Reproductive & OB

A placental disease that injures the mother’s blood vessels everywhere — the pressure is the symptom, delivery is the cure, and magnesium is the exam.

The uterus is supposed to clamp its own arteries shut after birth — when it doesn’t, a healthy patient can lose a liter of blood before the vital signs admit it.

The placenta makes the mother insulin-resistant on purpose, to feed the fetus. When her beta cells cannot keep up, glucose crosses to a fetus whose own insulin is already high — and the consequences arrive at the shoulders and at the cord clamp.

Two ways a placenta bleeds in the second half of pregnancy. Previa is a placenta in the wrong place, bleeding painlessly when the lower segment stretches. Abruption is a placenta in the right place that comes off too early, and its worst bleeding is the blood you never see.

Contractions producing cervical change after 20 weeks and before 37. The treatment does not stop it. Everything given buys about 48 hours, and the 48 hours are for the steroids, the magnesium, the antibiotic and the ambulance to a hospital with a neonatal intensive care unit.

A fertilized egg implants outside the uterine cavity, almost always in a fallopian tube that cannot stretch to hold it. The pregnancy cannot continue to birth, and the whole diagnostic effort exists to find it before the tube tears.

Pelvic inflammatory disease is what an untreated cervical infection becomes once it climbs past the cervix. Syphilis is what a painless ulcer becomes once it is ignored. Both do their damage quietly, which is why screening rather than symptom recognition is the intervention that changes outcomes.

The most common noncutaneous cancer in U.S. women — often found on a screening mammogram before any symptom, treated by surgery plus therapy matched to its hormone-receptor and HER2 status, and followed by years of nursing issues: the drain, the arm, lymphedema, and the side effects of endocrine and HER2 therapy.

Two common hormone-driven gynecologic conditions with long reaches: PMOS (formerly PCOS), where insulin resistance and androgen excess stop ovulation and raise diabetes and heart risk, and endometriosis, where estrogen-fed tissue outside the uterus bleeds, scars and causes chronic pelvic pain and infertility.

Two male cancers with opposite profiles: prostate cancer — common, usually slow, found by a PSA test whose benefits and harms need a shared decision — and testicular cancer — a young man’s cancer that usually presents as a painless lump and is cured in more than 9 of 10 cases.

After birth, mood changes fall on a spectrum. The baby blues are common, mild and gone within about 2 weeks. Postpartum depression lasts longer or is more severe, affects functioning and bonding, and needs therapy, medication or both. Postpartum psychosis is rare, sudden and a psychiatric emergency with a risk of suicide or harm to the baby. Nurses screen (EPDS), ask directly about thoughts of harm, teach families the warning signs, and know the zuranolone driving warning and breastfeeding options.

Hyperemesis gravidarum is the severe end of nausea and vomiting of pregnancy: vomiting so persistent that the patient cannot keep food or fluids down, with weight loss (typically more than 5%), dehydration, ketonuria and electrolyte loss such as hypokalemia. Care centers on IV fluids and electrolyte correction, thiamine before or with any glucose to prevent Wernicke encephalopathy, antiemetics used within their label limits, nutrition support, and emotional support.

Two gynecologic cancers with opposite exam logic. Cervical cancer is caused almost entirely by HPV, grows slowly and is prevented by vaccination and screening. Epithelial ovarian cancer gives vague bloating-type symptoms, spreads early through the peritoneum and has no screening test for average-risk women.

Spontaneous abortion (miscarriage) is the unexpected loss of a pregnancy before 20 weeks, most often from a genetic problem in the pregnancy. Types are named by symptoms, the cervical os and whether tissue has passed. Care means assessing bleeding and hemodynamic stability, offering expectant, medical or surgical management, giving Rh(D) immune globulin to eligible Rh-negative patients, recognizing septic abortion as an emergency, and supporting grief.

Rh(D) alloimmunization happens when an Rh-negative mother is exposed to Rh-positive fetal red cells and makes anti-D antibodies. In a later Rh-positive pregnancy these IgG antibodies cross the placenta and destroy fetal red cells — hemolytic disease of the fetus and newborn, with anemia, hydrops and dangerous newborn jaundice. Rh(D) immune globulin, given to unsensitized Rh-negative women at the right times, prevents sensitization.

Postpartum (puerperal) infection covers infections in the 6 weeks after birth: endometritis (the most common), cesarean and perineal wound infection including necrotizing fasciitis, lactational mastitis, septic pelvic thrombophlebitis and maternal sepsis. Cesarean birth is the biggest risk factor. Care means knowing the fever definition, recognizing sepsis early, giving the right antibiotics (clindamycin plus gentamicin for endometritis), keeping mothers with mastitis breastfeeding, and teaching urgent warning signs.