HY lecture notes:
You need to know fibrocystic change will show up with an unusual presentation on one of the obgyn forms. Normally we’d expect the standard bilateral breast tenderness in a young woman that waxes and wanes with the menstrual cycle; we’d see descriptors such as “blue dome cysts,” or “sclerosing adenosis,” or “apocrine metaplasia.” Once again, pretty standard. But on one of the newer obgyn forms (I think form 6), it presents as a unilateral painless cyst filled with brown serous fluid. I believe adenoma was another answer. Either way, that’s an unusual presentation I want to at least make you aware of.
Tx fibrocystic change with Evening Primrose Oil, warm showers, and/or acetaminophen for tenderness as needed. On the USMLE however, I’ve only ever seen “no treatment necessary” as an answer to fibrocystic change.
Placenta previa –> painless third-trimester bleeding.
Placental abruption –> painful third-trimester bleeding.
Placenta accreta/increta/percreta –> postpartum bleeding.
Placenta previa can move off the cervical os before 36 weeks gestation, so don’t automatically jump on C-section as the management. We wait until after 36 weeks. If at this point there’s still placenta over the os, C-section is mandatory.
Placental abruption occurs after deceleration injury (MVA or fall) or cocaine use. The woman will be in pain.
Placenta accreta –> implantation of the placenta onto the surface of the myometrium.
Placenta increta –> implantation of the placenta into the myometrium, but not through it.
Placenta percreta –> implantation of the placenta through the myometrium, often onto external structures such as the bladder.
Uterine atony is most common cause of postpartum bleeding (>80% of the time). This is exceedingly HY. Do uterine massage to Tx.
If the Q tells you McRoberts maneuver was performed for shoulder dystocia and now the mom has postpartum bleeding, answer = vaginal laceration as the most likely cause of bleeding. They’ll often throw in the detail that the uterus is firm so there’s no confusion. Fetus is of course at risk of clavicular fracture.
