Risk factors

Question 1

RFs for placenta praaevia

Answer 1

Previous caesarean-section: causes uterine scarring, resulting in an adherent placenta
Increasing parity
Multiple pregnancy
Increasing maternal age
Smoking
Previous miscarriage
Previous abortion

Question 2

RFs for vasa praaevia

Answer 2

Low lying placenta
IVF pregnancy
Multiple pregnancy

Question 3

placenta accreta RFs

Answer 3

Previous placenta accreta
Previous endometrial curettage procedures (e.g. for miscarriage or abortion)
Previous caesarean section
Multiparity
Increased maternal age
Low-lying placenta or placenta praevia
Uterine structural abnormality

Question 4

placental abruption RFs

Answer 4

Previous placental abruption
Pre-eclampsia or HTN
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Foetal growth restriction
Multigravida
Increased maternal age
Smoking
Placenta praevia.
Cocaine or amphetamine use
Polyhydramnios multihydamnios

Question 5

pre-eclampsia RFs

Answer 5

Moderate risk factors:
≥ 40 years of age
First pregnancy
Pregnancy interval > 10 years
BMI ≥ 35
Family history of pre-eclampsia
Multiple pregnancies

High risk factors:
Chronichypertension
Chronic kidney disease
Hypertensionduring a previous pregnancy
Type 1 or2 diabetes
Autoimmune disease: such assystemic lupus erythematosusor antiphospholipid syndrome

Question 6

cord prolapse RF

Answer 6

Premature rupture membranes
Polyhydramnios(i.e. a large volume of amnioticfluid)
Long umbilical cord
Foetalmalpresentation(e.g. if baby’s head notdown)
Multiparity
Multiple pregnancy

Question 7

shoulder dystocia RF

Answer 7

Macrosomia(most cases occur in normally grown babies)
Maternal diabetes
Previous shoulder dystocia
Disproportion between mother andfetus
Postmaturityand induction of labour
Maternal obesity
Prolonged 1stor 2ndstage of labour
Instrumental delivery

Question 8

PPH RF

Answer 8

Previous PPH
Multiple pregnancy
Obesity
Large baby
Failure to progress in the second stage of labour
Prolonged third stage
Pre-eclampsia
Placenta accreta
Retained placenta
Instrumental delivery
General anaesthesia
Episiotomy or perineal tear

Question 9

VTE RF

Answer 9

Smoking
Parity ≥ 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy

Question 10

uterine rupture RF

Answer 10

Hx of C-section OR uterine surgery  scar rupture
Previous uterine rupture
VBAC
High BMI
High parity
Induction of labour with oxytocin
↑ age

Question 11

ectopic pregnancy RF

Answer 11

Pelvic inflammatory disease
Prior ectopic pregnancies
IVF
In situ intrauterine device.
Endometriosis – scarring + adhesion
Smoking
POP or implant due to fallopian tube ciliary dysmotility
Genital infection e.g. gonorrhoea
Older maternal age >35

Question 12

miscarriage RFs

Answer 12

↑ maternal age >35.
↑ paternal age >45
Previous miscarriage. Significantly ↑ risk after 3 consecutive miscarriages.
Lifestyle: smoking, alcohol and recreational drug use during pregnancy
Previous gynaecological surgery
antiphospholipid syndrome andSLE
Uncontrolled DM or thyroid disorders

Question 13

molar pregnancy RFs

Answer 13

Extremes of reproductive age : < 16 years or > 45 years
Prior gestational trophoblastic disorder
Family history

Question 14

ovarian torsion RFs

Answer 14

women of reproductive age
ovarian cysts

Question 15

PID RFs

Answer 15

Not using barrier contraception
Multiple sexual partners or new partner
Younger age
Existing sexually transmitted infections
Previous pelvic inflammatory disease
Intrauterine device (e.g. copper coil).
Recent instrumentation of the uterus [e.g. TOP, IVF]

Question 16

Endometriosis RFs

Answer 16

Family hx, early menarche, late menopause, nulliparity, smoking.
low BMI white ethnicity

Question 17

fibroid RFs

Answer 17

family hx
black ethnicity
obesity
early puberty
nulliparity

Question 18

lichen sclerosis RFs

Answer 18

other autoimmune conditions
T1DM
alopecia
vitiligo
hypothyroidism etc

Question 19

atrophic vaginitis RFs

Answer 19

Menopause
Ovariectomy
Anti-oestrogen medication:tamoxifen, aromatase inhibitors
Postpartum +/- breastfeeding
chemo/radiotherapy.

Question 20

BV RFs

Answer 20

Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
hormonal changes such as those that happen in pregnancy.
Smoking
Copper coil

Question 21

PCOS RFs

Answer 21

Family history of PCOS
Obesity
Insulin resistance

Question 22

STI RFs

Answer 22

<25 yrs
Unprotected sex/contact with genital fluid:
oral, vaginal, anal
Multiple partners
Sharing unwashed sex toys
Social deprivation

Question 23

RFs / methods of transmission of syphilis

Answer 23

Oral, vaginal or anal sex via direct contact with an infected ulcer. Can penetrate skin or mucous memb.
Vertical transmission via placenta  foetal or congenital infection
IVDU
Blood transfusions or other transplants

Question 24

ovarian cancer RFs and protective factors

Answer 24

Advanced age
Smoking
Increased number of ovulations (early menarche, late menopause, no preggos)
Obesity
Hormone replacement therapy (HRT)
BRCA1 and BRCA2 genes (consider the family history)
Recurrent use of clomifene

Protective factors
Pregnancy
Breastfeeding
COCP uses

Question 25

endometrial cancer RFs and protective factors

Answer 25

Exposure to unopposed oestrogen is the main RF, which can manifest via: Nulliparity or fewer pregnancies Early menarche or late menopause Oestrogen-only HRT Tamoxifen – anti oestrogen in breast but oestrogenic in endometrium Obesity – aromatase converts androgens --> oestro. PCOS [lack of ovulation + corpus luteum --> chronic oestrogen exposure] ↑ age, T2DM, HNPCC, Lynch syndrome [unrelated to oestrogen.] Protective factors: COCP, smoking, Mirena coil, many pregnancies.

Question 26

cervical cancer Rfs

Answer 26

Increased risk of catching HPV: Early sexual activity Increased number of sexual partners Sexual partners who have had more partners Not using condoms Later detection of precancerous and cancerous changes (non-engagement with screening) Other risk factors: Smoking HIV COCP use for >5 years [↓ risk of endometrial + ovarian cancer] Family history ↑ number of full-term pregnancies

Question 27

vulval cancer RFs

Answer 27

↑ Age [>75 especially] Exposure to HPV Conditions causing chronic inflammation of the vulva Immunosuppression Lichen sclerosus ~5% of women with LS develop vulval cancer

Question 28

IUGR RFs

Answer 28

Previous SGA baby Smoking / alcohol Obesity Diabetes Existing HTN / pre-eclampisa Mum>35yrs Multiple pregnancy Antiphospholipid syndrome Antepartum haemorrhage

Question 29

GDM RFs

Answer 29

Previous gestational diabetes Previous macrosomic baby (≥ 4.5kg) BMI > 30 Ethnic origin with ↑ risk of T2DM (black Caribbean, Middle Eastern and South Asian) Family history of diabetes in first-degree relative

Question 30

foetal complications of GDM

Answer 30

SHAME Shoulder dystocia, birth injuries and emergency C-section. Hypoglycaemia: Neonatal Hypoglycaemia Regular blood glucose checks and frequent feeds are needed. Aim to maintain blood sugar >2mmol/l, using IV dextrose and NG feeds is needed. Amniotic fluid excess = polyhydramnios Macrosomia – LGA [contributes to 1] Early birth: Pre-term delivery Perinatal foetal death ↑ risk of developing T2DM later in life Also, at risk of jaundice, cardiomyopathy, congenital heart diseases and polycythaemia.

Question 31

Breast cancer RFs

Answer 31

Female (99% of breast cancers) Increased oestrogen exposure (obesity, earlier onset of periods and later menopause) COCP ↑ risk slightly but falls after 10yrs stopping it. More dense breast tissue (more glandular tissue) Late pregnancy/nulliparity. Breastfeeding and multiparity are protective. Smoking Family history (first-degree relatives) BC + OC BRCA 1 or 2 mutation [chromosome 17 + 13 respectively]

Question 32

pelvic organ prolapse

Answer 32

* Multiple vaginal deliveries * Traumatic or prolonged or instrumental deliveries * Obesity * Advanced age +/ or postmenopausal status * Chronic coughing * Chronic constipation causing straining. * Hysterectomy * Heavy lifting

Question 33

urinary incontinence RFs

Answer 33

↑ age Previous pregnancies and vaginal deliveries High BMI Neurological conditions e.g. MS Pelvic organ prolapse or past pelvic surgery Cognitive impairment / dementia. Lifestyle factors: caffeine, alcohol, BMI, meds.

Question 34

preterm delivery RFs

Answer 34

* MC =Infection introduced iatrogenically, ascending up the genital tract or retrograde from peritoneum * Ischaemia * Uterine over distension – seen in polyhydramnios, multiple pregnanices + uterine abnormalities * Cervical weakness, 1º due to prior procedures [C-sections at full dilatation, LETZ, cone biopsy]