PASSMED Flashcards
MOA of HRT
has oestrogen combined with a progestrogen in women with uterus
SEs fo HRT
nausea
breast tenderness
fluid retention
potential complications of HRT
1) increased risk of breast cancer
- increased by the addition of a progestogen
2) increased risk of endometrial cancer
- oestrogen by itself should not be given as HRT to women with a womb
3) increased risk of VTE
- increased by the addition of a progestogen
- transdermal HRT does not appear to increase the risk of VTE
4) increased risk of stroke
5) increased risk of IHD if taken more than 10 years after menopause
when to suspect rubella
- ‘pink or light red’ rash, small, red papules on her son’s soft palate
- resolution of the rash after around 3 days then a diagnosis of rubella may be suspected - especially if the child has not had the MMR (measles, mumps and rubella) vaccination.
what is vasa praevia
complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding.
what is the classic triad of vasa praevia
1) rupture of membranes
2) painless vaginal bleeding
3) fetal bradycardia
classification of FGM
Type 1 - Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Type 2 - Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Type 3 - Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).
Type 4 - All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.
Mx for large fibroids
myomectomy
features of uterine fibroids
- may be asymptomatic
- menorrhagia
- -> may result in iron-deficiency anaemia
- lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility
rare features:
polycythaemia secondary to autonomous production of erythropoietin
Diagnosis of fibroids
transvaginal US
bleeding in 1st trimester
spontaneous abortion
ectopic pregnancy
hydatidiform mole
bleeding in 2nd trimester
Spontaneous abortion
Hydatidiform mole
Placental abruption
bleeding in 2rd trimester
- Bloody show
- Placental abruption
- Placenta praevia
- Vasa praevia
what is hydatidiform mole
Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high
what is normal dose of folic acid
400mvg until the 12th week of pregnancy
what is high dose of folic acid and when will you give it
5mg before conception until the 12 th week
- partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
- the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
- the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
bleeding and <6 weeks gestation Mx
- to return if bleeding continues or pain develops
- to repeat a urine pregnancy test after 7–10 days and to return if it is positive
- a negative pregnancy test means that the pregnancy has miscarried
bleeding and >6 weeks gestation
EPAU
RFs for cord prolapse
prematurity multiparity polyhydramnios twin pregnancy cephalopelvic disproportion abnormal presentations e.g. Breech, transverse lie placenta praevia long umbilical cord high fetal station
major cause for cord prolapse and diagnosis
ARM
fetal HR abormal
cord is palpable vaginally
cord is visible beyond the level of the introitus.
Mx for cord prolapse
presenting part of the fetus may be pushed back into the uterus to avoid compression
tocolytics
clinical findings of chorioamnioitis
foul smelling discharge
uterine tenderness
fever
tachycardia
neutrophilia
drugs that should be avoided when breastfeeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
What are women with PCOS at particular risk of when undergoing IVF?
ovarian hyperstimulation syndrome
if woman has intrahepatic cholestasis when can IOL take place
37-38 weeks gestation
causes if an increased nuchal translucency
Down’s syndrome
congenital heart defects
abdominal wall defects
causes of hyperechogenic bowel
cystic fibrosis
Down’s syndrome
cytomegalovirus infection
presentation of fibroid degeneration
low-grade
fever
pain
vomiting.
what are false labour features
contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent.
occurs in the last 4 weeks of pregnancy
what manouevre do you do for shoulder dystocia
McRobert’s
entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen. This rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.
define sensitisation
fetal red blood cells (RhD-positive) enter the maternal circulation, where the mother is RhD-negative. The fetomaternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse fetal red blood cells.
potentially sensitising events in pregnancy
- Ectopic pregnancy
- Evacuation of retained products of conception and molar pregnancy
- Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
- Vaginal bleeding > 12 weeks
- Chorionic villus sampling and amniocentesis
- Antepartum haemorrhage
- Abdominal trauma
- External cephalic version
- Intra-uterine death
- Post-delivery (if baby is RhD-positive)
RFs for vaginal candidiasis
diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV
features and Ix for vaginal candidiasis
‘cottage cheese’, non-offensive discharge
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen
Mx for vaginal candidiasis
local treatments include clotrimazole pessary (e.g. clotrimazole 500mg PV stat)
oral treatments include itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat
if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated
recurrent vaginal candidiasis
BASHH define recurrent vaginal candidiasis as 4 or more episodes per year
compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus
consider the use of an induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
chocolate cysts
endometrial cyst
what is HCG and its main role
hormone first produced by the embryo and later by the placental trophoblast.
main role is to prevent the disintegration of the corpus luteum
Rokitansky protuberance means
dermoid cyst
what is fibronectin
is produced by the gestational sac and its sort of indicates premature labour
features of primary dysmennorhoea
- pain typically starts just before or within a few hours of the period starting
- suprapubic cramping pains which may radiate to the back or down the thigh
Mx of primary dysmennorhoea
NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
combined oral contraceptive pills are used second line
features of secondary dysmennorhoea
In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period. Causes include:
- endometriosis
- adenomyosis
- pelvic inflammatory disease
- intrauterine devices*
- fibroids
what is immune thrombocyopenia
autoimmune condition
can pass to the child
complications of twin pregnancy
preterm labour and birth - c section
placental problems - slows fetal growth esp late 3rd trimester
twin-twin trasfusion - one gets more blood than the other
preeclampsia
diabetes
risk of cerebral palsy 4x
what is conscientious objection in health care
A person is engaging in conscientious objection when they
- refuses to provide legal and professionally accepted goods or services that fall within the scope of their professional competence, and
- justifies their refusal by claiming that it is an act of conscience or is conscience-based
when can a professional object and what are the legislations
The only two areas where the right to conscientious objection of health care professionals are:
Termination of pregnancy (Abortion Act 1967) Fertility treatment (Human Fertilisation and Embryology Act 1990
Conscientious objection (Medical Activities) Bill 2017 (currently HoL)- relates to end of life care
