obs/gynae vol 1 Flashcards
pregnany induced HTN definition
blood pressure (BP) of ≥140/90 mmHg on two occasions (at least 4 hours apart) after 20 weeks’ gestation in a previously normotensive woman, without the presence of proteinuria or other clinical features (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache) suggestive of pre-eclampsia.
if over 160/110 admission to hospital is warented for reduction.
risk factors for pregnancy induced HTN + Ix + Mx
nulliparous
maternal age > 35 years.
black/ hispanic
obese, diabetes, migrane.
Ix:
urinanalysis (exclude protein)
FBC
LFT
Mx:
do not offer early deliver (<37/52) if less than 160/110
Labetalol is the drug of choice (anti HTN)
all women should undergo medical r/v 6-8 weeks after birth to check if still needed.
discuss the first stage of labour
from first signs (strong contractions 3-5 min apart) to dilation to 10 cm.
Latent is 0cm to 6cm - 20 hrs or 14 hrs in nulli or multiparous women.
Active 6-10 cm- generally dilation 1.2- 1.5cm an hour
measurements taken every 2-3 hours.
if 4 hour absecnce of dilation with contraction
or 6 hr delay without then this is a delay in progression - arrest of labour – may need clinical intervention
discuss the 2nd stage of labour
10cm to delivery of bab
fetus goes through some movements: engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
lasts about 3 hrs in nulli, 2 hrs in multiparous
if longer than this then considered arrest (+1hr in people who get neurospinial anaesthetic)
discuss 3rd stage of labour
after delivery of baby to delivery of placenta
managed with fundal pressure and traction on the chord
should take 30 mins or less
marked by- gush of blood, lengthening of the cord + globular shape on fundus palpation.
oxytocin is given to contract the uterus ands prevent bleeding.
what is pre-ecclampsia + risk factors for
triad of
hypertension
proteinurea
oedema
usually starts after 20 weeks of gestation
disorder of abnormal placentation
risk factors:
FHx of pre-eclampsia
PMHx of pre-eclampsia
< 155cm maternal height
Obesity/ overweight mother
Maternal age <20 or >35
Past Hx of migraine
Hypertension at onset of pregnancy
Underlying renal disease
Hx of autoimmune disease
can progres to ecclampsia which is deadly
signs and symptoms of pre-ecclampsia + criteria for diagnosis
flu like sx
vom
tacy
hyperreflexia
clonus
seziures (indicated progression)
headache
visual disturbances
bruising
urea and creatinine rise
Diagnosis:
proteinurea
bp 140/60 on 2 seperate occasion
OR bp 160/100 alone
OR 30/20 rise over booking BP
Mx of pre ecclampsia
labetalol for control of BP aim <150/100
in ecclampsia - anti hypertensives
catherterise + measure output
no diuretics- concentrates things more
seziures with magnaesium sulphate
pre-ecclampsia may take 3/12 to resolve.
evaluation and management of post partum bleeds
rapid assessment of status. (tacy, Hpotn)
ax entire genital tract for lac
manual exam +/- extractio of retained products
USS
a soft/ Boggy non-contracted uterus is common with uterine atrophy.
Mx: resusitation + identify and treat the specific cause.
uterine atony: oxytocin- contracts uterus no contraindications
Methylergonovine- ergot- sustained uterine contraction
prostoglandins
if they fail- put a baloon in (tamponade)
if still fail- exploratory laporotomy.
overview of post partum haemorrhage
acute- blood loss of 1000ml with symptoms of hypovolaemia within 24 hrs of delivery of any route.
2ndary is bleeding that occurs after 24 hrs but within 12 weeks.
most common cause is uterine atony- lack of contraction of uterus.
leading cause of morbidity and mortality in childbirth. uterine atony 70-80% of all bleed causes!.
RF: high maternal parity, chorioamnionitis, prolonged use of oxytocin, general anesthesia.
coagulation disorders - more common in foetal death in utero.
define endometriosis + risk factors
presence of endometrial glands and strome outside the endometrial cavity + uterine musculature.
RF: reproductive age, white, FH, nulliparity, mullerian anomalies.
epidaemiology + pathology of endometriosis
10% of reproductive age women
infiltration of cells causes fibrosis and long standing inflammation.
if they are sufficiently deep infiltrations then they can distort anatomy. - this anatomical distortion can cause sub fertility.
signs and symptoms of endometriosis + investigations of
large spectrum - GU (dysuria, flank pain, haematuria), GI (dyschezia).
often pain on deep penetration during sex
unexplained sub fertility.
dysmenorrhoeea, chronic/ cyclic pelvic pain.
Ix:
transvag ultrasound is 1st line investigation
surgical diagnosis (gold standard) is not required before treatment can start.
Mx of endometriosis
Medical:
NSAIDS + hormonal contraceptives (combines and progestogens)
GnRH analougues if above isnt effective.
surgical:
preservation of fertility- indicated refractory to medical mgt or advanced disease-
laproscopic destruction (ablation) of implants + restoration of pelvic anatomy. – recurrance is quite common.
if fertility preservation is not desired- hysterectomy with bilateral salpingo-ooporectomy + exicion of any pertioneal disease.
complications of endometriosis
infertility, bowel obstruction, chronic pain,
ovarian faliure post surgical intervention- not enough estrogen to stim
epithelial cell ovarian cancer
adhesion formation
what is adenomyosis and what is its etiology
endometrial tissue infiltrating into the myometrium
presentes a painful menses and heavy menstrual bleeding.
etiology is unsure but:
disrupted boundary between endometrium and myometrium, leads to inappropriate proliferation.
epidaemiology, risk factors of adenomyosis
20-35% of people, but generally under diagnosed.
pre menopausal multiparous women in 30s-40s.
risk factors are generally things that increace estrogen exposure (inc parity, early menarche, short menstrual cycle, inc BMI, contraceptive pill, tamoxifen) + prior uterine surgery.
Ix + Rx of adenomyosis
difficult diagnosis as many things present similarly.
physical exam- ‘Boggy’ enlarged uterus.
no leb tests are specific
transvag ultrasound.
Rx:
NSAIDS +/- OCP, IUD Or Aromatase inhibitors
Surgery-
if desire to have kids- USS guided thermal ablation
histerectomy if do not want kids
prognosis:
no cure without hysterectomy
infertility 11-12%.
define dysfunctional uterine bleeding
a diagnosis of exlusion, where there is no systemic or locally definable structural cause for abnormal bleeding.
occurs more commonly in adolescents and perimenopausal women.
E.G disorders of endometrial origin, hypothalamic-pituitary ovarian axis or hemostasis.
how to investigate + treat DUB
nature of bleeding, any associated symptoms, (post coital, pelvic pain or pressure)
impact on QOL.
can start pharmacological Rx without physical Ax.
NSAIDS, transexamic acid, IUD, COCP1`
do a full work up to conclude the exclusion diagnnosis, FBC, Clotting, consider transvaginal ultrasound.
