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Flashcards in Examination book Deck (22):
1

Vaginal discharge

Non-infective: physiological (women of repro age), postmenopausal atrophic changes, cervical polyps, cervical / uterine / ovarian malignancy, foreign body, vulval dermatitis, fistula

Non STI: bacterial vaginosis, thrush

STI: trichomonas, chlamydia, gonorrhoea

2

Bartholin's glands

2 pea sized glands located posterior to the vaginal opening either side of the midline
Secrete mucus to lubricate the vagina
Bartholin's cyst can develop if duct becomes obstructed
Bartholin's abscess can develop if cyst become infected

3

Bacterial Vaginosis

Thin white / grey
Fishy
Minimal / absent itching
>4.5 (pH)

4

Candida albicans

White, curd like
Non-offensive
Itching present
Pain, dyruria, dyspareunia
Vulval erythema, oedema, fissures
< 4.5 (normal)

5

Trichomonas vaginalis

Frothy yellow
Offensive
Itching present
Lower abdo pain, dysuria
Vulval inflammation, strawberry cervix
> 4.5

6

Cervical Cancer RF

HPV infection
Smoking
Immunosuppression
Young age of first coitus
High number of sexual partners
Partners of promiscuous males
Young age of first pregnancy
High parity
Low socio economic class
Long term OCP use

7

Cervical Ca symptoms

Often asymptomatic
Abnormal PV bleeding (postcoital, postmenopausal, intermesntrual)
Blood-stained vaginal discharge
Pelvic pain may indicate advanced disease

(80% SCC, 10-15% adenocarcinoma, remainder - melanoma, sarcoma, lymphoma)

8

Management of Cervical Ca

Surgery
Radiotherapy
Chemo if advanced / recurrent / radio ineffective

9

Large fundal height

Macrosomia
Multiple pregnancy
Polyhydramnios

10

Small fundal height

Fetal descent into pelvis before delivery
Intrauterine growth retardation
Oligohydramnios

11

Intrauterine growth restriction

Maternal causes: increasing maternal age, smoking, alcohol, infections (CMV, toxo, rubella, syphilis), DM, renal disease, HTN, thrombophilia, drugs

Placental causes: pre-eclampsia, placental abruption

Fetal causes: chromosomal abnormalities, anencephaly, multiple pregnancy

12

RF for breech presentation

High maternal parity
Uterine anomaly
Placenta praevia
Pelvic bone abnormality
Smoking
Diabetes
Fetal malformation
Multiple pregnancy
Poly- or oligohydramnios
Low birth weight
Previous breech delivery

13

Physiological changes: CV

Increased CO
Reduced PR
BP falls mid-pregnancy and rises to normal by week 36
Impaired venous return from IVC
RAAS activation, salt and water retention, peripheral oedema

14

Physiological changes: Resp

Increased tidal volume
Compensatory resp alkalosis

15

Physiological changes: GI

Increased appetite
Reflux
Constipation - reduced motility and increased transit time
Gallbladder dilation and incomplete emptying - gallstone formation

16

Physiological changes: Urinary

Increased renal blood flow and GFR
Uretric and bladder relaxation due to progesterone (increased risk of UTI)

17

Physiological changes: Endocrine

Increased progesterone and oestrogen
Suppressed LH and FSH
Increased ACTH and cortisol
Increased prolactin
Increased T4 and T3
Reduced peripheral insulin sensitivity - GDM

18

Physiological changes: Haematological

Increased plasma volume and dilutional anemia
Slightly raised WCC
Reduced serum iron, increased transferrin and TIBC
Increased clotting factors and reduced fibrinolytic activity - increased VTE risk

19

Physiological changes: Skin

Hyperpigmentation of umbilicus, nipples, abdominal midline and face (chloasma)
Striae gravidarum
Palmar erythema

20

Physiological changes: MSK

Increased ligament laxity (back pain and pubic symphysis dysfunction)
Exaggerated lumbar lordosis in late pregnancy

21

Large for dates

Macrosomia
Multiple pregnancy
Polyhydramnios
Incorrect gestational age
Constitutionally large

Non pregnancy related: full bladder / bowel, fibroids

22

Small for dates

IUGR
Oligohydramnios
Incorrect gestational age
Small for gestational age
Constitutionally small