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Reproduction > Reproduction A Grade Conditions > Flashcards

Reproduction A Grade Conditions Flashcards

1
Q

What is atrophic vaginitis?

A

Falling levels of oestrogen in postmenopausal women leads to drier, thinner and more fragile vaginal mucosa

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2
Q

What is the aetiology behind atrophic vaginitis?

A

Natural menopause or oopherectomy
Ani-oestrogenic treatment (tamoxifen)
Radiotherapy/chemo
Post-partum

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3
Q

How does atrophic vaginitis present?

A 
Vaginal dryness
Burning or itching of vagina or vulva
Dyspareunia
Vaginal discharge
Vaginal bleeding 
Post coital bleeding
Urinary symptoms 
 - increased frequency, nocturia, UTI, dysuria
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4
Q

What may be found on examination in atrophic vagina?

A

External genitalia may show reduced pubic hair, reduced turgor or elasticity

Thin mucosa with diffuse erythema
Lack of vaginal folds
Dryness

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5
Q

What are the investigations for atrophic vaginitis?

A

Genital Examination
Urine dip/culture if UTI symptoms
Vaginal ph testing (more alkaline)

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6
Q

How should atrophic vaginitis be managed?

A

Personal lubricants
Moisturisers
Systemic or topical HRT
Vaginal oestrogen pessaries

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7
Q

What is an ectopic pregnancy

?

A

Where a fertilised egg implants itself outside the uterus

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8
Q

Epidemiology of ectopic pregnancy

A

11/1000

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9
Q

Where is the most common site for an ectopic pregnancy?

A

Fallopian tubes (ampulla or isthmus)

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10
Q

What are the risk factors for ectopic pregnancy?

A 
IVF
History of pelvic inflammatory disease
Pelvic adhesions
Previous tubal surgery 
IUCDs
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11
Q

How does ectopic pregnancy present?

A 
Abdo pain
Pelvic pain
Amenorrhoea
Missed period 
Vaginal bleeding 
Dizziness
Breast Tenderness
Shoulder tip pain
Urinary symptoms
Passage of tissue 
Rectal pain 
GI symptoms

Adnexal or pelvic tenderness on examination

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12
Q

What investigations should be done for a suspected ectopic pregnancy?

A

TV US

hCG levels

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13
Q

How is an ectopic pregnancy managed?

A

Anti-D rhesus prophylaxis to all rhesus negative women

Medical Management
- single dose methotrexate

Surgical Management
- adnexal mass >35mm, fetal heartbeat visible on scan, serum hCG >5000 IU/L

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14
Q

What is pelvic inflammatory disease?

A

Infection and inflammation of the upper female genital tract. Usually ascending infection from the cervix Common and serious complication of chlamydia and gonnorhoea.

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15
Q

What is the epidemiology of PID?

A

Commonly occurs in women aged 20-29

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16
Q

What is the aetiology behind PID?

A

Chlamydia trachomatis or Neisseria gonorrhoeae.
Endogenous vaginal flora
Mycobacterium tuberculosis

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17
Q

What are the risk factors for developing PID?

A 
Young age
New sexual partner
Multiple sexual partners
Lack of barrier contraception
Termination of pregnancy
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18
Q

How does PID present?

A 
Can be asymptomatic
Bilateral lower abdominal pain
Deep dyspareunia
Abnormal vaginal bleeding 
Purulent cervical or vaginal discharge

On Examination

  • lower abdo tenderness
  • mucopurulent cervical discharge and cervicitis on speculum discharge
  • Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination
  • Fever above 38 degrees
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19
Q

What investigations should be done for someone with suspected PID?

A

Pregnancy test
Cervical swabs for chlamydia and gonnorhoea
Endocervical swab for c.trachomatis and n. gonnorhoeae
Elevated ESR or CRP
Endometrial biopsy and US
Urinalysis and urine culture

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20
Q

How is PID managed?

A

Antibiotic treatment
- IM ceftriaxone 500mg
+ oral doxycycline 100mg + metronidazole 400mg for 14 days

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21
Q

What are the complications of PID?

A 
Infertility
Ectopic pregnancy
Chronic pelvic pain
Perihepatitis
Reactive arthritis
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22
Q

What is chlamydia ?

A

An STI caused by chlamydia trachomatis

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23
Q

Epidemiology

A

50% of men infected DO NOT show symptoms
70% of women infected DO NOT show symptoms

Most common in people <25

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24
Q

What are the risk factors for chlamydia?

A 
age <25
Two or more sexual partners in the last year 
Recent change in sexual partner
Non-barrier contraception use
Infection with another STI
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25
Q

What are the symptoms of chlamydia?

A

Female

  • vaginal discharge
  • dysuria
  • vague lower abdominal pain
  • fever
  • intermenstrual or post coital bleeding
  • deep dyspareunia

Male

  • urethritis
  • dysuria
  • urethral discharge
  • epididymo-orchitis presenting with unilateral testicular pain and swelling
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26
Q

Signs of chlamydia?

A

Female

  • friable, inflamed cervix
  • abdo tenderness
  • endocervical discharge
  • cervical excitation

Male

  • epidydimal tenderness
  • mucoid or mucopurulent discharge
  • perineal fullness due to prostatitis
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27
Q

What investigations can be done for chlamydia?

A

Female
- vulvovaginal swab

Men
- first catch urine specimen

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28
Q

How is chlamydia managed?

A

Antibiotics
- doxycycline 100mg BD for 7 days
OR
- single dose azithromycin

Repeat test after treatment
Screen for other STIs
Offer partner tracing
Reiterate safe sex practices

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29
Q

What are the complications of chlamydia?

A 
PID
Infertility
Ectopic pregnancy
Epididymo-orchitis
Reactive arthritis
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30
Q

What is gonorrhoea?

A

An STI caused by Neisseria gonorrhoeae which infects the membranes of the urethra, endocervix, rectum, pharynx and conjunctiva

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31
Q

How is gonorrhoea transmitted?

A

Sexually

Perinatally

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32
Q

What is the epidemiology of gonorrhoea?

A

> risk in MSM
Symptomatic in 90-95% of men
Symptomatic in 50%

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33
Q

What are the risk factors for gonorrhoea ?

A 
Young age
Hx of prev STI
Co-existent STI 
New or multiple sexual partners 
Inconsistent condom use 
Hx of drug use or commercial sex work
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34
Q

How does gonorrhoea present ?

A

Men
- urethral infection (discharge, dysuria,
asymptomatic)
- rectal infection (anal discharge, perianal pain, pruritus, bleeding)
- pharyngeal infection (usually asymptomatic)

Women

  • Endocervical infection (frequently asymptomatic, increased vaginal discharge, lower abdo pain, intermenstrual bleeding)
  • urethral infection (dysuria)
  • rectal infection
  • pharyngeal infection
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35
Q

What are the signs of gonorrhoea ?

A

Men

  • mucopurulent urethral discharge
  • epidydimal tenderness

Women

  • mucopurulent endocervical discharge
  • easily induced contact bleeding of endocervix
  • pelvic/lower abdominal tenderness
  • normal examination
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36
Q

How is gonorrhoea investigated?

A

Men
- first pass urine

Women
- endocervical swab

Swab of pharynx and rectum

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37
Q

How is gonorrhoea managed?

A

IM ceftriaxone 500mg

plus oral azithromycin 1g

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38
Q

What are the complications of gonorrhoea?

A

Prostatitis
Peri-urethral abscess

Perihepatitis
PID

Reactive arthritis

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39
Q

What is trichomoniasis vaginalis?

A

A STI caused by a parasite. Spread thorugh sexual activity. Lives in urethra of men and women, and in the vagina of women

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40
Q

How does trichomonas present?

A

Asymptomatic in 50% of cases

  • vaginal discharge (frothy, yellow green and fishy smell)
  • itching
  • dysuria
  • dyspareunia
  • balanitis
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41
Q

What clinical signs are associated with trichomoniasis?

A

Strawberry cervix

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42
Q

How is trichomoniasis diagnosed?

A

Charcoal swab with microscopy from vagina

Men:
Urethral swab
First catch urine

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43
Q

How should trichomoniasis be managed?

A

Metronidazole

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44
Q

What is HIV?

A

Human immunodeficiency virus - a RNA retrovirus which destroys CD4 T-helper cells of the immune system

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45
Q

What is AIDS?

A

Acquired Immunodeficiency Syndrome - infections gained when HIV positive

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46
Q

How is HIV transmitted?

A
  • Unprotected anal, vaginal or oral sexual activity
  • Mother to child at any stage of pregnancy, birth or breastfeeding
  • Mucous membranes, blood or open wound exposure to infected blood or bodily fluids
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47
Q

Give examples of AIDS defining illnesses?

A 
Kaposi's sarcoma
Pneumocystis jirovecii pneumonia
Cytomegalovirus infection
Candidiasis 
Lymphomas 
TB
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48
Q

How long after infection do HIV antibodies develop?

A

Roughly three months

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49
Q

How is HIV tested for?

A

Antibody testing
p24 antigen testing
PCR for HIV RNA tests for viral load

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50
Q

How is HIV monitored ?

A 
CD4 count (500-1200 = normal, <120 = end stage HIV)
Viral Load
51
Q

How is HIV treated?

A

ART medications

  • protease inhibitors
  • integrase inhibitors
  • NRTIs
  • NNRTIs
  • Entry Inhibitors

Prophylactic co-trimoxazole to protect against PCP
Yearly cervical smears
Cardiac monitoring
Yearly vaccination

52
Q

What is syphilis ?

A

STI caused by treponema pallidum which enters via skin or mucous membranes, replicates and then disseminates throughout the body

53
Q

How is syphilis transmitted?

A

Oral, vaginal or anal sex involving direct contact with the area

Vertical transmission

IV drug use

Blood transfusions and other transplants

54
Q

What are the stages of syphilis?

A

Primary syphilis
- painless chancre at original site of infection

Secondary Syphilis
-systemic symptoms of skin and mucous membranes that resolve within 3-12 weeks

Latent stage
- symptoms disappear and patient becomes asymptomatic despite being infected

Tertiary
- can occur after many years after the initial infection. Can affect many organs of body, gummas develop and CV and neuro complications arise

55
Q

How does syphilis present?

A

Primary
- chancre

Secondary

  • maculopapular rash
  • wart like lesions around genitals/rectum
  • low grade fever
  • alopecia
  • oral lesions

Tertiary

  • Gummas
  • aortic aneurysms
  • neurosyphilis

Neurosyphilis

  • headache
  • altered behaviour
  • dementia
  • ocular syphilis
  • tabes dorsalis
56
Q

What eye sign can be seen in neurosyphilis?

A

Argyll-roberston pupil - pupil accomodates when focusing on near object, it does not react to light

57
Q

How is syphilis diagnosed?

A

Antibody testing for t pallidum

Swabs from infected area then dark field microscopy and PCR

58
Q

How is syphilis managed?

A

Deep IM injection of benzathine benzylpenicillin

Contact tracing
Information about other STIs
Screening for other STIs
Education on prevention

59
Q

What is a post partum haemorrhage?

A

Bleeding after the delivery of the baby and placenta, and is the most common cause of significant obstetric haemorrhage

Defined as:
over 500ml of blood loss after vaginal delivery
over 1000ml of blood loss after c-section

60
Q

What is a minor PPH?

A

<1000ml blood loss

61
Q

What is major PPH?

A

> 1000ml blood loss

62
Q

What is moderate PPH?

A

1000-2000ml blood loss

63
Q

What is severe PPH?

A

> 2000ml blood loss

64
Q

What is primary PPH?

A

Bleeding within 24 hours of birth

65
Q

What is secondary PPH?

A

Bleeding from 24hrs to 12 weeks after birth

66
Q

What are the causes of of PPH?

A

4 Ts

  • Tone
  • Trauma
  • Tissue
  • Thrombin
67
Q

What are the risk factors ?

A 
Previous PPH
Multiple pregnancy
Obesity
Large Babies
Failure to progress in the second stage of labour
Prolonged third stage
Pre-eclampsia
Placenta Accreta
Retained Placenta
Instrumental delivery
Episiotomy or perineal tear
68
Q

How can you reduce the risk and consequences of a PPH?

A

Treating anaemia during the antenatal clinic
Giving birth with an empty bladder
Active management of the third stage of labour
IV tranexamic acid during C-Section in high risk patients

69
Q

How is a PPH managed?

A

ABCDE approach
Lie patient flat and insert two large bore cannula
Bloods for FBC, U&E and clotting screen
Grouped and cross match 4 units
Warmed IV fluids and blood resuscitation as required
Oxygen
Fresh frozen plasma after 4 units

70
Q

What treatments are used to stop the bleeding?

A

Mechanical

  • rubbing uterus to stimulate uterine contraction
  • catheterisation

Medical

  • Oxytocin
  • Ergometrine (contraindicated in HTN)
  • Carboprost
  • Misopristol
  • Tranexamic Acid

Surgical

  • Intrauterine balloon tamponade
  • B-Lynch suture
  • Uterine artery ligation
  • Hysterectomy
71
Q

What is the most common cause of secondary post partum haemorrhage?

A

Retained products of conception

Infection

72
Q

How do you investigate a secondary post partum haemorrhage?

A

US

Endocervical and high vaginal swabs

73
Q

How is a secondary PPH managed?

A

Evacuation

Antibiotics

74
Q

What is maternal sepsis?

A

A condition where the body launches a large immune response to infection, causing systemic inflammation and affecting organ function

75
Q

What are the two most common causes of maternal sepsis?

A

Chorioamnionitis

Urinary Tract Infections

76
Q

What is chorioamnionitis ?

A

Infection of chorioamniotic membranes and amniotic fluid

77
Q

How does maternal sepsis present?

A 
Fever
Tachycardia
Raised RR 
Reduced oxygen saturations
Low blood pressure
Altered consciousness 
Reduced urine output
Raised WBC
Evidence of fetal compromise on CTG
78
Q

What signs and symptoms are related to chorioamnionitis?

A

Abdominal Pain
Uterine Tenderness
Vaginal Discharge

79
Q

What signs and symptoms of maternal sepsis are related to UTI ?

A 
Dysuria
Urinary frequency
Suprapubic Pain
Renal angle pain
Vomiting
80
Q

What investigations should be done for maternal sepsis?

A 
FBC
U&Es
LFTs
CRP
Clotting
Blood cultures
Blood Gas

Urine dipstick and cultures
High vaginal swab

81
Q

How should maternal sepsis be managed?

A

Maternal and fetal monitoring
- if foetus distressed then C-Section indicated. Spinal anaesthesia should be avoided in sepsis.

SEPSIS 6
Take 
- lactate
- blood cultures
- urine output

Give

  • IV fluids
  • IV antibiotics (amoxicillin, clindamycin and gentamycin)
  • Oxygen
82
Q

What is thrombosis a result of?

A

Stagnation of blood and hyper-coaguable states

83
Q

What are the risk factors for developing a VTE in pregnancy?

A 
Smoking
Parity >/= 3
Age >35
BMI>30
Reduced mobility
Multiple Pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
FH of VTE
Thrombophilia
IVF Pregnancy
84
Q

When is VTE prophylaxis advised?

A

In first trimester, if there are three risk factors

At 28 weeks if there are four or more risk factors

If patient has had previous VTE, medical conditions such as cancer or arthritis, surgical procedures during pregnancy, hospital admission during pregnancy

85
Q

What VTE prophylaxis is used in pregnancy?

A

LMWH e.g. dalteparin, enoxaparin

Compression stockings

86
Q

How does a VTE present?

A

DVT

  • unilateral leg pain
  • calf swelling
  • oedema
  • colour changes to the leg

PE

  • shortness of breath
  • cough +/- blood
  • pleuritic chest pain
  • tachypnoea
  • tachycardia
  • pleuritic chest pain
  • hypoxia
  • low grade fever
  • haemodynamic instability causing hypotension
87
Q

How is a VTE investigated?

A

Doppler US of leg for suspected DVT

PE

  • CXR
  • ECG
  • CTPA
  • VQ Scan
88
Q

How is VTE managed in pregnancy?

A

LMWH immediately if VTE suspected. Treatment can be stopped if VTE is excluded

89
Q

What is pre-eclampsia?

A

New high blood pressure and end organ dysfunction, notably proteinuria, which occurs after 20 weeks gestation. This occurs because the spiral arteries of the placenta form abnormally, leading to high vascular resistance in these vessels

90
Q

What is the pre-eclampsia triad?

A

Hypertension
Proteinuria
Oedema

91
Q

What is chronic hypertension?

A

HTN which exists before 20 weeks gestation and is longstanding

92
Q

What is gestational hypertension?

A

Hypertension occurring after 20 weeks gestation, without proteinuria

93
Q

What is eclampsia?

A

Seizures that occur as a result of pre-eclampsia

94
Q

What are the risk factors for developing pre-eclampsia?

A 
Pre existing HTN
Prev HTN in pregnancy
Existing autoimmune condition
Diabetes
CKD
Older than 40
BMI >35
>10 years since last pregnancy
Multiple pregnancy
First pregnancy
FH of pre-eclampsia
95
Q

What symptoms present in pre-eclampsia?

A 
Headache
Visual Disturbance
Nausea and vomiting
Upper abdominal or epigastric pan due to liver swelling
Oedema 
Reduced urine output 
Brisk Reflexes
96
Q

How is pre-eclampsia diagnosed?

A

BP monitoring

  • systolic >140
  • diastolic >90

Urine dipstick
- proteinuria

Blood tests
- raised liver enzymes, raised creatinine, thrombocytopenia, haemolytic anaemia

US
- fetal growth restriction

Clinic Hx - seizures/headaches/visual changes

97
Q

How is proteinuria quanitified?

A

Albumin:creatinine ratio >30mg/mmol

Urine protein:creatinine ratio >8mg/mmol

98
Q

How is pre-eclampsia managed?

A

Aspirin prophylaxis at 12 weeks (if 1 risk factor present)

Monitor BP, urine dipstick and symptoms

Medical

  • labetalol
  • nifedipine
  • methyldopa
  • IV hydralazine
  • IV magnesium sulphate
  • Fluid restriction

Corticosteroids should be given to women having a premature birth to encourage lung development

99
Q

What medications are not safe to use for hypertension control in pregnancy?

A

ACEi (Ramipril)
ARB (losartan)
Thiazide/Thiazide-like diuretics (indapamide)

100
Q

What medications are safe to use to treat hypertension in pregnancy?

A

Labetalol
CCBs - nifedipine
Alpha Blockers (doxazosin)

101
Q

How much folic acid should be taken by women with epilepsy if they are planning to get pregnant?

A

5mg from before conception to reduce risk of neural tube defects

102
Q

What anti-epileptics can be used during pregnancy?

A

Leveteracetam, lamotrigene, carbamezapine

103
Q

What anti-epileptics should be avoided during pregnancy?

A

Sodium valproate

Phenytoin

104
Q

What does obesity during pregnancy put you at risk of?

A 
Pre eclampsia
Thrombosis
Gestational diabetes
Miscarriage
Large for gestational age babies
105
Q

What is gestaional diabetes?

A

Diabetes triggered by pregnancy, caused by reduced insulin sensitivity during pregnancy, and resolves after birth

106
Q

What are the complications of having gestational diabetes?

A

Macrosomia
Large for dates fetus
Shoulder dystoica
Long term increased risk of type 2 diabetes outwith pregnancy

107
Q

What are the risk factors for developing gestational diabetes?

A 
Prev. gestational diabetes
Prev. macrosomic baby (>4.5 kg)
BMI>30 
Ethnic origin
FH of diabetes
108
Q

How is gestational diabetes diagnosed?

A

OGTT at 24-28 weeks gestation if risk factors identified

Fasting results should be <5.6
At two hours, should be <7.8

109
Q

How is gestational diabetes managed?

A

Four weekly ultrasound from 28 weeks

Fasting glucose <7 = trial of diet and exercise for 2 weeks, then metformin, then insulin

Fasting glucose >7 = insulin and metformin

Fasting glucose >6 + macrosomia = insulin and metformin

110
Q

If ladies with pre-existing diabetes decide to become pregnant, what should be done?

A

5mg of folic acid from before conception until 12 weeks gestation

111
Q

How should pre-existing type 1 and 2 diabetes be managed in pregnancy?

A

Good insulin control

Type2 - stop other oral diabetic medications - metformin and insulin are safe

Retinopathy screening after booking and at 28 weeks

Planned delivery for 37-38+6 weeks + consider sliding scale insulin

112
Q

What are babies of mothers with diabetes at risk of ?

A 
Neonatal hypoglycaemia
Polycythaemia
Jaundice
Congenital heart disease 
Cardiomyopathy
113
Q

What is placenta praevia ?

A

When the placenta presents in the lower portion of the uterus, lower that the presenting part of foetus.

Covers the cervical os

114
Q

What are the risks of having placenta praevia?

A 
Antepartum Haemorrhage
Emergency c-section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth
Stillbirth
115
Q

What are the risk factors for developing placenta praevia?

A 
Prev c-section
Prev placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities (fibroids)
Assisted reproduction
116
Q

What are the grades of placenta praevia?

A

Grade I = Placenta is in the lower segment of uterus but does not reach the internal cervical os
Grade II - Placenta reaches but does not cover the internal os
Grade III - placenta partially covers the interal os
Grade IV - placenta completely covers the os

117
Q

How is placenta praevia diagnosed?

A

20 week US scan

118
Q

How does placenta praevia present?

A

Can be asymptomatic

Painless vaginal bleeding usually after 36 weeks

119
Q

How is placenta praevia managed?

A

Repeat TV US at 32 weeks and then again at 36 weeks

Corticosteroids given at 34 and 35+6 weeks due to risk of preterm labour

Planned delivery betwen 36-37 weeks to avoid spontaneous labour and bleeding. C-section.

120
Q

What is the main complication of placenta praevia ?

A

Haemorrhage before, during and after delivery

121
Q

What is placental abruption?

A

When placenta separates from the wall of the uterus during pregnancy.

122
Q

What are the risk factors for placental abruption?

A 
Pre Eclampsia
Bleeding early in pregnancy
Trauma (?domestic violence)
Multiple pregnancy
Fetal growth restriction 
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use
123
Q

How does placental abruption present?

A

Sudden and severe abdominal pain that is severe
Vaginal bleeding
Shock
Abnormalities on CTG
Woody abdomen on palpitation, suggesting a large haemorrhage

124
Q

How is placental abruption managed?

A

Clinical diagnosis

Management

  • 2x grey cannula
  • bloods - FBC, UE, LFT, Coagulation Studies
  • Crossmatch 4 units of blood
  • Fluid and blood resuscitation as required
  • CTG monitoring of the foetus
  • Close monitoring of the mother
  • Emergency section if mother unstable or fetus distressed

Kleihauer test and prophylactic Anti-D

Corticosteroids at 24 and 36 weeks

Active management of third stage of labour

Reproduction (17 decks)

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