General gynaecology Flashcards
DDx for intermenstural bleeding
- cervical malignancy
- cervical ectropion
- endocervical polyp
- atrophic vaginitis
- pregnancy
- irregular bleeding related to contraceptive pill
Drugs associated with hyperprolactinaemia (due to dopamine agonist effects)?
- metoclopramide
- phenothiazines (e.g. chlorpromazine, prochlorperazine, thioridazine)
- reserpine
- methyldopa
- omeprazole, ranitidine, bendrofluazide (rare)
Effects of premature menopause
Hypo-oestrogenic effects:
- vaginal dryness
- vasomotor symptoms (hot flushes, night sweats)
- increased cardiovascular risk
Psychological and social effects:
- infertility
- feeling of inadequacy as a woman
- feelings of premature ageing and need to take HRT
- impact on relationships
Treatment of anovulation?
Clomifene citrate
How is anovulation shown on investigations?
Progesterone level below 30nmol/L
What is a non-specific marker for ovarian carcinoma??
CA-125
Typical presentations of fibroids
- menorrhagia
- abdominal mass
- pressure effect from pressure on the bladder, stomach or bowel
- infertility
What advice should you give after LLETZ procedure
- patient may have light bleeding for several days
- if heavy bleeding occurs, should return as secondary infection may occur and need treatment
- avoid sexual intercourse and tampon use for 4 weeks, to allow healing of the cervix
- fertility is generally unaffected by the procedure, though cervical stenosis leading to infertility has been reported. Mid-trimester loss from cervical weakness is rare
After LLETZ, when should the follow up smears be?
6 months, and then yearly smears for 10 years
What is dysfunctional uterine bleeding?
Excessive heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease
What should always be measured in a woman with amenorrhoea?
Prolactin
May have a pituitary adenoma (prolactinoma).
NB levels up to 1000mu/L can be found as a result of stress, breast examination or PCOS. Above 1000mu/L is usually a pituitary adenoma
DDx of secondary amenorrhoea
Hypothalamic - chronic illness - anorexia - excessive exercise - stress Pituitary - hyperprolactinaemia (drugs, tumour) - hypothyroidism - breast feeding Ovarian - PCOS - premature ovarian failure - iatrogenic (chemo/radiotherapy, oophorectomy) - long-acting progesterone contraception Uterine - pregnancy - Asherman's syndrome - cervical stenosis
Causes of post-menopausal bleeding
PMB is considered to be caused by endometrial cancer until proven otherwise.
Others:
- endometrial/endocervical polyp
- endometrial hyperplasia
- atrophic vaginitis
- iatrogenic (anticoagulants, intrauterine device, HRT)
- infective (vaginal candidiasis)
Causes of dysmenorrhoea
- idiopathic
- premenstural syndrome
- pelvic inflammatory disease
- endometriosis
- adenomyosis
- subcostal pedunculated fibroids
- iatrogenic (e.g. intrauterine contraceptive device, or cervical stenosis after LLETZ
DDx of postcoital bleeding in a young woman
- cervical ectropion
- chlamydia or other STIs
- cervical maligancy
- complication of the COCP
- endocervical polyp
What consists of an STI screen?
- endocervical swab for chlamydia - 30 secs
- endocervical swab for gonorrhoea
- high vaginal swab for trichomonas (and candida)
Diagnosis of antiphospholipid syndrome
Presence of one of the clinical features:
- three or more consecutive miscarriages
- mid-trimester fetal loss
- severe early-onset pre-eclampsia, IUGR or abruption
- arterial or venous thrombosis
AND haematological features:
- anticardiolipin antibody or lupus anticoagulant detected on two occasions at least 6 weeks apart
What is antiphospholipid syndrome often secondary to?
Systemic lupus erythematosus (SLE)
What is the management of antiphospholipid syndrome?
Oral low dose aspirin and low-molecular-weight subcutaneous heparin from the time of a +ve pregnancy test, to improve the likelihood of a successful live birth
Causes of recurrent miscarriage
- parental chromosome abnormality
- antiphospholipid syndrome
- other thrombophilia (e.g. activated protein C resistance)
- uterine abnormality (intracavity fibroids, uterine septum)
- uncontrolled diabetes or hypothyroidism
- bacterial vaginosis (usually associated with second-trimester loss)
- cervical weakness (‘incompetence’, second-trimester loss only
How is prolapse categorised?
According to the level of descent of the cervix in relation to the introitus
What are the degrees of prolapse?
First degree: descent within the vagina
Second degree: descent to the introitus
Third degree: descent of the cervix outside the vagina
Procidentia: complete eversion of the vagina outside the introitus
Management of hypovolaemic shock with hypokalaemia?
- supportive management
- monitor electrolytes
- fluid restriction
- potassium supplementation
- ECG monitoring until K+ is normal
- HDU and oxygen
- monitor ABG
What should PMB be considered to be?
Endometrial carcinoma until proven otherwise
