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3A Flashcards > Obs+Gynae Conditions > Flashcards

Obs+Gynae Conditions Flashcards

1
Q

Causes of antepartum haemorrhage

A

Placenta praevia (placenta covering the cervix)
Placental abruption (placenta separating from the uterus)
Vasa Praevia (Foetal blood vessels exposed)
Preeclampsia (high blood pressure during pregnancy)

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2
Q

Antepartum haemorrhage definiton

A

Genital track bleeding post 24 weeks

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3
Q

What is placenta praevia

A

Placenta lies in the lower uterine segment causing poor attachment. if severe may lie over cervical OS

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4
Q

Placenta praevia risk factors

A

previous C-section
previous termination
multiparity
maternal smoking
advanced maternal age

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5
Q

Placenta praevia history

A

painless vaginal bleeding
maybe contractions

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6
Q

Placenta praevia findings on examination

A

vaginal bleeding
non-tender uterus
abnormal lie/presentation
low lying placenta

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7
Q

Placenta Praevia Investigations

A

Ultrasound - low lying placenta
FBC, U+E, LFT - rule out preeclampsia

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8
Q

Placenta Praevia management

A

when detected, rescan
if present at 36 weeks c-section

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9
Q

What is Placenta accreta

A

Placenta grows too deeply into uterine wall, cannot detach and causes blood loss

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10
Q

Placenta accreta symptoms

A

sometimes vaginal bleeding in 3rd trimester
symptomless

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11
Q

placenta accreta complications

A

severe vaginal bleeding
early labour onset

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12
Q

placenta accreta management

A

C-section and hystorectoms if severe
if mild, normal vaginal delivery + blood transfustion

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13
Q

Placenta accreta investigation

A

MRI/Ultrasound - inspect growth of placenta

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14
Q

Placenta accreta risk factors

A

Placenta praevia
previous c-section
multiparity
age 35+

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15
Q

what is placenta increta

A

placenta has grown into muscle wall of uterus

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16
Q

what is placental abruption

A

complete or partial detachment of placenta prior to delivery

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17
Q

Placental abruption risk factors

A

previous abruption
trauma
pre-eclampsia
maternal age 35+
smoking

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18
Q

placental abruption investigations

A

ultrasound - identify bleed
FBC U+R LFT - rule out pre-eclampia
crossmatch - haemorrhage expected

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19
Q

placental abruption symptoms

A

abdominal pain
vaginal bleeding
uterine contractions
dizzyness/loss of consciousness

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20
Q

placental abruption examination findings

A

woody tense uterus
foetal heart rate distress/absent

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21
Q

placental abruption managment

A

no foetal distress
under 36 - monitor
over 36 - induction+vaginal birth

foetal distress
c-section

foetal death
induction and vaginal delivery unless mother is haemodynamically compromised then C-section

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22
Q

what is vasa praevia

A

foetal blood vessels are in foetal membrane instead of umbilical cord

may run across internal cervical OS

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23
Q

types of vasa praevia

A

multi lobed placenta - blood vessels attach to different lobe than umbilical chord

velamentous umbilical cord insertion - the foetal vessels insert into the membranes and travel round to the placenta, rather than inserting directly into the placenta.

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24
Q

vasa praevia risk factors

A

IVF
Placenta praevia
multiple pregnancy (twins)

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25
Q

vasa praevia symptoms

A

painless vaginal bleeding
membrane rupture
foetal bradycardia

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26
Q

vasa praevia management

A

c-section at 34-36 weeks
corticosteriods from 32 weeks

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27
Q

what are the foetal blood vessels

A

the two umbilical arteries and single umbilical vein

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28
Q

Post partum haemorrhage definition and categorisation

A

blood loss of 500ml + following childbirth

primary - within 24 hours
secondary - 24hr to 12 weeks

minor 500-1000ml no shock
major 1000+ or 500-1000 with shock

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29
Q

difference between major and minor PPH

A

minor 500-1000ml no shock
major 1000+ or 500-1000 with shock

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30
Q

Difference between primary and secondary PPH

A

primary - within 24 hours
secondary - 24hr to 12 weeks

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31
Q

Causes of primary PPH (4 T’s)

A

Tone: an atonic (not well contracted) uterus (most common)

Trauma: injury, most commonly perineal tears or lacerations

Tissue: retained products of conception (e.g. retained placenta).

Thrombin: underlying disorders of clotting

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32
Q

causes of secondary PPH

A

retained products of conception
endometritis - infection

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33
Q

Risk factors of Post partum haemorrhage

A

Previous PPH
antepartum haemorrhage
Grand multiparity
multiple pregnancy (twins)

prolonged labour
induced labour

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34
Q

signs of haemodynamic instability

A

tachycardia, hypotension, prolonged capillary refill time or cool peripheries.

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35
Q

Primary PPH presentation

A

Haemodynamic instability
atony - enlarged soft boggy uterus
retained products - placement and membranes incomplete
injury - visible tears

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36
Q

endometritis presentation

A

vaginal bleeding
haemodynamic instability
Endometritis - sepsis - fever, hypotension, tachycardia
Also tender bulky uterus and foul discharge

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37
Q

Post partum haemorrhage investigations
(Blood tests)

A

FBC - anaemia
Coagulation screen - clotting disorder
Groups and save/crossmatch - allow transfusion
If secondary do sepsis screen - Blood cultures and CRP

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38
Q

How to reduce risk of post partum haemorrhage

A

anaemia testing (FBC)
Active third stage management
-uteronic drugs - oxytocin/synometrine
- deferred clamping and cord cutting
- controlled cord traction to deliver placenta

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39
Q

Emergency management of Post partum haemorrhage

A

Airway - anaesthesia support if required
Breathing - oxygen if required
Circulation - check for haemodynamic instability, estimate blood loss, establish IV access, administer warm crystalloid solution/blood products
Urinary catheter in case of surgery

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40
Q

Management of Primary Post partum haemorrhage (Atony)

A

Atony
Mechanical - rub uterine fundus to stimulate contractions
pharmacological - uterotonic drugs eg. oxytosin, syntometrine
Surgical - balloon tamponade/haemostatic sutures. rarely hysterectomy if severe

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41
Q

Management of primary post partum haemorrhage (excluding Atony)

A

trauma - repair surgically
tissue - theatre for placenta removal
thrombin - consider tranexamic acid or vitamin K before - blood products on standby

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42
Q

How is the 3rd stage of labour actively managed

A

-uteronic drugs - oxytocin/synometrine
- deferred clamping and cord cutting
- controlled cord traction to deliver placenta

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43
Q

Secondary post partum haemorrhage management

A

Ultrasound to check for retained products - removal in theatre
blood transfusion if anaemic

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44
Q

Ectopic pregnancy definition

A

Egg implants outside of the uterus, eg in the fallopian tube, ovary or abdomen

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45
Q

Risk factors for ectopic pregnancy

A

Previous ectopic
tubal damage
infertility/IVF
Smoking
age 35+

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46
Q

Symptoms of ectopic pregnancy

A

Vaginal bleeding
one sided pain - iliac fossa - ?appendicitis
shoulder pain if bleeding/peritoneal irritation

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47
Q

Ectopic pregnancy investigations plus findings

A

Serum beta hCG
Ultrasound - adnexal mass moving separately to ovary

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48
Q

Ectopic pregnancy management

A

conservative - only if clinically stable and pain free - monitor HCG (must be decreasing)
medical - methotrexate - prevents cell division - teratogenic so no conception for 3 months
Surgical - if significant pain, mass over 35mm or live ectopic - salpingectomy to remove fallopian tube

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49
Q

Miscarriage time categorisation

A

early - before 13 weeks
late - 13-24 weeks

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50
Q

Complete Miscarriage definition

A

the products of conception have passed, the cervical os is closed and ultrasound shows an empty uterine cavity

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51
Q

Incomplete Miscarriage definition

A

vaginal bleeding, an open cervical os and products of conception are seen on examination.

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52
Q

Miscarriage symptoms

A

Vaginal bleeding
Cramping abdominal pain
Passage of any foetal tissue or clots

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53
Q

Complete miscarriage diagnostic investigation

A

Beta hCG - decrease of 50% in 48 hours

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54
Q

Miscarriage management

A

expectant - waiting for spontaneous passage of the products of conception - only if incomplete miscarriage/delayed under 35mm

medical - prostaglandin agent (misoprostol) to induce uterine contractions

surgical removal of products of conception

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55
Q

delayed miscarriage investigation and diagnosis criteria

A

Transvaginal ultrasound
Required

gestation sac
yolk sac
foetal pole
no heart beat
over 7mm

If less than 7mm scan 1 week later

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56
Q

Cause of miscarriage in first trimester

A

chromosome abnormality

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57
Q

cause of miscarriage in second trimester

A

cervical incompetence

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58
Q

Ovarian torsion definition

A

Ovary twists and blocks blood supply

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59
Q

Causes/risk factors of ovarian torsion

A

cyst or ovarian mass
PCOS
endometriosis

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60
Q

Ovarian torsion symptoms

A

Severe (twisting) abdominal pain, nausea and vomiting, shoulder tip irritation if peritoneal irritation

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61
Q

Ovarian torsion management

A

laparoscopic surgery to untwist ovary - if necrotic remove

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62
Q

pre-eclampsia vs severe pre-eclampsia vs eclampsia

A

pre-eclampsia - hypertension + proteinurea
severe preeclampsia - hypertension + proteinurea + end organ effect
Eclampsia - hypertension + proteinurea + seizures

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63
Q

What end organ effects occur in severe pre-eclampsia

A

Headache/visual disturbance/papilledema
clonus
Liver tenderness/abnormal enzymes

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64
Q

treatment for pre-eclampsia

A

stabilize BP - labetalol/nifedipine
fluid restriction +output monitoring
assess foetal wellbeing
delivery via induction/caesarean as required

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65
Q

Risk factors of pre-eclampsia

A

Chronic hypertension

previous pre-eclampsia

Type I or type II diabetes mellitus

Chronic kidney disease

Autoimmune disease

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66
Q

Pre-eclampsia symptoms

A

Headache
Visual disturbance: such as blurring or flashing lights
Swelling of the arms, legs and face
Nausea and vomiting
Abdominal pain

67
Q

what medicine is used to prevent the onset of pre-eclampsia

A

Aspirin 150mg once daily

68
Q

what is HELLp sydrome

A

Haemolysis
Elevated liver enzymes
low platelets

69
Q

eclampsia treatment

A

seizure onset = magnesium sulfate IV and caesarean/delivery once mum is stable

70
Q

Ultrasound findings in PCOS and their pathophysiology

A

immature follicles which have had their ovulation phase arrested. This occurs due to an elevated baseline of LH and lack of LH surge

71
Q

What hormone changes are seen in PCOS

A

Elevated LH - follicles are not released due to lack of surge

Hyperinsulinemia - excess glucose causes androgen production

Elevated testosterone - prevents follicles from growing normally

72
Q

Polycystic ovarian syndrome (PCOS) risk factors

A

Obesity
Diabetes mellitus
Family history of PCOS
Premature adrenarche (early onset of pubic hair)

73
Q

Polycystic ovarian syndrome (PCOS) Symptoms

A

Hirsutism: excessive hair growth in women
Infertility
Acne
Menstrual cycle disturbance
Obesity and weight gain

74
Q

PCOS investigations

A

ultrasound - Multiple small follicles of similar size around the periphery of the ovaries, resembling a “string-of-pearls”

Testosterone (total and free): raised in PCOS

75
Q

PCOS diagnostic criteria

A

Rotterdam criteria (2/3 required)

Imaging: polycystic ovaries on ultrasound
Abnormal periods
Hyperandrogenism: clinical and/or biochemical changes

76
Q

What is the Rotterdam criteria for PCOS

A

(2/3 required)

Imaging: polycystic ovaries on ultrasound
Abnormal periods
Hyperandrogenism: clinical and/or biochemical changes

77
Q

PCOS Treatment

A

conservative: Weight loss, regular exercise and diet

Medicine: Combine pill - regulated period OR clomiphene - promotes fertility

78
Q

What is a uterine prolapse

A

Uterine prolapse is where the uterus itself descends into the vagina.

79
Q

What is a vault prolapse

A

Vault prolapse occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina

80
Q

What is a rectocele

A

Rectoceles are caused by a defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina.

81
Q

what is a cystocele

A

Cystoceles are caused by a defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina.

82
Q

Types of uterine prolapse

A

uterine
vault
rectocele
cystocele

83
Q

Grades of uterine prolapse

A

Grade 0: Normal
Grade 1: The lowest part is more than 1cm above the introitus
Grade 2: The lowest part is within 1cm of the introitus (above or below)
Grade 3: The lowest part is more than 1cm below the introitus, but not fully descended
Grade 4: Full descent with eversion of the vagina

84
Q

vault prolapse treatment

A

colposuspension

85
Q

rectocele prolapse treatment

A

posterior wall repair

86
Q

cystocele prolapse treatment

A

anterior wall repair

87
Q

risk factors for vaginal prolapse

A

vaginal delivery
Instrumental delivery
prolonged delivery
menopause
Obesity
constipation
chronic respiratory condition
(increased intraabdominal pressure)

88
Q

vaginal prolapse presentation

A

A feeling of “something coming down” in the vagina
A dragging or heavy sensation in the pelvis
Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
Bowel symptoms, such as constipation, incontinence and urgency
Sexual dysfunction, such as pain, altered sensation and reduced enjoyment

89
Q

Vaginal prolapse conservative management

A

pessary
pelvic floor exercise
weight loss

90
Q

Vaginal prolapse medical management

A

Oestrogen cream to prevent irritation and maintain vaginal tissue health

91
Q

What are fibroids

A

benign tumours of uterine smooth muscle (leiomyoma)

92
Q

What hormone are fibroids sensitive to

A

oestrogen

93
Q

Where is an intramural fibroid

A

within the uterine muscle

94
Q

where is a subserosal fibroid

A

outside of the uterus

95
Q

where is a submucosal fibroid

A

just below the uterine endometrium

96
Q

what is a pedunculated fibroid

A

fibroid on a stalk

97
Q

Fibroid presentation

A

Asymptomatic

potentially
Heavy periods/long periods
abdominal pain worse on menstruation
bloating
pain on intercourse

98
Q

Investigation for fibroids

A

hysteroscopy - submucosal
pelvic ultrasound if large
MRI - prior to surgery

99
Q

Medicinal management of fibroids

A

mirena coil/combined pill

100
Q

Surgical fibroid management

A

endometrial ablation
resection during hysteroscopy
hysterectomy

101
Q

What is red degeneration of fibroids

A

ischaemia, infarction and necrosis of fibroids

102
Q

when does red degeneration of fibroids occur

A

during pregnancy to large fibroids

103
Q

pathophysiology of red degeneration of fibroids

A

during pregnancy, fibroids grow rapidly (due to oestrogen) and blood supply is kinked during uterine expansion. fibroids become ischaemic

104
Q

red degeneration of fibroids symptoms

A

abdominal pain
low grade fever
tachycardia
vomiting

105
Q

what is a functional ovarian cyst

A

a fluid filled sac caused by fluctuation in hormones during the menstrual cycle

106
Q

In what women are ovarian cysts concerning

A

post menopausal women

107
Q

diagnostic criteria for PCOS

A

anovulation
hyperandrogenism
polycystic (string of pearl ovaries) on ultrasound

108
Q

Presentation of ovarian cysts

A

asymptomatic

maybe
pelvic pain
bloating
palpable mass
abdominal fullness

109
Q

Types of functional cyst

A

follicular (most common)
corpus luteum

110
Q

what causes a follicular cyst

A

failure of follicle to rupture and release egg

111
Q

what causes a corpus leuteum cyst

A

the corpus leuteum fails to breakdown in early pregnancy and fills with fluid

112
Q

Risk factors for malignant ovarian cyst

A

post menopausal
increased age
obesity
HRT
Smoking
BRAC1 BRAC2

113
Q

symptoms of malignant ovarian cyst

A

bloating
loss of appetite/early satiety
weight loss
urinary symptoms

114
Q

management of functional ovarian cyst

A

less than 5cm = do nothing - spontaneously resolves
5cm to 7cm = gynae referral and annual ultrasound
7cm + = consider surgery as difficult to determine malignancy

115
Q

what are functional ovarian cysts

A

fluid filled sac’s caused by the fluctuation in hormones due to periods (benign)

116
Q

when do malignant ovarian cysts occur

A

post-menopause

117
Q

diagnostic criteria for PCOS

A

String of pears/multipls cycts
anovulation
hyperandrogenism

118
Q

Presentation of ovarian cyst

A

asymptomatic

maybe
pelvic pain, bloating, abdominal fullness palpable mass

119
Q

Types of functional ovarian cyst

A

follicular
corpus leuteum

120
Q

what is a follicular cyst and what does it look like on an ultrasound

A

follicle fails to rupture and release egg

has thin walls and no internal structures

121
Q

what is a corpus luteal cyst and when is it seen?

A

corpus luteum fails to break down and fills with fluid

seen in early pregnancy

122
Q

Risk factors for malignant ovarian cyst

A

increased age
post menopausal
Obesity
Smoking
HRT
BRCA1/BRCA2

123
Q

symptoms of malignant ovarian cyst

A

bloating
loss of appetite/early satiety
weight loss
urinary symptoms

124
Q

Management of ovarian cyst (size dependant)

A

less than 5cm - will spontaneously resolve
5-7cm - scan every year
7cm+ consider surgery due to inability to tell if malignant

125
Q

processing/management/follow up of cervical smear test HPV results

A

If HPV +ve check for dysplasia + colposcopy

If HPV -ve repeat in 3 years

126
Q

Management of high grade cervical dysplasia

A

Loop electrosurgical excision

127
Q

Management of low grade cervical dysplasia

A

recheck in 6 months

128
Q

Cervical cancer Initial symptoms

A

post coital bleeding, menorrhagia + vaginal discharge

129
Q

Cervical cancer severe symptoms

A

Loss of appetite, weight loss, early satiety, single swollen leg, pelvic pain, faecal/urinary incontinence

130
Q

Pathophysiology/histology of cervical cancer

A

squamous cell carcinoma caused by dysplasia caused by HPV infection (type 16/18)

131
Q

Risk factors for cervical cancer

A

risky sexual activity eg. multiple partners/not using condoms
Smoking
HIV

132
Q

Staging of dysplasia

A

1 - mild - 1/3 of epilthelium - will return to normal
2 - moderate - 2/3 epithelium - may progress to cancer
3 - severe - very likely to become cancer

133
Q

Treatment of cervical cancer

A

Cone biopsy (if small enough)
Hysterectomy if invades uterus
Chemo/radiotherapy

134
Q

Endometrial cancer histology

A

adenocarcinoma

135
Q

what is endometrial hyperplasia + treatment

A

precancerous thickening of the endometrium

Most return to normal - if not progestogens eg mirena coil/methyprogesterone

136
Q

Risk factors for endometrial cancer

A

Unopposed oestrogen:
No pregnancies
early onset of menstruation
increased age
late menopause
Obesity
PCOS

137
Q

What effect does smoking have on endometrial cancer deveopment

A

protective - reduces unopposed oestrogen

138
Q

Presentation of endometrial cancer

A

post coital bleeding
intermenstrual bleeding
abnormal discharge
Anaemia

139
Q

Staging of endometrial cancer

A

1 - uterus only
2 - cervix
3 - ovaries/lymph nodes
4 - bladder/beyond pelvis

140
Q

Management of endometrial cancer

A

hysterectomy
radiotherapy
chemotherapy

Progesterone to slow progression

141
Q

Investigations for endometrial cancer

A

transvaginal ultrasound/pipelle biopsy

142
Q

Ovarian cancer histology

A

epithelial, germ cell or metastasis from elsewhere

143
Q

Ovarian cancer risk factors

A

60+
BRCA1/BRCA2
increased number of ovulations eg. no pregnancy/ early onset of menstruation
Obesity
Smoking

144
Q

Investigation for ovarian cancer

A

CA125 blood test
Pelvic ultrasound
CT to establish staging

145
Q

what does a snowstorm appearance on ultrasound indicate

A

a hydatidiform mole/ molar pregnancy

146
Q

Ovarian cancer management

A

surgery/chemotherapy

147
Q

what can cause a raised CA125 blood test

A

Endometriosis
fibroids
liver disease
Ovarian cancer

148
Q

Vulval cancer histology

A

Squamous cell carcinoma

149
Q

Vulval cancer risk factors

A

75+
immunosupression
HPV
Lichen sclerosis

150
Q

Vulval cancer presentation

A

Vulval lump - irrecular mass/fungating lesion
ulceration
bleeding
pain/itching

151
Q

investigation of vulval cancer

A

Biopsy + sentinel node biopsy
CT for staging

152
Q

what is lichen sclerosis

A

an autoimmune inflammatory disease affecting the labia, perineum and perianal skin

153
Q

lichen sclerosis Presentation

A

itching
soreness (worse nocturnally)
Skin tightness
Pain on intercourse
erosions/fissures

154
Q

Lichen sclerosis appearance (poem)

A

Porcelain white,
shiny and tight,
slight raise

155
Q

what is koebners phenomenon

A

symptoms made worse by friction

156
Q

Management of lichen sclerosis

A

potent topical steriods

157
Q

Complications of lichen sclerosis

A

Vulval cancer (squamous cell carcinoma)
sexual dysfunction
narrowing of urethral/vaginal opening

158
Q

what is a molar pregnancy

A

a tumour that grows in the uterus like a pregnancy (a hydatidiform mole)

159
Q

What is a complete mole

A

2 sperm fertilise an empty egg - no foetal material will form

160
Q

what is an incomplete mole

A

2 sperm fertilise a normal egg - foetal material will form

161
Q

what is the appearance of a hydatidiform mole on ultrasound

A

snowstorm appearance

162
Q

Symptoms of a hydatidiform mole/molar pregnancy

A

Pregnancy on Crack
Severe morning sickness
Very high HCG
Thyrotoxicosis
vaginal bleeding
uterine enlargement

163
Q

Management of molar pregnancy

A

evacuation of uterus
monitor HCG and if does not decrease - chemotherapy

3A Flashcards (9 decks)

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