Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Maternal Care > Abnormal Uterine Bleeding > Flashcards

Abnormal Uterine Bleeding Flashcards

1
Q

What is the normal blood loss during menses

A

5-80 mL

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

Discuss your Approach to Abnormal uterine bleeding

A

Excluding bleeding from
1. Vulva (trauma, lesions, tumour)
2. Vagina (infection, laceration etc)
3.. Cervix (cancer)
4. Tubes
5. Ovaries

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

Discuss the management of heavy menstrual bleeding

A

Acute:
Bloodloss
-Large bore IV line and normal saline
-Crossmatch
Medical
-Conjugate equine oestrogen IV for 1 day
-COC 1 tab for 7days
-POP 1 tablets for 7days
-Tranexamic acid 1g IV
Surgical
-uterine artery embolisation

Chronic
-come for majority of 6months
-medical: COCs, Progesterone injections
-fine underlying cause

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

Outline the classification of abnormal uterine bleeding (9)

A

PALM COEIN

Structural:
Polyps
Adenomyosis
Leiomyomata
Malignancy and hyperplasia

Non structural:
Coagulopathy
Ovulatory dysfunction
Endometrial and endometriosis
Iatrogenic
Not classified yet

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

Sescribe endometrial polyps

A

Hyperplastic outgrowths of endometrial glands
Common 10-24% of hysterectomies due to polyps
Asymptomatic or causebAUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What investigations do you do for endometrial polyps

A

US
Diagnostic hysteroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of endometrial polyps

A

Conservative unless :

Symptomatic
Multiple polyps
Postmenopausal
Prolapsed through cervix
Infertile patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Descuss Adenomyosis

A

Endometrial glands grow into myometrium causing hypertrophy of myometrium and a globular uterus

20-35 % we,en normally multiaparous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the symptoms of Adenomyosis (3)

A

HMB
Dysmenorrhea
Chronic pelvic pain

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

What investigations would you do for Adenomyosis suspicion

A

US
MRI for difficult cases

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

Discuss your management for Adenomyosis

A

Completed family:
-hysterectomy
-uterine artery embolisation

Desire fertility
-analgesia
-coc, progesterone injectables, mirena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are fibroids

A

Tumours of the myometrium (20-40% are women over the age of 35) so it’s common in older women kahle kahle

Ass with increase oestrogen exposure
-obesity
-nilliparous
-persistent anovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline 3 risk factors of fibroids

A

Obesity
Nulliparous
PCOS/ persistent anovulation

Prolonged oestrogen exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List the types of fibroids

A

Submucosal
Intramural
Subserosal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the symptoms of fibroids (5)

A

1.Abdominal swelling / fullness
2.Urinary retention or frequency
3.Leg oedema due to pressure in vessels
4.Heavy menstrual bleeding (most common), May be ass/w dysmenorrhea
5. Infertility
6. Miscarrriage/ preterm labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of pain in fibroids/leiomyomas (5)

A
  1. Pressure on surrounding organs
  2. Subserosal fibroids can be torted and cause acute pain
  3. Malignant transformation
  4. Submucosal pedunculated prolapses out the cervix
  5. Red degeneration which is when during pregnancy, the gravity uterus compresses the venous outflow of blood which causes blood vessels to burst and it becomes red due to the blood.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Discuss management of fibroids

A

Conservative
-if small and asymptomatic
-regular reassessment

Medical:
GnRH agonists; used to shrink fibroids before surgery
Trial of mirena to treat AUB if surgery not desired

Surgery:
Myomectomy to preserve fertility (<17weeks uterus, small number fibroids, Subserosal&intramural)
Hysterectomy
Uterine artery embolisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the criteria for diagnosis g coagulopathy/ coagulation dysfunction in a woman with AUB

A

✔️Heavy menstrual bleeding since menarche

One of the following:
✔️PPH
✔️Bleeding during or after surgery
✔️Bleeding due to dental procedures

Two or more of the following:
✔️Bruising 1-2 times per month
✔️Epistaxis 1-2 times per month
✔️Frequent gum bleeds
✔️Family history of coagulopathy

19
Q

What are the causes of coagulopathy that can lead to AUB (4)

A

Von Wilebrand disease (common)
Thrombocytopenia
Renal/hepatic failure
Leukaemia

20
Q

List the causes of ovulatory dysfunction

A

Perimenopause
PCOS
Stresss
Overweight/Obesity
Hyperprolectilemia
Hypothyroidism
Medication affecting prolactin/dopamine levels

21
Q

Which two hormones in the bodyinhibit GnRH and therefore lead to ovulatory dysfunction

A

Cortisol
Prolactin

22
Q

List some of the risk factors for PCOS (3)

A

Genetic predisposition
Obesity
Insulin resistance

23
Q

How would you make the diagnosis of PCOS

A
  1. Anovulation or oligoovulation
  2. Increase in androgens clinically or biochemically so features like acne, hirsutism and male pattern balding
  3. Poly cystic ovaries on US
    ≥ 12 follicles of 8mm or more
    OR
    Ovarian volume of 10cm2 or more
24
Q

How would you manage a patient with PCOS

A

Metabolic syndrome or Insulin resistance/obesity- weight loss, lifestyle, metformin, statin, HPT

Hyper androgens- COCs, POP, Mirena

Menstrual dysfunction-COCs, if fertility required letrozole for ovulatory induction,

Refer for fertility

25
Q

What is the main complication of COC

A

DVTs esp in obese

26
Q

Describe endometriosis

A

Tissue containing endometrial glands, storm and haemosiderin outside the uterine lining
-ovary
-Peritoneum
-bowel
-lower genital tract (cervix, vagina, vulva, perineum)
-urinary tract

So you get heavy menstrual bleeding but normal ovulation and regular cycles

27
Q

Outline the symptoms of endometriosis (4)

A

-Pain (dysmenorrhea, dyspareunia, pelvic pain)
-Menstrual dysfunction (heavy bleeding, spotting, frequent cycles)
-Infertility
-Urinary and bowel symptoms (haematturia, dysuria, rectal bleeding, diarrhoea, constipation, painful defeacation

28
Q

What investigations would you do to diagnose endometriosis

A

-US useful in ovarian endometriomas
-Laparoscopy is the gold standard
-Presumptive dx based on clinical features

29
Q

Discuss the management of endometriosis

A

-Medical
NSAIDs- especially when fertility is desired
COCs
Progesterone only pill/injection, or mirena
GnRH analogues
Danazol

-Surgical
BO
Bowel resection

30
Q

List some of the common causes of Iatrogenic causes of AUB

A

Hormonal contraception
Copper IUD
Anticoagulants
Dopamine anytagonists: sedatives,antipsychotics, Metochlopromide

31
Q

What is a hysteroscopy

A

Hysteroscope is a procedure that allows a surgeon to look inside a uterusused for treating and diagnosing causes of abnormal uterine bleeding eg polyps, fibroids and adhesions (which you can remove during the operative hysteroscopy)

32
Q

What is an HSG test

A

Hysterosalpingography is an X-ray dye used to check whether Fallopian tubes are blocked. Blocked Fallopian tubes =difficulty falling pregnant.

33
Q

What are the main indications for hysteroscope (diagnostic and operative) (4*2)

A

Abnormal uterine bleeding
Heavy menstrual
Irregular spotting between periods
Bleeding after menopause
Cause of Infertility
Locating an IUD and removing it (Operative)
Removing polyps, fibroids and adhesions (operative)
Inserting IU device (operative)
Uterine biopsy (operative)

34
Q

What are the three medical conditions that can be corrected by hysteroscopy

A

Polyps
Fibroids
Adhesions - Ashermans syndrome
Septum’s

35
Q

What are the contraindications for a hysteroscopy

A

Pregnant
Pelvic inflammation

36
Q

List some of the complications of a hysterectomy (6)

A

1.Infection
2.Heavy bleeding
3.Intrauterine scarring
4.Injury to cervix, uterus, bowel or bladder
5.Reaction to substance used to expand your uterus
6.Reaction to anaesthesia

37
Q

After how long can you have sex after a hysterectomy

A

2 weeks

38
Q

List some of the iatrogenic causes of abnormal uterine bleeding

A

Hormonal methods of contraception
Copper IUD
Anticoagulants
Dopamine antagonists :
-Dopamine
-Antipsychotics
-Metochlopromide

39
Q

Differentiate between acute and chronic uterine bleeding

A

Acute uterine bleeding is an episode of bleeding in a woman of reproductive age who is not pregnant , the bleeding is sufficient to require immediate intervention to prevent further blood loss in the opinion of health care provider

Chronic uterine bleeding is breeding abnormal in frequency, duration and volume and has been present for the majority of 6 months.

40
Q

List the causes of PMB

A
  1. Atrophy
  2. Genital malignancies: Cervical, Endometrial, Ovarian, Vulval, Vaginal cancers
  3. Polyps
  4. Endometrial hyperplasia
  5. Iatrogenic :HRT
  6. Trauma
  7. Infections eg cervicitis
41
Q

How do you manage the ff causes of PMB:

a)Atrophy
b) cervical & uterine cancer
c) hyperplasia

A

a) Atrophy- topical hormonal cream, HRT, lubricants for sex
b) Cervical & uterine ca- refer to gynae oncology
c) hyperplasia - Progestin tx either orally or IM depot or Mirena. Hysterectomy in complex hyperplasia

42
Q

Which cancer is most common in post menopausal women

A

Cervical cancer

43
Q

List the causes of irregular menstruation

A

(Think ovulatory dysfunction )

PCOS
Premenopause
Post menopause
Hyperprolactineamia
Hypothyroidism
Poor nutrition
Systemic disease eg renal, liver

44
Q

List the causes of intermenstrual bleeding

A

Polyps (cervical&endometrial)
Cervicitis
Cervical cancer
C/S scar
Cervical ectropion

Maternal Care (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions