last min gynae Flashcards
Inhibin selectively inhibtis
FSH
thec cells produce andogens from cholesterol by
LH
drop in what causes dom follicle
FSH
whats most likely to be the dom follcile
high conc of FSH induced LH receptors
inhibin acts to decrease
FSH
androgens rise during ovulation - thought to be important in libido
LH surge is the best predictor of imminent ovulation and this principle is used in ovulation predictor tests.
ovulation occurs when
12 hours after the Lh surge
high levels of porgesteron during teh – phase supress LH and FSH
luteal
decrease in what causes menstruation
progesterone
7 day before period progesterone
assesses ovualtion
when is the endometrium in the proliferating vs secretory pahse
follicular phse - proliferatin
luteal - secretory
- is the formation of a specialised glandular epithelium and is an irreversible process and apoptosis occurs if there is no embryo implantation.-
decidualisation
menstruation is how long after ovualtion
14
mefenamic acid is a
prostaglandin inhibitor - act by increasing the ratio of vasconcstrictor to vasodilator ratio
Nsaids such as mefenamic acid is contraindicaed if hsitory of
duodenal ulcers or severe asthma
why GnrH analogue bad long temr
osteoporosis - however can combine with HRT
GNRH decrease
FSH and LH
examples of gnrh analogues
buserelin and goserelin
most common reasons for cervical ectropion
preg or pill
women with PMB over what age should have 2 week by US for endometrial cancer
55
most common cause of post menstual bleedig
atrophic vaginits
exception to doing US for if got post mentrual bleeding
if on tamoxifen - as they will have a thickened endometrium so need direct visualisation by hysterocscopy and endoemtrial biopsy
first line for endometrial hyperplasia
MIRena
LH and FSH in PCOS
LH are very high and FSH are low or normal
clomifene works by
blcokign oestrogen negative feedback so more gnrh and more FSH and LH
best thing for acne in PCOS
Co-cyrprindol (diannette)
dysmenorrhoea
excessive pain during menstrual period
primary dysmenorrhoea - usually appears 1-2 years after menarche
secondary dysmenorrhoea- starts many yeats after starting menarceh
uterus appears large and globualr
adenomyosis
endometrium in muscle layer of uterus
adenomyosis
nsaids such as mefenamic acid and ibuprofen are first line for
dysmenorrohoea
absent uterus
mullerian agenesis
mx for kallamn
HRT
ashermann syndrome
secondary to endometrial infection or durgery - secondary amenorrheoa
climateric is
time around the beginning of the menopause
mx can be avoid what in start of menopause
spicy foods
main medical mamagement for troublesome menopasue symptoms
HRT
oestrogen only hrt given if not got
uterus
hrt oestogen patches avoisd
first past metabolism
when given continous vs cyclical hrt
contunous - menopausal
cyclical - perimenopsual who still get pridso
what decreases risk HRT causing endoemtrial cancer
adding progesterone if got a uteurs
Suspected pregnancy
Breast cancer
Endometrial cancer
Active liver disease
Uncontrolled hypertension
Known VTE
Known thrombophilia e.g. factor V leiden
otosclerosis
absolute contrainicatiosn to HRT
cigarette appearance
lcihen scleorus
what is common in lichen sclerosus
splitting of the skin and often leads to superficial dyspareunia
mx of lcihen sclerossus
high dose steriods and emollient s– dermovate (topical steriod)
pagets disease is often a sign of
malignancy elsewhere in teh body
mucin in epdeirmis in
pagets
Benign ovarian cysts are < 5cm in maximum diameter, are physiological and tend to resolve over 2-3 menstrual cycles.
what tumour markers recommeded for all pre menopausal woman with compelx ovarian cyst
ca125, afp, beta hcg
It is the most common benign ovarian tumour in women <30years
dermoid cysts- as they tend to be big they are more likely to present with torsion
if mucinois cysts rupture they can cause
pseudomyxoma peritoneii
tender nodualrity on posterior fornixx
endometriosis
us shows whirpool sign
ovarian torsion
average labour for first time mums is
10hrs and for multi parous women is 5.5
1st stage of labour
no more than 12hrs in 1st time mum
or 10 in second
early latent phase
dilates up to 4cm
cord isnt clamped until
pulsations have ceased
There are 3 classic signs to indicate separation of the placenta and membranes:
The uterus contracts, hardens and rises
Umbilical cord lengthens permanently
There’s a gush of blood variable in amount
Placenta and membranes appears at introitus.
increased hyaluronic acid causes cervix to ripen
enagment -
passage of widest diamter of the presenting part below the pelvic inlet
need to catheterise before using froceps as bladder needs to be empty
chignon
swelling on babys head
caput succdenaemum
present at brith
what haematoma develops several hours after birth
cephalohaemtoma- swelling is firm
caput succedaneum
- often occurs due to pressure of the presenting part agaginst the cervix
- soft puffy swellign
how to induce labour if memebranea are intact
prostaglandin E2 - pessary most commonly used
negative nuber if above spine
women on anticonvulsants can only take
opiates
patietn controleld - pethidine, morphine and remifentatanil (very fast acting and good) -last one
ferguson refex - increased uterine contraction due to oxytocin
continous electrical fetal monitoring done if
below 37 or after 42
A terminal bradycardia is when the baseline fetal hear t rate drops to below 100beats per minute for more than 10minutes. A terminal deceleration is when heart rate drops and does NOT recover for more than 3 minutes.
indicators for emergency c section
early decelartion often due to
head compression
fetal sleeping - reduced varaibility usually lasts no longer than
40 misn
variable deceleration idnciates
cord compression=Cord compression which initially compresses the umbilical vein causing acceleration which is a healthy response. The occlusion of the umbilical artery results in a rapid deceleration. When pressure on the cord is reduced, another acceleration occurs and baseline rate returns.
mx of variable deveeraltions
change position of mother
sinusoidal pattern on partogram
urgent c section
early deceleration are physiological
variable deceleration
change position of mother
amnioscope detects
fetal Ph
reversible causes of death that can be added to the list in preg
eclampsia and intracranial haemorrhaeg
most common cause of maternal cllapse - ahemorrhage
most common cause of direct maternal death - thromboemmbolism
aortic dissection can have
wide pusle pressure
ejection systolic murmurs are common in preg
malg sulphate drug toxicity in presence of renal impairemnt
in cpr if cardaic output not restored after 3 mins of cpr then do
c secction
