72 - abnormal vaginal bleeding, 78 - menstrual disturbance, 79 - pelvic pain, 87 - vaginal discharge Flashcards
initial Ix in 1st trimester spotting?
USS and exam
who gets cervical screening and how often
Screens women 25-64 for dysplastic changes (dyskaryosis) and HPV
every three years (25-49) and five years beyond that. Smear test.
If there is dyskaryosis on screening whats the next Ix?
colposcopy
define miscarriage
TOP before 20/52
rfs for miscarriage
ectopic risks, previous miscarriage, antiphospholipid syndrome, smoking, obesity, chromosomal abnormalities,
What can help evacuate remaining contents in miscarriage
misprostol
surgical
Mx of miscarriage
ABCDE
if shocked -> admit
Abdo + pelvic exam
USS, B-HCG
Miscarriage types threatened? inevitable? complete? incomplete? septic? missed?
Threatened - Os: CLOSED. Foetus: alive. Bleeding often present. <20 weeks gestation. 25-50% miscarry.
Inevitable - Os: OPEN. Foetus: alive/dead. <20 weeks gestation. Miscarriage imminent.
Complete - Os: CLOSED. Complete expulsion of ‘products of conception’
Incomplete - Os: OPEN. Incomplete expulsion of products. Bleeding ++.
Septic - Os: Open/Closed. Mother has serious intrauterine infection (PID) with fever. Causes: unsafe abortion, tissue remnant from previous miscarriage, STI etc.
Missed - Os: CLOSED. Foetus: dead. <20 weeks gestation.
Most common cause of vaginal bleeding ?
fibroids
What is dysfunctional vaginal bleeding?
mx?
Abnormal vaginal bleeding caused by changes in hormone levels.
Not caused by pregnancy, miscarriage, cancer or fibroids.
Caused by low levels of progesterone.
Diagnosis of exclusion.
Replace progesterone.
Rfs placental abruption?
pre-eclampsia, HTN, PROM, thrombophilia, multiple pregnancy, multiparity, smoking,
What is placental abruption?
Sx?
Pregnancy complication where the lining of the placenta seperates from the uterus.
Sudden onset abdo pain, contractions, bleeding, decreased foetal movement and heart rate
Mx abruption
Urgent blood volume replacement and delivery. Vaginal birth is preferred, especially in DIC.
Rfs for placenta previa
c-section, d&c, multiparity, twin pregnancy
types of emergency contraception
Levonelle within 72 hours.
ellaOne within 120 hours.
IUD within 5 days.
Some causes of secondary amenorrhea
breastfeeding, pregnancy, menopause, drug-induced, pituitary, Sheehan’s and Asherman’s
Ix in amenorrhoea
Check FSH/LH levels, pelvic exam, USS, b-HCG!
Causes of menorrhagia
endometriosis, fibroids, ovarian cysts, coagulation defects, cancers, PID, adenomyosis, contraceptives
What is PID? sX?
Ascending infection of upper section of female reproductive tract.
May be silent. Discharge, dysuria, fever, dyspareunia, dysmenorrhea,
PID ->?
infertility, ectopic, cancer and chronic pain.
Mx of PID
Test for STIs (Chlamydia and gonorrhoea a common cause). Pain relief.
If gonococcal risk low: Oral ofloxacin 400 mg twice daily plus oral metronidazole 400 mg twice daily, both for 14 days.
If gonococcal risk high: Ceftriaxone 500 mg as a single intramuscular dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily, both for 14 days.
What is the normal vaginal flora? function
Lactobacilus
inhibit pathogenic bacteria
maintaining normal pH.
BV caused by what?
sx?
Excessive growth of bacteria in the vagina. Most common vaginal infection in young women.
Smelly discharge, dysuria, may be silent.
Rfs for BV
douching, promiscuity, ABX, IUDs,
Mx BV
Clindamycin or metronidazole.
