Gynaecological Abnormalities And Pregnancy Loss Flashcards
What is endometriosis
Where endometrium cells migrate spontaneously or due to reasons implant and cause prolifertion of endometrium fibroids in that area
Where does endometriosis usually occur?
Ovaries and ligaments
Can peritoneal cells transform into endometrial cells?
Yes
First line of treatment for endometriosis?
Paracetamol/nsaids
Secondary line of tx for endometriosis
COCP/POP
when is COCP for endometriosis tx contraindicated
Migraine with aura
What is GnRH analogue
Induce a menopausal state third line tx for endometriosis
Last tx for endometriosis
Laparoscopic excision or ablation
What is a common site of ectopic pregnancy
Ampulla
What tests are used to verify ectopic pregnancy
Pregnancy test positive and TVUS
What 3 types of management is used for ectopics
- Expectant - close monitoring over 48hrs if b-hCG rises or Sx manifest interventions performed
- Medical - methotrexate + follow up
- Surgical - salpingectomy for no risk for infertility, salpingotomy for risk of infertility
When is an open salpingectomy used
Emergency cases with ruptured fallopian tube
<35mm unruptured and asymptomatic with hCG <1000?
Expectant management of ectopic pregnancy
<35mm unruptured no significant pain hCG <1,500 ?
Medical management of miscarriage
> 35mm, ruptured?, pain, visible HB, HCG >5,000 ?
Surgical.
5 categories of miscarriages?
- Threatened
- Inevitable
- Incomplete
- Complete
- Missed
Bleeding less than menstruation, close cervical os, slight/no pain before 24 weeks (6-9)
Threatened
Missed (delayed) miscarriage
Light vaginal bleeding, pregnancy symptoms disappear, no pain, closed cervical os,
What’s an inevitable miscarriage
Heavy bleeding clots pain and open os
What’s an incomplete miscarriage e
Not all products expelled, pain, bleeding open os
Loss of internal labial margin, redness and soreness, scaling?
Lichen sclerosis
What’s adenomyosis
Endometrial tissue within myometrium
Describe the physiology of micturition
2 phases: 1. Storage 2. Voiding - uses pontine continence centre - spinal continence - hypogastric nerve - detrusor muscle relaxation and internal sphincter constriction for storage.
Uses pontine micturition centre - spine - pelvic nerves - contraction of detrusor muscle and relaxation of internal sphincter voluntary external sphincter depending on what you want
What acts on the bladder to cause relaxation
Acetylcholine
What can cause increase risk of voiding
Anticholinesterases
Diabetes
Caffeine
Alcohol
What is receptive relaxation
Intra vesicle pressure is lower than the urethral pressure
How long does the voiding phase last?
20-25ml/s fo men, 25-30ml/s for women
how much urine do you need to void?
400ml
What is urodynamics testing?
Pressure difference measurement between rectum and bladder.
How is urodynamics testing conducted
Thin catheter in front and back passage
When is urodynamic testing used?
Women with overflow incontinence or those where first line urge incontinence treatments aren’t working
What’s measured on a urodynamic test?
Post voiding pressure
Leak point pressure (pressure needed to leak)
Flow rate
Custom entry (bladder contraction pressure)
What is stress incontinence
Urine leakage due to weak pelvic floor muscles
What 4 things can cause stress incontinence?
- Pregnancy
- Coughing
- Laughing
- Sneezing
What is urge incontinence
Overactivity of the bladder muscle
What causes urge incontinence
- Alcohol
- Caffeine
- Medications
4, UTI
What causes overflow incontinence
- Bladder stones
- Chronic urinary retention
- Anticholinergic medication
- Urodynamics neeed
What is overflow incontinence?
Urine leakage due to bladder being overfilled
When is pelvic floor exercises indicated?
Stress incontinence
When is bladder retraining indicated?
Urge incontinence
What is classed as heavy menstrual bleeding?
Blood loss of over 80ml
What is normal blood loss for periods?
40ml
3 criteria for menorrhagia
Changing pads every 1-2 hours
Bleeding more than 7 days
Large clots
What causes menorrhagia (4 subcategories)
- Disorders (diabetic, hypothyroid, bleeding and connective tissue disorder)
- Medication (anticoagulation, contraception)
- Abnormalities (PCOS, fibroids, PID)
- Dysfunctional bleeding or extreme of reproductive age
What subcategories are there for causes of heavy menstrual bleeding /
- Conditions
- Medications
- Problems/abnromlaities
- General issue/natural
What is chronic pain defined as?
Pain that is usually continuous and dull that is suggested to affect mental health more that lasts longer than 6 moths
What is acute pain defined as?
Sharp severe immediate pain that usually has sudden-short onset and is usually recent or new and less than 2 weeks/6months
what is important in distinguishing pelvic pain? Describe steps taken (7)
- History/collateral history
- Sats
- Abdo and I manual pelvic exam
- STI screen (HVS, chlamydia/gonorhhoea)
- TVUS/MRI (endo/adenomyosis/fibroids)
- Diagnostic laparoscopy
- CA125 (cancer and endometriosis/fibroids)
3 non GUM causes of pelvic pain
Appendicitis
IBS
IBD
3 Basic screening modalities used in pelvic pain
TVUS, mri, ct sometimes and laparoscopy
What is the clinical criteria needed to make an endometriosis diagnosis? (5+1)
Infertility and 1 more of these:
- chronic pain for more than 6 months
- period pain that affects ADLl
- period related GI problems (diarrhoea/vomiting/constipation)
- period related excessive bleeding/toilet pain etc
- deep pain during sex
What investigative steps are taken for suspected endometriosis
- History
- Abdo and pelvic exam
- TVUS
- Laparoscopy
What’s a tell tale sign of adenomyosis?
Enlarged, boggy uterus
how would you investigate adenomyosis?
TVUS, MRI alternative
How would you treat/manage adenomyosis?
- Symptomatic treatment such as TXA
- GnRH agonists
- Uterine artery emobolism
- Hysterectomy
