Obs and gynae Flashcards
What is mittelmudge pain?
Ovulation pain
Causes of abnormal uterine bleeding?
Strucural PALM
Non structural COEIN
Polyp, adenomyosis, leiomyomas, malignanacy and hyperplasia
Coagulopathies, ovulatory duysfunction, endometrial, iatrogenic, no known cause
Symptoms of PCOS?
Hyperandrogenism (hirsutism, acne, alopecia)
Menstrual disturbances
Infertility
Obesity
Types of PV bleeding
Inter menstural
Post coital
Menorrhagia
Poly-menorrhoea
Dysmenorrhea
Questions for history taking in AUB?
Age at menarche
Cycle-length days, flow
Duration since heavy flow or periods
Impact on her quality of life
Red flag symptoms- persistent IMB, PCB or dysparenuia, dysmenorrhea, pelvic pain /pressure symptoms, vaginal discharge
Underlying systemic disease-hypothyroidism coagulation Von Willebrand disease,
Family –coagulation disease or endometriosis.
Smear status
about current contraceptive use, contraceptive plans, and future plans for a family
1st line treatment for AUB?
LNG-IUS
Pathophysiology of PCOS?
Basic problem is increased insulin resistance.
This decreases the SHBG, so increase free Testosterone – androgenic symptoms.
How many years shoudl you allow since menarch before diangosisng pcos?
2
What does the greene climateric scale do?
Provides a brief measure of menopause symptoms. It can be used to assess changes in different symptoms, before and after menopause treatment. Three main areas are measured:
Management of OAB?
Oestrogen (topical or systemic), medication (antimuscarinics, B3 modulators (Mirabegron)
Management of urge incontinence?
Bladder retraining, oestrogen
Management of stress incontinence?
Pelvic floor physiotherapy, oestrogen, surgery
Management of shoulder dysocia?
McRoberts Manoeuvre
Diagnostic thresholds for gestational diabetes
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
Results seen in trisomy 21 pregnancy?
Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency
What diabetes medication is safe during pregnancy?
Metformin and insulin
Bleeding in placenta praevia?
Painless bright red vaginal bleeding
Mneumonic for ABRUPTION?
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
Iron supplementation cut off in pregnancy?
110 g/L
Management of intrahepatic cholestasis?
induction of labour at 37-38 weeks is common practice but may not be evidence based
ursodeoxycholic acid - again widely used but evidence base not clear
vitamin K supplementation
What is a puerperal pyrexia?
temperature of > 38ºC in the first 14 days following delivery
Poem for routine antenatal care?
The first visit is from eight
Check everything with mum is great
Urine, bloods and rhesus state
Give advice and educate
From eleven to thirteen
Is the best time to do the Downs screen
While youre at it, check the dates
At sixteen or ten plus six
Do BP and multistix
Second scan is at twenty
To check the fingers and toes
(Make sure theres twenty.)
Once again at twenty-eight
Urine, blood and rhesus state
Anti-D if appropriate
Must give anti-D once more
When the week is thirty-four
And plan for the birth, what a chore
Check the lie at thirty-six
If breech offer a quick fix
Last visit at thirty-eight
All that is left it to wait
Routine measures of what for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE)
Anti Xa activity
AFP
Unconjugated oestriol
HCG
INhibin A levels in downs syndrome?
AFP
Unconjugated oestriol
HCG
INhibin A levels in edwards syndrome?
AFP
Unconjugated oestriol
HCG
INhibin A levels in neural tube defects?
Physiological changes to the circulation results in what?
increased perfusion to the kidneys in pregnancy. This results in reduced serum urea and reduced serum creatinine. There is also usually increased urine protein and the threshold for excessive proteinuria in pregnancy is >300 mg/24 hours versus >150 in non-pregnant patients. H
TIme fram for a category 2 C section?
75 minutes
Medical management of PPH?
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
Management of eclampsia?
Magnesium sulphate
The classic triad of vasa praevia?
rupture of membranes followed by painless vaginal bleeding and fetal bradycardia
Edwards results on quadruple test?
↓ AFP
↓ oestriol
↓ hCG
↔ inhibin A
first-line treatment for magnesium sulphate induced respiratory depression
Calcium gluconate
Causes of folic acid deficiency:
phenytoin
methotrexate
pregnancy
alcohol excess
VEAL CHOP mneumonic to do with CTG?
VEAL CHOP
Variable decelerations –> Cord compression
Early decelerations –> Head compression
Accelerations –> Okay!
Late decelerations –> Placental Insufficiency
Bishops score of more than what indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour
More than or equal to 8
Drug that reduces uterine contractions?
Tocolytics
Management of women who’ve had GBS detectd in previous pregnancies?
informed that their risk of maternal GBS carriage in this pregnancy is 50%. They should be offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive
What is placenta increta?
chorionic villi invade into the myometrium
What is placenta percreta?
chorionic villi invade through the perimetrium
Best epileptic drug in pregnancy?
Lamotrigin
What to monitor in magnesium sulphate?
Monitor reflexes and respiratory rate
medication of choice in suppressing lactation when breastfeeding cessation is indicated
Cabergoline
First choice of antidepressant in breastfeeding women?
Sertaline
Most common cause of PPH?
Uterine atony
CAuses of oligohydramnios?
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
Group B strep prophylaxis?
Benzylpenicllin
What is a second degree perineal tear?
injury to the perineal muscle, but not involving the anal sphincter
Fetus alive and less than 36 weeks management of placental abruption?
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
Mneumonic for antenatal screening?
4 3 2 1
4 blood (FBC, rhesus, blood group, alloantibodies)
3 virus (hepB, HIV, syphilis) rubella no more
2 UTI (dipstick, culture)
1 full physical examination (breast, BMI, BP)
Cut off for iron supplementation in post partum period?
less than 100 g/L
What is third degree perineal tear?
injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
What is a fourth degree perineal tear?
injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
What does oxytocin do?
Increase smooth muscle contraction
Recommended treatment for delayed placental delivery in patients with placenta accreta?
Hysterectomy
Test for oral glucose tolerance test?
24-28 weeks
Best step to confirm Preterm prelabour rupture of membranes?
terile speculum examination should be performed (to look for pooling of amniotic fluid in the posterior vaginal vault) but digital examination should be avoided due to the risk of infection
if pooling of fluid is not observed NICE recommend testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1
ultrasound may also be useful to show oligohydramnios
Treatment for VTE in pregnancy?
Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy. Direct Oral Anticoagulants (DOACs) and warfarin should be avoided in pregnancy.
First line anti-hypertensive for women with severe asthma?
Nifedipine
Antibiotic management of PPROM?
Oral erythromycin
Layers cugt when C section
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
Investigation for placenta praevia?
Transvaginal ultrasound scan
Gestational diabetes fasting glucose?
> = 5.6 mmol/L
How long would lochia persisting warrant an US?
6 weeks
What is a Kleihauer test?
test for FMH which detects fetal cells in the maternal circulation and, if present, estimates the volume of FMH to allow calculation of additional anti-D immunoglobulin.
What is Twin to twin transfusion syndrome?
one fetus, the ‘donor’ receives a lesser share of the placenta’s blood flow than the other twin, the ‘recipient’. This is due to abnormalities in the network of placental blood vessels. The recipient may become fluid-overloaded whilst the donor can become anaemic. One fetus may have oligohydramnios and the other may have polyhydramnios as a result of differences in urine production, causing additional problems.
Combined test in downs syndrome?
nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A)
Investigation for placenta praecia?
Transvaginal ultrasound scan
Percentage of birth weight that if lost in first week of life then referral to a midwife-led breastfeeding clinic may be appropriate
Breastfeed baby loses more than 10% of weight
Curd like vaginal discharge, vulvitis and itch. What condition is this?
Candida
Adverse effects of injectable contraceptives?
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time
When is Omitting the pill-free interval is advised
if 2 or more pills are missed in week 3 of a packet.
How long till IUS effective after fitted?
7 days
How many days need to take additional contraceptive after starting POP?
2 ays
How long after giving birth can you start POP?
Immediatelly even if breastfeeding. but not needed till 21 days
COCP is protective against what cancers?
Ovarian and endometrial
When is levonelle most effective?
When taken within 72 hours
When is ella One most effective?
When taken within 120 hours
How long after levonorgestrel can hormonal contraceptive be started~?
Immediately
When can COCP be stated again after giving birth?
21 days due to the increased venous thromboembolism risk post-partum
What to do if 2 pills are missed between days 8-14 of the cycle?
No emergency contraceptive required as long as previous 7 days taken correctly
What to do if 2 pills are missed between days 15-21 of the cycle?
Finish the pills in her current pack and omit pill free period
What does a COCP do?
Inhibits ovulation
What is the action of implantable contraception?
Inhibits ovulation and thickens cervical mucus
Action of copper IUD?
Decreases sperm motility and surivial
What is the mode of action of POP?
Thickens cervical mucus
Moe of action of desogestrel only pill?
Inhibits ovulation and thickens cervical mucus
Action of the intrauterine system?
Prevents endometrial proliferation and thickens cervical mucus
When should dose of levonorgestrel be doubled?
BMI over 26 or weight over 70kg
What should you do if person vomits within 3 hours of taking levonorgestrel?
Give again at same dose
UKMEC 4
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
How many hours is a missed POP and what to do?
More than 3 or 12 depending on the pill. Take naother pill and use condoms for 48 hours
What contraception myst be stopped at 50?
Depo provera because of risk of osteoporosis
And the COCP
Contraceptive patch wear regimen?
wear one patch a week for three weeks and do not wear a patch on week four
What is the earlies ovulation date?
Day 14 in a 28 day cycle
Antibitoics effect on POP?
None unless antibiptic alters the P450 enzyme system like rifampicin
How long after taking ulipristal acetate should women wait before stating regular hormonal contraception?
Wait 5 days
How long after levonorgestrel can hormonal contraception options be startd?
Straight away
ulipristal acetate, can impact the efficacy of hormonal contraception methods. After taking ulipristal, women using hormonal contraceptives should use barrier method precautions or abstain from intercourse for 5 days after the ulipristal prior to restarting their hormonal contraceptive.
First line for infertility in PCOS?
Clomifene
Investigations for Ovarian cancer
CA125
US
Management of BV?
Oral metronidazole
What is the cervix finding sometimes found in trichmonas vaginalis?
Strawberry cervix
Gonorrhead first line?
IM ceftriaxone
Effective treatment for large fibroids causing problems with infertility?
Myomectomy
What is Rokitansky protuberance
olid protuberance projecting from an ovarian cyst in the context of mature cystic teratoma. It often contains calcific, dental, adipose, hair, and/or sebaceous components
What size of ectopic pregnancy requires surgical manageemnt?
More than 35mm
What is Ovarian hyperstimulation syndrome
one of the potential side effects of ovulation induction, and unfortunately can be life-threatening if not identified and managed promptly
In OHSS, ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, which has the potential to result in multiple life-threatening complications including:
Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism
What part of HRT increases risk of breast cancer?
Progestogen
What is a side effect of ondansteron if taken in first triester?
Cleft lip/palate
Diagnosis of vaginal candidiassis?
Diagnosis is clinical
Side effect of metoclopramid?
Extrapyramidal side effect
Clinical features of endometriosis?
chronic pelvic pain
secondary dysmenorrhoea- pain often starts days before bleeding
deep dyspareunia
subfertility
non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)
on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen
Risk factors for hyperemesis gravidarum?
increased levels of beta-hCG- multiple pregnancies and trophoblastic disease
nulliparity
obesity
family or personal history of NVP
Investigayion for endometrial cancer?
All women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway
first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
hysteroscopy with endometrial biopsy
What is the first line for ectopic pregnancies?
Salpingectomy
What is a salpingotomy?
creation of an opening into the fallopian tube, but the tube itself is not removed in this procedure
Risk factors for endometrial cancer?
excess oestrogen
metabolic syndrome- obesity. diabetes mellitus and polycystic ovarian syndrome
tamoxifen
hereditary non-polyposis colorectal carcinoma
What is the most common identifiable cause of postcoital bleeding?
Cervical ectropion
First line step after FGM identified?
Contact the police
First line for vomiting in pregnancy?
Promethazine
Then ondansteron and metoclopramide
Management of vaginal candidiasis?
Oral fluconazole
What is a risk for ovarian cancer- Early or late menarch?
Early. More periods. More chances for cancer
Medical management of a miscarriage?
Vaginal misoprostol
Medical management to shrink/remove fibroids?
GnRH agonists
What decreases incidence of hyperemesis gravidarum?
Smoking
What is Androgen insensitivity syndrome
X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype. Complete androgen insensitivity syndrome is the new term for testicular feminisation syndrome
What is mittelschmerz pain?
Mid cycle pain
Stress incontinece medical treatment?
Duloxetine
A woman >= 55 years of age presenting with postmenopausal bleeding (i.e. more than 12 months after menstruation has stopped) should be what
referred using the suspected cancer pathway (within 2 weeks) to exclude endometrial cancer
cOmmonest type of ovarian cyst?
Follicular cyst
What is a corpus luteum cyst?
during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
What are dermoid cysts?
mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
most common benign ovarian tumour in woman under the age of 30 years
What type of ovarian patholy is associated with Meigs syndrome?
Fibroma
Vaginal candidiasis treatment?
Oral fluconazole
What is hypothalamic hypogonadism?
. Where the body has low levels of fat, the hypothalamus releases less gonadotrophin-releasing hormone which in turn causes hypogonadism. This is thought to occur because very low-fat levels in a female are incompatible with successful pregnancy.
WHat to do if abnormal cytology?
Colposcopy
Pregnant patient management of thrush?
Clotrimazole pessary
Contraindications to HRT?
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
How often do women who are HIV positive require cervical screening?
Annual cervical cytology
Urge incontinence treatment?
bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)
bladder stabilising drugs: antimuscarinics are first-line
NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
Immediate release oxybutynin should, however, be avoided in ‘frail older women’
mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
Management of stress incontinence?
pelvic floor muscle training
NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
surgical procedures: e.g. retropubic mid-urethral tape procedures
duloxetine may be offered to women if they decline surgical procedures
a combined noradrenaline and serotonin reuptake inhibitor
mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
Investigation of choice for ectopic pregnancy?
Transvafinal US
Investigation for women in infertility?
serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.
Features of vulval carcinoma?
lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation
What are the most common complication of open myomectomys
Adhesion
Medical manageemnt of a miscarriage?
Vaginal misoprostol
How does ovarian cancer initally spread?
Local invasion
Complications of PID?
perihepatitis (Fitz-Hugh Curtis Syndrome)
occurs in around 10% of cases
it is characterised by right upper quadrant pain and may be confused with cholecystitis
infertility - the risk may be as high as 10-20% after a single episode
chronic pelvic pain
ectopic pregnancy
Investigations for PCOS?
pelvic ultrasound, FSH, LH, prolactin, TSH, testosterone, sex hormone-binding globulin (SHBG)
Investigation findings in PCOS?
raised LH:FSH ratio is a ‘classical’ feature but is no longer thought to be useful in diagnosis
prolactin may be normal or mildly elevated
testosterone may be normal or mildly elevated - however, if markedly raised consider other causes
SHBG is normal to low in women with PCOS
Investigation findings in PCOS?
raised LH:FSH ratio is a ‘classical’ feature but is no longer thought to be useful in diagnosis
prolactin may be normal or mildly elevated
testosterone may be normal or mildly elevated - however, if markedly raised consider other causes
SHBG is normal to low in women with PCOS
Antimuscarinic drugs?
oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
Immediate release oxybutynin should, however, be avoided in ‘frail older women’
If treated for CIN1, 2 or 3 when should the next follow up be?
6 months
What does the mirena coil release?
Progestrone
The three features of Meig’s syndrome are:
a benign ovarian tumour
ascites
pleural effusion
Types of endometrial hyperplasia?
simple
complex
simple atypical
complex atypical
Which of the following ovarian tumours is associated with the development of endometrial hyperplasia?
Granulosa cell tuymours
Management of endometrial hyperplasia?
simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
atypia: hysterectomy is usually advised
Hyperemesis gravidarum, diagnostic criteria triad:
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
Management of stage IA cervical cancer?
Cone biopsy and close follow up
What is a chocolate cyst?
Endometriotic cyst
The most common ovarian cancer
Serous carcinoma
Commonest type of ovarian cyst?
Follicular cyst
Management of stress incontinence after pelvic floor exercise if dont want surgical inervention?
Duloxetine
Ectopic pregnancy which area of fallopian tube is most likely to rupture?
Ishthmus
Features of vulval carcinoma?
lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation
Management of stage 2-4 of ovarian cancers?
Surigcal excision of. thetumour
Secondary treatment of endometriosis?
GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels
drug therapy unfortunately does not seem to have a significant impact on fertility rates
surgery
this may be an option for women who have not responded to conventional medical treatment
for women who are trying to conceive, NICE recommend laparoscopic excision or ablation of endometriosis plus adhesiolysis as this has been shown to improve the chances of conception. Ovarian cystectomy (for endometriomas) is also recommended
Most common case of post menopausal bleeding?
Vaginal atrophy
What is used in a medical abortion?
Oral mifepristone and vaginal prostaglandins
What is the action of metformin do?
Increases peripheral insulin sensitivity
What part of HRT increases risk of breast cancer?
Progestogen
What part of HRT increases risk of endometrial cancer?
oestrogen by itself should not be given as HRT to women with a womb
What part of HRT increases risk of venous thromboembolism?
increased by the addition of a progestogen
Investigations for HMB?
a full blood count should be performed in all women
NICE recommend arranging a routine transvaginal ultrasound scan if symptoms (for example, intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms) suggest a structural or histological abnormality. Other indications include abnormal pelvic exam findings.
Ovarian cyst that ruptures can cause pseudomyxoma peritonei
Mucinous cystadenoma
Which test would be most useful to investigate for a potential underlying cause of recurrent vaginal candidiasis?
HbA1c
Expectant managaemnt of miscarriage vs ectopic?
-miscarriage- wait 7-14 days
-ectopic- monitor 48hr and if bhcg rises again or symptoms manifest, intervention
Medical management of mischarriage vs ectopic?
Miscarriage -vaginal misoprostol
Ectopic - oral MTX
Surgical management of miscarriage and ectopic pregnancies?
Miscarriage- vacuum aspiration (suction curettage) or surgery in theatre under GA (evacuation)
Ectopic - salpingectomy or salpingotomy
Management of cystocele/cystourethrocele?
anterior colporrhaphy, colposuspension
Management of uterine prolapse?
hysterectomy, sacrohysteropexy
Management of rectocele?
posterior colporrhaphy
What must be ruled out in atrophic vaginitis?
Endometrial cancer
Risk factors for endometrial cancer?
Excess oestrogen
Metabolic syndrome
Tamoxifen
Heredirary non-polyposis colorectal carcinoma
What is red degeneration?
ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply. Red degeneration is more likely to occur in larger fibroids (above 5 cm) during the second and third trimester of pregnancy. Red degeneration may occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic. It may also occur due to kinking in the blood vessels as the uterus changes shape and expands during pregnancy.
Red degeneration of fibroids?
severe abdominal pain, low-grade fever, tachycardia and often vomiting. Management is supportive, with rest, fluids and analgesia.
Diagnostic criteria for PCOS?
a formal diagnosis should only be made after performing investigations to exclude other conditions
the Rotterdam criteria state that a diagnosis of PCOS can be made if 2 of the following 3 are present:
infrequent or no ovulation (usually manifested as infrequent or no menstruation)
clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
Non HRT management of vasomotor symptoms
Fluoxetine
Citalopram
Venlafaxine
Non HRT management of vaginal dryness
Vaginal lubricant or moistuiser
Non HRT management of psychological symptoms
Self help groups, CBT, antidepressants
Non HRT management of urogenital symptoms?
if suffering from urogenital atrophy vaginal oestrogen can be prescribed. This is appropriate if they are taking HRT or not
vaginal dryness can be treated with moisturisers and lubricants. These can be offered alongside vaginal oestrogens if required.
Inital investigations for urinary incontinence?
bladder diaries should be completed for a minimum of 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies
What should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services
Vesicovaginal fistulae
What should be done if vesicovaginal fistula?
Urinary dye studies
A dye stains the urine and hence identifies the presence of a fistula.
When should a post void residual number be done?
in cases of voiding dysfunction or in patients in whom overflow incontinence is suggested. Features that would indicate this are a full bladder on examination after voiding
First line investigation for urinary incontinence?
Urinalysis to rule out a UTI and diabetes mellitus
What is adenomyosis?
Characterised by the presence of endometrial tissue within the myometrium. It is more common in multiparous women towards the end of their reproductive years.
Incestigation for adenomyosis?
MRI is the investigation of choice
first line treatment for primary dysmenorrhoea
NSAIDs such as mefenamic acid
Features of an ovarian cyst?
Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder
First line for infertility in PCOS?
Comifene
What is ovarian hypersimulation syndrome?
ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, which has the potential to result in multiple life-threatening complications including:
Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism
There are three main categories of anovulation
Class 1 (hypogonadotropic hypogonadal anovulation) - notably hypothalamic amenorrhoea (5-10% of women)
Class 2 (normogonadotropic normoestrogenic anovulation) - polycystic ovary syndrome (80% of cases)
Class 3 (hypergonadotropic hypoestrogenic anovulation) - premature ovarian insufficiency (5-10% of cases). In this class, any attempts at ovulation induction are typically unsuccessful and therefore usually require in-vitro fertilisation (IVF) with donor oocytes to conceive
First line medical therapy in patients with PCOS
Letrozole
aromatase inhibitor, reducing the negative feedback caused by estrogens to the pituitary gland, therefore increasing the amount of follicle-stimulating hormone (FSH) production and promoting follicular developmen
Treatment for women with class 1 ovulatory dysfunction- hypogandotrophuc hypogonadal anvoluation
Gonadotropin therapy
What is Androgen insensitivity syndrome
X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype. Complete androgen insensitivity syndrome is the new term for testicular feminisation syndrome
Endometrial cancer management
localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy
patients with high-risk disease may have postoperative radiotherapy
Common long term complications of vaginal hysterectomy with antero-posterior repair include what
enterocoele and vaginal vault prolapse
Management of induction if Bishop’s score more than 6?
amniotomy and an intravenous oxytocin infusion
What is adenomyosis?
Characterized by the presence of endometrial tissue within the myometrium. It is more common in multiparous women towards the end of their reproductive year
Features of adenomyosis?
dysmenorrhoea
menorrhagia
enlarged, boggy uterus
Labour management if Bishops score more than 6?
amniotomy and an intravenous oxytocin infusion
How long after levonorgestrel can hormonal contraception options be startd?
Straight away
ulipristal acetate, can impact the efficacy of hormonal contraception m
