Gynaecology and EPU Flashcards
When is cervical screening performed?
Every 3 years from the ages of 25-50, then every 5 years from the ages of 50-64
What is the virus called that, if it progresses, causes cervical cancer?
HPV (Human Papillomavirus)
What are the 2 types of cells of the cervix?
Squamous and columnar
Describe HPV
- Infects genital area
- Normally asymptomatic and resolves spontaneously
- If it is persistent, can cause cancer
- Found at screening = organise biopsy
What are the 5 types of treatment available for cervical cancer?
- LLETZ
- Cold coagulation
- Cryocautery
- Cone biopsy
- Laser treatment
What is a LLETZ procedure?
Killing abnormal cells using a loop with an electrical current - under local anaesthetic
What is cold coagulation?
Killing abnormal cells using a heated probe
What is cryocautery?
Abnormal cells are frozen and destroyed
What is a cone biopsy?
A cone-shaped piece of tissue is cut out that contains abnormal cells - under GA
What is laser treatment?
A laser is used to pinpoint and destroy abnormal cells
If a woman is due a smear test when she falls pregnant, how soon after delivery should she have one?
3 months
Why is it not advised to have a smear test procedure during pregnancy?
Risk of preterm labour
What are the 5 most common sites for an ectopic pregnancy?
- Fallopian tube
- Abdomen
- Cervix
- Ovary
- CS scar
What is a heterotopic pregnancy?
Ectopic and IU pregnancy occur at the same time
What are some of the symptoms of an ectopic pregnancy?
- Abdo pain
- Vaginal bleeding
- Breast tenderness
- Shoulder tip pain
What are the 2 types of surgery that can be performed on the fallopian tubes?
- Salpingectomy = surgical removal of tubes
2. Salpingotomy = creating an opening in the tubes
What medication is sometimes given for an ectopic pregnancy?
Methotrexate - an immunosuppressant which stops cells from dividing
When must methotrexate not be used?
Heterotopic pregnancy - will stop the IU pregnancy from growing
What are the 4 types of miscarriage?
The spontaneous loss of a pregnancy before 24 weeks gestation
What is an early miscarriage?
Occurs <13/40
What is a late miscarriage?
Occurs between 13-24/40
What are the 5 classifications of miscarriage?
- Complete
- Incomplete
- Missed
- Threatened
- Inevitable
What is a complete miscarriage?
- All products of conception expelled
- Bleeding stopped
What is an incomplete miscarriage?
- Diagnosed non-viable pregnancy
- Bleeding continues
What is a missed miscarriage?
Diagnosed miscarriage with no pain or bleeding
What is a threatened miscarriage?
Vaginal bleeding in the first 24 weeks of pregnancy
What is an inevitable miscarriage?
Diagnosed miscarriage where bleeding is occurring and the cervix is open (this will proceed to complete/ incomplete)
What are the 3 types of miscarriage management?
- Expectant
- Medical
- Surgical
What is expectant management of a miscarriage?
Wait for 7-14 days for foetus to pass naturally
What would be some contraindications for expectant management of miscarriage?
- Increased risk of haemorrhage
- Previous trauma
- Evidence of infection
What is medical management of a miscarriage?
- Misoprostol given
- Must be admitted if bleeding hasn’t started within 24 hours
- Prescribe pain relief and anti-emetic
- Take pregnancy test 3 weeks post treatment
If the pregnancy test 3 weeks after medical management is positive, what might this indicate?
Molar or ectopic pregnancy
What is surgical management of a miscarriage?
ERPC (evacuation of retained products of conception)
- Vacuum aspiration under local anaesthetic or ERPC under GA
What must be given after surgical management of miscarriage?
Anti-D to Rh-ve women
What is gestational trophoblastic disease?
A group of conditions in which tumours grow inside the uterus
What are the symptoms of gestational trophoblastic disease?
- Abnormal pv bleeding
- Uterus larger than expected
- Severe N+V
- High BP in early pregnancy
What is the treatment for gestational trophoblastic disease?
- Suction curettage (for molar pregnancies)
- Pregnancy test 3 weeks after treatment
- Anti-D prophylaxis for Rh-ve women
What is PCOS?
- Polycystic ovary syndrome
- ?Caused by excess insulin = increased testosterone production
- No dominant follicle so none reach maturity
What are the symptoms of PCOS?
- Infrequent/ anovulation
- Hirsutism (male-pattern hair growth)
- Male-pattern alopecia
- Acne
- Elevated testosterone levels
What is the treatment for PCOS?
- Clomiphene (clomid)
- Combined contraceptive pill
- Surgery
- Metformin
How does Clomiphene treat PCOS?
It induces ovulation
How is surgery used to treat PCOS?
Laparoscopic ovarian drilling used to destroy cells that are producing testosterone and increase levels of FSH to attempt to restore ovulation and fertility
How is the combined contraceptive pill used to treat PCOS?
Controls excessive hair growth and hair loss by increasing oestrogen and progesterone levels
How is metformin used to treat PCOS?
- Lowers insulin levels = lower testosterone
- Stimulates ovulation
- Not licensed in UK for PCOS treatment but can be used ‘off-label’
What is endometriosis?
Endometrial tissue found outside of the uterus
What are the symptoms of endometriosis?
- Abdominal cramps
- Dyspareunia
- Infertility
- Pain on defecation
- Chronic pelvic pain
How is endometrisos treated?
(No cure for endometriosis)
- Combined contraceptive pill
- POP
- Surgery
How does the combined contraceptive pill/ POP help with endometriosis?
Reduces oestrogen levels to reduce production of endometrial tissue
How is surgery used to treat endometriosis?
- Laparoscopy treatment to remove tissue/ cysts
- Hysterectomy
If a woman has had 3 or more miscarriages, what investigations should take place?
Blood tests to determine antibodies in blood (looking for Lupus)
What is Lupus?
- Disease in which the immune system attacks organs, causing swelling and excessive blood clotting
- Can cause clots in the placenta, causing miscarriage
What colposcopy investigations can be performed during pregnancy?
- Can perform biopsy
- Avoid LLETZ procedures unless cancerous cells found
What advice should be given after a colposcopy procedure?
- Cramping and small amount of pv bleeding normal
- Avoid strenuous exercise for 2-3 weeks
- No baths or tampons for 2-3 weeks
How is a miscarriage diagnosed?
- CRL >7mm and no FH activity
- No foetal pole or yolk sac seen
- 2nd sonographer must check findings
How is Hyperemesis diagnosed?
- > 5% pre-pregnancy weight loss
- Dehydration
- Electrolyte imbalance
What is a molar pregnancy?
There is cell growth present but they don’t differentiate into a foetus
What should women be advised to do 2 weeks after a miscarriage?
Pregnancy test (progesterone can remain high for up to 2 weeks after end of pregnancy, so test may be positive before then)
