Gyn Flashcards
Colposcopy
HSIL within 8 weeks
-adequate facilities + consent + FU
MUST RECORD: adequate/inadequate, squamocolumner junction visibiity
Transformation zone 1-3
Aceto white: minor (thin AWE, fine mosiac/punctation), Major (dense, cuffed gland openings, coarse mosaic/punctation)
INVASION - atypical vessels, irregular surface, exophytic mass, necoriss
Location of lesion by clock position, size of lesion
Risks of excisional treatment: PTB/LBW/PROM
Recommend at least 7 mm depth
Risks are if >10mm
Can do smear in pregnancy, defer to 3/12 postpartum if needed
If BF, use ovestin 2-3 weeks prior
Annual smears = HIV + solid organ transplant. Consider in other immune conditions such as RA.
Turner Syndrome
1 in 2000
Often found in aborted fetus but can be viable
Short stature, webbed neck, “shield” chest
Pubertal failure - 15-30% do have spont breast development
Cardiac (most significant) - need to ensure re risk aortic root dilatation/aortic dissection, cardiac MRI more sensitive than echo
Renal - horseshoe kidney
HTN
Hearing loss
Diabetes
Autoimmune - such as hypothyroid
If have Y present, then gonadectomy (mosaicism)
Pregnancy risks:
Up to 1/3 have a malformation, Growth, Hypertensive diseases, miscarriage, 80-100% risk of CS (CPD), if aortic root >2.5cm = CS, glucose intolerance (OGTT)
ASSIST model for comms
Acknowledge
Sorry
Story - their story/our story/understanding
Inquire - is there anything youd like me to explain again,
Solutions - what do you think should happen
Travel - dont abandon
You will think of other questions after this meeting, please write them down and bring them with you when we next meet
ASSIST - acknowledge
Acknowledge Sorry Story Inquire Solution Travel
Acknowledge - we are hear to discuss that you have experienced complications, i can only imagine how upset you must be
I appreciate that you are anxious and upset about what has happened, this may have come as a big shock
Management of fibroids
Conservative
Medical
Surgical - UAE, myomectomy, hysterectomy, MRGFUSS
Uterine artery embolisation
Benefits - day case, short return to activities, fertility preservation if controversial, 65% reduction in hysterectomy
NO histo, need to check not sarcoma (i.e. ethnic, previous pelvic irradiation, rapidly enlarging)
Risks
Procedural - groin haematoma, pseudo anuerysm, bleeding, arterial thrombosis
Short - postembolisation syndrome (fever, malaise, dc), expulsion necrotic tissue, pelvic infection, discharge
Long - failure, ovarian insufficiency, fertility
Fertility - increased MC, stillbirth, PPH
Risks and benefits RR BSO
Risks
-surgical risks
-loss of fertility
-increased mortality CHD, osteoporosis, dementia, depression/anxiety, more severe vasomotor than natural, reduction sexual function
Reduction all cause mortality by 60%, ovarianc cancer by 79%, breast cancer by 56%, still have 1% primary peritoneal
Risks HRT - okay in BRCA in women <50
If women are >65, potential risks and benefits to be carfeully considered
Transfusion or drug reaction
STOP IV Call for help, resus trolley ABC Directed hx + exam Invx - FBC, CRP, G+H, haemolytic screen (hapto/LDH/bili/reticulocytes) antihistamine/steroid/fluid monitoring/icu Q15m obs minimum Document reaction
Differentials oligomenorrhea/hyperandrogenism
Ovary - PCOS, hormone secreting tumour
Adrenal - tumour (adenoma or carcinoma)
Delayed CAH
Cushing disease (pituitary too much ACTH )
Fertility options in PCOS
Lose weight/bariatric surgery
Letrozole 1st line (metformin if androgenic, clomiphene = less successful, can become resistant, hot flushes)
Ovarian drilling or gonadotrophins 2nd line
IVF 3rd line
Steps of colp
Thorough hx Explain indication Lithotomy Macroscopic assessment vulva/vagina/cx Speculum, repeat smear + HPV Colposcopy w microscope Visualise entire TZ + lower tract 5% acetic acid, lugol iodine Targeted biopsies Endometrial currettings, pipelle FU 2/52 w result Safety advice - pelvic rest 5 days, seek help bleeding/dc/fevers
Cervical shock
Abandon procedure Lower head Raise legs Remove IUD if mirena Monitor vital ABC Atropine if persistent brady COnsdier adrenaline if concern anaphylaxis Apply AED
Differentials abnormal glandular cells on smear
AIS Adenocarcinoma Endometrial cells Endometiral hyperplasia Endometrial cancer
PMS
Standardised questionnaire/daily record severity
MDT approach
GnRH for 3 cycles to ensure truly is PMS
1) Exercise, CBT, B6, COCP containing drosperione Luteal phase (or continuous ) SSRI - citalopram
2) Estradiol patches + progesterone, higher dose SSRI
3) GnRH + add back
4) BSO + HRT
HPV vaccination
Gardasil 9
If <15, 2 doses, >15 = 3 doses
If inadvertently vax in pregn, delay completion till later, no safety data to suggest dangerous, but not encouraged
Funded if underoing transplant or chemo
