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3rd year > OBSGYN > Flashcards

OBSGYN Flashcards

1
Q

Risk factors for endometriosis

A

Reproductive age group

Positive family Hx

Nulliparity

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2
Q

Endometriosis symptoms

A

Dysmenorrhoea Chronic or cyclic pelvic pain Dyspareunia Sub-fertility Dysuria, dyschezia, haematuria, haematochezia Pelvic mass (Ovarian involvement)

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3
Q

Endometriosis investigations

A

TVUS Laparoscopy

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4
Q

Endometriosis management (medical & surgical)

A

NSAIDs COCP Oral progestins/ implanon Mirena IUD Surgical removal

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5
Q

Endometriosis recurrence rate after surgery

A

~20%

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6
Q

Most common organisms involved in PID

A

Chlamydia Gonorrhoea BV organisms

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7
Q

PID risk factors

A

Prior chlamydia or gonorrhoea infection Young age at onset of sexual activity Unprotected sex multiple partners Prior Hx PID IUD use Instrumentation of cervix (e.g. D&C)

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8
Q

PID clinical features

A

Abnormal vaginal bleeding Dyspareunia Vaginal discharge Dysuria Lower abdo or pelvic pain Fever Lower back pain

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9
Q

PID investigations

A

Vaginal and cervical swabs Bloods (CRP) STI screening USS or MRI

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10
Q

PID management (mild/moderate & severe)

A

Mild/moderate: Oral Abx (azithromycin 1g, doxycycline, metronidazole, + ceftriaxone IM if gonorrhoea suspected) Severe: Cefotaxime IV, metronodazole IV, azithromyin IV + oral doxycycline

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11
Q

PID complications

A

Tubo-ovarian abscess Infertility due to adhesions and tubal occlusion Chronic pelvic pain Ectopic pregnancy

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12
Q

Innervation of muscle of pelvic floor and vulval skin

A

Pudendal nerves S2,S3,S4

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13
Q

Innervation of mons and labia

A

Ilioinguinal and genitofemoral nerves L1, L2

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14
Q

Visceral innervation of pelvic contents

A

SNS to T10 and L1

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15
Q

Aetiology of primary dysmenorrhoea

A

Excess of endometrial prostaglandins (PGE2 & PGF2-a)

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16
Q

Clinical features of primary dysmenorrhoea

A

Cramping Worse on first few days of menstruation Bilateral Can be associated with nausea, vomiting, diarrhoea, headache

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17
Q

Medical management of primary dysmenorrhoea

A

NSAIDs COCP Progesterone only methods (implanon, POP, depo-provera)

18
Q

Mechanism of pain of primary dysmenorrhoea

A

Progesterone –> Excess prostaglandins –> increased myometrial contraction –> increased uterine pressure (>arterial pressure) –> ischaemia –> anaerobic metabolite accumulation –> type C fibre activation –> Pain

19
Q

Risk factors for GDM

A

>25BMI Age >40 Previous GDM PCOS Family Hx Black, Islander, Middle Eastern Previous Hx macrosomia Medications: Corticosteroids, antipsychotics

20
Q

Effects of pregnancy on diabetes

A

1st half –> Improvement in glucose tolerance (foetal demands and reduced appetitie) 2nd half –> Placental hormones (esp. hPL) have anti-insulin effect After –> Return to pre-pregnancy state May be more rapid progression of microangiopathy

21
Q

Effects of diabetes on pregnancy

A

Pre-eclampsia Polyhydraminos Preterm labour Placental insufficiency Infections (UTI, Vaginal candidiasis)

22
Q

Effects of diabetes on newborn

A

Macrosomia 2x risk congenital malformations (NTDs, VSDs, aortic coarctation) Increased tendency for hypocglycemia and respiratory distress Birth injury (from macrosomia) Prematurity Perinatal mortality increased

23
Q

Explain GDM screening

A

26 to 28 weeks OGTT 75g glucose Fasting glucose (if ≥5.1mmol/L GDM( 1 hr glucose (if ≥10mmol/L GDM) 2 hr glucose (if ≥8.5mmol/L GDM)

24
Q

Diabetes in pregnancy surveillance

A

Home BGL monitoring: Fasting and 2hrs after every meal Maintain fasting BGL

25
Q

GDM post-pregnancy follow up

A

OGTT 6 weeks postpartum

26
Q

At how many weeks can pre-eclampsia be diagnosed?

A

After 20 weeks

27
Q

What is hypertension and proteinuria before 20 weeks classified as?

A

Pre-existing hypertension

28
Q

Risk factors for pre-eclampsia

A

Antiphospholipid antibodies

Previous pre-eclampsia

Pre-gestational diabetes

Multiple pregnancy

BMI >26

Age <18 or >40

Nulliparity

Family hx of pre-eclampsia

CKD

Pre-existing HTN

29
Q

Basic pathophysiology of pre-eclampsia

A
  • Abnormal placental vasculature
  • Placental under-perfusion, hypoxia and ischaemia
  • Release of circulating antiangiogenic factors and other substances that cause widespread maternal systemic endothelial dysfunction (increased vascular permeabiliy, vasoconstriction, activation of coaagulation system, microangiopathic haemolysis)
  • HTN, proteinuria, and other clinical manifestations of pre-eclampsia result
30
Q

Clinical features of pre-eclampsia

A
  • CVS: Severe hypertension, persistent and/or severe headache
  • Neurological: Brisk reflexes, visual abnormalities (scotoma, photophobia, bluirred vision), ankle clonus
  • GIT: RUQ pain due to stretching of liver capsule as a result of bleeding
  • Resp: Pulmonary oedema (in severe form of disease)
31
Q

Laboratory abnormalities in pre-eclampsia

A
  • Microangiopathichaemlytic anaemia (abnormal peripheral smear & elevated bilirubin)
  • Thrombocytopenia
  • Increased P:Cr (>30mg per mmol creatinine)
  • Proteinuria
  • Increased LDH (raised in haemolysis)
  • Elevated liver enzymes & bilirubin
32
Q

Investigations for pre-eclampsia

A
  • Blood
  • FBC
  • EUC
  • LFTs
  • LDH
  • Coagulation profile
  • Urine (dip, spot [P:Cr], MSSU for microscopy)
  • Baby (CTG, USS of foetal growth, umbilical artery flow, amniotic fluid volume)
33
Q

Medications for acute management of HTN associated with pre-eclampsia

A
  • Labetalol (IV)
  • Nifedipide (oral)
  • Hydralazine (IV)
34
Q

Medications for ongoing (non-acute) management of HTN associated with pre-eclampsia

A
  • Methyldopa
  • Labetalol
  • Nifedipine
35
Q

Complications of pre-eclampsia of foetus and mother

A

Mother

  • Eclampsia
  • Multiple organ dysfunction
  • Bleeding
  • Coagulation disorders (DIC)
  • Maternal death (most frequently due to cerebral bleeding)

Foetus

  • IUGR
  • Foetal death
  • Need for preterm delivery
36
Q
A
37
Q

Risk factors for eclampsia

A
  • Antiphospholipid antibodies
  • Previous pre-eclampsia
  • BMI>26
  • Pre-gestational diabetes
  • Multiple pregnancy
  • Age <18 or >40
  • Nulliparity
  • Family Hx pre-eclampsia
  • Pre-existing hypertension
  • CKD
38
Q

Pathophysiology of eclampsia

A
  • Autoregulation of cerebral blood flow is dysregulated due to changes from HTN
39
Q

Clinical features of eclampsia

A
  • HTN
  • Visual changes
  • Headache
  • RUQ or epigastric pain
  • Can be asymptomatic
40
Q

Management of eclampsia

A
  • ABCs (including IV access, sunction of vomit etc)
  • MgSO4 administration (IV) - and should be given for 24h after the last seizure
  • Control HTN
  • Delivery (no role for continuation of pregnancy once eclampsia has occurred)
41
Q

Caesarean section informed consent

(refer to relevant document on G-drive / Yr3Core folder)

A
42
Q
A

3rd year (3 decks)

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