PACEs gynae Flashcards

1
Q

RFs for miscarriage

A
  • advances maternal age
  • previous miscarriages
  • chronic conditions (e.g. uncontrolled diabetes)
  • cervical or uterine abnormalities
  • smoking
  • alcohol
  • illicit drug use
  • underweight or overweight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

counselling in miscarriage

A

breaking bad news

  • explain diagnosis: reassure this is common and under reported (1/5 pregnancies), risk increases with age, explain most of the time there is no cause
  • explain management options (expectant, medical, surgical)
  • if medical: explain what to expect (pain, bleeding, nausea),
  • antiemetics and pain relief given
  • advise to do pregnancy test after 3 weeks
  • safety net: return if symptoms get worse, bleeding persists after 7-14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RFs in ectopic pregnancy

A

PID
smoking
IUD/IUS
tubal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

counselling in ectopic

A
  • implantation of pregnancy outside the womb, means it is not viable
  • risks: damage to surrounding structures, bleeding and rupture
  • treatment options are based on US findings and level of pregnancy hormone in blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

explain ectopic medical management

A
  • 1 x IM injection
  • expect: tummy pain, nausea, diarrhoea - should pass within few days
  • can go home after injection but need to come back a couple of times over next week for a blood test
  • avoid sex during treatment, don’t concieve for 6 months, avoid drinking alcohol/ excess sunlight
  • risk of treatment failure requiring further intervention
  • discuss ongoing contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

explain surgical management

A
  • salpingectomy is best procedure
  • salpingotomy is considered if fertility issues/problems with other tube
  • salpingotomy 1/5 chance of needing more
  • fertility isn’t drastically reduced
  • follow up
  • discuss ongoing contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GTD RFs

A
  • advances maternal age
  • prior molar pregnancy
  • prior miscarriages
  • Asian heritage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

counselling in GTD

A
  • foetus doesn’t form properly and baby doesn’t develop, instead there is an irregular mass of pregnancy tissue
  • risks: treat because can invade and damage other tissues
  • immediate management: suction curettage
  • F/U: referral to trophoblastic screening centre to monitor pregnancy hormone levels
  • molar pregnancy does not affect fertility (1/80 chance of recurrence)
  • do not get pregnant until F/U is complete
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

key aspects of history in contraception

A

RFs: smoking, VTE Hx, migraine, breast cancer, stroke, HTN, liver disease
menstrual problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

explain about contraception

A

split in to long acting and short acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PCOS counselling

A
  • disease with no clear cause
  • leads to abnormalities in hormone levels (leads to symptoms experienced)
  • very common (1/10 women)
  • main consequences: irregular periods, subfertility, metabolic syndrome, CVD, acne
  • Mx based on pt concerns
  • fertility = weight loss, clomiphene, LOD
  • periods = COCP, progestogens (3-4 bleeds per year)
  • metabolic syndrome = check for DM, high cholesterol, heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

termination of pregnancy counselling

A
  • best option dependent on how many weeks pregnant as more weeks = more pregnancy tissue
  • medical: 1 pill by mouth, another in 24-48 hours (bleeding can last about 2 weeks, pregnancy test after 3 weeks, occasionally needs further surgey)
  • surgical: gently dilate cervix, remove pregnancy using suction tube. Takes 10 mins, need to ripen cervix first, LA or GA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

subfertility RFs

A
  • advances maternal age
  • smoking
  • alcohol use
  • obesity
  • irregular periods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

subfertility counselling

A
  • still a chance of getting pregnant naturally
  • 15% of couples fail to conceive after 1 year
  • like to start investigations (blood tests looking at hormone levels, USS looking at uterus/ follicle count)
  • continue having unprotected sex at least every other day
  • Management options depending on likely cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

menopause counselling

A
  • usual changes that occur at menopause (hot flushes, sexual dysfunction, mood changes)
  • lifestyle factors: healthy diet, weight loss, smoking cessation
  • explain medical options (HRT, SSRIs, topical oestrogen/lubricants)
  • explain risks and Ses
  • explain need for contraception (>1 year no period if >50, >2 years of <50)
  • advice on bone health, keep up to date with breast and cervical screening, contraception, support groups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

thrush counselling

A
  • explain diagnosis
  • tx: intravgainal clotrimaxole or oral flucanzole
  • hygiene measures: not cleaning too often, avoid fabric conditions/ soap substitues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PID counselling

A
  • infection that has spread up to the womb
  • explain risks of PID: infertility, ectopic pregnancy, chronic pelvic pain
  • treated with antibiotics (1 injection and 2 tablets taken for 14 days)
  • do not have sec until course is complete
  • full STI screen and contact tracing
  • discuss contraception
  • F/U: 3 days time and in 2-4 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

RFs for stress incontinence

A

age
traumatic delivery
obesity
previous pelvic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RFs for urge incontinence

A
age
obesity
smoking
FH
DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

couselling for incontience

A
  • stress incontinence is due to weak pevlic floor
  • urge due to bladder muscle overactivity
  • lifestyle measures: control fluid intake, avoid caffeine, lose weight
  • treatment: urge (bladder retrain for 6 weeks, inc time between going to toilet), stress (pelvic floor training for 3 months)
  • medical and surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

prolapse counselling

A
  • explain diagnosis
  • lifestyle modifications (lose weight, healthy diet, stop smoking)
  • conservative (pelvic floor exercises, oestrogens)
  • explain ring pessary or surgery
22
Q

Bartholin’s cyst RFs

A

nulliparoud
child bearing age
previous one

23
Q

Bartholin’s cyst counselling

A
  • blockage of a duct in your vagina that has become infected
  • Mx:
    conservative = observation and Abx
    word catheter insertion
    marsupilisation
  • recommend STI screen
24
Q

endometriosis RFs

A
early menarche
FH
nulliparity
prolonged menstruation 
short menstrual cycles
25
Endometriosis counselling
- condition where tissue that lines the womb starts appearing outside womb - very common: 10% - Mx: conservative = NSAIDs medical = COCP, LNG-IUS, POP surgical = diagnostic laparoscopy, excision/ablation - explain potential impact on ferility
26
fibroids counselling
- common smooth muscle masses - can cause heavy menstrual bleeding and fertility issues - very common, increases with prevalence until menopause - management: HMB = LNG-IUS, COCP Fertility = surgery, tranexamic acid Sx = tranexamic acid
27
CIN counselling
- explain purpose of screening and results - management: CIN 1 = repeat smear in 1 year CIN 2, 3 and CGIN = LLETZ or cone biopsy LLETZ = otpt procedure with LA Cone biopsy = larger lesions, GA risk: mid trimester loss, preterm birth - F/U: repeat smear in 6 months and test for cure
28
endometrial hyperplasia counselling
- abnormal thickening of endothelium - can be caused by benign things - taken seriously because of risk to progression to cancer (further investigations) - Mx: no atypia = LNG-IUS, review in 3-6 months (with biopsy) Atypia = total hysterectomy + BSO
29
RFs for ovarian cancer
``` age FH obesity HRT endometriosis smoking diabetes ```
30
protective factors for Ovarian Ca
COCP breastfeeding hysterectomy
31
ovarian Ca counselling
- explain diagnosis - further investigations may be necessary - definitive Mx = surgery +/- chemo
32
Thrush counselling
- return if symptoms not improved in 7-14 days - avoid predisposing factors - ask if partner has any Sx - not STI but can be spread by sexual contact
33
menstrual bleeding important points
any blood/coagulation problems in family | iron supplements?
34
important sx with endometriosis
pain with bowel movements and urination | PCB
35
causes of dysmennorhoea
endometriosis adenomyosis PID fibroids
36
PMB counselling
- PMB can be caused by many things, lots of which are quite harmless e.g. trauma/infection - priority is to rule out things that could be harmful e.g. cancer - refer for scan (TVUSS) to visualise reproductive organs - from here we can start a plan - further testing may be needed based on scan result
37
what to do if emergency/bleeding?
ABCDE approach senior help send G+S
38
medical management and follow up in ectopic emergency
IM Methotrexate | bHCG: 4, 7, 11 day then weekly until undetectable
39
HRT risks
VTE, stroke, CHD, breast/ovarian cancer Breast risk = 5 more per 1000 Ovarian risk = 1 more per 1000
40
menopause advice
all features of menopause experienced by most women they can be really debilitating 3 avenues of treatment: lifestyle modifications, HRT, non-HRT
41
fertility support
fertility friends adoption UK, surrogacy UK human fertilisation and embryology authority = provides informaiton on all types of fertility treatment
42
PCOS counselling
- multiple fluid filled sacs in ovaries - these can derange levels of hormones and prevent ovulation - also leads to increased production of testosterone ( = weight gain + acne)
43
what is first line treatment for confirmed miscarriage?
expectant management for 7-14 days
44
emergency contraception counselling
- offer STI screen - recommend taking pregnancy test if next period is late - ongoing contraception
45
prolapse questions
bladder, bowel, intercourse obstetric complications constipation
46
ddx of prolpase
sebacous cyst Bartholin's cyst vulval/vaginal Ca
47
prolapse surgery
pelvic repair surgery (with mesh) | hysterectomy
48
what makes up bulk of perineum?
levator ani - puborectalis - pubococcygeus - illiococcygeus
49
what if TVUSS shows empty uterus?
miscarriage completed | no intervention needed
50
investigations in recurrent miscarriages
APL abs cytogenic analysis TVUSS for uterine malformations screen for inherited thrombophillia
51
what if it is early pregnancy?
booking visit first scan Rhesus?