Gynaecology 1 Flashcards
Amenorrhoea definition
Primary
Primary: failure to establish menses by 15yo with secondary sexual characteristics or 13yo if no secondary sexual characteristics
Amenorrhoea definition
Secondary
Cessation of menses for 3-6 months in women with previously normal and regular menses
Or 6-12 months in women with previous oligomenorrhoea
Postpartum hypopituitarism caused by necrosis of the pituitary gland.
Sheehan’s
An acquired condition where scar tissue (adhesions) form inside your uterus
Asherman’s syndrome
Investigations for amenorrhoea
FBC, U+E, Coeliacs, TFTs, prolactin, androgen levels, oestradiol, gonadotrophins
Amenorrhoea screen
Raised gonadotrophins versus low
Raised = ovarian cause
Low = hypothalamic cause
Bleeding in the first trimester
Who should be referred to an early pregnancy assessment service?
> =6 weeks
How is bleeding for <6K managed?
If no pain or RF for ectopic then to return if bleeding develops
Repeat pregnancy test in 7-10days and return if positive
If negative then = miscarriage
Most common type of cervical ca?
SCC 80%
Adeno 20%
HPV serotypes that can increase risk of cervical ca (3)
16,18, 33
Cervical ca RF (8)
HPV
Smoking
HIV
Early first intercourse
Many sexual partners
High parity
Lower socioeconomic status
COCP
Cervical screening ages:
25-49 - every 3 years (Scotland every 5 years)
50-64 - every 5 years
Cervical screening in pregnancy
Delay for 3 months post partum unless missed screening or previous abnormal smears
Screening explained/ results explained
HPV negative =
HPV negative - return to normal recall
Screening explained/ results explained
HPV +ve =
Cytology if normal then repeat test at 12 months
Cytology if abnormal then for colposcopy
If inadequate then repeat sample within 3 months, if x2 inadequate then colposcopy
Mx of patients who have been treated for CIN 1/2/3
Test of cure repeat cervical sample at 6 months
Mx cervical ectropion
Ablative treatment such as cold coagulation
Primary dysmenorrhoea =
Mx (3)
No underlying pelvic pathology
Pain during and a few hours prior to the period starting
Mx mefanamic acid and ibuprofen
2nd line COCP
Secondary dysmenorrhoea (how does it differ from primary)
CKS Mx
Usually starts a few days prior to the period
Refer all patients with secondary dysmenorrhoea to gynae
Ectopic pregnancy bHCG
> 1500
Endometrial cancer is classically seen in which group of women?
Post menopausal
RF endometrial cancer (9)
Nulliparity
Early menarche
Late menopause
Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca
Cervical versus endometrial ca RF
Early first intercourse
High parity
Endo - nulliparity, late menopause
Smoking and COCP RF for cervical but protective for endo ca
Symptoms of endometrial ca (2)
PMB, IMB in premenopausal women
Ix for suspected endometrial ca
Who gets put on a 2ww?
TVUS ET less than ?mm = high negative predictive value
Ix (2)
> =55yo with PMB = 2ww
TVUS ET <4mm = high negative predictive value
Hysteroscopy with endometrial biopsy
Mx endo ca
TAH + BSO +/- post op RT
OR
Progestogen therapy if frail and old
Protective factors for endometrial ca
COCP and smoking
Endometrial hyperplasia feature (1)
Mx
Simple (2)
Atypia (1)
IMB/ abnormal vaginal bleeding
Mx if simple - high dose prog and repeat sampling in 3-4 months or mirena
Atypia - hysterectomy
Endometriosis mx
1st line
2nd line
1st line NSAIDs/ paracetamol
2nd line COCP or progestogens (medroxyprogesterone acetate)
FGM types (4)
1 partial or total removal of clitoris/ prepuce
2 partial or total removal of clitoris and labia minora
3 narrowing of vaginal orifice
4 all other harmful procedures
Fibroid degeneration symptoms (4)
Mx
Low grade fever, pain, vomiting, pregnancy
Mx resolve within 4-7 days rest and analgesia
HMB Mx
If does not (2) and does require contraception (3)
If doesn’t require contraception
Mefanamic acid
TXA
(Start of first day of period)
If does
1. Mirena
2. COCP
3. Long acting progestogens
What can be used in the short term to rapidly stop HMB?
Norethisterone 5mg TDS
What is a blighted ovum?
Gestational sac >25mm but no embryonic or fetal part is seen
TOP
Gestation
Who is needed to sign?
K24
x2 medical practitioners (or one in an emergency)
TOP Mx
<K9 mifepristone followed 48 hours later by PG
<K13 D&C
>K15 D&evacuation
Semen analysis
Abstinence for how long?
Sample to be delivered in what time period?
3-5 days
1 hour
Normal semen results
volume
pH
Sperm concentration
Morphology
Motility
Vitality
Normal semen results*
volume > 1.5 ml
pH > 7.2
sperm concentration > 15 million / ml
morphology > 4% normal forms
motility > 32% progressive motility
vitality > 58% live spermatozoa
Definition of recurrent miscarriages
3 or more consecutive miscarriages
Causes of recurrent miscarriages (7)
Antiphospholipid syndrome
PCOS
DM
Thyroid issues
Uterine septum
Smoking
Parental chromosomal abnormalities
Mx pruritus vulvae
Showers not baths
Emmolients OD
Underlying conditions = topical steroids
Seborrhoeic dermatitis - anitfungal combined with steroid
Pruritus vulvae usually has …
An underlying cause
HRT complications
HINT BEoVIS
Increased risk of
Breast ca
EndOmetrial ca
Ovarian ca
VTE
Ischaemic heart disease if taken more than 10 years after menopause
Stroke
Hyperemesis triad definition:
Triad:
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
Hyperemesis Mx
1st line (3)
2nd line (2)
1st line PO cyclizine/ PO promethazine/ PO prochlorperazine
2nd line ondansetron/ metoclopramide
Which anti-emetic can increase the risk of cleft lip/palate?
Ondansetron
Investigations for infertility (2)
D21 serum prog + semen analysis
D21 prog interpretation
<16 = repeat, if consistently low then refer to fertility clinic
16-30 repeat
>30 indicates ovulation
Counselling for infertility:
Medication
BMI
Sex how often?
- Folic acid
- BMI 20-25
- Regular sexual intercourse every 2-3 days
Define premature ovarian insufficiency
Onset of menopausal symptoms before the age of 40
Hormone levels in premature ovarian insufficiency
FSH LH oestradiol
Numbers for FSH and LH
Raised FSH LH
FSH >40
Must be demonstrated on 2 blood samples taken 4-6 weeks apart
Low oestradiol <100
Mx premature ovarian insufficiency
COCP until average age of menopause (51yo)
Then HRT
Meig’s syndrome
Benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
