The Challenge Description: To understand the imaging modalities available to detect occult breast disease and characterize clinically identified lesions. Scope of the Problem: Imaging is paramount for the early detection and staging of breast cancer, as well as to inform management decisions and direct therapy for this and other breast conditions. Objectives of Management: To appropriately use imaging modalities for evaluating breast disease and to improve…

Description Open breast biopsy is a technique used to obtain tissue samples for the histologic diagnosis of breast masses. Open biopsy techniques remove more tissue in larger specimens than do core biopsy methods. Indications Breast mass or suspicious lesion (palpable; nonpalpable masses may be sampled if image guidance is available). Contraindications Local skin infection, known or suspected allergy to agents used (eg, latex, iodine). Patients who…

Description Core breast biopsy is a technique used to obtain small tissue samples for the histologic diagnosis of breast masses. It has become the preferred method of histologic diagnosis for breast masses. Indications Breast mass or suspicious lesion (palpable; nonpalpable masses may be sampled if image guidance is available). Contraindications Local skin infection, known or suspected allergy to agents used (eg, latex, iodine). Core needle biopsy…

Description Marsupialization is the drainage and permanent fistulization of a symptomatic cystic dilation of the Bartholin gland. This provides an alternative to the obstructed anatomic drainage of the Bartholin gland. Indications Symptomatic cystic dilation of the Bartholin gland. Asymptomatic cysts in women younger than 40 years do not require treatment; in patients older than 40 years, biopsy is indicated. When performed for recurrent abscess formation, marsupialization…

Description Bartholin gland cyst/abscess drainage is an acute drainage of a symptomatic cystic dilation of the Bartholin gland. Indications Symptomatic cystic dilation or abscess of the Bartholin gland. Asymptomatic cysts in women younger than 40 years do not require treatment; in patients older than 40 years, biopsy is indicated. Mild Bartholin gland infections also may be treated with broad-spectrum antibiotics and frequent warm sitz baths. Contraindications…

Description Fluid is removed from breast cysts via aspiration. This may be performed for both diagnosis and therapy. Indications Palpable breast mass that is credibly considered to be cystic in nature. Contraindications Local skin infection, known or suspected allergy to agents used (eg, latex, iodine), uncorrected coagulopathy. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If…

Description Amniocentesis is the sampling of fluid from around the growing fetus for prenatal biochemical or genetic diagnosis. For these purposes, amniocentesis is being replaced by chorionic villus sampling and cell-free DNA analysis. Amniocentesis may rarely be used to reduce the amount of amniotic fluid present in cases of polyhydramnios. Indications This procedure is used for assessing fetal genetics or metabolic disorders, fetal infection, or isoimmunization…

Introduction Description: Uterine rupture is characterized by the breach of the uterine wall (new or after previous uterine surgery such as cesarean delivery) that may result in significant maternal or fetal morbidity or mortality. This should be distinguished from uterine scar dehiscence, in which there is a separation of an old scar that does not penetrate the uterine serosa or result in complications. Rupture of an…

Introduction Description: Uterine inversion is the turning inside-out of the uterus immediately after delivery. Uncommon and often iatrogenic, this may be associated with catastrophic bleeding and cardiovascular collapse. The condition also has been reported in nonpregnant patients with intrauterine pathology (eg, pedunculated leiomyomata), accounting for 5% of inversions. Although schema exist to quantitate the degree of inversion, any degree of inversion represents a clinical emergency. Prevalence:…

Introduction Description: Uterine atony is the loss of uterine tone after delivery that often manifests as a postpartum hemorrhage. Postpartum hemorrhage is sometimes divided into primary (first 24 hours after delivery) and secondary (up to 12 weeks postpartum), although the causes and management of secondary bleeding are very different and are not covered here. Prevalence: Hemorrhage is observed in 5% of deliveries, mostly because of atony…

Introduction Description: Trauma and violence are the leading causes of maternal death and death for women at reproductive age. The most common cause of fetal death in automobile accidents is the death of the mother. The altered physiologic state of pregnancy and the need to treat two patients simultaneously alter the management of even simple trauma. Prevalence: 1/12 pregnancies. Predominant Age: Reproductive age. Genetics: No genetic…

Introduction Description: Vaginal bleeding during the third trimester of pregnancy (generally >25–27 weeks gestation). Vaginal bleeding should be seen as a symptom, rather than a diagnosis. Most often, the blood is of maternal origin. Prevalence: Bleeding complicates 4%–5% of pregnancies. Predominant Age: Reproductive age. Genetics: No genetic pattern. ETIOLOGY AND PATHOGENESIS Causes: Cervical dilation, premature separation of a part or all of the placenta, abnormal placentation…

Introduction Description: In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably. Abortion is the loss or failure of early pregnancy (generally first trimester) in several forms: complete, incomplete, inevitable, missed, septic, and threatened. Except for threatened abortions, these losses generally involve a nonviable pregnancy. A complete abortion is the termination of a pregnancy before the age of viability, typically…

Introduction Description: Shoulder dystocia is an obstruction to delivery that is caused by the impaction of the fetal shoulder behind the maternal symphysis. Shoulder dystocia is less commonly due to an impaction of the posterior fetal shoulder on the sacral promontory. Shoulder dystocia is most often an unpredictable and unpreventable obstetric emergency, usually defined as a delivery that requires additional obstetric maneuvers (following failure of gentle…

Introduction Description: Isoimmunization to any fetal blood group not possessed by the mother is possible. The most common example is the Rh (D) factor. What was once a common cause for intrauterine fetal death has been largely eradicated by prophylactic administration of immunoglobulins to those at risk. When mothers develop antibodies against fetal blood antigens, the fetus is at risk for developing hemolytic disease of the…

Introduction Description: Although the term puerperal infection can be used to describe any infection during or after labor, it generally applies to the infection of the uterus and surrounding tissues after delivery. This can vary from mild to life-threatening severities. Some of the most severe infections may appear within hours of delivery and are often opportunistic and not associated with reliable risk factors. Vigilance and aggressive…

Introduction Description: Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most common dermatosis specific to pregnancy. It is also called polymorphic eruption of pregnancy (PEP), Bourne toxemic rash of pregnancy, linear immunoglobulin M (IgM) dermatosis of pregnancy, or toxic erythema of pregnancy. It typically manifests as itchy, erythematous papules within striae on the abdominal wall, which then may spread to the extremities, coalescing into…

Introduction Description: Pre-eclampsia is a pregnancy-specific syndrome (occurring after 20 weeks gestation) of reduced organ perfusion, vasospasm, and endothelial activation that is characterized by hypertension, proteinuria, end-organ failure, and other symptoms. Pregnancy can induce hypertension or aggravate existing hypertension. Edema and proteinuria (one or both) are characteristic pregnancy-induced changes. If pre-eclampsia is untreated, convulsions (eclampsia) may occur. Chronic hypertension may be worsened by or superimposed on…

Introduction Description: Postpartum depression is a cluster of symptoms that are characterized by a disturbance of mood; loss of sense of control; intense mental, emotional, and physical anguish; and loss of self-esteem associated with childbirth. There is a spectrum of symptoms and severity from postpartum “blues” that are mild and self-limited (subsyndromal depressive symptoms) to debilitating major depression. The American Psychiatric Association’s Diagnostic and Statistical Manual…

Introduction Description: Postpartum breast engorgement is characterized by tender, swollen, hard breasts that are caused by the accumulation of milk in the postpartum period or during weaning or interstitial edema with the onset of lactation after birth. Prevalence: Common. Predominant Age: Reproductive age, 3–4 days after delivery. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Increased milk production relative to use. Generally occurs 3–4 days after…