Obs And Gynae Flashcards
Indications for c section
Maternal reasons e.g infections such as herpes or eclampsia, cervical ca. Or previous uterine surgery. Cardiac disease, high HIV viral load over 1000 copies Foetal indications such as distress, position, cord prolapse or congenital anomalies Maternal-foetal implications such as rupture, placenta previa and failure of labour to progress.
What is the success rate of vaginal delivery after previous Caesarian (vbac)
60-80% with a 0.5-1% increased risk of rupture
Factors associated with decreased success of trial of labour after previous Caesarian section
Body mass index of 40 or more 2 or more previous c sections Previous c section for failure to descend into second stage of labour Infant weight over 4000g Maternal age over 35
What is placenta previa
Placenta previa is when the placenta is covering the cervix And can be categorised by: Complete - completely covering the cervix Partial - a portion is covering the cervix Marginal - extends just to the edge of the cervix
Incidence of finding placenta previa on 20 week scan
4% of 20 scans have an incidental finding of placenta previa. Most of which resolve by term and therefore follow up uss at x weeks is best in the absence of bleeding. 0.4% of pregnancies have placenta previa at term
Types of uterine incisions for c section
low segment Transverse - through non contractile portion of the uterus. The bladder must first be dissected off the uterus. Classic - vertical incision through the contractile fundus of the uterus. Higher risk of bleeding and adhesions as well as rupture with VBAC
Complications of a c section in order of most common to least common
Haemorrhage Infection Visceral injury Thrombosis
Types of breech position
Non cephalic Tranverse Footling
Assessment of breakthrough bleeding with women on OCP
Insert picture
Characteristics of trichomonas
Wet saline mount shows flagellated, motile organisms, pmns and WBC’s
Most common cause of spontaneous abortion
Aneuploidy
Signs and symptoms of trichomonas
Yellow green malodorous discharge 25% asymptomatic Petechiae on vagina and cervix
Signs and symptoms of candidiasis
White cottage cheese discharge Intense pruritus Swollen inflamed genitals Vulvar burning, dysuria, dyspareunia
Signs and symptoms of bacterial vaginosis
Grey thin diffuse discharge 50-75% asymptomatic Fishy odour especially after coitus Absence of vulval/vaginal irritation
How to prevent breast engorgement post partum
Frequent nursing 8-12 a day Optimal nursing position Satisfactory latch No breastfeed skipping during the first several weeks Avoidance of formula feedings in the first several weeks Can also try warm compress before feedings and cool compress in between
Highest maternal mortality rates are associated with which cardiac condition
Eisnmengers syndrome - where there is a communication between systemic and pulmonary system, with increased pulmonary resistance (right to left shunt) 50% risk of dying Fatal mortality also reaches 50%
Most common histology of cervical Ca
Squamous cell carcinoma
Differential for postmenopausal bleeding
Endometrial cancer until proven otherwise Endometrial polyps - treated with polypectomy Vaginal atrophy
Definition of menorhagia
Menstruation at regular cycle intervals but with excessive flow and duration
Differential for abnormal uterine bleeding
Polyp Adenomyosis Leiomyoma Malignancy Hyperplasia Coagulopathy Ovulatory disfunction Endometrial Iatrogenic Not yet classified PALM COEIN
Treatment of mild menorrhagia
NSAIDS Antifibrinolytics Combined ocp Progestin son d10-14 of each month More a IUD danazol
Contraindications to mirena use
Presence of pregnancy Uterine cancer or fibroids Uterine malformations Acute liver disease or liver tumors Breast carcinoma Existing pelvic inflammatory disease Uterine bleeding not previously diagnosed
Common acid base status in hyperemesis gravidarum
Metabolic alkalosis early on from vomiting but as vomiting becomes chronic you develop a mixed metabolic acidosis and metabolic alkalosis due to a higher anion gap which is usually due to the ketoacidosis which develops with startvation.
Most appropriate antibiotic from prophylaxis of post c section endometritis
Cefazolin
How does post c section endometritis present
Postpartum fever, uterine tenderness, foul smelling Lothian and leucoytosis.
post partum thyroiditis
variation of hashimotos and presents in a variety of ways. begins 1-4 months after delivery and can last 2-8 weeks. can be transient or become permanent. treatment is not usually necessary unless significant symptoms develop.
uterine inversion
severe abdominal pain, shock and uterine tissue outside the cervix. Give oxygen, crystalloids, stop oxytocin infusion and leave placenta in place. This is a life threatening complication of third stage of labour.
degrees of uterine inversion
- fundus is partially turned out 2. fundus passes through cervix but not outside vagina 3. fundus is prolapsed outside of the vagina 4. the uterus cervix and vagina are outside and visible
risk factors for developing DVT post delivery
BMI>30 emergency C section cesarian hysterectomy previous DVT known thrombotic disorder age>35 parity>3 current infection major illness immobility > 4 days prior to surgery pre eclampsia gross varicose veins
absolute contraindications for HRT
severe liver disease undiagnosed vaginal bleeding venous thrombosis known or suspected breast or uterine cancer
relative contraindications include
hypertriglyceridemia uncontrolled hypertension migraine headaches history of uterine fibroids history of breast cancer atypical ductal hyperplasia of the breast active gallbladder disease
risk factors for endometrial cancer
long term exposure of non opposed oestrogen high cumulative doses of tamoxifen estrogen producing tumors obesity nulliparity diabetes hypertension thyroid or gallbladder disease older age history of infertility late age of natural menopause early age of menarche menstrual irregularities white race
risks of having intrahepatic cholestasis during pregnancy
prematurity fetal distress increased perinatal mortality
intrahepatic cholestasis of pregnancy
rare, presents in 3rd trimester - usually as itching can become jaundice. Usually have elevated Bilirubin with relatively normal transaminases.
total bile acids are most specific and sensitive test
most common cause of jaundice during pregnancy
acute viral hepatitis
Bishops score
lichen sclerosis
benign chronic inflammatory progressive dermatological condition found in the anogenital region
cervical insuffieciency
inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of contractions
tranvaginal USS from 12 weeks is recommended to assess cervix length <25mm is considered short
management of cervical insufficiency
cervical clervage
hydroxyprogesterone caproate weekly from 16 weeks up to 36 weeks gestation
diagnositic criteria for severe pre eclampsia
systolic BP greater than 160 on 2 occassions 6 hours apart
proteinuria greater than 5g in 24h collection or 3+ on 2 random urine samples
oliguria less than 500ml in 24h
persistent headache or visual disturbances
pulmonary oedema or cyanosis
concerning abdominal pain
impaired LFTs
thrombocytopenia
oligohydraminos
decreased fetal growth
placental abruption
FIGO Staging
staging for endometiral cancer
Ia cancer has invade less the myometirum
Ib cancer has invaded greater than half the myometrium
II cervical involvement without sread outside uterus
III regional spread to adenexa/serosa, lymph nodes etc
IV cancer in bladder, rectum and outside the pelvis
types of endometrial cancer
Type 1 - low grade estrogen related
Tyoe 2 - high grade not estrogen related
How is cervical ripening performed
prostaglandins or special devices
