benign + reproductive gynae

Question 1

how many doctors required to sign abortion documentation?

Answer 1

2

if F + G emergency clauses - 1 doctor can sign

Question 2

conscientious objection in abortion, limits?

Answer 2

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

Question 3

medical termination of pregnancy

Answer 3

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)

Question 4

up until what date can medical termination of pregnancy (MTOP) be self-administered?

Answer 4

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

Question 5

until what date is medical termination of pregnancy available ?

Answer 5

19+6wks in most areas of scotland

> 20wks requires travel to england

Question 6

surgical termination of pregnancy

Answer 6

cervical priming via misoprostol or osmotic dilators

<14weeks
- electric vacuum aspirations (GA)
manual vacuum aspiration (LA) - up to 10wks

> 14weeks
- dilation + evacuation

Question 7

how long is surgical termination of pregnancy availbale for in scotland?

Answer 7

13+6weeks

> =14weeks require travel to englands

Question 8

prophylaxis at abortion

Answer 8

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)

Question 9

fertility after abortion

Answer 9

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

Question 10

contraception after abortion

Answer 10

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

Question 11

secretory phases

Answer 11

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

Question 12

mentrual, proliferative and secretory phase vs follicular + luteal

Answer 12

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

Question 13

diagnosis of endometritis

Answer 13

histology = abnormal pattern of inflmmatory cells

(cervical mucous plag protectts the endomentrium from ascending infection)

Question 14

chronic plasmacytic endometritis

Answer 14

infectious unless proved otherwise

assoc with PID - gonorrhoea, chlamydia

Question 15

endometrial polyps

Answer 15

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

Question 16

oogenesis, folliculogenesis

Answer 16

oogenesis = development of oocytes

folliculogenesis = growth of follicle consisting of oocyte + any assoc support cells

Question 17

pathophysio if implantation occurs vs if it doesnt

Answer 17

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!

Question 18

layers of endometrium

Answer 18

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

Question 19

cervical transition zone

Answer 19

stratified squamous epithelium on vaginal surface transitioning to simple columnar epithelium as goes into canal

common site of dysplasia + neoplastic changes

Question 20

endocervical glands in proliferative vs post ovulation

Answer 20

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

Question 21

4 layers of vagina

Answer 21

1. non-keratinised stratified squamous epithelium - thicker during reproductive years
2. lamina propria
3. fibromuscular layer
4. adventitia

no glands in wall of vagina
commensal bacter metabolism glycogen to lactic acid which inhibits growth of pathogenic bacteria

Question 22

key hormones in female reproductive cycle

Answer 22

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

Question 23

menstrual phase

Answer 23

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

Question 24

preovulatory phase

Answer 24

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

Question 25

ovualatory phase

Answer 25

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

Question 26

postovulatory phase

Answer 26

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