0071643192.pdf

OBSTETRICS AND GYNECOLOGY

DIAGNOSIS

■ Ultrasound is the imaging test of choice.

Postpartum Infections

ENDOMETRITIS

Polymicrobial postpartum infection of the endometrium

Risk factors include:

■ Cesarean delivery (most important)
■ Chorioamnionitis
■ Duration of time since rupture of membranes
■ Many vaginal exams during labor
■ Presence of high-virulence organisms
■ Use of an internal monitoring device

SYMPTOMS/EXAM

Fever, uterine tenderness, and foul-smelling lochia

TREATMENT

Hospitalization and IV antibiotics (ampicillin and gentimicin or cefotaxime,
or zosyn).

SEPTICPELVICTHROMBOPHLEBITIS

Develops from an infection of the placental site along with thrombosed myo-
metrial veins. Incidence is increased after C-section. Treatment includes anti-
coagulation and antibiotics.

MEDICATIONS DURING PREGNANCY

See Tables 12.3 and 12.4.

EMERGENCY CONTRACEPTION

Emergency contraception refers to contraceptive measures taken after sex
to prevent a pregnancy. In the United States, two medical options are avail-
able for patients who want to prevent implantation or terminate an early
pregnancy.

■ Plan B(ie, the morning-after pill): A progestin-only treatment usually con-
sisting of levonorgesterol 1.5 mg PO ×1, or divide into 750 μg taken
12 hours apart
■ Most effective when taken in the first 72 hours after sex
■ Reduces likelihood of pregnancy from about 8% to 1%
■ Causes nausea and vaginal bleeding