Gynaecology - 204 Flashcards
What is DUB (dysfunctional uterine bleeding)?
Menorrhagia that is not associated with organic disease of the genital tract
What are uterine leiomyomas?
Fibroids - benign growths in the uterus that can cause heavy regular periods.
What is endometriosis?
A condition where endometrial tissue is found outside the uterus -> this can cause painful periods, persistent pain in the pelvic area and infertility.
What does adenomyosis refer to?
Ectopic endometrial tissue within the myometrium
What investigations would you do in a women presenting with menorrhagia?
FBC -> to exclude anaemia
USS -> to see if the uterus is normal sized
Outpatient endometrial biopsy -> usually performed on women over 45 years.
If a women with menorrhagia is also anaemic what would you treat with?
Fe supplements, e.g ferrous sulphate 200mg bd
What are the medical options for menorrhagia?
- Tranexamic acid (antifibrinolytic) 1g tis, during menstruation only
- Mefenamic acid (NSAID)
- OCC
- Oral progestogens
- Mirena IUS, Levonorgestrel -> v. good, reduces blood loss by 90%
Name the surgical options for menorrhagia
Endometrial ablation (nova sure and thermal balloon) and hysterectomy
Hyperemesis gravidarum, vaginal bleeding, abdominal pain, miscarriage and ectopic pregnancy are all what?
Common problems in early pregnancy
How long can hCG levels take to return to normal following a miscarriage?
2-3 weeks
A lady presenting to A&E in early stages of pregnancy with continual abdominal pain and persistent vaginal bleeding is suggestive of what?
Ectopic pregnancy.
Name some risk factors for ectopic pregnancy
Chlamydia, mirena coil, infection
How do you manage an ectopic pregnancy medically? How do you manage it surgically?
Methotrexate injection.
Laparoscopy/laparotomy
What is methotrexate? What must be checked before it is given?
An antimetabolite that kills the pregnancy.
Liver and kidney function must be checked
What drugs are used for the evacuation and termination of pregnancy?
- Mifepristone tablets are taken first - 200mg. These start the evacuation process and ripen cervix
- Misoprostol taken 1-2 days later at 400mg. Ripens the cervix
Where is the most common site for an ectopic pregnancy?
Ampulla of the tube
What is a molar pregnancy?
A benign tumour that develops in the uterus, it occurs when there is an extra set of paternal chromosomes in a fertilised egg.
If untreated, what can molar pregnancies lead to?
Choriocarcinoma -> this is due to the hCG levels staying high. Very rare
In what demographic are fibroids more common?
Afro-carribean women, women approaching menopause.
They are found in 1:3 women >30 years
Name some factors that increase the risk of fibroids
Tamoxifen, Ethnicity, Hypertension, FH, Obesity, Null Parity
What tumour markers would be assessed in a women with fibroids?
Ca125, CEA
How can fibroids be treated medically?
- Esyma (ulipristal acetate) tablets
- GnRH agonists
- Mirena
What % of sub fertility is due to unexplained failure with absence of pathology?
25%
What is an example of an ovulatory disorder that has a hypothalamic cause?
Eating disorders, stress, excessive exercise
