Womens health Flashcards
(238 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
1840
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
105
106
When is it recommended for a female to take folic acid tablets?
When they start trying to conceive and for the first 12 weeks of pregnancy
107
Why is folic acid intake important for expectant mother's?
It decreases the risk of neural tube defects such as spina bifida and cleft palate as well as helping to produce RBC
108
What is the normal dose recommended for folic acid?
400 micrograms daily
109
Which group of women is it recommended take 5mg of folic acid daily?
Previous pregnancy with NTD, family history of NTD, anti-eplieptic medication, diabetes, bowel disease, obesity
110
How many appointments will a nulliparous woman have for an uncomplicated pregnancy?
10
111
How many appointments will a parous woman have for an uncomplicated pregnancy?
7
112
Why should pregnant women avoid liver?
it contains high levels of vitamin A which could be teratogenic if intake above 700 micrograms
113
How much is the recommended supplement of vitamin D?
10 micrograms daily
114
Which groups of women is it vital to recommend vitamin D supplement?
Those with dark skin or with limited exposure to sunlight (housebound, skin covered for cultural reasons)
115
Which foods should pregnant women avoid to reduce the risk of listeriosis?
unpasteurised milkcamembert, brie and blue-veined cheesesany type of pateuncooked or underprepared ready meals
116
Which foods should pregnant women avoid to reduce the risk of salmonella?
raw or partially cooked eggs or meat especially poultry and mayonnaise
117
What are the recommendations regarding alcohol consumption during pregnancy?
No safe limitIncreased risk of miscarriage in the first trimesterBinge drinking (\>5 drinks on one occasion) maybe harmful to unborn baby
118
How should a pregnant woman wear a three point seatbelt?
Above and below the bump, not over it
119
Which interventions appear to be effective in reducing symptoms of morning sickness?
gingerP6 (wrist) acupressureantihistamines
120
What is the normal range of haemoglobin levels for pregnant women?
110g/L at first contact105g/L at 28 weeks
121
If the woman is identified as a carrier of a clinically significant haemoglobinopathy what is the recommendation?
The father should be offered counselling and appropriate screening without delay
122
What are the four options to be discussed with the woman regarding the anomaly scan to enable an informed choice?
Reproductive choiceParents to prepareManaged birth at specialist centreIntrauterine therapy
123
What is included in a 'combined test'?
nuchal translucencybeta-human chorionic gonadotrophinpregnancy-associated plasma protein-A
124
Which strain of hepatitis should be serologically screened for in pregnancy?
Hepatitis Bso that effective postnatal interventions can be offered to reduce the risk of mother to child transmission
125
What are the five primary prevention measures to avoid toxoplasmosis infection for pregnant women?
Washing hands before handling foodThoroughly washing all fruit and veg, including pre-prepared saladsThoroughly cooking raw meats and ready mealsWearing gardening gloves and thoroughly washing hands after handling soliAvioding cat faeces in cat litter and soil
126
Name 5 of the 9 risk factors for pre-eclampsia
Aged 40 or aboveNulliparityPregnancy interval greater than 10 yearsFamily historyPrevious historyBMI 30kg/m2 and abovePre-existing vascular diseasePre-existing renal diseaseMultiple pregnancy
127
What are the main 5 symptoms of pre-eclapsia?
Severe headacheProblems with vision (blurring or flashing lights)Severe pain just below the ribsVomitingSudden swelling of the face, hands or feet
128
Which age groups are at higher risk of having problems with the grow of their baby?
less than 18more than 40
129
What are the 3 main risks identified from the family origin questionnaire?
DiabetesHaematological disorder such as Thalassaemia or Sickle Cell DiseaseFGM
130
What events in a previous pregnancy can impact a current one?
PrematurityFetal growth restrictionAntepartum haemorrhageGestational hypertension, pre-eclampsia, diabetes, thrombocytopeniaAssisted delivery, c section, forceps, ventousePPHPrevious stillbirth, late miscarriage or neonatal death3rd or 4th degree tear
131
Family history is associated with which risks in pregnancy?
First degree relative with diabetes increases risk of gestational diabetesFirst degree relative with gestational hypertension or pre-eclampsia is at increased risk
132
Why is social history so important during antenatal booking?
Women are most vulnerable when pregnantWomen who do not usually engage with services are in contact with medical or midwifery services.It is an important time to identify domestic abuse, homelessness, addiction, or financial problems
133
Which blood tests are taken at the booking appointment?
Haemoglobin levelPlateletsInfections - HIV, syphilis, Hepatitis BBlood group and antibody statusSickle cell & thalassaemia if indicated by FOQ
134
When is the dating ultrasound scan usually performed?
Between 8 to 14 weeks
135
Which factors are considered to give a predicted risk of the baby having down syndrome?
Size of nuchal fold combined with blood test, maternal age and some other factors
136
The quad test can be carried out between 14-20 weeks, what does it include?
Blood test for Alpha-fetoprotein, Inhibin A, Oestriol and Beta-HCG
137
What are the diagnostic tests for T21?
Chorionic villous samplingAmniocentesis
138
When is the anomaly screening ultrasound scan usually performed?
Between 18-21 weeks
139
What are the 6 risk factors for gestational diabetes?
BMI\>30EthnicityFirst degree relative with DMPCOSPrevious baby \>4.5kg (9lb 15)Previous gestational diabetes
140
Under which circumstances is a baby's blood tested at birth and why?
If the mother is Rh-ve, she is at risk of Rhesus disease if her baby is Rh+veRhesus disease will affect future pregnancies unless prophylactice Anti-D is injected
141
Which of the following is diagnostic for gestational diabetes?A - Fasting glucose \>3.5B - Fasting glucose \>2.5C - 2 hour glucose \>6.0D - 2 hour glucose \>7.8
D
142
Which of the following is not a physiological change observed in early pregnancy?A - Increased cardiac outputB - Reduction in blood pressureC - Reduction in clotting factorsD - Increase in red cell volume
C
143
How and when would you screen for gestational diabetes?
GTT between 26-28 weeks
144
What are the risks of poorly controlled blood glucose in pregnancy?
miscarriagecongenital malformationstill birthneonatal death
145
What advice should you given to diabetic women who are planning pregnancy?
Diet, weight & exerciserisks of hypoglycaemiaNausea and vomiting effect of BGRisk of large babies - birth trauma, induction & c sectionassess diabetic retinopathyassess diabetic nephropathyimportance of controlling maternal BG during labourtemporary neonatal health problemsrisk of child developing obesity or diabetes later in life
146
What advice would you give regarding folic acid?
Take 5mg and day from starting to plan pregnancy until 12 weeks gestation
147
How often should women with diabetes who are trying to conceive have their HbA1c level monitored?
Monthly
148
What is the preconception advice around ketoaemia for type 1 diabetics?
Offer women blood ketone testing strips and meter so they can test if they become hyperglycaemic or unwell
149
What are the target blood glucose levels for diabetic women preconception?
Fasting plasma glucose 5-7 mmmol/L on wakingPlasma glucose 4-7 mmol/l before meals and other times of day
150
What is the target HbA1c level for diabetic women preconception?
48 mmol/L
151
At what HbA1c level and above would you advise diabetic women not to get pregnant?
86 mmol/L
152
Which diabetic medicines are considered safe during preconception and pregnancy?
Metformin for blood glucose lowering agentsLong-acting insulin - isophane insulin AKA NPH insulin is first line insulin therapy
153
Which medicines should be discontinued or replaced during preconception and pregnancy?
ACEi and Angiotensin 2 receptor antagonists - find alternative anti-hypertensivesDiscontinue statins
154
What is the lifetime risk of ovarian cancer of women in England and Wales?
2%
155
What is the overall 5 year survival rate for women with ovarian cancer?
Less than 35%
156
What are the symptoms of ovarian cancer?
persistent abdominal distensionearly satiety or loss of appetitepelvic or abdominal painincreased urinary urgency / frequency
157
What is the first test of ovarian cancer?
Measure serum CA125 and arrange USS if greater or equal to 35 IU/ml
158
What symptoms are red flag if a woman is over 50?
IBS symptoms if presenting for the first time
159
What test would you order for women under 40 with symptoms of OC?
CA125AFP - aplha fetoproteinbeta-hCG - beta human chorionic gonadotrophin
160
What are the 5 characteristics on an ultrasound to note for RMI?
Multilocular cystsSolid areasmetastasesascitesbilateral lesions
161
Define Heavy Menstrual Bleeding
Excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life
162
What percentage of women are affected by HMB?A - 10-20%B - 15-25%C - 20-30%D - 25-35%E - 30-40%
C
163
What are the four main areas to ask about during history for HMB?
Age (over 45 = high risk of pathology)Is the bleeding regular? Irregular bleeding need to rule out malignancyAssociated symptoms - heaviness in pelvis, urinary problemsOther issues with history such as clotting disorders, thyroid dysfunction or anti-coagulant medication
164
Match the types of fibroid (Intramural, Subserosal, Submucosal, Pedunculated) with the location of development (perimetrium, myometrium, endometrium, attached via stalk)
Intramural = myometriumSubserosal = perimetriumSubmucosal = endometriumPedunculated = via stalk
165
How many cycles should a patient wait before seeing results after the insertion of Levonorgestrel-releasing IUS?
6
166
What six subjects should you discuss with the patient when considering hysterectomy for treatment of fibroids?
Sexual feelingsFertilityBladder functionExpectationsPsychological impactfurther treatment & complications
167
What are the 3 main risks to discuss with a patient regarding hysterectomy?
Damage to abdominal organsIntraoperative haemorrhageLoss of ovarian function and consequences of this
168
What treatments are offered for fibroids less than 3cm if LNG-IUS declined?
tranexamic acidNSAIDScombined pillcyclical progestogens
169
What are the 7 RED FLAGS for heavy menstrual bleeding?
Age \>45Persistent intramenstrual bleedingPost-coital bleedingEnlarged uterusPelvic massLesion on cervixPost-menopausal bleeding
170
What are the side effects of Mirena?
risk of ovarian cystsacnemood changesbreast soreness
171
What are the statistics linked to endometrial ablation?
90% of patients it reduces HMB50% of patients it stops menstrual bleeding completely1% risk of uterine perforation and/or infection
172
A 49 year old woman presents to her GP with a six months history of HMB. What should the GP do?A - insert mirena IUDB - Arrange ultrasound scan and check her haemoglobinC - Prescribe tranexamic acid and review in 3 monthsD - Refer to gynaecologist for hysteroscopy and biopsy
D
173
A 35 year old has HMB, is trying to conceive and has a normal US. Should the GP do?A - reassure the scan is normal and should not have treatment as trying to conceiveB - Prescribe tranexamic acid and mefanemic acid to be taken during her periodC - refer for hysteroscopyD - Prescribe norethisterone 5mg tds between days 41-25 of her cycle
B
174
What are the three main symptoms of an ectopic pregnancy?
Abdominal or pelvic painAmenorrhoeavaginal bleeding
175
Name three other reported symptoms of ectopic pregnancy
breast tendernessGI symptomsDizziness or syncopeshoulder tip painurinary symptomspain of defecation
176
What are the non-sexually transmitted infection causes of vaginal discharge?
Bacterial vaginosisCandida
177
Name the sexually transmitted infection causes of vaginal discharge?
Chlamydia trachomatisNeisseria gonorrhoeaeTrichomonas vaginalisHerpes simplex virus
178
What are the non-infection causes of vaginal discharge?
Foreign bodies e.g. tampons, condomsCervical polypsGenital tract malignancyFistulae
179
What is the medical terminology for pain during sexual intercourse?
Dyspareunia
180
During a Colposcopy, when staining with acetic acid there are some patches of white - what does this show?
CIN = Cervical interepithelial neoplasia
181
What medication is administered during augmentation of labour?
Syntocinon (Synthetic oxytocin)
182
Where is natural oxytocin produced and stored?
Hypothalamusstored in posterior pituitary
183
What does Oxytocin do?
Caused the uterus to contract
184
When does labour change from latent to established?
Cervix dilated to 3cm and regular contractions
185
When should a patient contact their midwive during first stage labour?
Contractions become regular and 3 in 10Waters breakContractions are strong and need pain reliefIf the patient is worried about anything
186
How often will the midwife listen to the baby's heart rate during established labour?
Every 15 mins
187
What are the two alternatives for speeding up labour?
Breaking the patients watersOxytocin drip
188
What risk factors indicate that an operative vaginal delivery is more common?
Primiparous womenSupine and lithotomy positionsEpidural anaesthesia
189
What mnemonic is used to assess a CTG?
DR C BRAVADODefine RiskContractionsBaseline RAteVariabilityAccelerationsDecelerationsOverall
190
What is the definition of Miscarriage?
UK = Loss of intrauterine pregnancy \<24 weeks gestationWHO = Expulsion of fetus / embryo weighing 500g or less
191
What is the difference between early and late miscarriage?
Early = loss before 12 weeksLate = loss between 12-24 weeks
192
What percentage of miscarriages are caused by chromosomal abnormalities?
50%
193
How would you diagnose a miscarriage?
Crown-Rump length of embryo 7mm or more with No fetal heart actionMean sac diameter of 25mm gestational sac with no yolk sac or embryo
194
What is a threatened miscarriage?
Pregnancy confirmed, presenting with vaginal bleeding
195
What is an inevitable miscarriage?
Cervix open on examination, miscarriage likely imminent
196
Complete miscarriage?
when all pregnancy tissue has passed out of uterus
197
Incomplete miscarriage?
when some pregnancy tissue remains in the uterus
198
Delayed miscarriage?
When pregnancy has stopped growing or when fetus has died and there is no sign of bleeding
199
What are the three management options of miscarriage?
Expectant - let's the pregnancy pass naturallyMedical - Misoprostol is given to instigate uterine contraction and passing of tissueSurgical - operation to remove pregnancy tissue
200
What are the three management options for Ectopic pregnancy?
Surgical - if symptomatic or unstableMedical - Methotrexate (folate antagonist)Conservative - if asymptomatic or falling HCG
201
What is the definition of an ectopic pregnancy?
Implantation of pregnancy outside the womb
202
How much is the of ectopic pregnancy increased following a first ectopic?
10%
203
If a patient with a previous ectopic pregnancy becomes pregnant again, what additional appointment would they have during antenatal care?
Offer an ultrasound scan at 7 weeks to determine if pregnancy is intrauterine
204
Where is the most common site for ectopic pregnancy?
Fallopian tubes
205
What happens to serum HCG in a normal viable pregnancy?
Increase by at least 53% every 48 hours
206
abnormal vaginal bleeding and severe lower abdo pain
ectopic
207
copper coil IUD
most effective type of emergency contraception and can be left in for long term contraception can make periods heavier and more painful
208
how to treat UTI
nitrofuratoin or trimethoprim
209
UTI in first trimester
nitrofurantoin
210
UTI in end of pregnancy
trimethoprim
211
high risk pregnancy
advanced age, medical problems, gynae surgey, IVF, c-section, diabetes, previous obs Hx- HTN, growth restriction etc
212
20 week scan
anomaly scan
213
12 week scan
dating
214
26 weeks
Glucose tolerance test
215
gestational diabetes screening
BMI over 30, previosu macrosomic baby, previous GDM, FH, ethnicity
216
treatment of gestational diabetes
diet, metfomin , insulin. escalate appropriately
217
headache, vision changes, vomiting, swelling of face, hands and feet
think pre-eclampsia. check BP
218
treatment of pre eclampsia
deliver babyreduce BP- labetalol
219
quick evaluation of newborn
APGAR- appearance, pulse, grimace, activity, resp
220
What should you advise people who are concerned about their fertility?
Vaginal sexual intercourse every 2-3 days optimises the chance of pregnancy
221
What proportion of couples conceive in 1 year if the woman is under 40 and the have regular sex without contraception?
80%
222
What proportion of women under 40 conceive using intrauterine insemination within 6 cycles?
50%
223
What should men be informed about alcohol consumption?
Remaining within DoH recommended limits is unlikely to effect semen quality, however excessive alcohol intake is detrimental to semen quality
224
What should women be informed about alcohol consumption?
Drink no more than 1/2 units once or twice a week and avoid intoxication
225
Does smoking affect fertility in men?
Yes
226
Does passive smoking affect fertility in women?
Yes
227
Does caffeine affect fertility?
No
228
How does a BMI above 30 affect fertility?
Women BMI\>30 take longer to conceive as they may not ovulateMen BMI\>30 are likely to have reduced fertility
229
What advice is given to women of BMI\<19?
Increasing weight is will increase likelihood of conception
230
Define infertility
A couple of reproductive age who has not conceived after 1 year of regular unprotected vaginal sexual intercourse
231
What are the seven WHO reference values for semen analysis?
Semen volume: 1.5ml or morepH: 7.2 or moresperm concentration: 15 million per ml or moretotal sperm number 39 million or moretotal motility: 40% or more motile or 32% or more with progressive motilityVitality: 58% or moresperm morphology: 4% or more
232
When should a repeat semen analysis take place following an abnormal result?
3 months after initial analysis to allow for the cycle of spermatozoa formation
233
What are the three measures used to predict the ovarian response to gonadotrophin stimulation in IVF?
Total antral follicle count less than 4 indicates low response and higher than 16 indicates a high responseAnti-Mullerian hormone less than 5.4 pmol/l indicates low response and higher than 25 pmol/l indicates high responseFSH greater the 8.9 IU/l indicates low response and less than 4 IU/l indicate high response
234
How is ovulation confirmed?
A blood test to measure serum progesterone in the mid-luteal phase (21-28 days)
235
What are the four first line investigations for infertility?
OvulationOvarian reserveTubes and transportSperm
236
What are the four main reasons why fertility is reducing in the general population in the last 100 years?
AgeObesitySTISperm reduction due to processed foods and oestrogen remaining in water
237
How is PCOS diagnosed?
Irregular, infrequent periodsAndrogen excessUltrasound scan showing more than 10 follicles
238
What are the two medications that can be used for a woman with PCOS to promote ovulation?
MetforminClomiphene
