general gynae

Question 1

Molar pregnancy non communication station

Answer 1

A molar pregnancy is cause by the fertilization of 2 sperm into a empty ovum (Diploid)
(partum is 2 sperm into a normal egg - triploid)

This is a combination that never could have developed into a normal pregnancy

Risks a Gestational trophoblastic neoplasia
complete 5%
partial 0.5%
this would need further treatment

Ix
CXR
FBC U+E CR LFT

Treatment
EVAC and histology

O
Referral to molar follow up clinic 
Avoid pregnancy during follow up 
weekly hcg until 3 consecutive negative then monthly  
partial 3X neg then stop
complete - hcg for 6/12 from negative 
Recurrence 1/70 
tumor hcg after any further pregnancy  event

Contraception
barrier until hcg normalized then can consider hormonal treatment
(mixed evidence can discuss)
Avoid IUCD until hcg negative - increased risk perforation

If plateau over 3 weeks or rise over 2 weeks then will refer to MDT, FBC U+E CR LFT G+H Bhcg and TFT
Metastatic screen CT head thorax abdomen pelvis
WHO risk score
Single agent or multiagent chemotherapy

Question 2

Recurrent miscarriage
Investigations
management

Answer 2

Send cytogenetics of future POC

Anti phospholipid screen
lupus anticoagulant,
anticardiolipin antibodies
anti-B2 glycoprotein-I antibodies
2 readings 12 weeks apart

Karyotype for parental chromosomal rearrangements

Pelvic USS to assess for Uterine abnormalities

Systemic disorders TFT HbA1c

If recurrent second trimester loss then thrombophilia screen - factor V leiden, prothombin gene mutation and protein S deficiency

Management
Specialist clinic
mixed evidence about progesterone use for woman with recurrent pregnancy loss

Unexplained - excellent prognosis
Affected by age

Question 3

Translocation

Answer 3

Unbalanced translocation 0.8% chance of surviving to T2 (multiple abnormalities)
Increased spontaneous miscarriage
Chance of a successful pregnancy 83%