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Gynaecology > Conditions > Flashcards

Conditions Flashcards

1
Q

Postpartum contraception methods

A

Lactational amenorrhoea; 98% effective if;
- amenorrhoea
- <6/12 postpartum
- Baby fully breastfed and nil long intervals between feeds (<4hrs day, <6hrs night)
- BUT recommend additional contraception as variable night time feeding and ovulation may still occur
IUD; immediately postpartum
Progestogen-only pill; safe in breastfeeding
COCP; 6/52 postpartum (nil effect on BM from 6/52 onwards)

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2
Q

Ceasing contraception once 50yo

A

LNG-IUD, POP, implant
- amenorrhoeic for >=12/12
- 2x FSH 6/52 apart - if both >=30IU/L then only need contraception for another 12/12
- OR continue until >=55
Cu-IUD; cease amenorrhoeic 12/12

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3
Q

Contraception + epilepsy

A

Carbamazepine, phenytoin, lamotrigine -> reduce efficacy of COCP
LVG-IUD, copper IUD, depot are effective

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4
Q

Interacting drugs with contraception (excluding IUD/depot/Copper)

A

Antiepileptics: carbamazepine, oxcarbazepine, perampanel, phenobarbitone
Antiretrovirals for hiv
Antibiotics: rifampicin, rifabutin
Complementary: St John’s wort

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5
Q

Quick start indications

A

Irregular/long periods
If unintended pregnancy would cause harm
Difficulties accessing health care

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6
Q

Quick start contraindications

A

IUD
COCP with cyproterone (feminisation of foetus)

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7
Q

How to exclude pregnancy

A

Negative preg test + nil UPSI in last 3/52
Nil intercourse since period
Consistent with current contraception
within 5 days of start of period
21 days postpartum
5 days post abortion/miscarriage

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8
Q

COCP UMEK

A

Smoking
- >=35yo + >=15cig = 4
Obesity
- BMI >=35 = 3
HTN
- >=160/100 = 4
Vascular disease = 4
Previous CVA/IHD = 4
Hx VTE = 4
Fhx VTE = 3
Migraine + aura = 4
Current breast Ca = 4

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9
Q

Contraindications IUD

A

PID
STD
Unexplained PV bleeding
Cervical/endometrial Ca

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10
Q

LNG-IUD

A

52mg (menorrhagia/dysmenorrhoea/endo) or 19.5mg (dysmenorrhoea, reduce bleeding)
Contra; breast Ca, PID

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11
Q

Copper IUD

A

Immediately effective at any time
Complication; expulsion, PID, ectopic, perforation
Avoid sex 48hrs post insertion

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12
Q

Implanon

A

etonorgestrel 68mg every 3 years
Contra; breast Ca
Advantage
- cost-effective
- can quick start
- safe postpartum + breast feeding
- Amenorrhoea in 22%
- Improves dysmenorrhoea
Risks; infection, scarring, cysts

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13
Q

Mx bleeding on implanon

A

1st line; COCP continuously 3/12, mefenamic acid 500mg TDS 5/7, TXA 500mg BD 5/7
2nd line; norethisterone 5mg TDS 21/7

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14
Q

Depot medroxyprogesterone

A

Medroxyprogesterone 150mgcg 12/52ly
Consider; contraindication to COCP, drugs that induce liver enzymes, wanting discrete method
Risks; CVD risk, BMD
Contra; breast Ca
Precaution; IHD/CVA/TIA, CVD risk factors, avoid >50yo
Disadvantage; altered bleeding, low continuation rate, 20% have weight gain, loss of bone density, 18mo return of fertility

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15
Q

Late depo injection

A

up to 14/52 since injection is ok
14/52 + 1 or more days
- if UPSI within last 5/7 - need emergency contraception
- multiple UPSI >5 days ago and <=3/52 ago -> urine test needed

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16
Q

POP

A

Consider if oestrogen contraindication
Quick start = immediately effective - otherwise takes 3 pills before being effective
Contra; breast Ca
Precaution; unexplained PV bleed, Hx breast Ca, cirrhosis/liver disease, IHD/CVA/TIA that develops during use
Disadvantage; 3hr window, altered bleeding, low continuation rate, ectopic pregnancy,

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17
Q

Missed POP

A

1 pill missed
- immediately take, condoms until 3 consec pills
- consider EC if UPSI occurred in time since missed pill
>1 pill missed
- take most recent missed pill and condoms for 3 consec pills
- consider EC if UPSI occurred in time since missed pill

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18
Q

Oestrogen types in COCP

A

Estradiol
Ethyinylestradiol
Mestranol

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19
Q

Progestogen types in COCP

A

1st gen; norethindrone
2nd gen; levonorgestral, norethisterone
3rd gen (less androgen, more VTE)
- desogestral, etonogestrel
Unclassified; cyproterone acetate, drosperinone
- both antiandrogenic

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20
Q

COCP advantages

A

Tx
- acne
- menorrhagia
- dysmenorrhoea
- endometriosis
- PCOS
- PMS
Reduce risk
- endometrial/ovarian/bowel Ca

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21
Q

COCP disadvantages

A

high user involvement
VTE risk
MI/CVA risk
increase risk cervical/breast Ca
HTN
irregular bleeding

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22
Q

COCP contraindications

A

Breastfeeding <6/52 postpartum
Smoker >35 and >15 cig per day
Migraine + aura
HTN >160/110
>50yo
Hx VTE
Breast Ca
Cirrhosis/liver ca
Known thrombogenic mutations

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23
Q

Mx COCP ADR

A

Breakthrough bleeding
- Higher dose oestrogen or less androgenic progestin
- extending cycling
Breasts tenderness
- reduce oestrogen/progestogen dose
Nausea; take at night
Headache; reduce oestrogen
Bloating; reduce oestrogen or change to diuretic progestogen (drosperinone)

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24
Q

COCP missed

A

> 24hrs overdue
- take most recent
- condoms 7/7
- if <7 pills from placebo -> EC if UPSI in last 5/7
- <7 till next placebo - skip and take active

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25
Q

COCP types

A

Microgynon ED; ethinyloestradiol 20mcg + levonorgestral 100mcg
Levlen ED; ethinyloestradiol 30mcg + levonorgestrel 150mcg
Microgynon 50; ethinyloestradiol 50mcg +levonorgestral 125mcg
Brenda-35; ethinyloestradiol 35mcg + cyproterone 2mg
Yaz; ethinyloestradiol 20mcg + drosperinone 3mg
Yasmin; ethinyloestradiol 30mcg + drosperinone 3mg

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26
Q

Ulipristal acetate

A

30mg dose
Best taken within 24hrs - but can use up to 5 days UPSI
Contra; severe asthma, severe liver impairment
If vomiting within 3hrs ingestion - repeat dose
Delay resumption of contraception until 5 days after dose

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27
Q

Levonorgestrel EC

A

1.5mg PO within 72hrs
if vomit <2hrs - repeat
if on liver enzyme-inducing drug - take 3mg
Avoid in obese due to risk of failure
Resume contraception immediately within LNG-ECG

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28
Q

Minipill as EC

A

25x minipill 12 hrs apart (50 tab)

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29
Q

Copper IUD EC

A

Within 5 days UPSI
Good option if taking liver enzyme inducers, BMI >30
Can keep in for ongoing contraception
Need to screen for STI in high risk
Need preg test 3/52 post UPSI

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30
Q

Copper IUD EC

A

Within 5 days UPSI
Good option if taking liver enzyme inducers, BMI >30
Can keep in for ongoing contraception
Need to screen for STI in high risk
Need preg test 3/52 post UPSI

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31
Q

Signs of secondary dysmenorrhoea

A

Onset in third decade of life or later
Dyspareunia
Heavy menstrual bleeding
Intermenstrual bleeding
Post-coital bleeding
Irregular periods
Poor response to 3/12 tx
Signs of endometriosis/fhx of same

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32
Q

Mx dysmenorrhoea

A

1st line; NSAID or COCP
Ibuprofen 400mg TDS for 72hrs of menstruation
Mefenamic acid 500mg TDS for 72hrs of menstruation
Local heat
Acupuncture
Diet; thiamine, magnesium, fish oil

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33
Q

Secondary dysmenorrhoea causes

A

Endometriosis
Pelvic infection
Adenomyosis
Fibroids
Chronic PID
Ovarian cysts
Cervical stenosis

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34
Q

Abnormal uterine bleeding causes

A

PALM COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not classified

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35
Q

Primary amenorrhoea

A

Failure menses by age 16yo with normal secondary sex characteristics
Causes
- Hypothyroidism
- HPRL
- PCOS
- Androgen insensitivity
- Mullerian agenesis
- Turner’s
- Low FSH; constitutional delay, pituitary failure, T1DM

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36
Q

Secondary amenorrhoea

A

amenorrhoea for 6/12
Causes
- Pregnancy
- Functional hypothalamic amenorrhoea (weight change, stress, eating disorder)
PCOS
Prolactinoma
Premature ovarian failure
Thyroid disease
Exogenous androgen use
Cervical stenosis
Asherman’s syndrome
Sheehan syndrome
Congenital adrenal hyperplasia

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37
Q

Secondary amenorrhoea Ix

A

bHCG
FSH/LH
Oestradiol/testosterone
TSH
PRL
Pelvic USS

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38
Q

Premature ovarian insufficiency

A

<=40yo with irregular periods or amenorrhoea >=4/12
FSH >=25 on 2x occasions 6/52 apart confirms Dx
Consider karyotyping - Fragile X or Turner syndrome
Autoimmune screen with (ANA) - could be autoimmune POI
Consequences
- Menopause
- Accelerated cognitive impairment
- CVD
- Inferility
- Osteoporosis
- Premature mortality

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39
Q

Asherman’s syndrome

A

Adhesions inside uterus +/- endocervix
Sx
- light period, amenorrhoea, infertility, miscarriage
Risk; curettage post miscarriage

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40
Q

DUB

A

Heavy/prolonged/frequent bleeding of unknown cause
Tx
- Cease smoking
- Dietary iron
- Exercise
- Tranexamic acid
- Naproxen / mefenamic acid
- COCP
- Oral progesterone
- Depot
- IUD

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41
Q

Heavy menstrual bleeding cause

A

Pregnancy
PALM COEIN
PCOS
Hypothyroidism
IUD
Ginseng

42
Q

HMB Ix

A

FBC
Ferritin
Coag
TSH
BHCG
STD
CST if due
USS on day 5-10 cycle

43
Q

HMB referral criteria

A

Refer if 6/12 ongoing sx despite tx
Early referral
- severe dysmenorrhoea
- if wanting to conceive
- fibroids >3cm
- Endometrial polyp
- Risk factors of endometrial ca

44
Q

HBM tx

A

IUD
TXA
mefenamic acid
COCP
Depot
PO medroxyprogesterone 10mg TDS day1-21
Uterine artery embolisation
Acute severe heavy bleed
- Medroxyprogesterone 10mg TDS until bleeding stops

45
Q

Adenomyosis

A

Infiltration of endometrium into myometrium
Risks
- preterm labour
- PROM
- miscarriage
- pre-eclampsia
Sx
- HMB, dysmenorrhoea, irregular bleeding
Tx
- LNG-IUD best
- COCP, POPO
- TXA/NSAID
- If no longer wanting babies - endometrial ablation or hysterectomy

46
Q

Endometriosis sx

A

Dysmenorrhoea
Dyspareunia
Dysuria
Cyclical haematuria
HMB
Diarrhoea/bloating
Infertility
urinary sx

47
Q

Endometriosis tx

A

1st line; NSAID, panadol
Next; COCP, Progestogen, LARC
Refer after 3/12 tx

48
Q

Post-menopausal bleeding ddx

A

Endometrial ca
Endometrial polyp
Endometrial hyperplasia
Vaginal atrophy
Cervical polyp
Endometrial fibroid

49
Q

Endometrial Ca risks

A

Nulliparity
Late menopause
OBesity
DM
Unopposed oestrogen therapy
Tamoxifen
Endometrial hyperplasia

50
Q

Normal endometrial thickness based on menopausal status

A

Post; <4mm
Peri; <5mm
Pre; <12mm

51
Q

Hypogonadotropic hypogonadism

A

Cause
- Functional; eating disorder, exercise
- Acute illness
- Chronic disease; DM
- Nutritional deficiency
- Medication; opioids, anabolic steroids
- Contraceptive progestogens
Ix
- Normal LH/FSH with low oestradiol

52
Q

Menopause sx

A

Vasomotor; hot flush, night sweats
Urogenital; dryness, urinary freq, dysuria, nocturia, incontinence
Insects crawling in skin
Reduced libido
Sleep disturbance
Mood/memory issues
Irregular PV bleeding

53
Q

Menopause ddx

A

Thyroid
Depression
Anaemia
Diabetes
SSRI (cause flushes)

54
Q

Menopause evaluation

A

Assess breast Ca, CVD, VTE, osteoporosis risk
BMI
CVD exam
Thyroid exam
Lymphatic exam - if concerns malignancy
Cervical + vulvar exam
Bimanual if indicated

55
Q

Routine health screening for menopausal women

A

Exclude thyroid disease, diabetes, iron deficiency
Vitamin D if risk
CST + mammogram
BP, cholesterol, FPG
Smoking
Bone health

56
Q

Non-hormonal menopause tx

A

Use if contra-indication to systemic therapy or vulvovaginal sx only
Good for sleep and vasomotor sx
SSRI; escitalopram 5mg daily
SNRI; venlafaxine 37.5mg PO
Gabapentin 100-300mg nocte
Clonidine 25-75mcg BD

57
Q

Non-pharmacological mx of menopause sx

A

Psychologist for CBT
Keep cool, air-conditioner, cool liquids
Avoid triggers; stress, spicy food, caffeine, alcohol
Smoking cessation
Weight loss
Pelvic floor exercises
Vaginal lubricants; KY jelly

58
Q

Types of systemic MHT

A

Most effective for hot flushes, night sweats, helps prevent osteoporosis
- Oestrogen only MHT
- Combination MHT; cyclical combined or continuous combined
- Other; tibolone

59
Q

Contraindication to systemic MHT/oestrogen

A

> =60yo
Previous VTE
Prev TIA/CVA/MI
Uncontrolled HTN
Oestrogen-dependent cancer
Undx PV bleeding
High breast Ca risk
Significant liver disease
Porphyria/SLE

60
Q

Contraindication to oral oestrogen for menopause tx

A

VTE risk factors
CVD risk factors
Elevated TAG
Liver/gallbladder disease
If so -> use transdermal oestrogen
If not - can use either transdermal or oral

61
Q

Indication for addition of progestogen for transdermal/oral oestrogen for menopause tx

A

Intact uterus
Endometrial ablation
Subtotal hysterectomy
If not -> oestrogen-only MHT

62
Q

Mx menopause of contraception required

A

<50yo; CHC
Or oestrogen PLUS LNG-IUD

63
Q

Mx menopause if nil contraception required

A

POI/early menopause; cyclical combined or continuous combined
Perimenopause; CHC (<50yo), oestrogen PLUS LNG-IUD, cyclical combined MHT
Postmenopause; continuous combined MHT, tibolone

64
Q

Oestrogen only MHT

A

Increases risk CVA/VTE
Oestradiol valerate 0.5-2mg (progynova) PO
Oestradiol 25-100mcg/24hr patch (Climara)
Oestradiol 1.5mg 2x pumps gel (Estrogel)

65
Q

Intravaginal oestrogen therapy

A

Most effective for vulvovaginal atrophy, reduce risk of UTI and improve some urinary sx
Nil CVD/VTE/breast Ca risk - but if they have personal breast Ca risk then prefer non-hormonal therapy
Estriol 1mg/g one applicatorful intravag nocte 2-3/52 then one or twice weekly

66
Q

Cyclical combined MHT

A

Indication; POI, perimenopausal (breakthrough bleeding occurs with continuous)
Increases risk of; bresat Ca, CVA, VTE, CVD
Component: oestrogen PO/transdermal PLUS PO progestogen
Continuous oestrogen + progestogen 10-14/7 of cycle
1mg oestradiol/10mg dydrogesterone (Femoston) tablet
Estrogel Pro; 1 pump 0.75mg oestradiol PLUS 2 capsules (200mg) progesterone PO 12/7

67
Q

Continuous combined MHT

A

Indication; postmenopausal, POI, migraines
Estradiol 1mg + drosperinone 2mg (Angeliq) PO
Oestradiol 0.75mg 1 pump gel + progesterone 100mg (Estrogel Pro) 25/7

68
Q

Counselling prior to commencing MHT for menopause

A

Discuss cyclical bleeding on cyclical MHT
Discuss ADR; mastalgia, nausea, headaches
Increase risk of breast ca
Increase risk of VTE
Use for max 5 years due to risks of cancer
If develops breakthrough bleeding- needs review
F/u in 3/12

69
Q

Causes of PV itch

A

Lichen sclerosus
Psoriasis
Atopic dermatitis
Atrophic vaginitis
Candidiasis
Lichen planus

70
Q

Vulvodynia

A

Chronic vulvar discomfort in absence of other findings
Sx
- tender
- burning/raw feeling
- provoked by intercourse, tampons, tight clothing
Mx
- Topical lignocaine 2% gel prior to sex
- Low dose TCA 1st line

71
Q

Causes of vulvar pain

A

Infection; candida, bacterial, HSV
Eczema/lichen simplex/contact dermatitis/psoriasis
Atrophic vaginitis
Vulval neoplasia
TRauma
Vaginismus

72
Q

Primary vaginismus

A

Pain/difficulty of intercourse due to spasm of pelvic floor
Sx
- pain
- difficulty with intercourse
- fear of pain/penetration
Mx
- vaginal dilation
- progressive desensitisation/relaxation
- sex therapy to reduce fear
- CBT
- Pelvic floor physio for progressive desensitisation

73
Q

Chronic vulvovaginal candidiasis

A

Sx
- itch
- burning/rawness
- premenstrual pain / itch
Mx
- Avoid irritants; soap, wipes, panty liners, fabric softener, perfume
- Candida suppression - prolonged course - prefer oral
-> fluconazole 150mg weekly for 6/12

74
Q

Bartholin gland mass

A

Small cyst <3cm; sitz bath, warm compress
Abscess <3cm; I+D
If 3rd episode - may need marsupialization + ABx

75
Q

Candidal vulvovaginitis tx

A

Clotrimazole 1% cream intravaginally nocte 6/7
If can’t tolerate - fluconazole 150mg PO stat
Non-pharm
- cotton underwear
- unperfumed detergent
- avoid tight pants
- avoid soap
- avoid douche
Glabrata; Boric Acid 600mg pessary nocte 14/7
Can’t use orals if pregnant - topical

76
Q

Pelvic pain in women - exam

A

Vitals
Peritonism
External genitals
- HSV lesion
- Vulvar/perineal abscess
- Imperforate hymen
Speculum
- discharge, open OS, POC
Bimanual
- Motion tenderness; PID, cystitis
- enlarged uterus; pregnancy, fibroid
- Painful adnexal mass; ectopic, tubo-ovarian abscess, ovarian cyst, torsion
- Rectal exam; thrombosed haemorrhoids

77
Q

Virilisation in woman (masculine)

A

DDx
- adrenal/ovarian tumour secreting androgens
- Congenital adrenal hyperplasia
- PCOS
- Exogenous androgen use
- Severe insulin resistance
Ix
- FSH/LH
- Oestradiol
- PRL
- Testosterone
- Sex hormone binding globulin
- DHEAS
- Progesterone
- TSH

78
Q

Hx for ovarian mass

A

Fhx; breast / colon / uterus / ovarian Ca
BRCA gene mutation
Lynch syndrome
Protective factors; parity, breast-feeding, COCP use
Menopause status

79
Q

Ovarian mass Ix

A

USS; TVUS + transabdominal
Ca-125
<40yo; LHD + AFP + BCHG
Risk malignancy index for postmenopausal women
Premenopausal
- Asymp + <5cm simple cyst - nil f/u
- 5-7cm simple cyst; repeat USS 3/12
- >7cm refer gyn
Postmenopausal
- Simple unillocular cyst <5cm + low RMI - monitor - resolve by 3/12
- Mod-high RMI; refer gyn

80
Q

Risk malignancy index ovarian mass component

A

= USS findings x menopause status x Ca125 (U/mL)
USS finding
Menopausal status (3 points if menopause)
Ca125; Actual level

81
Q

PCOS diagnostic criteria

A

Two or following and other causes excluded;
- Menstrual disturbance
- Clinical or biochemical hyperandrogenism
- polycystic ovaries on USS

82
Q

Clinical features of PCOS

A

Obesity
Insulin resistance
Subfertility
Irregular periods
Hirsutism
Oligo/Anovulation; cycles <21 or >35 days indicate this

83
Q

PCOS Ix

A

Hyperandrogenism; wait 3/12 post cessation oestrogen (can falsely elevated SHBG)
- Total serum testosterone; 2x upper limit
- Free androgen index; total serum test / SHBG x 100 -> best measure of hyperandrogenism
- Serum 17-hydroxyprogesterone; measure during follicular phase - if elevated then indicates congenital adrenal hyperplasia
- LH/estradiol/progesterone; confirms in follicular phase to avoid misinterpretation of serum 17-hydroxy
- TSH
Exclude other causes
- PRL
- TSH
- Cortisol
- Vitamin D; deficiency can increase testosterone
USS
- >=12 follicles per ovary +/- vol >=10ml (not to be done if <8yo from menarche as will always have polycystic ovaries) - do in 1st week of cycle

84
Q

PCOS mx

A

Weight loss 5%
Exercise
COCP; regular period, suppress androgen
- if COCP contraindicated -> medroxyprogesterone 10mg 12 days of each month
Mirena 52mg IUD good for menstrual regulation
Metformin 250mg IR BD; subfertility (doesn’t tx androgen)

85
Q

PCOS infertility

A

1st line; exercise + 5% weight loss
2nd line; specialist referral for letrozole
Metformin; can induce ovulation but not effect. can trial whilst awaiting specialist
Laparoscopic ovarian drilling
IVF

86
Q

PCOS monitoring

A

Lipid 2 yearly
BP annual
OGTT 1-3 yearly
Mental health
Monitor OSA
Fertility

87
Q

Ovarian cancer risk factors

A

Age
Caucasian
Premature menarche
Late menopause
Never taken COCP
Post-menopausal HRT
Use of IUD in past
Smoking
Fhx

88
Q

Ovarian Ca sx

A

Abdominal pain
Bloating
Dyspareunia
Altered bowel habits
Anorexia
Nausea
Vaginal bleeding
Urinary freq
Weight loss
Fatigue

89
Q

Ovarian ca exam

A

Abdominal exam - masses, organomegaly
Bimanual exam
Lymph node exam

90
Q

Endometrial ca risk factors

A

Chronic anovulation
Unopposed oestrogen
PCOS
Tamoxifen
Lynch syndrome
nulliparity
Obesity
Endometrial thickness >8mm

91
Q

Incontinence risk factors women

A

Age
Obesity
Parity
Vaginal delivery
Fhx
Smoking
Caffeine
Diabetes
Menopause
Genitourinary surgery

92
Q

Types of incontinence

A

Stress
Urgency
Mixed
Overflow; chronic retention and leakage

93
Q

Incontinence hx

A

Urgency
Stress
Nocturia
Incomplete emptying
Overflow
Haematuria
Lower limb weakness
Pelvic prolapse
Constipation
Alcohol/caffeine intake
Medication

94
Q

Incontinence exam

A

Vulvovaginal exam; atrophic vaginitis
Pelvic exam; adnexal mass
Pelvic organ prolapse
Pelvic floor weakness
Anal tone
Constipation on exam
Lower limb neurology
Cardiac; volume status, CHF

95
Q

Incontinence Ix

A

UMCS
FPG
Bladder diary

96
Q

Incontinence mx Non-pharm

A
  • Weight loss
  • Diet; reduce EtOH/caffeine/spicy food
  • Tx constipation
  • Avoid heavy lifting
  • Smoking cessation
  • Bladder training (scheduled voiding)
  • Physio for pelvic floor rehab
  • Fluid restriction 8 cups per day
97
Q

Incontinence pharmacological mx

A

Vaginal oestrogen; vagiefem pessaries weekly
Oxybutynin 5mg TDS
Mirabegron (Betmiga) 25mg daily
Botox in bladder wall
SNRI - duloxetine 30mg (good for stress)

98
Q

Pelvic organ prolapse risk factors

A

Menopause
Smoking
Chronic cough
Vaginal deliveries
Obesity
Fhx
Chronic constipation

99
Q

Pelvic organ prolapse mx

A

Non-pharm
- Avoid lifting
- tx constipation
- pelvic physio
- weight loss
- educate condition is mechanical and minimal long term health impacts
Vaginal pessary via O+G
Local oestrogen cream in menopausal women
Referral
- failed conservative
- voiding issues or obstructed defecation
- recurrent prolapse post surgery
- ulceration of prolapse or irreducible

100
Q

Mx postcoital bleeding flowchart

A

Do Co-test
If co-test negative
- and single episode + normal cervix - nil further Ix
- recurrent / persistent bleed -> refer gyn
If co-test positive -> refer to gyn

Gynaecology (1 decks)

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