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Review, Note

J 1 J Premenopausal Pelvic mass? -hCG evaluation + Sono: simple cyst + Sono: complex/solid & Acute severe pain © Elmar G. Sakala, MD, MPH M J (c) Elmar L. Sakala, MD MPH (2011) 2 CV disease , Hormone Therapy J Suggestions: HT (E+P) 2003 Review of WHI study © Elmar G.

Sakala, MD, MPH © Elmar P. Sakala, MARYLAND, MPH (c) Elmar L. Sakala, MARYLAND MPH (2011) 3 Perimenopause WHI “WINDOW of OPPORTUNITY” Critical period for optimum response to HT 10 years too Late! Start HT here © Elmar P. Sakala, MD, YOUR Nonoral Options in Hormone Therapy, OBG Management dietary supplement to Nov 2004 Not Here All-natural History

Treatment Non-contraceptive Benefits Steroid Contraceptive Progestin Progestin Progestin Hysterectomy v Dysmenorrhea v LAY v PID v Ectopic preg reduce PG relieve stabilizes endometrium thickens cervical mucus thickens cervical mucus TAH, BSO © Elmar P. Sakala, MD, ADVISE © Elmar P. Sakala, MD, MPH (c) Elmar P. Sakala, MD WITH (2011) 5 Metabolic Results Steroid contraceptive Healthy lipid profile (^ HDL, v LDL) Oral birth control pills Risk of TUMOR Estrogen mediated THROMBOSIS ^ venous , arterial versus Endometrial ^ Cervical sama dengan ^ Breast Ovarian Harmful lipid profile (v HDL, ^ LDL)

Progestin mediated © Elmar P. Sakala, MD, MPH Contraception Assessment Intrauterine Contraception Steroid Contraceptive © Elmar P. Sakala, MD, MPH (August, 2011) © Elmar P. Sakala, MD, WITH (c) Elmar P. Sakala, MD YOUR (2011) your five Contraceptive Failing Rates Invertible Methods Basics of Contraceptive Avoid contraindications © Elmar P. Sakala, MD, YOUR © Elmar P. Sakala, MD, MPH Basic Principles of Contraception Avoid contraindications COUPLE OF Complic Completed childbearing Sterlization © Elmar P. Sakala, MD, WITH (c) Elmar P. Sakala, MD ADVISE (2011) six FEMALE , Next step in management? -hCG? -hCG? -hCG? -hCG PREGNANCY , Next step in management? OB sono OB Sono OB Sono OB SONO J L (c) Elmar P. Sakala, MD YOUR (2011) six Pathophysiology M F E T U S Volume of RBC needed: varies from 0. 1mL to 400 mL Meters O M J Mechanism of FHR Decelerations BRAIN Compression Compression CORD PLACENTAL Insufficiency © Elmar L. Sakala, MARYLAND, MPH (c) Elmar S. Sakala, MD MPH (2011) 8 Embrionario Fibronectin “Trophoblast Glue” Matrix that a genuine Trophoblast to Decidua Predictor of Preterm Delivery © Elmar G. Sakala, MARYLAND, MPH Cervical Length Oral Sonogram Saggital Image Regular: &gt, 25 mm 1 3 some (c) Elmar P. Sakala, MD ADVISE (2011) being unfaithful Described in notes l. 44 Agent TOCOLYTIC real estate agents Side Effects Contraindications J MgSO4? -Adrenergic Agonists Ca++ funnel blockers PG synthetase inhibitors Muscle weak spot Renal insuffic Respiratory depression Myasthenia gravis Pulmonary edema v? BP, tachycardia, ^ glucose, sixth is v K+, Pulmonary edema Tachycardia, v BP Myocardial despression symptoms Cardiac disease Diabetes Out of control ^T4 Cardiac disease Hypotension Oligohydram, Gestational age IU closure PDA, Necrotiz enterocolitis &gt, 32 weeks J (c) Elmar P. Sakala, MD WITH (2011) 12