Obs & Gynae Gang Flashcards
Why is mid-luteal progesterone taken and when should it be measured?
To assess if a woman is ovulating.
Measure 7 days before the period (day 21 in a 28 day cycle, day 28 in a 35 day cycle etc.)
Name 5 causes of recurrent miscarriage?
Blood clotting disorders (e.g. APS, F5LD, or SLE), structural abnoramlities of the uterus, infection (e.g. BV in late miscarriage), Endocrine issues (PCOS, poorly controlled DM, hyperprolactinaemia, thyroid disease), smoking, low BMI, increasing maternal age. Most commonly idiopathic!
Define recurrent miscarriage?
Loss of 3 or more pregnancies before 24 weeks
What is seen in testing in a molar pregnancy?
Very high Beta-HCG (>100,000 in complete), snow storm appearance on TVUS
How do you treat an overactive bladder?
Oxybutalin, Mirabegron or Tolterodine
Complications of endometriosis?
Sub-fertility, adhesions, chocolate cysts, frozen pelvis
What are the most common SEs of the 2 pills?
POP = irregular bleeding COCP = breakthrough bleeding
Name 5 absolute contraindications to COCP?
<6 weeks post-partum and breastfeeding, >35 and smoking >15 a day, HTN >160/100, personal history of VTE/CVA/AF/severe cirrhosis/complicated DM/IHD, current breast cancer, migraine with aura
How do you treat BV?
NOT pregnant = Metronidazole single dose or twice daily for 5-7 days
ARE pregnant = Metronidazole twice daily 5-7 days
How do you treat thrush?
Oral fluconazole or Clotrimazole pessary. If pregnant MUST have pessary (for up to 7 days)
How often should you recieve a smear test?
25-49 = every 3 years
50-64 = every 5 years
>=65 only one (if last test was abnormal)
Which HPV causes cervical cancer, which causes genital warts?
Cancer = 16, 18 Warts = 6, 11
What are the Fraser Guidelines and Gillick Competence?
Fraser Guidelines = used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment
Gillick Competence = concerned with determining a child’s capacity to consent
What are the types of female sexual dysfunction?
- Low sexual desire. This most common of female sexual dysfunctions = lack of sexual interest and willingness to be sexual.
- Sexual arousal disorder. Desire for sex may be intact, but there is difficulty becoming aroused or maintain arousal during sexual activity.
- Orgasmic disorder. Persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
- Sexual pain disorder. Pain associated with sexual stimulation or vaginal contact.
What is Paraphillia?
Abnormal sexual behaviors or impulses characterized by intense sexual fantasies and urges that keep coming back. E.g. exhibisionism, fetishism and paedophillia
What does tamoxifen treat?
Oestrogen receptor positive breast cancer
What does herceptin treat? what is it also known as?
HER2 positive breast cancer (aka Trastuzumab it can also treat stomach cancer)
What does Bishops socre indicate?
Likelyhood of spontaneous labour
>=8 = spontaneous labour is likely
<=5 = spontaneous labour is very unlikely - consider IOL
What is the name of the surgical procedure used to correct cystolcele or rectocele?
Colporrhaphy
The copper coil can be given the longest after UPSI. How long after ovulation is it affective for?
5 days
Name 5 complications of multiple pregnancy?
Preterm labour, Gestational HTN/DM, anaemia, birth defects, miscarriage, twin-twin transfusion syndrome, abnormal lie, PPH, vasa praevia, placental abruption, cord prolapse
How do you treat GBS in pregnancy?
IV Benzylpenicillin during labour
How is the 3rd stage of labour activley managed?
Syntocinon/Syntometrine, Delayed cord clamping, placental traction (to assist removal)
When are the anomoly and dating scans performed?
Anomoly = 18-20+6 Dating = 10-13+6
In the normal menstrual cycle which cells are sensitive to LH/FSH, what do they synthesise?
Theca cells = sensitive to LH, they synthesise progesterone and testosterone.
Granulosa cells = sensitive to FSH, they convert testosterone to oestrogen
Which hormone stimulates ovulation?
LH.
Oestrogen levels surge causing a surge in LH which causes ovulation
What does the corpus luteum release, what does this do?
Progesterone and oestrogen.
Progesterone acts to proliferate the endometrium for implantation.
Progesterone is secreted until the placenta can release it or the corpus luteum degenerates into the corpus albicans
A 16 year old girl has not started her periods, has no secondary sexual characteristic and has low FSH/LH on blood test. What is this condition and what can cause it?
Hypogonadotrophic hypogonadism
Causes = pituitary gland damage, hypothalamic issues, hyperprolactinaemia, hypo/hyperthyroidism and Kallmann’s syndrome (anosmia)
A 16 year old girl has not started her periods, has no secondary sexual characteristic and has high FSH/LH on blood test. What is this condition and what can cause it?
Hypergonadotrophic Hypogonadism - problem is with the gonads themselves. Swyer syndrome (46XY) Turner's syndrome (45XO) Premature Ovarian Failure (46XX)
A 16 year old girl has not started her periods, has secondary sexual characteristic and has a uterus present on US. What is this condition and what can cause it?
Outflow tract obstruction (imperforated hymen or transverse vaginal septum).
Patients may experience cyclical abdominal pain but no bleeding. Patients may also have bloating due to build up of menstrual blood in the vagina (haematocolpus)
A 16 year old girl has not started her periods, has secondary sexual characteristic and has no uterus present on US. What is this condition and what can cause it?
Androgen Insensitivity (46XY) - X-linked recessive condition where by patient is resistant to testosterone but is genetically male. There will be palpable abdominal hernias but breast development due to oestrogen. OR Mullerian Agenesis (46XX) - failure of the development of the mullerian duct causign missing uterus and vaginal hypoplasia
Define secondary amenorrhoea?
Cessation of menstruation for 3-6 months in women with previously normal and regular periods or for 6-12 months in women with previously irregular periods
What is the order of treatment for women with PCOS who are struggling to concieve?
Lifestyle changes -> Metformin (if overweight) -> Letrozole (1st line) -> Clomifine (2nd line now) -> Laparoscopic ovarian drilling -> IVF/IUI
How many withdrawal bleeds should you aim for a year in a woman with PCOS?
4
Giver her the combined OC pill
How do you treat excess hair in women with PCOS?
Topical elfornine
Which 2 conditions could cause secondary amenorrhoea by outflow tract obstruction?
Asherman’s syndrome = complication of uterine surgery. Caused by adhesions (e.g. after evacuation of retained products of conception)
OR
Cervical stenosis = complication of cervical trauma.
Stenosis is the cervical canal (e.g. after treatment for cervical dyskaryosis)
What is SHeehan’s syndrome? How will LH and FSH levels be?
A complication of PPH where under perfusion of the anterior pituitary due to hypotension causes necrosis.
Low LH and FSH
Sx, Ix and Mx of hyperprolactinaemia?
Galactorrhoea, amenorrhoea, infertility
Ix = pituitary MRI
Mx = cabergoline or bromocriptine (dopamine agnoists)
What is premature ovarian failure?
<40, not on hormonal contraception with:
Menopausal symptoms - including no or infrequent periods
AND elevated FSH (>30) on two blood samples taken 4-6 weeks apart.
What can cause premature ovarian fialure?
Chemo/radiotherapy
Idiopathic
Autoimmunie
Infection (e.g. mumps)
Mx of Heavy menstrual bleeding?
Not trying to concieve = IUS 1st line, OC pill 2nd line
Trying to concieve = tranexamic acid
How do uterine polyps present?
Menorrhagia and intermenstrual bleeding