Obs + Gynae Differentials Flashcards
If a woman presented with early pregnancy bleeding, what would your differential diagnosis be?
- Miscarriage
- Ectopic pregnancy/PUL
- Molar pregnancy
- Implantation bleed
- Genital tract trauma
- Cervical pathology: - ectropion / polyp / malignancy
What are causes of antepartum haemorrhage?
- Unexplained
- Placenta praevia
- Placental abruption
- Local GI tract lesions
- Vasa Praevia
- Cervix - Cervical erosions/ectropion, Cervical Carcinoma, Cervical polyps, Cervicitis
- Vulval varicosities
- Anticoagulants
- Bleeding diathesis
What are causes of primary PPH?
4 T’s - Tone, tissue, trauma, thrombin
- Uterine atony
- Genital tract trauma
- Coagulation disorders
- Large placenta
- Abnormal placental site
- Retained placenta
- Uterine inversion
- Uterine rupture
What are causes of intrapartum haemorrhage?
- Placental abruption
- Placenta Praevia
- Uterine rupture
- Vasa praevia
How would you distinguish placental abruption from placenta praevia asa a cause of antepartum haemorrhage?
- Shock out of keeping with visible loss
- Pain constant
- Tender, tense uterus
- Normal lie/presentation
- Foetal heart distressed/abnormal
- Coagulation problems
What might your differential diagnosis be for a pelvic mass?
- Ovarian – ovarian cyst/benign tumour, ovarian cancer
- Tubal – tubo-ovarian abscess, tubal malignancy (treat as ovarian)
- Uterine – pregnancy, fibroids/benign tumour, uterine cancer
- Urological – distended bladder, pelvic kidney, transplanted kidney
- GI – the 6 Fs: fat, fluid, flatus, faeces, fetus, filthy big tumour
- Other – primary peritoneal cancer, retroperitoneal sarcoma.
What would be your differential diagnosis for someone presenting with post-menopausal bleeding?
- Trauma
- Ovarian tumour
- Endometrial causes - Endometrial atrophy, Endometritis/PID, endometrial polyps, endometrial hyperplasia, endometrial cancer
- Cervical causes - cervicitis, cervical polyps, cervical cancer
- Vulval causes - dermatitis, vulval dystrophy, cancer
- Bleeding disorder
- Metasatic cancer
- GU/PR bleeding - rectal carcinoma, bladder cancer etc.
What are causes of post-coital bleeding?
- Trauma
- Ectropian
- Cervicitis
- Cervical/endometrial polyp
- Cervical cancer
- Vaginitis
- Vaginal cancer
- Vulval dermatitis
- Vulval cancer
- STI’s - gonorrhoea, chlamydia
What are causes of intermenstrual bleeding?
- Physiological
- Trauma
- Ovarian tumour
- Uterus - endometritis/PID, polyp, hyperplasia, cancer
- Cervix - cervicitis, polyp, cancer
- Vagina - vaginitis, cancer
- Vulva - dermatitis, dystrophy, cancer
- Pregnancy - miscarriage, ectopic, molar pregnancy
- Systemic - bleeding disorder, metastatic cancer
- Iatrogenic - IUCD, HRT, POP, depoprovera
- STI’s - gonorrhoea, chlamydia
- Bleeding from somewhere else - urethra, bladder, anus, rectum
What are causes of secondary dysmenorrhoea?
- Adenomyosis
- Endometriosis
- PID
- Fibroids
What is the most likely cause of primary amenorrhoea if secondary sexual characteristics are absent?
Most likely delayed puberty. Should also consider genetic causes - turner’s syndrome, androgen insensitivity
What can cause primary amenorrhoea?
- Chromosomal problem - turner’s etc.
- Hypothlalamic - Physiological delay, weight loss/anorexia, heavy exercise, GnRH deficiency
- Pituitary - partial/total hypopituitarism, hyperprolactinaemia, adenoma, trauma
- Ovarian - True agenesis, prem. ovarian failure, PCOS
- Primary hypothyroid
- Adrenal hyperplasia
- Imperforate hymen
What are causes of secondary amenorrhoea?
- Physiological - pregnancy, lactation, menopause
- Hypothalamic - weight loss, heavy exercise, stress
- Pituitary - hyperprolactinaemia, hypopituitarism
- Ovarian - PCOS, prem. ovarian failure, surgery/radio/chemo, virilising ovarian tumours
- Primary hypothyoridism
- Adrenal hyperplasia/tumour
- Hysterectomy
- Endometrial ablation
- Minera IUS
What are causes of menorrhagia?
- Dyfunctional uterine bleeding
- IUCD
- Fibroids
- Endometriosis
- Adenomyosis
- Pelvic infection
- Polyps - endometrial, cervical
- Hypothyroidism
- Coagulation disorders
- Endometrial carcinoma - post menopausal
What should you consider as differential diangosis for someone presenting with features of menopause?
- Pregnancy
- Hyperthyroidism
- Hypothyroidism
- Anorexia
- Medications
