Women's Health

Question 1

What to do in ectopic pregnancy?

Answer 1

• Quantative serum HCG below cutoff threshold
• transabdominal US (<1500 US everytime)
• Do a pelvic US for everyone with pregnancy symptoms - ‘any discriminatory threshold’ - could miss an ectopic.
• B-HCG alone can not rule out ectopic
• needs 48 hour followup
• Call OB

Use of methotrexate for ectopic in ED if:

• <3.5 cm
• Stable
• Followup

Question 2

What are some common problems that occur during the 2nd trimester?

Answer 2

1. Placenta privia

Pathogenesis:

• Implantation over the cervical Os.

Ix:

• Do NOT use a speculum
• DIC, IV access (s lines)
• US will see it

1. Placental abruption

RF:

• HTN
• Preeclampsia
• Trauma
• Cocaine use

Px:

• Painful vaginal bleeding
• 30% have no hypotension, 70% have pain
• Nausea, back pain

Ix:

• US
• DIC coagulopathy (fibrinogen)

Tx:

• IH prophylaxis 15mcg Rogram
• 300mcg Rogram later if Rho - patients

Question 3

What are some causes of abdominal pain without bleeding?

Answer 3

• Appendicitis is the most common
• Cholecystitis
• PID
• Septic abortion (<20 weeks)
• Chorea Amniotis (>20 weeks) will have fever ○
• These two above are similar
  
  • quatative HCG,
  • Hb
  • give clindamycin and gentamycin
• Help Syndrome
  
  • Splenic rupture
  • Similar to eclampsia/preeclampsia
    
    • >140/90 20 weeks gestation
    • No longer requires proteinuria
    • Other findings (thrombocytopenia, pulmonary oedema)
  • Tx:
    
    • Hydrolyzine, metoprolol
  • Complications:
    
    • Seizure,
    • death
    • Renal
    • platelets, liver, abdo pain.

Question 4

What is pre-eclampsia? What are the effects of this condition?

Answer 4

WHO definition:

1. BP >140/90 or change upwards of 20 systolic, 10 diastolic
2. Proteinuria (300mg in 24hours)

Inadequate placentation of trophoblasts not reaching maternal vessels HTN and decreased blood to the placenta results (can lead to reprofusion injury) Hypoxic placenta means you don’t produce hormones to dilate vasculature

Complications:

• Intrauterine growth restriction
• Change in vision
• Headache
• Hyperreflexia
• Seizure

Question 5

What are the signs and symptoms of pre-eclampsia? What are the RFs?

Answer 5

1. BP
2. Dipstick
3. Headache
4. RUQ pain

Risk Factors:

• 1st pregnancy
• < exposure with the father (i.e. 1 night stand, sperm donor)

Question 6

What is the treatment of pre-eclampsia?

Answer 6

• If after 20weeks without preexisting HTN admit them
• Only management is to remove the baby >37 weeks get them into hospital and deliver
• Manage Hypertension: 3 medications safe in pregnancy LMN

1. Lebidolol
2. Methyldopa
3. Nifedipine

+ hydralazine

ACEI/ARBs not used in pregnancy - kill the baby in 3rd trimester of pregnancy

Question 7

What happens if you miss a dose of HPV vaccination?

Answer 7

There are two types of injection the 2vHPV only in girls and the 4vHPV in boys and girls.

The recommended 3-dose schedule for the 2vHPV vaccine is at times 0 (the day the 1st dose is given), 1 and 6 months.

The missed dose(s) should be given as soon as is practicable, making efforts to complete doses within 12 months.

Question 8

What sort of topics do you discuss when you want to talk about domestic violence?

Answer 8

HARK:

H - Humiliation

A - Afraid

R - Rape

K - Kick (hit or physically hurt)

• prepare the patient
• use open ended questions
• dicuss plan

Question 9

Barriers to Domestic Violence Disclosure?

Answer 9

1. Fear of the abuser
2. shame and embarassment
3. fear of judgemental attitude
4. her partner is present
5. belief the abuse is normal
6. perception health practioner is unable to help

Question 10

What should your response be to Domestic Violence?

Answer 10

• respect the women’s wishes and don’t pressurise them
• important to counter the women’s normalisation claims
• reassure them you want to work together
• reassure them you are happy they told you

1. women centred care
2. written information in private areas
3. no mandatory reporting
4. psychological treatments
5. mother-to-child interventions

Question 11

What is the Rotterdam criteria for PCOS?

Answer 11

1. Oligo-ovulation (infrequent or irregular ovulation)
2. clinical and/or biochemical signs of hyperandrogenism
3. Polycystic ovaries (confirmed with US)

Hyperandrogenism:

• hirsutism
• persistence of acne
• alopecia
• insulin resistence

Question 12

What is the treatment for PCOS?

Answer 12

• lifestyle modification is the foundation:
  
  • weight loss
  • healthy diet
  • increased physical activity
• oligomenorrhoea
  
  • OCP - insulin and hyperandrogenism impact
  • cyclic progestins
  • metformin
• hirsutism
  
  • eflornithine cream
  • cosmetic therapies
  • primary - OCP
  • anti-androgen monotherapy (e.g. spirinolactone)