O&G written - Uterine abnormalities Flashcards
Risk factors for fibroids
Oestrogen - early menarche Afro-Caribbean Obese Nulliparity First degree family hx
Classification of fibroids
Intramural - within uterine wall
Submucosal - within myometrium, project into uterine cavity
Subserosal - may be intraligamentary (broad ligament folds) or pedunculated
Medical Tx of fibroid
IUS, COCP, oral POP, injectable progesterone
NSAIDs
Tranexamic acid
Surgical management of fibroids
For larger fibroid or failed medical Tx (or distorting cavity –> infertility)
Hysteroscopic surgery - small, submucosal
Myomectomy
Hysterectomy
+/- GnRh agonist pre-surgery to shrink fibroids
Complications of fibroids in pregnancy
Abnormal lie, malpresentation
Pre-tem labour
PPH
Red degeneration - fibroid grows rapidly + outstrips blood supply
- low grade fever
- abdo pain
- vomiting
- Tx = rest, analgesia, resolves in 4-7 days
Complications of fibroids in pregnancy
Abnormal lie, malpresentation
Pre-tem labour
PPH
Red degeneration - fibroid grows rapidly + outstrips blood supply
- low grade fever
- abdo pain
- vomiting
- Tx = rest, analgesia, resolves in 4-7 days
Endometrial cancer staging
Stage 1: 1A = <50% myometrial invasion, 1B = >50%
Stage 2: + cervical stromal invasion but not beyond uterus
Stage 3: 3A = serosa or adnexae, 3B = vaginal and/or parametrial, 3Ci = pelvic lymph nodes, 3cii = para-aortic lymph nodes
Stage 4: 4A = bowel or bladder, 4B = distant mets
Management of endometrial cancer
Total (abdominal) hysterectomy with bilateral oophorectomy
+/- pelvic/para-aortic lymph node dissection
Adjunctive radiotherapy and/or chemotherapy for Stage II Type 1 and any Type 2 tumours
Presentation of leiomyosarcoma
Painful, rapid uterine enlargement
Tx of leiomyosarcoma
Hysterectomy+/- radiotherapy, chemotherapy
Presentation of endometrial ca.
Post-menopausal bleeding
If pre-menopause, abnormal bleeding - heavy, frequent, IMB
Enlargement of uterus - pain
Unusual discharge
Dyspareunia
Risk factors for endometrial hyperplasia/cancer
Oestrogen exposure
- early menarche, late menopause
- nulliparity
- Tamoxifen
- unopposed oestrogen HRT
- Diabetes, PCOS, high BMI
- family Hx including HNPCC (Lynch syndrome)
Investigation of PMB
TV USS
- endometrium <4mm = ca. umlikely
- endometrium >4mm = need second line Ix
Hysteroscopy +/- pipette biopsy
Management of endometrial hyperplasia WITHOUT atypia
Reverse RF
1st line = LNG-IUS 5 years (or oral progestogens for min 6 months)
2nd line = hysterectomy
If wanting fertility –> endometrial surveillance (TV USS) every 6 months + biopsies if high risk
Management of endometrial hyperplasia WITH atypic
Fertility preserving:
1st line = LNG-IUS
2nd line = Oral progestogens
+ endometrial surveillance + biopsies every 3 months
Not fertility preserving = total hysterectomy + bilateral salpingo-oophorectomy if post-menopausal
