obs/gynae Flashcards
what happens to total plasma volume in pregnancy
increases by around 30-50%
what happens to kidney function in pregnancy
increases
what happens to BP in pregnancy
biphasic
decreases in early/mid pregnancy
increases in late pregnancy
what is aortocaval compression syndrome
compression of the abdominal aorta and inferior vena cava when pregnant woman lies supine
what speculum is used to examine prolapse
sims
lifestyle modifications for prolapse
weight loss
smoking cessation
reduce caffeine intake
avoid straining/constipation
what type of cells make up detrusor muscle
transitional epithelium
where do the sympathetic nerve fibres come off the spinal cord to relax the bladder
T11-L2
where do the parasympathetic nerve fibres come off the spinal cord to contract the bladder
S2-S4
what receptors are on the detrusor muscle
muscarinic M2 and M3
name some anticholinergics
oxybutynin
tolterodine
(propiverine, trospium, solifenacin)
side effects of oxybutynin
dry mouth
blurred vision
drowsiness
constipation
what class of drugs are given to manage incontinence
anticholinergics, antimuscarinics and beta-2 adrenergic agonists
name a beta-3 adrengeric agonist
mirabegnon
when is a person said to be in menopause
12 months of amenorrhoea
onset of symptoms if hysterectomy
what characterises perimenopause
irregular periods and symptoms
what are the central effects of decreased oestrogen levels in perimenopause
hot flushes/sweats
joint muscle/pain
low mood + sexual difficulties
what are the local effects of decreased oestrogen in perimenopause
vaginal dryness due to vaginal atrophy
non-hormonal medication to treat menopause
clonidine
indications for transdermal oestrogen
gastric upset e.g. crohns
need for steady absorption e.g. migraines/epilepsy
increased risk of VTE
older women
medical conditions e.g. htn
what is premature ovarian insufficiency
menopause <40
how do you diagnose premature ovarian insufficiency
FSH > 30 (2 samples more than 4 weeks apart)
4 months of amenorrhoea
medication often used for HRT in breast cancer patients
venlafaxine
problems with benzodiazepines in pregnancy
associated with cleft palate, neonatal withdrawal syndrome and floppy baby syndrome
avoid in 3rd trimester
potential problem with olanzapine in pregnancy
weight gain and increased risk of gestational diabetes
potential problems with risperidone in pregnancy
increased prolactin levels
potential problem with lithium in pregnancy
increased risk of abstain anomaly (tricuspid valve)
avoid in 1st trimester and when breast feeding
what is placenta acreta
when placenta attaches to myometrium
what is placenta increta
when placenta invades the myometrium
what is placenta percreta
when placenta invades through the myometrium
what is an endometrioma
collected old menstrual blood forming a ‘chocolate cyst when endometrial tissue grows on or in the ovaries
pain treatments for endometriosis
OCP, GnRH agonists to control cyclicality
oral progestogens, depot provera, morena coil for glandular atrophy
secondary care endometriosis treatment if fertility is desired
ablation
excision
secondary care endometriosis treatment if fertility is no longer desired
oophorectomy
pelvic clearance
what is adenomyosis
when endometrial tissue grows into the muscular wall of the uterus
how do you treat adenomyosis
hysterectomy
what are the 5 different types of uterine fibroids
pedunculated fibroid
intracavity fibroid
intramural fibroid
submucosal fibroid
subserosal fibroid
what are the 2 indicators of preeclampsia
proteinuria
hypertension
if a smear shows hPV positive and cytology negative when should a smear be repeated
in 12 months
name some associations with hyperemesis gravidum
trophoblastic disease (choriocarcinoma)
multiple pregnancies
hyperthyroidism
nulliparity
obesity
what does intrahepatic cholestsis of pregnancy present as and what does it put patient at higher risk of
intensive itching
risk of still birth (induction offered at 37/38 weeks)
when should progesterone bloods be taken in the menstrual cycle to check for ovulation
7 days before next menstrual period
when is lactational amenorrhoea a reliable method of contraception?
amenorrhoea
baby <6 months
exclusively breastfeeding
when should initial booking to midwife by made
8-12 weeks
when should ECV be offered if baby is breech
36 weeks
when should down syndrome screening with nuchal scanning be carried out
11-13+6 weeks
if a pregnant woman has a BMI >30, what investigation should she be offered, when and why
oral glucose tolerance test
24-28 weeks
test for gestational diabetes
how long do baby blues last for
3 days after giving birth
what is placenta previa
I - lower segment but not os
II - reaches os but doesn’t cover it
III - covers it but not when dilated
IV - completely blocks it
what type of ovarian tumour is associated with endometrial hyperplasia
granulosa cell tumours
what is the most common type of ovarian cancer
serous carcinoma
what can cause a raised AFP in a woman who is pregnant
omphalocele
what is HELLP syndrome
severe form of pre-eclampsia
haemolysis
elevated liver enzyme’s
low platelets
how would a patient with HELLP syndrome present
malaise
nausea
vomiting
headaches
3 main causes of bleeding in 1st trimester
spontaneous abortion
ectopic
hydatidiform mole (molar pregnancy)
what are the 3 most common causes of bleeding in the 2nd trimester
spontaneous abortion
hydatidiform mole
placental abruption
what are the 4 likely causes of bleeding in the 3rd trimester
bloody show
placental abruption
placenta previa
vasa previa
what are the 3 types of spontaneous abortion
threatened miscarriage
missed/delayed miscarriage
inevitable miscarriage (complete/incomplete)
how would a threatened miscarriage present
painless vaginal bleeding typically around 6-9 weeks
how would a missed/delayed miscarriage present
light vaginal bleeding and pregnancy symptoms disappear
how would an incomplete inevitable miscarriage present
heavy bleeding and cramps, lower abdominal pain
how would a hydatidiform mole typically present
bleeding in 1st/early 2nd trimester
exaggerated symptoms of pregnancy
uterus may be large for dates
Beta HCG may be high
how would placental abruption typically present
constant lower abdominal pain
woman more in shock than expected from visible blood loss
tender, tense uterus
normal lie and presentation
metal heart may be distressed
how would vasa praaevia typically present
rupture of membranes followed by immediate vaginal bleeding
fetal bradycardia
what is the diagnostic criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
what is the normal dose of folic acid
400 micrograms
what is the higher dose of folic acid given and when
5 milligrams
previous child with neural tube defects, on certain anti epileptics, diabetes, sickle cell, thalassaemia, BMI>30
what is the first stage of labour
onset of labour until 10cm cervical dilatation
what is the 2nd stage of labour
10cm cervical dilatation until delivery of the baby
what is the 3rd stage of labour
delivery of the baby until delivery of placenta
what is the latent phase of the 1st stage of labour
0-3cm
0.5cm/hour progression
irregular contractions
what is the active phase of the 1st stage of labour
3-7cm
1cm/hour progression
regular contractions
what is the transition phase of the 1st stage of labour
7-10cm
1cm/hour progression
strong, regular contractions
what does the ‘show’ refer to
mucus plug in cervix falling out and creating space for the baby to move down
what is used to treat eclampsia
magnesium
3 causes of primary amenorrhoea
- abnormal functioning of hypothalamus/pituitary gland
- abnormal functioning of gonads
- imperforate hymen
what does Kallman’s syndrome cause and what is it associated with
hypogonadotrophic hypogonadism
anosmia
what is the triad (Rotterdam Criteria) for diagnosing PCOS
oligoovulation/anovulation
hyperandrogenism
polycystic ovaries/ovarian volume >10cm3
what is the most common type of ovarian cyst
follicular
what are serous cystadenomas
benign tumours of the epithelial cells
what are mutinous cystadenomas
benign tumours of the epithelial cells
what are dermoid cysts/germ cell tumours
benign ovarian tumours derived from teratomas
what are sex cord-stomal tumours
rare - can be malignant or benign
several types:
- sertoli-leydig cell tumours
- granulose cell tumours
what is the triad of Meig’s syndrome
ovarian fibroma
pleural effusion
ascites
what would be seen on a pelvic ultrasound in ovarian torsion
whirlpool sign
free flu in the pelvis
oedema of the ovary
what is asherman’s syndrome
adhesions form in the uterus following damage to it
gold standard test for asherman’s
hysteroscopy
what are Nabothian cysts and what causes them
fluid filled cysts often seen on the surface of the cervix
mucus secreted by the endocervix (columnar epithelium) is trapped by the ectocervix (squamous epithelium)
what is a rectocele
defect in the posterior vaginal wall allowing the rectum to prolapse into the vagina
what is a cystocele
defect in the anterior vaginal wall allowing the bladder to prolapse into the vagina
what is a uterine procidentia
prolapse extending beyond the introitus
typical treatment for lichen sclerosis
clobetasol
what do the upper vagina, cervix, uterus and Fallopian tubes develop from
Mullein ducts (paramesonephria)
what is the most and 2nd most common cervical cancer
1st = squamous cell carcinoma
2nd = adenocarcinoma
what are the 2 strains of HPV that are responsible for most cervical cancers
16 and 18
what 2 proteins does hPV produce and what do they inhibit
E6 and E7
E6 inhibits P53
E7 inhibits pRb
what is the most common type of endometrial cancer
adenocarcinomas
what is the most common type and sub-group of ovarian cancer
epithelial cell tumours
- serous tumours
what is a Krukenberg tumour
metastasis in ovary usually from a GI tract cancer
- signet ring appearance under microscope
most common type of vulval cancer
squamous cell carcinoma
most common type of anaerobic bacteria associated with BV
Gardnerella vaginalis
what would BV look like under a microscope
clue cells
treatment for BV
metronidazole 2g single dose or 400g for 5-7 days (clindamycin as alternative)
most common cause of thrush/candidiasis
candida albicans
treatment for candidiasis
fluconazole 150 oral single dose
what is Lymphogranuloma Venereum (LGV)
affects lymphoid tissue around site of chlamydia (more common in MSM)
what are the primary, secondary and tertiary stages of LGV
1 - painless ulcer
2 - lymphadenitis
3 - proctitis
treatment for gonorrhoea when sensitivities are known/unknown
not known = IM ceftriaxone
known = oral ciprofloxacin
what is Fitz-Hugh-Curtis syndrome
complication of PID
- inflammation/infection of the liver capsule (Glisson’s)
= RUQ pain and potentially radiation to right shoulder tipq
what is the characteristic sign of Trichomoniasis and how is it treated
strawberry cervix
metronidazole 2g single dose or 400g 5-7 days
what is given to HIV patients with low CD4 count to protect from PCP
co-trimoxazole
what is given during a CS if a woman with HIV’s viral load is unknown/high
iV zidovudine
what bacteria causes syphilis
treponema palidum
what is primary syphilis
painless ulcer (chancre) at site of infection
what is secondary syphilis
involves systemic symptoms (Particularly skin and mucous membrane)
resolves 3-12 weeks
what is an Argyll Robertson pupil
finding in neurosyphilis
constricted pupil that accommodates when focusing on a near object but does not react to light
treatment for syphilis
deep IM dose of benzathie benzylpenicilin
when can the COCP be restarted after childbirth in women who are breastfeeding
6 weeks
a COCP containing what hormones is 1st line
(microgynon)
levonorgestrel
what type of progesterone in COCP is better for pMS
(Yasmin)
drospirenone
what 2 side effects are unique to the progesterone injection
weight gain
osteoporosis
medical management of an ectopic
methotrexate
medical management of a miscarriage
misoprostol
what are the 2 medical treatments given in an abortion
mifepristone
misoprostol
ultrasound appearance in a molar pregnancy
snowstorm
what is the triad of features in congenital toxoplasmosis
intracranial calcification
hydrocephalus
chorioretinitis
treatment for obstetric choleastasis
ursodoexycholic acid
what is given to relax the uterus before ECV
terbutaline (subcut)
what test is used to determine the dose of anti-D needed
Kleihauer
what are the 3 major causes of cardiac arrest in pregnancy
obstetric haemorrhage
pulmonary embolism
sepsis
what is cervical clearage
putting a stitch in the cervix to keep it closed
what antibiotic should be given in SROM to prevent chorioamnionitis
erythromycin
what is Bishop’s score used for, and what 5 things are assessed
determining whether to induce labour
- fetal station
- cervical position
- cervical dilatation
- cervical effacement
- cervical consistency
what Bishop’s score predicts a high chance of spontaneous labour
above 8
what is McRoberts manoeuvre
in shoulder dystocia
hyeprflexion of mother at the hip providing a posterior pelvic tilt
what is Rubins manoeuvre
in shoulder dystocia
reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder
what is woods screw manoeuvre
in shoulder dystocia
performed during rubins
other hand puts pressure on the anterior aspect of the posterior shoulder. top shoulder pushed forward, bottom shoulder pushed backwards in attempt to rotate the baby
what is Zavanelli manoeuvre
in shoulder dystocia
pushing baby’s head back into the vagina in order to have an emergency CS
what is the key risk to the baby in ventouse delivery
cephalohaematoma
what is the key risk to the baby with a forceps delivery
facial nerve palsy
what is the decision to delivery time for a Cat 1 CS
30 minutes
what is the decision to delivery time for a Cat 2 CS
75 minutes
what is Johnson manoeuvre
in uterine inversion
using hand to push the funds back up into the abdomen, hold for few minutes then administer oxytocin to induce a contraction
when can the copper coil or IUS be used following birth
either within 48 hours or after 4 weeks
most common bacteria causing mastitis
staph aureus
treatment for candida of the nipple
topical miconazole
typical pattern of postpartum thyroiditis
thyrotoxicosis - first 3 months
hypothyroid - 3-6 months
thyroid levels returning to normal within a year
what is Sheehan’s syndrome
rare complication of pph
drop in blood volume leading to avascular necrosis of the anterior pituitary gland
what is the presentation of Sheehan syndrome
reduced lactation
amenorrhoea
adrenal insufficiency/crisis
hypothyroidism
what is first line medical management for hyperemesis gravidarum
antihistamines e.g. cyclizine
what secretes HCG
syncytiotrophoblasts
for how long following a termination can pregnancy tests be positive for
up to 4 weeks
by what week should a patient be referred to a specialist for lack of fetal movements
24 weeks
what is the most common site of an ectopic
ampulla of the Fallopian tube
what is the treatment for PID
ceftriaxone followed by doxycycline and metronidazole
what is the first line treatment for stress and urge incontinence
urge = bladder retaining
stress = pelvic floor muscle training
how would an amniotic fluid embolism present
<30 minutes of delivery
respiratory distress
hypoxia
hypotension
when should magnesium be stopped for eclampsia
24 hours after last seizure
requirements for instrumental delivery to be carried out
FORCEPS
- fully dilated cervix
- OA position preferably
- Ruptured membranes
- Cephalic presentation
- Engaged presenting part
- Pain relief
- Sphincter (bladder) empty
how long before an IUS is effective
7 days
how long before an IUD is effective
immediately
how before the POP is effective
2 days
how long before the COCP is effective
7 days
how long before the implant and injection is effective
7 days
how far along in pregnancy would a woman have to be to be diagnosed with pre-eclampsia or pregnancy-induced hypertension
20 weeks
first line treatment for fertility issues in PCOS
clomifene
treatment for respiratory depression secondary to magnesium sulphate
calcium gluconate
criteria for ectopic pregnancies to be managed surgically
> 35mm in size and beta HCG > 5000
results on combined test indicating higher chance of Downs syndrome
thickened nuchal translucency
low pappa - A
increased beta HCG
what is given to manage PMS is COCP is contraindicated
low dose SSRI
if a semen sample is abnormal when should it be repeated
3 months
what procedure carries greatest risk of haemorrhage in a newborn if the mother has ITP
prolonger ventouse delivery
what procedure carries greatest risk of haemorrhage in the mother if she has ITP
C-section
Where would you see a Rokitansky protuberance
teratoma - dermoid cyst
why is aspirin contraindicated in breastfeeding
association with Reyes syndrome
1st line for primary dysmennorhoea
mefanemic acid
where is beta HCG secreted
trophoblastic cells of the blastocyst
what is the role of human placental lactogen
- mobilises glucose from fat reserves
- diabetogenic to increase nutrient supply to the blastocyst
- converts mammary glands into milk secreted tissue
what is the only antibody to cross the placenta
IgG
when do you give anti-D
28 and 34 weeks
what drug stops effect of oxytocin
atosiban
what level of the spine is an epidural given
L3-L4
3 infectious diseases screened for in pregnant women
HIV
Hep B
Syphillis
what are the 4 baseline parameters on CTG
Baseline foetal heart rate
FHR variability
number of accelerations
number of decelerations
what test result is diagnostic for pre-eclampsia
protein creatinine ratio > 30
what cell type produces oestrogen
granulosa
gold standard investigation for adenomyosis
MRI
when should methotrexate be stopped before trying to get pregnant
6 months
how is the thyrotoxicosis phase of postpartum thyroiditis managed
propanolol
an ectopic pregnancy located where increases risk of rupture
isthmus
how long should someone wait before resuming hormonal contraception after taking upsilatte
5 days
what would quadruple screening show in Edwards’ syndrome
decreased hcg, afp and oestrial
normal inhibin
what type of tumour is characterised by psammoma bodies on histology
serous cystadenocarcinoma
what do you give if a person is HER2 receptor positive breast cancer
trastuzumab
what can trastuzumab cause
cardiotoxicity and in turn heart failure
what can cause oligohydramnios
PROM
renal angenesis
IUGR
post term gestation
pre-eclampsia
what should be considered with postpartum continuous dribbling
vesicovaginal fistula
investigation for vesicovaginal fistula
urinary dye studies
how long do you take folic acid for
first 12 weeks
how long do you take vitamin d for
entire pregnancy
components of the bishops score
cervical position, consistency, dilation, effacement
foetal station
treatment for vaginal vault prolapse
sacrocolpoplexy
what is a normal foetal baseline rate
110-160
what is a normal foetal baseline variability
5-25
when is an acceleration/decelartion pathologically abdominal
change in 15 bpm for > 15 seconds
what are the causes of non-immune fetal hydrops
severe anaemia (parvovirus B19, alpha thalassaemia major, massive maternal-fetal haemorrhage)
cardiac abnormalities
chromosomal
infection (toxoplasmosis, rubella, CMV, varicella)
twin-twin transfusion syndrome in recipient twin
chorioangioma
when would CVS be carried out
11-14 weeks
when would amniocentesis be carried out
15-20 weeks
what sign is seen on transvaginal USS in an ectopic
bagal
indications for surgical management of an ectopic
> 35mm
BCG > 5000
fetal heart rate
pain/symptoms
how long do nulliparous women have to push
2 hours
how long do multiparous women have to push
1 hour
how long do you have for active management of 3rd stage
30 minutes!!
how long do you have for passive management of 3rd stage
1 hour
what is the Amsel criteria for BV
3/4 needed
white homogenous thin discharge
fishy odour
clue cells on microscopy
ph > 4.5
what do you give an oestrogen receptor positive post menopausal woman
anastrazole
what do you do with a woman who gets pregnant with stable hypothyroidism
increase levothyroxine by 25mcg
how many pulls are allowed on ventouse before c section
3 pulls
how often should people with pre eclampsia have their bloods taken
3 times a week
what is gold standard for confirming diagnosis of PCP
bronchoalveolar lavage
what colour will cancerous cells appear on colposcopy
yellow
when should women with gestational diabetes give birth by
40+6
how long after a termination can women have a smear
3 months
what is the treatment for a Batholian cyst
marsupialisation
what is Naegele’s rule to calculate EDD
add 1 year and 7 days onto LMP, subtract 3 months
order of layers dissected in a c section
skin
subcutaneous fat
rectus sheath
rectus abdominal muscle
peritoneum
uterine myometrium
amniotic sac
what is the inheritance of androgen insensiviitvy syndrome
autosomal recessive
where is vulval cancer most likely to affect
labia majora
signs/symptoms of androgen insensitivity syndrome
primary amennorhoea
little to no pubic or axillary hair
undescended testes
breast development may occur
management of lichen sclerosis
topical dermovate
which STI would you see colpitis macularis
trichomoniasis
what is criteria for RMI
ultrasound scan
ca125
menopausal status
what is chandelier sign
another name for cervical excitation
seen under microscope in syphilis
spirochaete
what tests should be done in women under 40 with complex ovarian cyst
Lactate dehydrogenase
AFP
HCG
what type of cancer is someone with lichen sclerosis at slightly higher risk of getting
squamous cell carcinoma of vulva
when can you have cervical smear after pregnancy
3 months
management of CIN and early stage 1a
LLETZ or cone biopsy
management of cervical cancer 1b and 2a
radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
management of cervical cancer 2b-4a
chemotherapy and radiotherapy
management of cervical cancer 4b
surgery, chemo, radiotherapy and palliative care
treatment of endometrial hyperplasia
mirena
continuous oral progesterons
how does a complete molar pregnancy occur
2 sperm fertilise an egg with no genetic material
how does a partial molar pregnancy occur
2 sperm fertilise normal egg
first line for heavy menstrual bleeding
mirena
hormonal blood test results for PCOS
Raised LH
high LH to FSH ratio
when would you induce someone showing signs of eclampsia
more than 34 weeks
gold standard for investigating PCOS
transvaginal
what could be seen on transvaginal ultrasound in PCOS
string of pearls
how do you reduce risk of endometrial hyperplasia and cancer in someone with pcos
Mirena coil
induce withdrawal bleed 3-4 months with cyclical progestogens (medroxyprogesterone acetate) or cocp
managing hirtuism in pcos
co-cyprindiol (cocp) - stopped after 3 months as increased risk of VTE
topical eflornithine (takes 6-8 weeks)
when would you take a IUD out in pID
symptoms not resolved in 72 hours
what is the process of foetal descent through birth canal
descent
engagement
flexion
internal rotation
crowing
extension of presenting part
external rotation of head
delivery
what is classed as polyhydramnios
AFI more than 24cm
what is classed as oligohydramnios
AFI less than 5
what is hypoactive sexual desire disorder
persistent deficient sexual fantasies and desire for sexual activities that causes marked distress and interpersonal issues
what is sexual aversion disorder
unwillingness to get involved in sexual activity, with avoidance to any touching or communication that may lead to sexual involvement
what is sexual arousal disorder
you’re interest in sex may still be there but have difficulty in becoming aroused/maintaining arousal
high risk factors for preeclampsia
HTN in previous pregnancy
CKD
autoimmune disease e.g. lupus
DM
chronic HTN
moderate risk factors for preeclampsia
1st pregnancy
>40
pregnancy interval > 10 years
BMI > 35
multiple pregnancy
FH of preeclampsia
when should you take aspirin for preeclampsia and why
12 weeks - gestation
1 high risk factor or 2 moderate
when can you try and delay birth
before 24 weeks, history of preterm birth, ultrasound showing cervical length of 25mm or less
2 methods of trying to delay birth
prophylactic vaginal progesterone
prophylactic cervical cerclage
what can you give and when when trying to improve outcome of preterm labour
tocolysis with nifedipine to suppress labour
corticosteroids before 35 weeks
IV magnesium sulphate before weeks to protect babies brain
delayed cord clamping
what age is primary amenorrhoea defined as with no other signs of pubertal development
13
treatment for mycoplasma genitalium
doxycycline 100mg twice daily for 7 days
azithromycin 1g stat, 500mg once a day for 2 days
when do you give prophylaxis for VTE from in pregnancy
28 weeks if 3 risk factors
12 weeks if 4
when do you carry on VTE prophylaxis for 10 days
BMI>40
c section
admission > 3 days
any surgical procedure
any medical co morbidities
