Clinical Gynaecology Flashcards Preview

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Flashcards in Clinical Gynaecology Deck (22)

What is clinical Gynaecology?

  • Issues of discomfort and/or disease of the female genital tract.
  • Prevention of disease eg; cervical screening.
  • Reproduction and contraception.


Cervical Screening is?

One of the most effective screening tests in reducing the incidence and mortality from cervical cancer. By 60-80%!!


HPV is the underlying cause, a vaccine has been introduced.



>5mill babies born by IVF

  1. Stimulate via hormones the female ovaries so lots of follicles/eggs mature.
  2. Puncture via abdominal wall, takes eggs our and mix in vitro with sperm
  3. Find the best fertilised eggs, place them back in the womb


The founding of the first contraceptive pill was?

Pincus was initially shut down, but at the same time Djerassi synthesized progestogen, and they together synthesized the first contraceptive pill, that was on the market in 1960.


What is the major breakthrough in womens reproductive health??

The Oral contraceptive Pill.
Currently used by >100 mill women.

Women could decide if/when they wanted to get pregnant!!!


What kind of things do you see in terms of womens health in the community and/or emergency health system?

heavy menstrual bleeding

Abnormal cervical smears

Early pregnancy complication

Lower abdo pain


Gynaecologic History taking

  1. What's the presenting complaint?
    -onset, duration, course, severity 
    -impact on life
  2. Specific complaint related history (exclude pregnancy)
    -cervical smear, sexual health etc


Gynacaelogical Examination

  1. General Abdominal Examination
  2. Pelvic Examination
    -Speculum &bimanual (checks cervix, cervical motion tenderness, uterus, adnexa)


What is a speculum examination?

-Because in normal circumstances vaginal walls have collapsed, but speculum allows us to expand the walls and clearly view the cervix


Gynacaelogical Investigations

  • Urine (pregnancy)
  • Cervical smear
  • Vaginal Swabs
  • Biopsy (pipelle)


Uterine Fibroids are? Symptoms?

Very common cause of menstrual bleeding, benign SM tumor from uterine myometrium.

Symptoms: abnormal bleeding, pelvic discomfort, no pain


Uterine Fibroid Treatment?

Don't treat unless the symptoms are really bad. If treatment is required, use drugs (eg NSAIDS) or surgery can be done. 

These can grow in different places, eg; bladder


Causes of Heavy menstrual bleeding?

Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia (PALM)


Non-Structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified (COEIN)


Treatment for Acute HMB

Progestogens  (high dose/ 10 days)

or Tranexamic acid


Progestogens action on the Endometrium

  • Stops the oestorgen induced growth of the endometrium
  • Stabilizes endometrial Vasculature 
  • Initiates the clotting cascade
  • inhibits matrix metallo proteinase activity


How does Tranexamic Acid work?

Anti-fibronlytic that prevents plasminogen activation.

It works by preventing blood clots from breaking down too quickly. This helps to reduce excessive bleeding.

Little bit of coagulation at the level of the uterus, restoring blanace of coagulating and anti-coagulating products.


What is Endometrial Ablation and when do we do it?

  • Minor procedure, whole inner womb lining taken out
  • Short recovery
  • 80% satisfaction
  • 25% repeat procedure

Only done if after 3 months medical management for HMB has failed!!


Types of Incontinence




Pain during menstrual cycle

45-72% in menarche +3years


39% use analgenics



pain during sex



Endometriosis stats and associated pain types

1 in 10 women

Most painful condition, functional extra-uterine endometrium, only way to diagnose is a painful invasive procedure.

Dysmenorrhoea, dyspareunia, dyschezia (pain on opening bowels), dysuria


Endometriosis treatment?

  1. Pain management
  2. Hormones
  3. Surgery

But is is a chronic condition and will carry on within reproductive lifespan.