J 1 J Premenopausal Pelvic mass ?-hCG test + Sono: simple cyst + Sono: complex/solid + Acute severe pain © Elmar P. Sakala, MD, MPH J J (c) Elmar P. Sakala, MD MPH (2011) 2 CV disease & Hormone Therapy J Recommendations: HT (E+P) 2003 Critique of WHI study © Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD MPH (2011) 3 Menopause WHI “WINDOW of OPPORTUNITY” Critical period for maximum response to HT 10 yrs too Late!! Start HT here © Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004 Not Here Natural History
Treatment Non-contraceptive Benefits Steroid Contraception Progestin Progestin Progestin Hysterectomy v Dysmenorrhea v DUB v PID v Ectopic preg suppress PG release stabilizes endometrium thickens cervical mucus thickens cervical mucus TAH, BSO © Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD MPH (2011) 4 Metabolic Effects Steroid contraception Healthy lipid profile (^ HDL, v LDL) Oral Contraceptives Risk of CANCER Estrogen mediated THROMBOSIS ^ venous & arterial v Endometrial ^ Cervical = ^ Breast Ovarian Unhealthy lipid profile (v HDL, ^ LDL)
Progestin mediated © Elmar P. Sakala, MD, MPH Contraception Review Intrauterine Contraception Steroid Contraception © Elmar P. Sakala, MD, MPH (August, 2011) © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD MPH (2011) 5 Contraceptive Failure Rates Reversible Methods Basic Principles of Contraception Avoid contraindications © Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH Basic Principles of Contraception Avoid contraindications FEW Complic Completed childbearing Sterlization © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD MPH (2011) 6 FEMALE – Next step in management? -hCG ? -hCG ? -hCG ? -hCG PREGNANCY – Next step in management? OB sono OB Sono OB Sono OB SONO J J (c) Elmar P. Sakala, MD MPH (2011) 7 Pathophysiology J F E T U S Vol of RBC needed: varies from 0. 1mL to 450 mL M O M J Mechanism of FHR Decelerations HEAD Compression Compression CORD PLACENTAL Insufficiency © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD MPH (2011) 8 Fetal Fibronectin “Trophoblast Glue” Matrix that bonds Trophoblast to Decidua Predictor of Preterm Delivery © Elmar P. Sakala, MD, MPH Cervical Length Vaginal Sonogram Saggital Image Normal: > 25 mm 1 3 4 (c) Elmar P. Sakala, MD MPH (2011) 9 Described in notes p. 44 Agent TOCOLYTIC agents Side Effects Contraindications J MgSO4 ? -Adrenergic Agonists Ca++ channel blockers PG synthetase inhibitors Muscle weakness Renal insuffic Respiratory depression Myasthenia gravis Pulmonary edema v? BP, tachycardia, ^ glucose, v K+, Pulmonary edema Tachycardia, v BP Myocardial depression Cardiac disease Diabetes Uncontrolled ^T4 Cardiac disease Hypotension Oligohydram, Gestational age IU closure PDA, Necrotiz enterocolitis > 32 weeks J (c) Elmar P. Sakala, MD MPH (2011) 10
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