repro revision Flashcards by Linda Lee

4 phases of menstrual cycle

menstruation
follicular
ovulation
luteal

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how is the menstrual cycle controlled by feedback systems??

level of oestrogen = negative / positive feedback of HPO axis

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3 phases of ovarian cycle and what happens

follicular - theca (produce androgens) and granuloma (inhibin) cells, FSH production inhibited by oestrogen and inhibin

ovulation - LH surge after 12 hrs, day 14, after maturation of dominant follicle and ruptures, releasing oocyte

luteal - lasts for 14 days, formation of corpus luteum,
progesterone production

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gold standard investigation for suspected endometriosis ??

laparoscopy

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adenomyosis - definitive tx??

hysterectomy

occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus (myometrium)

Basically, ‘endometriosis but with the extra tissue being in the uterine wall only’

Can treat with hormonal therapy (eg, Mirena coil), tranexamic and mefanamic acid, uterine artery embolisation (fertility-sparing), or ablation/hysterectomy.

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what meds can be used to reduce the size of fibroids before surgery??

GnRH

ulipristal acetate for fibroids ≥3cm in diameter

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USE OF Mefenamic acid VS Tranexamic acid

Mefenamic acid - to relieve the dysmenorrhoea. usually 2nd line after using IUS

3rd line - Tranexamic acid is used for heavy menstrual bleeding, rather than dysmenorrhoea (painful bleeding).

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VIN

how long to turn into cancer??

Vulval intraepithelial neoplasia
pre-cancerous condition, will usually take over 10 yrs to turn into cancer

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Lymph from the gonads drains to which lymph node group??

lumbar (caval/aortic)
para-aortic nodes

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______ signals corpus luteum to secrete progesterone

hCG

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what happens when you forget to take a pill (COCP)?? do you need any emergency contraception ??

fine if missed in middle of wk
if 1 pill has been missed and it is 48-72 hrs since the last pill in the current pack, or is 24-48 hrs late starting the new pack, MISSED PILL NEEDS TO BE TAKEN ASAP
remaining pills continued at usual time
if 2 pills have been missed, take most recent one. Barrier contraception until 7 consecutive pills are taken

emergency contraception not required unless pills were missed earlier or in last wk of previous pack

if COCP, implant, IUS, injection is started after day 5, need to use contraception for at least 1 week
IUD = immediately fine, no contraception needed
POP = 2 days

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patient has menorrhagia with small subserosal fibroids. what is an appropriate form of contraception??

IUS
IF PATIENT DOES NOT WANT IUS, THEN MAYBE POP

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IUS

IUD

IUS coil - up to 5 yrs, making menstrual periods lighter and shorter
invasive - risk of perforation, ectopic pregnancy

IUD - up to 10 yrs, making menstrual periods heavier and irregular
invasive - PID, perforation

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Most likely embryonic explanation for 2 uteri

incomplete fusion of paramesonephric duct

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in males, which structure develops to form the vas deferens (ductus deferens)?

mesonephric duct

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in females, which structure develops to form the superior portion of the vagina ??

paramesonephric duct

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how long do male lice live on average ??

22 days (3 wks)

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what structures relax in pregnancy that may cause pelvic pain??

pelvic inlet
first sacral segment, ilium, and the pubis

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what is a complete hydatidiform mole at risk of turning into? compared w partial moles

choriocarcinoma

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Best contraception for 46 yr old, BMI of 42, smokes 20 a day, history of PID. Has multiple fibroid uterus including intramural and submucous fibroids

what is contraindicated in this?

POP

Difficult to fit Mirena w fibroid uterus.

COCP contraindicated in smoking and high BMI and aged above 40

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vertex

area of foetal skull:
anterior and posterior fontanelle
and
parietal eminences

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occipitofrontal diameter and biparietal

occipitofrontal - longer than wider

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distance of the foetal head from the ischial spines is called the ________

station

negative number = the baby head is above the ischial spines
positive number = baby head is positive

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placenta accreta vs placenta praevia vs placental abruption

accreta = attached to myometrium due to defective decidua basalis, previous C SECTIONS

praevia = vaginal painless bleeding, 3rd trimester

abruption = placenta separates from the uterus

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PPH

-primary postpartum haemorrhage -emergency -4Ts causes, trauma, tissue, thrombin, tone

normal value for NT

<3.5mm assessing the amount of fluid in neck of foetus

screening for Down's

11+0 weeks and 13+6 weeks = combined test bloods and USS US = NT Bloods = PAPP-A, aFP, beta-hCG 2ND STAGE OF SCREENING = 15-16 WEEKS, add in inhibin and oestriol

in downs, what are the levels of PAPP-A, aFP, beta-hCG and NT??

PAPP-A and aFP are low beta hcg and nt are increased

when are foetal anomaly scans done??

18-20 weeks 20 week scan for every woman

when is SFH measured??

from 24 weeks

when is anti-d offered if neg?? 1st and 2nd dose

28 weeks 34 weeks

what test can be done to check the right dose for anti-d sensitizing event by quantifying fetal red blood cells in mother's blood?? to have maximal effect, when should anti-d be given by??

KLEIHAUER within 72 hrs

2 main diagnostic tests for fetal abnormality?? when can they be done??

CVS - between 11 and 13+6 wks amniocentesis - after 15 wks

NIPT - screening test (NOT diagnostic)

non-invasive prenatal test more sensitive and specific than other screening tests reduces the risk of miscarriage

chorionicity is most determined by ________ using the shape and thickness of membrane when is this done?? and why is this important??

USS 11 - 13+6 weeks to pick up early signs of TTTS

what is the mode of delivery for MCMA?? mode of delivery for BREECH BABIES

C-section due to higher risk for cord entanglement C-section or ECV

3 types of breech presentation, which one is the most risky??

complete breech - legs folded at bottom footling breech - one or both feet point down frank breech - both legs UP FOOTLING - cord prolapse

IN FOETAL HYPOXIA, umbilical artery __________ its resistance MCA __________ its resistance

definition of stillbirth and causes

baby born with no signs of life at or after 28 weeks gestation labour complications, maternal infections and disorders, FGR

hypertensive disorders of pregnancy - 3

pre-existing hypertension gestational hypertension pre-eclampsia gestational hypertension develops after 20 wks but does not involve proteinuria/oedema unlike pre-eclampsia

what happens if pre-eclampsia is not controlled ??

develop into eclampsia = characterised by grand Mal seizures

gestational diabetes

polyhydramnios glycosuria

PPROM

pre-term prelabour rupture of membranes if the latent period between rupture of membranes to onset of painful contractions is greater than 4hrs

hydrops fetalis - what is this a late sign of ??

placental praevia and vasa praevia

infections in pregnancy

_____ is the leading direct cause of maternal death?? what is the leading indirect cause of maternal death??

SGA - has an estimated weight or abdo circumference below the _____ centile

10th

large for dates fetus has an estimated fetal weight to be greater than the _____ centile

what substance would you give for inducing labour ?

prostaglandin

pregnant woman has confirmed DVT and suspected PE. Tx?

start low molecular weight heparin in suspected PE CTPA and V/Q scan = confirm or rule out the presence of a thrombus

1ST LINE AND 2ND LINE for management of hypertensive disorders in pregnancy.

1. Labetalol (do NOT use in asthmatics) 2. Nifedipine

mx for severe pre-eclampsia, she has presented with moderate hypertension and also has symptoms of headache and vomiting

IV magnesium sulphate and plan immediate delivery

most common cause of antepartum haemorrhage?? second most common cause??

1. placental rupture 2. placental praevia

prolonged labour - diagnosis

when cervical dilatation is of less than 2cm in 4 hours during active labour

labour 3 stages

1 stage is divided into latent and active, latent = up to 4cm active = 4-10cm 2nd = full dilatation to delivery (passive/active stage) 3rd = time between delivery of foetus and delivery of placenta and membranes (active/physiological mx) active - need to use drugs

in a nulliparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs?? in a multiparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs??

2 1

what are the 7 steps of the mechanism of labour??

engagement descent flexion internal rotation extension external rotation expulsion

caput succedaneum cephalohaematoma subgaleal haemorrhage

present at birth develops several hrs after birth at delivery and may progress rapidly

pros and cons of operative vaginal delivery vs C-section

vag = shorter stay and quicker recovery neonatal trauma, facial nerve palsy, postpartum haemorrhage, shoulder dystocia C-section = no injury to cervix or tears haemorrhage, TTN, risk of uterine rupture, venous thromboembolism

IOL - most commonly used method of assessment? what are the methods of inducing labour??

Bishop's score >6 = most likely to predict labour artificial rupture of membrane drugs mechanical - balloon catheter

CEFM

continuous electronic fetal monitoring associated w increased level of intervention without much improvement in low risk women, so usually for people with risk factors

DR C BRAVADAO mnemonic - for interpreting CTGs

amniotic fluid embolism

CPR in pregnant woman

uterine neoplasia / cancer

endometrial carcinoma endometrial sarcoma carcinosarcoma endometrial hyperplasia myometrium abnormalities

ovarian neoplasms/cancer

benign tumours pathology functional cysts endometrioma polycystic ovaries theca lutein cyst serous cystadenoma mucinous cystadenoma fibroma sertoli/leydig mature teratoma

malignant tumours epithelial mucinous endometrioid clear cell sex cord germ cell

cervical neoplasia