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
CIN treatment
Lettz
Stage 1 cervical cancer treatment
Radical trachylectomy
Hysterectomy
Stage 2 cervical cancer treatment
Radiotherapy
Chemotherapy
Palliative care
Endometrial cancer red flag
Postmenopausal bleeding
Main risk factor for endometrial cancer
Unopposed oestrogen
Risk factors for endometrial cancer
Obesity Diabetes Nulliparity Late menopause Ovarian tumours HRT Pelvic irradiation Tamoxifen PCOS
Treatment for endometrial cancer
Hysterectomy and pelvic lymph nodes
+radiotherapy
+progesterone therapy
What is brachytherapy
Radiotherapy from the inside out
What causes ovarian cancer
Ovulation and gene mutation (BRCA1 and 2)
Factors affecting ovulation
Early menarche and late meopause= more
Breast feeding and parity= less
Ovarian cancer presentation
50s, IBS symptoms
Urinary frequency
Bowel obstruction
What cells do ovarian cancers normally come from
Epithelial
Risk of ovarian cancer calculator
Risk of malignancy index Symptoms and age CA125 Ultrasound score Menopausal score
Treatment for ovarian cancer
Hysterectomy or debulking
Chemo/ radio
Palliative care
Vulval cancer causes
HPV and lichen sclerosis
What is lichen sclerosis
Premalignant condition
Scaly white plaques on vulva
Older population
Symptoms of vulval cancer
Vulval itching Non healing lesion Vulval soreness Persistent lump Bleeding Pain on passing urine Past history of HPV or lichen sclerosis
Vulval cancer treatment
Surgery
Chemotherapy
Radiotherapy
Late pregnancy problems
Symphysis pubis dysfunction IUGR Gestational diabetes Anaemia Reduced fetal movements Preeclampsia
Differential diagnosis in obstetrics
Can just get migraines, tension headache etc UTI MSK pains Diarrhoea and vomitting Appendicitis
28 year old lady, 24 weeks pregnant, abdo pain
Appendicitis Abruption Miscarriage Braxton hicks Symphysis pubis dysfunction
40 year old lady, 36 weeks pregnant
Preeclampsia
Migraine
Tension headache
Venous sinus thrombosis
Stroke in pregnant woman and why
Venous sinus thrombosis, hypercoagulable when pregnant
16 year old, 8 weeks with vomitting
Hyperemesis
Molar pregnancy
Why do people get sick in hyperemesis and molar pregancy and twins
Beta hCG
Infertility definition
Inability to conceive after 2 years of regular unprotected sexual intercourse and in the absence of known reproductive pathology
Pretesticular male infertility causes
Chemotherapy, hyperprolactinaemia
How does hyperprolactinaemia cause low testosterone
Surpresses FSH
Testicular causes of male infertility
Kleinfelters, trauma, infection, radiation
Post testicular causes of male infertility
Obstruction, retrograde ejaculation, absence of vas deferens
Causes of no eggs
Tuners syndrome Trauma Toxins (chemo and radio) Oophrectomy Premature ovarian failure
Turners syndrome
45X
What does the embryo inplant as
Blastocyst
Anovulation causes
PCOS
increased androgens can cause hirsuitism and acne, weight gain
Problems with implantation of blastocyst
Recurrent miscarriage
Antiphospholipid syndrome
Polyps, fibroids, Ashermans syndrome
What is ashermans syndrome
Adhesions within the uterus
Male factor infertility treatment
Sperm donation, stop steroids
General fertility tips
Stop smoking, lose weight, good sleep, regular sex, stress reduction
Anovulation treatment
Clomiphene, metformin, ovarian drilling
Ovarian reserve treatment
Donor egg
Tubal fertility treatment
Tubal cannulation
Unexplained infertility treatment
IVF
On which days are women most likely to conceive in a cycle
8-14 days (14 days from end)
What number day is the first day someone bleeds
day 1
Fetal complications of maternal smoking
Prematurity, respiratory disease, IUGR, cot death
Fetal complications of maternal alcohol
Neurological damage, facial deformities, fetal growth retardation, spontaneous miscarriage
What vitamin is in liver and vitamins and can cause foetal abnormalities
Vitamin A
Why shouldnt pregnant people take multivitamisn
Vitamin A
Foods to avoid in pregnancy
Soft cheese (listeria) Raw eggs (salmonella) Liver (vitamin A) Shellfish ( Tuna (mercury) Caffeine Alcohol
Why should you avoid cat litter in pregnancy
Toxoplasmosis
What is the normal dose of folic acid
400mcg
5mg of folic acid for
Family history of neural tube defect
Diabetes
Previous neural tube defect
Obese
Which drugs should you avoid in pregnancy
Propanolol and NSAIDS (premature PDA closure)
Warfarin (foetal abnormalities)
Furosemide (renal development problems)
What drug is defo safe in preganncy
Paracetamol
Serum markers triple test for risk of downs syndrome
Alpha feto protein, beta HCG, Estriol
When is the best time to do an ultrasound scan, for nuccal translucency
11-14 weeks- 12 week scan
What do you look for on ultrasound scan for downs syndrome
Nuccal translucency
Most appropriate time for amniocentesis
15 weeks+
Risk of miscarriage in amniocentesis
1%
Whats the most appropriate time for chorionic villous sampling
from 11 weeks as placenta needs to be big enough
What is commonly seen on USS at 12 weeks
Anencephaly (no brain)
When can you see oligohydramnios
18+ weeks
What can confuse looking at nuccal translucency
Cystic hydroma on the neck
At every appointment what do you look at
Blood pressure Urine Symphysis fundal height Fetal heart beat (not fetal position)
Physiological changes in pregnancy
Fall in BP in early pregnancy
Increased maternal ventilation
Hypercoagulability
Increased GFR
What hormone causes N and V
Beta HCG
Which serum makers increase in preganncy
T3, T4, thyroid binding globulin
AlkPhos
Which serum markers go down in pregnancy
Protein and albumin
Preeclampsia diagnosis
High blood pressure, protien in urine
Epigastric pain, facial swelling, headache
Risk factors for preeclampsia
Diabetes Hypertension Renal disease Molar pregnancy High BMI
HELLP syndrome
High liver enzymes
High Us and Es
Low platelets
Management for preeclampsia
Labetalol