Female Health Flashcards
(153 cards)
1
Q
What is labour defined as?
A
Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part
2
Q
Signs of labour
A
- regular and painful uterine contractions
- a show (shedding of mucous plug)
- rupture of the membranes (not always)
- shortening and dilation of the cervix
3
Q
Stages of labour
A
Stage 1: from the onset of true labour to when the cervix is fully dilated
Stage 2: from full dilation to delivery of the fetus
Stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered
4
Q
What do you monitor in labour?
A
- FHR monitored every 15min (or continuously via CTG)
- Contractions assessed every 30min
- Maternal pulse rate assessed every 60min
- Maternal BP and temp should be checked every 4 hours
- VE should be offered every 4 hours to check progression of labour
- Maternal urine should be checked for ketones and protein every 4 hours
5
Q
What is the normal delivery position?
A
The head normally delivers in an occipito-anterior position
6
Q
When is instrumental delivery indicated?
A
If longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section
7
Q
What is the indication for elective c-section?
A
Breech
>2 previous CS
maternal request
8
Q
Indication for emergency c-section
A
- Foetal distress
- Failure to progress
- cord prolapse
- footling breech
9
Q
Indications for induction of labour
A
- prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
- prelabour premature rupture of the membranes, where labour does not start
- diabetic mother > 38 weeks
- pre-eclampsia
- rhesus incompatibility
10
Q
what score is used to induce labour?
A
Bishop score
11
Q
Methods of induction of labour
A
- membrane sweep
- vaginal prostaglandin E2 (PGE2)
- maternal oxytocin infusion
- amniotomy (‘breaking of waters’)
- cervical ripening balloon
12
Q
Define HTN in pregnancy
A
systolic > 140 mmHg or diastolic > 90 mmHg
- -> No proteinuria, no oedema
- -> Resolves following birth (typically after one month).
13
Q
Who are at high risk of developing pre-eclampsia?
A
- hypertensive disease during previous pregnancies
- chronic kidney disease
- autoimmune disorders such as SLE or antiphospholipid syndrome
- type 1 or 2 diabetes mellitus
14
Q
What is pre-eclampsia?
A
Pregnancy-induced hypertension in association with proteinuria
15
Q
Classic signs of pre-eclampsia
A
- Proteinuria
- High BP
- Oedema
16
Q
Other signs & symptoms of pre-eclampsia
A
- Headache and visual disturbance (floaters)
- RUQ pain (liver)
- Acute onset oedema
- Hyper-reflexia (brisk reflexes) & clonus
17
Q
What is eclampsia?
A
Grand mal seizures in a woman with preeclampsia
18
Q
Symptoms of ectopic pregnancy
A
- Severe lower abdominal pain – usually unilateral
- PV bleeding
- Vomiting
19
Q
Symptoms of ruptured ectopic pregnancy
A
- Shoulder tip pain
- Feeling faint/light-headed
- Collapse
20
Q
Investigation for ectopic pregnancy
A
Diagnostic = Transvaginal USS
21
Q
What is the most common cause of severe infection in neonates?
A
Group B Streptococcal disease (GBS)
22
Q
What is gestational diabetes?
A
High blood sugars that develop during pregnancy and usually disappears after delivery.
23
Q
Screening for gestational diabetes
A
Oral glucose tolerance test
- fasting glucose is >= 5.6 mmol/L
- 2-hour glucose is >= 7.8 mmol/L
24
Q
Targets for self monitoring
A
Fasting = 5.3 mmol/l
1 hour after meals = 7.8 mmol/l, or:
2 hour after meals = 6.4 mmol/l
25
Abortion time frame
<24 weeks – can be maternal choice
>24 weeks if risk to maternal or foetal health
26
Medical TOP:
At how many weeks?
What medication?
Less than 9 weeks = mifepristone (an anti-progestogen) followed 48 hours later by prostaglandins to stimulate uterine contractions
27
Surgical TOP:
At how many weeks?
What method?
1. less than 13 weeks: surgical dilation and suction of uterine contents
2. more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')
28
Define abruptio placenta
Separation of a normally sited placenta from the uterine wall
--> resulting in maternal haemorrhage into the intervening space
29
Clinical features of abruptio placenta
* pain constant + PVB *
- shock out of keeping with visible loss
- tender, tense uterus
- normal lie and presentation
- foetal heart: absent/distressed
- coagulation problems
- beware pre-eclampsia, DIC, anuria
30
Investigations in abruptio placenta
FBC + USS
31
Maternal complications of abruptio placenta
1. shock
2. DIC
3. renal failure
4. PPH
32
Foetal complications of abruptio placenta
Hypoxia
| Death
33
Define placenta praevia
placenta lying wholly or partly in the lower uterine segment
34
Clinical features of placenta praevia
1. shock in proportion to
2. visible loss
3. no pain
4. uterus not tender
5. lie and presentation may be abnormal
6. fetal heart usually normal
7. small bleeds before large
35
Investigations for placenta praevia
Usually picked up on 20- week USS
| --> transvaginal USS (improves accuracy on placental localisation)
36
Define Postpartum haemorrhage (PPH)
blood loss of > 500mls
37
Types of PPH
Primary: occurs within 24 hours
Secondary:
occurs between 24 hours - 12 weeks
38
Symptom of PPH
Uncontrolled PV bleeding
39
Causes of PPH
1. Tone - Uterine atony (failure of uterus to contract down post delivery) (primary)
2. Trauma - perineal trauma (primary)
3. Tissue - retained placenta (secondary)
4. Thrombosis- clotting disorder (primary)
40
Define premature rupture of membranes
Rupture of the amniotic sac prior to the commencement of labour.
41
Investigation for PROM
Speculum examination
| Pelvic USS
42
What is Rh incompatability?
Rhesus sensitisation
- When a mothers Rh-ve blood mixes with foetal Rh+ve blood
- Mothers immune system develops antibodies against Rh+ve RBCs
This may lead to haemolytic disease of the new-born in future pregnancies:
- -> If in their next pregnancy the foetus is Rh+ve
- -> Antibodies attack RBCs -> haemolytic anaemia & neonatal jaundice
43
What tests need to be carried out in rh incompatability?
1. all babies born to Rh -ve mother should have *cord blood* taken at delivery for FBC, blood group & direct Coombs test
2. Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
44
Features for rh incompatibility in affected foetus
1. oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
2. jaundice, anaemia, hepatosplenomegaly
3. heart failure
45
What is shoulder dystocia?
1. complication of vaginal cephalic delivery.
| 2. inability to deliver the body of the foetus using gentle traction, the head having already been delivered.
46
Risk factors for shoulder dystocia
1. Previous shoulder dystocia
2. Diabetes
3. BMI >30
4. Macrosomia (large baby)
47
Complications of shoulder dystocia
maternal
- postpartum haemorrhage
- perineal tears
fetal
- brachial plexus injury
- neonatal death
48
What are the risk factors for ovarian cancer?
- Family hx of BRCA1/2 gene mutation
| - many ovulations: early menarche, late menopause, nulliparity
49
Clinical features of ovarian cancer
Usually vague:
- abdo distension + bloating
- abdo + pelvic pain
- urinary symptoms (urgency)
- early satiety
- diarrhoea
50
Investigations for ovarian cancer
1. CA125 test
- -> raised: urgent USS of abdo + pelvis
- -> usually raised in endometriosis, menstruation, ovarian cysts
2. Diagnostic laparotomy
51
What is breast abscess?
localized collection of pus within the breast
| - more common in lactating women
52
Features of breast abscess
1. Red, hot tender swelling
| 2. O/E : tender fluctuant mass
53
Diagnosis of breast abscess
USS
54
Treatment for breast absecess
Abx + USS guided aspiration
55
What are breast fibroadenoma?
1. Breast tissues are arranged into lobules which are milk secreting glands
2. Fibroadenomas occur due to increase in size of these milk secreting glands.
3. Fibroadenomas are benign breast tumours that are thought to occur due to hormonal fluctuations.
56
Features of breast fibroadenoma
Mobile, firm, smooth, non-tender breast lump - a 'breast mouse'
57
Investigations for breast fibroadenoma
USS if pt < 40, mammogram & needle biopsy
58
Features of fibrocystic disease
- 'Lumpy' breasts which may be painful.
| - Symptoms may worsen prior to menstruation
59
Investigations for fibrocystic disease
USS/ mammogram if suspecting breast cancer
60
What is mastitis?
Mastitis is a painful inflammatory condition of the breast.
| --> usually occurs in lactating women
61
Features of mastitis
1. A painful breast.
2. Fever and/or general malaise.
3. A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.
62
Investigations for mastitis
send a sample of breast milk for microscopy, culture, and antibiotic sensitivity
63
When is abx indicated in mastitis?
1. if systemically unwell
2. if nipple fissure present
3. if symptoms do not improve after 12-24 hours of effective milk removal
4. if culture indicates infection'
64
What abx is given in mastitis?
1st line = flucloxacillin for 10-14 days
Allergic to penicillin: erythromycin
65
What is the most common infective organism in mastitis?
Staphylococcus aureus
66
Complication of mastitis if left untreated
Develop into breast abscess
67
Clinical features of breast cancer
1. breast lump
- Malignant --> painless
2. Nipple symptoms: change in shape or bleeding
- -> Tethering or peau d’orange
- -> Unilateral discharge, retraction
68
Investigations for breast cancer
Mammography and core biopsy
69
What is the 2 - week wait referral indication for breast cancer?
1. >30 y/o + unexplained breast lump with or without pain
or
2. > 50 y/o + unilateral discharge/retraction
70
What other symptoms which consider 2WW
1. with skin changes that suggest breast cancer
or
2. > aged 30 with an unexplained lump in the axilla
71
Non-urgent referral indication for breast cancer
< 30 y/o with an unexplained breast lump with or without pain.
72
Treatment for breast cancer
1. Wide local excision or mastectomy
| 2. Chemo or radiotherapy
73
What is pelvic inflammatory disease?
sudden or severe inflammation of the womb, fallopian tubes, ovaries and surrounding areas in the lower abdomen
74
Features of PID
1. lower abdominal pain
2. fever
3. deep dyspareunia
4. dysuria
5. menstrual irregularities may occur
6. vaginal or cervical discharge - purulent
7. cervical excitation
75
Investigation for PID
1. pregnancy test - exclude pregnancy
2. high vaginal swab
3. screen for chlamydia + gonorrhoea
Diagnosis is usually clinical
76
What is menorrhagia?
excessive blood loss with regular menstruation (>80ml)
77
Common causes of menorrhagia
no underlying pathology - dysfunctional uterine bleeding
anovulatory cycles : chaotic cycles common at extremes of reprodutive life
fibroids
Hypothyrodism
PID
78
Investigations for menorrhagia
FBC
routine transvaginal US if sx like pelvic pain, intermentrual or post-coital bleeding
79
Is it necessary to measure blood loss to diagnose menorrhagia?
NO
80
What is endometritis?
infection or inflammation of the endometrium, the inner lining of the uterus
81
When is endometritis a common problem?
during pregnancy as bacteria can easily reach the uterus during childbirth
82
Sx of endometritis
- abnormal vaginal bleeding
- dyspareunia
- fever
- abdominal swelling
- lower abdominal pain / discomfort
83
Causes of endometritis
- normal vaginal bacteria
| - STI
84
How is endometritis tested for
- blood cultures
- FBC
- MSU
- high vaginal swab
- endometrial biopsy is diagnostic but rarely appropriate
85
What is urogenital prolapse
descent of one of the pelvic organs resulting in protrusion on the vaginal walls
86
Risk factors of urogenital prolapse
- increasing age (commonly post-menopausal women)
- multiparity
- obesity
- spina bifida
87
Sx of urogenital prolapse
```
pressure, heaviness, ' bearing-down'
urinary sx (incontinence, frequency and urgency)
```
88
adenomyosis vs endometriosis
The difference between these conditions is where the endometrial tissue grows. Adenomyosis: Endometrial tissue grows into the muscle of the uterus. Endometriosis: Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.
89
What is endometriosis?
growth of ectopic endometrial tissue outside of the uterine cavity
90
clinical features of endometriosis
- chronic pelvic pain
- secondary dysmenorrhoea (pain often days before bleeding)
- deep dyspareunia
- urinary sx
91
Gold standard investigation for endometriosis
laparoscopy
92
treatment for symptomatic relief of endometriosis
NSAIDs +/- paracetamol (first-line)
| Hormonal (COCP/Progestogens)
93
Features of adenomyosis
dysmenorrhoea
menorrhagia
enlarged, boggy uterus
94
What is a leimyoma also known as
fibroids
95
What is leimyoma
benign smooth muscle tumours of the uterus
96
epidemiology of leimyoma
more common in afro-carribean, rare before puberty
97
sx of leimyoma
- may be asymptomatic
- menorrhagia
- lower abdo pain
- bloating
- urinary sx e.g frequency
- subfertility
polycythaemia (rare)
98
how is leimyoma diagnosed
transvaginal US
99
treatment of asymptomatic fibroids
none-
| periodic review to monitor size and growth
100
Risk factors for endometrial cancer
- obesity
- nulliparity
- early menarche
- late menopause
- PCOS
- Diabetes
- tamoxifen
101
Features of endometrial cancer
- postmenopausal bleeding
| - change in inter-menstraul bleeding in premenopausal
102
When should a patient be referred under the cancer pathway for suspected endometrial cancer?
women >= 55 years who present with postmenopausal bleeding
103
First line investigation for endometrial cancer
transvaginal US
Other investigations:
- hysteroscopy with endometrial biopsy
104
Which factors are considered protective in endometrial cancer
COCP and smoking
105
Symptoms of cervicitis
- purulent yellow/green discharge
- intermenstrual / postcoital bleeding
- dysuria
- Pelvic pain
106
main cause of cervicitis
STI
107
What is cervical dysplasia
abnormal growth of cells on the surface of the cervix
108
The primary cause of cervical dysplasia
HPV
109
Risk factors of cervical dysplasia
multiple sexual partners
smoking
immunocompromised
110
symptoms of cervical dysplasia
usually asymptomatic
| - genital warts can indicate exposure to certain types of HPV
111
How is cervical dysplasia diagnosed
smear - cervical screening programme , HPV first system
112
What is the HPV first system?
sample tested for high-risk strains for HPV first and cytological examination performed if positive
113
What happens if hrHPV is negative?
return to normal recall
114
Positive hrHPV + abnormal cytology. What should you do next?
colposcopy
115
hrHPV +ve but cytologically normal- next steps?
repeat test in 12 months
116
inadequate hrHPV sample? - next step
repeat sample in 3 months
117
2 consecutive inadequate hrHPV samples - next step?
colposcopy
118
treatment of CIN
Large loop excision of transformation zone (LLETZ)
119
What is cervical insufficency / incompetent cervix
weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
120
Sx of incompetent cervix
discharge during pregnancy
usually asymptomatic
premature labour
121
How is incompetent cervix diagnosed
transvaginal US
122
what is a nabothian cyst
small bump or bumps on the cervix caused by a build-up of normal mucus that is produced by the cervix
123
How is a nabothian cyst diagnosed
pelvic exam
transvaginal US
124
How is a nabothian cyst treated
none necessary
125
Symptoms of vaginitis
- itchy, sore vagina
- vaginal discharge
- vaginal dryness
- dysuria
- dyspareunia
- spotting
126
causes of vaginitis and sx associated to each
```
thrush - white thick discharge
STI - green/yellow/smelly discharge
menopause (hormonal) - dry, itchy
skin condition (eczema) - itschy, sore patches
```
127
investigation for vaginitis
pelvic examination and STI screen
128
Most common cause of vaginal neoplasm
HPV
129
Vaginal neoplasm sx
- lump in vagina
- ulcers and skin changes
- post-menopausal bleeding
- intermenstrual bleeding
- post-coital bleeding
- dyspareunia
130
management of women with an unexplained palpable mass in or at the entrance to the vagina
2WW referral
131
What is a cystocele
when the wall between the bladder and the vagina weakens (bladder prolapse)
132
sx of cystocele
- feeling of a vaginal bulge / pressure
- frequent voiding
- increased urgency
- urinary incontinence
- freuqnet UTI
133
major cause of cystocele
- multiparity
| - difficult childbirth
134
diagnosis of cystocele
- pelvic exam
- cytsoscopy
- MRI / US/ Xrays
135
What is a rectocele
tissues between the rectum and vagina weaken, causing the rectum to bulge into the vagina - posterior vaginal prolapse
136
rectocele sx
may include pelvic, vaginal and rectal pressure
137
risk factors of rectocele
multiparity, age, obesity, chronic constipation
138
What is a Bartholin's cyst
small fluid-filled sac just inside the opening of the vagina
139
sx of Bartholin's cyst
soft, painless lump
usually only noticeable and uncomfortable after growth
- pain when walking
- pain during sex
140
What causes Bartholin's cyst
Bacterial infections / STI which clog the bartholin gland
141
diagnosis of Bartholin's cyst
- examination
- bacterial swab
- biopsy if ?Bartholin gland cancer
142
epidemiology of Bartholin's cyst
sexually active women aged 20 to 30
143
Define Dysmenorrhoea
excessive pain during the menstrual period
144
How is dysmenorrhoea divided?
primary - no underlying pelvic pathology
secondary - underlying pathology including:
endometriosis
PID
fibroids
145
features of primary dysmenorrhoea
- pain before/ within few hours of periods starting
| - suprapubic cramping pain radiating to back / thigh
146
Which phase of the menstrual cycle does PMS occur
luteal phase - after ovulation (when your ovaries release an egg) and before your period starts. During this time, the lining of your uterus normally gets thicker to prepare for a possible pregnancy.
147
sx of premenstrual syndrome
emotional:
- anxiety
- stress
- fatigue
- mood swings
physical:
- bloating
- breast pain
148
Define Primary Amenorrhea
failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development)
or by 13 years of age in girls with no secondary sexual characteristics
149
Define secondary Amenorrhea
cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea (irregular periods)
150
initial investigations for amenorrhoea
- EXCLUDE PREGNANCY
- FBC
- TFT
- coeliac screen
- gonadotrophins (low = hypothalamic cause, high = ovarian problem)
- prolactin
- androgen level (high in PCOS)
- oestradiol
151
3 main features of PCOS
- irregular periods
- excess androgen (excess facial / body hair)
- polycystic ovaries
- sub/infertility
- obesity
152
Why might a woman with PCOS have acanthosis nigricans
insulin resistance is commonly seen with PCOS
153
investigations for PCOS
- Pelvic US : multiple cysts
- fsh, LH, (LH:FSH raised)
- prolactin normal/mildly elevated
- TSH
- testosterone normal/mildly elevated
- check for impaired glucose tolerance
