Gynaecology Flashcards
What are risk factors for miscarriage?
Increasing age Previous miscarriage Chronic condition eg diabetes Uterine/cervical problems Smoking Alcohol Underweight or overweight Invasive prenatal tests Cervical cone biopsy
What is the most common place for an ectopic?
Ampulla of fallopian tube
What is the most common place for an ectopic to rupture?
Isthmus of the fallopian tube
What are the methods for a termination of pregnancy?
<9 weeks = PO Mifepristone followed by vaginal Misoprostol 48 hours later
<13 weeks = surgical dilation and suction
<15 weeks = surgical dilation + evacuation
What is the medical management of miscarriage? When might it be considered?
Vaginal misoprostol
If mother has coagulation problems
If expectant management has failed
if late in to first trimester
Induction of ovulation in patients with PCOS?
- Lifestyle measures e.g. weight loss
- Clomifene
- Metformin
How to manage menorrhagia?
First check that theres no underlying pathology
FIRST LINE = Mirena IUS
If does not want contraception= Tranexamic acid/NSAIDs
How to manage dysmenorrhoea?
- Mefenamic acid/NSAIDs
2. COCP
What are complications of PID?
Infertility
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome (Perihepatitis ) - RUQ pain
How is endometriosis managed?
First line = NSAIDs and/or paracetamol
Second line = COCP
Third line = Referral to secondary care for consideration of GnRH analogues
Fourth line = surgery
What is the management of endometrial hyperplasia?
No atypia found on biopsy –> High dose progesterone
Atypia found on biopsy –> Hysterectomy
What are risk factors for endometrial cancer?
Obesity Nulliparity Early menarche Late menopause Unopposed oestrogen DM Tamoxifen PCOS HNPCC
What are the two most common ovarian cysts?
Follicular
Corpus luteum
How do ovarian cysts present?
Usually asymptomatic but if large can cause bloating, fullness, pelvic pain
How are ovarian cysts investigated?
- Transvaginal ultrasound - if less than 5cm then no further investigation required.
- If post-menopausal consider CA125
How are ovarian cysts monitored?
<5cm = no further management 5-7cm = yearly monitoring >7cm = consider MRI
What is Meig’s syndrome?
Triad
- Ovarian fibroma
- Pleural effusion
- Ascites
How does ovarian cyst rupture present? What is seen on ultrasound?
Shock
Fever
Severe abdominal pain (Iliac fossa)
Ultrasound = free fluid in the pouch of Douglas
What is ovarian torsion and how does it present?
Ovary twists - usually when there is an ovarian mass
Sudden onset severe iliac fossa pain
Nausea and vomiting
What is seen on ultrasound in ovarian torsion?
Whirlpool sign
What are signs on examination of ectopic pregnancy?
Abdominal tenderness
Cervical motion tenderness
What is seen on ultrasound in a complete hydatidiform mole?
Snowstorm appearance
What does the bHCG have to be to allow for expectant management of an ectopic?
Less than 1000
What bHCG means that you need surgical management for an ectopic?
OVer 5,000
First line management for hyperemesis?
ORal cyclising or oral promethazine
If ketones/weight loss –> admission may be needed
How to treat infertility caused by fibroids?
Go straight to myomectomy
What might be seen on examination in fibroids?
x
What is Mittelschmerz pain?
transient pain in the middle of their cycle secondary to ovulation
What is the management of fibroids?
First line = Mirena unless there is uterine distorsion
Second line = Tranexamic acid/Mefenamic acid
