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Selected Notes obgyn 3 Flashcards

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1
Q

What is stress incontinence?

A

Leaking small amounts when coughing/laughing

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2
Q

What is mixed incontinence?

A

Both urge and stress

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3
Q

What is overflow incontinence?

A

Due to bladder outlet obstruction<br></br>E.g. from prostate enlargement

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4
Q

When is cystometry not recommended?

A

In patients with clear histories and a clear cause of incontinence

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5
Q

When is a cystogram suggested as an investigation for urinary incontinence?

A

When a fistula is suspected

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6
Q

When should you be cautious in prescribing anticholinergics for urge incontinence?

A

In the elderly due to risk of falls

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7
Q

When is a vaginal vault prolapse most common?<br></br>

A

After a hysterectomy

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8
Q

What is the surgical management for a uterine prolapse?

A

Hystrectomy, sacrohysteropexy

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9
Q

What is the surgical management of a rectocele?

A

Posterior colporrhaphy

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10
Q

When can’t LNG-IUS(levornegstrel intrauterine device) be used for treating uterine fibroids?

A

If there is distortion of the uterine cavity

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11
Q

What treatment/management should be used to shrink/remove fibroids?

A

GnRH agonists-> short term treatment to reduce size of fibroids<br></br>Surgical-> myomectomty, ablation, uterine artery embolisation, hysterectomy

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12
Q

Why can’t GnRH agonists be used long term to treat fibroids?

A

Side effects such as menopausal symptoms (hot flushes, vaignal dryness) and loss of bone mineral density

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13
Q

Where do submucosal fibroids grow?

A

Just below the lining of the uterus (endometrium)

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14
Q

What is Meig’s syndrome?

A

Triad of:<br></br><ul><li>Ovarian fibroma(benign ovarian tumour)</li><li>Pleural effusion</li><li>Ascites</li></ul><div>Typically occurs in older women-> remove tumour and other issues resolve</div>

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15
Q

What should be considered in a patient presenting with recurrent ovarian cysts?

A

PCOS<br></br>Can’t be diagnosed just off cysts, needs 2 of:<br></br><ul><li>Anovulation</li><li>Hyperandrogenism</li><li>Polycystic ovaries on US</li></ul>

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16
Q

What is the commonest type of ovarian cyst?

A

Follicular cysts

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17
Q

Whatg are the tumour markers for a  germ cell tumour?

A

<ul><li><b><i>Lactate dehydrogenase</i></b>&nbsp;(<b><i>LDH</i></b>)</li><li><b><i>Alpha-fetoprotein</i></b>&nbsp;(<b><i>α-FP</i></b>)</li><li><b><i>Human chorionic gonadotropin</i></b>&nbsp;(<b><i>HCG</i></b>)</li></ul>

<div>&nbsp;</div>

<br></br>

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18
Q

What is taken into account with the risk of malignancy index for ovariance tumours?

A

<ul><li>Menopausal status</li><li>Ultrasound findings</li><li>CA125 level</li></ul>

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19
Q

What is ovarian torsion?

A

Ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

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20
Q

When can ovarian torsion happen in normal ovaries in girls before menarche

A

When girls have longer infundibulopelvic ligaments that can twist more easily

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21
Q

What might be present upon examination of a patient with ovarian torsion?

A

Localised tenderness<br></br>Palpable mass in the pelvis-may be absent

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22
Q

What parts of the body does lichen sclerosus typically affect?

A

Gential and anal regions of the body

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23
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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24
Q

What is the second most common type of cervical cancer?

A

Adeoncarcinoma

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25
What is the most common casue of cervical cancer?
HPV-typically type 16 and 18
26
What is meant by dysplasia?
Premalignant changes
27
What is the grading system for the level of dysplasia in the cervix?
Cervical intraepithelial neoplasia(CIN)
28
What is the first thing smear tests looking for cervical cancer are tested for?
High risk HPV
If HPV is negative, cells aren't examined further, returned to normalm screening programme
29
What might be seen in cervical cancer screening in women with the coil/IUD?
Actinomyces-like organisms-no treatment required unless symptomatic
30
What is pelvic exenteration?
Operation that involved removing ost or all of the pelvic organs including vagina cervix, uterus, fallopian tubes, ovaries bladder and rectum
Last resort for cervical cancer
Significant implications
31
What monoclonal antibody can be used to treat cervical cancer?
Bevacizumab(avastin) used in combination with other chemo to treat metastatic/recurrent cervical cancer
32
Which strains does the HPV vaccine Gardasil protect against?
Strains 6,11,16,18,31,33,45,52,58
33
What might you find on bimanual pelvic examination in a patient with endometrial cancer
Enlarged uterus(may be normal)
34
What is the most common type of endometrial cancer?
Adenocarcinoma
35
What stimulates the growth of endometrial cancer cells?
Oestrogen
36
Why is obesity a risk factor for endometrial cancer?
Adipose tissue is a source of oestrogen
37
Why does ovarian cancer typically carry a poor prognosis?
Uusally diangosed late
38
What is the peak age of incidence of ovarian cancer?
60years
39
What is the most common type of ovarian cancer?
Epithelial origin-serous carcinomas
40
What is recognised as the site of origin of many ovarian cancers?
Distal end of the fallopian tubes
41
Where do epithelial ovarian cancers originate from?
Epithelium which lines the fimbria of the fallopian tubes or ovaries
42
Where do epithelial ovarian tumours typically spread to first?
  • Peritoneal cavity->m particularly bladder, paracolic gutters and diaphragm
43
Where do germ cell ovarian tumours typically originate from?
Germ cells in the embryonic gonad
44
Where do ovarian sex cord stromal tumours arise from?
Connective tissue
45
Which is more aggressive: sex cord stromal ovarian tumours or ovarian epithelial tumours?
Epithelial 
46
Which genes are associated with developing ovarian cancer?
BRCA1&2
47
Why does late stage ovarian cancer cause ascites
Vascular growth factors causing increased vessel permeability
48
When should CA125 not be used?
For screening for ovarian cancer in asymptomatic women
49
What is the most common type of vulval cancer?
Squamous cell carcinoma
50
Which skin cancers can affect the vulva?
  • Squamous cell carcinoma-most common
  • Basal cell carcinoma
  • Melanomas
51
What proportion of patients with lichen sclerosus get vulval cancer?
About 5%
52
What is vulval intraepithelial neoplasia?
Premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer
53
What type of VIN is associated with HPV infection and younger women?
High grade squamous intraepithelial lesion
54
Which type of VIN is associated with lichen sclerosus?
Differentiated VIN
55
What might be seen on a pelvic exam of a patient with endometriosis?
  • Tender, nodular masses may be palpable on ovaries or ligaments surrounding the uterus
  • Reduced organ mobility
  • Visible vaginal endometriotic lesions 
56
When do symptoms of adenomyosis tend to resolve?
After menopause
57
What might be found on examination of a patient with adenomyosis?
Enlarged and tender uterus
Feels more soft than a uterus containing fibroids
58
When is atrophic vaginitis most common?
After menopause
59
What is the difference between early and late miscarriages?
  • Early-most common: <13 weeks
  • Late: 13-24 weeks
60
What is the definitive way a miscarriage can be diagnosed?
Transvaginal US: fetal cardiac activity (from 5.5 weeks gestation)
Also fetal crown rump length(>7mm) and mean sac diameter
  • >25mm-failed pregnancy
  • <25mm: repeat scan in 10-14 days
61
What surgery would be performed in a miscarriage?
<12 weeks: manual vacuum aspiration
>12 weeks: evacuation of retained products of conception(ERPC)
62
What risks are associated with conservative management of msicarriage?
  • Allowing it to pass naturally
  • Risks: infection, heamorrhage
63
What risks are associated with surgical management of a miscarriage?
  • Infection
  • Uterine perforation
  • Haemorrhage
64
What would be seen on a transvaginal US in a threatened pregnancy?
  • Viable pregnancy
65
What would be seen on a transvaginal ultrasound of a patient with an inevitable miscarriage?
  • Internal cervical os open
  • Fetus viable or non-viable
66
What might be seen on a transvaginal US in a patient with a missed/delayed miscarriage?
  • No fetal heart pulsation where crown rump >7mm
67
What might be seen on an ultrasound of a patient who has had a complete miscarriage?
  • No POC in uterus
  • Endometrium <15mm diameter
  • Previous pregnancy proof
68
What might be found on examination of a patient with an ectopic pregnancy?
  • Bimanual exam: Cervical tenderness-Chandelier sign
  • Hameodynamic instability of ectopic ruptures, signs of peritonitis
  • Vaginal exam: Pouch of Douglas
69
When is IM methotrexate likely to be used as treatment for an ectopic pregnancy
Patients with:
  • Well controlled pain
  • B-HCG<1500iU
  • Unruptured and no visible heartbeat
70
What is the most common site for an ectopic pregnancy to occur?
  • Ampullary portion of fallopian tube
71
What is oligohydramnios?
Lower levels of amniotic fluid within the uterus
72
What results in low levels of amniotic fluid
  • Anything that decreases urine production, blocks urine outputs, or ruptures membranes
73
What is polyhydramnios?
  • Presence of too much amniotic fluid in the uterus
74
What is the first stage of labour?
  • Period that starts with regular uterine contractions and ends when cervix is fully dilated to 10cm
75
Which hormones are primarily indicated in the first stage of labour?
  • Prostaglandins and oxytocin
76
What is the second stage of labour?
  • Period from complete cervical dilation to delivery of the foetus
77
What is the third stage of labout?
  • Period beginning at the delivery of the foetus and ending with delivery of placenta and foetal membranes
78
What is pre-term labour?
  • Onset of regular uterine contractions and cervical changes occuring before 37 weeks gestation
79
What is preterm birth?
  • Delivery of baby >20wks but <37wks
80
What is the premature rupture of membranes?
  • Rupture of membranes at least one hour before onset of contractions
81
What is prolonged premature rupture of membranes?
  • Rupture of membranes >24 hours before onset of labour
82
What is pre-term premature rupture of the membranes?
  • Early rupture of the membranes <37 weeks gestation
83
What is menopause?
  • Permanent cessation of menstruation characterised by at lease 12 months of amenorrhoea in otherwise health women who aren't using contraception
84
What is the underlying cause of menopause?
  • Ovarian failure resulting in oestrogen deficiency
85
What is perimenopause?
  • Period when symptoms of menopause begin, continues until 12 months after last menstrual period
86
What is the difference between premature ovarian insufficiency and menopause?
  • Premature ovarian insufficiency: <40 years
87
When should oestrogen only HRT be used vs oestrogen and progesterone?
  • Oestrogen only: for women with a hysterectomy
  • Otherwise use combined
88
What medication can be used as a non hormonal treatment for menopause
  • Clonidine
  • alpha 2 adrenergic receptor agonist
89
What is the normal duration of a menstrual cycle?
  • 21-35 days
90
Which axis controls the menstrual cycle?
  • Hypothalamic-pituitary-gonadal axis
91
What is the role of FSH in menstruation?
  • Binds to granulosa cells to stimulate follicle growth, permit the conversion of androgens(from theca cells) to oestrogens and stimulate inhibin secretion
92
What is the role of LH in menstruation?
  • Acts on theca cells to stimulate production and secretion of androgens
93
What is the corpus luteum?
  • Tissue in the ovary that forms at the site of a ruptured follicle following ovulation. 
  • Produces oestrogens, progesteron and inhibin to maintain conditions ofr fertilisation and implantation
94
What produces HCG?
  • synctiotrophoblast of embryo
95
When does menses occur?
  • Start of new menstrual cycle
  • Occurs in absence of fertilisation when corpus luteum has broken down and internal lining of uterus is shed
96
What is PCOS?
  • Condition characterised by hyperandrogenism, ovulation disorders and polycystic ovarian morphology
97
What might be seen on imaging in a patient with PCOS?
  • Transvag/Transabdo US
  • Increased ovarian volume and multiple cysts
98
What might be found on blood tests of patients with PCOS
  • increase in LH:FSH ratio
  • prolactin normal or mildly raised
  • testosterone normal or mildly raised
  • sex hormone-binding globulin normal/low
99
What is the most common cause of Asherman's syndrome?
  • Post pregnancy related dilatation and curettgae procedure e.g. retianed products of conception
100
What is the prognosis of Asherman's syndrome like?
  • Recurrence of adhesions post treatment is common
101
When do congenital malformations of the female genital tract typically present?
  • Often not until or after puberty
102
What is ovotesticular disorder of sex development?
  • 'True hermaphroditism'
  • Presence of both ovarian and testicula tissue in single patient
  • Many menstruate and some can become pregnant
  • Treatment: remove contradictory organs and reconstruct external genitalia corresponding to sex of rearing-can wait until person can decide gender
103
What symptoms might someone with endometrial polyps present with?
  • Asx
  • Abnormal uterine bleeding: menorrhagia, intermenstrual bleeding
  • Postmenopausal bleeding
  • Infertility or recurrent pregnancy loss
104
What is pelvic inflammatory disease(PID)?
  • Infeciton/inflammation of the pelvic organs including uterus, fallopian tubes, ovaries and peritoneum, usually due to ascending infection form endocervix from vagina
105
What is urolithiasis?
  • Urinary tract stones-> solid concretions or crystal aggregations formed in urinary system from substances present in urine
106
What is the circular body of the breast?
  • Large and most prominent part of the breast
107
What is the axillary tail of the breast?
  • Inferior lateral edge or pec major towards axillary fossa
  • Nipple at centre surrounded by areola
108
Where do veins in the breast drain into?
  • Axillary and internal throacic veins
109
Where does the skin of the breast drain into?
  • Axillay, inferior deep cervical and infraclavicular nodes
110
Where does the nipple and areola of the breast drain into?
  • Drains to subareolar lymphatic plexus
111
Which hormones regulate the production and secretion of milk from the breast?
  • Prolactin 
  • Oxytocin
112
Where do fibroadenomas originate from?
  • Originate from lobules
113
Where does breast cancer most commonly metastasise to?
  • Bones
  • Liver
  • Lungs
  • Brain
114
What is the most common subtype of breast cancer?
  • Invasive ductal carcinoma
115
What is the difference between invasive and pre-invasive breast cancer?
  • Invassive: penetrated through the basement membrane
116
What screening is in place for breast cancer?
  • Mammogram every 3 years for women aged 50-70yrs
117
What is the criteria for a 2 week wait referral for breast cancer?
  • Unexplained breast lump in a woman >30yrs
  • >50 yrs with unilateral nipple changes: dicharge, retraction etc

Consider if:
  • Skin changes suggestive of breast cancer
  • >30yrs with a lump in axilla
118
What mammogram features might be seen in a patient with pre-invasive breast cancer?
  • Unifocal/widespread microcalcifications
119
What mammogram features might be seen in a patient with invasive breast cancer?
  • Irregular spiculated mass
  • Clustered microcalcifications
  • Linear branching calcifications
120
What surgical techniques might be used for a patient with breast cancer?
  • Tumour excision
  • Mastectomy
  • Breast reconstruction
  • Sentinel node biopsies durng surgeryy/axillary node clearance if invasive
121
When is radiotherapy used for breast cancer treatment?
  • Recommended after a wide local excision
  • Or after a mastectomy for those with >4 positive axillary nodes
122
When might chemotherapy be used for breast cancer treatment?
  • Downstage a primary lesion or after surgery depending on stage of tumour, e.g. if axillary node disease
123
Why is anastrazole used for post-menopausal women?
  • It's an aromatose inhibitor
  • Sromatisation accounts for majority of oestrogen production in post menopausal women
124
When is hormonal therapy offered to women?
  • If tumours are positive for hormone receptors
  • HER2 over expressing hormone receptor negative patients
125
What is Paget's disease of the nipple?
  • Rare condition characterised by the presence of cancer cells in the nipple
  • Often underlying DCIS/invasive breast cancer
126
What is the role of oxytocin in labour?
  • Surge in levels at onset of labour will contract the uterus
127
What is the role of prolactin in pregnancy
  • Starts the process of milk production in the mammary glands
128
What is the role of oestrogen in labour
  • Surges at onset of labour to inhibit progesterone to prepare the smooth muscles for labour
129
What is the role of prostaglandins in labour
  • Aid with cervical ripening
130
What is the role of beta endorphins in labour?
  • Natural pain relief
131
What is the role of adrenaline in labour?
  • Released when birth is imminent to give the woman energy for birth
132
What is meant by dilation in pregnancy and how is this measured?
  • Diameter of opening of the cervix
  • Measured in cm through vaginal exam
133
What is the most common pelvis type in females?
  • Gynaecoid

134
When does 'descent' stage of labour happen?
  • Can be from 37 weeks gestation onwards
  • Might not happen until established labour
135
What pain managment techniques might be used in labour
Non invasive: 
  • Water immersion
  • Massage
  • TENS machine

  • Entonox(gas and air)
  • Paracetemol
  • Codeine

  • Diamorphine
  • Pethidine
  • Remifentanyl
136
Whata re the disadvantages of using entotox?
  • Can cause nausea/light headedness
  • Effect wears off quickly
137
What is the ventouse?
  • Instrument that attaches a cup to a fetal head via a vacuum
138
What stage of labour should the decision for an operative vaginal delivery be based on?
  • 2nd stage of labour
139
What is the combined test?
  • Assesses chance of fetus having Down's, Edward's or Patau's using maternal and fetal measurements
140
When is the combined test done?
  • 11-14 weeks-anomaly screen
141
What things are measured in the combined test?
Maternal:
  • Age
  • Free B-HCG(high: downs, low: edwards.pataus)
  • Pregnancy associated plasma protein A-PAPP-A(low in all 3)
Fetus via US:
  • Nuchal translucency(high-Down's)
  • Crown Rump length
142
What is nuchal translucency?
  • Measure via US the thickness of the nuchal pad at the nape of the fetal neck
143
What is the quadruple test?
  • Screens for Down's syndreom
144
When is the quadruple test offered?
  • 14-20 weeks
145
What weeks are in 1st trimester?
  • 1-13
146
What weeks are in 2nd trimester?
  • 14-27
147
What weeks are in 3rd trimester?
  • 28-40
148
What things are check in the quadruple test?
  • Alpha fetoprotein(AFP)
  • hCG or free bhCG
  • Inhibin A
  • Unconjugated oestriol(uE3)
149
Which is more accurate-the combined test or the quadruple test?
  • Combined
  • Quadruple has a lower detection rate and higher screen positive rate
150
What is the cut off for combined/quadruple screening test?
1/150
  • Low: <1/150
  • High: >=1/150
151
What options are available for women who have been deemed higher risk of Down's syndrome?
  • No further testing
  • Non-invasive prenatal testing(NIPT)
  • Prenatal diagnostic testing
152
What is non-invasive prenatal testing(NIPT)?
  • Assess placental cell-free fetal DNA found in maternal blood and combines with mother's probability of a trisomy to provide a likelihood ratio
  • Screening test only-positive result needs to be confirmede through invasive testing
153
When is the anomaly scan offered?
  • 18-20+6 weeks
154
What is mastitis?
  • Inflammation of the breast tissue with/without infectoin associated with lactation
155
What is puerperal mastitis?
  • Mastitis associated with lactation in postpartum women
156
What organism is implicated in infective mastitis?
  • S.aureus
157
What organism most commonly causes bacterial vaginosis?
  • Mc gardnerella vaginalis
  • Often polymicrobial
158
What is the treaatment for bacterial vaginosis?
  • Oral/vaginal gel: metronidazole or clindamycin
  • Avoid douching, shampoos etc, recurrence is common
159
What is vulvovaginal candidiasis?
  • 'Yeast infection/thrush'
  • Fungal infection of lower reproductive tract
160
What should be done if treatement for vulvovaginal candidiasis fails?
  • Consider further ix
  • Assess risk factors-> diabetes control etc
  • Medication concordance
  • Specialist referral
161
Why is vulvovaginal candidiasis more common in pregnancy?
  • Oestrogen-> increased glycogen production-> promotes candida growth
162
What organism causes chlamydia?
  • Chlamydia trachomatis
  • Obligate intracellular gram negative organism
163
When would test of cure be done for chlamydia treatment?
  • Pregnant women
  • Poor complicance
  • Rectal infection
  • Persistent symptoms
164
What is the incubation period of gonorrhoea
  • 2-5 days
165
What might be seen on microscopy in a patient with v
  • Gram negative diplococci
  • Polymorphonucelar leukocytes
166
Which HPV strains are associated with cancer?
  • HPV 16/18-cervical cancer
167
What is the best treatment for genital warts in pregnancy?
  • Physical ablation
168
What should be monitored in patients with HIV?
  • CD4 count
  • HIV viral load
  • FBC
  • U&Es
  • Urinalysis
  • AST, ALT, bilirubin
169
What is PEP?
  • Post exposure prophylaxis
  • Given within 72 hours, lasts for 1 month
170
What medications are used in PEP?
  • Truvada(1 tablet daily) + raltegravir(1 tablet BD)
171
What would be seen on transvagianl US in a threatened miscarriage?
  • Viable pregnancy
172
What is the treatment for a threatened miscarriage?
  • Reassurance
  • If heavy: admit and observe
  • If >12 weeks + rhesus negative: Anti D
173
What is the role of misoprostol in miscarriage management?
  • Vaginal misoprostol-> stimulate cervical ripening and myometrial contractions
174
What should be done if the cause of polyhydramnios is idiopathic?
  • Baby's 1st feed needs to be examined
  • NG tube to check for fistula/atresia
175
Why is there a higher risk of postpartum haemorrhage in patient with polyhydramnios?
  • Uterus has to contract more to achieve haemostasis
176
What is the difference between post-term pregnancy and post dates pregnancy?
  • Post term: past 42 weeks
  • Post dates: pregnancy past estimated delivery date(EDD) or due date(40 weeks gestation)
177
What should be considered as a differential for prolonged pregnancy?
  • Consider inaccurate dating
  • Incidence of this has decreased now due to 11-14 week scans
178
What is the main complication of a prolonged pregnancy?
  • Stillbirth
179
What is placenta praevia?
  • Placenta lying over the cervical os

180
Why is it important to identify placenta praevia early?
  • Important cause of antepartum haemorrhage-> vaginal bleeding from 24 weeks gestation
181
What is placental abruption?
  • Part of all of the placenta separates from the uterus prematurely


182
What might be found on exam of a patient with placental abruption?
  • 'woody' uterus
  • Tense all the time and painful on palpation
183
What is meant by 'breech' presentation?
  • Baby present bottom down
184
When is a vaginal breech brith contraindicated?
  • Footling breech due to risk of head trapping
185
What is the difference between 'lie', 'presentation' and 'position' with regards to fetal position?
  • Fetal lie: relationship between long axis of fetus and mother
  • Presentation: fetal part that first enter the mother's pelvis
  • Position: fetal head position as it enters the birth canal
186
What is pre-eclampsia?
  • Placental condition affecting wmen from 20 weeks gestation characterised by hypertension and proteinuria
187
What is the criteria for pre-eclampsia?
Criteria:
  1. Htn(>140/90) on 2 occasions at least 4 hours apart
  2. Significant proteinuria >300mg protein in 24 hr sample or >30mg/mmol urinary protein: creatinine ratio
  3. Women >20 wks gestation
188
What should be given for magnesium sulfate toxicity
  • Calcium gluconate
189
What is the target MAP in a patient on treatment for eclampsia?
  • <120mmHg
190
What is trichomoniasis?
  • STI caused by flagellated protozoan parasite: trichomonas vaginalis
  • Primarily infects the urogenital tract
191
What kind of organism is trichomonas vaginalis?
  • Highly motile, flagellates protozoan parasite
192
What is the incubation period of trichomoniasis
  • 7 days
193
What is lymphogranuloma venereum?
  • STI caused by L1, L2 or L3 serovars of chlamydia trachomatis
194
What is the treatment for bacterial balanitis?
  • Oral flucloxacillin
  • Clarrithromycin in penicillin allergy
195
What is syphilis?
  • STI caused by the spircohete bacterium treponema pallidum
196
What is the incubation period of syphilis?
  • 9-90 days
197
What tests can be used to diagnose syphilis?
  • Dark field microscopy: shouldn't be used for oral lesions
  • PCR: oral lesions
  • Serological testing-main-used for screening, diagnosis confirmation and treatment monitoring
  • Serology usually done using a combination of treponemal and non-treponemal tests
198
What is the treatment for breast cysts?
  • If large/painful: might need draining
  • Usually no treatment
199
What is mammaary duct ectasia?
  • Dilatation of the large breast ducts
200
When is mammary duct ectasia most common?
  • Most common around the menopause
201
What might mammography look like in a patient with mammary duct ectasia?
  • Potentially similar to cancer
202
When does HELLP syndorme usually manifest?
  • 3rd trimester
203
What is the main risk of a cord prolapse?
  • Acute risk ro umbilical blood supply to infant
204
What is vasa praevia?
  • Fetal vessels unprotected by umbilical cord or placental tissue run dangerously close to or across the internal cervical os

205
What od fetal vessels lack the protection of?
  • Wharton's jelly
206
What is velamentous insertion?
  • Umbilical cord inserts into the chorioamniotic membranes instead of centrally into placental mass
207
What is puerperal psychosis?
  • Severe psych disorder that typicallly develops within the first 2 weeks following childbirth
208
What is the main risk of peurperal psychosis
  • Self harm/suicide
  • Harm to baby
209
What is postpartum depression?
  • Significant mood disorder that can develop any time up to one year after the birth of a baby
210
Which antidepressants are safe for use in breastfeeding?
  • SSRIs: sertraline and paroxetine
211
What needs to be balanced when deciding delivery time in a patient with PPROM?
  • Increased risk of maternal chorioamnionitis
  • Decreased risk of respiratory distress syndrome
212
What is postpartum haemorrhage?
  • Loss of >=500ml blood within the first 24 hours of a vaginal delivery
213
What is the difference between primary and secondary postpartum haemorrhage?
  • Primary: within 24 hours
  • Secondary: 24hours-12 weeks
214
What usually causes secondary postpartum haemorrhage?
  • Retained placental tissue or endometritis
215
What is the Kleihauer test?
  • Determines proportion of fetal RBCs present-used in rhesus negative pregnancies
216
What tests are used in rhesus negative pregnancies?
  • All babies born to rheesus negative mother will have cord blood taken for FBC, blood group and direct Coombs test
  • Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
  • Kelihauer test: add acid to maternal lood, fetal cells are resistant
217
What is the current law surrounding abortion in the UK?
  • 1967 abortion act
  • Abortion up to 24 weeks in most cases
218
What kind of medication is mifepristone and how does it work?
  • Progesterone antagonist
  • Blocks progesterone reqquired for continuation of pregnancy
219
What kind of medication is misoprostol and how does it work?
  • Prostaglandin analogue
  • Stimulates uterine myometrium contractions resulting in expulsion of uterine contentss
220
Where can medical termination of pregnancy occur?
  • Early: 0-9 weeks:: at home
  • 9-24weeks: clinic
221
What might be required for later pregnancies undergoing medical termination of pregnancies?
  • >=22 wweeks
  • Feticide(intracardiac KCl injection)-stops fetal heart before abortion
222
What options are there for surgical termination of pregnancy?
  • Suction termination
  • Dilatation and evacuation/curettage('D&C')
  • Cervical priming with misoprostol +/- mifepristone
  • Women generally offered local anaesthesia alone, conscious sedation with local anaethetics, deep sedation or general anaesthetic
223
When are women considered high risk for developing neural tube defects?
  • Either partner has a neural tube defect, previous pregnancy affected by NTD, or fhx
  • Women is taking antieepileptic drugs, has coeliac disease, diabetes or thalassaemia trait
  • Woman is obese: BMI>=30kg/m2
224
What screening is done for gestational diabetes?
  • Oral glucose tolerance test: OGTT
  • If previous gestational diabetes: OGTT asap after booking and at 24-28 weeks if first test normal
  • Any other risk factors: OFTT at 24-28 weeks
225
Whata re the features of pre-existing hypertension in pregnancy?
  • History of htn before pregnancy or elevated BP before 20 weeks gestation
  • No proteinuria or oedema
  • Mc in older women
  • 3-5% of pregnancies
226
What organism causes Group B strep infection?
  • Bacterium streptococcus agalactiae
227
What is obesity during pregnancy defined as?
BMI>30kg/m2 at first booking visit
228
What is the main consequence of cephalopelvic disproportion?
  • Obstructed labour-? dystocia etc
229
What is the most common cause of cephalopelvic disproportion?
  • Contracted pelvis with an average sized infant
230
What is prolonged labour?
  • AKA dystocia
  • Slow cervical dilation and/or descent of fetus, typically beyond expected time frame of 20 hrs for primigravida and 14 hrs for multigravida women
231
What is obstetric cholestasis?
  • AKA intra-hepatic cholestasis of pregnancy
  • Impaired bile flow-> accumulation of bile acids, typically manifests after 24 weeks
232
What is the main risk assoociated with obstetric cholestasis?
  • Risk of spontaneous intrauterine death
233
What is shoulder dystocia?
  • Type of obstructed labour where following delivery of fetal head the anterior shoulder becomes impacted behind maternal pubic symphysis
  • Complication of vaginal cephalic delivery
234
What is the McRoberts manoeuvre?
  • Hyperflexion and abduction of mother's legs tightly into abdoment
  • Applied suprapubic pressure
  • Routine traction in axial direction to assess if shoulders have been delivered
235
What is symphysiotomy?
  • Division of maternal symphysial ligament
236
What is the Zavanelli manoeuvre?
  • Replacement of head into canal and subsequent delivery via C section
237
What monitoring should be done following the delivery of a baby with shoulder dystocia?
  • Mother: examined for  PPH, severe perineal tears and genital tract trauma
  • Baby: examined by neonatologist for injury including brachial plexus injury, hypoxic brain injury, humeral/clavicle fractures
238
Why are pregnant women predisposed to anaemia?
  • During pregnancy: both plasma volume and RBC mass increase
  • Plasma volume increases disproportionately -> haemodilution effect
239
What screening is done for anaemia in pregnancy?
  • All screened at booking and at 28 weeks
  • Mutiple pregnancy: extra screenign at 20-28 weeks
240
What is treatment for micro/normo-cytic anaemia in pregnancy?
  • Mc: iron deficiency anaemia
  • Trial of oral iron(100-200mg)-repeat FBC after 2 weeks of treatment
  • Parental iron infusion considered if poor complicance or evidence of malabsorption
241
What is the treatment for beta thalassaemia in pregnancy>
  • Folate supplementation and blood transfusions as required
  • Aim for Hb of 80g/L during pregnancy and 100g/L at delivery
242
What is the treatment for sickle cell disease in pregnancy?
  • Folate supplementation and irone supplementation if lab evidence of iron deficiency
243
What is the incubation period and infectivity period of rubella?
  • Incubation period: 14-21 days
  • Infectious from 7 days before symptoms appear to 4 days after onset of rash
244
What signs/sympotms might newborn with congenital rubella syndrome have?
  • Sensorineural deafness
  • Cataracts or retinopathy
  • Congenital heart disease
Also:
  • Organ dysfunction
  • Microcephaly
  • Micrognathia
  • Haematological abnormalities
  • Low birth weight
  • Developmental delay and learning disability later in life
  • Characteristic petechial rash described as a 'blueberry muffin' rash
  • Cerebral palsy
  • 'Salt and pepper' chorioretinitis
245
Why is it important to check parvovirus B19 serology in patients who might have congenital rubella syndrome?
  • Difficult to distinguish rubella from parvovirus B19 clinically
  • Parvovirus B19-30% risk of transplacental infection with a 5-10% risk of fetal loss
246
When should MMR vaccines not be givenn?
  • Women known to be pregnant or attempting to be pregnancy
247
When is an amniotic fluid embolism most likely to occur?
  • During or shortly after labour
248
When is hyperemesis gravidarum most common?
  • Between 8-12 weeks
249
When should hospital admission be considered in patients with hyperemesis gravidarum?
  • Continued n+v and unable to keep down liquids/oral antiemetics
  • Continueed n+v +ketonuria +/- weight loss despite treatment of oral antiemetics
  • Confirmed/suspected comorbidity(e.g. unable to tolerate abx for UTI)
250
What risks are associated with metoclopramide use in pregnancy?
  • Can cause extrapyramidal side effects: don't use for >5 days
251
When does acute fatty liver of pregnancy most commonly develop?
  • Sx almost always ddevelop in 3rd trimester
252
When might liver transplantation be considered for acute fatty liver of pregnancy
  • Heaptic rupture
  • Acute liver failure 
  • Post birth
253
What thromboprophylaxis might be used in pregnancy?
  • LMWH
254
What VTE prophylaxis might be used in pregnancy?
  • LMWH
255
What is obstructed labour?
  • Failure of fetus to descend through the birth canal due to a barrier blocking its descent despite strong uterine contractions
  • Usually occurs at pelvic brim
256
What is ovarian hyperstimulation syndrome?
  • Complication arising from iatrogenic induction of ovulation, characterised by an exaggerated response to hormonal therapies used in procedures like IVF
257
What is the risk to the mother of exposure to VZV in pregnancy?
  • 5 times greater risk of pneumonitis
258
What is placental insufficiency?
  • Oxygen and nutrients aren't sufficiently transferred to the fetus via the placenta during pregnancy
259
When should a VTE assessment be completed in a pregnant woman?
  • At booking and on any subsequent hospital admission
260
What treatments/prophylaxis for VTE should be avoided in pregnancy?
  • DOACs
  • Warfarin
261
What kind of twin is more at risk of complications and needs to be monitored more closely?
  • Monozygotic
262
Why is the rate of dizygotic twins increasing?
  • Infertility treatment
263
What is twin-to-twin transfusion syndrome?
  • Severe condition that can occur in 10-15% of twins sharing a placenta(monochorionic twins)
264
What signs and symptoms might be exhibited in twin-to-twin transfusion syndrome
  • Heart failure in both twins
  • Fetal hydrops
  • Donor twin: high output cardiac failure: severe anaemia
  • Recipient twin: fluid overload due to excess blood volume
265
What is the most common puerperal infection and why?
  • Endometritis
  • Lining of uterus undergoes trauma and tears during the birthing process
266
Whata re the most common causes of puerperal infection?
  • S.pyogenes
  • S.auureus
  • E.coli
267
What is primary amenorrhoea?
  • Never had a period
  • 13+ no primary sex development
  • 15+ no secondary sex development
268
What is seconday amenorrhoea?
  • 6 montjs without a period in normal cucle
269
Whhat is an imperforated hymen?
  • Hymen blocks the passage of the vagina preventing menstrual blood and discharge
270
What is Sheehan's syndrome?
  • Postpartum hypopituitarism causing necrosis of pituitary secondary to hypovolaemic shock
271
When is serum progesterone measured?
  • 7 days before the end of the menstrual cycle(usually day 21)
272
What medications might be used for treating fertility?
  • Clomiphene
  • FSH and LH injections
  • GnRH or DA agonists
273
What surgical options are there for treating infertility?
  • Assisted reproductive technology including IVF or intracytoplasmic sperm injection
  • Treat underlying cause: e.g. fibroids, endo etc
274
Which location of an ectopic pregnancy would increase the risk of rupture?
  • Isthmus

3A med mine (12 decks)

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