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Phase 3a/4 > Women's > Flashcards

Women's Flashcards

1
Q

describe the hormonal changes in pregnancy

A

↑ acth = ↑ cortisol + aldosterone
↑ prolactin
↑ T3/4
↑ progesterone - to maintain pregnancy
↑oestrogen - produced by placenta

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2
Q

describe the resproductive system changes in pregnancy

A

uterus increase in size = hypertrophy/hyperplasia
cervical discharge
hypertrophy of vaginal muscles + vaginal discharge

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3
Q

describe the CVS changes in pregnancy

A

↑ blood volume
↑ plasma volume
↑ cardiac output/stroke volume/heart rate
↓ peripheral vasc resistance
↓ blood pressure in early/mid pregnancy
varicose veins
peripheral vasodilation = flushing/hot sweats

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4
Q

describe the respiratory changes in pregnancy

A

increase tidal volume
increase resp rate

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5
Q

describe the renal changes in pregnancy

A

↑ renal blood flow
↑ GFR
↑ aldosterone = ↑ Na/water retention
↑ protein excretion
LESS urea + creatinine
dilatation of ureters and collecting system = hydonephrosis

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6
Q

describe the haematological changes in pregnancy

A

↑ RBC
↑ iron/folate/B12/calcium requirements
↑ WBC
↑ ESR/d dimer
↑ ALP (secreted by placenta)

↓haemoglobin concentration
↓ clotting factors/fibrinogen
↓ haemocrit
↓ platelets
↓ albumin (loss thru kidneys)

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7
Q

describe the skin and hair changes in pregnancy

A

increase pigmentation due to ↑ melanocyte stimulating hormone = linea nigra and melasma
striae gravidarum
pruitus
spider naevi
palmar erythema
postpartum hair loss

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8
Q

describe the GI changes in pregnancy

A

delayed gastric emptying
cardiac sphincter relaxation (= heart burn)
reduced secretion of CCK from GB
increased risk of gallstones
dyspepsia
slower gut transit time
small bowel = increase nutrient uptake
large bowel = increased water absorption = constipation risk

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9
Q

what is an ovarian cyst and what is the main type

A

fluid filled sac
functional = common in premenopausal + fluctuate with hormones
= follicular cyst most common but not harmful
= corpus luteum cyst can cause pain/discomfort/delayed menstruation

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10
Q

describe 5 other types of ovarian cysts

A
  1. serous cystadenoma = benign
  2. mucinous cystadenoma = benign but can become huge
  3. endometrioma = endometriosis lumps of tissue = pain/disrupt ovulation
  4. dermoid cyst/germ cell tumour = benign, associated with torsion
  5. sex cord-stromal tumours = rare, can be malignant
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11
Q

what features suggest ovarian cyst malignancy

A

abdo bloating
reduced appetite
weight loss
urinary symptoms
pain
ascites/lymphadenopathy

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12
Q

describe the investigations and management for a simple/small ovarian cyst

A

blood test
USS
CT or MRI if unable to see on USS
laparoscopy and fine needle aspirate
premenopausal + simple cyst <5cm on USS = no further
rule out pregnancy + CA125 tumour marker

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13
Q

what is the tumour marker for ovarian cancer and what does a raised marker indicate

A

CA125
raised = not specific:
endometriosis
fibroids
adenomyosis
pelvic infection
liver disease
pregnancy

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14
Q

what is the risk of malignancy index

A

RMI = risk of malignant ovarian mass:
1. menopausal status
2. USS findings
3. CA125 level

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15
Q

describe the management for a larger ovarian cyst

A

5-7cm - refer to gynae and yearly USS
>7cm - MRI or surgical evaluation = laparoscopy/ovarian cystectoomy/oopherctomy

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16
Q

what are the complications of an ovarian cyst

A

= ACUTE ONSET PAIN
torsion
haemorrhage into the cyst
rupture = bleeding into peritoneum

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17
Q

what is Meig’s syndrome

A

triad:
1. ovarian fibroma (mass)
2. pleural effusion
3. ascites
= older women
= remove tumour to resolve effusion/ascites

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18
Q

what is early miscarriage vs late miscarriage

A

spontaneous termination of pregnancy
early = before 12 weeks
late = 12-24 weeks gestation

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19
Q

what is a missed miscarriage

A

fetus no longer alive but no symptoms

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20
Q

what is a threatened miscarriage

A

vaginal bleeding with closed cervix and alive foetus

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21
Q

what is an inevitable miscarriage

A

vaginal bleeding and open cervix (finger into internal os)

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22
Q

what is an incomplete miscarriage vs complete miscarriage

A

incomplete = retained products of conception remain in uterus = may need medical/surgical management for miscarriage
complete = full miscarriage, no products left in uterus

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23
Q

what is an anembryonic pregnancy

A

gestational sac present but no embryo

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24
Q

how is a miscarriage diagnosed

A

transvaginal USS
1. mean gestational sac diameter (should be >25mm before pole)
2. fetal pole and crown-rump length (should be >7mm before heartbeat)
3. fetal heartbeat = pregnancy considered viable

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25
Q

how is a miscarriage <6 weeks gestation managed

A

expectantly = allow natural course
repeat urine test 7-10 days

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26
Q

how is a miscarriage >6 weeks gestation managed

A

early pregnancy assessment unit = USS
1. expectant
2. medical = misoprostol = prostaglandin analogue
3. surgical = manual/electric vacuum aspiration

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27
Q

describe the medical management of miscarriage

A

misoprostol = prostaglandin analogue
softens cervix and stimualtes contracions
vaginal suppository/oral dose
SE of bleeding/nausea/vomiting/diarrhoea

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28
Q

what is the most common site of ectopic pregnancy

A

fallopian tubes

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29
Q

what are the risk factors for ectopic pregnancy

A

previous ectopic
previous PID
previous surgery to fallopian tube
coils
older age
smoking

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30
Q

how does ectopic pregnancy present

A

6-8 weeks
missed period
constant LIF/RIF pain
vaginal bleeding
lower abdo/pelvic pain
cervical motion tenderness

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31
Q

describe the findings on transvaginal USS of ectopic pregnancy

A

gestational sac in fallopian tube
mass moving separately to ovary
empty uterus
fluid in uterus

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32
Q

describe a pregnancy of unknown location

A

positive test but no evidence on USS
= monitor hCG:
should rise by >63% in 48hrs = normal pregnancy
rise <63% = ectopic
fall >50% = miscarriage

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33
Q

describe the management for ectopic pregnancy

A
  1. expectant - monitor
  2. medical = methotrexate
  3. surgical =laproscopic salpingectomy 1st line
    laparoscopic salpingotomy may be used if increased risk of infertility = remove ectopic but fallopian tube remains
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34
Q

what is hyperemesis gravidarum

A

excessive vomiting with dehydration and ketosis
thought that higher hCG = more vomiting/nausea
start 4-7 weeks
worst 10-12 weeks
resolve 16-20

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35
Q

what is the diagnostic criteria for hyperemesis gravidarum

A

more than 5% weight loss
dehydration
electrolyte imbalance

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36
Q

describe the antiemetics used in pregnancy

A
  1. prochlorperazine (stemetil)
  2. cyclizine
  3. ondansetron
  4. metoclopramide
    (ranitidine or omeprazole if bad reflux)
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37
Q

how is moderate/severe hyperemesis gravidarum managed

A

= unable to tolerate oral
= ketones present on dipstick
1. admit to hospital
2. IV/IM antiemetics
3. IV fluids
4. monitor U&E
5. thiamine supplements
6. thromboprophylaxis

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38
Q

what is menopause

A

retrospective diagnosis after no periods for 12 months = end of menstruation
average age 51 years

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39
Q

what is perimenopause

A

period leading up to menopause
irregular periods
mood swings
hot flushes
urogenital atrophy
women >45 years

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40
Q

describe the physiology of menopause

A

lack of ovarian follicular function
= oestrogen and progesterone LOW
= LH/FSH are HIGH due to absence of negative feedback

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41
Q

describe the symptoms of perimenopause

A

hot flushes
emotional instability
PMS symptoms
irregular periods
heavier/lighter perods
vaginal dryness/atrophy
reduced libido

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42
Q

what risks are associated with perimenopause

A

CVS/stroke
osteoporosis
pelvic organ prolapse
urinary incontinence

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43
Q

why is the progesterone depot injection unsuitable for women over 45 years old and when else is it CONTRAINDICATED

A

SE = weight gain and reduced mineral bone density
contraindicated in current breast cancer

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44
Q

describe the benefits of HRT

A

relief of menopause symptoms
bone mineral density protection
possible prevent long term morbidity

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45
Q

describe the risks of HRT

A

breast cancer
VTE - oral HRT increases risk
CVS disease - fine if started under 60y/o or monitored well
stroke - oral HRT increases risk

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46
Q

how should HRT be given in women with intact uterus

A

need progestogen to be given with oestrogen to protect endometrium from over-proliferating = neoplasm risk (oestrogen effect)

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47
Q

what is the difference between sequential and continuous combined form of HRT

A

oestrogen everyday
sequential = progesterone 12-14 days every 4 weeks = bleeding
continuous combined = progesterone every day = no bleeding

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48
Q

what is Tibolone

A

synthetic form of continuous combined HRT taken daily

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49
Q

how is HRT given in those without a uterus/ with a MIRENA in situ

A

mirena = already supplies progesterone
= no progesterone needed in combination with oestrogen

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50
Q

when is transdermal HRT given

A

malabsoprtion syndromes
need for steady absorption (epilepsy)
medical conditions

older women
increased risk of VTE

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51
Q

what is premature ovarian insufficiency POI

A

menopause <40 y/o
= hypergonadotrophic hypogonadism
= under-activity in gonads = lack of negative feedback on pituitary gland = excess of gonadotrophins
= ↑ FSH/LH
= low oestradiol

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52
Q

what are the causes of POI

A

idiopathic (50%)
iatrogenic - chemo/radio/surgery
autoimmune - associated coeliac, T1DM, adrenal insufficiency
genetic
infections - mumps/TB/CMV

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53
Q

how does POI present and how is it diagnosed

A

irregular/lack of menstrual periods
hot flushes
night sweats
vaginal dryness
diagnosis = symptoms + <40 y/o + persistently raised FSH

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54
Q

what conditions are women with POI at risk of

A

CVS disease
stroke
osteoporosis
cognitive impairment
dementia
parkinsons

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55
Q

how is POI managed

A

HRT until 51 y/o
traditional hrt OR combined OCP
* can still be fertile so contraception is needed*

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56
Q

describe some non hormonal treatments for menopause

A

CBT
SSRI antidepressants
antiepileptics

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57
Q

what are some contraindications for HRT

A

breast cancer current or past
known or suspected oestrogen-dependent cancer
undiagnosed vaginal bleeding
VTE previous or current

acute liver disease
pregnancy
thrombophilic disorder

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58
Q

what is the puerperium and what are the features

A

delivery of placenta to 6 weeks following birth
= return to prepregnant state
= intitiation/suppression lactation
= trasnition to parenthood

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59
Q

describe the prolactin response with breast feeding

A

baby suckles
prolatin secreted by ant. pit. goes to breasts
lactocytes produce milk
suppresses ovulation
more at night

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60
Q

describe the oxytocin reflex in breastfeeding

A

baby suckles
oxytocin secreted by post. pit. goes to breasts
myoepithelial cells contract to expel milk
helped by senses of baby
happens before and after feed

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61
Q

what is lactoferrin and what does it do

A

functional protein in breast milk
high colostrum earlier
regulates Fe absorpt
protects against bacteria/viruses/funghi
helps regulate bone marrow function
boost immune system

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62
Q

what are the signs of sepsis in a new mother

A

3 Ts with sugar
Temp <36 or >38
Tachycardia >90bpm
Tachypnoea >20
Hyperglycaemia >7.7mmol
WBC >12 or <4(x10^9)

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63
Q

what is adenomyosis and who is it more common in

A

endometrial tissue inside myometrium = muscle layer of uterus
10% of women
premenopausal women but older than endometriosis
previous uterine surgery

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64
Q

how does adenomyosis present

A

dysmenorrhoea
menorrhoea
dyspareunia (pain in intercourse)
fertility/pregnancy complications
examination = enlarged and tender uterus

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65
Q

how is adenomyosis diagnosed

A

transvaginal USS = 1st line
MRI/transabdo USS = alternate
GOLD STD = histological exam after hysterectomy but not always possible

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66
Q

how is adenomyosis managed

A

depends on sympt/age/pregnancy plans
same Tx as for menorrhagia
specialist options = GnRH to induce menopause or endometrial ablation or hysterectomy

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67
Q

what are some complications of adenomyosis

A

infertility
miscarriage
preterm birth/rupture of membranes
small for gestational age
postpartum haemorrhage

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68
Q

describe the different types of fibroids

A

intramural = within myometrium
subserosal = just below outer layer uterus = can fill abdo cavity
submucosal = below lining of uterus
pedunculated = on a stallk

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69
Q

a pregnant woman with history of fibroids presents with severe abdo pain and low grade fever - likely diagnosis?

A

red degeneration of fibroids

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70
Q

what is pelvic congestion syndrome

A

incompetence of pelvic vein valves
typical after pregnancy
occurs in 1 in 5 with varicose veins

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71
Q

what are the features of pelvic congestion syndrome

A

constant dull ache lower abdomen
worse after standing/prolonged standing or after intercourse
can cause interstitial cystitis

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72
Q

what is salpingitis, oophoritis and parametritis

A

salpingitis = inflammation of fallopian tubes
oophoritis = inflammation of ovaries
parametritis = inflammation of the parametrium (connective tissue around uterus)

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73
Q

what is a vault prolapse

A

hysterectomy = no uterus
top of vagina descends into vagina

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74
Q

what is a rectocele

A

defect of post. wall of vagina = rectum prolapse into vagina
= causes constipation and urinary retention
= can use fingers to temporarily fix

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75
Q

what is a cystocele

A

ant. vagina wall defect = bladder prolapse backwards into vagina
urethra prolapse also possible = urethrocele

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76
Q

what are some risk factors for pelvic organ prolapse

A

multiple vaginal deliveries
prolonged/traumatic delivery
advanced age an post menopause
obesity
chronic resp disease causing coughing
chronic constipation causing straining

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77
Q

describe the pregnancy trimesters

A

1st = conception to 12 weeks
2nd = 13-26 weeks
3rd = 27 weeks until birth

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78
Q

what is an USS used to assess in pregnancy

A

assess growth
liquor volume
umbilical artery doppler
= if abnormal then placenta is insufficient

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79
Q

what mneumonic is used for CTG interpretation

A

CTG = cardiotocography
Dr = define risk
C = contractions
Bra = baseline rate
V = variability
A = accelerations
D = decelerations (early/variable/late)
O = overall assessment

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80
Q

when is CTG used, when is it suspicious and when is it pathological

A

high risk pregnancies in hospital
suspicious = 1 non-reassuring feature
pathological = 2+ non reassuring feature or 1+ abnormal feature

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81
Q

what is the gold standard for fetal heart monitoring

A

fetal scalp ECG

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82
Q

when is the dating scan and what happens at it

A

10-13+6 weeks
gestational age calculated from crown rump length
multiple pregnancies identified

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83
Q

when is the anomaly scan

A

18-20+6 weeks
USS to identify anomalies e.g. heart conditions

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84
Q

what occurs at the routine antenatal appointments

A

symphysis-findal height measured from 24 weeks +
fetal presentation from 36+ wks
urine dip for protein for pre-eclampsia
BP for pre-eclampsia
urine for microscopy = asymptomatic bacteruria

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85
Q

what vaccines are offered to pregnant women

A

pertussis form 16 wks
influenza when available
live vaccines avoided

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86
Q

how does low lying placenta present and how is it diagnosed

A

antepartum bleeding
painless bleed
USS

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87
Q

what is intrauterine growth restriction

A

baby’s growth slows or ceases when in the uterus
part of wider group of small for gestational age fetusus (SGA)
applies to neonates born with features of malnutrition and IN UTERO growth restriction IRRESPECTIVE of birth weight percentile

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88
Q

what signs indicate IUGR

A

reduced amniotic fluid
abnormal doppler studies
reduced foetal movements
abnormal CTGs

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89
Q

how are low risk women monitored for IUGR

A

symphysis fundal height at every antenatal appt after 24 wks
plotted on a graph
SFH <10th centile = need serial growth scans with umbilical artery doppler

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90
Q

how are high risk women for SGA monitored

A

USS measuring:
estimated fetal weight +
abdominal circumference
= growth velocity
umbilical arterial pulsatility index
amniotic fluid volume

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91
Q

what is chorioamnionitis

A

infection of chorioamniotic membranes and amniotic fluid
= leading cause of maternal sepsis and can cause DEATH
occurs later in pregnancy/during labour

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92
Q

what constitutes a primary/secondary/minor/major PPH

A

primary = >500mls blood loss after birth of baby
secondary = >24hrs to 2 weeks after birth
minor = <1500mls lost and no shock
major = 1500ml + continuing to bleed OR shock

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93
Q

describe the management of post partum haemorrhage (8 steps)

A
  1. resus ABCDE
  2. lie flat, warm and calm
  3. 2 large bore cannulas
  4. bloods for FBC/U&E/clotting
  5. cross match 4 units
  6. warmed IV fluid and blood resus as needed
  7. oxygen regardless of sats
  8. fresh frozen plasma if clotting abnormalities/after 4 units
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94
Q

what is a secondary postpartum haemorrhage

A

bleeding occurs 24hrs to 12 week postpartum
likely due to retained products of conception or infection
USS/endocervical swab for infection
treat by surgery or antibiotics for infection

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95
Q

what is a postdural puncture headache and how does it present

A

accidental dural puncture during epidural
leakage of CFS and reduced pressure in fluid around brain
headache worse on sitting/standing
1-7 days after epidural
neck stiffness/photosensitivity

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96
Q

how is postdural puncture headache treated

A

lying flat
analgesia
epidural blood patch

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97
Q

what is the leading cause of maternal death up to 6 weeks after pregnancy in the UK

A

VTE

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98
Q

what is the leading cause of direct deaths 6wk- 1 year after end of pregnancy

A

maternal suicide

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99
Q

when is the risk of VTE highest

A

postpartum

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100
Q

name some of the VTE risk factors

A

smoking
parity over 3/multiple pregnancy
age over 35
bmi under 30
reduced mobility
preeclampsia
varicose veins
family history
thrombophilia
IVF pregnancy

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101
Q

when should VTE prophylaxis be started

A

28 weeks if 3 RFs
first trimester if 4+ RFs
continues until 6 wk postnatal
temporarily STOPPED in labour

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102
Q

what prophylaxis is given for VTE

A

LWMH
= enoxaparin
= dalteparin
= tinzaparin

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103
Q

name 2 forms of mechanical VTE prophylaxis

A

intermittent pneumatic compression
anti-embolic compression socks

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104
Q

how does VTE present

A

UNILATERAL
calf leg swelling
dilated veins
tender calf
oedema
colour changes
>3cm between calf diameter = significant

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105
Q

how does a PE present

A

SoB
cough +/- blood
pleuritic chest pain
hypoxia
tachypnoe/tachycardia

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106
Q

how is VTE diagnosed

A

doppler USS
suspected PE = CXR and ECG
CTPA = definitive diagnosis (higher risk mother)
VQ scan also can be used (higher risk foetus)

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107
Q

what is NOT used for investigation of VTE in pregnancy

A

D dimer

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108
Q

what are the Tx options for PE in pregnancy

A

unfractionated heparin
thrombolysis
surgical embolectomy

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109
Q

what is baby blues and when does it present

A

> 50% women affected
within 1st week post natal
mood swings
low mood
anxiety
irritable
tearful
= usually resolve within 2 weeks

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110
Q

what is postnatal depression and when does it present

A

1 in 10 women
peak 3 months postnatal
1. low mood
2. anhedonia (lack of pleasure in activities)
3. low energy
sympt for 2 weeks before diagnosis can be made

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111
Q

how is postnatal depression treated

A

mild = behavioural/therapy
moderate - antidepressants and CBT
severe = specialist psychiatry

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112
Q

what screening tool is used for postnatal depression

A

edinburgh postnatal depression scale
10 questions 30 points
>10 = suggests diagnosis

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113
Q

what is puerperal psychosis and when/how does it present

A

rare but severe
2-3 weeks postnatal
- delusions
- hallucinations
- depression
- mania
- confusion

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114
Q

how is puerperal psychosis treated

A

urgent assessment and input from specialist services
1. admit to mother and baby unit
2. CBT
3. antidepressants/antipsychotics/mood stabilisers
4. electroconvulsive therapy

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115
Q

how are pregnant women with existing mental health concerns managed

A

referred to perinatal mental health services for specialist input
continue on medications
plan for delivery
neonates monitored for neonatal abstinence syndrome

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116
Q

what is the difference between stress incontinence and urge incontinence

A

stress incontinence = weak pelvic floor and sphincter muscles
urge incontinence = overactivity of detrusor muscle

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117
Q

what is overflow incontinence

A

chronic urinary retention due to obstruction to the outflow of urine = overflow of urine = incontinence without urge to pass urine
can occur with neurological conditions (MS, diabetic neuropathy, spinal cord injury)
more common in men

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118
Q

what are the risk factors for urinary incontinence

A

increased age
post menopause
increase BMI
previous pregnancies/vaginal deliveries
pelvic organ prolapse
pelvic floor surgery
neuro conditions (MS)
cognitive impairment/dementia

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119
Q

describe the physiology of detrusor contraction

A

parasympathetic S2,3,4 nerves from brain => ACh to muscarinic M3, M3 receptors => detrusor contraction

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120
Q

what is an obstetric fistula

A

hole develops in birth canal due to childbirth
can be between vagina and rectum/ureter/bladder
result in incontinence of urine or faeces
rare in developed world
urinary catheter/stent can be useful treatment
surgery may be needed to close fistula/repair tissue

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121
Q

what advice should you give when prescribing metronidazole

A

NO ALCOHOL
can cause disulfiram-like reaction:
nausea/vomiting/flushing
rare = shock + angioedema

122
Q

what is trichomonas vaginalis and what does it increase the risk of

A

protozoan with flagella
increase risk:
- contracting HIV
- BV
- cervical cancer
- PID
- pregnancy complications

123
Q

what is the typical discharge associated with trichomonas vaginalis

A

frothy
yellow-green
(maybe fishy)

124
Q

what is the typical examination findings of trichomonas vaginalis

A

strawberry cervix (colpitis)
= inflammation
= tiny haemorrhages
vaginal pH above 4.5

125
Q

where should swabs be taken for trichomonas vaginalis

A

from the posterior fornix of vagina

126
Q

describe the different strains of herpes virus and what they are associated with

A

HSV-1 :
= cold sores
= contracted in childhood
= cause genital herpes by oral sex
HSV-2:
= genital herpes
= STI spread

127
Q

describe the presentation of herpes

A

initial episode more severe, recurrent = milder
ulcers/blisters
neuropathic pain = tingling/burning
flu-like sympts
dysuria
inguinal lymphadenopathy

128
Q

how is herpes diagnosed and managed

A

clinically based on history and exam
viral PCR swab
refer to GUM
Tx = acyclovir
topical lidocaine
paracetamol
vaseline

129
Q

what is the concern with herpes in pregnancy

A

risk of neonatal herpes simplex infection = high morbidity and mortality
pregnant woman antibodies should cross placenta and give baby passive immunity
acyclovir still given in pregnancy
asympt women can have vaginal delivery
sympt women should have C section

130
Q

what is lymphogranuloma venerum (LGV)

A

condition affects lymphoid tissue around site of chlamydia infection
most common MSM
primary stage = painless ulcer
secondary stage = lyphadenitis swelling/pain
tertiary stage = inflammation of the retum and anus (proctitis)

131
Q

what is proctocolitis and how does it present

A

inflammation of rectum and colon
anal pain
change in bowel habit
tenesmus
discharge

132
Q

how is LGV treated

A

doxycycline 100mg twice daily for 21 days = 1st line

133
Q

describe the natural course of HIV

A
  1. acute primary infection = transient immunosuppression = low then high CD4
  2. asymptomatic phase = progressive loss of CD4 = poor immunity
  3. early symptomatic phase = manifestation of clinical features
134
Q

how is AIDS defined (late stage HIV)

A

CD4 <200
immune deficiency symptoms and opportunistic infections
normally 5-10 years to reach AIDS

135
Q

how is HIV transmitted

A
  1. unprotected vaginal/anal/oral sex
  2. mother to child = vertical
  3. mucous membranes = blood/bodily fluids
136
Q

name 6 examples of AIDS defining illnesses

A

kaposi’s sarcoma
pneumocystisis jirovecci pneumonia (PCP)
CMV
candidiasis
lymphoma
TB

137
Q

who should be tested for HIV and when

A

all persons admitted to hospital with infectious disease
all high risks persons
test initially then repeat 3 months later as antibodies take 3 months to build up

138
Q

what are the HIV infection markers

A

CD4 count
RNA = viral load

139
Q

how is HIV treated and what are the treatment aims

A

antiretroviral therapy (ART) for all people - different regimes depending on person
aims:
achieve normal CD4 count and undetectable viral load
treat individual infections

140
Q

what is the prophylactic for PCP

A

co-trimoxazole (septrin)

141
Q

what monitoring do female patients with HIV need

A

yearly cervical smears
increased risk HPV and cervical cancer

142
Q

how should women with HIV give birth

A

normal vaginal if viral load <50
CS if viral load >50
IV zidovudine if high or unknown viral load

143
Q

what prophylaxis is given to babies of HIV+ mothers

A

low risk = zidovudine for 4 weeks
high risk = zidovudine + lamivudine + nevirapine for 4 weeks

144
Q

what should new mothers with HIV NOT do

A

breastfeed

145
Q

what is post menopausal bleeding until proven otherise

A

endometrial cancer

146
Q

what is endometrial hyperplasia

A

precancerous condition = thickening of endometrium
<5% progress to cancer
hyperplasia +/- atypia
treat with IUS or continuous oral progestogens

147
Q

what HPV strains are responsible for the majority of cervical cancers

A

type 16
type 18

148
Q

how does HPV promote the development of cancer

A

inhibits tumour suppressor genes p53 and pRb

149
Q

describe the management of smear results (PHE guidelines)

A

inadequate sample = repeat after at least 3 months
HPV negative = continue routine screening
HPV positive with normal cytology = repeat HPV test 12 months
HPV positive with abnormal cytology = refer for colposcopy

150
Q

what is a colposcopy

A

insert speculum and magnify the cervix
can apply stains to differentiate abnormal areas e.g. acetic acid pr schillers iodine test

151
Q

what is a large loop excision of the transformation zone LLETZ

A

loop biopsy
can be performed during a colposcopy = removes abnormal epithelium and cauterises the wound

152
Q

what is a cone biopsy and what is it used for

A

treatment for cervical intraepithelial neoplasia (CIN)
under GA = cone shaped piece of cervix removed = sample sent to histology
risk of bleeding/infection/pain/scars

153
Q

what is vulval intraepithelial neoplasia

A

premalignant proliferation of squamous epithelium of vulva
high grade = associated with HPV + young women 35-50
differentiated = associated lichen sclerosis age 50-60
Tx:
W&W
wide local excision
imiquimod cream
laser ablation

154
Q

describe the initial investigations for infertility

A

BMI
chlamydia screening
semen analysis
female hormonal testing
rubella immunity in mum

155
Q

describe the female hormone testing for infertility

A

serum LH/FSH on day 2-5 of cycle
serum progesterone on day 21
anti-mullarian hormone
TFT
prolactin when sypts = galactorrhea or amenorrhoea

156
Q

what is the most accurate indicator of ovarian reserve

A

antimullarian hormone

157
Q

what is a hysterosalpingogram (HSG)

A

scan used to assess shape of uterus and fallopian tube patency
also has therapeutic effect = increase rate of conception
contrast and XR
risk of infection with procedure = prophylactic Abx
screening for STI needed before scan

158
Q

what is a laparoscopy and dye test

A

dye injected into uterus = can see entering fallopian tubes
can assess for endometriosis/adhesions and treat

159
Q

describe the management of anovulation

A
  1. weight loss
  2. clomifene/letrozole = stimulate ovulation
  3. gonadotrophins
  4. ovarian drilling = for PCOS
  5. metformin for insulin insenstitivity and obesity in PCOS
160
Q

what is clomifene and how does it work

A

ani-oestrogen given on day 2-6
stops neg feedback of oestrogen = greater GnRH and FSH/LH

161
Q

how is infertility treated when it is a tubal problem

A

tubal cannulation during HSG
laparoscopy to remove adhesions/endometriosis
IVF

162
Q

how are sperm fertility problems managed

A

surgical sperm retrieval = directly from epididymis
surgical correction of obstuctrion
intra-uterine insemination
intracytoplasmic sperm injection ICSI
donor insemination

163
Q

what are dermoid cysts/germ cell tumours

A

benign ovarian tumours can contain hair/skin/teeth/bone
can cause raised alpha FP and hCG

164
Q

what is a krukenberg tumour

A

metastasis in the ovary usually from GI tract
‘signet-ring’ appearance on histology

165
Q

when are women screened for anaemia in pregnancy

A

booking clinic
28 weeks
screening for haemoglobinopathies, sickle cell and thalassaemia also occur

166
Q

what are the normal ranges of Hb in pregnancy

A

booking = >110
28 weeks = >105
post partum = >100

167
Q

how does the MCV indicate the cause of anaemia

A

low MCV = iron deficiency
normal MCV = physiological anaemia (pregnancy)
raised MCV = B12/folate deficiency

168
Q

how is anaemia in pregnancy treated

A
  1. iron replacement 200mg 3x daily ferrous sulfate
  2. low ferritin = iron supplement
    test for pernicious anaemia = IM hydroxocobalamin or oral cyanocobalamin
  3. ALL women to take 400mcg folic acid every day + 5mg folic acid if deficient
  4. thalassaemia = specialist Mx
169
Q

why is iron deficient anaemia bad in pregnancy

A

associated with preterm birth and low birthweight

170
Q

which asthma meds can be used in pregnancy

A

all of them

171
Q

what is the leading cause of maternal death in the UK

A

cardiac disease
ischaemic or congenital

172
Q

what are some high risk cardiac issues in pregnancy

A

aortic stenosis
coarctation of aorta
prostetic valves
cyanosed mum

173
Q

what are the lower risk cardiac issues in pregnancy

A

mitral/aortic incompetence
ASD
VSD

174
Q

describe hyperthyroidism in pregnancy

A

uncommon
often resolves after 1st trimester
risk of thyroid crisis with caridac failure
risk of foetal thyrotoxicosis
can treat with antithyroid drugs (carbimazole)

175
Q

describe hypothyroidism in pregnancy

A

common
if untreated = early foetal loss and impaired neuro development
aim for adequate replacement with thyroxine in 1st trimester especially

176
Q

what screening is needed in pregnant women with pre-existing diabetes

A

retinopathy screening after booking + at 28 weeks

177
Q

what is recommended for pregnant women with pre-existing diabetes

A

planned delivery at 37-38+6 weeks
sliding scale insulin during labour in T1DM

178
Q

what are the foetal complications for babies with diabetic mothers

A

neonatal hypoglycaemia
jaundice
polycytheamia
congenital heart disease
cardiomyopathy

179
Q

what medications should be stopped in pregnancy

A

(AST)
ACEi/ARBs
Statins
Thiazide and thiazide-like diuretics

180
Q

what are the complications of gestational diabetes for the mother

A

DKA
hypoglycaemia (common)
progression of retiopathy
pre-eclampsia
premature labour

181
Q

what are the complications of gestational diabetes for the baby

A

miscarriage
stillbirth
macrosomia = shoulder dystocia
fetal abnormality
neonatal hypoglycaemia

182
Q

what is the effect of chronic renal disease on pregnancy

A

severe HTN
deterioration renal function
growth restriction
abnormalities due to drug therapy
pre-eclampsia

C section
premature delivery
stillbirth

183
Q

which medications for HTN are suitable for use in pregnancies

A

labetalol (other BB not suitable)
CCBs (nifedipine)
alpha blockers (doxazosin)

184
Q

how are pregnant women with epilepsy managed

A

5mg folic acid reduce neural tube defects
AVOID sodium valproate = neural tube defects
AVOID phenytoin = cleft lip/palate
CAN USE levetiracem/lamotrigine/carbamazepine

185
Q

how is a pregnant woman with rheumatoid arthritis managed

A

AVOID methotrexate = teratogenic
1st choice = hydroxychloroquine
sulfasalazine is safe
corticosteroids can be used in flare ups

186
Q

how are pregnant women monitored for UTIs

A

urine dip and urine sample for asymptomatic bacteriuria at booking and routinely at appointments

187
Q

what are the causes of UTI in pregnant women and how are they managed

A

e.coli most common
klebsiella pneumoniae
7 days of Abx
- nitrofurantoin (NOT in 3rd trim)
- amoxycilin (after sensitivities)
- cefalexin
AVOID trimethoprim in 1st trimester (and most of pregnancy)

188
Q

what is chronic hypertension vs pregnancy induced HTN/gestational HTN

A

chronic = exist before 20 weeks gestation and longstanding
pregnancy induced =occuring after 20 weeks WITHOUT proteinuria

189
Q

what is PlGF testing

A

test for placental growth factor
in pre-eclampsia = LOW
can be used to rule out pre-eclampsia

190
Q

what is used to treat eclampsia

A

IV magnesium sulfate

191
Q

how is pre-eclampsia treated after delivery

A
  1. enalapril
  2. nifedipine/amlodipine (1st line black/caribbean)
  3. labetalol or atenolol
192
Q

what is HELLP syndrome

A

Haemolysis
Elavated Liver enymes
Low Plateletes
= complication of preeclampsa
= exacerbation of sympts
= definitive Tx is delivery of child

193
Q

what are the foetal indications to deliver in preeclampsia

A

severe foetal growth restriction
nonreassuring foetal test results
oligohydramnios

194
Q

what are the maternal indications to deliver in preeclampsia

A

over 38 weeks
plt <100,000
deterioration liver and renal function
suspected placenta abruption
persistent symptoms

195
Q

name 3 causes of antepartum haemorrhage

A
  1. placenta praevia
  2. placental abruption
  3. vasa praevia
196
Q

describe the breast imaging pathway for symptomatic women

A

under 35:
1. clinical exam
2. targeted USS
over 35:
1. clinical exam
2. bilateral mammogram AND targeted USS

197
Q

what is mammography used for

A

1st choice imaging >40
screening asymptomatic
characterise symptomatic abnormalities
follow up and surveillance
detect breast cancer 90%

198
Q

what are the benefits and limitations of breast MRI

A

high sensitivity for invasive breast carcinoma
does NOT use ionising radiation

limited availability
expensive
limited biopsy facilities

199
Q

what are the risk factors for breast cancer

A

radiotherapy <35 y/o
BRCA1 BRCA2
HRT
Li Fraumeni syndrome
moderate/high alcohol consumption
not breast feeding
nuliparous

200
Q

when was nhs breast screening introduced and how many lives a year does it save

A

1988
1400 lives a year

201
Q

how are high risk women screened for breast cancer

A

= use MRI
further Ix = USS and biopsy

202
Q

describe the genetics of breast cancer

A

BRCA1 = chromosome 17 = 60% BC + 40% ovarian cancer
BRCA2 = chromosome 13 = 40% BC + 15% ovarian cancer

203
Q

where can breast cancer metastasise to

A

Lungs
Liver
Bones
Brain

204
Q

what is a ductal carcinoma in situ DCIS

A

(pre)cancerous epithelial cells of breast duct
localised 1 area
mammogram Dx
potential to spread locally
30% become invasive
good prognosis if fully excised + adjuvant treatment

205
Q

what is a lobular carcinoma in situ LCIS (lobular neoplasia)

A

precancerous condition in premenopausal women
asymptomatic and undetectable in mammogram
incidental Dx on biopsy
30% increase risk of invasive cancer
managed with close monitoring (6 monthly)

206
Q

what is invasive breast cancer NST

A

no specific type NST
originate in cells from breast ducts
80% of invasive breast cancers Dx on mammogram

207
Q

what are invasive lobular carcinomas ILC

A

10% of invasive breast cancer
originate in cells from lobules
not always visible on mammogram

208
Q

what is inflammatory breast cancer

A

1-3%
present similar to abcess/mastitis
swollen/warm/red/tender + PEU D’ORANGE
no response to Abx = consider inflamm breast cancer
worse prognosis

209
Q

what is paget’s disease of the nipple

A

eczema of nipple/areolar
red scaly rash = breast cancer of nipple
may represent DCIS/invasive BC
requires biopsy/staging/treatment

210
Q

name the conditions screened for at antenatal clinic

A

sickle cell and thalassaemia
infectious diseases
Down’s/Edwards/Patau’s
foetal anomaly scan
diabetic eye screening

211
Q

what is alpha thalassaemia

A

depletion of alpha chains
no. faulty genes related to severity
african/asian population
alpha thalassaemia major = fatal (hydrops fatalis)

212
Q

what is beta thalassaemia

A

depletion of beta chains
no. fautly genes NOT related to severity
mediterranean/middle east/africa/asia
require lifelong transfusion therapy/chelation therapy to Tx iron overload

213
Q

when are pregnant women screened for sickle cell

A

8-10 weeks
prenatal diagnosis (of baby?) by 12+6
can be offered termination

214
Q

what infectious diseases are women screened for

A

HIV
Hep B
syphillis
reoffered at 20 weeks to anyone who declines

215
Q

what are the complications of syphilis in pregnancy

A

miscarriage
pre-term labour
stillbirth
congenital syphilis

216
Q

describe the testing for fetal anomaly

A

downs (T21) edwards (T18) Patau’s (T13)
offered to ALL women
combined test = 11+2 - 14+1 weeks
quadruple testing = 14+2 - 20 weeks
low chance = receive letter
higher chance = screening and offer of prenatal diagnosis
DOCUMENT RESULTS/OUTCOMES

217
Q

what is edward’s syndrome

A

T18
incidence ^ with maternal age
80% female
survival rates beyond 1 year = 10%
severe learning difficulties + extremely serious physical disabilities
most = stillborn

218
Q

what is patau’s syndrome

A

T13
incidence ^ with maternal age
most stillborn/die shortly after birth
associated with multiple severe foetal abnormalities :
congenital heart defects
holoprosencephaly
face/abdo/urogenital malformations

219
Q

what is the purpose of the early pregnancy scan

A

confirm viability
singleton or multiple
estimate gestational age
detect major structural abnormalities
component of screening for trisomy

220
Q

when are ultrasounds performed in pregnancy

A

early = 10-14 weeks
structural abnormalities = 18+0 - 20+6

221
Q

what is the triple assessment for breast cancer

A
  1. clinical score
  2. imaging score
  3. biopsy score
222
Q

describe the stages of labour

A

LATENT:
0-4cm
irregular contractions
cervix begins effacement
2-3 days
ACTIVE:
stronger contractions
1st = 4-10cm
2nd = 10cm - head delivery
3rd = head delivery to placenta delivery

223
Q

describe the mechanism of labour

A

DESCENT
FLEXION = fetus head flexes
INTERNAL ROTATION = fetus head pushed onto pelvic floor = with each contraction small rotations to 90 degrees
EXTENSION = fetus extends head during birth
RESTITUTION/EXTERNAL ROTATION = fetus head turn to align with shoulders
BODY DELIVERY

224
Q

what gynae complaints may FGM present as

A

dysparareunia
sexual dysfunction/anorgasmia
chronic pain
keloid scar
dysmenorrhoea (including haematocolpos)
urinary obstruction/recurrent UTI
PTSD

225
Q

what obstetric complains may FGM present as

A

fear of childbirth
increased risk of CS/PPH/episiotomy/vaginal lacerations
difficulty performing VE in labour
difficulty in catheterisation in labour

226
Q

what is precocious puberty in boys and girls

A

girls = before 8
boys = before 9

227
Q

when is an oral glucose tolerance test performed

A

in women with risk factors (BMI/ethnicity/family history/obstetric history)
24-28 weeks

228
Q

when does the fetus have rights

A

in termination - after 24 weeks is person with rights
mum has a right to refuse emergency CS and fetus has no rights there

229
Q

define abnormal uterine bleeding

A

any menstrual bleeding from uterus that is abnormal in volume/regularity/timing or is non-menstrual

230
Q

what are the causes of heavy menstrual bleeding

A

uterine fibroids
uterine polyps
adenomysosis
endometriosis (rarely presents this way)
40-60% have no clear pathology on investigation

231
Q

what are uterine polyps

A

common benign localised growths of endometrium
fibrous covered by columnar epithelium
disordered cycles of apoptosis and regrowth = polyp
malignancy is RARE

232
Q

describe the investigation of menorrhagia

A
  1. FBC
  2. TVUSS
  3. endometrial biopsy if >45 + IMB + unresponsive to Tx
  4. hysteroscopy if abnormal/concerning Ix
233
Q

what is post menopausal bleeding

A

bleeding that occurs after 1 year of amenorrhoea in a woman NOT receiving HRT

234
Q

name the causes of post menopausal bleeding

A

vaginal atrophy (most common)
use of HRT
endometrial hyperplasia
endometrial cancer
endometrial polyps
cervical/ovarian cancer

235
Q

what is endometrial hyperplasia, how is it classified and what are the risk factors

A

abnormal proliferation of the endometrium
atypical = premalignant condition
without atypia = low risk of carcinoma
risk factors = anything causing increased oestrogen

236
Q

how does endometrial hyperplasia present

A

abnormal vaginal bleeding:
intermenstrual
irregular
menorrhagia
post-menopausal
+/- discharge

237
Q

how is endometrial hyperplasia investigated

A

endometrial biopsy = definitive diagnosis
hysteroscopy and biopsy
TVUS = can be used to distinguish between normal proliferation and hyperproliferation + indicate need for biopsy

238
Q

how is endometrial hyperplasia managed

A

without atypia:
reassurance (cancer risk)
address RFs
WW
progestogen treatment
follow up and monitoring
atypical: (30-40% progress to carcinoma)
hysterectomy +/- salpingo-oophrectomy

239
Q

what is dysfunctional uterine bleeding

A

menorrhagia with no underlying cause
diagnosis when other causes excluded
use contraceptives to treat
hysterectomy/endometrial ablation in severe cases

240
Q

how does ovarian torsion present

A

sudden onset severe unilateral pelvic pain
pain constant and progressively worse
nausea + vomiting
localised tenderness
palpable mass (not always)

241
Q

how is ovarian torsion investigated and managed

A

pelvic USS - TV ideal = whirlpool sign = free fluid in pelvis and oedema of ovary
laparoscopic surgery = definitive diagnosis + detorsion and removal of ovary

242
Q

describe the complications of ovarian torsion

A

lead to loss of ovary
necrotic = infected = abcess = sepsis = rupture = peritonitis = adhesions

243
Q

name some treatments for PMS

A

COCP containing dispirenone
continuous use of the pill
GnRH analogues to induce menopausal state + HRT
hysterectomy + bilaterla oophorectomy + HRT
danazole + tamoxifen for breast pain
spirinolactone for oedema in PMS

244
Q

name the causes of hypogonadotrophic hypogonadism

A

= low LH low FSH low oestrogen
hypopituitarism
damage to hypothalamus/pituitary (surgery/radiation)
chronic condition (IBD/cystic fibrosis)
excessive diet or exercising or stress
constitutional delay = temporary/no underlying pathology
endocrine disorders (hypothyroid/cushings)
kallman syndrome

245
Q

name the causes of hypergonadotrophic hypogonadism

A

high LH/FSH but low oestrogen
previous damage to gonads = torsion/cancer/infections
congenital absence of ovaries
turners syndrome X0

246
Q

what is ashermans syndrome

A

adhesions in uterus following damage/surgery
can distort pelvic organs and bind walls together/endocervix shut
secondary amenorrhoea
lighter periods
dysmenorrhoea

247
Q

how is ashermans syndrome diagnosed and managed

A

hysteroscopy = gold standard
hysterosalpingography = contrast injected and XR
sonohysterography = uterus filled with fluid and USS
MRI scan
dissection of adhesions = treatment

248
Q

name some causes of oligomenorrhoea

A

pcos
contraceptives/HRT
perimenopause
thyroid disease/diabetes
eating disorders/excessive exercise
medications = anti-psychotics or anti-epileptics

249
Q

when would anti D be given to mothers

A

to Rh -ve mothers:
- abdo trauma
- miscarriage after 12 wks
- bleeding
- 28 wks pregnant
- after birth if baby is +ve

250
Q

what is a bishop score and what factors are included

A

= assessment of how likely a woman will go into labour
- dilation of cervix
- effacement of cervix (how thin)
- consistency of cervix (soft/firm)
- position of cervix
- foetal station (how far up birth canal)

251
Q

what is tested for in a TORCH screening and when is it routinely performed

A

Toxoplasmosis
Other (parvovirus)
Rubella
Cytomegalovirus
Hepatitis
routinely at 28 wks in all pregnancies

252
Q

name some indications for induction of labour

A

prolonged gestation 40-42+ wks
PROM >37 (unless <37 then depending on baby and mother health, <34 = delay)
maternal health - HTN/preeclampsia/DM etc
foetal growth restriction
intrauterine foetal death

253
Q

what are the contraindications for induction of labour/vaginal delivery

A

ABSOLUTE:
cephalic disproportion
major placenta praevia
vasa praevia
cord prolapse
transverse lie
acute primary genital herpes
previous classical C section
RELATIVE:
breech
triplet +
2+ low transverse C section

254
Q

what is the role of prostaglandins in labour

A

ripen cervix
contraction of SM of uterus

255
Q

describe the 2 types of premature rupture of membranes

A
  1. PROM = rupture at least 1hr prior to onset of labour >37 weeks
    occurs in 10-15% pregnancies
    minimal risk to mother and baby
  2. Preterm PROM = rupture of membranes <37 weeks
    2% pregnancies
    higher risk complications
    associated with 40% preterm deliveries
256
Q

what is the kleihauer test

A

checks how much foetal blood has passed to mother during sensitising event
used after any sensitising event >20wks
check to see if further doses anti-D needed

257
Q

how is preterm labour prevented

A
  1. vaginal progesterone = decreases activity of myometrium and prevent cervix remodelling for delivery
    offered 16-24wks <25mm cervical length
  2. cervical cerclage = stitch in cervix to support and keep closed
    removed when in labour
    given to 16-24wks <25mm and previous preterm
    can be given as rescue stitch
258
Q

what is preterm labour with intact membranes

A

painful regular contractions and cervical dilatation without rupture of amniotic sac
requires speculum to assess dilatation
requires management of preterm labour

259
Q

describe the management of preterm labour

A
  • CTG
  • tocolysis with nifedipine (CCB suppresses labour)
  • maternal corticosteroids for foetal lungs
  • IV magnesium sulfate <34wks to protect fetal brain (CP)
  • delayed cord clamping/cord milking = increase baby blood volume/Hb at birth
260
Q

what is given to babies born <34 weeks

A

magnesium sulfate bolus then infusion for up to 24hrs following birth
prevent cerebral palsy

261
Q

what needs to be monitored if mother is given IV MgSo4

A

magnesium toxicity at least 4 hrly
- reduced RR
- reduced BP
- absent reflexes

262
Q

what is foetal hydrops

A

occurs in fetal parvovirus B19 infection
parvovirus causes replication of erythoid progenitor cells in liver and BM = severe anaemia
= high output cardiac failure
= increased hepatic erythropoiesis = portal HTN and hypoproteinaemia = ascites

263
Q

how is foetal hydrops diagnosed and managed

A

diagnosis on USS:
ascites
subcutaneous oedema
pleural effusion
pericardial effusion
scalp oedema
polyhydroamnios
treatment limited + high fetal mortality

264
Q

describe the features of congenital rubella syndrome

A

congenital deafness
congenital cataracts
congenital heart disease (PDA and pulmonary stenosis)
learning disability
risk is higher earlier in pregnancy

265
Q

describe the management of rubella in pregnancy

A

<12 weeks = termination of pregnancy
12-20 weeks = prenatal diagnosis required, if fetal rubella confirmed = termination of pregnancy of USS surveillance of defects
>20 weeks no action required

266
Q

what is congenital cytomegalovirus

A

occurs due to CMV infection in mother
spread by infected saliva/urine of asymptomatic children
features:
- fetal growth restriction
- microcephaly
- hearing loss
- vision loss
- learning disability
- seizures

267
Q

what is congenital toxoplasmosis

A

toxoplasma gondii parasite spread by cat faeces
risk is higher later in pregnancy
TRIAD:
1. intracranial calcification
2. hydrocephalus
3. chorioentinitis (inflammation choroid and retina of eye)

268
Q

describe the complications of parvovirus in pregnancy

A

miscarriage/foetal death
severe foetal anaemia
hydrops fetalis
maternal pre-eclampsia-like sydrome

269
Q

describe maternal pre-eclampsia-like syndrome

A

aka mirror syndrome
rare complication of hydrops fetalis
1. hydrops fetalis
2. placental oedema
3. oedema in mother
- HTN
- proteinuria

270
Q

describe the risk factors of GBS infection of the neonate

A

GBS in previous baby
prematurity <37 weeks
rupture of membranes >24hrs before delivery
pyrexia during labour
positive GBS in mother
mother diagnosed with GBS UTI in pregnancy
**give benpen

271
Q

what are the indications for an instrumental delivery

A

failure to progress
fetal distress
maternal exhaustion
control of the head in various fetal positions
epidural = increased risk instrumental

272
Q

what are the risks for the mother of an instrumental delivery

A

PPH
episiotomy
perineal tears
injury to anal sphincter
bladder/bowel incontinence
nerve injury (obturator/femoral)

273
Q

what are the risk to the baby of an instrumental delivery

A

cephalohaematoma with ventous
facial nerve palsy with forceps
serious:
- subgaleal haemorrhage
- intracranial haemorrhage
- skull fracture
- spinal cord injury

274
Q

which type of twin pregnancy is most successful

A

diamniotic dichorionic

275
Q

how does each type of twin present on USS

A

dichorionic diamniotic = membrane between + lamda/twin peak sign
monochorionic diamniotic = membrane between + T sign
monochorionic monoamniotic = no membrane separating

276
Q

when do foetal movements begin to be felt

A

16-24 weeks
generally after 20 weeks

277
Q

what is the average birth weight of a healthy baby

A

3-4kg
6-8lbs

278
Q

describe the difference between miscarriage and stillbirth

A

early miscarriage = <12 weeks
late miscarriage = 12-24wks
stillbirth = birth of a dead foetus after 24 weeks

279
Q

describe the types malpresentation

A

most common = breech
complete = hips and knees flexed
frank = flexed at hips, extended at knees (most common)
footling = one or both legs extended at hip, foot is presenting part
oblique lie = head in iliac fossa
transverse lie = lie across abdomen
unstable lie = changes day to day

280
Q

what is the best foetal position for vaginal delivery

A

occipito-anterior

281
Q

which position is most associated with umbilical cord prolapse

A

footling breech

282
Q

describe the usual position of the head at engagement

A

occipitotransverse

283
Q

describe the important diameters in brow and face presentation

A

brow presentation = mentovertical
face presentation = submentobregmatic

284
Q

describe the management of breech birth

A
  1. external cephalic version = manipulate foetus into cephalic pres. BUT contraindications
  2. C section
  3. vaginal delivery but requires highly skilled practitioners
285
Q

how might breech presentation present

A

meconium stained liquor = foetal distress due to breech

286
Q

what are the risk factors associated with obesity in pregnancy

A

gestational diabetes
pre-eclampsia
gestational HTN
sleep apnoea
macrosomia
birth defects
miscarriage
preterm birth
stillbirth

287
Q

what are some risk factors for congenital anomalies

A

genetic factors
socioeconomic factors (lack of access to healthcare)
environmental factors (chemicals/medications)
infections (rubella/syphillis)
maternal nutrition (folic acid)

288
Q

what are the most common congenital anomalies

A

heart defects
neural tube defects
downs syndrome

289
Q

abortion is legal up until

A

24 weeks
1990 human fertilisation and embryology act

290
Q

what are the legal requirements for an abortion

A

2 registered medical practitioners must agree
carried out by registered practitioner in an NHS hospital/clinic

291
Q

describe a medical abortion

A

mifepristone (anti-progestogen) = halt pregnancy/relax cervix
misoprostol (prostaglandin analogue) = softens cervix/stimulate contractions
rhesus negative = require antiD
fetus will be expelled

292
Q

describe a surgical abortion

A

under local/local+sedation/general
give misoprostol/mifepristone before
cervical dilation with suction (up to 14weeks) or forceps (14-24 weeks)

293
Q

what is a hydatiform mole

A

= molar pregnancy
= growing mass of tissue in uterus that will not develop into a baby
complete hydatidiform mole = empty egg fertilised
partial = 2 sperm 1 egg
higher levels of hCG
vaginal bleeding early in pregnancy
diagnosed through USS and hCG
need to be removed through tube into uterus and suction
small risk of developing gestational trophoblastic neoplasia
continual monitoring of hCG afterwards

294
Q

what causes gonorrhoea and how does it present

A

gram negative diplococcus bacteria infecting mucous membranes of columnar epithelium
can affect urethra/rectum/conjunctivwa/pharynx
= STI
females (90% sympt) vs males (50%):
odourless purulent discharge
dysuria
pelvic pain/testicular pain

295
Q

how is gonorrhoea diagnosed

A

nucleic acid amplification test NAAT to detect rna/dna of gonorrhoea
charcoal endocervical/vulvovaginal/urethral/1st catch urine/rectal/pharyngeal swabs
standard charcoal endocervical swab for microscopy/culture/sensitivities

296
Q

how is gonorrhoea managed

A

high levels of antibiotic resistance
single dose IM ceftriaxone 1g OR oral ciprofloxacin 500mg is sensitivities known
need follow up test
abstain from sex 7 days
treat other STIs
consider safeguarding

297
Q

name some complications of gonorrhoea

A

PID
chronic pelvic pain
infertility
epididymo-orchiditis
conjunctivities
neonatal gonococcal conjunctivitis during birth

298
Q

what is a disseminated gonoccocal infection

A

= complication of gonorrhoea = bacteria spread to skin and joints
various non-specific skin lesions
polyarthralgia
migratory polyarthritis
tenosynovitis
systemic symptoms

299
Q

what is the danger of chicken pox in pregnancy

A

if immune = no problems
not immune = given VZ Igs
chickenpox <28 weeks = developmental problems
chickenpox around delivery = dangerous neonatal infection = VZ Igs + aciclovir

300
Q

what constitutes proteinuria

A

urine protein = Cr >30mg/mmol
urine albumin = Cr >8mg/mmol

301
Q

what is a strong indicator of rupture of membranes and where is it found

A

insulin-like growth factor protein binding 1 is found in amniotic fluid
if present in vagina = strong indicator of RoM

302
Q

what are the causes of PPH

A

Tone = most common
Trauma
Tissue - clots/retained products
Thrombin - bleeding

Phase 3a/4 (6 decks)

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