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Gynaecology cases






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Gynaecology cases. Rehan Salim MD MRCOG Consultant Gynaecologist. Case 1. 34 year old Irregular periods No significant gynaecological problems 3 day history of pelvic pain. Case 1. Observations normal Urinalysis normal. Pregnancy test positive Ectopic pregnancy unless proven otherwise.
Gynaecology cases

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Gynaecology cases

Rehan Salim MD MRCOG

Consultant Gynaecologist

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Case 1

  • 34 year old

  • Irregular periods

  • No significant gynaecological problems

  • 3 day history of pelvic pain

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Case 1

  • Observations normal

  • Urinalysis normal

Pregnancy test positive

Ectopic pregnancy unless proven otherwise

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Case 1

  • Ultrasound scan

    • No evidence of intrauterine or extrauterine pregnancy

    • BHCG 400, progesterone 29

  • Called same day by EPU

    • Come for a repeat bloods in 2 days

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Case 1

  • 2 days later

    • More pain

    • Repeat scan

      • Small amount of blood in pelvis

      • Right ectopic

    • HCG 755

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Case 1

  • Theatre

    • Right salpingectomy

  • Uneventful recovery

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Case1

  • What is the effect on my fertility?

  • Risk of another ectopic pregnancy?

  • Why did it happen?

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Case 2

  • 54 year old

  • Fit and well

  • Single episode of fresh vaginal bleeding

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Case 2

  • Speculum

  • Ultrasound

    • Thick endometrium

  • Pipelle

    • Endometrial hyperplasia

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Case 2

Up to 50% of patients with CAH have co-existent endometrial carcinoma detected at histology of subsequent hysterectomy

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Case 2

  • Simple cystic hyperplasia without atypia

    • progestagens such as norethisterone 5 mg bd for three out of four weeks.

    • The treatment should last at least three months, then the biopsy should be repeated.

    • In young women with polycystic ovaries, treatment with cyclical progestogens should continue or it can be replaced by long term combined oral contraceptive pill.

    • In postmenopausal women the treatment may be stopped if the result of second biopsy is normal, but they should be advised to return if their symptoms recur.

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Case 2

  • Adenomatous hyperplasia

    • more likely to progress to cancer than cystic hyperplasia.

    • However, the treatment is the same as in cystic hyperplasia.

    • If abnormality persists after the therapy hysterectomy may be considered in older women.

  • Complex hyperplasia

    • may progress to atypical hyperplasia in 10% and to carcinoma in 4% of cases

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Case 2

  • Atypical hyperplasia

    • is believed to progress to cancer in up to 30% of cases depending on the degree of atypia.

    • Severe atypia is often impossible to differentiate from cancer even on hysterectomy specimens.

    • In postmenopausal women hysterectomy should be considered, whilst in young women treatment with oral progestagens or Mirena IUS are preferred options. All women managed conservatively should be followed up very closely.

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Case 3

  • 21 years old

  • Infrequent periods, hirsute

  • BMI 34

  • Fit and well otherwise

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Case 3

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Case 3

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Case 3

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Case 3

  • Oligomenorrhoea

    • Endometrial hyperplasia/ cancer

    • Infertility

    • Pregnancy

  • Hyperandrogenism

    • Cosmetic

  • Long term

    • NIDDM

    • GDM

    • Cycle control

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Case 3

  • Weight loss

  • COCP

  • Endometrial protection

  • Metformin

    • Incremental dose

    • 500md OD/BD/TDS → 850mg BD

  • Ovulation induction


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