6. Obs and Gyn 3 Flashcards
When do women require contraception after giving birth?
Day 21
What is endometrial hyperplasia and give the pathophysiology, and a risk factor.
Abnormal proliferation of the endometrium.
It develops due to presence of unopposed oestrogen; oestrogen stimulates endometrial growth whilst progesterone stimulates shedding of this tissue.
Tamoxifen has pro-oestrogenic effects on endometrium (though it has anti-oestrogenic effects on breast)
Risk factors for endometrial carcinoma (7).
Obesity
Hypertension
PCOS
Diabetes mellitus
Tamoxifen use
Late menopause
High levels of oestrogen
Third stage of labour is measured from the birth of the baby to the expulsion of placenta and membranes. Why is active management of this stage recommended and what does it involve (3 things)?
Reduce PPH and need for blood transfusion post delivery.
Lasts <30 minutes, involves uterotonic drugs, deferred clamping and cutting of cord (1 min < x < 5 mins) and controlled cord traction after signs of placental separation.
What is an amniotic fluid embolism, and give some signs and symptoms a patient may present with.
Fetal cells / amniotic fluid enter the mother’s bloodstream and stimulate a reaction.
Shivering, chills, sweating, anxiety, coughing.
Cyanosis, hypotension, tachycardia, dyspnoea, arrhythmias, MI
Supportive management in a critical care setting.
What is the intervention used in obstetric cholestasis that prevents stillbirth, and also give 4 other management strategies for symptom relief.
Elective induction from 37 weeks.
Ursodeoxycholic acid
Vitamin K
Emollients
Chlorphenamine
What are the 3 types of oestrogen, where and when are they produced?
E1 = ESTRONE; post menopause, converted from androgens in peripheral tissues.
E2 = OESTRADIOL; premenopausal, from ovaries.
E3 = ESTRIOL; produced from the placenta, weakest of them all. Maintains uterine lining and supports fetal development.
Describe the histological types of endometrial cancer.
Endometrioid type = 80%. Split into mostly endometrioid adenocarcinoma, + some others inc mucinous carcinoma.
Non-endometrioid type = 20%. Split into clear cell, serous and mixed adenocarcinoma.
State some contraindications to HRT.
History of unprovoked / recurrent VTE
Oestrogen sensitive malignancy
Undiagnosed PV bleeding
Untreated hypertension
Liver dysfunction
Untreated endometrial hyperplasia
What is adenomyosis, and give 3 clinical features of it.
Endometrial tissue present in the myometrium. More common in multiparous women at the end of their reproductive years.
Dysmenorrhoea
Menorrhagia
Enlarged, boggy uterus
What is the first line investigation for adenomyosis?
TVUS
What specific levels are measured in the combined screening and the quadruple screening tests offered in pregnancy, and when are they offered?
Combined at 11-13+6 weeks. Nuchal translucency, PAPP-A, b-hCG.
Quadruple at 15-20 weeks. Inhibin A, unconjugated estriol, AFP, hCG.
