Gynaecology Flashcards
1
Q
Who does vaginal cancer affect
What are the 3 ways it presents?
What is the 1st and 2nd stage of management?
Where does secondary cancer arise from?
Give 5 RF of vaginal cancer
A
Vaginal cancer generally only affects older post menopausal ladies
Pain, Vaginal Discharge or Bleeding or a mass
1st stage: surgery
2nd stage: radiotherapy
The secondary cancer arises from cervix, endometrium, vulva
Risk Factors:
- Lichen sclerosis
- HPV
- pelvic radiation
- CIN
2
Q
What is a definition of a hydatiform mole?
What causes one?
Explain the differences between a complete, partial and invasive mole
Give 5 RF:
Give 3 symptoms:
Give 3 investigations:
What is the treatment: and what is the management post evacuation?
A
What is a definition of a hydatiform mole? Is a growing mass of tissue in the womb that can not develop into a foetus. It is a result of abnormal conception
What causes one? It is caused when all the genetic information comes from the mother. The trophoblast which is part of the blastocyst proliferates more aggressively and secretes hCG in excess
Explain the differences between a complete, partial and invasive mole
- Complete: all genetic information is from the mother
- Partial: the cells have 3 sets of chromosomes (caused by 2 sperm and one egg)
- Invasive mole: when the mole invades the myometrium. Has metastatic potential to form choriocarcinomas
Give 5 RF:
- Extreme age (bellow 16 or over 45)
- Previous molar pregnancy
- multiple pregnancy
- Asian
- Use of COCP
Give 3 symptoms:
- Feeling larger than date
- Bad morning sickness
- Vaginal bleeding
Give 3 investigations:
- Beta HCG. this will be very very high as more trophoblast is secreting it
- Pelvic ultrasound
- Histology
Treatment:
- Need a pelvic evacuation
- Need to monitor the beta HCG post evacuation and pregnancy test to see if all was removed
- Need to monitor for a while to confirm the cause is not gestational trophoblastic disease (if it is chemo is needed)
What is the treatment: and what is the management post evacuation?
3
Q
What is an uterine rupture? Is it serious When does it happen normally? What is a protective factor? What are the two types? What are 5 RF? What are 5 symptoms? What investigations would you do? What is your management?
A
What is an uterine rupture? This is when the uterus ruptures normally due to a traumatic event or previous C Section Scar
Is it serious? It is dangerous it is an emergency!
When does it happen normally? It happens after trauma, or if there has been a previous C Section not LSCS. Another cause is just de nova
What is a protective factor? Having a LSCS
What are the two types? Incomplete (normally surgical scar asymptomatic) or complete (emergency surgery required normally a RTA)
What are 5 RF?
What are 5 symptoms?
What investigations would you do?
What is your management?
4
Q
What is mastitis?
What are 4 symptoms you get?
What are the two types you can get?
What is the causative organism?
A
Mastitis is the inflammation of the duct systems in the breast. Normally caused by a blockage.
Symptoms: red, hot, painful breast. Lady will have a fever and flu like symptoms
Lactional: caused by breast feeding. You need to aspirate and treat with Abx
Non-Lactional: blocked duct secondary to smoking
Causative organism: Staph Aureus
5
Q
What is chronic periodical mastitis associated with?
A
It is associated with nipple numbness, nipple necrosis and and recurrent sepsis.
Treatment total duct excision
6
Q
What are 3 signs of an inflammatory breast cancer?
A
Red
Oedematous
Lymphadenopathy
Thickening of Skin
7
Q
How do you treat cyclical breast pain ?
A
Make sure you have a well supported bra
If not tell them to use NSAIDs and a low fat diet
8
Q
How is life limited in a normal cell?
What is altered in malignant cells?
What controls cell death?
A
Life is limited by the number of divisions by telomeres
Malignant cells lengthen their telomeres
Apoptosis controls cell death
9
Q
What are the stages of the Cell Cycle?
A
G1: growth S1: synthesis to double the chromosomes G2: double check everything Mitosis Cytokinesis
10
Q
Where in the cell cycle does Tumor Supressor Genes work?
A
They work at G1 to slow down the process before S1
11
Q
What is P53?
A
It is a transcription factor that controls the rate of cell division and cell death.
When it is activated it leads to reduction in cells
12
Q
What are oncogenes. Give an example?
A
they are genes that speed up the growth and division of cells so promote cancer forming
Cancer can not be caused by a single mutated oncogene. As there is a conflicting tumour supressor gene to stop that. Thus there needs to be multiple modified genes
13
Q
How common in Breast Cancer? Name two genes that cause it? What are 5 RF for breast cancer? Does pre or post menopausal cause an increased risk? Give 5 signs of breast cancer?
A
- 1 in 8
- BRCA 1 BRCA2
- RF include: smoking, no parity, no breast feeding, age, obesity, FH and COCP or HRT
- Post menopausal as increased fat
- 5 Signs: nipple inversion, bloody discharge from nipple, dimpling of skin, breast lump, redness or irritation of breast skin.
14
Q
What is the treatment for breast cancer?
A
Normally you do a breast conservation with radiotherapy
Alongside this you need to do Axilla surgery
Depending on receptors you need to give medication for those too
15
Q
Is lobular or ductal breast cancer a worst prognosis?
A
Lobular
16
Q
What prognostic index is used for breast cancer?
A
The Nottingham prognostic index
17
Q
What are the different types of breast cancer receptor types?
What is the treatment for them
A
HER2:give trastuzumab and chemotherapy
Triple Negative: chemo
ER receptor +ve: give the patient tamoxifen and chemotherapy. You also need to give bisphonates!
18
Q
What breast cancer has the best prognosis and the which has the worst?
A
Worst: triple negative
Best: Oestrogen receptor positive
19
Q
WHAT is primary breast reconstruction used for:
How do you treat locally advanced breast cancer (when you can see it on the skin?)
A
Increased option for skin preservation and better cons metic appearance. Lowers psychological trauma
You need to use radio to shrink it then give chemo and/or hormonal therapy
20
Q
DCIS : What are 5 RF? Why is it becoming more prevalent? How does it occur? How do you diagnose? What are the two treatments?
A
- RF: age, early menarche, late menopause, no parity, no breast feeding, HRT and COCP use, smoking and FH
Routine mammogram
It occurs due to the lining cells of the epithelium proliferate allowing for central necrosis. But they can’t metastasise.
Mammogram or US then biopsy
Treatment: Wide local excision and radiotherapy
21
Q
Prolactinoma:
- What is one?
- Who are they common in?
- What is the pathophysiology?
- What are 5 signs and symptoms?
- How do you diagnose it?
- How do you treat it?
What are 3 causes of hyperprolactinaemia?
A
A benign growth in the posterior pituitary gland
More common in females
The pathophysiology: is that there is a prolactin excess due to a tumor of the lactroph cells of the posterior pituitary. Prolactin is normally released due to prolactin agonists like Epidermal Growth Factor or VIP. Or by infant suckling.
Symptoms include: - Galactorrhoea - Amennorhoea - Loss of libido - Erectile dysfunction - Visual field issues - Hirsutism. Diagnosis: serum prolactin, visual fields and MRI of head Treatment: dopamine agonists like cabergoline then surgery
Other causes include: pregnancy, head injury and breast stimulation
22
Q
When does premature menopause occur?
What are 3 possible causes?
What are two possible complications
What would you treat it with?
A
Happens before the age of 40 (2 SD below average)
Radiotherapy, Chemotherapy, Hysterectomy + oophectomy and Tamoxifen
Osteoporosis and Heart Disease
Treatment: HRT until the age of 52
23
Q
What is Menopause?
What is the average age that this happens?
What is climacteric?
A
The seizing of menstrual period. CLassed as a year
Happens around mid 40s to 50s
Climacteric: this is the difference between reproductive to non reproductive state
The pathophysiology is that when you are young oestrogen stimulates a lot of follicles to be released and from there you get a chief follicle. When you get older there is resistance to FSH and LH and less follicles. Causing menstruation to seize
24
Q
What is the hormone profile of a menopausal women?
What are some symptoms (5 of menopause?)
What is the treatment?
A
Increased LH and FSH
Decreased progesterone and oestrogen
Hot flush, mood disturbance, poor concentration, urinary symptoms, vaginal atrophy and sexual difficulties
You need to give the patient: HRT and alongside a protective progesterone. They will also need bisphosphonates
25
Vasa Previa:
- What is this?
- What are 3 RF of this?
- How does it present?
- What is the management?
This is when there are vessels running below the presenting part of the foetus
Low lying placenta, IVF and multiple pregnancies are all risk factors
It presents with ROM then vaginal bleeding and foetal distress
Emergency C Section. Often still not fast enough
26
What is a placenta increta?
What are 3 RF?
How do you investigate?
What is the treatment?
When the placenta is morbidly fixed to the myometrium
The 3 RFs include: previous C Section, previous placenta praevia and advanced maternal age.
Investigations: Doppler US and MRI
Management: you need to give uterine artery embolization and methotrexate
27
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What is a placenta praevia
What are 5 RF?
What two types can you get?
What is the presentation?
How do you make a diagnosis?
What investigations would you like to do?
What is the management plan?
```
This is when the placenta is low lying and covering the cervical os
There are 5 RF: these include previous C Section, increasing age, smoking and multiple pregnancy
You can get PP major (urgent surgery) or minor
The presentation is painless vaginal bleeding in the 3rd trimester
You diagnose the condition from 20w scan but then checked at 3rd trimester
Investigations: anti-d, group and save, clotting profile and don’t forget to do foetal CTG.
Management: at 3rd trimester sent into hospital. Give steroids and C SEction
28
What is the pathophysiology of PCOS?
| What are the tests for PCOS? Name 3
- That the theca cells are producing too many androgens.
- This causes there to be increased LH and insulin resistance
- You then get this leading to reduced SHBG by the liver and causes free testosterone
- Increased LH from pituitary
- Basal days 2-5 of LFT, FSH, prolactin and testosterone
- Abdo US
- SHBG levels
29
What is the Rotterdam Criteria?
```
Criteria in diagnosing PCOS
It involves 3 steps:
- Anovulatory
- Clinical signs of hyperandrogenism (acne, male balding and hirsutism)
- Polycystic ovaries >12 in both ovaries
```
30
How do you help PCOS get pregnant
Need to give lifestyle advice
You need to give metformin
You need to give clomifene
You can do ovarian drilling
31
PCOS
What are 5 symptoms and 3 signs
What is the diagnostic criteria called?
What is the management?
```
Amenorrhoea (<9 in a year)
Low/irritable mood
Acne
Subfertility
Hirsuitism
```
Male balding
Central obesity
Rotterdam
Management:
- conservative: weight loss, more exercise
- Use of COCP
- Metformin
32
What is a partogram?
What is is dependent on?
What does it plot
A diagram showing the progress of labour
The 3 Ps the power, passage and passenger
The progression of cervical dilatation and descent of the head
33
What cm is classed as late phase on a partogram?
What is the minimal rate per hour after the late phase?
What is classed as slow progress?
What else is recorded on the partogram except for dilation and head descent?
1. 4 cm
2. 1cm per hour
3. Less than 2 cm dilation in 4 hours
4. You get maternal vital, foetal heart rates contraction frequency and liquor colour
34
What does a CTG do?
Measures the foetal heart rate electronically and on paper.
One tranducer is for the abdomen (foetal HR) or on the scalp
The second transducer is for uterine contractions
35
What can a CTG be used for?
To measure foetal distress
36
What is the vulva?
The area of skin that stretches from the labia majora laterally and the mons pubis anteriorly
It is lined by squamous cell epithelium
Possible metastatic spread by the inguinal lymph nodes
37
What would be some of the symptoms of vulval cancer?
- Itchiness
- A mass
- Bleeding
- Superficial dyspareunia
- Soreness and burning
38
What are the causes of vulval cancer?
Infection
Dermatological
Neoplasm
39
What is the pre-malignant condition to vulval cancer?
Vulval Intraepithelial neoplasia (VIN)
| Atypical cells in the vulval epithelial
40
What are the different types of VIN?
1. Usual type VIN: warty appearance, most common condition and seen in 35-55 yr olds. Cause is HPV, CIN and smoking
2. Differentiated type VIN: not as common as usual type. Associated with lichen sclerosis. Unifocal and has ulcers
More likely to become cancer than usual VIN
41
What is the management of VIN?
- You need local wide excision
| - Symptom relief: steroids and emollients
42
What is Asherman's Syndrome?
What are 3 causes of Asherman's Syndrome?
What type of amennorhoea is it?
What are 4 symptoms?
What is the Gold Standard Diagnosis?
What is 1st line treatment?
- Uncommon acquired gynaecological issue. That presents as amenorrhoea, increased cramps and infertility
- Dilatation and Curettage, Endometriosis and infection with schistomiasis or tuberculosis
- Secondary amennorhoea
- Amenorrhoea
- Increased menstrual cramps
- Infertility
- Repeated miscarriages
Gold Standard: Hysteroscopy
Treatment: surgery to remove scar tissue and adhesions
43
What is Lichen Sclerosis
Where does it affect in women and in men?
Who does it affect?
What is the cause?
Lichen Sclerosis is a chronic inflammatory dermatitis that affects the skin of the anogenital region.
It affects anogenital in women and glans penis in men.
It commonly affects young boys or older men (AI so common in diabetes)
The cause is autoimmune
44
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What can make Lichen Sclerosis worse?
What is Koebner's response?
What are 4 symptoms?
What does it look like?
What are two ways to diagnose it?
How do you treat it?
```
Sex, irritating clothing and urine
The above problems lead to Koebner's response making it better.
Symptoms: itchiness, dyspareunia, discomfort and bleeding
Signs: it has thick white shiny plaques. If it is a chronic condition the labia can get so inflamed that adhesions form and they fuse together.
Diagnosis: clinical examination and biospy
Management: steroids and emollients
Increased risk of differentiated VIN
45
```
What is Adenomyosis?
Who is it common in?
What is driving it's pathophysiology?
What are 4 possible causes?
What are 3 RF?
What are 4 symptoms?
What is the diagnostic test?
How do you manage the condition?
```
This is when you get endometrial tissue that grows in the muscular wall of the uterus. Normally resolves after menopause.
It common in women in their 40s/50s and those who have given birth/ endometriosis and fibroids.
Driven by oestrogen!!!
Causes include: invasive tissue growth, embryological origin, stem cell origin and uterine inflammation.
RF: uterine surgery, childbirth and middle age
Symptoms: Heavy or prolonged periods, severe cramping period pain, pelvic pain and bloated and tender lower abdomen.
Diagnosis: by US
Mangement: NSAIDs, Mirena coil and hysterectomy.
46
Is cord prolapse dangerous?
What happens in a cord prolapse?
What are 3 RF?
What is the management?
It is an obstetric emergency
What happens is that the umbilical cord descends below the presenting part of the baby. If left there there cord will undergo compression and spasm. This will lead to hypoxia
3 RF:
- Pre term
- Multiple pregnancy
- Flexed breach
- Poly hydramnios
Management:
- Push the foetus back into the vagina and give terbutaline (anti-tocolytic agent)
- No presenting part: do C Section. Presenting part go to surgery and do Instrumental delivery.
47
What is Paget's Disease of the Breast
How may people with Paget's have invasive breast cancer?
What is the pathophysiology of paget's disease?
Where on the breast does it begin?
Give 4 symptoms?
How do you diagnose?
What is the treatment?
- Eczema like skin changes to the nipple skin and areola
- Very high percentage of people with Paget's disease have invasive breast cancer
- Invades the epidermis via the mammary duct epithelium, This then proliferates and leads to thickening of the affected skin.
- Always starts at the nipple and spreads
- Symptoms: skin changes, unilateral, sore and inflamed, itchy and burning sensation with a bloody nipple discharge
- Diagnosis: via Biopsy and mammogram
- Treatment: surgical central excision. Depending on cause give appropriate chemotherapy and radiotherapy.
48
What breast cancer is paget's disease associated with?
High grade: oestrogen and progesterone receptor breast cancer
49
What are breast implants made from?
What is preferred a smooth or textured capsule?
How long do they last for?
What is a very rare complication of them?
```
Silicon
Textured: reduces chance of capsulation
They last for 10-15 yrs
Anaplastic Large Cell Lymphoma
** note make mammograms a lot harder **
```
50
```
What is a fibroadenoma?
What is the peak age of presentation?
What are they comprised of?
How do they examine?
How would you diagnose them?
What is the treatment?
```
Is a benign breast lump common in young women
20-24
They are comprised of fibrous and epithelial tissue
They are firm non tender and highly mobile
Diagnosis: is by US if under 40. If older mammogram. Then a biopsy.
Treatment:
- Conservative
- Very annoying then you can do surgery!
51
```
What is a breast cyst?
Who are they common in? Are they always there?
What is the appearance?
How do we diagnose?
How do we treat?
```
A breast cyst is a fluid filled sac
They are common on the approach of menopause and are cyclical
They are small and (soft/hard) they can be painful
They are diagnosed with US/Mamo
They can then be sent for aspirate culture
Treat: aspirate the cyst and if infected give Abx
52
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What is a breast abscess?
What can cause one?
What are 4 symptoms
How do you diagnose?
How do you treat? 2 ways
What must you tell them about breast feeding?
```
painful build up of pus in the breast caused by an infection. Commonly affect women who breast feed
They are caused by mastitis and breast feeding
It can present with a painful, red, warm swollen breast. They are unwell and high temperature.
Diagnosis: US of the breast
Management: Abx for the access. May need draining.
Tell them to continue breast feeding from both breasts/
53
What are the 4 things measured on a CTG?
Baseline rate
Baseline variability >5 beats per minute
Acclerations
Deccelerations
54
What are the 4 indications for CTG?
Pre-eclampsia
IUGR
Presence of meconium, maternal fever or use of oxytocin
55
What and when is the APGAR Scoring System used?
What does it stand for?
It is a scoring system that is useful in checking a baby's progress of deterioration immediately after delivery. It should be checked every 1, 5 and if needed 10 minutes
Appearance, Pulse (>100), Grimace (cry on stimulation), Activity (active flexion against resistance) and Respiration (strong crying)
56
What is the best score for APGAR?
| What is the worst score for APGAR?
10/10
| 0/10
57
In what groups of babies is a slightly lower APGAR score after birth common in?
C- Section
Premature
Complicated labour/delivery
58
What is the Bishop's Score?
What is a favourable score?
This is a scoring system used to assess the favourable situation for women to give birth in.
A favourable score is more than 8. With it being scored out of 10.
59
What things are scored in a Bishop's Score?
```
Position of cervix
Consistency of cervix
Effacement (length of the cervix)
Dilation
Station (presenting part of baby in relation (cm) to the ischial spines)
```
You at +1 for each previous birth and -1 for being nulparida
60
What ways can you induce women?
1. Indictions with prostaglandins (gel) good for nulliparous women
2. Amniotomy (mechanical rupture of membranes) plus a oxytocin infusion
3. Cervical sweep
61
What are indications for induction?
Pre-eclampsia, HTN and diabetes
IUGR or too large for date babies
Prolonged pregnancy
62
What are the purposes of a foetal scalp sample?
1. Metal Tube: blood is collected from the scalp
| 2. pH and lactate are measured immediately
63
What is amniocentesis?
When a bit of a foetus' amniotic fluid is taken using a fine gauge needle under US.
64
When is amniocentesis performed from? What are some reasons to do it?
Performed from 15 weeks gestation
To see chromosomal abnormalities, foetal infections like CMV or toxoplasmosis or also can look for thalassaemia or SC anaemia
65
What is chorionic villus sampling?
This is a biopsy of the trophoblast by passing a fine gauge needle through the abdominal wall and into the placenta from 11 weeks.
Allows abnormalities to be spotted earlier.
Has a higher miscarriage rate than amniocentesis.
66
How do you test the samples from chorionic villus sampling or amniocentesis?
This is done by karyotyping, FISH and PCR
67
Indications for an episiotomy?
- Breech delivery
- Shoulder Dystonia
- Abnormal CTG
68
What are the 4 types of perineal tears:
1st degree: superfical skin can heal on its own
2nd degree: includes skin and perineal muscle
3rd degree: partial/complete rupture of the anal sphincter
4th degree: like above but also anal sphincter
3rd and 4th need a GA to repair
69
When is a ventouse indicated?
| What is required for one? 2 things
It is indicated when there is failure to progress past the second stage of labour alongside an abnormal CTG.
The baby's head needs to be below the ischial spines and maternal has to have suitable energy and contractions. One complication is scalp oedema
70
What are the two types of forceps?
| When are they indicated?
Rotational and Non-rotational (used on OP position babies)
Maternal heart disease or an unconscious person
Foetal gestation <34 weeks
Face presentation
71
When do you carry out a C-Section?
When the head it above the ischial spines
Carried electively at 39 weeks because of reduced respiratory morbidity secondary to transient tachypnoea of the newborn.
IV oxytocin is given after so the placenta and membranes can be removed.
72
What are some indications for a C Section?
- Malpresentation
- Failure to progress
- Twins when first is not cephalic
- Previous C Section
- Placenta Praevia
73
Possible complications of a C Section include:
- Haemorrhage: why you need to group and save
- Blood clot: why Tinzaparin is given
- Infection risk: give abx
- Visceral: i.e bladder give a catheter
74
what is menarche?
What is the average age?
What triggers it?
the development of secondary sex characteristics
average age is 13
GnRH pulses from the age of 8. Leads to an increase in FSH and LH.
75
What 3 processes does oestrogen stimulate?
What happens at the age of 16?
Menarche: 13
Adrenarche: the stimulation of hair development (testosterone also plays a part): 11-12
Thelarche: breast development: age 9-11
At the age of 16 growth finishes and the epiphyses fuse.
76
What does GnRH lead to?
What does FSH do?
What does LH do?
GnRH causes LH and FSH to be released
FSH attaches to the granulosa cells and stimulates follicle growth and permit androgen to be converted to oestrogen. Also allows inhibin release. This releases FSH
LH attaches to the theca cells and stimulates them to release androgens.
77
What happens in
Day 1-4
Day 5-13
Day 14-28
Menstruation: break down of the endometrial wall as the egg has not be fertilised. Corpus Luetum breaks down.
Proloferative phases: this happens when oestrogen is released and casuses there to be thin alkaline cervical mucus.
Secretory phase: progesterone stimulates further thickening of the myometrium and alkali cervical mucous made.
78
Describe how hormones work in the menstrual cycle:
You get low levels of oestrogen at the start of the cycle
This means that the FSH means that follicles can develop and leads to oestrogen production
Oestrogen leads to a surge of GnRH and LH.
Inhibin inhbits FSH release.
LH leads to ovulation and conditions for fertilisation are maintained.
If fertilisation does occur. hormonal support comes from synctiotrophoblasts. Placenta takes over at 4 months
79
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What causes gestational diabetes?
What are 4 RF for it?
How is it diagnosed?
How is it managed?
What are some complications
```
Caused by cortisol and oestrogen releasing fasting glucose levels. This increases fat deposition and delay gastric emptying. But increase appetite
Higher levels of glucagon, cortisol and Human placental lactogen lead to glucose tolerance.
RF:
- Obesity
- Past GDM
- Past large baby
- Ethnic minority
- Age
- Smoking
Diagnosed by an ORAL GLUCOSE TOLERANCE TEST
fasting glucose of 5.6 or above
Or two hour plasma levels of 7.8 or above.
Diet
Metformin
Insulin
Shoulder Dystonia
Miscarriage
Still birth
Mal presentation + risk of instrumental delivery
80
What is a placental abruption?
What are 3 RF?
What is the presentation
When the placenta seperates from the uterus before the delivery of the foetus.
- Advanced maternal age
- Smoking
- Multiparity
- Trauma
- Previous Abruption
Well there is concealed or revealed
Generally will have a sudden exruitating abdominal pain and tender stomach
If revealed they will have a vaginal loss
General signs of shock
Diagnosis : Ultrasound
Management: get a foetal CTG on and deliver
81
What age are you screened for Breast Cancer?
If you are a BRCA gene carrier how often will you undergo screening?
What are 3 cons of breast cancer screening?
47-73
- You get screened from the age of 30 and have a MRI screening.
Negatives include:
- Overdiagnosis
- Costs
- Anxiety
- X-Ray dose
82
What are the 4 states of male and female response?
Can women have multiple orgasms?
Excitation
Plateau (penile erection and redness on labia minora)
Orgasmic (females lower 1/3rd of vagina and males ejaculate)
Resolution (all structures go back to normal)
Yes and they generally last for longer
83
What is pre-eclampsia?
Is it more common in multiparous or nulparous?
What is the pathophysiology?
PE is a condition that is due to the placenta that leads to there being HTN and foetal distress
More common in nulparous
Pathophysiology: normally the spiral arteries invade the myometrium and dilate. In PE they don't do this they constrict instead. Causing low flow and high resistance
84
What are 5 High Risk Factors behind pre eclampsia?
```
Kidney Disease
Autoimmune conditions
Diabetes
Chronic HTN
HTN in pregnancy or a past Pre Eclamp
```
85
What are 3 moderate RF of pre eclampsia
FH of pre-eclampsia
Maternal Age >40
Maternal BMI
Multiple pregnancy
86
To commence on prophylactic treatment for Pre eclampsia what is the criteria?
1 major or 2 moderate RF
start them on aspirin as soon as possible
87
What are the 3 main clinical signs:
What are 3 other signs
1. BP 140/90
2. Signficant proteinuria
3. Greater than 20w gestation
Eye loss
Face and hand oedema
Stomach pain
Hyperreflexia
88
What is HELLP syndrome:
Haemolysis
Elevated Liver Enzymes
Low Platelets
Urine output will be low and Urea and Creatinine High
89
How do you treat pre-eclampsia:
```
Give IV Steroids
Give IV fluids
Give IV labetalol
Give Magnesium sulphate prophylactic for eclampsia
Delivery is the only cure
```
90
What is the cause of HTN in pregancy?
What should happen in most people's 2nd trimester?
treatment?
What are 3 complications?
BP = CO x Vascular resistance
The CO increases by 40% and the vascular resistance is still too high
In most people BP decreases!!
Labetalol
3 complications: Placental abruption, premature delivery , IUGR and increased risk of pre eclampsia
91
What mneumonic can be used to remember the causes of dysfunctional endometrial bleeding?
PALM COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy
```
Coagulopathy
Ovulatory dysfunction
Endometrial
Idiopathic
Not specified
```
92
What are some causes of HMB?
What is the treatment?
- High progesterone levels
- Infection
- Tumours
- Fibroids and polyps
Tranexamic acid --> mirena --> COCP --> hysterectomy
93
What are some causes of irregular/absent bleeding?
1. Extremes of age
2. Pregnancy
3. Breast Feeding
4. Prolactinoma
94
What is the cause of PC bleeding until proven otherwise
Cervical Cancer
95
What condition does eating disorders and extreme exercise cause?
Hypothalmic Hypogonadism
96
What is the main cause of dysmenorrhoea?
High Prostaglandin levels
| Treat with NSAIDs and COCP
97
Why can;t you give pregnant ladies warfarin?
Its terratogenic
98
What are the management of VTEs for the different levels of severity?
Low: Early mobilisation and fluids
Moderate: LMWH (10 days) or stockings
Severe: LMWH (6 weeks) and stockings
99
What are some of the RF for VTE in pregnancy:
- Thrombophilia
- ANti-phospholipid
- Smoker
- BMI >30
- Age >35
- Parity >4
- Previous VTE
- Kidney/Heart disease
100
What are some of the causes of subfertility?
Ovulatory: PCS, hyperprolactinaemia and eating disorders
Tubular factors: endometriosis, PID, previous ectopic or surgery
Uterine problem: Fibroid, ashermans, adenomyosis
Coital issues: vaginismus and dyspareunia
Male: azoospermia (cystic fibrosis, Klinefelter's) steroids, mumps radiation therapy or STI
101
What is classed PPH?
What are 3 major causes?
What is it associated with?
loss of 500ml within a 24 hour period of delivery
loss of 1000ml of blood after C-Section
- Atonic Uterus
- Retained Placenta
- vaginal injury. Secondary to an episotomy tear or a perineal tear
- HELLP syndrome
- Antepartum haemorrhage
- Retained products
- Grand multiparity
Instrumental delivery
102
How can a PPH be prevented?
What is the clinical presentation?
How do you manage the condition?
- By giving IV oxytocyin routinely
- by having a hard uterus and vaginal blood
- IV fluids, Bloods and give IV oxytocin
103
What is a Secondary PPH?
One that occurs between 24 hours and 6 weeks post giving birth. It is caused by endometritis.
104
What is the presentation of a secondary PPH?
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You can get a tender stomach
Fever
Offensive liqour
Vaginal bleeding and discharge
Dysuria and Dyspareunia
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105
What will the examination of a secondary PPH look like?
What is the management?
Uterus tender and enlarged
Open cervical os
IV abx and evacuation of retained products
106
What is menopause?
| What is peri-menopause?
What is Menopause:
- Cessation of menstruation. Average age is 51 years.
Diagnosed 12 months after amenorrhoea
What is peri-menopause?
- Period leading up to the menopause
- Characterised by irregular periods, hot flushes, mood swings and urogenital atrophy.
107
What urinary symptoms can you get with menopause?
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Vaginal atrophy
Dyspareunia
Recurrent UTIs
Bleeding
Urinary incontinence
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108
What are the benefits and risks of HRT therapy (3 of each )
Benefits:
- Relief from menopausal symptoms
- BMD protection
- Possibly prevent long term morbidity
Risks:
- breast cancer
- VTE risk
- CVS disease and stroke
109
What should be given alongside HRT:
Progesterone for roughly 12-14 days every 4 weeks.
| This can be a mirena coil. It is used to protect the endometrial from the unopposed effects of oestrogen
110
How do you treat premature ovarian insufficency?
You need to give HRT up until the average age of menopause. I.e. 52.
Can give anti-depressants alongside HRT to help with physical symptoms of the condition
111
What is the Puerperium:
from the delivery of the placenta to six weeks following the birth
112
What hormones decreases rapidly after delivery
human placental lactogen, HCG, Oestrogen and Progesterone,
| This initiates reversal of most of the pregnancy-related changes.
113
What is the level of the fundus after birth?
The level of the umbilicus
114
What is the decidua of the utereus shed as:
Lochia Rubra (Day 0-4): blood, cervical discharge and foetal membrane + Meconium (baby poo). Appearance: RED in colour.
- Lochia Serosa (Day 4-10): cervical mucus, foetal membrane, micro-organisms and white blood cells.(PINK colour)
- Lochia Alba (Day 10-28): cholesterol, epithelial cells, fat and mucus (WHITE colour)
115
What is Lochia Rubra:
Lochia Rubra (Day 0-4): blood, cervical discharge and foetal membrane + Meconium (baby poo). Appearance: RED in colour.
116
What is Lochia Serosa
- Lochia Serosa (Day 4-10): cervical mucus, foetal membrane, micro-organisms and white blood cells.(PINK colour)
117
What is Lochia Alba
- Lochia Alba (Day 10-28): cholesterol, epithelial cells, fat and mucus (WHITE colour)
118
What is colostrum?
Colostrum: clear fluid. Everything for baby for first couple days. However, does not let baby put on weight. Rich in Vitamin A. Contains lots of LACTOFERRIN: abundant in anti-microbial action.
119
When is prolactin secreted the most..
| How is it secreted?
- More is secreted at night
- Supresses ovulation
- Level peaks after the feed to produce more milk for the next feed.
The baby suckles --> leads to a sensory impulses passing from nipple to the brain
The prolactin is the secreted by the anterior pituitary gland and goes into the blood stream via the breast.
120
What is the oxytocin reflex?
- Helped by sight, sound and smell of baby
- Becomes conditioned over time
- Hindered by stress, anxiety, pain and doubt
- Works before or during the feed to make the milk flow
The baby suckles --> Sensory impulses pass from the nipple to the brain --> Oxytocin is secreted by the posterior pituitary gland and goes into blood stream to the breast --> Myo-epithelial (muscle) cells contract and expel milk
121
What is the Sepsis 6:
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BUFALO plus 2:
- Blood Cultures
- Urine output
- Fluid Resuscitation
- Antibiotics
- Lactate
- Oxygen
Plus 2: Consider delivery (ERPC) and VTE prophylaxis
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