Obstetrics and Gynecology Gathering.


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Early Pregnancy Unit. Lead Consultant: Pradnya Pisal0208 3751250, 1267, 1979Lead Sister: Annie Fowler0208 3751240, 1958Lead Sonographer: Jyoti Shah0208 3751979. EPU. Pregnant ladies with torment and/or seeping from 6-14 weeks amenorrhoea (positive UPT)Pregnant ladies with <6 weeks amenorrhoea who have an unusually light last period where there is a suspicion of or who have a high hazard element for ecto
Transcripts
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Obstetrics and Gynecology Forum Pradnya Pisal Jyoti Shah Annie Fowler

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Early Pregnancy Unit Lead Consultant: Pradnya Pisal 0208 3751250, 1267, 1979 Lead Sister: Annie Fowler 0208 3751240, 1958 Lead Sonographer: Jyoti Shah 0208 3751979

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EPU Pregnant ladies with torment and/or seeping from 6-14 weeks amenorrhoea (positive UPT) Pregnant ladies with <6 weeks amenorrhoea who have an anomalous light last period where there is a suspicion of or who have a high hazard component for ectopic pregnancy Appointment framework open just to GPs and birthing specialists and healing center specialists

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EPU Routine filtering in early pregnancy is not prompted as it will create pointless nervousness if the pregnancy is not pictured on sweep Patients ought to be given a reasonable thought regarding the output arrangement and just real cases ought to be alluded to EPU as there are just settled openings accessible (not for routine dating)

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Early pregnancy checks Earliest gestational sac on TA examine: 6 weeks Earliest feasible pregnancy on TA scan:7 weeks Earliest gestational sac on TV filter: 5 weeks Earliest practical pregnancy on TV check: 6 weeks At 1000 IU, an intrauterine gestational sac on TV check 85% of suitable intrauterine pregnancies show multiplying of HCG in 48 hrs Suboptimal increment in HCG more than 48 hrs without intrauterine gestational sac seen on TV output is s/o ectopic pregnancy

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Value of USS post-premature delivery 1 in each 5 clinically known pregnancies will lose in the primary trimester Post unsuccessful labor or post TOP dying: outputs are temperamental to affirm or reject held results of origination USS can\'t separate between blood, clusters or POC in the uterine cavity Surgical clearing: intricacies in 2% cases: uterine puncturing, cervical tears, intra-stomach injury, intrauterine grips, drain, mortality 0.5/100,000

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Post - unnatural birth cycle or post - TOP Management of post-premature delivery or post-TOP draining will rely on upon clinical discoveries If the draining is overwhelming and stressing, allude to A&E If cervical os shut even with moderate seeping with/without uterine delicacy, treat with augmentin or mix of cephelexin and metronidazole for 7 days. Screen for PID, particularly chlamydia

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Post - unsuccessful labor or post - TOP If draining not settled after course of anti-microbials, allude as earnest case to an expert to be found in the following advisor facility If draining is >6 weeks post unnatural birth cycle, and bimanual examination is unremarkable, treat with a short course of hormones: COC or progestogens Counsel ladies to expect moderate seeping for postnatally, (at any incubation) Next period might be deferred to 6 weeks

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Screening for ovarian tumor Not prescribed in generally safe populace Screening can be considered in ladies with: 2 first degree relatives with ovarian growth 1 first degree relative with ovarian malignancy and 1 first degree relative with bosom growth analyzed less than 50 years old One first degree relative with ovarian disease and 2 first or second degree relatives with bosom disease, analyzed less than 60 years old Presence of broken ovarian malignancy bringing about quality in the family 3 first or second degree relatives with entrail growth and one instance of ovarian disease in the family

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Screening for ovarian disease Women with a critical family history can be alluded to a hereditary qualities center from where they can either be alluded for the UKFOCSS or for BRCA1 quality testing if proper Yearly CA125 and ovarian output from 25-65 years age Prophylactic oophorectomy and mastectomy does not avert essential peritoneal growth

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Suspected gynecology pathology Incidental finding in asymptomatic ladies with -uterine size 8-10 weeks: console -uterine size >10 weeks: pelvic sweep, allude if suitable Symptomatic ladies < 40 yrs old: pelvic sweep if uterus is cumbersome, allude if fitting Asymptomatic ladies < 40 yrs old with adnexal mass: pelvic output and allude if fitting All ladies =/> 40 yrs old with adnexal mass: demand pelvic output + allude Pelvic agony without menstrual issues in young ladies with agreeable & ordinary bimanual examination: pelvic sweep not required, allude if appropriate

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Endometrial appraisal on pelvic output Asymptomatic postmenopausal ladies: endometrial sweep thickness of >/= 4mm, or liquid in the uterine cavity, ought to have endometrial evaluation with pipelle or hysteroscopy In symptomatic ladies, endometrial evaluation is suggested even is endometrium <4mm For symptomatic ladies on HRT, research at same level (4mm) of endometrial thickness

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PID Lower abdo torment & delicacy Deep dyspareunia Abnormal vaginal release Cervical excitation & adnexal delicacy Fever (>38deg C) Diagnosis: endocervical swab for chlamydia and gonorrhea and HVS, pee HCG USS if clinical suspicion of TO boil Ofloxacin 400mg BD + metronidazole 400mg BD for 14 days

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PID IM ceftriaxone 250mg detail or IM cefoxitin 2g with oral probenecid 1g foll by doxycycline 100mg BD + metronidazole 400mg BD for 14 days IUCD might be left in situ with mellow infection however expel with extreme illness Offer screening and contact following for accomplices Women on COC with achievement draining ought to be screened for chlamydia

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Endometriosis Pelvic output just if clinical suspicion of endometriotic sore or adnexal pathology 0.06% danger of real intricacies, 1.3% with agent laparoscopy Therapeutic trial with COC or progestogen Induce amenorrhoea with danazol, GnRH analogues(3-6 months), include back HRT if longer term of treatment utilized

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HRT Increase in danger of - coronary supply route ailment( chances proportion 1.29) -Breast growth (chances proportion 1.26) -Stroke (chances proportion 1.41) -Pulmonary embolism Reduced danger of colorectal disease and diminished hip breaks

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Ovarian pimples in PM ladies TVS and CA 125 No part for routine CT,MRI or shading doppler evaluation Risk of harm list: U x M x CA 125 (USS-1 point each for multilocular sore, confirmation of strong regions, proof of metastases, ascites, two-sided sores, U=0 for USS score of 0, U=1 for USS score of 1, U=3 for USS score of 2-5) M=3 for all PM ladies - RMI >250: 70% affectability and 90% specificity

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Ovarian sores in PM ladies Is ovarian sore <5cm, one-sided, unilocular, reverberation free with no strong parts or papillary arrangements, CA 125 <30: preservationist administration as half will resolve in 3 months, rehash check in 4 months If sore decreased or unaltered and CA 125 typical, release after 1 yr If continues and ladies demands surgery: laparoscopic oophorectomy

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PCOS Truncal heftiness, oligomenorrhoea, anovulation, fruitlessness, hirsutism, skin inflammation, Familial Diagnosis by >LH/FSH proportion, USS 10-20% danger in middle age for sort II diabetes FBS, urinalysis for glycosuria every year Lipid profile: fasting cholesterol, lipids and TGs Risk of gestational diabetes

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PCOS Small danger of endometrial hyperplasia, carcinoma: standard atleast 3-4monthly withdrawal drains COC (dianette) Ovulation enlistment for barrenness Exercise and weight control Metformin 250-500mg bd

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Investigations for fruitlessness Screening for chlamydia before uterine instrumentation If no noteworthy gynae history: HSG + filter If huge gynae history: laparoscopy + color test 84% couples imagine inside 1 yr and 92% in 2 yrs 94% at 35yrs age and 77% at 38 yrs age will consider inside 3yrs of attempting If BMI >29, <19, will take more time to consider

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Investigations for barrenness Advise folic corrosive 400mcg/day (5mg with antiepileptic medicine or prev history) Rubella weakness screening D2 FSH, LH D21 progesterone in 28 day cycle TFT and prolactin, if oligoamenorrhoea Limited treatment cycles with clomiphene If BMI>25, offer metformin with clomiphene

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Menorrhagia If no IMB or PCB and no different indications: -uterus 8-10wks: FBC, TFT, console -Uterus >10wks/pelvic mass: examine, allude -If taking tamoxifen, unopposed oestrogens, PCOS, hefty: allude Treatment: - COC, POP, Depo provera - Mefenamic corrosive 500mg tds & Tranexamic corrosive 1g tds for 3 months at first - Mirena IUS

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USS asks for Accurate patient subtle elements with contact number LMP Result of UPT History/clinical discoveries and/or suspected analysis - keeping in mind the end goal to organize fittingly Patients may have impossible assumptions about arrangement times Approximately 130 gynecology filter solicitations are gotten every week At present there is a 16 week sitting tight rundown for non-pressing USS asks for

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Thank you

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