Obs & Gynaecology - Introduction Flashcards
Gynae history taking: jargon
Jargon
- Menstruation
- Menarche
definition
- Menopause
Definition
- Gravidity, Parity, (e.g. G4 Para 1)
How to calculate Gravity/Parity
Gravida (G) =total number of pregnancies including this one
Para (P)=delivery of previous potential viable pregnancies over 24/40 use suffix + to denote Miscarriages, abortion, (use t2= tGravida (G) =total number of pregnancies including this one
Para (P)=delivery of previous potential viable pregnancies over 24/40 use suffix + to denote Miscarriages, abortion, (use t2= twins)wins)
Formula to calculate
- Gravida x, para a + b
- X = total number of pregnancies (including this one)
- A= number of births beyond 24/40
- B = number of miscarriages or termination before 24/40
For example
- a woman who has had 2 term pregnancies, one which was twins, one miscarriage and one abortion and is pregnant again would be G5, P2 (t2)+1+1
For example
- a women who has had 3 pregnancies with 2 miscarriages would be G3 P 0 +2
Therefore a woman with 6 children, 2 miscarriages and still birth at 20/40 = ? G, P
Gynae history taking continued:
LMP
NB 1st day
Menstrual cycle
NB day 1 to day 1
Range and implications
Menorrhagia: how defined/’measured’/history(Heavy periods)
Dysmenorrhoea: life-cycle (painful periods)
Oligomenorrhoea (Infrequent periods)
IMB (intermenstrual bleeding - bleeding between periods)
DUB (idiopathic - dysfunctional uterine bleeding
PCB (post coital bleeding
PMB (post menopausal bleeding)
Dyspareunia (painful intercourse)
- Superficial
Causes (NOT always ‘gynae’)
- Deep
Causes (NOT always ‘gynae’)
Vaginal discharge
- Normal
- Normal variation with cycle and ovulation
Hence: ‘natural family planning’
- Abnormal
Appearance
Smell
Additional symptoms eg itch, pain
Vulval problems
- Infection, atrophy, FGM
Cervical Smears
Uterine Positions?
Verted
- Lower uterus segment
- The angle of the cervix to the vagina
- 80% of uterus are anteverted (tilts up toward the abdominal wall)
- Retroverted, in 20% it tilts back into pelvis (toward spine)
Flexion
- Upper uterus segment
- Angle of the uterine body to the cervix
Gynae Ivestigations
- Smears
- Colposcopy
- LLETZ/LEEP
- D & C
- Ultrasound
- •Abdominal
- •Transvaginal
- Hysterosalpingogram
- Laparoscopy
Smear Indications?
- Start at 25 years old (ideally within 5 years of starting sexual activity)
- Every 3 years
- After 50 , every 5 years unless history of abnormal smears
- Stop at 65 IF 3 NORMAL SMEARS
- Requires special training and accreditation
Colposcopy?
- Inspection of cervix and vagina under magnification
- Inspect for atypical vessels
- 3% acetic acid (vinegar) applied to cervix: acetowhitening
- Iodine application: non-staining areas
- Suspicious areas are biopsied
What can be done after identify abnormal lesion?
- Cryotherapy
- Laser
- LLETZ
- Formal cone biopsy
Large Loop excision of transformation zone procedure (LLETZ)
- Loop electrosurgical excision procedure (LLETZ) is a surgical method of removing tissue from the cervix using a fine loop of wire.
- Removes abnormal tissue that is high in the cervical canal (more extensive form of cervical bx)
- The wire is heated with an electric current until it is extremely hot and can cut through tissue.
- LEEP can be used to take a sample of tissue for a biopsy (cone biopsy) and diagnosis or to remove tissue in a treatment procedure.
- The patient usually takes ibuprofen or a similar medication before the procedure and has a local anesthetic applied to the cervix.
Hysteroscopy?
- Endoscopy of uterine cavity
- Requires fluid or gas under pressure to open up the cavity
- Endometrium can be inspected and biopsied.
- Polyps and submucosal fibroids can be removed.
Dilation and Curettage (D&C) Introduction
- The dilation and curettage procedure is called a D&C.
- The D stands for dilation, which means enlarging.
- Curettage (the C) means scraping.
- Involves expanding or enlarging the entrance of a woman’s uterus so that a thin, sharp instrument can scrape or suction away the lining of the uterus and take tissue samples
OB/GYN IMAGING
- Primary modality is ULTRASOUNDU/S can be abdominal or transvaginal
- U/S can be real-time; color; 3D; 4D
- CT is more of a secondary modality
- Plain x-ray of the female pelvis has a low yield
- Hysterosalpingogram (HSG) is used to assess tubal patency and to evaluate uterine malformations
Hysterosalpingogram (HSG)
- x-ray procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal.
- Positioned under a fluoroscope
- The uterus with a liquid containing iodine (contrast) through the cannula which outlines the tubes and spills over if they are open.
- Abnormalities in the uterine cavity or fallopian tubes can be visualized
Prolapses
- Cystocele-prolapse of anterior wall of the vagina involving the bladder
- Uterine (apical) describes prolapse of uterus, cervix and upper vagina
- Enterocele-prolapse of upper posterior wall of vagina
- Rectocele-prolapse of lower posterior vaginal wall
Short cuts to remember
- Cystocele - bladder bulges into vagina
- Urethrocele - urethra bulges
- Rectocele- rectum bulges
- Enterocele- loops of intestine bulge
- Uterine- uterus descends into vagina
Fibroids
- Most common benign tumour arising from the myometrium of the uterus (leiomyomata)
- Present in 20-40%of women in reproductive age
- Often asymptomatic, but may present with dymenorrhea, bleeding, infertility,
Gynae Cancers
- Vaginal
- Cervical
- Endometrial
- Uterine
- Ovarian
FGM
- Type I: (clitoridectomy) Partial or total removal of the clitoris and/or the prepuce
- Type II: (excision) Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
- Type III: (infibulation) Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
- Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing,2 incising, scraping and cauterization.
Importance of FGM to clinicians
- Late complications relate mostly to conception and delivery
- Issues for conception if infibulation (often reversed at marriage)
- Issues for delivery: plan reversal
- In UK ILLEGAL to re-establish the partial closure of the vestibule
- Now need to report if seen in a patient under 18 years old
Pregnancy Complications
Minor conditions of Pregnancy
- Itching, pelvic girdle pain, heartburn, ankle oedema, constipation,
- back pain, carpal tunnel syndrome, haemorrhoids, varicose veins
Major Conditions:
- Vomiting-Hyperemesis Gravidarum (excessive morning sickness)
- Bleeding-Placental Abruption
- Placenta Previa (NO PV if PP) (low lying placenta)
- Hypertension- chronic (pre-existing) versus post partum vs pre eclampsia/eclampsia
- Coagulation disorders-HELLP
- Gestational Trophoblastic Disease (Hydatidform mole)
Types of Miscarriages
Threatened
- PVB but foetus still alive, uterus appropriate sized, os closed, 25% will go on to miscarry
Inevitable
- Bleeding usually heavier, foetus +/- alive, os open, miscarriage about to occur
Incomplete
- Some foetal parts have passed, os still open
Complete
- All foetal tissue has passed, bleeding minimal, uterus not enlarged, os closed
Septic
- Contents of uterus infected causing endometritis
Missed
- The foetus has not developed, or died in utero, not known until US shows no foetal heart beat, os closed
Blighted ovum
Types of Abortion
Medical
- Use of antiprogesterone (mifepristone) plus prostaglandin (misoprostol or gemeprost) 36-48 hours later most effective at gestations under 7/40 and can be used in 7-9/40 period
Surgical
- Suction curettage between 7-13/40
- After 13/40 Dilatation and evacuation preceded by cervical preparation
Selective
- Performed in an high order multiple pregnancies to reduce the risk of preterm labour especially if one of the foetuses is abnormal
Nagle’s Rule
Used to estimate EDD
Subtract 3/12 from date of
LMP, add 7/7 Used to estimate EDD
Subtract 3/12 from date of
LMP, add 7/7 and 1 year
Measuring Pregnancy
- Measure Fundal Height (in cm) after 24/40 from symphysis pubis
- Should be within +/- gestational age by 2 cm
Obstetric Terms
Lie:
refers to the relationship between foetus and long axis of the uterus. Can be longitudinal, transverse or oblique
Bear traps & other issues
Age of consent and capacity (at any age)
Safeguarding
‘Ectopics are ALWAYS atypical’
‘STIs hunt in packs’
•And chlamydia can ‘lurk’ (as can other STIs)
Chaperones?
‘flying false colours’
