Other topics in gynae

Question 1

Post-partum contraception

Answer 1

Req. after day 21

Lactational amenorrhoea effective in 98% if fully bf, amenorroeic and <6m post partum

Question 2

Post partum contraception Progestogens

Answer 2

PoP, Depo-provera, Nexplanon

• start anytime pp
• after d21 additional contraception for 2d
• small amount progesterone enters mik but not a problem

Question 3

Post partrum COCP

Answer 3

Absolute CI: bf and <6wks pp
Relative CI: bf and <6m pp
if NOT bf: begin d21 and will provide immediate contraception
if started after d21 use extra for 7d

Question 4

Post partum IUD/LNG-IUS

Answer 4

Can be inserted within 48hrs

after 4wks

Question 5

FIGO staging

Answer 5

I: uterus (IB myometrium)
II: uterus + cervix
III: adnexa (A; ovary, B, vagina, C: LN
IV: distant (B) and bladder/bowel (A)

Question 6

Ovarian cancer

Answer 6

I: ovaries
II: pelvic extension eg uterus
III abdo. other than pelvic organs
IV: distant mets

Question 7

Where does ovarian ca. met?

Answer 7

Lungs
Liver
Spleen

Question 8

Cervical cancer stages

Answer 8

I: cervix
II: beyond cervix but not pelvic wall or lower vagina
III extends to pelvic wall/lower vagina/causes hydronephrosis
IV: beyond pelvis and involves mucosa of bladder/rectum

Question 9

Functional Ovarian Csyts

Answer 9

1. Follicular (most common)
   - >3cm, USS: thin wall unilocular, anechoic
2. Corpus luteal
   - after ovulation, may rupture at end of cycle, USS:diffuse thick wall lacey pattern
3. Theca Lutein
   - a/w pregnancy (gonadotrophins), can cause htn, often bilat, resolve spontanously, USS: bilat. enlarge, multicystic, thin walled anechoic

Question 10

Inflammatory ovarian cysts

Answer 10

1. Tubo-ovarian abcess
   - Feature of PID, tender adnexal mass USS: ovary and tube indistinguishable from mass
2. Endometrioid
   - chocolate cyst, a/w endometriosis USS: unilocullar w/ground glass echoes

Question 11

Germ cell Ovarian Cysts

Answer 11

Dermoid

• Mature: benign solid or cystic USS: unilocular diffusely/partially echogenic (?teeth, no internal vascularity)
• Immature: embryonic elements, malignant

Question 12

Epithelial ovarian cysts

Answer 12

Serous cystadenoma (most common ovarian neoplasm)
- unilocular sometimes bilat. USS: anechoic, no flow on doppler
Mucinous cystadenoma
- small, urothelial like epithelium USS: hypoechoic. ?calciifications

Question 13

Sex cord stromal ovarian cyst

Answer 13

Fibroma:
- benign no endocrine prod. USS: solid hypoechoic
Thecoma:
- Benign may produce oestrogens (rarely androgens) USS:variable
Granulosa cell
- produce oestrogen USS: variable

Question 14

UK Abortion act

Answer 14

A: RISK OF LIFE to pregnant woman more likely than with TOP
B: GRAVE AND PERMANENT INJURY to health (phys/mental) more likely than with TOP
C: <24 weeks and risk of harm (phys/ment) is greater than TOP
D: <24 weeks and risk of harming EXISTING children
E Serious HANDICAP
F Save life of woman
G Prevent Grave permanent injury

Question 15

IVF eligibility <40

Answer 15

3 cycles on NHS if:
-Trying for 2 yrs regular UPSI
- OR Failed 12 cycles of artificial insem
If turning 40 during cycle it can be completed but no more

Question 16

IVF eligibility 40-42y

Answer 16

1 cycle on NHS if

• 2yrs UPSI OR 12 cycles art. insem.
• Never IVF before
• No evidence of low ovarian reserve
• Been informed about IVF implications

Question 17

Other likely CCG criteria for IVF

Answer 17

Not having children
healthy weight
not smoking
age

Question 18

Private IVF cost?

Answer 18

5000/cycle