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Year 3 - Reproductive and Sexual Health (DP) > Child Birth > Flashcards

Child Birth Flashcards

1
Q

The external obliques attach between the lower ribs and what other three structures?

A

Iliac crests
Pubic tubercle
Linea alba (midline blending of aponeuroses)

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2
Q

What direction do the fibres of the external obliques run in?

A

Same direction as external intercostals

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3
Q

The internal obliques and transverse abdominis attach between the lower ribs and what three other structures?

A

Thoracolumbar fascia
Iliac crest
Linea alba

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4
Q

What do the dividing the rectus abdominis into 3 or 4 smaller muscles do?

A

Improves mechanical efficiency

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5
Q

Where does the linea alba run from?

A

Xiphoid to pubic symphysis

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6
Q

What is the arcuate line?

A

Horizontal line

Marks the lower limit of the posterior rectus sheath

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7
Q

Where do the inferior epigastric vessel perforate the rectus abdominis?

A

At the arcuate line

Half way between umbilicus and pubic crest

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8
Q

What is the anterior rectus sheath composed of?

A

External oblique aponeurosis
AND
Anterior lamina of internal oblique aponeurosis

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9
Q

What is the posterior rectus sheath composed of?

A

Posterior lamina of internal oblique aponeurosis
AND
Transverse abdominis aponeurosis

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10
Q

What is the structure of the rectus sheath below the arcuate line?

A

All 3 layers of aponeuroses make the sheath which runs anterior to the rectus abdominis:

  • External oblique aponeurosis
  • Internal oblique aponeurosis
  • Transverse abdominis aponeurosis
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11
Q

What part(s) of the rectus sheath are cut when undertaking a suprapubic incision (lower segment Cesarean section)?

A

Anterior sheath only (as it is below arcuate line)

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12
Q

Why is the rectus sheath stitched closed after surgery?

A

Increased wound strength
Reduced risk of would complications:
- Incisional hernia

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13
Q

From what spinal segment does the iliohypogastric nerve arise?

A

L1

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14
Q

From what spinal segment does the ilioinguinal nerve arise?

A

L2

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15
Q

Where plane do the nerves supplying the anteriolateral abdominal wall travel in?

A

Plane between:

  • Internal oblique and
  • Transverse abdominis
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16
Q

What part of the abdominal wall do the superior epigastric arteries supply?

A

Anterior wall

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17
Q

What artery do the superior epigastrics originate from?

A

Continuation of internal thoracic arteries

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18
Q

Where do the superior epigastric arteries arise from and lie?

A

Emerge at superior aspect of abdominal wall

Lie posterior to rectus abdominis

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19
Q

What part of the abdominal wall do the inferior epigastric arteries supply?

A

Anterior

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20
Q

What artery do the inferior epigastric arteries originate from?

A

Branch of external iliac

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21
Q

Where do the inferior epigastric arteries arise from and lie?

A

Emerge at inferior aspect of abdominal wall

Lie posterior to rectus abdominis

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22
Q

What part of the abdominal wall do the intercostal and subcostal arteries supply?

A

Lateral wall

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23
Q

What artery do the intercostal and subcostal arteries originate from?

A

Continuation of posterior intercostal arteries

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24
Q

Where do the intercostal and subcostal arteries arise from?

A

Lateral aspect

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25
Q

In a LSCS incision, what happens to the rectus muscles?

A

NOT cut:

- Separated laterally towards their nerve supply

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26
Q

What layers are cut/separated in an LSCS?

A
  1. Skin and fascia
  2. (Anterior) rectus sheath (inferior to arcuate line)
  3. Rectus abdominis (separated)
  4. Fascia and peritoneum
  5. Bladder retracted
  6. Uterine wall
  7. Amniotic sac
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27
Q

What layers of the abdominal wall are stitched closed after an LSCS?

A

Uterine wall (with visceral peritoneum)
Rectus sheath
Fasica (if high BMI)
Skin

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28
Q

What layers are opened for a laparotomy?

A

Skin and fascia
Linea alba
Peritoneum

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29
Q

What layers are stitched closed following a laparotomy?

A

Peritoneum
Linea alba
Skin (fascia if high BMI)

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30
Q

Why does a laparotomy have an increased risk of wound complication?

A

Bloodless

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31
Q

What wound complications can result after a laparotomy?

A

Dehiscence

Incisional hernia

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32
Q

When inserting a lateral laparoscopic port, what must be avoided?

A

Inferior epigastric artery

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33
Q

How can the pelvic organs be viewed during laparoscopy?

A

Forceps inserted through vagina to grasp cervix and manipulate uterus

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34
Q

Where does the inferior epigastric artery emerge?

A

Just medial to the deep inguinal ring
Halfway between:
- ASIS
- Pubic tubercle

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35
Q

What direction does the inferior epigastric artery move in?

A

Superomedial direction posterior to rectus abdominis

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36
Q

Why must care be taken during a hysterectomy in regards to arteries?

A

Differentiate the ureters and uterine arteries:

  • Ureter passes inferior to artery
  • Ureters will ‘vermiculate’ when touched
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37
Q

What are the 3 components of the pelvic floor?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

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38
Q

What is the deepest layer of the pelvic floor?

A

Pelvic diaphragm

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39
Q

What does the pelvic diaphragm consist of?

A

2 muscle groups:

  • Levator ani
  • Coccygeus
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40
Q

There is an anterior gap between the medial borders of the pelvic diaphragm, what is this called and what does it allow?

A

Urogenital hiatus allowing passage of:

  • Urethra (M and F)
  • Vagina (F)
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41
Q

What are the origins of the levator ani?

A

Pubic bones
Ischial spines
Tendinous arch of levator ani

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42
Q

What are the insertions of the levator ani?

A

Perineal body
Coccyx
Walls of organs in the midline

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43
Q

What are the 3 parts of the levator ani?

A

Puborectalis
Pubococcygeus
Ilicoccygeus

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44
Q

What must the levator ani do to allow urination and defaecation?

A

Relax

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45
Q

What is the levator ani innervated by?

A 
Pudendal nerve (S3, S4)
Nerve to levator ani (S4)
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46
Q

Where does the deep perineal pouch lie?

A

Below fascia covering the inferior surface of the pelvic diaphragm
Superior to perineal membrane

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47
Q

What does the deep perineal pouch contain?

A 
Part of urethra (and vagina)
Bulbourethral glands (male)
Neurovascular bundle for penis/clitoris
Extensions of the:
- Ischioanal fat pads
- Muscles
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48
Q

Where does the perineal membrane attach?

A

Laterally to the sides of the pubic arch (close urogenital triangle)

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49
Q

What are the openings in the perineal membrane for?

A

Urethra

Vagina

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50
Q

What parts of the penis does the superficial perineal pouch contain in males?

A 
Bulb of penis - Corpus spongiosum
Crura of penis - Corpus cavernosa 
Associated muscles:
- Bulbospongiosus
- Ischiocavernosus
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51
Q

What else does the superficial perineal pouch contain (apart from parts of the penis) in males?

A 
Proximal spongy (penile) urethra
Superficial transverse perineal muscle
Branches of:
- Internal pudendal vessels
- Pudendal nerve
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52
Q

What parts of the female erectile tissue does the superficial pouch contain?

A 
Clitoris and crura - Corpus cavernosa
Bulbs of vestibule (paired)
Associated muscles:
- Bulbospongiosus
- Ischiocavernosus
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53
Q

What else does the superficial perineal pouch contain (apart from parts of the female erectile tissue) in females?

A 
Greater vestibular glands
Superficial transverse perineal muscles
Branches of:
- Internal pudendal vessels
- Pudendal nerve
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54
Q

What does tonic contraction of the puborectalis do?

A

Bends anorectum anteriorly:

- Maintains faecal continence

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55
Q

What does active contraction of the puborectalis do?

A

Maintains continence after rectal filling

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56
Q

What does urinary continence depend on?

A

Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall

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57
Q

What is a cystocoele?

A

Bladder moves through prolapse in anterior vaginal wall

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58
Q

What is an enterocoele?

A

Loops of small bowel move through prolapse in upper posterior vaginal wall

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59
Q

What is a rectocoele?

A

Rectum moves through prolapse in lower posterior vagina wall

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60
Q

What is a 1st degree uterine prolapse?

A

Lowest part descends halfway down vagina

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61
Q

What is a 2nd degree uterine prolapse?

A

Lowest part at vaginal entrance

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62
Q

What is a 3rd degree uterine prolapse?

A

Lowest part lies outside of vagina

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63
Q

What is a 3rd degree uterine prolapse also known as?

A

Procidentia

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64
Q

What are the symptoms of a uterine prolapse?

A

Dragging sensation
Feeling of a ‘lump’
Urinary incontinence

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65
Q

When is a sacrospinous fusion carried out?

A

To repair a cervical or vault descent

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66
Q

How is a sacrospinous fusion carried out?

A

Vaginally:

  • Sutures placed in sacrospinous ligament
  • Just medial to the ischial spin
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67
Q

What does a sacrospinous fusion risk injury to?

A

Pudendal neurovascular bundle

Sciatic nerve

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68
Q

How is incontinence surgery carried out?

A 
Trans-obturator approach
Mesh through obturator canal:
- Space in obturator foramen for passage of NVB
- Create a sling around urethra
- Incisions through vagina and groin
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69
Q

What are the three key factors for labour?

A

Power (of uterine contractions)
Passage (size of maternal pelvis)
Passenger (size of foetus)

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70
Q

What role does progesterone play in labour?

A

Promotes smooth muscle relaxation (keeps uterus ‘settled’)
Prevents formation of gap junctions
Reduces contractility of myocytes

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71
Q

What role does oestrogen play in labour?

A

Makes uterus contract

Promotes prostaglandin production

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72
Q

What role does oxytocin play in labour?

A

Initiates and sustains contractions

Acts on decidual tissue to promote prostaglandin release

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73
Q

What synthesises oxytocin during labour?

A

Decidual tissue
Extra-embryonic foetal tissues
Placenta

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74
Q

What happens to the number of oxytocin receptors near the pregnancy? In what tissues?

A

Increases in:

  • Myometrium
  • Decidual tissues
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75
Q

What does myometrial stretch do in the initiation of labour?

A

Increases excitability of myometrial fibres

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76
Q

What is the Ferguson reflex?

A
  1. Increased pressure on cervix
  2. Oxytocin release
  3. Contractions
  4. Positive feedback to step 1.
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77
Q

What does the secretion of pulmonary surfactant into the amniotic fluid do?

A

Prostaglandin synthesis

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78
Q

What does a rise in foetal cortisol?

A

Increases maternal oestriol

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79
Q

What does an increase in myometrial oxytocin receptors and their activation do?

A

Phospholipase C activity:

  • Increased cytosolic calcium
  • Increased uterine contractility
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80
Q

What is the latent phase of the first stage of labour?

A

Up to 3-4cm cervical dilatation

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81
Q

What is the active phase of the first stage of labour?

A

4-10cm (full) cervical dilatation

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82
Q

What is the second stage of labour?

A

From full dilatation to delivery of the baby

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83
Q

What is the third stage of labour?

A

From delivery of baby to the expulsion of placenta and membranes

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84
Q

What happens during the latent phase of the first stage of labour?

A

Mild irregular uterine contractions

Cervix shortens and softens

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85
Q

How long does the latent phase of the first stage of labour last?

A

Variably duration:

- May last a few days

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86
Q

What happens during the active phase of the first stage of labour?

A 
4-10cm cervical dilatation
Slow descent of the presenting part
Contractions progressively become more:
- Rhythmic
- Strong
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87
Q

In nulliparous women, when is the second stage of labour deemed prolonged?

A

If it lasts longer than:

  • 3 hours if there is regional anaesthesia
  • 2 hours without regional anaesthesia
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88
Q

In multiiparous women, when is the second stage of labour deemed prolonged?

A

If it lasts longer than:

  • 2 hours if there is regional anaesthesia
  • 1 hour without regional anaesthesia
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89
Q

How often is vaginal examination done to assess cervical dilatation in low risk care?

A

Infrequently

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90
Q

How long does the third stage of labour last for?

A 
10 minutes
(Can last from 3 minutes longer)
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91
Q

What is the expectant management of the third stage of labour?

A

Spontaneous delivery of placenta

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92
Q

What is the active management of the third stage of labour?

A

Use of oxytocic drugs

Controlled cord traction

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93
Q

What does the active management of the third stage of labour reduce the risk of?

A

Post-Partum haemorrhage

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94
Q

What drugs can be used during the active management of the third stage of labour?

A 
Administration of Syntometrine - 1ml ampoule containing:
- 500mcg ergometrine maleate AND
- 5 IU oxytocin
OR
Administration of 10 IU oxytocin
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95
Q

How else can active management of the third stage of labour be carried out?

A

Cord clamping and cutting
Controlled cord traction
Bladder emptying

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96
Q

What effect does hyaluronic acid have on the cervix?

A

Increases molecules between collagen fibres:

- Results in cervical softening

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97
Q

What effect does reduced collagen fibre bridging have on the cervix?

A

Reduces cervical firmness:

- Results in cervical softening

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98
Q

What causes cervical ripening?

A 
Reduced collagen fibre alignment
Reduced collagen fibre strength
Reduced tensile strength of the cervical matrix
Increased cervical decorin:
- Dermatan sulfate proteoglycan 2
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99
Q

What are Braxton Hicks Contractions?

A

Tightening of the uterine muscles:

- Thought to aid the body prepare for labour

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100
Q

How early can Braxton Hicks Contractions start?

A

6 weeks

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101
Q

When are Braxton Hicks Contractions usually felt?

A

2nd or 3rd trimester

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102
Q

What effect can Braxton Hicks Contractions have on the cervix?

A

Thin it

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103
Q

How can Braxton Hicks Contractions be differentiated from uterine contractions in labour?

A

Irregular
Frequency and duration stay constant:
- Do not increase
Relatively painless

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104
Q

How can Braxton Hicks Contractions be resolved?

A

Ambulation

Change in activity

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105
Q

What is the spacing of true labour contractions?

A

Evenly spread:

  • Typically starts at about 5 minutes apart
  • Time between them shortens
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106
Q

How do true labour contractions change as they progress?

A

Get more intense
Get more painful
Last longer

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107
Q

What is the purpose of true labour contractions?

A

Tighten the top of the uterus:

- Pushes baby down into birth canal

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108
Q

How does the abdomen feel during true labour contractions?

A

Rigid

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109
Q

What cervical changes occur during true labour contractions?

A

Softening
Effacement
Dilatation

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110
Q

How does position affect true labour contractions?

A

Do not resolve

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111
Q

What kind of muscle is in the uterus?

A

Smooth

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112
Q

Where is uterine muscle most dense?

A

At fundus

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113
Q

What is cervical tissue made up of?

A 
Collagen (mainly), types:
- 1
- 2
- 3
- 4
Smooth muscle
Elastin
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114
Q

What are the components of cervical tissue held together by?

A

Connective tissue ground substance

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115
Q

Where is the pacemaker for uterine contractions? What does it do?

A

Region of the tubal ostia:

  • Wave spreads downwards
  • Synchronisation of contraction waves from both ostia
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116
Q

What happens to the upper segment of the uterus during contractions?

A

Contracts

Retracts

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117
Q

What happens to the lower segment of the uterus (and the cervix) during contractions?

A

Stretch
Dilate
Relax

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118
Q

Where is the dominance of the uterine contractions?

A

Fundus

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119
Q

What is the intensity of a uterine contraction essentially?

A

Degree of uterine systole

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120
Q

When is the intensity of uterine contractions greatest?

A

2nd stage of labour

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121
Q

What is the typical frequency of uterine contractions?

A

Up to 3-4 in 10 minutes

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122
Q

How long does a uterine contraction last initially and what is the max length?

A

Initially 10-15 seconds

Max 45 seconds

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123
Q

What is the typical gynaecoid AP diameter of the pelvic outlet?

A

12-13cm

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124
Q

What is the typical gynaecoid transverse diameter of the pelvic inlet?

A

13.5-14cm

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125
Q

What is the typical gynaecoid transverse diameter of the pelvic outlet?

A

11cm (between ischial tuberosities)

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126
Q

What is the typical gynaecoid oblique diameter of the pelvic outlet?

A

12cm

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127
Q

What is the oblique diameter of the pelvis?

A

Sacroiliac joint to contralateral iliopubic eminence

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128
Q

What is the shape of the anthropoid pelvis?

A

Oval shaped inlet

AP > Transverse diameter

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129
Q

What is the shape of an android pelvis?

A

A typically ‘male’ pelvis

Heart shaped/Triangular inlet

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130
Q

What results in the shape of an android pelvis?

A

Prominent sacrum

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131
Q

Who is an android pelvis most common in?

A

Afro-Caribbean women

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132
Q

What is the normal foetal position?

A 
Longitudinal lie
Cephalic presentation
Position:
- Occipitoanterior
- Head engages occipitotransverse
Flexed head
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133
Q

What are abnormal foetal positions?

A 
Presentation:
- Breech
- Oblique lie
- Transverse lie
Position:
- Occipitoposterior
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134
Q

What is the sequence of movements of the foetus during labour?

A
  1. Engagement and descent of the head in an occipitotransverse position as it descends through pelvic inlet
  2. Neck flexion
  3. Internal rotation of neck to OA position
  4. Crowing and extension of neck
  5. Restitution and external rotation (head back to OT to aid shoulder delivery)
  6. Expulsion
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135
Q

How is the anterior shoulder delivered?

A

Downward traction:

- Lateral flexion posteriorly

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136
Q

How is the posterior shoulder delivered?

A

Upward traction:

- Lateral flexion anteriorly

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137
Q

How is the descent of the foetal head measured?

A

In abdominal fifths

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138
Q

What parts of the foetal head are used to determine the position of the foetal head?

A

Frontal synciput

Occipital eminences

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139
Q

When are vaginal exams for cervical assessment carried out during normal labour?

A

~4 hourly

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140
Q

What is crowning?

A

Appearance of a large segment of foetal head at the introitus
Labia stretched to full capacity
Largest head diameter encircled by vulval ring

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141
Q

What does the Bishop Score aid in the assessment of?

A

Cervix
Helps determine if labour will be:
- Spontaneous
- Induced

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142
Q

What are the dilatation scores in the Bishop Score?

A 
0cm = 0 points
1-2cm = 1 point
3-4cm = 2 points
>5cm = 3 points
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143
Q

What are the effacement scores in the Bishop Score?

A 
0-30% = 0 points
40-50% = 1 point
60-70% = 2 points
80-100% = 3 points
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144
Q

What are the station scores in the Bishop Score?

A

-3 = 0 points
-2 = 1 points
-1 = 2 points
+1 or +2 = 3 points

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145
Q

What are the cervical consistency scores in the Bishop Score?

A 
Firm = 0 points
Med. = 1 point
Soft = 2 points
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146
Q

What are the cervix position scores in the Bishop Score?

A 
Posterior = 0 points
Mid. = 1 point
Anterior = 2 points
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147
Q

What Bishop’s Score indicates labour is likely to be spontaneous/induction would likely work?

A

> =9 points

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148
Q

What Bishop’s Score indicates labour is likely to proceed and induction will likely not work?

A

=<5 points

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149
Q

What amount of blood loss is normal during labour?

A

<500 ml

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150
Q

What amount of blood loss is abnormal and more significant?

A

> 1500 ml

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151
Q

Where is the plane of separation for the placenta?

A

Spongy layer of decidua basalis

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152
Q

What causes placental separation?

A

Shearing force

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153
Q

What are the methods of placental separation?

A 
Matthew Duncan:
- Marginal
- Most common
Schultz:
- Central
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154
Q

What 3 signs indicate placental separation in the 3rd stage of labour?

A

Uterus hardens, contracts and rises
Umbilical cord lengthens permanently
Gush of blood cariable

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155
Q

When is the 3rd stage of labour considered normal up to?

A

30 minutes

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156
Q

How is haemostasis after labour achieved?

A

Tonic contraction:
- Lattice pattern of uterine muscles strangulates blood vessels
Thrombosis of torn vessel ends:
- Hypercoagulability in pregnancy
Myo-tamponade due to opposition of AP walls

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157
Q

How long does it take the tissues to return to a non-pregnant state after labout?

A

Over 6 weeks

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158
Q

What is the lochia rubra?

A

The 1st vaginal discharge after labour:

  • Fresh red
  • Lasts 3-5 days
159
Q

What is the lochia serosa?

A

The second vaginal discharge after labour:

  • Brownish-red and watery
  • Continues until 10 days after delivery
160
Q

What is the lochia alba?

A

The third vaginal discharge after labour:

  • Yellow
  • 2-6 weeks after delivery
161
Q

What weight does the uterus decrease from and to after labour?

A

Down from 1kg to 50-100g

162
Q

How long does it take for the fundal height to move from the umbilicus to pelvis?

A

2 weeks

163
Q

How long does the endometrium take to regenerate?

A

By the end of the first week post-labour

164
Q

When does diuresis occur post-natally?

A

2-3 days

165
Q

What causes labour pain?

A

Compression of paracervical nerves

Myometrial hypoxia

166
Q

What is Entonox?

A

Inhaled analgesic:

- Nitrous oxide and oxygen

167
Q

What is TENS and where can it be carried out?

A

Transcutaneous Electrical Nerve Stimulation:

  • T10-L1
  • S2-S4
168
Q

How can morphine be delivered during labour?

A

IM

169
Q

What drug can be given IV in a patient-controlled analgesia?

A

Remifentanil

170
Q

How does epidural anaesthesia affect uterine activity?

A

No effect

171
Q

What is the typical solution of epidural anaesthesia used?

A

Levobupivacaine (10-15ml of 0.0625-0.1%) for LA
WITH
Fentanyl (1-2mcg/ml) Opiod

172
Q

What are the side effects of epidural anaesthesia?

A 
Hypotension
Dural pressure
Headache
Back pain
Atonic bladder
173
Q

When is delayed labour suspected in stage 1 of labour if nulliparous?

A

<2cm dilation in 4 hours

174
Q

When is delayed labour suspected in stage 1 of labour if multiparous?

A

<2cm dilation in 4 hours
OR
Slowing in progress

175
Q

In regards to the ‘Power’, what can delay labour?

A

Inadequate contractions:

  • Frequency +/or
  • Strength
176
Q

In regards to ‘Passages’, what can delay labour?

A

Short stature
Trauma
Shape

177
Q

In regards to ‘Passenger’, what can delay labour?

A

Big baby

Malposition

178
Q

What are the measurements recorded on a partogram?

A 
Foetal heart rate
Contractions
Amniotic fluid
Cervical dilatation
Descent
Obstruction
Maternal observations
179
Q

When is a Doppler auscultation of the foetal heart carried out in stage 1 of labour?

A

During and after a contraction

Every 15 minutes

180
Q

When is a Doppler auscultation of the foetal heart carried out in stage 2 of labour?

A

Every 5-10 minutes

181
Q

If there are risk factors for foetal hypoxia, how often is the foetal heart monitored?

A

Continuously

182
Q

What is foetal tachycardia on CTG?

A

> 150

183
Q

What is foetal bradycardia on CTG?

A

<110

184
Q

What is a normal/reassuring variability on CTG?

A

5-25bpm

185
Q

What is a reduced/non-reassuring variability on CTG?

A

<5bpm for 30-90 minutes

186
Q

What is an abnormal/complete loss of variability on CTG?

A

<5bpm for >90 minutes

187
Q

What is a saltatory variability on CTG?

A

> 25bpm

188
Q

What is an acceleration on CTG?

A

An increase in baseline HR >15bpm for >15 seconds

189
Q

How often should an acceleration occur on CTG?

A

At least 2 every 15 seconds

Occurring alongside contractions

190
Q

What causes an early deceleration on CTG?

A

Increased foetal ICP resulting in increased vagal tone (physiological)

191
Q

What causes variable decelerations on CTG?

A

Reduced amniotic fluid volume

192
Q

What causes late decelerations on CTG?

A

Insufficient blood flow through uterus and placenta:

  • Maternal hypotension
  • Pre-eclampsia
  • Uterine hyperstimulation
193
Q

How can foetal distress be managed?

A 
Change maternal position
IV fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis (suppresses labour):
- Terbutaline 250mcg S/C
Maternal assessment
Foetal blood sampling
C-section
194
Q

What does a scalp pH of >7.25 suggest?

A

Normal

No action needed

195
Q

What does a scalp pH of 7.20-7.25 suggest?

A

Borderline

Repeat in 30 minutes

196
Q

What does a scalp pH of <7.20 suggest?

A

Abnormal

Deliver baby

197
Q

When are monthly antenatal visits carried out?

A

From 12 weeks until 28 weeks

198
Q

When can Anti-D be given?

A

28 weeks and 34 weeks

199
Q

When are fortnightly antenatal visits carried out?

A

28-36 weeks

200
Q

When are weekly antenatal visits carried out?

A

From 37 weeks until delivery

201
Q

If there is hypertension present at booking appointment or <20 weeks pregnancy, what kind is it?

A

Chronic (essential) hypertension

202
Q

If there is hypertension that is new >20 weeks pregnancy without significant proteinuria, what is it?

A

Gestational hypertension

203
Q

If there is hypertension that is new >20 weeks pregnancy with significant proteinuria, what is it?

A

Pre-eclampsia

204
Q

What is HELLP syndrome?

A

Haemolysis
Elevator Liver enzymes
Low Platelets

205
Q

If there are risk factors for pre-eclampsia, what can be prescribed?

A

Aspirin

206
Q

When is Nifedipine used to manage hypertension in pregnancy?

A

If monotherapy of either fails:

  • Labetalo OR
  • Methyldopa
207
Q

What can be used for severe hypertension in pregnancy?

A

Labetalol PO or IV
Hydralazine IV
Nifedipine PO

208
Q

What is severe hypertension in pregnancy defined as?

A

> 165/110

209
Q

What is the target BP aim in hypertension without end organ damage in pregnancy?

A

<150/100

210
Q

What is the target BP aim in hypertension with end organ damage in pregnancy?

A

<140/90

211
Q

If a pregnant woman’s BP is <140/90, what should be done?

A

Consider reducing dose

212
Q

If a pregnant woman’s BP is <130/90, what should be done?

A

Reduce dose

213
Q

When should a foetus be delivered, ideally, in pre-eclampsia?

A

37 weeks

214
Q 
If there are signs of:
- Vasoconstriction
- Kidney, liver, eye disease
- Foetal IUGR, abruption, death
What should be done if there is hypertension in regards to monitoring?
A

Growth scans

215
Q

How can pregnancy affect diabetes?

A

Poorer control
Deterioration of renal function
Deterioration of ophthalmic disease
Gestational DM

216
Q

How can diabetes affect pregnancy?

A 
Miscarriage
Foetal malformations
IUGR/Macrosomia
Unexplained IUD
Pre-eclampsia
217
Q

When should labour be induced in diabetes?

A

37-38 weeks

218
Q

What does foetal macrosomia increase the risk of?

A

Birth injury

Shoulder dystocia

219
Q

What does polyuria and polyhydramnios increase the risk of?

A

Preterm labour
Malpresentation
Cord prolapse

220
Q

What does increased oxygen demand and polycythaemia increase the risk of?

A

Unexplained term stillbirth

221
Q

What does neonatal hypoglycaemia increase the risk of?

A

Cerebral palsy

222
Q

How does polycythaemia arise in maternal hyperglycaemia?

A 
Foetal hyperglycaemia results in hyperinsulinaemia
Increased metabolism results in:
- Tissue hypoxia
- Increased EPO
- Erythroblastosis
Hyperinsulinaemia also results in:
- Increased EPO
- Erythroblastosis
223
Q

What are the aims for BM and HbA1C in the management of gestational diabetes?

A 
BM = 4-6
HbA1c = <6.0
224
Q

How is gestational diabetes managed postnatal?

A

Stop treatment

Monitor blood glucose for 48hrs

225
Q

How can VTE be treated in pregnancy?

A

LMWH

226
Q

What is the biggest risk factor for a VTE during pregnancy?

A

Previous VTE (Except 1 event due to surgery)

227
Q

If a pregnant woman has had any previous VTE (except related to surgery), how should this be managed?

A

HIGH RISK

Antenatal LMWH

228
Q

If there are >=4 lifestyle risk factors, for VTE in pregnancy, how should this be managed?

A

LMWH from 1st trimester

229
Q

If there are 3 lifestyle risk factors, for VTE in pregnancy, how should this be managed?

A

LMWH from 28 weeks

230
Q

If there are <3 lifestyle risk factors, for VTE in pregnancy, how should this be managed?

A

Mobilisation

Avoidance of dehydration

231
Q

If any of the following are met, how should the risk of postnatal VTE be reduced:

  • Any previous VTE
  • Anyone requiring antenatal LMWH
  • High risk thrombophilia
  • Low risk thrombophilia and FHx
A

At least 6 weeks of LMWH

232
Q

If there is an intermediate risk of postnatal VTE, how should it be managed?

A

At least 10 days LMWH

233
Q

If there is an intermediate risk, or >3 intermediate risk factors or the intermediate risk persists beyond initially prophylaxis, what should be done?

A

Extend LMWH

234
Q

What is the ratio of left:right DVT?

A

8:1

235
Q

What is the therapeutic dose of LMWH during pregnancy after DVT or PE?

A

1mg/kg twice (or once) daily

236
Q

When should LMWH be continued in following a DVT or PE?

A

3 months after pregnancy
OR
6 months after treatment began

237
Q

How long should therapeutic heparin be stopped before a planned delivery where an epidural is to be given?

A

24 hours

238
Q

How long should prophylactic heparin be stopped before a planned delivery where an epidural is to be given?

A

12 hours

239
Q

How soon before delivery should warfarin be stopped?

A

6 weeks

240
Q

How should hypothyroidism dosing be changed in pregnancy?

A

Increase dose by 25-50mcg in 1st trimester

Repeat TFTs every trimester

241
Q

How should hyperthyroidism dosing be changed in pregnancy?

A

Gets worse due to hCG in 1st trimester

Improves in 2nd and 3rd trimesters

242
Q

How can hyperthyroidism affect pregnancy?

A

IUGR
Preterm labour
Thyroid storm

243
Q

How is asthma affected in the 3rd trimester?

A

Often improves

244
Q

What are the dysmorphic features of Foetal Anticonvulsant Syndrome?

A

V-shaped eyebrows
Low set ears
Broad nasal bridge
Irregular teeth

245
Q

What are the other features of Foetal Anticonvulsant Syndrome?

A

Hypertelorism:
- Increased distance between 2 organs/body parts
Hypoplastic nails and distal digits

246
Q

Postpartum, how is a foetus treated if the mother was given anticonvulsants during pregnancy?

A

1mg IM Vitamin K

247
Q

Half of suicides occur up to what stage postnatally?

A

12 weeks

248
Q

What can predict a psychiatric disorder following pregnancy?

A

Previous mental illness
Other vulnerable factors
FHx of bipolar disorder

249
Q

What anticonvulsant causes the following foetal abnormalities:

  • Neural tube defects
  • Craniofacial defects
  • CV abnormality
  • IUGR
  • Reduced IQ
  • Cleft lip/palate
  • Genitourinary anomalies
A

Sodium valproate

250
Q

What anticonvulsant causes the following foetal abnormalities:

  • Facial dysmorphism
  • Cardiac anomalies
  • Fingernail hypoplasia
  • Neural tube defects
A

Carbamazepine

251
Q

What anticonvulsant causes the following foetal abnormalities:

  • Cleft lip/palate
  • SJS to baby if breastfed
A

Lamotrigine

252
Q

What drug causes foetal Ebstein’s anomaly?

A

Lithium

253
Q

Are antipsychotics safe in pregnancy?

A

Yes

254
Q

What can atypical antipsychotics result in during pregnancy?

A

Gestational diabetes

IUGR

255
Q

All antipsychotics are sedating and have long half lives. What should babies be observed for following birth?

A

Lethargy
Sedations
Developmental milestones

256
Q

What antipsychotic drugs are contraindicated in breastfeeding any why?

A

Clozapine:
- Can induce life-threatening events in infant
Olanzapine:
- Can induce extrapyramidal reactions

257
Q

What can venlafaxine cause in pregnancy?

A

Hypertension

258
Q

What can paroxetine cause in pregnancy?

A

Cardiac abnormalities

259
Q

What can SSRIs cause in pregnancy?

A

Pulmonary hypertension after 20 weeksq

260
Q

What antidepressants enter breast milk?

A

TCAs
SSRIs:
- Citalopram and Fluoxetine have high levels!

261
Q

What TCAs are safe in pregnancy and breastfeeing

A

Amitriptyline

Nortriptyline

262
Q

When does ‘baby blues’ occur?

A

Days 3-10

263
Q

When does postnatal depression first present?

A

2-6 weeks postnatally

264
Q

What clinical features can differentiate postnatal depression from ‘baby blues’?

A 
Lack of enjoyment
Weight loss
Presenting as concersns about baby
Has effects on:
- Bonding
- Marriage
- Child development
265
Q

When does puerperal psychosis tend to present?

A

Within 2 weeks of delivery

266
Q

What are the early symptoms of puerperal psychosis?

A

Sleep disturbance
Confusion
Irrational ideas

267
Q

What are some later symptoms of puerperal psychosis?

A

Mania
Delusions
Hallucinations
Confusion

268
Q

How is puerperal psychosis managed?

A 
Admission to hospital
Antidepressants
Antipsychotics
Mood stabilisers
ECT
269
Q

What is Wernicke’s Encephalopathy?

A

Triad of:

  • Ophthalmoplegia
  • Ataxia
  • Confusion
270
Q

What is Korsakoff syndrome?

A 
Anterograde amnesia
Retrograde amnesia
Confabulation
Minimal content in conversation
Lack of insight
Apathy
271
Q

What teratogenic effects can amphetamines have in pregnancy?

A

Microcephaly
Cardiac
Genitourinary
Limb

272
Q

What other complications of pregnancy can result from amphetamine use?

A

Pre-eclampsia

Abruption

273
Q

What complications of pregnancy can result from ecstasy use?

A 
IUGR
Pre-term labour
Miscarriage
Developmental delay
SIDS
Withdrawal
274
Q

What complications of pregnancy can result from opiate use?

A 
Maternal death (1-2%)
Neonatal withdrawal
IUGR
SIDS
Stillbirth
275
Q

What complications of pregnancy can result from nicotine use?

A 
Miscarriage
Abruption
IUGR
Stillbirth
SIDS
276
Q

What is placental abruption?

A

Separation of a normally implanted placenta BEFORE birth of the foetus

277
Q

What can result from a placental abruption?

A 
Revealed/Concealed bleeding
Couvelaire uterus
PPH
DIC
Foetal/Maternal death
278
Q

What is a couvelaire uterus?

A

Bleeding penetrates myometrium and forces into peritoneal cavity

279
Q

How does a placental abruption present?

A 
Small/Large blood loss
Pain
Uterine tenderness/Wooden hard
Uterus feels larger
Difficulty feeling foetal parts
CTG:
- Abnormally frequent contractions
- Abnormal uterine hypertonus
280
Q

What is placenta praevia?

A

Placenta is partially OR totally implanted in the lower uterine segment

281
Q

How can placenta praevia be classified according to position?

A

Lateral
Marginal
Incomplete centralis
Complete centralis

282
Q

What are the grades of placenta praevia?

A

Grades I-IV

283
Q

What defines major or minor placenta praevia?

A

Distance from cervix on USS:

  • Major is =<2cm from/covering os
  • Minor is >2cm from os
284
Q

How does placenta praevia present?

A 
Painless (+ 'causeless') recurrent 3rd trimester bleeding
Uterus soft and non-tender
Malpresentations
High head
CTG usually normal
285
Q

How is placenta praevia diagnosed?

A 
Anomaly scan (20 weeks)
32/34 week scan
286
Q

When is a vaginal exam carried out in placenta praevia?

A

NOT until praevia excluded

287
Q

How is a major placenta praevia managed?

A

Caesarean section

288
Q

How is a minor placenta praevia managed?

A

Consider vaginal delivery

289
Q

What is placenta accreta?

A

Placenta invades myometrium

290
Q

What is placenta percreta?

A

Placenta has reached serosa

291
Q

What is placenta accreta associated with?

A

Severe bleeding
PPH
Hysterectomy

292
Q

What are the risk factors for placenta accreta?

A

Placenta praevia

Prior C-section

293
Q

How does uterine rupture present?

A 
Small/Large volume
Intrapartum loss of contractions
Obstructed labour
Peritonism
Foetal head high
Foetal distress/IUG
Haematuria
294
Q

What are the risk factors for uterine rupture?

A

Previous C-section

Previous uterine surgery

295
Q

What is vasa praevia?

A 
Velamentous insertion of cord:
- Umbilical cord inserts into foetal membranes
OR
Succenturiate lobe:
- A smaller accessory placental lobe
296
Q

What happens in velamentous insertion of cord?

A

Travels to placenta

Exposed vessels vulnerable to rupture

297
Q

How does vasa praevia present?

A

Bleeding (foetal blood - 200ml) after rupture of membranes

Foetal death

298
Q

How is placenta praevia managed?

A 
ADMIT
IV
USS
Anti-D
Steroids
Delivery:
- <2cm carry out C-section at 38-39 weeks
299
Q

How is delivery timed in placenta praevia?

A 
Major bleeding may require preterm deliver
C-section at 37-38 weeks if:
- Prior bleeding
- Suspected/Confirmed placenta accreta
Cell saver
Steroids
300
Q

How is placental abruption managed?

A 
ADMIT
IV
Resuscitate/Manage DIC
Deliver a viable baby
If stillbirth -> Vaginal delivery
Anti-D
Steroids if expectant management
301
Q

If there is any history of acute bleeding 23-32 weeks, how long should the mother be admitted for?

A

Minimum stay of 24 hours clear of bleeding

302
Q

If there is any history of recurrent bleeding after 28 weeks, how long should the mother be admitted for?

A

Minimum stay 72 hours

Consider admission until delivery

303
Q

If there is any history of bleeding after 32 weeks, how long should the mother be admitted for?

A

Minimum stay of 72 hours

Consider admission until delivery

304
Q

If there is any history of major placenta praevia with no bleeding after 36 weeks, how long should the mother be admitted for?

A

Consider:

  • Social circumstances
  • Obstetric factors
  • Need for admission until delivery
305
Q

What is the role of steroids in labour?

A

Promote foetal lung surfactant production

306
Q

When do steroids need to be given to reduce the risk of neonatal respiratory distress syndrome by up to 50%?

A

24-48 hours before delivery

307
Q

When are steroids administered up to? Up to what point to they have significant effects?

A

Up to 36 weeks

Only significant up to 34 weeks

308
Q

Which steroid is best to aid in foetal lung surfactant production?

A

Betamethasone > Dexamethasone

309
Q

What is one course of steroids before delivery?

A

12mg Betamethasone IM, 2 injections, 12 hours apart

310
Q

When is C-section planned in placenta accreta?

A

At 37 weeks

311
Q

How many units should be cross-matched following how much PV bleeding when antenatally admitted?

A

2-4 units with any bleeding >1tsp

312
Q

After what test should anti-D be administered if the mother is Rh-?

A

Kleihauer test:

- Looks for foetal blood in mother’s blood

313
Q

What is the classic definition of PPH?

A

> 500ml

314
Q

What is primary PPH?

A

Within 24 hours

315
Q

What is secondary PPH?

A

24hrs - 6 weeks

316
Q

What is a minor PPH?

A

<500ml

317
Q

What is a moderate PPH?

A

500-1500ml

318
Q

What is a major PPH?

A

> =1500ml

319
Q

What are the possible aetiologies of PPH?

A

The “4 Ts”:

  • Tone (70%)
  • Trauma (20%)
  • Tissues (10%)
  • Thrombin (<1%)
320
Q

A pregnant woman presents with vaginal bleeding. On examination the uterus is soft. On USS, the placenta is complete?

A

Uterine atony

321
Q

A pregnant woman presents with vaginal bleeding. On examination the uterus is soft and contracted. On USS, the placenta is incomplete?

A

Retained placental tissue

322
Q

A pregnant woman presents with vaginal bleeding. On examination the uterus is well contracted. On USS, the placenta is complete?

A

Vaginal/Cervical/Perineal trauma

323
Q

A pregnant woman presents with abdominal pain. There is no vaginal bleeding. She is hypotensive, with a weak, thready pulse. She is hypothermic. The uterus is seen at the vulva and is not palpable.

A

Inverted uterus

324
Q

A pregnant woman presents with vaginal bleeding, severe abdominal pain that has spread to the shoulder tip. The uterus is extremely painful on palpation.

A

Ruptured uterus

325
Q

A pregnant woman presents with continual vaginal bleeding. There is some oozing from a perineal wound site. The uterus is soft.

A

Coagulopathy

326
Q

How is a PPH initially managed?

A

Uterine massage
5 units IV Syntocinon stat.
40 units Syntocinon in 500ml Hartmanns at 125m/hr

327
Q

How is persistent PPH managed?

A 
Confirm placenta and membranes complete
Urinary catheter
500mcg Ergometrine IV, avoided if:
- Cardiac disease
- Hypertension
PGF2-alpha (Carbaprost/Haemabate) 250mcg IM (up to 8x)
328
Q

What are the non-surgical managements of persistent PPH >1500ml?

A

Packs and balloons
Tissue sealants
Factor VIIa
Arterial embolisation

329
Q

What are the surgical managements of persistent PPH >1500ml?

A 
Undersuturing
Brace sutures
Uterine artery ligation
Internal iliac artery ligation
Hysterectomy
330
Q

When does maternal BP reach its lowest point during pregnancy?

A

22-24 weeks

331
Q

What happens to BP after delivery?

A

Falls

Subsequently rises - Peaks at day 3-4 postnatal

332
Q

How is hypertension diagnosed in pregnancy?

A

> =140/90 on 2 occasions
Diastolic BP >110
ACOG >30/15 compared to booking BP

333
Q

When might essential hypertension be a retrospective diagnosis?

A

If BP has not returned to normal within 3 months of delivery

334
Q

When does pregnancy-induced hypertension resolve after delivery?

A

Within 6 weeks

335
Q

What is proteinuria defined as in pre-eclampsia?

A

> =0.3g/L
OR
=0.3g/24 hours

336
Q

What is the pathogenesis behind stage 1 of pre-eclampsia?

A

Abnormal placental perfusion

337
Q

What is the pathogenesis behind stage 2 of pre-eclampsia?

A

Maternal syndrome

338
Q

What is the proposed overall pathogenesis of pre-eclampsia?

A 
Abnormal placentation and trophoblast invasion:
- Failure of normal vascular remodelling
Spiral arteries fail to adapt to become:
- High capacitance
- Low resistance
339
Q

What does placental ischaemia in pre-eclampsia result in?

A

Widespread endothelial damage and dysfunction

340
Q

What does endothelial activation in pre-eclampsia result in?

A 
Increased capillary permeability
Increased expression of CAM
Increased prothrombotic factors
Increased platelet aggregation
Vasoconstriction
341
Q

When should a woman be referred to the day care unit (in regards to hypertension)?

A

BP >=140/90
Proteinuria (++)
Oedema!!
Symptoms - esp. Persistent headache

342
Q

When should a woman be admitted (in regards to hypertension)?

A 
BP >=170/110 OR >140/90 with proteinuria (++)
Significant symptoms:
- Headache
- Visual disturbance
- Abdominal pain
Abnormal biochemistry
Significant proteinuria - UPCR >30mg/mmol
Need for antihypertensive therapy
Signs of foetal compromise
343
Q

What is a contraindication for using methyldopa in hypertension?

A

Depression

344
Q

What is a contraindication for using labetalol in hypertension?

A

Asthma

345
Q

How does methyldopa work?

A

Centrally acting alpha-agonist

346
Q

How does labetalol work?

A

Alpha and Beta antagonist

347
Q

How can seizures be prevented during pregnancy?

A

Magnesium sulfate:

  • Loading dose is 4g IV over 5 mins
  • Maintenance dose is IV infusion 1g/hr
  • 2g for further seizures
348
Q

How are persistent seizures treated in pregnancy?

A

10mg Diazepam IV

349
Q

What is the main cause of death in pregnancy?

A

Pulmonary oedema:

  • Capillary leak
  • Fluid overload
  • Cardiac failure
350
Q

What is urge urinary incontinence?

A

Involuntary urine leakage

Accompanied by/Immediately preceding by urgency

351
Q

What is Overactive Bladder Syndrome?

A

Urgency +/- UUI:
- OAB wet = UUI present
- OAB dry = UUI absent
In absence of pathological/metabolic conditions

352
Q

How does Overactive Bladder Syndomr present?

A

Urgency, usually with:

  • Frequency
  • Nocturia
353
Q

What can trigger urge incontinence?

A

Running water
Opening a door
Removing underwear

354
Q

What is mixed urinary incontinence?

A 
Involuntary leakage associated with urgency (UUI)
Also with stress urinary incontinence:
- Exertion
- Sneezing
- Coughing
355
Q

What is OAB associated with?

A

Involuntary detrusor contractions that may cause UUI

356
Q

What can SUI be caused by?

A 
Urethral hypermotility
Displacement of urethra/bladder neck during:
- Exertion
- Increased intra-abdominal pressure
Urethral sphincter weakness due to:
- Trauma
- Hypoestrogenism
- Ageing
- Surgical procedures
357
Q

What is the initial treatment for OAB (+/-UUI)?

A

Bladder retraining (Bladder drills):

  • For minimum of 6 weeks
  • Aim to increase bladder capacity and reduce frequency
358
Q

If frequency is a problem in OAB, what can be used as treatment?

A

Retraining plus antimuscarinic

359
Q

What lifestyle factors can aid in OAB?

A

Sensible fluid intake
Reduce caffeine
Reduce weight if BMI >30

360
Q

In what kinds of urinary incontinence are pelvic floor muscle exercises effective in?

A

SUI

MUI

361
Q

How long should pelvic floor muscle exercises be carried out for urinary incontinence?

A

Minimum 3 months

362
Q

How do antimuscarinic agents improve urinary incontinence?

A

Reduce intravesical pressure
Increase compliance
Increase volume threshold for micturition
Reduce uninhibited contractions

363
Q

What is the first line antimuscarinic agent for urinary incontinence (UUI or MUI)?

A 
Oxybutynin:
- Immediate release 2.5-5mg PO bd/tid
OR
- Extended release 5mg PO od
OR
- Transdermal patch if side effects
364
Q

What other antimuscarinics are available for UUI or MUI?

A 
Tolterodine
Solifenacin
Darifenacin
Propiverine
Trospium
Fesoterodine
365
Q

What are the side effects of antimuscarinic agents?

A

Dry mouth
Constipation
Blurred vision
Somnolence

366
Q

What type of drug is Mirabegron?

A

Selective beta-3 adrenoreceptor agonist

367
Q

What effects does Mirabegron have?

A

Relaxes bladder smooth muscle
Increases voiding interval
Inhibits spontaneous bladder contractions during filling

368
Q

When is Mirabegron recommended?

A

If antimuscarinics are:

  • Contraindicated
  • Ineffective
  • Causing unacceptable side effects
369
Q

What are the contraindications to Mirabegron?

A

Severe uncontrolled hypertension (>=180/110)

eGFR <15ml/min

370
Q

What is Percutaneous Posterior Tibial Nerve Stimulation useful in?

A

Reducing symptoms in OAB

371
Q

What is uroflowmetry?

A

Measurement of volume of urine (ml) expelled from the bladder each second

372
Q

What are the indications for uroflowmetry?

A 
Hesitancy
Voiding difficulty
Neuropathy
History of urine retention
Postoperative follow up
373
Q

What does flow rate enable the measurement of? What is the minimum amount of urine that must be voided?

A

Peak flow
Mean flow
Voided volume
200mls

374
Q

What is cystometry?

A

Method by which the pressure/volume relationship of the bladder is measured during:

  • Filling
  • Provocation
  • Voiding
375
Q

What is the normal post-void residual?

A

10-80ml

376
Q

What is an abnormal post-void residual?

A

> 100-150ml

377
Q

What causes overflow incontinence?

A

Obstruction of urethra

Poor contractile bladder muscle

378
Q

What must be done in overflow incontinence?

A

Find out post-void residual

Must stop anticholinergics

379
Q

What are the lifestyle treatments of SUI?

A

Lose weight
Stop smoking
Avoid caffeine
Avoid excessive fluids

380
Q

What are the physiotherapy treatments of SUI?

A

PFME
Biofeedback
Electrical stimulation
Pessaries

381
Q

What drugs can be used in SUI?

A

Duloxetine:
- Combined NA and 5-HT reuptake inhibitor
- Increases intraurethral closure pressure
?Pseudoephedrine

382
Q

What are the surgical options for SUI?

A

Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension

383
Q

What volume of leakage is seen in OAB?

A

Large volume

384
Q

What volume of leakage is seen in SUI?

A

Small

385
Q

Is nocturia present in OAB?

A

Usually

386
Q

Is nocturia present in SUI?

A

Seldom

387
Q

What are the three compartments of pelvic organ prolapse?

A

Anterior
Middle/Apical
Posterior

388
Q

What are the symptoms of a cystocoele and enterocoele?

A 
Bulging, pressure, 'mass'
Difficulty voiding and incomplete emptying
Splinting vaginal wall
Difficulty inserting tampon
Painful intercourse
389
Q

What are the symptoms of a rectocoele?

A

Bulging, pressure, ‘mass’
Difficulty defaecating
Splinting vaginal wall
Difficulty inserting tampon

390
Q

How many sites are measured in the Pelvic Organ Prolapse Quantification System?

A

6 when patient is straining

3 when patient is resting

391
Q

What is measured at each site in the Pelvic Organ Prolapse Quantification System?

A

Each measured (cm) in relation to ‘fixed’ hymenl ring:

  • Zero point of reference
  • If above hymen = Negative number
  • If below hymen = Positive number
392
Q

What is a Manchester repair and what is it used for?

A

Cervix amputated
Uterosacral ligaments shortened
Used in uterine/vault prolapse

393
Q

When are pessaries used in prolapse?

A 
Unsuitable for surgery
Symptom relief while awaiting surgery
Further pregnancies planned/currently pregnant
As diagnosis
Patient request
394
Q

When are vaginal oestrogens used in prolapse?

A

If symptomatic atrophic vaginitis

Year 3 - Reproductive and Sexual Health (DP) (7 decks)

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