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Reproductive and Neonatal Health (RNH) > Random > Flashcards

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1
Q

Define BREECH PRESENTATION. What are the types of breech?

A

Breech is a type of malpresentation when the baby’s bottom is the presenting part to the cervix, as opposed to the head.

There are three types of breech:

  1. frank breech (extended)
  2. complete breech (flexed)
  3. incomplete breech (footling)
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2
Q

What are the risks associated with breech delivery?

A 
✔️ prolonged labour
✔️ obstructed labour
✔️ cord prolapse
✔️ perineal tears
✔️ post partum haemorrhage
✔️ need to convert to emergency C/S
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3
Q

What are the indications and contraindications for trial of labour (TOL) in a breech presentation?

A 
INDICATIONS
✔️ no CPD (favourable pelvis)
✔️ baby weight between 2,500 to 3,500g
✔️ complete or incomplete breech
✔️ flexed head
CONTRAINDICATIONS
✔️ footling breech
✔️ weight > 3,500g
✔️ CPD (unfavourable pelvis)
✔️ nulliparity
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4
Q

Describe the procedure of EXTERNAL CEPHALIC VERSION (ECV).

A

ECV is a procedure in which a trained professional attempts to manually turn the baby from a beech to a cephalic position.

A muscle relaxant is given +/- pain relief.

The baby’s HR is monitored using CTG for 20 to 30 mins before the procedure.

3 x 3 minute attempts can be trialled (maximum of 10 minutes).

There is a 50% success rate. If successful, a small amount of baby’s turn back to the breech position, so labour may be induced, if appropriate.

EVC is conducted between 36 to 37 weeks GA.

Contraindications include: 
✔️ antepartum haemorrhage within last 7 days (PV bleeding)
✔️ rupture of membranes
✔️ placental abruption 
✔️ placenta previa / acreta
✔️ abnormal cord position
✔️ non-reassuring foetal signs

FU in clinic in 7 days to re-check the position of the baby. If baby remains in cephalic position, wait until normal labour begins.

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5
Q

Define VBAC.

A

VBAC stands for vaginal birth after C/S. It is recommended in ALL women who have had only ONE C/S and have no contraindications to trial of labour.

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6
Q

What are the indications for VBAC.

A

✔️ one previous C/S
✔️ indication for C/S was related to modifiable factors (e.g. malpresentation)
✔️ no current contraindications for C/S

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7
Q

What are the benefits and risks of VBAC.

A

BENEFITS
✔️ improved prospects for family planning (if women wants > 2 children)
✔️ improved outcome for recovery (reduced recovery time)
✔️ avoids risks associated with C/S
✔️ benefits for baby (e.g. respiratory, immunological)

RISKS
✔️ need to convert to emergency C/S (25% risk)
✔️ uterine rupture (0.3% risk) –> increases with more C/S
✔️ perineal tears
✔️ shoulder dystocia
✔️ cord prolapse

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8
Q

Define INFERTILITY.

A

Infertility is the inability to fall pregnant after 12 months of unprotected, regular sexual intercourse.

Statistics for fertility:
✔️ 84% of couples achieve pregnancy within the first 12 months of actively trying
✔️ 92% of couples fall pregnant within 24 months
✔️ 93% of couples fall pregnancy within 3 years

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9
Q

Outline some male and female causes of infertility.

A 
MALE CAUSES
✔️ reduced sperm count
✔️ abnormal sperm morphology
✔️ reduced sperm motility / function
✔️ ejaculatory failure or retrograde ejaculation

FEMALE CAUSES
✔️ hypogonadotropic hypogonadism (e.g. hypothalamic dysfunction, pituitary dysfunction)
✔️ normogonadotropic hypogonadism (e.g. PCOS)
✔️ hypergonadotropic hypogonadism (e.g. primary ovarian insufficiency, perimenopause, menopause)
✔️ endometriosis
✔️ fibroids (particularly submucosal)
✔️ tubal dysfunction (e.g. adhesions, fibrosis)

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10
Q

Outline some appropriate investigations for INFERTILITY.

A 
MALE INVESTIGATIONS
Sperm analysis is the gold-standard investigation: 
✔️ semen volume
✔️ sperm count
✔️ sperm motility 
✔️ sperm morphology 
✔️ semen pH
✔️ sperm vitality 
FEMALE INVESTIGATIONS
✔️ day 3 to 5 estradiol, LH and FSH
✔️ day 21 progesterone
✔️ progestin challenge
✔️ androgen levels (e.g. testosterone)
✔️ cortisol levels
✔️ AMH levels
✔️ prolactin levels
✔️ TFTs
✔️ DHEA and sex binding hormone
✔️ transvaginal USS + follicle count
✔️ hysteroscopy / laparoscopy
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11
Q

Outline some general advice that can be given in the context of infertility.

A

✔️ aim for regular unprotected sex 2 to 3 times per week
✔️ try not to be too stressed by sex; try to make it enjoyable
✔️ avoid ovulation charts / basal temperature monitors etc.
✔️ optimise BMI
✔️ optimise nutrition and physical activity
✔️ smoking cessation
✔️ alcohol cessation
✔️ commence folic acid supplementation

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12
Q

Outline the WHO CLASSES FOR INFERTILITY management options.

A

CLASS I
✔️ lifestyle measures
✔️ gonadotropins (e.g. GnRH analogues)
✔️ dopamine agonists (for hyperprolactinemia)

CLASS II
✔️ gonadotropins
✔️ clomiphene citrate
✔️ metformin
✔️ ART

CLASS III
✔️ IVF
✔️ oocyte donation
✔️ adoption

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13
Q

Identify the eight principles of IVF.

A
  1. pituitary down-regulation
  2. ovarian stimulation
  3. monitor response to ovarian stimulation
  4. ovulation trigger
  5. oocyte collection
  6. luteal support
  7. fertilisation
  8. embryo transfer or cryopreservation
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14
Q

Define MENOPAUSE.

A

Menopause is defined as the absence of periods for > 12 months duration with no underlying pathological cause.

Perimenopause is the period (2 to 8 years) leading up to complete amenorrhea characterised by oligomenorrhoea and menopausal symptoms, particularly vasomotor symptoms.

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15
Q

Define the following terms:
✔️ late menopause
✔️ early menopause
✔️ primary ovarian insufficiency

A

LATE MENOPAUSE: menopause > 55 years

EARLY MENOPAUSE: menopause < 45 years

PRIMARY OVARIAN INSUFFICIENCY: < menopause < 40 years

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16
Q

Describe the clinical symptoms of MENOPAUSE.

A 
PHYSICAL SYMPTOMS
✔️ fatigue
✔️ increased cardiovascular risk
✔️ increased osteoporosis and fracture risk
✔️ vaginal dryness and atrophy
✔️ reduced libido
✔️ breast atrophy and tenderness
✔️ increased weight
✔️ urinary incontinence

PSYCHOLOGICAL SYMPTOMS
✔️ depression and anxiety
✔️ insomnia

VASOMOTOR SYMPTOMS
✔️ hot flushes and night sweats
✔️ insomnia

17
Q

Identify appropriate investigations for MENOPAUSE.

A 
✔️ FBC + Inflammatory markers
✔️ UECs + eLFTs
✔️ Iron studies
✔️ oestrogen, LH and FSH
✔️ prolactin levels
✔️ AMH
✔️ TFTs
✔️ DHEA and sex binding hormone
✔️ transvaginal USS and follicle count
18
Q

Describe the use of HORMONE REPLACEMENT THERAPY in the context of menopause.

A

HRT is available in two forms:

  1. oral HRT
  2. transdermal HRT

In women < 60 years of age or within 10 years of menopause onset, transdermal HRT is recommended for use where the benefits of therapy outweigh the risks.

HRT is indicated in the context of:
✔️ reducing cardiovascular risk
✔️ improving vasomotor symptoms

Contraindications to HRT include:
✔️ personal or family Hx of breast cancer
✔️ personal or family Hx of VTE (DVT or PE)
✔️ significant liver disease
✔️ unexplained vaginal bleeding

In women with NO uterus, unopposed oestrogen therapy is acceptable.

In women with a uterus, oestrogen therapy MUST be combined with progesterone (e.g. Mirena IUD).

19
Q

What are some risks of HRT?

A

✔️ endometrial hyperplasia / cancer (especially if oestrogen therapy is use without progesterone)
✔️ slight increased risk of breast cancer in combined therapy
✔️ increased risk of cholelithiasis
✔️ increased DVT and stroke risk
✔️ symptom recurrence in ~50% of women when HRT is ceased

20
Q

Outline some management strategies for complications and associations of MENOPAUSE.

A 
CARDIOVASCULAR RISK
✔️ weight loss / BMI optimisation
✔️ improved nutrition and physical activity
✔️ statins (if dyslipidemia)
✔️ ACE / ARB (if HTN)
✔️ smoking and alcohol cessation

OSTEOPOROSIS RISK
✔️ encourage weight-bearing activities
✔️ bisphosphonates, calcium and Vitamin D supplementation

MOOD CHANGES
✔️ CBT
✔️ SSRIs / SNRIs
✔️ clonidine

URINARY INCONTINECE
✔️ vaginal estrogen
✔️ pessaries

21
Q

Define COMPLETE MOLAR PREGNANCY.

A

Diploidy (46 chromosomes)

No foetal tissue present

Either:
✔️ 2 x sperm and no ovum DNA
✔️ 1 x sperm and no ovum DNA

22
Q

Define PARTIAL MOLAR PREGNANCY.

A

Triploidy (69 chromosomes)

Foetal tissue present –> cause for IUGR

3 x sets of chromosomes.

23
Q

What are some risk factors for pelvic organ prolapse?

A 
✔️ increasing age
✔️ post-menopausal 
✔️ previous vaginal deliveries
✔️ previous traumatic vaginal deliveries
✔️ previous abdominal surgeries
✔️ chronic constipation
✔️ chronic cough / COPD
24
Q

What is defined as NEONATAL HYPOGLYCAEMIA? What are some risk factors?

A

Neonatal hypoglycaemia is defined as blood glucose level < 2.6 mmol / L.

Risk factors include: 
✔️ premature birth
✔️ small for gestational age
✔️ low birth weight
✔️ large for gestational age
✔️ macrosomnia
✔️ post-term delivery
✔️ maternal diabetes
✔️ maternal drug / medication use (e.g. beta-blockers)
✔️ hypothermia
✔️ inborn errors of metabolism
✔️ hyperinsulinemia
25
Q

Describe clinical signs / symptoms of neonatal hypoglycaemia.

A

CARDIOVASCULAR
✔️ tachycardia
✔️ pallor

RESPIRATORY
✔️ aponea
✔️ tachyponea
✔️ cyanosis

GASTROINTESTINAL
✔️ poor feeding
✔️ vomiting

NEUROLOGICAL
✔️ irritability 
✔️ tremor
✔️ seizures
✔️ reduced consciousness
26
Q

Outline the management of NEONATAL HYPOGLYCAEMIA.

A

If BGL < 2.6 mmol / L and enteral feeding is possible / safe:
✔️ encourage enteral feeding (oral or NGT)
✔️ re-measure BGL in 60 mins
✔️ if BGL remains < 2.6 mmol / L, use buccal glucose gel 0.5mL / kg
✔️ consider increasing feeds to 20mL / kg / day

If BGL < 2.6 mmol / L and enteral feeding is NOT possible / unsafe:
✔️ IV glucose 10% 2mL / kg
✔️ consider IV dextrose infusion
✔️ consider IV glucagon infusion

Reproductive and Neonatal Health (RNH) (8 decks)

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