Obs gynae Flashcards
Prophylactic measures for all women undergoing total abdominal hysterectomy?
Co-amoxiclav IV intraop
What is the definitive treatment for leiomyomata?
Leiomyomata : fibroids
Hysterectomy
What obstetric complications can occur due to fibroids?
Red degeneration
Malpresentation
C section
A 25-year-old woman presents 5 months after having dilation and curettage for a miscarriage. Since this procedure she has not had a period. A pregnancy test is negative. Hysteroscopy is performed which reveals the diagnosis.
Asherman’s syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would.
Hypothalamic dysfunction
The gonadotrophin levels should rise in response to low levels of oestradiol, due to hormonal feedback on the hypothalamic-pituitary axis. As this feedback is absent it suggests hypothalamic dysfunction. Causes of hypothalamic amenorrhea can include excessive: exercise, stress or dieting. It is important to ask about these risk factors in your history.
Melanocytic naevi and cubitus valgus (wide carrying angle) are also features ?
of Turner’s syndrome
Androgen insensitvity syndrome
A 45-year-old woman presents to the outpatient gynaecology clinic with complaints of nausea, severe menstrual cramps and heavy menstrual bleeding that have been worsening over the past few months. On further questioning, she reports pain mostly in the lower abdomen radiating to her back. She has a past medical history of acne for which she takes lymecycline. She is sexually active with a regular partner and uses barrier contraception. She has one child who is sixteen years old. On examination, the gynaecologist notes an enlarged, boggy uterus.
What is the most likely diagnosis for this patient?
Adenomyosis
Because of ‘boggy enlarged’
otherwise it was giving fibroids
True or false:
The menopause is associated with an increase in follicle-stimulating hormone
During the menopause, follicles disappear and are replaced by fibrous tissue. The decreased production of oestrogens from the ovaries results in the loss of the negative feedback effect of oestrogens on the anterior pituitary and a rise in follicle-stimulating hormone (FSH). This rise in FSH can be measured and used to verify the start of menopause. This is the most accurate blood test in confirmation of menopause.
True or false
Both oestrogen and progesterone are necessary for ovulation to take place
Both FSH and luteinising hormone (LH) are needed for ovulation to take place. Follicle-stimulating hormone (FSH) stimulates a follicle to develop, and LH to trigger ovulation.
True or False
Oestrogen concentration peaks just before menstruation
Oestrogen production during the menstrual cycle is principally 17β-oestradiol. It increases steadily during the follicular phase to reach a peak before ovulation.
True or false
Oestrogen production is confined to ovarian tissue
Oestrogen production is mainly confined to ovarian tissue, but the adrenal cortex and adipose tissue contribute to oestrogen production. Adipose tissue contains an aromatase enzyme that converts androgens to oestrogen. This is how oestrogen continues to be produced after menopause as the ovarian tissue fibroses.
True or false
Fertilisation of the human ovum normally takes place in the uterus
Fertilisation of the human ovum normally takes place in the outer third of the Fallopian tubes rather than the uterus. The fertilised egg implants in the uterus.
A 45-year-old female attends her General Practitioner complaining of a two-month history of hot flushes, worse at night, that interfere with her sleep and work. She reports that she is very tired and embarrassed at work; she sweats profusely when an attack occurs and needs extra clothes to get changed. She is tearful and reports avoiding sexual intercourse because it has become painful. She is normally fit and well and takes no medication. She still has menses, which have become very irregular, once every 2–3 months. She decides to start hormone replacement therapy (HRT).
Which would be the most appropriate HRT regime for this patient?
Oestradiol one tablet daily for a three-month period, with norethisterone on the last 14 days
NOT the Oestrodiol tablet one daily with norethisterone on the last 14 days of cycle as this is if her cycles were already regular
A 30 year old primiparous woman presents to the labour ward at 33 weeks gestation with regular painful uterine contractions occurring every 15 minutes. A vaginal examination reveals that the cervix is 4cm dilated and the membranes have ruptured. All maternal observations are normal and there is no vaginal bleeding. Fetal cardiotocogram is reassuring.
What pharmacological therapy should be offered to this woman?
This woman is in established pre-term labour. Benzylpenicillin and betamethasone would be an appropriate combination to use in this woman. The betamethasone is used to accelerate fetal lung maturation in preterm births. Benzylpenicillin is an antibiotic which is indicated in preterm birth to protect against Group B Streptococcus.
when to intervene with forceps during 2nd stage of labour?
These are the Indications:
For nulliparous women a lack of progress for 2 hours without regional anaesthesia or for 3 hours with regional anaesthesia
For multiparous women a lack of progress for 1 hour without regional anaesthesia or 2 hours with regional anaesthesia
absolute C/I to vaginal birth after C sections?
Classical (vertical) caesarean scar
Previous history of uterine rupture
The usual contraindications to a vaginal delivery (such as major placenta praevia)
A 29 year old G2P1 presents to the antenatal clinic for review at 22 weeks gestation. She is worried that her previous baby had developed a Group B streptococcus (GBS) infection shortly after delivery. She enquires about what what can be done for her present pregnancy.
Which of the following steps is the most appropriate treatment for this patient?
Group B Streptococcus is a bacterium, which can colonise in the vagina. The biggest risk factor for a baby developing GBS is the mother having a previous baby with a GBS infection. About 50% of infants born to women who carry GBS will go on to become carriers and less than 1% become ill with the infection themselves. According to NICE guidelines, maternal antibiotic prophylaxis is to be offered to women with a previous baby with a GBS infection. Benzylpenicillin is the antibiotic of choice
is GBS screened for?
GBS is not routinely screened for in pregnancy. If she is incidentally found to have GBS bacteruria or a positive vaginal swab for GBS she will receive high dose antibiotics intrapartum - usually benzylpenicillin or ampicillin.
