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OB/GYN UPDATE

OB/GYN UPDATE. Let’s have an open discussion. NEW STUFF. ACOG now has order sets for hydralizine and labatalol. NEW STUFF. New Pap Smear Guidelines Prevalence affects predictive value. When used in low prevalence settings even excellent tests have low predictive value

georgia-becker
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OB/GYN UPDATE

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  1. OB/GYN UPDATE Let’s have an open discussion

  2. NEW STUFF • ACOG now has order sets for hydralizine and labatalol

  3. NEW STUFF • New Pap Smear Guidelines • Prevalence affects predictive value. When used in low prevalence settings even excellent tests have low predictive value • Here Specificity is more important

  4. HPV • VIN I-----No treatment needed---call it what it Is----A WART!!!!! • Colposcopy in pregnancy---DO IT---But have experience.

  5. HPV • Remember------risk of invasive cancer can last up to 20 years after clearing HPV……KEEP SCREENING!!!!

  6. EIN::::IT’s NEW • Endothelial Intraepithelial Neoplasia • This is new---this is the old endometrial hyperplasia • <1 high risk progression • >1 Low risk

  7. EIN • WHEN DO WE BIOPSY??????? • Adolescent 13-18 with anovulatory bleeding despite treatment for 2-3 yrs---esp. obese • > 35 if not responding to therapy • No cardiac prophylaxis for cardiac issues needed

  8. Tamoxifen • No role for routine biopsy • Only if symptomatic

  9. Recurrent Pregnancy Loss • EMB not accurate for luteal phase deficit

  10. Gestational Diabetes • No data for 1 hr GTT in early pregnancy—Carpenter and Coustan • AIC < 5.7 and fasting > 92 less false neg more specific and sensitive---start your glucometers!!!! • 2 hr GTT---not enough data yet

  11. BIRTH • Infants born at 37 weeks of life twice as likely to die in first year of life compared top term. • 70% pre term births 34-37 weeks • Fetal lung maturity is not equal to maturity of other organs

  12. BIRTH • 34-36 wks 3X increase in cerebral palsey 36% developmental delay 19% risk kindergarten retention

  13. BIRTH • Oligohydraminos and PIH---do not deliver early anymore • NO SLIPPERY SLOPE—39 wks is the line. • Do not deliver early anymore…..

  14. PRE NATAL CARE UPDATE • No need to do PAP SMEAR with prenatal care unless due. Same with after. • IT IS HARD TO CHANGE!!!!!!

  15. Progesterone • No Progesterone needed when treating Vaginal Atrophy in menopause -----If you use menopausal local therapies----i.e. estring • The IUD is being looked at for treating endometrial cancer---remember megace??

  16. BRCA • Hereditary BRCA • Tough---recc: alternate mammogram and MRI Q 6 months

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