Womens health Flashcards
(104 cards)
1
Q
I though about making a joke at the begining of this topic. But, I see the news and I don’t think it would be funny to make fun of women.
A
Instead here is a link to a charity I like:
https://www.golddiggertrust.co.uk
2
Q
What medical management can aid with becoming pregnancy?
A
400mcg folic acid
5mcg Vit D
Diet and wieght control
Medication review
3
Q
Which patient need to have more folic acid (5mg) suplimentation pre-pregnancy?
A
Past NTD
DM
Obesity
Bowel disease
Anti-epileptic meds
4
Q
What factors indicate a high risk pregnancy?
A
18<yo>40</yo>
PMH/ PSH
IVF
Previous cesearian
Previous pregnancy complications
5
Q
What is involved in the combination test for down syndrome?
A
Blood test - PAPP-A and HCG
Nucal translucency
6
Q
When is the combination test performed and what does it involve?
A
Performed at 12 weeks with dating scan
USS - Nuchal translucency
Bloods - B-HCG PAPP-A
7
Q
When is the anomaly scan performed?
A
20 weeks
8
Q
What definitive test are there for Down syndrome
A
Chorionic villus biopsy
Amniocentesis
9
Q
What happens to BP during pregnancy?
A
BP decreases
Even though HR and SV increase total peripheral resistance decreases
10
Q
What cuases aneamia during a normal pregnancy?
A
Increase in RBC volume
Increase in plasma volume
11
Q
Why is there a greated chance VTE during pregnancy?
A
Increased prouction of clotting factor
12
Q
What is a 3rd degree tear?
A
A tear from the vaginal wall to the anal sphincter muscle
13
Q
What is a 4th degree tear?
A
A tear from the vaginal wall to the anus or rectum
14
Q
What conditiond are exacerbated during pregnancy?
A
Some cardiac disease
renal disease
DM
15
Q
What conditions are improveed during pregnancy?
A
Muiltiple sclerosis
Rheumatological diseases
16
Q
Which mother should be screened for GDM?
A
> BMI
Ethnicity
Previous GDM
FH of GDM
GGT performed at 26 weeks
17
Q
What blood glucose indicates gestational diabetes mellitus (GDM)?
A
fasting > 5.3
1 hour post meal > 7.8
18
Q
What risk with GDM?
A
Macrosomnia - neonatal hypo, shoulder dystopia (Erbs palsy)
Birth defects
Still births
19
Q
What treatments are there fore GDM?
A
Diet controlled
Metformin
Insulin
20
Q
What increases the chance of shoulder dystopia during birth?
A
Microsomnia
GDM
Previous episode
High BMI
Induction
instrumental delivery
21
Q
Should pregnanct women on insulin be carried to term?
A
Yes, >39/40 as any less can iindice ARDS in neonate
22
Q
What medication can be used to mature then lungs and therefore avoid ARDS?
A
Steroids, however watch out for glycaemic control
23
Q
What medication are used to avoid VTE in at riskk pregnant women?
A
LMWH
75mg aspririn OD
24
Q
What is Oligohydramnios?
A
Deficiency of amniotic fluid
25
What is pregnancy induced hypertension?
HTN after 20 weeks gestation
26
What is pre-eclempsia?
HTN after 20 weeks with proteinurea (spot protien/creatinine ratio)
27
What is eclempsia?
Siezures during pregnancy as a result of pre-eclempsia
28
What is HELP syndrome?
**H**eamolysis
**E**levated **L**iver enzymes
Low **P**latelets
29
What symptoms are there for pre-eclempsia?
Headaches
visual changes
epigastric pain
Oedema
N+V
Orthostatic hypotension -dizzines on standing
O/E - brisk reflexes and decreased urine output
30
Underperfused placenta which then activates maternal vascular endothelium. This leads to HTN and end-organ damage. Baby may develope Intra-uterine growth restriction
31
What treatments are there for pre-eclempsia?
C- sections
Antihypertensives
Fluid restriction
magnesium sulfate - for fits
32
What medicaiton can be used to treat hypertension in pregnancy?
Labetalol
Nifedipine
Hydralazine
33
What is the definition of Small for Gestational Age (SGA)?
\<10 centile on costomised growth chart
Normal growth velocity
Not due to pathology oftern constitutionally small
34
What is the definition for Fetal Growth resiction (FGR)?
Failure to reach pre-determind growth potential due to pathology
Poorer growth velocity or static growth
35
What is the cause of symterical (equivalent head and abdomen size) FGR?
Causes earlier on in pregnancy
Chromosomal/ congenital abnormalites
Infections - rubella CMV
Fetal alcohol syndrome
36
What is the cause of asymetrical (non-equivalent head and abdomen) FGR?
Later on in pregnancy where blood flow is proritised to head from abdomen.
HTN and pre-eclempsia
smoking
37
Is anaemia a risk fractor for SGA?
NO
38
What is the Hadlock calculation?
Estimates fetal height involving:
Head circumfrance
Abdomen circumfrance
Femur length
39
WHat is used to determin a babies zise and well being?
Hadlock calculation
Liquor volume
Umbilical artery doppler
40
What features should be in a normal arterial doppler
No back flow/ Decreased diastolic flow
41
Is this a normal umbilical artery doppler and why?
Noo shows reverse flow, this can indicate poor perfusion and therefore fetal acidosis which in turn may require delivery
42
What is APGAR scoring and what are its components?
APGAR - scoring of neonates to identify problems
Involves measuring the following at 1 and 5 mins:
**A**pearence
**P**ulse
**G**rimace
**A**ctivity
**R**espirations
43
What does an APGAR of \<3 indicate?
Immediate resus of baby needed
44
What does an APGAR of \>7 indicate?
Baby is fine
45
What are the indicators of magnesium toxicity?
Loss of tendon reflexes
Respiratory depression
Cardiac arrest
46
What medication can be used to controll post partum heamorrhage?
Oxytocin - synocnin, syntometrine
Prostoglandins - misoprostol, carborpstol
Clotting agents - tranexamic acid
47
What is the first stage of labour?
Latent phase - ≥ 4cm cervical dilation with braxton hicks contractions
Active phase 4-10 cm cervical dilatation with active contractions
48
What is the second stage of labour?
Propulsive and expilsive phase ending with the delivery of the baby. This includes the mechanism of labour
49
What is delivered in the third stage of labour?
placenta
50
What are the steps in the mechanism of labour?
Descent
Flextion
Internal roation
Extension
External roation (restitution)
delivery of anterior and then posterior shoudlers
51
At watch age is abnormal uterine bleeding should be reffered as a 2 ww?
Women aged \> 40
52
What are the a causes of abnormal vaginal bleeding?
Think of the acronym
**PALM COEN**
**P**oyps
**A**denmyosis
**L**iomyomas
**M**alignancy
**C**oagulopathy
**O**varian dysfunciton
**E**ndomtrial dysfunction
**N**ot yet classified
53
What cuases of abnormal menstratl bleeding is most common in post menopausal women?
**PALM**
**P**olyps
**A**denomyosis
**L**eiomyomas
**M**alignancy
54
What are Uterine leiomyomas?
Fibromas
Benign and responsive to oestrogen
55
How are leiomyomas treated?
mostly conservative
OCP, GnRH agnoist, interventional uterine artery embolisaiton, surgically by myomectomy nad hysterectomy
56
What are the red flag symptoms for gyneoncologica problems:
\> 45 years old
persistnet intramenstrual bleeding
post coital or post menopausal bleeding
enlarged uterus/ abdo mass
lesion on cervix
\> 45 years old
persistnet intramenstrual bleeding
post coital or post menopausal bleeding
enlarged uterus/ abdo mass
lesion on cervix
57
What is the treatment for menrrhagia when a patient prefference is not contraception?
Tranexamic acid
Mefenamic acid (NSAID)
58
What is the treatment for menorragia when contraceptive are appropriate?
1st line **Mirena coil**
OCP
Dep injeciton
59
What is a Mirena coil and what are its side effects?
Progesterone releasing IUD
SE - ovarian cysts, acne, mood changes and breast soreness
60
What a threatened miscarraige?
Vaginal bleed with a known pregnancy
61
What is an inevitable miscarraige?
When the cervix is open
62
What symptoms can accompany an ectopic pregnancy?
Abdo pain
Shoulder tip pain
Peritonitis
D+V
lightheadedness
Potential pregnancy -LMP, sexual history
Cervical excitation
63
Risk factors for ectopic pregnancy?
Infertility
Prior surgery
Smoking
Pelvic inflammatory disease - chlamydia
Assisted reprodeuctive techniques
64
What is investigation is done when an ectopic or misscarraige is suspected?
Trans-abdominal and then trans-vaginal USS
65
When a scan is inconclusive and a pregnancy of unknown origin (PUO) is diagnosed what is the next investigation?
HCG
66
What HCG indicate a uterine pregnancy?
\>1500
doubles every 48 hours
67
What is the medical management of ectopic pregnancy?
Methotrexate SC
Strict criteria - low HCG, small ectopic
Need follow up HCG
Advice no pregnancy in the next 3 months
68
F 24yo has a 2 week history of abdo pain with postcoital PV bleed. There is a purulent vaginal discharge.
O/E there is diffuse abdo tenderness.
What is a possible diagnosis
Pelvic inflammatory disease - Ascending infection through cervix to uterus
69
What is the term for a failed pregnancy?
\> 24 weeks = preterm
\< 24 weeks = miscarraige
70
What causes are there for 1st trimester miscarraiges?
Congenital
Chromosomal abnormalities
71
What causes are there for 2nd trimester miscarraiges?
Thromobophilia - Liedons FV
Cervical incompetance - LETTS or cone biopsy
72
What eponymous names of stiches can be used to for a incompetant cervix during pregnancy?
Shirodkar - common in UK
McDonalds
73
What is the definition of recurrent pregnancy loss?
≥ 3concecutive miscarriage
74
When visualising the cervix what histolgy is in the ectocervix and endocervix?
Endovervix - columnar epithelium
Ectocervix - Squamous epthithium
75
What is the SCJ and what happens to it during in puberty?
Sqaumo-calumnar junction
This can move forward during menarchy leading to ectropion.
76
What is the tranformative zone?
The ectropion - site between original and current SCJ. This is the site of most dyskariosis
77
During copolscopy a smear may be taken. What can acetic acid and iodine on the cervix reveal?
Acetic acid can show dyskariosis
Iodine can show normal squamous epithelium
78
What are the 2 main types of ovarian cyst?
Physiological - Eostrogen dependent/ cyclical pain, most common.
Malignant - differentiated on scan, muiltilobulated irregular and suspicious looking.
79
What does progesterone do in pregnancy?
Relaxes the uterus
80
What does estorgen do in pregnancy?
Increases oxytocin receptors in the placenta
81
What hormonal pathway is thought to lead to labour?
ACTH released by feotus leads to cortisol release which increases oxytocin and decreases progerstrone and oestrogen. This contract uterus and cervix which therefore leads to more oxytocin release. Positive feedback loop is formed.
82
A baby is poapated and scanned and showen to be in the foetal position. What are the next steps in managment?
Offer External Cephalic Version (ECV). If unsecceful contineue to breach birth or C-section (preffered)
83
What can be the cause of abnormal labour
**3Ps:**
**P**assenger
**P**assage
**P**ower
84
What is the main problems which occur with the "**P**assenger" during labour?
Cephalopelvic dyspropotion
foetal compromise
85
A mother notices a decreased fetal movements and therefore a CTG is done. This is abnormal and meconium is noticed in the amniotic fluid. What would you be concerned of?
Feotal distress.
86
What is intraptartum heamorrhage?
Blood loss for the onset of labour to the end of the 2nd stage
87
What are the common causes of intraptartum heamorrhage?
Uterine rupture
Vasa Previa
88
When should uterine rupture be suspected?
A PMH of classical C-section and oxytocin induction with a muiltiparous women.
89
What is Vasa Previa?
When the cord runs along the fetal membrane and into the internal os. Compression lead to foetal distress or death.
90
What is a primary PPH?
≥500ml lost with in 24 hours of delivery
91
What are the **4Ts** of PPH?
**T**issue
**T**one
**T**rauma
**T**hrombin
92
What is the most common cause of primary PPH?
80% is caused by uterine atony
93
How long should it take to deliver the placenta (3rd stage)?
Within 30mins of babies delivery
Managment includes Oxytocin or manual delivery in theater.
94
What is Secondary PPH?
Significant blood loss from 24hours to 6 weeks
95
What can cause 2nd PPH?
Reatiained product of conception
Infection
96
A Mother has a succesful delivery. However suddenly collapses. What condictions should be susected?
PE
Amniotic fluid embolus
97
What is shoulder dystocia and what major complication can it cuase?
Any addition abstertric manoeuvres to release the shoulder after gentle downwards traction has failed.
This can cause Erbs Palsy
98
What are the indications for a C section?
99
Placental praevia
Breech position
Cephalopelvic dyproportion
IUGR
HIV
Cervical cancer
100
What are contraindication for vaginal birth after cesarean (VBAC)?
Classical C section
Previous uterine rupture
Normal C-section indications
101
What indication are there for instrumental vaginal delivery?
Failure to progress
Maternal distress
Controll of baby's head
102
What is the main complication of ventous delivery?
Cephaloheamatoma
103
What is the main complication of forceps delivery?
Facial nerve palsy
104
