OBGYN Flashcards
Which pregnant woman should be treated for group B Strep
Offer Intrapartum antibiotic prophylaxis if:
- previous baby with GBS infection
- Carrier of GBS in a previous pregnancy & positive test result on swab for GBS
- Prelabour rupture of membranes & preterm baby / positive GBS carrier
- Preterm labour
- GBS positive term labour
Management of primary dysmenorrhoea
1st: NSAIDs e.g. mefanamic acid
2nd: COCP
Causes of secondary dysmenorrhoea
Endometriosis
Adenomyoisis
PID
IUD (Copper)
Fibroids
What is tranexamic acid used for?
Heavy menstrual bleeding
What is mefenamic acid used for
Dysmenorrhoea
What contraceptive is proven to cause weight gain
Depo-provera
Correct position for woman with cord prolapse to be in while being prepared for surgery
On all fours, on knees and elbows
While someone pushes the presenting part of the foetus up
Criteria to diagnose a miscarriage
A confirmed miscarriage can be diagnosed on ultrasound if there is no cardiac activity and:
- The crown-rump length is greater than 7mm
OR
- The gestational sack is greater than 25mm
Conditions that raise CA125
Ovarian cancer
But also:
- endometriosis
- Adenomyosis
- Pelvic infection
- Liver disease
- Pregnancy
- menstruation
- benign ovarian cysts
Risk and protective factors for endometrial cancer
RF: XS oestrogen
* Nulliparity
* Early menarche
* Late menopause
* Unopposed oestrogen (e.g. tamoxifen/oestrogen)
RF: Metabolic syndrome
* Obesity
* Diabetes
* PCOS
Protective = multiparity, COCP, smoking
Risk and protective factors for ovarian cancer
RF: Increased no. of ovulations
* Early menarche
* Late menopause
* Nuliparity
Genetic:
* FHx BRCA 1/2
* FHx HNPCC (Lynch)
Protective: anything that decreases number of ovulations
* COCP
* Lactation
* Pregancy
Pathology of endomedial cancer cells
90% = adenocarinoma (columnar endometrial glands)
- oestrogen dependent (oestrogen stimulates growth of endometrial cancer cells
What is endometrial hyperplasia? What are the 2 different types?
Precancerous condition involving thickening of the endometrium
* Hyperplasia without atypia
* Atypical hyperplasia
Tx of endometrial hyperplasia
IUS (mirena)
Continuous oral progestogens (e.g. levonorgestrel)
Primary source of oestrogen in a postmenopausal woman
Adipose tissue
- Contains aromatase which is an enzyme that converts androgens to oestrogen
- Extra oestrogen is unopposed in women that are not ovulating (e.g. PCOS or post menopause) because there is no corpus luteum to produce progesterone
Oestrogenic effects of tamoxifen
Anti-oestrogen on breat tissue
Oestrogenic effect on endometrium –> increasing risk of endometrial cancer
Key symptoms of endometrial cancer
Post menopausal bleeding
/ discharge
- Post coital bleeding
- IMB
- Unsually heaving menstrual bleeding
- Anaemia
Investigations for endometrial cancer
- TV USS - for endometrial thickness Normal = <4mm post-menopause
- endometrial biopsy - pipelle biopsy or hysteroscopic biposy
- hysterscopic biopsy - staging
- MRI/CXR = to assess spread
Staging for endometrial cancer
International Federation of Gynaecology and Obstetrics (FIGO) staging system
Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
Stage 4: Invades bladder, rectum or beyond the pelvis
Management of stage 1/2 endometrial cancer
total abdominal hysterectomy with bilateral salpingo-oophorectomy
+/- post-op radiotherapy
Key symptoms of ovarian cancer
Suspect ovarian cancer in anyone >50 with IBS Sx
- New symptoms of IBS / change in bowel habit
- Abdominal bloating
- Early satiety
- Pelvic pain
- Urinary frequency or urgency
- Weight loss
Risk of malignancy index for ovarian cancer
RMI estimates the risk of an ovarian mass being malignant, taking account of three things:
Menopausal status
Ultrasound findings
CA125 level
Investigations for ovarian cancer
- CA 125 levels (>35 is significant)
- USS abdo/pelvis
- CT abdo pelvis
- Histology - CT guided biopsy or laparscopy
- Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells
Tumour markers to test in a pt <40 with suspected ovarian cancer
Alpha fetoprotein
HCG
(Possibly a germ cell tumour)
Timing of cervical cancer screening
hrHPV -ve tests:
* Every 3 years from 25-49 years
* Every 5 years from age 50-64 years
hrHPV +ve test:
- repeat in 12 months
What is done next if hrHPV +ve
- Samples examined cytologically
- If cytology is abnormal –> colposcopy
- If cytology normal –> repeat test in 12 months
Management of CIN II/III
Large loop excision of transformation zone (LLETZ)
Treatment of Gonorrhoea
IM ceftriaxone 1g
then oral ciprofloxacin 500mg
PALM COEIN
Causes of HMB
Polyps
Adenomyosis
Leiomyoema (fibroid)
Malignancy / hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic -
Not yet classified
Rotterdam criteria for PCOS
- Oligo-/An-ovulation
- Hyperandrogenism (hirsutism/acne)
- Polycycstic ovaries
Common hormone abnormalities present in PCOS
XS leutenising hormone (LH) - produced by anterior pituitary gland in response to an increased GnRH pulse frequency –> ovarian production of androgens.
Insulin resistance - suppresses hepatic production of sex hormone binding globulin (SHBG), resulting in higher levels of free circulating androgens.
Increased testosterone
Decreased SHBG
FSH normal - disruption in FSH:LH ratio can disrupt ovulation
Low Progesterone
Diagnostic criteria for “Polycycstic ovaries”
Not syndrome
> = 12 small folliciles in an enlarged ovary
Management of PCOS
- Oligo/amenorrhoea
- Induce bleeds COCP, POP - Obesity
- Aim for BMI under 30
- Diet, exercise, lifestyle
- Orlistat (severe cases) - Infertility
- Clomifene +/- metformin - Hirsutism
- Anti-androgen medications
- Topical eflornithine
- Cyproterone
- Spironolactone
- Finasteride
Ix for amenorrhoea
- Pregancy test
- FSH/LH
- TSH
- Prolactin
- Pelvic USS
Tx of hyperemesis Gravidarum
Antiemetics - cyclizine or promethazine
Rehydrate - not with glucose as precipitates wernickes
Treat Complications
Medications to induce ovulation
Letrozole (aromatase inhibitor)
Clomiphene citrate (SERM)
How to test ovulation is occuring
Day 21 serum progestogen (peaks day 7 after ovulation has occured and luteal phase is constant)
When is fetal cardiac activity observed on transvaginal USS
around 5.5 to 6 weeks gestation
