Reproductive Health Workbook 2 Flashcards
Describe the physiology of breastfeeding
controlled by the let-down reflex
In response to suckling, oxytocin is released from the pituitary gland which stimulates myoepithelial cells that surround alveoli to contract, squeezing milk out of the breast
What are the components of breast milk?
Water (90%)
Lactose (7%)
Fat (2%)
Protein (1%)
Vitamins and Minerals
What support is available for women to achieve successful breastfeeding?
1-to-1 support for breastfeeding
Midwives, health visitors and trained local volunteers (peer supporters)
Breastfeeding drop-ins, cafes and centres
Helplines and websites e.g. National Breastfeeding Helpline and La Leche League
Give some common drugs that are contraindicated in breastfeeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
What features would you look for on examination of suspected mastitis?
Erythema of the breast
Swelling of the breast
the presence of fluctuation suggests abscess formation
Other differentials to look out for:
Galactocele: smooth round painless swelling
Breast cancer (inflammatory cancer): diffuse painful redness with skin oedema (peau d’orange)
Fat necrosis of breast: presents as a firm lump with bruised skin
Lactational mastitis happens due to milk stasis due to reduced breastfeeding. Give some key risk factors
Changes in feeding regime
Introduction of bottle feeding
Poor attachment of the infant to the breast
Maternal stress and fatigue
How does chlamydia present in women? Ix? Mx?
cervicitis (discharge, bleeding), dysuria
Ix: NAATs are now the investigation of choice, the vulvovaginal swab is first-line, test two weeks after exposure
gram negative rod
Mx: doxycycline (7 day course) is first-line
Check if pregnant : azithromycin 1g stat
alert partners, treat then test
How does gonorrhea present in women? Ix? Mx?
cervicitis e.g. leading to vaginal discharge
Ix: NAAT
gram negative diplococcus
Mx: single dose of IM ceftriaxone 1g
if ceftriaxone is refused (e.g. needle-phobic) then oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
Risks of untreated PID?
perihepatitis (Fitz-Hugh Curtis Syndrome)
infertility
chronic pelvic pain
ectopic pregnancy
Presentation of chlamydia in men?
Urethral discharge (usually clear)
Dysuria
Proctitis
Epididmyo-orchitis is a complication of chlamydial infection, and patients may present with scrotal pain.
Presentation of gonorrhea in men?
Mucopurulent urethral discharge
Dysuria
What is a BBV risk assessment?
Blood Borne Virus (BBV) Risk Assessment
used to identify those at risk of BBVs, including Hepatitis B, Hepatitis C and HIV
number of partners, use of contraception, partners with known BBV, IV drug use
What is Chemsex? What drugs are often involved?
intentional sex under the influence of psychoactive drugs, mostly among MSM
mephedrone, γ-hydroxybutyrate (GHB), γ-butyrolactone (GBL), and crystallised methamphetamine
How does epidiymo-orchitis present?
Main differential?
Mx?
unilateral testicular pain and swelling
urethral discharge may be present
testicular torsion
if an STI is the most likely cause advise urgent referral to a local specialist sexual health clinic
if enteric organisms are the most likely cause send an MSU as above
treat empirically with an oral quinolone for 2 weeks (e.g. ciprofloxacin)
What should you ascertain if symptoms of epididymitis have not improved with tx / returned after tx?
Check compliance with treatment
check sexual abstinence and ensure that partner notification is complete if not already undertaken
consider alternative diagnoses
What may USS show in epididymitis?
an enlarged hypoechoic or hyperechoic (presumably secondary to hemorrhage) epididymis
What is the risk of transmission of untreated HIV?
25-30%
Factors which reduce vertical transmission of HIV (from 25-30% to 2%)?
antepartum:
maternal antiretroviral therapy
intrapartum:
mode of delivery (caesarean section)
IV infusions of zidovudine if patient presents in labour
post-partum:
neonatal antiretroviral therapy
infant feeding (bottle feeding)
Can women with HIV have a vaginal delivery?
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
What neonatal therapy can be offered to babies of mothers with HIV?
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml.
Otherwise triple ART should be used
Therapy should be continued for 4-6 weeks.
Can women with HIV breastfeed?
they should be advised against it
if the mother is well-controlled with a low viral load the risk of transmission is low, but it is still not non-existent
How can the risk be reduced for a partner of someone with HIV?
compliance with ART - undetectable viral load
using barrier contraception
not sharing sex toys
partner can receive pre/post exposure prophylaxis
