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Women's Health Flashcards

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1
Q

Pre-eclampsia definition

A

New hypertension in pregnancy (after 20 weeks gestation) with end-organ dysfunction, notably with proteinuria

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2
Q

Pre-eclampsia triad

A

Hypertension
Proteinuria
Oedema

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3
Q

Eclampsia definition

A

Seizures as a result of pre-eclampsia

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4
Q

Pre-eclampsia high risk factors

A

Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune condition
Diabetes
Chronic kidney disease

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5
Q

Pre-eclampsia moderate risk factors

A

Older than 40
BMI >35
>10 years since pregnancy
Multiple pregnancy
First pregnancy
Family Hx of pre-eclampsia

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6
Q

Pre-eclampsia preventative medication & indication

A

Aspirin from 12 weeks
1 high risk factor
>1 moderate risk factor

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7
Q

Pre-eclampsia NICE definition and symptoms

A

Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (this is due to liver swelling)
Oedema
Reduced urine output
Brisk reflexes

NICE guidelines state diagnosis with bp >140/90 (only need diastolic or systolic)

PLUS any of proteinuria, organ dysfunction, placental dysfunction

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8
Q

Pre-eclampsia medical management

A

Labetolol = first-line
Nifedipine = second-line
IV hydralazine
IV magnesium sulfate (during labour & in 24hrs after)
Fluid restriction

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9
Q

HELLP syndrome definition

A

Combination of features occurring due to pre-eclampsia/eclampsia

Haemolysis
Elevated Liver enzymes
Low Platelets

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10
Q

Premature ovarian insufficiency definition & biochem presentation

A

Menopause under the age of 40 (amenhorrea for 1 year; high FSH at 2 samples >4 weeks apart)

High LH/FSH
Low oestradiol

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11
Q

Premature ovarian insufficiency management

A

HRT until usual age of menopause (reduces cardiovascular, osteoporosis, cognitive, and psychological risks ass. w/ premature menopause)

Traditional HRT (increased risk of VTE, give transdermally)
Combined oral contraceptive pill

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12
Q

Placental abruption definition

A

Placenta separates from wall of uterus during pregnancy

Significant cause of antepartum haemorrhage

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13
Q

Placental abruption risk factors

A

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use

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14
Q

Placental abruption presentation

A

Sudden onset severe abdo pain (continuous)
Vaginal bleeding
Shock (hypotension & tachycardia)
CTG showing fetal distress
Woody abdomen on palpation

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15
Q

Concealed abruption definition

A

Placental abruption when cervical os remains closed, with bleeding contained within uterine cavity

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16
Q

Fertility investigations

A

BMI
Chlamydia
Semen analysis
Rubella immunity (mother)
Female hormonal testing

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17
Q

Management of anovulation

A

Weight loss
Clomifene
Letrozole
Gonadotrophins
Metformin

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18
Q

Female hormone testing details

A

Serum LH and FSH on day 2 to 5 of the cycle
Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).
Anti-Mullerian hormone
Thyroid function tests when symptoms are suggestive
Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

High FSH suggests poor ovarian reserve
High LH suggests PCOS
Rise in progesterone on day 21 indicates that ovulation has occurred

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19
Q

Stages of labour

A

First stage - from onset of labour (true contractions) to 10cm dilation
Second stage - from 10com dilation to delivery of baby
Third stage - from delivery of baby to delivery of placenta

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20
Q

Stages of first stage of labour/what happens

A

Cervical dilation and effacement, loss of mucus plug

Latent phase - 0-3cm dilation & irregular contractions
Active phase - 3-7cm dilation & regular contractions
Transition phase -7-10cm dilation & strong, regular contractions

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21
Q

Braxton-Hicks contractions

A

Occasional irregular contractions of the uterus
Usually during second and third trimester
Not true contractions

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22
Q

Diagnosing onset of labour

A

Show (mucus plug)
Rupture of membranes
Dilating cervix
Regular, painful contractions

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23
Q

Prematurity definition

A

Birth before 37 weeks gestation

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24
Q

Non-viabilty definition

A

Babies below 23 weeks gestation

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25
Management of preterm labour
Fetal monitoring Nifedipine (blocks Ca ion channels to prevent smooth muscle contraction) Atosiban (oxytocin receptor agonist, use when nifedipine contraindicated) Maternal corticosteroids (<35 weeks, helps develop fetal lungs) IV magnesium sulphate Delayed cord clamping
26
Signs of magnesium toxicity
Reduced respiratory rate Reduced blood pressure Absent reflexes
27
Induction of labour - beneficial situations
Prelabour rupture of membranes Fetal growth restriction Pre-eclampsia Obstetric cholestasis Existing diabetes Intrauterine fetal death
28
Options for induction of labour
Membrane sweep - insert finger to cervix to stimulate onset of labour Vaginal prostaglandin E2 Cervical ripening balloon (silicone balloon inserted into cervix and gently inflated to dilate) Artificial rupture of membranes with oxytocin (only if prostaglandins can't be used/haven't worked) Oral mifepristone & misoprostol where intrauterine foetal death has occurred
29
Uterine hyperstimulation definition
Main complication of induction of labour with vaginal prostaglandins Contraction of uterus is prolonged and frequent, causing foetal distress & compromise IU contractions >2 mins duration >5 contractions every 10 minutes
30
Uterine hyperstimulation complications
Foetal compromise w/ hypoxia and acidosis Emergency c-section Uterine rupture
31
Management of uterine hyperstimulation
Removing vaginal prostaglandins/stopping oxytocin Tocolysis w terbutaline
32
Sepsis 6
Three tests: Blood lactate level Blood cultures Urine output Three treatments: Oxygen to maintain sats 94-98% Broad-spectrum antibiotics IV fluids
33
Ectopic pregnancy definition
Pregnancy implanted outside the uterus, most commonly the fallopian tube
34
Ectopic pregnancy risk factors
Prev ectopic preg Prev pelvic inflammatory disease Prev surgery IU devices Older age Smoking
35
Ectopic pregnancy presentation
Missed period Constant lower abdo pain in R/L iliac fossa Vaginal bleeding Lower abdo/pelvic tenderness Cervical motion tenderness
36
Ectopic pregnancy ultrasound findings
Gestational mass in fallopian tube Blob/bagel/tubal ring sign (mass with empty gestational sac) Empty uterus/fluid in uterus
37
Ectopic pregnancy management options
Expectant management (await natural termination) Medical management (methotrexate) Surgical management (salpingectomy/salpingotomy)
38
Ectopic pregnancy expectant management criteria
Follow up needed Unruptured ectopic Adnexal mass <35mm No visible heartbeat No significant pain HCG <1,500 IU/L
39
Ectopic pregnancy medical management criteria
Follow up needed Unruptured ectopic Adnexal mass <35mm No visible heartbeat No significant pain HCG <5,000 IU/L Confirmed absence of IU pregnancy Should not get pregnant for 3 months following
40
Ectopic pregnancy surgical managements
Laparoscopic salpingectomy - general anaesthetic & key-hole surgery to remove affected fallopian tube Laparoscopic salpingotomy - avoids removing whole tube e.g. for women who have a risk of infertility if tube is removed Anti-rhesus D prophylaxis given to rhesus negative women
41
PCOS definition & key features
Polycystic ovarian syndrome is a common condition causing metabolic and reproductive problems in women Key features: Anovulation - lack of ovulation Oligoovulation - irregular, infrequent ovulation Amenorrhoea - lack of periods Oligomenhorrhoea - irregular, infrequent periods Hyperandrogenism - effects of high levels of androgens (i.e. male sex hormones) Hirtuism (male pattern facial hair growth) Insulin resistance - lack of response to hormone insulin
42
Rotterdam criteria
Used for making a diagnosis of PCOS Anovulation/oligoovulation (presents a missed or irregular periods) Hyperandrogenism (hirsutism and acne) Polycystic ovaries on ultrasound
43
PCOS presentation
Oligomenorrhoea or amenorrhoea Infertility Obesity (in about 70% of patients with PCOS) Hirsutism Acne Hair loss in a male pattern
44
PCOS complications
Insulin resistance and diabetes Acanthosis nigricans Cardiovascular disease Hypercholesterolaemia Endometrial hyperplasia and cancer Obstructive sleep apnoea Depression and anxiety Sexual problems
45
Differential diagnoses of hirsutism
PCOS Medications e.g. testosterone, corticosteroids, ciclosporin Androgen secreting tumours Cushing's syndrome Congenital adrenal hyperplasia
46
Mechanism of insulin resistance in PCOS
Insulin promotes release of androgens from ovaries & adrenal glands Higher levels of insulin result in higher levels of androgens Insulin also suppresses sex hormone-binding globulin production by the liver, which normally binds to androgens and suppresses their functions Reduced SHBG further promotes hyperandrogenism in PCOS High insulin levels contribute to halting development of the follicles in the ovaries, leading to partially developed follicles and anovulation
47
Blood tests for PCOS/results
Testosterone SHBG LH FSH Prolactin (may be mildly elevated) TSH Would see: High LH High LH:FSH ratio High testosterone High insulin Normal or raised oestrogen
48
PCOS investigations
Pelvic ultrasound Transvaginal ultrasound May see follicles around the edge of ovary, giving appearance of a string of pearls Diagnostic criteria = >=12 developing follicles in one ovary, or ovarian vol of >10cm^3 Also 2-hr 75g oral glucose tol test
49
General PCOS management
Weight loss Low glycaemic index, calorie-controlled diet Exercise Smoking cessation Antihypertensive medications where required Statins where indicated (QRISK >10%)
50
PCOS managing risk of endometrial cancer/mechanism of increased risk
Loss of progesterone due to amen/anovulation leads to loss of uterine shedding and continued proliferation due to oestrogen, increasing risk of endometrial cancer Mirena coil gives continual endometrial protection Cyclical progestogens or combined oral contraceptive pill allow for withdrawal bleed every 3-4 months
51
PCOS managing hirsutism
Co-cyprindiol (combined oral contraceptive) which has anti-androgenic effects, but increases risk of VTE - only take for 3 months at once Topical eflornithine Electrolysis Laser hair removal Spironolactone Finasteride Flutamide Cyproterone acetate
52
Monitoring whilst on magnesium sulphate
urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression
53
Placenta praevia definition
a placenta lying wholly or partly in the lower uterine segment
54
Placenta praevia presentation
Painless vaginal bleeding, ranging from spotting to life threatening haemorrhage Mean initiation of bleeding is 30 weeks shock in proportion to visible loss no pain uterus not tender lie and presentation may be abnormal fetal heart usually normal coagulation problems rare small bleeds before large
55
Placenta praevia differential diagnoses
Placental abruption - usually painful, with a woody abdomen on examination Miscarriage - often accompanied by cramp-lie pain, and is more common in 1st/2nd trimester (3rd is more common for placenta praevia). Cervical os may be open, and products of conception may be lost Placenta accreta - placenta invades too deeply into uterine wall. Ultrasound used to differentiate
56
Placenta praevia investigations
Ultrasound Full blood count Blood type and cross match for surgery Fetal cardiotocography Biochem to rule out pre-eclampsia
57
Placenta praevia management
If serious haemorrhage, ABCDE corticosteroids where gestational age <34 weeks Tocolytics to delay age Anti-D prophylaxis to rhesus negative mothers C-section usually arranged
58
Perineal tears classification
first degree superficial damage with no muscle involvement do not require any repair second degree injury to the perineal muscle, but not involving the anal sphincter require suturing on the ward by a suitably experienced midwife or clinician third degree injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS) 3a: less than 50% of EAS thickness torn 3b: more than 50% of EAS thickness torn 3c: IAS torn require repair in theatre by a suitably trained clinician fourth degree injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa require repair in theatre by a suitably trained clinician
59
When to refer for lack of foetal movements
If fetal movements have not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit
60
Indications for high dose folic acid
Take MORE Folic acid (5mg) if: M- Metabolic disease (diabetes or Coeliac) O- Obesity R- Relative or personal Hx of NTDs E- Epilepsy (taking antiepileptic medications) + Sickle Cell and Thalassaemia
61
Pre-term rupture of membranes management
admission regular observations to ensure chorioamnionitis is not developing oral erythromycin should be given for 10 days antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome delivery should be considered at 34 weeks of gestation - there is a trade-off between an increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses
62
Placenta praevia grading
I - placenta reaches lower segment but not the internal os II - placenta reaches internal os but doesn't cover it III - placenta covers the internal os before dilation but not when dilated IV ('major') - placenta completely covers the internal os

Human Development (4 decks)

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