OG Flashcards
Benefits of HRT?
Improves:
- vasomotor symptoms
- sleep, muscle aches, QoL
- mood
- sexual function
Reduces:
- Urogenital atrophy
- Vaginal dryness
- Osteoporosis risk
- Cardiovascular risk
- Colon cancer risk
Risks of HRT?
- VTE risk
- endometrial/ovarian cancer risk in those with a uterus if oestrogen-only therapy
- breast cancer risk
- stroke risk
How can premature ovarian insufficiency be diagnosed?
Women aged under 40 years, based on:
- menopausal symptoms, including no or infrequent periods (taking into account presence of uterus!) AND
- elevated FSH on 2 blood samples taken 4-6weeks apart.
What symptoms might you get with urethral prolapse?
Asymptomatic or dysuria
How might you manage urethral prolapse?
Topical estrogen cream
Sitz bath
Antibiotics
How might a urethral diverticulum present?
Dysuria
Dribbling incontinence
urgency
haematuria
How might you treat a urethral diverticulum?
Excision and marsupilization
How might you manage a Bartholin cyst?
Usually leave it
Can insert a Word catheter to drain it
Marsupilization
What might you prescribe for somebody with candida vulvitis?
Topical imidazole
oral fluconazole
What signs/symptoms are there of lichen sclerosus?
External genitalia losing shape/definition
Epithelial thinning
Dry, shiny fragile parchment-like genitalia
How can you treat lichen sclerosus?
Topical steroid cream
How might you manage vestibulodynia?
pelvic floor exercises
CBT
TCAs
What is Mullerian agenesis?
Congenital absence of the uterus and upper portions of the vagina
What are typical symptoms associated with imperforate hymen?
Cyclical pelvic pain with amenorrhoea
How might you manage an imperforate hymen?
COCP
NSAIDs
Hymenotomy
Where can Gartner’s duct cysts be found?
Along the lateral walls of the vagina
How can Gartner’s duct cysts be managed?
expectantly
surgical excision if painful
What are Nabothian cysts?
Normal mucinous filled cysts found on cervical surface.
What are some contraindications to VBAC?
Previous uterine rupture
‘Classical’ cesarean scar (high vertical)
Major placenta praevia
Signs of uterine rupture?
Maternal shock (hypotension, fainting, tachycardia)
Persistent severe abdominal/scar pain
Abnormal PV bleeding
Haematuria
Cessation of previously normal uterine activity
Abnormal CTG
Loss of station of presenting part
What is the percentage risk of uterine rupture in VBAC?
less than 1%
What is the percentage success rate of VBAC?
70 - 90%
By how many weeks gestation should a planned VBAC or elective cesarean section take place?
ideally after 39 weeks, before 41 weeks
If a patient is post-dates, 41+ weeks, what should happen regarding her VBAC?
Review by a senior obstetrician for induction of labour versus cesarean. Induction and augmentation increases the risk of uterine rupture.
What effect does preterm labour have on VBAC success rate and complication rate versus term labour?
Preterm VBACs have similar success rates to term VBACs
Reduced risk of rupture in preterm
If a patient has a twin pregnancy what should happen regarding her VBAC?
Review by senior obstetrician
Some studies show similar success rates compared to singleton VBACs
Name the top 5 causes of direct maternal mortality in the UK.
Thrombosis/VTE APH/PPH Amniotic fluid embolism Genital tract sepsis Early/ectopic pregnancy
What are the top 5 causes of maternal mortality according to the WHO?
- PPH
- post-partum infection
- Pre-eclampsia/eclampsia
- Complications during delivery
- Unsafe abortions
Criteria for diagnosing menopause
- Women over the age of 45
- Menopausal symptoms (vasomotor, musc, mood, urogenital, sex)
- No period for 1 year
- Not on any hormonal contraception
Criteria for diagnosing perimenopause
- Women over the age of 45
- Vasomotor symptoms
- Irregular periods
When should you use an FSH test to diagnose menopause?
- women aged 40-45 with menopausal symptoms and change in menstrual cycle
- women aged under 40 in ?menopause
If a fetus dies under 24 weeks what is it known as?
miscarriage or late fetal loss
If a fetus dies over 24 weeks what is it known as?
If delivered - ‘Still birth’
If in utero - Intrauterine fetal death
According to NICE guidelines when should you clinically assess/investigate a woman with her partner regarding infertility?
- she is of reproductive age
- trying for 1 year unprotected vaginal sex
- in absence of known cause of infertility
What is the name of the system used to assess pubertal development?
Tanner Scale
How is delayed puberty in girls defined?
No breast development by 13 years or no menarche by 3 years after breast development (or by 16)
What factors improve/reduce chance of IVF success?
Things that improve chances:
- Being younger
- BMI 19-30
- Previous pregnancy/live birth
Things which reduce chances:
- Previous unsuccessful IVF
- Smoking
- Alcohol greater than 1unit/day
- Caffeine consumption
6 steps for IVF in women
- Suppress cycle
- injection/spray OD
- two weeks - Boost egg supply
- FSH injection OD
- 10-12 days - Monitor progress
- USS/bloods - Collect eggs
- 34 hours before have final hormone injection
- USS and per vaginal extraction
- 20 minutes, cramps or bleed afterwards normal - Fertilise eggs
- partner/donor sperm mixed in lab
- 2-6days
- pessary to prep uterus lining - Transfer embryo
Based on age, how many embryo transfers should a woman have in the first, second and third IVF cycles?
Under 37:
- first IVF cycle = single embryo transfer
- second = single (consider double if no top-quality)
- third = no more than two
37-39:
- first = single (consider double if no top-quality)
- second = single (consider double if no top-quality)
- third = no more than two
40-42:
- double
Hypothalamic causes of pathological amenorrhoea?
Functional: stress; exercise
Non-functional: SOL; surgery
Anterior pituitary causes of pathological amernorrhoea?
Micro/macroadenoma
Surgery
Sheehan’s
Ovarian causes of pathological amenorrhoea?
PCOS
POF
Ovarian dysgenesis due to Turner’s
Genital tract outflow obstruction causes of pathological amenorrhoea?
Transverse vaginal septum
Imperforate hymen
Cervical stenosis
Asherman’s syndrome
Endocrinopathies causing pathological amenorrhoea?
Hyperprolactinaemia
Severe hypo/hyperthyroidism
CAH
Cushing’s syndrome
Common physiological causes of amenorrhoea?
Pregnancy
Lactation
Menopause
Common iatrogenic causes of amenorrhoea?
Progestagenic stuff: depot/miraena/POP
Continuous COCP
