congenital torticollistypically develops by 2 to 4 weeks of age
It is most commonly caused by birth trauma (eg, breech delivery) or ☆malposition of the head in utero (eg, due to fetal macrosomia or oligohydramnios),both of which can result in sternocleidomastoid muscle(SCM) injury and fibrosis. OBGYpediatricsUWorld Jun 16, 2020, 6:53 AM HirotoShishido
placenta accreta/increta/percreta(morbidity adherent placenta)
Placenta accreta—placenta attaches to myometrium without penetrating it; most common type.
Placenta increta—placenta penetrates into myometrium.
Placenta percreta—placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall) reproductiveOBGYUWorld Jun 27, 2020, 12:53 AM HirotoShishido
GI functions of pregnant womanProgesterone decreases colonic smooth muscle activity and decreases fasting MMCs in the small intestine
Gravid uterus mechanically impedes small intestine transit
medical abortionmifepristone (progesterone antagonist to make the uterus an uninhabitable/unsustainable environment for the fetus)
+ Misoprostol (prostaglandin E1 agonist) is taken 24–48 hours later; this drug causes uterine contraction and expulsion of the uterine contents OBGYreproductive Dec 9, 2019, 10:02 PM HirotoShishido
target of colposcopyThe TZ(transformation zone) undergoes active cell division, young women are vulnerable to the oncogenic effects of human papillomavirus (HPV) infection and tobacco use.
Therefore, ☆the TZ is the most common site of cervical dysplasia/neoplasia. A colposcopy visualizes this area for biopsy.
function of human placental lactogen(hPL)Stimulates insulin production; ☆increased overall insulin resistance.
Gestational diabetes can occur if maternal pancreatic function cannot overcome the insulin resistance.
warfarin effects on fetusBone and cartilage deformities (stippled epiphyses, nasal and limb hypoplasia), optic nerve atrophy, fetal cerebral hemorrhage. embryologyreproductiveOBGY Jul 8, 2020, 4:57 AM HirotoShishido
inflammatory breast cancerDermal lymphatic space invasion→ breast pain with warm, swollen, erythematous skin around exaggerated hair follicles, ☆peau d’orange.
Poor prognosis (50% survival at 5 years). Often mistaken for mastitis or Paget disease. Usually ☆lacks a palpable mass.
"inflammatory" is a misnomer because the classic skin findings are not due to infection but are instead caused by cancerous cells obstructing lymphatic drainage after spreading to the dermal lymphatic spaces. breast surgeryOBGYUWorld Jul 9, 2020, 5:36 AM HirotoShishido
invasive lobular (breast) carcinoma↓E-cadherin expression(diffuse gastric cancer)→ orderly row of cells (“single file”) and no duct formation. Often lacks desmoplastic response.
comedocarcinomaSubtype of DCIS(dultal carcinoma in situ). Cells have ☆high-grade nuclei with extensive central necrosis and dystrophic calcification breast surgeryOBGYUWorld Jul 9, 2020, 5:23 AM HirotoShishido
the difference between complete mole and partial mole
p57 expressioncomplete→46XX/XY enucleated egg+single sperm(subsequently duplicates paternal DNA)
no fetal parts, ↑↑↑↑hCG, 15-20% of malignancy
☆46XX(90%)>>46XY
*46YY cannot survive
proliferation of ☆cytotrophoblast
p57 is maternally expressed→ ☆p57 negative⇔ partial mole
renal functions of pregnant womanIncreased blood volume and cardiac output result in the following alterations in renal hemodynamics:
• Increased renal plasma flow (RPF), ☆which peaks at 12 weeks gestation.
• Increased glomerular filtration rate
• Increased creatinine clearance, leading to decreased serum creatinine levels, typically by an average reduction of approximately 0.4 mg/dL renalOBGYUWorld May 30, 2020, 1:09 AM HirotoShishido
selective estsogen receptor modulator(SERM)
①indications ②side effectsraloxifene
① osteoporosis in postmenopausal indivisuals, prevention of breast cancer
② hot flashes, ☆increased risk of venous thrombosis
treatment for postpartum hemorrhageuterine massage, ¥oxytocin. If refractory, surgical ligation of uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation). reproductiveOBGYAmboss level4 Jul 9, 2020, 2:44 AM HirotoShishido
