Women's health - Pathology and symptoms Flashcards

Question

Hyatidiform mole/molar pregnancy Rf Pathology Sx

Answer 1

Chromosomal abnormal pregnancies that have the potential to become malignant RF - Asian women, first trimester of pregnancy Gestational trophoblastic disease - Trophoblastic tissue part of the blastocyst that invades the endometrium proliferates more aggressively than normal. 1) Hyatidiform mole - where proliferation is localised and non invasive. --- PREMALIGNANT 2) Invasive mole - molar tissue invade the myometrium (locally invasive) Malignant (gestational trophoblastic neoplasm) If metastases occurs = Choriocarcinoma (chemosensitive) Sx - Vaginal bleeding (from light spotting to heavy bleeding) - Uterine size is greater than expected for gestational age (Possible: Pre eclampsia, hyperthyroidism, nausea and vomiting)

Answer 2

Rf - MEN 1, oestrogen therapy, females aged 20-50 Pathology - Benign lactotroph adenomas - Represent 50% of all pituitary adenomas Sx - Amenorrhea - Infertility - Galactorrhoea - Osteoporosis Dx - Serum prolactin - Pituitary MRI Tx - Dopamine agonists (cabergoline, bromocriptine) GS - Trans-sphenoidal resection of the pituitary

Answer 3

Rf - 60 years, mutation of BRCA1/BRCA2, early menarche, late menopause, nulliparity ( the last 3 relates to the number of ovulations --> the higher the number of ovulations, the higher the risk) Pathology - 90% are epithelial in origin (epithelium covers the ovarian capsule and distal fallopian tube). (with 70-80% being serous adenocarcinomas - serous epithelial layer) - The disease is widely metastatic as they usually present late. Sx (Vague) - Abdominal distention (/mass) and bloating - Abdominal and pelvic pain - Urinary symptoms - urgency/frequency - Early satiety - Diarrhoea

Answer 4

Rf - early menarche, PCOS, pre-menopausal group, first trimester of pregnancy Benign ovarian cysts - very common Complex (e.g. multi-loculated) ovarian cysts should be biopsied to exclude malignancy. Pathology Follicular cyst - Most common type of ovarian cyst - Due to non-rupture of the dominant follicle Corpus luteum cyst - If corpus luteum doesn't break down (when pregnancy does not occur) - Can present with intraperitoneal bleeding (Benign germ cell tumour - Dermoid cyst/teratoma --> most common in women <30 years (may contain, skin, hair, teeth)) Vague symptoms - Palpable adnexal mass (near the fallopian tube and ovaries) - Abdominal distension/bloating - Early satiety - Pelvic pain

Answer 5

Torsion of the ovary on its supporting ligaments that may compromise the blood supply. (if fallopian tube also involved - adnexal torsion) Rf - Ovarian mass, reproductive age, pregnancy, ovarian hyperstimulation syndrome Sx - Sudden onset (usually unilateral) colicky abdominal pain with a history of recent vigorous activity/sudden increase in abdominal pressure - Vomiting - Fever in a minority Dx - Ultrasound - whirlpool sign GS (diagnostic and therapeutic) - Laparoscopy/surgical detorsion/salpingo-oopherectomy

Answer 6

(Sexually transmitted) Infection and inflammation of the female pelvic organs (uterus, fallopian tubes, ovaries and surrounding peritoneum) Rf: Young age sexual activity, unprotected sex, history of PID, multiple sex partners Pathology - Usually the result of ascending infection from the endocervix Common causes - Chlamydia trachomatis - Most common cause - N.gonorrhoea - Mycoplasma Sx - Bilateral lower abdominal pain - Dyspareunia - Fever, vomiting - Dysuria - Menstrual irregularities and vaginal discharge - Cervical excitation (pain on moving cervix)

Answer 7

A condition of ovarian dysfunction affecting 5-20% of women of reproductive age. Pathology - Highly associated with hyperinsulinaemia and high levels of luteinising hormone Sx - Subfertility and infertility - Menstrual disturbances; oligomenorrhoea and amenorrhoea - Hirsutism, acne (due to hyperandrogenism) - Obesity

Answer 8

A short term dip in mood after delivering a baby. (Seen in 6-70% of women) It usually starts 2-7 days after giving birth and goes away 1-2 weeks after. (Could be due to changes in hormone levels - oestrogen dropping by more than 100 times. or due to parental stress) Sx - Mood swings - Irritable, anxious, restless - Feeling guilty that you're not happy - Fatigue - Changes to appetite (Usually emotional support, counselling and patience can help a new mum get through this period)

Answer 9

RF: history of depression, recent stressful life events, poor social support Affects about 10% of women. Depression starts within a month and peaks at 3 months Sx - Depression - Anhedonia (loss of interest and pleasure) - Decreased energy - Suicidal - Unreasonable self-blaming/guilt Investigations Depression identification questions - During the last month, have you often been bothered by feeling down, depressed or hopeless? - During the last months, have you often been bothered by having little interest of pleasure in doing things? 1) Edinburgh postnatal depression scale (score >13 = suggestive of moderate depression) 2) Patient health questionnaire 9 (PHQ 9) score (score <16 = less severe depression) Tx - Reassurance and support 1st line - Cognitive behavioural therapy 2nd line - In breast feeding women/severe symptoms --> SSRIs (Sertraline/paroxetine)

Answer 10

A mental health emergency affecting a person's sense of reality. (Affects 0.2% of women) Rf: first child, history of PP, sleep deprivation Pathology - Onset within the first 2-3 weeks following birth (up to 6 weeks after) Sx - Severe mood swings - Hallucinations - Delusions (false beliefs) - Higher risk of harming themselves or their child - Irritable Dx - Blood and urine tests - CT/MRI (All to exclude other causes) Tx - Admission to hospital Antipsychotics, mood stabilisers, antiepileptics

Answer 11

Persistent low mood, loss of interest and enjoyment and reduced energy leading to social and occupational dysfunction. Rf - Postnatal status, family history, history of anxiety disorder, adverse childhood experiences. Sx - Depressed mood/loss of interest for most of the day, nearly every day for a period of 2 weeks. - Diminished interest of pleasure in almost all/all activities most of the day, nearly every day for a period of 2 weeks - Weight loss - Sleep disturbance - Low energy - Excessive guilt - Poor concentration - Suicidal ideation

Answer 12

Implantation of a fertilised ovum outside the uterus Rf: (Anything that can slow the ovum's passage to the uterus) - Pelvic inflammatory disease (damages the tubes), endometriosis, progesterone only pill, IVF, IUD use, smoking, STI Pathology - Most common site - ampulla of fallopian tube - Most dangerous in the isthmus as it increases the risk of rupture - Should the ectopic pregnancy rupture, the women may present in shock from blood loss (and referred pain from intraperitoneal blood) Sx - history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops dark vaginal bleeding. - Constant lower abdominal pain (due to tubal spasm - mostly unilateral) - Dizziness or syncope - Peritoneal bleeding can cause shoulder pain. (Pregnancy related symptoms like breast tenderness)

Answer 13

Rf - Advanced maternal age (>35), history of miscarriage, smoking, alcohol, obesity, diabetes, thyroid problems, previous cervical cone biopsy. Pathology - Highest incidence in the first trimester (first 12 weeks) - Chromosomal abnormalities account for 50% of early miscarriages Sx - Vaginal bleeding with/without clots - Suprapubic pain (cramping may signify the process of expulsion of the fetus) (post coital bleeding)

Answer 14

1) Threatened miscarriage - Painless vaginal bleeding (usually within the first 12 weeks) 2) Missed/delayed miscarriage - A gestational sac containing a dead fetus before 20 weeks without the symptoms of expulsion (light vaginal bleeding/discharge -Symptoms of pregnancy disappear) 3) Inevitable miscarriage - Heavy bleeding with clots and pain - Cervical os is open 4) Incomplete miscarriage - Not all products of conception have been expelled - Pain and vaginal bleeding - Cervical os is open

Answer 15

3 or more consecutive spontaneous abortions. Causes - Antiphospholipid syndrome - Poorly controlled diabetes/thyroid disorders - PCOS - Parental chromosomal abnormalities - Smoking

Answer 16

(Abortion) - 2 registered medical practitioners must sign a legal document. Abortion can only be performed within 24 weeks of gestation. Anti-D prophylaxis should be given to women are rhesus D negative and are having an abortion after 10 weeks gestation --> to prevent the mother's own body from producing it's own natural anti-D prophylaxis (which can affect future pregnancies) Medical abortion - Mifepristone (anti-progestogen) followed by misoprostol 48 hours later - to stimulate uterine contractions (this mimicks a miscarriage) Multi-level pregnancy test (detecting hCG level) - A pregnancy test is required after 2 weeks to confirm the pregnancy has ended. Surgical - Transcervical proecdures e.g. vaccum aspiration, dilatation and evacuation --> Following this, an intrauterine contraceptive can be inserted immediately after evacuation.

Answer 17

Twins occur 1 in 100 pregnancies, triplets 1 in 10000 pregnancies. Rf of dizygotic twins: Previous twins, IVF, induced ovulation, multigravida, increasing maternal age, Afro-carribean. Types of multiple pregnancies 1) Dizygotic twins (most common twin type - 80%) - Non identical - Fertilisation of 2 different oocytes by 2 different sperm (Triplets same cause) 2) Monozygotic twins - Identical - A single ovum that (mitotically) divided into 2 embryos --> Monoamniotic monozygotic twins share the same placenta and amniotic sac. They are associated with: increased spontaneous miscarriage, perinatal mortality rate, increased malformations, prematurity (Most diagnosed only at ultrasound. (Uterus may be larger and palpable before 12 weeks)

Answer 18

Maternal complications - Gestational diabetes - Pre-eclampsia - Anaemia (due to increased blood volume - dilutional effect + increased demand for folic acid and iron) Antenatal complications (for twins. Triplets will be worse odds) - Greater mortality (6x) - Long term handicap (5x) (Rf: pre term delivery, intrauterine growth restriction, monochorionicity) Monochorionicity 1) Monochorionic, diamniotic - shared placenta but separate amnions --> Leads to twin-twin transfusion syndrome (TTTS) - unequal blood distribution due to abnormal vascular anastomoses with the shared placenta --> One twin (the donor) develops anaemia, IUGR and oligohydramnios whilst the other may develop polycythaemia, polyhydramnios. (TX: laser ablation) - poor prognosis

Answer 19

Defined as BMI >30. Maternal risks - Miscarriage - Venous thromboembolism - Gestational diabetes - Pre-eclampsia - Postpartum haemorrhage - Wound infections (Higher C-section rate) Fetal risks - Prematurity - Macrosomia - Stillbirth - Increased risk of developing obesity and metabolic disorders in childhood - Neonatal death (within the first 28 days of birth)

Answer 20

Rf - Obese, previous gestational diabetes, previous macrosomic baby, first degree relative with diabetes, unexplained still birth in previous pregnancy, south asian (usually asymptomatic) Pathology - Glucose tolerance decreases in pregnancy Fetal complications - Macrosomia - Raised fetal blood glucose levels induce fetal hyperinsulinemia --> increased fetal fat deposition and excessive growth - POLYHYDRAMNIOS - Raised blood glucose --> increased glucose excretion into the urine --> water follows glucose --> thus producing more urine than usual - Congenital abnormalities - neural tube or cardiac defects Maternal complications - Hypoglycemia may result from treatment - UTI infection - Pre-eclampsia - Pre-existing ischaemic heart disease can worsen

Answer 21

(Blood pressure falls in the first 24 weeks of pregnancy) Rf of gestational hypertension: nulliparous, maternal age >35, black, obesity. 3 types of hypertension 1) Pre-existing hypertension - A history of hypertension before pregnancy/before 20 weeks gestation - No proteinuria/oedema - If a pregnant woman is taking ACE inhibitor or ARB for hypertension, stop this immediately and start labetolol 2) Gestational hypertension - Blood pressure > 140/90 occurring after 20 weeks gestation in a previously normotensive patient without the presence of proteinuria. - No proteinuria, no oedema - Resolves following birth (after 1 month) - increased risk of pre-eclampsia or hypertension later in life (also an increase in systolic >30 or diastolic >15) MANAGEMENT - Regular monitoring of BP and urinalysis during the pregnancy to exclude pre-eclampsia 1st line - Oral labetalol 2nd line/asthmatic - oral nifedipine (hydralazine) 3) Pre-eclampsia - Pregnancy induced hypertension associated with proteinuria - Possible oedema

Answer 22

New onset BP >140/90 after 20 weeks of pregnancy AND proteinuria/other organ involvement e.g. renal insufficiency (creatinine > 90), liver, neurological, uteroplacental dysfunction. Triad of: new-onset hypertension, proteinuria, oedema Pre-eclampsia is thought to be caused by abnormal trophoblast invasion and failure of spiral artery remodelling --> and so remains narrow and high resistance --> hypoxic placenta --> oxidatively stressed placenta over secretes proteins --> resulting in manifestations of the disease RF: hypertension in previous pregnancy, CKD, autoimmune diseases, diabetes, maternal age >40, obesity, family history, nulliparity Sx - Hypertension (usually >160/110) - Proteinuria - Headache - Visual disturbance - Papilloedema - Oedema - Abdominal pain (RUQ/epigastric) - Hyperreflexia - Low platelets, abnormal liver enzymes or HELLP syndrome

Answer 23

A severe form of pre-eclampsia that can develop in the late stages of pregnancy A subtype of severe pre-eclampsia characterised by: Haemolysis - Dark urine, raised lactic dehydrogenase, anaemia Elevated Liver enzymes - epigastric pain, liver failure, abnormal clotting Low platelets - normally self limiting Sx - N+V - RUQ pain - Lethargy (Most have hypertension and proteinuria) Dx - Bloods: Elevated liver enzymes and low platelet count - Peripheral blood smear - Haemolysis --> Schistocytes Tx - Deliver the baby - IV dexamethasone is administered before and after delivery - Magnesium sulphate for seizure prophylaxis If haematocrit <20% - Blood transfusion If platelet count low - platelet transfusion

Answer 24

The development of seizures in association with pre-eclampsia - Pregnancy induced hypertension after 20 weeks gestation with proteinuria Tx First line - magnesium sulphate (for prevention and treatment of seizures) - should be continued for 24 hours after delivery/last seizure Important things to monitor during treatment: - Oxygen saturations - Urine output - Reflexes - Respiratory rate (if respiratory depression occurs due to magnesium sulphate, GIVE CALCIUM GLUCONATE)

Answer 25

Screened at booking visit and at 28 weeks Pathology The 40% increase in blood volume during pregnancy is greater than the increase in red cell mass. Iron supplementation is necessary to prevent iron-deficiency anaemia. Folic acid and vitamin B12 are also necessary supplements. First trimester - <110g/L Second/third trimester - <105g/L Post partum <100g/L Management - Oral ferrous sulphate/ferrous fumarate --> Continued 3 months after iron deficiency is corrected.how

Answer 26

1st trimester - Conception to 12 weeks 2nd trimester - 13 to 27 weeks 3rd trimester - 28 to 40 weeks

Answer 27

Rf - Previous VTE (high risk), >35 years, smoker, varicose veins, immobility, family history, multiple pregnancy, IVF pregnancy, >30 BMI For women with previous VTE or high risk thrombophilia - LMWH throughout antenatal period For women at risk of VTE due to hospitalisation, surgery, co-morbidities --> LMWH should be started and continued until 6 weeks postnatal. Tx In pregnancy - LMWH is the treatment of choice for VTE prophylaxis (DOAC and warfarin is avoided in pregnancy)

Answer 28

Most women are asymptomatic Best known as causes of pelvic inflammatory disease and subfertility. Can be associated with preterm labour Tx Chlamydia - Azithromycin/erythromycin (Tetracyclines cause fetal tooth discolouration) Gonorrhoea - Ceftriaxone

Answer 29

An overgrowth of predominantly anaerobic organisms e.g. Gardnerella vaginalis --> leads to raised vaginal pH Not sexually transmitted but seen almost only in sexually active women Sx - Asymptomatic in 50% - Vaginal discharge that is offensive Preterm labour, low birth weight and late miscarriages are more common

Answer 30

Chlamydia trachomatis - Most prevalent STI in UK - Mostly asymptomatic --> possibly vaginal discharge and bleeding and dysuria - Dx: Vulvovaginal swab and NAAT (in women).... if positive then culture (National screening programme for ages 15-24) - Tx: First line: Doxycycline 7 days, if pregnant - azithromycin/erythromycin Neisseria gonorrhoea - Sx: Vaginal discharge - Dx: Dx: Vulvovaginal swab and NAAT (in women)... Culture Tx: IM ceftriaxone Complication: disseminated gonococcal infection - triad: tenosynovitis, migratory polyarthritis, dermatitis

Answer 31

The most common cause of early-onset severe infection in the neonatal period. (about 20-40% of mothers have group b strep in their bowel flora) --> Infants can be exposed to GBA during labour. Rf- prematurity, prolonged rupture of the membranes/prolonged labour, previous sibling GBS infection, maternal pyrexia (Symptoms in a baby - Floppy - Respiratory distress - Not feeding well - Unusually/slow/fast heart rate - Changes in skin colour) Dx Women who've had GBS detected in a previous pregnancy should either be given intrapartum antibiotic prophylaxis (BENZYLPENCILLIN) (or testing in late pregnancy followed by antibiotics if positive) Women with pyrexia during labour should also be given intrapartum antibiotic prophylaxis

Answer 32

(Rare in pregnancy women) Disease in pregnancy can cause: miscarriage, severe congenital disease or stillbirth. Congenital syphilis: saddle nose, deafness, rhagades (linear scars at the angle of the mouth) Dx and Tx Screen the mother - Venereal Disease Research Laboratory (VDRL) test If the mother has syphilis, Benzylpenicillin should be given to treat the mother (at least 4 weeks of treatment)

Answer 33

A temperature of >38 degrees in the first 6 weeks following delivery Causes (mainly infection) - Endometritis - UTI - Wound infection - Mastitis - DVT Treated with sepsis 6 Give: Antibiotics, fluids, oxygen Take: Urine output, blood cultures, lactate Antibiotics - for endometritis - clindamycin and gentamicin

Answer 34

A protozoa (STI) Sx - Offensive yellow/green discharge - Dysuria - Dyspareunia - Vulval irritation - Strawberry cervix Investigation - Wet film microscopy - motile trophozoites - NAAT Tx - Oral metronidazole (Can cause premature baby/low birth weight)

Answer 35

Arrange urgent hospital admission if: - Severe systemic symptoms e.g pyelonephritis or sepsis Arrange referral if - Recurrent UTI diagnosed during pregnancy - Catheter associated UTI - Atypical organism on culture If first presentation of uncomplicated UTI - Simple analgesia (paracetamol/NSAIDS) - Prescribe antibiotic - nitrofurantoin (avoid in 3rd trimester) 2nd line - cefalexin Associated with increased risk of pre term delivery and intrauterine growth restriction

Answer 36

Risk to the mother - 5 times greater risk of pneumonitis Fetal varicella syndrome (mostly is exposure to varicella before 28 weeks gestation) Sx: Skin scarring, eye defects (micropthalmia), microcephaly, learning disabilities May be fatal to the newborn child if mother develops rash close to the birth. Dx - Urgently check if mother has varicella antibodies Tx - Oral aciclovir 7-14 days after exposure for post-exposure prophylaxis If the pregnant women develops chicken pox --> immediate oral aciclovir - within 24 hours onset of rash.

Answer 37

An abnormally low volume of amniotic fluid surrounding the fetus during pregnancy. Pathophysiology - Amniotic fluid is initially produced by the mother which is then replaced by fetal urine. Volume peaks at 38 weeks and decreases near birth --> it's function is to protect the fetus and aid organ development. Causes (either due to increased fluid loss or decreased fluid production) - Rupture of membranes - most common - Renal agenesis + pulmonary hypoplasia (potter sequence) - Decreased fluid production (Intrauterine growth restriction) - Pre-eclampsia - Maternal comorbidities e.g. hypertension (Sx - fetal parts would be easier to palpate, uterus may appear small for dates, if there is rupture of membranes - there may be fluid leaking from the vagina) Dx - Ultrasound - A maximum vertical pocket <2cm) Tx - Serial monitoring and possible therapeutic amnioinfusion - Labour induction between 36-38 weeks.

Answer 38

(poorer prognosis if diagnosed <24 weeks) - Limb deformities - Pulmonary hypoplasia - Increased risk of chorioamnionitis - Umbilical cord compression - Meconium aspiration

Answer 39

Abnormally large volume of amniotic fluid. Mechanisms that are involved 1) Fetal swallowing - Atresia of the GI tract, fetal hypoxia, neuromuscular disorders can decrease fetal swallowing volume 2) Fetal urination - Anaemia and gestational diabetes can cause increased urination due to increased cardiac output Causes - Mostly idiopathic - Oeseophageal/duodenal atresia - Cardiovascular defects - Renal defects - Genetic disorders - Trisomy 21, 18 and 13 - Gestational diabetes - Fetal anaemia (heart works harder to compensate for the reduced oxygen delivery) - Multiple pregnancy Sx - Uterus is large for its date - Fetal parts are difficult to palpate - Picked up on ultrasound Dx Ultrasound - A maximum vertical pocket >8cm If fetal anemia/hydrops fetalis is suspected - Tx Mild polyhydramnios - monitored and treated conservatively Severe polyhydramnios --> Amnioreduction (needle aspiration) Indomethacin can also be given --> reduces renal blood flow and thus fetal urination (however there is a risk of ductus arteriosus constriction)

Answer 40

- Increased risk of preterm labour - Premature rupture of membranes - Placental abruption - Postpartum haemorrhage - Increased risk of UTI due to increased pressure on urinary tract

Answer 41

Failure to progress - First stage - less than 2cm cervical dilation in 4 hours - Second stage - Taking more than 1 hour in a multiparous woman and more than 2 hours in a nulliparous woman (pushing stage) - Third stage (delivery of placenta) - Longer than 30 mins with active management (oxytocin infusion/cord traction) or longer than 60 mins with physiological management 3 causes: Power - Force of uterine contractions (insufficient uterine action- most common cause) Passenger - SIZE (the larger the more difficult), PRESENTATION (cephalic, shoulder, breech), POSITION (straight down or side to side) Passage - Shape and size of pelvis --> Cephalopelvic disproportion (baby's head doesn't fit through the opening of pelvis) Dx A partogram is used to measure the progress of labour (cervical dilation, maternal BP, pulse, fetal heart rate, etc) --> Dilation of cervix is plotted against duration of labour and if it is progressing too slowly and it crosses the: - ALERT line --> Amniotomy (artificial rupture of the membranes) - ACTION line --> care is escalated to senior decision (perhaps C-section)

Answer 42

Power - If too weak, give OXYTOCIN infusion to stimulate uterus. Passenger - Changing positions (rotates the baby) Passage - INSTRUMENTAL delivery, C-SECTION, episiotomy (surgical incision to widen the vaginal opening) AMNIOTOMY if cervical dilation is progressing too slowly (Usually prostaglandin first, then amniotomy then oxytocin infusion) Other methods - Membrane sweep - inserting a finger into the vagina to stimulate the cervix - Prostaglandin E2 --> stimulates cervix and uterus to cause onset of labour

Answer 43

RF - Post term birth, family history of large babies, maternal gestational diabetes, obese parents Causes - Large babies - Bony growths of the pelvis - Petite body size - pelvic opening is too small Tx - Delivery either by instrumental delivery or C-section Complications - Shoulder dystocia - Vaginal tears - Postpartum haemorrhage

Answer 44

Cephalic - Head first (normal) (Transverse - lying side to side) Shoulder - Shoulder first Breech - Complete breech --> Hips and knees flexed - Frank breech --> Hips flexed and knees extended (butt first - most common breech) - Footling breech --> Foot hanging out the cervix

Answer 45

- Uterine malformations - Fibroids (non cancerous growths in the uterus) - Placenta praevia (placenta partially/completely covers the opening of the uterus) - Poly/oligohydramnios - Prematurity Cord prolapse is more common in breech presentation Tx At 36/37 weeks if still breech- External cephalic version (applying pressure on the mother's abdomen) - CI in multiple pregnancy or ruptured membranes (or if C-section is required) If baby is still in breech --> Planned C-section (or vaginal delivery)

Answer 46

A complication of cephalic delivery where the anterior fetal shoulder becomes stuck behind the pubic symphysis after the head has been delivered --> OBSTETRIC EMERGENCY (Can cause maternal and fetal morbidity/mortality) RF - Fetal macrosomia, high maternal BMI, maternal DM, prolonged labour Tx - Need assistance from senior doctors/paediatricians/anaesthetics - McRobert's manoeuver - flexion and abduction of the maternal hips (posterior pelvic tilt) Episotomy is sometimes used to prevent perineal tears and to allow better access for internal manoeuvers e.g. Rubin/wood screw - reaching into the vagina and rotating the baby Zavenelli - can cause significant maternal morbidity (pushing the baby back into the vagina to be delivered by C-section) (Suprapubic pressure to help shoulders move under the pubic symphysis) Maternal - Perineal tear - Postpartum haemorrhage Fetal - Brachial plexus injury, erb's palsy - Fetal hypoxia and death

Answer 47

A complication of labour where the muscle layer of the uterus (myometrium) ruptures. Rf - Previous C-section, previous uterine surgery, high parity, increased BMI, increased age, induction of labour, use of oxytocin to stimulate contraction Incomplete rupture - with serosa (surrounding the uterus) intact Complete rupture - Serosa and myometrium ruptured - releasing contents of the uterus into the peritoneal cavity. (possibly the baby released as well) Sx - Acutely unwell mother and abnormal CTG - May occur in induction/use of oxytocin --> Abdominal pain, CEASING OF UTERINE CONTRACTIONS, vaginal bleeding, tachycardia and hypotension Tx - Emergency C-section - Possible hysterectomy (Maternal resus with IV fluids and blood transfusion) Complication Can cause massive internal haemorrhage in the mother and acute fetal hypoxia

Answer 48

Birth occurring before 37 weeks gestation. (Would present with painful contractions and cervical dilation) Rf - Previous premature labour, previous induced abortion, maternal infections, multiple pregnancy, short cervix length, low socioeconomic status, maternal diabetes/thyroid disease, fibroids, polyhydramnios Dx - Speculum examination - assessing dilation of cervix - Fetal fibronectin assay (swab) - elevated means high risk of preterm labour - Transvaginal ultrasound - measure cervical length - Cardiotocography - monitoring both fetus and mother

Answer 49

Prophylaxis 1) Cervical cerclage - inserting sutures into the cervix to strengthen it and keep it closed 2) Progesterone supplement - Maintains pregnancy and prevent labour by decreasing activity of the myometrium and prevents remodelling of the cervix in preparation for delivery. Treatment 1) Tocolysis with nifedipine 2) Corticosteroids - IM betamethasone - reduce perinatal morbidity by promoting pulmonary maturity (given before 35 weeks gestation) (Magnesium sulphate can be given before 34 weeks gestation to protect baby's brain and reduce risk of cerebral palsy) - Cord clamping can also be delayed to increase circulating blood flow in the baby at birth.

Answer 50

Mifepristone (anti progesterone) and Misoprostol (Prostaglandin E2) - Used in abortion for pregnancies less than 10 weeks long - Used in intrauterine fetal death (to induce labour)

Answer 51

Uterine hyperstimulation - Contraction of the uterus is prolonged and more frequent, causing fetal distress and compromise Contractions last more than 2 mins/ more than 5 contractions in 10 mins Can lead to: fetal hypoxia, uterine rupture and emergency c-section Management - Remove vaginal prostaglandin/stop oxytocin infusion - Tocolysis with terbutaline (terbutaline is for acute) (tocolysis in premature labour - longer term --> nifedipine)

Answer 52

It involves the umbilical cord descending ahead of the presenting part of the fetus. --> It can lead to compression of the cord which can cause fetal hypoxia and eventual death. Rf - Prematurity, multiparity, abnormal presentations e.g. transverse lie, breech, polyhydramnios, multiple pregnancy 50% of cord prolapses occur during amniotomy Dx - This should be suspected when there are signs of fetal hypoxia on CTG or when the cord is visible beyond the introitus. Tx - The presenting part of the fetus may be pushed back into the uterus to avoid compression - If cord is visible past introitus, keep it warm and moist to avoid vasospasm - Mother should be in the knee-chest position (on all 4s) - Tocolytics are used to reduce contractions (terbutaline) (filling the bladder with saline to elevate the presenting part may help) - C SECTION IS USUALLY FIRST LINE DELIVERY

Answer 53

1) Ventouse suction cup delivery 2) Forceps delivery (A single dose of co-amoxiclav is recommended after instrumental delivery to reduce risk of maternal infection) Indications - Failure to progress - Fetal distress - Maternal exhaustion - Needing to control the head in various positions Maternal risks - Perineal tears - Postpartum haemorrhage - Incontinence of the bladder/bowel - injury to the anal sphincter - Nerve injury (femoral) - weakness of knee extension - anterior thigh - Nerve injury (obturator) - weakness of hip abduction and numbness of medial thigh Fetal risks - Cephalohaematoma - ventouse suction delivery - Facial nerve palsy - forceps delivery

Answer 54

- Cephalopelvic disproportion - Malpresentation (breech, shoulder)

Answer 55

Rupture of the amniotic sac before the onset of true labour contractions (smoking, infection, placental issues could be risk factors) Dx: Speculum examination - amniotic fluid pooling in vagina - Insulin like growth factor 1 binding protein elevated on vaginal swab (or placental alpha microglobin 1) Prophylactic erythromycin for CHORIOAMNIONITIS Tx if >34 weeks gestation may induce labour If <34 weeks gestation - Corticosteroids (betamethasone), magnesium sulphate, tocolysis

Women's health - Pathology and symptoms Flashcards

(79 cards)