O and G Flashcards
Post Pill Amenorrhoea
Normal : Amenorrhea up to 6 months / Wait for a spontaneous remission
If the patient is Anxious after 3 months : Give Clomiphene
After 6 months check USG for ovary for ovulation
Blood test for FSH LH and Oestrogen
Normal Levels :
- FSH 5-20 IU/L.
- LH 1.5-15 IU/L. ( Follicular Phase ) Up to 75 ( Peak of Cycle )
- Estrogen < 10 pg/mL.
- Prolactin :
Non-pregnant 2-30 ng/mL
Pregnant 10-210 ng/mL
Prolactinoma it’s supposed to be over 400 and
macroadenoma it is over 4000
Menopause and associated symptoms
menopausal woman with bleeding is always a sign of cancer - endometrial until proven otherwise.
Menopause + brown discharge—> endometrial cancer
Menopause + grey yellow purulent discharge —> infection
Menopause + painless bleeding after intercourse —> endometrial cancer Menopause + green discharge —> chalamydia
Bleeding within 1st yr of menopause —> follicular reactivation
sexually active / Menorrhagia / Dysmenorrhoegia or Fibroids not distroting the uterine cavity
Mirena IUS
If Mirena contraindicated
Assess for risk factors for OCP pills then give
If she has sickle cell anemia Then Depo will the first choice
Emergency Contraceptive Pills
Levo nelle pill 72 hr
IUD copper or ELLA ONE pill if 120hrs
Lower abdominal pain / Recent Amenorrhea / ± vaginal spotting
Antihypertensive in Pregnancy
Labetalol
If asthmatic - Nifedipine (also in post partum asthmatic )
If not suitable - Methyl dopa
Post menopausal bleeding is Cancer
especially endometrial cancer Until PROVEN otherwise
Transvaginal USG is the first line for endometrial thickness
Post menopausal bleeding is Cancer
especially endometrial cancer Until PROVEN otherwise
Transvaginal USG is the first line for endometrial thickness
Genital Herpes during Pregnancy Main rx- OB 4360
Women who are in the third trimester and develops first time genital herpes
Advised to Have oral Acyclovir until delivery and CS delivery
ORAL Acyclovir
First exposure-
o 1st and 2nd trimester: • Acyclovir for 5 day
• Acyclovir from 36 week to delivery NVD
o 3rd trimester • Acyclovir upto delivery C/S
Subsequent or recurrent
• Acyclovir from 36 week to delivery NVD
What Types of Miscarrages Via the USG ?
Complete: No fetus seen on US
Incomplete: Part of fetus seen on US
Missed: Dead fetus+Closed cervical os
Threatened: Alive fetus+Closed cervical os
Inevitable: Alive fetus+Opened cervical os
Failure rates of different Contraceptive methods
Failure rates of different contraceptive methods:
A. Permanent methods: -
Vasectomy= 0.1% or 1:1000 -
Tubal ligation= 0.5% or 1:200
B. Temporary methods: -
Condom (male)= 95% effective and 5% chance of failure rate -
Condom (female)= 5% failure rate -
IUCD= 0.6% - IUS (Mirena contains levonorgestrel)= 0.1% -
POP (progesterone only pill)= 0.3%
Contraception failure rates & duration of use:
- IUS 0.1% to 0.4% (3-6 years)
- IUD 0.8% (10 years)
- Implant 0.1% (3 years)
- Injection 4% (3 months)
- COCP 7%
- POP 7%
- Patch 7% (once per week then 4th week stop for menses)
- Male condom 13%
- Female diaphragm 17-27 %
- Tubal ligation 0.5%
- Vasectomy 0.15%
Peri menopausal symptoms
With hypertension and controlled with ACEi or SMOKER = Can give HRT patch (Oestrogen transdermal no effect on thromboembolism )
But in OC pills (Oestrogen not given to Controlled hypertension )
However Patch = much less Thrombo embolism Than ORAL OESTROGEN
Treatment of Post-menopausal symptoms:
- Life-style modification.
- If there is a uterus: - Combined hormone replacement therapy (HRT). -
Another possible answer= transdermal estradiol and progesterone patches. - If no uterus (H/O hysterectomy) or if there is IUS in place: - Oestrogen only HRT. - This is because progesterone is given with oestrogen to protect the uterus against endometrial carcinoma.
- If post-menopausal woman is a smoker: - HRT is given as transdermal patch, as oral route has higher risk for venous thromboembolism.
Types of combined HRT:
A. Sequential “cyclical” combined HRT: -
Used in the first 12 months of menopause or in perimenopause “still menstruating”.
Oestrogen is taken daily while progesterone is taken cyclically for the last 14 days of a menstrual cycle.
B. Continuous combined HRT: -
Used in menopausal women who have had their last menstrual cycle 12 months ago.
Both oestrogen and progesterone are taken daily.
***Perimenopause= still menstruating but may be irregularly or heavily near the age of 50 +/- other vasomotor symptoms.
Myoma treatment
If doent want child then symptomatic
If want child and intra mural - Myomectomy (GNRH given to reduce size before operation but it inhibits ovulation )
asymptomatic … follow up
menorhagia … IUS ( if not distortion ) , NSAID ,, COCS
severe menorhagia .. ellanova surgery …
need child … myomectomy surgery ….
doesnt need child ,,, hysterectomy or endometrial ablation ( if small less 3 cm ) ##
GNRH agonist beforee surgery is indicated
Anti HTN in pregnancy: LMN –Labetalol –Methyldopa –Nifedipine
In severe preeclampsia 1- AntiHTN medication 2- Mgso4 to prevent eclampsia 3- CTG and USG to monitor the baby 4- If>34 weeks give steroids to stimulate surfactant production
deal with the cause (HTN!) before trying to prevent complications.
Anti HTN in pregnancy: LMN –Labetalol –Methyldopa –Nifedipine
In severe preeclampsia 1- AntiHTN medication 2- Mgso4 to prevent eclampsia 3- CTG and USG to monitor the baby 4- If>34 weeks give steroids to stimulate surfactant production
deal with the cause (HTN!) before trying to prevent complications.
Lichen Planus Vs Vaginal Thrush
vaginal thrush(candidiasis):
white cheesy vaginal discharge +itching lichen sclerosis:
white plaques on anogenital skin+ itching at night
(tx:topical steroids,follow up 3 and 6 months because risk of scc of vulva)
lichen planus: white lacy pattern on oral mucosa
Ectopic Pregnancy management OB 1257
asymptomatic (with visible heart rate ) —>methotexae
stable symptomatic or/and visible heart rate —> laparascopy
unstable —->laparatomy
Anemia in pregnancy
If 33 weeks (U have enought 3 weeks time to correct anaemia with iron supplement)
but after 36 weeks Blood transfusion for quick refill (as there will also be blood lost during delivery )
1st trimester 1wk-13wk <11g/dl
2nd 14wk -26wk <10.5 3rd
27wk-40wk <10.5
postpartum <10
1unit to Blood Transfusion increases Hb by 10g/L.
Oral Ferrous supplements increase Hb by 10g/L in one week.
This is why after 36 wks BT is preferred, to have an adequate Hb level for delivery.
Panicillin allergy patient CS 0211 which ab to give Tri metho / Nitro furen Amoxi / Co amoxi Cefelaxime
DONT GIVE trimethoprim in 1st tri
DONT GIVE nitrofurantoin in 3rd tri
DONT GIVE ciprofloxacin at any time
Give Cefelaxime (10% coross reaction with penicilline but is avoidable )
Based on plabable info Safe in pregnancy:
HTN: labetalol, nifedipine, hydralazine
UTI: penicillin / amoxicillin; cephalosporin / cephalexin ; erythromycin (the rest macrolids CI); clindamycin
Malaria prophylaxis: chloroquine, proguanil, mefroquine
Constipation: lactulose
CI in pregnancy: Trimethoprim (I trimester) Nitrofurantoin (near term) All macrolids excepting erythromycin Quinolone / ciprofloxacin Tetracycline / doxycycline
Malaria prophylaxis: primaquine
Two types of HRT
Cyclical and Continuous
Perimenopausal —cyclic HRT
Post menopausal … >12 months… Continues HRT
Without uterous estrogen only
With uterous if compulsion .. give IUS with estrogen only
GY 4540 Endometrial ablation not Mirena
GY 4540 Endometrial ablation not Mirena
Diagnosis of PCOS CS 0040
Cannot be verified by Lab values
but usually the LHS and FSH levels will be on the BOderline maximum
and its ratio will be increased
the ratio of LH: FSH is more important and both may be raised.
Moreover, a diagnosis of PCOS does not depend on the levels of FSH/LH.
it depends on
- hirsuitism/ raised testosterone
- ultrasound criteria for PCOS and
- oligomenorrhoea or amenorrhoea
Normally In Pregnancy
there will be Odema of hands and Proteinuria which is consider normal
BUT NICE guidlines
if the proteinuria is 2+= refer to obstetric urgently………… even if normotensive
if the proteinuria is 1+ and no signs for pre-eclampsia= review 1 week in the GP surgery.
Management of Ectopic pregnancy
1) Signs of shock plus suspected ectopic
plus positive hcg- immediate laparotomy.
2) No signs of shock plus hcg positive plus
signs of peritonism - transvaginal
usg- if empty-
diagnostic laparoscopy.
3) no signs of shock plus hcg positive plus
no signs of peritonism-
usg- if empty-
serial hcg measurements -
if raised- diagnostic plus therapeutic laparoscopy. -
if not raised- repeat in 48 hours.
Gestational hypertension or Pre eclampsia
Dx by PROTEIN CREATNIN RATIO
In GH Prot cret ratio <30 example 10mg/mmol
Protien values for the diagnosis of pre-eclampsia:
1) 24 hrs urine protien >0.3g
2) PCR >30 mg/mmol
3) ACR >8 mg/mmol
Tubo ovarian abscess or PID
Lower abdominal pain + fever + abdominal tenderness WITHOUT discharge + risk factors of PID —> Possible tubo-ovarian abscess —> USG (USG could diagnose or exclude TOA quickly, swab will take time)
OB 4170
Menopause cannot be diagnosed by FSH (but yes for pre mature ovarian failure )
its based on Clinical
If menopause + other symptoms Menorrhagia (Endometrial cancer DO USG )
we’re not diagnosing whether she’s menopausal or not. We’re investigating why she’s bleeding heavily at the age of 51. Hence endometrial thickness is crucial here.
Contraception IUD or COPPER worsen menorrhagia
DVT - omit OC and Mirena and all
DVT only - Copper iud
patient with headace without migraine , migraine with aura , and also VTE COCP is contraindicated. Next best one is IUCD which is UKEMC1 while IUS is UKEMC 2
If it’s asking about safety, choose IUCD over IUS except with the following:
- Anemias
- Severe dysmenorrhea (ablation if Hb is very low)
- Endometriosis Went through the UKMEC list.
PID suspected patient Antibiotic given
but not effective
think
Best initial investigation
USG
Tubo Ovarian abscess (abscess is not controlled by AB )
Tx for Hyper emesis gravidoram OB 4210
hypermesis management:
FAST First:
1. Fluids
- Antiemetics FIRST IM THEN IV
(First line -cyclines, Second line metroclopramide or ondansetron) - Steroids (Third line) Dont give BEFORE IV ANTIEMETICS
- Thiamine
Pregnancy and pain killer Junior doctor can only prescribe Paracetamol to pregnant woman.
NSAIDs is contraindicated after 30 weeks’ gestation
It is associated with an increased risk of premature closure of the fetal ductus arteriosus and oligohydramnios
Types of Operation for Myoma removal
Uterus approach
Abdominal approach
For Intramural and subserosal —> Abdominal myomectomy
Submucosal fibroid—> hysteroscopic myomectomy
Dont Repeat Cervical Smear in Symptomatic patient
\Cervical Smear is a Screening test
GY 2042
if there is abnormal bleeding that persist for > 6-8 weeks
——refer for colposcopy despite of normal cervical smear,
normal speculum examination or normal cervical swab result.
Dont Repeat Cervical Smear in Symptomatic patient
\Cervical Smear is a Screening test
GY 2042
if there is abnormal bleeding that persist for > 6-8 weeks
——refer for colposcopy despite of normal cervical smear,
normal speculum examination or normal cervical swab result.
Placenta previa
OB 2043
Bleeding after sexual intercourse
what to do next
To do speculum examination to look for cervical tears
SPECULUM IS SAFE
DIGITAL FINGER IS NOT SAFE
Gynacological Swabs
High vaginal swab for vaginosis and trichomonas
Vulvovaginal swab for chlamydia or gonorrhea
Vulvovaginal is superior to endocervical swab
Suspected cervicitis:
Vulvovaginal swab NAATs:
1- Chlamydia +ve»_space; Treat (Doxy OR Azithro)
2- Gonorrhea +ve»_space; DO culture first before treating (because of resistance) To take samples for culture:
Endocervical swab in Charcoal +
High vaginal swap in Charcoal Then treat according to the sensitivity results
GY 0020
Meigh syndrome
Benign ovarian tumor
Ascities and
Pleural effusion
