Oral contraceptives

Two types of oral contraceptives are avail able in the USA combination oral contraceptives that contain both an estrogen and a progestin, and progestin-only contraceptives, or mini-pills. All oral contraceptives marketed in the USA are similarly effective in preventing pregnancy. B. Combination oral contraceptives. Monophasic oral contraceptives contain fixed doses of estrogen and progestin in each active pill. Multiphasic oral contraceptives vary the dose of one or both hormones during the...

Diagnosis of gestational diabetes

The diagnosis of gestational diabetes is usually accomplished early in the third trimester of pregnancy. The one-hour glucola test is the screening test for gestational diabetes. Nonfasting women are given 50 grams of glucose in a flavored solution, and their blood is taken one hour after ingestion. If the blood sugar equals or exceeds 140 mg dL, then women are asked to take a three-hour glucose tolerance test (GTT). B. For the three-hour GTT, women are advised to consume an unrestricted...

Treatment of endometrial cancer

The treatment of endometrial cancer is usually surgical, such as total abdominal hysterectomy, bilateral salpingo-oophorectomy and evaluation for metastatic disease, which may include pelvic or para-aortic lymphadenectomy, peritoneal cytologic examination and peritoneal biopsies. The extent of the surgical procedure is based on the stage of disease, which can be determined only at the time of the operation. Staging for Carcinoma of the Corpus Uteri Invasion of less than one half of the...

Urinary Incontinence

Urinary incontinence is defined as the involuntary loss of urine in amounts or with sufficient frequency to constitute a social and or health problem. The prevalence of urinary incontinence is 15 to 35 percent in community-dwelling individuals older than age 60. Urinary Incontinence Types, Signs and Symptoms, and Causes With or without urgency, usually large volume loss Involuntary detrusor contraction, isolated or with cystitis, ureteritis, stones, neoplasia Detrusor hyperreflexia (DI with...

Pathophysiology

A The etiology of breast cancer remains unknown, but two breast cancer genes hsve been cloned-the BRCA-1 and the BRCA-2 genes. Only 10 of all of the breast cancers can be explained by mutations in these genes. B. Estrogen stimulation is an important promoter of breast cancer, and, therefore, patients who have a long history of menstruation are at increased risk. Early menarche and late menopause are risk factors for breast cancer. Late age at birth of first child or nulliparity also increase...

Antepartum Urinary Tract Infection

Four to 8 of pregnant women will develop asymptomatic bacteriuria, and 13 will develop symptomatic cystitis with dysuria. Pyelonephritis develops in 25-30 of women with untreated bacteriuria. I. Asymptomatic bacteriuria is diagnosed by prenatal urine culture screening, and it is defined as a colony count 105 organisms per milliliter. Patients with symptomatic cystitis should be treated with oral antibiotics without waiting for urine culture results. A. Approximately 80 of infections are caused...

Delivery of the placenta

The placenta usually separates spontaneously from the uterine wall within 5 minutes of delivery. Gentle fundal massage and gentle traction on the cord facilitates delivery of the placenta. 2. The placenta should be examined for missing cotyledons or blind vessels. The cut end of the cord should be examined for 2 arteries and a vein. The absence of one umbilical artery suggests a congenital anomaly. 3. Prophylaxis against excessive postpartum blood loss consists of external fundal massage and...

Estrogen replacement therapy

Postmenopausal women without contraindications should consider ERT. Contraindications include a family or individual history of breast cancer estrogen dependent neoplasia undiagnosed genital bleeding or a history of or active thromboembolic disorder. 2. ERT should be initiated at the onset of menopause. Conjugated estrogens, at a dose of 0.625 mg per day, result in increases in bone density of 5 . 3. Bone density assessment at regular intervals possibly every 3-5 years provides density data...