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ICM Matrix > Female Health > Flashcards

Female Health Flashcards

1
Q

What is labour defined as?

A

Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part

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2
Q

Signs of labour

A
  1. regular and painful uterine contractions
  2. a show (shedding of mucous plug)
  3. rupture of the membranes (not always)
  4. shortening and dilation of the cervix
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3
Q

Stages of labour

A

Stage 1: from the onset of true labour to when the cervix is fully dilated

Stage 2: from full dilation to delivery of the fetus

Stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

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4
Q

What do you monitor in labour?

A
  1. FHR monitored every 15min (or continuously via CTG)
  2. Contractions assessed every 30min
  3. Maternal pulse rate assessed every 60min
  4. Maternal BP and temp should be checked every 4 hours
  5. VE should be offered every 4 hours to check progression of labour
  6. Maternal urine should be checked for ketones and protein every 4 hours
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5
Q

What is the normal delivery position?

A

The head normally delivers in an occipito-anterior position

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6
Q

When is instrumental delivery indicated?

A

If longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section

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7
Q

What is the indication for elective c-section?

A

Breech
>2 previous CS
maternal request

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8
Q

Indication for emergency c-section

A
  • Foetal distress
  • Failure to progress
  • cord prolapse
  • footling breech
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9
Q

Indications for induction of labour

A
  1. prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
  2. prelabour premature rupture of the membranes, where labour does not start
  3. diabetic mother > 38 weeks
  4. pre-eclampsia
  5. rhesus incompatibility
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10
Q

what score is used to induce labour?

A

Bishop score

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11
Q

Methods of induction of labour

A
  1. membrane sweep
  2. vaginal prostaglandin E2 (PGE2)
  3. maternal oxytocin infusion
  4. amniotomy (‘breaking of waters’)
  5. cervical ripening balloon
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12
Q

Define HTN in pregnancy

A

systolic > 140 mmHg or diastolic > 90 mmHg

  • -> No proteinuria, no oedema
  • -> Resolves following birth (typically after one month).
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13
Q

Who are at high risk of developing pre-eclampsia?

A
  1. hypertensive disease during previous pregnancies
  2. chronic kidney disease
  3. autoimmune disorders such as SLE or antiphospholipid syndrome
  4. type 1 or 2 diabetes mellitus
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14
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension in association with proteinuria

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15
Q

Classic signs of pre-eclampsia

A
  1. Proteinuria
  2. High BP
  3. Oedema
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16
Q

Other signs & symptoms of pre-eclampsia

A
  1. Headache and visual disturbance (floaters)
  2. RUQ pain (liver)
  3. Acute onset oedema
  4. Hyper-reflexia (brisk reflexes) & clonus
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17
Q

What is eclampsia?

A

Grand mal seizures in a woman with preeclampsia

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18
Q

Symptoms of ectopic pregnancy

A
  1. Severe lower abdominal pain – usually unilateral
  2. PV bleeding
  3. Vomiting
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19
Q

Symptoms of ruptured ectopic pregnancy

A
  1. Shoulder tip pain
  2. Feeling faint/light-headed
  3. Collapse
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20
Q

Investigation for ectopic pregnancy

A

Diagnostic = Transvaginal USS

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21
Q

What is the most common cause of severe infection in neonates?

A

Group B Streptococcal disease (GBS)

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22
Q

What is gestational diabetes?

A

High blood sugars that develop during pregnancy and usually disappears after delivery.

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23
Q

Screening for gestational diabetes

A

Oral glucose tolerance test

  • fasting glucose is >= 5.6 mmol/L
  • 2-hour glucose is >= 7.8 mmol/L
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24
Q

Targets for self monitoring

A

Fasting = 5.3 mmol/l

1 hour after meals = 7.8 mmol/l, or:

2 hour after meals = 6.4 mmol/l

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25
Q

Abortion time frame

A

<24 weeks – can be maternal choice

> 24 weeks if risk to maternal or foetal health

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26
Q

Medical TOP:
At how many weeks?
What medication?

A

Less than 9 weeks = mifepristone (an anti-progestogen) followed 48 hours later by prostaglandins to stimulate uterine contractions

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27
Q

Surgical TOP:
At how many weeks?
What method?

A
  1. less than 13 weeks: surgical dilation and suction of uterine contents
  2. more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
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28
Q

Define abruptio placenta

A

Separation of a normally sited placenta from the uterine wall
–> resulting in maternal haemorrhage into the intervening space

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29
Q

Clinical features of abruptio placenta

A
  • pain constant + PVB *
  • shock out of keeping with visible loss
  • tender, tense uterus
  • normal lie and presentation
  • foetal heart: absent/distressed
  • coagulation problems
  • beware pre-eclampsia, DIC, anuria
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30
Q

Investigations in abruptio placenta

A

FBC + USS

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31
Q

Maternal complications of abruptio placenta

A
  1. shock
  2. DIC
  3. renal failure
  4. PPH
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32
Q

Foetal complications of abruptio placenta

A

Hypoxia

Death

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33
Q

Define placenta praevia

A

placenta lying wholly or partly in the lower uterine segment

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34
Q

Clinical features of placenta praevia

A
  1. shock in proportion to
  2. visible loss
  3. no pain
  4. uterus not tender
  5. lie and presentation may be abnormal
  6. fetal heart usually normal
  7. small bleeds before large
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35
Q

Investigations for placenta praevia

A

Usually picked up on 20- week USS

–> transvaginal USS (improves accuracy on placental localisation)

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36
Q

Define Postpartum haemorrhage (PPH)

A

blood loss of > 500mls

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37
Q

Types of PPH

A

Primary: occurs within 24 hours

Secondary:
occurs between 24 hours - 12 weeks

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38
Q

Symptom of PPH

A

Uncontrolled PV bleeding

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39
Q

Causes of PPH

A
  1. Tone - Uterine atony (failure of uterus to contract down post delivery) (primary)
  2. Trauma - perineal trauma (primary)
  3. Tissue - retained placenta (secondary)
  4. Thrombosis- clotting disorder (primary)
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40
Q

Define premature rupture of membranes

A

Rupture of the amniotic sac prior to the commencement of labour.

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41
Q

Investigation for PROM

A

Speculum examination

Pelvic USS

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42
Q

What is Rh incompatability?

A

Rhesus sensitisation

  • When a mothers Rh-ve blood mixes with foetal Rh+ve blood
  • Mothers immune system develops antibodies against Rh+ve RBCs

This may lead to haemolytic disease of the new-born in future pregnancies:

  • -> If in their next pregnancy the foetus is Rh+ve
  • -> Antibodies attack RBCs -> haemolytic anaemia & neonatal jaundice
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43
Q

What tests need to be carried out in rh incompatability?

A
  1. all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test
  2. Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
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44
Q

Features for rh incompatibility in affected foetus

A
  1. oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
  2. jaundice, anaemia, hepatosplenomegaly
  3. heart failure
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45
Q

What is shoulder dystocia?

A
  1. complication of vaginal cephalic delivery.

2. inability to deliver the body of the foetus using gentle traction, the head having already been delivered.

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46
Q

Risk factors for shoulder dystocia

A
  1. Previous shoulder dystocia
  2. Diabetes
  3. BMI >30
  4. Macrosomia (large baby)
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47
Q

Complications of shoulder dystocia

A

maternal

  • postpartum haemorrhage
  • perineal tears

fetal

  • brachial plexus injury
  • neonatal death
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48
Q

What are the risk factors for ovarian cancer?

A
  • Family hx of BRCA1/2 gene mutation

- many ovulations: early menarche, late menopause, nulliparity

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49
Q

Clinical features of ovarian cancer

A

Usually vague:

  • abdo distension + bloating
  • abdo + pelvic pain
  • urinary symptoms (urgency)
  • early satiety
  • diarrhoea
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50
Q

Investigations for ovarian cancer

A
  1. CA125 test
    - -> raised: urgent USS of abdo + pelvis
    - -> usually raised in endometriosis, menstruation, ovarian cysts
  2. Diagnostic laparotomy
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51
Q

What is breast abscess?

A

localized collection of pus within the breast

- more common in lactating women

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52
Q

Features of breast abscess

A
  1. Red, hot tender swelling

2. O/E : tender fluctuant mass

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53
Q

Diagnosis of breast abscess

A

USS

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54
Q

Treatment for breast absecess

A

Abx + USS guided aspiration

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55
Q

What are breast fibroadenoma?

A
  1. Breast tissues are arranged into lobules which are milk secreting glands
  2. Fibroadenomas occur due to increase in size of these milk secreting glands.
  3. Fibroadenomas are benign breast tumours that are thought to occur due to hormonal fluctuations.
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56
Q

Features of breast fibroadenoma

A

Mobile, firm, smooth, non-tender breast lump - a ‘breast mouse’

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57
Q

Investigations for breast fibroadenoma

A

USS if pt < 40, mammogram & needle biopsy

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58
Q

Features of fibrocystic disease

A
  • ‘Lumpy’ breasts which may be painful.

- Symptoms may worsen prior to menstruation

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59
Q

Investigations for fibrocystic disease

A

USS/ mammogram if suspecting breast cancer

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60
Q

What is mastitis?

A

Mastitis is a painful inflammatory condition of the breast.

–> usually occurs in lactating women

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61
Q

Features of mastitis

A
  1. A painful breast.
  2. Fever and/or general malaise.
  3. A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.
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62
Q

Investigations for mastitis

A

send a sample of breast milk for microscopy, culture, and antibiotic sensitivity

63
Q

When is abx indicated in mastitis?

A
  1. if systemically unwell
  2. if nipple fissure present
  3. if symptoms do not improve after 12-24 hours of effective milk removal
  4. if culture indicates infection’
64
Q

What abx is given in mastitis?

A

1st line = flucloxacillin for 10-14 days

Allergic to penicillin: erythromycin

65
Q

What is the most common infective organism in mastitis?

A

Staphylococcus aureus

66
Q

Complication of mastitis if left untreated

A

Develop into breast abscess

67
Q

Clinical features of breast cancer

A
  1. breast lump
    - Malignant –> painless
  2. Nipple symptoms: change in shape or bleeding
    - -> Tethering or peau d’orange
    - -> Unilateral discharge, retraction
68
Q

Investigations for breast cancer

A

Mammography and core biopsy

69
Q

What is the 2 - week wait referral indication for breast cancer?

A
  1. > 30 y/o + unexplained breast lump with or without pain

or

  1. > 50 y/o + unilateral discharge/retraction
70
Q

What other symptoms which consider 2WW

A
  1. with skin changes that suggest breast cancer

or

  1. > aged 30 with an unexplained lump in the axilla
71
Q

Non-urgent referral indication for breast cancer

A

< 30 y/o with an unexplained breast lump with or without pain.

72
Q

Treatment for breast cancer

A
  1. Wide local excision or mastectomy

2. Chemo or radiotherapy

73
Q

What is pelvic inflammatory disease?

A

sudden or severe inflammation of the womb, fallopian tubes, ovaries and surrounding areas in the lower abdomen

74
Q

Features of PID

A
  1. lower abdominal pain
  2. fever
  3. deep dyspareunia
  4. dysuria
  5. menstrual irregularities may occur
  6. vaginal or cervical discharge - purulent
  7. cervical excitation
75
Q

Investigation for PID

A
  1. pregnancy test - exclude pregnancy
  2. high vaginal swab
  3. screen for chlamydia + gonorrhoea

Diagnosis is usually clinical

76
Q

What is menorrhagia?

A

excessive blood loss with regular menstruation (>80ml)

77
Q

Common causes of menorrhagia

A

no underlying pathology - dysfunctional uterine bleeding

anovulatory cycles : chaotic cycles common at extremes of reprodutive life

fibroids
Hypothyrodism
PID

78
Q

Investigations for menorrhagia

A

FBC

routine transvaginal US if sx like pelvic pain, intermentrual or post-coital bleeding

79
Q

Is it necessary to measure blood loss to diagnose menorrhagia?

80
Q

What is endometritis?

A

infection or inflammation of the endometrium, the inner lining of the uterus

81
Q

When is endometritis a common problem?

A

during pregnancy as bacteria can easily reach the uterus during childbirth

82
Q

Sx of endometritis

A
  • abnormal vaginal bleeding
  • dyspareunia
  • fever
  • abdominal swelling
  • lower abdominal pain / discomfort
83
Q

Causes of endometritis

A
  • normal vaginal bacteria

- STI

84
Q

How is endometritis tested for

A
  • blood cultures
  • FBC
  • MSU
  • high vaginal swab
  • endometrial biopsy is diagnostic but rarely appropriate
85
Q

What is urogenital prolapse

A

descent of one of the pelvic organs resulting in protrusion on the vaginal walls

86
Q

Risk factors of urogenital prolapse

A
  • increasing age (commonly post-menopausal women)
  • multiparity
  • obesity
  • spina bifida
87
Q

Sx of urogenital prolapse

A 
pressure, heaviness, ' bearing-down'
urinary sx (incontinence, frequency and urgency)
88
Q

adenomyosis vs endometriosis

A

The difference between these conditions is where the endometrial tissue grows. Adenomyosis: Endometrial tissue grows into the muscle of the uterus. Endometriosis: Endometrial tissue grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls, or bowel.

89
Q

What is endometriosis?

A

growth of ectopic endometrial tissue outside of the uterine cavity

90
Q

clinical features of endometriosis

A
  • chronic pelvic pain
  • secondary dysmenorrhoea (pain often days before bleeding)
  • deep dyspareunia
  • urinary sx
91
Q

Gold standard investigation for endometriosis

A

laparoscopy

92
Q

treatment for symptomatic relief of endometriosis

A

NSAIDs +/- paracetamol (first-line)

Hormonal (COCP/Progestogens)

93
Q

Features of adenomyosis

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

94
Q

What is a leimyoma also known as

95
Q

What is leimyoma

A

benign smooth muscle tumours of the uterus

96
Q

epidemiology of leimyoma

A

more common in afro-carribean, rare before puberty

97
Q

sx of leimyoma

A
  • may be asymptomatic
  • menorrhagia
  • lower abdo pain
  • bloating
  • urinary sx e.g frequency
  • subfertility
    polycythaemia (rare)
98
Q

how is leimyoma diagnosed

A

transvaginal US

99
Q

treatment of asymptomatic fibroids

A

none-

periodic review to monitor size and growth

100
Q

Risk factors for endometrial cancer

A
  • obesity
  • nulliparity
  • early menarche
  • late menopause
  • PCOS
  • Diabetes
  • tamoxifen
101
Q

Features of endometrial cancer

A
  • postmenopausal bleeding

- change in inter-menstraul bleeding in premenopausal

102
Q

When should a patient be referred under the cancer pathway for suspected endometrial cancer?

A

women >= 55 years who present with postmenopausal bleeding

103
Q

First line investigation for endometrial cancer

A

transvaginal US

Other investigations:
- hysteroscopy with endometrial biopsy

104
Q

Which factors are considered protective in endometrial cancer

A

COCP and smoking

105
Q

Symptoms of cervicitis

A
  • purulent yellow/green discharge
  • intermenstrual / postcoital bleeding
  • dysuria
  • Pelvic pain
106
Q

main cause of cervicitis

107
Q

What is cervical dysplasia

A

abnormal growth of cells on the surface of the cervix

108
Q

The primary cause of cervical dysplasia

109
Q

Risk factors of cervical dysplasia

A

multiple sexual partners
smoking
immunocompromised

110
Q

symptoms of cervical dysplasia

A

usually asymptomatic

- genital warts can indicate exposure to certain types of HPV

111
Q

How is cervical dysplasia diagnosed

A

smear - cervical screening programme , HPV first system

112
Q

What is the HPV first system?

A

sample tested for high-risk strains for HPV first and cytological examination performed if positive

113
Q

What happens if hrHPV is negative?

A

return to normal recall

114
Q

Positive hrHPV + abnormal cytology. What should you do next?

A

colposcopy

115
Q

hrHPV +ve but cytologically normal- next steps?

A

repeat test in 12 months

116
Q

inadequate hrHPV sample? - next step

A

repeat sample in 3 months

117
Q

2 consecutive inadequate hrHPV samples - next step?

A

colposcopy

118
Q

treatment of CIN

A

Large loop excision of transformation zone (LLETZ)

119
Q

What is cervical insufficency / incompetent cervix

A

weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy

120
Q

Sx of incompetent cervix

A

discharge during pregnancy
usually asymptomatic
premature labour

121
Q

How is incompetent cervix diagnosed

A

transvaginal US

122
Q

what is a nabothian cyst

A

small bump or bumps on the cervix caused by a build-up of normal mucus that is produced by the cervix

123
Q

How is a nabothian cyst diagnosed

A

pelvic exam

transvaginal US

124
Q

How is a nabothian cyst treated

A

none necessary

125
Q

Symptoms of vaginitis

A
  • itchy, sore vagina
  • vaginal discharge
  • vaginal dryness
  • dysuria
  • dyspareunia
  • spotting
126
Q

causes of vaginitis and sx associated to each

A 
thrush - white thick discharge
STI - green/yellow/smelly discharge
menopause (hormonal) - dry, itchy
skin condition (eczema) - itschy, sore patches
127
Q

investigation for vaginitis

A

pelvic examination and STI screen

128
Q

Most common cause of vaginal neoplasm

129
Q

Vaginal neoplasm sx

A
  • lump in vagina
  • ulcers and skin changes
  • post-menopausal bleeding
  • intermenstrual bleeding
  • post-coital bleeding
  • dyspareunia
130
Q

management of women with an unexplained palpable mass in or at the entrance to the vagina

A

2WW referral

131
Q

What is a cystocele

A

when the wall between the bladder and the vagina weakens (bladder prolapse)

132
Q

sx of cystocele

A
  • feeling of a vaginal bulge / pressure
  • frequent voiding
  • increased urgency
  • urinary incontinence
  • freuqnet UTI
133
Q

major cause of cystocele

A
  • multiparity

- difficult childbirth

134
Q

diagnosis of cystocele

A
  • pelvic exam
  • cytsoscopy
  • MRI / US/ Xrays
135
Q

What is a rectocele

A

tissues between the rectum and vagina weaken, causing the rectum to bulge into the vagina - posterior vaginal prolapse

136
Q

rectocele sx

A

may include pelvic, vaginal and rectal pressure

137
Q

risk factors of rectocele

A

multiparity, age, obesity, chronic constipation

138
Q

What is a Bartholin’s cyst

A

small fluid-filled sac just inside the opening of the vagina

139
Q

sx of Bartholin’s cyst

A

soft, painless lump
usually only noticeable and uncomfortable after growth
- pain when walking
- pain during sex

140
Q

What causes Bartholin’s cyst

A

Bacterial infections / STI which clog the bartholin gland

141
Q

diagnosis of Bartholin’s cyst

A
  • examination
  • bacterial swab
  • biopsy if ?Bartholin gland cancer
142
Q

epidemiology of Bartholin’s cyst

A

sexually active women aged 20 to 30

143
Q

Define Dysmenorrhoea

A

excessive pain during the menstrual period

144
Q

How is dysmenorrhoea divided?

A

primary - no underlying pelvic pathology

secondary - underlying pathology including:
endometriosis
PID
fibroids

145
Q

features of primary dysmenorrhoea

A
  • pain before/ within few hours of periods starting

- suprapubic cramping pain radiating to back / thigh

146
Q

Which phase of the menstrual cycle does PMS occur

A

luteal phase - after ovulation (when your ovaries release an egg) and before your period starts. During this time, the lining of your uterus normally gets thicker to prepare for a possible pregnancy.

147
Q

sx of premenstrual syndrome

A

emotional:

  • anxiety
  • stress
  • fatigue
  • mood swings

physical:

  • bloating
  • breast pain
148
Q

Define Primary Amenorrhea

A

failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development)

or by 13 years of age in girls with no secondary sexual characteristics

149
Q

Define secondary Amenorrhea

A

cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea (irregular periods)

150
Q

initial investigations for amenorrhoea

A
  • EXCLUDE PREGNANCY
  • FBC
  • TFT
  • coeliac screen
  • gonadotrophins (low = hypothalamic cause, high = ovarian problem)
  • prolactin
  • androgen level (high in PCOS)
  • oestradiol
151
Q

3 main features of PCOS

A
  • irregular periods
  • excess androgen (excess facial / body hair)
  • polycystic ovaries
  • sub/infertility
  • obesity
152
Q

Why might a woman with PCOS have acanthosis nigricans

A

insulin resistance is commonly seen with PCOS

153
Q

investigations for PCOS

A
  • Pelvic US : multiple cysts
  • fsh, LH, (LH:FSH raised)
  • prolactin normal/mildly elevated
  • TSH
  • testosterone normal/mildly elevated
  • check for impaired glucose tolerance

ICM Matrix (15 decks)

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