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 • Here Specificity is more important
HPV • VIN I-----No treatment needed---call it what it Is----A WART!!!!! • Colposcopy in pregnancy---DO IT---But have experience.
HPV • Remember------risk of invasive cancer can last up to 20 years after clearing HPV……KEEP SCREENING!!!!
EIN::::IT’s NEW • Endothelial Intraepithelial Neoplasia • This is new---this is the old endometrial hyperplasia • <1 high risk progression • >1 Low risk
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
Tamoxifen • No role for routine biopsy • Only if symptomatic
Recurrent Pregnancy Loss • EMB not accurate for luteal phase deficit
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
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
BIRTH • 34-36 wks 3X increase in cerebral palsey 36% developmental delay 19% risk kindergarten retention
BIRTH • Oligohydraminos and PIH---do not deliver early anymore • NO SLIPPERY SLOPE—39 wks is the line. • Do not deliver early anymore…..
PRE NATAL CARE UPDATE • No need to do PAP SMEAR with prenatal care unless due. Same with after. • IT IS HARD TO CHANGE!!!!!!
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??
BRCA • Hereditary BRCA • Tough---recc: alternate mammogram and MRI Q 6 months