Female Health Flashcards
What is labour defined as?
Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part
Signs of labour
- regular and painful uterine contractions
- a show (shedding of mucous plug)
- rupture of the membranes (not always)
- shortening and dilation of the cervix
Stages of labour
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
What do you monitor in labour?
- FHR monitored every 15min (or continuously via CTG)
- Contractions assessed every 30min
- Maternal pulse rate assessed every 60min
- Maternal BP and temp should be checked every 4 hours
- VE should be offered every 4 hours to check progression of labour
- Maternal urine should be checked for ketones and protein every 4 hours
What is the normal delivery position?
The head normally delivers in an occipito-anterior position
When is instrumental delivery indicated?
If longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section
What is the indication for elective c-section?
Breech
>2 previous CS
maternal request
Indication for emergency c-section
- Foetal distress
- Failure to progress
- cord prolapse
- footling breech
Indications for induction of labour
- prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
- prelabour premature rupture of the membranes, where labour does not start
- diabetic mother > 38 weeks
- pre-eclampsia
- rhesus incompatibility
what score is used to induce labour?
Bishop score
Methods of induction of labour
- membrane sweep
- vaginal prostaglandin E2 (PGE2)
- maternal oxytocin infusion
- amniotomy (‘breaking of waters’)
- cervical ripening balloon
Define HTN in pregnancy
systolic > 140 mmHg or diastolic > 90 mmHg
- -> No proteinuria, no oedema
- -> Resolves following birth (typically after one month).
Who are at high risk of developing pre-eclampsia?
- hypertensive disease during previous pregnancies
- chronic kidney disease
- autoimmune disorders such as SLE or antiphospholipid syndrome
- type 1 or 2 diabetes mellitus
What is pre-eclampsia?
Pregnancy-induced hypertension in association with proteinuria
Classic signs of pre-eclampsia
- Proteinuria
- High BP
- Oedema
Other signs & symptoms of pre-eclampsia
- Headache and visual disturbance (floaters)
- RUQ pain (liver)
- Acute onset oedema
- Hyper-reflexia (brisk reflexes) & clonus
What is eclampsia?
Grand mal seizures in a woman with preeclampsia
Symptoms of ectopic pregnancy
- Severe lower abdominal pain – usually unilateral
- PV bleeding
- Vomiting
Symptoms of ruptured ectopic pregnancy
- Shoulder tip pain
- Feeling faint/light-headed
- Collapse
Investigation for ectopic pregnancy
Diagnostic = Transvaginal USS
What is the most common cause of severe infection in neonates?
Group B Streptococcal disease (GBS)
What is gestational diabetes?
High blood sugars that develop during pregnancy and usually disappears after delivery.
Screening for gestational diabetes
Oral glucose tolerance test
- fasting glucose is >= 5.6 mmol/L
- 2-hour glucose is >= 7.8 mmol/L
Targets for self monitoring
Fasting = 5.3 mmol/l
1 hour after meals = 7.8 mmol/l, or:
2 hour after meals = 6.4 mmol/l
Abortion time frame
<24 weeks – can be maternal choice
> 24 weeks if risk to maternal or foetal health
Medical TOP:
At how many weeks?
What medication?
Less than 9 weeks = mifepristone (an anti-progestogen) followed 48 hours later by prostaglandins to stimulate uterine contractions
Surgical TOP:
At how many weeks?
What method?
- less than 13 weeks: surgical dilation and suction of uterine contents
- more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
Define abruptio placenta
Separation of a normally sited placenta from the uterine wall
–> resulting in maternal haemorrhage into the intervening space
Clinical features of abruptio placenta
- 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
Investigations in abruptio placenta
FBC + USS
Maternal complications of abruptio placenta
- shock
- DIC
- renal failure
- PPH
Foetal complications of abruptio placenta
Hypoxia
Death
Define placenta praevia
placenta lying wholly or partly in the lower uterine segment
Clinical features of placenta praevia
- shock in proportion to
- visible loss
- no pain
- uterus not tender
- lie and presentation may be abnormal
- fetal heart usually normal
- small bleeds before large
Investigations for placenta praevia
Usually picked up on 20- week USS
–> transvaginal USS (improves accuracy on placental localisation)
Define Postpartum haemorrhage (PPH)
blood loss of > 500mls
Types of PPH
Primary: occurs within 24 hours
Secondary:
occurs between 24 hours - 12 weeks
Symptom of PPH
Uncontrolled PV bleeding
Causes of PPH
- Tone - Uterine atony (failure of uterus to contract down post delivery) (primary)
- Trauma - perineal trauma (primary)
- Tissue - retained placenta (secondary)
- Thrombosis- clotting disorder (primary)
Define premature rupture of membranes
Rupture of the amniotic sac prior to the commencement of labour.
Investigation for PROM
Speculum examination
Pelvic USS
What is Rh incompatability?
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
What tests need to be carried out in rh incompatability?
- all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test
- Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
Features for rh incompatibility in affected foetus
- oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
- jaundice, anaemia, hepatosplenomegaly
- heart failure
What is shoulder dystocia?
- complication of vaginal cephalic delivery.
2. inability to deliver the body of the foetus using gentle traction, the head having already been delivered.
Risk factors for shoulder dystocia
- Previous shoulder dystocia
- Diabetes
- BMI >30
- Macrosomia (large baby)
Complications of shoulder dystocia
maternal
- postpartum haemorrhage
- perineal tears
fetal
- brachial plexus injury
- neonatal death
What are the risk factors for ovarian cancer?
- Family hx of BRCA1/2 gene mutation
- many ovulations: early menarche, late menopause, nulliparity
Clinical features of ovarian cancer
Usually vague:
- abdo distension + bloating
- abdo + pelvic pain
- urinary symptoms (urgency)
- early satiety
- diarrhoea
Investigations for ovarian cancer
- CA125 test
- -> raised: urgent USS of abdo + pelvis
- -> usually raised in endometriosis, menstruation, ovarian cysts - Diagnostic laparotomy
What is breast abscess?
localized collection of pus within the breast
- more common in lactating women
Features of breast abscess
- Red, hot tender swelling
2. O/E : tender fluctuant mass
Diagnosis of breast abscess
USS
Treatment for breast absecess
Abx + USS guided aspiration
What are breast fibroadenoma?
- Breast tissues are arranged into lobules which are milk secreting glands
- Fibroadenomas occur due to increase in size of these milk secreting glands.
- Fibroadenomas are benign breast tumours that are thought to occur due to hormonal fluctuations.
Features of breast fibroadenoma
Mobile, firm, smooth, non-tender breast lump - a ‘breast mouse’
Investigations for breast fibroadenoma
USS if pt < 40, mammogram & needle biopsy
Features of fibrocystic disease
- ‘Lumpy’ breasts which may be painful.
- Symptoms may worsen prior to menstruation
Investigations for fibrocystic disease
USS/ mammogram if suspecting breast cancer
What is mastitis?
Mastitis is a painful inflammatory condition of the breast.
–> usually occurs in lactating women
Features of mastitis
- A painful breast.
- Fever and/or general malaise.
- A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.