benign + reproductive gynae Flashcards
how many doctors required to sign abortion documentation?
2
if F + G emergency clauses - 1 doctor can sign
conscientious objection in abortion, limits?
allows HCPS the right to refucse to participate in abortion care
- does not apply in emergency or lifethreatening situations
- should not delay or prevent patients access to care
- does not apply to “indirect” tasks assoc with abortion - admin, supervision of staff etc
medical termination of pregnancy
mifepristone 200mg PO
misoprostol 800mcg (prostoglandins) 24-48hrs later - to stimulate contractions
home pack also includes analgesia, antiemetics, antibiotics, contraceptions + low sensitivity preg test (used 2wks later to identify incomplete/failed procedure)
up until what date can medical termination of pregnancy (MTOP) be self-administered?
up to 11wks +6days
- can self admin both at home
- 2nd dose misoprostol if expulsion not occured within 4hrs
12-24+6
- inpatient procedure
- repeated doses of PV (intravaginal) misoprostol
until what date is medical termination of pregnancy available ?
19+6wks in most areas of scotland
> 20wks requires travel to england
surgical termination of pregnancy
cervical priming via misoprostol or osmotic dilators
<14weeks
- electric vacuum aspirations (GA)
manual vacuum aspiration (LA) - up to 10wks
> 14weeks
- dilation + evacuation
how long is surgical termination of pregnancy availbale for in scotland?
13+6weeks
> =14weeks require travel to englands
prophylaxis at abortion
antibiotics -> 7days doxycycline
admin of antiD Ig - sensitising event
VTE
- if high risk - LMWH for 1wk after abortion
- if v high risk - start LMWH before abortion +/- continue for longer (6wks)
fertility after abortion
1 in 3 experience repeat abortion
ovulation occurs in >90% within 1st month - as early as 8 days after MTOP
50% resume sexual activity 2wk after
contraception after abortion
can be started at/soon after abortion
- immediately effective if started within 5 days
> 5days
- 2 days for POP
- 5days for rest
hormonal can start day of
intrauterine - inserted immediately after STOP or after MTOP once expulsion confirmed
secretory phases
just after ovulation, driven by progesterone by corpus luteum
- follicle left behind transforms into corpus luteum which produces progesterone which drives change from proliferative to secretory activity within endometrium preparing for implantation of blastocyst
if fertilisation dont occur, corpus luteum will fail + degenerate -> menstruation
mentrual, proliferative and secretory phase vs follicular + luteal
menstrual - 3-7days
proliferative - 1-14days starts at same time menstrual (new endometrium grows)
secretory is as long a luteal phase
menstrual + proliferative same as follicular
diagnosis of endometritis
histology = abnormal pattern of inflmmatory cells
(cervical mucous plag protectts the endomentrium from ascending infection)
chronic plasmacytic endometritis
infectious unless proved otherwise
assoc with PID - gonorrhoea, chlamydia
endometrial polyps
common
usually asymptomatic but may present with bleeding or discharge
often occur around + after menopause
almost always benign, BUT endometrial carcinoma can present as polyp
oogenesis, folliculogenesis
oogenesis = development of oocytes
folliculogenesis = growth of follicle consisting of oocyte + any assoc support cells
pathophysio if implantation occurs vs if it doesnt
no implantation = becomes white connective tissue -> corpus albicans
successful implantation -> placenta secretes HCG which prevents degeneration of corpus luteum for a time + so maintains progesterone levels -> maintains pregnancy!
layers of endometrium
stratum functionalis - undergoes monthly growth, degeneration + loss
–> during menstrual phase, arterioles constrict causing ischaemia + breakdown
stratum basalis - reserve tissue that regenerated functionalise (underneath)
- during proliferative phase, it proliferates increasing thickness of endometrium byt reconstituting the stratum functionalis
cervical transition zone
stratified squamous epithelium on vaginal surface transitioning to simple columnar epithelium as goes into canal
common site of dysplasia + neoplastic changes
endocervical glands in proliferative vs post ovulation
proliferative = thin + watery
post ovulation - thick + viscous - prevent passage of sperm/organisms
outlets of these glanfs can become blocked causing glands to expands with secretions forming nabothian cyst
4 layers of vagina
- non-keratinised stratified squamous epithelium - thicker during reproductive years
- lamina propria
- fibromuscular layer
- adventitia
no glands in wall of vagina
commensal bacter metabolism glycogen to lactic acid which inhibits growth of pathogenic bacteria
key hormones in female reproductive cycle
GnRH secreted by hypothalamus -> stimulates LH+FSH
FSH - initiates follicular growth
LH - stimulates further development of follicles
FSH + LH - stimulates ovarian follicles to secrete oestrogen
progesterone - secreted mainly by corpus luteum
menstrual phase
1st 5 days of cycle
in ovaries -
- under influence of FSH, primary develop to secondary follicles
in uterus -
- fall in oestrogen + progesterine stimulates release of prostoglandins causing uterine arterioles to constrict
- stratum functionalis sheds leaving thin stratum basalis
preovulatory phase
between menstruation + ovulation - varies in length
in ovaries -
- secondary follicle secretes oestrogen
- one secondary follicule outgrows the rest to become dominant + develops into GRAAFIN follicle
in uterus
- oestrogens released by secondary + graafin follicle - stimulate growth of endometrium
- cells of statum basalis undergo mitosis + produce a new stratum functionalis
ovualatory phase
in ovaries
- oestrogen stimulates more GnRH release -> leads to increase LH + FSH
–> LH causes rupture of graafin follicles + explusion of secondary oocyte (approx 9hrs after LHsurge)
- oocyte taken into fallopian tube
in uterus
- progesterone + oestrogen continue to stimulate proliferation of endometrium
postovulatory phase
lasts 14 days
in overies -
- collapsed follicle becomes cirpus luteum under influence of LH
- corpus luteum secretes progesterone, oestrogen, relaxin + inhibin
- if fertilisation does NOT occur, this secretory activity declines after 2wks + new cycle begins
in uterus
- progesterone + oestrogen promotes growth + coiling of endometrial glands, vasculisation, further thicking of endometrium
- endometrial glands begin to secrete glycogen
