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Women's Health Flashcards

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0
Q

What are the subdivisions of the first stage of labour?

A

Latent stage - from beginning of contractions to cervical effacement (~4cm dilated)
Active stage - cervical effacement to full dilation

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1
Q

When does the first stage of labour start and finish?

A

Onset of labour till the cervix is fully dilated

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2
Q

What is cervical effacement?

A

Thinning and stretching of cervix

The internal os and cervical canal is incorporated into uterus

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3
Q

Ideally, how quickly does the cervix want to dilate?

A

1cm per hour

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4
Q

When does the second stage of labour begin and end?

A

Begins when cervix is fully dilated

Ends when baby is delivered

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5
Q

What are the subdivisions of the second stage of labour and describe them?

A

Propulsive phase - fully dilated to head at pelvic floor

Exclusive phase - irresistible desire to ‘bear down/push’ to delivery of baby

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6
Q

What happens in the third stage of labour?

A

Expulsion of placenta and membranes

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7
Q

How long should the second stage of labour last?

A

<2 hours if no epidural

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8
Q

How long should the third stage of labour last?

A

<30 minutes

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9
Q

What is cervical dilation?

A

Increased diameter of the external os

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10
Q

What is operculum (‘show’)?

A

Blood stained mucous discharge (the plug of mucous from the cervical canal)
Occurs in 2/3 pregnancy in early labour

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11
Q

What is ‘waters breaking’?

A

Rupture of the membranes

75% occur after cervix is >9cm dilated

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12
Q

What is the difference in the cervix between a nulliparous and multiparous woman?

A

Nulliparous have a more tubular cervix

Multiparous have a more open/expanded cervix

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13
Q

What problems might you get in a primigravid mother?

A

Inefficient uterine contraction
Prolonged labour
Risk of cephalopelvic disproportion and foetal trauma

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14
Q

What is a risk in multigravid mother that has previously had a NVD?

A

Risk of uterine rupture

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15
Q

In which primigravid women is inefficient uterine contraction more common?

A 
Very young (teenagers)
Older (>40)
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16
Q

What rate of contractions can cause foetal distress?

A

More than 5 contractions in 10 minutes

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17
Q

What is caput?

A

Oedema of the scalp due to pressure of the head against the rim of the cervix

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18
Q

What is moulding?

A

Overlapping of the vault bones, altering the shape of the skull so the engaging diameters become shorter

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19
Q

What is engagement?

A

Descent of the biparietal diameter through the pelvic brim

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20
Q

When is the head of the foetus engaged?

A

When it is at the level of the ischial spines (not more than 2/5ths can be felt abdominally)

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21
Q

What is the lie of the baby?

A

Relation of the long axis of the foetus to that of the mother
Can be longitudinal, oblique or transverse

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22
Q

What is presentation?

A

The part of the foetus that is in the lower pole of the uterus
Can be cephalic, vertex or breech

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23
Q

What is the attitude of the foetus?

A

Posture of the foetus’ head

Can be flexion, deflexion or extension

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24
What is meant by the position of the foetus?
Relationship of the presenting part of the foetus to the mother
25
What is the denominator?
Describes the position of the baby with respect to the mothers pelvis. Eg left occipito posterior, right occipito lateral, direct occipito anterior
26
What is the normal denominator of the foetus?
Direct occipito anterior
27
What is the station of the foetus?
Relationship of the head to the ischial spines
28
What is fifths palpable per abdomen?
On examination, the amount of the head felt above the pubic symphysis and is expressed in fifths
29
What are the five steps of the mechanism of a normal birth?
``` Engagement and descent Flexion Internal rotation Extension External rotation ```
30
What is syntocinon?
Synthetic oxytocin
31
What is oxytocin important in?
Effacement and stimulating uterine contraction | Neuromodulator of brain
32
What is syntocinon used for?
Inefficient uterine contractions | Postpartum haemorrhage
33
What does oxytocin cause?
Short rhythmic contractions
34
What is ergometrine used to treat?
Postpartum haemorrhage
35
What does ergometrine cause?
Tetanic contractions (prolonged spasms)
36
How quickly does ergometrine act?
IV - 40 seconds | IM - 6 minutes
37
What are the main side effects of ergometrine?
Nausea Vomiting Hypertension
38
What is syntometrine?
Combination of syntocinon (10iu) and ergometrine (500mcg)
39
What is syntometrine used for?
Active management of the third stage of labour - speeds up delivery of placenta to reduce blood loss
40
Give an example of a prostaglandin E2 analogue and when would you use it.
Dinoprostone - induce labour
41
What does prostaglandin E2 do in labour?
Ripens and effaces cervix
42
What is gravidity?
The number of times a woman has been pregnant
43
What is parity?
The number of times a woman has given birth to a foetus with a gestational age of 24 weeks or more (regardless of alive or stillbirth)
44
What is a risk in giving syntocinon?
Cause rupture of uterus (less likely in primigravid)
45
What does meconium signify?
That the foetus may be in distress
46
When is the triple test for Down's syndrome conducted?
Between 15 and 20 weeks
47
What is measured in the triple test?
Alpha-feta protein Beta-hCG Unconjugated oestradiol
48
What tends to happen to pre-existing conditions during pregnancy?
1/3 improve 1/3 stay the same 1/3 deteriorate
49
What does hypertension during pregnancy predispose to?
Pre-eclampsia
50
When can pre-eclampsia develop?
Anytime after 20 weeks, usually in the last trimester (after 26 weeks)
51
What are the characteristic clinical features of pre-eclampsia?
Hypertension Proteinuria With/without oedema
52
When might a woman develop gestational hypertension?
Anytime after 20 weeks
53
What is a complete molar pregnancy?
An egg with no genetic information is fertilised by a sperm and grows to become a lump of tissue, not a foetus
54
What is a partial molar pregnancy?
An egg with no genetic information is fertilised by 2 sperm, and the placenta develops to become the molar growth
55
Why do molar pregnancies need to be evacuated quickly?
They can develop into choriocarcinomas
56
What is spontaneous miscarriage?
Spontaneous loss of pregnancy prior to viability (before 23 weeks and 6 days)
57
When do the majority of miscarriages occur?
First trimester (upto 12 weeks)
58
What is the cause of the majority of first-trimester miscarriages?
Chromosomal abnormalities
59
What is a threatened miscarriage?
Bleeding in early pregnancy
60
What is an incomplete miscarriage?
The products of conception remain in the uterus
61
What is a silent miscarriage?
The embryo or foetus has died but a miscarriage has not yet occurred
62
How many miscarriages must you have to be considered to have recurrent miscarriages?
Three consecutive
63
What medical management is there for a miscarriage?
Mifepristone with misoprostol (prostaglandin)
64
How would an ectopic pregnancy present?
Pain 5-8 weeks amenorrhea Scanty brown vaginal bleeding Tenderness
65
What are the clinical features of a miscarriage?
PV spotting Pain Hyperemesis
66
What can cause subfertility?
``` Ovulation disorder Sperm dysfunction Tubal disease Endometriosis Coital failure Uterine abnormalities ```
67
What do ovulatory disorders tend to involve?
Hypothalamic-pituitary-ovarian axis
68
Name some hypothalamic causes of ovulation disorders.
Eating disorder Stress Excessive exercise Underweight
69
What are some ovarian causes of ovulatory disorders?
Polycystic ovarian syndrome | Primary ovarian failure
70
What classified PCOS?
Having 2 of the following criteria: Hyperandrogenism Oligo-ovulation/anovulation Polycystic ovaries of ultrasound
71
What is the treatment of ovulatory disorders that cause subfertility?
Ovulation induction, mainly by oestrogen anatgonists or gonadotropins
72
What are the risks of ovulation induction?
Multiple pregnancies, eg twins
73
What can cause sperm dysfunction that leads to subfertility?
Primary failure, eg failure of sperm production | Obstruction, eg congenital
74
What are the fertility treatments for sperm dysfunction?
Intrauterine insemination Donor insemination IVF
75
What can causes tubal disease leading to subfertility?
Infection Inflammation Trauma/Post op Sterilisation
76
What infections can causes tubal disease?
Chlamydia | Gonorrhoea
77
What is the main inflammatory cause of tubal disease?
Endometriosis
78
What are the treatment options for subfertility caused by tubal disease?
Tubal surgery Ablation of endometriosis IVF
79
What are uterine fibroids?
Benign growth of smooth muscle of uterus
80
What are the different types of fibroids?
Subserosal fibroids Intramural fibroids Submucosal fibroids
81
What symptoms occur with fibroids?
Menorrhagia Dyspareunia Urinary frequency and urgency May suffer miscarriages
82
What are the treatments for fibroids?
Medication for symptoms, eg. NSAIDs, OCP | Surgery, eg. myomectomy (remove fibroid), hysterectomy
83
What is an ovarian cyst?
Collection of fluid surrounded by a thin wall within an ovary
84
What can ovarian cysts be sub classified into?
Epithelial Stromal cell tumours Germ cell tumours Mixed/metastatic
85
In reference to a gynaecological history, what is kappa?
The number of days she bleeds over the cycle length, eg. k=6/28
86
For menorrhagia, what is it important to know?
Kappa Last smear (when and results) Parity Contraceptive use (which one)
87
What is the difference between primary and secondary dysmenorrhea?
Primary - not associated with an organic disease or psychological cause Secondary - linked with a cause, eg endometriosis, PID
88
What are the most common causes of menorrhagia?
Dysfunctional uterine bleeding | Fibroids
89
What would make a diagnosis of dysfunctional uterine bleeding more likely than fibroids in menorrhagia?
A normal sized painless uterus on examination
90
How does tranexamic acid treat menorrhagia?
An antifibrinolytic that you take during menstrual cycle. | Reduces blood loss by approx 50%
91
Do oral progestogens have a role in the treatment of menorrhagia?
No - not in regular menorrhagia
92
What is mefenamic acid and how is it useful in menorrhagia?
An NSAID | Good to reduce heavy bleeding and dysmenorrhea
93
What can mefenamic acid be used in conjunction with?
Tranexamic acid
94
What are the effects of the combined oral contraceptive pill in menorrhagia?
Reduce bold loss by 20-30% | Improves dysmenorrhea
95
What are the effects of the (mirena) coil in treatment of menorrhagia?
Reduce blood loss by up to 90% | At 1 year, 30% are amenorrhoeic
96
What is the treatment for menorrhagia patients who are very anaemic and bleeding continuously?
GnRH agonist or high dose progestogen to achieve amenorrhoea quickly
97
When are surgical options applicable to menorrhagia?
When patient is sure family is complete and there is failure of medical treatment
98
What are the three types of HRT?
Oestrogen only Sequential HRT (14 days oestrogen, followed by 14 days O & P) Continuous O & P
99
Which patients are applicable for oestrogen only HRT?
Have had hysterectomy
100
Which patients are applicable for sequential HRT?
Still have uterus and are in peri-menopause
101
Which patients are applicable for continuous combined HRT (O & P)?
Patients who are at least 1 year after menopause
102
What are the advantages of HRT?
Elimination of hot flushes, night sweats and vaginal dryness | Protects against osteoporosis
103
What are the disadvantages of HRT?
Small increase in breast cancer and VTE
104
What is classified as post-menopausal bleeding?
Vaginal bleeding more than 12 months after LMP
105
What are uterine fibroids also known as?
Uterine leiomyomas

Medicine (19 decks)

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