Core conditions 2 Flashcards by Amy Spicer

What is PPROM, SROM, ARM defined as?

PPROM: Premature rupture of membranes <37weeks. 80% labour within 7days
SROM: Spont rupture of membranes 90% labour within 48hours
Prolonged SROM: >24hours
ARM: Artificial rupture of membranes as part of induction/augmentation

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What can cause PPROM?

Infection
Trauma
Overstretching

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What are RFs for PPROM?

Smoking
Lower GU infection
Prev preterm delivery
Vaginal bleeding
\+ve amniotic fluid culture

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How is PPROM diagnosed?

Pooling of amniotic fluid on sterile speculum when lying for 30mins (check liquor & umbilical cord)

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How is PPROM managed?

DO NOT perform necessary PV exam
Abx: Erythromycin
Hospital referral
Prophylactic steroids: Betamethasone

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What are the types of ovarian cysts? How do they develop?

Follicular cysts: Response to gonadotrophic stimulation ?dominant follicle fails to rupture
Corpus luteum cysts: Evolve from mature Graafian follicles 2-4days after ovulation

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What are the RFs for ovarian cysts?

pre-menopausal
Early menarche
1st trimester pregnancy
Inc intrinsic/extrinsic gonadotrophin
Personal Hx of infertility/PCOS
Tamoxifen

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What are the causes of ovarian cysts?

Genetic mutation
Physiological processes
Normal/increased hormone production
Pluripotent stem cells lacking normal growth regulation
Extrinsic gonadotrophin

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How are ovarian cysts investigated?

TVUS

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How are ovarian cysts managed?

Acute: laparoscopy, resus & hem support, borad spec Abx
Ongoing: Conservative, laparoscopy, gynae oncology referral

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Define endometriosis

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature.
Can lead to infertility, adhesions & fibrosis

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What are the causes of endometriosis?

Retrograde menstruation
Mullerian rests
Deficient cell-mediated immune response
Vascular &amp; lymphatic dissemination
Genetics
Inc level of inflammatory &amp; angiogenic mediators

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What is endometriosis dependent on?

Oestrogen- cyclical symptoms

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What is adenomyosis?

Endometrial tissue within the myometrium

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What are the signs of endometriosis?

Dysmenorrhoea
Dyspareunia
Sub-fertility
Uterosacral ligament modularity
Pelvic mass
Fixed, reteroverted uterus

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How is endometriosis diagnosed?

Laparoscopy- Gold standard

TVUS

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How is endometriosis managed?

OCPs (take packets back to back)
NSAIDs: Ibuprofen
GnRH agonists + HRT
Mirena coil
Laparoscopy: Ablation, resection, cystectomy, oophorectomy
Progestogens: Medroxyprogesterone
Androgens: Danazol
Total abdominal Hysterectomy

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Where are the main sites of endometriosis?

Retrograde
Peritoneum
Pouch of Douglas
Ovary/tubes
Ligaments
Bladder
Myometrium

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How is the menopause defined?

The cessation of menses for at least 12 consecutive months, without some other reason for amenorrhoea (such as pregnancy, hormone therapy, or other medical condition).

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What is the pathophysiology of the menopause?

Result of ovarian failure
Oestrone derived from estradiol metabolism in the liver& androstenedione in adipose tissue becomes dominant oestrogen

What are menopausal symptoms related to?

Decreasing estradiol levels

What are the long-term risks implicated with the menopause?

Osteoporosis

CV disease

How is the menopause managed?

Lifestyle changes
Conjugated oestrogen
Irregular periods: Oestrogen & Progestin

What is premenstrual syndrome (PMS)?

cyclical physical and behavioural symptoms occurring in the luteal phase of the menstrual cycle.

How is PMS diagnosed?

Symptom diary

How is PMS managed?

Mild: Lifestyle advice Moderate: COC (Yasmin), CBT, analgesia Severe: Tx for mild & SSRI

What is hyperemesis gravidarum?

Severe nausea & vomiting in pregnancy

When is hyperemesis gravidarum most likely to occur?

4-7weeks gestation peaks at 9-16weeks and resolves by around week 20

What are the RFs for hyperemesis gravidarum?

``` Multiple pregnancy GTD Triploidy Trisomy 21 Hydrops Fetalis Fhx/prev Hx ```

How is hyperemesis gravidarum diagnosed?

``` N&V on symptoms alone If weight loss; Bloods (U&Es+, TFTs: TSH-, T4 n Metabolic panel (hyperNA, hypochloraemia) Urinalysis- Ketones+++ ```

What are the signs that N&V is hyperemesis and not just early pregnancy related?

>5% weight loss Dehydration Electrolyte imbalance Ketonuria

How is hyperemesis managed?

Rest & IV hydration Food: Plain biscuits/crackers, small frequent meals Antiemetics: Cyclizine/Promethiazine/Prochlorperazine reassess after 24hours Ondansetron 2nd line (not for >5days) Corticosteroids (IV Methylpred)

What are the complications of hyperemesis?

``` Pre-eclampsia Mallory-Weiss tear Splenic avulsion IUGR Fetal mortality Oesophageal rupture ```

What are the causes of uterine prolapse?

``` Vaginal delivery Genetics Elevated intra-abdominal pressure CT disorders Decreased Levator Ani tone ```

What are the signs & symptoms of a prolapse?

``` Dragging sensation Back pain Vaginal bulge/protrusion Constipation Urinary incontinence ```

How is a prolapse investigated?

Assess post-void residual urine volume Urinalysis Urodynamics

How is a prolapse treated?

``` Pelvic floor exercises Weight loss Avoid heavy lifting Pesery-ring Surgery: Suturing, hysterectomy, sacrospinus fixation ```

What are uterine fibroids?

Leiomyomata | Benign tumours of myometrium usually composed of smooth muscle & fibrous CT

What causes uterine fibroids?

Mutatuon of single uterine myometrial cell OE & Progesterone De novo

What is the pathophysiology of uterine fibroids?

Arise from myometrial layer or uterine cervix May remain within musclar layer or protrude outwards becoming subserosal May protrude inwards towards uterine cavity becoming submucous

Which type of uterine fibroids most commonly cause bleeding?

Submucous fibroids | Bleeding caused by distortion of the endometrial lining

What are the signs & symptoms of uterine fibroids?

Asymptomatic-depends on size & location Menorrhagia/dysmenorrhoea Irregular firm central pelvic mass Pelvic pain/discomfort Pressure symptoms: Frequency, hydronephrosis (compression of ureters), Bloating Infertility/miscarriage

When should a woman with fibroids be referred? What tests will be done?

``` Symptoms not improved with treatment Complications (compressive symptoms) Obs/fertility issues Clinical/radiological suspicion of malignancy >12cm or palpable abdominally Ix: USS, Endometrial biopsy ```

How are uterine fibroids treated?

``` Asymptomatic= leave <3cm w/menorrhagia: IUS, Tranexamic acid/NSAID (3m then refer), COCP, PO injection >3cm w/menorrhagia: Ulipristal acetate Fertility desired: GnRH: Leuprorelin IM/ monthly <3months Mifepristone 3-6months Ulipristal Acetate Myomectomy +/- UEA Fertility NOT desired: UAE/myomectomy Hysterectomy Leuprorelin IM/monthly <3months ```

What are the different types of uterine fibroids?

Submucous: Below mucosal surface of uterus Subserous: Below serosal layer of uterus Intramural: Within uterine wall

What are the causes of a cervical ectropion?

Hormonal changes: Puberty, Pregnancy, OCP

What are the signs & symptoms of a cervical ectropion?

Asymptomatic Persistent vaginal discharge Postcoital bleeding

How is a cervical ectropion treated?

Asymptomatic- leave | Normal smear- Diathermy, cryocautery