Gynae Flashcards
Risk factors for ovarian cancer
all related to an increase in ovulation: old clomifene early menarche late menopause no/low pregnancy
red degeneration of fibroid summary
most common in second and third trimester due to fibroid rapidly outgrowing blood supply and uterus changing shape. fibroids grown under oestrogen
red degeneration of fibroid presentation
pregnant, severe abdo pain, fever, tachycardia, vomiting. History of menorrhagia/diffuclty conceiving (fibroids)
during which trimester is placental abruption most common
third
when is the first trimester
1-12 weeks
when is the second trimester
13-27 weeks
when is the thrid trimester
28-end
management of PID
start antibiotics immediately (doxycycline, metronidazole and IM ceftriaxone)
In mild PID IUD can be left it.
risks of PID
Fitz-Hugh Curtis syndrome (perihepatitis) infertility chronic pelvic pain (not dysparunia) ectopic pregnancy hydrosalpinx (fluid in fallopian tubes) tubo-ovarian abscesses
When should nitrofuratonin be avoided in pregnancy
3rd trimester as risk of haemolytic anaemia in neonate with G6PD deficiency
When should trimethoprim be avoided in prenancy
1st trimester as it is a folate antagonist
when should sulfonamides be avoided in pregnancy
3rd trimester associated with kernicterus
how long should pelvic floor exercises for stress incontenence be used
3 months
what drug for stress incontinence
duloxetine (SNRI)
What can cause raised CA125
loads breast cancer ovarian cancer ovarian torsion endometrial cancer liver disease metastatic lung cancer adenomyosis ascites endometriosis menstruation
what is adenomyosis
presence of endometrial tissue within the myometrium, it is more common in multiparous women towards the end of their reproductive years
features of adenomyosis
dysmenorrhoea menorrhagia enlarged uterus Management: GnRH agonists hysterectomy
GnRH agonist functions
decrease LH, FSH release and hence lower sex hormones
GnRH is usually released in PULSATILE fashion hence why this works
Treatment for fibroids
Reduce oestrogen to reduce mirena coil first line for <3cm OCP for les than 3cm endometrial ablation <3cm GnRH given to shrink before surgery (myomectomy) uterine artery embolisation for large
What would indicate admission for a patient with PID
temp >38 as indicates severe infection
How long should endometriosis pain be present to diagnose
over 6 months (can be continous pain not always cyclical)
Chronic pelvic pain has to be 6 months!
Treatment of endometriosis
NSAIDs/paracetamol first line
OCP (unless contraindicated)
progesterone only contraception
late can try GnRH analouges
Risk factors for ectopic pregnancy
smoking multiple sexual partners use of IUD prior fallopian surgery infertility and using IVF age <18 first sexual intercourse black race age >35 PID
How is haemorrhagic ovarian cyst managed
Admit to hospital, they will have marked tenderness
What would indicate ovarian torsion
low abdo pain, tenderness, vomiting, peritonism, fever
Risk factors for IUGR
maternal age <16 or >35
low BMI
high BMI
interpregnancy interval <6 or >120 months
when should antibiotics be given form PPROM
10 days following or until woman is in labour
Causes of recurrent miscarriage
antiphospholipid syndrome endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome uterine abnormality: e.g. uterine septum parental chromosomal abnormalities smoking
What is the role of HCG
Prevent the breakdown of the corpus luteum
How often do HCG levels double during pregnancy
every 48 hours for the first few weeks
When do HCG levels peak
8-10 weeks
Signs of hydatiform mole
vaginal bleeding
uterus size greater than expected for gestational age
abnormally high hCG
snow storm appearance on ultrasound
What would point towards an ectopic in pregnancy of unknown location
bHCG>1500
Should you examine for an adnexal mass for ectopic
NO you might rupture it.
A pelvic examination for cervical excitation is recommended as this indicates ectopic
How many weeks does an ectopic pregnancy present
6-8 weeks, if >10 weeks likely another cause e.g. inevitable abortion
Placental abruption presentation
mild or no vaginal bleeding PAIN, woody uterus
RF ffor placental abruption
hypertension IUGR, cocaine, multiparity, increasing age
presentation of praevia
red profuse blood, painless, shock consistent with loss
rf for vte in pregnancy
factor v leiden deficiency/thrombophilia
multiple pregnancy
pre-eclampsia
When are heart pulsations visible
six weeks
what is the fetal pole
a thick area alongside the yolk sac
when is the insertion of the placenta visivle
12 weeks
what is the gold standard test for endometriosis
laproscopy
Risk factors for GBS infection
maternal pyrexia
prematurity
previous sibling GBS
prolonged rupture of membranes
signs/symptoms of cervical cancer
postcoital bleeding purulent discharge red brown discharge age 45-49 smoker multiple sexual partners
features of BV
fishy odour
grey-white discharge
what colour is the discharge from trichomonas
green
what colour would chlamydia discharge be if present
yellow
rf for placenta praevia
>40 yrs multiple pregnancy high parity previous praevia previous uterine surgery
presentation of vasa praevia
presents at rupture of membranes
painless bleeding
acute foetal compromise
what is contraindicated in vasa praevia and placenta praevia
digital vaginal examination (risk rupturing)
which hormonn initially produced by the corpus luteum causes stromal hypertrophy and increased blood supply to the endometrium
progesterone
Causes of polyhydraminos
idiopathic (most common) macrosomia maternal diabetes structural deformities of foetus viral infection
what is first-line treatment for symptomatic uterine fibroids
levonorgestral IUD
second line - tranexamic acid, OCP
myomectomy
What are the Rotterdam criteria for PCOS
- 12 or more follicles or increased ovarian volume >10
- oligo-ovulation or anovulation
- clinical signs of hyperandrogenism
How metformin help in PCOS
appetite reduction
decreased androgen production
decreases LH from the anterior pituitary
decreases sex-hormone binding globulin in the liver
Fluid choice for correcting dehydration in DKA
saline with 20mmol potassium chloride
Clinical features of pre-eclampsia
epigastric pain facial oedema hypertension proteinurea papilloedema hyperreflexia (due to raised ICP)
what test detects feto-maternal haemorrhage is suspected sensitising event
Kleinhauer test
what is a normal fetal baseline rate
110-160
what should variability be
5-25
how long should contraception be used for after menopause
2 years after last period if under 50
1 year after period if over 50
when can HRT with unopposed oestrogen be used
when had hysterectomy
what age would you be sent for mammogram
over 35, if under then USS
what is the most common type of breast cancer
invasive ductal carcinoma in situ.
begins in milk ducts - fixed in position, hard and irregular
causes of fetal hydrops
(abnormal accumulation of serous fluid in 2+ fetal compartments) (fetal anaemia)
IMMUNE - blood group incompatibility causing fetal anaemia
NON-IMMUNE:
congenital parvovirus B19
alpha thalassaemia
cardiac abnormalities
trisomy 13, 18, 21 or turners
infection (toxoplasmosis, rubella, CMV, varicella)
twin-twin transfusion
chorioangioma
commonest cause of anaemia in pregnancy
iron deficiency
risk factors for developing pre-eclampsia
High BMI maternal antiphospholipid syndrome multiple pregnancy pre-eclampsia in previous pregnancy >10 years between births
first line treatment for heavy menstrual bleeding
intrauterine system
then COCP
progesterone only/tranexamic acid
endometrial ablation
risk factors for obstetric cholestasis
hep C infection
multiple preganncy
obstetric cholestasis in previous pregnancy
gallstones
when is external cephalic version offered
36 weeks if nulliparous
37 weeks if multiparous
first line management for seizure control in pregnancy
magnesium sulphate
diazepam second line
risk factors for placenta accreta
IVF >35 years previous C section previous uterine surgery (think any surgical cause)
severity of placental adhesion
placenta accreta - attach to myometrium
placenta increta - deep into myometrium
placenta percreta - into peritoneum
what blood results see in premature ovarian failure
high FSH and LH as there is no negative feedback from ovaries
what is first degree tear
skin only
what is second degree tear
fascia and muscles of perineum
what is third degree tear A
fascia muscles and <50% of external anal sphincter
what is third degree tear B
fascia and muscles and >50% of external anal sphincter
what is third degree tear C
fascia and muscles and internal and external sphincter
which nerve roots are affected in Erb’s palsy
C5 and C6
what is the treatment of choice for TOP <9 weeks
mifepristone and misoprostol
what is the treatment of choice for TOP >9 weeks
surigcal dilation and suction
If >15 weeks induce mini labour
why is lactic dehydrogenase raise in HELLP
haemolysis
rf for placenta praevia
increased age
ivf
maternal smoking
previous c section
features of ovarian neoplasms
hirsutism due to testosterone secretion acute abdomen due to torsion rupture or haemorrhage thyrotoxicosis amenorrhoea
what is haematocolpos
accumulation of blood in the vagina e.g. imperforate hymen
what is ovarian hyperthecosis
accounts for most cases of hyperandrogenaemia in postmenopausal women.
Presence of leutenised theca cells in ovarian stroma
testosterone levels are much higher than in PCOS
indications/management of peurperal psychosis
poor interaction with baby (very unusual even in post natal depression)
talking in an incoherent fashion
saying baby has been brought into a bad world
psychotic delusions
URGENT HOSPITAL ADMISSION
how long after sex can take levonogestrel emergency contraceptive
72 hours
how long to take ulipristal acetate after sex
120 hours
how long to take copper coil after sex
5-7 days
complications of c section
increased abdo pain
hysteractomy
bladder/ureteric injury
VTE
decreased complications of c section
perineal pain
urinary incontinence
uterovaginal prolapse
blood results in hyperemesis gravidum
raised haematocrit FBC
raised transaminases and low albumin LFT
low potassium and sodium and metabolic hypochloremic alkalosis in U&Es
ketones in urine
what defect is sodium valproate most associated with in pregnancy
hypospadiasis
also: spina bifida, ASD, cleft palate and polydactyly
marfans mode of inheritance
autosomal dominant
antibiotic for PPROM
oral erythromycin 10 days
group B strep treatment
iv benpen in labour
rf for ectopic preganncy
think anything that could slow passage of ovum (scarring etc)
POP (slows passage of ovum)
endometriosis
investigation for ovarian cancer
CA125
abdominal US
then CT
