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Year 5 > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Topics covered at the booking appointment

A
  • Folic acid until 12 weeks
  • Smoking
  • Dietary advice
  • Alcohol advice
  • Recreational drug advice
  • Physical activity and exercise
  • Screening options
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2
Q

Risks of maternal smoking during pregnancy

A
  • Infertility
  • Miscarriage
  • Preterm birth
  • IUGR
  • Neonatal RDS
  • Cot death
  • Club foot
  • Palate defects
  • Childhood asthma and ear infections
  • Increased hospital admissions in first year of life
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3
Q

Dietary advice given to pregnant women

A
  • Do not eat raw eggs
  • Wash all fruits and veg
  • Cook meat and shellfish thoroughly
  • Avoid large quantities of liver and pate
  • Avoid soft cheese
  • Eat foods high in folic acid
  • Take a vit D supplement
  • AVOID vit A supplements
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4
Q

Factors which should be assessed at each 2nd trimester appointment

A
  • Maternal physical and emotional wellbeing
  • Maternal social situation
  • Maternal BP
  • Maternal urinalysis
  • Pain/weight loss
  • Auscultation of foetal heart from 18 weeks
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5
Q

Additional factors to include in 3rd trimester appointments

A
  • Abdominal exam
  • Assessment of foetal presentation
  • Evaluation of foetal growth with SFH
  • Enquiry about foetal movements
  • CTG and US to identify foetal heart rate and movements
  • Hypertension/preeclampsia screen
  • FBC
  • Red cell antibody screen at 28 weeks
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6
Q

What is included in the Dating scan

A
  • History
  • Examination
  • Abdo exam
  • BMI
  • Obs
  • Urinalysis
  • FBC
  • Blood group
  • Antibody screen
  • Rubella, Hep B, Hep C status
  • Hb electrophoresis
  • Syphillis and HIV screen
  • Blood glucose
  • Abdo US
  • STI screen in <25s
  • U&Es in hyperemesis
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7
Q

Aims of the dating scan

A
  • Identify risk factors
  • Screen for illness/abnormalities
  • Screen for symptoms
  • Confirm pregnancy viability
  • Confirm number of babies and chorionicity/amnionicity
  • Detect gross foetal anomalies
  • Establish gestational age
  • Trisomy screening
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8
Q

Components of the Down syndrome screen offered after 14 weeks

A
  • AFP
  • B-hCG
  • Oestriol
  • Inhibin A
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9
Q

Aims of the foetal anomaly scan

A
  • Identify structural abnormalities

- identify foetal gender

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10
Q

Indications for maternal Rhesus Anti-D in a Rhesus negative mother

A

Dose given as soon as possible after the event, within 72 hours

  • Routinely given at 28 and 34 weeks
  • CVS/Amniocentesis
  • Miscarriage management
  • Threatened miscarriage after 12 weeks gestation
  • Ectopic pregnancy
  • After birth if baby is Rhesus positive
  • ECV
  • Abdominal trauma
  • Antepartum haemorrhage
  • TOP
  • Delivery
  • Stillbirth
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11
Q

Features of amniocentesis

A
  • Performed after 15 weeks

- Miscarriage risk: 1%

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12
Q

Features of CVS

A
  • Performed after 10 weeks

- Miscarriage risk: 1.5-2%

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13
Q

Risk factors for foetal anomalies

A
  • Maternal age
  • FH
  • Consanguinity
  • Maternal pre-existing diabetes or epilepsy
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14
Q

Contra-indications for the COCP

A
  • Current or previous VTE
  • FH of VTE
  • Major surgery with prolonged immobilisation
  • Immobility
  • Thombogenic mutations
  • Smokers age >35
  • Current or previous vascular disease
  • Liver disease
  • Migraine with aura
  • Postpartum breastfeeding
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15
Q

Side effects of COCP

A
  • Increased risk of VTE and vascular disease
  • Small increase in risk of breast and cervical cancer
  • Interacts with anti-epileptics, antiretrovirals, some antibiotics, St johns wort
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16
Q

Benefits of the COCP

A
  • Reduced risk of ovarian, endometrial and colorectal cancer
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17
Q

Side effects of POP

A
  • Irregular bleeding
  • Abdo bloating
  • Weight changes
  • Acne
  • Headache
  • Mood changes
  • Interacts with anti-epileptics, antiretrovirals, some antibiotics, St johns wort
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18
Q

Side effects of progesterone injection

A
  • WEIGHT GAIN
  • Unpredictable bleeding then amenorrhoea
  • DELAY IN RETURN OF FERTILITY for up to 1 year
  • REVERSIBLY LOSS OF BONE MINERAL DENSITY
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19
Q

How long does the progesterone injection last?

A

12 weeks

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20
Q

How long does the progesterone implant last?

A

3 years

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21
Q

Side effects of the progesterone implant

A
  • Changes in bleeding pattern

- Risk of deep insertion

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22
Q

How long does the progesterone IUS last?

A

3-5 years

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23
Q

Contraindications to the IUS

A
  • 48 hours-4 weeks postpartum
  • Organ transplant
  • Post-abortion sepsis
  • Long QT syndrome
  • Unexplained vaginal bleeding
  • HIV with CD4 <200
  • Gestational trophoblastic neoplasia
  • Cervical or endometrial cancer
  • Radical trachelectomy
  • Current STI/PID
  • Known pelvic TB
  • Structural uterine anomalies
  • Postpartum sepsis
  • Current/previous breast cancer
  • Severe decompensated liver cirrhosis
  • HCC
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24
Q

Side effects of IUS/IUD

A
  • Discomfort
  • Irregular bleeding - HEAVIER BLEEDING IN IUD
  • Uterine perforation
  • Expulsion
  • Lost threads
  • Pelvic infection
  • Increased risk of ectopic pregnancy
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25
Q

Contraindications to IUD

A
  • 48 hours-4 weeks postpartum
  • Organ transplant
  • Post-abortion sepsis
  • Long QT syndrome
  • Unexplained vaginal bleeding
  • HIV with CD4 <200
  • Gestational trophoblastic neoplasia
  • Cervical or endometrial cancer
  • Radical trachelectomy
  • Current STI/PID
  • Known pelvic TB
  • Structural uterine anomalies
  • Postpartum sepsis
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26
Q

How long after unprotected sex can levonorgestrel be used?

A

72 hours (PRIOR to ovulation)

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27
Q

How long after unprotected sex can ulipristal acetate be used?

A

5 days after unprotected intercourse or 5 days after earliest likely date of ovulation

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28
Q

Contraindications for ulipristal acetate

A
  • Liver enzyme-inducing drugs
  • Severe asthma controlled by oral steroids
  • Breast-feeding women: discard milk for 1 weeks after taking
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29
Q

How long after taking ulipristal acetate must a woman wait to start using hormonal contraception?

A

5 days

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30
Q

How long after unprotected sex can the copper IUD be used?

A

5 days after unprotected intercourse or 5 days after earliest likely date of ovulation

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31
Q

Causes of high hCG/hyperemesis gravidarum

A
  • Multiple pregnancy
  • Molar pregnancy
  • Germ cell tumours
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32
Q

Prevalence of miscarraige

A

1 in 4

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33
Q

Risk factors for miscarriage

A
  • Obesity
  • Age >35
  • History of IUD, Ashermann’s
  • Maternal illness
  • CVS or amniocentesis
  • Uterine malformation
  • Bac vag
  • Thrombophilia
  • Smoking
  • Alcohol
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34
Q

Clinical features of miscarriage

A
  • PV bleeding
  • Suprapubic pain
  • Recent post-coital bleed
  • Asymptomatic
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35
Q

Investigations for suspected miscarriage

A
  • Urine pregnancy test
  • FBC and blood group
  • Serum BhCG
  • Transvaginal US
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36
Q

Management of a miscarraige

A
  • Watchful waiting
  • Medical management: single dose vaginal misoprostol
  • Surgical evacuation
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37
Q

Follow up after a miscarriage

A
  • Pregnancy test in 3 weeks - if this is positive, US scan to confirm uterus is empty
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38
Q

Prevalence of recurrent miscarraige

A

1%

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39
Q

Define recurrent miscarriage

A

3 or more consecutive miscarriages

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40
Q

Causes for recurrent miscarriage

A
  • Parental genetic anomaly
  • Uterine abnormality
  • PCOS
  • Antiphospholipid syndrome
  • Thrombophilia defects
  • Cervical incompetence
  • Bac vag
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41
Q

Prevalence of ectopic pregnancy

A

1%

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42
Q

Define an ectopic pregnancy

A

A pregnancy which has implanted outside the uterine cavity, most commonly in the ampulla of the Fallopian tube

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43
Q

Sites of ectopic pregnancy

A
  • Cervix
  • Fallopian tubes
  • Ovary
  • C-section scar
  • Intra-abdominally
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44
Q

Risk factors for ectopic pregnancy

A
  • PID
  • Previous ectopic
  • Tubal surgery
  • Peritonitis
  • Previous pelvis surgery
  • IUD in situ
  • IVF/infertility
  • Endometriosis
  • POP
  • In utero exposure of mother to diethylsillboestrol
  • Smoking
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45
Q

Clinical features of ectopic pregnancy

A
  • Abdo pain
  • Shoulder tip pain
  • Amenorrhoea
  • Vaginal bleeding
  • Bowel upset
  • Adnexal tenderness/mass
  • Blood in vaginal vault
  • Circulatory shock/collapse
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46
Q

Investigations in ectopic pregnancy

A
  • Urine/serum hCG (lower than expected)
  • High resolution TVUS: ‘donut sign’ or ‘ring of fire’
  • TAUS
  • Laparoscopy
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47
Q

Management options for ectopic pregnancy

A
  • Watchful waiting
  • Methotrexate IM or direct injection
  • Surgery: salpingectomy, salpingotomy
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48
Q

Indications for watchful waiting in ectopic pregnancy

A
  • hCG <1500 and falling
  • No foetal heartbeat
  • Reliable patient
  • Minimal symptoms
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49
Q

Indications for methotrexate in ectopic pregnancy

A
  • Tube intact
  • Mass <3.5cm
  • hCG <1500
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50
Q

Side effects of methotrexate management of an ectopic

A
  • Can’t conceive for 3 months
  • Bone marrow suppression (CI in active infection)
  • Stomatitis
  • Requires follow up with FBC, LFTs, u&Es, hCG on day 1 and 4
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51
Q

Indications for surgical management in ectopic pregnancy

A
  • Significant pain
  • Mass >3.5cm
  • Foetal heartbeat on US
  • hCG >5000
  • Failed medical management
  • Haemodynamically unstable
  • Significant free fluid
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52
Q

Follow up required after management of an ectopic pregnancy

A
  • Serial B-hCG levels

- Urine pregnancy test at 3 weeks

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53
Q

Prevalence of molar pregnancies

A

1 in 1000

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54
Q

Clinical features of a molar pregnancy

A
  • Early PV bleeding
  • Vaginal discharge
  • Abdo pain
  • Hyperemesis gravidarum
  • Large for dates uterus
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55
Q

Investigations for a molar pregnancy

A
  • US scan: ‘bunch of grapes’
  • Histopathology
  • Serum hCG (very high)
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56
Q

Management of molar pregnancy

A

Surgical uterine evacuation

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57
Q

Follow up for molar pregnancy

A
  • 2-weekly serum BhCG for 6 months after evacuation or from first normal hCG level
  • If levels rise or plateau, methotrexate must be started
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58
Q

Define SGA

A

A foetus whose estimated weight or birth weight is below the 10th centile

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59
Q

Define FGR

A

A foetus which fails to reach it’s genetic growth potential

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60
Q

Risk factors for SGA/FGR babies

A
  • Maternal age >40
  • Smoking >10/day
  • Cocaine
  • Previous SGA baby
  • Previous stillborn baby
  • Chronic hypertension
  • Diabetes with vascular disease
  • Renal impairment
  • Antiphospholipid syndrome
  • Threatened miscarriage
  • Preeclampsia
  • Placental abruption
  • Unexplained antepartum haemorrhage
  • Abnormal uterine artery Doppler
  • Low PAPP-A
  • Hyperechogenic foetal bowel
  • Foetal chromosomal or structural anomalies
  • Maternal malnutrition
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61
Q

Screening for mothers with ?SGA babies

A

Serial US foetal biometry from 26-28 weeks onward

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62
Q

Normal SFH

A

Approximately equal to gestational age +/- 2cm

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63
Q

Management of ?SGA/FGR babies

A
  • Screening by serial US scans
  • US confirmation
  • Exclusion of foetal anomaly
  • Doppler studies
  • Monitor as appropriate
  • Deliver if foetal demise is anticipated
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64
Q

Complications of FGR

A
  • Stillbirth
  • Birth hypoxia
  • Operative delivery
  • Neonatal complications
  • Impaired neurodevelopment
  • T2DM and coronary artery disease in adult life
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65
Q

Risk factors for bacterial vaginosis

A
  • excessive washing/douching
  • sexual activity
  • recent change in sexual partner, frequent changes, multiple regular partners
  • no condom use
  • history of STIs
  • smoking
  • IUD
  • Afro-Caribbean ethnicity
  • Prolonged/heavy periods
  • Hormonal changes
  • Recent use of antibiotics
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66
Q

Clinical features of BV

A
  • Watery grey fishy discharge, particularly after sex or after a period
  • painless, no itch
  • dyspareunia
  • vaginal pH >4.5
  • Vaginal discharge swab: clue cells
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67
Q

Management of BV

A

7 days PO metronidazole

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68
Q

Complications of BV

A
  • Vaginal vault infection following hysterectomy
  • postpartum endometritis following C-section
  • PID after surgical TOP
  • HIV infection
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69
Q

Risk factors for thrush

A
  • Pregnancy
  • Hormonal contraception
  • Diabetes
  • Immunosuppression
  • Recent antibiotics
  • Vulval irritation/trauma
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70
Q

Clinical features of candida infection

A
  • Vaginal itching or pain
  • Dyspareunia
  • Dysuria
  • Thick white cottage cheese discharge
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71
Q

Diagnosis of candida

A
  • Clinical

- Vaginal discharge swab

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72
Q

Management of candida

A
  • Clotrimazole pessary + cream

- PO Fluconazole + clotrimazole cream

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73
Q

Risk factors for chlamydia

A
  • Age <25
  • Sexual activity with infected partner
  • New sexual partner
  • Multiple sexual partners
  • History of STIs
  • No condoms
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74
Q

Clinical features of chlamydia

A
  • Asymptomatic
  • Cervical cloudy yellow discharge
  • Friable cervix
  • Abnormal vaginal bleeding
  • penile/vaginal discharge: odourless mucoid or mucopurulent
  • Dysuria
  • Scrotal pain
  • lower abdo pain
  • Dyspareunia
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75
Q

Diagnosis of chlamydia

A
  • Vaginal swab/first void urine for NAAT
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76
Q

Management of chlamydia

A

10 days PO doxycycline (azithromycin in pregnancy)

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77
Q

Complications of chlamydia

A
  • PID/tubal infertility
  • Chronic pain
  • Epididymitis
  • Prostatitis
  • Reactive arthritis
  • Skene’s and Bartholin’s abscesses
  • Endometritis/salpingitis/peripherpatitis
  • Miscarriage
  • Preterm birth
  • Postpartum infection
  • Neonatal ocular and respiratory infection
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78
Q

Risk factors for gonorrhoea

A
  • Age 15-24
  • Black ancestry
  • Current/past history of STIs
  • Multiple recent sexual partners
  • Inconsistent condom use
  • MSM
  • Partners with risk factors
  • History of physical or sexual abuse
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79
Q

Clinical features of gonorrhoea

A
  • Asymptomatic
  • Mucopurulent discharge
  • Friable cervix
  • Pelvic pain
  • Post-coital/inter-menstrual bleeding
  • Lower abdo pain
  • Urethral irritation/dysuria
  • Rectal bleeding
  • Pharyngitis
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80
Q

Diagnosis of gonorrhoea

A
  • Vaginal swab/first void urine for NAAT
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81
Q

Management of gonorrhoea

A

IM ceftriaxone + oral azithromycin

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82
Q

Complications of gonorrhoea

A
  • PID
  • Chronic pelvic pain
  • Male infertility
  • Prostatitis
  • Bartholinitis
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83
Q

Risk factors for herpes

A
  • HIV
  • Immunosuppression
  • High risk sexual behaviour
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84
Q

Clinical features of herpes

A
  • Asymptomatic
  • Painful genital ulcers
  • dysuria
  • Painful inguinal lymphadenopathy
  • Tingling sensation
  • Oral ulcers
  • Systemic upset
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85
Q

Investigations in herpes

A
  • HSV PCR or viral culture from lesions

- Glycoprotein G1 and 2: useful to assess risk in asymptomatic pregnant women

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86
Q

Management of herpes

A
  • Oral Aciclovir for 5 days within 3 days of symptom onset (10 days and higher doses for immunosuppression)
  • PO Aciclovir for 3 days in recurrent episodes
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87
Q

Risk factors for HIV

A
  • IVDU
  • Unprotected sexual intercourse, especially MSM
  • Tattoos, piercing
  • Blood transfusion
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88
Q

Clinical features of HIV

A
  • Fevers/night sweats
  • Unexplained weight loss
  • Skin rashes and post-inflammatory scars
  • Mouth ulcers, angular chellitis, oral thrush, oral hairy leukoplakia
  • Diarrhoea
  • Wasting syndrome
  • Changes in mental state or neuropsychiatric function
  • Generalised lymphadenopathy
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89
Q

Investigations for HIV

A
  • Serum HIV rapid test: may be falsely negative in first month
  • CD4+ cell count
  • Serum viral load
  • Other BBV testing
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90
Q

Management of HIV

A

3 antiretrovirals

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91
Q

Indications for PrEP

A
  • Regular partner with detectable HIV load
  • MSM and transgender women who have had unprotected anal sex with more than one partner in the last year
  • Rectal STIs
  • Anyone else at equivalent risk
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92
Q

When can PEPSE be used?

A

For up to 72 hours post-exposure to HIV

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93
Q

Cause of genital warts

A

HPV 6 and 11

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94
Q

Clinical features of genital warts

A
  • Asymptomatic warts round vaginal or penile opening

- Itching, bleeding or pain

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95
Q

Diagnosis of genital warts

A
  • Clinical

- Biopsies if lesions bleed, are ulcerated or indurated

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96
Q

Management of genital warts

A

1) Topical podophyllotoxin or imiquimod

2) Cryotherapy or surgical excision

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97
Q

Complications of genital warts

A
  • Anogenital cancer
  • Head and neck cancer
  • Scarring after treatment
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98
Q

Risk factors for syphilis

A
  • Sexual contact with an infected person
  • MSM
  • IVDU
  • Commercial sex workers
  • Multiple sexual partners
  • HV
  • Other STIs
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99
Q

Clinical features of syphilis

A

1) Indurated PAINLESS anogenital ulcer
2) Widespread symmetrical non-pruritic maculopapular rash involving palms and soles, alopecia, condylomata lata, generalised lymphadenaopthy, oral snail-track lesions, systemic upset
3) Neurosyphilis: tabes dorsalis, general paresis, stroke
Cardiovascular syphilis: aortitis, aortic aneurysms
Granulomatous syphilis: formation on granulomas on bone, skin and mucosa

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100
Q

Investigations in syphilis

A
  • Serum treponemal serology
  • Serum rapid plasma reagin or VDRL test
  • Syphilis PCR from swab from lesion
  • Dark-field microscopy of swab from lesion
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101
Q

Management of syphilis

A

Single dose IM benzathine Benzylpenicillin and PO prednisolone for 3 days

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102
Q

Complications of syphilis

A
  • Jarisch-Herxheimer reaction

- HIV

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103
Q

Clinical features of trichomoniasis

A
  • Thin, frothy, yellow fishy smelling discharge
  • Vulval pruritus
  • Dysuria
  • Dyspareunia
  • Balanitis
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104
Q

Investigations in trichomoniasis

A
  • Vaginal pH: >5
  • High vaginal swab and wet mount microscopy
  • Culture of vaginal discharge
  • Urethral swab/first void urine
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105
Q

Management of trichomoniasis

A

Single dose PO metronidazole OR 5-7 days metronidazole

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106
Q

Complications of trichomoniasis

A
  • PID
  • Altered vaginal flora
  • Prostatitis
  • PROM and preterm birth
  • LBW
  • HIV
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107
Q

Risk factors for PID

A
  • Age <25
  • Single
  • Young at first sexual intercourse
  • High frequency of sexual intercourse
  • Multiple sexual partners
  • Past history of STI
  • Past history of PID
  • Recent uterine instrumentation
  • Use of IUD
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108
Q

Causes of PID

A
  • Chlamydia
  • Gonorrhoea
  • Mycoplasma genitalium
  • Gardnerella vaginalis
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109
Q

Clinical features of PID

A
  • Bilateral pelvic/lower abdo pain
  • Deep dyspareunia
  • Dysmenorrhoea
  • Increased vaginal discharge
  • Fever
  • Asymptomatic
  • Infertility
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110
Q

Diagnostic criteria of PID

A

At least 3 of:

  • Temp >37.5
  • Abdo tenderness
  • Purulent vaginal discharge
  • Cervical excitation
  • Adnexal tenderness
  • Adnexal swelling
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111
Q

Investigations for PID

A
  • Bloods
  • Blood cultures
  • STI screen
  • Pregnancy test
  • US
  • Laparoscopy (gold standard)
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112
Q

Management of PID

A

14 days PO doxycycline and metronidazole

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113
Q

Complications of PID

A
  • Pelvic abscess
  • Sepsis
  • Infertility
  • Ectopic pregnancy
  • Chronic pelvic pain
  • Dyspareunia
  • Menstrual disturbances
  • Psychological effects
  • Fitz-Hugh-Curtis syndrome
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114
Q

Risk factors for a high risk pregnancy

A
  • Extremes of maternal age
  • > 6 previous births
  • High or low BMI
  • Smoking, drugs, alcohol
  • Social difficulties
  • First pregnancy
  • Infertility/IVF
  • FH of high risk pregnancies
  • Miscarriage, stillbirth or neonatal death
  • Medical conditions
  • Recurrent miscarriage
  • Pelvic surgery
  • Maternal mental illness
  • Previous preterm birth
  • Previous SGA baby
  • Previous pregnancy-related disease
  • IOL
  • Operative delivery
  • PPH
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115
Q

Risk factors for gestational diabetes

A
  • FH of diabetes
  • BMI >30
  • Previous baby >4.5kg
  • Previous GDM
  • Ethnic minorities
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116
Q

Screening for gestational diabetes

A

OGTT at 24-28 weeks

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117
Q

Diagnostic criteria for gestational diabetes

A
  • Fasting glucose >5.6

- OGTT >7.8

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118
Q

Management of gestational diabetes

A

1) Dietary advice and weight loss
2) Metformin
3) Insulin

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119
Q

Delivery in women with diabetes

A

IOL between 37 and 39 weeks

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120
Q

Delivery in women with gestational diabetes

A

IOL by 41 weeks if no complications

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121
Q

Complications of diabetes in pregnancy

A
  • Foetal congenital abnormalities e.g. cardiac defects, neural tube defects, renal anomalies
  • Preeclampsia
  • maternal infection
  • Polyhydramnios
  • Macrosomia with organomegaly
  • Neonatal polycythaemia
  • Unexplained intrauterine death
  • Shoulder dystocia
  • Neonatal hypoglycaemia
  • Hyaline membrane disease/RDS
  • Development of diabetes
  • Recurrent GDM in future pregnancies
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122
Q

Define preeclampsia

A

Hypertension developing after 20 weeks gestation with one or more of:

  • Proteinuria
  • Maternal organ dysfunction
  • Foetal growth restriction
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123
Q

Define eclampsia

A

Neurological involvement (generalised tonic clonic seizures) in a woman with preeclampsia, when seizures can not be attributed to another cause

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124
Q

Prevalence of preeclampsia

A

<5%

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125
Q

Risk factors for gestational hypertension and preeclampsia

A
  • First pregnancy
  • FH
  • Extremes of maternal age
  • New sexual partner
  • Obesity
  • Medical conditions e.g. hypertension, renal disease, thrombophilia, connective tissue disease, diabetes, autoimmune disease
  • Multiple pregnancy
  • History of preeclampsia
  • Complete molar pregnancy
  • Triploidy
  • Hydrops fetalis
  • Inter-pregnancy interval of >10 years
  • Donor insemination
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126
Q

Symptoms of preeclampsia

A
  • Severe headache
  • Severe RUQ/epigastric pain
  • Sudden swelling of hands/feet/face
  • Visual disturbance
  • Vomiting
  • Restlessness/agitation
  • Hyperreflexia
  • Clonus
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127
Q

Investigations in women with preeclampsia

A
  • BP: raised
  • Urinalysis: proteinuria
  • 24 hour urinary collection
  • FBC: haemolytic anaemia, decreased platelets
  • U&Es: raised creatinine and urea
  • LFTs: elevated
  • Coagulation screen
  • Fundoscopy
  • SFH
  • Growth scan US
  • Umbilical artery Doppler
  • Uterine artery doppler velocimetry
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128
Q

Management of preeclampsia

A
  • Daily aspirin 75mg from 12 weeks gestation for high risk women
  • Admit for assessment and initial diagnosis
  • Antihypertensives to reduce BP <150/100
    1) Labetaolol (CI in asthma)
    2) Nifedipine
  • Monitoring of maternal fluid input and output
  • Monitor O2 sats, U&Es, LFTs, Hb, haematocrit, platelets, coagulation
  • MgSo4 to prevent seizures
  • Elective delivery at 37 weeks
  • Continued monitoring postpartum
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129
Q

Management of gestational hypertension without proteinuria

A
  • Repeat BP measurement if BP is elevated
  • BP and urinalysis 2x weekly
  • Serum biochemistry and haematology 1x weekly
  • Advise to return to hospital if she feels unwell
  • Antihypertensives if BP consistently >150/100
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130
Q

Indications for immediate delivery in preeclampsia

A
  • Gestation >37 weeks
  • Uncontrolled hypertension
  • Deteriorating liver/renal function
  • progressive fall in platelets
  • Neurological complications
  • Deteriorating foetal condition
  • Abnormal foetal HR
  • HELLP syndrome
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131
Q

Complications of preeclampsia

A
  • FGR
  • Foetal hypoxia and neurological deficits
  • Intrauterine death
  • Premature birth
  • Longterm foetal cardiovascular morbidity
  • Placental rupture
  • DIC
  • HELLP syndrome
  • Pulmonary oedema
  • Aspiration
  • Eclampsia
  • Liver failure
  • Hemorrhagic stroke
  • Long term maternal cardiovascular morbidity
  • Maternal death
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132
Q

Management of eclampsia

A
  • Turn patient to left hand side
  • Secure airway
  • High flow oxygen
  • IV MgSO4 followed by IV infusion for at least 24 hours following delivery or last seizure
  • Urgent delivery
  • Paralysis and ventilation in prolonged recurrent seizures
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133
Q

Risk factors for VTE in pregnancy

A
  • Age >35
  • BMI >30
  • Para 3+
  • Gross varicose veins
  • Current infection
  • Preeclampsia
  • Immobility
  • Major current illness
  • C-section
  • Extended major pelvic or abdominal surgery
  • Personal or family history
  • Antiphospholipid syndrome
  • Paralysis of lower limbs
  • Smoking
  • Multiple pregnancy
  • IVF
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134
Q

Clinical features of VTE

A
  • Calf tenderness
  • Calf swelling
  • Breathlessness
  • Chest pain
  • Abdo pain
  • Groin pain
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135
Q

Thromboprophylaxis used in pregnancy

A

LMWH

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136
Q

Investigations in VTE

A
  • Duplex Doppler US
  • X-ray venography
  • V/Q scan
  • CTPA
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137
Q

Effects on foetus of chickenpox in pregnancy

A
  • Limb deformity
  • Skin scarring
  • Eye abnormalities
  • Neurological abnormalities
  • Hydrops fetalis
  • Microcephaly
  • IUGR
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138
Q

Management of chickenpox in pregnancy

A
  • Check immunisation status
  • Give varicella IgG if mum is exposed
  • Neonatal IgG if delivery occurs within 5 days of maternal infection or mother develops chickenpox within 2 days of birth
  • Neonatal infection: Acyclovir
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139
Q

Effects on foetus of rubella in pregnancy

A
  • Miscarriage
  • IUGR
  • Low platelets
  • Hepatosplenomegaly
  • Jaundice
  • Sensorineural deafness
  • Congenital heart disease
  • Neurodevelopmental disorders
  • Cataracts
  • Microphthalmia
  • Microcephaly
  • CP
  • Pulmonary stenosis
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140
Q

Management of rubella in pregnancy

A
  • Consider TOP if <12 weeks

- Postnatal maternal vaccination

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141
Q

Effects on foetus of toxoplasmosis in pregnancy

A
  • Hydrocephalus
  • Chorioretinitis
  • Intracranial calcification
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142
Q

Management of toxoplasmosis in pregnancy

A

Consider TOP if primary infection <20 weeks

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143
Q

Effects on foetus of CMV in pregnancy

A
  • Hepatosplenomegaly
  • Low platelets
  • IUGR
  • Microcephaly
  • Sensorineural deafness
  • Chorioretinitis
  • Hydrops fetalis
  • Exomphalos
  • CP
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144
Q

Delivery of women with HSV

A
  • Primary herpes should be treated with Acyclovir, continued to delivery if >28 weeks
  • Vaginal delivery encouraged if >6 weeks after primary infection
  • Elective C-section if >28 weeks with primary infection
  • Acyclovir from 34 weeks in recurrent episodes
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145
Q

Complications of twin pregnancies

A
  • Hyperemesis
  • Anemia
  • Preeclampsia
  • Antepartum haemorrhage
  • VTE
  • Gestational diabetes
  • General discomfort
  • Varicose veins
  • Dependent oedema
  • Delivery trauma
  • C-section
  • PPH
  • Psychological disorders
  • Breastfeeding and parenting challenges
  • Chromosomal abnormalities
  • Structural defects
  • Preterm birth
  • FGR
  • Twins with one foetal death
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146
Q

Antenatal complications specific to monochorionic twin pregnancies

A
  • Twin to twin transfusion syndrome
  • Twin anaemia polycythaemia sequence
  • Severe selective IUGR
  • Cord entanglement
  • Twin reversed arterial perfusion sequence
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147
Q

Delivery in twin pregnancies

A

At 37 weeks in dichorionic twins

At 36 weeks in monochorionic twins

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148
Q

Indications for a C-section in a twin pregnancy

A
  • Significant growth discordance
  • Concern about foetal wellbeing
  • <34 weeks gestation
  • Previous C-section
  • Twin II is transverse
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149
Q

Prevalence of polyhydramnios

A

0.5-2%

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150
Q

Risk factors for polyhydramnios

A
  • Maternal diabetes

- Congenital foetal anomaly

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151
Q

Define polyhydramnios

A
  • A single pool of amniotic fluid >8cm in depth AND/OR

- Amniotic fluid index >90th centile for gestational age

152
Q

Complications of polyhydramnios

A
  • Placental abruption
  • Malpresentation
  • Cord prolapse
  • LGA
  • C-section
  • PPH
  • Premature birth
  • Perinatal death
153
Q

Management of polyhydramnios

A
  • Increased foetal surveillance
  • Exclusion of gestational diabetes
  • Examination of neonate for congenital anomalies e.g. oesophageal atresia
154
Q

Prevalence of oligohydramnios

155
Q

Define oligohydramnios

A
  • AFI <5 cm OR

- Single cord-free pool of amniotic fluid <2cm

156
Q

Complications of oligohydramnios

A
  • Prolonged pregnancy
  • Rupture of membranes
  • IUGR
  • Fetal renal anomalies
  • Fetal hypoxia due to cord compression
157
Q

Prevalence of prolonged pregnancies

158
Q

Define prolonged pregnancy

A

Pregnancy continuing beyond 42 weeks

159
Q

Management of prolonged pregnancy

A
  • Membrane sweeps and IOL offered between 41 and 42 weeks

- If declined, offer a 2x weekly CTG and US estimation of amniotic fluid volume

160
Q

Prevalence of infertility

161
Q

Risk factors for infertility

A
  • Smoking
  • Previous pelvic infection
  • Previous pelvic surgery
  • Regular NSAIDs
  • Cannabis
  • Ashermann’s syndrome
162
Q

Causes of male factor infertility

A
  • Genetic causes
  • Acute illness
  • Alcohol binge
  • Drugs
  • Vasectomy
  • Obstructive disease
163
Q
  • Low LH
  • Low FSH
  • Low oestrogen
  • Normal/low testosterone
  • Normal prolactin
  • Normal TFTs
A

Hypogonadotrophic hypogonadism:

  • Low BMI
  • Pre-pubertal
  • Stress
  • Systemic illness
  • Sheehan’s syndrome
164
Q

Management options for hypogonadotrophic hypogonadism

A
  • Lifestyle modification: weight gain, stress management

- GnRH pulses or LH/FSH injections

165
Q
  • Low LH
  • Low FSH
  • Low oestrogen
  • Normal/low testosterone
  • HIGH prolactin
  • Normal TFTs
A

Hyperprolactinaemia

  • Breast feeding
  • Prolactinoma
166
Q

Management options for hyperprolactinaemia

A
  • Dopamine agonists
  • Cessation of implemented drugs
  • Surgical removal of prolactinoma
167
Q
  • HIGH LH
  • HIGH FSH
  • Low oestrogen
  • Normal/low testosterone
  • Normal prolactin
  • Normal TFTs
A

Premature ovarian failure:

  • Turner syndrome
  • Chemotherapy
168
Q

Management of premature ovarian failure

169
Q
  • HIGH LH
  • HIGH FSH
  • Normal oestrogen
  • HIGH testosterone
  • Normal prolactin
  • Normal TFTs
170
Q

Management of PCOS

A

1) Lifestyle modification
2) Metformin
3) COCP
4) Clomifene citrate for 5 days at start of cycle

171
Q

Management of tubal infertility

172
Q

Investigations for infertility

A
  • BMI
  • Signs of PCOS
  • Secondary sexual characteristics
  • Vaginal examination
  • Testicular examination
  • STI screen
  • Evidence of MMR immunisation
  • 21 day progesterone
  • Sex hormones
  • Semen analysis: 2 samples 12 weeks apart after 3 days abstinence from ejaculation
  • TVUS
  • HSG or lap and dye or hysterosalpingo contrast sonography
  • Serial US or hysteroscopy
173
Q

Clinical features of OHSS

A
  • Abdominal distention
  • Nausea and vomiting
  • Abdominal discomfort
  • Ascites
  • Pleural effusion
  • Hepatorenal failure
  • ARDS
  • Thromboembolism
174
Q

Stages of labour

A

1) From onset until full cervical dilatation:
a) Latent: cervical effacement and dilatation to 4cm
b) Active/established: regular, longer stronger contractions and dilatation from 4-10cm

2) From full cervical dilatation until delivery of the baby
a) Propulsive: from full dilatation until head descends onto pelvis floor
b) Expulsive: from time mother has irresistible urge to push to delivery

3) From birth of baby to delivery of placenta

175
Q

Diagnosis of labour

A
  • Regular contractions and a fully effaced cervix

OR

  • Regular contractions + a show or spontaneous membrane rupture
176
Q

Monitoring during labour

A
  • Baseline BP, pulse, temp, urinalysis
  • Baseline assessment of length, strength, frequency and contractions
  • Confirm if membranes have ruptured or not, colour and volume of amniotic fluid
  • Assessment of contractions using abdo palpation
  • 4 hourly VE
  • Intermittent FHR: for 1 min before and after contractions, at least every 15 mins in first stage and 5 mins in second stage
177
Q

Indications for CTG monitoring in labour

A
  • High risk pregnancy
  • Abnormal intermittent auscultation
  • Abnormal maternal obs
  • PV bleeding/antepartum haemorrhage
  • Thick meconium-stained amniotic fluid
  • Oxytocin use
  • Hypertonus
  • Tachysystole
  • Epidural
  • FGR or SGA
  • Preeclampsia/hypertension
  • Precipitate labour
  • Preterm labour
  • Prolonged labour
  • IOL or augmentation with Syntocinon
  • Previous C-section
178
Q

Define a suspicious CTG

A
  • One non reassuring and two reassuring features
179
Q

Define a pathological CTG

A
  • One abnormal feature OR

- Two non reassuring features

180
Q

CI to FBS

A
  • Risk of infection transmitted from the mother
  • Foetal bleeding disease
  • <34 weeks gestation
  • Acute even necessitating immediate delivery
181
Q

Action if FBS pH is 7.2107.25

A

Repeat in 30-60 mins if not delivered

182
Q

Action if FBS pH is <7.2

A

Instrumental delivery or C-section

183
Q

Grades of perineal tears

A

1) Injury to vaginal epithelium and vulval skin
2) Injury to perineal muscles but not anal sphincter
3) Injury to perineum involving the anal sphincter complex
4) Injury to the perineum involving the anal sphincter and anal/rectal muscle

184
Q

Indications for episiotomy

A
  • Instrumental delivery
  • Fetal distress
  • Extensive scarring
  • Rigid perineum which is preventing delivery
  • Large tear is suspected
  • Shoulder dystocia
185
Q

Complications of episiotomy

A
  • Extension
  • Bleeding
  • Pain
  • Infection
  • Scarring
  • Dyspareunia
  • Fistula
186
Q

Active management of the third stage of labour

A
  • Oxytocin IM (+/- Ergometrine)
  • Double clamping of the cord after delayed cord clamping
  • Observe for signs of separation of the placenta
  • Stabilise the uterus during controlled cord traction
  • Empty bladder
  • Massage fundus to ensure it is well contracted
187
Q

Risk factors for PPH

A
  • Age of mother
  • Previous PPH
  • Large baby
  • Placental abruption
  • Preeclampsia
  • Long labour
  • Multiple pregnancy
188
Q

Non-pharmacological methods of pain management in labour

A
  • Massage
  • Heat pads
  • Mobilisation
  • Birthing pool/immersion in warm water
  • Breathing exercises
  • Creation of a calm environment
  • 1:1 midwifery care
  • TENS machine
  • Acupuncture
189
Q

Analgesics for use in labour

A
  • Paracetamol
  • Dihydrocodeine
  • Entonox
  • IM Diamorphine OR pethidine + antiemetic
  • IV remifentanil
  • Sterile water injections
  • Pudendal nerve block
  • Epidural
  • Spinal
190
Q

Side effects of entonox

A
  • Nausea
  • Vomiting
  • Drowsiness
  • Lightheadedness
191
Q

CI for IM diamorphine in labour

A
  • Delivery expected within 4 hours
192
Q

Side effects of diamorphine

A
  • Nausea
  • Vomitnig
  • Drowsiness
  • Short term respiratory distress and drowsiness in the neonate
193
Q

Advantages and disadvantages/side effects of an epidural

A
  • Effective
  • Fast
  • Reduces adrenaline
  • Can be topped up
  • Non-drowsy
  • No neonatal effects
  • Incomplete block
  • Hypotension
  • Reduced mobility
  • Tenderness over insertion site
  • Dural puncture headache
  • Respiratory distress if migrates into subarachnoid space
  • Abscess
  • Haematoma
  • Needs secure IV access and continuous CTG monitoring
  • Needs regular BP monitoring
  • Increased risk of prolonged second stage and instrumental delivery
194
Q

Indications for an epidual

A
  • Maternal request
  • Expectation of operative delivery
  • Maternal cardiac or respiratory distress
  • Preeclampsia
  • Trial of labour after previous LUCS
  • Neurological disease
  • Obstetric disease
  • Breech delivery
  • Multiple pregnancy
  • GA contraindicated
  • Intrauterine death
195
Q

CI to an epidural

A
  • Overlying skin infection
  • Hypotension
  • Coagulation disorders
  • Sepsis during labour
  • Maternal refusal
  • Uncontrolled hypovolaemia or haemorrhage
  • Expectation of significant haemorrhage or manual removal of placenta
  • Certain spine surgery and spinal abnormalities
  • Lack of trained staff available
196
Q

Complications of epidural

A
  • Severe headache
  • Temporary or permanent nerve damage
  • Infection
  • Meningitis
  • Epidural blood clot
197
Q

Indications for a spinal

198
Q

Advantages of a spinal

A
  • Easier than epidurals
  • Allows bonding with baby
  • Reliable
199
Q

Disadvantages of a spin

A
  • Severe hypotension
  • Can wear off
  • Risk of conversion to GA
200
Q

Indications for induction of labour

A
  • Prolonged pregnancy
  • Maternal age >40
  • Maternal diabetes
  • Twin pregnancy
  • PROM
  • FGR and suspected foetal compromise
  • Hypertensive disorders of pregnancy
  • Deteriorating maternal medical condition
  • Maternal request
201
Q

Contra-indications for IOL

A
  • Placenta previa
  • Transverse lie
  • Previous C-section or uterine surgery
  • Previous history of precipitate labour
202
Q

IOL if Bishop score <6

A

Vaginal prostaglandin +/- membrane sweep

203
Q

IOL if Bishop score >6

A

Vaginal prostaglandins or ARM +/- Syntocinon

204
Q

Complications of IOL

A

Uterine hyperstimulation

205
Q

Incidence of breech presentation

206
Q

Risk factors for breech delivery

A
  • Placenta previa
  • Multiple pregnancy
  • Bicornuate uterus
  • Fibroids
  • Polyhydramnios/oligohydramnios
  • Foetal anomalies
207
Q

Management options for breech presentation

A
  • ECV at 36-37 weeks
  • C-section
  • Vaginal breech birth
208
Q

Contraindications/cautions for ECV

A
  • Multiple pregnancy
  • C-section indications
  • Abnormal uterine anatomy
  • Abnormal CTG
  • Ruptured membranes
  • Antepartum haemorrhage in last 7 days
  • IUGR
  • Oligohydramnios
  • Pre-eclampsia
  • Nuchal cord
  • Major foetal anomalies
  • Hyperextended foetal head
  • Morbid maternal obesity
209
Q

Risks of vaginal breech delivery

A
  • Intracranial injury
  • Widespread bruising
  • Damage to internal organs
  • Spinal cord transection
  • Cord prolapse
  • Hypoxia
  • Head entrapment
210
Q

Risk factors for transverse/oblique lie

A
  • Multiparity
  • Multiple pregnancy
  • Preterm labour
  • Polyhydramnios
  • Placenta previa
  • Congenital uterine anomalies
  • Lower uterine fibroids
  • Pelvic masses
211
Q

Management of oblique/transverse lie

A
  • ECV

- C-section

212
Q

Prevalence of face presentation

213
Q

Risk factors for face presentation

A
  • Prematurity
  • Foetal neck tumours
  • Loops of cord around foetal neck
  • Foetal macrosomia
  • Anencephaly
214
Q

Complications of malposition

A
  • Longer first and second stages of labour
  • Back pain
  • Increased frequency of epidural
  • Obstructed labour
  • More likely to require augmentation with Syntoncinon
  • More likely to require instrumental delivery or C-section
  • Increased risk of 3rd and 4th degree perineal tears
215
Q

Define precipitate labour

A

Expulsion of the foetus within 2-3 hours from onset of contractions

216
Q

Management of precipitate labour

A
  • Cessation of oxytocin infusions
  • Turn woman to left lateral position
  • Administration of a tocolytic e.g. SC terbutaline or GTN spray
  • Delivery via instrumental delivery or C-section if foetal distress
217
Q

Complications of precipitate labour

A
  • Cervical and perineal tears
  • Retained placenta
  • PPH
  • Need for blood transfusion
218
Q

NICE definition of delayed labour

A

First stage

  • <1cm dilation in 4 hours in primiparous women
  • <2cm dilation in 4 hours OR slowing in progress for multiparous women

Second stage

  • Baby not delivered after 3 hours of active second stage in primiparous women
  • Baby not delivered after 2 hours in parous women

Third stage

  • Failure to pass placenta within 30 mins with active management
  • Failure to pass placenta within 60 mins with passive management
219
Q

Causes of delayed labour

A
  • Idiopathic inadequate contractions
  • Obstructed labour
  • Maternal dehydration
  • Maternal obesity
  • Maternal age
  • CPD
  • Malpresentation
  • Malposition
220
Q

Complications of slow labour

A
  • Maternal fatigue
  • Maternal anxiety/loss of moral
  • Pelvic floor dysfunction or obstetric fistula
  • Uterine rupture
  • Maternal/foetal sepsis
  • PPH
  • Fetal hypoxia
  • Instrumental delivery or C-section
221
Q

Management of inadequate contractions in labour

A
  • Fluids
  • Mobilisation
  • Pain management
  • ARM
  • Syntocinon infusion
222
Q

CIs/cautions for syntocinon infusion in labour

A
  • Obstructed labour
  • Previous C-section
  • Multiparous women
223
Q

Management of true CPD in labour

224
Q

Indications for operative vaginal delivery

A
  • Suspected foetal compromise
  • Maternal exhaustion
  • Fetal malposition
  • CPD
225
Q

Criteria for a operative vaginal delivery

A
  • Consent obtained
  • Cervix is fully dilated with membranes ruptured
  • Head is fully engaged and at or below ischial spines, with no head palpable abdominally
  • Position of the head is known
  • Bladder is empty
  • Satisfactory analgesia
226
Q

Complications of instrumental delivery

A
  • Failure resulting in C-section
  • Low APGAR scores
  • Foetal acidosis
  • Cerebral trauma
  • Cerebral haemorrhage
  • Brachial plexus injuries
  • Fracture
  • Perineal tears
  • PPH
  • Perineal infection
  • Urinary/bowel incontinence
  • Dyspareunia
  • Fear of childbirth
227
Q

Increased risks with ventouse (compared to forceps) of…

A
  • Failure
  • Neonatal cephalohaematoma
  • Retinal haemorrhage
  • Low APGAR score at 5mins
228
Q

CI for ventouse

A
  • Face presentation

- Risk of foetal bleeding disorder

229
Q

Indications for a vertical incision in C-section

A
  • Transverse fetal lie
  • Placenta previa
  • Very preterm birth
  • Lower uterine segment fibroids
230
Q

Preparation for a C-section

A
  • Consent
  • IV access
  • Group and save +/- crossmatch
  • Sodium citrate +/- ranitidine
  • Appropriate thromboprophylaxis
  • Antibiotics prophylaxis
  • Anaesthesia
  • Catheterisation
231
Q

Incision used in most C-sections

A

Pfennenstiel incision

232
Q

Layers to cut through in a C-section

A
  • Skin
  • SC fat
  • Rectus sheath
  • Peritoneum
233
Q

Complications of a C-section

A
  • Infection
  • PPH
  • VTE
  • Bowel/bladder injury
  • TTP
234
Q

Define menopause

A

Absence of menstrual periods for 12 months in a woman with a uterus who is not pregnant or taking hormones that may induce amenorrhoea

235
Q

Clinical features of menopause

A
  • Hot flushes/night sweat
  • Headaches
  • Palpitations
  • Insomnia
  • Irritability
  • Poor concentration and short-term memory
  • Depression/low mood
  • Lethargy
  • Decreased self confidence
  • Decreased libido
  • Dyspareunia
  • Joint aches
  • Irregular periods
  • Atrophic vaginitis
  • Vaginal dryness
  • Urethral symptoms
  • Urge incontinence or urinary frequency
236
Q

Adverse effects of menopause on long-term health

A
  • Cardiovascular disease
  • Cerebrovascular disease
  • Osteoporosis
237
Q

Clinical diagnosis of menopause

A

FSH >30 with irregular or absent menses

238
Q

Marker of ovarian reserve

239
Q

Risks and side effects of HRT

A
  • Nausea
  • Breast tenderness
  • Uterine bleeding
  • Endometrial cancer (unopposed oestrogen therapy)
  • Breast cancer
  • VTE
240
Q

CIs for HRT

A
  • Pregnancy
  • Current or previous VTE
  • Liver disease
  • Undiagnosed vaginal bleeding
  • Breast carcinoma
  • Advanced endometrial carcinoma
241
Q

Define neonatal encephalopathy

A

Clinically define syndrome of disturbed neurological function occurring in the first week of birth, characterised by difficulty with initiating and maintaining respiration, depression of tone and reflexes, altered consciousness level and seizures

242
Q

Risk factors for haemolytic disease of the newborn

A
  • Miscarriage
  • Ectopic pregnancy
  • Invasive intrauterine procedures
  • ECV
  • Abdominal trauma
  • Antepartum haemorrhage
  • Labour and delivery
243
Q

Clinical features of haemolytic disease of the newborn

A
  • Reduced/absent foetal movement
  • FGR
  • Anaemia
  • Hydrops fetalis
  • Polyhydramnios
  • Unreactive pattern or decelerations on CTG
  • Sinusoidal fetal HR pattern
  • Postnatal jaundice and kernicterus
244
Q

Features of hydrops fetalis

A
  • Hypoxia
  • Acidosis
  • Hepatic dysfunction
  • Cardiac dysfunction
  • Generalised skin oedema
  • Ascites
  • Pericardial effusions
  • Pleural effusions
245
Q

Investigation for haemolytic disease of the newborn

A

Foetal MCA Doppler velocity

246
Q

Management of haemolytic disease of the newborn

A
  • Intrauterine transfusion
247
Q

Complications of intrauterine transfusion

A
  • Cord haematoma
  • Foetal bradycardia
  • Intrauterine death
  • Further sensitisation of the mother
248
Q

Delivery of babies with haemolytic disease of the newborn

A
  • Delivery in a NICU hospital
  • Term delivery if US normal and antibody level is low
  • Vaginal delivery in mild anaemia or those successfully treated with intrauterine transfusion
  • C-section in hydrops fetalis
  • Induction at 35 weeks in those being managed with intrauterine transfusion
  • Kleihauer testing of foetal cord blood
249
Q

Complications of haemolytic disease of the newborn

A
  • CP
  • Abnormal development
  • Hearing problems
250
Q

Causes of abnormal uterine bleeding

A
  • Polyps
  • Adenomyosis
  • Leiomyoma/fibroids
  • Malignancy/premalignant conditions
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial causes
  • Iatrogenic
  • Not-otherwise classified
251
Q

Causes of amenorrhoea

A
  • CNS disorders
  • Gonadal dysfunction
  • Genital tract disorders
  • Endocrine disorders
  • Drug therapy
252
Q

Define primary amenorrhoea

A

Lack of menstruation after age 16

253
Q

Investigations in secondary amenorrhoea

A
  • Pregnancy test
  • TFTs
  • Blood glucose
  • Serum gonadotrophins
  • Serum androgens
  • Serum prolactin
  • Pelvic US
  • Lateral skull X-ray/CT
254
Q

Definition of menorrhagia

A
  • Technically defined as >80ml per period
  • Clinically defined as excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life
255
Q

Causes of menorrhagia

A
  • Thyroid disease
  • Clotting disorders
  • Fibroids
  • Endometrial polyps
  • Endometrial carcinoma
  • Endometriosis/adenomyosis
  • PID
  • Dysfunctional uterine bleeding
  • IUCD
  • Oral anticoagulants
256
Q

Investigations in menorrhagia

A
  • Subjective assessment
  • Pictorial blood loss assessment chart
  • FBC
  • TFTs
  • Coagulation studies
  • Laparoscopy
257
Q

Management for menorrhagia

A

1) NSAIDs e.g. mefenamic acid
2) Fibrinolytics e.g. tranexamic acid
3) COCP or POP
4) IUS
5) Endometrial ablation
6) Hysterectomy

258
Q

Define PMB

A

Vaginal bleeding occurring >6 months after the menopause

259
Q

Causes of PMB

A
  • Endometrial hyperplasia/carcinoma
  • Atrophic vaginitis
  • Endometrial polyps
  • Fibroids
  • Cervical malignancy
  • Ovarian carcinoma
  • Oestrogen-secreting tumour
260
Q

Investigations for PMB

A
  • TVUS
  • Pipelle biopsy (4-10mm)
  • Hysteroscopy and biopsy (>10mm)
261
Q

Risk factors for fibroids

A
  • African-Caribbean
  • Increasing age
  • Nulligravida
  • Obesity
262
Q

Protective factors for fibroids

A
  • Smoking
  • COCP
  • Pregnancy
263
Q

Clinical features of fibroids

A
  • Asymptomatic
  • Menorrhagia
  • Intermenstrual/post-coital/continuous vaginal bleeding
  • Dysmenorrhoea
  • Abdo/pelvic pain
  • Abdo/pelvic mass
  • Pressure symptoms
  • Bloating
264
Q

Investigations for fibroids

A
  • Clinical examination: firm irregular uterus, moves with fibroid movement
  • Pelvic US: characteristic diffuse changes
  • Hysteroscopy + Pipelle biopsy: normal
265
Q

Management for fibroids

A

1) Leuprelin or Mifepristone OR IUS
2) Myomectomy
3) Uterine artery embolisation
4) Hysterectomy

266
Q

Complications of fibroids

A
  • Subfertility/infertility
  • Miscarriage
  • Preterm labour
  • Malpresentation
  • Obstructed labour
  • PPH
  • Acute abdomen due to torsion
  • Urinary retention
  • Hyaline, cystic or calcific degeneration
  • Malignant transformation (rare)
267
Q

Risk factors for endometriosis

A
  • Reproductive age
  • FH
  • Nulliparity
  • Mullerian abnormalities
268
Q

Clinical features of endometriosis

A
  • Secondary dysmenorrhoea (cyclical)
  • Deep dyspaurenia
  • Pelvic pain
  • Infertility
269
Q

Investigations for endometriosis

A
  • Clinical examination: tender, retroverted, retroflexed fixed uterus with thickening of cardinal or uterosacral ligaments, endometriotic nodules, pain on moving cervix anteriorly
  • Diagnostic laparoscopy: gun powder lesions
270
Q

Management of endometriosis

A

1) COCP/POP +/- NSAIDs
2) GnRH agonist
3) Diathermy treatment of lesions
4) TAHBSO

271
Q

Risk factors for shoulder dystocia

A
  • Macrosomia
  • Current or past diabetes
  • Postdates gestation
  • Obese mother
  • High parity
  • Male foetus
  • Prolonged first stage of labour
  • Secondary arrest >8cm
  • Mid-cavity arrest
  • Instrumental delivery
  • Difficulty delivering chin
272
Q

Management of shoulder dystocia

A

Try each manoeuvre for 30 secs

  • Call for help
  • Episiotomy
  • McRoberts position
  • Suprapubic pressure
  • Woodscrew/reverse woodscrew manoeuvre
  • Roll over
  • Removal of posterior arm
  • Symphisiotomy
  • Clavicle/humerus fracture
  • Zavanelli manoeuvre
273
Q

Complications of shoulder dystocia

A
  • Erb’s palsy
  • Klumpke’s palsy
  • Maternal genital tract trauma
  • Atonic PPH
274
Q

Risk factors for cord prolapse

A
  • Breech presentation
  • Malposition
  • Preterm labour
  • Polyhydramnios
  • FGR
  • Placenta previa
  • Long umbilical cord
  • ARM
  • Second twin
275
Q

CTG features of cord prolapse

A
  • Deep variable decelerations

- Single prolonged deceleration

276
Q

Management of cord prolapse

A
  • Woman moved into knees to chest position
  • Hand placed in vagina to lift presenting part off cord
  • Tocolytic
  • Immediate delivery by C-section or instrumental delivery
277
Q

Prevalence of APH

278
Q

Grading of placenta previa

A

1) Enroaches the lower uterine segment
2) Reaches the internal os
3) Covers part of the internal os
4) Completely covers internal os

279
Q

Delivery in placenta previa

A

Elective C-section at 38-39 weeks recommended in placentas <2cm away from the internal os

280
Q

Clinical features of placenta previa

A
  • Vaginal bleeding
  • PAINLESS
  • Soft uterus
  • Presenting foetal part is free and foetal heartbeat usually present
281
Q

Clinical features of placental abruption

A
  • Vaginal bleeding
  • PAINFUL
  • Hard, tender uterus
  • Contractions
  • Foetal heartbeat may be absent
  • Suspicious/pathological CTG
282
Q

Management of APH

A

Minor haemorrhage with soft uterus and normal CTG:

  • US scan for placental site
  • Speculum examination (CI in placenta previa)
  • Admission to hospital until bleeding stops
  • Anti-D prophylaxis
  • Delivery by C-section: placenta previa in 37+ weeks gestation

Minor/major haemorrhage with a hard tender uterus:

  • Maternal resus
  • Assessment of foetal condition with CTG
  • Prompt delivery

Haemorrhage requiring maternal resus:
- Prompt delivery

283
Q

Causes of intrapartum haemorrhage

A
  • Placental abruption
  • Placenta previa
  • Uterine rupture
  • Vasa previa
284
Q

Define a primary PPH

A

Blood loss >500ml within 24 hours of delivery

285
Q

Define a secondary PPH

A

Any significant blood loss between 24 hours and 12 weeks postpartum

286
Q

Risk factors for PPH

A
  • 4+ deliveries
  • Age >35
  • BMI >35
  • Multiple pregnancy
  • Fibroids
  • Placenta previa
  • Long labour
  • Instrumental delivery
  • Previous PPH or APH
287
Q

Causes of primary PPH

A
  • Uterine atony/poor contractility
  • Trauma
  • Coagulopathy e.g. DIC
  • Retained placental tissue
288
Q

Management of primary PPH

A
  • IM Oxytocin in 3rd stage
  • Reassurance
  • 2222 call
  • Estimation of blood loss
  • Measure pulse and BP
  • Assess size and tone of uterus
  • Abdominal massage/bimanual compression
  • IV access with 2 widebore cannulas
  • Take FBC, clotting and cross-match
  • IV bolus of Syntocinon followed by infusion
  • IV fluids stat
  • Insertion of urinary catheter
  • Encourage delivery of placenta with cord traction
  • Arterial line insertion
  • Blood transfusion +/- FFP +/- cryoprecipitate
  • 1g IV tranexamic acid
  • Brace suture
  • Intrauterine balloon insertion
  • Internal iliac artery ligation
  • Hysterectomy
289
Q

Causes of secondary PPH

A
  • Endometritis
  • Retained products of conception
  • Trophoblastic disease
290
Q

Assessment in secondary PPH

A
  • Pulse, BP, temp
  • Uterine palpation
  • Endocervical and vaginal swabs for culture
  • US scan
291
Q

Management of secondary PPH

A
  • Antibiotics

- Evacuation of retained products with fingers (in first week) or instrumentation

292
Q

Causes of prolapse

A
  • Childbirth, especially prolonged second stage of labour with a large baby and instrumental delivery
  • Chronic constipation
  • menopause
  • Gynae surgery
  • Genetic factors
293
Q

Clinical features of prolapse

A
  • Asymptomatic
  • Discomfort
  • Dragging sensation
  • Feeling a lump
  • Coital problems
  • Vaginal bleeding or discharge
  • Associated urinary problems: stress incontinence, poor bladder emptying, urinary frequency, UTI
  • Associated bowel problems: pressure, backache, difficulty emptying bowels
294
Q

Staging of prolapse

A

0) none
1) Most distal part is more than 1 cm above hymen
2) Most distal part is 1cm or less proximal or distal to hymen
3) Most distal part is more than 1cm below hymen but protrudes no further than 2cm less than total vaginal length
4) Complete eversion of total length of lower genital tract

295
Q

Management of prolapse

A
  • No treatment
  • Lifestyle advice: smoking cessation, weight reduction, fluid and dietary advice
  • Pelvic floor exercises
  • Vaginal pessaries changed every 4-6 months
  • Vaginal oestrogen
  • Surgery: pelvic floor repair e.g. colporrhaphy, vaginal hysterectomy
296
Q

Side effects of pessaries

A
  • Urinary symptoms
  • Vaginal discharge
  • Bleeding
  • Fistula formation (rare)
297
Q

Side effects of pelvic floor repair

A
  • Infection
  • Bleeding
  • Organ damage
  • Chronic pain
  • Vaginal scarring
  • Prolapse recurrence
298
Q

Risk factors for stillbirth

A
  • Maternal age
  • Obesity
  • Social deprivation
  • Smoking
  • Non-white ethnicity
  • Domestic violence
299
Q

Causes of stillbirth

A
  • Lethal congenital anomaly
  • FGR
  • Infection
  • Anaemia
  • Fetomaternal haemorrhage
  • Twin to twin transfusion syndrome
  • Cord obstruction
  • Maternal metabolic disturbance
  • Reduced maternal oxygen states e.g. CF
  • Maternal antibody production e.g. rhesus disease
  • Diabetes
  • Preeclampsia
  • Antiphospholipid syndrome
  • Thrombophilia
  • Smoking
  • Cocaine
  • Uterine abnormality
  • Uterine rupture
  • Placenta previa
  • Vasa previa
  • Intrapartum asphyxia
300
Q

Clinical features of stillbirth

A
  • Reduced foetal movements
  • Vaginal bleeding
  • Abdo pain
301
Q

Management of stillbirth

A
  • Offer to call someone to support the mother
  • Assessment for underlying conditions that might threaten maternal wellbeing
  • Vaginal birth via IOL
  • Psychological support
  • Suppression of lactation with dopamine agonists
302
Q

Investigations that can be done to investigate the cause of stillbirth

A
  • Haematology and biochemistry
  • Coagulation studies
  • Kleihauer test
  • Bacteriology
  • Serology
  • Random blood glucose, HbA1c
  • TFTs
  • Anti red cell antibody
  • Parental karyotype
  • Foetal and placental microbiology
  • Foetal and placenta karyotype
  • Postmortem
303
Q

Stillbirths must be registered within 21 days (T/F)

304
Q

Causes of neonatal death

A
  • Complications after birth
  • Congenital anomalies
  • Premature birth and complications
  • Infection
  • Complications pre-labour
  • Intrapartum complications
  • Placental issues
305
Q

Criteria for a legal abortion in the first 24 weeks of pregnancy in the UK

A
  • Treatment must be carried out in a hospital/licensed clinic
  • Two doctors must agree that abortion would cause less risk to a woman’s health than continuing with the pregnancy, meeting one of the following 5 reasons:
    a) continuance of the pregnancy would involve risk to the life of the pregnant women
    b) termination is necessary to prevent grave permanent injury to the physical or mental health of the woman
    c) continuance of the pregnancy would involve risk of injury to the physical or mental health of the woman
    d) continuance of the pregnancy would involve risk of injury to the physical or mental health of any existing children of the family of the woman
    e) substantial risk that the child would be born with physical or mental abnormalities which would render it seriously handicapped
306
Q

Criteria for legal abortion over 24 weeks gestation in UK

A

Only one doctor needs to consent to an abortion in an emergency

  • Necessary to save woman’s life
  • To prevent grave permanent injury to the physical or mental health of the pregnant woman
  • Substantial risk that the child would be born with serious physical or mental disabilities
307
Q

Medical management of a miscarriage

A

1) Oral mifepristone +/- antibiotic prophylaxis
2) Vaginal/buccal/sublingual misoprostol 1-2 days later
- Can be taken at same time as mifepristone in <9+1 weeks
- Can be taken at home in <10+1 weeks
- Needs to be taken in hospital if >10+0 weeks, age <16, needs a translator, lives a long way from home, hyperemesis

308
Q

Side effects of mifepristone

A
  • Nausea
  • Vomiting
  • Diarrhoea
309
Q

Side effects of misoprostol

A
  • Bleeding
  • Cramping
  • Passage of blood clots
310
Q

Advantages of medical management of TOP

A
  • Can be used at any gestation
  • Avoidance of surgery
  • Can go home same day
311
Q

Disadvantages/complications of medical management of TOP

A
  • Woman is awake and aware of process
  • May see pregnancy pass
  • Bleeding
  • Infection
  • RPOC
  • Failure of abortion (<1 in 100)
  • Need for second procedure (<5 in 100)
  • Uterine rupture (<1 in 1000)
312
Q

Surgical management of TOP

A
  • Misoprostol 1-3 hours before operation

- Insertion of suction tube/vacuum aspiration into uterus under GA

313
Q

Benefits of surgical management of TOP

A
  • Avoids seeing pregnancy pass
314
Q

Disadvantages of surgical management of TOP

A
  • Can only be done up to 14 weeks gestation
  • Needs accompanying adult if sedation/anaesthetic used
  • Inpatient stay may be necessary
  • Severe bleeding
  • Infection/sepsis
  • RPOC
  • Failure of abortion (<1 in 100)
  • Need for second procedure (<5 in 100)
  • Uterine perforation (<1 in 1000)
  • Cervical trauma (rare)
315
Q

Clinical features of urethral caruncle

A
  • Commonly seen after menopause
  • Asymptomatic
  • Dysuria
  • Frequency
  • Urgency
  • Focal tenderness
  • Soft, red, smooth tissue
316
Q

Clinical features of Bartholin’s cyst

A
  • Tense, retention cyst in the lower third of the labia majora
317
Q

Management of Bartholin’s cyst

A

Marsupilisation

balloon catheterisation is a non-surgical alternative

318
Q

Clinical features of lichen sclerosus

A
  • More common in older women
  • Associated with other autoimmune disease
  • Itch
  • Dyspaurenia and pain
  • Skin appears white, thin and crinkly or thickened and keratotic
  • Clitoral and labial atrophy
319
Q

Diagnosis of lichen sclerosus

A
  • Usually clinical

- Can be confirmed on biopsy

320
Q

Management of lichen sclerosus

A
  • Potent topical corticosteroids e.g. dermovate reducing to a milder preparation +/- emollient
  • Avoidance of soaps, perfumed products or washing powder,
321
Q

Management of VIN

A
  • Surgical excision with clear margins
  • Imiquimod
  • Laser ablation
  • Close follow up
322
Q

Risk factors for stress incontinence

A
  • Pregnancy and vaginal delivery
  • Prolapse
  • Menopause
  • Collagen disorders
  • Obesity
323
Q

Risk factors for overactive bladder

A
  • Neurological conditions

- Psychological conditions

324
Q

Clinical features of stress incontinence

A
  • Involuntary loss of small amounts of urine on effort or physical exertion in the absence of detrusor contraction
  • No urgency, frequency or nocturia
  • Able to reach the toilet in time
325
Q

Clinical features of overactive bladder

A
  • Sudden compelling desire to pass urine which is difficult to defer
  • No leakage during physical activity
  • Large amounts of urine leakage
  • Often can’t reach the toilet in time
  • Day time frequency and nocturia
  • Enuresis
326
Q

Risk factors for voiding difficulties

A
  • Previous surgery
  • Ageing
  • Pregnancy
  • Childbirth
  • Neurological disease
327
Q

Clinical features of incontinence

A
  • Frequency
  • Urgency
  • Nocturia
  • Incontinence on exertion or constant urinary leakage
  • Hesitancy
  • Straining to avoid
  • Poor or intermittent urinary stream
  • Post-micturition dribbling
  • Sensation of incomplete emptying
  • Prolapse symptoms
  • Associated bowel symptoms
328
Q

Red flag symptoms in urinary incontinence

A
  • Haematuria
  • Persistent bladder or urethral pain
  • Recurrent UTI
329
Q

Investigations for women with urinary incontinence

A
  • Urinalysis
  • Frequency-volume chart/bladder diary
  • Urodynamic studies
  • Post-void residual volume US
  • QOL questionnaires
  • Cystoscopy and upper renal tract US
330
Q

Management of stress incontinence

A

1) Pelvic floor exercises for at least 3 months
2) Duloxetine +/- vaginal oestrogen
3) Mid-urethral sling OR colposuspension OR autologous fascial sling OR bladder neck injection

331
Q

Management of an overactive bladder

A

1) Lifestyle advice
2) Bladder retraining
3) Anticholinergics
4) Beta 3 agonists
5) Intravesical botox injection OR sacral nerve root stimulation

332
Q

Management of voiding difficulties

A

Clean intermittent self-catheterisation OR indwelling catheter

333
Q

Management of a GU fistula

A
  • Contrast studies
  • Indwelling catheter
  • Surgery
334
Q

Prevalence of preterm birth

335
Q

Risk factors for preterm labour

A
  • Previous preterm labour
  • BMI <18
  • Low social class
  • Lack of support
  • Afro-Caribbean
  • Extremes of reproductive age
  • Smoking
  • BV
  • Chronic medical conditions
  • Multiple pregnancy
  • Bleeding in 1st or 2nd trimester
  • APH
  • FGR
  • Placenta previa
  • Intrauterine infection
  • PPROM
  • Congenital foetal anomaly
  • Polyhydramnios
  • Congenital uterine anomaly
  • Preeclampsia
  • UTI and asymptomatic bacteriuria
  • Physiological stress e.g. domestic violence
336
Q

Causes of preterm labour

A
  • Infection
  • Uteroplacental ischaemic e.g. abruption
  • Uterine overdistention
  • Cervical incompetence
  • Foetal anomaly
  • PPROM
  • Iatrogenic
337
Q

Investigations in suspected preterm labour

A
  • Haemodynamic assessment
  • Assessment for precipitants e.g. bloods, MSU, high vaginal and endocervical swabs
  • VE
  • Foetal monitoring with CTG
  • US scan
  • TVUS to examine cervical length
  • Maternal cervical secretion fibronectin levels
  • Clinical risk scoring based on risk factors
338
Q

Management in preterm labour

A
  • Close monitoring of foetus
  • Maternal IM corticosteroid injections (CI in active sepsis)
  • Antibiotics as indicated: 10 days of PO erythromycin following PPROM, intrapartum penicillin/clindamycin in GBS
  • IV Mag sulphate
  • IV beta-agonists
339
Q

Side effects of IV magnesium sulphate

A
  • Blurred vision
  • Loss of tendon reflexes
  • Arrhythmias
  • Reduced foetal HR variability
  • Hypotonia
  • Neonatal respiratory depression
  • Perinatal mortality
340
Q

Complications of preterm labour

A
  • Risk of recurrence in future pregnancies
  • Perinatal mortality
  • Intrapartum complications e.g. abnormal lie, cord prolapse, abruption, infection
  • CP
  • Chronic lung disease
  • Visual and hearing difficulties
  • Learning difficulties
341
Q

Prevalence of PPROM

342
Q

Risk factors for PPROM

A
  • Polyhydramnios
  • Multiple pregnancy
  • Vaginal infection
343
Q

Complications of PPROm

A
  • Secondary pulmonary hypoplasia
  • Severe skeletal deformities
  • Preterm delivery
  • Intrauterine infection/chorioamnionitis
  • Cord prolapse
344
Q

Clinical features of chorioamnionitis

A
  • Maternal pyrexia
  • Maternal and foetal tachycardia
  • Abdo pain
  • Uterine tenderness
  • Offensive smelling liquor
  • Raised inflammatory markers
345
Q

Management of PPROM

A
  • Regular foetal monitoring
  • Advise to report if feeling unwell or pyrexia detected
  • Aim for delivery around 34-36 weeks
  • Corticosteroids and Antibiotics if PPROm occurs <35 weeks
346
Q

Risk factors for cervical cancer

A
  • Young age at first sexual intercourse
  • High number of sexual partners
  • Smoking
  • HPV
  • Lower SES
  • Partner with prostate or penile cancer
347
Q

Most common type of cervical cancer

A

Squamous cell carcinoma

348
Q

Clinical features of cervical cancer

A
  • Postcoital/intermenstrual/postmenopausal bleeding

- Offensive vaginal discharge

349
Q

Investigations for cervical cancer

A
  • Smear
  • Colposcopy
  • Cone biopsy
  • CXR
  • IV urogram
  • Cystoscopy and sigmoidoscopy or MRI
350
Q

Indications for colopscopy

A
  • 3 unsatisfactory smears
  • 2 borderlines or 2 mild dyskaryosis
  • One moderate or severe dyskaryosis
  • Clinical suspicion of cancer
  • Glandular smear
351
Q

Red flag features at colposcopy

A
  • Intense acetowhite staining or pale iodine staining
  • Mosaicism and punctuation
  • Raised or ulcerated surface
352
Q

Management of CIN

A
  • LLETZ with local anaesthetic
  • Needle excision of transformation zone
  • Cone biopsy
  • Follow up with a smear test and HPV screen in 6 months as proof of cure - if this is negative they can return to routine screening, if it is positive they should have a repeat colposcopy
353
Q

Management of cervical cancer

A

Stage I:
- Extended hysterectomy or radical trachelectomy

Stage II:
- Radiotherapy and chemotherapy

Stage III or IV: radical radiotherapy and chemotherapy

354
Q

Screening for cervical cancer

A
  • Smears every 3 years from 25-64

- Every 5 years from 65 over

355
Q

Risk factors for endometrial cancer

A
  • Age
  • Obesity
  • Nulliparity
  • Late menopause/early menarche
  • PCOS
  • Unopposed oestrogen HRT
  • Tamoxifen
  • Diabetes
  • Personal or family history of breast or colon cancer
356
Q

Cancer type of endometrial cancer

A

Adenocarcinoma

357
Q

Clinical features of endometrial cancer

A
  • PMB
  • Pain
  • Vaginal discharge
358
Q

Investigation for endometrial cancer

A
  • TVUS
  • Pipelle biopsy
  • Hysteroscopy and biopsy
  • MRI for staging
359
Q

Management of endometrial cancer

A

Stage I:
- TAHBSO +/- radiotherapy

Stage II:
- TAHBSO + radiotherapy

Stage III:
- Debulking surgery + radiotherapy

Stage IV:
- Palliative care

360
Q

Risk factors for ovarian cancer

A
  • Nulliparity
  • Treatment with ovulation-induction drugs
  • Caucasian
  • Blood group A
  • higher SES
  • Late age at first conception
  • Family history
361
Q

Protective factors for ovarian cancer

A
  • Multiparity
  • COCP
  • Black/Asian
  • Blood group O
362
Q

Clinical features of ovarian cancer

A
  • Abdominal pain
  • Abdominal distention
  • Urinary frequency
  • GI upset
363
Q

Investigation of ovarian cancer

A
  • US (+ liver US if cancer suspected to look for mets)

- Ca125

364
Q

Ovarian risk of malignancy index features

A
  • US appearance
  • Ca125
  • Menopausal status
365
Q

Red flag signs for ovarian cancer on US

A
  • Solid mass or cyst containing septae
  • Mass >5cm
  • Presence of ascites
  • Bilateral tumours
366
Q

Causes of a raised Ca125

A
  • Ovarian cancer
  • Fibroids
  • Diverticular disease
  • Pregnancy
367
Q

Management of ovarian cancer

A

Stage I:
- Surgery

Stage II and III:
- Surgery + chemotherapy (cyclopshophamide + carboplatin)

Stage IV:
- Palliative care

368
Q

Side effects of chemotherapy for ovarian cancer

A
  • Myelosuppression
  • GI upset
  • Peripheral neuropathy
  • Alopecia
  • Renal toxicity
  • Ototoxicity
  • Eye toxicity
369
Q

Risk factors for vaginal tumours

A
  • CIN
  • HPV
  • History of a gynae malignancy
370
Q

Clinical features of a vaginal cancer

A

Abnormal bleeding

371
Q

Investigation of vaginal tumours

A
  • Biopsy
  • Exploration under anaesthetic
  • Bladder/rectum assessment (at surgery or on MRI
  • CXR
372
Q

Management of vaginal cancer

A
  • External beam and intravaginal radiotherapy
373
Q

Risk factors for vulval tumours

A
  • Age
  • Smoking
  • Immunosuppression
  • Vulvar mutation disorders e.g. lichen sclerosus
  • History of CIN, VIN or HPV
374
Q

Clinical features of a vulval carcinoma

A
  • Pruritus
  • Lump/ulcer on vulva
  • Bleeding
  • Pain
  • Urinary symptoms
  • Unusual discharge
375
Q

Investigations for vulval cancer

A
  • Biopsy
  • CT/MRI
  • Examination under anaesthesia
376
Q

Management of vulval cancer

A

Microinvasive disease:

  • Cone biopsy
  • TAH

Early stage:
- Radical hysterectomy + pelvic lymphadenectomy +/- radical radiotherapy
OR radical radiotherapy alone

Stage IIb to IVa:
- Radical radiotherapy

Distant metasasis:
- Palliative care

Year 5 (9 decks)

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