Chapter 14 of 157% of exam

Reproductive System

The reproductive block covers breast, cervical, uterine, ovarian and vulvovaginal disorders, contraception, infertility, menopause, and a long list of pregnancy topics from prenatal care to postpartum complications. Management often depends on gestational age and on maternal hemodynamic stability.

Bleeding in pregnancy

Stability decides management in ectopic pregnancy. Pain and uterine tenderness separate placental abruption from placenta previa. After delivery, the tone of the uterus is the first thing to assess.

Ectopic pregnancy

Positive hCG without intrauterine pregnancy; methotrexate if stable and eligible, surgery if unstable.

Merck Manual Professional Edition, Ectopic Pregnancy

Placenta previa

Painless bright red bleeding; avoid digital exam until previa is excluded.

Merck Manual Professional Edition, Vaginal Bleeding During Late Pregnancy

Postpartum hemorrhage

Uterine atony is the most common cause; massage and uterotonics.

Merck Manual Professional Edition, Postpartum Hemorrhage

Prenatal care

Blood pressure, Rh status and glucose screening are core prenatal checks. Preeclampsia is defined by timing after 20 weeks and by organ involvement. Rh prophylaxis prevents alloimmunization in future pregnancies.

Preeclampsia

New hypertension with proteinuria after 20 weeks; magnesium sulfate prevents eclamptic seizures.

Merck Manual Professional Edition, Preeclampsia and Eclampsia

Rh(D) prophylaxis

Rho(D) immune globulin at 28 weeks and after delivery or sensitizing events.

Merck Manual Professional Edition, Hemolytic Disease of the Fetus and Neonate

Gestational diabetes

All pregnant patients are screened, typically at 24 to 28 weeks.

Merck Manual Professional Edition, Diabetes Mellitus in Pregnancy (citing ACOG)

Gynecology and screening

Contraception, vaginitis and breast screening are high-volume primary-care topics. Eligibility for estrogen-containing methods depends on cardiovascular risk. Vaginitis is sorted by pH, odor and microscopy.

Combined hormonal contraception

Contraindicated in smokers 35 or older and with migraine with aura.

CDC US Medical Eligibility Criteria for Contraceptive Use, 2024

Bacterial vaginosis

Amsel criteria: pH above 4.5, whiff test, clue cells; metronidazole.

Merck Manual Professional Edition, Overview of Vaginitis

Breast cancer screening

Biennial mammography from 40 to 74 for average-risk women.

USPSTF Breast Cancer Screening, 2024

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