Gynaecology Summaries

Question 1

Buys et al (PLCO)

Answer 1

Prostate, Lung, Colorectal, Ovarian Cancer
Screening with annual Ca125 and USS does not significantly improve diagnosis or mortality from ovarian cancer, and is not effective to detect cancer at an earlier stage. It does increase the risk of oophorectomy.

Question 2

Janda et al / LACE

Answer 2

Laparoscopic Approach to Cancer of the Endometrium (stage 1) has no difference in recurrence or survival compared to TAH, with benefits for hospital stay, recovery, quality of life, and adverse events, so should be considered as a standard approach.

Question 3

Million Women Study

Answer 3

Current use of HRT is associated with an increased risk of breast cancer and death from breast cancer, the risk increases with duration of use and is higher in combination HRT than oestrogen alone.

Question 4

Parker / Ovarian conservation at time of Hysterectomy

Answer 4

In women undergoing hysterectomy for benign disease, ovarian conservation benefits long term survival, particularly women before age 55 undergoing oophorectomy having significantly excess mortality by the age of 80. After age 65 the risks and benefits approximate each other.

Question 5

Womens Health Initiative 2002

Answer 5

In postmenopausal women, the initiation of combined HRT increased risk of breast cancer and VTE, which outweighed the reduction in risk of fractures.

Question 6

Womens Health Initiative 2004

Answer 6

Oestrogen HRT after hysterectomy increases risk of stroke, but decreases risk of hip fractures, and does not increase risk of CHD. Overall, there is no difference in all cause mortality or chronic disease prevention.

Question 7

SPIN

Answer 7

Scottish Pregnancy INtervention study. Pregnancy loss in women with recurrent miscarriage without antiphospholipid syndrome is not reduced by LDA and LMWH.

Question 8

Kaandorp

Answer 8

Aspirin alone or with LMWH does not improve live birth rate for unexplained recurrent miscarriage.

Question 9

Zhang et al

Answer 9

Misoprostol is effective (71% by day 3) and acceptable to women for management of first trimester miscarriage, with similar rates of haemorrhage and endometritis but higher side effects than surgical management.

Question 10

Secura

Answer 10

LARCs are an acceptable method of contraception for young women and provide a significant reduction in teen pregnancy, abortion and birth compared to the USA national average, when financial and access barriers are removed.