Gynaecology Flashcards
What is the first-line treatment for urge incontinence?
Bladder retraining
COCP increases the risk of which cancers?
Breast and cervical
What is the first medical option for stress incontinence?
Duloxetine
COCP is protective against which cancers?
Ovarian and endometrial
How long does it take for an IUS to be effective contraception?
7 days
How should women who test positive for high-risk HPV at 12 and 24 months be managed?
Refer for colposcopy
Which features of an ectopic pregnancy may prompt surgical management?
> 35mm in size, heartbeat visible, hCG >5,000IU/L
How long after unprotected sex will levonestrogel be effective?
72 hours
How long after unprotected sex will UPA be effective as emergency contraception?
120 hours
What is the screening programme for cervical cancer?
Every 5 years for women aged 25-64
How long does it take for DepoProvera to become effective?
7 days
whirl pool sign on USS suggests…
Ovarian torsion
Where is the most common site for an ectopic pregnancy?
Ampulla of the fallopian tube
How are ‘inadequate’ cervical smear resuls managed?
repeat in 3 months. If still inadequate, refer for colposcopy.
hr-HPV positive with abnormal cytology should be managed with…
Colposcopy
Which features confirm a miscarriage?
No foetal heartbeat and
CRL > 7mm OR
GS > 25mm
Where is the most common site of ectopic pregnancy?
Ampulla of fallopian tube
Give risk factors for ectopic pregnancy.
Previous ectopic PID Intra-uterine device Previous pelvic surgery Endometriosis
What is the investigation of choice for ectopic pregnancy?
TV USS
In which women with ectopic pregnancy may expectant management be appropriate?
Clinically stable, no foetal heartbeat, GS < 35mm and HCG < 1000
What is the medical management for ectopic pregnancy?
Methotrexate
In which women may medical management of ectopic pregnancy be suitable?
Can be done if clinically stable, live close to hospital and no visible heartbeat, GS < 35mm and HCG 1000 - 5000
Which women should be offered surgical management of ectopic pregnancy?
Significant pain or rupture
Foetal heartbeat
GS > 35mm
HCG > 5000
What is the usual surgical management of ectopic pregnancy?
Laparoscopic salpingectomy
Which medication may be prescribed to help with vasomotor symptoms of menopause?
SSRI
What is the most common cause of first trimester miscarriage?
Chromosomal abnormality
What is the most common cause of second trimester miscarriages?
Incompetent cervix
Vaginal bleeding but cervical os closed and USS shows viable IUP suggests…
Threatened miscarriage
Early pregnancy vaginal bleeding with open cervical os suggests…
Inevitable miscarriage
Vaginal bleeding, open cervical os and products of conception seen on exam suggests…
Incomplete miscarriage
Non-viable intrauterine pregnancy without symptoms or passage of POC suggests…
Missed miscarriage
Which features indicate a completed miscarriage?
POC have passed, cervical os is closed and USS shows empty uterine cavity
Which examinations should be completed in suspected miscarriage?
Vital signs & abdo exam - ectopic
Speculum - os closed or open
What are the options for management of miscarriage?
Expectant, medical with misoprostol or surgical
Under what circumstances should surgical manangement of miscarriage always be offered?
Haemodynamically unstable, significant bleeding with retained POC or in patients which conservative/medical management has failed
What follow-up should patients opting for expectant or medical management of miscarriage receive?
Pregnancy test 3 weeks later
What should be considered in patients having surgical management of miscarriage?
Anti-D if rhesus negative
After one miscarriage, is the risk of further miscarriages increased?
No, only increased after 2 or more
What is meant by recurrent miscarriage?
3 or more miscarriages
Give causes of recurrent miscarriage.
Genetic factors eg. balanced translocations
Thrombophilic disorders such as APS
Endocrine - DM, thyroid disorders, PCOS
Structural uterine abnormalities
Which legislation permits abortion?
Abortion Act 1967
Which form needs to be filled in before a TOP is performed?
Certificate A form - needs to be signed by 2 doctors (unless mother’s life is at immediate risk)
What is the gestational limit for TOP?
23 + 6 weeks unless threat to maternal life or severe disability (no limit)
What is the medication regimine for medical abortion?
Mifepristone then Misoprostol 24 - 48 hours later
What is the MOA of Mifepristone?
Anti-progesterone which also increases number of prostaglandin receptors.
Which women would be eligible for EMAH?
Under 10 weeks and pt over 16
Which medication is given before surgical abortion?
Misoprostol
What follow-up is required after medical abortion?
pregnancy test 2 weeks later
Which surgical technique is used in early surgical abortion?
Vacuum aspiration
Which surgical technique is used in late surgical abortion?
Dilatation & evacuation
All women undergoing surgical abortion should receive…
Antibiotic prophylaxis & anti-D
Positive PT after TOP can be considered normal for how long after TOP?
4 weeks
