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Obs And Gynae > Abnormal Bleeding > Flashcards

Abnormal Bleeding Flashcards

(52 cards)

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1
Q

What is “normal” menstruation?

A

Less than 80mls
Over 3-5days
At 28-30 day intervals

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2
Q

What is “abnormal” bleeding?

A

Increased/decreased bleeding - cyclical vs non-cyclical

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3
Q

Menorrhagia?

A

More volume, more days

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4
Q

Polymenorrhoea?

A

Short cycle with normal volume

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5
Q

Hypermenorrhoea?

A

Bleeds more days than normal (>5)

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6
Q

Classify organic causes of excessive uterine bleeding.

A

Gynaecological
>Polps
>Adenomyosis
>Leimyoma
>Malignancy
>Coagulation disorders
>Ovulatory disorders
>Endometrial
>Iatrogenic
>Not otherwise classified

Non-gynaecological
>Contraception - IUD, breakthrough bleeding
>Haematological - bleeding disorders
>Endocrine - hyper/hypothyroidism
>Medication - anticoagulants

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7
Q

What is the most common cause of abnormal uterine bleeding in adolescents and how is it managed?

A

Dysfunctional, Anovulatory >80%

= immature hypothalamic pituitary axis (produces oestrogen, not progesterone)

> clinical exam including PR
FBC, platelets, HIV

Treatment
>oral contraceptive pill (give progesterone if excess oestrogen)

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8
Q

What is cyclocapron and what is it used for?

A

Anti-fibrinolytic = used to reduce blood loss (CI in pts with previous thrombosis)

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9
Q

What is the most common cause and management of abnormal uterine bleeding in women of reproductive age?

A

Gynaecological = fibroids, adenomyomas, polyps, endometrial hyperplasia, endometriosis, PID, ovarian/uterine tumors, pregnancy, cx of miscarriages, molar/ectopic pregnancy

Non-gynae = bleeding disorders, thyroid disorders, medication

Management
>medical: document bleeding
1) IUD containing progestogen
2) cyclocapron
3) oralcontraception
4) NSAIDS
5) Treat the anaemia

> Surgical (Family completed/failed medication)
1) Hysterectomy
2) Endometrial ablation/resection

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10
Q

What is the most common cause and management of abnormal uterine bleeding in perimenopausal women? (45-55ish)

A

Exclude malignancy and pregnancy complications
Most common = anovulation

Management
> clinical exam
> tests = cervical smears, endometrial biopsies, endometrial ultrasound, pregnancy test
> medical = mirena, O+P pills, NSAIDS
> surgical = hysterectomy

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11
Q

What is the triad of signs found on ectopic pregnancy?

A

Lower abdo pain
PV bleeding
Ammenorrhoea

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12
Q

Define miscarriage/abortion

A

Premature termination of pregnancy by spontaneous or induced expulsion of a non-viable fetus from the uterus

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13
Q

Viability?

A

24weeks / 500g

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14
Q

What does recurrent abortion refer to?

A

3 consecutive abortions before a GA <20weeks

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15
Q

Classify abortions

A

1)Spontaneous
>incomplete
>complete
>missed
>inevitable
>threatened

2)Induced
>safe
>unsafe

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16
Q

What are the causes of spontaneous abortions in the first trimester?

A

> sporadic chromosomal abnormalities
developmental abnormalities
environmental factors - smoking, infections, toxins, drugs
poor placentation
ovary insufficiency
corpus luteum defect
autoimmune diseases

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17
Q

What are causes of spontaneous abortions on the second trimester?

A

> cervical incompetence
uterine abnormalities
poor placentation
infections - SYPHILUS NB, chlamydia, rubella
medical - hypothyroidism, diabetes mellitus

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18
Q

What are signs and symptoms of threatened abortion?

A

> lower abdominal pain
PV bleeding (NO clots)
os closed
intrauterine fetus with heart on u/s and + pregnancy test

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19
Q

What is your differential for a threatened miscarriage?

A

> implantation bleed
anovulatory bleed
ectopic pregnancy
anembryonic pregnancy

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20
Q

How do you manage a threatened abortion?

A

> counsel and reassure mother
bed rest

If uncertain diagnosis - repeat u/s in 2 weeks

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21
Q

What are the signs and symptoms of a inevitable abortion?

Study These Flashcards
A

> PV bleeding (CLOTS)
lower abdominal pain with increasing severity
os open
products still inside
uterus may be tender

22
Q

What can you mistake an inevitable abortion with and how do you differentiate the two?

Study These Flashcards
A

Incompetent cervix
In an incompetent cervix, there will be no pain and no/minimal bleeding

23
Q

How do you manage an inevitable abortion?

Study These Flashcards
A

> resus if shocked
give oxytocin for uterine bleeding
first trimester = MVA
second trimester = oxytocin until fetus aborted followed by evac if retained products

24
Q

What are the signs and symptoms of an incomplete abortion?

Study These Flashcards
A

> PV bleeding (CLOTS) - products of conception have been passed = amniotic fluid, fetus, placenta)0
lower abdominal pain (decreases after “passing something”)
os open
products of conception felt on os
uterine size smaller than period of amenorrhoea

25
How do you manage an incomplete abortion?
>resus if in shock >1st trimester = misoprostil then MVA >2nd trimester = prostaglandins + evac/MVA after pregnancy expelled >rule out septic incomplete abortion NB do not use misoprostil in a scarred uterus = it will rupture
26
What are the requirements for an MVA?
>GA <13weeks (height of fundus) > Hb>9 > clinically and haemodynamically stable patient
27
What are the signs and symptoms of a complete abortion?
>abdominal pain that has subsided >PV bleeding that has stopped >os closed Diagnosed only if you have seen and examined the expelled products yourself
28
How do you manage a complete abortion?
>observe patient for bleeding >try and find a cause/diagnosis - examine fetus for congenital abnormalities, chromosomal abn on fetal blood, intrauterine infection, cervical incompetence, syphilis - placenta for chorioamnionitis
29
What are the signs and symptoms of a missed abortion?
>asymptomatic >ammenorrhoea >usually diagnosed on u/s checkup (accidental finding) = no fetal heartbeat >can present with PV bleeding
30
How do you manage a missed abortion?
> if <12weeks = MVA/dilation and evac in theatre > if >12weeks = induce labour with prostaglandins followed by evac
31
What types of septic abortion can you get?
Complete Incomplete
32
How does a patient with a septic abortion present?
>fever >Hx of unsafe intervention >signs and sx of pelvic infection -lower abdominal pain, peritonitis -foul smelling/pussy discharge through os -cervical excitation tenderness -adnexal tenderness
33
How do you manage a patient with a septic abortion?
>NB identify other organs involved by systemic evaluation >resus with colloids and crystalloids and blood!!! >antibiotics (aminoglycosides, metronidazole, cephalosporins) >remove source of sepsis >proper monitoring of disease process
34
How do you assess for organ dysfunction?
CVS = pulse, BP CNS = decreased GCS, confusion, meningeal signs Resp = RR, saturation, CXR, ABG GIT = liver enzymes Renal = creatinine, UO Haematological = Haematocrit, platelets, clotting profile Immunological = WCC, CRP, temperature, VCT
35
How do you treat a patient with septic abortion?
>resus (CAB) >antibiotics >evac/hysterectomy >repeat bloods post evac to monitor condition >careful monitoring and follow-up
36
When is a hysterectomy indicated for a patient with a septic abortion?
>multiple organ dysfunction >septic shock >necrotic cervix >pus in abdomen (acute abdomen, colpopuncture) >no improvement after evac
37
When is a evac indicated in a septic abortion patient?
Only if SIRS
38
Classify induced abortions/TOP
Safe (within law) Unsafe (outside law)
39
How do you describe your findings on u/s writhing the ovary?
Using the IOTA (International ovarian tumor analysis) terminology to describe the appearance. >unilocular (one incomplete septum) >unilocular solid ( >multilocular (at least one complete septa) >multilocular solid >solid (at least 80% of mass is solid) Anechoic Hyperechoic Low level echogenicity showing acoustic shadowing Spider-web/lattice appearance = haemorrhage within cyst Ground glass = endometrioma
40
What models are used to assess an adnexal mass to predict if it’s benign or malignant?
Simple rules Logistic regression 1 Logistic regression 2 IOTA Adnex model
41
What is the Rotterdam PCOS criteria?
1) >presence >12 follicles >2-9mm OR >ovarian volume >10cm^3 in one or both ovaries 2) oligo-anovulation 3) yperandrogenism
42
When will you be able to see the gestational sac on u/s?
6 weeks
43
What is the most accurate way to measure GA on u/s between 6-10 weeks?
Crown rump length (CRL) measurement
44
What are the most common causes of abnormal bleeding in prepubertal girls?
1) associated with secondary sexual characteristics >precocious puberty 2) not associated with secondary sexual characteristics >acute -mass =urethral prolapse =perineal haematoma =neoplasm -no mass =infective vulvovaginitis =sexual abuse =other injury >chronic -foreign body -irritant vulvovaginitis -dermatoses
45
What is adenomyosis?
The growth of endometrial tissue into the myometrium
46
What causes adenomysosis?
Prolonged oestrogen exposure, local trauma and inflammation
47
What ultrasound criteria must be met to diagnose adenomyosis?
>asymmetrical myometrium thickening >increased vascularity in lesions >Hyperechoic islands >specific junctions zone irregularities/disruptions
48
What is a leiomyomata?
A benign Timor of Müllerian duct origin, composing of smooth muscle and fibrous strands (originates from muscle tissue)
49
Myomectomy?
Surgical removal of leiomyoma
50
In which circumstances of abnormal uterine bleeding is endometrial sampling ALWAYS indicated? ie independent of age
LYNCH syndrome PCOS Breast cancer oestrogen positive survivor
51
What are the risk factors for leiomyomatas?
>race (African Americans) >genetic factors >early menarche >obesity (more oestrogen) >nulliparety/low parity
52
How are uterine fibroids classified and what is the name of this classification?
FIGO staging 0 = peduncuoated intracavitary 1 = submucosal <50% intramural 2 = submucosal >50% 3 = contact with endometrium 100% intramural 4 = intramural 5 = subserosal >50% intramural 6 = subserosal <50% intramural 7 = subserosal pedunculated 8 = other, for example, cervical, parasitic

Obs And Gynae (16 decks)

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