Lecture 21: Clinical Gynaecology Flashcards
What is clinical Gynaecology?
- Issues of discomfort and/or disease of the female genital tract.
- Prevention of disease eg; cervical screening.
- Reproduction and contraception.
Cervical Screening is?
One of the most effective screening tests in reducing the incidence and mortality from cervical cancer. By 60-80%!!
HPV is the underlying cause, a vaccine has been introduced.
IVF??
>5mill babies born by IVF
- Stimulate via hormones the female ovaries so lots of follicles/eggs mature.
- Puncture via abdominal wall, takes eggs our and mix in vitro with sperm
- Find the best fertilised eggs, place them back in the womb
What is the major breakthrough in womens reproductive health??
The Oral contraceptive Pill.
Currently used by >100 mill women.
Women could decide if/when they wanted to get pregnant!!!
What kind of things do you see in terms of womens health in the community and/or emergency health system?
heavy menstrual bleeding
Abnormal cervical smears
Early pregnancy complication
Lower abdo pain
Gynaecologic History taking
3 key history questions?
What’s the presenting complaint?
- onset, duration, course, severity
- impact on life
Specific complaint related history (exclude pregnancy)
-cervical smear, sexual health etc
- mestrual history
- contraceptive history
- sexual history
Gynacaelogical Examination
- General Abdominal Examination
- Pelvic Examination
- Speculum &bimanual (checks cervix, cervical motion tenderness, uterus, adnexa)
IT MAY NOT EVEN BE A GYNACOLOGICAL PROBLEM
What is a speculum examination?
checking for?
- Because in normal circumstances vaginal walls have collapsed, but speculum allows us to expand the walls and clearly view the cervix
- cervix size, motion, temderness, uterine movement
Gynacaelogical Investigations
- Urine (pregnancy)
- Cervical smear
- Vaginal Swabs
- Biopsy (pipelle)
- Ultrasound (5-12mm)
Uterine Fibroids are? Symptoms?
Very common cause of menstrual bleeding, benign SM tumor from uterine myometrium. Estrogen dependent and regress post menopause
Symptoms: abnormal bleeding, pelvic discomfort, no pain
Uterine Fibroid Treatment?
Don’t treat unless the symptoms are really bad. If treatment is required, use drugs (eg NSAIDS) or surgery can be done.
These can grow in different places, eg; bladder
Causes of Heavy menstrual bleeding?
Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia (PALM)
Non-Structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified (COEIN)
Treatment for Acute HMB
Progestogens (high dose/ 10 days)
or Tranexamic acid
Progestogens action on the Endometrium
- Stops the oestorgen induced growth of the endometrium
- Stabilizes endometrial Vasculature
- Initiates the clotting cascade
- inhibits matrix metallo proteinase activity
What is Endometrial Ablation and when do we do it?
- Minor procedure, whole inner womb lining taken out
- Short recovery
- 80% satisfaction
- 25% repeat procedure
Only done if after 3 months medical management for HMB has failed!!
How does Tranexamic Acid work?
Anti-fibrinolytic that prevents plasminogen activation.
It works by preventing blood clots from breaking down too quickly. This helps to reduce excessive bleeding.
Little bit of coagulation at the level of the uterus, restoring blanace of coagulating and anti-coagulating products.
Types of Incontinence
..
Dysmenorrhea
Pain during menstrual cycle
45-72% in menarche +3years
39% use analgenics
Dyspareunia
pain during sex
Endometriosis stats and associated pain types
1 in 10 women
Most painful condition, functional extra-uterine endometrium, only way to diagnose is a painful invasive procedure.
Dysmenorrhoea, dyspareunia, dyschezia (pain on opening bowels), dysuria
Endometriosis treatment?
- Pain management
- Hormones
- Surgery
But is is a chronic condition and will carry on within reproductive lifespan.
- surgical - laprascopic excision of endometrial deposits
- definitive surgery - hysterectomy and bilateral salpingo-oopherectomy
