Core conditions 2 Flashcards
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
What can cause PPROM?
Infection
Trauma
Overstretching
What are RFs for PPROM?
Smoking Lower GU infection Prev preterm delivery Vaginal bleeding \+ve amniotic fluid culture
How is PPROM diagnosed?
Pooling of amniotic fluid on sterile speculum when lying for 30mins (check liquor & umbilical cord)
How is PPROM managed?
DO NOT perform necessary PV exam
Abx: Erythromycin
Hospital referral
Prophylactic steroids: Betamethasone
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
What are the RFs for ovarian cysts?
pre-menopausal Early menarche 1st trimester pregnancy Inc intrinsic/extrinsic gonadotrophin Personal Hx of infertility/PCOS Tamoxifen
What are the causes of ovarian cysts?
Genetic mutation Physiological processes Normal/increased hormone production Pluripotent stem cells lacking normal growth regulation Extrinsic gonadotrophin
How are ovarian cysts investigated?
TVUS
How are ovarian cysts managed?
Acute: laparoscopy, resus & hem support, borad spec Abx
Ongoing: Conservative, laparoscopy, gynae oncology referral
Define endometriosis
The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature.
Can lead to infertility, adhesions & fibrosis
What are the causes of endometriosis?
Retrograde menstruation Mullerian rests Deficient cell-mediated immune response Vascular & lymphatic dissemination Genetics Inc level of inflammatory & angiogenic mediators
What is endometriosis dependent on?
Oestrogen- cyclical symptoms
What is adenomyosis?
Endometrial tissue within the myometrium
What are the signs of endometriosis?
Dysmenorrhoea Dyspareunia Sub-fertility Uterosacral ligament modularity Pelvic mass Fixed, reteroverted uterus
How is endometriosis diagnosed?
Laparoscopy- Gold standard
TVUS
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
Where are the main sites of endometriosis?
Retrograde Peritoneum Pouch of Douglas Ovary/tubes Ligaments Bladder Myometrium
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).
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
