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Year 5 > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

1
Q

Where is oestrogen produced?

A

By Theca granulosa cells in the ovaries in response to LH and FSH

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2
Q

Where is progesterone produced? Where is it produced in pregnancy?

A

Corpus luteum after ovulation

In pregnancy after 10 weeks gestation the placenta produces it

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3
Q

What does progesterone do?

A

It acts on tissues which have previously been stimulated by oestrogen. It: Thickens and maintains the endometrium, thickens cervical mucus and increases body temperature

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4
Q

How can you determine the stage of pubertal development?

A

Tanners staging

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5
Q

There are 2 phases of the menstrual cycle, what are they?

A

Follicular phase: from menstruation to ovulation (first 14 days of 28 day cycle)
Luteal phase: from Ovulation to menstruation (last 14d)

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6
Q

What is a fibroid?

A

A benign tumour of the uterine myometrium (smooth muscle). They are very common and more commonly affect black women. They are oestrogen sensitive

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7
Q

What are the types of fibroids?

A

Intramural - within the myometrium
Subserosal - On the outer layer, growing into the abdominal cavity
Submucosal - In the endometrium
Pedunculated - has a stalk

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8
Q

What is red degeneration of the fibroids?

A

Ischaemia, infarction and necrosis of the fibroid due to an interruption of the blood supply
Severe abdominal pain, low-grade fever, tachycardia and vomiting

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9
Q

What is a chocolate cyst?

A

Endometriomas in the ovaries

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10
Q

What is endometriosis?

A

A oestrogen dependent, benign inflammatory condition characterised by ectopic endometrial tissue, usually with cysts and fibroids.

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11
Q

In endometriosis, the inflammation can lead to scarring and so adhesions, binding organs together, how might someone with this present?

A

Chronic, NON-CYCLICAL pain that is sharp, stabbing or pulling and associated with nausea

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12
Q

How might someone with endometriosis present?

A

Cyclical abdominal or pelvic pain (Dull, heavy or burning)
Dysmenorrhoea
Deep dyspareunia
Infertility
Cyclical bleeding from other sites such as haematuria

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13
Q

What is gold standard in diagnosing endometriosis?

A

Laparoscopic surgery with biopsy of the lesion

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14
Q

What is menopause?

A

It is a retrospective diagnosis made after a women has had no periods for 12 months

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15
Q

What do you need for a diagnosis of PCOS?

A

At least 2 of:

Anovulation, hyperandrogenism, PCOS on US

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16
Q

What tumour markers may you look at in a patient with an ovarian mass?

A

CA125

LDH, hCG, alpha-FP, CEA

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17
Q

What might cause a raised CA125?

A

Ovarian cancer, endometriosis, fibroids, pregnancy, pelvic infection, adenomyosis, liver disease

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18
Q

What factors are involved in the risk of malignancy index in an ovarian mass?

A

US findings, menopausal status, CA125 level

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19
Q

What are some complications of ovarian cysts?

A

Torsion, haemorrhage, rupture

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20
Q

What triad is seen in Meig’s syndrome?

A

Ovarian fibroma, pleural effusion, ascites

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21
Q

What is cervical ectropion?

A

When the columnar epithelium of the endocervix extends to the ectocervix. It is visible on speculum exam

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22
Q

What is lichen sclerosis?

A

A chronic inflammatory, AI skin condition that presents with patches of shiny ‘porcelain-white’ skin. Commonly affects labia, perineal and perianal area
Vulval itching and skin changes *

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23
Q

What is a serious potential complication of lichen sclerosis?

A

Squamous cell carcinoma of the vulva

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24
Q

What are the types of urinary incontinence?

A

Stress - weakness of pelvic floor muscles and sphincter muscles
Urge (OAB) - detrusor overactivity
Mixed
Overflow

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25
Q

How might you treat stress incontinence?

A
  1. Conservative - reduce caffeine, alcohol, weight loss, avoid excess fluid intake
  2. Pelvic floor exercises
  3. Surgery - TVT (tension free vaginal tape) , autologous sling, colposuspension, intramural urethral bulking
  4. Duloxetine
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26
Q

How might you treat Urge incontinence (OAB)?

A
  1. Conseervative - Bladder retraining, physio
  2. Medication - Oxybutynin (anticholinergic), mirabegron (beta 3 agonist)
  3. Surgery - Botulinum toxin A, percutaneous sacral nerve stimulation, augmentation cystoplasty, urinary diversion
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27
Q

What is bacterial vaginosis?

A

Overgrowth of bacteria in the vagina, specifically anaerobic (gardenerella vaginalis). Loss of lactobacilli (good bacteria). Not an STI but increases risk of getting one

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28
Q

What is the mechanism of the bacterial vaginal flora like lactobacilli?

A

They produce lactic acid making the vagina pH low (acidic). When there is lack of them it causes the pH to rise and so an alkaline environment allowing anaerobic bacteria to grow

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29
Q

How might bacterial vaginosis present?

A

Fishy-smelling, watery grey or white vaginal discharge

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30
Q

What is the normal pH of the vagina?

A

3.5-4.5

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31
Q

What might ‘Clue cells’ on microscopy indicate?

A

Bacterial vaginosis

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32
Q

What advise is crucial to give when prescribing a patient metronidazole?

A

Do not give alcohol
Disulfiram-like reaction
N&V, flushing, sometimes shock or angioedema

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33
Q

What is the most common type of cervical cancer?

A

Squamous cell Ca

Then Adenocarcinoma

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34
Q

What cancers are HPV associated with?

A

Cervical. (type 16 and 18*)
Anal, vulval, vaginal, penile, mouth and throat
HPV is a sexually transmitted infection

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35
Q

How does HPV cause cancer?

A

It inhibits tumour suppressor genes

It produces 2 proteins, E6 and E7. E6 inhibits p53 and E7 inhibits pRb

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36
Q

When do you get a cervical smear? (screening)

A

Every 3 years in25-49
Every 5 years in 50-64
Looking for Dyskaryosis via liquid based cytology

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37
Q

Who gets the HPV vaccine and why?

A

Girls and boys aged 12-13
BEFORE they become sexually active
Should be given to reduce risk of cervical cancer and genital warts

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38
Q

What strains of HPV are in the vaccine?

A

6 and 11 (genital warts)

16 and 18 (cervical cancer)

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39
Q

How might you grade the level of dysplasia in the cervix?

A

CIN grading
CIN I - mild dysplasia, affecting 1/3 thickness of epithelial layer, likely to return to normal
CIN II - moderate dysplasia, affecting 2/3 thickness, likely to progress to ca if left untreated
CIN III (carcinoma in situ) - sever dysplasia, very likely to progress

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40
Q

What infections may be picked up on a smear test?

A

Bacterial vaginosis, candidiasis, trichomoniasis

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41
Q

What is endometrial hyperplasia and how might you manage it?

A

Precancerous - 5% become endometrial cancer

Progesterones - Mirena coil or continuous oral progesterone

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42
Q

What are some risk factors for endometrial hyperplasia/ cancer?

A

Exposure to unopposed oestrogen - No progesterone

  • Obesity - increased Aromatase to convert androgen to oestrogen
  • PCOS - due to lack of ovulation - no progesterone produced
  • Late menospause, early menarche, no/few pregnancies
  • T2DM - Insulin stimulates endometrial cells
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43
Q

What blood markers can indicate a germ cell tumour?

A

AFP, hCG

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44
Q

What is a Krunkenberg tumour?

A

Metastasis to the ovary, usually from a GI tumour like the stomach
‘Signet ring’ cells on histology

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45
Q

What is Lymphogranuloma veredum?

A 
Condition affecting the lymphoid tissue around the site of chlamydia
Primary stage - painless ulcer
Secondary - Lymphadenitis
Tertiary - Proctitis 
Tx - Doxycycline
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46
Q

A complication of PID is Fitz-hugh-curtis syndrome, what is it?

A

Inflammation and infection of the Glission’s capsule (liver capsule), leading to adhesions between the liver and peritoneum
RUQ pain, can be referred to R shoulder tip pain

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47
Q

What does Gravida mean?

A

The total number of pregnancies a women has had

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48
Q

What does primigravida mean?

A

A patient who is pregnant for the first time

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49
Q

What does para mean?

A

The number of times a women has given birth after 24 weeks gestation, regardless if it was alive or stillborn

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50
Q

When do foetal movements start?

A

~20 weeks - in the 2nd trimester

Ix if none by 24 weeks

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51
Q

What are the trimesters?

A

1st - 0- 12 weeks
2nd - 13-26 weeks
3rd - 27 - birth (36-40 weeks)

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52
Q

At the dating scan at ~10-13 + 6 weeks, how is the gestational age calculated?

A

Crown to rump length (CRL)

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53
Q

What is pre-eclampsia?

A

New onset HTN with evidence of end-organ dysfunction, notably proteinuria. It occurs after 20 weeks gestation
- High vascular resistance in the spiral arteries and so poor placental perfusion - oxidative stress

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54
Q

What triad makes up pre-eclampsia?

A

Proteinuria, oedema, HTN

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55
Q

What is eclampsia?

A

Seizures as a result of pre-eclampsia

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56
Q

What are some of the symptoms of the complications from pre-eclampsia?

A

Headache, visual disturbances, blurring, oliguria, epigastric pain, oedema, brisk reflexes, N&V

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57
Q

What can be given as prophylaxis for pre-eclampsia if the patient is deemed to be high risk or has 2+ moderate risk factors?

A

Aspirin - can be given from 12 weeks

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58
Q

What anti-hypertensive is used first line in Pre-elcmapsia?

A

Labetolol

after delivery switch to Enalapril

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59
Q

How is HIV transmitted?

A

Verticle - Mum to baby at birth or breastfeeding
Unprotected anal, oral or vaginal sex
Blood or bodily fluids on mucous membranes or open wounds (e.g. needle stick injury)

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60
Q

When CD4 count has dropped, in late-stage HIV, the person may have AIDS-defining illnesses, what are some examples.

A

Kaposi’s sarcoma, PCP, CMV, candidiasis, lymphoma, TB

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61
Q

Do you need to tell a patient you are testing them for HIV?

A

Yes- patients must be consented and it must be documented

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62
Q

What is the window period?

A

A time when the patient may be infected but are not showing a positive test yet

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63
Q

What additional management may be needed in an HIV patient?

A

Yearly cervical smears in women
Prophylactic co-trimoxazole in CD4 below 200 cells/mm3 to protect against PCP
Statin to protect against CVD
Up to date vaccines (DONT give LIVE vaccines)

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64
Q

What is the most common location for ectopic pregnancy?

A

Fallopian tubes

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65
Q

When do ectopic pregnancies normally present?

A

Between 6-8 weeks gestation

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66
Q

What might you suspect if a women who is pregnancy presents with collapse?

A

EMERGENCY - RUPTURED ECTOPIC PREGNANCY

until proven otherwise

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67
Q

When might you suspect an ectopic pregnancy?

A

Constant lower abdominal pain, maternal collapse

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68
Q

What results in hCG tracking over 48 hours can you get?

A

Rise in more than 63% - Intrauterine pregnancy
Rise in less than 63% - Ectopic
Fall than more than 50% - miscarriage

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69
Q

What medical management is used for ectopic pregnancy?

A

methotrexate

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70
Q

What is a miscarriage?

A

Any pregnancy loss before 24 weeks
Early - before 12 weeks
Late - between 12 and 24 weeks

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71
Q

What is a missed miscarriage?

A

The foetus is no longer alive. but no symptoms have occured

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72
Q

What is a threatened miscarriage?

A

Vaginal bleeding with a closed cervix, and the foetus is alive

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73
Q

What is an inevitable miscarriage?

A

Vaginal bleeding with an open cervix

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74
Q

What is an incomplete miscarriage?

A

RPOC remain in the uterus after the miscarriage

75
Q

What is a complete miscarriage?

A

Full miscarriage, there are no products of conception left

76
Q

What is an anembryonic pregnancy?

A

A gestational sac is present but contains no embryo

77
Q

What are the 3 key features used in US to assess the viability of the pregnancy?

A

Mean gestational sac diameter
Foetal pole and crown to rump length
foetal heart beat

78
Q

What is used in the medical management of miscarriage?

A

Misoprostol - PG analogue - binds to the receptor, activating them - softening the cervix and stimulating uterine contractions
- Vaginal suppository or oral dose

79
Q

Define recurrent miscarriage.

A

3 or more consecutive miscarriages

80
Q

What are some causes of recurrent miscarriage?

A

Maternal age, environment (smoking, alcohol)
Idiopathic
Anti-phospholipid syndrome (may be a PMHx of DVT)
Diabetes, PCOS, untreated thyroid disease, SLE
Uterine abnormalities

81
Q

How might you reduce someone with anti-phospholipid syndromes risk of miscarriage?

A

Low dose aspirin and LMWH

82
Q

What legal frameworks are in place for termination of pregnancies?

A

Human fertilisation and embryology act 1991

1967 Abortion act

83
Q

What is the criteria according to the HFE act allow termination at any gestational age?

A

Risk of maternal death if continue the pregnancy
Termination would prevent grave permanent injury to the mum
The child would suffer from serious disability

84
Q

What is the criteria according to the HFE act allow termination before 24 weeks?

A

If continuing the pregnancy involves physical or mental health risk to the women or existing children.

85
Q

What are the legal requirements for abortion?

A

2 medical practitioners must sign to agree an abortion is indicated
Must be carried out by a registered medical practitioners in an NHS or approved premises

86
Q

When is N&V common in pregnancy?

A

First trimester, starts ~4-7 weeks and peaks ~10-12 weeks, usually settles by 16-20 weeks

87
Q

What is thought to cause N&V in pregnancy?

A

Placenta produces hCG

88
Q

Hyperemesis gravidarum is a severe form of N&V, what is the key diagnostic criteria?

A

Protracted N&V plus:
More than 5% weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance

89
Q

What antiemetics may be used in hyperemesis gravidarum?

A

Promethazine, cyclizine, Prochlorperazine, ondansetron, metolopramide
Can also give ranitidine or omeprazole

90
Q

What is the role of progesterone in pregnancy?

A

Uterine relaxation and to maintain the endometrium

91
Q

What is the role of oestrogen in pregnancy?

A

Softens tissues making them more flexible - allows pelvic muscles and ligaments to relax and softens the cervix ready for birth

92
Q

When is the normal onset of labour?

A

Between 37 and 42 weeks

93
Q

What are the stages of labour?

A

1st- Onset of labour - true contractions, until the cervix is dilated to 10cm (dilation and effacement)
2nd - from 10cm dilated to delivery of the baby
3rd - delivery of the baby to delivery if the placenta

94
Q

What can you use to induce labour?

A

Prostaglandin E2 pessary (dinoprostone)

95
Q

What is a Braxton-Hicks contraction?

A

Occasional irregular contractions
Temporary irregular tightening and mild cramping in the abdomen
Not true contractions

96
Q

What are the 7 movements of labour?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. Restitution and external rotation
  7. Expulsion
97
Q

A cause of primary amenorrhoea is hypOgonadotrophic hypogonadism, what are some causes?

A 
Kallmann's syndrome
Damage to hypothalamus or pituitary - radiation or surgery
Constitutional delay 
Excessive exercising or low BMI
Hypopituitarism 
Chronic conditions - CF, IBD
98
Q

A cause of primary amenorrhoea is hypERgonadotrophic hypogonadism, what are some causes?

A 
Turners syndrome (XO)
Congenital absence of ovaries
Previous damage to the gonads (cancer, torsion, mumps)
99
Q

What is premature ovarian insufficiency?

A

Menopause before the age of 40
Raised LH and FSH*
Low oestradiol

100
Q

What are indications for HRT?

A
  1. Replacing hormones in premature ovarian insufficiency
  2. Reducing vasomotor symptoms
  3. Improving symptoms such as low mood, reduced libido, poor sleep and joint pain
  4. Reducing risk of osteoporosis in women under 60
101
Q

What are the types of Progestogens that can be given in HRT?

A

C19 - derived from testosterone - good for symptoms such as reduced libido - levonorgestrel, norethisterone
C21 - derived from progesterone - good for mood symptoms and acne - medroxyprogesterone, dydrogestrone

102
Q

What criteria is used to diagnose PCOS?

A

Rotterdam criteria- Must have at least 2/3
Anovulation or oligovulation
Hyperandrogenism seen by acne and hirstuism
Multiple cysts on ovaries on US

103
Q

What complications may be seen in a women with PCOS?

A

Insulin resistance and diabetes
OSA, depression and anxiety
Endometrial hyperplasia and cancer
CVD, acanthosis nigricans

104
Q

PCOS can cause hirstuism, what else can?

A

Medications - anabolic steroids, phenytoin, testosterone
CAH, cushings syndrome
Ovarian or adrenal tumour - secreting androgens

105
Q

What blood results are seen in PCOS?

A

Raised LH
Raised LH:FSH ratio
Raised testosterone, raised insulin

106
Q

What is the US criteria for diagnosing PCOS?

A

String of pearls appearance:

  • 12 or more developing follicles in 1 ovary
  • Ovarian volume of >= 10cm3
107
Q

What lifestyle measure can make a huge difference in PCOS?

A

Weight loss - restore fertility, reduce insulin resistance, reduce hirsutism and acne, reduces risk of CVD

108
Q

How can infertility be managed in PCOS?

A

Weight loss
Metformin + Letrozole (aromatase inhibitor - blocks negative feedback - inc FSH - ovulation)
Clomifene - SERM (same as above)
Ovarian drilling via laparoscopic surgery
IVF

109
Q

What is an important contraindication to HRT contraception?

A

Breast cancer

Use Barrier method or copper coil

110
Q

What is an important contraindication to IUS contraception?

A

Endometrial or cervical cancer

111
Q

What is an important contraindication to the copper coil?

A

Wilson’s disease

112
Q

What are some contraindications to the COCP (UKMEC 4)?

A

Uncontrolled HTN, AF, IHD, migraine with aura, major surgery with prolonged immobility, vascular disease or stroke, SLE, history of VTE

113
Q

What contraception is safe in breast feeding?

A

Progestogen-only pill or implant *!
COCP only UKMEC2 6 weeks after birth
IUS can be inserted within 48 hours or 4 weeks after birth

114
Q

How does the COCP work?

A

Inhibits ovulation

Progesterone thickens the cervical mucous, and inhibits proliferation of the endometrial lining

115
Q

What are some side effects of COCP?

A

Unscheduled bleeding in first 3 months

HTN, increased risk of VTE, breast and cervical ca, headache, mood changes and depression, breast pain

116
Q

Do you need extra protection if you miss one COC pill (within 72 hours since last pill)?

A

No

Take missed pill ASAP

117
Q

Do you need extra protection if you miss more than one COC pill (more than 72 hours since last pill)?

A

yes - until 7 days of regular pill taking
Take missed pill ASAP
If missed in day 1-7 - emergency contraception is needed if had unprotected sex
d15-21 - immediately take next pill packet, don’t take a pill free period

118
Q

What contraindication is there for Progestogen-only pill (POP)?

A

Active breast cancer

119
Q

What is the mechanism of action of POP?

A

Thickens cervical mucus, alters endometrial lining making it less accepting, reducing ciliary function
Desogestrel also inhibits ovulation

120
Q

What is a common side effect in POP?

A

Unscheduled bleeding?
1/3 stop
1/3 regular
1/3 irregular, prolonged or troublesome

121
Q

What is the progestogen only injection made of, and how is it taken?

A

Depot medroxyprogesterone acetate

IM or SC every 12-13 weeks

122
Q

What are 2 important side effects to consider in the progestogen only injection (depo)?

A

Weight gain, osteoporosis

123
Q

What are the 2 types of coils/ IUD?

A 
Copper coil - creates a hostile environment for pregnancy
Levonorgestrel IUS (e.g. mirena) - Slow release of progesterone
124
Q

When is the copper coil contraindicated?

A

In Wilsons disease

125
Q

What are the uses of the mirena coil?

A

HRT (4 years), menorrhagia, contraception (5 years)

126
Q

What might be seen incidentally on a smear in someone with an IUD/IUS?

A

Actinomyces-like organisms

127
Q

What options are available for emergency contraception?

A

Levonorgestrel - within 72h of unprotected sex
Ulipristal - within 120h of UPS (avoid in severe asthma)
Copper coil - within 5 days of UPS or within 5 days of estmiated date of ovulation

128
Q

What is Post Partum Haemorrhage?

A

Bleeding after delivery of the baby and placenta
VD - 500ml
C-section - 1000ml

129
Q

What are the definitions of minor - severe PPH?

A

Minor < 1000ml
Major >1000
Moderate 1000-2000
Severe > 2000

130
Q

What can PPH be categorised into?

A

Primary - within 24 hours of birth

Secondary - between 24hours and 12 weeks

131
Q

What are some causes of PPH? (4 T’s)

A

Tone (uterine atony), tissue, trauma, thrombin

132
Q

What are some preventative measures in PPH?

A

Treat anaemia in antenatal period
Give birth with an empty bladder
Active management of the 3rd stage of labour - IM oxytocin
IV transexamic acid in high risk pts in c-sections

133
Q

what are the 2 key causes of maternal sepsis?

A

Chorioamnionitis

UTI

134
Q

What is chorioamnionitis?

A

Infection of the chorioamnionic membranes and amniotic fluid
Caused by gram positive or negative bacteria or anaerobic bacteria

135
Q

What is an amniotic fluid embolism?

A

A medical emergency usually during delivery or labour

When the aniotic fluid gets in to the mums blood and mum mounts a response to the foetal cells

136
Q

What is uterine inversion?

A

A medical emergency, where the fundus of the uterus drops down through the uterine cavity and cervix.
Incomplete - fundus descends inside uterus and vagina but not as far as the introitus (vaginal opening)
Complete - descends through vagina into introitus

137
Q

What are the 3 main causes of antepartum haemorrhage ?

A

Placenta praaevia, placenta abruption, vasa praaevia

138
Q

What is a low-lying placenta?

A

When the placenta is within 20mm from the internal cervical OS

139
Q

What is placenta praevia?

A

When the placenta is over the internal cervical os

140
Q

What is placental abruption?

A

When the placenta separates fro the wall of the uterus during pregnancy

141
Q

How might a patient with placenta abruption present?

A 
Sudden onset severe abdominal pain that is constant
Vaginal bleeding (unless concealed)
Shock - maternal collapse
Abnormal CTG - foetal distress
Hard, 'woody' abdomen on palpation
142
Q

What can you do to quantify how much foetal and maternal blood has mixed in an antepartum haemorrhage to know how much ant-D to give?

A

Kleihauer test

Can be used after 20 weeks

143
Q

What is infertilty/ subfertility?

A

Inability of a heterosexual couple to achieve clinical pregnancy within 12 months of regular unprotected sex

144
Q

What are some causes of infertilty?

A

Sperm problems - 30%
Ovarian problems - 25%
Tubal problems - 15%
Uterine problems - 10%

145
Q

What investigations can you preform to investigate subfertiltiy?

A

LH, FSH, serum progesterone, prolactin, anti-mullarian hromone
Hysterosalpingogram
Laparoscopy and dye

146
Q

What do you look for in semen anaylsis?

A 
Semen volume - >1.5ml
Semen pH - >7.2
Concentration >15 million per ml
Total concentration >39 million per sample
Mobility ~>40% are mobile 
Vitality >58% are active
% of normal sperm >5%
147
Q

What are causes of male infertiltiy?

A

Pre-testicular - hypogonadotrophic hypogonadism (kallmanns, pit tumour, chronic conditions)
Testicular (mumps, cancer, undescended testes, trauma)
Post-testicular (retrograde ejaculation, obstruction of vas deference or ejaculatory duct)

148
Q

What are the steps in IVF?

A
  1. Suppression of the natural menstrual cycle
  2. Ovarian stimulation
  3. Oocyte collection
  4. IUI or ICSI
  5. Embryo culture
  6. Embryo transfer
149
Q

How might you suppress the natural menstrual cycle in IVF?

A

GnRH antagonist - e.g. Cetrorelix. SC at ~day 5-6 of ovarian stimulation. suppresses LH and so ovulation

GnRH agonist e.g. Goserelin injection ~d21 (luteal phase), acts on pituitary for initial stimulation of LH and FSH but then negative feedback causes GnRH suppression

150
Q

What is done to stimulate the ovaries in IVF?

A

FSH SC injection for 10-14 days starting day 2 of menstruation - helps promote development of follicles

Once enough follicles have to developed to an adequate size, FSH is stopped and hCG is started 36 hours before oocyte collection. ‘Trigger injection’

151
Q

What is vasa praevia?

A

When the foetal vessels are in the foetal membranes and they travel across the internal cervical os

152
Q

What are the 2 scenarios of vasa praevia?

A
  1. Velamentous umbilical cord - foetal vessels connected to choroamniotic membrane, the foetal vessels then travel unprotected before joining placenta
  2. Accessory lobe of placenta will be connected to the other placenta by the foetal vessels through the choroamniotic membranes
153
Q

What is placenta accreta?

A

When the placenta implants deeper, through and past the endometrium, making it difficult to separate the placenta after delivery of the baby

154
Q

What are the types of placenta accreta?

A

Superficial placenta accreta - implants in the surface of the myometrium
Placenta increta - deeply into the myometrium
Placenta percreta - past the myometrium and perimetrium, and potentially other organs

155
Q

What is stillbirth?

A

Birth of a dead foetus after 24 weeks gestation

156
Q

What are 3 important causes of cardiac arrest in pregnancy?

A

Obstetric haemorrhage
PE
Sepsis leading to metabolic acidosis and septic shock

157
Q

What is an umbilical cord prolapse?

A

When the umbilical cord descends past the presenting part of the foetus, through the cervix, into the vagina, after the foetal membranes have ruptured

158
Q

What is shoulder dystocia?

A

When the anterior shoulder of the baby gets stuck behind the pubic symphysis of the pelvis after delivery of the babys head

159
Q

How do you manage shoulder dystocia?

A
  1. Call for help
  2. Episiotomy?
  3. Mc Roberts manoeuvre - Hyperflexion of the hips to tilt the pelvis posteriorly
  4. Pressure on suprapubic region to encourage posterior aspect of anterior shoulder down and under pubic symphysis
  5. Rubin’s manoeuvre - reaching into vagina and putting pressure on posterior aspect of anterior shoulder to push forward
  6. Wood’s screw manoeuvre - while doing Rubin’s use other hand to push anterior aspect of posterior shoulder back to rotate baby
  7. Zavanelli manoeuvre - push baby back in and do an emergency C-section
160
Q

What are the indications for instrumental delivery?

A

Failure to progress
Foetal distress
Maternal exhaustion
Control of the foetal head

161
Q

What nerves may be compressed in an instrumental delivery?

A

Femoral or obturator

162
Q

What are some indications for a election C-section?

A

Multiple pregnancies, previous C-section, uncontrolled HIV infection, Breech, cervical cancer, symptomatic after previous significant perineal tear, placenta praaevia, vasa praaevia

163
Q

Define prematurity?

A

Birth before 37 weeks gestation

164
Q

What is the classification of prematurity?

A

Extreme preterm - under 28 weeks
Very preterm - 28-32 weeks
Moderate to late preterm - 32-37 weeks

165
Q

Vaginal progesterone can be given as prophylaxis for preterm labour, what does it do?

A

Given via gel or pessary
Prevents labour by reducing myometrium activity and preventing cervical remodelling in preparation for delivery. Given if cervical length less than 25mm on TVUS

166
Q

What is preterm, prelabour ROM?

A

When the amniotic sac ruptures before the onset of labour and in preterm pregnancy (under 37 weeks gestation)

167
Q

What does a cardiotocography measure?

A

Foetal HR and uterine contraction

168
Q

What is a reassuring baseline rate in a CTG?

A

110-160 (foetal HR)

169
Q

What is a reassuring variability of HR in a CTG?

170
Q

What is an early deceleration on a CTG?

A

When the HR drops with uterine contraction. The lowest point corresponds to the peak uterine contraction. Normal
Due to the uterus compressing the head of the foetus, stimulating the vagus nerve and slowing the HR

171
Q

What is late deceleration?

A

Due to foetal hypoxia - Maternal hypotension or hypoxia, excessive uterine contractions
Peak deceleration occurs after peak contraction

172
Q

What are variable decelerations?

A

Abrupt decelerations unrelated to uterine contraction - >15bpm drop, lowest part within 30s of contraction, and lasts for < 2 min
Due to intermittent compression of the umbilical cord

173
Q

What are signs of delay in the first stage of labour?

A

<2cm cervical dilation in 4 hours

Slowing of progress in a multiparous women

174
Q

What factors are considered in the progress of the 2nd stage labour?

A

Power
Passenger
Passage

175
Q

How do you classify perineal tears?

A

1 - vaginal epithelium and vulval skin only
2 - perineal muscles
3 - anal sphincter (A <50% EAS affected, B >50% EAS affected, C - internal and external sphincters affected)
4 - rectal mucosa

176
Q

What is postpartum anaemia?

A

Hb of <100g/L in the postpartum period

177
Q

In the luteal phase of the menstrual cycle, what happens when the egg is fertilised to make the corpus luteum keep on producing progesterone?

A

The embryo implants and the synchytiotrophoblast secretes human chorionic gonadotrophin

178
Q

What are the names of the stages as the fertilised ovum travels and then impants?

A

Zygote (when it is fertilised)
Morula
Blastocyte - Fullid filled cavity - blastocoele and embryoblast
(embryoblast then differentiates into the yolk sac and amniotic cavity separated by the embryonic disc which will form the foetal pole/ foetus)

179
Q

What are the SE of the progesterone depot injection?

A

Weight gain
Reduced BMD
DO NOT give if > 45

180
Q

How could you treat a sx pt with bacterial vaginosis?

A

Metronidazole orally or vaginal gel
(warn about disulfiram like reaction)
or Clindamycin

181
Q

In a mum with HTN, what medication needs to be STOPPED in pregnancy?

A

ACEi, ARB, (oligohydraminos, hypocalvaria)

thiazide and thiazide like diuretics (indapamide)

182
Q

What anti-epileptics are safe in pregnancy?

A

Lamotrigine, carbamazepine, levetriacetam

183
Q

Anti-epileptic drugs can reduce the efficacy of contraception, what contraception is not affected and should be advised?

A

Copper coil, LNG-IUS, depo injection (medroxyprogesterone acetate)

Year 5 (9 decks)

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