Obstetrics + Gynaecology Flashcards
1
Q
what are the main two urinary tract disorders in pregnant women?
A
- overactive bladder
2. stress incontinence
2
Q
what is the pathophysiological cause of stress incontinence?
A
weakness of the urethral sphincter combined with increased intra-abdominal pressure
3
Q
what % of pregnant women have stress incontinence?
A
> 10%
4
Q
what are 4 causes of stress incontinence?
A
- pregnancy
- prolonged labour
forceps delivery - obesity
- age
5
Q
what are 3 urinary symptoms that may present with stress incontinence?
A
- frequency
- urgency
- urge incontinence
(faecal incontinence may co-exist)
6
Q
what is a cystocoele?
A
where the bladder prolapses into the vagina?
7
Q
what is a urethrocoele?
A
bulging of the urethra into the vaginal wall
8
Q
what 3 ways can you test for urethrocoeles and cystocoeles?
A
- Sims speculum examination
- urine dipstick
- cystoscopy
9
Q
how do you treat stress incontinence?
A
- 1st line is pelvic floor muscle training
- vaginal cones/ sponges
- duloxetine
- surgery
10
Q
what type of drug is duloxetine?
A
an antidepressant (SS+NRI) that can treat urinary incontinence
11
Q
what surgery can be done for stress incontinence?
A
tension-free vaginal tape
12
Q
what is the clinical presentation of an overactive bladder?
A
- urinary urgency without incontinence
- usually occurs with frequency or nocturia
- can lead to incontinence
13
Q
what are 3 causes of an overactive bladder?
A
- detrusor overactivity
- multiple sclerosis
- spinal cord injury
14
Q
what are 6 ways you can treat an overactive bladder non-medically?
A
- reduce fluid intake
- avoid caffeine
- bladder training
- education
- timed voiding
- positive reinforcement
15
Q
what are 4 ways you can treat an overactive bladder medically?
A
- anticholinergics
- oestrogen treatment
- botulinum toxin A
- neuromodulation
16
Q
what are 6 causes of acute urinary retention?
A
- childbirth
- surgery
- anticholinergics
- retroverted gravid uterus
- pelvic masses
- neurological disease
17
Q
how do you treat acute urinary retention?
A
catheter insertion
18
Q
how do you diagnose acute urinary retention?
A
ultrasound or catheterisation after micturition
19
Q
what is painful bladder syndrome?
A
where someone experiences suprapubic pain related to bladder filling. can also manifest with urinary frequency
20
Q
what is interstitial cystitis?
A
inflammation of the bladder that can cause suprapubic pain?
21
Q
how do you diagnose interstitial cystitis?
A
cystoscopy and histology
22
Q
what are 6 ways to treat interstitial cystitis?
A
- dietary changes
- bladder training
- tricyclic antidepressants
- analgesics
- intravesicular drug infusion
23
Q
how do you treat vesicovaginal and urethrovaginal fistulae?
A
surgery
24
Q
how do you define a uterine or vaginal prolapse?
A
descent of the uterus or vagina beyond anatomical confines due to weakness of surrounding structures
25
what are 5 types of vaginal prolapse?
1. urethrocele
2. cystocoele
3. rectocoele
4. enterocoele
5. apical prolapse
26
what is a rectocoele?
prolapse of the lower posterior wall of the vagina involving anterior wall of rectum
27
what is an enterocoele?
prolapse of the upper posterior wall of the vagina involving loops of small bowel
28
what is an apical vaginal prolapse?
a vaginal prolapse of the uterus, cervix and upper vagina
29
what % of parous women (women who have given birth) have some degree of prolapse?
50%
30
what are the symptoms of a vaginal prolapse?
dragging sensation or a lump. severe prolapse can interfere with sex, ulcerate and bleed. cystourethrocoele can cause urinary frequency
31
how do you diagnose prolapse?
1. abdominal and bimanual exam
2. ultrasound
3. urodynamic testing for cystourethrocoele
32
what are 2 ways to avoid vaginal prolapse?
1. pelvic floor exercises
| 2. avoidance of excessively long 2nd stage of pregnancy
33
how do you treat vaginal/ uterine prolapse?
1. surgery
2. pessaries if unfit for surgery
3. physiotherapy
vaginal hysterectomy for uterovaginal prolapse
4. hysteropexy (suspension of prolapsed uterus) for uterine prolapse
34
what are 3 possible side effects of using a pessary?
1. pain
2. urinary retention
3. infection
35
what is endometriosis?
presence and growth of tissue similar to endometrium outside the uterus that causes inflammation and progressive fibrosis and adhesions
36
what causes endometriosis in the pelvis?
retrograde menstruation
37
what are 2 factors that make a woman more likely to have endometriosis?
1. age 30-45
| 2. nulliparous (never given birth) women
38
what is the clinical presentation of endometriosis?
1. often symptomless
2. dysmenorrhoea (painful menstruation)
3. deep dyspareunia (difficult or painful intercourse)
4. sub-fertility
5. pain on passing stool
6. menstrual problems
39
what are some common findings on observation and examination?
tenderness or thickening behind the uterus, with the pelvis feeling normal if mild disease
40
how do you diagnose endometriosis?
visualisation and biopsy at laparoscopy
41
what does an active endometriosis lesion look like
red vesicles on the peritoneum
42
what does a less active endometriosis lesion look like?
white scars or brown spots on the peritoneum
43
what additional pathophysiological features are present in severe endometriosis?
extensive adhesions and ovarian endometriomas (endometrial cyst)
44
what investigations are recommended for endometriosis?
1. transvaginal ultrasound
2. laparoscopy
3. MRI to exclude adenomyosis
4. MRI with IV pyelogram (kidneys, ureters and bladder) for deep penetrating disease
45
how do you treat endometriosis?
1. pain management- progestagens or mirena good for pain (mimic pregnancy)
2. combined oral contraceptive pill (tricyclic regimen)
3. GnRH analogue- danazol (mimic menopause)
46
what hormone does a GnRH analogue inhibit the synthesis of to treat endometriosis, and what physiological state does this induce?
oestrogen (they induce temporary menopause)
47
what condition can be caused by taking GnRH analogues over a long period of time, and what is the therapy duration as a result?
reversible bone demineralisation so therapy is <6 months
48
how do you laparoscopically destroy endometriosis lesions?
scissors, laser or bipolar diathermy
49
what is the last resort surgery for endometriosis?
hysterectomy
50
how are progestogens and mirena good for pain management in endometriosis?
they create a pseudo-pregnant state that prevent endometrial sloughing and pain
51
what is mirena?
an implantable uterine device that secretes progestagens
52
what is adenomyosis?
presence of endometrium within myometrium (deeper muscular layer of the uterine wall)
53
what are 3 risk factors for adenomyosis?
1. 40-ish years old
2. endometriosis
3. fibroids
54
what are the differences in occurence between endometriosis and adenomyosis regarding age and pregnancies?
endometriosis- young and nulliparous
adenomyosis- older and multiparous
55
what is the clinical presentation of adenomyosis?
1. symptomless
| 2. painful, regular heavy menstruation
56
what can be seen on observation and examination of adenomyosis?
mildly enlarged and tender uterus
57
how do you diagnose adenomyosis?
MRI and clinical picture
58
how do you treat adenomyosis?
1. progesteron IUD
| 2. combined OC pill
59
what are fibroids?
benign tumours of the myometrium (middle layer of uterine wall)
60
what % of women have fibroids?
25%
61
what three names are given to fibroids in different locations within the uterine wall and what are these locations?
1. intramural (between muscles)
2. subserosal (outside of uterus)
3. submucosal (under the uterine lining)
62
what hormone is the growth of fibroids dependent on?
oestrogen
63
what is the clinical presentation of fibroids?
1. 50% asymptomatic
2. 30% menorrhagia
3. dysmenorrhoea
4. sub-fertility
5. frequency and retention with large fibroids pressing on bladder
64
what two types of degeneration can fibroids undergo and what are the associated symptoms?
1. red degeneration- occurs in pregnancy, causes pain, tenderness, haemorrhage and necrosis
2. hyaline/ cystic degeneration- fibroid soft and partly liquefied
65
how can fibroids affect pregnancy?
can cause severe pain, premature labour, malpresentations and obstructed labour
66
how do you diagnose fibroids?
1. MRI, but ultrasound is useful
| 2. hysteroscopy or hysterosalpinogram can assess distortion of the uterine cavity
67
what might cause a low haemoglobin in a patient with fibroids?
bleeding
68
what might cause a high haemoglobin in a patient with fibroids?
excess EPO secretion
69
how do you treat fibroids?
1. asymp patients do not need treatment
2. GnRH agonists cause temporary amenorrhoea and fibroid shrinkage but use <6 months
3. small fibroid resection with surgery
4. hysterectomy
5. uterine artery embolisation to reduce volume of fibroids (but can cause more pain)
70
what are intrauterine polyps?
small benign tumours that grow in the uterine cavity, most endometrial and some are submucosal
71
what age are intrauterine polyps common?
40-50 year old women
72
what drug can cause intrauterine polyps in post-menopausal women?
tamoxifen (breast cancer hormone therapy)
73
how do you diagnose intrauterine polyps?
ultrasound or hysteroscopy
74
what is the clinical presentation of intrauterine polyps?
menorrhagia and inter-menstrual bleeding
75
how do you treat intrauterine polyps?
resection of polyps with cutting diathermy
76
what is subfertility?
pregnancy has not occurred after 1 year of regular unprotected intercourse
77
what is the difference between primary and secondary failure of conception?
1. primary- never conceived
| 2. secondary- previous termination/ miscarriage
78
what are 4 general causes of subfertility?
1. anovulation
2. inadequate sperm
3. fallopian tube damage
4. defective implantation
79
what shows that ovulation has happened in the menstrual cycle?
elevated serum progesterone in the mid-luteal phase
80
what condition causes >80% of anovulatory infertility?
polycystic ovary syndrome
81
what is polycystic ovary syndrome?
a syndrome describing an enlarged ovary with multiple small follicles
82
how do you diagnose polycystic ovary syndrome?
1. PCO on ultrasound
2. irregular periods
3. hirsutism
83
what causes increased androgen production in polycystic ovary syndrome?
disordered LH and peripheral insulin resistance
84
what is important to check for in the family history of polycystic ovary syndrome?
diabetes mellitus type 2
85
what is the typical clinical presentation of polycystic ovary syndrome?
1. obesity
2. acne
3. hirsutism
4. oligo/amenorrhoea
female of reproductive age
5. sometimes hypertension and scalp hair loss
86
what investigations should be done for polycystic ovary syndrome?
1. FSH- normal in PCOS, raised in ovarian failure, lowered in hypothalamic
2. prolactin and TSH
3. serum testosterone
4. LH
5. screening for diabetes and abnormal lipids
87
what type of cancer is more common in polycystic ovary syndrome?
endometrial cancer
88
how do you treat polycystic ovary syndrome?
1. 1st line weight loss plus oral contraceptive pill
2. metformin
3. mechanical hair removal
4. cytoproterone acetate for hirsutism
5. 2nd line anti-androgen
6. clomiphene for fertility
89
what is hypothalamic hypogonadism?
reduction in GnRH release from the anterior pituitary gland leading to amenorrhoea
90
what are 4 risk factors for hypothalamic hypogonadism?
1. anorexia nervosa
2. dieting
3. athletes
4. stress
91
how do you treat hypothalamic hypogonadism?
1. increase weight
| 2. OC or HRT for bone protection
92
the excessive release of which hormone can reduce GnRH release?
prolactin
93
what 3 things is excessive prolactin release associated with?
1. PCOS
2. hypothyroidism
3. psychotropic drugs
(and tumours)
94
how does clomiphene (for inducing ovulation) work?
blocks oestrogen receptors on the hypothalamus and pituitary
95
what is 2nd line to clomiphene for infertility treatment?
gonadotrophin (FSH and LH)
96
what is ovarian hyper-stimulation syndrome?
a condition where gonadotrophins overstimulate follicles that get large and painful
97
what are 3 risk factors for ovarian hyper-stimulation syndrome?
1. gonadotrophin stimulation
2. age <35
3. previous polycystic ovaries
98
what are 2 serious complications of severe ovarian hyper-stimulation syndrome?
thromboembolism and ascites
99
what are 10 causes of male subfertility?
1. idiopathic oligospermia (no causative factor for reduced sperm count)
2. asthenozoospermia (reduced sperm motility)
3. alcohol
4. smoking
5. varicocele
6. exposure to industrial chemicals
7. mumps
8. testicular abnormalities
9. retrograde ejaculation
100
what hormone levels would suggest primary testicular failure?
high FSH and LH with low testosterone
101
what should men with azoospermia and an absent vas deferens be tested for?
cystic fibrosis
102
that investigations should be done for male subfertility?
1. semen analysis
| 2. FSH, LH, testosterone, prolactin, TSH
103
how do you treat male subfertility?
1. advice on loose clothing and testicular cooling
2. lifestyle changed and drug exposures
3. hormonal treatments
104
what is the most common cause of fallopian tube damage?
pelvic inflammatory disease
105
what is the clinical presentation for pelvic inflammatory disease?
1. pelvic pain
2. vaginal discharge
3. abnormal menstruation
106
how do you assess the patency of the fallopian tubes?
laparoscopy and dye testing
107
what are 3 forms of assisted conception?
1. intrauterine insemination
2. IVF
3. intracytoplasmic sperm injection
108
what is intrauterine insemination?
washed sperm is injected directly into the uterine cavity following gonadotrophin ovulation induction
109
what conditions make intrauterine insemination suitable?
1. unexplained subfertility
| 2. cervical, sexual and male factors
110
what is in-vitro fertilisation?
1. multiple follicular development with FSH+LH
2. Egg collection
3. embryo culturing
4. implantation of embryos
111
what is intracytoplasmic sperm injection?
injection of sperm into the oocyte cytoplasm
112
what are the conditions that are screened for antenatally?
1. sickle cell and thalassaemia
2. infectious diseases (HIV, Hep B, Syphilis)
3. down's, edward's and patau's
4. diabetic eye screening (for mother)
5. fetal anomaly scan
113
what is edward's syndrome?
1. trisomy 18
2. low survival rates and only 10% live past first birthday
3. severe learning disabilities and organ defects
114
what is patau's syndrome?
1. trisomy 13
2. most babies die before or shortly after birth
3. major defects include heart, midline facial, abdo wall and urogenital defects
115
what are the 11 fetal abnormalities that are screened for in the fetal abnormality scan?
1. anencephaly
2. open spina bifida
3. cleft lip
4. diaphragmatic hernia
5. gastroschisis
6. exomphalos
7. serious cardiac abnormalities
8. bilateral renal agenesis
9. lethal skeletal dysplasia
10. trisomy 18 (edward's)
11. trisomy 13 (patau's)
116
what are the things examined in the newborn infant physical examination?
1. eyes
2. heart
3. hips
4. testes
hearing is tested separately
117
what are the 9 conditions tested for in the newborn blood spot test?
1. cystic fibrosis
2. sickle cell disease
3. congenital hypothyroid
4. phenylketonuria
5. MCAD deficiency
6. maple syrup urine disease
7. isovaleric acidaemia
8. glutaric aciduria type
9. homocystinuria
118
what are 5 pregnancy specific conditions that can affect someone during pregnancy?
1. pre-eclampsia
2. thromboembolism
3. gestational diabetes mellitus
4. obstetric cholestasis
5. acute fatty liver
119
what are 8 pre-existing conditions that are important to remember during pregnancy?
1. asthma
2. epilepsy
3. hypertension
4. diabetes
5. thyroid problems
6. renal problems
7. cardiac problems
8. SLE/ RA
120
what should be done before pregnancy with regards to pre-existing medical conditions?
1. optimise disease control and ensure medical condition is stable before pregnancy (contraception until ready to conceive)
2. rationalise drug therapy to minimise effects on the baby
3. advise on risks
4. agree a care plan
121
what are 2 important things to consider about pre-existing medical conditions during pregnancy?
1. the effect pregnancy has on the condition
| 2. the effect the condition may have on the baby
122
what is a condition that improves during pregnancy?
rheumatoid arthritis
123
what pre-existing medical condition increases the risk of pre-eclampsia?
essential hypertension
124
what are some factors to consider during delivery and postpartum care?
1. safest mode of delivery
2. neonatal support
3. anaesthetic expertise
4. ITU/HDU facilities
5. ongoing post-partum care
125
what changes in the manifestation and management of anaemia during pregnancy?
1. 2-3 fold increase in iron requirements
| 2. 10-20 fold increase in folate requirements
126
what effects can maternal anaemia have on the baby?
iron deficiency is associated with low birthweight and pre-term delivery
127
what changes in the manifestation and management of asthma during pregnancy?
1. risk of exacerbation particularly in the 3rd trimester
| 2. all medications normally used in asthma can be used during pregnancy
128
what effects can maternal asthma have on the baby?
1. risk of fetal growth restriction due to inadequate perfusion of the placenta
2. premature delivery with deterioration of the mother's condition
129
what are 4 low cardiac conditions during pregnancy?
1. mitral incompetence
2. aortic incompetence
3. atrio-septal defect
4. ventriculo-septal defect
130
what are 4 high risk cardiac conditions during pregnancy?
1. aortic stenosis
2. coarctation of the aorta
3. prosthetic valves
4. cyanosed patients
131
what are some management issues relating to cardiac problems during pregnancy?
1. anti-coagulation for mechanical heart valves
2. need to alter and add medications
3. consistently monitor fetal growth and wellbeing- consider timing and mode of delivery of the scane
4. post-partum cardiac failure
132
what is the most common liver disease during pregnancy?
obstetric cholestasis
133
what is the presentation of obstetric cholestasis?
itching with no rash, usually resolving after delivery
134
what is raised during obstetric cholestasis?
AST, ALT and bile acids
135
what is the recurrence risk for obstetric cholestasis?
>80%
136
what effects can obstetric cholestasis have on the baby?
1. risk of stillbirth and premature labour
2. treatment with ursodeoxycolic acid does not seem to reduce fetal complications but is associated with improved biochem abnormalities
137
what changes in the manifestation and management of hyperthyroidism during pregnancy?
1. often improves in pregnancy after 1st trimester
2. maternal risk of thyroid crisis with cardiac failure
3. carbimazole and propylthiouracil can cause maternal liver failure and fetal abnormalities
138
what effects can maternal hyperthyroidism have on the baby?
thyrotoxicosis due to transfer of thyroid stimulating antibodies
139
what effects can maternal hypothyroidism have on the baby?
early fetal loss and impaired neurodevelopment if untreated, aim for thyroxine replacement during pregnancy
140
what complications can diabetes cause to the mother during pregnancy?
1. diabetic ketoacidosis
2. hypoglycaemia
3. retinopathy progression
4. pre-eclampsia
5. premature labour
141
what complications can diabetes cause to the baby during pregnancy?
1. miscarriage
2. macrosomia, shoulder dystocia
3. fetal abnormality
4. stillbirth
5. neonatal hypoglycaemia, respiratory distress, hypocalcaemia and polycycaemia
142
what drugs are used for diabetes during pregnancy?
1. insulin- basal bolus regime
2. metformin
3. glibenclamide (all of hypoglycemics contraindicated)
4. statins and ACE-i contraindicated
143
what complications can chronic renal disease cause to the mother during pregnancy?
1. severe hypertension
2. deterioration in renal function
3. pre-eclampsia
4. caesarean section
5. premature delivery
144
what complications can chronic renal disease cause to the baby during pregnancy?
1. growth restriction
2. stillbirth
3. abnormalities due to maternal drug therapy
145
what are 4 physiological factors that determine the outcome in pregnancy of chronic renal disease?
1. renal dysfunction
2. maternal blood pressure
3. creatinine levels
4. proteinuria
146
how should you treat renal disease during pregnancy?
1. pre-pregnancy risk assessment
2. multidisciplinary care
3. close renal function and blood pressure monitoring
4. regular fetal growth and wellbeing assessment
147
what is the risk to the mother of having epilepsy during pregnancy?
1. 25-33% increase in seizure frequency
2. sudden unexpected death in epilepsy, which is more common in patients who do not take their prescribed anti-convulsants (EG mothers scared of harming babies)
148
what are the risks to the baby of the mother having epilepsy during pregnancy?
1. risk of fetal abnormality, mainly due to anti-convulsant medication but possibly also epilepsy itself
2. inheritance of epilepsy
3. fetal hypoxia during seizures
4. spina bifida may be related to maternal epilepsy
149
what is the risk of a congenital malformation during pregnancy if a woman is using sodium valproate, and what are some of these malformations?
10.7%
spina bifida, cleft palate, hypospadias, polydactyly
4.4% risk of autism spectrum disorder
150
what are 4 risk factors for thromboembolism during pregnancy?
1. maternal age
2. BMI
3. operative delivery
4. haematological changes during pregnancy
151
what should be done if thromboembolism is suspected during pregnancy?
1. investigate with doppler ultrasound for DVT or VQ scan (ventilation-perfusion scan)/ CT pulmonary angiogram for PE
2. LMWH is the treatment of choice for VTE in pregnancy
152
what is a normal cycle of menstruation?
loss for 2-8 days
| cycle for 21-35 days
153
what is the normal volume of blood loss per menstrual cycle?
60-80ml
154
what is the definition of abnormal uterine bleeding?
any menstrual bleeding from the uterus that is either abnormal in volume, regularity, timing, or is non-menstrual
155
what is the definition of heavy menstrual bleeding?
menstrual blood loss that is subjectively considered to be excessive by the woman that interferes with her quality of life
156
what are the three most common broad causes of heavy menstrual bleeding?
1. coagulopathy
2. ovulatory
3. endometrial dysfunction
157
what are the four most common pathological causes of heavy menstrual bleeding?
1. uterine fibroids
2. uterine polyps
3. adenomyosis
4. endometriosis
158
what % of women with heavy menstrual bleeding have no uterine, endocrine, haematological or infective pathology on investigations?
40-60%
159
what are the four main causes of abnormal menstruation?
1. uterine fibroids
2. uterine polyps
3. endometriosis
4. adenomyosis
160
what is a uterine fibroid made up of?
smooth muscle cells with collagen
161
what is a uterine polyp made up of?
benign growth of the endometrium, fibrous core covered by columnar epithelium
162
what is an adenomyosis deposit?
ectopic endometrial tissue in the myometrium
163
what 3 things should be covered in a menses history?
1. duration
2. cycle
3. index of heaviness (clots, protection, flooding)
164
what associated concerns should be covered in a menses history?
1. pain- duration and relation to cycle
2. premenstrual tension
3. infertility worries
4. cancer phobia
5. interference with life
165
what associated symptoms should be covered in a menses history?
1. thyroid disease- cold/ heat intolerance, consistency of hair, lethargy
2. clotting disorder- bruising, family history
3. drug therapy- warfarin, heparin
166
what should be included in the general bodily examination for a history of irregular menstruation?
1. sclera, palms, gingiva
2. thyroid gland
3. abdomen
167
what should be included in a pelvic examination for a history of irregular menstruation and why?
1. vulva and vagina- malignancy
2. cervix
3. uterus- fibroids, adenomyosis
4. adnexae- ovaries and fallopian tubes (adnexae- appendages)
168
what investigations should be done with a history of menorrhagia?
1. FBC
2. transvaginal ultrasound
2. endometrial biopsy if older than 45 years and unresponsive to treatment
3. hysteroscopy if there is an abnormal scan, no treatment response or a diagnosis of polyps or fibroids
169
what are 7 treatments for abnormal menstruation
1. antifibrinolytics
2. NSAIDs
3. progestagens
4. danazol
5. COCP
6. mirena coil
7. endometrial ablation
170
what is the % reduction in menstrual blood loss for antifibrinolytics and how do they work?
1. inhibit tissue plasminogen activator (stop the breakdown of blood clots)
2. 50%
171
what is the % reduction in menstrual blood loss for NSAIDs and how do they work?
1. inhibit cyclooxygenase and blog PGE2 receptors (reduce the concentration of prostaglandins which are associated with heavy menstrual bleeding)
2. 25%
172
what is the % reduction in blood loss for danazol and how does it work?
1. inhibits the production of sex steroids
| 2. 86%
173
what is the % reduction in blood loss for COCP and how does it work?
1. inhibits ovarian function
| 2. 43%
174
what is the % reduction in blood loss for the mirena coil and how does it work?
1. local release of progestagens
| 2. 85% after 3 months
175
what are 4 indications for endometrial ablation?
1. heavy menstrual loss
2. normal endometrium
3. completed family
4. not expecting amenorrhoea
176
what are 3 contraindications for endometrial ablation?
1. malignancy
2. acute pelvic inflammatory disease
3. desire for future pregnancy
177
what is the largest cause of post-natal death in normal fetuses?
prematurity
178
what 4 conditions is prematurity a major contributor to?
1. developmental delay
2. visual impairment
3. chronic lung disease
4. cerebral palsy
179
what are 5 factors in neonatal intensive care that improve survival rates in premature infants?
1. antenatal steroids
2. artificial surfactant
3. ventilation
4. nutrition
5. antibiotics
180
what are 6 risk factors for premature birth?
1. antepartum haemorrhage and vaginal bleeding
2. multiple pregnancies
3. race
4. previous pre-term births
5. cervical weakness
6. genital infection
181
what are 4 primary prevention strategies for preterm birth?
1. smoking and STD prevention
2. prevention of multiple pregnancy
3. planned pregnancy
4. physical and sexual advice
182
what are 4 tertiary prevention strategies for preterm birth?
1. prompt diagnosis
2. antibiotics
3. corticosteroid
4. tocolysis (drugs to prevent contractions)
183
define the diagnosis of preterm labour
persistent uterine activity and change in cervical dilation and/ or effacement before week 37
184
what is a secondary prevention strategy for preterm birth?
select those at increased risk for surveillance and prophylaxis
185
what are 2 screening methods for preterm labour?
1. transvaginal cervical ultrasound
| 2. qualitative fetal fibronectin test
186
what is fetal fibronectin and what range of weeks will it start breaking down in for preterm delivery?
a glycoprotein that holds the fetal membranes to the uterine membrances and if it starts to break down between 22 and 35 weeks it indicated preterm delivery
187
what is a cervical risk factor for preterm delivery?
shortened cervix (<3cm)
188
what hormonal treatment can help women who are at risk of preterm delivery?
progesterone
189
what is pre-eclampsia?
pregnancy induced hypertension with proteinuria +/- oedema
190
what is the pathophysiological cause of pre-eclampsia?
failure of trophoblasts to invade spiral uterine arteries leaving them vasoactive (meaning they are still able to shrink in response to vasoconstrictors). increased blood pressure is an attempt to compensate
191
what 3 other systems can pre-eclampsia affect?
1. hepatic
2. renal
3. coagulation
192
what are 3 high risk factors for pre-eclampsia?
1. chronic hypertension
2. chronic kidney disease
3. diabetes mellitus
193
what are 3 moderate risk factors for pre-eclampsia?
1. first pregnancy
2. aged over 40
3. family hx
194
what does proteinuria in pre-eclampsia indicate?
it is a late stage sign indicating renal involvement
195
what is the clinical presentation of symptomatic pre-eclampsia?
may mimic flu, can include-
1. headache
2. chest or epigastric pain
3. vomiting
4. increased pulse
5. visual disturbance
6. shaking
7. irritability
8. hyperreflexia
196
prophylaxis of which drug can reduce the risk of pre-eclampsia?
magnesium sulfate halves the risk of pre-eclampsia
197
how do you manage pre-eclampsia?
1. regular BP measurements
2. admittance is BP raises 30/20 since booking or is 160/100 total or 140/90 with proteinuria
3. monitor fluid balance, U+E, LFT and platelets regularly
4. cardiotocography (fetal heartbeat recording)
5. ultrasound scanning
6. labetalol or hydralazine to reduce blood pressure (pretreatments before the real treatment which is delivery)
7. magnesium sulfate can be used to treat the first seizure caused by pre-eclampsia
the only cure for pre-eclampsia is delivery!!!! anti-hypertensives do not stop it
198
what are some indication for delivery in pre-eclampsia?
1. severe fetal growth restriction
2. oligohydramnios- deficient volume of amniotic fluid
3. non-reassuring fetal testing results
199
what is the difference between pre-eclampsia and hypertension in pregnancy and how do you treat hypertension in pregnancy?
pre-eclampsia always involved an element of proteinuria
if bp is above 160/100-
1. parenteral hydralazine and labetalol
2. oral nifedipine used with caution
3. sodium nitroprusside (vasodilator)
200
what are the 5 important basic components of a sexual health history?
1. history of presenting complaints
2. past GU history
3. past general medical/ surgical history
4. drug history- any recent antibiotics?
5. sexual history
201
what are 4 important components of the sexual history section of a sexual health history?
1. last sexual intercourse
2. regular/ casual partner
3. male/ female
4. condom use
202
what are 4 female specific components of a focused sexual health history?
1. menstrual history
2. pregnancy history
3. contraceptive history
4. cervical cytology history
203
what is 1 male specific component of a focused sexual health history?
1. when last voided urine
204
what are the 6 stages of a genital examination in a woman?
1. vulva
2. perineum
3. vagina
4. cervix
5. bimanual pelvic examination
6. possibly anus and oropharynx if indicated
205
what are the 4 stages of a genital examination in a man?
1. penis
2. scrotum
3. urethral meatus
4. anus and oropharynx in msm or if indicated
206
what screening tests should be done on an asymptomatic woman for their sexual health?
1. self taken vulvo-vaginal swab for gonorrhoea/ chlamydia
| 1. Bld test for STS and HIV
207
what screening tests should be done on an asymptomatic man for their sexual health?
1. first void urine for gonorrhoea/ chlamydia
| 2. Bld test for STS and HIV
208
what are 8 symptomatic presentations of a woman regarding sexual health?
1. vaginal discharge
2. vulval discomfort/ soreness/ itching/ pain
3. superficial dyspareunia
4. pelvic pain/ deep dyspareunia
5. vulval lumps
6. vulval ulcers
7. intermenstrual bleeding
8. post-coital bleeding
209
what are 7 symptomatic presentation of a man regarding sexual health?
1. pain/burning during micturition
2. pain/ discomfort in the urethra
4. urethral discharge
5. genital ulcers, sores, or blisters
6. genital lumps
7. rash on penis or genital area
8. testicular pain or swelling
210
what symptomatic screening is necessary for a woman regarding sexual health?
1. vulvo-vaginal gonorrhoea and chlamydia swab
2. high vaginal swab
3. cervical swab for gonorrhoea
4. dipstick urinalysis
5. bld for STS and HIV
211
what STI's does a high vaginal swab test for?
1. bacterial vaginosis
2. trichomonas vaginalis
3. candida
212
what symptomatic screening is necessary for a man regarding sexual health?
1. urethral swab for gonorrohoea
2. first void urine for gonorrhoea and chlamydia
3. dipstick urinalysis
4. bld for STS and HIV
5. MSM also has urethral and rectal slides and urethral and rectal and pharyngeal cultures
213
what are 4 at risk groups of people for hepatitis B?
1. MSM
2. commercial sex workers
3. IVDU
4. people from africa, asia and eastern europe and their partners
214
what is the most common type of cancer in the UK and the second biggest cancer killer of women?
breast cancer
215
what are the 1 year and five year survival rates for breast cancer?
1 year- 96%
| 5 years- 85%
216
what is the lifetime risk of breast cancer for a woman?
1:9
217
what are 6 risk factors for breast cancer?
1. radiotherapy treatment below 35 years old
2. BRCA1 and BRCA2 gene carriers
3. HRT
4. moderate-high alcohol consumption
5. not breast feeding
6. nulliparous
218
what are the 4 stages of the screening program for breast cancer?
1. invitation
2. screening mammography
3. assessment- about 5% recalled
4. results, surgery and further treatment
219
what are 5 reasons seen on a mammogram that warrant recalling of the patient?
1. mass
2. microcalcificaiton
3. parenchymal deformity/ distortion
4. asymmetrical density
5. enlarged axillary lymph nodes
220
what are 4 steps after recall in breast cancer screening to confirm a diagnosis?
1. ultrasound
2. biopsy
3. marker insertion
4. MDT discussion
221
what is the most common type of breast cancer?
invasive ductal carcinoma
222
what is the surgical treatment for invasive ductal carcinoma?
1. wire localisation
| 2. wide local excision
223
what ages are routinely invited for mammograms?
50-70 years old, often younger high risk women (previous radiotherapy or familial predisposition)
224
what are 3 important descriptors of the 1st stage of labour and what are the spinal cord locations of the nerves involved with the pain?
1. uterine contraction, cervical effacement and dilatation
| 2. T10-L1 and S2-4
225
what is an important descriptor of the 2nd stage of labour and what are the spinal cord locations of the nerves involved with the pain?
1. stretching of the vagina, peritoneum and extrauterine pelvic structures
2. S2-4 pudendal and L5-S1
226
what are 4 non-pharmacological pain management options for labour?
1. acupuncture
2. hypnotherapy
3. massage
4. hydrotherapy
227
what are 4 pharmacological pain management options for labour?
1. entonox
2. oral analgesia
3. parenteral opioids
4. PCA opioids (self-administered by pushing a button)
228
what is entonox comprised of and why is it a good way to manage pain in labour?
1. 50% N2O and 50% O2
| 2. rapid onset, minimal side effects, self limiting
229
what are some simple options for systemic analgesia during labour?
paracetamol or codeine
230
what are 3 options for single shot opioid pain relief during labour and why are they good?
1. morphine, diamorphine and pethidine
| 2. they cross placenta rapidly due to being lipid soluble
231
what are some adverse effects of using opioid pain relief during labour?
1. pethidine can cause seizures in epileptic patients
| 2. all cause sedation, respiratory depression, nausea and vomiting and pruritis
232
what are 3 options for PCA opioids during labour?
1. fentanyl
2. alfentanil
3. remifentanil
233
what are 3 options for regional pain relief during labour?
1. epidural
2. spinal
3. combined spinal and epidural
234
at what spinal level should epidural analgesia be inserted and what anatomical landmark overlies this area?
L3/4 at tuffiers line (the top point of both iliac crests connected by a line)
235
what are 5 indications for epidural anaesthesia in labour?
1. maternal request
2. cardiac and other medical diseases
3. augmented labour
4. multiple births
5. instrumental/ operative delivery likely
236
what are 6 contraindications for epidural/ regional anaesthesia in labour?
1. maternal refusal
2. local infection
3. allergy
4. coagulopathy
5. hypovolaemia
6. abnormal anatomy
237
what are 5 broad adverse effects of regional anaesthesia in labour?
1. cardiovascular- hypotension and bradycardia
2. respiratory- poor cough
3. neurological- rare related to haematoma or abscess
4. drug-related- allergy, anaphylaxis
5. headache
238
what type of delivery might regional anaesthesia increase the likelihood of?
instrumental delivery
239
what are 4 indications for general anaesthesia in labour?
1. imminent threat to mother or fetus
2. regional anaesthesia contraindicated
3. maternal preference
4. failed regional techniques
240
what are 4 issues with general anaesthesia in labour?
1. increased risk associated with altered physiology
2. aspiration
3. failed intubation
4. awareness
241
what are 4 advantages to regional anaesthesia compared to general anaesthesia during labour?
1. safer
2. can see baby immediately
3. partner present
4. improved post op analgesia
242
what are 4 disadvantages to regional anaesthesia compared to general anaesthesia during labour?
1. hypotension
2. headache
3. discomfort associated with pressure sensations
4. failure
243
what are 4 obstetric emergencies related to the mother?
1. antepartum haemorrhage
2. postpartum haemorrhage
3. venous thromboembolism
4. preeclampsia
244
what are 3 obstetric emergencies related to the baby?
1. shoulder dystocia
2. cord prolapse
3. fetal distress
245
what is an antepartum haemorrhage?
bleeding from anywhere in the genital tract (uterus, cervix, vagina, vulva) after 24th week of pregnancy
246
what % of pregnancies does antepartum haemorrhage occur in?
3-5%
247
what % of antepartum haemorrhage does not have an identifiable cause?
40%
248
what are 5 identifiable causes of antepartum haemorrhage?
1. low lying placenta/ placenta praevia
2. placenta accreta
3. vasa praevia
4. minor/ major abruption
5. infection
249
what is placenta accreta?
a condition in which the placenta grows too deeply into the uterine wall and remains attached after delivery, leading to major blood loss
250
what is placenta praevia?
a condition in which the placenta partially or totally covers the opening of the cervix which can cause major bleeding during delivery
251
what is vasa praevia?
a conditions in which fetal blood vessels cross near the cervix and are at risk of rupture when the supporting membranes rupture
252
what is placental abruption?
a condition in which the placenta partially or fully seperates from the uterine wall before delivery, causing major blood loss during delivery
253
how do you diagnose a low lying placenta/ placenta praevia?
1. 20 week anomaly scan
2. abnormal lie or painless bleed
3. repeat scan for praevia
4. placenta must be 20mms from the cervical os or C-section needed
254
how do you manage a low lying placenta/ placenta praevia?
1. advise symptoms to watch out for
2. outpatient management
3. may need admission with repeated bleeds
4. anti-D is rhesus negative baby
5. elective caesarean section at 38-39 weeks or before if bleeding doesn't settle
255
how do you manage bleeding during low lying placenta/ placenta praevia?
1. ABCDE- if major bleed two cannulas, IV fluids, crossmatch 6 units, inform senior team and paeds
2. examination- general and abdominal, vaginal, USS
3. fetal CTG monitoring +/- delivery
4. steroids if less than 34 weeks gestation
256
how do you manage placenta accreta?
1. 20 week scan
2. loss of definition between wall of uterus and abnormal vasculature
3. MRI scan
4. elective c-section at 36-37 weeks
5. discussion and consent
6. ensure blood and blood products and a level 2 critical care bed are available
257
if the mother has vasa praevia, is the mother or the fetus in more danger, and what is the mortality?
there is a major fetal risk, mortality is 60%
258
how do you manage placental abruption?
small abruptions can be managed conservatively, large abruptions require resuscitations and delivery
1. make sure blood is available
2. ABCDE
3. monitor fetal heart beat
4. stabilisation of mother
5. delivery if necessary
259
what are 5 complications that can occur after antepartum haemorrhage?
1. premature labour
2. blood transfusion
3. acute tubular necrosis
4. disseminated intravascular coagulation
5. fetal morbidity and mortality
260
what are the categories of postpartum haemorrhage?
1. primary- within 24 hours of delivery with less than 500mls of blood
2. secondary- between 24hrs- 12 weeks after delivery
3. minor- 500-1000mls
4. major- >1000mls
261
what are the 'four T's' causes of postpartum haemorrhage?
1. tissue- ensure placenta is complete
2. tone- ensure uterus contracted
3. trauma- look for tears
4. thrombin- check clotting
262
what are 5 risk factors for postpartum haemorrhage?
1. big baby
2. nulliparity and grand multiparity
2. multiple pregnancy
4. shoulder dystocia
5. operative delivery
263
what are 7 risk factors for maternal sepsis?
1. obesity
2. diabetes
3. immunosuppression
4. anaemia
5. history of pelvic infection
6. prolonged SROM
7. vaginal discharge
264
what are 9 signs and symptoms of maternal sepsis?
1. pyrexia
2. hypothermia
3. tachycardia
4. tachypnoea
5. hypoxia
6. hypotension
7. oliguria
8. impaired consciousness
9. failure to respond to treatment
265
what is the sepsis six?
1. O2 as required to achieve SpO2 over 94%
2. blood cultures
3. IV antibiotics
4. IV fluids
5. bloods for Hb, lactate and glucose
6. hourly urine output
266
what are 5 signs of severe pre-eclampsia?
1. severe headache
2. visual disturbance
3. papilloedema
4. clonus
5. liver tenderness
267
what is the treatment for severe pre-eclampsia?
1. stabilise BP with labetalol and nifedipine
2. check bloods include platelets, renal and liver function
3. magnesium sulphate if hyperreflexic (stops seizures developing)
4. monitor urine output
5. treat coagulation defects
6. fetal wellbeing
7. delivery
268
what is eclampsia?
onset of seizures in a woman with pre-eclampsia (seizures in pregnant woman always eclampsia until proven otherwise)
269
how do you treat eclampsia?
1. IV magnesium sulphate for 24 hours
2. recurrent seizures may require further doses
3. treat hypertension with labetalol and nifedipine and hydralazine
4. stabilise mother then deliver baby
270
what factors make you suspicious of fetal compromise?
prolonged fetal bradycardia and fetal acidosis on the scalp
271
what is cord prolapse?
when the cord presents before the baby in delivery after SROM, this can lead to vasospasm and hypoxia
272
what are 5 risk factors for cord prolapse?
1. premature rupture of membranes
2. polyhydramnios (large volume of amniotic fluid)
3. long umbilical cord
4. fetal malpresentation (EG breech)
5. multiple pregnancy
273
how do you manage cord prolapse?
1. call emergency buzzer
2. infuse fluid into bladder via catheter if at home
3. trendelenburg position with feet higher than head
4. constant fetal monitoring
5. alleviate pressure on cord
6. transfer to theatre and prepare for delivery
274
what is shoulder dystocia?
failure of the anterior shoulders to pass under the symphysis pubis after delivery of the fetal head, there is a high risk for maternal morbidity and fetal mortality and morbidity
275
what are 3 maternal complications after shoulder dystocia
1. postpartum haemorrhage
2. 3rd and 4th degree vaginal tear
3. psychological
276
what are 4 neonatal complications after shoulder dystocia?
1. hypoxia
2. fits
3. cerebral palsy
4. brachial plexus injury
277
what are 5 risk factors for shoulder dystocia?
1. macrosomia (although most cases occur in normally grown babies)
2. maternal diabetes
3. previous episodes
4. disproportion between mother and fetus
5. post-maturity and induction of labour
278
what is the HELPERRR mnemonic for shoulder dystocia
```
H- call for help
E- evaluate for episiotomy
L- legs in mcroberts
P- suprapubic pressure
E- enter pelvis
R- rotational manoeuvres
R- remove posterior arm
R- replace head and deliver by c-section
```
279
what is menopause and how do you diagnose it?
cessation of menstruation, diagnosable after 12 months of amenorrhoea or onset of symptoms if hysterectomy
280
what is perimenopause and what are some of the symptoms?
the period leading up to menopause characterised by irregular periods, hot flushes, mood swings and urogenital atrophy
281
what are some short term symptoms of menopause?
vasomotor symptoms (flushing and sweats), mood change, memory loss, headaches, dry skin, joint pain, lack of energy
282
what are some medium term symptoms of menopause?
1. dyspareunia
2. recurrent UTI
3. post-menopausal bleeding
4. urinary incontinence and prolapse
283
what are some long term impacts of menopause?
1. osteoporosis due to low oestrogen
2. cardiovascular disease due to adverse changes in lipids
3. dementia has increased prevalence with early menopause
284
how do you manage menopause?
1. holistic approach with lifestyle approach and modification of risk factors
2. inform about options such as HRT, vaginal oestrogen, clonidine or CBT
285
what are 3 risks and 3 benefits of HRT during menopause?
risks-
1. breast cancer (risk is most increased with oestrogen and progesterone, with little to no increase with just oestrogen)
2. VTE
3. cardiovascular disease
benefits-
1. relief of symptoms of menopause
2. bone mineral density protection
3. might prevent long term morbidity
286
how do you manage HRT with regards to breast cancer?
1. discontinue HRT in diagnosed women
2. do not routinely offer HRT to women with menopausal symptoms and a history of breast cancer
3. can be offered in exceptional cases with severe menopausal symptoms after discussion
287
which type of HRT increases the risk of venous thromboembolism- oral or transdermal?
oral
288
what ages do you have start women on HRT by to ensure there is no increased risk of cardiovascular disease?
less than 60 years old
289
which type of HRT increases the risk of stroke- oral or transdermal?
oral (only slightly)
290
which regimen of HRT is recommended for perimenopausal women?
sequential/ cyclical- progesterone added to oestrogen 12-14 days every 4 weeks
291
which regimen of HRT is recommended for menopausal women?
continuous combined HRT
292
which regimen of HRT is recommended for women who have had a hysterectomy or have a MIRENA coil in situ?
oral or transdermal estradiol
293
what are 5 groups of people who should have transdermal rather than oral HRT?
1. gastric upset EG crohn's disease
2. need for steady absorption EG epilepsy
3. increased risk of VTE
4. medical conditions like hypertension
5. patient choice
294
what is premature ovarian insufficiency?
menopause, either natural or iatrogenic, primary or secondary that comes on before the age of 40
295
what are 4 natural causes of premature ovarian insufficiency?
1. chromosome abnormalities
2. autoimmune disease
3. enzyme deficiencies
4. inhibin B mutations
296
what are 3 iatrogenic causes of premature ovarian insufficiency?
1. surgery
2. chemotherapy
3. radiotherapy
297
how do you diagnose premature ovarian insufficiency?
FSH> 25 Iu/L in 2 samples greater than 4 weeks apart with 4 months of amenorrhoea
298
how do you manage premature ovarian insufficiency?
1. hormone replacement therapy at-least until average age of menopause (51)
2. psychological support
299
what are 4 non-hormonal alternative to HRT?
1. alpha adrenergic receptor agonist- clonidine
2. SSRI- fluoxetine, citalopram, sertraline
3. SNRI/SSRI- venlafaxine
4. anti-epileptic- gabapentin
300
what are 3 contraindications for HRT?
1. undiagnosed abnormal PV bleeding
2. breast lump
3. acute liver disease
301
what are 4 cautions for HRT?
1. fibroids, uncontrolled BP, migraine, epilepsy
302
what are 8 causes of endometrial cancer?
1. obesity
2. diabetes
3. nulliparity
4. late menopause
5. ovarian tumours
6. HRT
7. pelvic irradiation
8. tamoxifen
303
what investigations should be done if a patient presents with postmenopausal bleeding?
1. transvaginal ultrasound
2. endometrial biopsy
3. hysteroscopy
304
what is the most common type of endometrial cancer?
adenocarcinoma of columnar endometrial gland cells
305
what is a type of endometrial cancer with a worse prognosis than adenocarcinoma?
adenosquamous
306
what hormone ratio is a risk factors for endometrial cancer?
a high oestrogen: progesterone ratio
307
what medication is protective against endometrial cancer?
the combined oral contraceptive pill
308
how does oestrogen cause endometrial cancer?
oestrogen causes cystic hyperplasia which can lead to dysplasia
309
what is the treatment for endometrial cancer if the uterus is preserved?
progestogens with 6 monthly biopsy
310
what is the treatment for endometrial cancer if the uterus is not preserved?
1. hysterectomy and adjuvant radiotherapy. 2. salpingo-oopherectomy if necessary.
3. progesterone therapy can be helpful
311
what is a common clinical presentation of endometrial cancer?
1. post-menopausal bleeding
2. pre-menstrual women have irregular or intermenstrual bleeding
3. can coexist with atrophic vaginitis
312
what investigations should be done for someone with endometrial cancer?
1. FBC, renal function, ECG glucose
2. transvaginal ultrasound
3. endometrial biopsy
4. hysteroscopy
313
what are the 4 stages of endometrial cancer?
1- body of the uterus
2- body of the uterus and the cervix
3- beyond the uterus, but not beyond the pelvis
4- beyond the pelvis, EG bowel or bladder
314
what are 7 risk factors of cervical carcinoma?
1. early age of intercourse (<16)
2. multiple sexual partners
3. STDs
4. cigarette smoking
5. other genital tract neoplasia
6. OCP use
7. multiparity
315
what is the main causative factor for cervical carcinoma?
presence of HPV
316
what % of the population will have HPV at some point of their life?
75%
317
what are the two main oncogenic types of HPV?
16 and 18
318
what is the most common histological type of cervical cancer?
squamous
319
what is the stage 1 prognosis of cervical cancer?
>90% 5 year survival
320
how do you diagnose and stage cervical cancer?
1. smear test can come back irregular
2. cervical biopsy
3. staging with vaginal and rectal examination and CT/MRI
321
how do you treat cervical cancer?
1. early stage cancers can be cured by excision of the cancerous region via cone excision, laser or cryotherapy
2. extrafascial hysterectomy
3. radical hysterectomy
4. lymphadenectomy
5. cisplatin chemotherapy
6. radiotherapy
322
what are the 6 (two 'b' denominations) stages of cervical cancer?
```
1- tumour confined to cervix
2- tumour in cervix and upper 2/3 of vagina
3- tumour in lower 1/3 of vagina
3b- pelvic wall
4- bladder or rectum
4b- distant organs
```
323
what are 2 causes of vulval cancer?
1. VIN HPV
| 2. lichen sclerosis
324
what is the most common histological type of vulval cancer?
squamous
325
what is the clinical presentation of vulval cancer?
1. vulval itching
2. vulval soreness
3. persistent lump
4. bleeding
5. dysuria
6. past history of VIN HPV or lichen sclerosis
326
what are the 4 stages of vulval cancer?
1- <2cm
2- >2cm
3- adjacent organs or unilateral nodes
4- bilateral nodes or distant mets
327
how do you treat vulval cancer?
1. conservative or radical surgery
2. radiotherapy
3. chemotherapy
328
what is the clinical presentation of ovarian cancer?
1. bloating/ IBS symptoms
2. abdominal pain
3. change in bowel habit
4. urinary frequency
5. bowel obstruction
6. symptomless
329
what are 2 causes of ovarian cancer?
1. ovulation
| 2. gene mutation (BRCA 1/2)
330
what % of ovarian cancer patients present with advanced disease, and what is the prognosis?
50%, and a 40% 5 year survival rate
331
what is the most common histological type of ovarian cancer?
epithelial
332
what investigations should be done for ovarian cancer?
1. CA125 testing
2. ultrasound
3. symptoms and age index
4. referral based on risk of malignancy index
333
how do you treat ovarian cancer?
1. surgery
| 2. chemotherapy
334
what are 2 less common gynaecological cancers?
1. vaginal
| 2. fallopian tube
335
what is the puerperium?
a period of time from the delivery of the placenta to six weeks follow the birth where a woman's organs return to their pre-pregnancy state
336
what are 3 important features of puerperium?
1. return to pre-pregnant state
2. initiation or suppression of lactation
3. transition to parenthood
337
what are 2 endocrine changes in the puerperal period?
1. profound decrease in placental hormones- lactogen, hcg, oestrogen and progesterone
2. increase in prolactin
338
what happens to the uterus and the genital tract during the puerperal peroid?
involution (shrinkage) back to original size, with the decidua (thickened uterus lining during pregnancy) being shed as lochia rubra, serosa and alba
339
what is shed in the locha rubra, and what time period does it occur over?
day 1-4 post-birth-
1. blood
2. cervical discharge
3. decidua
4. fetal membrane
340
what is shed in the lochia serosa, and what time period does it occur over?
day 4-10 post-birth-
1. cervical mucus
2. exudate
3. fetal membrane
4. while blood cells
341
what is shed in the locha alba, and what time period does it occur over?
day 10-28 post-birth-
1. cholesterol
2. epithelial cells
3. fat
4. micro-organisms
342
what two hormones are responsible for lactogenesis?
1. prolactin- milk production (anterior pituitary)
| 2. oxytocin- milk ejection reflex (posterior pituitary)
343
what are 8 minor postnatal problems?
1. infection
2. mild post-partum haemorrhage
3. fatigue
4. anaemia
5. backache
6. breast engorgement/ mastitis
7. urinary stress incontinence
8. haemorrhoids
344
what are 9 major postnatal problems?
1. sepsis
2. severe post-partum haemorrhage
3. pre-eclampsia/ eclampsia
4. thrombosis
5. uterine prolapse
6. incontinence (urinary or fecal)
7. post dural puncture headache
8. breast abscess
9. depression/ psychosis
345
what are 6 signs and symptoms postnatally that women should report to health professionals?
1. sudden and profuse blood loss
2. fever
3. abdominal pain
4. offensive vaginal loss
5. headaches accompanied by visual disturbance or nausea or vomiting
6. unilateral calf pain, redness or swelling
7. shortness of breath/ chest pain
346
what early warning score can be used to assess women postnatally?
modified early obstetric warning score
347
define sepsis
infection plus systemic manifestation of infection
348
define severe sepsis?
sepsis plus sepsis-induced organ dysfunction and tissue hypoperfusion
349
define septic shock?
persistent hypoperfusion of organs despite adequate fluid replacement therapy
350
what are 5 risk factors for post-natal sepsis?
1. obesity
2. diabetes
3. anaemia
4. amniocentesis
5. prolonged spontaneous rupture of membranes
351
what are 5 likely causes of post-natal sepsis?
1. endometriosis
2. skin and soft tissue infection
3. UTI
4. mastitis
5. epidural infection
352
how do you differentiate minor and major post-partum haemorrhage?
minor- <1500mls blood loss and no clinical signs of shock
| major- >1500mls blood loss and clinical signs of shock or continuing bleeding
353
what is secondary post-partum haemorrhage?
abnormal or excessive bleeding from birth canal between 24hrs-12 weeks postnatally
354
what are 4 causes of post-partum haemorrhage?
1. endometriosis
2. retained products of contraception
3. pseudo-aneurysms
4. arteriovenous malformations
355
what 4 investigations should be done with post-partum haemorrhage?
1. assessment of blood loss
2. haemodynamic status
3. bacteriological testing (HVS and endocervical swab)
4. pelvic ultrasound
356
what % of eclamptic seizures occur after the birth?
50%
357
when is there maximum risk of venous thomboembolism relating to pregnancy?
post-partum, five fold higher than antepartum, 22 fold increase in first 3 weeks and persists relatively up to 6 weeks post partum
358
what are 4 high risk factors for venous thromboembolism in the puerperal period?
1. previous VTE
2. antenatal LMWH requirements
3. high risk thrombophilia
4. low risk thrombophilia and FHx
359
what are four lower risk factors for venous thromboembolism in the puerperal period?
1. age over 35 years
2. obesity
3. smoker
4. elective c-section
360
what is the cause of a post-dural puncture headache?
leakage of cerebrospinal fluid and reduce pressure in fluid around the brain
361
what is the clinical presentation of post-dural puncture headache?
1. headache worse on sitting or standing and starts 1-7 days after spinal or epidural
2. neck stiffness
3. photophobia
362
how do you treat post-dural puncture headache
1. lying flat
2. simple analgesia
3. epidural blood patch
4. fluids and caffeine
363
what is post-natal urinary retention?
abrupt onset of achine or acheless inability to completely micturate, requiring catheterisation, over 12h after birth, or inability to spontaneously micturate within 6h of vaginal delivery
364
what are 5 risk factors for post-natal urinary retention?
1. epidural analgesia
2. prolonged 2nd stage of labour
3. forceps or ventouse deliver
4. extensive perineal laceration
5. poor labour bladder care
365
how do you treat and minimise risk for post-natal urinary retention?
1. maintain bladder function
2. minimise risk of urethra/ bladder damage
3. appropriate management such as catheterisation
366
what is 'the baby blues'
feeling emotional or tearful around 3-10 days after birth
367
what are three red flag signs of mental health disorders in the puerperal period?
1. recent significant change in mental state
2. new thoughts of violence or self harm
3. new and persistent expression of incompetency as mother or estrangement from infant
368
what are 5 symptoms of post-natal depression?
1. depressed
2. irritable
3. tired
4. appetite changes
5. negative thoughts
369
what are 5 symptoms of post-partum psychosis?
1. depression
2. mania
3. psychosis
4. rapid cycling mood
5. confusion
370
what are 5 symptoms of post-natal ptsd and 4 consequences of this?
1. anger, low mood, flashbacks, suicidal ideation, isolation
2. delay or avoid future pregnancy, request c-section to avoid vaginal delivery, avoidance of physical or intimate relationships, impact on breastfeeding
371
define maternal death?
the death of a woman while pregnant or within 42 days of termination of a pregnancy, irrespective of duration and site of pregnancy, and from any cause related to or aggravated by the pregnancy
372
what are the 3 most common causes of maternal mortality?
1. cardiac disease
2. thromboembolism
3. neurological
373
what are the three main methods of fetal heart rate monitoring?
1. intermittent auscultation
2. pinard stethoscope
3. hand-held doppler device (cardiotocography)
374
what are some advantages and disadvantages of intermittent auscultation?
adv- inexpensive, non-invasive, can be done at home
disadv- variability and decelerations not detected, cannot monitor long tern, affected my movement and maternal HR
375
what are some advantages and disadvantages of cardiotocography?
adv- provides info about FHR and contractions, long term monitoring possible, variability can be determined
disadv- no morphological assessment, no true beat to beat data, exposure to ultrasound insonation, no improvement in perinatal outcome in low risk pregnancies
376
what is the mnemonic DR C Bravadao relating to cardiotocography?
```
Dr- define risk
C- contractions
Bra- baseline rate
V- variability
A- accelerations
D- decelerations
O- overall assessment
```
377
what is a direct method of measuring a fetal heart rate? and what are some advantages and disadvantages?
scalp ecg
adv- gold standard for direct, true beat to beat information
disadv- invasive, only monitors during labour, membranes must be absent and atleast 2cm dilatation, associated with scalp injury and perinatal infection
378
what is an indirect method of measuring a fetal heart rate? and what are some advantages and disadvantages?
abdominal fetal ECG
adv- non-invasive, true beat to beat FHR and morphological analysis possible
disadv- research tool, signal is not guaranteed antenatally
379
what is female genital mutilation?
any procedures involving partial or total removal of female external genitalia or injury to female organs with no medical reason. involves damaging and removing normal, healthy genital tissue.
380
what is type 1 FGM?
clitoridectomy- partial or total removal of the clitoris
381
what is type 2 FGM?
excision- partial or total removal of the clitoris and labia minora, with or without labia majora excision
382
what is type 3 FGM?
infibulation- narrowing of vaginal orifice with creating of covering seal by cutting and appositioning the labia minora and or majora, with or without clitoral excision
383
what is type 4 FGM?
all other harmful procedures involving pricking, piercing, incising, scraping and cauterising
384
what are some societal reasons that make people think they need to participate in FGM?
1. bringing status and respect
2. protects virginity
3. upholds family honour
4. cleansing and purification
5. perceived religious requirement
385
which countries have the highest FGM prevalence?
most mid-african countries, 89% in mali, 97% in guinea, 90% in sierra leone, 88% in sudan
386
how many women roughly are there in the uk living with FGM?
103,000
387
is FGM legal?
FGM and any measures to assist FGM are illegal in the UK and can result in a fine and/or imprisonment for up to 14 years
388
what are 8 gynaecological complications of FGM?
1. dyspareunia
2. sexual dysfunction and anorgasmia
3. chronic pain
4. keloid scar formation
5. dysmenorrhoea with haematocolpos (blood filled dilated vagina due to obstruction)
6. urinary outflow obstruction/ recurrent UTI
7. PTSD
8. difficulty in conceiving
389
what are 8 obstetric complications of FGM?
1. fear associated with childbirth
2. increased chance of c-section
3. increased likelihood of post-partum haemorrhage
4. increased likelihood of episiotomy
5. increased likelihood of severe vaginal lacerations
6. extended hospital stay
7. difficulty performing vaginal examinations during labour
8. difficulty catheterising the bladder
390
what is de-infibulation?
reversal of type 3 FGM
391
what are 4 common complaints in paediatric gynaecology?
1. amenorrhoea
2. precocious puberty
3. delayed puberty
4. menstrual disorders
392
what age is normal for menarche?
12-13 (95% 11-14.5)
393
what counts as amenorrhoea in the paediatric population?
no menses by age 16 in the presence of secondary sexual characteristics, or in the absence of secondary sexual characteristics by 13, or menses more than 35 days apart
394
what is secondary amenorrhoea in the paediatric population and what are some common causes?
cessation of menses after the onset of menses, often induced by weight loss, excessive exercise or PCOS
395
what is precocious puberty in the paediatric population?
appearance of physical and hormonal signs of pubertal development before the age of 8 in girls and 9 in boys with secretion of high-amplitude pulses of GnRH by the hypothalamus
396
what are 3 causes of central precocious puberty and is gonadotropin dependent or independent?
gonadotropin dependent
1. trauma
2. tumours
3. hydrocephalus
397
what are 3 causes of precocious pseudo-puberty and is it gonadotropin dependent or independent?
gonadotropin independent
1. tumours of the adrenal glands
2. ovarian tumours
3. McCune Albright syndrome
398
what is delayed puberty in the paediatric population?
lack of sexual development and pubertal onset in the normal time frame
399
what investigations should be done in delayed puberty?
1. FBC, CRP or ESR to exclude anaemia or hidden inflammatory disease
2. U+E and LFT's to exclude renal and liver disease
3. bone profile- low for age alkaline phosphatase confirms slow growth
4. coeliac antibodies for cryptic coeliac disease
5. TSH and free T4 to exclude hypothyroidism
400
what are 4 less common menstrual disorders in the paediatric population?
1. irregular periods
2. heavy periods
3. dysmenorrhoea
4. pre-menstrual tension
401
what are 5 risk factors for ectopic pregnancy?
1. increased maternal age
2. lower socioeconomic class
3. previous ectopic
4. smoking
5. assisted conception
402
what are 4 locations that ectopic pregnancies can form?
1. fallopian tube
2. cervix
3. cornu
4. ovary
403
what is the clinical presentation of an ectopic pregnancy?
1. abdominal pain
2. vaginal bleeding
2. amenorrhoea
404
what investigations and examinations should be performed in an ectopic pregnancy?
1. pelvic examination
2. pregnancy test
3. ultrasound
4. serum hCG if there is an empty uterus
5. cross match blood
405
how do you treat ectopic pregnancy?
1. low risk- expectant management
2. haemodynamically stable- surgery, methotrexate and RhD
3. haemodynamically unstable- fluid resuscitation, surgery, RhD
406
what surgery can be performed to treat ectopic pregnancy?
1. salpingectomy
| 2. salpingostomy (removal of ectopic from tube)
407
what is a spontaneous miscarriage?
where a fetus dies or is delivered dead before 24 completed weeks of pregnancy
408
what is a threatened miscarriage and what % miscarry?
vaginal bleeding is present but foetus is still alive, 25% miscarry
409
what is inevitable miscarriage?
vaginal bleeding is present and cervical os is open, despite foetus being alive
410
what is an incomplete miscarriage?
where some foetal parts are passed and the cervical os is open
411
what is complete miscarriage?
bleeding has diminished, uterus is not enlarged and os is closed
412
what is septic miscarriage?
uterus contents are infected causing endometritis- presents with abdo pain and peritonism
413
what is a missed miscarriage?
where the foetus has not developed but is not noticed until bleeding
414
what accounts for 60% of miscarriages?
isolated non-recurring chromosomal abnormalities
415
how do you diagnose a micarriage?
1. serial beta hCG titers
2. transvaginal ultrasound
3. transabdominal ultrasound
4. serum progesterone
416
how, in general, do you manage a miscarriage?
1. rhesus blood group, if negative give RhD
2. venous access and monitoring of vital signs and fluid balance with heavy bleeding
3. monitor urine output if hypotensive
4. analgesia
417
how do you manage a threatened miscarriage?
1. conservative pain management
| 2. no specific treatment, reassurance and hope for good outcome
418
how do you manage an inevitable/incomplete/missed miscarriage?
1. surgical evacuation of early pregnancy tissue from the vagina and cervix (vacuum aspiration)
2. natural evacuation
3. analgesia
4. misoprostol (a prostaglandin analogue)
5. IM ergometrine can reduce bleeding
419
how do you manage a complete miscarriage?
1. analgesia
| 2. counselling
420
what is recurrent miscarriage?
>3 miscarriages occurring in succession
421
what % of men aged 40-70 have erectile dysfunction?
52%
422
what are 5 organic risk factors for male sexual dysfunction?
1. diabetes mellitus
2. smoking
3. surgery
4. trauma
5. atherosclerosis
423
what are 5 neurological risk factors for male sexual dysfunction?
1. parkinson's disease
2. multiple sclerosis
3. tumours
4. stroke
5. spinal cord injury
424
what are 4 hormonal risk factors for male sexual dysfunction?
1. hypogonadism
2. hyperprolactinaemia
3. thyroid disease
4. cushing's
425
what are 5 drug related risk factors for male sexual dysfunction?
1. antihypertensives
2. beta blockers
3. diuretics
4. anti-depressants
5. anti-psychotics
426
what is the clinical presentation of psychogenic male sexual dysfunction?
1. sudden onset
2. early collapse of erection
3. premature ejaculation
4. major life events
427
what is the standard presentation of male sexual dysfunction?
1. gradual onset
2. normal ejaculation
3. normal libido
4. poor lifestyle
428
what should a physical exam for male sexual dysfunction include?
1. genitals
2. CVD assessment
3. digital rectal examination in men over the age of 50
4. neurological or endocrine examination or psych evaluation if necessary
429
what investigations should be ordered for male sexual dysfunction?
1. glucose
2. lipid profile
3. morning testosterone
4. FSH, LH, prolactin
5. vascular studies
430
how do you treat testicular failure?
1. holistic management
| 2. testosterone
431
how do you treat erectile dysfunction?
1. psychological support
2. treat lifestyle factors
3. sildenafil
4. vacuum devices
5. intracavernosal injection
6. 3rd line is penile prosthetic
432
what are 3 side effects of sildenafil?
1. headache
2. facial flushing
3. dyspepsia
433
what is premature ejaculation?
ejaculation within 1 minute of vaginal penetration or significant reduction in latency time that provides distress
434
what are 6 risk factors for premature ejaculation?
1. obesity
2. genetics
3. poor health
4. emotional problems
5. history of traumatic sex
6. prostatitis
435
what should you ask about when taking a history of someone with premature ejaculation?
1. length of latency time
2. context
3. lifelong/ acquired
4. impact on sexual function
5. medication
436
how do you treat premature ejaculation?
1. more frequent masturbation
2. woman on top
3. condom
4. squeeze technique
5. stop and go technique
6. SSRI
7. dapoxetine
437
what is peyronie's disease?
the formation of fibrous plaques in the corpus cavernosa that causes an angled erection and causes erectile dysfunction and painful erections
438
what are three conditions associated with peyronie's disease?
1. diabetes mellitus
2. dupuytrens contractures
3. lipid abnormalities
439
how do you treat peyronie's disease?
1. measure penis
2. vacuum devices
3. oral para-aminobenzoate
4. surgery after stable for 2 months with extracorporeal shock wave therapy
440
what are 5 causes of menorrhagia?
1. fibroids
2. endometriosis
3. adenomyosis
4. polyps
5. PCOS
441
what are 5 causes of amenorrhoea?
1. hypothalamic hypogonadism
2. PCOS
3. being overweight
4. excessive exercise/ weight loss
5. contraceptive pill
442
what are 5 causes of dysmenorrhoea?
1. endometriosis
2. fibroids
3. adenomyosis
4. polyps
5. PCOS
(a lot of things that cause menorrhagia also cause dysmenorrhoea)
443
what are 6 risk factors for pelvic inflammatory disease?
1. low socioeconomic status
2. frequent sex
3. no barrier contraception
4. younger women
5. intrauterine devices
444
what are 2 common bacteria that cause pelvic inflammatory disease?
1. chlamydia
| 2. gonococcus
445
what is shown on examination in severe cases of pelvic inflammatory disease?
1. tachycardia
2. high fever
3. lower abdo peritonism
4. bilateral adnexal tenderness
5. cervical excitation
446
what are 3 differential diagnoses for pelvic inflammatory disease?
1. appendicits
2. ovarian cyst accident
3. ectopic pregnancy
447
what investigations and examinations should be done for pelvic inflammatory disease?
1. endocervical swabs
2. WBC, CRP
3. pelvic ultrasound
4. laparoscopy with fimbral biopsy
448
how do you treat pelvic inflammatory disease?
1. analgesia
2. IM ceftriaxone, then doxycycline and metronidazole
3. drainage of pelvic abscess
449
what are 4 complications of pelvic inflammatory disease?
1. abscesses
2. tubal obstruction
3. subfertility
4. chronic pelvic pain
450
what is chronic pelvic inflammatory disease?
persisting pelvic infection with dense adhesions and obstructed fallopian tubes
451
what is the clinical presentation of chronic pelvic inflammatory disease?
1. chronic pelvic pain
2. dysmenorrhoea
3. deep dyspareunia
4. heavy/irregular menstruation
5. chronic vaginal discharge
6. subfertility
452
what are the 3 things categorised as ovarian cyst accidents?
1. cyst haemorrhage
2. cyst rupture
3. cyst torsion
453
how do you manage an ovarian cyst accident?
1. laparoscopy or laparotomy (or other relevant surgery)
2. resuscitation and haemodynamic support
3. broad-spectrum antibiotics for peritonitis
454
how do you manage a ruptured ectopic pregnancy?
1. laparoscopy or laparotomy
2. resuscitation and haemodynamic support
3. broad spectrum antibiotics for peritonitis
455
what are three risk factors for gynaecandidiasis?
1. pregnancy
2. diabetes
3. use of antibiotics
456
what is the clinical presentation of gynae candidiasis?
1. discharge
2. vulval irritation
3. itching
4. superficial dyspareunia
5. dysuria
457
how do you diagnose gynae candidiasis?
culture
458
how do you treat gynae candidiasis?
imidazoles (clotrimazole) or oral fluconazole
459
what is the bacterial vaginosis?
normal lactobacilli that are overgrown by anaerobes and gardnerella
460
what is the clinical presentation of bacterial vaginosis?
1. grey white discharge
| 2. fishy odour
461
how do you diagnose bacterial vaginosis?
1. raised pH
| 2. clue cells on microscopy
462
how do you treat bacterial vaginosis?
metronidazole or clindamycin cream
463
what is the a likely concerning explanation for infection and discharge in children?
foreign body, consider abuse
464
what is the clinical presentation of chlamydia?
usually asymp but can occur with urethritis and vaginal discharge and complicate to pelvic infection
465
what MSK condition can chlamydia cause?
reiter's syndrome/ reactive arthritis
466
how do you diagnose chlamydia?
nucleic acid amplification test
467
how do you treat chlamydia?
azithromycin or doxicycline
468
what is the clinical presentation of gonorrhoea?
often asymp but can occur with vaginal discharge, urethritis, cervicitis and bartholinitis (glands on either side of the vagina). may also present with bacteraemia and monoseptic arthritis
469
how do you diagnose gonorrhoea?
culture and endocervical swabs
470
how do you treat gonorrhoea?
usually IM ceftriaxone
471
what is the cause of genital warts?
HPV
472
how do you treat genital warts?
topical podophyllin or imiquimod cream, cryotherapy for resistant warts
473
what is the cause of genital herpes?
herpes simplex virus 2
474
what is the clinical presentation of genital herpes?
multiple small painful vesicles and ulcers around introitus (opening to vaginal canal), lymphadenopathy, dysuria and systemic symptoms common. attacks after dormancy are preceded by localised tingling
475
where does the genital herpes virus lie dormant usually?
dorsal root ganglia
476
how do you diagnose genital herpes?
examination and viral swabs
477
how do you treat genital herpes?
acyclovir
478
what bacteria causes syphilis?
treponema pallidum
479
what is the clinical presentation of primary syphilis?
solitary painless vulval ulcer
480
what is the clinical presentation of secondary syphilis?
weeks following primary with rash, flu symptoms and warty genital growths
481
what is the clinical presentation of tertiary syphilis following a latent period?
dementia, tabes dorsalis- weakness, ataxia, loss of co-ordination, ataxia
482
how do you treat syphilis?
parenteral penicillin
483
what is the clinical presentation of trichomoniasis?
offensive grey/green discharge, vulval irritation and superficial dyspareunia
484
how do you diagnose trichomoniasis?
wet film microscopy
485
how do you treat trichomoniasis?
metronidazole
486
what are 4 causes of endometritis?
pregnancy or instrumentation of the uterus, c-section or miscarriage can make it more common
487
what organisms can cause endometritis?
chlamydia and gonococcus
488
how do you diagnose endometritis?
swabs and full blood count
489
how do you treat endometritis?
broad spectrum antibiotics
490
describe normal physiological vaginal discharge
increases around ovulation, pregnancy and OC pill usage and is usually non-offensive
491
what is bloody offensive discharge indicative of?
cervical carcinoma
492
what is watery discharge in post-menopausal women indicative of?
rare fallopian tube carcinoma
493
what is a hydatidiform mole?
a tumour consisting of chorionic villi that have swollen and degenerated
494
what hormone is secreted by a hydatidiform mole?
human chorionic gonadotrophin (HCG)
495
what is the clinical presentation of a hydatidiform mole?
exaggerated pregnancy symptoms- morning sickness, fatigue, headaches, may be heavy bleeding
496
how do you diagnose a hydatidiform mole?
a strongly positive pregnancy test, and a snowstorm effect on ultrasound in a 'large for date' uterus
497
what are 3 risk factors for hydatidiform moles?
1. asian heritage
2. extremes of child-bearing age
3. previous mole
498
what condition can HCG cause by mimicking a different hormone in a molar pregnancy?
hyperthyroidism by mimicking TSH, watch out for thyrotoxic storm during evacuation
499
how do you treat a hydatidiform mole?
1. suction removal of molar tissue
2. give anti-D is rhesus-ve
3. pregnancy avoided for a year with monitored levels of HCG
4. oral contraceptives can be used if hcg levels drop rapidly after 6 months, if not, the mole was invasive or has given rise to choriocarcinoma
500
where might an invasive hydatidiform mole metastasise?
lung, vagina, brain, skin, liver
501
how do you treat an invasive hydatidiform mole?
chemotherapy
502
what 2 types of cancer can a hydatidiform mole become and what are some characteristics of each?
1. choriocarcinoma- post pregnancy pv bleeding, malaise, mets, responsive to methotrexate
2. placental site trophoblastic tumour- slower growing, later presentation
503
what is the criteria for a baby to be 'small for gestational age'?
the baby must be < the 10th centile for their gestational age of weight
504
what are 5 maternal risk factors that can lead to a baby being small for gestational age?
1. multiple pregnancy
2. malformation
3. infection
4. smoking
5. diabetes
505
what is asymmetrical growth restriction and what is the cause?
where placental insufficiency was the cause and the head circumference is relatively spared
506
how do you measure the growth of a baby in utero?
measure the fundal height progress from the symphysis pubis
507
what are 2 indications of placental insufficiency that can lead to a small for gestational age baby?
1. oligohydramnios
| 2. poor fetal movements
508
how should you monitor growth in utero in a baby that is suspected to be small for gestational age?
serial ultrasounds of head and abdominal circumference
509
how can you examine fetal blood flow in a baby suspected of being small for gestational age?
umbilical cord doppler blood flow
510
what are growth restricted babies more susceptible to in labour?
hypoxia
511
what are 4 things that growth restricted babies are more susceptible to after being born?
1. jaundice
2. hypoglycaemia
3. trouble with temperature regulation
4. infection
512
what growth markers can be used to distinguish premature babies from growth restricted babies?
1. breast bud tissue development 34 wks
| 2. ear cartilage development at 35-39 wks
513
what are 4 common problems for growth restricted babies in adult life?
1. hypertension
2. type 2 diabetes
3. coronary arteries
4. autoimmune thyroid disease
514
what is the criteria for a baby to be 'large for gestational age' ?
baby is above the 90th centile in weight for gestation
515
what are 4 causes of babies being large for gestational age?
1. constitutionally large
2. maternal diabetes
3. hyperinsulinism
4. beckwith-wiedemann syndrome
516
what large for gestational age babies more susceptible to during labour?
shoulder dystocia
517
what are 4 things that large for gestational age babies are more susceptible to after birth?
1. immaturity of suckling and swallowing
2. hypoglycaemia
3. hypocalcaemia
4. left colon syndrome (temporary bowel obstruction)
