PACEs gynae Flashcards
1
Q
RFs for miscarriage
A
- advances maternal age
- previous miscarriages
- chronic conditions (e.g. uncontrolled diabetes)
- cervical or uterine abnormalities
- smoking
- alcohol
- illicit drug use
- underweight or overweight
2
Q
counselling in miscarriage
A
breaking bad news
- explain diagnosis: reassure this is common and under reported (1/5 pregnancies), risk increases with age, explain most of the time there is no cause
- explain management options (expectant, medical, surgical)
- if medical: explain what to expect (pain, bleeding, nausea),
- antiemetics and pain relief given
- advise to do pregnancy test after 3 weeks
- safety net: return if symptoms get worse, bleeding persists after 7-14 days
3
Q
RFs in ectopic pregnancy
A
PID
smoking
IUD/IUS
tubal surgery
4
Q
counselling in ectopic
A
- implantation of pregnancy outside the womb, means it is not viable
- risks: damage to surrounding structures, bleeding and rupture
- treatment options are based on US findings and level of pregnancy hormone in blood
5
Q
explain ectopic medical management
A
- 1 x IM injection
- expect: tummy pain, nausea, diarrhoea - should pass within few days
- can go home after injection but need to come back a couple of times over next week for a blood test
- avoid sex during treatment, don’t concieve for 6 months, avoid drinking alcohol/ excess sunlight
- risk of treatment failure requiring further intervention
- discuss ongoing contraception
6
Q
explain surgical management
A
- salpingectomy is best procedure
- salpingotomy is considered if fertility issues/problems with other tube
- salpingotomy 1/5 chance of needing more
- fertility isn’t drastically reduced
- follow up
- discuss ongoing contraception
7
Q
GTD RFs
A
- advances maternal age
- prior molar pregnancy
- prior miscarriages
- Asian heritage
8
Q
counselling in GTD
A
- foetus doesn’t form properly and baby doesn’t develop, instead there is an irregular mass of pregnancy tissue
- risks: treat because can invade and damage other tissues
- immediate management: suction curettage
- F/U: referral to trophoblastic screening centre to monitor pregnancy hormone levels
- molar pregnancy does not affect fertility (1/80 chance of recurrence)
- do not get pregnant until F/U is complete
9
Q
key aspects of history in contraception
A
RFs: smoking, VTE Hx, migraine, breast cancer, stroke, HTN, liver disease
menstrual problems
10
Q
explain about contraception
A
split in to long acting and short acting
11
Q
PCOS counselling
A
- disease with no clear cause
- leads to abnormalities in hormone levels (leads to symptoms experienced)
- very common (1/10 women)
- main consequences: irregular periods, subfertility, metabolic syndrome, CVD, acne
- Mx based on pt concerns
- fertility = weight loss, clomiphene, LOD
- periods = COCP, progestogens (3-4 bleeds per year)
- metabolic syndrome = check for DM, high cholesterol, heart disease
12
Q
termination of pregnancy counselling
A
- best option dependent on how many weeks pregnant as more weeks = more pregnancy tissue
- medical: 1 pill by mouth, another in 24-48 hours (bleeding can last about 2 weeks, pregnancy test after 3 weeks, occasionally needs further surgey)
- surgical: gently dilate cervix, remove pregnancy using suction tube. Takes 10 mins, need to ripen cervix first, LA or GA
13
Q
subfertility RFs
A
- advances maternal age
- smoking
- alcohol use
- obesity
- irregular periods
14
Q
subfertility counselling
A
- still a chance of getting pregnant naturally
- 15% of couples fail to conceive after 1 year
- like to start investigations (blood tests looking at hormone levels, USS looking at uterus/ follicle count)
- continue having unprotected sex at least every other day
- Management options depending on likely cause
15
Q
menopause counselling
A
- usual changes that occur at menopause (hot flushes, sexual dysfunction, mood changes)
- lifestyle factors: healthy diet, weight loss, smoking cessation
- explain medical options (HRT, SSRIs, topical oestrogen/lubricants)
- explain risks and Ses
- explain need for contraception (>1 year no period if >50, >2 years of <50)
- advice on bone health, keep up to date with breast and cervical screening, contraception, support groups
16
Q
thrush counselling
A
- explain diagnosis
- tx: intravgainal clotrimaxole or oral flucanzole
- hygiene measures: not cleaning too often, avoid fabric conditions/ soap substitues
17
Q
PID counselling
A
- infection that has spread up to the womb
- explain risks of PID: infertility, ectopic pregnancy, chronic pelvic pain
- treated with antibiotics (1 injection and 2 tablets taken for 14 days)
- do not have sec until course is complete
- full STI screen and contact tracing
- discuss contraception
- F/U: 3 days time and in 2-4 weeks
18
Q
RFs for stress incontinence
A
age
traumatic delivery
obesity
previous pelvic surgery
19
Q
RFs for urge incontinence
A
age obesity smoking FH DM
20
Q
couselling for incontience
A
- stress incontinence is due to weak pevlic floor
- urge due to bladder muscle overactivity
- lifestyle measures: control fluid intake, avoid caffeine, lose weight
- treatment: urge (bladder retrain for 6 weeks, inc time between going to toilet), stress (pelvic floor training for 3 months)
- medical and surgical
