General Gynaecology including Chronic Pelvic Pain GT41 Flashcards
What is the prevalence of fibroids in women of reproductive age?
20-40%
When should pharmaceutical treatment for fibroids be considered?
When fibroids are under 3cm and not distorting the cavity and symptomatic
What is the prevalence of chronic pelvic pain in women of reproductive age?
15-25% (1 in 6)
Similar to asthma and migraine!
What is the rate of negative laparoscopy for chronic pelvic pain?
35%
What is the rate of finding endometriosis and adhesions at laparoscopy when conducted for chronic pelvic pain?
33% and 24% respectively
What is the incidence of adnexal pathology detected for the first time in pregnancy?
0.5%
In how many cases do simple cysts of <= 5cm regress spontaneously in pregnancy?
90-100%
No need to rescan unless other indication
What is the size cut off for conservative management of dermoid cysts in pregnancy?
6cm
When would aspiration of ovarian cyst in pregnancy be considered?
Simple unilocular with no solid elements
>10cm
Causing pain
Increasing risk of fetal malpresentation or obstructed labour due to its position
What is the Caesarean section rate following UAE?
2/3
What is the preterm delivery rate following UAE?
20%
What is the risk of recurrent molar pregnancy (1 or 2 previous)?
1 in 55 for 1 previous
1 in 10 for 2 previous
What follow up is required in suspected benign premenopausal cysts <50mm?
No follow up
What follow up is required in suspected benign premenopausal cysts 50 - 70 mm?
Yearly ultrasound follow up
What follow up is required in suspected benign premenopausal cysts >70 mm?
Consider MRI or surgical intervention (difficulty in visualising whole cyst at USS)
What is the incidence of psychosexual disorders in women attending gynae clinic?
20-30%
What are the chances of needing reintervention following endometrial ablation aged 40?
20%
What are the chances of needing reintervention following UAE for uterine fibroids?
8-9%
Why should pre-operative treatment with GnRH analogues be considered for fibroids?
- See demonstrative reduction in fibroid size
- Slight improvement in haematological indices
- Possible reduction in intraoperative blood loss and op time
- May be able to use laparoscopic approach instead
In which patients should Selective Progesterone Receptor Modulators be used with caution?
- Severe asthma requiring PO steroids
- Hepatic dysfunction
- Hereditary problems of galactose intolerance
- Lapp lactase deficiency
- Glucose-galactose malabsorption
What is the definition of chronic pelvic pain?
Intermittent or constant pain in the lower abdomen or pelvis of a woman lasting at least 6 months duration
What % of women referred to gynae cinic for pain had symptoms suggestive of IBS?
50%
What is the incidence of nerve entrapment persisting for >5/52 after 1 Pfannenstiel incision?
3.7%
When should a Ca125 be performed in women presenting with chronic pelvic pain?
If has symptoms of bloating, early satiety, urinary urgency or frequency; especially new IBS symptoms in >50yo
What is the pre-treatment before a diagnostic laparoscopy for chronic pelvic pain?
Therapeutic hormonal treatment for 3-6 months
What is LUNA?
Laparoscopic uterosacral nerve ablation
Not useful in treatment of chronic pelvic pain
What are the Rome III criteria for IBS?
- Continuous/recurrent abdo pain/discomfort on >=3/7 a month in the last 3/12, with the onset >=6/12 ago + 2:
- Improvement with defecation
- Onset associated with a change in the frequency of stool
- Onset associated with a chage in the form of stool
What are the ‘red flag’ symptoms when taking a history for chronic pelvic pain.?
- Bleeding PR
- New bowel symptoms >50yo
- New pain after monepause
- Pelvic mass
- Suicide ideation
- Excessive weight loss
- Irregular bleeding >40yo
- PCB
