FEMALE HEALTH Flashcards
chronic pelvic pain, dysmenorrhoea, deep dyspareunia, subfertility and urinary symptoms, dyschezia
endometriosis
Investigation for endometriosis?
Laproscopy
management of endometriosis?
- NSAIDS/paracetamol
2. COCP/progestogens e.g. medroxyprogesterone
dysmenorrhoea, menorrhagia and an enlarged, boggy uterus
adenomyosis
management of adenomyosis?
GnRH analogues + hysterectomy
more common in Afro-Carribean
can be asymptomatic
otherwise, menorrhagia, lower abdo pain usually linked to menstruation, bloating, urinary symptoms, subfertility
uterine fibroids/leimyoma
Investigation for uterine fibroids
TVUS
Management for uterine fibroids
asymptomatic = no Tx
GnRH analogues, myomectomy
control any menorrhagia with LNG-IUS, NSAIDs and COCP
pressure, heaviness and bearing down sensation
and urinary symptoms
Uterine prolapse
management of uterine prolapse
start off with conservative = weight loss pelvic floor muscle exercises
ring pessary
hysterectomy or sacrohysteropexy
often postpartum abdo pain radiated to adanexae fever abnormal PV bleeds dyspareunia/uria malaise and tachycardic
endometritis
investiagtion for endometritis
FBC, Blood cultures, high vaginal swabs and biopsy (diagnostic)
management for endometritis
clindamycin and gentamicin
post-menopausal bleeding
pre-menopausal = Intermenstrual bleeding
pain and discharge unusual
endometrial cancer
Ix for endometrial cancer
first line = TVUS
hysteroscopy with endometrial biopsy
management for endometrial cancer
localised disease = total abdo hysterectomy
bilateral salphingo-oophrectomy with post opertaive radiotherapy
frail/elderly - give progestrogen therapy, not suitable for surgeryv
protective factors in endometrial cancer
COCP and smoking
lower abdo pain fever cervical excitation dysuria/discharge menstrual changes deep dyspareunia
pelvic inflammatory disease (PID)
Ix PID
pregnancy test
high vaginal swab
STI screen
urine dip
management of PID
ofloxacin and metronidazole
OR
oral doxy, oral metronidazole and IM ceftriaxone
usually detected on smear
PMB, IMB, PCB
vaginal discharge
cervical cancer
mainly squamous cell but can also have adenocarcinoma
which HPV are linked to cervical cancer
16, 18 & 33
Cervical screening
25-49yrs = every 3 years 50-64 = every 5 years 64+ = self refer
if pregnant = delay screening 3 months post partum
management of cervical cancer
hysterectomy, radiation and concurrent chemo
excessive pain during menstrual period
suprapibic pain - can radiate down thigh of to the back
usually close to time prior to period or during
dysmenrrhoea
management for dysmenorrhoea
first line = NSAIDs - mefanamic acid/ibuprofen
second line = COCP
bloating breast pain anxiety stress fatigue mood swings
usually in luteal phase of cycle
pre-menstrual syndrome
management of premenstrual syndrome
if mild = lifestyle advice
moderate = COCP
severe = SSRI - fluoxetine
sub/infertility menstrual disturbances hirsutism acne obesity acanthosis nigracans
Polycystic ovarian disease (PCOS)
Ix of PCOS
pelvic US
management for PCOS
general = weight reduction and COCP hirsutism/acne = topical eflornithine infertility = clomiphene (+metformin)
failure to establish menstruation
primary amenorrhoea
15yrs
13yrs without any secondary sexual characteristic
cessation of mestruation
secondary amenorrhoea
3-6months for normal
6-12 months for oligomenorrhoea
management of primary amenorrhoea
investigate and treat cause
management of secondary amenorrhoea
exclude pregnancy, lactation, menopause (40yrs+)
gynae referral - tx underlying cause
hypertension in pregnancy
systolic >140mmHg
diastolic >90mmHg
management of HTN in pregnancy
labetalol
nifedipine (if asthmatic)
methyldopa
pregnancy induced hypertension after 20 weeks
with associated proteinuria
some oedema
(brisk tendon reflexes)
pre-eclampsia
management of pre-eclampsia
aspirin 75mg- 150mg from 12 weeks till birth
definitive management is delivery of the baby if at 34weeks
gestational diabetes mellitus (GDM) diagnosis
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
screening for gestational diabetes
previous GD = OGTT asap and at 24-28weeks
management of GDM
start off with diet and exercise
1-2 week if target not met = start netformin
persists = start insulin (fasting gluc >=7)
pre-existing DM in pregnancy
weight loss in BMI >27kg/m
oral hypoglycaemic drugs, metformin, commence insulin
folic acid pre-conception - 12 weeks
aspirin 75mg from 12 weeks to birth (lower pre-eclampsia risk
hx amenorrhoea for 6-8weeks lower abdo pain vaginal bleeding shoulder tip pain dizziness, fainting/syncope breast tenderness cervical excitation
ectopic pregnancy
Ix of ectopic pregnancy
serum bHCG >1,500 = indicative of ectopic
pregnancy test = positive
TVUS
management of pregnancy
watchful waiting 48hrs - bHCG levels
medical = methotrexate
surgical = salpingotomy/ectomy if >35mm
condition seen after 20 weeks gestation
pregnancy-induced hypertension
proteinuria
development of seizures
eclampsia
management of ecalmpsia
IV Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop.
give when decision to deliver has been made
continue for 24hrs after seizure or delivery
calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression
shock disproportionate to blood loss constant pain/contractions tender, tense uterus fetal heart = absent/distressed coagulation problems
abruptio placenta
Management of abruptio placenta
ABC approach = high-flow oxygen and fluids (2L of Hartmann’s)
assess fetus and decide on whether to deliver
fetus alive = C-section
fetus not alive = vaginal delivery
shock appropriate to visible loss
no pain, non-tender uterus
fetal heart normal
small bleeds prior to large bleed
Placenta previa
management of normal placenta previa
detected at 20week scan
re-scan at 34 weeks and if still present - scan every 2 weeks
fine US at 36-37 weeks
elective c-section at 37-38 weeks
management of placenta previa with bleeding
admit & ABC approach
stabilise pt & emergency c-section
blood loss of >500mls after delivery
post-partum haemorrhage
Primary PPH?
within 24hrs after delivery usually due to uterine atony
secondary PPH?
12-24hrs due to retained placental tissue/endometriosis
management of PPH
ABC, 2 peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) or IV ergometrine 500cmg
IM carboprost
failure of medical options = surgical = intrauterine balloon tamponade
in severe cases = hysterectomy
pre-term prelabour rupture of amniotic fluid
Premature rupture of membranes (PPROM)
Ix for PPROM
sterile speculum exam - check for pooling of amniotic fluid
US = oligohydramnios
management of PPROM
admit + regular observation
oral erythromycin 10 days
oral antenatal corticosteroids = lowers respiratory distress syndrome
consider delivering at 34 weeks.
RUQ pain
nausea and vomiting
lethargy
in pregnancy
HELLP syndrome
HELLP syndrome management
delivery of baby
oedematous fetus, jaundice, anaemia, hepatosplenomegaly, heart failure and kernicterus (brain damage)
Rh incompatibility
Ix in Rh incompatibility
FBC, group and save
Coombs test
kleihauer test
management of Rh incompatibility
transfusions and UV phototherapy
bleeding in first/early second trimester
large uterus
exaggerated pregnancy symptoms
very high hCG
gestational trophoblastic disease
management of gestational trophoblastic disease
urgent specialist care referral = evacuation of uterus
effective contraception recommended to avoid pregnancy for 12months
management for multiple gestation
rest US for diagnosis + monthly checks additional iron + folate supplementation more antenatal care >=30 weeks precautions at labour induce at 38-40weeks
abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea
IBS in elderly - peak incidence 60yrs
ovarian cancer
Ix for ovarian cancer
Ca125 and US
diagnosis usually needs laprotomy
management of ovarian cancer
a combination of surgery and platinum-based chemotherapy
Usually the sudden onset of deep-seated colicky abdominal pain.
Associated with vomiting and distress
fever may be seen in a minority
Vaginal examination may reveal adnexial tenderness
majority present with an ovarian mass
usually in reproductive age group
ovarian torsion
Ix for ovarian torsion
US = whirpool/free fluid
management of ovarian torsion
laparoscopic surgery with detorsion
strawberry cervix purulent vaginal or cervical discharge dysuria and urinary frequency intermenstrual/postcoital bleeding lower abdo pain
cervicitis
secondary to STI
management of cervicitis
1g oral azithromycin
OR
100mg doxycycline 7days
small cysts identified on cervix
nabothian cysts (self-limiting)
It presents as a painless dilatation of the cervix through which the membranes bulge and eventually spontaneously erupt.
usually those with a history of three or more spontaneous preterm births or second-trimester losses.
cervical incompetence
generally asymptomatic
PCB
excessive discharge
ectropion
management of cervical incompetence
Treatment involves prophylactic placement of a cervical stitch (cerclage) with the aim to prevent loss of the pregnancy
cervical dysplasia
are abnormal, or precancerous, cells in and around a woman’s cervix
usually removed to prevent progression into cervical cancer
what is needed for Termination of pregnancy
two registered medical practitioners must sign a legal document (in an emergency only one is needed)
only a registered medical practitioner can perform an abortion, which must be in a NHS hospital or licensed premise
TOP at less than 9 weeks
mifepristone
TOP at less than 13 weeks
surgical dilation and suction of uterine contents
TOP more than 15 weeks
surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
termination of pregnancy has to be before ….
24 weeks
