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1
Q

RFs for endometrial cancer

A
  • high number of ovulations (so OCP PROTECTIVE)
  • obesity
  • unopposed oestrogen HRT
  • PCOS
  • tamoxifen
  • post-menopausal
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2
Q

features of endometrial cancer

A

usually adenocarcinoma

  • PMB
  • IMB
  • sometimes pain/discharge present
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3
Q

investigation for endometrial cancer

A
  • TVUS
  • endometrial biopsy
  • hysteroscopy
  • FIGO staging
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4
Q

treatment for endometrial cancer

A
  • hyterectomy + salpingo-oophorectomy +/- pelvic lymph nodes
  • radio + chemotherapy
  • progesterone in frail/elderly
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5
Q

RFs for cervical cancer

A
  • HPV (16 + 18)
  • COCP
  • smoking
  • STI
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6
Q

features of cervical cancer

A 
usually squamous cell carcinoma
- abnormal vaginal bleed
     > post-coital
     > IMB
     > PMB
- vaginal discharge
- normally picked up on cervical smear testing
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7
Q

treatment of cervical cancer

A

if fertility is not an aim then hysterectomy with lymph node clearance is best management
- FIGO 1 = LETZ (loop excision of transitional zone)
- FIGO 2+:
> radiotherapy
> chemotherapy
- palliative when appropriate

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8
Q

smear test availability

A

women aged 25-64 eligible

  • 25-49 yrs = every 3 yrs
  • 50-64 yrs = every 5 yrs
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9
Q

RFs of ovarian cancer

A
  • BRCA 1/2

- many ovulations (COCP = PROTECTIVE)

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10
Q

features of ovarian cancer

A

usually serous carcinoma

  • commonly asymptomatic and late presenting
  • bloating/IBS-like symptoms
  • abdominal mass
  • urinary frequency
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11
Q

investigations for ovarian cancer

A
  • CA125 (may be raised due to endometriosis/PID/menstruation/ovarian cyst)
  • USS abdo/pelvis
  • risk of malignancy index (RMI) - CA125 score x USS score (1-3) x pre/post menopausal (1-3)
    > score >250 = referral
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12
Q

management of ovarian cancer

A
  • surgery

- chemotherapy

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13
Q

contraindications of COCP

A
  • migraine with aura
  • VTE history
  • hypertension/IHD/stroke
  • BMI > 35
  • smoker > 35yrs age
  • breast cancer
  • liver cirrhosis
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14
Q

SEs of COCP

A 
- Oestrogenic
   > breast tenderness
   > headaches
   > vaginal discharge
- Progestogenic
   > acne
   > hirsuitism
   > mood swings/low mood
   > breakthrough bleeds
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15
Q

implant (implanon)

A
  • progestogin - blocks ovulation + thickens mucus
  • lasts up to 3 yrs
  • SEs
    > irregular bleeds
    > mood changes
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16
Q

depo-provera

A
  • progestogen based - inhibits ovulation + thickens mucus
  • lasts for 12 wks
  • SEs
    > weight gain
    > delay back to fertility
    > decreased BMD
    > irreversible once injected
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17
Q

IUD

A
  • copper coil - decreases sperm motility + survival
  • lasts up to 5 yrs
  • SEs
    > perforation risk
    > infection risk
    > may make bleeding heavier (can give hormonal alongside to relieve)
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18
Q

IUS/Mirena

A
  • progestogen-based - thickens mucus, thins endometrium, inhibits ovulation
  • lasts up to 5 yrs
  • SEs
    > may cause irregular bleeds in first few months, then lighter menses/amenorrhoea and reduced dysmenorrhoea
    > perforation risk
    > infection risk
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19
Q

early menopause age

A

<45 yrs

2 yrs period-free if <45 yrs, otherwise 12 months period-free = menopause

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20
Q

premature ovarian insufficiency age

A

<40 yrs

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21
Q

risks of HRT

A

increased risk of:

  • breast cancer (prog. affects risk) (CI if active or past breast cancer)
  • endometrial cancer (if UNOPPOSED oestrogen)
  • VTE (transdermal HRT in high-risk)
  • stroke (oral HRT slightly increases risk)
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22
Q

benefits of HRT

A
  • symptom relief
  • BMD protection
  • prevent long-term morbidity (CVD/dementia)
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23
Q

continuous or cyclical HRT?

A

cyclical if peri-menopausal

continuous if post-menopausal

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24
Q

transdermal HRT in…

A
  • high risk of SEs groups (eg. VTE/hypertension)
  • women > 60 yrs
  • digestion issues (eg. Crohn’s)
  • steady absorption requirement (migraine/epilepsy)
  • patient preference
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25
Q

causes of secondary ovarian insufficiency

A
  • autoimmune (thyroiditis/Addison’s/etc.)
  • iatrogenic - surgery/chemo/radio
  • metabolic disorder
    diagnosed with FSH levels (2 samples 4 weeks apart, with 4 months amenorrhoea)
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26
Q

types of incontinence

A
  • stress (sphincter weakness)
  • urge (detrusor overactivity)
  • overflow (obstruction of bladder outlet)
  • mixed (urge and stress)
    others include fistula/ neurological/functional/etc.
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27
Q

assessment of incontinence

A
  • history - type of incont./caffeine/fluid intake/etc
  • fluid volume chart
  • ePAQ questionnaire
  • urinalysis
  • residual urine measurement
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28
Q

treatment of urge incontinence

A
  • education (eg. fruit juice and coffee)
  • bladder retraining
  • anticholinergics (oxybutynin)
    > mirabegron (adrenergic) if frailty (due to risk of falls in anticholinergics)
  • sphincter botox
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29
Q

treatment of stress incontinence

A
  • pelvic floor exercises/physiotherapy
  • surgery (sling, suspension, TVT - tension-free transvaginal tape)
  • duloxetine if unsuitable for/declined surgery
  • pads for leaks
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30
Q

markers of ovarian cancer

A
  • CA125
  • alpha fetoprotein
  • beta-hCG
  • inhibin A
  • LH
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31
Q

physiological ovarian cyst

A

commonest = follicular cysts
- due to failed follicle atresia
- usually regresses after a few menstrual cycles
also corpus luteum cysts
- normally corpus luteum breaks down if follicle not fertilised, if not then it can fill with blood/fluid
- can present as intraperitoneal bleeding
- take a few cycles to resolve

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32
Q

benign germ cell tumours

A

commonest = dermoid cyst (cystic teratoma)

  • epithelial tissue lining so can contain hair/teeth/etc
  • usually asymptomatic
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33
Q

benign epithelial tumours

A
  • serous cystadenoma

- mucinous cystadenoma

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34
Q

ectopic pregnancy risk

A
  • 1% in general population

- 10% if already had an ectopic preg

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35
Q

RFs for ectopic pregnancy

A
  • PID/genital infection
  • previous ectopic
  • tubular surgery
  • endometriosis
  • IVF
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36
Q

treatment options for ectopic preg

A
  • conservative (monitor B-hCG)
  • medical - one off methotrexate dose
  • surgery - salpingectomy/salpingotomy
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37
Q

primary amenorrhoea definition

A
  • no menses by age 16 WITH secondary sex characteristics

- no menses by 13 WITHOUT secondary sex characteristics

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38
Q

STI Mx

A
  • chlamydia = doxycycline for 7 days PO (azithromycin PO can be given but may predispose to mycoplasma genitalium)
  • gonorrhoea = IM ceftriaxone (unless sensitive to ciprofloxacin, in which case give PO cipro)
  • BV = metronidazole PO
  • trichomoniasis = metronidazole PO
  • thrush = fluconazole PO/fluconazole pessary (do not give PO therapy in pregnancy, pessary only)
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39
Q

USS findings suggestive of malignancy for ovarian mass

A
  • multilobularity
  • solid areas
  • bilateral masses
  • ascites
  • evidence of metastases
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40
Q

tests for ovulation

A
  • mid-luteal (day 21) progesterone
  • US follicular tracking
  • LH-based urine predictor kit
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41
Q

test for tubal patency

A
  • hysterosalpingogram
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42
Q

PCOS Mx

A
  • weight loss
  • clomifene
  • metformin
  • ovarian drilling for infertility
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43
Q

management of hyperthyroidism in pregnancy

A
  • propylthiouracil (1st trimestre)

- carbimazole (after 1st tri)

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44
Q

causes of antepartum haemorrhage

A
  • placental abruption
  • placenta praevia (low-lying)
  • placenta accreta (vessels deep into uterus)
  • vasa praevia
  • genital tract infection
  • cervical ectropion
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45
Q

causes of postpartum haemorrhage

A 
4Ts
- tone
     > uterine atony
- tissue
     > retained placenta
     > retained products of conception
- trauma
     > genital tract trauma
     >macrosomic baby
- thrombin
     > clotting disorders
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46
Q

RFs for maternal sepsis

A
  • history of GBS
  • diabetes/obesity
  • amniocentesis
  • prolonged SROM
  • hx of genital infection
  • immunocompromised
  • anaemia
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47
Q

fetal complications of shoulder dystocia

A
  • hypoxia
  • fits
  • cerebral palsy
  • Erb’s palsy due to brachial plexus injury
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48
Q

management of shoulder dystocia

A 
CALL FOR HELP
- McRoberts manoeuvre
- all fours manoeuvre
- episiotomy
     > aids internal manoeuvres such as Woods' screw/zavanelli
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49
Q

analgesia options in labour

A 
systemic analgesia
- paracetamol/codeine
- opioids (morphine, diamorphine, pethidine, fentanyl)
gas and air
- entonox 
spinal
- spinal
- epidural
- combined spinal-epidural (CSE)
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50
Q

non-pharma pain relief options in labour

A
  • trained support
  • hydrotherapy
  • acupuncture
  • TENS
  • massage
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51
Q

SEs of opiate use in labour

A 
MATERNAL
- sedation
- N+V
- euphoria
- lengthened stage 1 and 2 of labour
FETAL
- respiratory distress
- diminished breast-seeking behaviour
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52
Q

contraindications of epidural/spinal/CSE

A 
ABSOLUTE
- local infection
- allergy
RELATIVE
- coagulopathy
- systemic infection
- hypovolaemia
- abnormal anatomy
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53
Q

SEs of spinal/epidural/CSE

A 
Maternal
- lenghened stages 1 and 2 of labour
- increased likelihood of 
    > malpresentation
    > instrumental delivery
    > increased need for oxytocin
- decreases
    > mobility
    > bladder control
Fetal
- diminished feeding behaviours
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54
Q

cardiotocography

A 
Dr = define risk
C = contractions (regular 4 in 10 mins in true labour)
Bra = baseline rate
V = variability
     - >5bpm = reassuring
     - <5bpm for between 40 and 90 mins = non-reassuring
     - <5bpm for > 90 mins = abnormal
A = accelerations (presence = reassuring)
D = decelerations 
     - early decels = reassuring
     - variable decels = non-reassuring
     - late/prolonged decels = abnormal
O = overall assessment
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55
Q

CTG - reassuring or not?

A

normal CTG = all 4 (Bra, V, A, D) = reassuring
suspicious = 1 non-reassuring
pathological = 2+ non-reassuring OR 1+ = abnormal

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56
Q

RFs for breast cancer

A 
- lobular carcinoma in situ (LCIS)
    > not cancer but increased risk
    > LCIS = micro-calcifications on imaging
- late first childbirth (>35yrs)
- alcohol
- COCP
- HRT use > 5yrs
- atypical ductal hyperplasia
ALSO GENETICS
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57
Q

breast screening

A 
women aged 47-73 invited for screening every 3 yrs
- triple assessment from:
    > clinical score (1-5)
    > imaging score (1-5)
    > biopsy score (1-5)
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58
Q

presentation of breast cancer

A 
- painless lump
    > irregular
    > hard 
    > fixed
- nipple discharge
- nipple in-drawing + skin tethering
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59
Q

blood tests for infertility

A
  • LH
  • FSH
  • testosterone
  • TSH
  • prolactin
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60
Q

SEs of axillary lymph node clearance

A
  • lymphoedema of arm
  • arm stiffness
  • axillary numbness
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61
Q

causes of nipple discharge

A 
- physiological = reassurance
   > on squeezing
   > bilateral
   > yellow/creamy
- hormonal = pregnancy test/serum hormones
   > milky multiduct
   > large volume
- duct ectasia = reassure
   > green/brown/bloody
   > multiduct
- papilloma OR DCIS = imaging and microdochectomy 
   > clear or bloody
   > uniduct
62
Q

booking visit

A

8-12 wks

  • general info
  • BP/urine dipstick
  • BMI
  • blood test
  • infectious disease screen (hep C, syphilis, rubella, HIV)
63
Q

dating scan

A

10-14 wks

  • confirm dates
  • multiple preg?
  • Down’s screening offered (combined test = nuchal translucency + serum testing)
64
Q

anomaly scan

A

18-21 wks (20wk scan)

  • infection screen offered again
  • whooping cough vaccine advised to be given after this scan
65
Q

combined test for Down’s syndrome

A 
11-13 wks
- nuchal translucency
- serum testing 
    > PAPP-A (preg. associated plasma protein-A)
    > free beta hCG
66
Q

quadruple test for Down’s syndrome

A 
after 13 wks
- serum markers
    > alpha fetoprotein
    > total beta-hCG
    > oestriol
    > inhibin A (not included in triple test)
67
Q

anti D given for Rh- at:

A
  • first dose at 28wks

- second dose at 34wks

68
Q

newborn blood spot screen

A 
at 5-8 days age
Tests for:
- sickle cell
- thalassaemia
- cystic fibrosis
- congenital hypothyroid
- 6 inherited metabolic disorders (phenylketonuria/homocysteinuria/maple syrup disease/etc.)
69
Q

newborn hearing screen

A

within 4wks age
- otoacoustic emission test
if abnormal then
- auditory brainstem response test

70
Q

newborn + infant physical examination (NIPE)

A

within 72hrs age

  • testes - undescended?
  • hips - dev dysplasia?
  • eyes - cataracts?
  • heart - defects?
71
Q

VTE RFs in pregnancy

A

4+ RFs indicates IMMEDIATE LMW HEPARIN until 6wks post-natal

  • age >35yrs
  • BMI > 30
  • parity >3
  • smoker
  • pre-eclampsia in current preg
  • prev VTE
  • varicose veins
  • multiple pregnancy
  • IVF
  • immobility
72
Q

RFs for gestational DM

A
  • BMI > 30
  • prev macrosomic baby (>4kg)
  • prev gest. DM
  • 1st degree relative diabetic
  • ethnicity (S asian, black, middle eastern)
    OGTT at 24-28wks if 1+ RF
    If already had GDM before then OGTT asap and if normal then another OGTT at 24-28wks
73
Q

management of gestation DM

A

If pre-existing DM
- stop diabetes medications except for metformin, then add insulin
Gestational
- if dietary control preferred then must be effective in 1-2 weeks
- metformin
- then insulin if needed
- FOLIC ACID 5mg/day in diabetics

74
Q

pre-eclampsia complications

A 
MATERNAL
- eclampsia
- haemorrhage (placental abruption/intra-abdo/intra-cerebral)
- HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)
- organ failure
- DIC
FOETAL
- prematurity/IUGR
- neonatal hypoxia
75
Q

RFs for pre-eclampsia (high risk) - 5

A
  • previous hypertension in preg
  • CKD
  • SLE/antiphospholipid
  • DM1/2
  • chronic hypertension

1+ = aspirin prophylaxis (75mg)

76
Q

RFs for pre-eclampsia (moderate) - 6

A
  • nulliparous
  • 40yrs +
  • pregnancy interval of 10+ yrs
  • BMI>35
  • multiple pregnancy
  • FH of pre-eclampsia

2 or more = aspirin prophylaxis (75mg)

77
Q

stage 1 of labour

A 
from the onset of labour to full dilation of cervix
Latent phase
- 0-3cm dilation
- normally lasts ~6hrs (can last 2-3 days)
- IRREGULAR CONTRACTIONS
- cervix effacing + thickening
Active phase
- 4-10cm (progresses 1cm/hr)
- REGULAR CONTRACTIONS
- role of prostaglandins and oxytocin
78
Q

stage 2 of labour

A

from full dilation to delivery of baby
- head visible
primigravida = ~3hrs from start of pushing
multi = ~2hrs from start of pushing

79
Q

stage 3 of labour

A

delivery of fetus to delivery of placenta + membranes

80
Q

contents of colostrum

A
  • growth factors
  • Vit A
  • antimicrobials
  • proteins
  • NaCl
81
Q

where is prolactin secreted from?

A 
anterior pituitary (lactocytes produce milk)
(prolactin suppresses ovulation)
82
Q

where is oxytocin secreted from?

A 
posterior pituitary (myoepithelial cells expel milk)
(post pit = oxy + ADH)
83
Q

causes of secondary PPH

A
  • endometritis
  • retained products of conception
  • subinvolution of placental implantation site
  • poorly healed perineal tear
84
Q

complications of premature birth

A
  • developmental delay
  • visual impairment
  • chronic lung disease
  • necrotising enterocolitis
  • cerebral palsy
  • perinatal mortality
85
Q

RFs for PTB

A 
non-recurrent
- APH
- multiple pregnancy
recurrent
- race
- prev. PTB
- genital infection (particularly BV)/UTI
- socioeconomics
86
Q

RFs for hypertension in preg

A
  • young mother
  • black/afro-caribbean
  • multiple pregnancy
  • underlying hypertension
  • renal disease
87
Q

severe pre-eclampsia signs

A
  • BP > 170/110
  • proteinuria > 0.3g/24hrs (3+ urine dip)
  • visual disturbance
  • RUQ/epigastric pain
  • brisk reflexes/clonus
  • HELLP syndrome
  • IUGR (intra-uterine growth restriction)
88
Q

maternal indications for delivery in pre-eclampsia

A
  • gestation 38wks+
  • thrombocytopenia
  • progressive liver/kidney deterioration
  • placental abruption
  • CNS symptoms
89
Q

fetal indications for delivery in pre-eclampsia

A
  • severe IUGR
  • non-reassuring fetal monitoring
  • oligohydramnios
90
Q

treatment for pre-eclampsia

A
  • if at risk of pre-eclampsia = low dose aspirin 12wks-birth
  • labetalol
  • nifedipine (2nd line antihypertensive - eg. in asthma)
  • MgSO4 (anticonvulsant)
91
Q

symptoms of endometriosis

A
  • chronic/cyclical pelvic pain
  • dysmenorrhoea
  • deep dyspareunia
  • subfertility
  • non-gynae (urinary, bowel - diarrhoea/constipation)
92
Q

investigations for endometriosis

A
  • LAPAROSCOPY
  • pelvic exam = posterior fornix tenderness, reduced organ mobility
  • speculum = visible endometriomas
  • pelvic USS
93
Q

adenomyosis

A
  • endometrial tisue in myometrium
  • more common in older/multiparous
  • dysmenorrhoea
  • menorrhagia
  • enlarged boggy uterus
    NO EFFECT ON FERTILITY
94
Q

fibroid epidem + symptoms

A 
benign smooth muscle tumour
- rare before puberty/after menopause (role of oestrogen)
- more common black/afro-caribbean
Symptoms
- menorrhagia
- lower abdo pain/cramps
- bloating
- urinary symptoms (larger fibroid)
SUBFERTILITY
95
Q

polyps symptoms and associations

A 
overgrowth of endometrium - can be pre-malignant
- menorrhagia
- intermenstrual bleeds
- SUBFERTILITY
Associations
- peri/post-menopausal
- hypertension
- high BMI
- tamoxifen
96
Q

complications of PID

A
  • infertility
  • chronic pelvic pain
  • ectopic pregnancy
97
Q

risk factors for placenta praevia

A
  • multiparity
  • multiple pregnancy
  • embryos are more likely to implant on a lower segment scar from previous caesarean section
98
Q

features of placenta praevia

A
  • shock in proportion to visible loss
  • painless bleed and non-tender uterus
  • suspect in bleed after 24 weeks gestation, may be picked up in 20 week scan
99
Q

management of known stable placenta praevia pre-term

A
  • USS monitoring

- advise pelvic rest (no penetrative intercourse) and hospital if significant bleeding

100
Q

management of bleeding with known placenta praevia

A
  • ABCDE
  • emergency C-section if unable to stabilise
  • consider corticosteroids if 24-34 weeks and risk of preterm labour
101
Q

management of bleeding with unknown placenta praevia

A
  • ABCDE
  • urgent USS if stable
  • if unable to stabilise, emergency C-section
102
Q

definition of placenta accreta

A

adherence of the placenta directly to superficial myometrium but does not penetrate the thickness of the muscle

103
Q

definition of placenta percreta

A
  • the villi invade through the full thickness of the myometrium to the serosa
  • there is increased risk of uterine rupture and in severe cases the placenta may attach to other abdominal organs such as the bladder or rectum
104
Q

definition of placenta increta

A

the villi invade into but not through the myometrium

105
Q

management of placental abnormality (accreta/increta/percreta)

A
  • safest management plan is elective Caesarean section and abdominal hysterectomy
  • if maintaining fertility is vital then a less destructive placental resection may be attempted
106
Q

features of placental abruption

A

premature separation of the placenta from the uterine wall during pregnancy, resulting in maternal haemorrhage

  • abdominal pain (often sudden and severe)
  • “woody” hard uterus
  • hypovolaemic shock which is often disproportionate to the amount of vaginal bleeding visible
  • contractions
  • reduced foetal movements and abnormal CTG
107
Q

RFs for placental abruption

A
  • maternal trauma eg. assault, road traffic accident
  • pre-eclampsia or hypertension
  • multiparity or increased maternal age
  • polyhydramnios
  • previous history of abruption
  • substance abuse during pregnancy (particularly smoking and cocaine)
  • coagulation disorders
108
Q

management of placental abruption

A
  • ABCDE
  • C-section if maternal/foetal compromise
  • induction of labour if no compromise, at term
  • conservative management if marginal abruption with no compromise and not at term
109
Q

epilepsy in pregnancy

A
  • pregnancy lowers threshold for fits
  • seizure can cause foetal hypoxia
  • maternal use of anti-convulsants associated with congenital abnormalities
  • safest anti-convulsants in pregnancy = carbamazepine and lamotrigine
  • folate supplementation (5mg) required in first trimester (and prior if possible) to reduce neural tube defect risk
  • regular monitoring of foetus required when taking anti-convulsants (serial growth and anomaly scans)
  • breastfeeding on anti-convulsants likely safe
110
Q

causes of oligohydramnios

A 
oligohydramnios = lower than normal volume of amniotic fluid in the uterus
UTEROPLACENTAL INSUFFICIENCY
- chronic hypertension/pre-eclampsia
- placental abruption
- maternal smoking
FOETAL URINARY ABNORMALITY
- renal agenesis
- PKD
MISCELLANEOUS 
- premature rupture of membranes (PROM)
- post-term gestation
- chromosomal anomalies
111
Q

complication of oligohydramnios

A

Potter’s syndrome

  • clubbed feet
  • hip dysplasia
  • facial deformity
  • pulmonary hypoplasia
112
Q

classification of perineal tears

A

1st degree tear = tear limited to the superficial perineal skin or vaginal mucosa only

2nd degree tear = tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)

3rd degree tear

  • 3a: less than 50% of the thickness of the external anal sphincter is torn
  • 3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
  • 3c: external and internal anal sphincters are torn, but anal mucosa is intact

4th degree tear = perineal skin, muscle, anal sphincter and anal mucosa are torn

113
Q

congenital rubella syndrome features

A
  • sensorineural deafness
  • cataracts or retinopathy
  • congenital heart disease
114
Q

timings for external cephalic version (ECV) in breech presentation

A 
nulliparous = 36 wks
multiparous = 37 wks
115
Q

absolute contraindications for external cephalic version (ECV)

A
  • caesarean section is already indicated for other reason
  • antepartum haemorrhage has occurred in the last 7 days
  • non-reassuring cardiotocograph
  • major uterine abnormality
  • placental abruption or placenta praevia
  • PROM
  • multiple pregnancy (but may be considered for delivery of the second twin)
116
Q

features of hydatidiform molar pregnancy

A

COMPLETE MOLE

  • 1 sperm and an empty egg with no genetic material
  • no foetal tissue present; just a proliferation of swollen chorionic villi
  • snowstorm appearance on TVUS

PARTIAL MOLE

  • 2 sperms and a normal egg
  • variable evidence of foetal parts

BOTH

  • B-hCG levels often much higher than expected
  • uterus larger than expected for gestation
  • vaginal bleeding
  • hyperemesis gravidarum
117
Q

maternal causes of miscarriage

A
  • idiopathic
  • uterine abnormality
  • cervical incompetence
  • PCOS
  • poorly controlled diabetes
  • poorly controlled thyroid disease
  • anti-phospholipid syndrome
118
Q

threatened miscarriage

A
  • mild symptoms of bleeding
  • foetus retained within the uterus as the cervical os is closed
  • little or no pain
119
Q

inevitable miscarriage

A
  • often heavy bleeding and pain

- the foetus is intrauterine but the cervical os is open

120
Q

complete miscarriage

A
  • intrauterine pregnancy with has now fully miscarried, with all products of conception expelled
  • uterus is empty
  • os is usually closed
  • patient may have had pain and bleeding
121
Q

missed miscarriage

A
  • uterus still contains foetal tissue, but the foetus is no longer alive
  • miscarriage is ‘missed’ as often the woman is asymptomatic
  • cervical os is closed
122
Q

investigations for recurrent miscarriage (3+ consecutive miscarriages)

A
  • antiphospholipid antibodies
  • thrombophilia screen
  • cytology of products of conception (karyotype parents if abnormal)
  • pelvic USS (for uterine abnormalities)
123
Q

listeria monocytogenes in pregnancy

A

listeriosis typically follows eating soft cheeses or unpasteurised milk
- infection can travel through placenta and infect foetus via amniotic fluid
- can cause:
> neonatal sepsis
> meningitis
> resp distress

124
Q

features of congenital varicella zoster virus

A

VZV infection in non immune mother in first trimester

  • skin scarring
  • microcephaly
  • eye defects
  • learning disability
125
Q

management of congenital VZV

A
  • immunoglobulin given as prevention if comes into contact with virus
  • aciclovir for mother and foetus if maternal infection (within 24hrs rash in mother, IV after delivery for foetus)
126
Q

choice of antibiotic for group B strep infection

A
  • benzylpenicillin (vancomycin in pen resistance)
127
Q

first line tocolytic in pre-term labour

A

nifedipine

128
Q

triad for diagnosing hyperemesis gravidarum

A
  • 5% pre-pregnancy weight loss
  • dehydration
  • electrolyte imbalance
129
Q

management of hyperemesis gravidarum

A
  • ABCDE
  • cyclizine or promethazine (antihistamines)
  • ondansetron (second line)
130
Q

risks of inducing labour

A
  • induction may be unsuccessful, requiring emergency caesarean section
  • uterine hyper-stimulation, excessive contractions can lead to foetal bradycardia increasing risk of uterine rupture and placental abruption
  • cord prolapse
  • uterine rupture - greater risk in women with previous caesarean section/uterine surgery
131
Q

ovarian hyperstimulation syndrome

A

FSH used in IVF leads to enlarged ovaries due to excessive oestrogen, progesterone and VEGF
- leads to
> bloating/abdo discomfort (enlarged ovaries)
> oedema/ascites/pleural effusion/weight gain (leaky vessels due to VEGF)

132
Q

causes of polyhydramnios

A 
EXCESS PRODUCTION
- maternal diabetes
- foetal renal disorder
- foetal anaemia
- twin-twin transfusion syndrome
INSUFFICIENT REMOVAL
- oesophageal/duodenal atresia
- diaphragmatic hernia
- chromosomal abnormalities
133
Q

complications of polyhydramnios

A 
MATERNAL
- respiratory compromise
- worsened pregnancy symptoms, eg. GORD, constipation, peripheral oedema
- increased risk of UTI
FETAL
- preterm
- PROM
- malpresentation
- cord prolapse
134
Q

Bishop score is used for…

A

assessing whether a patient is likely a good candidate for induction of labour

  • score of 9+ = good candidate for vaginal delivery by induction
  • lower score = less likely
135
Q

treatment for obstetric cholestasis

A

ursodeoxycholic acid for cholestasis

chlorphenamine for pruritis

136
Q

contraception post-partum

A
  • no need for contraception for 3 weeks post-partum
  • convenient to start contraception post-partum and most methods are suitable immediately, however COCP contraindicated due to VTE risk
  • IUS/IUD may be inserted immediately following delivery, but if not within 48hrs must delay for 28 days
137
Q

supplementation in pregnancy

A

FOLIC ACID
- high risk of neural tube defects = 5mg/d
- low risk woman aiming to conceive = 400mcg/d
VIT D
- 400 units/d

138
Q

medical termination of pregnancy drugs

A
  • mifepristone
    FOLLOWED BY
  • misoprostol
139
Q

management of uterine fibroids

A 
symptomatic (dysmenorhoea/menorrhagia)
- IUS (consider family planning)/COCP/POP
- mefenamic acid
- tranexamic acid
surgical
- myomectomy
- uterine artery embolisation
- hysterectomy (if completed family)
140
Q

management of endometriosis

A 
analgesia
- NSAID/paracetamol
- COCP/depo-provera
surgical
- diathermy of lesions
- bilateral oophorectomy (consider family planning)
141
Q

causes of post-menopausal bleed

A
  • HRT breakthrough bleed (common in first 3-6 months on combined HRT)
  • vaginal atrophy
  • endometrial cancer
142
Q

gynaecological causes of menorrhagia

A
  • fibroids
  • adenomyosis
  • endometrial polyps
  • endometriosis
  • pelvic inflammatory disease
  • endometrial cancer (be wary if there is postmenopausal bleeding)
143
Q

systemic causes of menorrhagia

A
  • bleeding disorders
  • hypothyroidism
  • liver and kidney disease
  • obesity
144
Q

management of menorrhagia

A

treat underlying cause if possible, if dysfunctional uterine bleeding then:

  • IUS/COCP
  • mefenamic acid
  • tranexamic acid
  • norethisterone can be given for acute menorrhagia
145
Q

cervical screening criteria

A

national cervical screening programme runs for women aged 25 to 64. From 25 to 49 women are called every three years, and afterwards every five years

  • aim is to identify dyskaryotic
  • if negative then no action required until next screen
  • if borderline (mild dyskaryosis) then HPV tested, if positive then colposcopy within 6 weeks
  • if positive (moderate/severe dyskaryosis) then colposcopy within 2 weeks
146
Q

diagnostic criteria of PCOS

A

Rotterdam criteria - assuming that other causes have been excluded, PCOS can be diagnosed if two of the following are present:

  • polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
  • oligo-/anovulation
  • clinical or biochemical features of hyperandrogenism
147
Q

biochemical investigations for PCOS

A
  • high LH:FSH ratio (>2), normal ratio excludes menopause
  • slightly high/normal free testosterone
    also consider:
  • OGTT
  • TFTs
  • prolactin
  • urinary cortisol (Cushing’s)
148
Q

causes of post-coital bleeding

A
  • sexually transmitted infections
  • endocervical and cervical polyps
  • cervical ectropion
  • cervical cancer
  • atrophic vaginitis
149
Q

Fraser guidelines

A

1) . they have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
2) . they cannot be persuaded to tell their parents or to allow the doctor to tell them
3) . they are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
4) . their physical or mental health is likely to suffer unless they receive the advice or treatment
5) . the advice or treatment is in the person’s best interests

150
Q

management of antiphospholipid syndrome in pregnancy

A
  • low dose aspirin from positive pregnancy test

- LMWH from fetal heart on USS, discontinued at 34 wks

o+g (1 decks)

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