topics in Gynecology
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What should be done if uterine perforation is suspected How and when is an MVA performed
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Immediate laparoscopy or laparotomy to examine the abdominal contents to assess bowel injury Anytime before 12 weeks The cervix is dilated using cervical dilators and the uterine contents are evacuated using a cannula that is attached to a handheld syringe which has the vacuum source The cervix is dilated using cervical dilators and the uterine contents are evacuated using an electrically powered vacuum device Anytime before 14 weeks The cervix is dilated using osmotic dilators placed intracervically 1 2 days prior to the procedure to slowly soften and dilate the cervix and thus minimize mechanical damage to the cervix At the time of the procedure, these are removed and mechanical dilators are used for further dilation as needed The uterine contents are evacuated using specialized forceps (sophers and bierers) Many people confirm completion by performing a curettage and feeling a good cri (gritty texture) throughout the cavity Vacuum can also be used to remove any remaining blood or tissue Anytime before 24 weeks, depending on the legal limit in the state It is similar to a D&E except that the fetus is delivered in breech presentation through the dilated cervix and the cranial contents are suctioned before delivery of the fetal head From approximately 18 24 weeks It potentially minimizes uterine and cervical injury from the fetal bones and from instrumentation Yes Women given antibiotics periabortion have a lower risk of postoperative infection
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When can a D&X be performed What is the advantage of a D&X procedure over a D&E Are prophylactic antibiotics indicated to prevent infection
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4: General Gynecology
What types of antibiotics can be used prophylactically What is a medical abortion
Doxycycline, ofloxacin, or ceftriaxone Termination of pregnancy or evacuation of POCs using medications only Very effective it is successful in 90 98% of women Intravaginal misoprostol alone Oral or IM methotrexate followed by intravaginal, oral, or buccal misoprostol 3 7 days later Oral mifepristone followed by intravaginal, oral, or buccal misoprostol 6 72 hours later (up to 49 63 days)
How effective is medical abortion What are the various modalities for medical abortion
How do each of the following agents work
Misoprostol: a prostaglandin analogue; increases contractility by directly stimulating the myometrium Methotrexate: blocks dihydrofolate reductase, an enzyme necessary for the production of thymidine during DNA synthesis, thus affecting the rapidly growing cytotrophoblast Mifepristone: binds to the progesterone receptor with a greater affinity than progesterone itself, and therefore blocks the pro-gestation action of progesterone
What are the side effects of a medical abortion
Cramping, bleeding (often heavier than a menstrual period) Gastrointestinal (GI) distress (nausea, vomiting, diarrhea)
What are the contraindications to a medical abortion
Allergies to any of the medications An in situ IUD Severe anemia Coagulopathy/use of an anticoagulant Active liver disease Cardiovascular disease Uncontrolled seizure disorder Adrenal disease
Is there any effect of medical termination on subsequent pregnancies
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Section II: Topics in Gynecology
What is a septic abortion
Evidence of localized infection and systemic infection after a spontaneous or elective abortion Stabilize the patient Take blood and endometrial cultures Administer parenteral broadspectrum antibiotics Surgically evacuate the uterine contents Administer anti-D immunoglobulin if it is warranted
How is a septic abortion managed
What antibiotic combinations can be used to treat septic abortion
Clindamycin and gentamicin with or without ampicillin Ampicillin and gentamicin and metronidazole Ticarcillin-clavulanate or piperacillintazobactam or imipenem alone
What are the indications for laparotomy in the management of a septic abortion
Failure to respond to evacuation/ antibiotics Pelvic abscess Gas gangrene or other fulminant disease (ie, Clostridium sordelii)
Who should be given Rh(D)-immune globulin postabortion When does ovulation resume postabortion
All Rh(D)-negative women who are unsensitized As early as 2 weeks after an abortion Therefore if pregnancy is undesired, contraception must be started immediately Usually within 6 weeks (average 4 weeks) Pregnancy and gestational trophoblastic disease; less likely are Asherman syndrome or other systemic diseases (eg, thyroid disorder) Women should be advised to have nothing per vagina for 2 weeks after the procedure/passage of POC Some recommend deferment of pregnancy (if desired) for 2 3 months, although there is no data to support this recommendation If she experiences heavy bleeding, fever, or abdominal pain
When do menses resume postabortion What conditions need to be considered if menses do not resume within 6 weeks
What instructions should be given postabortion
When should a woman return to clinic postabortion
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4: General Gynecology
Sexually Transmitted Diseases and Pelvic Infections
SEXUALLY TRANSMITTED INFECTIONS OF THE LOWER GENITAL TRACT Condyloma Accuminata
What is condyloma accuminata How is condyloma accuminata transmitted Genital warts It is the most common sexually transmitted infection Through skin-to-skin contact; it is primarily transmitted through sexual activity A DNA virus called human papillomavirus (HPV); subtypes 6 and 11 Warts located on the external genitalia, perineum, anus, cervix, mouth, inside the vagina, and urethra; These are generally raised, pedunculated/cauliflower-shaped lesions but they can vary in number, size, and color (flesh-colored, pinkishwhite, grayish-white) Condyloma lata of secondary syphilis Visualization by colposcopic examination and cytologic smear Biopsy can be performed if the diagnosis is uncertain Koilocytosis (vacuolated keratinocyte with peri-nuclear halo) It is often also associated with atypia and dysplasia Cryotherapy, laser excision, trichloroacetic acid, podophyllum, or imiquimod cream If left untreated, visible lesions may resolve on their own, remain unchanged, or increase in size or number
What is the pathogen and which subtypes are associated more commonly with genital warts What are the clinical manifestations of condyloma accuminata
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