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Phase 4 > Obstetrics & Gynaecology > Flashcards

Obstetrics & Gynaecology Flashcards

1
Q

describe genitourinary syndrome of menopause

A

hypoestrogenic changes leading to

  • dry skin excoriation
  • discomfort/burning pain
  • dyspareunia
  • recurrent UTIs

management
- oestrogen cream

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2
Q

describe umbilical cord prolapse and its management

A

umbilical cord descends ahead of the presenting part of the fetus

50% occur at artificial rupture of the membranes

left untreated it can lead to compression of the cord / cord spasm - leads to potentially fatal fetal hypoxia

Risk factors for cord prolapse include:
- prematurity
- multiparity
- polyhydramnios
- twin pregnancy
- cephalopelvic disproportion
- abnormal presentations e.g. Breech, transverse lie

clinical features
- abnormal fetal heart rate
- palpable cord vaginally
- cord is visible beyond the level of the introitus

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3
Q

describe the management of umbilical cord prolapse

A

obstetric emergency

  • push presenting part of the fetus back into the uterus to avoid compression
  • cord past level of introitus: minimal handling, kept warm and moist to avoid vasospasm
  • patient is asked to go on ‘all fours’ until emergency caesarian section
    > left lateral position is alternative
  • tocolytics e.g. terbutaline may be used to reduce uterine contractions
  • retrofilling the bladder with 500-700ml of saline to elevate the presenting part
  • caesarian section is first-line method of delivery
    > instrumental vaginal delivery is possible if cervix is fully dilated and head is low
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4
Q

describe premenstrual syndrome and its management

A

emotional and physical symptoms experienced in the luteal phase of the menstrual cycle

clinical features
- anxiety, stress, fatigue, mood swings
- bloating
- breast pain

Management
- mild: lifestyle advice
- moderate: combined oral contraceptive pill (COCP)
- severe: SSRI

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5
Q

describe adenomyosis

A

endometrial tissue in myometrium

clinical features
- dysmenorrhoea (cyclical pain)
- menorrhagia
- enlarged, boggy uterus

usually women over age 30

investigations: transvaginal ultrasound / MRI

management
- tranexamic acid for menorrhagia
- GnRH agonists
- uterine artery embolisation
- hysterectomy is definitive

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6
Q

describe endometriosis

A

abnormal deposition of endometrial tissue outwith uterus

clinical features
- chronic abdominal pain/pressure
- dyspareunia
- painful/heavy periods
- infertility
- bowel/bladder dysfunction

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7
Q

describe chronic endometritis

A

clinical features
- abnormal uterine bleeding
- constant, vague abdominal pain
- examination: uterine tenderness / cervical motion tenderness
> can be normal

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8
Q

describe pelvic inflammatory disease (PID)

A

infection of female reproductive tract usually caused by Chlamydia trachomatis

clinical features
- bilateral pelvic pain
- abnormal uterine bleeding
- vaginal discharge
- uterine, adnexal and cervical motion tenderness

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9
Q

describe Fitz-Hugh-Curtis syndrome

A

complication of pelvic inflammatory disease in which liver capsule becomes inflamed causing RUQ pain

leads to scar tissue formation and perihepatic adhesions

treatment
- eradication of responsible organism
- laparoscopy for lysis of adhesions

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10
Q

describe a uterine leiomyoma (fibroid)

A

benign tumour due to proliferation of myometrial cells

clinical features
- menorrhagia
- dysmenorrhea
- examination: enlarged uterus irregular in shape

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11
Q

list risks of SSRIs in pregnancy

A

first trimester: small risk of congenital heart defects
third trimester: persistent pulmonary hypertension of the newborn

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12
Q

list requirements for instrumental delivery

A

FORCEPS

  • Fully dilated cervix, generally second stage of labour must be reached
  • OA position preferably OP delivery with Keillands forceps and ventouse
  • Ruptured membranes
  • Cephalic presentation
  • Engaged presenting part
    > head at/below ischial spines
    > head must not be palpable abdominally
  • Pain relief
  • Sphincter (bladder) empty - usually requires catheterisation
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13
Q

list indications for forceps delivery

A
  • fetal or maternal distress in second stage of labour
  • failure to progress in second stage of labour
  • control of head in breech delivery
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14
Q

describe contraception post-partum

A
  • COCP: absolutely contraindicated
  • progesterone-only pill: started on or after day 21 post-partum
  • progestogen-only implant can be inserted at any time
  • Mirena IUS / Copper IUD: used from 4 weeks post-partum
  • lactational amenorrhoea
    > if exclusively breastfeeding
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15
Q

describe contraception in menopause

A

non-hormonal methods of contraception
- stop contraception after 1 year of amenorrhoea if aged over 50 years
- stop after 2 years if aged under 50 years

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16
Q

which nodes does ovarian cancer most commonly metastasise to?

A

para-aortic nodes

17
Q

describe post-partum depression and its management

A

clinical features
- low self-esteem
- low mood
- anxiousness
- severe: psychotic symptoms, risk of self-harm/suicide

more common in primiparous women

Edinburgh Postnatal Depression Scale >13 suggests moderate/severe symptoms

management
- mild: reassurance and follow-up
- give antidepressants e.g. sertraline or offer CBT if
> persistent symptoms
> EPDS >13
> history of severe depression

puerperal psychosis may happen rarely

18
Q

describe different types of ovarian cysts

A
  • follicular cysts
    > most common
    > due to non-rupture of dominant follicle or failure of atresia of non-dominant follicle
    > usually regress after several menstrual cycles
  • corpus luteum cyst
    > corpus luteum fails to disappear and fills with blood/fluid
    > more likely to present with intraperitoneal bleeding
19
Q

describe different types of benign tumours of the ovary

A

benign germ cell tumour
- teratomas (dermoid cysts)
> include a range of tissues e.g. skin, bone, which may protrude from Rokitansky protuberance

benign epithelial tumours
- serous cystadenoma
> most common type, resembles most common type of ovarian cancer (serous carcinoma)
> can be bilateral

  • mucinous cystadenoma
    > typically large and may become massive
    > if ruptures may cause pseudomyxoma peritonei
20
Q

describe adverse effects of HRT

A

HRT is small dose of oestrogen with progestogen in women with a uterus to alleviate menopausal symptoms

side effects
- nausea
- breast tenderness
- fluid retention and weight gain

potential complications
> increased risk of breast cancer if addition of progestogen
> increased risk of endometrial cancer
> increased risk of VTE (unless transdermal HRT), increased by addition of progestogen
> increased risk of stroke
> increased risk of ischaemic heart disease if taken more than 10 years after menopause

21
Q

describe the management of anaemia in pregnancy

A

first trimester cut-off: <110g/L
second/third trimester: <105g/L
post-partum: <100g/L

Management
- oral ferrous sulfate or ferrous fumarate
> continue treatment for 3 months after iron deficiency is corrected

22
Q

describe the management of pre-existing hypertension in pregnancy

A

stop ACEi/ARB if taking

start
- labetalol first-line
- nifedipine second-line

23
Q

describe cervical cancer screening

A

negative hrHPV
- return to normal recall, unless
> test of cure pathway: individuals treated for CIN1/2/3 should repeat cervical sample for test of cure 6 months after
> untreated CIN1 pathway
> follow-up for incompletely treated CGIN or other abnormalities

positive hrHPV
- refer for colposcopy if abnormal cytology
- if cytology is normal recall in 12 months
> if repeat test is hrHPV -ve then return to normal recall
> if repeat test is hrHPV +ve repeat again in 12 months, if positive at 24 months refer for colposcopy

if inadequate sample, repeat in 3 months
> if 2 inadequate samples - refer for colposcopy

smear should be at least 12 weeks post-partum

24
Q

describe the treatment of cervical intraepithelial neoplasia

A

large loop excision of transition zone (LLETZ)

alternatively cryotherapy

25
Q

describe polycystic ovarian syndrome (PCOS)

A

triad of anovulation, hyperandrogenism and polycystic ovaries

clinical features
- acne
- weight gain
- hirsutism
- oligomenorrhoea
- insulin resistance
- infertility
- ultrasound: polycystic ovaries, “string of pearls” appearance

lab features
- increased LH, increased LH/FSH ratio
- increased testosterone
- prolactin may be mildly raised

management
- weight loss, exercise
- COCP, mirena coil
- clomifene for infertility

26
Q

describe the prevention and management of preterm labour

A

women with cervical length <25mm or history of preterm labour
> prophylactic vaginal progesterone suppository
> prophylactic cervical cerclage (suture to hold closed)

management
- tocolysis: nifedipine
- maternal corticosteroids: <35 weeks gestation to reduce neonatal morbidity and mortality
- IV magnesium sulphate: <34 weeks to protect baby’s brain
- delayed cord clamping/cord milking

27
Q

describe a cervical ectropion

A

aka cervical erosion, columnar epithelium that lines endocervical canal extends onto vaginal portion of cervix (ectocervix)

symptoms
- vaginal discharge
- post-coital bleeding

more common in women using COCP

ablative treatment only for troublesome symptoms

28
Q

describe bacterial vaginosis

A

Imbalance of normal vaginal flora with reduction in Lactobacilli and overgrowth of anaerobic bacteria e.g. Gardnerella vaginalis.

Overgrowth results in production of white malodorous discharge which is non-irritating and not associated with itch or dyspareunia

amsel’s criteria
- thin, white homogenous discharge
- stippled vaginal epithelial (clue) cells on microscopy of wet mount
- vaginal pH >4.5
- positive whiff test (addition of potassium hydroxide results in fishy odour)

management
- asymptomatic: no treatment
- symptomatic: metronidazole 5-7 days
OR topical clindamycin if metronidazole not tolerated

29
Q

describe Ebstein’s anomaly

A

caused by use of lithium in pregnancy

posterior leaflets of tricuspid valve are displaced anteriorly towards apex of right ventricle

> creates tricuspid regurgitation (pansystolic murmur) and tricuspid stenosis (mid-diastolic murmur)

> enlargement of right atrium

30
Q

list vaccinations offered in pregnancy

A

influenza vaccine at any point in pregnancy

16-32 weeks: pertussis

31
Q

list teratogenic drugs in pregnancy and their effects

A
  1. phenytoin: Cleft lip/palate, cardiac defects, hypoplastic nails and craniofacial abnormalities (foetal hydantoin syndrome)
  2. sodium valproate/ carbamazepine: neural tube defects
  3. lithium: Ebstein’s anomaly
  4. warfarin: frontal bossing, cardiac defects, microcephaly, nasal hypoplasia and epiphyseal stippling
  5. tetracycline: discolouration of teeth
32
Q
A
33
Q
A

Phase 4 (14 decks)

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