FM ITE OBGYN

Bartholin Gland Abscess

Most appropriate treatment for a recurrent Bartholin gland abscess

• Marsupialization
  
• If >5cm, refer to OB/GYN
  
• Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess.

Cervical Screening

Cervical cancer screening: basic guidelines:

• PAPs (with cytology only) start at 21 y/o or age regardless of sexual activity every 3 years until 30 y/o
• Start co-testing cytology + HPV at 30 – 65 y/o every 5 years
  
  
• Screening may be d/c at 65 y/o if patient’s last two tests have been negative and the patient was tested within the previous 5 years, OR any age if they have had a hysterectomy with removal of their cervix AND do not have a history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer.

Endometriosis

• Endometriosis is caused by menstrual tissue in the pelvic peritoneal cavity.
• Infertility, dysmenorrhea, and dyspareunia with postcoital bleeding are common.
• Although laparoscopy with histology is the definitive test, transvaginal ultrasonography is the noninvasive test of choice.
• CA-125 will often be elevated but is nonspecific.
• CT and MRI also have low specificity in the evaluation of endometriosis.

Migraines

What are the only safe medications for abortive treatment of migraines in pregnancy?

• Acetaminophen
  
• Metoclopramide (Reglan – dopamine antagonist)

Pelvic Inflammatory Disease

Does PID require a positive GC/CT test?

• No.
  
  
• Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered at the time of diagnosis and not delayed until the results of the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk woman presenting with lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or adnexal tenderness that can range from mild to severe. Causative agent may not be gonorrhea or Chlamydia. PID should be considered a polymicrobial infection.

Preeclampsia

• During the treatment of severe preeclampsia with intravenous magnesium, the occurrence of apnea and areflexia is most consistent with magnesium toxicity.
• In addition to hemodynamic support, calcium infusion is recommended as an antidote.
• Calcium chloride can be used if a central line has been established.
• Calcium gluconate would be safer with a peripheral intravenous site.
• Lorazepam, phenytoin, and fosphenytoin are less useful in preventing eclamptic seizures than magnesium.