Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 > Obstetrics and gynae > Flashcards

Obstetrics and gynae Flashcards

1
Q

when is a pregnancy considered full term

A

37-40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

differnetials to post menopausal bleeding

A
  • atrophic vaginitis
  • endometrial polyp, hyperplasia or cancer
  • cervical polyps or cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk facors for endometrial cancer

A
  • unopposed oestrogen (HRT)
  • early menarche, late menopause
  • nulliparity
  • obesity
  • PCOS
  • tamoxifen
  • FH (Lynch, HNPCC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

symptoms of endometrial cancer

A
  • postmenopausal bleeding

- premenopausal change in intermenstrual bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

investigations for endometrial cancer

A
  • women > 55 with PMB: 2WW
  • transvaginal ultrasound (normal thickness <4mm)
  • hysterectomy and endometrial biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

management of endometrial cancer

A
  • localised disease: total abdominal hysterectomy with bilateral salpingo-oopherectomy (+ maybe post operative radiotherapy)
  • progesterone if women frail and not suitable for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

def parity

A

nb of times pregnant beyond 24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

def gravidity

A

nb of times women pregnant (including miscarriages and abortions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do you write the nb of pregnancies (including abortions/miscarriages)

A

Para x + y

x: parity
y: gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Trimester dates

A

T1: up to w12
T2: w13-w28
T3: w29-w40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

beta HCG (curve of production and function)

A
  • detectable 24-48h after implantation, peaks at 3 months

- produced by placenta to keep corpeus luteum alive (to produce oestrogen and progesterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

progesterone if pregnancy (curve of production and function)

A
  • continuously rising throughuot pregnancy, drops just before birth (produced by CL first then placenta)
  • function: smooth muscle relaxant, maintains uterine lining, strengthens cervical mucus, stimulates growth of breast tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

oestrogen during pregnancy (curve of production and function)

A
  • continuously rises throughout pregnancy, drops just before birth (produced by CL and the placenta)
  • function: increases nb of oxytocin receptors in uterus , increases uterine blood flow, stimulates breast tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

changes to resp system during pregnancy

A
  • increase in intraabdominal pressuer leading to more of a diaphragmatic breathing
  • relative hyperventilation
  • increase tidal volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

changes to cardiovascular system during pregnancy

A
  • increase in CO
  • drop in BP in T1 and T2
  • heart and valves displaced to the right
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

changes to haematological system during pregnancy

A
  • increase in plasma volume (oedema and anaemia (disproportionate increase in plasma volume over red blood cell volume)
  • reeduced platelets (does not increase bleeding risk)
  • hypercoaguability
  • immunodeficient (protective to fetus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

changes to MSK system during pregnancy

A
  • increase in BMI
  • lower back pain
  • lordosis
  • carpal tunnel syndrome
  • siatica
  • muscle cramps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

endocrine changes during pregnancy

A
  • bHCG, oestrogen, progesterone, placental lactogen and GH
  • hypertophy of ant pituitary gland
  • increase in thyroid hormones
  • increase in aldosterone and renin
  • increase in relaxin (to loosen pelvis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

dermatological changes during pregnancy

A
  • increase in skin pigmentation
  • distention and proliferation of blood vessels
  • spider angiomata, facial flusing and striae gravidarum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

gynaecological changes during pregnancy

A
  • breast enlargement
  • areolar pigmentation
  • uteric hypertrophy and stretching
  • cervical gland hypertrophy (softening of cervix + mucus plug)
  • vagina lactobacilli proliferation: increase in lactic acid, decrease in pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

breast changes during pregnancy

A

oestrogen

  • increase adipose tissue
  • increase lactiferous duct system

progesterone:
- breast lobule enlargement
- milk production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

change to urological system during pregnancy

A
  • renal blood flow increased (increase eGFR and kidney size)
  • increase chance of UTI (uteric stretching + decrease in uteric motility)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

change to GI system during pregnancy

A
  • oesophageal relaxation (GORD)
  • increase intraabdominal pressure (haemorhoids)
  • reduced bowel motions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

planning pregnancy management

A

LIFESTYLE

  • folic acid 400 micrograms for 12/52 before pregnancy (or 5mg if diabetes, FH neuraal tube defects or on antiepileptic meds)
  • vit D
  • smoking: stop
  • alcohol
  • weight: BMI <25/30

PMH

  • optimise health conditions: diabetes, epilepsy, cardiac, resp & GI disease, coeliac disease, psychiatry disorders
  • seek pre- pregnancy counselling

VACCINATION

  • flu
  • MMR
  • whooping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do you calculate date of birth

A
  • take first day of last period, add 1 year and substract 3 months then add 7 days
  • ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ilpact of overweight on baby

A
  • high BP
  • blood clots
  • miscarriage
  • gestational diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

affect of smoking on baby

A
  • time of birth
  • weight of baby
  • miscarriage
  • sudden infant death syndrome
  • breathing problems in first 6/12 of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

risk factors for high risk pregnancy

A
  • age <20, >40
  • ethnicity
  • PMH
  • previous surgery
  • IVF treatment
  • previous C section
  • previous pb in pregnancy (hypertension FGR, fetal abnormalities, premature labour, APH/PPH, preeclampsia, thrombocytopaenia, 3rd/4th degree tear, previous stillbirth, late miscarriage or noeonatal death)
  • FH
  • SH (domestic abuse, homelessness, addition, financial support)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what needs to be assessed at each antenatal visit

A
  • BP
  • urine
  • symphysiofundal height
  • fetal movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how do you assess for gestational age on USS

A

crown rump length

if > 84mm: use head circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

timeline antenatal care for normal pregancy

A
  • first contact: planning pregnancy
  • 8 weeks: booking appointment
  • 10+0 - 13+6: dating USS and nuchal fold measurement
  • 16w: appointment for discussion
  • 18+0 to 20+6: USS for fetal abnormalities/anatomy
  • 25 weeks: routine appointment for nulliparous
  • 26-28 weeks: glucose tolerance test
  • 28 weeks: antiD (if at risk)
  • 31w: appointment for nulliparous
  • 34w: 2nd dose antiD
  • routine appointments at 36, 38 and 40w
  • 41w: induction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is done at a booking appointment

A
  • Hx taking
  • discussion about: dvlpt of baby, nutrition and diet, exercise, place of birth, pregnancy care pathway, breastfeeding, screening, mental health
  • bloods: Hb, platelets, infection (HIV, hep B, syphylis), blood group and ab status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

screening in normal pregnancy

A
  • infections (HIV, heep B, syphilis)
  • sickle cell and thalassaemia (if high risk)
  • down syndrome: nuchal translucency, PAPP-A, HCG
  • gestational diabetes at 28 weeks
  • pre eclampsia from
  • placenta praevia
  • bloods to check for anaemia, clotting etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

hormones prodcued by placenta to regulate insulin

A

human placental lactogen: increase insulin resistance

- human chorionic somatommatrophin: increase production of insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

pathophysiology of gestational diabetes

A
  • increase insulin resistance
  • reduced glucose tolerance
  • reduced renal tubular threshold for glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

risk factors for GDM

A
  • BMI > 30
  • previous macrosomic baby > 4.5kg
  • previous GDM
  • FH of diabetes
  • ethnicity
  • PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

screening for GDM

A
  • at 24-28 weeks (12-16 weeks if previous GDM)
  • 2h 75g glucose tolerance test
  • diagnostic criteria:
    fasting glucose levels > 5.6 mmol/L
    2h blood glucose levels >7.8 mmol/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

treatment of GDM

A
  • diet and excercise
  • metformin
  • insulin
  • monitoring before and after each meal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

birth plan for GDM

A

offer delivery at 40+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

complications of GDM

A
  • more likely to develop diabetes later (mother)

- same as diabetes in pregnancy (for baby)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

pb of diabetes in pregnancy for baby

A
  • glucose crosses placenta
  • from w10, fetus produces insulin; increase fetal growth: macrosomia, polyhydramniosis, organomegaly, chronic fetal hypocia, shoulder dystocia, intrauterine fetal death, hypoglycaemia at birth, defects (cardiac, neural tube and renal abnormalities)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

effect of pregnancy on diabetes

A
  • insulin requirements increase during T2 and T3
  • tight glycaemic control may worsen diabetic retinopathy
  • increased hypoglycaemic attacks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

effects of diabetes on pregnancy

A
  • increased incidence of preeclampsia
  • UTI
  • miscarriage
  • worsening renal disease
  • increase C section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

management of diabetes in pregnancy

A
  • measure blood glucose fasting, pre and post meals and bedtime
  • metformin or insulin
  • aspirin 75mg (before 12/40 to educe risk of preeclampsia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

target blood glucose levels during pregnancy for women with diabetes

A
  • fasting < 5.3

- 1h post meal: < 7.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

timeline of antenatal appointments for diabetic pregnancy

A
  • booking appointment 10w
  • USS 7-9 weeks
  • 16w: retinal assessment (if retinopathy persent)
  • 20w: USS fetal abnormalities
  • 28w: USS fetal growth and liquor volume + retinal assessment (+ those with GDM enter pathway) and antiD
  • 31w: routine invest (nulliparous)
  • 32w: USS fetal growth and liquor volume
  • 34w: antiD
  • 36w:: USS fetal growth and liquor volume + info about delivery
  • 37+0 - 38+6: offer induction/C section
  • 38 and 39 weeks: offer test of fetal wellbeing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

how many appointments should a nulliparous women with normal pregancy have

A

10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

how many appointments should a parous women with normal pregancy have

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

how often should anomaly scan be done for women with diabetes

A

from 20 weeks, every 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

birth plan for pregnancy with diabetes

A
  • delivery should be at 38w
  • offer LSCS or IOL (esp if macrosomia), give steroids if before 39 weeks
  • if T1DM: insulin dextrose sliding scle during labour
  • first feed should be within 30mins and fetal blood sugars check every 2-4h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

which medications should be avoided during pregnancy

A
  • ACEi/ARB
  • statins
  • glibenclamide
  • diuretics
  • warfarin
  • epileptic drugs: phenobarbitone, phenytoin, sodium valproate
  • sex hormones, radioactive iodine
  • methotrexate, cyclosphamide, NSAIDs
  • trimethroprim (in T1) and nitrofurantoin (at term)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

which meds are commonly used during pregnancy for the following
- diabetes, hypertension, clotting disorder, epilepsy, endocrine, inflammatory conditions, UTI, antiemetics

A
  • diabetes: metformin, insulin
  • hypertension: labetalol, nifedipine, methyldopa
  • clotting: LMWH
  • epilepsy: lamotrigine
  • endocrine: carbimazole, propylthiouracil (only in T1)
  • inflam: sulfazalazine, mesalazine, prednisolone
  • UTI: nitrofurantoin
  • antiemetics: cyclizine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

hypertensive disorders in pregnancy

A
  • chronic hypertension

- pregnancy induced hypertension /gestational hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

def pre-eclampsia

A

hypertension edveloping after 20 weeks gestation with 1+ of following:

  • proteinuria
  • maternal organ dysfunction (renal insufficiency, liver involvement, neurological, haematological
  • fetal growth restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the maternal organ dysfunction in pre-eclampsia

A
  • renal insufficiency: creatinine <90
  • liver: elevated transaminase, RUQ or epigastric pain
  • neuro: altered mental status, blindness, stroke, hyperreflexia, severe headache
  • haematological: thrombocytopaenia, DIC, haemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

def eclampsia

A

Neurological involvement (generalised tonic clonic convulsiuons) in women with pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

BP curve during pregancy

A
  • T1: normal
  • T2: decreases
  • T3: increases back to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

def pregnancy induced hypertension

A

hypertension ( >140/90) in second half of pregnancy in absence of proteinuria or other markers of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

treatment of hypertension in pregnancy

A

nifedipine and labetalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

risk factors for pre-eclampsia

A
  • first pregnancy
  • FH
  • extremes of age
  • obesity
  • PMH: pre-existing hypertension, renal disease, acquired/inherited thrombophilia, connective tissue disease, DM
  • obstretics factors: multiple pregnancies, previous pre-eclampsia, triploidy, inter-pregnancy interval > 10y, IVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

pathophysioogy of pre-eclampsia

A
  • abnormal immunological response and genetic predisposition leading to poor placental development.
    hypoperfused placenta and release of circulating factors which leads to activated vascular endothelium –> hypertension and organ damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

symtoms of preeclampsia

A
  • sevre headache
  • severe RUQ or epigastric pain
  • sudden swelling of hands, face or feet
  • visual disturbances (burring, flashing, scotomas)
  • vomiting
  • restlessness/agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

signs of pre-eclampsia

A
  • hypertension and proteinuria
  • hyperreflexia and clonus
  • serum creatinine raised
  • decreased platelet count
  • haemolytic anaemia
  • elevated liver enzymes
  • retinal haemorrhage and papilloedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

investigations for pre-eclampsia

A
  • BP monitoring
  • urine dipstick
  • bloods: FBC, U&Es, coag, LFTs
  • fetal assessment: SFH, fetal mvnt, USS (liquor volume and umbilical artery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

diagnosis of pre-eclampsia

A
  • > 140/90 on 2 occasions, 4h appart

- proteinuria > 300mg/24h or >30mg on spot test proteine creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management of pre-eclampsia

A
  • consultant led care
  • BP < 160: labetalol, nifedipine, hydrallazine
  • aspirin 75mg qd from 12/40 to birth
  • lifestyle advice + fluid restriction
  • management of HELLP
  • induction of labour/C section at 37-38w
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

complications of pre-eclampsia (maternal and neonatal)

A
  • maternal: placental rupture, DIC, HELLP syndrome, pulmonary oedema, aspiration, eclampsia, liver failure/haemorrage, stroke, death, long term CV mortality
  • neonatal: pre-term delivery, intrauterine growth restriction, hypoxia neurological delay, perinatal death, long term CV morbidity (low birth weight association)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

def small for gestational age

A

fetus with weight less than 10th centile (in personlised growth chart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

def fetal growth restriction

A

failure of fetus to reach predetermined growth potential due to pathology
(faltered growth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

types of FGR

A
  • symmetrical: head and abdominal size are equally small. due to insult early in pregnancy/chromosomal/congenital abnormalities, Intrauterine infections, substance abuse
  • assymetrical: inadequate nutrition: redistribution of blood flow to head/brain and heart. usually due to insult later in pregnancy: PET, essential hypertension, maternal smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

risk factors for FGR

A
  • mat age > 40
  • pat or mat SGA
  • prev SGA or stillbirth or PET
  • nulliparity
  • pregnancy interval < 6m or >6y??
    PMH: renal impairement, chronic HTN, DM with vascular disease, APS, heavy BVP
  • IVF
  • low PAPP-A
  • smoking
  • cocaine use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

investigations if risk factors for FGR

A
  • uterine artery doppler scan at 20w if low risk (if normal, single scan in T3 and if abnormal, serial scans from 28 weeks)
  • if high risk; serial scans from 28 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

aetiology of FGR

A
  • gas exchange and nutrient delivery to fetus impaired (impaired maternal oxygen carrying and delivery, placental damage)
  • instrinsic pb with fetus (chromosal or congenital abnormalities, intrauterine inf)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

implications for fetus of FGR

A

short term:

  • premature birth
  • low APGAR
  • hypoglycaemia and hypocalcaemia
  • NICU stay

long term:

  • learning difficulties
  • short stature
  • failure to thrive
  • cerebral palsy
  • HTN
  • DMT2
  • heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

management of FGR

A
  • early onset < 32w: suggestive of congenital infection or chromosomal abnormalitie: USS and amniocentesis, steroids and intensiive monitoring
  • late onset: >32w: surveillance and delivery if needed (36w with steroids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

management of iron deficiency anaemai in pregnancy

A

oral iron for 2 weeks, then test again. if not come up,, do follow up tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

uterine relaxants

A 
magnesium 
relaxin 
nefedipine 
terbutaline 
atosiban 
oxytoxin 
endothelin 
misoprostol
nitric oxide 
indomethacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

uterine stimulants

A 
oxytoxin 
endothelin 
misoprostol
prostin 
ergometrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

risk factors for ectopic pregancy

A
  • previous ectopic pregnancy
  • previous/current PID
  • previous surgery to tubes
  • IUS/IUD
  • assisted concetion, especially in vitro
  • smoking (reduces cilia function)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

sites of occurance of ectopic pregnancy

A
  • Fallopian tube (mainly ampulla)
  • ovary
  • cervix
  • interstitial
  • C section scar
  • heterotopic (multiple pregnancies, one implanted right, the other ectopic)
  • abdominal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

presentation of ectopic pregnancy

A
  • usually by 5-7 weeks
  • pelvic tenderness
  • adnexal tenderness
  • abdominal tenderness

+ cervical excitation

  • rebound tenderness or peritoneal signs
  • pallor
  • abdominal distention
  • enlarged uterus
  • tachycardia, hypotension/ shock, collapse
  • free fluid in pouch of douglas
  • referred pain to shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

investigations for ectopic pregnancy

A

bloods: baseline, HCG (baseline and 48h), G&S, progesterone

- transvaginal USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

management of ectopic pregnancy

A
  • call for help and refer to EPAU
  • conservative: monitor and pain relief
  • medical: methotrexate up to two doses
  • surgical: salphingectomy or salphingotomy
  • give anti D (if rhesus neg)
  • book scan if pregnant again
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what must be communicated in medical management of ectopic pregnancy

A

delay pregnany for 3 months after due to methotrexate teratogenicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what must be communicated in medical surgical of ectopic pregnancy

A

salphinotomy can increase risk of future ectopic pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

miscarriage definitions

A
  • loss of pregnancy <24weeks
  • early miscarriage: before 12w
  • late miscarriage: 12-24w
87
Q

causes of miscarriage

A
  • unknown
  • chromosoma, fetal or placental abnormalites
  • infection (listeria, toxoplasmosis, VZV, malaria)
  • other: multiple pregnancies, smoking, advanced paternal/paternal age, stress, high BMI, alcohol, assisted conception
88
Q

def threatened miscarriage

A

pregnancy confirmed

presenting with vaginal bleeding

89
Q

def inevitable miscarriage

A

cervix open on exam

miscarriage likely imminent

90
Q

def complete miscarriage

A

when all pregnancy tissue has passed form uterus

91
Q

def incomplete miscarriage

A

when some pregnancy tissue remains in uterus

92
Q

def delayed miscarriage

A

when pregancy has stopped growing or fetus died but no signs of bleeding

93
Q

management of miscarriage

A
  • expectant: may take few days/weeks, follow up 2-3 weeks later
  • medical: misoprolol
  • surgical: vaccum aspiration or surgery
  • antiD
94
Q

risk of miscarriage management

A

infection
haemorrhage
similar outcomes in future pregnancy

95
Q

diagnosis of miscarriage

A

2 transvaginal USS 7 days difference:

  • crown rump length of embryo 7 mm with no fetal heart rate
  • mean sac diameter of 25mm gestational sac w/ no sac or embryo
96
Q

causes of bleeding in pregnancy

A

Lower ano-genital tract:

  • post coidal bleeding
  • anal fissure
  • vaginal infections
  • cervical dilation
  • cancer

Placental:

  • placenta praevia
  • placental abruption
  • vasa praevia

unexplained

97
Q

investigations of bleeding in pregnancy

A

rh, FBC, G&S
ABCDE
fetal HR (CTG)
kleinhauer test (fetal red cells in maternal circulation)
USS (not useful acutely but for fetal growth)

98
Q

def placenta praevia

A

low lying placenta: in lower uterine segment

on USS: extends 5cm from cervical os

99
Q

risk factors for placenta preavia

A

previous C section

  • multiparity
  • multiple pregnancy
100
Q

presentation of placenta praevia

A
  • USS of 20w
  • non painful bleeding
  • may be associated with abnormal lie or presentation
101
Q

classification of placenta praevia

A
  • minor: encroaches lower uterine segment ot reaches internal os (marginal)
  • major: covers internal os (partly or completely)
102
Q

delivery with placenta praevia

A
  • if minor: can deliver safely
  • if placenta edge is <2cm from internal os should have elective surgery planned at 38-39w (haemorrhage in later inevitable)
103
Q

def placental abruption

A

retroplacental haemorrage (between placenta and uterus) and usually involves some degree of placental seperation

104
Q

risk factors for placental abruption

A
  • maternal thombophilia
  • abdominal trauma
  • previous abruptions
  • > 35y
  • multiple pregnancies
  • PET
  • smoking
  • cocaine use
105
Q

symptoms and signs of placental abruption

A
  • bleeding
  • abdo pain
  • uterine tenderness and woody hardness
  • maternal shock
  • DIC
106
Q

types of placentaal abruptions

A

revealed and concealed

107
Q

management of placental abruption

A
  • minor: expectant (esp <37w), w/ monitoring and steroids <36w
  • immediate delivery if fetal or maternal compromise
108
Q

complications of placental abruption

A
  • ischemia of underlying myometrium
  • couvelaire uterus (bleed into myometrium)
  • fetal death in utero
  • maternal coagulopathy
109
Q

uterine rupture risk factors

A

previous CS

110
Q

signs and symptoms of uterine rupture

A
  • abdo pain
  • hypovolaemic shock
  • CTG abnormalities
  • uterine contraction may stop
  • palpation of fetus outside uterus
111
Q

def PPH

A

primary: blood loss > 500ml within 24h of delivery

- secondary: any significant loss between 24h-12 weeks post delivery

112
Q

causes of primary PPH

A

Tissue, Tone, Trauma, Thrombin

  • vaginal trauma
  • uterine atony
  • placental (retained products pr placenta accreta)
113
Q

causes of secondary PPH

A
  • retained products
  • infection
  • dysfunction uterine bleeding
114
Q

risk factors for primary PPH

A
  • grand multiparities
  • women > 35
  • multiple pregnancies
  • fibroids
  • placenta praevia
  • long labour or instrumental delivery
  • past Hx of PPH
  • macrosomia/polyhydrramniosis
115
Q

prevention of PPH

A
  • treat anaemia in antenatal period
  • give uterotonic w/ delivery of baby’s anterior shoulder
  • in future pregnancies, must be in consultant led labour ward
116
Q

management of PPH

A
  • atony: fundal or bimanual massage and syntocinon for uterine contraction
  • placental removal
  • compression baloon
  • stitch
  • uterine artery ligation
  • hysterectomy

+ crystalloid/blood to maintain circulating volume

117
Q

secondary PPH management

A
  • conservative management w/ antibiotics

- if antibiotics fail: OCC

118
Q

risk factors for VTE in bleeding

A

> 35
3 babies
previous VTE
FH
thrombophilia
PMH heart diesase, lung disease or arthritis
severe varicose veins
overweight
wheelchair user
during pregnancy: multiple prenancies, admitted to hospital, dehydration, PET
after birth: long labour, CS, haemorrage, received blood transfusion

119
Q

management of VTE in pregnancy

A

LMWH

120
Q

investigations for heavy menstrual bleeding

A
  • bimanual and speculum
  • bloods: FBC, TFTs, coag
  • ultrasound
  • hysteroscopy and endometrial biopsy
  • cervvical cytology (if cervix suspicious)
121
Q

treatment of heavy menstrual bleeding

A
  • IUS (try for 6 months)
  • tranexamic acid
  • NSAID
  • CCP
  • cyclical oral progesterone
  • if fibroids: GnRH agonists to shrink fibroid

surgical (if tried others for 3 months)

  • endometrial ablation
  • hysterectomy
  • myomectomy
122
Q

causes of abnormal uterine bleeding

A 
PALM COIN 
polyps 
fibroids
leiomyoma
malignancy
coagulopathy 
PCOS
STIs
thyroid
123
Q

norml endometrial thickness

A

premenopausal:

  • during menstruation: 2-4 mm
  • early proliferatice: 5-7mm
  • in secretatory phase: 7-16mm

postmenopausal: <5mm

124
Q

uterine fibroids def

A

benign tumours of myometrium

125
Q

symptoms of uterine fibroids

A
  • asymptomatic
  • menstrual dysfunction (menorrhagia or dysmenorrhea)
  • pelvic discomfort/pressure/mass
  • infertility/subfertility
  • miscarriage
  • bloating
  • dyspareunia
  • increase frequency of mictruition
126
Q

symtoms of bacterial vaginosis

A
  • thin, white/grey homogenous discharge
  • fishy small
  • vaginal ph > 4.5
127
Q

treatment of bacteriial vaginosis

A
  • metronidazole 400 mg bid for 7 days

- intravaginal clindamycin cream for 7 days

128
Q

symptoms of candidal infection

A
  • cottage cheese discharge
  • vulvitis: superficial dyspareunia, dysuria
  • itch
  • vulval erythema, fissuring, satellite lesions
129
Q

treatment of candidal infections

A

azole antifungals

130
Q

symptoms of trichomonas vaginalis

A
  • offensive yellow/green, frothy disharge
  • vulvovaginitis
  • strawberry cervix
  • ph>4.5)
131
Q

treatment of trichomonas vaginalis

A

metronidazole

132
Q

symptoms and signs of chlamydia trachomatis or neisseria gonorrhoeae

A
  • vaginal discharge
  • dysuria
  • post coidal bleeding
  • dyspareunia, lower abdo pain, intermenstrual bleeding (if spread beyond cervix)
  • mucopureulent cervititis and/or contact bleeding
  • rectal itch and/or pain with gonorrhea
133
Q

diagnosis of lower genital tract infections

A

NAAT (swabs) of vagina, cervix, rectum, throat and urine

134
Q

treatment of chlamydia

A
  • azithromycin or doxycycline (both single doses)
  • abstain from sex (1-2w)
  • tell other partners to get treated
135
Q

complications of chlamydia or gonorrheea

A
  • if spread beyond lower genital tract: gland abscess, endometritis, saphingitis, perihepatitis
  • PID (tubal complications)
  • if pregant: miscarriage, pre-term birth, postpartum infection, neonatal occular and resp inf)
  • reiter syndrome: reactive arthritis (genetically susceptible)
  • increase chance of acquiring HIV
136
Q

treatment of neisseria gonorrheae

A
  • ceftriawone single dose AND
  • azithromycin single dose
  • abstain from sex (for 1-2w)
137
Q

def PID

A

inf goes from cervix/vagina into upper genital tract

138
Q

examples of PID

A

endometritis
salphingitis
tubo-ovarian abscess
pelvic peritonitis

139
Q

risk factors for PID

A
  • more than one sexual partner
  • STD/previous PID
  • bacterial vaginosis
  • sexual intercourse during menses
  • vaginal douching
  • IUD
  • procedures involving uterine cavity
140
Q

symptoms/signs of PID

A
  • cervitits
  • lower abdo pain/local pain
  • abnormal discharge (purulent)
  • vaginal and post coidal bleeding
  • general: nausea, fever, malaise
  • cervical excitation
  • tachycardia
141
Q

investigations in PID

A
  • speculum exam: absence of pus cells from cervix or vaginal wall is sensitive marker for absence of PID
  • pregnancy test
  • triple swab: high vaginal, endocervical and vulvuvaginal
  • bloods: ESR, CRP, WBC, U&Es
  • blood cultures if pyrexia
  • urine dip
  • laparoscopy (GOLD standard)
  • ultrasound
142
Q

differentials of PID

A
  • ectopic pregnancy
  • acute appendicitis
  • endometriosis
  • IBS
  • UTI
  • functional pain
143
Q

treatment of PID

A
  • ceftriaxone single dose IM AND
  • azithromycin single dose AND
  • metronidazole oral 14 days
  • appropriate analgesia
  • sex abstination
  • removal of IUD after 24-48h
  • test partners
144
Q

complications of PID

A
  • tubal damage
  • tubal infertility
  • ectopic pregnancy
  • abdominal/pelvic pain > 6 months
  • hysterectomy
  • repeat infections
  • salphingitis spread to liver capsule: perihepatitis (Fitz-Hugh-Curtis syndome)
145
Q

cervical intraepithelial neoplasia def

A
  • develops in ‘transformation zone’ of cervix: cervical epithelium that has unedrgone change
146
Q

classification of CIN

A

CIN I: mild (low grade)
CIN II: moderate (high grade)
CIN III: severe (high grade)

147
Q

if test pos for CIN changes what investigations to do

A

colposcopy (binocular microscope)

148
Q

treatment of CIN

A
  • abnormal cells often return to normal on their ow^n
  • treat CIN II and III: see and treat during colposcopy: LLETZ or biopsy and treat after
  • follow up: ‘test of cure’ smear test after 6 months
149
Q

indications for colposcoy

A
  • suspicious looking cervix
  • invasive carcinoma on cytology
  • CIN II or III
  • persisting (> 12-18months) CIN I
  • persistent unsatuisfactory quality of cytology
  • infection with HPV
150
Q

differentials of post coidal bleeding

A

cevical carcinoma
cervical ectropian
cervical polyp

151
Q

differntials for vaginal discharge

A 
normal 
STI
non seually transmitted infection 
PID
foreign body (ie tampon)
genital tract malignancy
152
Q

normal labour def

A

onset of reg uterine activity associated with effacement and dilation of the cervix and descent of the presentinf part through the cervix

153
Q

effect of niitric oxide during pregnancy

A

cervival ripeing

154
Q

effect of relaxin during pregnancy

A

loosens pelvic ligaments and pubic symphyasis joint + dilates cervix during labour

155
Q

prolabour factors

A
  • oestrogen (increases oxytocin receptors on uterus)
  • oxtocin (stimulates uterine contractibility and production of prostaglandins)
  • corticotrophin-releasing hormon (increease prostaglandin levels
  • prostaglandin dehydrogenase
  • inflammatory mediators (cervical ripening and membrane rupture)
156
Q

onset of partruition

A
  • fetal stress stimulates ACTH release from fetal brain which stimulates cortsol release
    cortisol: decreases prog and oestro prod and increas prostaglandin prod by placenta
  • mechanical push of baby on cervix: nerve fibres: released oxytocin from mother hypothalamus
157
Q

stages of labour

A 
Stage 1: 
A: latent 
- 'the show' mucus
- regular painful contractions 
- rupture of membranes 
- effacement (thinning of cervix ): dilation up to 3 cm
B active:
- continuous dilation of cervix up to 10 cm

Stage 2: from full cervical dilation (10cm) until baby is born

Stage 3: delivery of placenta

158
Q

def premature rupture of membranes

A

<37 weeks

159
Q

contraindications of artificial rupture of membranes

A

breech position

placenta praevia

160
Q

monitoring in delivery

A
  • uterine pattens (interval from onset of one contraction to the onset of the next and palpable fundus)
  • fetal HR (every 15mins in 1st satge, every 5 mins in second stage, CTG if high risk)
161
Q

mechanism of delivery for explanation

A
  1. flexed fetus descends (decends and engages)
  2. internal rotation (until faces towards maternal back, head at level of ischial spines)
  3. extension of head (head extends towards pubic symphasis until delivered)
  4. restitution/external rotation (after head delivered, fetus rotates back to orignal position: shoulders sideways)
  5. delivery of shoulders
162
Q

complications at each stage of labour

A

FIRST STAGE

  • passenger: cephalopelvic disproportion, fetal malrepresentation
  • passage: fibroids/cervical stenosis
  • power: primary uterine inertia

SECOND STAGE:

  • second uterine inertia
  • persistent occipito-posterior position
  • narrow mid pelvis

THIRD STAGE:

  • PPH
  • retained placenta
  • inversion of uterus
163
Q

interventions in labour

A

first stage: prostaglandin gel (initiation of labour), artificial rupture of membranes (cervical dilation), oxytosin (contractions)

SECOND STAGE:

  • maternal/fetal distress, incomplete intenal rotation causing failure to progress
  • instrumental delivery, CS
164
Q

failure to progress

A

stage 1
latent phase: >20h (null), >14h (multi)
active phase: dil <1.2cm/hr (null), <1.5cm/hr (mutli)

165
Q

different perineal tears

A
  • first degree: small tear affecting skin
  • second degree: muscle of peritoneum and skin, usually requires stitches
  • third/fourth degree: extends to anal sphincter, requires surgery
166
Q

apgar score

A 
appearance 
pulse
grimace
activity 
respirations

calculated at 1, 5 and 10 mins after birth

167
Q

breastfeeding mechanism

A
  • alveolar cells make milk, stored in alveolus
  • myoepithelial cells squeeze milk down the ducts

hormones involved:
- human placental lactogen, progesterone, prolactin

stimulation of milk letdown: reflex of suckling

168
Q

breastfeeding benefits

A
  • free
  • skin to skin contact

TO BABY

  • lower rates of allergies, ear/lung inf, obesity, sudden infant death
  • healthier weight gain

TO MOTHER

  • reduce uterine bleeding
  • burns calories
  • reduces risk of breast/ovarian/uterine cancer, osteoporosis, arthritis, T2DM, heart disease
169
Q

places of birth

A
  • home
  • free standing midwifery led unit
  • alongside midwifery unit
  • obstetrics unit
170
Q

indications for instrumental vaginal delivery

A
  • suspected fetal compromise (fetal abnormalities)
  • second stage delay due to maternal exhaustion, fetal malposition (occipitotransverse or posterior), cephalopelvic disproportion
171
Q

risk factors for instrumental vaginal delivery

A

primiparous women
supine or lithotomy positions
epidural anaesthesia

172
Q

complications of instrumental vaginal delivery

A
  • failure with chosen instrument (CS or use of other instrument)
  • fetal-neonatal complications (low APGAR score, fetal acidosis, cerebral trauma, cerebral haemorrhage, brachial plexusinjury or fracture)
  • maternal complications (perineal tear, PPH, perineal inf, urinary or bowel incontinence, dyspareunia, subsequent fear of childbirth)
173
Q

types of instrumental delivery

A

ventouse

forceps

174
Q

when should operative vaginal delivery be abandonned

A
  • no evidence of progression with moderate traction during each contraction or delivery not imminent with 3 contractionw with instrument
  • high risk of failure: >30 BMI, EFW>4kg, OP position, mid cavity delivery or 1/5th head palpable per abdomen
175
Q

reasons CS

A
  • absolute cephalopelvic disproportion (ie macrosomia)
  • placenta praevia
  • pre-eclampsia
  • IURG
  • post maturity
  • fetal distress in labour/prolapsed cord
  • failure of labour to progress
  • malpresentation
  • placental abruption (if dead, deliver vaginally)
  • vaginal infection (ie active herpes)
  • cervical cancer
176
Q

complications of CS

A

FREQUENT

  • wound/abdo discomfort for months after surgery
  • risk of repeat CS
  • readmission to hospital)
  • haemorrage
  • infection
  • laceration of baby

SERIOUS

  • emergency hysterectomy
  • surgery at further date
  • admission ICU
  • thromboembolic disease
  • bladder injury
  • uteric injury
  • death
  • uterine rupture in future pregnancies
  • antepartum stillbirth
  • placenta praaevia or accreta in future pregnancies
177
Q

primary causes of amenorrhoea

A

delayed puberty (hypothalamic physiological delay)

  • anatomical (absence of uterus, imperforate hymen)
  • PCOS
  • low BMI/excessive excercise
178
Q

management of amenorrhoea

A
  • exclude pregnancy or menopause
  • weight changes (BMI), drugs, medical disorders, thyroids disorders?
  • check visual fields
  • presence of hirtuism
  • check LH, FSH, prolactin, testosteone, TFTs,
179
Q

def of subertility

A

inability of couple to achieve pregnancy within 12 months of beginning regular unprotective intercourse (can be primary or secondary)

180
Q

causes of infertility

A
  • ovulation disorders
  • sperm (azoospermia, oligospermia, asthenospermia, teratospermia, sperm delivery pb)
  • unexplaoned
  • tubal factors
  • endometriosis related infertility
181
Q

risk factors for infertility

A
  • age
  • not previously conceived
  • intercourse not around ovulation
  • uterine pb (endometrial pb, fibroids, polyps)
  • duration of trying
  • lifestyle: high BMI, excessive alcohol, smoking, stress, lack of excerise
  • PMH: PCOS, CF
182
Q

initial investigations for subfertility

A

female:

  • early folicular phase LH, FSH, oestradiol (ovarian reserve and pituitary function)
  • anti-Müllerian hormone (ovarian reserve)
  • rubella
  • lutheal phase serum progesterone (ovulation)
  • test tubal patency (HSG)

male:
- semen analysis done at day 1 and 3 months later

183
Q

data interpretation for subertility

A

FSH/LH:

  • low: hypothalamic/pituitary pathology
  • normal: disrupted folliculogenesis but oocyte present
  • high: low nb/absence of oocytes

oestradiol:
- low in everything except PCOS

AMH:
- indication of oocyte reserve

184
Q

treatment of subertility

A
  • tubal pb: IVF
  • endometriosis: prevention (see further)
  • sperm pb: lifestyle/meds, IVF
  • unexplained: IVF
  • PCOS: metformin and clomiphene
185
Q

symptoms of PCOS

A
  • signs of androgen excess: hirsutism/Acne
  • obesity
  • irregular menses/amenorrhea/infertility
186
Q

PCOS rotterdam criteria

A

MUST HAVE 2

  • irregular menses
  • clinical evidence of androgen excess (clinically or biomedically)
  • polycystic ovaries on ultrasound
187
Q

biomedical findings of PCOS

A

increased serum testosterone
increased LH and FSH (especially LH)
prolactin may be slightly elevated

188
Q

treatment of PCOS

A
  • OCP
  • weight loss
  • pregnancy wanted: metformin and clomiphene
189
Q

on visualisation, what does endometriosis look like

A
  • clear, white lesions
  • powder burn lesions
  • dark red or blue domes
190
Q

symptoms/signs of endometriosis

A

SYMPTOMS

  • dymenorrhea
  • dyspareunia
  • infertility
  • painful bowel movement
  • rectal bleeding

SIGNS

  • fixed, non mobile retroverted uterus secondary to adhesions
  • ovarian endometriomas
  • uterosacral nodularity
191
Q

investigations for endometriosis

A

direct visualisation of tissue and biopsy

192
Q

management of endometriosis

A
  • analgesia
  • OCC, progesterone therapy
  • GnRH agonist (induce menopause)
  • surgical: excision and ablation, hysterectomu
193
Q

pre conception advice

A
  • manage medical conditions
  • weight: 19-30
  • both gender stops smoking and recreational drugs
  • alcohol: not excessive
  • intercourse: at least twice from 6 days prior to ovulation to 2 days after
  • folic acid: 400 micrograms daily or 5mg (diabetes, epilepsy or previous NTD)
  • check rubella immunity
  • cervical smears: keep up to date
194
Q

what increases risk of ovarian cancer and what decreases the risk

A

increase:

  • nulliparity
  • early menarche
  • late menopause
  • high ovulation events
  • FH

reduce:
- breast feeding
- the more children you have
- 1st child before 25
- oral contraception

195
Q

investigations for ovarian cancer

A
  • CA125

- ultrasound

196
Q

staging of ovarian cancer

A

stage 1: ovaries
stage 2: extends to tubes and uterus or other pelvic tissue
stage 3: peritoneal spread
stage 4: distal metastases

197
Q

treatment of ovarian cancer

A

like chronic disease

  • surgery (bilateral oophorectomy, hysterectomy, omentectomy)
  • chemo
  • PARP inhibitors (if BRCA pos)
198
Q

types of urinary incontinence

A
  • stress
  • urge
  • overflow
199
Q

pathophyisology of stress incontinence

A

urethral hypermobility

intrinsic sphincter deficiency

200
Q

risk factors for stress incontinence

A 
high BMI
athetic
multiparity 
childbirth 
smoking/COP (chronic chough)
201
Q

symptoms of stress incontinence

A
  • incontinence when bladder under pressure (sneezing, coughing, laughing, exercise)
  • symptoms worsen when oestrogen is low + post menopause
202
Q

treatment of sttress incontinence

A
  • lifestyle advice: weight loss if BMI>30 and smoking cessation
  • pelvic floor muscle training
  • surgical (synthetuc mid urethral tape, coposuspension, sling)
  • drugs: duloxetine
203
Q

pathophysiology of urge incontinence

A
  • detrusor muscle contraction
204
Q

risk factors for urge incontinence

A
  • bladder infection
  • bladder cancer
  • stroke/MS/spinal cord
  • alcohol/diuretucs
205
Q

symptoms of urge incontinence

A

need to void that cannot be deferred

206
Q

management of urge incontinence

A
  • lifestyle chage (reduce excessive intake of alcohol, caffeine, water)
  • bladder training (6 weeks min)
  • drugs: antimuscarinic (oxybutinine)
  • secondary referral: botulin injection into bladder, sacral nerve stimulation urinary diversion)
207
Q

types of pelvic organ proplapse

A 
cystocele (ant wall of vagina)
rectocele (post wall of vagina)
enterocele (peritoneum of cul de sac)
uterine prolapse
vaginal vault prolapse
208
Q

causes of pelvic organ prolapse

A
  • pelvic floor muscle and tissue weakened
  • pregnancy/childbirth
  • old age, menopause
  • overweight
  • long term constipation
  • hysterectomy
  • heavy lifting
209
Q

symptoms of pelvic organ prolapse

A
  • dragging sensation in vagina (worse on activity)
  • heaviness in pelvis
  • dyspareunia
  • urinary symptoms
  • faecal symptoms
210
Q

what tool is used to quantify pelvic organ prolapse

A

POP-Q: pelvic organ prolapse quantification

211
Q

management of pelvic organ prolapse

A
  • lifestyle: loose weight, stop heavy lifting, treat constipation
  • pelvic floor muscles training
  • hormonal treatment: vaginal oestrogen or oestrogen ring
  • vaginal pessaries
212
Q

investigations for urinary incontinence

A
  • bladder diairies for at least 3 days (how often, how much, leackage, what were you doing, urge, drink/food, pads used)
  • vaginal exam tto exclude pelvic organ prolapse
  • urine dip to exclude UTI
  • urodynamic studies
213
Q

urodynamic studies: what are we looking for

A
  • pattern and speed of emptying
  • post void residual
  • pressure catheter: in bladder for vesical pressure and vagina and rectum for intraabdominal pressure
  • bladder filled with water to measure detrusor muscle function

Year 4 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions