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