Obstetrics/Gynaecology/Breast/Contraception Flashcards
Mechanism and risks COCP
Inhibits ovulation
Cervical and breast cancer, VTE
Mechanism and risks POP
Thickens cervical mucous
Breast cancer
Mechanism injectable and how often
Inhibits ovulation and thickens mucous
12w
Contraception most associated weight gain
Injectable
Mechanism implant and how long lasts
Inhibits ovulation and thickens mucous
3y
Irregular bleeding common contraception adverse
POP
Implant
IUS
COCP missed 2 pills
Condom 7d
Week 1 - emergency
Week 2 - none
Week 3 - skip pill free week
Emergency cannot use with asthma
Ullupristal
Most common breast cancer
Invasive ductal carcinoma
Breast cancer screening
Every 3y between 50 to 70
When do masectomy and when wide local excision
Masectomy - multifocal, or >4cm
Wide locatl - solitary and <4cm
Treatment for auxillary node clearance
If no lymphadenopathy - US then sentinal node biopsy if positive
If lymphadenopathy - auxillary node clearance
When is radiotherapy used breast cancer
If masectomy - T3 or above
If wide local - always
Hormonal therapy for oestrogen +ve receptors breast cancer
Premenopausal - tamoxifen
Postmenopausal - anastrazole (aromatase inhibitors)
Treatment for Her2 positive breast cancer
Trastuzumab (Herceptin)
Prognosis criteria for breast cancer
Nottingam prognostic index
Mastitis/abscess treatment
1) Continue breast feeding
2) Fluclox if systemicaly unwell
Treatment fibroadenoma
Conservative, unless >3cm then resection
Mechanism tamoxifen
Oestreogen receptor antagonist and partial agonist
Anastrozole mechanism
Reduced peripheral oestrogen synthesis
“Snowstorm appearance”
Breast implant rupture
“Halo sign”
Breast cyst
Diagnosis atrophic vaginitis
By exclusion
Treatment atrophic vaginitis
Lubricants and oestrogen creams
Most common ectopic location and most dangerous
Common - ampulla
Dangerous - isthmus
Diagnose ectopic
Transvaginal US
Ectopic treatment decide method
Expectant - asymptomatic and <35mm and hCG < 1000
Medical - little pain, hCG < 1500
Surgery - size > 35mm, rupture, pain, heatburn, hCG > 5000
Ectopic medical treatment
Methotrexate
Diagnose pelvic inflammatory disease
High vaginal swab and NAAT
HIV and syphilis tests
Treatment PID
IM ceftiaxone and oral deoxycycline and oral metronodazol
Identify Fits Hugh Curtis syndrome
PID and RUQ pain
Treatment urge incontinence
1) Antimuscurinics (oxybutynin) and bladder retraining
Treatment stress incontinence
1) Pelvic floor exercises
2) Surgery
2) Duloxetine
Cervical cancer screening
5 yearly from 25 to 64
Endometriosis diagnosis
Laparoscopy
Endometriosis treatment
1) NSAID - mefanemic acid
2) COPC
3) Referal - GnRH analogue or surgery
Fibroid diagonsis
Transvaginal US
Fibroids treatment
1) IUS - if no distortion
2) COCP and NSAID
3) GnRH to reduce size and myomectomy
Fibroid complication during pregnancy
Degeneration - pain and fever and vomiting
Menopause definition
If under 50 - 24m after last period
If over 50 - 12m after last period
Treatment menopause
1) Lifestyle
2) HRT - progesterone only if no uterus
3) SSRI/CBT
Commonest ovarian cyst
Follicular cyst - benign
Ovarian cyst contains hair/teeth
Dermoid cyst
Diagnosis ovarian cyst
US
Can be massive ovarian cyst
Mucinous cystadenoma
Staging for cervical cancer system
FIGO
Cervical cancer treatment
Hysterectomy and lymph node clearance
Cone biopsy if want to preserve fertility
Diagnose endometrial cancer
Transvaginal US
Hysteroscopy and biopsy
Risks ovarian cancer
Many ovulations
BRCA 1 and 2
Diagnosis ovarian cancer
CA125
US
CT scan establish and stage
FIGO staging ovarian cancer
1) Confined ovary
2) Outside ovary but in pelvis
3) Outside pelvis but in abdomen
4) Outside abdomen
Most common ovarian tumour
Serous tumour
“Signet ring”
Krukenberg tumour in ovary from GI tract
Infertility diagnosis
Progesterone levels 7 days before next period
Semen analysis
Termination of pregnancy method
<9w - mifepristane
>9w - surgery
Definition miscarriage and still birth
Miscarriage <24w
Stillbirth >24w
Treatment miscarriage
1) Expectant
2) Vaginal misoprostol
3) Surgery
What is adenomyosis
Endometrial tissue within myometrium
Identify adenomyosis
Large boggy uterus
Painful and heavy periods
What is cervical ectropion
Elevated oestrogen levels cause larger areas columnar epithelium at ectocervix
“Snow storm”
Complete hydaidiform mole
Treatment dysmenorrhoea
1) NSAID - mefenamic acid
2) COCP
“Whirlpool sign”
Ovarian torsion
Diagnosis ovarian torsion
Laparoscopy, also for treatment
What is Meigs syndrome
Benign ovarian cyst causing ascites and pleural effusion
What is Sheehans syndrome
Postpartum pituitary infarction causing global hypopituiritism
“Chocolate cyst”
Endiometriotic cyst
How long pregnancy test positive after miscarriage
4w
What is Asherman syndrome
Scar tissue in uterus following previous surgery causing amenorrhoea
What is premature ovarian failure
<40y
Diagnose VTE in pregnancy
1) Doppler US
2) Ventilation perfusion scan
Cannot use D dimer or wells score in pregnancy
Treatment VTE in prengnacy
1) LMWH
Treatment eclampsia
1) Magnesium sulphate
2) Calcium gluconate
HELPP syndrome
Haemolysis, elevated liver enzymes and low platelets
Treatment postpartum haemorrhage
1) IV syntocin or ergometrine
2) Intrauterine baloon tamponade, B lynch suture, uterine artery ligation
3) Hysterectomy
“Woody uterus”
Placental abruption
Diagnosis placental abruption
Clinical, US exclude placenal praevia
Treatment placental abruption
<36w - steroids if no distress, caesarean if distress
> 36w - vaginal no distress, caesarean distress
Treatment cord prolapse
Patient get on all 4s
Tocolytics reduce contractions
If cord past introitis minimal handling
Postnatal depression assessment
Edinburgh postnatal depression scale
Baby blues treatment
Reassurance and follow up
Postnatal depression treatment
1) CBT
2) SSRI - sertraline or paroxetine
Peurperal psychosis treatment
Admission together with baby
Gestational diabetes diangosis
Oral glucose tolerance test:
- fasting 5.6
- 2h 7.8
Treatment gestational diabetes
If fasting <7:
1) Diet and exercise
2) Metformin after 2w
3) Insulin
If fasting >7:
1) Insulin
Gestational diabetes complications
Macrosomia
Polyhydramnios
Epilepsy drug choice in pregnancy
Lamotrigine
Identify pregnancy induced hypertension
20 weeks or later
No proteinuria, no oedema
Identify pre-eclampsia
Pregnancy induced hypertension and proteinuria (>0.3g/24h)
Pre-eclampsia prophylaxis
Aspirin 75mg from 12w to birth
Hypertension treatment pregnancy
1) Labetolol
2) Nifedepine
Obesity treatment in pregnancy
Folic acid 5mg from conception to 12w
Screening for gestational diabetes at 24 and 28w
Levothyroxine in pregnancy
Increase by 30-50%
Cut of for iron therapy in pregnancy
1st trimester - <110
2/3rd trimester - <105
Post partum <100
Identify hypermesis gravidarum
Triad:
- 5% pre pregnancy weight loss
- dehydration
- electrolyte imbalance
Scoring system hypermesis gravidarum
PUQE
Treatment hypermesis gravidarum
1) Oral cyclizine or promethazine
2) Ondansetron or metochlopramide
Admit if unable to keep things down, ketones
Diagnosis placental praevia
Transvaginal US
Treatment low lying placenta at 20w
1) Reasses at 34w and scan every 2
2) If still low at 37w then elective caecaerean
Treatment bleeding placental praevia
1) Emergency caecrean if not able to stabilise
Definition of premature labour
<37w
Diagnosis preterm prelabour rupture of membranes
Speculum first then US
Treatment preterm prelabour rupture of membranes
Oral erythromycin 10d
Corticosteroids
Consider delivery at 34w
Diagnosis preterm labour in tact membranes
<30w - speculum
>30w - transvaginal US
Treatment preterm labour in tract membranes
Tocylysis - nifedepine
Corticosteroids if <35w
IV magnesium sulphate if <34w
Drug to suppress lactation
Dopamine agonist (eg cabergoline)
What is vasa praevia
Foetal vessels are within foetal membrane and travel across internal cervical OS
Stages of labour
1) Onset to cervix fully dilated
2) Full dilation to delivery foetus
3) Delivery foetus to delivery placenta
When is anti-D prophylaxis given if needed routine
Week 28 and week 34
When is presentation checked and external cephalic version offered if indicated
Week 36
When is induction if late
Week 41
When is anomaly scan
18-21w
When is early scan confirm dates
10-14w
When is booking visit
8-12w
When is down syndrome screening
11-14w
Increases AFP
Neural tube defect
Abdominal wall defect
Decreases AFP
Down syndrome
Trisomy 18
Breastfeeding contraindications
Lithium, benzos Methotrexate Sulphonylureus Asprin Amiodarone Some antibiotics
EPILEPSY DRUGS SAFE
Breech presentation treatment
36w - offer external cephalic conversion
If fails - planned caesarean
Down syndrome reslts
Increased HCG
Increased nuchal translucency
Decreased PAPP-A
Treatment group B strep in pregnancy
Intrapartum antibiotics:
- benzylpenicillin
Induction of labour scoring
Bishop score:
- >8 high chance
Induce labour
Membrane sweep
Vaginal prostaglandin
Oxytoxin infusion
Intrahepatic cholestasis of pregnancy treatment
Ursodeoxycholic acid
Induction at 37w
When to refer if no movements felt
24w
