Obs and gynae: revision session Flashcards
APH definition
Bleeding from genital tract from 24 weeks to birth of baby
Minor APH
<50mls and stopped
Major APH
50-100mls
Massive APH
100mls + signs of shock
Causes of APH
Cervical ectropian Vaginal infection Bleeding from placental edge Placenta praevia Abruption
Placenta praevia
When placenta is within 2.5cm of cervix
Management of APH
ABCDE IV access Bloods, G and S IV fluids Blood transfusion Delivery of baby
32 weeks, Post coital bleed
Cervical ectropian
Infection
6 weeks, PV bleeding, saw something jelly like, now bleeding stopped
Miscarriage
28 weeks, large volumes, woody hard uterus, drug missuse
Abruption
Painless PV bleeding, previous children
Placenta praevia
Menorrhagia
Regular, heavy menstrual bleeding. Excessive amount which interferes with quality of life.
Ix of menorrhagia
Detailed history Bimanual examination Speculum Blood test TV USS
Bulky uterus
Adenomyosis
Fibroids
Menorrhagia
Fibroids
Endometriosis
Polyps
Endometrial hyperplasia
Which maternal non gynae diseases can cause menorrhagia
Hypothryoidism Coagulation problems Diabetes Liver/ kidney disease Anticoagulant therapy Copper IUD
Red flag symptoms for menorrhagia
Postcoital bleeding
IMB
Dyspareunia
Dysmenorrhoea
PCB
Cervical cancer
IMB
Cervical cancer or endometrial cancer
Dyspareunia
Cervical cancer
Irregular periods
PCOS
Pelvic pain and pressure symptosm
Prolapse or cancer
Vaginal discharge
PID
Menorrhagia first line
Levonorgesterel IUS- Mirena coil
Menorrhagia second line
Tranexamic acid
NSAIDS
COCP
Mirena benefits
Progesterone very local long term, mainly causes amenorrhoea
Why is tranexamic acid bad
VTE risk (avoid if fat and VTE risk already)
COCP cant be given to
Anyone with clot risks (high BMI, FHx)
Menorrhagia surgeries
Endometrial ablation
Uterine artery embolisation
Hysterectomy
Myomectomy
21 year old student, 3 months menorrhagia
Infection?
New contraception?
PCOS
What contraceptions can cause heavy bleeding
Copper coil, implant
Treatments for menorrhagia in young
Mirena coil
COCP
POP
45 year old lady
Heavy IMB
BMI 50
Flooding
Endometrial cancer
Fibroids
Endometriosis
Adenomyosis
Over growth of muscle of uterus
Treatment for endometrial cancer, fibroids, endometriosis
Surgery- ablation, hysterectomy, myomectomy
Whats a myomectomy for
Fibroids
Investigation for 45year old heavy bleeder (at risk for endometrial cancer)
Pipelle biopsy
Why does obesity risk factor for cancers
Fat cells produce oestrogen
Who gets endometrial
Menopause
Who gets ovarian cancer
50+
Who gets vulval cancer
70+
PCB in a young person
Cervical cancer
What causes cervical cancer
High risk HPV
Cervical cancer risk factors
High risk HPV early age intercourse multiple sexual partners STDs Cigarette smoking Multiparity OCP uses Previous cervical intraepithelia neoplasia
Precancer of cervical cancer
Cervical intraepithelial neoplasia
Who gets high risk HPV
16, 18, 31 and 33
What do smears check for
CIN 1, 2 and 3 not cancer