Ovarian hyperstimulation syndrome
Complication seen with IVF therapy (especially with hCG & gonadotrophin treatment)
Breast cancer | Screening
Screen women between 50 - 70 every 3 years (mammogram)
Breast cancer | Risk factors
- Increases risk of breast cancer: Early menarche, late menopause, COCP, HRT
- Reduces risk of breast cancer: multiple pregnancy, breast feeding
Emergency contraception | Ulipristal
- Ulipristal is a selective progesterone receptor modulator
- Used within 5 days (120 hours) of UPSI
- Ulipristal can affect the effectiveness of CHC. Do not use CHC for 5 days after using ulipristal. Use condoms/abstain
- Use with caution in patients with severe asthma
Emergency contraception & CHC
- With levonorgestrel: CHC can be restarted immediately
- With ulipristal: CHC should be started after 5 days of ulipristal use; Ulipristal can reduce the effectiveness of CHC
Enzyme inducers & Hormonal contraceptives
- Enzyme inducers list (SCRAP GPs): Sulphonylureas, Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbitone, St. John’s Wort. These list of drugs can increase metabolism of other drugs and thus decrease their efficacy
- Mirena IUS is safe to use with enzyme-inducing drugs
- Double the dose of levonorgestrel if using along with enzyme-inducers
- AVOID using ulipristal with enzyme inducers
Missed pills | Combined hormonal contraception
Missed pill: when more than 24 hours have lapsed
A) If 1 pill missed at any time of the cycle
- Take the last pill even if it means taking 2 pills in a day
- Continue taking pills daily
- No additional contraception needed
B) If 2 or more pills missed
- Week 1 (day 1 to 7): Emergency contraception if UPSI
- Week 2 (day 8 to 14): No action
- Week 3 (day 15 to 21): Finish pills in current pack & commence new pack (omiting pill free interval)
Postpartum contraception
- Contraception to start after day 21
- CHC can increase risk of thrombus if used in first 28 days
- CHC can also affect breast milk production
- Intrauterine devices should be avoided in the first 28 days due to risk of uterine perforation
- Lactational amenorrhoea: 98% effective; The woman should be amenorrhoeic & exclusively breast feeding until 6 months post partum
Female sterilization | Failure rate
1 in 200
Bacterial vaginosis
- Overgrowth of gardnerella vaginalis
- Amsel criteria
- Fishy vaginal discharge
- Clue cells on microscopy
- pH > 4.5
- Positive Whiff test
- Mx: oral metronidazole 400 mg BD for 7 days
- Do not drink alcohol while on treatment with metronidazole and also for 48 hours after completion of treatment. It can cause nausea, vomiting, flushing, shortness of breath and tachycardia.
Genital herpes | Investigation
- Genital herpes caused by herpes simplex virus
- Gold standard investigation: NAAT (nucleic acid amplification test)
Antiepileptics & neural tube defects
- Sodium valproate
- Carbamazepine
Trimethoprim & pregnancy
- Do NOT use in first trimester
- Teratogenic risks (folate antagonist)
Nitrofurantoin & pregnancy
- Do NOT use at term due to risk of neonatal hemolysis
Coarctation of aorta
- Common congenital heart defect
- More common in males
- Bicuspid aortic valve
- Differential upper & lower extremity blood pressure (upper > lower)
- Diminished lower extremity pulses
- Critical co-arctation can develop post natally after closure of ductus arteriosus
- Infants require prostaglandin E1 infusion to maintain a patent ductus arteriosus till definitive surgical correction
Von Willibrand disease
- Most common inherited bleeding disorder
- Autosomal inheritance
- Affects males & females equally
- Due to abnormality with von willibrand factor
- VWF acts as a link between platelets and exposed (injured) vascular endothelium
- APTT prolonged due to decreased factor VIII
- Mx options
a) Use of desmopression causes release of VWF & Factor VIII from endothelial stores
b) VWF-containing concentrate
c) Anti-fibrinolytics such as tranexemic acid
HPV (human papilloma virus)
- HPV 16 & 18: responsible for cervical cancer
- HPV 6 & 11: responsible for genital warts
- Gardasil is a vaccine that protects against HPV 6/11/16/18. This vaccine is offered to girls & boys aged 12 to 13 and men who have sex with men.
