OBGYN Flashcards
What is pre-eclampsia?
What is the 1st line management?
~ 2nd line management?
Pregnancy-induced hypertension occurring after 20 weeks gestation with proteinuria.
Labetelol
~ Nifedipine
List some complications of shoulder dystocia: (4)
- Brachial plexus injury (commonly Erb’s palsy (waiter’s tip))
- Perineal tears
- Fetal hypoxia (→ cerebral palsy if prolonged)
- Postpartum haemorrhage (T = trauma!)
What pathology is seen in the condition: “transposition of the great arteries”?
What needs to occur postnatally to make it temporarily compatible with life? - Give examples of 3 things that could occur:
This condition is usually detected antenatally. What is given immediately after birth before the baby is transferred for surgical correction? - What does this do?
The pulmonary artery arises from the left ventricle & the aorta arises from the right ventricle (they’ve swapped)
There needs to be a shunt between R & L ventricles so that oxygenated blood goes to systemic circulation
1) patent ductus arteriosus (connection between pulmonary trunk & aorta)
2) atrioseptal defect
3) ventriculoseptal defect
Prostaglandin E is given - prevents the ductus arteriosus from closing
How long after starting the following contraception is additional protection (condom’s) needed?
a) combined contraceptive pill
b) progesterone-only pill
a) 7 days
b) 2 days
What are Braxton-Hicks contractions?
Are they indicative of the onset of labour?
Occasional irregular contractions of the uterus.
They are NOT true contractions & do not indicate the onset of labour
List some common symptoms of ovarian cancer: (6)
What are the 2 initial investigations if ovarian cancer is suspected?
- Abdominal bloating
- Early satiety
- Loss of appetite
- Weight loss
- Ascites
- Pelvic pain
CA125 & Transvaginal US
State the 5 criteria of the Bishops Score:
~ state the characteristics seen in each criteria that indicate onset of labour
What is the Bishops Score used for?
~ what is the pivoting score?
→ Position of the cervix (anterior)
→ Effacement of the cervix (length - shorter = better)
→ Consistency of the cervix (soft)
→ Dilatation of the cervix (bigger = better)
→ Station of the presenting part (distance in cm in relation to the ischial spines)
Bishops score is used to assess whether induction of labour would be successful
~ score of 8 indicates successful induction
What causes urge incontinence?
What causes stress incontinence?
Urge incontinence:
Overactive detrusor muscle (aka, overactive bladder)
Stress incontinence:
Weak pelvic floor & sphincter muscles
Which muscles compose the pelvic diaphragm?
Levator ani (puborectalis, pubococcygeus, iliococcygeus) & coccygeus
What is placenta praevia?
When would placenta praevia be diagnosed in a pregnancy if it’s present?
What is the common presentation of placenta praevia?
If someone is identified as having placenta praevia, when would they be given repeat US’s?
What is the management of placenta praevia regarding the delivery?
Placenta praevia: when the placenta is attached in the lower portion of the uterus - often covering the cervical os.
At the 20 week anomaly scan
Painless bleeding (antepartum haemorhage)
32 & 36 weeks gestation (if present on the 32 week scan to guide decisions about delivery)
C-section should be planned for 36-37 weeks (to avoid spontaneous labour as vaginal delivery is contraindicted)
What is the commonest presenting symptom of endometrial cancer?
List 2 other common symptoms:
Name 2 protective factors against endometrial cancer:
POST-MENOPAUSAL BLEEDING !
~ Intermenstrual bleeding
~ Unusually heavy menstrual bleeding
• Smoking
• COCP
What are the steps of the 2nd stage of labour? (The steps/ movements of the baby as it moves along the birth canal) (7)
1) Engagement: foetus head is fully engaged with pelvis
2) Descent: foestus starts to descend along birth canal
3) Flexion: foetus head flexes towards chest
4) Internal rotation: foetus internally rotates to face mothers back
5) Extension: foetal head extends & is delivered
6) Restitution: foetus externally rotates to face anteriorly
7) Expulsion: anterior shoulder is delivered, followed by the rest of body
When would a primary postpartum haemorrhage occur?
When would a secondary postpartum haemorrhage occur?
How many mls of blood needs to be lost for a classification of:
a) minor PPH
b) major/ moderate PPH
c) severe PPH
What are the 4 causes of a PPH?
~ what is the commonest cause?
- *Primary**: within the first 24h
- *Secondary**: between 24h - 12 weeks after delivery
- *Minor** PPH: under 1000mls
- *Major/ moderate** PPH: 1000 - 2000mls
- *Severe** PPH: 2000mls +
- Tissue (retained placenta)
- Tone (of uterus = uterine antony is commonest cause)
- Trauma (eg, perineal tear)
- Thombin (bleeding disorder)
What are the steps of the 2nd stage of labour? (The steps/ movements of the baby as it moves along the birth canal) (7)
1) Engagement: foetus head is fully engaged with pelvis
2) Descent: foestus starts to descend along birth canal
3) Flexion: foetus head flexes towards chest
4) Internal rotation: foetus internally rotates to face mothers back
5) Extension: foetal head extends & is delivered
6) Restitution: foetus externally rotates to face anteriorly
7) Expulsion: anterior shoulder is delivered, followed by the rest of body
What is the diagnostic triad for hyperemesis gravidarum?
- >5% pre-pregnancy weight loss
- Dehydration
- Electrolyte imbalance
Erb’s palsy results in damage to what nerves of the brachial plexus?
What obstetric emergency can result in Erb’s palsy?
C5 & C6
Shoulder dystocia
Explain the pathology in each miscarriage & say whether miscarriage is certain or not:
a) Threatened miscarriage
b) Inevitable miscarriage
c) Complete miscarriage
d) Missed miscarriage
a) Threatened miscarriage:
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr
b) Inevitable miscarriage:
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable
c) Complete miscarriage
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred
d) Missed miscarriage
Asymptomatic, cevical os closed, foetus currently present intrauterine but is dead
If a woman is *Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don’t have the D antigen on their RBC’s so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events
What is the physiological cause of the menopause?
Ovarian failure* which results in oestrogen deficiency
* Decreased ovarian function due to very few follicles remaining
List some symptoms of pre-eclampsia: (5)
What medication is used to treat a seizure in eclampsia?
Headache
Changes in vision (commonly blurred vision)
Nausea / vomiting
Ankle oedema
Upper abdominal pain
Eeclampsia: IV magnesium sulphate
List some drug free techniques to control pain during labour: (3)
List the 4 main pain relief options for labour that involve medications:
- TENS machine
- Birthing ball
- Birthing pool
- Entenox (gas & air = NO)
- IM diamorphine
- Remifentanil (administered as patient controlled anaesthesia - patient has a button to press when needing a dose)
- Epidural
What method is used in primary prevention of cervical cancer in the UK?
What method is used in secondary prevention of cervical cancer in the UK?
What 2 strains of HPV are associated with cervical cancer?
HPV vaccine to 12-14y olds
Smear tests - every 5 years between 25-64y
Strains 16, 18
List some common symptoms of menopause. (6)
Hot flushes
Night sweats
Vaginal dryness
Reduced libido
Mood swings
Fatigue
Around what week gestation should a booking appointment occur in?
Week 10
What is the 2nd line management of pre-eclampsia?
Nifedipine (anti-hypertensive)
If premature delivery is likely, what should be given to the mother & why?
Corticosteroids - to encourage maturation of the fetal lungs
In regards to multiple pregnancy, what do the following terms mean:
- Monoamniotic
- Diamniotic
- Monochorionic
- Dichorionic
If you see the lambda sign on an US, what type of twins does that indicate?
1. Monoamniotic: Single amniotic sack (shared between babies)
2. Diamniotic: 2 separate amniotic sacs (each baby has their own)
3. Monochorionic: Single placenta (shared between babies)
4. Dichorionic: 2 separate placenta’s (each baby has their own)
Lambda sign = dichorionic, diamniotic (2 sacs & 2 placenta’s)
What features are seen in HELLP syndrome?
H - haemolysis
EL - elevated liver enzymes
LP - low platelets
List 3 functions of oxytocin:
List 2 uses of nifedipine throughout pregnancy:
Oxytocin
• Ripening of cervix
• Stimulates contractions of uterus
• Squeezes mammary ducts to aid in breastfeeding
Nifedipine
• 2nd line Pre-eclampsia treatment (to control hypertension)
• Tocolysis (in premature labour)
Which diagnosis must you rule out if someone presents with post-menopausal bleeding?
Endometrial cancer
What is the commonest cause of macrosomia?
List some risk factors of a macrosomic baby during birth: (5)
Maternal diabetes (eg, gestational diabetes)
- Shoulder dystocia
- Pernieal tears
- Instrumental delivery/ C-section
- Clavicle fracture of baby
- Erbs palsy (brachial plexus injury - common from shoulder dystocia)
Interpret the following:
G2 P1
This lady has been pregnant twice but has only had 1 delivery past 24 weeks gestation
Shoulder dystocia is a medical emergency. This occurs when the shoulder gets stuck behind what structure?
What sign is seen when the head is delivered but then retracts back into the vagina?
What are the 2 initial management options to deliver the anterior shoulder?
Pubic symphysis
Turtle-neck sign
- *Episiotomy** (cutting the perineum to make the vaginal opening larger)
- *McRoberts Manoeuvre** (mothers knee’s to abdomen - this provides posterior tilt to pelvis, lifting pubic symphysis out of way)
What 5 factors are assessed using the Bishop Score for induction of labour?
Fetal station (this is how far down into the pelvis the babies head is palpated in relation to the ischial spines)
Cervical position (as the cervix ripens, it moves more anteirorly)
Cervical dilatation (as the cervix ripens, it dilates)
Cervical effacement (as the cervix ripens, it becomes shorter)
Cervical consistency (as the cervix ripens, it becomes softer)
How is a patient mean’t to use Entonox?
~ how long does it take for it to work?
Entonox = gas & air (NO)
~ breathe it in at the start of a contraction
~ takes about 30s to work
What is the 1st line management of pre-eclampsia?
Labetolol (anti-hypertensive)
Name the antibiotic used to treat Gonorrhoea?
What is the dose of this & what route is it given?
Ceftriaxone 1g, given IM
Women with a RF for gestational diabetes are investigated for gestational diabetes at what gestational week?
How is this investigated?
What additional investigation are women with a history of gestational diabetes given?
Week 24-28
OGTT
Women with a history of GD are given an OGTT at their booking appointment (~10 weeks) - if this is normal, it is repeated at weeks 24-28
What is placental abruption? - name the 2 types
List some clinical features seen in placental abruption: (4)
What is the management of placental abruption if:
- maternal +/- foetal compromise
- no maternal/ foetal compromise
Premature separation of the placenta from uterus during pregnancy
~ Concealed & revealed
- Woody, hard uterus
- Sudden onset, severe abdominal pain
- Vaginal bleeding (may be disproportionate to observations though)
- Fetal distress on CTG (bradycardia/ reduced foetal movements)
-
1. Emergency C-section*
2. Conservative management with CTG & maternal monitoring
What is the medical management of a miscarriage? - how does it work?
What is the surgical management of a miscarriage?
- *Misoprostol
- ** prostaglandin analogue (softens the cervix & stimulates uterine contractions to expel the miscarriage)
- *Surgical management:**
- *-** vacuum aspiration & curettage (products are sucked & scooped out) → misoprostol is given before procedure to soften the cervix
What is the medical management of an ectopic pregnancy? - how long after treatment is it advised to avoid pregnancy?
What are the 2 surgical options of ectopic termination?
~ which one is 1st/ 2nd line
- *Medical:**
- Methotrexate IM* - avoid pregnancy for 3 months due to teratogenic effects!
Surgical:
1st line:Laparoscopic salpingEctomy
~ removal of whole affected fallopian tube
2nd line: Laparoscopic salpingOtomy
~ removal of only ectopic, fallopian tube is left
What timeframe does postnatal depression occur within?
Within 6 months of giving birth
Describe the rule of 3’s for management of prolonged foetal bradycardia:
- *3 mins:** call for help
- *6 mins:** move to theatre
- *9 mins:** prepare for delivery of the baby
- *12 mins:** deliver the baby (by 15 mins!)
Describe the discharge associated with each condition below:
1) Bacterial vaginosis
2) Candidiasis
3) Chlamydia
4) Gonorrhoea
5) Trichomoniasis
1) Watery, FISHY discharge
2) Thick, white discharge (cottage cheese)
3) Watery, odourless discharge
4) Yellow discharge
5) Frothy, green discharge
What is the Bishop Score used to assess?
It assess whether someone should have their labour induced
What are the typical triad of features seen in pre-eclampsia?
Hypertension that occurs after 20 weeks gestation
Proteinuria
Oedema (usually ankle)
Explain the pathology in each miscarriage & say whether miscarriage is certain or not:
a) Threatened miscarriage
b) Inevitable miscarriage
c) Complete miscarriage
d) Missed miscarriage
a) Threatened miscarriage:
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr
b) Inevitable miscarriage:
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable
c) Complete miscarriage
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred
d) Missed miscarriage
Asymptomatic, cevical os closed, foetus currently present intrauterine but is dead
What is an episiotomy?
Episiotomy: a cut is made in the perineum to avoid perineal tears during labour
Describe the damage involved in each degree of perineal tears:
~ First degree tear
~ Second degree tear
~ Third degree tear: 3A, 3B, 3C
~ Fourth degree tear
What is the management of the various tears?
First degree: Tear limited to the superficial perineal skin or vaginal mucosa only
~ Don’t require treatment
Second degree: Tear extends to perineal muscles and fascia, but the anal sphincter is intact
~ Requires a simple stitch (midwife can do this)
- *Third degree:** tear involves the external anal sphincter
- *3A** - less than 50% thickeness of sphincter is torn
- *3B** - more than 50% thickeness of sphincter is torn
- *3C** - External & internal anal sphincters torn
- ~ Requires surgical correction*
- *Fourth degree:** tear extends to the rectal mucosa
- ~ Requires surgical correction*
P, C, R
Name 3 medications that affect the efficacy of the COCP:
- Phenytoin
- Carbamazepine
- Rifampicin
List the 4 signs of labour:
What drug is the 1st line for tocolysis?
~ what is tocolysis?
- Show (mucus plug from the cervix)
- Rupture of membranes
- Regular, painful contractions
- Dilation of cervix (seen on examination)
Nifedipine (orally)
~ the use of medications to stop uterine contractions
What investigations should you do to diagnose PID? (5)
Pelvic examination
Pregnancy test (to rule out ectopic)
STI swabs
Transvaginal ultrasound
Bloods
What is the management of PID?
Antibiotics: ofloxacin & metronidazole
Analgesia if severe pain
What are the 5 things that a CTG measures?
What is the normal HR of a fetus?
~ what is the range of normal variability within this?
- Contractions (num. of uterine contractions in 10 mins)
- Baseline fetal HR (the average HR)
- Variability (of fetal HR)
- Accelerations (increase in HR of 15bpm for 15 secs)
- Decelerations (decrease in HR by 15bpm for 15 secs) - concerning
Foetal HR = 110 - 160bpm
~ normal variability = 5 - 25bpm
Name the 3 types of emergency contraception available and:
a) state the timeframe in which they are effective after UPSI
b) state their mechanism of action against pregnancy
List 2 contraindictations of EllaOne
- *EllaOne**
a) effective up to 5 days after UPSI
b) delays ovulation
c) asthma, breastfeeding should be avoided for 1 week - *IUD (copper coil)**
a) effective up to 5 days after UPSI
b) copper is spermicidal + prevents implantation
c) insertion may cause PID - *Levonorgestrel**
a) effective up to 3 days after UPSI
b) delays ovulation
If a woman still has a uterus, what type of HRT should she be offered?
Oestrogren + progesterone
Name the 2 most common types of urinary incontinence:
Urge & Stress incontinence
What symptoms might PID present with? (5)
Bilateral abdominal pain
Vaginal discharge
Post coital bleeding
Fever
Adnexal tenderness
What muscle helps to maintain continence?
Pelvic floor (pelvic diaphragm)
List some extrinsic causes of urinary incontinence: (5)
- Immobility issues - unable to get to toilet
- Diuretics - increase volume of urine
- Constipation
- Confusion - may be unaware of needing toilet
- Painkillers - can cause constipation
List some risk factors for urinary incontinence: (6)
- High parity / previous vaginal deliveries
- High BMI
- Pelvic organ prolapse
- Previous pelvic floor surgery (eg perineal tear repair)
- Increased age
- Neurological conditions, eg dementia, MS
What 2 antibiotics are used to treat a Chlamydia infection?
Doxycycline & Azithromycin
State some risk factors for uterine rupture: (3)
List some common clinical features of uterine rupture: (5)
What is the management of uterine rupture?
Risk factors of uterine rupture:
• VBAC (vaginal birth after C-section - C-section scar is a weak point in the uterus!)
• The use of oxytocin to stimulate contractions
• High BMI
Clinical features:
• Sudden abdominal pain
• Vaginal bleeding
• Maternal shock (hypotension, tachycardia, collapse)
• Ceasing of uterine contractions
• ABNORMAL CTG
Management: EMERGENCY C-SECTION
If the CTG is showing signs of fetal distress, what can you do to determine whether the baby is hypoxic?
How is this done?
Take a fetal blood sample
Speculum is inserted and babies head is ‘scratched’ to obtain a blood sample ⇒ ONLY shows if baby is hypoxic
Name the muscles that form the pelvic floor:
Levator ani:
~ Puborectalis
~ Pubococcygeus
~ Iliococcygeus
Coccygeus (also known as ischiococcygeus)
If needing treatment, what is used to treat Bacterial Vaginosis?
What is the treatment of Candidiasis infection?
What is the treatment of Chlamydia infection? (In non pregnant/ breastfeeding people)
What is the treatment of Gonorrhoea infection?
What is the treatment of Trichomoniasis infection?
What is the treatment of Herpes infection?
Bacterial vaginosis: Metronidazole
Candidiasis: Antifungal cream/ pessary (clotrimazole)/ oral tablet
Chlamydia: doxycycline 100mg 2x daily for 7 days
Gonorrhoea: IM ceftriaxone (if sensitivities are known) / oral ciprofloxacin (if sensitivities aren’t known)
Trichomoniasis: Metronidazole
Herpes: Aciclovir
If a pregnant woman is HIV positive, is she able to have a normal vaginal delivery?
If a pregnant woman is HIV positive, is she able to breastfeed?
What prophylaxis treatment is given to all babies born to HIV+ women?
Vaginal delivery: ONLY if her viral load is undetectable (< 50 copies/ ml) - otherwise C-section recommended
Breastfeeding: NO. Even if viral load is undetectable, HIV can be transmitted to baby through the breast milk!
Prophylaxis:
• Viral load is undetectable (< 50 copies/ ml) = 1x antiviral for 4 weeks
• Viral load is detectable (> 50 copies/ ml) = 3x antiviral for 4 weeks
What is the commonest cause of post partum haemorrhage?
What are the other causes of PPH? (the 4 T’s)
Atony of the uterus (failure of the uterus to contract)
→ Tone (atony of the uterus)
→ Tissue (retained placenta)
→ Trauma
→ Thrombosis
A 44y woman attends the GP practice complaining of a 6y history of abdominal pain and menorrhagia. She describes the pain as being worse immediately before and during the first day of menstration. O/E the uterosacral ligament is thickened and the ovaries are enlarged. Laparscopic examination reveals chocolate cysts.
What is the likely diagnosis?
Endometriosis
Where is the commonest anatomical site to find an implanted ectopic pregnancy?
Ampulla
Between which weeks does labour & delivery usually occur?
37 - 42 weeks
What is the peri-menopause?
The period of time from when symptoms of the menopause start, until 12 months after the last menstrual period
When palpating the anterior & posterior fonatelles on vaginal examination during delivery, what shapes do they typically have?
- *Anterior fontanelle:** diamond
- *Posterior fontanelle:** triangle
What antibiotic is used to treat Bacterial Vaginosis?
Metronidazole
A 48y old woman presents with intense ithcing in the perineal area, associated with pain on micturation and dyspareunia.
O/E you notcie white polygonal papules on the labia majora, coalescing into a patch affecting the labia minora. There is one fissuring area, which bleeds on contact. The skin is white, thin & shiny. Mild scarring is noted. There is no vaginal discharge.
What is the likely diagnosis:
a) Lichen Planus
b) Lichen Sclerosus
What is the 1st line treatment for this condition?
LICHEN SCLEROSUS
3 month trial of topical steroids
List some adverse effects of an epidural: (5)
What 2 simple analgesics are commonly given in labour alongside the additional pain relief options?
~ which simple analgesic is avoided?
- Increased risk of instrumental delivery
- Prolonged 2nd stage of labour
- Hypotension
- Motor weakness in legs (cannot walk around after)
- Headache (after insertion - uncommon)
Paracetemol & codeine
~ NSAIDs are avoided!!
Is a ductal carcinoma in-situ (DCIS) an invasive/non-invasive form or breast cancer?
Non-invasive
It is performed in preterm labour with intact membranes
What is tocolysis?
When medications are used to stop uterine contractions.
What do the 3 stages of labour consist of?
First stage - from the onset of labour (contractions) until 10cm cervical dilatation
Second stage - from 10cm dilatation until the baby is delivered
Third stage - from delivery of the baby to delivery of the placenta
Interpret the following:
G1 P1
This woman has been pregnant once & has delivered one baby after 24 weeks gestation
What is the difference between an STI & an STD?
STI: a sexually transmitted infection that is only an infection (it hasnt caused any disease yet)
STD: a sexually transmitted infection that has caused a disease (aka, it is causing harm, eg PID)
What day of a 28d cycle does ovulation usually occur on?
What hormone spike triggers ovulation?
Between which days of a 28d menstrual cycle is the:
a) follicular phase
b) luteal phase
What physiologically occurs during the:
a) follicular phase
b) luteal phase
Ovulation = 14d
~ Stimulated by spike in LH
a) follicular phase = days 0 - 14
b) luteal phase = days 14 - 28
Follicular phase:
• Under FSH stimulation, follicles mature → ovulation
• Mature follicles secrete oestrogen which negatively feedbacks on A.pituitary to decrease release of FSH & LH
Luteal phase:
• Follicle that released the ovum changes into corpus luteum which secretes progesteron to maintain endometrium
• If no fertilisation occurs, corpus luteum degenerates → low progesterone → menstruation
If a whirlpool sign is seen on a transvaginal US, what condition does this suggest?
What is the definitive investigation to diagnose this condition?
What are the 2 management options?
Ovarian torsion
Laparoscopic surgery
- *Management**: done whilst doing the laparoscopic surgery!
1) Detorsion of the ovary
2) Oophorectomy (removal of the affected ovary)
What is the commonest cause of post-menopausal bleeding?
Why does this occur?
Atrophic vaginitis
After menopause, the vaginal mucosa becomes drier and thinner - more likely to bleed, especially after sexual intercourse
States whether the following hormones would be low, normal or high in PCOS:
~ Testosterone
~ LH
~ FSH
~ Sex hormone binding globulin (SHBG)
Testosterone: high
LH: high
FSH: normal
SHBG: low
A 30 year old female, who is breast feeding, presents to her general practice. She has noticed some swelling and tenderness of her right breast. The pain becomes worse on breast feeding. She has had difficulty with breast feeding as her baby has a poor latch when feeding.
On examination there is swelling and erythema in a wedge-shaped distribution on the right breast. The patient’s observations are normal.
What is the most likely diagnosis?
What are the 2 causes of this condition?
Mastitis
Causes:
• blocked milk duct
• infection (usually staph aureus)
Describe what each stage of labour consists of:
~ Stage 1
~ Stage 2
~ Stage 3
Stage 1: Onset of contractions until 10cm dilated
Stage 2: 10cm dilated until delivery of the baby
Stage 3: Delivery of the baby to delivery of the placenta
Failure to progress in labour is when the labour isn’t developing at a satisfactory rate. Name the 3 things that progress in labour is influenced by: (3 P’s)
What is considered as a delayed 2nd stage of labour in:
a) nulliparous women
b) multiparous women
What is considered as a delayed 3rd stage of labour in:
- *a) active management**
- ~ what does active management of the 3rd stage of labour involve?*
b) physiological management
- Power (of uterine contractions)
- Passenger (size/ presentation/ position of baby!)
- Passage (shape & size of mothers pelvis)
- *Nulliparous**: 2nd stage taking 2 hours
- *Multiparous**: 2nd stage taking 1 hour
- *Active**: 3rd stage taking longer than 30 mins
- ~ IM oxytocin & controlled cord traction*
- *Physiological**: 3rd stage taking longer than 60 mins
What is placenta praevia?
When would placenta praevia be diagnosed in a pregnancy if it’s present?
What is the common presentation of placenta praevia?
If someone is identified as having placenta praevia, when would they be given repeat US’s?
What is the management of placenta praevia regarding the delivery?
Placenta praevia: when the placenta is attached in the lower portion of the uterus - often covering the cervical os.
At the 20 week anomaly scan
Painless bleeding (antepartum haemorhage)
32 & 36 weeks gestation (if present on the 32 week scan to guide decisions about delivery)
C-section should be planned for 36-37 weeks (to avoid spontaneous labour as vaginal delivery is contraindicted)
Between which weeks of gestation would an induction of labour be offered?
Between weeks 41 - 42 gestation
What are fibroids?
Benign, smooth muscle tumours of the myometrium of the uterus
List some risk factors of pre-eclampsia. (8)
Pre-existing hypertension
Previous pre-eclampsia / FH
Diabetes
Chronic kidney disease
Autoimmune conditions (eg SLE)
>40y
BMI >35
Multiple pregnancy
List 3 complications of HRT.
- Increased risk of breast cancer
- increased risk of venous thromboembolism
- Increased risk of endometrial cancer if oestrogen is given alone
The results of a womans cervical smear screening identifies the presence of high-risk human papillomavirus (hrHPV). What should happen next?
If the next step is positive, what should be done?
If the step was negative, what should be done?
The sample should be sent for cytology.
Cytology positive (dyskaryosis): Woman should be sent for colposcopy
Cytology negative: Woman should have another smear in 12 months
A pregnant woman attends the obstetric clinic for a routine early pregnancy scan. She has been struggling in the pregnancy so far with extreme, persisten nausea & vomiting. The US scan shows a snowstorm appearance.
What is the most likely diagnosis?
Name the 2 types and their causes:
What would you expect to see regarding the hCG? - what condition can this often mimic & why?
What is the treatment of this?
Molar pregnancy (hydatiform mole)
Complete mole: 2 sperm fertilise 1 egg that contains no genertic material (empty egg)
~ no fetal material will form
Partial mole: 2 sperm fertilise 1 normal egg, resulting in a cell that has 3 sets of chromosomes!
~ some fetal material may be seen
hCG is abnormally high for gestational dates - can cause hyperthyroidism as hCG mimics TSH & overstimulates the thyroid gland
Treatment: evacuation of the uterus to remove it - the products of conception are sent to histology to confirm the molar pregnancy
What type of formula is used to treat CMPA?
If the child still can’t tolerate this formula, what would they be swapped to?
Hydrolysed formula
An amino acid formula
What Bishop Score would indicate induction of labour would be successful?
8 or more
What medication is used to treat a seizure in eclampsia?
IV magnesium sulphate
What is the 1st line medication used in pre-eclampsia to control blood pressure?
What is the 2nd line medication?
Labetalol
Nifedipine
What is the difference between pre-eclampsia and gestational hypertension (pregnancy-induced hypertension)?
Gestational hypertension occurs after 20 weeks gestation without proteinuria
Pre-eclampsia is when hypertension occurs after 20 weeks gestation with proteinuria
Name the 3 sexually transmitted diseases that are screened for at the start of pregnancy:
- HIV
- Syphilis
- Hepatitis B
For lactational amenorrhea to be 98% effective as a form of contracteption, the woman must be doing what 2 things?
~ If these are done, how long is lactational amenorrhea effective as contraception for after birth?
How many days after birth is fertility considered to return?
If postpartum women are wanting to start a form of contraception, what are the available options to them?
~ when can each of these be started after delivery?
• Fully breastfeeding
• Amenorrhoeic (no periods)
~ effective up to 6 months postpartum
21 days
- *Postpartum contraception:**
- Progesterone only pill / implant* - can be started anytime after birth
- COCP* - should be avoided with breastfeeding, can only be started 6 weeks after birth
- IUD/ IUS* - can either be inserted within first 48h after birth OR 4 weeks after delivery
A 34y/o woman has a pelvic ultrasound performed due to amenorrhea for 10 months.
The US shows a string of pearls appearance.
What condition does this indicate?
PCOS
In PCOS, would you expect the following to be low, normal or high?
1) Testosterone
2) Sex hormone binding globulin
3) LH
4) FSH
5) Insulin
6) LH:FSH ratio
1) Testosterone - high (insulin promotes release of androgens)
2) Sex hormone binding globulin - low (insulin decreases SHBG production)
3) LH - high
4) FSH - low (low FSH results in follicles not maturing and turning into cysts)
5) Insulin - high (insulin resistance is a feature of PCOS)
6) LH:FSH ratio - high (High LH & low FSH)
A low birth weight is considered below what?
A large baby is considered as weight what at birth?
2500g (2.5kg)
4.5kg
What changes occur at birth regarding the foetal circulation? (6)
1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases
Explain stress incontinence:
What are the treatments of stress incontinence?
• Non-pharmacolgical
• Pharmacological
• Surgical
Stress incontinence occurs when abdominal pressure is increased, eg coughing/ jumping
- *Non-pharmacolgical:** physiotherapy (pelvic floor exercises)
- *Pharmacological:** oestrogen pessary/ duloxetine (SSRI)
- *Surgical**: Colposuspension
What is the commonest type of breast cancer in the UK? - what cells are cancerous in this cancer?
If the cancer hasn’t breached the basement membrane, what is the name of it?
What is the commonest breast cancer in younger patients?
- Mutations in what gene are associated with this cancer?
Ductal carcinoma - cancer of the ductal cells
Ductal carcinoma in situ!
Medullary carcinoma
BRCA1
List 2 methods of prophylaxis of preterm labour:
Vaginal progesterone pessary/gel - this prevents cervical ripening & decreases activity of the myometrium
Cervical cerclage - a stitch is put into the cervix to keep it closed until nearer term date
What are the 6 components of sepsis 6?
~ state the order you would do these in
(take 3, give 3)
1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output
What test is commonly used to screen for down’s syndrome during pregnancy?
The combined test
Explain urge incontinence:
• state the commonest cause
What are the treatments of urge incontinence?
• Non-pharmacolgical
• Pharmacological
The sudden need to urinate without warning
• overactive/ irritated bladder (detrusor muscle is over stimulated!)
- *Non-pharmacolgical:** Bladder retraining
- *Pharmacological:** Antimuscarinics** (eg Oxybutinin)
Antimuscarinics act to block activation of the detrusor muscle
Paget’s disease of the breast is commonly mistaken for what condition?
What severe condition does Paget’s disease of the breast overlie?
What part of the breast is involved first in Paget’s disease of the breast?
~ List some presenting features (4)
Eczema !!
An underlying breast cancer
Nipple:
• Nipple discharge +/- blood
• Eczema like rash on/ around the nipple
• Burning/ pain of the nipple
• Nipple inversion
Is Gonorrhoea a gram positive or gram negative bacteria?
Gram negative
What medication should be prescribed with methotrexate to avoid toxicity?
Folic acid
Regarding breast cancer screening:
a) which age groups are screened?
b) how often is the screening?
c) what does screening involve?
a) 50 - 70y
b) every 3 years
c) mammogram (xray of breasts)
What 5 factors are assessed using the Bishop Score for induction of labour?
Fetal station (this is how far down into the pelvis the babies head is palpated in relation to the ischial spines)
Cervical position (as the cervix ripens, it moves more anteirorly)
Cervical dilatation (as the cervix ripens, it dilates)
Cervical effacement (as the cervix ripens, it becomes shorter)
Cervical consistency (as the cervix ripens, it becomes softer)
What are the medical management options for urge incontinence? (3)
What are the invasive management options for urge incontinence? (1)
Medical:
1. Bladder retraining (gradually increasing time between voiding to strengthen detrusor muscle)
2. Anticholinergic medications
3. Mirabegron (alternative to anticholinergics)
Invasive:
~ Botulin toxin (injected into the bladder wall)
What is eclampsia?
Seizures that occur as a result of pre-eclampsia
What are the 3 Rotterdam criteria for PCOS?
How many do you need to be diagnosed with PCOS?
What is the gold standard investigation for PCOS?
~ what ‘buzzword’ will be seen on this?
- Irregular/ absent menstrual periods
- Hyperandrogenism (eg acne/ hirsutism)
- polycystic ovaries on US (>12) (or ovarian volume 10cm3 plus)
2 out of the 3 criteria
Transvaginal US: follicular arrangement within the ovary has a string of pearls appearance
What condition is indicated by a woody, tender uterus?
Placental abruption
Bacterial vaginosis is associated with an increased risk of complications during pregnancy? What are these complications? (2)
Preterm delivery
Late miscarriage
What is the 1st line management of an ovulatory cause of infertility?
What is the 2nd line management if the above doesn’t help?
What is the 3rd line management if the woman is still unable to get pregnant?
If all of the above fail, what is the final management to assist in successful pregnancy?
Lifestyle modification: weight loss, exercise, diet
2nd line: Clomiphene
3rd line: Laparoscopic ovarian drilling
Assisted conception
What medication is commonly used to treat oestrogen receptor positive breast cancers?
What drug class is this?
Tamoxifen
SERM - selective oestrogen receptor modulator
Between which weeks of gestation would an induction of labour be offered (in an uncomplicated pregnancy!)?
Between 41 - 42 weeks
What syndrome is a complication associated with PID?
Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule which forms adhesions with the anterior abdominal wall)
A diagnosis of pre-eclampsia requires what? (1 + 3)
BP 140/90 +
PLUS any of:
Proteinuria
Organ dysfunction (raised creatinine / elevated LFTs / seizures)
Placental dysfunction (eg, foetal growth restriction)
What are the 2 commonest methods used to induce labour?
What is a complication of induction of labour?
~ what can this result in?
~ what is the management of this complication?
- Membrane sweep
- Vaginal prostaglandins (pessary)
Uterine hyperstimulation
~ fetal distress & hypoxia!
~ management: removing vaginal prostaglandins +/- giving tocolysis (using terbutaline)
What is **placenta:
- accreta
- increta
- percreta**?
List 3 risk factors for placenta accreta:
If placenta accreta isn’t detected on antenal US, how does it usually present?
- When the placenta implants deeper than the endometrium…*
- *Placenta accreta:** into the surface of myometrium ONLY
- *Placenta increta:** into the myometrium but not through it
- *Placenta percreta:** into AND through the myometrium (commonly onto pelvic organs!)
- Previous placenta accreta
- Previous C-section
- Previous endometrial courettage procedures (eg, for abortion)
Difficulty delivering placenta & significant postpartum bleeding as a result!
A bacterial growth of what suggests a UTI?
105
What num. of sperm/egg cause a:
- a.* partial molar pregnancy
- b.* complete molar pregnancy
What investigations are done if a molar pregnancy is suspected?
~ What results would you expect?
- a.* 2x sperm PLUS 1x egg
- b.* 1x sperm PLUS empty egg
Investigations:
~ bHCG: higher than expected HCG levels
~ trans-vaginal US: snowstorm appearance in complete molar pregnancy
Premature menopause occurs before what age?
What is the cause of premature menopause?
The symptoms of menopause are caused by a lack of what hormone?
What test can be done to investigate menopause/ peri-menopause?
Beofre 40y
Cause: premature ovarian insufficiency
Oestrogen!
FSH levels! - they will be high near menopause
What is the 1st line investigation in the diagnosis of fibroids?
Trans-vaginal ultrasound
At what age does the menopause typically occur?
50y
What antibiotic is used to treat Herpes?
Aciclovir
A 29y woman, smoker, referred to the antenatal clinic with a small amount of dark brown vaginal bleeding at 39+2 weeks gestation. A speculum exam showed some old blood in the vagina but no active bleeding.
2 hours later the emergency buzzer is pulled as the woman is distressed with extreme abdominal pain and fresh vaginal bleeding. The uterus has a hard, woody feeling.
What is the likely diagnosis here?
What is the management if there is maternal/ foetal compromise?
What is the management is there isn’t maternal/ foetal compromise?
Placental abruption
Maternal/ foetal compromise: emergency C section
No compromise: induction of labour
What is the 1st line management of menorrhagia if:
a) woman is trying to concieve & has no pain
b) woman is trying to concieve but has pain
c) woman is not trying to concieve
a) Tranexamic acid (anti-fibrinolytic)
b) Mefenamic acid (reduced bleeding & pain)
3) Mirena coil
What are the 2 types of instrumental delivery options commonly used?
Explain briefly how each are used to aid in delivery:
List some risk factors of instrumental delivery to the mother: (4)
Ventouse suction cup
Suction cup is put on babies head and is slowly pulled to help pull baby out of vagina
Forceps
Forceps are placed either side of babies head and babies head is slowly pulled out of vagina
- Perineal tears
- Episiotomy
- Postpartum haemorrhage
- (stress) Incontinence of bladder/ bowel
What is the prophylaxis used against pre-eclampsia?
Aspirin from 12 weeks gestation
What results of an OGTT are normal and thus above would qualify as gestational diabetes? (5,6,7,8!)
What is the initial management if fasting glucose is less than 7mmol/l?
What is the initial management if fasting glucose is more than 7mmol/l?
Results:
Fasting glucose: < 5.6 mmol/l
2h glucose: < 7.8 mmol/l
< 7 mmol/l: 2 week trial of diet & exercise → metformin
> 7 mmol/l: insulin +/- metformin
List some indications to induce labour: (6)
Prelabour rupture of membranes
Pre-eclampsia
Diabetes
Intrauterine fetal death
Obstetric cholestasis
Fetal growth restriction
Interpet the following:
G2 P2
2 pregnancies of which both have been delivered past 24 weeks gestation
Women with risk factors for gestational diabetes are tested at what point of gestation?
~ What is the test used?
~ How is this test performed?
What results of this test are normal and thus above would qualify as gestational diabetes? (5,6,7,8!)
OGTT - 24-28 weeks
~ Patient fasts throughout night, BM measured in morning before patient takes sugary drink (75g glucose) → BM measured 2h later
Results:
Fasting glucose: < 5.6 mmol/l
2h glucose: < 7.8 mmol/l
What is the 1st line investigation of suspected endometrial cancer?
What investigation is needed to diagnose & stage endometrial cancer?
Trans-vaginal ultrasound - to look for abnormal thickening of endometrium
Hysteroscopy with biopsy
List the investigations that can be done in someone presenting with urinary incontinence:
- Bladder diary (of at least 3 days)
- Urine dip (to check for infection/ haematuria/ any other pathology)
- Post-void residual bladder volume (to assess for incomplete emptying)
Urodynamic testing (mainly for patients with urge incontinence that aren’t responding to treatment)
In utero, oxygenated blood enters the foetus through what vessel?
What is the course of this vessel to the heart?
Through what mechanism does most foetal blood bypass the lungs?
Most blood that does enter the pulmonary artery still bypasses the lungs - how?
What does this drain into?
Umbilical vein
Umbilical vein→ductus venosus (through liver)→IVC→R atrium
Foramen ovale inbetween 2 atria
Through the ductus arteriosus
Ductus arteriosus drains into aorta
What is vasa praevia?
What are the triad of features commonly seen in vasa praevia presentation?
What is the management of vasa praevia? (planned/ unplanned)
Vasa praevia: occurs when the fetal blood vessels cover the internal cervical OS.
- Painless vaginal bleeding
- Rupture of membranes
- Fetal bradycardia → death
- *Planned management:** elective C-section 34-36 weeks (before membranes rupture spontaneously)
- *Unplanned management:** emergency C-section!
What are the clinical features of chorioamnionitis? (6)
Fever
Abdominal pain
Offensive vaginal discharge
Preterm rupture of membranes
Uterine tenderness
Maternal & foetal tachycardia
What is pelvic inflammatory disease?
PID occurs when an infection spreads from the vagina into the cervix and up into the upper genital tract
A baby is considered non-viable before which gestational week?
Week 23
If a woman is *Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don’t have the D antigen on their RBC’s so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events
Explain the pathology in each miscarriage & say whether miscarriage is certain or not:
a) Threatened miscarriage
b) Inevitable miscarriage
c) Complete miscarriage
d) Missed miscarriage
a) Threatened miscarriage:
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr
b) Inevitable miscarriage:
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable
c) Complete miscarriage
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred
d) Missed miscarriage
Asymptomatic, cevical os closed, foetus currently present intrauterine but is dead
What are the clinical features of an amniotic fluid embolism? (5)
High RR
Tachycardia
Hypotension
Hypoxia
Disseminated intravascular coagulopathy
The uterus returns to it’s non-pregnant size by how many weeks postpartum?
4 weeks
What is urge incontinence?
What is stress incontinence?
What is functional incontinence?
Urge incontinence = incontinence of urine caused by a sudden need to urinate (caused by an overactive bladder)
Stress incontinence = incontinence of urine caused by increased abdominal pressure, eg coughing, laughing, exercise
Functional incontinence = incontinence of urine caused by not being able to access a toilet
What is a complication of pre-eclampsia & eclampsia?
HELLP syndrome
Between which weeks gestation is the combined test usually performed?
Weeks 11 - 13
Where is the commonest location to find an ectopic pregnancy?
What is the best investigation to confirm an ectopic pregnancy?
Ampulla
Trans-vaginal US
What is the 1st line treatment of fibroids under 3cm in size if the patient doesn’t need to remain fertile?
IUS (Mirena coil)
Women that are at high risk of having a baby with down’s syndrome are offered 2 tests to provide a definitive answer. What are these tests?
Chorionic villus sampling
Amniocentesis
A 46 year old woman who is 7 weeks pregnant presents to her GP with vaginal bleeding. She also complains of severe nausea and vomiting over the last few days.
On examination, the symphysis-fundal height is 14cm. She is referred to the Early Pregnancy Assessment Unit where she has a trans-vaginal ultrasound, which is difficult to interpret but does identify some fetal tissue in the uterus.
What is the most likely diagnosis?
Partial molar pregnancy
*Partial as there is some fetal tissue present!
What 3 things are measured in the combined test during pregnancy?
If Down Syndrome was indicated, what results would you expect to see in the above?
Nuchal translucency (**increased** in downs) PAPP-A hormone (**decreased** in downs) Beta-hCG hormone (**increased** in downs)
Delayed puberty & anosmia (lack of smell) would suggest what condition?
What is the physiological cause behind delayed puberty in this condition?
Kallmann’s syndrome
Hypogonadotropic hypogonadism: hypothalamus doesn’t secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted
Weight loss is the initial step in improving fertility in women with PCOS, however if this fails to help, what medication can be used instead?
If the above medication doesn’t help, what is the 2nd line management option to increase fertility in these women?
Clomifene
Laparoscopic ovarian drilling
What are the 5 commonest in-utero causes of infection? (TORCH)
T - toxoplasmosis
O- other (syphilis & chickenpox (varicella-zooster virus))
R - rubella
C - cytomegalovirus
H - herpes simplex virus (HSV)
When would baby blues typically present?
When would postnatal depression typically present?
Baby blues: Within 2 weeks of delivery
Postnatal depression: several weeks after delivery up to 1y
What is the 1st line investigation of endometrial cancer? - what is this used to look for/ what is normal?
What investigation is done if the above is abnormal?
What is the management of stage 1 & 2 endometrial cancer? (cancer confined to cervix/ invaded cervix only)
- *Investigations:**
- 1st line:* Transvaginal US to look at endometrial thickness (should be <4mm)
- If ^ abnormal:* Endometrial biopsy (pipelle biopsy)
Management:
TAH & BSO
(total abdominal hysterectomy with bilateral salpingo-oophorectomy = removal of uterus, cervix & ovaries)
What condition is indicated if a woman presents with recurrent miscarriages & a history of VTE events?
What is the treatment of this condition? (2)
Antiphospholipid syndrome
Aspirin & LMWH
What hormone stimulates milk production?
What hormone stimulates milk contraction? (by contracting myoepithelial cells within the breast)
Prolactin
Oxytocin
Why does physiological anaemia occur during pregnancy?
Blood volume increases during pregnancy, but plasma volume > RBC = anaemia (as RBC’s are diluted!)
Which strains of HPV are associated with genital warts?
6 & 11
What hormone stimulates milk production?
What hormone stimulates milk contraction? (by contracting myoepithelial cells within the breast)
Prolactin
Oxytocin
What colour do gram 1) positive, 2) negative bacteria stain on gram staining?
1) Positive = purple
2) Negative = pink/red
What week of gestation is considered ‘term’? (and thus before this is ‘preterm’)
Week 37
What are the fertility sparing surgical managements for fibroids? (3)
Myomectomy (removes the fibroid from the uterine wall)
Radiofrequency ablation (induces necrosis of the fibroid so that it no longer bleeds)
Uterine artery embolism
What is the management of mastitis if it is caused by:
a) blocked milk duct
b) infection
If an infective cause of mastitis is suspected, how is it diagnosed?
What is a complication if an infective mastitis isn’t treated?
Blocked milk duct: conservative - analgesia & continuation of breastfeeding
Infection: antibiotics: flucloxacillin is 1st line + continuation of breast feeding
Milk sample is sent to lab for culture & sensitivities
Breast abscess (requires surgical inscision & drainage!)
Interpret the following:
G3 P1
3 pregnancies of which only 1 has been delivered past 24 weeks gestation
What is cord prolapse?
Why is this an obstetric emergency?
How is cord prolapse diagnosed?
What is the management of this?
Cord prolapse: occurs when the umbilical cord exits the cervix before the presenting part of the foetus does
EMERGENCY: the foetus can compress the cord → fetal hypoxia!!!!
Cord prolapse should be suspected if there are signs of foetal distress on the CTG
~ vaginal/ speculum examination can confirm it.
Women should lie in left lateral position/ knee-chest position until emergency C-section can be done
What are 2 side effects of the progesterone injection (depot injection)?
~ These S/E make it unsuitable for women over what age?
• Weight gain
• Osteoporosis
~ over 45y
Between which weeks gestation is considered as a ‘term’ delivery?
37 - 42 weeks
What are the 2 commonest causes of PID?
Gonorrhoea
Chlamydia
Explain urinary retention with overflow:
• state the commonest cause in males!
What are the treatments of overflow incontinence?
• Non-pharmacolgical
• Pharmacological
• Surgical
Stenosed urethra causing blockage of urinary flow
• benign prostatic hyperplasia
- *Nonpharmacolgical**-: suprapubic catheterisation (last resort)
- *Pharmacological**: Alpha blockers or anti-androgens
- *Surgical**: TURP (trans-urethral resection of prostate)
What are the non-surgical management options for stress incontinence? (3)
What are the surgical management options for stress incontinence? (3)
Non-surgical:
1. Lifestyle changes: avoid caffeine/ alcohol/ diuretics, weight loss
1. Pelvic floor exercises
2. Duloxetine (an SSRI used if surgery isn’t wanted)
Surgical:
~ Tension-free vaginal tape (a sling is looped under the urethra and to the abdominal wall, providing support to the urethra)
~ Colposuspension (stitches to connect the anterior vaginal wall & pubic symphysis around the urethra, providing support to the urethra)
~ Intramural urethral bulking (injections around the urethra to reduce diameter of urethra & add support)
What is chorioamnionitis?
Infection of the membranes in the uterus
A 48y/o woman presents with perimenopausal symptoms. Apart from suffering from migraines with aura, she does not have any relevant PMH. She has a FH of DVT. The patient’s last menstrual periods are irregular, the last one being 3 months ago. She is not currently on any contraception.
What would be the most suitable type of HRT?
Topical cyclical combined HRT
~ topical preferred over oral due to migraines with aura
~ cyclical as she is still perimenopausal
~ combined oestrogen + progesterone as she still has a uterus
List 2 methods of prophylaxis of preterm labour:
Vaginal progesterone pessary/gel - this prevents cervical ripening & decreases activity of the myometrium
Cervical cerclage - a stitch is put into the cervix to keep it closed until nearer term date
Is the MMR vaccine safe to be given during pregnancy?
No, it’s a live vaccine so shouldn’t be given to pregnant women or women trying to concieve.
Progesterone increases the risk of developing which type of cancer?
Oestrogen increases the risk of developing which type of cancer?
Breast cancer
Endometrial cancer
What normally happens to blood pressure during pregnancy?
In the first half of pregnancy (20-24 weeks), BP falls however it increases to pre-pregnancy levels by term.
A 35y/o woman is 28 weeks pregnant. Her pregnancy has so far been progressing well, with no known complications. She had glucose in her urine at her 28-week midwife appointment and so her fasting plasma glucose was measured. The result was 6.7mmol/L.
What levels of blood glucose would indicate a diagnosis of gestational diabetes in:
1. fasting blood glucose
- 2-hour blood glucose
What is the next step in this woman’s management?
If her fasting plasma glucose was 7.2mmol/L, what would the next management step be instead?
1. Fasting blood glucose: 5.6mmol/L
2. 2-hour blood glucose: 7.8mmol/L
A trial of diet and exercise should be offered
~ I**f glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
Fasting blood glucose above 7 = start insulin straight way!
Explain what a salpingectomy is:
Explain what a salpingotomy is:
Salpingectomy: removal of the ectopic pregnancy + whole fallopian tube
Salpingotomy: removal of the ectopic pregnancy only (fallopian tube remains intact)
Which antibiotic is used to treat mastitis?
Should women still breastfeed if they have mastitis and are taking the above antibiotic?
Flucloxacillin
YES, they are advised to still breastfeed if able!
Which 2 commonly used anti-epileptics are safe to use in pregnancy?
Lamotrigine & carbemazepine
A pregnant woman presents to the labour ward ready to deliver. She is 38-weeks pregnant and her pregnancy was uncomplicated. Her first child, who is now 1-year-old had neonatal sepsis caused by Group B Strep. She is otherwise well with no relevant PMH.
What management should be given to reduce the risk of Group B Strep transmission to the baby?
Intrapartum antibiotics (benzylpenicillin) given to the woman
