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D TO REVISE - PHASE 3A > TO REVISE WOMENS HEALTH > Flashcards

TO REVISE WOMENS HEALTH Flashcards

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1
Q

UTIs IN PREGNANCY
what antibiotics are used to treat UTIs in pregnancy?

A

1st and 2nd trimester = nitrofurantoin

3rd trimester = amoxicillin or cefalexin if penicillin allergic

All are for 7 days

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2
Q

HYPEREMESIS
What is the diagnostic triad for hyperemesis gravidarum?

A

Triad –
- >5% weight loss compared to before pregnancy
- Dehydration
- Electrolyte imbalance

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3
Q

PLACENTA PRAEVIA
What are some risk factors for placenta praevia?

A
  • Embryos more likely to implant on lower segment scar from previous c-section
  • Multiple pregnancy
  • Multiparity
  • Previous praevia
  • Assisted conception
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4
Q

PLACENTAL ABRUPTION
What are the major risk factors for placental abruption?
What are some other risk factors?

A

ABRUPTION
Abruption previously
Blood pressure (HTN)
Ruptured membranes
Uterine injury
Polyhydramnios
Twins/multiple pregnancy
Infection (chorioamnionitis)
Older age (>35)
Narcotic use (cocaine)

+ smoking, IUGR

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5
Q

VASA PRAEVIA
What are some risk factors for vasa praevia?

A
  • Placenta praevia
  • Multiple pregnancy
  • IVF pregnancy
  • Bilobed placentas
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6
Q

PRE-ECLAMPSIA

What are the…

i) high risk
ii) moderate risk

factors for pre-eclampsia?

A

i) Pre-existing HTN, previous pre-eclampsia, CKD, autoimmune (SLE, T1DM)
ii) Nulliparity, multiple pregnancy, >10y pregnancy interval, FHx, >40y, BMI >35kg/m^2

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7
Q

IUGR
What are some maternal causes of IUGR?

A
  • Chronic disease (HTN, cardiac, CKD)
  • Substance abuse (cocaine, alcohol) smoking, previous SGA baby
  • Autoimmune
  • Low socioeconomic status
  • > 40
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8
Q

OLIGOHYDRAMNIOS
What are some causes of oligohydramnios?

A
  • PROM or SROM
  • Renal agenesis (Potter’s syndrome) or non-functional kidneys
  • Placental insufficiency (pre-eclampsia, post-term gestation) as blood redistributed to brain so reduced urine output
  • Genetic anomalies
  • Obstructive uropathy
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9
Q

POLYHYDRAMNIOS
What are the causes of polyhydramnios?

A
  • Increased foetal urine production (maternal DM), twin-twin transfusion, foetal hydrops
  • Foetal inability to swallow/absorb amniotic fluid (GI tract obstruction e.g. duodenal atresia, foetal neuro/muscular issues)
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10
Q

INFECTIONS + PREGNANCY
What are the risks of Varicella zoster?

A
  • Maternal risk = 5x greater risk of pneumonitis
  • Foetal varicella syndrome = skin scarring, microphthalmia, limb hypoplasia, microcephaly + learning difficulties
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11
Q

BREECH
What are some causes/risk factors for breech presentation?

A
  • Idiopathic
  • Prematurity as baby may not have turned itself yet
  • Previous breech
  • Uterine abnormalities (bicornuate uterus), fibroids
  • Placenta praevia
  • Foetal abnormalities (CNS malformation
  • Multiple pregnancy
  • Poly/oligohydramnios
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12
Q

UTERINE RUPTURE
What are some risk factors for uterine rupture?

A
  • VBAC
  • Previous uterine surgery
  • Increased BMI
  • High parity
  • Congenital uterine abnormalities
  • Oxytocin use
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13
Q

PPH
What are the risk factors for PPH?

A
  • Before birth = previous PPH, APH, twins/triplets, pre-eclampsia, obesity, polyhydramnios
  • Labour = prolonged, c-section, perineal tear or episiotomy, macrosomia
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14
Q

HYPEREMESIS
What are some associations of hyperemesis gravidarum?

A
  • nulliparity,
  • hyperthyroid,
  • obesity,
  • decreased in smokers
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15
Q

HELLP
what are the risk factors for HELLP?

A

➢ White ethnicity
➢ Maternal age >35 yrs.
➢ Obesity
➢ Chronic hypertension
➢ DM
➢ Autoimmune disorders
➢ Abnormal placentation and multiple gestation
➢ Previous pregnancy with preeclampsia

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16
Q

HELLP
what is the management for HELLP?

A

➢ Seizure prophylaxis (magnesium sulfate), IV dexamethasone, labetalol. IM beclametasone
when patient <36wks
➢ Delivery is definitive treatment (should be done when patient is 37+ wks)

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17
Q

LOW BIRTH WEIGHT
what are the causes of low birth weight?

A

➢ Preterm birth (before 37 weeks gestation)
➢ Genetics (could be chromosomal abnormalities…)
➢ Uteroplacental insufficiency
➢ Multiple pregnancy
➢ Substance abuse (smoking, drinking alcohol, illicit drug) causing IUGR
➢ Chronic conditions and infections (hypertension, rubella, CMV, syphilis, toxoplasmosis, BV…)
➢ Medications (sodium valproate, ramipril, warfarin…)

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18
Q

UTEROPLACENTAL INSUFFICIENCY
what are the causes of uteroplacental insufficiency?

A

➢Abnormal trophoblast invasion:
▪ Pre-eclampsia
▪ Placenta accreta
➢ Abruption
➢ Infarction
➢ Placenta previa
➢ Tumor: chorioangiomas
➢ Abnormal umbilical cord or cord insertion (i.e., two vessel cord)
➢ Maternal diabetes
➢ Maternal hypertension
➢ Anemia
➢ Smoking
➢ Drug abuse (cocaine, heroin, methamphetamine)
➢ Antiphospholipid syndrome
➢ Renal disease
➢ Advanced age

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19
Q

UTIs IN PREGNANCY
what are the antenatal risk factors for UTIs?

A
  • previous infection
  • renal stones
  • diabetes mellitus
  • immunosuppression
  • polycystic kidneys
  • congenital abnormalites of renal tract
  • neuropathic bladder
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20
Q

UTIs IN PREGNANCY
which antibiotics should be avoided in the third trimester and why?

A
  • nitrofurantoin - risk of haemolytic anaemia in newborn with G6PD
  • sulfonamides - risk of kernicterus in newborn due to displacement of protein binding of bilirubin
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21
Q

UTIs IN PREGNANCY
which antibiotics are contraindicated in pregnancy?

A
  • tetracyclines - cause permanent staining of teeth and problems with skeletal development
  • ciprofloxacin - causes skeletal problems
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22
Q

FIBROIDS
What are some risk factors for fibroids?

A
  • Afro-Caribbean
  • Obesity
  • Early menarche
  • FHx
  • Increasing age (until menopause)
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23
Q

PCOS
What diagnostic criteria is used in PCOS?

A

Rotterdam criteria (≥2) –
- Oligo- or anovulation (may present as oligo- or amenorrhoea)
- Hyperandrogenism (biochemical or clinical)
- Polycystic ovaries (≥12) or ovarian volume >10cm^3 on USS

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24
Q

PCOS
What are some associations and complications of PCOS?

A
  • DM, CVD + hypercholesterolaemia
  • Obstructive sleep apnoea, MH issues, sexual problems
  • Endometrial hyperplasia or cancer
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25
PCOS What are the PCOS risk factors for endometrial cancer? How is the risk of endometrial cancer managed in PCOS?
- Obesity, DM, insulin resistance, amenorrhoea - Mirena coil for continuous endometrial protection - Induce withdrawal bleed AT LEAST every 3m with COCP or cyclical progesterones medroxyprogesterone 10mg 14d)
26
OVARIAN CANCER What are some risk factors of ovarian cancer?
Unopposed oestrogen + increased # of ovulations – - Early menarche - Late menopause - Increased age - Endometriosis - Obesity + smoking Genetics (BRCA1/2, HNPCC/lynch syndrome)
27
OVARIAN CANCER Hence, what are some protective factors of ovarian cancer?
- COCP - Early menopause - Breast feeding - Childbearing
28
ENDOMETRIAL CANCER What are some risk factors for endometrial cancer?
Unopposed oestrogen – - Obesity (adipose tissue contains aromatase) - Nulliparous - Early menarche - Late menopause - Oestrogen-only HRT - Tamoxifen - PCOS - Increased age - T2DM - HNPCC (Lynch syndrome)
29
MENOPAUSE What is the management of menopause in more severe cases?
- HRT first-line for vaso-motor Sx as most effective - Clonidine (alpha adrenergic receptor agonist) second line with low-dose antidepressants like venlafaxine (not C/I in breast cancer Tx) or fluoxetine - CBT - Vaginal oestrogen cream/tablets + moisturisers for dryness
30
HRT What are the side effects associated with oestrogen?
- Nausea, - bloating, - headaches, - breast swelling or tenderness, - leg cramps
31
URINARY INCONTINENCE What is the mechanism of action of anti-muscarinics?
- Parasympathetic so Pissing = decreases need to urinate + spasms
32
URINARY INCONTINENCE What is the mechanism of action of beta-3-adrenergic agonists?
- Sympathetic so Storage = relaxes detrusor + increases bladder capacity
33
URINARY INCONTINENCE What are the surgical interventions for stress incontinence?
- Colposuspension - Tension free vaginal tape (TVT) - Autologous sling procedures (TVT but strip of fascia from abdo wall)
34
HRT What are the side effects associated with progesterone?
Mood swings, fluid retention, weight gain, acne greasy skin
35
HYDATIDIFORM MOLE What are some risk factors for hydatidiform mole?
- Extremes of reproductive age - Previous molar pregnancy - Multiple pregnancies - Asian women - OCP
36
PELVIC INFLAMMATORY DISEASE What are the non-infective causes of PID?
- Post-partum (retained tissue), - uterine instrumentation (hysteroscopy, IUCD), - descended from other organs (appendicitis)
37
URINARY INCONTINENCE What are some side effects of anti-muscarinics?
- "Can't see, spit, pee or shit" > caution in elderly as falls esp oxybutynin immediate release in frail
38
BACTERIAL VAGINOSIS What are the risk factors of bacterial vaginosis?
- Multiple sexual partners - Excessive vaginal cleaning - Recent Abx - Smoking - IUD
39
TRICHOMONAS VAGINALIS What is the clinical presentation of TV?
- PV discharge classically offensive, frothy + yellow/green. - Vulvovaginitis, itching, dysuria + dyspareunia. - May cause urethritis + balanitis in men
40
SYPHILIS How would you manage syphilis?
- Specialist GUM (full STI screening, contact tracing, contraceptive information). - Single dose IM benzathine benzylpenicillin or PO doxycycline if allergic
41
CANDIDIASIS What treatment should be used in pregnancy?
Clotrimazole in pregnancy as fluconazole can cause congenital abnormalities
42
BALANITIS what is the treatment for bacterial infection?
flucloxacillin or clarithromycin if penicillin allergic
43
LYMPHOGRANULOMA VENEREUM what are the clinical features?
Painless genital ulcer Appears 3-12 days after infection May not be noticeable e.g. if occurs inside the vagina Inguinal lymphadenopathy Proctitis, rectal pain, rectal discharge (in rectal infections) Systemic symptoms such as fever and malaise
44
CHANCROID what are the clinical features?
A painful genital lesion which may bleed on contact Associated symptoms include painful lymphadenopathy
45
CHANCROID what is the management?
The infection is treated using antibiotics (typically Ceftriaxone, Azithromycin or Ciprofloxacin)
46
COCP What are some side effects + risks with the COCP?
- Unscheduled bleeding common in first 3m. - Breast pain + tenderness. - Mood changes + depression. - Headaches, HTN, VTE. - Small raise in risk of breast + cervical cancer (risk normalises after 10y taking pill). - Small raise in risk of MI + stroke.
47
COILS What are the drawbacks of the IUD?
- Procedure with risks for insertion/removal. - Can cause HMB/IMB which often settles. - Some women have pelvic pain. - No STI protection. - Increased risk of ectopic pregnancies. - Occasionally falls out.
48
EMERGENCY CONTRACEPTION For Ulipristal acetate, what are the pros and cons?
Pros - More effective than levonorgestrel - Can be used >1 in one cycle Cons - Avoid breastfeeding for 1w (express but discard) - Avoid in severe asthma - Wait 5d before starting COCP or POP with 7 or 2d extra contraception needed
49
FEMALE INFERTILITY What are some risk factors of infertility?
- Extremes of weight - Increasing age - Smoking - Alcohol/drug use
50
ASSISTED CONCEPTION What are the risk factors for ovarian hyperstimulation syndrome?
- Younger age. - Lower BMI. - PCOS. - Higher antral follicle count.
51
GYNAECOMASTIA What are some pathological causes of gynaecomastia?
- Drugs (spironolactone, oestrogen, anabolic steroids) - Marijuana - Liver failure - Testicular failure or tumour (Can produce beta-hCG)
52
BREAST CANCER what are the complications of tamoxifen?
hot flushes nausea vaginal bleeding rarely thrombosis and endometrial cancer
53
BREAST CANCER what are the side effects of aromatase inhibitors?
hot flushes reduced bone density joint pains
54
POI What are some causes of POI?
- Majority idiopathic - Iatrogenic (chemo/radio, oophorectomy) - Autoimmune (coeliac, T1DM) - Genetic (FHx, Turner's) - Infections (mumps, TB, CMV)
55
THYROID + PREGNANCY What is post-partum thyroiditis?
3 stages – - Thyrotoxicosis (3m) - Hypothyroidism (3–6m) - Normal thyroid function Sx control of thyrotoxicosis, treat hypothyroidism with levothyroxine Just need TFTs to Dx if within 12m of giving birth + Sx
56
PREMATURITY What is the prophylaxis for prematurity and how do they work?
- Progesterone gel or pessary decreases activity of myometrium + prevents cervix remodelling in preparation for delivery - Cervical cerclage = ≥1 sutures to strengthen + keep cervix closed - 'Rescue' cerclage to halt delivery
57
PREMATURITY What are the indications for... i) progesterone prophylaxis? ii) cervical cerclage? iii) 'rescue' cerclage?
i) Cervical length <25mm on TVS at 16–24w ii) Cervical length <25mm on TVS at 16–24w, previous premature birth or cervical trauma (colposcopy, cone biopsy) iii) Cervical dilatation without ROM at 16–27+6 with no infection, bleeding or contractions
58
MATERNAL SEPSIS What are the investigations for maternal sepsis?
- Monitor Maternal Early Obstetric Warning Score (MEOWS) - Warning signs of sepsis (3Ts white with sugar)
59
MATERNAL SEPSIS What are the warning signs of sepsis?
3Ts white with sugar – - Temp <36 or >38 - Tachycardia >90bpm - Tachypnoea >20bpm - WCC >12 or <4 - Hyperglycaemia >7.7mmol/L in absence of diabetes
60
MATERNAL SEPSIS What are the SEPSIS 6 components?
BUFALO (3 in, 3 out) – - Blood cultures (out) - Urine output by catheter (hourly, out) - Fluids resus (IV, in) - Abx (IV broad-spec, in) - Lactate (ABG, out) - Oxygen (high flow SpO2 >94%, in)
61
PREGNANCY PHYSIOLOGY What hormones increase in regards to the anterior pituitary gland?
- ACTH = rise in steroid hormones (cortisol, aldosterone) = improves autoimmune conditions (RA) but susceptible to DM + infections - Prolactin = suppresses FSH + LH - Melanocyte stimulating hormone = increased skin pigmentation (linea nigra + melasma = brown pigmentation)
62
PREGNANCY PHYSIOLOGY What other hormones rise in pregnancy?
- T3/T4 - HCG = doubles every 48h until plateau at 8–12w then gradual fall - Progesterone - Oestrogen
63
PREGNANCY PHYSIOLOGY In terms of the cardiovascular system in pregnancy, what... i) increases? ii) decreases?
i) Blood volume, plasma volume, CO (as increased SV + HR) ii) Peripheral vascular resistance (can cause flushing + hot sweats) + BP in early-mid pregnancy but returns to normal by term
64
PREGNANCY PHYSIOLOGY In terms of the respiratory system, what are the biochemical changes?
- Increased oxygen consumption (20%) + RR - Compensated resp alkalosis may occur as increased pO2 + reduced pCO2 (facilitates foetal CO2 excretion), renal HCO3- excretion to prevent this - Increased 2,3 DPG to promote maternal Hb to release oxygen
65
PREGNANCY PHYSIOLOGY What 4 forces/pressures govern fluid retention in pregnancy?
- Capillary (hydrostatic) pressure of blood in vessel = draws fluid OUT - Interstitial fluid colloid oncotic pressure of proteins in interstitial fluid = draws fluid OUT - Interstitial fluid pressure of tissues surrounding vessel = draws fluid IN - Plasma colloid oncotic pressure (albumin) = draws fluid IN
66
PREGNANCY PHYSIOLOGY In terms of haematology in pregnancy, what... i) increases? ii) decreases?
i) WBCs, ESR, d-dimers, ALP ii) Platelets, albumin
67
PREGNANCY PHYSIOLOGY In pregnancy, what changes to the humoral and cell-mediated immunity?
- Humoral = unchanged, plenty of circulating Th2 cells to fight infections (antibodies) - Cell-mediated = reduced as progesterone down regulates production of Th1 cells (phagocytes, cytotoxic T lymphocytes)
68
REPRODUCTION What are the different stages in follicular genesis and what stage in the cell cycle are they?
- Primordial follicles = diploid, arrested at prophase I - Primary follicle = diploid, undergoing meiosis I - Secondary follicle = haploid, once meiosis I complete - Antral (Graafian) follicle = haploid, frozen in metaphase II
69
REPRODUCTION What happens immediately after fertilisation?
- Cell rapidly divides > mass of cells (morula) travels to uterus - Fluid filled cavity (blastocele) expands to form blastocyst (>80 cells) with outer layer (trophoblast) + inner layer (embryoblast)
70
REPRODUCTION What are the main hormones produced by the placenta?
- hCG (maintain corpus luteum) - Oestrogen - Progesterone - Human placenta lactogen
71
REPRODUCTION What is the role of oestrogen in pregnancy?
- Softening tissue > more flexible, allows muscles + ligaments of uterus and pelvis to expand + cervix become soft - Enlarges + prepares breasts + nipples for breast feeding - E3 declines with foetal distress, E2 increases endometrial progesterone receptors
72
REPRODUCTION What is the role of progesterone in pregnancy?
- Produced by corpus luteum until 10w - Initially prepares endometrium for implantation by proliferation, vascularisation + decidual reaction - Later, maintains pregnancy by preventing contraction - Relaxation elsewhere > heartburn, constipation, hypotension
73
MENSTRUAL CYCLE what happens during the follicular phase?
- rising levels of FSH stimulates developing follicles to produce oestrogen - oestrogen inhibits FSH leading to one dominant follicle - follicle starts developing LH receptors - egg completes first meiotic division - oestrogen levels cause positive feedback leading to LH surge
74
MENSTRUAL CYCLE What happens in the early secretory phase of the menstrual cycle?
- after ovulation progesterone predominates - changes from focusing on growth to preparing for implantation - development of complex glands, increased spiral arterioles - endometrial cells produce and store glycogen
75
MENSTRUAL CYCLE What happens in the late secretory phase of the menstrual cycle?
- Cervical mucus thickens + less hospitable for sperm - Decrease in oestrogen + progesterone > spiral arteries collapse + constrict + functional layer prepares to shred
76
MENSTRUAL CYCLE What are the stages of the menstrual cycle?
- Menstruation (Days 1-5) - Proliferation (Days 6-14) - Ovulation (Day 14) - Secretion (Days 16-28)
77
MENSTRUAL CYCLE What happens in the proliferative phase?
- endometrium grows under influence of oestrogen - oestrogen causes hyperplasia of the endometrium - early development of glands and spiral arterioles
78
MENSTRUAL CYCLE what are the stages of the ovarian cycle?
follicular phase luteal phase
79
MENSTRUAL CYCLE what happens during the luteal phase?
- follicle becomes corpus luteum (lifespan of 14 days) - corpus luteum secretes progesterone which peaks 7 days after ovulation unless maintained by pregnancy - falling progesterone causes menstrual bleeding
80
MENSTRUAL CYCLE What happens during the menstrual phase?
- falling levels of progesterone cause shedding of endometrium - spasm of spiral arteries - ischaemic necrosis - generalised inflammation

D TO REVISE - PHASE 3A (9 decks)

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