Womens Flashcards
(393 cards)
1
Q
define normal birth
A
spontaneous vertex 37-42 weeks mum + baby good condition no instruments
2
Q
latent phase - what will woman see/feel? how long?
A
irregular contractions
bloody show (mucoid plug)
6hrs - 3days
3
Q
latent phase - whats happening to cervix?
A
effacing and thinning
4
Q
advice for women in latent phase
A
stay at home
paracetamol
eat and drink
5
Q
describe effacement
A
cervix moves forward, retraction of muscle fibres, cervix thins and opens
6
Q
how would you feel a fully engaged baby on abdo palpation
A
feel 2 finger width of head above symphysis pubis
7
Q
what does ‘presentation’ refer to when assessing fetus?
A
anatomical part of fetus which presents through birth canal 1st e.g. breach/cephalic (vertex, brow, face)
8
Q
what does ‘lie’ refer to in fetal assessment?
A
relationship between uterus axis and fetal axis. e.g. longitudinal/transverse
9
Q
what does fetal ‘attitude’ refer to?
A
flexed/deflexed
10
Q
what is engagement, in labour?
A
widest part of presenting part has passed through pelvic brim
11
Q
what is the fetal ‘station’ and how is it measured?
A
relationship between lowest part of fetus and ischial spines. measured on vaginal exam
12
Q
what fetal station would you expect in a woman in 2nd stage
A
at least at the ischial spines (0)
13
Q
what dilatation is expected at active phase?
A
at least 4cm
14
Q
describe contractions at active phase
A
stronger
every few mins (3-4 in 10 mins)
15
Q
where is oxytocin released and what is its role in the active phase?
A
pituitary
keeps contractions going
16
Q
what reduces oxytocin levels and why?
A
anxious mother, ^adrenaline release inhibits oxytocin
17
Q
what are the 3 Ps used to categorise a problem in labour?
A
power (of contractions)
passage (pelvis problem)
passenger (baby’s position)
18
Q
what does entonox contain and in what quantities
A
Nitrous oxide and oxygen 50:50
19
Q
non-pharmacological pain relief for labour
A
in water TENS relaxation hypnosis SUPPORT
20
Q
fetal side effects of opiates for labour pain (pethidine, morphine)
A
respiratory depression
drowsy
decreased breast seeking
21
Q
maternal side effects of opiates in labour (pethidine, morphine)
A
drowsy
nausea/vom
LONGER LABOUR
22
Q
epidural consequences
1 maternal side effect
A
longer labour need more oxytocin malposition ^instruments incontinence (catheter) decreased mobility headache
23
Q
in a normal labour, how often vaginal exams
A
every 4 hrs
24
Q
fetal heart rate monitoring in high and low risk
A
low - intermittent
high - continuous
25
1st stage of labour can be split into what 3 phases?
latent
active
transition
26
what will mother see/feel during transition phase of labour
spontaneous rupture of membranes with clear liquor
feel pressure (like want to poo)
contractions slow/stop
27
what can be seen in the 2nd stage of labour
head
bulging perineum
anal dilatation
28
which fontanelle should you be able to feel on vaginal exam during labour, and which is a bad sign and why?
small post font good
| larger ant font bad - deflexed
29
what suture joins anterior and posterior fontanelles
sagittal
30
describe left occiput anterior position
back of baby's head towards pubic symphysis
| baby's back on mothers left side
31
at how many hours after commencement of pushing would you diagnose delay in a primagravid and a multiparous
prima - 2 hrs
| multi - 1 hr
32
within how many hours of pushing would you expect birth (prima/multi)?
prima - within 3 hrs
| multi - within 2 hrs
33
which shoulder is delivered first?
anterior/pubic symphysis side
34
during delivery, when and why does internal rotation of the fetus occur?
head hits pelvic floor, rotates because the ant/posterior diameter of the pelvis is wider further down
35
when the head is crowning, what is done when delivering in water vs air?
in air, support head and perineum
| in water, dont touch head
36
labour - what drug is given for active 3rd stage management and route
oxytocin IM
37
risk of physiological 3rd stage of labour
^blood loss
38
what is controlled cord traction
pull on cord and massage uterus
39
why do we do delayed cord clamping
prevent neonatal anaemia
40
17 yr old. Lower abdo pain. Nausea. Ix?
pregnancy test
WCC/CRP
USS
41
17 yr old F. Right sided lower abdo pain. Differentials?
ectopic pregnancy
appendicitis
ovarian torsion
42
why does torsion cause pain?
ischaemia
43
symptoms of threatened miscarriage
vaginal bleeding
| occasionally abdo pain
44
what does it mean for the pregnancy when the cervical os is open 1 finger width O/E
inevitable miscarriage
| retained tissue
45
what is a delayed miscarriage?
fetus has died but miscarriage has not occurred i.e. no vaginal bleeding
46
best way to diagnose delayed miscarriage
USS
47
in the 1st few weeks of pregnancy, what should happen to serum bhCG levels over a 36-48 hr period?
double
48
which is better, transabdo or transvaginal scan at early gestation? and why?
transvaginal. closer to fetus, can pick up heartbeat earlier, don't need full bladder
49
what might you see on an USS of a delayed miscarriage?
empty gestation sac
| fetal pole with no heartbeat
50
what percentage of pregnancies with early vaginal bleeding remain viable?
60%
51
risk of surgical Tx of miscarriage
uterine perforation
52
appropriate management of incomplete miscarriage
expectant management (watch and wait)
53
treatment for delayed miscarriage, >12 weeks fetal size
mifepristone (antiprogestogen)
| misoprostol (prostaglandin)
54
treatment for delayed miscarriage, <12 weeks fetal size
misoprostol (prostaglandin)
55
most common site of ectopic pregnancy
ampulla of fallopian tube
56
what should you consider when an empty uterus is found on USS in a patient with positive pregnancy test?
ectopic pregnancy
57
management of ectopic pregnancy
expectant
methotrexate
laparoscopy/laparotomy salpingotomy/salpingectomy
58
what is hyperemesis gravidarum?
excessive vomiting associated with weight loss, dehydration and ketosis
59
management of hyperemesis gravidarum
anti-emetics
fluids
nil by mouth
K+ and Na+ replacement
60
anti-emetics for hyperemesis gravidarum?
metoclopramide
| ondansetron
61
why is breast cancer incidence increasing?
living longer
obesity
screening
62
risk factors for breast cancer
```
obesity
decreased exercise
alcohol
HRT
OCP
ADH (atypical ductal hyperplasia)
FH
early menarche, late menopause
older 1st pregancy
```
63
breast cancer symptoms
```
nipple retraction
nipple discharge
painless lump
skin tethering
fracture
confusion
```
64
what is the triple assessment in breast cancer?
1. clinical score
2. imaging score (USS/mammo)
3. biopsy score
1 normal -> 5 cancer, aim for concordance
65
in triple assessment, if clinical and imaging score is 5, and biopsy score is 1... what would you do?
re-biopsy. may have missed lesion
66
how does cancer appear on mammogram?
white/dense
67
if one breast appears different shape/smaller on mammogram, what might this suggest?
tethering (wont squash as well)
68
when would MRI be used in breast imaging?
dense breast
screening in young women w/ e.g. BRCA
w/ contrast to see if lump is benign or malig
69
in breast cancer if nodes are palpable clinically, what axilliary Tx is required?
full axillary clearance
70
reasons for mastectomy
large cancer relative to breast size
tumour under/indrawing nipple
multifocal
patient choice
71
complication of axillary clearance
lymphoedema
72
axillary management if nodes are not palpable in breast cancer
sentinel lymph node biopsy
| limited axillary clearance
73
% of breast cancers that are ductal and typical presentation?
70%
| hard lump
74
% of breast cancers that are lobular and typical presentation
10%
| soft, dont show well on mammogram
75
difference between stage and grade of breast cancer
stage is anatomical (tumour, nodes, mets)
| grade - how they look down microscope
76
endocrine treatment for breast cancer are used in oestrogen or progesterone +ve disease. Give the commonly used endocrine therapy and another that is used only in post-menopausal women
tamoxifen [oestrogen receptor blocker]
aromatase inhib [peripheral oest synth]
77
when would you use trastuzumab (Herceptin) in breast cancer Mx?
Her-2 positive cancers
78
side effects/complications of tamoxifen
hot flushes, nausea, vaginal
bleeding (thromboses, endometrial
cancer rarely)
79
side effects of aromatase inhib
hot flushes, reduced bone density
80
why are bisphosphonates given in breast cancer?
prevent bone mets
81
methods of intermittent fetal auscultation used in community
Pinard stethoscope
| Hand-held Doppler
82
disadvantages of intermittent auscultation methods
diff to distinguish maternal and fetal heart
| can't pick-up variation and decelerations
83
adv of intermittent ausculation
cheap, non-invasive, home setting
84
what are the parameters you're looking for on a CTG?
```
Bra- baseline HR
Variability
Accelerations
Decelerations
Overall
```
85
how would you classify a reassuring CTG
baseline 110-160bpm
variability <5bpm
accelerations
no/early decelerations
86
what are the 2 CTG transdusers detecting?
fetal HR
| uterine contractions
87
disadvantages of CTG
dec mobility
| no improved outcome, ^intervention
88
advantages of CTG
continuous
| non-invasive
89
what are accelerations and decelerations on ctg?
rise/ fall in fetal HR by 10-15bpm
90
what are early decelerations/ why do they happen?
uterus contracts, blood supply to baby dec > fetal HR dec. uterus relaxes>HR^. physiological
91
what are late decelerations on ctg?
fetal HR drop after uterine contraction, takes longer to recover. sinister
92
what are variable decelerations on ctg?
fetal HR drops with no relation to uterine contraction
93
why could variation be <5bpm for up to 40 mins?
baby sleeping
94
gold standard for fetal monitoring and why?
scalp ECG, not confused w/ maternal heart
95
disadvantages of scalp ECG for fetal heart monitoring
```
invasive
can only be done when waters broken
X with maternal infection
scalp injury
only in labour
```
96
adv and disadv of abdo fetal ECG
non-invasive, mother mobile
still being developed
signal hampered by ^amniotic fluid 28-32wks
97
side effects of entonox
maternal nausea and vom
98
difference between spinal and epidural anaesthesia
epidural outside dura, spinal -intrathecal/ subarachnoid (continuous space with intracranial)
99
how would you deliver opoids to a woman in labour (X2)
1. single shot IM
| 2. patient controlled analgesic pump IV
100
side effects of single shot opoids
sedation
respiratory depression
seizure
N and V
101
at what level does the spinal cord terminate?
L2
102
indications for epidural
```
maternal request
pregancy induced HTN
pre-eclampsia
cardiac disease
multiple births
theatre likely
```
103
contraindications for epidural
maternal refusal
local infection
LA allergy
(coagulopathy, systemic infection)
104
effects of epidural other than analgesia
fever
breathlessness
headache
105
disadv of general anaethesia over regional for CS
partner cant be there
aspiration
failed intubation
seeing baby
106
disadv of regional anaesthesia
failure
discomfort
headache
107
what is menopause and when is it diagnosed?
cessation of menstruation. after 12 months amenorrhoea
108
name of period leading up to menopause
perimenopause
109
Sx of perimenopause
```
irregular periods
hot flushes, night sweats
mood swings
dec sex drive
vaginal dryness
joint/muscle pain
```
110
health impacts of the menopause
```
dyspareunia
^UTIs
prolapse
incontinence
dementia
heart disease
osteoporosis
```
111
what hormone causes endometriosis
oestrogen
112
what is the most common site of endometriosis and why
pouch of douglas [betw rectum and uterus]
| lowest anatomical part
113
how does endometriosis enter the abdo cavity
retrograde menstruation through fallopian tubes
114
symptoms of endometriosis
```
pain
infertility
nosebleed
cough blood
lump
dyspaerunia
```
115
how does endometrium travel to other areas of body in endometriosis
blood stream
lymphatics
metaplasia
116
describe the pain experienced in endometriosis and why
fluctuating, worsening until period then improving after. Oestrogen fluctuates, thickens endometrium
117
what is a chocolate cyst?
ovary full of blood, seen in endometriosis
118
why can endometriosis cause dyspareunia?
pouch of douglas irritated
119
at what age would endometriosis typically present?
teens/early 20s
120
Tx options for endometriosis
```
stop oest or give prog!
OCP
GnRH
POP
mirena
depo
oophorectomy
```
121
what effect do oestrogen and progesterone have on endometrial lining
oest^, prog decrease
122
what is triphasing with the OCP?
give back to back for 3 months without week off
123
what doe giving GnRH effectively do to a woman?
make menopausal
124
why can't you give oestrogen alone without progesterone?
^^^endometrial growth > endometrial cancer
125
what reason may you need to give endometriosis patient prog alone instead of OCP? and disdv of this
migraines
| irregular bleeding/spotting
126
how do you diagnose endometriosis?
laparoscopy
127
whats a frozen pelvis
everything stuck togtehr in endometriopsis
128
surgical options in endometriosis
ablation
hysterectomy
oophorectomy
129
theories for why endometriosis causes infertility
immune factors
tubal dysfunction
ovary dysfn
adhesions
130
what type of woman does adenomyosis typically present
older, multiparous
131
sx of adenomyosis
cyclic pain
dyspareunia
dysmenorrhoea
132
what are fibroids and hormonal cause of them
benign uterine tumours of myometrium
| oestrogen
133
tx for fibroids
```
nothing if asymptomatic
COCP, Mirena
tranexamic acid
mefanamic acid/ ibuprofen
ulipristal acetate
GnRH
surgery[myomectomy/hysterectomy]
```
134
sx of fibroids
depends where
bleeding, pain, miscarriage, infert
lump
anaemia
135
what is a endometrial polyp?
growth from endometrium as opposed to myometrium
136
sx of endometrial polyp
miscarr, bleed, pain, infert
137
what is battery?
failure to obtain informed consent
138
What is autonomy
patients right to make decision, without Dr.s opinion influencing
139
elements of full informed consent
```
nature of procedure
alternatives
benefits/risks
assess Pt understanding
Pt acceptance
```
140
can a woman refuse emergency CS for fetal distress?
yes
141
recommendations of fraser competence
1. patient understanding
2. encourage parental involvement
3. likely to have sex anyway?
4. physical\mental health suffer if no Tx?
5. Pt's best interests
142
limit for termination of pregnancy and exeptions
<24 weeks
OR risk to pregnant woman's life
child would be severe disability
143
risks of HRT
breast cancer
DVT/PE
stroke
MI
144
non hormonal Tx for hot flushes and mood. what type of drug?
clonidine, alpha blocker
145
non-pharmaceutical Mx for menopause
CBT
146
hormonal Tx for menopause
local [vaginal] oest
| HRT
147
when to give HRT with oest and prog
if they have a uterus
148
what type of HRT has ^breast cancer risk? combined/ just oest
combine oest and prog
149
how would your HRT management differ is woman with implant/Mirena?
implant - give combined oest/prog
| mirena - give only oest
150
how does oestrogen ^clot risk? how would you combat this with a different method?
^clotting factor production by liver. transdermal patch instead of oral
151
why might you use transdermal HRT over other methods?
crohns
Pt with ^clot risk
patient choice
152
what is premature ovarian insufficiency?
menopause <40
153
tx for prem ovarian insufficinecy
HRT
combined OCP
until age 50
154
how long are women fertile after menopause
if menopause <50 - 2yrs
| menopause >50 - 1yr
155
2 syndromes of incont + cause
overactive bladder [Involuntary bladder contractions]
| stress incont [sphincter weakness]
156
presentation of overactive bladder
```
Urgency incont
Frequency
Nocturia
Nocturnal enuresis (bed wetting)
‘Key in the door’
‘Handwash’
sex
```
157
presentation of stress incont
Involuntary leakage: Cough, Laugh, Lifting, Exercise, Movement
158
initial simple assessment of incont
bladder diary/freq vol chart
MSU
questionnarie
residual [catheter/USS]
159
frequency vol chart shows voiding 400-600ml 4 times a day with some leakage in between. What type of incont
stress
160
freq. vol chart shows voiding 100-150ml 10X a day. what type incont
overactive bladder
161
why do diabetics get ^incont
^UTIs
neuropathy/dec sensation bladder
polydipsia/polyuria
162
what could microscopic haematuria on MSU suggest?
glomerulonephrits, infection, nephropathy, cancer
163
how does urodynamics study measure detrusor pressure
bladder pressure [catheter] - abdo pressure [rectum]
164
urodynamics, cough causes urine leak w/ no change in detrusor pressure. Dx?
stress incont
165
urodynamics, wash hands, ^detrusor pressure. Dx?
overactive bladder
166
medical/surgical Mx for stress incont
surgery [sling]
| vag oest
167
medical/surg Mx of overactive bladder
```
oxybutynin
mirabegron
Botox
sacral nerve stimulation
augmentatioin cystoplasty
vag oest [vaginal atrophy]
```
168
non pharma/invasive Mx of incont
physio/pelvic floor
lifestyle [caffeine, weight, smoking]
pads
Bladder training
169
side effects of anticholinergics [oxybutynin]
Dry mouth, blurred vision, Drowsy, Constipation
170
prolapse management
pessary
| surgery
171
define antepartum haemorhage
Bleeding from anywhere in genital tract >24 weeks
172
causes of antepartum haemorrhage
```
placenta praevia
placenta accreta
vasa praevia
abruption
infection
unexplained
```
173
when/how is Dx of placenta praevia made? &when would you re-check
20 week anomaly scan
| re-check 32[major]/36[mild]
174
what must be done is placenta remains <25mm from os
CS
175
bleeding placenta praevia, <34 wks, what drugs may you want to give
steroids
176
mx of placenta accreta
CS
177
in vasa praevia who's at most risk, mum or baby?
baby, no major maternal risk
178
what is placental abruption?
Premature separation of placenta from uterine wall
179
Woody-hard, tense uterus and maternal shock out of proportion with PV bleed
placental abruption with concealed haemorrhage
180
risk factors for placental abruption
```
Previous abruption
Hypertension
Multiple pregnancy
Trauma
iatrogenic [amniodrainage]
Infection
Smoking, drugs
```
181
complications following antepartum haemorrhage
```
Premature delivery
Acute tubular necrosis
DIC
PostPH
ARDS
Fetal hypoxia/death
```
182
causes of post partum haemorrhage
Tissue - placenta complete?
Tone - uterus contracted?
Trauma - tears
Thrombin - clotting
183
risk factors for PPH
```
big baby
prima/^multigravid
multiple preg
precipitate/prolonged labour
pyrexia
instrumental delivery
shoulder dystocia
previous PPH
APH
```
184
how do you prevent maternal post partum PE
LMW heparin, dose is weight dependent
185
risk factors for postpartum maternal VTE
```
previous VTE
thrombophilia
^age
^BMI
smoking
parity>4
mult preg
pre eclam
immobile
CS
systemic infection
```
186
risk factors fro maternal sepsis
obesity, DM, immunosupp, anaemia, PROM, Hx groupB strep
187
Sx/signs of sepsis [maternal post partum]
pyrexia, hypothermia, tachycardia, tachypnoea, hypoxia, hypoTN, oliguria, imp consciousness, failure to respond to Tx
188
sepsis 6
1. ABG + give O2
2. cultures
3. IV Abx
4. fluids
5. bloods [lactate, Hb, glucose]
6. urine output
189
Sx of severe pre-eclampsia
```
RUQ pain
oedema
blurred vision/flashing
nausea/vom
headache
```
190
Mx pre-eclampsia
```
labetalol/nifedipine
magnesium sulphate
urine output/fluid restrict
CTG/USS
delivery
```
191
seizures in pregnant woman is what until proven otherwise
eclampsia
192
eclampsia seizure Mx
IV mag sulphate
treat HTN labetalol
deliver
193
why does cord prolapse cause fetal mortality/morbidity
cord vasospasm > hypoxia
194
risk factors for cord prolapse
```
PROM
polyhydramnios
long umb cord
fetal malpresentation
multiparity
multi preg
```
195
Mx of cord prolapse
trendelenburg
tocolytics
push baby off cord
CS
196
what is shoulder dystocia?
failure of ant shoulder to pass under symphysis pubis after delivery of fetal head
197
risk factors for shoulder dystocia
```
big baby
DM
postmaturity
obesity
prolonged labour
instrumental delivery
```
198
maternal and fetal complicaitons of shoulder dystocia
maternal: PPH, vaginal tear
fetal: hypoxia, fits, CP, brachial plexus injury
199
WHO screening criteria
```
important disease
latent stage
natural course known
test known
acceptable test
continuous testing
treatment accepted
facilities
who to treat agreed
cost
```
200
what's in infectious diseases screening on preg women
HIV, hep B, syphilis
201
newborn blood spot screening diseases
```
CF
congenital hypothyroidism
sickle cell
Phenylketonuria
MCADD
maplesyrup urine disease
IVA
GA1
homocystinuria
```
202
what is down's syndrome and main maternal risk factor
trisomy 21
| ^maternal age
203
what is edwards syndrome, maternal risk factor and prognosis
trisomy 18
^maternal age
most die before birth/shortly after
204
what is patau's syndrome, maternal risk factor and prognosis
trisomy 13
^maternla age
most die before birth/shortly after
205
what does screening for downs edwards and pataus involve and when
combined test- US [nuchal trans] and bloods [PAPPA-A and BHCG]
10-14 weeks [same time as dating scan]
206
downs high risk from combined test, what next?
offered diagnositic test:
<15 weeks chorionic villous sampling
>15 weeks amniocentesis
207
when do pregnant women have USSs and what are they for?
8-14 weeks: gest age, fetal demise, multi preg, fetal abnorm/nuchal trans
18-21: abnorm [gastroschisis, spina bifida, anencephaly]
208
what's PKU
inability to metabolise phenylalanine. leads to leanring dis. need special diet
209
when do newborn and infant physical exams take place
within 72 hrs, 6-8 weeks
210
why ask about Abx in sexual Hx
may partially treat STI > false -ve test
211
why do you ask male when last void urine in sexual Hx
if weed in last hr, sample may be false -ve
212
ix sexual medicine female
vaginal swab [gon/chlam]
bact vag, trichomonas vaginalis,candida
bloods [syph/hiv]
urine dip
213
Ix sexual med heterosexual male
first void urine [chlam/gon]
urethral swab
urine dip
blood [hiv/syph]
214
ix sexual med MSM
```
urine
pharyngeal swap
rectal swab
bloods [hiv/syph/hepB]
culture plates
```
215
who would yoiu test for hepB
commercial sex workers
MSM
IV drug users
from high risk area [africa/asia]
216
when are women breast screened
50-70 every 3 years
217
symptomatic breast clinic, what Ix in < and >40
<40 USS
| >40 USS and mamogram
218
breast cancer tend to be mobile or fixed?
fixed
219
what is the definition of prematurity?
<37 weeks
220
health consequences of prematurity
chronic lung disease
developmental delay
CP
visual impairmen
221
contributors to improved survival after prematurity
```
Antenatal steroids
Artificial surfactant
Ventilation
Nutrition
Antibiotics
```
222
risk factrs for preterm birth
```
multiple preg
APH
previous preterm
infection [UTI/BV/pyeloneph/appendicitis/pneumonia]
Cervical weakness
```
223
primary and tertiary prevention of preterm birth
primary: smoking, STIs, no multiple pregs, cervical assessment [20-26wks] -Transvaginal cervical ultrasound, Fetal fibronectin swab
tertiary: tocolytics, steroids, Abx
224
what are the aims of primary, sec, tertiary prevention in preterm labour
1. population/public health interventions
2. target those at risk/surveillance
3. prevent morbidity/mortality
225
risk factors for pre-eclampsia
```
prev preE
chronic HTN, or HTN in prev preg
CKD
DM
autoimm disease [SLE/antiphospholipid/thrombophilia]
```
```
1st baby
^BMI
>40
FH
multi preg
```
226
diff between gestational HTN and pre-eclampsia
preE have proteinuria
227
pathophysiology of preeclampsia
no trophoblastic invasion of spiral arteries = Xdilatation -> placental ischaemia
228
what are the consequences of dec placental perfusion in preE
fetal growth restriction
| maternal vasoconstriction, kidney dysfn
229
severe complications of preE including causes of maternal morbidity
```
eclampsia
placental abruption
IUGR
iatrogenic prematurity [ony cure is to deliver]
HELLP syndrome
DIC
haemorrhagic stroke
multiorgan failure/ renal failure
ARDS
```
230
what makes up HELLP syndrome
haemolysis
elevated
liver enzymes
low platelets
231
what is the time range when preE can occur?
20 weeks gestation to 6 weeks post-delivery
232
describe relfexes in preE
hyperactive/brisk
233
Ix in preE
```
BP
LFT
FBC [low HB, platelets]
USS
urine dip
```
234
side effects of mag sulph to treat eclampsia seizures
cardiac arrest
| toxicity [lose reflexes]
235
name the 3 main preg hormones
hcg, oest, prog
236
at day 6-7, blastocyst signals to mother by secreting
hcg
237
where does progesterone come from during gestation?
corpus lutuem up to 7/8 weeks then placenta takes over
238
roles of prog during preg
Proliferation/vascularisation of endometrium
myometrial quiescence
^maternal ventilation
fat storage
239
what is the principle fetal nutrient
glucose
240
what is Haemolytic disease of the new born
[rhesus disease] rhesus -ve mum produces antibodies against rhesus +ve fetus's RBCs
241
Tx for rhesus diseas?
anti-D
242
sx/signs of rhesus disease in foetus
jaundice
| anaemia
243
roleof oxytocin in labour
uterine contraction
244
tocolytic drugs used in preterm labour
nifedipine
| atosiban
245
mx postmaturity in preg
membrane sweep
vaginal prostaglandin
artificial rupture of membranes
oxytocin
246
risks to fetus of gestational diabetes
macrosomia -shoulder dystocia, birth diff
malformation - cleft palate
death
247
most common pathological cause of heavy menstruation
uterine fibroids
248
what is adenomyosis
endometrial tissue within the myometrium
249
causes/differentials to consider in menorrhagia
fibroids
hypothyroidism
clotting disorder
drugs [warfarin]
250
Ix of menorrhagua
FBC
| transvaginal sonography
251
Tx of menorrhagia
```
mirena
tranexamic acid
mefanamic acid
progestagen
COCP
endometrial ablation/ hysterectomy
```
252
what is a bartholins cyst
blocked gland that produces lubrication. on labia minora
253
define FGM
partial or total removal of, or injury to female external genitalia for non-medical reasons
254
define type 1-4 FGM
1. CLITORIDECTOMY partial/total removal of clitoris
2. EXCISION part/total removal of clitoris & labia minora [+/- majora]
3. INFIBULATION narrowing vaginal orifice +/- clitoris
4. anything else
255
complications of FGM
```
chronic pain
dyspareunia
anorgasmia
keloid scar
PTSD
recurrent UTI
PPH
CS
episiotomy
```
256
causes of primary amenorrhoea by age 16
genes
turners/swyers syndrome
imperforate hymen
257
causes of secndary amenorrhoea [cessaton after onset]
```
weight loss
excessive exercise
PCOS
pregnancy
stress
hyperprolactinaemia
hypo/hyperthyroid
Sheehan's syndrome
POF
```
258
causes of precocius puberrty
CAH
hydrocephalus
adrenal tumor
ovarian tumuor
259
Ix delayed puberty
```
FBC -amaenia
CRP
U and E
LFT
Bone profile
Coeliac
TFT
```
260
name 5 risk factors for endometrial cancer
```
obesity
DM
nulliparity
late menopause
ovarian tumour
HRT,
Pelvic irradiation,
Tamoxifen,
PCOS,
HNPCC
```
261
Ix for endometrial cancer
transvaginal US
endometrial biopsy
hysteroscpoy
262
Tx endometrial cancer
hysterectomy +/- lymph
radiotherapy
progesterone therapy
263
risk factors for cervical cancer
```
HPV
1st intercourse <16
STD
smoking
multiparity
previous genital tract cancer
OCP
```
264
Mx cervical cancer
diathermy
radio
chemo
265
Tx vulval cancer
surgery, radio, chemo
266
presentation ovarian cancer
```
Bloating
Abdo pain
Change in bowel habit
Urinary frequency
Bowel obstruction
```
267
risk factors for ovarian cancer
```
BRCA gene
OCP
HRT
age
obesity
menopause
```
268
Ix in ovarian cancer
CA125 bloods
| USS
269
Mx of ovarian cancer
surgery
| chemo
270
causes of female infertility
```
PCOS
prolactinoma
chlamydia
congenital uterus abnormality
endometriosis
adhesions from surgery
obesity
```
271
Ix for female infertility
```
mid-luteal progesterone
FSH
chlamydia
USS
HSG xray
```
272
management of anovulation
weight loss/gain
clomifene citrate
laparoscopic ovarian drilling [PCOS]
273
what % of couples <40 will conceive in 1st year
80%
274
female infertility - criteria for early referral (before 1 yr)
```
>35 yrs
no periods/irregular
prev STI
adbo/pelvic surgery
abnorm pelvic exam
```
275
pre-conception advice
```
stop smoking
folic acid
lose weight
no alcohol
sex 2-3X/week
smear
```
276
reproductive probs associated w/ obesity
```
PCOS
dec success of ART
miscarriage
infertility
obstetric complications
```
277
Ix of male infertility
```
semen analysis
examine testicles
CF
hormones- test/LH/FSH/prolactin
karyotype
```
278
Mx for male infertility
```
IUI
IVF
surgical sperm recovery [azoospermia]
epididymal block correction
hormones
smoking, weight
```
279
criteria for PCOS
2 out of 3:
1. oligo/amenorrhoea [anovulation]
2. polycystic ovaries on USS
3. raised androgens
280
TX for PCOS
clomefine [+metformin]
281
causes of tubal defect infertility
STI
surgery
endometriosis
282
risks of IVF
Multiple Pregnancy
Miscarriage
Ectopic
283
management of infertility due to anovulation [pituitary tumour]
bromocriptine
284
name a condition that worsens in preg, one that improves, and one that can go either way
worsens - mitral stenosis
improves- RA
asthma variable
285
complications of maternal iron deficiency
low brith weght
| preterm delivery
286
1st and 2nd most common anaemia in preg
1. iron def
| 2. folate def
287
Prgenant woman with low haemoglobin, low MCV. type of anaemia, likely cause, and management?
microcytic, iron def,
| iron tabs > infusion > D/W haematology
288
preg woman. low haemoglobin, ^MCV. type of anaemia, likely cause, Tx?
macrocytic, folate deficiency, ^ folic acid dose
289
changes to resp function and blood gas during preg
^O2 consumption
^tidal vol
arterial O2^, dec CO2
290
maternal asthma risk to foetus
inadequate placental perfusion
fetal growth restriction
prem delivery
291
asthma drugs in preg
same as non-preg
292
cardiac changes in preg
^cardiac output due to ^stroke vol
293
Commonest liver disease in pregnancy
obstetric cholestasis
294
1 Sx and one Ix result seen in obstetric cholestasis
itch
| deranged LFTs
295
complications of obstetric cholestasis
stillbirth
| prem labour
296
obstetric cholestasis resolves when?
after delivery
297
risks of hyperthyroidism in preg
maternal thyroid crisis >cardiac failure
| fetal thyrotoxicosis
298
risk of untreated maternal hypothyroidism
early fetal death
| neurodevelopmental impairment
299
Tx for obstetric hypothyroidism? most important trimester and why?
thyroxine
| 1st - fetal thyroid takes over at 14 weeks
300
what is erb's palsy?
paralysis of arm caused by damage to brachial plexus by shoulder dystocia
301
diabetes drugs which are acceptable in preg
insulin
| metformin
302
statins in preg?
contraindicated
303
kidney changes in preg and effect on blood creat/alb
^renal blood flow and GFR
| dec serum creat/alb
304
fetal risks of maternal epilepsy
abnormality [drugs +/-epilepsy]
| fetal hypoxia associated with maternal seizure
305
risk factors for maternal thromboembolism
surgical delivery
age
obesity
306
prevention Tx of maternal thromboembolism in preg
low molecular weight heparin
307
how would you 1st investigate suspected obstetric PE
doppler US for DVT
308
intermens bleeding could suggest?
fibroids
309
which vaccination is importnant to ask aboput in fertility history
rubella
310
gravidity
total no. of pregnancies, even if terminated etc
311
parity
total number of deliveries, even stillborn, >24 weeks
312
define timeframe for neonatal death
death in 1st 28 days of life
313
define preterm and postterm
<37, >42 weeks
314
define puerperium
from the delivery of the placenta to six weeks following the birth
315
define 1st to 4th degree tear
1st skin
2nd perineal muscle
3rd rectal muscle/sphincter
4th into rectal mucosa
316
severe maternal postnatal problems
```
sepsis
pph
eclampsia
uterine prolapse
incont
thrombosis
depression
```
317
After delivery of the placenta, the uterus is at the size of ?-week pregnancy
20
318
postnatally palpable uterus reduces by what measure each day
1 finger breadth
319
what is lochia and what does it contain
vaginal discharge to 6 weeks after giving birth containing blood, mucus, and trophoblastic tissue
320
reasons for deviation from reduction in uterus size postnatally
fibroids, RPOC, infection
321
at how many weks gestation does fundus reach umbilicus?
20-24
322
reasons for discrepancy between fundal height and dates
```
inacurate menstrual histry
multi preg
maternal size
hydatiform mole
polyhydramnios
fibroids
```
323
confirmed ectopic, drug Tx
methotrexate
324
define acute and chronic pelvic pain
pelvic pain = below belly button
| chronic =6 months or longer
325
name 4 causes of chronic pelvic pain
```
endometriosis
PID
adenomyosis
IBS
constipation
fibroids
```
326
name 4 causes of acute pelvic pain
```
appendicitis
ovarian torsion
ectopic pregnancy
ovarian cyst rupture
UTI
PID
```
327
copper coil increases risk of what cause of pelvic pain
PID
328
21 yr old female, severe LIF pain. IX?
```
urine pregnancy test
urinalysis
CRP, FBC
serum beta HCG
USS
triple swabs for chlam/gon
```
329
management of ectopic
methotrexate
surgery
pain relief
330
management of PID
ceftriaxone, doxycycline, metronidazole
331
caauses of PID
```
STI
IUCD insertion
post-partum
hysteroscopy
appendicitis
```
332
drug treatment for heavy periods
transansamic acid
| mefanamic acid
333
28 yr old, lower abdo pain starts 3 days before period and ends 1 day after. Dysmenorrhoea, dyspareunia. Hasn't got pregnant despite 3 yrs off OCP
endometriosis
334
describe uterus on VE in endometriosis
fixed, retroverted
335
what is the gold standard Ix for endometriosis
laparoscopy with biopsy
336
at how many weeks would you normally induce a preg woman
42
337
abruption, placenta praevia, vasa praevia. In which is it acceptable to dok vaginal delivery?
abruption. Never in other 2
338
causes of antepartum haem
vasa praevia
placenta praevia
abruption
339
causes of bleeding in 1st trimester of preg
miscarriage
| ectopic
340
define priamry and secondary PPH in time frame
prim 1st 24 hrs
| sec over 24 hrs
341
causes of primary PPH
Tone
Tissue
Trauma
Thrombin
342
causes of secondary PPH
tissue
| infeciton
343
delivery plan for placenta praevua
if major [covering os] - CS 38 weeks
344
acute immediate management of obstetric haemorrhage
```
regular Obs
2 wide, bore cannulae
blood - clotting, crossmatch, Hb
fluids
transfusion
O2
catheter
```
345
define placenta accreta
abnormal adherence of placenta to uterus
346
what are placenta increta and percreta
increta - myometrium infiltrated
| percreta - reaches serosa
347
name an aspect of a woman's obs History that increases risk of placenta acreta
previous CS
348
implications of placenta accreta for moyher
PPH
| hysterectomy
349
relationship between APH and PPH
APH increases riskm of PPH
350
3rd trimester pregnancy, vaginal bleeding, contaction and abdo pain
abruption
351
risk factors for abruption
smoking, drugs, ^maternal age, trauma, pre-E
352
most common cause of PPH
uterine atony
353
why catheterise in PPH
urine output [renal failure]
| full bladder can stop uterus contracting
354
side effects of uterotonics
nausea and vomiting
355
surgical measures for PPH
rusch balloon
B-lynch suture
uterine artery ligation/embolisation
356
what is DIC
Disseminated intravascular coagulation
widespread activation of the clotting cascade
blood clots form in small blood vessels
357
why do you get vaginal bleeding in ectopic pregnancy
hormones cause endometrium to build up, but when no uterine pregnancy grows, the lining sheds
358
why does ectopic cause internal bleeding and what symtoms may this cause
vascular tube ruptures
shoulder pain when lying down due to irritation of the diaphragm
diarrhoea due to irritation of rectum
359
what conditions may cause raised CA125
ovarian cyst
malignancy [VERY HIGH]
PID
360
In early pregnancy, at what level of serum beta HCG would you expect to see an intrauterine pregnancy?
1500+
361
why do you give Anti D in a miscarrying rhesus -ve woman?
to protect next pregnancy from rhesus disease
362
gold standard diagnostic test for ectopic
laparoscopy
363
cervical excitation leads to increased pain - diagnosis and why?
ectopic
| irritates structures/tubes
364
risk factors for ectopic
previous ectopic
pelvic surgery
coil
365
what contraception would you advise against following ectopic
coil
366
measures of progression in labour
decent of head
effacement
dilatation
367
most common cause of failure to progress in labour in prima gravida
poor contraction
368
most common cause of failure to progress in labour in multigravida
cephalo-pelvic disproportion
369
how much dilatation of cervix should you see in active phase of the 1st stage of labour in 1 hr
1cm/hr prima
| 2cm/hr multi
370
why does rupturing membranes speed up labour?
releases prostaglandins
371
management of failure to progress in labour
oxytocin infusion
| consider CS
372
risks of oxytocin infusion in multiparous
rupture of uterus
373
1st stage of labour - latent phase is up to how many cm dilated
4
374
36-year-old woman wants contraceptive advice.
Heavy, painful periods. Family is complete. Smoker.
(a) Combined oral contraceptive pill
(b) Cyclical progestogens
(c) Endometrial ablation
(d) Hysterectomy
(e) Mirena intrauterine system
e) mirena
375
25-year-old pregnant woman has insulin-dependent DM.
Which of the following is true?
(a) Determination of glycated haemoglobin levels is a measure of glycaemic control
(b) Dietary advice includes avoidance of carbs
(c) Should switch to an oral hypoglycaemic agent
(d) risk of congenital anomaly is similar to non-diabetic
(e) risk of fetal growth restriction is increased
a) HbA1c
376
9 year old with eczema presents with increasing pruritis of hands + behind knees, despite regular emollient use. Unkempt/ dry skin, in particular on hands and behind knees. Skin is very erythematous + painful with multiple pustules and a yellow crust.
What is the most appropriate additional treatment?
(a) Aciclovir
(b) Flucloxacillin
(c) Hydrocortisone cream
(d) UV therapy
(e) Washing of linen and application of permethrin
b) fluclox
| infected eczema
377
risk factors for small for gestational age fetus
```
previous SGA baby
smoking
preE
high BMI
excessive exercise
low fruit intake
TORCH
```
378
examination and Ix IN A SUSPECTED SGA BABY
```
maternal bmi
bp
fundal height
USS
umblical artery doppler
CO
TORCH screen
```
379
why would HC, AC, FL, AFI be 50th centile but estimated fetal weight below 10th?
customised growth chart
380
management of IUGR
regular growth scans
induction at 37 weeks
corticosteroids
381
what are the criteria for APGAR score and what is the maximum score
Appearance, Pulse, Grimace, Activity, Respiration
| max 10
382
casues of polyhydramnios
matrernal DM, cardiac/renal failure
| fetal duodenal atresia
383
management of macrosomia
induction
offer CS
warn of shoulder dystocia risk
384
complications of polyhydramnios
```
preterm contractions/ ROM/ labour
malposition
maternal resp compromise
umbilical cord prolapse
uterine atony
placental abruption
```
385
if a pregnant women is too late in her pregnancy for the usual combined test for downs/edwards/patau's, what next?
quadruple test bloods for downs at 14-20
| edwards/patau's at 20 week scan for abnormality
386
Ix for amenorrhoea
```
BHCG
serum androgens [PCOS]
FSH/LH
kayotype
prolactin
TFT
```
387
define pagets disease of the breast
eczema-like changes to the nipple associated with breast cancer
388
define fibroadenoma
benign firm smooth mobile breast lump, common in young women
389
1st line antiepileptic in pregnancy
lamotrigine
390
1st line for UTI in preg
nitrofurantoin
391
benign fluid filled rounded lump in 45 yr old woman. Not fixed, occasionally painful. Diagnoiss?
breast cyst
392
peri-menopausal smoker presents with green/brown/bloody nipple discharge + nipple retraction + lump
duct ectasia
393
differentials for breast lump
```
CA
fibroadenoma
cyst
abscess/mastitis
duct ectasia
fat necrosis
```
