OBS + GYNAE

Question 1

What is the mechanism of an IUD?

Answer 1

The Intra-uterine device works due to the toxic effect of the copper to both egg and sperm. It prevents implantation.

Question 2

How long can an IUD be kept in for?

Answer 2

The device can stay in for up to 10 years

Question 3

What happens to fertility once an IUD is removed?

Answer 3

When removed, fertility returns to normal

Question 4

What happens to fertility once an IUD is removed?

Answer 4

When removed, fertility returns to normal

Question 5

In which women is an IUD not acceptable?

Answer 5

It is not suitable for women with current pelvic infection or a distorted uterus. Women with repeated history of STI are not suitable for the device also.

Question 6

How long can an IUD be kept in after the age of 40?

Answer 6

If fitted after 40, the device can stay in place until the menopause. Women need to be taught how to check whether their device is in the right place.

Question 7

What are the contraindications of an IUD?

Answer 7

Contraindications include unexplained bleeding and an abnormal cervix

Question 8

What is the most effective form of emergency contraception?

Answer 8

The IUD

Question 9

How long after the first episode of UPSI is the IUD effective for?

Answer 9

It prevents implantation and can be used 120 hours after the first episode of UPSI or after the earliest expected date of ovulation.

It is not recommended to be used before 28 days post-partum.

Question 10

What are the side effects of the IUD?

Answer 10

Some women may experience spotting and period type pains.

Question 11

How long should women take before seeing their doctor after they’ve had the IUD fitted as emergency contraception?

Answer 11

Women should visit their doctor 3-4 weeks later to check they are not pregnant, discuss future contraception and evaluate whether they would like the IUD as a form of contraception for the long term.

Question 12

What is the definition of a molar pregnancy?

Answer 12

A molar pregnancy, also known as a hydatidiform mole, is part of a spectrum of gestational trophoblastic disease. It occurs where there is an imbalance in the number of chromosomes from the mother and father.

Those women at highest risk are those at the ends of the age of fertility (under 16 and over 45).

Question 13

What are the features of a complete Mole?

Answer 13

A complete mole is formed from 1 sperm and an empty egg with no genetic material
The sperm then replicates to give a normal number of chromosomes; this is therefore diploid and all chromosomes are of paternal origin
There is no foetal tissue present; just a proliferation of swollen chorionic villi.

Question 14

What are the features of a partial mole?

Answer 14

A partial mole is formed from 2 sperm and a normal egg
Both paternal and maternal genetic material is present
There is variable evidence of foetal parts.

Question 15

What are the clinical features of a molar pregnancy?

Answer 15

Vaginal bleeding
Nausea
Hyperemesis gravidarum
Thyrotoxicosis (because hCG is closely related to TSH and can therefore activate it’s receptors)
Uterus is larger than expected for gestational age. This enlargement is due to excessive growth of trophoblasts and retained blood.

Question 16

What are the investigations needed to diagnose a molar pregnancy?

Answer 16

B-hCG levels are often much higher than would be expected in a normal pregnancy
Trans-vaginal ultrasound is also used which in a complete molar pregnancy may show a ‘snowstorm’ appearance, low resistance of blood vessel flow, and absence of a foetus.

Question 17

What is the management for molar pregnancy?

Answer 17

Patient requires urgent referral to a specialist centre for treatment as to reduce the timeframe for potential complications such as choriocarcinoma or invasion from developing
Molar pregnancies cannot survive, and so a managed with suction curettage to remove them from the uterus
Alternatively, when fertility does not need to be preserved, a hysterectomy may be performed.
Surveillance is recommended:
Two weekly serum and urine hCG until levels are normal
If a partial mole a repeat hCG is done 4 weeks later - if normal the patient is discharged from surveillance.
In complete mole monthly repeat hCG samples are sent for at least 6 months