Obs & Gynae Flashcards
What is miscarriage?
Spontaneous expulsion of products of conception before week 24 of pregnancy
Define menorrhagia?
Excessive blood loss >80ml with regular menstruation
What are the maternal cause of miscarriage? General and Local causes. 5 things
GENERAL Age Obesity Septicaemia Severe hypertension/Renal disease Diabetes Hypothyroidism Trauma
LOCAL Fibroids Congenital uterine malformations Adenomysis Incompetent internal os Hormone deficiency
Give 3 fetal causes of miscarriage?
Genetic abnormalities
Congenital malformations
Faulty implantation
What are the symptoms of a threatened miscarriage?
Scanty uterine bleeding
Pain usually absent; may be slight uterine contractions and backache
On examination, give 2 things that might be seen in a threatened miscarriage?
Active breasts (enlarged and tender)
Enlarged uterus
Closed cervix
No pelvic tenderness
What is the management for a threatened miscarriage?
Rest until bleeding has ceased. After bleeding, woman to resume normal life
What are symptoms of an inevitable miscarriage?
Bleeding
Pain-Crampy low abdominal pains
Give 2 examination findings in an inevitable miscarriage?
Uterus enlarged
Internal os of cervix open (products of conception may be felt)
Low BP/Pulse
What is the management of an inevitable miscarriage?
Remove any products from the open os
Evacuation of retained products of conception
Excessive bleeding-give Ergometrine
What is an incomplete miscarriage?
When some of the products of conception are retained in the uterus
What is the management of an incomplete miscarriage?
Prostaglandins to evacuate products
Evacuation of the uterus in the theatre
What is the definition for recurrent miscarriage?
3 consecutive spontaneous miscarriages
What are the risk factors for ectopic pregnancy? 4 things
PID Previous pelvic surgery Previous ectopic surgery Intrauterine device POP Sterilisation Emergency contraception
What are the 4 common associations to recurrent miscarriages?
Anti phospholipid syndrome
Polycystic ovaries
Incompetent cervix
Fibroids
How do you investigate a couple with recurrent miscarriages?
Anti Phospholipid Syndrome: Lupus anticoagulant and anticardiolipin antibodies. 2 positive results
PCOS: LH, FSH and Testerone levels + U/S
Cervical incompetence: Hysterosalpingography and Transvaginal U/S
Give 3 ways a tubal pregnancy can terminate?
Absorption
Tubal abortion-products expelled into peritoneal cavity
Tubal rupture
Secondary abdominal pregnancy
What are the causes of infertility in both partners?
Mechanical difficulty
Periods of separation
Give 3 causes for infertility in males?
Impotence Premature ejaculation Azoospermia/oligospermia (<20) Poor sperm motility Abnormal morphology
Give 4 areas where infertility could arise from in females?
Fallopian tubes-obstructed by infection
Ovaries-anovulation, PCOS, Peri menopausal
Intact hymen
Vagina-congenital malformation
Uterus-malformation or tuberculous endometritis
What is the action of the COCP?
Inhibits ovulation
Modifies endometrium preventing implantation
Thickens cervical mucus
Give 3 advantages of the COCP?
Most effective reversible birth control
Method doesn’t affect intercourse
Dysmenorrhea and menorrhagia are eased
Menstruation becomes regular
Hb levels maintained so anaemia less common
What are the risk factors for cervical malignancy? 4 things
High parity Multiple sexual partners Early first coitus Smoking Long term use of oral contraceptives
Give 2 indications for a colposcopy referral?
Two consecutive borderline smears
Dyskaryosis
3 abnormal smears in 5 years
2 consecutive smears inadequate for assessment
Give 3 side effects of the COCP?
Fluid retention and weight gain
Thromboembolism
Skin pigmentation
Migraine aggravation
When should emergency contraception be administered?
Within 72 hours
Give 4 contraindications to COCP use?
History or FHx. of thrombophlebitis, severe heart disease or cerebrovascular accidents
40y/o+, obese and heavy smoker
Liver damage
Hx. of breast cancer
> 30 BMI
Moderate hypertension (>160 systolic)
Give 3 types of barrier contraception?
Condoms
Cervical diaphragm
Female condom
Spermicide
Give 3 problems attached with using a copper intrauterine device?
Expulsion from uterus
Pelvic infection
Dysmenorrhea/Menorrhagia
State 3 contraindications to using an intrauterine device?
Pregnancy
Current pelvic/ST infection
Gynaecological cancer
Give 4 symptoms of endometriosis?
Dysmennorrhea
Deep dyspareunia
Ovulation pain
Infertility
State 3 investigations in endometriosis?
Laparoscopy (gold standard)
USS
MRI
Give 3 ways to manage endometriosis?
Medical: simple analgesia, hormones (COCP, POP, GnRH)
Surgical: excision, laparoscopic ablation
Give the antibiotic of choice for chlamydia infection?
Doxycycline
Define primary and secondary amenorrhea?
Primary: Absence of menses at 14 (without secondary sexual characteristics)
OR Absence of menses at 16
Secondary: Absence of menses for 6 months after period of regular menses
Name 5 causes of amenorrhea?
Pregnancy Menopause Head injury, Tumour Weightloss Hypopituitarism PCOS
State 5 clinical features of PCOS?
Oligo/Amenorrhea Infertility Hirtuism Obesity Acanthosis nigricans on flexural surfaces
Give 5 ways you can manage PCOS?
Lifestlye changes (lose weight, stop smoking, exercise etc.) Supportive
Metformin - increase insulin sensitivity
Clomifene - induce ovulation for infertility
COCP - increase sex hormone binding globulin
Cosmetic - hair removal
State 4 ways fibroids can be managed?
Medical:
IUCD
GnRH analogues
Surgery:
Hysterectomy (definitive)
Myomectomy
Give 4 risk factors for developing endometrial cancer?
Unopposed oestrogen therapy Obesity Nulliparity Late menopause FHx Tamoxifen
If a patient is experiencing post menopausal bleeding, what differentials come to mind?
Endometrial/cervical carcinoma Vaginitis Polyps Oestrogen withdrawal (stopping HRT) Foreign body
State 6 immediate complications of menopause?
Vasomotor: Hot flushes, Night sweats
End organ atrophy: Vaginal dryness, dyspareunia, dysuria
Psychological: Depression, loss of libido
Give 2 long term complications of menopause?
Osteoporosis
Cardiovascular disease
State 4 possible complications of HRT?
Unopposed oestrogens: increased risk of endometrial/ovarian cancer
Increased risk of breast cancer
Increased risk of IHD and CVA
Increased risk of venous thromboembolism
How can you estimate the date of delivery?
EDD=LMP+1year-3months+7days
What are the 3 stages of labour?
Creation of birthing canal
Expulsion of foetus
Expulsion of placenta
What drug is given in the 3rd stage of labour and whats its action?
Syntometrine (oxytocin and ergometrine)
Stimulation of uterine contraction and smooth muscles in blood vessels to contract
Expulsion of placenta and reduces risk of PPH
How is Premature rupture of membranes managed?
Administration of: Prostaglandinds and oxytocin to induce labour
If there is meconium in the liquor, what 2 steps must be taken?
Fetal blood sampling
Scalp electronic monitoring (CTG)
?C-section (thick meconium or low foetal pH)
Name 4 ways pain relief can be achieved during labour?
Simple: breathing exercises, relaxation techniques, water immersion
Narcotic injections (pethidine) IM
Nitrous oxide (entonox)
Spinal block
Epidural anesthesia
Transcutaneous electrical nerve stimulation (TENS)
How can a breech presentation be managed?
External cephalic version (ECV)
C-Section
Give 3 indications for induction of labour?
Prolonged pregancy Hypertension Pre-eclampsia Rhesus disease PROM
Give 6 causes of dystocia?
Difficulty in labour
Passage: Abnormal bony pelvis, Cervical dystocia (fail to dilate)
Passenger: Large (macrosomia, hydrocephalus), Malpresentation
Powers: Insufficient activity, hypotonic contractions, Uncoordinated contractions
How might a problem with contractions be managed during labour?
Hydration
Analgesia (pain & fear produces catecholamines which can inhibit uterine activity)
Amniotomy
Oxytocin infusion
What are 4 indications for forceps delivery?
Delay in the second stage of labour (failure of maternal effort e.g. exhaustion, epidural analgesia or malposition of fetal head)
Complications in the second stage (fetal distress, prolapsed cord, ecalmpsia)
Prevent undue maternal effort (cardiac disease, respiratory disease, pre-eclampsia)
Breech delivery
What are 3 possible complications of forceps deliever?
Maternal trauma
Foetal bruising
Foetal facial nerve paralysis (usually resolves)
Foetal brachial plexus injury
Give 6 indications for emergency C-Section?
Severe pre-eclampsia Placental abruption Foetal distress Failure to progress Prolapsed cord Failed induction of labour
What are the TORCH infections?
Infections passed from mother to foetus which can have severe consequences?
Toxoplasmosis Others: syphillis, VZV, HIV, Parvovirus Rubella Cytomegalovirus Herpes simplex
How are the TORCH infections managed?
High dose aciclovir
What 4 pieces of advice will you give to a woman at her first antenatal clinic appointment?
Folic acid supplements
Lifestyle advice (smoking and alcohol cesation)
Food hygiene
Antenatal screening tests available (anomalies, downs syndrome, haemoglobinopathies)
What 2 tests can be done to screen for downs syndrome and when?
1st trimester: Combined test (nuchal translucency, bHCG, pregnancy assosciated plasma protein, womans age)
2nd trimester: Quadruple test (bHCG, Alpha fetoprotein, Inhibin A, unconjugated estriol)
How is gestational diabetes and pre-eclampsia screened?
Oral glucose tolerance test
&
Blood pressure and protein in urine
State 4 causes of a large for gestational age foetus?
Constitutionally large
Maternal diabetes
Intrauterine infections
Hyperinsulinaemia
State 4 possible complications of intrauterine growth restriction?
Hypoxia Hypothermia Jaundice Hypoglycaemia Infection
Give 4 possible causes of intra uterine growth restriction?
Maternal: poor nutrition, smoking/alcohol
Foetal: abnormality, infection
Placental: failure of trophoblast invasion
Give 5 possible complications of pre-eclampsia?
Eclampsia Cardiac/pulmonary oedema Acute renal failure HELP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count) Placental abruption Foetal death
How can pre-eclampsia be managed?
Primary prevention: calcium supplements/aspirin
Medical: magnesium sulphate prevents seizures, antihypertensives (labetalol), steroids for foetal lungs, induction of labour
Surgery: C-Section
Delivery is the only cure!
Give 4 risk factors for developing pre-eclampsia?
FHx of pre-eclampsia Primigravida Past Hx of pre-eclampsia Multiple pregnancy Extremes of maternal age
Give 4 problems associated with twin pregnancies?
Malpresentation Polyhydramnios Conjoined twins IUGR Low birth weights
Give 5 possible complications to the foetus from gestational diabetes?
Macrosomia Shoulder dystocia Hypoglycaemia Hypoxia Intrauterine death/Miscarriage
State 4 conditions which are suggested by presence of hyperemesis gravidarum?
Multiple pregnancy
Thyrotoxicosis in pregnancy
Molar pregnancy
UTI in pregnancy
Give 4 things you look for on vaginal examination during labour?
Cervix (consistency, effacement and dilatation) Intact membranes Colour of amniotic fluid Presenting part Size of pelvic outlet
Give 4 signs on a CTG that might indicate foetal distress?
Absence accelerations
Presence decelerations
Decreased baseline activity
Baseline tachycardia/bradycardia
What is the difference between an epidural and a spinal anaesthetic?
Epidural anaesthetic is inserted in the potential space between dura mater and periosteum inside the vertebral column
Spinal anaesthetic is inserted into CSF fluid after piercing the dura mater
State 4 risk factors for prematurity?
Extremes of maternal age Smoking PROM Prev. preterm labour Drug abuse
How can you prolong labour?
Tocolytics: Beta agonists (Terbutaline) Calcium channel blockers (Nifedipine)
State 3 risk factors of developing cervical cancer?
Multiple sexual partners
Smoking
Early onset of sexual activity
Give 4 ways you can manage prolapse in women?
Lifestyle: Lose weight, stop smoking Topical oestrogens Pessary Pelvic floor physiotherapy Surgery
What are the advantages and disadvantages of breast feeding? Give 3 each
Advantages for the baby: Reduced diarrhoea Reduced risk of infections Advantages for the mother: Reduced risk of breast CA+ ovarian CA Bonding with the baby
Disadvantages:
Volume of intake is uncertain
Transmission of drugs
Insufficient vit K/vit D
Give 3 differences of amniocentesis and chorionic villius sampling?
Time to test
Chorionic villus sampling = 10wks-20wks
Amniocentesis = 16wks+
Foetal death
Chorionic villus sampling = 4%
Amniocentesis = 1%
Neural tube defects
Chorionic villus sampling = Not detected
Amniocentesis = Detected
State 3 ways you can manage menorrhagia?
Progesterone containing IUCDs (Mirena)
Antifibrinolytics (Tranexamic acid)
Antiprostaglandins (Mefenamic acid)
Endometrial resection
Give 4 clinical features of fibroids?
Menorrhagia
Fertility problems
Pain
Palpable mass
How might vaginal thrush present?
Red and sore
Non offensive with white curds
Around vagina and vulva
How can you treat vaginal thrush?
Topical Tx. Cotrimazole and cream
Oral fluconazole
How can you differentiate Trichomoniasis and Bacterial vaginosis?
Trichomoniasis produces vaginitis and sexually transmitted
BV mostly asymptomatic
BOTH produce fishy odour
BOTH treated by Metronidazole
