O&G: Presentations Flashcards
A 39 year old woman, 38 + 2 weeks gestation, G0, P0 is in labour and is found to be fully dilated since her last VE. The head of the baby has been delivered, but normal downward traction has failed to deliver the shoulders. She has a BMI of 26, with type II diabetes. Previous ultrasound predicted a foetal weight as 3.9 kg. What is the most likely diagnosis?
Shoulder Dystocia
A 20 year old female, G0 P0 presents to her GP with irregular periods, hirsuitism and acne. Her mother has type II diabetes. What is the most likely diagnosis?
Polycystic Ovarian Syndrome -A constellation of symptoms associated with polycystic ovaries.
A 29 year old nulliparous woman presents to her GP complaining of dysmenorrhoea, dyspareunia and PR bleeding upon menstruation. What is the most likely diagnosis?
Endometriosis
Spontaneous abortion Threatened miscarriage - painless vaginal bleeding typically around 6-9 weeks Missed (delayed) miscarriage - light vaginal bleeding and symptoms of pregnancy disappear Inevitable miscarriage - complete or incomplete depending or whether all fetal and placental tissue has been expelled. Incomplete miscarriage - heavy bleeding and crampy, lower abdo pain. Complete miscarriage - little bleeding Ectopic pregnancy Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present Hydatidiform mole Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high Placental abruption Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed Placental praevia Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal Vasa praevia Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
Spontaneous abortion Threatened miscarriage - painless vaginal bleeding typically around 6-9 weeks Missed (delayed) miscarriage - light vaginal bleeding and symptoms of pregnancy disappear Inevitable miscarriage - complete or incomplete depending or whether all fetal and placental tissue has been expelled. Incomplete miscarriage - heavy bleeding and crampy, lower abdo pain. Complete miscarriage - little bleeding Ectopic pregnancy Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present Hydatidiform mole Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high Placental abruption Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed Placental praevia Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal Vasa praevia Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
A 55-year-old woman attends the GP surgery as she is worried about her risk of developing ovarian cancer, especially because of the amount of exposure ovarian cancer has received in the news. Which of the following is most associated with the development of ovarian cancer? Early menarche Early menopause Combined oral contraceptive use Multiple pregnancy Low body mass index
-Early menarche
A Cardiotocogram (CTG) is performed on a 28-year-old female at 36 weeks gestation who has attended labour ward in spontaneous labour. The CTG shows a foetal heart rate of 120bpm and variable decelerations and accelerations are present. There are no late decelerations. However, the midwife notices a 20 minute period where the foetal heart rate only varies by 3-4bpm. The mum is concerned as she has not felt her baby move much for about 20 mins and would like to know what the likely cause is. She starts crying when she tells you that she took some paracetamol earlier as she was in so much pain from the contractions and is worried this has harmed her baby. Which of the following is the most likely cause of this decreased variability?
Foetus is sleeping
A 59-year-old woman awoke with blood on her nightdress, which was bright red but not
heavy. There were no clots of blood and there was no associated pain. The bleeding has
recurred twice since in similar amounts.
Her last period was at the age of 49 years and she has had no other intervening bleeding
episodes. She suffered hot flushes and night sweats around the time of her menopause,
which have now stopped. She is sexually active but has noticed vaginal dryness on inter-
course recently.
She has always had normal cervical smears, the last one being 7 months ago. She had
two children by spontaneous vaginal delivery and had a laparoscopic sterilization aged
34 years. She has never used hormone-replacement therapy (HRT). She takes atenolol for
hypertension and omeprazole for epigastric pain.
Examination
She is slightly overweight. Abdominal examination is normal. The vulva and vagina
appear thin and atrophic and the cervix is normal. The uterus is small and anteverted and
with no palpable adnexal masses.
An outpatient endometrial biopsy is taken at the time of examination and sent for histo-
logical examination.
Transvaginal ultrasound scan is shown in Fig. 11.1.
Endometrial biopsy report: the specimen shows atrophic endometrium with no evidence of inflammation, hyperplasia or malignancy.
What is the likely diagnosis?
-Atrophic vaginitis
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Endometrial cancer is excluded since ultrasoubnd shows endometrial thickness of <3mm
