Flashcards in Pastest: Obs and Gynae Deck (141):
What is cholestasis and what week of pregnancy might it occur?
Cholestasis is where bile cannot flow from the liver to the duodenum
-typically occurs around 35 weeks of pregnancy
How might you treat itching if cholestasis occurs in pregnancy?
Normal parameters for protein excretion in pregnancy?
300mg or less per 24 hours (in urine) is normal in pregnancy
The symphysis-fundal height roughly corresponds to what?
The gestational age e.g. 35 cm equals 35 weeks gestation
Maternal causes of intrauterine growth restriction?
When is chorionic villus sampling usually carried out?
Usually performed between weeks 11 and 13
(can be performed weeks 10-20)
When is amniocentesis usually performed?
From week 15 of pregnancy
Which hormones concentration increases by 1000 fold in pregnancy?
Which hormone can be used to verify the start of menopause?
FSH (its level increases)
Tamoxifen blocks the action of what?
the action of oestrogen on breast tissue
The pregnant uterus first becomes palpable at which week?
-reaches umbilicus by week 20
-reaches xiphisternum by week 36
Name an enzyme produced by the placenta?
Alkaline phosphatase (so levels might be high in pregnancy)
During pregnancy, tidal volume increases and results in ...
Increased minute ventilation
Increased minute ventilation during pregnancy is due to increased _____
A surge in this hormone triggers ovulation
In relation to the peak in LH, when does ovulation occur?
LH surge usually occurs day 13 of cycle
-ovulation occurs 24-36 hours after surge
LH and FSH cause growth of what?
LH and FSH cause growth of ovarian follicles, which in turn secrete oestrogen
Oestrogen causes growth of which glands?
Oestrogen causes growth of endometrial glands
-progesterone then induces secretory activity of endometrial glands in anticipation of implantation
What does hCG do?
Maintains the secretory activity of the corpus luteum so that menstruation does not occur and pregnancy is established
If a gastric adenocarcinoma metastasises to the ovaries, what type of cell might you see?
Signet ring cells
What type of cell would you see in a Brenner tumour? (Brenner tumours are benign ovarian tumours)
Triad of Meigs syndrome?
and how do you treat it?
-Benign ovarian tumour
Treatment = resection of tumour
What type of cell might you see in a fibroma?
Spindle shaped fibroblast
Are the ovaries retroperitoneal?
No, they are intraperitoneal
What structure may be damaged when operating on ovary?
What lies lateral to the ovary?
The obturator neurovascular bundle
(a diseased ovary may therefore cause referred pain along the cutaneous distribution of the obturator nerve on the inner side of the thigh)
Nerve supply to the ovary?
Sympathetic, originating at T10
What is contained within the suspensory ligament of the ovary?
Ovarian artery, nerve and lymphatics
Where does lymph from the ovaries/testes drain into?
The para-aortic lymph nodes
Why might uterine fibroids enlarge during pregnancy?
They are responsive to oestrogen and progesterone
"A 23 year old primigravida found collapsed at home by her husband. She has refused all antenatal care. She is drowsy and complaining of headache"
"A 35 year old woman with a recent history of watery vaginal discharge. She is tachycardic and flushed, with a wide pulse pressure"
"A gravida-2 para-1 woman presents with collapse and severe abdominal pain. Examination reveals a hard uterus with no signs of labour"
When would an amniotic fluid embolism occur?
Amniotic fluid embolisms occur in labour, usually at the height of contraction
How would an amniotic fluid embolus present?
Amniotic fluid embolism presents with signs of shock WITH CYANOSIS
"a 43- year old woman presents following collapse at home. She is cyanosed and is noted to be in active labour"
Amniotic fluid embolism
Why is it REALLY important to make sure diabetic mothers receive folic acid supplementation during pregnancy etc?
Diabetic mothers have an increased risk of having babies with neural tube defects
What type of congenital defects are especially associated with pregnancies of diabetic women?
Cardiac birth defects
Increased miscarriage rates in diabetic women are associated with _____ control?
Levels below __% are considered to be a good indicator of glycemic control?
How does placenta previa present?
Painless third trimester bleeding
Associated with growth retardation and placental abruption
Associated with bone anomalies
This drug affects the fetal renal system
Ebstein's anomal is classically associated with which drug use?
Most common cause of disseminated intravascular coagulation in pregnancy?
What is a schistocyte
A fragmented part of a red blood cell
Haemoglobin concentration changes in pregnancy
Concentration falls due to dilution
When is the pregnancy test usually positive?
Around 2 weeks after conception (not missed period)
Changes in ventilation and depth of breathing during pregnancy?
Ventilation and depth of breathing increase
Changes in cardiac output during pregnancy?
CO increases due to increased stroke volume
Criteria for PCOS
-polycystic ovaries on US
-clinical and/or biochemical signs of hyperandrogenism
Blood tests will show what in PCOS?
Raised LH with a normal FSH and raised free testosterone levels
In which part of the uterine tube does ectopic pregnancy most frequently occur?
Ampullary part of the uterine tube (80%)
Postpartum fever with bleeding and adnexal tenderness suggest what?
Anaerobic bacteria associated with acute endometritis?
Bacteroides fragilis and peptostreptococcus
PID is most commonly caused by which organisms?
Chlamydia trachomatis and Neisseria gonorrhoeae
Blood pressure drugs contraindicated in pregnancy
Conservative management for pre-eclampsia
Salt and water restriction, bed rest and close monitoring of blood pressure
`Drugs which are effective at reducing seizures in eclampsia
Most cervical cancers derive from which type of cell?
(cervix adenocarcinomas are dervied from the endocervix and are very rare)
Most common site of sarcoma in the female pelvis?
Trauma to the upper trunk (C5, C6) of the brachial trunk results in what
Injury to the lower trunk of the brachial plexus (C8, T1) results in what?
Uterus larger than dates
What drug can be given in ectopic pregnancy to stop it growing?
Side effects of depoprovera injection?
Recognised risk factor for ectopic pregnancy
-weight gain, irregular bleeding and amenorrhea
Commonest type of vulval malignancy?
Squamous cell carcinoma
Clinical features of vulval carcinoma?
Vulval discomfort and itching, which is associated with a growth
Why might you get shoulder pain in an ectopic pregnancy?
Phrenic nerve irritation
When is endometriosis usually worst?
Immediately before and during the first day of menstruation
Gold standard diagnostic method for endometriosis?
Surgical management of endometriosis:
How does an IUD work?
(lecture says prevents fertilisation)
-Cause an inflammatory response in the endometrium (spermicidal)
-Thicken cervical mucus
-Reduce sperm motility
-Reduce likelihood of implantaion
Risk of perforation using IUD
Is there an increase in risk of ectopic pregnancy with an IUD?
Absolute contraindications for IUD
-undiagnosed irregular vaginal bleeding
-48 hours - 4 weeks post partum
-STI, pelvic or post-partum infection if less than three months ago
-significantly distorted uterine cavity
-History of copper allergy or wilsons disease
-bacterial endocarditis post valve replacement
Which of the following is a recognised cause of premature ovarian failure:
Contraindications to HRT?
-History of recurrent venous thromboembolisms
Most common cause of vulval carcinoma?
Squamous cell carcinoma
What volume of amniotic fluid in polyhydramnios?
>2-3 litres of amniotic fluid
In which trimesters do the fetal kidneys begin to produce fluid?
2nd and 3rd trimesters
-fluid is then swallowed by fetus (boke)
A tumour of trophoblastic villi
What percentage of complete moles will become invasive?
15% (incidence of subsequent choriocarcinoma is 3%)
What is exomphalos?
Protrusion of the peritoneal sac through the abdominal wall
What chromosome abnormality is exomphalos associated with?
(exomphalos also associated with cardio and renal pathologies)
What is gastroschisis?
Herniation of abdominal contents through an abdominal defect
(usually gastroschisis is isolated and there is no genetic association)
Difference between exomphalos and gastroschisis?
Exomphalos - when the stuff protrudes out your tummy, there is a thin membrane covering it all
In Gastroschisis, there is no covering membrane, everything just falls out boke
Most common cause of anovulatory infertility?
Endometrium and PCOS?
In the long-term, there are increased risks of endometrial hyperplasia and endometrial carcinoma
Most common cause of urinary incontinence in adult women?
Genuine stress incontinence
(2nd most common = detrusor overactivity)
Investigations for stress urinary incontinence
-Midstream urine specimen
-Frequency volume chart
-Filling urodynamic assessment
-Voiding urodynamic assessment
Drug which may help stress urinary incontinence?
Factors increasing risk of ovarian cancer
Factors reducing risk for ovarian tumours?
-Having a child before 25
-Having several children
This type of ovarian cancer generally involves both ovaries and have both cystic and solid componenets?
Types of epithelial ovarian tumours?
Difference between term and preterm
Term = any pregnancy that progress beyond 37 weeks
Rock hard uterus
How would you diagnose intrauterine death?
Diagnosis made in the absence of a fetal heartbeat on ultrasound scanning
"A 20-year pregnant woman, 32/40 weeks by date, presents to the antenatal clinic with a history of painless per vaginal bleeding after intercourse. On examination- abdomen soft and relaxed, uterus = dates. Cardiotocograph (CTG) - reactive
This is a classical presentation of PLACENTA PRAEVIA.
Painless, post-coital bleeding
-Constant abdominal pain
-Bleeding per vagina
This is probably a small abruption so answer was antepartum haemorrhage on pastest
Why are young women on the OCP more prone to cervical polyps and erosion?
This is due to the effect of oestrogen on the squamous epithelium
"red, inflamed and thin vulva"
Treatment for atrophic vaginitis?
"A 72 year old woman comes into the gynae clinic with a history of vaginal bleeding. She complains of having had spotting for a couple of days but this has now completely resolved. On examination the vulva looks red and inflamed"
Can you be pregnant if your pregnancy test is negative?
This syndrome is caused by vaginal colonisation by toxigenic staphylococci
Toxic shock syndrome
This thing is common in HRT users
Which investigation would be most appropriate for the following case:
"a 23 year old woman is rushed into A&E in a state of shock. Her partner informs you that she had been complaining of lower abdominal pain this morning and then suddenly collapsed. He also tells you that her LMP was 6-7 weeks ago. A portable TAS shows free fluid in the pelvis. OE her GCS is 3, pulse is 140/min, BO 70/40 mmHg.
Ectopic pregnancy is the only gynaecological, life-threatening emergency that requires immediate surgery.
While you are on call on the labour ward you are asked to help at a delivery in one of the rooms. On entering the room you notice the woman delivering with "turtling" of the neck
-This is a classical description of the situation when the head comes out but the shoulders get stuck. Risk factors for should dystocia include macrosomia, diabetes and maternal weight gain. The management involves manoeuvres to deliver the shoulders in addition to gentle traction downwards (to disimpact the shoulders) and an episiotomy
While on-call on the labour ward you are urgently summoned to one of the delivery room. The attending midwife briefs you that the patient had just delivered a 5kg baby and after placental delivery has continued to bleed profusely. On examination you find the uterus to be hard and contracted
(the clinical findings of a hard and contracted uterus rule out an atonic postpartum haemorrhage (PPH))
While on call on the labour ward you are crash-bleeped to see one of the labouring patients. On entering the room you note fetal bradycardia on the CTG. While quickly reviewing the patient's notes, you gather this is her second pregnancy and her last delivery was by caesarean section 2 years ago.
(risk of uterine rupture is greatly increased if labour is induced or augmented with oxytocics or prostaglandins)
Management of scar rupture is a 'crash caesarean'. It is associated with high fetal morbidity and mortality, and only prompt action and a high index of suspicion improves the outcomes.
A constant complaint of abdominal pain (even when the uterus is relaxed), sudden collapse and abdominal palpation of fetal parts are other signs and symptoms associated with obstetric emergency
While on call for obstetrics, you are crash bleeped to see a patient who has suddenly collapsed in the postnatal ward. The midwife informs you that the patient had a caesarean section 5 days ago and was due to be discharged tomorrow
(pregnancy, pelvic surgery and immobilisation increase the risk of these patients developing a pulmonary embolism and DVT.
While on call on the labour ward you are urgently asked to review a patient who has just delivered. On entering the room you find the patient to be in a state of shock. The attending midwife informs you that the patient suddenly collapsed after delivery of the placenta. On abdominal palpation you find it hard to outline the uterus fundus.
(although uncommon, uterine inversion is a life-threatening complication in the third stage of labour. Poor management of the third stage of labour, including pulling on an unseparated placenta, fundal pressure to deliver the placenta and manual removal of the placenta have all been implicated. Management involves immediate replacement of the uterus and active resuscitation
LH raised and FSH normal
Polycystic ovarian syndrome
A malignancy in the ovary that has metastasized from a primary site (classically the GI tract, although it can arise in other tissues such as the breast)
This is a type of abdominal hernia that arises along the semilunar line, resulting in herniation between the muscles of the abdominal wall
What is a hematometra of the uterus?
A collection/retention of blood in the uterus (e.g. this could happen if someone has an imperforate hymen)
A 24 year old woman in a stable relationship presents in the clinic with a 1 year history of lower abdominal pain, deep dyspareunia, secondary dysmenorrhoea and an inability to conceive
First line investigation for endometrial cancer
-then do hysterectomy with endometrial biopsy
Pill and cancer
Slightly increases risk of cervical and breast
Protective against ovarian, endometrial and colon
What is Asherman's syndrome?
This is when intrauterine adhesions form - may occur following dilation and curettage. Can prevent endometrium responding to oestrogen as it would - can cause problems when trying to get pregnant
How do cervical carcinomas typically present?
Post-coital bleeding and inter-menstrual bleeding
Cottage-cheese like discharge
The most common cause of ovarian enlargement in women of a reproductive age?
Most common benign ovarian tumour in women under the age of 25
Dermoid cyst (teratoma)
Most common type of ovarian pathology associated with Meig's syndrome?
A 27 year old woman complains of an offensive 'musty', frothy green vaginal discharge. On examination you can see an erythematous cervix with pinpoint areas of exudation. What does she have
(treat with metronidazole)
Classification of menopausal?
-woman who has not had a period for over a year
-woman over 50 who has had hysterectomy
Definition of premature ovarian failure
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
Unopposed oestrogen increases the risk of which type of cancer?
Side effects of HRT
Fluid retention and weight gain
Bleeding patterns with progesterone only pill
-20% of women will be amenorrhoeic
-40% will bleed regularly
-40% will have erratic bleeding
Between 10 and 25% of women using POP will discontinue this method within 1 year as a result of these bleeding patterns
What happens if you miss a POP?
If less than 3 hours, continue as normal.
If more than 3 hours, take missed pill as soon as possible, continue with extra pack. Extra precautions should be used for 48 hours
Gold standard investigation for endometriosis?