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OG Flashcards

1
Q

Benefits of HRT?

A

Improves:

  • vasomotor symptoms
  • sleep, muscle aches, QoL
  • mood
  • sexual function

Reduces:

  • Urogenital atrophy
  • Vaginal dryness
  • Osteoporosis risk
  • Cardiovascular risk
  • Colon cancer risk
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2
Q

Risks of HRT?

A
  • VTE risk
  • endometrial/ovarian cancer risk in those with a uterus if oestrogen-only therapy
  • breast cancer risk
  • stroke risk
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3
Q

How can premature ovarian insufficiency be diagnosed?

A

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.
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4
Q

What symptoms might you get with urethral prolapse?

A

Asymptomatic or dysuria

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5
Q

How might you manage urethral prolapse?

A

Topical estrogen cream
Sitz bath
Antibiotics

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6
Q

How might a urethral diverticulum present?

A

Dysuria
Dribbling incontinence
urgency
haematuria

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7
Q

How might you treat a urethral diverticulum?

A

Excision and marsupilization

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8
Q

How might you manage a Bartholin cyst?

A

Usually leave it
Can insert a Word catheter to drain it
Marsupilization

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9
Q

What might you prescribe for somebody with candida vulvitis?

A

Topical imidazole

oral fluconazole

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10
Q

What signs/symptoms are there of lichen sclerosus?

A

External genitalia losing shape/definition
Epithelial thinning
Dry, shiny fragile parchment-like genitalia

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11
Q

How can you treat lichen sclerosus?

A

Topical steroid cream

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12
Q

How might you manage vestibulodynia?

A

pelvic floor exercises
CBT
TCAs

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13
Q

What is Mullerian agenesis?

A

Congenital absence of the uterus and upper portions of the vagina

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14
Q

What are typical symptoms associated with imperforate hymen?

A

Cyclical pelvic pain with amenorrhoea

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15
Q

How might you manage an imperforate hymen?

A

COCP
NSAIDs
Hymenotomy

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16
Q

Where can Gartner’s duct cysts be found?

A

Along the lateral walls of the vagina

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17
Q

How can Gartner’s duct cysts be managed?

A

expectantly

surgical excision if painful

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18
Q

What are Nabothian cysts?

A

Normal mucinous filled cysts found on cervical surface.

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19
Q

What are some contraindications to VBAC?

A

Previous uterine rupture
‘Classical’ cesarean scar (high vertical)
Major placenta praevia

20
Q

Signs of uterine rupture?

A

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

21
Q

What is the percentage risk of uterine rupture in VBAC?

A

less than 1%

22
Q

What is the percentage success rate of VBAC?

A

70 - 90%

23
Q

By how many weeks gestation should a planned VBAC or elective cesarean section take place?

A

ideally after 39 weeks, before 41 weeks

24
Q

If a patient is post-dates, 41+ weeks, what should happen regarding her VBAC?

A

Review by a senior obstetrician for induction of labour versus cesarean. Induction and augmentation increases the risk of uterine rupture.

25
Q

What effect does preterm labour have on VBAC success rate and complication rate versus term labour?

A

Preterm VBACs have similar success rates to term VBACs

Reduced risk of rupture in preterm

26
Q

If a patient has a twin pregnancy what should happen regarding her VBAC?

A

Review by senior obstetrician

Some studies show similar success rates compared to singleton VBACs

27
Q

Name the top 5 causes of direct maternal mortality in the UK.

A 
Thrombosis/VTE
APH/PPH
Amniotic fluid embolism
Genital tract sepsis
Early/ectopic pregnancy
28
Q

What are the top 5 causes of maternal mortality according to the WHO?

A
  1. PPH
  2. post-partum infection
  3. Pre-eclampsia/eclampsia
  4. Complications during delivery
  5. Unsafe abortions
29
Q

Criteria for diagnosing menopause

A
  • Women over the age of 45
  • Menopausal symptoms (vasomotor, musc, mood, urogenital, sex)
  • No period for 1 year
  • Not on any hormonal contraception
30
Q

Criteria for diagnosing perimenopause

A
  • Women over the age of 45
  • Vasomotor symptoms
  • Irregular periods
31
Q

When should you use an FSH test to diagnose menopause?

A
  • women aged 40-45 with menopausal symptoms and change in menstrual cycle
  • women aged under 40 in ?menopause
32
Q

If a fetus dies under 24 weeks what is it known as?

A

miscarriage or late fetal loss

33
Q

If a fetus dies over 24 weeks what is it known as?

A

If delivered - ‘Still birth’

If in utero - Intrauterine fetal death

34
Q

According to NICE guidelines when should you clinically assess/investigate a woman with her partner regarding infertility?

A
  • she is of reproductive age
  • trying for 1 year unprotected vaginal sex
  • in absence of known cause of infertility
35
Q

What is the name of the system used to assess pubertal development?

A

Tanner Scale

36
Q

How is delayed puberty in girls defined?

A

No breast development by 13 years or no menarche by 3 years after breast development (or by 16)

37
Q

What factors improve/reduce chance of IVF success?

A

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
38
Q

6 steps for IVF in women

A
  1. Suppress cycle
    - injection/spray OD
    - two weeks
  2. Boost egg supply
    - FSH injection OD
    - 10-12 days
  3. Monitor progress
    - USS/bloods
  4. Collect eggs
    - 34 hours before have final hormone injection
    - USS and per vaginal extraction
    - 20 minutes, cramps or bleed afterwards normal
  5. Fertilise eggs
    - partner/donor sperm mixed in lab
    - 2-6days
    - pessary to prep uterus lining
  6. Transfer embryo
39
Q

Based on age, how many embryo transfers should a woman have in the first, second and third IVF cycles?

A

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

40
Q

Hypothalamic causes of pathological amenorrhoea?

A

Functional: stress; exercise

Non-functional: SOL; surgery

41
Q

Anterior pituitary causes of pathological amernorrhoea?

A

Micro/macroadenoma
Surgery
Sheehan’s

42
Q

Ovarian causes of pathological amenorrhoea?

A

PCOS
POF
Ovarian dysgenesis due to Turner’s

43
Q

Genital tract outflow obstruction causes of pathological amenorrhoea?

A

Transverse vaginal septum
Imperforate hymen
Cervical stenosis
Asherman’s syndrome

44
Q

Endocrinopathies causing pathological amenorrhoea?

A

Hyperprolactinaemia
Severe hypo/hyperthyroidism
CAH
Cushing’s syndrome

45
Q

Common physiological causes of amenorrhoea?

A

Pregnancy
Lactation
Menopause

46
Q

Common iatrogenic causes of amenorrhoea?

A

Progestagenic stuff: depot/miraena/POP

Continuous COCP

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