O&G

• Nulliparity
• Obesity
• Early Menarche/Late menopause
• lack of breastfeeding
• Tamoxifen HRT

Endometrial Biopsy during D&C

• Total hysterectomy + Bilateral Salpingoophorectomy + LN dissection
• +/- RadioT and ChemoT

• Atrophic Vaginitis
• Vaginal trauma
• Vaginal infectoin

• Cervical atrophy
• Cervical polyp
• Cervical cancer

• uterine polyp/fibroid
• Endometrial atrophy
• Hyperplasia
• Endometriosis

• Monitor vitals for 24hours
• Analgesia
• Fluid maintenance balance whlist NGT?
• IDC
• DVT prevention (stockings, leg physio)
• Check wound sites

• Vaginal atrophy
• vaginal infection
• Vault carcinoma recurrence
• Vault Granulation
• Bladder infection

• FBC,
• urine MCS
• PEx speculum  bimanual
• vaginal swab
• PR

• vaginal atrophy
• loss of rugae
• increased redness, dryness
• reduced exudate

Topical Oestrogen

• 1. ABC
• shock? BP, HR, T
• IM morphine if not contraindicated

• 2. Further history
• Nildocaaf
• Period Hx - LMP, menarche, period cycle length, spotting, pain, contraception,
• Sexual Hx - contraception, partners, dysparenuria
• Pregnancy Hx -
• Papsmear Hx -

• 3. Ix
• FBC
• biochem
• bHCG
• Urine MCS
• DNA cervical swab (Gon, CHlamyd)
• USS pelvis (uterus, adnexal masses, Doppler blood fow, Inflammatory reactors)

• PID
• accute apendicitis
• ovarian cyst
• threatened abortion
• ectopic

unlikely - bowel issues (colic, IBS,) acute cystitis

• Chlamydia
• PCB, IMB, discharge

urine MCS, endocervical sample

• Fallopian tube 95% (Ampulla, isthmus, fimbirae, interstitium)
• Ovaries
• Peritoneal cavity

• Tubal diseases (PID/Chlamyd)
• previous ectopic
• previous tubal surgery
• subfertility
• IUD

20-24%

• most likely due to chromosomal abnormlaities, however exact is unkonwn
• Most commonly in middle first trimester

possible ectopic pregancy (ruptured)

• Obs - Shock?
• bimanual - cervical excitement, fornices pain,

• Obs - shock?
• FBC,
• Hb and group&hold
• bHCG quantitative (multiple reads)
• TVS - visible sac (@4.5weeks), HR (@5weeks), free fluid within peritoneal cavity (ruptured ectopic)

checking for high hCG against no sac/HR visible

• Hx
• PEx - BP, T, HR, bimanual
• Ix
• Hb + group&hold
• bHCG and quantitative hCG
• TVS - location

• expectant wait
• surgical management
• medical (misoprostol or PV gamepostrol with mifepristone Progesterone antagonist)

• advanced maternal age (pooor quality eggs)
• medical/endocrine disorddres
• uterine/chromosomal abnomralities
• infections,drugs,chemicals

• Complete Hydatidiform
• Partial Hydatidiform 46XXY. XYY, XXX
• Malignant GTD

• usual - PV bleed, pain
• increased uterus size, very high bHCG, hyperemesis gravidarum, big theca-lutein cells

• suction D&C
• ?hysterectomy
• rho-Gram antibodies against Rh + blood cells from fetus

• F/U
• Contraception during treatment
• Serial bHCGs until bHCG dropping for 6/12 monthly. plateua or increasing warrants investigations

• investigations for persistent bHCG -
• full works - FBC, U+E, Cr, bHCG, TSH, LFTs

• invasive mole, persistent GTD
• Choriocarcionma
• placental sitaion of trophoblastic cells

6-8 week mark most common

• non-pharma
• smaller, more frequent meals,
• don't mix solids and fluids
• stop prenatal vitamins apart from folic acid
• increse sleep n rest

rehydrate patient

• Pharma - Metoclopramide (class A) + Vit B6 Restivite
• Ondansetron (class b) VSDs etc
• Steroids - cleft palate

Azithromycin 1g Stat

Ceftriaxone 500mg IM stat in 2ml 1% lignocaine

• Trimethorim 300mg daily for 14/7. 
• cephalexin 500mg BD for 14/7

• Doxycycline 100mg BD 14/7
• + Metronidazole 400mg BD for 14/7
• + azithromycin 1g stat
• + (if gonorrhea) Ceftriaxone 500mg IM stat in 2ml 1% lignocaine

Acyclovir 400mg TDS for 5-10/7

• Gestational HTN
• Abruptio placenta
• IGUR
• IU fetal demise (IUFD)

• mother:
• body weight/BMI
• CNS - headache, visual disturbances, reflexes, irritabilty
• Bleeding, petechaie
• RUQ/epigastric hepatic pain, N + V
• UO and color
• non-dependednt oedema

Fetus:

• fetal movement
• Fetal HR
• Growth serial scans
• Biophysical profile
• Doppler studeies

• bleeding - Hb, platelets, blood fild, PTT, INR, fibrinogen, D-dimer
• liver - ALT, AST, LDH, bilirubin
• kidneys - proteinuria, creatinine, uric acid
• 24 hour collection for total protein and Creatinine clearance

not ACEi, diuretics, propanolol

• Methyldopa PO 250-500mg TDS, QDS
• or 
• Labetalol 100-300 mg PO BD or TDS
• or 
• Nifedipine 30-50mg PO OD

• HTN (pre-existing or gestational) with NEW onset of PROTEINURIA
• continue if normal, may be delivering 34-36 mark depending on fetal size etc

Immediate reduction of BP

• Hyrdralazine 5-10mg IV bolus over 5min, q15-30min
• Labetalol 20-50mg IV q10min or Nifedipine 10-20mg PO q20-60min

Prevent seizure

• MgSO4
• Contineu and manage for 12-24hrs post=partum cos highest risk of seizure

check bleeding - FBC, INR, aPTT

check liver - liver enzymes, LDH, bilirubin, albumin

Check urine - Cr, Uric acid, Urine Dip collection +24hr

• occurence of at least 1 generalised convulsion (60-70secs) in setting of pre-eclampsia in absence of other nruo conditions
• 2-3% of severely pre-eclamptic women.

• ABC
• roll patient to LLDP
• Oxygen (hypoventilation during convulsion)
• anti HTN therapy _ Hydralazine
• MGSO4 to prevent further seizures

DEFINITIVE TREATMENT - delivery of baby, irrespective of GA, due to risk of maternal morbidity

• stroke
• hypertensive disorder
• SOL in CNS
• Hypoglycaemia
• TTP
• illicit drugs

hyporeflexia, flushing, cardiorespiratory depreession, weakness, somnolence

increased urinary stasis from progesterone and mehcanical factros

increased risk of progession to cystitis, pyelonephritis and increased risk of pre-term labour.

• uncomplicated
• 1st line - amoxcilicin 250-500mg PO

Pyelonephritis - admit and IV antibiotics.

• B-hCG --> lower than expected if spontaneous abortion of ectopic
• US - confirm iuntra-uterine pregnancy and fetal viability
• FBC
• Group n hold

• Temperature
• Tenderness - abdominal
• Tenderness - bimanual
• Tissue - palpable adnexal mass (50%)

• acute abdomen with increasing pain
• abdominal distension
• shock

• Previous ectopic
• gyne causes: IUD, PID, Salpingitis, Infertility, Clomiphene citratie (used for ovulation)
• Previous procedures: ectopic removal/tubal ligation, abdo surgeries, IVF pregnancies + induction
• smoking
• abnormal uterus.

• serial B-hCG levels, non-doubling. 
• US checking for when serum B-hCG >1500 TVUS or bHCG>6000 Transabdomial US

Conservativ, maintain haemodynamic stabilitiy

• Surgical lap
• - salpingostomy
• salpingectomy

• Monitor B-hCG for weeks until non-detectable
• consider Rhogram

MethoTreXate if small unruptured ectopic with no hepatic/renal dysfunction

Vaginal bleeding from 20wk to term

• how much bleeding?
• Description of colour, clotting
• Contractions/cramping present?

• Placenta praevia, Abruptio PLacentae (MC pathological)
• Vasa Praveia

Shedding of cervical mucous plug (MC normal)

• Cervical lesion
• Uterine rupture.

• FSH (increased)
• Oestradial (decreased) - hence osteo
• Inhibin B (decreased)

• FSH, oestradial, 
• Serum androgens (free androgen index)
• TSH
• lipids, glucose
• chem 20

TVUS

• BMD + Hydroxy vit D
• pap
• mammogram

PM is diagnosed with amenorrhea <4 months, in a less than 40 year old, with FSH readings >40 on 2 separate occasions.

• reassure if within first 12 months, normal.
• however after 12 months, needs investigations for pathology. 
• TVUS - uterine pathology
• +/- endometrial biopsy

again, breakthru bleeds are expected on sequential HRT>

• reduce oestrogen dose, 
• or switch to transdermal
• or switch to tibolone

reduce progesterone dose or switch progestogen type

• hysterectomy - no uterus, therefore ET alone is good - ET alone is not as bad as EPT for breast cancer, CHD, VTE. 
• Urogenital only - dryness, atrophy, dysparenuria,  - oestrogen cream

smoking status - OCP not recommended, DVT risk

Hepatic or concurrent - patches

• Tibolone - synthetic steroid with androgenic, progestogenic, oestrogenic properties, reduces cancer risks in all BUT those with previous breast cancer.
• HIgher risk of recurrence if previously treated for breast cancer c.f. control

• gabapentin
• venlaxafine
• paroxetine - caution in women with tamoxfen + breast cancer
• clonidinee

weeks 2-8 post-concentpion = the embryonic periods where fetal organs are developing

weeks 0-2 (conception to 2 weeks post) there is an all-or-none survival or death mechanism. 

Fetal period (K9-) fetus is less susceptible to teratogens, but drug toxicieities, behavioural teratogenicity (vision, hearing, neurodevelopment) and vascular insults (IUGR) can be caused.

• occurs in K5-6,
• peaks at K8
• by K12 60% of vomiting has resolved

intractable vomiting resulting in dehydration, weithg loss, electrolyte imbalance

may require hospitalisation and IV fluid rehydration.

• bHCG
• hence higher in twin pregnancies, molar pregnancies
• TVUS can help.

• serum electrolyes - K, Na
• FBC - Increased haematocrit concentration due to depeletded plasma volume
• LFTs - transaminase elevation, check jaundice
• TSH - only TSH lowered and T4 should be raised, not T3 and T4 and reduced TSH (true hyperthyoidism)
• US - multiple pregnancy or GTD

• conservative 
• avoid spicy food, fatty foods, caffienes
• increase hydration
• eat small amounts, small snacks
• eating before rising

• Vit B6,
• ginger,
• antihistamines
• dopamine antagonists, 
• phenothiazines
• metoclopramide.

methylprednisolone is associated with cleft lip/palate before K10, with 3-4 fold increase

• significant dehydration
• inability to tolerate PO
• 2+ ketonuria in the setting of hyperemeiss.

• increased PG
• thus, reduced LOS pressure, incerased intra-gastric pressure, reduced pyloric sphincter tone
• increased gastric pressure - worsens from T1 to T3.

• antacid
• Fe needs acid for absorption - thus Fe deficiency should watch outn 

• Alginates - barrier added
• H2receptor antagnosits 
• Promotility - metoclopramisde
• PPIs - omperazole is B3.

20-40% of women of repro age

• impaired fibroid perfusion
• vessel occlusion or fibroid volume too much with growth
• inflammatroy process producing CKs and Prostaglandins and thus cellular injury.

K10-12 when the high relaxin concentrations cause widening of the symphysis pubis.

in T1- 20-40%

• threatened
• actual M/C
• GTD
• PLacenta preavia
• Placental abruption
• Prematuer labour

TVUS done at first triage.

• patient stable
• no adnexal masses
• no intraperitoneal bleeing sigsn
• fetal heart sounds on TVUS or abdominal.

• wommen at risk for PTL
• antepartuum haemorhage because of praevia

• stromal oedema
• increased vasularity
• enlargement of glandurlar structures.

• Chlamdyia 50%
• N. gonorrhea
• Trichomonas vaginalins,
• HSV type 2
• HPV.

• azithromycin or
• ceftriaxone or metronidazole

• Previous PTL delivery, or late miscarraiage
• multipregnancy
• cervical surgery
• uterine anomalies
• Pre-eclampsia and IUGR