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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
Q

What is a miscarriage?

A

spontaneous fetal death before 24 weeks

26
Q

Miscarriage symptoms

A

bleeding and pain

O/E inspect OS and uterine size

27
Q

Ix for suspected miscarriage?

A

USS

hCG (66% increase in viable pregnancy)

28
Q

Miscarriage management

A
  • 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
Q

Recurrent miscarriage testing

A

Antiphospholipid syndrone: anti-cardiolipin antibodies (mx- aspirin and LMWH, warfarin if not trying to conceive)

Parental karyotype

Pelvic USS

30
Q

RF for ectopic preg

A
  • PID
  • Pelvic surgery
  • Smoker
  • Higher maternal age

Copper IUD doesnt prevent tubal implantation

31
Q

Ectopic symptoms and examination findings

A

lower abdo pain (colicky -> constant)

dark vaginal bleeding

syncope and shoulder tip pain

O/E tachy, tednerness, cervical excitation

32
Q

Ectopic management

A

ABCDE + Anti D

Medical: methotrexate (<3cm, no cardiac activity, hCG<3000)

Surgical: salpingectomy or salpingotomy + Anti D if rhesus -ve

33
Q

Define small/large for dates, fetal growth restriction, macrosomia

A

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
Q

What is fetal growth dependent on?

A

maternal - height, weight, drug use, disease, infection, multiple preg

fetal - genetics, structural problems, infection (TORCH), hormones

35
Q

How are fetus’ measured and what is on a customised chart

A

CRL <13+6< HC (FL, AC)

ethnicity, parity, BMI, previous baby weights

36
Q

What is the fetal response to placental insufficiency

A

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
Q

Describe the management of a ?macrosomia pregnancy

A

assess every 4/52

umbilical artery doppler 2/52 for fetal wellbeing

38
Q

What is cervical ripening

A

biochemical changes in cervix that take place over the last few weeks of gestation. Cervix softens and stretching potential increases

39
Q

What is the first stage of labour and what happens when there is failure to progress

A

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
Q

What is the second stage of labour and what happens when there is failure to progress

A

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
Q

What are the 3 P’s and how do they contribute to failure to progress + management

A

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
Q

What is the 3rd stage of labour

A

Placental delivery

oxytocin IM to help uterus contract and prevent PPH

43
Q

What is the mechanism of labour

A

descent

flexion

int. rotation

crowing

extension

restitution

internal restitution

lat flex

Phase 3a ILA (4 decks)

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