Contraindictions to OCP
Localized vulvodynia includes vestibulodynia, cliterodynia and hemivulvodynia. It is characterized by burning, stinging irritation that occurs in the vulva and lasting 3 months.
inflammation (cause-lichen planus)
Neoplasm (cause-Paget's disease, vulvar carcinoma)
Neurologic disorder (neuralgia secondary to spinal nerve injury or herpes)
associated with the development of a partial hydatidiform mole
increased risk with previous cesarean sections and trauma
(singular= leiomyoma), sometimes referred to as fibroids, are the most common tumors of the uterus and affect up to 50% of all women at some point in their lives. Estrogen is believed to stimulate the growth of these benign tumors of smooth muscle, and they do not appear in prepubertal girls. Leiomyomata may increase in size during pregnancy and tend to regress or shrink after menopause.
tubo-ovarian abscess (TOA)
most often arises as a complication of pelvic inflammatory disease (PID), although it may on occasion develop after pelvic surgery. As with this patient, abdominal and/or pelvic pain is a characteristic symptom of TOA. Fever and leukocytosis may also be present but are not always observed.
effective outpatient antibiotic regimens for the treatment of PID include ceftriaxone or cefoxitin with doxycycline, with or without the addition of metronidazole. Recommended parenteral therapies are either cefotetan or cefoxitime along with doxycycline, or clindamycin plus gentamycin.
one of the most important causes of hypercoagulability which stem from the presence of autoantibodies directed against anionic macromolecules. Many have other connective tissue disorders like SLE. The autoantibodies in APS can result in a prolonger prothrombin time.
livedo reticularis (a skin condition)
thrombocytopenia (not thrombocytosis - choice B)
Headaches and migraines
Further studies for Factor V Leiden variant and the prothrombin mutation, Factor VIII levels, MTHFR mutation.
Levels of protein C, free and total protein S, Factor VIII, antithrombin, plasminogen, tissue plasminogen activator (TPA) and plasminogen activator inhibitor-1 (PAI-1)
gastrointestinal abnormalities such as esophageal atresia, duodenal atresia, facial cleft, neck masses, and tracheoesophageal fistula
fetal renal disorders that results in increased urine production during pregnancy, such as in antenatal Bartter syndrome
chromosomal abnormalities such as Down's syndrome and Edwards syndrome
neurological abnormalities such as anencephaly, which impair the swallowing reflex
Uterine bleeding in postmenopausal women
rule out endometrial hyperplasia or cancer
abnormal uterine bleeding in ovulating women
abnormal bleeding of pregnancy
blood clotting disorders
systemic lupus erythematosus
medications that interfere with blood clotting
Risk factors for cervical cancer
human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, stress and stress-related disorders, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer.
hpv 16, 18 and 31
Abx in pregnancy
-fluoroquinolones, tetrachyclines, trim/sulpha
can use nitrofurantoin
anti-hypertensives during pregnancy
-angiotension II receptor antagonists
-loop and thiazide diuretics
most commonly is seen to increase for 3-6 months prior to a woman starting an ovulatory cycle. The discharge can be thick and white or clear and watery with leukocytes, erythrocytes and mucus. It can be a natural defense mechanism that the vagina employs to maintain its chemical balance in addition to preserving the vaginal tissue flexibility.
The term physiologic leukorrhea is used to refer to the exudate occurring due to estrogen stimulation. It is a benign condition and needs only reassurance for treatment.
is characterized by lower abdominal and pelvic pain that occurs midway through a woman's menstrual cycle during ovulation. Approximately 20% of women experience mittelschmerz and is diagnosed when the pain is mid-cycle with no abnormalities on pelvic examination. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days. Because ovulation occurs on a random ovary each cycle, the pain may switch sides or stay on the same side from one cycle to another. The pain is not harmful and does not signify the presence of disease. No treatment is usually necessary. Pain relievers (analgesics) may be needed in cases of prolonged or intense pain. Hormonal forms of contraception can be taken to prevent ovulation -- and therefore ovulatory pain -- but otherwise there is no known prevention.
Although the pain is not harmful, it can be mistaken for appendicitis. If the duration lasts for more than 2-3 days, a pelvic ultrasound should be performed to rule out any other etiology. Causes of this condition have been associated with the following:
Ovarian wall rupture
Fallopian tube contraction
Smooth muscle cell contraction