PAEA OBGYN EOR TOPICS
________ is diagnosed clinically in postpartum patients with 2 fevers
and uterine tenderness and is mostly seen s/p *c-section* but can also
be present s/p vaginal delivery or postabortus - ANSWERS-
postpartum endometritis (polymicrobial infection of the endometrium
d/t exposure during childbirth)
what is the ddx/tx for postpartum endometritis? - ANSWERS--ddx:
surgical site infxn, UTI, mastitis, PNA
-tx: broad spectrum abx (*clindamycin + gentamicin* OR ampicillin-
sulbactam in clinda resistance or if GBS (+)); add ampicillin or
vancomycin if fever doesn't resolve in 48-72 hrs
-*ampicillin + gentamicin* if after vaginal delivery
*diagnosis made clinically from 2 fevers and uterine tenderness (other
sx's include foul lochia, chills, lower abdominal pain)
what are the differences b/t 1st-4th degree lacerations postpartum? -
ANSWERS--1st deg: skin/mucosa only
-2nd deg: extend into perineal body but do not involve anal sphincter
-3rd deg: extend into or completely through anal sphincter
-4th deg: through anal mucosa (may be a button hole laceration so
perform rectal exam)
,how are 1st-4th degree tears repaired? - ANSWERS--1st deg:
interrupted suture
-2nd deg: suture anchored at apex of lac, then through hymenal ring
and used to bring together the perineal body; then skin closed with
subcuticular sutures
-3rd deg: repair anal sphincter w/ severel interrupted sutures, then the
rest same as above for 2nd deg
-4th deg: repair anal mucosa meticulously to prevent fistula
formation, repair rectum, and repair the rest as above w/ 3rd deg
*all w/ dissolvable sutures
what is the size of the uterus postpartum/puerperium after delivery?
after 2 weeks? after 6 weeks? - ANSWERS--after delivery: @
umbilicus
-2 weeks: into pelvic cavity
-6 weeks: nml size
what is normal discharge/bleeding in the postpartum/puerperium
period? - ANSWERS--especially days 4-10, pinkish brown vaginal
bleeding called *lochia serosa* that should cease by *3-4 weeks*
postpartum
T/F: lactating/breast feeding mothers remain anovulatory -
ANSWERS-*true* but still use back up contraception just in case
,when do regular menses return postpartum? - ANSWERS-6-8 weeks
(if not breastfeeding)
a cystocele is the (anterior or posterior?) bladder herniating into the
(anterior or posterior?) vaginal wall; how is it tx'd? - ANSWERS--
*posterior* bladder through *anterior* vaginal wall
-kegels, wt control, pessary, anterior colporrhapy (reinforce fascia w/
sutures)
a rectocele is the (anterior or posterior?) rectum herniating into the
(anterior or posterior?) vaginal wall; how is it tx'd? - ANSWERS--
*anterior* rectum into *posterior* vaginal wall
-kegels, wt control, pessary, posterior colporrhapy (reinforce fascia w/
sutures)
an enterocele forms when small bowel descends into _______
herniating into the upper vaginal wall - ANSWERS-pouch of Douglas
what are the risk factors for uterine prolapse? - ANSWERS-weakness
of pelvic support structures (MC after childbirth, multiparity, obesity,
repeated heavy lifting)
explain grades I-IV of uterine prolapse - ANSWERS--I: descent into
upper 2/3 of vagina
-II: cervix approaches introitus
-III: outside introitus
-IV: entire uterus outside of vagina- complete prolapse
, symptoms of pelvic organ prolapse include: pelvic/vaginal
fullness/heaviness, "falling out" sensation, lower back pain, vaginal
bleeding, purulent discharge, urinary frequency/urgency, stress
incontinence; what PE maneuver can be done to check? - ANSWERS-
valsalva to inc abdominal pressure and produce a bulging mass on
exam
what are the tx options for pelvic organ prolapse? - ANSWERS--
kegels/PT to strengthen pelvic floor
-weight loss
-pessaries
-estrogen tx (improves atrophy)
-hysterectomy
-colporrhaphy (reinforcement of fascia w/ sutures)
-uterosacral or sacrospinous ligament fixation
a 33 yo women comes in with acute R pelvic pain, adnexal mass;
Ddx? workup? - ANSWERS--Ddx: ovarian torsion, ectopic
pregnancy, ruptured ovarian cyst/abscess, appendicitis, etc.
-w/u: pelvic US
ovarian torsion is usually seen in women of reproductive age with
acute unilateral pelvic pain and adnexal mass; how is it tx'd? -
ANSWERS--detorsion and ovarian conservation
-only perform salpingo-oopherectomy if PMP or necrotic ovary
________ is diagnosed clinically in postpartum patients with 2 fevers
and uterine tenderness and is mostly seen s/p *c-section* but can also
be present s/p vaginal delivery or postabortus - ANSWERS-
postpartum endometritis (polymicrobial infection of the endometrium
d/t exposure during childbirth)
what is the ddx/tx for postpartum endometritis? - ANSWERS--ddx:
surgical site infxn, UTI, mastitis, PNA
-tx: broad spectrum abx (*clindamycin + gentamicin* OR ampicillin-
sulbactam in clinda resistance or if GBS (+)); add ampicillin or
vancomycin if fever doesn't resolve in 48-72 hrs
-*ampicillin + gentamicin* if after vaginal delivery
*diagnosis made clinically from 2 fevers and uterine tenderness (other
sx's include foul lochia, chills, lower abdominal pain)
what are the differences b/t 1st-4th degree lacerations postpartum? -
ANSWERS--1st deg: skin/mucosa only
-2nd deg: extend into perineal body but do not involve anal sphincter
-3rd deg: extend into or completely through anal sphincter
-4th deg: through anal mucosa (may be a button hole laceration so
perform rectal exam)
,how are 1st-4th degree tears repaired? - ANSWERS--1st deg:
interrupted suture
-2nd deg: suture anchored at apex of lac, then through hymenal ring
and used to bring together the perineal body; then skin closed with
subcuticular sutures
-3rd deg: repair anal sphincter w/ severel interrupted sutures, then the
rest same as above for 2nd deg
-4th deg: repair anal mucosa meticulously to prevent fistula
formation, repair rectum, and repair the rest as above w/ 3rd deg
*all w/ dissolvable sutures
what is the size of the uterus postpartum/puerperium after delivery?
after 2 weeks? after 6 weeks? - ANSWERS--after delivery: @
umbilicus
-2 weeks: into pelvic cavity
-6 weeks: nml size
what is normal discharge/bleeding in the postpartum/puerperium
period? - ANSWERS--especially days 4-10, pinkish brown vaginal
bleeding called *lochia serosa* that should cease by *3-4 weeks*
postpartum
T/F: lactating/breast feeding mothers remain anovulatory -
ANSWERS-*true* but still use back up contraception just in case
,when do regular menses return postpartum? - ANSWERS-6-8 weeks
(if not breastfeeding)
a cystocele is the (anterior or posterior?) bladder herniating into the
(anterior or posterior?) vaginal wall; how is it tx'd? - ANSWERS--
*posterior* bladder through *anterior* vaginal wall
-kegels, wt control, pessary, anterior colporrhapy (reinforce fascia w/
sutures)
a rectocele is the (anterior or posterior?) rectum herniating into the
(anterior or posterior?) vaginal wall; how is it tx'd? - ANSWERS--
*anterior* rectum into *posterior* vaginal wall
-kegels, wt control, pessary, posterior colporrhapy (reinforce fascia w/
sutures)
an enterocele forms when small bowel descends into _______
herniating into the upper vaginal wall - ANSWERS-pouch of Douglas
what are the risk factors for uterine prolapse? - ANSWERS-weakness
of pelvic support structures (MC after childbirth, multiparity, obesity,
repeated heavy lifting)
explain grades I-IV of uterine prolapse - ANSWERS--I: descent into
upper 2/3 of vagina
-II: cervix approaches introitus
-III: outside introitus
-IV: entire uterus outside of vagina- complete prolapse
, symptoms of pelvic organ prolapse include: pelvic/vaginal
fullness/heaviness, "falling out" sensation, lower back pain, vaginal
bleeding, purulent discharge, urinary frequency/urgency, stress
incontinence; what PE maneuver can be done to check? - ANSWERS-
valsalva to inc abdominal pressure and produce a bulging mass on
exam
what are the tx options for pelvic organ prolapse? - ANSWERS--
kegels/PT to strengthen pelvic floor
-weight loss
-pessaries
-estrogen tx (improves atrophy)
-hysterectomy
-colporrhaphy (reinforcement of fascia w/ sutures)
-uterosacral or sacrospinous ligament fixation
a 33 yo women comes in with acute R pelvic pain, adnexal mass;
Ddx? workup? - ANSWERS--Ddx: ovarian torsion, ectopic
pregnancy, ruptured ovarian cyst/abscess, appendicitis, etc.
-w/u: pelvic US
ovarian torsion is usually seen in women of reproductive age with
acute unilateral pelvic pain and adnexal mass; how is it tx'd? -
ANSWERS--detorsion and ovarian conservation
-only perform salpingo-oopherectomy if PMP or necrotic ovary
