ACOG Practice Bulletins Questions and Answers Fully Solved 100%

When is endometrial evaluation indicated in women 13-18 years of age with AUB-O? - Endometrial cancer is rare in <20 yo women; if it occurs, it usually presents with 2-3 years of abnormal bleeding and obesity. Evaluation is needed when medical treatment has failed after thorough investigation When is endometrial evaluation indicated in women 19-39 years of age with AUB-O? - risk of endometrial cancer in 20-34 is 1.6% risk in 35-44 is 6.2% assessment is needed in women who do not respond to medical therapy or have prolonged periods of unopposed estrogen if biopsy is non-diagnostic, hysteroscopy or saline sonohysterscope may be warranted what are the risk factors for endometrial cancer in women <40 years old? - nulliparity hypertension BMI >30 irregular menstruation family history When is endometrial evaluation indicated in women 40+ years of age with AUB-O? - between 40- 50, incidence is 13-24/100,000 between 70-74, incidence is 87/100,000 Better prognosis in women less than 45 yo therefore women 45+ with suspected anovulatory uterine bleeding should received endometrial biopsy in women with AUB-O, what is the treatment approach to guide therapy? - Exogenous steroids 1. progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate, norethindrone acetate, depot medroxyprogesterone acetate 2. combined hormonal contraceptionboth will help thin endometrium and protect from hyperplastic transition; combined also induce regular withdrawal bleeding when taken cyclically What are examples of progestin only medications? - progestin only - levonogestrel IUD, medroxyprogesterone acetate, megestrol acetate, norethindrone acetate, depot medroxyprogesterone acetate what medical therapies are most appropriate for AUB-O in 13-18 yo age range? - 1. exogenous steroids 2. if clinically symptomatic or hemodynamically unstable --> ADMIT 3. can also prolong the interval of menstruation by skipping the placebo week, allowing anemia to resolve 4. combined hormonal contraceptives also have the added benefit of increased factor VIII and VWD levels, therefore combating coagulopathy what medical therapies are most appropriate for AUB-O in 19-40 yo age range? - 1. low dose combined hormonal contraceptives or 2. progestin only 3. weight loss and exercise for obese, anovulatory women what medical therapies are most appropriate for AUB-O in 40+ yo age range?` - in Late perimenopausal women, cyclic progestin therapy, low dose oral contraceptives, levonorgestrel IUD or cyclic hormone therapy It was found that perimenopausal symptoms were better managed with cyclic hormone therapy whats are the added benefit for younger patients who have a coagulopathy and AUB-O who take combined oral contraceptives? - combined hormonal contraceptives also have the added benefit of increased factor VIII and VWD levels, therefore combating coagulopathy whats are the added benefit for younger patients who have PCOS and AUB-O who take combined oral contraceptives? - combined oral contraceptives suppress ovarian and adrenal androgenproduction and increase hormone binding globulin, therefore decreasing androgens which in turn improve symptoms of hirsuitism and acne in PCOS In patients with AUB-O who have completed childbearing, what are the potential concerns of endometrial ablation treatment? - - risk for endometrial cancer - impeded future evaluation - postablation asherman, cervical stenosis, endometrial distortion, strictures, synechiae what is the suggested further investigation of women with AUB-O who have failed medical management? - 1. hysteroscopy 2. TVUS (in pre-menopausal women, should be conducted when endometrium is thinnest at days 4-6) 3. saline infusion sonohysterography (high sensitivity and high NPV) what method of contraception has been show to effectively treat AUB? - levonorgestrel IUD which women are candidates for hysterecomy without cervical preservation secondary to AUB? - women who have completed child bearing women have failed medical therapy women with contraindications What are the goal ranges of insulin therapy for women with pre-gestational diabetes mellitus (i.e. at fasting, pre-meal, 1 hour postprandial, and 2 hour) - fasting = <95 mg/dL pre meal = <100 1 hour = <140 2 hour = <120 when are the various insulins utilized during management of patient glucose levels? - short/rapid acting = before meals intermediate acting = before breakfast and before dinner (with short/rapid acting) longer acting = utilized to restrain hepatic glucose production during fasting stateswhat are the uses for magnesium sulfate during pregnancy? - - tocolysis during pre-term labor to provide time for steroid administration - neuroprotection What are the indications for treatment with magnesium sulfate for neuroprotection? - -PPROM -PTL with intact membranes -indicated Pre term delivery - limited to pregnancies less than 32 weeks GA