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Phase 3a ILA > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

Causes of pelvic pain and one sx and ix

A

PID (STI- endocervical swab)

Endometriosis (cyclical - laparoscopy)

Ectopic (shoulder tip pain - preg test)

Miscarriage (check OS, preg test)

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2
Q

Types of miscarriage and examination findings

A

Threatened - OS closed, uterus expected size, bleeding

Inevitable - OS open, heavier bleeding

Incomplete - OS open, some fetal parts passed

Complete, OS closed, all fetal tissue passed

Missed - OS closed, uterus smaller than expected, fetus not developed or died in utero

Septic - uterus contence infected, offensive vaginal loss, tender uterus

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3
Q

PID examination findings and investigations

A

OE bilateral adnexal tenderness and cervical excitation

  • gold standard - laparoscopy with fimbrial biopsy
  • endocervical swabs - chlam and gono
  • high vaginal swabs (TV, BV)
  • urine dip
  • preg test
  • pelvic USS
  • Blood cultures if fever
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4
Q

PID management

A

Abx

IM ceftriaxone + PO doxy and metronidazole BD 14 days

Severe: doxy + IV ceft and metron -> PO doxy and mentron as above

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5
Q

PID complications

A
  • increased ectopic risk
  • >abscess formation
  • >tubal obstruction
  • subfert
  • chronic pelvic pain
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6
Q

Endometriosis OE

A

fixed retrovertered uterus

adnexal mass

tenderness

can be normal

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7
Q

Endometriosis investigations

A

laparoscopy with biopsy (gold standard)

TAS/TVS

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8
Q

Endometriosis management

A

*aims to increased oestrogen and progesterone to maintain endometrium*

  • COCP
  • GnRH agonist
  • IUS
  • pain relief: naproxen

Surgery - laparoscopy ablation, hysterectomy

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9
Q

Define primary and secondary amenorrhoea

A

primary - hasnt started by 16

seconday - cessation > 6m

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10
Q

Primary amenorrhoea causes

A

Secondary signs present

  • late puberty
  • inperforated hymen
  • hyperprolactinaemia

Secondary signs abscent

  • Turners
  • Ovarian failure
  • CAH
  • hypothalamic failure (stress, low weight, high weight)
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11
Q

Secondary amenorrhoea causes

A
  • Physiological: Pregnancy, lactation, menopause
  • Hypothalamus - hypothalamic hypogonadism, low weight
  • Pituitary - hyperprolactinaemia, tumour, Sheehans
  • Ovary - PCOS
  • Outflow - Ashermanns
  • Hypo/hyper thyroid
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12
Q

Amenorrhoea investigations

A
  • preg test
  • FSH >20 on 2 occasions and high LH = ovarian failure
  • short stature + high LH/FSH = Turners
  • Prolactin >1000 X2 -> hypothalamic pituitary MRI
  • TFT
  • Pelvic USS = PCOS
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13
Q

PPH causes

A

Tone

Traume

Tissue

Thrombin

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14
Q

PPH risk factors

A

Long labour

anaemia

large baby

grand multip

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15
Q

PPH management

A

oxytocin

IV fluids

remove placenta

catheter and UO

min 4lts blood product

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16
Q

APH causes

A

Placental abruption

Placenta Praevia

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17
Q

Placenta praevia RF

A
  • Previous CS
  • Hx
  • increased parity
  • increased age

(more stretchy)

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18
Q

Placenta Praevia presentation and investigations

A

often incidental USS finding (breech and transverse)

intermittent painless bleeds

Fetal wellbeing

19
Q

Placenta praevia management

A

hospital from 34 weeks

C-section - delay until at least 38 weeks if possible

20
Q

Placental abruption RF

A
  • Lifestyle: smoking, cocaine
  • Medical; Hx, HTN, Pre E
  • Preg: IUGR, twins
21
Q

Placental abruption presentation

A

Painful dark bleeding, tachy, hypo, tender uterus

severe - woody uterus, materal collapse, fetal distress

22
Q

Placental abruption investigations and treatment

A

fetal well being (CTG, USS)

Mx: ABCDE, IV fluids, bloods, G&S, delivery if fetal distress or >37 weeks

23
Q

Placenta praevia complications

A
  • obstructs head engagement
  • haemorrhage
  • placenta accreta/percreta
24
Q

What would you prescribe to a patient at risk of PPH

A

syntometrine

AKA oxytocin

25
What is a miscarriage?
spontaneous fetal death before 24 weeks
26
Miscarriage symptoms
bleeding and pain O/E inspect OS and uterine size
27
Ix for suspected miscarriage?
USS hCG (66% increase in viable pregnancy)
28
Miscarriage management
* Immediate: Anti-D to rhesus -ve if surgery oxyocin to reduce bleeding, remove POC with forceps * Conservative: 2-6 weeks will come out * Medical: misoprostol (vaginal or oral) * Surgery:vacuum aspiration * after: counselling
29
Recurrent miscarriage testing
Antiphospholipid syndrone: anti-cardiolipin antibodies (mx- aspirin and LMWH, warfarin if not trying to conceive) Parental karyotype Pelvic USS
30
RF for ectopic preg
* PID * Pelvic surgery * Smoker * Higher maternal age Copper IUD doesnt prevent tubal implantation
31
Ectopic symptoms and examination findings
lower abdo pain (colicky -\> constant) dark vaginal bleeding syncope and shoulder tip pain O/E tachy, tednerness, cervical excitation
32
Ectopic management
ABCDE + Anti D Medical: methotrexate (\<3cm, no cardiac activity, hCG\<3000) Surgical: salpingectomy or salpingotomy + Anti D if rhesus -ve
33
Define small/large for dates, fetal growth restriction, macrosomia
SFD: weight of fetus \<10th centile for gestational age LFD: weight of fetus \>10th centile for gestational age FGR: fetus failed to reach growth potential (determined by estimated fetal weight and projectile) Macrosomia: birth weight \>4kg regardless of gestational age
34
What is fetal growth dependent on?
maternal - height, weight, drug use, disease, infection, multiple preg fetal - genetics, structural problems, infection (TORCH), hormones
35
How are fetus' measured and what is on a customised chart
CRL \<13+6\< HC (FL, AC) ethnicity, parity, BMI, previous baby weights
36
What is the fetal response to placental insufficiency
Reduced 02 increased C02 causes chemoreceptor response Vasodilation - brain, myocardium, kindyes, adrenals vasoconstriction - splanchinic vessels, limbs\*, subcut tissue\*, liver, kidneys (impaired fetal urine output and oligohydramnios) \*decreased AC, increased risk of hypothermia and hypoglycaemia after birth Hypoxia -\> increased RBC to 02 carrying capacity -\> jaundice
37
Describe the management of a ?macrosomia pregnancy
assess every 4/52 umbilical artery doppler 2/52 for fetal wellbeing
38
What is cervical ripening
biochemical changes in cervix that take place over the last few weeks of gestation. Cervix softens and stretching potential increases
39
What is the first stage of labour and what happens when there is failure to progress
initiation -\> full dilatation latent: up to 3cm, several hours active: up to 10cm, 1cm/h nulli, 2cm/h multip. head rotation OT-\> OA/OP FTP: ARM-\> oxytocin (couple hours) -\> c-section (after 12-16 hours)
40
What is the second stage of labour and what happens when there is failure to progress
full dilatation -\> fetal delivery passive: head reaches pelvic floor, mins active: mum pushing, fetus delivered 40m nuli, 20m multip Delivery: head reaches perineum, shoulders delivered first FTP: oxytocin, episotomy or instrumental (maternal exhaustion after \>1h so sponteanous deliery unlikely)
41
What are the 3 P's and how do they contribute to failure to progress + management
1) power - ineffective uterine action tx- ARM then oxytocin - hyperactive uterine action -\> fetal distress Tx terbutaline then csection 2) passenger Occipito posterior position (augmentation, instrumental Csection) Occipito transverse (ventouse) Brow (C section) Face presentation (flex over perineum) 3) passage C section
42
What is the 3rd stage of labour
Placental delivery oxytocin IM to help uterus contract and prevent PPH
43
What is the mechanism of labour
descent flexion int. rotation crowing extension restitution internal restitution lat flex

Phase 3a ILA (4 decks)

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