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OBGYN > OBGYN > Flashcards

OBGYN Flashcards

1
Q

What are the risk factors of pelvic organ prolapse?

A

Multiparity (biggest RF)

Obesity
Age
CTD (Ehlers Danlos)
Race: White > Black / asian
Increased abdominal pressure (constipation, straining, obesity, other)
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2
Q

What is the first line conservative and medical treatment for pelvic organ prolapse?

A

Pelvic Floor Exercises

Pessary

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3
Q

What is a complication of using pessary for pelvic organ prolapse?

A

Ulcers from irritation

Odour from secretions

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4
Q

What is the surgical management of pelvic organ prolapse?

A

Obliterative - Unable to have sex, the vagina is stitched up, ensure the patient is happy with this choice!

Reconstructive - Restore normal pelvic anatomy, a variety of approaches. Sutures, meshes, biomaterial. Vaginal, abdominal.

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5
Q

What are the 4 characterstics of hyperemesis gravidum?

A
  1. N&V (persistent and prolonged)
  2. Dehydration + Derranged U&E
  3. Ketones +++
  4. > 10% drop in BW
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6
Q

What are the risk factors of hyperemesis?

A

Anything that causes an increase in B-hCG

  1. Previous hyperemesis
  2. Twins or multiple pregnancies
  3. Molar pregnancy
  4. TSH
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7
Q

What is your immediate management for a patient with hyperemesis?

A
  1. Fluids IV - Crystalloid
  2. Antiemetic - Cyclizine*
  3. Vitamine - Thiamine & Folic Acid
  4. DVT prophylaxis

*Metclopramide and domperidone not used due to oliguric extrapyramidal side effects

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8
Q

What is a major complication of hyperemesis?

A

Wernickes Encephalopathy (due to depletion of Thiamine from excessive emesis)

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9
Q

What medication may be prescribed to resolve refractory hyperemesis?

A

Prednisolone

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10
Q

What may you find in a complete miscarriage?

A 
Expulsion of all contents
OS closed
PV bleeding
Abdo pain
Uterus not felt with bleeding settled
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11
Q

What may you find in an incomplete miscarriage?

A

Incomplete expulsion
OS open
Crampy abdominal pain
Products visible

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12
Q

What is the risk of retained products in an incomplete miscarriage?

A

Cervical shock, remove products to prevent this

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13
Q

What may you find in an inevitable miscarriage?

A

OS open
Products not expelled
Still bleeding
Crampy lower abdominal pain

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14
Q

What may you find in a threatened miscarriage?

A

OS closed

Viable pregnancy

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15
Q

What may you find in a missed miscarriage?

A

Asymptomatic
Gestational sac with NO fetal pole
25 weeks or 7 weeks

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16
Q

What is a recurrent miscarriage?

A

3 or more CONSECUTIVE miscarriages

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17
Q

What are the causes of recurrent miscarriages occurring in the 1st, 2nd and 3rd trimester?

A

1st - X abnormalities

2nd - APL syndrome, ANA

3rd - APL syndrome, Endocrine abnormalities, Age (maternal and paternal)

Most common reason / cause is antiphospholipid syndrome (APL)

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18
Q

What blood test should you perform in a patient with recurrent miscarriage?

A

Test for SLE, APL, X abnormalities (if 3rd loss), USS

If all test are normal&raquo_space;> unexplained miscarriage (TLC for the mother)

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19
Q

What is the Kleihauer-Betke test?

A

Blood test to measure amount of fetal hB transferred to mothers blood stream.

Results used to determine dose of Anti-D Ig

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20
Q

What are the options for managing an incomplete miscarriage and what are the success rates for each?

A
  1. Conservative (50-60% success) if NOT bleeding. Watch and wait for 14 days, call back unless bleeding within those days, and then do a pregnancy test.
  2. Medical (80% success).
    Misoprostol (uterine contractions) + Mifepristone (terminate fetal heartbeat).
    If bleeding stops > send home.
    If bleeding continues > Surgical
  3. Surgical (90% success)
    Suction / Manual Evacuation
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21
Q

What risks are there in the surgical management of an incomplete miscarriage?

A

Bleeding
Uterine perforation
Cervical trauma

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22
Q

What may a negative sliding scale on USS be indicative of?

A

Ectopic pregnancy

Implanted strongly to structure therefore pressure applied will not result in movement of the gestation.

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23
Q

What is the clinical presentation of an ectopic pregnancy?

A 
Amenorrhoea + sexually active
Colicky abdo pain
Dark or Fresh PV bleeding*
Fainting/dizziness**
Previous surgery (e.g. appendectomy)
PID
Conception after infertility
  • Ddx of PV bleeding, miscarriage, PID, cervicitis
  • *fallopian tube distention and stimulation of ANS
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24
Q

What are the risk factors for ectopic pregnancy?

A

Cause is usually tubular abnormalities. Things that affect this include…

Previous ectopic
Endometriosis
Smoking
Salpingitis; surgery
Progesterone IUD
Sexual partners
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25
Q

How may the levels of B-hCG affect your management of ectopic pregnancy?

A

<500 - Conservative
500-1500 - Medical
>5000 - Surgical

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26
Q

How may the presence of a fetal heart beat affect the management of an ectopic pregnancy

A

> > > Always SURGICAL!

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27
Q

What is the difference between a salpingostomy and a salpingectomy?

A

Salpingostomy - Creating of a new opening into fallopian tube

Salpingectomy - removal of fallopian tube

hint: salpingOstomy, Opening
salpingEctomy, ecsize

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28
Q

What is the management of an ectopic pregnancy?

A
  1. Give Anti-D
  2. IVI for shock
  3. BHCG (dipstix + blood)
  4. TV USS + CTG for fetal heart beat
  5. Immediate laparotomy
  6. Methotrexate*
  7. Follow up twice a wk until BHCG <20

*MUST arrange a follow up if given methotrexate! Cannot conceive for 3 months, provide adequate contraception.

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29
Q

What is a molar pregnancy?

aka hyaditiform moles

What is the typical appearance on USS?

A

Complete: No genetic material in ovum, sperm from father, 46XY or 46XX

Incomplete: Two sperms, empty ovum

*snowstorm appearance on USS

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30
Q

What are the key diagnostic features of a molar pregnancy?

A 
1st trimester of pregnancy
Vaginal bleeding (frogspawn)
Amenorrhoea / Missed period
Extremes of reproductive age (<20yrs, >35yrs)
Severe Hyperemesis
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31
Q

What is the management of molar pregnancies?

A

Surgical - Suction

Regular BHCG monitoring for 6months to 1 year

Avoid pregnancy for 1 year

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32
Q

What is the prognosis for a patient who has had a molar pregnancy?

A

Increased risk of recurrent molar pregnancy

Risk of choriocarcinoma, fortnightly B-hCG rest required to see if normalised, otherwise requires referring to molar pregnancy specialist

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33
Q

At what BMI should you do an OGTT in antenatal care?

A

> 30

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34
Q

What is the mnemonic for interpreting CTG’s?

A

DR C BRAVADO

Define Risk

Contractions

Baseline RAte

Variability

Acceleration

Deceleration

Overall plan

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35
Q

What are the features of pre-eclampsia?

A

PRE-eclampsia

Proteinuria (>0.3g/24h)
Rising blood pressure (>140/90)
Edema of the legs

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36
Q

What are the fetal and maternal complications of gestational diabetes?

A

Fetal: Macrosomia, Respiratory Destress Syndrome, Neonatal Hypoglycaemia, Congeintal Abnormalities (CHD)

Maternal: C-Section, pre-eclampsia, type 2 diabetes

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37
Q

What are the risk factors for pre-eclampsia?

A 
Nulliparity
FHx
Obesity
Diabetes
HTN
Extreme's of ages (<20 or >30)
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38
Q

At how many weeks pregnancy does pre-eclampsia usually develop?

A

~20 weeks

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39
Q

What are the clinical features of pre-eclampsia?

A

Headache
Nausea
Visual distrubances
Epigastric pain

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40
Q

What complications may arise from untreated UTI in pregnancy? What are the symptoms?

A

Pyelonephritis
(Fever, rigors, nausea, vomiting, loin pain)

Premature labour

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41
Q

What signs may be present, and should you comment about, during an obstetric examination?

hint: SSSUM

A

Symmetry - symmetrical / assymetrical abdominal distention

Scars - low transverse scar from C-sect, laparoscopic

Skin changes - Linea nigra (dark line from xiphisternum to pubis), Striae gravidum (purple stretch marks denoting current parity), Striae albicans (silvery stria denoting previous parity)

Umbilicus - flattened, eversion (polyhydramnios / multiple)

Movements - Fetal movements (occuring after 24 weeks)

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42
Q

What rate is a normal fetal heart beat?

A

110 - 160

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43
Q

What are some causes / associations of polyhydramnios?

A

Type 2 Maternal Diabetes
Macrosomia
Multiple pregnancies
Impaired swallowing by fetus

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44
Q

What are some consequences of polyhydramnios?

A

Pre-term labour
Placental abruption
Malpresentations (breech)

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45
Q

What are some causes of oligohydramnios?

A
  1. Inability of fetus to contribute to fluid, i.e. urinate (renal dysgenesis, polycystic kidneys, Potter’s syndrome)

or

  1. Rupture of amniotic membranes
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46
Q

What is a consequence of oligohydramnios?

A

Poor development of fetal lung tissue

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47
Q

What syndromes are assessed on nuchal scanning?

A

Pataus syndrome
Edwards syndrome
Downs syndrome

Nuchal scan measures the “fat PED” of the neck

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48
Q

At what weeks is the nuchal scan performed?

A

10-14 weeks

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49
Q

What invasive procedures are available for assessing whether a baby has a syndrome and at what week are they performed?

What risks do these tests carry and what is the probability of it happening?

A

Chorionic Villus Sampling (11-14 wks) - Needle into tummy

Amniocentesis (16 wks) - obtain babies cell from surrounding fluid

1/100 chance of miscarriage

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50
Q

What are the causes of PPH (4T’s)?

A

Tone - Abnormal uterine contraction
Tissue - Retained products of conception
Trauma - of genital tract
Thrombin - abnormal coagulation

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51
Q

What are the risk factors and protective factors of ovarian cancer?

A

Risk factors

  • Early menarche
  • Late menopause
  • Nulliparity
  • Fhx of ovarian/breast cancer

Protective factors

  • Multiparity
  • Lactation
  • COCP use
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52
Q

What are the symptoms of ovarian cancer?

A

Abdominal pain and distension
Abnormal vaginal bleeding
Changes in bowel habits
Ovarian / pelvic mass

Evidence of pleural effusion, bowel obstruction or breast symptoms due to metastesis

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53
Q

What are the risk factors for cervical cancer?

A 
HPV
STIs e.g. chalmydia
Multiple sexual partners
Smoking
Sex at a young age
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54
Q

What are the symptoms of cervical cancer?

A

Post-coital bleeding
Offensive vaginal discharge

Intermenstrual + Post-Menopausal bleeding may also be seen.

Late features include altered bowel habits, painless rectal bleeding, haematuria and chronic urinary frequency

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55
Q

What are some differentials for late pregnancy bleeding?

A

Divide by structures affected

  1. Cervical: Cervicitis, Polyp, Cancer
  2. Vaginal: Lacerations (more sensitive in pregnancy)
  3. Uterine: Rupture
  4. Placental: Abruption, previa, vasa previa
  5. Other: Hemorrhoids (notices only after BOed?)
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56
Q

What are the symptoms and RF of placental abruption

A

Painful between contractions!
Bleeding! (may be concealed)
Fetal distress
Firm tender uterus

Hypertension!
Blunt trauma
Cocaine use
Multiparity
Smoking

Placental Abruption is the No1 cause of late pregnancy bleeding and painful bleeding!

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57
Q

What CTG changes present in placental abruption?

A

Bradycardia
+
Late Decelerations (always seen in placental problems due to lack of blood flow to the fetus)

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58
Q

What are the complications of placental abruptions?

A

DIC! (prolonged PT and PTT, Thrombocytopaenia, schistocytes and helmet cells on film)

Preterm delivery
Maternal and/or fetal shock (resulting in renal failure)
Death

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59
Q

What is uterine rupture and what is the most common risk factors?

A

Complete separation of the wall of uterus

Classical (Vertical) C-Section

therefore uterine scarring as a result is a huge risk factor

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60
Q

What are the symptoms of uterine rupture?

How do you manage uterine rupture?

A

TEARING uterine pain

Popping sensation (significant pressure within uterus relieved on rupture which feels like pop)

Most reliable symptom is Fetal Distress (late decelerations)

Mx: Emergency C-Section

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61
Q

How may vasa-previa present?

A

artificial rupture of membrane > painLESS fresh pink blood > emergency c section

Vasa vessels covering cervical os. These vessels supply fetus. On artificial rupture, without knowing if vasa-previa, can result in massive bleeding.

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62
Q

What is the initial symptom of placenta-previa?

A

PainLESS uterine bleeding

63
Q

Name three obstetric causes of late pregnancy painLESS bleeding?

A

Placenta Previa
Vasa Previa
Abnormal placentation

64
Q

Name two obstetric causes of late pregnancy PAINFUL bleeding?

A

Placental Abruption

Uterine Rupture

65
Q

What is endometriosis? How does it differ to adenomyosis?

What are the characteristic symptoms and signs of endometriosis?

A

Endometrial glands and stroma OUTSIDE NORMAL LOCATION.
Adenomyosis is where the glands are in the myometrium

  1. Cyclical pelvic pain* (not always but very indicative)
  2. Uterosacral nodularity

*Most common presenting complaint is chronic pelvic pain
Also a differential for subfertility / infertility

Chiefly affects reproductive-aged women

66
Q

What are some risk factors for endometriosis?

A

Family history: Increased incident if 1st degree relatives also affected

Anatomical: anything causing Outflow Obstruction

Environmental: TCDD, caffeine, alcohol

*protective factors: smoking, exercise

67
Q

What is the treatment for primary dysmenorrhoea?

A

NSAIDs

COCP

68
Q

What are the symptoms of endometriosis?

A

Pain Symptoms

  • Secondary Dysmenorrhoea (not responsive to NSAIDS or COCP)
  • Dysparenuia (endometrial implants on uterosacral ligament which is moved during sexual intercourse)
  • Dysuria (implants in the urethra)
  • Defecatory pain (implants in the rectum)

Infertility / Subfertility (implants in the tubes / ovaries)

Intestinal obstruction (will appear like malignancy on CT, need to do laparoscopy to diagnose properly)

Urethral obstruction (increased frequency, urgency, retention, leading to renal failure, consult urologist)

69
Q

What may you see, in endometriosis, on physical exam?

Visual inspection?
Speculum?
Bimanual?

A

Visual: Normal

Speculum: Usually normal, maybe blue/red lesions that easily burn

Bimanual:
UTEROSACRAL NODULARITY & TENDERNESS
FIXED RETROVERTED UTERUS (should be anteroverted)
Cystic adnexal mass

70
Q

What is the management of endometriosis?

A

Conservative: Watch and wait

Medical: NSAIDs and COCP&raquo_space;> GnRH Agonist (gonadorelin)

Surgical: ablation, resection, hysterectomy (make sure they dont want children, these patients are young and often want children!)

71
Q

What are some differentials of endometriosis?

A

Gynecological

  • PID (fever)
  • Haemorrhagic ovarian cyst (no uterosacral nodularity)
  • Ovarian torsion (acute pain, not chronic)
  • Primary dysmenorrhea (younger, no other findings)
  • Ectopic (dx with B-hCG)

Non-Gyne

  • Chronic UTI (extensive hx)
  • Interstitial cystitis (UA)
  • Renal calculi (hx of kidney stones)
  • GI: IBD, IBS, Diverticulitis (not common in young ppl)
  • MSK:
72
Q

What is a normal and abnormal frequency for voiding?

A

Every 4h is considered normal

Voiding more than 6x per day, or more frequent than every 2h is abnormal.

73
Q

What is nocturia?

A

Interruption of sleep >1x per night to void

74
Q

What questions may you ask in the urinary history of someone coming in complaining of incontinence?

A

OFNAUSPA

Onset
Frequency
Nocturnal
Amount
Urge (Sudden? Make it in time?)
Stress (Staining, coughing, walking?)
Pads (How many, types?)
Access (to lavatories)
75
Q

What is the conservative, medical and surgical treatment for stress incontinence?

A

Conservative
- Pelvic floor exercises

Medical
- Pseudoephedrine / Duloxetine

Surgical
- Colposuspension (elevation of bladder neck)

76
Q

What are the different causes of urge incontinence that you should question about during a history?

A

BPH / Prostatic Carcinoma

  • Elderly male
  • Sx, from start to end, of hesitancy, intermittency, weak stream, terminal dribbling and feelings of incomplete voiding
  • Metastatic sx include bone pain, weight loss, jaundice

Autonomic Neuropathy

  • MS, PD, DM
  • Other neurological symptoms present

UTI
- Fever, flank/groin/back pain, dysuria, haematuria, confusion, N&V

Stool impaction
- Constipation

Also consider Post Menopausal Atrophic Changes of the Bladder which is seen in post-menopausal women who have not / never undergone HRT

77
Q

What clinical examination would you perform in a patient presenting with incontinence?

A

Performed with comfortably full bladder to demonstrate incontinence with cough

Signs of estrogen deficiency on inspection of genitalia

Uterovaginal descent on straining

Pelvic exam - pelvic mass which may be causing symptoms from pressure effects

Neurological disease, assess S2, S3, S4 dermatomes

78
Q

What is the conservative, medical and surgical management of urge incontinence?

A

Conservative

  • Involve incontinence advisory service
  • Fluid intake habits altered
  • Bladder training for detrusor instability

Medical

  • HRT
  • Abx for UTI
  • Antimuscarinics (oxybutynin / tolterodine)

Surgical
- None

79
Q

What are some common side effects of anticholinergics / antimuscarinics?

A

dry mouth
blurred vision
constipation

80
Q

What investigations should be performed in a patient presenting with incontinence?

A

MSU - To exclude UTI

Urodynamic studies - Stress incontinence will be normal, detrusor instability will produce anomalies

81
Q

How may you examine a patient presenting with symptoms congruent with a prolapse?

A

Record bodyweight, height, and fitness for surgery if indicated.

Inspect for masses, atrophy of genitalia, obvious prolapses.

Ask to cough, look for stress incontinence/prolapse. Describe prolapse.

Use Sim’s Speculum to assess prolapses.

Use bimanual to exclude masses.

82
Q

What is the conservative, medical and surgical management of prolapses?

A

Conservative

  • Stop smoking
  • Loose weight
  • Pelvic floor exercises
  • Pessaries

Medical

  • Vaginal estrogen cream
  • HRT

Surgical

  • Repair of prolapse
  • Hysterectomy
83
Q

How may you explain stress vs urge incontinence?

A

Stress

  • Weak support
  • Gives in to stress
  • Unable to hold urine when pressure increases

Urge

  • Bladder sensitive
  • Urges to go ever if very little volume
  • detrusor instability, sensitivity
84
Q

How may you counsel a surgically-unfit patient on managing her procidentia?

A

Ensure to patient that it is not harmful although it is progressive.

Advise estrogen cream to prevent excoriation and dryness of the vagina. Alternatively, HRT can be prescribed.

Pessaries can be inserted. Intially ring pessaries, then move onto shelf pessaries. 6 monthly replacements, risks of ulcers and excoriations, where if occurring will be remedied with estrogen creams for 2-4 weeks.

Risk of urinary incontinence and fecal impaction with pessaries.

85
Q

What are the causes of post-coital bleeding?

A

Cervical carcinoma
Cervical polyp
Cervical ectropion
Chlamydia

86
Q

What factors should you question the woman about for a couple presenting with sub-fertility?

A

Miscarriages
PCOS
STIs / PID
Cancers

87
Q

What general questions should you ask about a couples sexual relationship who have come in with sub-fertility?

A

Regularity
Problems with sex (pain, erectile dysfunction)
How long trying for?
Previous pregnancies together or with other partners?

88
Q

What factors should you question a man about for a couple presenting with sub-fertility?

A 
Undecended testes
Torsion or trauma
Mumps as an adult
STIs (chlamydia)
Cancer
89
Q

What questions should you ask about in the SH of sub-fertility?

A

Drinking, smoking, drugs

Employment? Tiredness?
Long time spent away from each other?

90
Q

What questions should you ask the woman in DH for sub-fertility?

A

Current medications
Allergies

Have you tried medicines to help with fertility
History of contraception use in the past (take full history)

91
Q

What are the female causes of subfertility?

A

Age
Weight
Unhealthy habits

Systemic conditions (SLE)

Iatrogenic - Surgery / Chemotherapy

Ovulatory disorders

  • PCOS
  • hyperprolactinaemia
  • thyroid
  • premature menopause

Tubular pathology

  • PID
  • Endometriosis

Uterine pathology
- fibroids

92
Q

What are the male causes of subfertility?

A 
V - systemic conditions (SLE)
I - Gonorrhoea, Chlamydia, Mumps
T - Trauma
A - SLE?
M - 
I - chemotherapy, vasectomy
N - testicular cancer, prostate cancer
C - undecended testes
D - 
E - 
F - 
K - downs
93
Q

What medication can be given to stimulate ovulation?

A

clomiphene

94
Q

What method of conception may be offered where there is a problem with the fallopian tubes or sperm quality?

A

IVF

95
Q

What are the causes of pelvic pain?

A

Gyne

  • PID
  • Ectopic pregnancy
  • Ovarian cyst / rupture / torsion / haemorrhage
  • Endometriosis
  • Ovulation pain

Urological

  • Pyelonephritis
  • Renal colic

GI

  • Appendicitis
  • Diverticulitis
  • IBS / IBD
96
Q

Symptoms of PID

A 
BILATERAL pelvic pain
PV Discharge
Dyspareunia and Dysmenorrhoea
Fever
Bleeding post-coital / intermenstrual
Unprotected sex with multiple / new partners
97
Q

Symptoms of ectopic

A

Unilateral pain + spotting + amenorrhoea

Trying to get pregnant / unprotected sex

Usually occurs at 5-9 weeks gestation

In tubal rupture&raquo_space;> collapse and shoulder tip pain

98
Q

Symptoms of ovarian pathology (cyst/rupture/torsion/haemorrhoage)

A

SUDDEN UNILATERAL pelvic pain

Fever & Vomitting

99
Q

Symptoms of endometriosis

A

CYCLICAL pelvic pain
DEEP dyspareunia
Dysmenorrhoea
Menstrual disturbance

100
Q

Symptoms of pyelonpehritis

A

Fever, chills, rigors
Loin pain
Urinary frequency and Dysuria

101
Q

Symptoms of appendicitis

A

Pain periumbilical&raquo_space;> RIF
Anorexia
Young

102
Q

Symptoms of diverticulitis

A

Elderly
LIF
Pyrexic

103
Q

Symptoms of IBD/IBS

A

Change in bowel habits
Lower abdominal pain

IBD: Blood / Mucus PR

104
Q

What are the causes of menorrhagia PV bleeding?

A

DUB (most cases)
Fibroids
Endometriosis

105
Q

What are the causes of inter-menstrual PV bleeding?

A 
Normal spotting at middle of cycle
Breakthrough bleed from contraception
Polyps (cervical or endometrial)
Ectropion
Ectopic
Infection / STI / PID
106
Q

What are the causes of post-coital PV bleeding?

A

Cervical Trauma
Cervical Cancer
Cervical Ectropion
Cervical Polyp

107
Q

What are the causes of post-menopausal PV bleeding?

A 
Cervical Cancer (until proven otherwise!)
Atrophic Vaginitis (90% of cases)
108
Q

What categories of questions should you ask in PV bleeding?

A

Type (menorrhagia/inter/post-coital or menopausal)

Timing (onset, duration, progression, frequency)

Bleeding (pattern, amount, pain)

Anaemia sx (tiredness, breathlessness on exertion)

Thyroid sx (hypothyroidism)

109
Q

What question should you always ask in a PV bleed systems review?

A

Weight loss, night sweats, fatigue

For cervical / endometrial cancer

110
Q

List the possible causes of amenorrhoea / oligomenorrhoea?

A

Gyne

  • Primary amenorrhoea
  • Pregnant
  • PCOS
  • Menopause

Endocrine

  • Hyperthyroidism
  • Hyperprolactinaemia
  • Hypogonadotrophic Hypogonadism
  • Cushings

Other
-Progesterone pill

111
Q

What is primary amenorrhoea?

What are the causes?

A

Menarche not reached by the age of 16

Most commonly constitutional delay
- Mother and siblings may also have a late start

Other causes

  • Testicular feminisation
  • PCOS
112
Q

What are the symptoms of PCOS? What causes these symptoms?

How is it investigated and managed?

A

Oligomenorrhoea more commonly than amenorrhoea

Hiristuism
Acne
Obesity
Subfertility

Sx due to excessive androgen hormones

Investigated by

  • USS
  • Blood glucose may show diabetes (insuline resistance)

Manage by

  • Weight loss
  • Diet
  • COCP for hirustism and irregular periods
  • Metformin for insulin resistance
  • Laparoscopic ovarian drilling
113
Q

What are the common causes of hypogonadotrophic hypogonadism?

What changes to FSH and LH does this cause?

A 
Anorexia
Anxiety
Excessive exercise
Stress
Depression
Starvation

Low FSH and LH levels

114
Q

How is menopause defined?
How is premature menopause defined?

What symptoms may a woman experience during the perimenopause phase (the change)?

A

Menopause: Periods absent for 12 consecutive months

Premature menopause: Menopause before the age of 40

The change: Hot flushes, profuse sweating, loss of libido, vaginal atrophy, irregular periods

115
Q

How is menopause investigated?

How are the symptoms of menopause managed?

A

PV exam - vaginal atropy

Managed

  • Topical: lubrican / cream / estrogen for atrophy
  • HRT
116
Q

What are the symptoms of hyperprolactinaemia?

What are the causes?

How is it investigated?

How is it managed?

A

Galactorrhoea, oligo/amenorrhoea, subfertility, (bitemporal hemianopsia if macroprolactinoma)

Antipsychotic use
Macroprolactinomas (will press on optic nerve)
Pregnancy, breast feeding
Stress

MRI head if visual disturbances

Managed

  • bromocriptine (DA agonist)
  • surgery if visual defect present
117
Q

What are some obstetric causes of PV Bleeding?

A 
Miscarriage
Ectopic
Braxton Hicks
Labour
Pre-eclampsia
Placental abruption
Uterine rupture
Acute fatty liver of pregnancy
118
Q

What are the symptoms of a miscarriage?

A

PV bleeding
Products of conception may be present
Pelvic pain
<24 wks

119
Q

What are the absolute contraindications of the COCP?

A 
Smoker >35 years
<6/52 post-partum
Breastfeeding
Hypertension
Current or past DVT Hx
Migraine with aura
CVD
Current breast cancer
Liver cirrhosis
120
Q

How does the COCP work and prevent conception?

A

Stops ovulation
Thickens cervical mucus
Thins endothelium

121
Q

What formulations of the COCP are available and how is each taken?

A

Pill

  • daily
  • 3 weeks on 1 week off

Patch

  • weekly
  • 3 weeks on 1 week off

Ring

  • changed after 3 week
  • 1 week break between taking out and putting in
122
Q

What are the SE of the COCP?

A

Hormonal SE: acne, headaches, weight gain

Blood clots

Increased risk of Breast and Cervical ca

Local irritation with the patch
Pain during intercourse with ring (can be taken out but only for maximum of 3 hours)

123
Q

What are some benefits of the COCP?

A

Controls periods, pain and bleeding

124
Q

What is the rule for missed doses of COCP?

A

Take ASAP even if with next dose.
If next dose on time then fine.

If missed second dose, take a pill immediately + condom for 7 days

125
Q

What is the treatment course for the minipill?
What are some of the side effects?
What are some of the pros and cons of it?
What should you do if you miss a dose?

A

Take everyday, at exactly the same time

SE: hormonal, irregular bleeding

-ve: needs taking at exactly the same time

Missed: take immediately (even with next one). If more than >3h late then use condom for next 2 days. Use emergency contraception if had unprotected sex 2-3 days before or after missed pill.

126
Q

What are the contraindications for the progesterone only pill?

A

Forgetfulness
Breast cancer
Liver disease
Undiagnosed PV bleeding

127
Q

What cancers can the COCP protect against?

A

Ovarian and endometrial

Hint: COCP protects O and E

128
Q

How does the copper coil work?

A

Copper is a spermicide

Causes uterine inflammation

129
Q

Compare the risks of the copper coil with marina coil

A

Both carry coil insertion risks: infection in first 3 weeks, bleeding, perforation

Copper - may cause heavier periods (think increased uterine inflammation resulting in more bleeding)

Marina - may cause spotting in first 6 months after which periods will be very light / stop

130
Q

What are the contraindications for both the copper and marina coil?

A

Both

  • pelvic infection
  • PID <3 months ago
  • Gyne ca
  • Small uterine cavity
  • undiagnosed PV bleeding

For Copper IUD
- copper allergy

131
Q

What are the contraindications for progesterone implant / injection?

A

liver / genital / breast ca
Liver disease
Undiagnosed PV bleeding

132
Q

How long does the Prog Implant last for?

What are the SE?

What are the + and -?

How is it implanted?

A

3 years

SE: Hormonal, periods spotting / light / stop

+ can forget about it
- some continue to experience spotting

Placed on inner upper arm
Around 4 cm
Under local anaesthetic
Can feel it after procedure

133
Q

What checks need doing before and during the insertion of a coil?

When during the cycle can it be fitted in?

A

STI check prior

Check string present every month

If not had sex since period then can fit any time, or within first 5 days of periods starting

134
Q

Side effects of prog implant

A

Hormonal

Periods > stop/ irregular / longer

Weight gain

Time for fertility to return

Osteoporosis (>2y consider, >5y stop)

135
Q

Drawbacks of prog implant?

A
  • must remember to come back every 3 months
  • time for fertility to return
  • cannot remove so side effects may last 3 months
136
Q

How is a vasectomy performed? How long does the procedure take?

What is the failure rate?

What are some side effects and complications of the procedure?

A

Vas deferens cut and tied by forceps
Local anaesthetics
20 minutes procedure

1/2000 fail

Bleeding bruising infection
Scrotal swelling for first few days
Chronic testicular pain (1-3%)
Irreversible (50%)

137
Q

After a vasectomy…

How long until intercourse?
When sperm free?
When sperm tests?

A

Condom sex - whenever you feel ready

May take up to 3 months for all of sperm to be used up

Sperm count test at 8 weeks and then 2-4 weeks later (both must be -ve)

138
Q

How is tubal ligation performed?

What is the failure rate?
What risks are involved?

A

Clipping of fallopian tubes under GA

1/200

Surgical risks
Anaesthetic risks

139
Q

What are some draw backs of condoms as a method of contraception?

A

Latex allergies

May slip off / break

New one every time

Oil based products may damage latex

140
Q

Screening tests for what two genetic conditions are done at 10 weeks or earlier?

A

Sickle Cell

Beta Thalassaemia

141
Q

Between 8-12 weeks, a screening test for which three infectious diseases is performed?

A

HIV
Hep B
Syphilis

142
Q

What additional screening test should be performed on a diabetic pregnant patient?

A

Eye screening

143
Q

What is the combined test and when is it performed? What does it screen for?

A

Nuchal scanning + Blood test for PaPP and BHCG

11-14 weeks

Pataus
Edawards
Downs

144
Q

When are the newborn checks done and what does it check for?

A

Within 72 hours of being born

Screens for problems with eyes, heart, hips, genetalia (+testes)

145
Q

What is the blood spot test and when is it performed?

A

@5 days old

Screens for rare but serious conditions such as

  • CF
  • Congenital hypothyroidism
  • Sickle cell
  • Inherited metabolic diseases
146
Q

What are the risk factors for miscarriage?

A 
old age
uterine malformation
bacterial vaginosis
thrombophilia
chromosomal anomaly
147
Q

How may an USS differentiate a miscarriage from an ectopic?

A

Products of conception would be visualised in an USS if a miscarriage. Uterus would be empty if it was an ectopic.

148
Q

What investigations should you order in the suspected miscarriage patient?

A

Urine B-HCG to confirm pregnancy

FBC for blood loss

Blood group for rhesus status (if negative, give anti D)

Cross match in case of shock

USS to visualise products vs empty (ectopic)

Serum B-HCG as doubling of levels within 48h indicates a viable intrauterine pregnancy

149
Q

What is the conservative, medical and surgical management of a miscarriage?

A

Conservative

  • Analgaesia
  • Anti-D
  • Wait for expulsion

Medical

  • Analgaesia
  • Misoprostol (pg) for severe vaginal bleeding
  • Mifepristone (anti-prog) induces evacuation of uterus
  • Anti-D

Surgical

  • Suction evacuation
  • GA
  • Analgaesia
  • Oxytocics to facilitate uterine evacuation
  • Mifepristone to facilitate uterine evacuation
  • Anti-D
150
Q

When may methotrexate be appropriate in the management of an ectopic pregnancy?

A

If

  • Haemodynamically stable
  • hCG <5000
  • Unruptured ectopic of <3-4cm
151
Q

What is the surgical management of an ectopic?

A

Salpingotomy/salpingostomy - incision made and ectopic removed

Salpingectomy - removal of ectopic WITH fallopian tube

PLUS methotrexate in either case, prevents failure rate in salpingostomies.

152
Q

What tests should be done after a salpingostomy and a salpingectomy?

A

B-hCG should be measured after both

153
Q

What risk factors, if present, require a hospital birth only?

A

Previous births

  • C section
  • Six children
  • Serious PPH

Current baby

  • Twins / multiple
  • Breech
  • Previa
  • Problems with baby

Maternal factors

  • Anaemia
  • GDM
  • Pre-eclampsia
  • Age >40yrs
  • Obesity

OBGYN (4 decks)

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