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P2 > OBS & GYN > Flashcards

OBS & GYN Flashcards

1
Q

What is normal menstrual bleeding?

A

Normal Menstrual Bleeding:
• Avg 30mL lost with each menstrual period
• Upper limit is 80mL

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2
Q

Definition of abnormal uterine bleeding

A
  • Blood loss of more than 80mL (subjective by the patient)
  • Cycle length of < 24 days or > 35 days
  • Intermenstrual or postcoital bleeding
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3
Q

Definition of dysfunctional uterine bleeding

A

Excessive bleeding which is not due to pregnancy, pelvic pathology or systemic disease that can be cyclical (ovulatory) or non-cyclical (anovulatory). Anovulatory bleeding commonly occurs at the beginning and end of reproductive life
(adolescence and premenapause).

Diagnosis of exclusion

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4
Q

Definition of menorrhagia

A
  • Excessive or prolonged menstrual bleeding occurring at regular intervals
  • Note: both patient and doctor are unreliable at predicting amount of blood lost
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5
Q

Definition of inter-menstrual bleeding

A

Bleeding that occurs between regular menstrual cycles

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6
Q

Definition of post-coital bleeding

A

Bleeding up to 24 hours after intercourse

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7
Q

Definition of pre-menstrual spotting

A

Bleeding during the week prior to a period

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8
Q

Definition of Metrorrhagia

A

Bleeding of normal or less than normal volumes at irregular intervals

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9
Q

Definition of Menometrorrhagia

A

Prolonged or excessive bleeding at irregular intervals

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10
Q

Definition of Polymenorrhoea

A

Regular bleeding that occurs at intervals < 24 days

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11
Q

Aetiology of abnormal uterine bleeding

A
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12
Q

What History and Examination for abnormal uterine bleeding

A
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13
Q

Investigations for abnormal uterine bleeding

A
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14
Q

Investigation considerations according to patient group

A

Common to consider:
- BHCG
- Bloods: iron, FBC, folate, B12, coags ,TFTs, LFTs
- Imaging: Pelvic, abdominal or transvaginal US
- STI swab
- Pap smear
- Colposcopy
- Hysteroscopy
- biopsy

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15
Q

Management of abnormal uterine bleeding

A
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16
Q

Uterine blood flow

A
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17
Q

Causes of abnormal uterine bleeding

A
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18
Q

DDx of abnormal uterine bleeding

A
  • Ectopic pregnancy
  • Miscarriage
  • Placental abruption, placenta previa
  • Breakthrough bleeding
  • Benign structural abnormalities (adenomyosis, fibroids, polyps)
  • Gynaecological malignancies
  • Chlamydia
  • Hormonal changes – menopause/perimenopause
  • Prolapse
  • Trauma
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19
Q

Investigation for abnormal uterine bleeding (part 2)

A
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20
Q

Treatment for abnormal uterine bleeding

A
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21
Q

Definition of uterine fibroids (leiomyoma)

A

Benign tumours of the uterus composed of smooth muscle and fibrous connective tissue

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22
Q

Epidemiology of uterine fibroids

A

Epidemiology:
• Incidence increases with age
• Affects 20-50% of women > 30 years
• Prevalence may be as high as 80%

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23
Q

Aetiology and anatomical classification of uterine fibroids

A
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24
Q

Clinical features of uterine fibroids

A
  • Asymptomatic – most common
  • Menorrhagia (caused by submucosal fibroids)
  • Dysmenorrhoea (painful periods)
  • Pelvic pain/pressure
  • Bloating
  • Enlarged uterus – firm, asymmetric, non-tender
  • Usually slow growing but can be accelerated growth in pregnancy due to high oestrogen
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25
Q

Investigations for uterine fibroids

A
  • Pelvic U/S
  • Endometrial biopsy (via hysteroscopy)
  • DDx – clinically similar to adenomyosis and uterine polyps (require biopsy)
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26
Q

Treatment for uterine fibroids

A
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27
Q

Complications and prognosis of Uterine fibroids

A
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28
Q

Anatomy of uterus

A
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29
Q

Definition and epidemiology of Antepartum Haemorrhage

A

Definition:
• Uterine bleeding that occurs after 20 weeks gestation that is unrelated to labour and delivery

Epidemiology:
• 6% of all pregnancies experience PV (per vagina) bleeding in the 3rd trimester

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30
Q

Aetiology of antepartum haemorrhage

A
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31
Q

General management of antepartum haemorrhage

A
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32
Q

Definition and epidemiology of abruptio placenta (placenta abruption)

A

Definition:
• Premature separation of a normal implanted placenta from the decidual lining of the uterus after 20 weeks gestation

Epidemiology:
• Occurs in 1 in 200 pregnancies
• Black women > white women

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33
Q

Aetiology and risk factors for placenta abruption

A

Aetiology:
• Exact cause is unknown

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34
Q

Types of placenta abruption

A

Types:
• Apparent: Bleeding apparent
• Concealed: Bleeding is not-apparent
• Mixed: Bleeding with concealment

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35
Q

Pathophysiology of placenta abruption

A

Pathophysiology:

  • Rupture of maternal vessels in the decidua basalis at the interface of the anchoring villi
  • Accumulating blood splits the decidua, separating a thin layer of decidua with its placental attachment from the uterus
  • The bleeding may be small and self-limited or it can continue to separate the decidua leading to complete or near complete placental separation
  • The detached portion is no longer able to exchange gases and nutrients
  • May lead to foetal compromise if the remaining foeto-placental unit is unable to compensate for this loss of function
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36
Q

Clinical features of antepartum haemorrhage

A
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37
Q

DDx for anterpartum haemorrhage

A

DDx:

  • Preterm labour - can co-exist/caused by placental abruption
  • Placenta praevia
  • Chorioamnionitis - bleeding is uncommon
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38
Q

Diagnosis and complications of antepartum haemorrhage

A

Diagnosis:
• Diagnosis of exclusion, based on clinical Hx and U/S

Complications:
• Hypovolaemic shock (medium)
• DIC
• Intra-uterine growth restriction
• Preterm birth
• Perinatal death

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39
Q

Management of antepartum haemorrhage

A
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40
Q

Definition of Placenta Praevia

A

Definition:

  • The presence of placental tissue that extends over or lies proximate to the internal cervical os
  • Should be suspected in any woman > 20 weeks gestation that presents with painless vaginal bleeding
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41
Q

Epidemiology and risk factors of placenta praevia

A

Epidemiology:

  • Uncommon in 1st pregnancies (0.2% in nulliparous)
  • 0.5% in multiparous and a 4-8% recurrence

Risk Factors:

  • Previous placenta praevia - 0.7% risk
  • Infertility treatments (IVF) - 2% risk • Endometrial scarring, (previous LSCS) - 0.6%
  • Impeded endometrial vascularisation e.g. HTN, diabetes, uterine tumour, drugs (cocaine) smoking and Advanced maternal age
  • Increased placental mass: ⁃ Multiparity
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42
Q

Aetiology and classification of placenta praevia

A
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43
Q

Clinical features of Placenta Praevia

A
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44
Q

DDx for placenta praevia

A

DDx:

  • Normal labour
  • Placental abruption
  • Placenta accreta
  • Miscarriage (more common in early pregnancy)
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45
Q

Investigations for placenta praevia

A

Investigations:

  • Transabdominal U/S - Assess placental position
  • Transvaginal U/S - Preferred
  • FBC - Assess Hb level in acute bleeds
  • Type and crossmatch
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46
Q

Management of Placenta Praevia

A
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47
Q

Complications of placenta praevia

A

Complications:

  • Anaemia (short-term high) - due to bleeding
  • Complications of C-section
  • Preterm birth
  • Abnormally adherent placenta
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48
Q

Prognosis of placenta praevia

A
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49
Q

Definition of Placenta Accreta

A
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50
Q

Epidemiology and risk factors of Placenta Accreta

A

Epidemiology

  • 5-10% risk in the presence of placenta praevia
  • 10-20% risk with previous LSCS

Risk Factors:

  • Placenta praevia
  • Previous C-section or uterine surgery
  • Maternal age > 35 years
  • Multiparity - increases after each childbirth
  • Uterine pathology like fibroids
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51
Q

Aetiology and pathophysiology of placenta accreta

A

Aetiology:

  • Unknown
  • Abnormality to the uterine lining

Pathophysiology:

  • Defective decidualisation (thin, poorly formed or absent decidua) related to previous surgeries or anatomical pathologies or extra-villous trophoblastic invasion
  • Allows for the placenta to attach directly to the myometrium
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52
Q

Clinical features, Investigations and Management of Placenta Accreta

A
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53
Q

For Vasa Previa what is the:

  • Definition
  • Epidemiology
  • Aetiology and pathophysiology
  • Clinical features
  • Diagnosis
A
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54
Q

Assisted reprodutive tech cards to be filled - Gobi’s incomplete - might have to check in Jims

A
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55
Q

Common cancer of the vulva, epidemiology and symptoms

A

The female external genitalia is called the vulva. Made up of 3 main parts: labia majora, labia minora and clitoris

  • Cancer of the vulva makes up around 4% of female genital tract cancers and is quite rare
  • Most are SCCs
  • Most commonly diagnosed in post-menopausal women, ~ 70 years
  • Symptoms include ulcerative sores that do not heal, itching, unusual vaginal bleeding and/or discharge
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56
Q

Aetiology of cancer of the vulva

A
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57
Q

Sites of vulval cancer

A
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58
Q

Symptoms of vulval cancer

A
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59
Q

Risk factors of vulval cancer

A
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60
Q

Types of vulval cancer

A
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61
Q

Diagnosis and staging of vulval cancer

A
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62
Q

Treatment of vulval cancer

A
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63
Q

Definition of cervical cancer

A
  • Cervical cancer is a HPV-related malignancy of the uterine cervical mucosa
  • HPV is transmitted via sexual intercourse
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64
Q

Epidemiology of cervical cancer

A

Epidemiology:

  • Cervical cancer is the 2nd most common malignancy in women worldwide
  • Peak infection incidence is between 15-25 years, with the majority resolving in 12-18 months
  • Prevalence of HPV at age 35 is 5%
  • Effective screening programs have reduced mortality by 75% in the last 50 years
  • 60% of diagnoses occur in women who have never had screening or have not been screened in the last 5 years
  • Pap smears are a very successful cancer screening tool
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65
Q

Aetiology and risk factors of cervical cancer

A
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66
Q

Pathophysiology of cervical cancer

A
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67
Q

Clinical features and staging of cervical cancer

A
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68
Q

Investigations for cervical cancer

A
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69
Q

Pap smear results in cervical cancer screening

A
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70
Q

Classification and staging of cervical cancer

A
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71
Q

Management of cervical cancer

A
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72
Q

Screening for cervical cancer

A
  • 25-74 years
  • Every 5 years
  • Test looks for HPV
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73
Q

Prognosis for cervical cancer

A
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74
Q

Histology of the transformation zone and types of smears

A
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75
Q

Histology of cervical cancer

A
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76
Q

Contraception cards - gobi’s incomplete - please insert

A
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77
Q

Epidemiology and factors enhancing risk of diabetes in pregnancy

A
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78
Q

Complications and maternal insulin requirements in T1DM and pregnancy

A
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79
Q

Management of T1DM in pregnancy and delivery

A
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80
Q

Considerations and management of T2DM in pregnancy

A
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81
Q

Definition and epidemiology of Gestational Diabetes Mellitus (GDM)

A

Definition:

  • Any degree of glucose intolerance with onset or first recognition in pregnancy
  • Includes women that develop T1DM/T2DM during the pregnancy, hence need for retrospective classification

Epidemiology:

  • Accounts for 70% of diabetes in pregnancy
  • Higher in asian and black populations
  • Rates of GDM are on the rise
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82
Q

Aetiology of GDM

A
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83
Q

Pathophysiology of GDM

A
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84
Q

Clinical features of GDM

A
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85
Q

Investigations for GDM

A
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86
Q

Screening for GDM

A
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87
Q

Management for GDM

A
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88
Q

Complications of GDM

A
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89
Q

Prognosis for GDM

A
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90
Q

Role of prostaglandins in labour

A
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91
Q

Role of oxytocin in labour

A
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92
Q

Role of B2 agonists in labour

A
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93
Q

Role of tocolytics in labour

A
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94
Q

Induction of labour and myometrial contraction

A
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95
Q

Inhibition of labour and myometrial relaxation

A
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96
Q

Definition of ectopic pregnancy

A

Definition:

  • A pregnancy resulting from the fertilised ovum implanting in a site other than the normal uterine cavity
  • Obstetric Emergency: If undiagnosed it can lead to maternal death due to rupture of the implantation site and intraperitoneal haemorrhage

Epidemiology:

  • Incidence rate of 1-2% and rising
  • Recurrence rate is 15% after 1st and 25% after the 2nd
  • Accounts for 80% of 1st trimester maternal deaths. Mortality rates are declining
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97
Q

Aetiology and risk factors of ectopic pregnancy

A
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98
Q

Classification of ectopic pregnancy

A
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99
Q

Pathophysiology of ectopic pregnancy

A
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100
Q

Clinical features of ectopic pregnancy

A
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101
Q

Investigations for ectopic pregnancy

A
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102
Q

Diagnosis of ectopic pregnancy

A

Diagnosis:

  • Elevated β-hCG with no intrauterine gestation sac (> 5 weeks is visible on TVS)
  • Detection of free-fluid in the peritoneal cavity
  • Laparoscopy rarely required for diagnostic purposes
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103
Q

Differential diagnosis for ectopic pregnancy

A

DDx:

  • Miscarriage
  • Acute appendicitis
  • Ovarian torsion
  • Ruptured corpus luteal cyst or follicle
  • Normal 1st trimester bleeding (20% of women have normal pregnancies)
  • UTI/PID
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104
Q

Management of ectopic pregnancy

A
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105
Q

Complications and management of ectopic pregnancy

A
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106
Q

Normal B-Hcg and diagnosis of interuterine/normal pregnancy

A
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107
Q

Definition and epidemiology of endometrial cancer

A

Definition:

• Epithelial malignancy of the uterine corpus mucosa - usually adenocarcinoma

Epidemiology:

  • Most common gynaecological malignancy in the developed world
  • 7th most common cancer in women overall
  • Incidence in western countries is 10x more than in developing
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108
Q

Aetiology of endometrial cancer

A
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109
Q

Risk factors for endometrial cancer

A

Risk Factors:

  • Obesity
  • Age > 50 years
  • Endometrial hyperplasia
  • Unopposed exogenous/endogenous oestrogen exposure
  • FHx of endometrial cancer
  • FHx of breast or ovarian cancer
  • HNPCC
  • Tamoxifen use (oestrogen receptors antagonist) for Rx of breast Ca (7x)
  • DM
  • HTN
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110
Q

Classification of endometrial cancer

A

Classification:

  • Adenocarcinoma (90%)
  • SCC
  • Transitional cell carcinoma
  • Small cell
  • Undifferentiated
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111
Q

Clinical features of endometrial cancer

A
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112
Q

Investigations for endometrial cancer

A
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113
Q

Differential diagnosis for endometrial cancer

A

DDx:

  • Endometrial hyperplasia - commonly presents with abnormal uterine bleeding, irregular or heavy periods
  • Endometrial polyp - usually asymptomatic, but if symptomatic presents similarly
  • Endometriosis - More common in younger pre-menopausal women
  • Cervical cancer - Typically younger women; PV bleeding usually provoked (post-coital)
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114
Q

Spread and management of endometrial cancer

A
115
Q

Complications and prognosis of endometrial cancer

A
116
Q

Definition and epidemiology of endometriosis

A

Definition:

• Ectopic endometrial glands and stroma growing outside the endometrial cavity and uterine musculature

Epidemiology:

  • 3-10% of women aged 20-50 (women of reproductive age usually)
  • Average age at diagnosis is 25-28 years
  • Account for 25-35% of infertility
  • Severity of symptoms increases with age and peaks at 40yrs • Prevalence higher in white women and women with Lower BMIs • Adolescent endometriosis exists
117
Q

Aetiology + risk factors for endometriosis

A

Aetiology:

• Several theories exist + Genetic predisposition

Risk Factors:

  • Reproductive Age
  • Family Hx
  • Nulliparity
  • Mullerian anomolies
  • Others: White, Low BMI, Autoimmune disease, Smoking
118
Q

Pathogenesis of endometriosis

A

1. Retrograde menstruation theory: ⁃ Retrograde menstruation seeds in the abdominal cavity ⁃ Occurs in 70-90% of women

2. Coelomic metaplasia: ⁃ Peritoneal mesothelium undergoes metaplastic transformation into endometrial tissue

3. Induction theory: ⁃ Unknown biochemical substance induce undifferentiated peritoneal cells to form endometrial tissue

4. Immunological theory: ⁃ Alterations in cell-mediated immunity leads to abnormal clearance of endometrial cells

119
Q

Pathophysiology of endometriosis

A
  1. Endometriosis and sub-fertility: Altered anatomy with tube/ovarian involvement and scarring and PG overproduction can also interfere with fertilisation
  2. Dysmenorrhoea occurs due to reactive hormonal-tissue in the abdomen
  3. Chronic pain may be due to fibrosis that occurs with chronic inflammation
120
Q

Types of lesions in endometriosis

A

Three types of lesions in endometriosis:

  • superficial peritoneal endometriosis – powder burn lesions on ovaries, serosa and peritoneum, may also appear as white plaques, scarring, red implants, serous vesicles
  • ovarian cysts (endometrioma) – ‘chocolate cysts’ forming from menstrual bleeding in the ovaries
  • deep infiltrative endometriosis – nodules extending more than 5mm beneath the peritoneum involving the uterosacral ligaments, vagina, bowel, bladder, or ureters
121
Q

Signs and symptoms of endometriosis

A
122
Q

Staging of endometriosis

A
123
Q

Clinical presentation of endometriosis

A
124
Q

Differential diagnosis of endometriosis

A
  • Adenomyosis – hyperplasia leading to growth of endometrial tissue within the myometrium, symptoms may be identical, and endometriosis is often concurrent
  • Pelvic inflammatory disease
  • Malignancy – ovarian, uterine, endometrial
  • Ovarian cyst
  • Irritable bowel syndrome
125
Q

Investigations and diagnosis of endometriosis

A

Investigations:

  • TVS - may show ovarian endometrioma or deep pelvic endometriosis
  • Diagnostic laparoscopy

Diagnosis:

  • Laparoscopy - Gold Standard. Finding of extra-uterine endometrial tissue on visualization and biopsy (histopathology)
  • Examination - Pouch of Douglas Pain with nodularity of the uterosacral ligament. Fixed in retroversion
  • TVS: Especially for endometrioma
126
Q

Management of endometriosis

A
127
Q

Complications and prognosis of endometriosis

A
128
Q

Definition of foetal malpresentation

A

Definitions:

  • In normal pregnancies the foetus assumes a normal longitudinal (vertical) lie with a cephalic presentation and the head well flexed
  • 5% of all term pregnancies have a deviation from this lie
129
Q

Causative factors for foetal malpresentation

A
130
Q

Types of foetal malpresentations

A

Types of Malpresentations:

  1. Unstable lie
  2. Face presentation
  3. Brow presentation
  4. Compound presenation
  5. Breech presentation
131
Q

Unstable or abnormal lie of foetal malpresentations

A
132
Q

Face presentation of foetal malpresentation

A
133
Q

Brow position of foetal malpresentation

A
134
Q

Compound presentation of foetal malpresentation

A
135
Q

Breech presentation of foetal malpresentation

A
136
Q

Definition of gestational trophoblastic disease

A
137
Q

Epidemiology and aetiology of gestational trophoblastic disease

A
138
Q

Pathophysiology of gestational trophoblastic disease

A
139
Q

Classification of gestational trophoblastic disease

A
140
Q

Clinical features of gestational trophoblastic disease

A
141
Q

Differential diagnosis of larger than stated uterus

A

DDx of larger than stated uterus:

  • Wrong dates for LMP
  • Multiple gestation (twins)
  • Other intrauterine pathology (e.g. fibroids)
  • GTD
142
Q

Investigations for gestational trophoblastic disease

A
143
Q

Differential diagnosis for gestational trophoblastic disease

A

DDx:

  • Spontaneous abortion - can be differentiated on U/S
  • Multiple gestation - larger than normal uterus and elevated hCG
  • Pelvic tumour - may present with enlarged uterus, painless bleeding and adnexal mass
144
Q

Management of gestational trophoblastic disease

A
145
Q

Complications and prognosis of gestational trophoblastic disease

A
146
Q

Gynae Hx Taking

A
147
Q

Abdomen and vaginal exam

A

Antenal exam”
- BP
- void bladder and urine analysis
- general inspection
- Check for ankle oedema
- fundal height
- Foetal lie
- Foetal doppler

148
Q

Vaginal examination

A
149
Q

Definition of pre-eclampsia

A
150
Q

Epidemiology, aetiology and risk factors for pre-eclampsia

A
151
Q

Pathophysiology and types of pre-eclampsia

A
152
Q

Clinical features of pre-eclampsia

A
153
Q

Investigations for pre-eclampsia

A
154
Q

Management of pre-eclampsia

A
155
Q

Complications and prognosis of pre-eclampsia

A
156
Q

Definition of eclampsia

A

Definition:

• Onset of convulsions during pregnancy or postpartum unrelated to other cerebral pathologies in women with pre-eclampsia

157
Q

Epidemiology of eclampsia

A
158
Q

Clinical features of eclampsia

A
159
Q

Management of eclampsia

A
160
Q

Definition of induction of labour

A

Definition:

  • The planned initiation of labour prior to its spontaneous onset.
  • It is an intervention designed to artificially initiate uterine contractions, resulting in progressive effacement and dilation of the cervix leading to birth of the baby
  • It is performed when the benefits of delivery outweigh the risks of continuing the pregnancy
  • Should be performed if the risk of the process to the mother and/or foetus is acceptable, otherwise proceed to a C-section
  • Occurs in 1 in 5 deliveries
161
Q

Aims for induction of labour

A

Aims:

  • To stimulate regular uterine contractions
  • To generate progressive cervical dilation
  • To facilitate a subsequent vaginal delivery
162
Q

Indication for Induction of Labour

A

Indication for IOL: “When the benefits of delivery outweigh the potential risks of continuing pregnancy”

  • Prolonged pregnancy (post-date pregnancy) ** most common cause
  • Foetal growth restriction
  • Pre-eclampsia or other maternal HTN disorders
  • Prelabour rupture of membranes
  • Chorioamnionitis - inflammation of the foetal membranes
  • Unexplained antepartum haemorrhage
  • Maternal medical problems - diabetes or renal disease
  • Logistics - distance from hospital
163
Q

Contraindications for induction of labour

A

Contraindications:

  • Placenta previa or Vasa previa (placental cord running close to the os)
  • Transverse foetal lie
  • Previous classical uterine incision
  • Active genital herpes infection
  • Pelvic structural abnormalities
164
Q

Pre-induction of labour scoring system

A
165
Q

Steps/Process involved in induction of labour

A
166
Q

Complications and special cases in IOL

A
167
Q

Questions

A
168
Q

Definition of infertility

A
169
Q

Epidemiology and risk factors for infertility

A

Epidemiology:

• Affects 1 in 12 couples

Risk Factors:

  • Age > 35 years
  • Hx of STIs
  • Very high BMI
  • Very low BMI
  • Cigarette smoking ⁃ Related to accelerated menopause and decreased cilia function in uterine tubes
170
Q

Aetiology of infertility

A
171
Q

Pathophysiology of infertility

A
172
Q

Fecundity to consider in infertility

A
173
Q

History taking in infertility

A
174
Q

Examination for infertility

A

Females:

⁃ General Exam

⁃ Pelvic Exam

⁃ Cervical Smear

⁃ Swabs as appropriate

Male:

⁃ General Exam

⁃ Testes, vas, varicocele

⁃ Prostate

175
Q

Investigations for infertility

A
176
Q

Management of infertility

A
177
Q

Prognosis for infertility

A
178
Q

Notes on IVF

A
179
Q

Infertility advice for couples

A
180
Q

Definition of labour

A
181
Q

Foetal and maternal anatomy in labour

A
182
Q

The process of labour

A
183
Q

Mechanism of labour

A
184
Q

Factors affecting the outcome of labour

A
185
Q

Factors affecting the duration of labour

A
186
Q

Management of labour

A
187
Q

Investigations prior to hospital booking for antenatal care

A
188
Q

Schedule of routine visits for normal antenatal care

A

Schedule of Routine Visits:

  • 11-12 weeks - booking Hx by hospital staff
  • 12-14 weeks - appointment with specialist & allocated a model of AN care
  • 16-24 weeks - 4 weekly appointments
  • 28-36 weeks - 2 weekly appointments
  • 36+ weeks - weekly appointments
189
Q

Checks on each visit for normal antenatal care

A
190
Q

Dietary advice for normal antenatal care

A
191
Q

Additional investigations in normal antenatal care

A
192
Q

Post delivery date women in antenatal care

A
193
Q

Ovarian cancer epidemiology and introduction

A
  • Ovarian cancer is the 2nd most common gynaecological malignancy and the major cause of death from gynaecological cancers
  • Mean age of presentation is 63 years
  • Patients with early-stage ovarian cancer are asymptomatic or have vague/non-specific symptoms
  • In late disease, patients present with abdominal pain or swelling
  • Survival rates for ovarian cancer remains poor due to late presentation of the disease
194
Q

Aetiology and risk factors for ovarian cancer

A
195
Q

Symptoms of Ovarian cancer

A
196
Q

Metastatic spread of ovarian cancer

A

Metastatic Spread:

  • Direct: Spread to surrounding structures
  • Lymphatic: Spread to the pelvic and para-aortic nodes is common
  • Haematoganous: Distant mets are uncommon
197
Q

Types of ovarian cancer

A
198
Q

Staging of ovarian cancer

A

Staging:

  • Stage 1: Growth limited to the ovaries -
  • Stage 2: Growth involving one or both ovaries with pelvic extension
  • Stage 3: Growth involving one or both ovaries with peritoneal implants outside the pelvis or positive retroperitoneal or inguinal nodes
  • Stage 4: Growth with distant metastases
199
Q

Investigations for ovarian cancer

A
200
Q

Blood tests and markers for ovarian cancer

A
201
Q

Management of ovarian cancer

A
202
Q

Definition of pelvic mass

A

Definition:

  • A mass arising from a pelvic organ
  • May originate from female reproductive organs (ovaries, uterus) or other pelvic organs (bladder, rectum, blood vessels)
203
Q

Clinical features of pelvic mass

A
204
Q

Definition of pelvic organ prolapse

A
205
Q

Epidemiology, risk factors and aetiology of pelvic organ prolapse

A
206
Q

Pelvic anatomy and support in pelvic organ prolapse

A

3 levels of pelvic support:
- Level I has long mesenteric attachments (cardinal and uterosacral ligaments),
- Level II has more direct connections to the pelvic walls (e.g. paravaginal attachments),
- Level III has a direct fusion of the vagina with the levator ani muscles, perineal membrane and body

207
Q

Cystocele types, grading and treatment in pelvic organ prolapse

A
208
Q

Rectocele and Enterocele description and treatment in pelvic organ prolapse

A
209
Q

Uterine and vaginal wall description and treatment in pelvic organ prolapse

A
210
Q

Staging and clinical features of pelvic organ prolapse

A
211
Q

Investigations and complications of pelvic organ prolapse

A
212
Q

Perineal tears description

A
213
Q

Risk factors for 3rd and 4th degree perineal tears

A

Risk Factors for 3rd and 4th Degree Tears:

  • Birth weight > 4kg
  • Persistant occipitoposterior position
  • Nulliparity
  • Induction of labour
  • Epidural anaesthesia
  • 2nd stage labour > 1 hour
  • Shoulder dystocia
  • Midline episiotomy
  • Forceps delivery
214
Q

Anatomy of perineum and classification of perineal tears

A
215
Q

Description of an episiotomy in perineal tears

A
216
Q

Perineal repair and prognosis

A
217
Q

Definition of Polycystic Ovarian Syndrome

A

According to the Rotterdam consensus,1 polycystic ovarian syndrome (PCOS) is defined by the presence of two of three of the following criteria:
- oligo‐anovulation,
- hyperandrogenism and
polycystic ovaries (≥ 12 follicles measuring 2‐9 mm in diameter and/or an ovarian volume > 10 mL in at least one ovary).

Definition:

• Complex endocrine disorder characterised by hyper-androgenism, symptoms of hyper-androgenism, oligo/ anovulation, and polycycstic ovarian morphology on U/S

218
Q

Epidemiology, risk factors and aetiology of polycystic ovarian syndrome

A
219
Q

Pathophysiology of polycystic ovarian syndrome

A
220
Q

Clinical features of polycystic ovarian syndrome

A
221
Q

Investigations for polycystic ovarian syndrome

A
222
Q

Differential diagnosis for polycystic ovarian syndrome

A

DDx:

  • 21-hydroxylase deficiency - Leads to accumulation of androgen precursors
  • Thyroid dysfunction - May lead to irregular menstruation but hyper-androgenism is absent
  • Hyperprolactinaemia - May lead to infrequent or absent menses. Galactorrhoea is usually present
  • Cushingʼs syndrome - Cortisol excess leading to obesity, HTN, hirsutism, acne and menstrual irregularities
  • Androgen secreting neoplasms - Of the adrenal gland or ovaries
223
Q

Diagnosis of polycystic ovarian syndrome

A

Diagnosis:

  • Clinical features, elevated androgens and polycystic ovarian morphology on U/S
  • NOTE: Up to 25% of women have polycystic ovarian morphology, but do not have PCOS without symptoms
224
Q

Management of polycystic ovarian syndrome

A
225
Q

Complications and prognosis of polycystic ovarian syndrome

A
226
Q

Definition of post partum haemorrhage

A
227
Q

Epidemiology of post partum haemorrhage

A
228
Q

Aetiology of post partum haemorrhage

A
229
Q

Antepartum risk factors for post partum haemorrhage

A
230
Q

Intrapartum and post partum risk factors for post partum haemorrhage

A
231
Q

Management of post partum haemorrhage

A
232
Q

Reasons for foetal HR monitoring

A
233
Q

CTG interpretations in foetal HR monitoring

A
234
Q

Deceleration in detail on CTG for foetal HR monitoring

A
235
Q

Management of Foetal HR in context of CTG readings

A
236
Q

Interpret CTG

A
237
Q

Interpret CTG

A
238
Q

Interpret CTG

A
239
Q

Interpret CTG

A
240
Q

Interpret CTG

A
241
Q

Interpret CTG

A
242
Q

Interpret CTG

A
243
Q

Interpret CTG

A
244
Q

Interpret CTG

A
245
Q

Definition of pre-term labour

A

Definition:

  • Pre-term Labour = Labour that occurs between 20 weeks and 36 + 6 weeks
  • Term Labour = Labour that occurs between 37 weeks and 41 + 6 weeks
246
Q

Epidemiology of pre-term labour

A

Epidemiology:

  • Leading cause of perinatal morbidity/mortality in developed countries
  • Morbidity/mortality inversely proportional to gestational age
  • Morbidity/mortality is uncommon > 32 weeks getation
  • Incidence of 5-25%
  • 12.7% in Australia with < 2% below 32 weeks
  • Increasing incidence (IVF, multiple pregnancies, elective)
247
Q

Aetiology of pre-term labour

A

Multifactorial:

⁃ 50% - Spontaneous

⁃ 30% - PPROM (Pre-term prelabour rupture of membranes) = Rupture of membranes < 37 weeks

⁃ 20% - Iatrogenic

⁃ < 1% - Cervical incompetence

248
Q

Pathophysiology and classification of pre-term labour

A
  • inflammation (infection or autoimmune)
  • uterine stretch + cervical incompetence
  • antepartum hemorrhage
  • premature desidual activation
  • social stress
  • Genetics
249
Q

Risk factors of pre-term labour

A
250
Q

Clinical features of pre-term labour

A
251
Q

Management of pre-term labour

A
252
Q

Definition of rhesus haemolytic disease

A
253
Q

Causes of foetal anaemia

A

Causes of Foetal Anaemia:

  • Rhesus disease
  • Transplacental viral infection (Parvovirus B16)
  • Placental foetal vessel rupture
  • Twin-twin transfusion
254
Q

Epidemiology of Rhesus Haemolytic Disease

A
255
Q

Aetiology of foetal haemolytic disease

A
256
Q

Pathophysiology of foetal haemolytic disease

A
257
Q

Signs of foetal aneamia

A

Signs of Foetal Anaemia:

  • Polyhydramnios
  • Enlarged foetal heart
  • Ascites and pericardial effusion
  • Hyperdynamic foetal circulation (detected on MCA flow doppler)
  • Reduced foetal movements
  • Abnormal CTG with reduced variability, eventually leading to a sinusoidal trace
258
Q

Investigations for foetal haemolytic disease

A
259
Q

Management of Foetal Haemolytic Disease

A
260
Q

Complications and prognosis of foetal haemolytic disease

A
261
Q

Red cell Antigens

A
262
Q

Definition of twin gestation

A

Definition:

  • Multiple Gestation: Consists of two or more foetuses (twins make up 99% of this)
  • Monozygotic Twins: Arising from a single fertilised egg that divides
  • Dizygotic Twins: Arising from two separately fertilised eggs
263
Q

Epidemiology of twin gestation

A

Epidemiology:

  • 1-2% of pregnancies have more than one foetus
  • The chance of miscarriage, foetal abnormalities, poor growth, preterm delivery and intrauterine or neonatal death are considerably higher in twin than singleton pregnancies
  • 2/3rds of twins are dizygotic (non-identical) & 1/3rd are monozygotic (identical)
  • Incidence is on the rise
264
Q

Risk factors of multiple gestations

A

Risk Factors for Multiple Gestations:

  • Assisted reproduction techniques (ovulation induction and IVF)
  • ↑Maternal Age (35-39 years)
  • High parity
  • Black race
  • Maternal family Hx
265
Q

Aetiology of twin gestation

A
266
Q

Classification of multiple gestations

A
267
Q

Types of twin gestation

A
268
Q

Maternal physiological changes of twin gestation

A
269
Q

Complications of twin gestation

A
270
Q

Medical management of twin gestation

A
271
Q

Twin to twin transfusion syndrome:

  • Pathophysiology
  • Management
  • Complications
  • Prognosis
A
272
Q

Twin Reversed Arterial Perfusion sequence:

  • Description
  • Management
  • Prognosis
A
273
Q

Multifoetal reduction

A
274
Q

Description/definition of vaginal cancer

A

The vagina is a muscular canal ~7.5cm long that extends from the vulva to the cervix

  • Primary cancer of the vagina is one of the rarest gynaecological cancers (makes up around 2%)
  • Most commonly diagnosed in women > 50 years who were exposed to the drug Diethylstilbestrol (DES) in the womb
  • Symptoms include abnormal vaginal bleeding, postcoital bleeding, vaginal discharge & pelvic pain
  • Most cases are detected in advanced stages and require radiation therapy or chemoradiation for treatment
275
Q

Aetiology of vaginal cancer

A
276
Q

Symptoms of vaginal cancer

A

Symptoms of Vaginal Cancer:

  • Early stages are asymptomatic
  • Painless vaginal bleeding not associated with menstruation
  • Postcoital bleeding
  • Smelly discharge
  • Pain on urinating or passing bowel motions (may indicate local spread) • Constant pelvic pain
277
Q

Metastatic spread of vaginal cancer

A
278
Q

Risk factors for vaginal cancer

A

Risk Factors:

  • Age - usually occurs in women > 50 years
  • Previous Hx of gynaecological cancers
  • Previous treatment of dysplastic cells
  • HPV infection
  • Smoking
  • Prenatal exposure to DES
  • Vaginal adenosis (almost all DES daughters have vaginal adenosis)
279
Q

Types of vaginal cancers

A

Types of Vulval Cancers:

  • Vaginal SCC - Accounts for 95%
  • Vaginal Adenocarcinoma - most are clear-cell carcinomas arising from DES daughters
  • Vaginal Melanoma - rare
  • Vaginal Sarcoma - arising from connective tissue or muscle cells of the vagina (rare)
280
Q

DES-related vaginal cancers

A

DES-related Vaginal Cancers:

  • Diethylstilbestrol was used from 1938-1971 as a synthetic hormone that was mistakenly used to prevent miscarriage
  • DES exposure in utero alters the shape of the cervix and uterus and up to 30% have vaginal adenosis
  • There is a small risk (1 in 1000) of vaginal adenosis in DES-exposed women to develop into a clear-cell carcinoma of the vagina
  • Mean age of diagnosis is 19 years
281
Q

Investigations for vaginal cancer

A

Investigations:

  • Colposcopy
  • Biopsy and staging
  • CXR, CT abdomen and pelvis or MRI/PET for mets
282
Q

Treatment for vaginal cancer

A
283
Q

Other complications of vaginal cancer

A

Other complications:

• Rectovaginal or vesicovaginal fistula formation, which can be hard to treat palliatively

284
Q

Shoulder dystocia

A

P2 (5 decks)

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