(c) Elmar P. Sakala, MD MPH (2011) 1

USMLE Step 3 Obstetrics-Gynecology

Supplement

Elmar P. Sakala, MD, MPH Professor of Gynecology & Obstetrics

Loma Linda University School of Medicine January, 2013

Copyright © Elmar P. Sakala, MD, MPH (2013) No part of this document can be reproduced or transmitted, in any form or by any means, without the written permission of the author.

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- β-hCG test

Sono: simple cyst

Sono: complex/solid

Acute severe pain

+

+

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Premenopausal Pelvic mass

© Elmar P. Sakala, MD, MPH

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CV disease & Hormone Therapy

Recommendations: HT (E+P) 2003

© Elmar P. Sakala, MD, MPH

Critique of WHI study

© Elmar P. Sakala, MD, MPH

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“WINDOW of OPPORTUNITY” Critical period for maximum response to HT

© Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004

WHI

Not Here

Start HT here

Menopause

10 yrs too Late!!

Progestin

Progestin

Progestin Hysterectomy

TAH, BSO

Natural History Treatment

© Elmar P. Sakala, MD, MPH

Non-contraceptive Benefits Steroid Contraception

↓ Dysmenorrhea

↓ DUB

↓ PID

↓ Ectopic preg

suppress PG release

stabilizes endometrium

thickens cervical mucus

thickens cervical mucus

© Elmar P. Sakala, MD, MPH

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Metabolic Effects Steroid contraception

Estrogen mediated

Progestin mediated

THROMBOSIS ↑ venous & arterial

Unhealthy lipid profile (↓ HDL, ↑ LDL)

Healthy lipid profile (↑ HDL, ↓ LDL)

© Elmar P. Sakala, MD, MPH

Oral Contraceptives Risk of CANCER

Ovarian

Endometrial

Breast

Cervical

↓

↑ ↑ =

© Elmar P. Sakala, MD, MPH (August, 2011)

Intrauterine Contraception

Steroid Contraception

Contraception Review

© Elmar P. Sakala, MD, MPH

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Contraceptive Failure Rates Reversible Methods

© Elmar P. Sakala, MD, MPH

Basic Principles of Contraception Avoid contraindications

© Elmar P. Sakala, MD, MPH

Basic Principles of Contraception Avoid contraindications

Completed childbearing Sterlization

© Elmar P. Sakala, MD, MPH

FEW Complic

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FEMALE - Next step in management?

β-hCG

β-hCG

β-hCG

β-hCG

PREGNANCY - Next step in management?

OB sono OB Sono OB Sono OB SONO

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Pathophysiology

F E T U S

M O M

Vol of RBC needed: varies from 0.1mL to 450 mL

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HEAD Compression

CORD Compression

PLACENTAL Insufficiency

© Elmar P. Sakala, MD, MPH

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© Elmar P. Sakala, MD, MPH

Fetal Fibronectin

Matrix that bonds Trophoblast to Decidua

Predictor of Preterm Delivery

“Trophoblast Glue”

Cervical Length

Saggital Image

Normal: > 25 mm

Vaginal Sonogram 1

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TOCOLYTIC agents

Agent

β-Adrenergic Agonists

Ca++ channel blockers

Side Effects

↓  BP, tachycardia, ↑ glucose, ↓ K+, Pulmonary edema

Tachycardia, ↓ BP Myocardial depression

Contraindications

Cardiac disease Diabetes Uncontrolled ↑T4

Cardiac disease Hypotension

PG synthetase inhibitors

Oligohydram, IU closure PDA, Necrotiz enterocolitis

Gestational age > 32 weeks

MgSO4

Muscle weakness Respiratory depression Pulmonary edema

Renal insuffic Myasthenia gravis

Described in notes p. 44

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