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Phase 3a (You) > Obs & Gyne > Flashcards

Obs & Gyne Flashcards

1
Q

What is the name of the axis, controlling the menstrual cycle?

A

Hypothalamic-pituitary-gonadal axis (HPG)

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2
Q

What are the 3 types of hormone involved in the control of the menstrual cycle?

A

Gonadotrophs (LH, FSH, hCG), steroids (Oestrogen, Progesterone), cytokines (activins, Inhibins)

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3
Q

What cells are sensitive to luteinising hormone?

A

Theca cells

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4
Q

What cells are sensitive to follicular stimulating hormone?

A

Granulosa Cells

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5
Q

What is the function of Theca cells?

A

Sensitive to LH, convert cholesterol precursor to testosterone and progesterone

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6
Q

What is the function of granulosa cells

A

Sensitive to FSH, Contain aromatase, and convert testosterone to oestrogen. Induce LH receptors one dominant follicle.

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7
Q

What hormone causes increased LH receptors on dominant follicle?

A

FSH, Granulosa cells cause increased receptors.

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8
Q

Which part of the menstrual cycle is variable in length.

A

Follicular stage (1-14 days)

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9
Q

What part of the menstrual cycle is constant in length?

A

Luteal Phase (15-28 days)

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10
Q

Explain implantation of the blastocyst.

A

2 way communication between the blastocyst and endometrium.

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11
Q

What is the function of hCG?

A

Signals to the corpus luteum to continue to produce progesterone, until the placenta is formed.

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12
Q

When does the fertilised egg start producing hCG?

A

6-7 days.

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13
Q

What is the name of the drug which competitively inhibits progesterone?

A

Mifepristone

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14
Q

What is mifepristone used for?

A

Medical abortion

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15
Q

What is the function of progesterone?

A

Proliferation, vascularisation and differentiation fo endometrium. Th1 regression and Th2 formation.

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16
Q

What does a decline in oestrogen during pregnancy indicate?

A

Fetal distress

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17
Q

What is the process of placenta formation called in humans?

A

Haemochorial placentation.

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18
Q

What are the cells called which invade the endometrium to aid implantation?

A

Extra-villus trophoblast.

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19
Q

What is the process of EVT invading spiral arteries called?

A

Endovascular invasion.

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20
Q

What diseases can failed endovascular invasion cause?

A 
Prematurity
Preeclampsia
Miscarriage
Abruption
Fetal growth restriction
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21
Q

What is the definition of ectopic pregnancy?

A

Pregnancy anywhere outside the uterus

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22
Q

Where is the Fallopian tube is the most common site for ectopic pregnancy?

A

Ampulla (50%)

Isthums (20%)

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23
Q

What term is given to a placenta which invades past Nitabuchs layer, into the superficial myometrium?

A

Placenta accreta (80%)

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24
Q

What term is given to a placenta which invades past Nitabuchs layer, into the deeper myometrium?

A

Placenta Increta (17%)

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25
Q

What term is given to a placenta which invades past Nitabuchs layer, and penetrated into the uterine serosa?

A

Placenta Percreta (5%)

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26
Q

What is the risk of an abnormal placental connection?

A

Poor placental separation at parturition, leading to significant post part UK bleeding.

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27
Q

Do syncitiotrophoblast cells contain MHC?

A

No

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28
Q

Which Th cells have more of a role in pregnancy?

A

Th2

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29
Q

What diseases improve during pregnancy?

A

Auto immune diseases, Th1, Rheumatoid Arthritis

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30
Q

Which autoimmune diseases get worse during pregnancy?

A

SLE, Th2

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31
Q

What are the 3 stages of parturition?

A

Cervical dilatation, fetal expulsion, placental delivery and haemostasis

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32
Q

What is the Ferguson reflex?

A

Positive feedback of oxytocin on the hypothalamus, to sustain uterine contractions.

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33
Q

What are the reasons for using contraception?

A

Prevent unwanted birth, prevent teenage birth, prevent STI Transmission, control family sizes, reduce abortion rates.

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34
Q

What should be asked in the clinical assessment when prescribing contraception?

A

Obs: Previous pregnancy, Menstrual History, contraceptive need

PMH: Previous STI, Heart disease, VTE. Breast cancer, migraine

DHx: StJohns Wort

Sx: Smoking, breast feeding

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35
Q

What should be included in the examination when prescribing contraception?

A

BP Measurements, BMI, Cervical smear, STI screen

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36
Q

What is the Fraser criteria?

A

A girl under 16 has capacity to contraception if they:
Understand the doctors advise,
The benefits outweigh the risks in giving contraception,
The girl will continue having unprotected sex,
Physical or mental health with suffer from pregnancy

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37
Q

What do you need to tell a patient starting contraception?

A 
How to use
Mode of action
Efficacy
Drug Interactions
Side-effects/ benefits
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38
Q

What is the mechanism of the COCP?

A

Prevents ovulation, and alters cervical mucus to act as a plug. It also thins the lining of the womb.

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39
Q

What is the perfect use failure rate of the COCP?

A

0.1% to 2%

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40
Q

What is the typical use failure rate of the COCP?

A

8%

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41
Q

What are the advantages of the COCP?

A 
Reversible, reliable, 12hr window
Regular predictable cycle.
Helps with acne.
Low menorrhagia.
Lower risk of PID
Helps with PMS.
Protective against ovarian, endometrium and colorectal cancer
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42
Q

What are the disadvantages of COCP?

A

Drug interactions (-epileptics, antibiotics, herbals)
Doesn’t prevent STI
D&V reduces efficacy
Small risk of breast cancer and cervical cancer
RISK OF VTE

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43
Q

What are the advantages of Contraceptive patches?

A

Even delivery of hormones (oestrogen and progesterone)

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44
Q

What are the disadvantages of contraceptive patches?

A

Skin irritation, expensive

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45
Q

How does the progesterone only pill work?

A

Thickens cervical mucus
Thins endometrium
Decreases tubular motility
Stops ovulation (15-40%)

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46
Q

What is the perfect use failure rate of the POP?

A

0.5%

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47
Q

What is the typical use failure rate of the POP?

A

13%

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48
Q

What are the advantages of the POP?

A

Prevent oestrogenic side effects (breast tenderness, headache, nausea),
Can be used in large BMI,
Unused in individuals with migraines.

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49
Q

What are the disadvantages of POP?

A 
Less effective than COCP,
3Hr window,
Risk of ectopic
Disrupt mistrial pattern,
Ovarian cysts.
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50
Q

What is the perfect use failure rate of condoms?

A

2%

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51
Q

What is the typical use failure rate of condoms?

A

15%

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52
Q

What are the disadvantages of female condoms?

A 
Loud,
Intrusive, 
Easy for penis to miss
Higher failure rate than male condoms,
Careful insertion
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53
Q

What are the advantages of female condoms?

A

Protection from STI

Not affected by oils

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54
Q

What is the failure rate of diaphragms?

A

2-5%

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55
Q

Why would someone need their diaphragm size changing?

A

> 3kg weight change

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56
Q

What are the disadvantages of diaphragms?

A

Correct insertion by trained staff,
Spermicide can be messy,
Must be in place 6hr after intercourse,
Can become dislodged.

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57
Q

What are fertility awareness methods?

A

Planning of menstrual cycle to predict fertility in infertility periods.

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58
Q

What are the disadvantages of FAM?

A

Teacher required pregnancy/ prevent,
3-12 months data needed before start,
Period of abstinence.

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59
Q

What is Lactational amenorrgea?

A

A postpartum period where a women is ammenorrhoeic if fully breast feeding

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60
Q

What is the effectiveness of LAM in normal breast feeding?

A

98%

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61
Q

What is the failure rate of LAM in pump breast milking?

A

5-6%

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62
Q

Give some examples of user dependant contraceptives.

A 
COCP
POP
Contraceptive patch
Condoms
LAM
FAM
Diaphragms
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63
Q

Give examples of London acting contraceptives (LARC).

A

Injectable contraceptive
Implant
IUD
IUS

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64
Q

Give examples of permanent contraceptives.

A

Male sterilisation

Female sterilisation

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65
Q

Give examples of emergency contraceptives.

A

Levonelle, elleOne

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66
Q

What is the name of the injectable contraceptive?

A

Deep-provera

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67
Q

What interval is depo-provers given?

A

12 week intervals

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68
Q

How does the injectable contraceptive work?

A

Inhibits ovulation by suppressing LH & FSH

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69
Q

How soon after abortion can depo-provers be given?

A

Immediately.

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70
Q

Should depo-provers be given to diabetic women?

A

Diabetic women can find altered blood sugar, so close regulation is needed.

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71
Q

What are the advantages of injectables?

A

Little user dependence, helps with PMS, heavy periods, amenorrhoic

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72
Q

What are the disadvantages of the injectables?

A

Irregular bleeding, amenorrhoea, increase appetite, increase weight gain, slow reversibility

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73
Q

What hormone do implants contain?

A

Progesterone

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74
Q

How long can I plants be fitted after abortion?

A

5 days

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75
Q

How is an implant identified on X-ray?

A

Barium sulphate

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76
Q

How do IUD’s work?

A

Foreign body reaction within uterus (copper), prevents implantation

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77
Q

How soon after abortion can IUD’s be fitted?

A

Immediately

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78
Q

How soon can IUD’s be fitted after delivery?

A

6 weeks

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79
Q

What are the advantages of IUD’s?

A

Long term, effective immediately, effective as immediate contraception

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80
Q

What are the disadvantages of IUD’s?

A

Menstrual irregularities, spotting, menorrhagia, increase risk of PID, Risk of ectopic

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81
Q

What hormone does mirena contain?

A

Progesterone

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82
Q

What are disadvantages of IUS?

A

Irregular bleeding, painful fitting, PID, Not emergency contraception

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83
Q

How does IUS work?

A

Endometrial atrophy

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84
Q

What are the advantages of IUS?

A

Effective, low risk of ectopic, low menstrual blood loss, low hormone levels

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85
Q

What hormone do levonella and Ella one contain?

A

Progesterone

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86
Q

What are the disadvantages of emergency contraception?

A

N&V, disrupt menstruation, doesn’t protect against STI

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87
Q

What are the advantages of emergency contraception?

A

Effective, easily available

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88
Q

What 2 medications are given to induce a miscarriage?

A

Mifepristone, and mesoprostol

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89
Q

What is the definition of Labour?

A

Spontaneous in onset, low-risk at start of labour and remaining throughout to delivery. The infant is born at 37-42 weeks of pregnancy. After birth mother and child are in good condition.

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90
Q

What is the latent phase?

A

Irregular contractions of uterus

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91
Q

How long does the latent phase last?

A

6hrs - 3 days

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92
Q

What is the management for the latent phase?

A

Stay at home, paracetamol

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93
Q

What is effacement?

A

Retraction of the cervix

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94
Q

What is dilation of the cervix?

A

Aperture of the cervix opening.

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95
Q

Labour: What is meant by ‘Presentation’?

A

The anatomical part of the foetus which presents itself first through the birth canal.

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96
Q

Labour: What is meant by ‘lie’?

A

The relationship between the long axis of the foetus and the long axis of the uterus.

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97
Q

Labour: What is meant by ‘attitude’?

A

Presenting part flexed or extended

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98
Q

Labour: What is meant by ‘engagement’?

A

The widest part of the presenting part has passed through the pelvic brim

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99
Q

Labour: What is meant by ‘station’?

A

Relationship between the lowest point of the presenting part and the ischial spines

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100
Q

What are the 3 P’s of active labour?

A

Power, passage, passenger

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101
Q

What is a side effect of Entonox?

A

N&V

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102
Q

What are fetal side effects of opiates?

A

Respiratory depression, diminished breast seeking behaviour

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103
Q

What are the maternal side effects of opiates?

A

N&V, euphoria, longer labour.

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104
Q

What is the most effective form of labour pain relief?

A

Epidural.

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105
Q

What are the maternal side effects of an epidural?

A

Longer labour (1&2 stage),
Fetal malposition, increase instrumental use,
Bladder incontinence, hypotension

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106
Q

What are fetal side effects of epidural?

A

Tachycardia, decreased breast feeding behaviour

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107
Q

How often is the fetal heart monitored at 1st stage & after a contraction?

A

Every 15 minutes, after 1 minute

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108
Q

What characterises 2nd stage labour?

A

Full dilation,
Visible head,
Descent.

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109
Q

What are the stages of the mechanism of labour?

A 
Descent, 
Flexion,
Internal rotation,
Crowning,
Extension,
Restitution,
Lateral flexion
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110
Q

What is the 3rd stage of labour?

A

Decrease blood loss, after birth delivery, cut cord, check placenta.

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111
Q

Why is cord clamping delayed?

A

Encourage drainage of blood into foetus, to reduce fetal anaemia.

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112
Q

What are risk factors for pelvic floor disorders?

A

Age, parity, obesity, smoking.

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113
Q

What is the definition of incontinence?

A

Involuntary leakage of urine

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114
Q

What are the 2 syndromes of incontinence?

A

Stress incontinence, overactive bladder

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115
Q

What is the pathophysiology of stress incontinence?

A

Sphincter weakness

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116
Q

What is the pathophysiology of an overactive bladder?

A

Involuntary bladder contractions.

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117
Q

What are the symptoms of an overactive bladder?

A 
Urgency incontinence
Frequency
Nocturia
Nocturnal enuresis
‘Key in door’/ handwash
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118
Q

What are the symptoms of stress incontinence?

A

Involuntary leakage

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119
Q

What are the simple assessments for incontinence?

A

Frequency volume chart
Urinalysis
Residual urine measurement
Questionnaire

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120
Q

What information does a frequency volume chart provide?

A 
Voided volume
Frequency
Fluid intake
Diurnal variation
Leakage frequency and quantity
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121
Q

What does nitrites on urinalysis indicate?

A

Infection

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122
Q

What can microscopic haematuria on urinalysis indicate?

A

Glomeruloneohritis,

Neoplasia, calculus, infection

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123
Q

What does protein on urinalysis indicate?

A

Nephrotic syndrome, cardiovascular disease

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124
Q

What does glucose on urinalysis indicate?

A

Diabetes, IGT

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125
Q

What are the e-PAQ dimensions?

A 
Vaginal
Bowel
Urinary
Coitus/ Sexual
(V-bucks)
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126
Q

What is the treatment for stress incontinence?

A

Conservative- physiotherapy

Surgical- sling

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127
Q

What is the treatment for overactive bladder?

A 
Bladder drill,
Botox
Anticholinergics
Augment
Bypass
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128
Q

Give some examples of containment options for incontinence.

A

Pads, catheters, odour control, skin care

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129
Q

What lifestyle adaptations could you give to someone who is incontinent?

A

Weight loss, smoking cessation, reduce caffeine intake, avoid straining

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130
Q

What symptoms can local vaginal oestrogen help with incontinence?

A

Frequency, urgency, incontinence.

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131
Q

What parasympathetic nerve roots innervate the detrusor?

A

S2,3,4

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132
Q

What nerve roots innervate the detrusor for micturition?

A

T11-L2 (Sympathetic)

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133
Q

What can be used to treat an overactive bladder?

A

Atropine.

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134
Q

What nerve controls the external sphincter?

A

Pudendal (S2,3,4)

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135
Q

What receptors innvervate the detrusor?

A

M2, M3

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136
Q

Name an muscarinic antagonist.

A

Oxybutynin

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137
Q

What are the side effects of muscarinic antagonists?

A

Dry mouth, constipation, blurred vision, fast heart, memory loss

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138
Q

Name a beta-3 adrenergic agonist.

A

Mirabegron

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139
Q

Give some examples of physiotherapy for incontinence.

A

Pelvic floor exercises, Tens, vaginal cones

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140
Q

When should you repair a prolapse?

A

Symptomatic or severe

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141
Q

What is the procedure called for a prolapsed vagina?

A

Sacrifice spinous.

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142
Q

Give some examples of non-STI, genital infections.

A

Candidiasis, vestibulitis, balantis, bacterial vaginosis, lichen sclerosis, vulvodynia

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143
Q

What is the definition of the menopause?

A

Cessation of menstruation

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144
Q

What is the average age of the menopause?

A

51

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145
Q

How is the menopause diagnosed?

A

12 months amenorrhoea

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146
Q

What is the perimenopause?

A

Period leading up to menopause

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147
Q

What are symptoms of the perimenopause?

A

Irregular periods, hot flush, mood swings, atrophy of vagina

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148
Q

Give some short term impacts of the menopause.

A 
Vasomotor symptoms (Sleep, mood, QoL)
Generalised symptoms
(Mood swings, hot flush, memory loss, headache, joint Pain)
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149
Q

Give some medium term impacts of the menopause.

A

Urogenital atrophy, UTI, Dyspareunia, incontinence (55-65 yrs)

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150
Q

Give some long term impacts of the menopause.

A

Osteoporosis, cardiovascular disease, dementia

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151
Q

What are the 3 options for menopause management.

A

Hormonal (HRT), non hormonal (Clonidine), non pharmaceutical (CBT)

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152
Q

What are the benefits of HRT?

A

Relief of menopausal symptoms, BMD protection

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153
Q

What are the risks of HRT?

A

Breast cancer, VTE, CVD, CVA

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154
Q

What is the risk increase of breast cancer with HRT (Oestrogen).

A

Little change

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155
Q

What is the increase risk of breast cancer with

HRT (Oestrogen and progesterone)?

A

Increased risk

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156
Q

What is the management of women with early, local breast cancer and menopausal symptoms?

A

Discontinue HRT, do not offer HRT

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157
Q

Women with BMI 32 is offered HRT? Transdermal or oral?

A

Transdermal, lower risk of VTE (Baseline population)

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158
Q

What age does CVD risk not increase when starting HRT?

A

<60 yrs

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159
Q

Who should have transdermal HRT?

A

Gastric upset, migraine, increased VTE, HTx, Choice

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160
Q

What is premature ovarian syndrome?

A

Menopause <40yrs, chromosomal abnormality, genetic

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161
Q

What is the advice in management of POS?

A

Hormonal replacement at least until the age of the menopause.

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162
Q

What are non hormonal methods to treat the menopause?

A

Clonidine, citalopram, fluoxetine.

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163
Q

What is endometriosis?

A

Endometrial tissue outside the uterus

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164
Q

What causes endometriosis?

A

Retrograde menstruation

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165
Q

What are 2 sites for endometriosis?

A

Umbilicus (Halbans), lungs (Meyers)

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166
Q

What is the usual presentation of endometriosis?

A

Pain, infertility

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167
Q

Describe the pain of endometriosis.

A

Cyclic Pain, dysmenorrhea, deep dyspareunia

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168
Q

What are the 2 methods of treatment of endometriosis?

A

Abolishing cyclicity, glandular atrophy

169
Q

Give 2 examples of abolishing cyclicity methods to treat endometriosis.

A

OCP (long will cause glandular atrophy), GnRH agonists

170
Q

Give examples of secondary care endometriosis care.

A

Surgery (ablation, excision, oooprectomy, pelvic clearance)

171
Q

What are fibroids?

A

Benign uterine tumours, smooth muscle tumours, Oestrogen dependant

172
Q

What are the symptoms of fibroids?

A

Asymptomatic, heavy periods, anaemia, infertility, miscariage

173
Q

What is informed consent?

A

Informed consent is the process by which a fully informed patient can participate in choices about her health. Care.

174
Q

What is the term for failing to obtain informed consent before performing a procedure?

175
Q

What elements make up informed consent?

A

Nature of the procedure,
Alternatives, risk and benefits,
Has patient understood?!
Acceptance by patient

176
Q

What is amniocentesis?

A

Is usually done at 15-20 weeks, check for chromosomal abnormalities

177
Q

What is choroid villus sampling?

A

Placental tissue is taken for analysis, 10-13 weeks.

178
Q

What is the definition of a premature birth?

A

Born before 37 weeks

179
Q

What is the definition of LBW infants?

180
Q

What can prematurity lead to?

A

Developmental delay, visual impairments, lung disease, cerebral palsy

181
Q

What can be given to premature neonates to improve survival?

A

Steroids, surfactant, ventilation, nutrition, antibiotics.

182
Q

What are related risk factors for PTB?

A

Vaginal bleeding, multiple pregnancy, race, infection (bacterial vaginosis, UTI, appendicitis)

183
Q

What is the primary prevention of PTB?

A

Smoking and STD prevention, prevention of multiple pregnancy, planned pregnancy, cervical assessment at 26 weeks

184
Q

What is the tertiary prevention for PTB?

A

Prompt treatments, steroids, antibiotics

185
Q

What is the definition of preterm labour?

A

Persistent uterine acitivity and change in cervical dilation or effacement

186
Q

What is the secondary treatment for preterm labour?

A

Trans vaginal cervical ultrasound, fetal fibronectin test

187
Q

What is fetal fibronectin?

A

Extra cellular matrix protein found in choriodecidual inferface

188
Q

What is the treatment for preterm labour?

A

Progesterone IM

189
Q

What percentage of pregnancies are complicated by hypertension?

190
Q

What proportion of hypertensive pregnancies are Gestational hypertension?

A

70%, 30% are chronic HTx

191
Q

What percentage of maturnal deaths are from hypertension?

192
Q

What are risk factors for hypertension in pregnancy?

A

Young females, black, multifetal pregnancy, renal disease,

193
Q

What are the classifications of hypertension in pregnancy?

A

Gestational hypertension, preeclampsia, chronic hypertension, preeclampsia superimposed in chronic

194
Q

What is the definition of gestational hypertension?

A

New HTx after 20 wks, 140/90, NO PROTEINURIA

195
Q

What is the definition of preeclampsia?

A

New HTx after 20 wks, WITH PROTEINURIA

196
Q

What is eclampsia?

A

Features of preeclampsia plus generalised tonic clinic seizures

197
Q

What are the thresholds for PROTEINURIA?

A

> 0.3g protein /24hrs, +2 urine dipstik

198
Q

How should blood pressure be measured in pregnancy women?

A

Left lateral position, rest for 10 minutes, cuff at heart level

199
Q

What is the classification of severe preeclampsia?

A

160/110, significant PROTEINURIA, oliguria, visual changes, headache, scotomata, pulmonary oedema, RUQ Pain

200
Q

What is the clinical criteria for severe preeclampsia?

A

Impaired liver function tests, thrombocytopenia, IUGR, oligohyroaminos.

201
Q

What physical findings are there in preeclampsia?

A

Brisk, hyperactive reflexes, ankle clonus

202
Q

What are the differential diagnosis of preeclampsia?

A

TTP, HUS, FL of pregnancy

203
Q

What blood tests are needed for preeclampsia?

A

Haemoglobin, Uris acid, LFT, platelets, creatinine, urine protein

204
Q

What is the management for preeclampsia?

A

Hospilatalisation

205
Q

What is the Antepartum management for preeclampsia?

A

Restricted activity.

206
Q

What are the maternal indications for deliver in preeclampsia?

A

38 weeks, low platelets, deteriating liver, severe CNS symptoms

207
Q

What a the the fetal indications for delivery in preeclampsia?

A

FGR, Oligohydramnios

208
Q

What is the cure for preeclampsia?

209
Q

What medication is given to prevent CNS symptoms in preeclampsia?

A

Magnesium sulphate

210
Q

What is the treatment of severe hypertention in pregnancy ?

A

Hydralyzine, labetalol

211
Q

What is menstruation?

A

Monthly bleeding from the reproductive tract induced by hormonal changes of the menstrual cycle

212
Q

How do you measure the menstrual cycle length

A

Start of day of bleeding to the start of the next day

213
Q

What is the normal menstrual cycle lengths?

214
Q

What is menorrhagia?

A

Heavy Bleeding that occurs at the expected intervals of the menstrual cycle

215
Q

What is intermenstrual bleeding?

A

Bleeding that occurs between clearly defined menses

216
Q

What is abnormal uterine bleeding?

A

Any bleeding from the uterus that is either abnormal in volume, regularity, timing, or is non menstrual

217
Q

What is the definition of heavy menstrual bleeding?

A

Menstrual blood loss that is subjectively excessive by the the woman, and interferes with her emotion, social or material quality of life.

218
Q

What are the pathological causes of AUB?

A

Uterine fibroids, polyps, adenomyosis, endometriosis

219
Q

What are uterine fibroids?

A

Leiomyomas of the myometrium, 20% of women of reproductive age

220
Q

What is most heavy menstrual bleeding due to a combination of?

A

Coagulopathy, ovulatory, endometrial dysfunction

221
Q

What are uterine polyps?

A

Common benign localised growths of endometrium

222
Q

What is adenomyosis?

A

Ectopic endometrial tissue within the myometrium.

223
Q

What information should you get from a history of heavy menstrual bleeding?

A

Duration, cycle, heavy ness, clots, flooding

224
Q

What are the differential diagnoses of HMB?

A

Thyroid disease, clotting disorder, drugs

225
Q

What investigations should be done for menorrhagia?

A

FBCM TVS,endometrial biopsy

226
Q

What are the treatments of HMB?

A

Reassurance, tranexamic acid, NSAIDs, progestagens, danazol, COCP, Mirena, ablation (infertility), hysterectomy

227
Q

What is the definition of the puerperium

A

From the delivery of the placenta to six weeks following birth

228
Q

What are the features of the puerperium?

A

Return to pre-pregnant state, transition to parenthood, initiation to suppression of lactation

229
Q

Describe the physiology of endocrine changes in the puerperium.

A

Decrease in placental hormones (hCG, Oestrogen, progesterone, placental lactogen), increase in prolactin

230
Q

Describe the physical changes in the puerperium.

A

Involution of the uterus and genital tract.

231
Q

Puerperium: What is the Lochia rubra?

A

Day 0-4, blood discharge, decidua, fetal membrane, meconium

232
Q

Puerperium: What is the Lochia serosa?

A

Day 4-10, cervical mucus, exudate, fetal membrane, WBC

233
Q

Puerperium: What is the Lochia alba?

A

Day 10-28, cholesterol, epithelial cells, fat, mucus

234
Q

What essential molecule is found in breast milk?

A

Lactoferrin.

235
Q

What is a mnemonic for the classification of sepsis?

A

3T’s with white sugar

236
Q

What is the definition of primary post partum haemorrhage?

A

> 500ml blood loss after birth of baby

237
Q

What is the definition of minor post partum haemorrhage?

A

Blood loss of <1500ml with no signs of shock

238
Q

What is the definition of major post partum haemorrhage?

A

1500ml blood loss or clinical shock

239
Q

What factors constitute 6 weeks postnatal LMWH?

A

Previous VTE, FHx, antenatal LMWH

240
Q

What is a risk of epidural?

A

Post dural puncture headache.

241
Q

What are the red flags of the puerperium?

A

Recent significant change in mental state, new thoughts of violent self harm, new expressions of incompetency as a mother, or estrangement from infant

242
Q

What percentage of new mothers suffer from postnatal depression?

243
Q

What is the medical term for fibroids?

A

Leiomyomas

244
Q

What is adenomyosis?

A

Endometrial tissue found in the myometrium of the womb.

245
Q

What are the symptoms of fibroids?

A 
Can be asymptomatic,
Heavy periods,
Painful periods,
Lower back pain,
Dyspareunia.
246
Q

How many deaths are there from breast cancer per year?

247
Q

What are some reasons why the incidence of breast cancer is rising?

A

Western lifestyle, screening, life expectancy

248
Q

What are some factors that predispose to breast cancer?

A

Late first child, alcohol, HRT, COCP, Obesity, lobular carcinoma in situ

249
Q

What are some non modifiable factors for breast cancer?

A

Age of menarche, early parity and breast feeding, breast density, heredity

250
Q

What are some modifiable factors for breast cancer

A

Weight, exercise, alcohol, exogenous oestrogen

251
Q

What percentage reduction does 150 minutes of brisk exercise do to breast cancer risk?

252
Q

How often does breast cancer screening occur in the UK?

253
Q

What is the age of breast cancer screening in the UK?

A

50-70 (47-73)

254
Q

What are the disadvantages of screening?

A

Overdiagnosis, anxiety, costs, X-ray dose

255
Q

What are the advantages of breast cancer screening?

A

Reduces breast cancer stage at diagnosis, diagnoses DCIS, which is rarely symptomatic

256
Q

What are the clinical features of breast cancer?

A

Nipple inversion, lump, visible, blood discharge, visible skin changes

257
Q

What are the signs of breast cancer?

A

Skin tethering, irregular lump

258
Q

What do microcalcifications indicate on mammography?

A

DCIS, Cancer

259
Q

What are the indications for a mastectomy?

A

Large tumour size, more than one cancer in same breast, patient choice, reconstruction

260
Q

What factors indicate conservation and radiotherapy treatment?

A

Small tumour, no previous radiotherapy, pre operative chemotherapy, choice

261
Q

What percentage of women with breast cancer have axillary involvement?

262
Q

What can unilateral lymph oedema indicate?

A

Axillary lymph blockage, due to breast cancer

263
Q

What are the 2 categories of breast cancer?

A

Ducal and lobular

264
Q

What is the name of the prognostic index which shows prognosis after surgery only for breast cancer?

A

Nottingham Prognostic Index

265
Q

What is the common name for trastuzumab?

266
Q

What adjuvant therapy is given to women with ER breast cancer?

A

Bisphosphonates

267
Q

What are the complications of tamoxifen?

A

Hot flush, nausea, vaginal bleeding, thrombosis, endometrial cancer

268
Q

What are the side effects of aromatase inhibitors?

A

Hot flushes, reduced bone density, joint Pain, DVT, endometrial cancer

269
Q

FINISH BREAST LECTURE

270
Q

What is the prevalence of infertility?

271
Q

What is the definition of infertility?

A

Failure to conceive after 1 year of unprotected sex.

272
Q

What is the single most important factor for fertility?

A

Maternal age

273
Q

What is the relationship between miscarriage and age?

274
Q

What are the 4 principles of care when carrying out a fertility clinic?

A

See both partners together, explanation and written advice, psychological effects of infertility, specialist team

275
Q

What reproductive disorders are associated with obesity?

A

PCOS, Miscarriage, infertility, obstetric complications

276
Q

What preconception advice is given to couples who are infertile?

A

Intercourse 2-3 times per week, folic acid, rubella, smoking, weight loss, smear,

277
Q

What investigations should be done in patients who are infertile?

A

Ovulation function, semen quality, tubal patency

278
Q

What investigations can be done to check ovulation?

A

Mid-luteal progesterone

279
Q

What are the 3 parts of the ovarian reserve testing?

A

FSH, Antral follicle count, antimullarian hormone

280
Q

What is the name of the criteria for polyciytic ovarian syndrome?

A

Rotterdam criteria

281
Q

What are the contents of the Rotterdam criteria?

A

Anovulation, PCOS on USS, raised androgens (2 out of 3)

282
Q

What is the treatment of PCOS?

A

Normalise weight, clomifiene(Oestrogen antagonist), metformin, gonadotrophins

283
Q

What can cause blocked Fallopian tubes?

A

Infections, endometriosis, Previous surgeries

284
Q

What are the treatment options for blocked Fallopian tubes?

A

Surgery, catheterisation, IVF

285
Q

What are the treatments for endometriosis?

A

Laparoscopic ablation, cystectomy

286
Q

What is the treatment of unexplained infertility?

A

IVF [2 years], THEN, Clomiphene, SIUI

287
Q

What are the risks of IVF?

A

Multiple pregnancy, miscarriage, ectopic, abnormality, ovarian hyper stimulation syndrome,

288
Q

What patient factors contribute to failed IVF?

A

Ahem cause of infertility, Previous pregancy, Previous attempts, environmental factors

289
Q

What are the maternal risks of increased age and IVF?

A

HTx, GD, IUGR, instrumental delivery, VTE, death

290
Q

What are the conditions of IVF?

A

Treatment after 12 months or 2 years of insemination

291
Q

What is the treatment for fibroids?

A

Myomectomy, pregnancy rate higher after surgery

292
Q

What are the differential diagnosis of a breast lump?

A

Benign breast change, fibroadenoma, cyst, sebaceous cyst, papilloma, fat necrosis, cancer, sarcoma, lymphoma

293
Q

What are the characteristics of a malignant lump?

A

Hard, irregular margin, skin tethering, nodal swelling, older age

294
Q

What are some indirect causes of maternal death in pregnancy?

A

CVD, Epilepsy, suicide, cancer, diabetes

295
Q

What are direct causes of maternal death in pregnancy?

A

Pre-eclampsia, thrombosis, PPH

296
Q

What are the cardiac changes in pregnancy?

A

Increase blood volume, increase oxygen demand,

Increase CO

297
Q

What changes does pregnancy have on haematology?

A

Increase iron requirements (2-3 times),
Dilutions anaemia,
Folate anaemia and

298
Q

What happens to tidal volume in pregancy?

299
Q

What happens to residual capacity in pregnancy?

300
Q

Is pregnancy associated with respiratory acidosis or alkalosis?

301
Q

What is the incidence of asthma in pregancy?

302
Q

What is the age range for fibroadenomas?

303
Q

What is the management for fibroadenoma?

A

Leave unless increasing in size

304
Q

What are the characteristics for a fibroadenoma?

A

Smooth, mobile, non-tender

305
Q

What is the age range for cysts?

306
Q

What are the characteristics of breast cysts?

A

Hard, irregular

307
Q

What is the management of breast cysts?

308
Q

What age does fibrocystic change occur in?

A

Younger patients

309
Q

What are the characteristics of fibrocystic change?

A

Tender, cyclical, rubbery

310
Q

What is the management of fibrocystic change?

A

Reassurance

311
Q

What are the risks with breast implants?

A

Capsule formation, rupture, migration, lymphoma

312
Q

What are the symptoms of mastitis?

A

Red, swollen, tender, Pyrexia, Pain

313
Q

What is a complication of mastitis?

A

Abscess formation

314
Q

What is a complication of drainage of a breast abscess?

A

Lactational fistula

315
Q

What organisms can cause acute peri-areole sepsis?

A

Staph Aureus, bacteroides, step, enterococci

316
Q

What organisms can cause acute peripheral Lactational sepsis?

A

Staph aureus

317
Q

What is duct ectasia?

A

Where the lactoferous ducks become blocked

318
Q

What are the symptoms of duct ectasia?

A

Nipple discharge, pain, bloody discharge, nipple inversion

319
Q

What are the symptoms of periodical mastitis?

A

Non cyclical pain, mass, nipple inversion

320
Q

What are the symptoms of a breast abscess?

A

Periareolar abcess, fistula

321
Q

What are the differential diagnosis of bloody nipple discharge?

A

Duct ectasia, papilloma, DCIS

322
Q

What is the management of bloody discharge of the nipple?

323
Q

What are the differential diagnosis of single duct non bloody nipple discharge?

A

Duct ectasia or papilloma

324
Q

What are papillomas of the breast?

A

Benign mass in a dilated ductal system

325
Q

What is the name of the screening criteria?

A

Wilson and Junger Criteria

326
Q

What is the definition of screening?

A

A process of identifying apparently healthy individuals who may be at an increased risk of a disease or condition

327
Q

What diseases does the fetal anomaly screening programme look for?

A

Downs, Edwards, Patau’s

328
Q

At what week does the fetal anomaly screening programme occur during pregnancy?

A

18 weeks to 20+6 weeks

329
Q

What diseases does the infectious diseases screening program look for?

A

Toxoplasmosis, rubella, cytomegalovirus, hepatitis, herpes, syphilis

330
Q

What are the 3 antenatal screening programme?

A

Fetal anomaly screening programme,
Infectious diseases screening programme,
Sickle cell and Thalassaemias screening program

331
Q

What can the newborn screening programme detect?

A

Cystic fibrosis, congenital hypothyroidism, sickle cell disease, inherited mental IC diseases

332
Q

What are the new born screening programmes?

A

New-born blood spot screening programme,
New#born hearing programme,
New-born physical examination screening programme

333
Q

What is the incidence of Down’s syndrome

334
Q

What can be the complications of Down’s syndrome?

A

Heart defect, leukaemia, thyroid disease, epilepsy, alzheimers

335
Q

What are the effects of Edwards syndrome?

A

Heart problems, facial and head deformities, brain abnormalities

336
Q

What measurements are used in the combined test (first trimester) to screen for T21, T18, T13?

A

NT (If CR length is 45-84), b-HCG (Higher), PAPP-A (Lower)

337
Q

What measurements are used in the quadruple test (second trimester) to screen for T21, T18, T13?

A

AFP, bHCG, Oestriol, inhibit A

338
Q

When is the quadruple test offered to women?

A

Is women presents too late, if the foetus position means NT cannot be measured

339
Q

What are dichorionic twins?

A

Two foetuses with 2 placentas

340
Q

What diagnostic tests are offered to women who have a positive screening result?

A

Chorionic villus sampling, amniocentesis, Non-invasive prenatal testing

341
Q

What is non-invasive prenatal testing?

A

Fetal Free DNA testing, from 10 weeks of pregnancy

342
Q

How many fetal anomaly screening are women offered during pregnancy?

343
Q

What is the Early ultrasound scan (10-14 weeks) used to detect?

A

Dating the pregancy and confirming viability, multiple pregnancy, NT

344
Q

What is the ultrasound can atm 18 weeks to 20 weeks and 6 days used to detect?

A

Structural abnormalities

345
Q

What screening test can be done in newborns?

A

Heel-prick screening test

346
Q

What conditions does the heel-prick test detect?

A

Sickle cell disease, cystic fibrosis, congenital hypothyroidism, thalassaemia, inherited metabolic disease

347
Q

What are some maternal obstetric emergencies?

A

Antepartum haemorrhage,
Postpartum haemorrhage,
Venous thromboembolism,
Pre-eclampsia

348
Q

What are fetal obstetric emergencies?

A

Fetal distress, cord prolapse, shoulder dystocia

349
Q

What is the definition of antepartum haemorrhage?

A

Bleeding from anywhere in the genital tract after 24 weeks of pregnancy

350
Q

What are the causes of antepartum haemorrhage?

A

Placenta praevia, placenta accreta, abruption, infection

351
Q

How is a low lying placenta diagnosed?

A

20 week anomaly scan, painless bleed

352
Q

What is the management of low lying placenta?

A

Education of symptoms, outpatient of management,anti D, elective Caesarian

353
Q

What is the emergency management for a placenta praevia?

A

ABCDE, Examination (vaginal, USS, abdominal), fetal monitoring, steroids

354
Q

What is the management for a placenta accreta?

A

20w scan, CS at 36 weeks, hysterectomy?, leave placenta in place, blood products available

355
Q

What is vasa praevia?

A

Where the vessels of the placenta are covering the cervical os

356
Q

What is the mortality of vas’s praevia?

357
Q

What must never be done in the examination of placenta praevia?

A

DIGITAL VAGINAL EXAMINATI9N

358
Q

What is placental abruption?

A

Premature separation of the placenta from the uterine cavity,

359
Q

What are the risks of a placental abruption?

A

Concealed haemorrhage, fetal distress, haemorrhage

360
Q

What are the complications after antepartum haemorrhage?

A

Premature delivery, blood transfusion, ATN, DIC, PPH, ITU, ARDS, fetal hypoxia or death

361
Q

What are the causes of post partum haemorrhage?

A

Tissue (placenta)
Tone (No uterine contraction),
Trauma (tears)
Thrombin (clotting)

362
Q

What are the risk factors for post partum haemorrhage?

A

Macrosomia, multiparty, long labour, pyrexia, instrumental delivery, shoulder dystocia

363
Q

What is the most common direct cause for maternal death in the UK?

364
Q

What is the pre management for sepsis in pregnant women ?

A

Flu vaccine

365
Q

What are the risk factors for sepsis in pregancy?

A

Obesity, diabetes, anaemia, immunosuppressive, vawginal discharge, PID, GBS, amniocentesis, rupture of membranes prolonged,

366
Q

What are the sings and symptoms of sepsis?

A

Pyrexia, hypothermia, tachycardia, tachypnoea, hypoxia, hypotension, oligouria, dizzy

367
Q

What is the difference in presentation between placenta praevia and placenta abruption?

A

Placenta abruption is not as much blood and LOTS OF PAIN

368
Q

What is the treatment of sepsis?

A

Oxygen, fluids, blood cultures, lactate, antibiotics, fluid chart

369
Q

What is the definition of severe pre-eclampsia?

A

Hypertension +PROTEINURIA, plus one of pappiloedema, headache, visual change, clonus, liver tenderness, platelet or LFT dysfunction

370
Q

What is the treatment for pre-eclampsia?

A 
BP control (labetalol, methyldopa, Hydralazine)
Magnesium sulphate,
Fluids
Coagulation factors,
Delivery
371
Q

What is given to induce uterine contraction?

372
Q

What is the physiological cause of fetal morbidity in cord prolapse?

373
Q

What are risk factors for cord prolapse?

A

Premature membrane rupture, Polyhydramnios, long umbilical cord, multiparty,

374
Q

What is shoulder dystocia?

A

Failure of the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head

375
Q

What are the risks of shoulder dystocia?

A

PPH, vaginal tear, cerebral palsy, brachial plexus injury

376
Q

What are the risk factors for shoulder dystocia?

A

Macrosomia, Previous SD, maternal diabetes, post maturity, obesity, instrumental delivery

377
Q

What are the 2 methods of fetal heart rate monitoring?

A

Intermittent monitoring, continuous monitoring

378
Q

What are the advantages of intermittent auscultation of FHR?

A

Inexpensive, non-invasive, can be used at home

379
Q

What are the disadvantages of intermittent auscultation?

A

Variability in accelerations and decelerations cannot be detected, long term monitoring not possible, quality of FHR can be affected by maternal heart rate and movement

380
Q

What can be used for intermittent auscultation

A

Pinnard stethoscope, Doppler

381
Q

What equipment is used for continuous monitoring in pregnancy?

A

Cardiotocography

382
Q

What are the advantages of CTG?

A

Information about fetal heart and uterine activity, long term monitoring is possible, can determine variability

383
Q

What are the disadvantages of CTG?

A

No I,provement in perinatal outcomes in low risk pregnancies, no morphological assessment of the heart, no true beat to beat FHR data, fetal exposure to ultrasound, ambulatory monitoring not possible.

384
Q

What mnemonic is used for CTG interpretations?

A 
DR C BRA V A D O
(Define risk)
(Contraction)
(Baseline rate)
(Variability)
(Accelerations)
(Decelerations, early, variable, late)
(Overal
385
Q

What is the normal baseline of a CTG?

A

110-160bpm

386
Q

What is the normal variability in CTG heart rate in pregancy?

387
Q

What are the advantages of fetal electrocardiograph?

A

Direct FHR monitoring, true beat-beat information

388
Q

What are the disadvantages of fetal ecg?

A

Invasive, monitoring only if in labour, 2cm dilated and membranes not present, scalp injury and infection

389
Q

What should the measurement be of the fundal height, compared to the gestational age?

A

+/-2cm from gestational age

390
Q

What does low liquor volume mean?

A

Placental dysfunction

391
Q

At what weeks are smokers babies scanned?

A

3 times! 26, 28, 32 weeks

392
Q

What is the most common cause of Polyhydramnios?

A

Gestational diabetes, swallowing malfunction

393
Q

What are tumour-suppressor genes?

A

Breaking signals during the G1 phase of the cell cycle, to stop progression to the S phase

394
Q

Give 2 examples of tumour suppressor genes?

395
Q

What is the aetiology of endometrial cancer?

A

Obesity, diabetes, nulliparity, late menopause, ovarian tumour, HRT, Irradiation, tamoxifen, PCOS, HNPCC
UNOPPOSED OESTROGEN

396
Q

What is the medical name of endometrial cancer?

A

Adenocarcinoma, adenosquamous,

Papillary serous

397
Q

What is the staging of endometrial cancer called?

A

FIGO I/II/III/IV

398
Q

What are the treatments for endometrial cancer?

A

Hysterectomy, lymph node removal, radiotherapy, progesterone

399
Q

What are the causes of cervical cancer?

A

HPV, early age intercourse, STD, cigarettes, OCP

400
Q

What is a red flag of endometrial cancer?

A

Postmenopausal bleeding

401
Q

What stains of HPV are common for cervical cancer

A

HPV16, HPV18

402
Q

What percentage of the population will come into contact with HPV ?

403
Q

What does E6 in HPV block?

404
Q

What does E7 in HPV block?

A

Retinoblastoma suppressor

405
Q

What is a persistent infection of HPV associated with?

A

High grade Cervical intraepithelial neoplasia

406
Q

What is the 5 year survival rate of stage I cervical cancer

407
Q

What are the causes of vulval cancer?

A

HPV, Lichen sclerosis

408
Q

What are the symptoms of vulval cancer?

A

Itching, soreness, lump, bleeding, dysuria

409
Q

What are the treatments of vulval cancer?

A

Surgery, radiotherapy, adjuvant chemotherapy

410
Q

What are the symptoms of ovarian cancer?

A

Bloating, abdomen pain, bowel habit change, urine frequency, obstruction,

411
Q

What are the causes of ovarian cancer?

A

Ovulation (menarche, menopause, parity, OCP)

Genetic (BRCA, HNPCC)

412
Q

What is the histological name for ovarian cancer?

A

Epithelial

413
Q

What investigations can be done for ovarian cancer?

A

CA125, CEA, USS

414
Q

What is the Risk of Malignancy Index?

A

CA125 x USS (3) x pre or post menopausal (3)

415
Q

What is the definition of term?

A

37 completed weeks (37+7)

416
Q

What is the definition of pre term?

A

Baby born at or before 37+6 weeks

417
Q

What is the definition of post-term?

A

After 42 weeks

418
Q

What ‘symptom’ questions should be asked in an obstetric history?

A 
Nausea and Vomiting
Visual change/ headache
Swelling
Itching
PV bleeding/ loss
Reduced fetal movements
LUTS
419
Q

What questions about ‘investigations should be asked in an obstetric history?

A 
Had a scan?
Had screening?
Taking folic acid?
Planned?
Last menstrual period

Phase 3a (You) (2 decks)

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