Women's health Flashcards
1
Q
Urinary incontinence
- Causes
- Presentation
- Ix
- Rx
A
- Age, previous pregnancy, high BMI, hysterectomy, FHX.
- Classified as; Urge (overactive detrusor), stress (leakage on stress), mixed and overflow (mainly males) 3. Bladder diary. Vaginal exam for prolapse, Urine dip for DM or UTI. Urodynamics.
- Bladder retraining. Oxybutynin, tolterodine. Mirabegron. Kegels.
2
Q
VTE in pregnancy management
A
Four or more of the below indicate LMWH should be used immediately until 6 weeks post-natal.
- Age >35
- BMI >30
- Parity >3
- Smoker
- Gross varicose veins
- Current pre-eclampsia
- Immobility
- FHx or personal Hx of unprovoked VTE
- Low risk thrombophilia
- Multiple pregnancy
- IVF
3 RFs = LMWH from 28 weeks until 6 weeks after birth. - Avoid warfarin and DOACs
3
Q
COCP Advice & Risks
A
- If taken within first 5 days of cycle. no need for further contraception.
- If taken at any other point - condoms should be used for the first 7 days.
- Take same time every day
- Take for 21 days then stop. however not required.
- Efficacy reduced when; N&V, liver enzyme inducing drugs.
- Risks = clots, MI and stroke, Breast Ca and Cervical Ca.
4
Q
Ectopic
- Causes
- Presentation
- Ix
- Rx
A
- Implantation of fertilised ovum in the fallopian tube (not in the uterus)
- Lower abdo pain and bleeding following 6-8 weeks amenorrhoea.
- BHCG >1500, USS
- MTX as a single dose. repeat if levels have not fallen. Surgical laparoscopy. Salpingectomy/salpingotomy.
5
Q
Contraception postpartum
A
- Require contraception day 21 postpartum.
- POP can be used.
- IUD, IUS
- Progestogen only implant
Avoid all combined contraceptives. NO COCP
6
Q
HRT prescribing
A
- Cyclical combined HRT if LMP was <1y ago.
- Continuous combined HRT if LMP was >1y ago or they have been using cyclical for 1y or 2y post LMP in premature menopause
7
Q
Vaginal Discharge
A
- Bacterial vaginosis.
- Fishy, green. Low pH.
- Oral metronidazole - Trichamonas vaginalis
- Strawberry cervix on exam (red with point of exudate). musty, frothy, green discharge.
- Oral metronidazole - Gonorrhoea
- Thin, purulent mild smelling discharge + Dysuria, bleeding and dyspareunia.
- IM ceftriaxone 500mg + oral azithromycin 1g - Candida
- Thick white discharge
- Local clotrimazole pessary or oral clotrimazole (CI in pregnancy)
8
Q
Active management of third stage of labour
A
- Uterotonic drugs
- Deferred clamping and cord cutting >1min after delivery but less than 5.
- Controlled cord traction for placental separation.
- Drugs = 10IU oxytocin
9
Q
TOP HCG levels
A
- It is normal for a urinary pregnancy test to return positive for up to 4 weeks post TOP.
- HCG has a stepwise decrease.
- Further than 4 weeks requires more Ix
10
Q
Emergency contraception
A
- Levonorgestrel - up to 3 days but ASAP is better. 1.5mg of levonorgestrel (progesterone).
- Ulipristal acetate (progesterone receptor modulator) up to 5 days afterwards.
- Copper coil - up to and over 5 days and if high BMI
11
Q
Management of a missed miscarriage
A
- Expectant - wait for 7-14 days
- Medical - Vaginal misoprostol. (contact Dr if bleeding hasn’t started in 24hrs) + antiemetics and pain relief.
- Surgical - vacuum.
12
Q
Cancerous HPV subtypes
A
16 and 18
- If positive refer to colposcopy
13
Q
Post term pregnancy complications
A
Fetal - Reduced placental perfusion
- Oligohydramnios
Maternal - Increased rates of labour intervention; section + forceps.
- Increased rates of IOL
14
Q
Placenta Praevia
- Causes
- Presentation
- Ix
- Rx
A
- Placenta lying wholly or partly in the lower uterine segment - obscuring to os.
- Associated w/ multiparity, multiple pregnancy, previous section. - Shock
- No pain
- Uterus non tender
- High lying foetus
- Small bleeds before large haemorrhage. - USS to locate, looked for at 20 week scan.
- Vaginal USS if safe - is more specific. - If low lying placenta a 20 weeks;
- Rescan at 34 weeks.
- Still low at 34 weeks, scan every 2 weeks.
- If low at 37 weeks or high presenting part - Section.
- Admit all those w/ bleeding.
15
Q
Ovarian Cysts
- Causes
- Presentation
- Ix
- Rx
A
- Benign cysts are common.
- Physiological cysts =
a) Follicular - common. Due to non-rupture of the dominant follicle or failure of atresia.. Commonly regress after a few menstrual cycles.
b) Corpus luteum cysts - more likely to present with intraperitoneal bleeding.
- Benign germ cell tumours =
a) Dermoid cyst - Lined with epithelium, most common in women under 30. Torsion risk.
- Benign epithelial tumours =
a) Serous cystadenoma - resembles ovarian cancer.
b) Mucinous cystadenoma - common, large. - Subfertility
- Often incidental findings
- Torsion
- Dyspareunia
- Pressure effects locally - Bimanual exam
- Pregnancy test (ectopic)
- USS
- Cancer markers in complicated cyst; CA-125, LDH, AFP and BHCG
- RMI = USS score + Menopausal status + ca125 - Expectant management in simple cysts.
- Surgical cystectomy or drainage in all which are symptomatic, complex or large.
