Women Health 2.0

Question 1

What is the significance of a corpus luteum rupture

Answer 1

At the time of ovulation, these can become sizeable, rupture and bleed into the pelvis and present as an ctopic pregnancy

Question 2

Would you give anti-d in an early pregnancy?

Answer 2

Probably, however as the placdneta doesn’t fully develop until 8-9weeks so its uncertain that isomixing would occur between maternal and fetal blood.

Question 3

PUL stands for

Answer 3

Pregnancy of Unknown Location

Question 4

What is the ‘discriminatory level’ of B-hcg? WHat does this mean?

Answer 4

1000-1500

Over this you should be able to locate the pregnancy (or at least the corpus luteum)

Question 5

Why do we need attempt to maintain the fallopian tube in the setting of an ectopic?

Answer 5

Because the liklihood of an ectopic in that same tube is too high, therefore a salpingectomy is instead performed?

Question 6

Post unilateral salpingectomy how much is your fertility reduced??

Why?

Answer 6

20-30%

The fimbriae will find the egg wherever it is released into the abdomen

Question 7

endocervical for:

High Vaginal for:

Vulvovaginal swab for NAAT:

Answer 7

endocervical for: Gonorrhoea

High Vaginal for: BV and Chlamydia

Vulvovaginal swab for NAAT: Chlamydia, gonorrohea and thrush

Question 8

Treatment of PID?

Answer 8

• Ceftriaxone 500mg IM stat or Azithromycin 1g stat
• Doxycycline 100mg bd 14/7
• Metronidazole 400mg bd 14/7

Alternative:

• Ceftriaxone 500mg IM stat
• azithromycin 1g stat then repeat in 1/52
• ??add metronidazole

Question 9

In what situations would you admit a patient with PID to hospital?

Answer 9

• Pregnancy
• Severe clinical illness or ?tubo-ovarian abscess
  
  • Sepsis?
• Diagnostic uncertainty
  
  • (consider torsion, appendix)
• Inability to tolerate/comply with treatment

Question 10

What scoring system can you use to exclude/diagnose appendicitis?

Answer 10

Alvarado Score

0-4 probably not; sensitivity 99%

5-10 Over-predicts appendicitis

Question 11

How does pregnancy change the pelvic floor?

Answer 11

1. Progesterone softens ligaments and muscles
2. Weight gain
3. Pressure on the bladder (abdominal pressure)
4. Altered breathing and muscle co-ordination
5. Constipation and straining

Question 12

What is the importance of perineal length?

Answer 12

Caucasian: 3.9cm

Asian: 3.7cm

If the perineal length is <2.5cm they are at 40% risk of a tear

Question 13

How long should you be able to ‘delay defecation’?

Answer 13

at least 30 minutes

Faecal urgency is a common post-partum problem

Question 14

Management of next pregnancy after OASIS

Answer 14

• 3rd or 4th degree tear, 50-60% chance of tear: elective LSCS
• Any bowel compromise with faecal or flatus incontinence or urgency: offer elective LSCS
• Asymptomatic with no bowel compromise: offer vaginal delivery (risk of recurrent 3rd degreee tear 5%)

Question 15

Pharmacological treatment of an overactive bladder

Answer 15

• Topical oestrogen cream
• Anticholinergic meds: oxybutinin
  
  • alt: solifenacin
• Commence at the lower dose and titrate dose over two weeks
• 80% improvement overall
• Compliance is an issue (due to dry mouth and constipation side effects)

**intravesical botox is also an option

Question 16

The most common procedure for stress incontinence?

Answer 16

Mid-urethral sling

With a mesh. Minimally invasive.

Question 17

How many stages of prolapse are there?

Answer 17

4 stages within two compartments