Obstetrics Flashcards
Average blood loss per menstrual cycle
30-40 mls
Treatment for heavy menstrual bleeding
First line is antiprostaglandins - NSAIDs and TXA
COCP is second line
What is primary amenorrhoea?
Pt never had period
When should you investigate for primary amenorrhoea ?
14yo girl with no breasts
15 yp girl with breasts
Causes of secondary amenorrhoea
HPA axis unbalanced - stress, hyperthyroidism, disease
What is placenta accreta
Placenta is unusually adherent to uterine lining
Sx placenta accrete
Painless vaginal bleeding, foetus is often in abnormal lie
sx placental abruption
woody uterus
single instance of large blood loss
contractions
Management placenta praaevia
If >24 weeks should go to ED
O2 and blood match
Treatment of bacterial vaginosis
Metronidazole and clindamycin
What is Ca125 a marker for ?
ovarian cancer
Which palsy is associated with shoulder dystocia?
Erb’s - c5-7
Most common place for ectopic
Ampulla
Gold standard to diagnose ectopic pregnancy
laparascopuy
Most common form of endometrial cancer
Adenocarcinoma of columnar cells
Sx endometrial cancer
Post-menopausal bleeding
Tx endometrial cancer
Hysterectomy with bilateral salpingo-oophorectomy
Cause of endometritis
Pregnancy
GBS
Management endometritis
Clindamycin and gentamicin
What is adenomyosis
endometrial tissue grows inside myometrium
sx adenomyosis
boggy uterus
dysmenorrhoea
Most common type of cervical cancer
sqmaous cell
Sx cervical cancer
abnormal vaginal bleeding/discharge
screening programme cervical cancer
every 3 years from 25-49 and every 5 from 50-64
treatment for 1A cervical cancer
LLETZ
treatment for 1B-2A cervical cancer
hysterectomy
treatment for 2B-4A cervial cancer
chemo and radiotherapy
vulval cancer
- Squamous cell tumours
- R/F = HIV
- Sx = lumps + itching + pain
endometrial cancer
- Adenocarcinoma
- Exposure to oestrogen
- Post-menopausal bleeding
Missing POP
take pill ASAP and use protection for 48h - emergency contraception needed if had sex since missing pill
symptoms of PCOS
- Oligo-ovulation/anovulation
- Hyperandrogenism (hirsutism, acne, alopecia)
- Polycystic ovaries
hormone levels PCOS
- Increased LH and testosterone
- FSH normal
- High oestrogen
management PCOS
- Lifestyle changes and weight loss
- COCP to protect against endometrial cancer
What is premature ovarian insufficiency
menopause <40 years
medical management of miscarriage
mifepristone pessary
medical abortion <7 weeks
mifepristone (progesterone antagonist) + mifepristone
Pre-eclampsia
Spiral arteries have increased resistance = reduced blood flow to placenta = inflammation
Sx pre-eclampsia
headaches, visual changes and oedema
Ix pre-eclampsia
BP and urinalysis
Mx pre-eclampsia
labetolol and c-section
what is eclampsia
seizures due to pre-eclampsia , increased BP, proteinuria
mx eclampsia
magnesium sulphate
HELLP syndrome
inflammatory complications due to pre-eclampsia
mx HELLP
IV labetolol
why do you give magnesium sulphate in eclampsia?
prevent seizures
treatment pregnancy induced hypertension
magnesium sulphate
pathophysiology of Rh -ve pregnancies
When a Rh -ve mum has a Rh +ve baby, fetal RBCs can leak across to the placenta. Mum then makes anti-D IgG antibodies which can attack baby
Sx in baby if mum -Rhve and baby +ve
hydrops fetalis (oedema), jaundice (kernicterus), heart failure and anaemia. Can be treated with transfusion and phototherapy
anti-D needs to be given <72h when…
- TOP
- Baby +ve (live/stillborn)
- Miscarriage >12w
- Ectopic pregnancy managed surgically
- External cephalic version
- Antepartum haemorrhage
- Invasive testing (amniocentesis, CVS, fetal blood test)
- Abdo trauma
Coombs test
tests for antibodies in RBCs of baby
Kleihauer test
add acid to maternal blood - fetal cells resistant
What is alpha feta-protein?
Secreted from GIT and yolk sac in developing foetus - test for in 16-18w testing
Reasons for high AFP
Neural tube defect (meningocele, myelomeningocele, anencephaly)
Abdominal wall defect (omphalocele, gastroschisis)
Multiple babies
Reasons for decreased AFP
Aneuploidy
Maternal DM
Spina bifida occulta
Spinal laminae of L5 +/- S1 fail to unite, produces no symptoms - has small dimple and tuft of hair at base of spine
Meningocele
Protrusion of meninges and CSF
Myelomeningocele
Protrusion of meninges, CSF and spinal cord
Anencephaly
Absence of skull and cerebral hemispheres
Gastroschisis
Herniation of abdo contents without peritoneal covering lateral to umbilicus