REPRO 4 Flashcards
menopause should happen when
early
late
premature and causes
51
45
54
40 genetics, radio/chemo, cancer
some symptoms of menopause
hot flushes and night sweats, mood changes, palpitations, insomnia, anxiety, difficulty concentrating, forgetfulness, decreased libido, dry vagina, atrophy of breasts and genitals, incontinance, UTIs, headaches, joint aches
ix for menopause
can check LH/FSH level which will be high but not done regularly as can be high in depo, breastfeeding, SSRIs, prior to ovulation, stopping COCP
complications of menopause
osteoporosis, increased risk of ischaemic heart disease
contraception till how long after last period if aged over 50 and if under
> 50 12mmonths
<50 24 months
PMB - when does it need to be investigation
after a year
contraindications for HRT
past or current angina, MI, PE etc
non HRT treatment - lifestyle - for menopause
diet, decrease weight, exercise, lifestyle, caffeine
mennorhagia
MFA, TXR, preg, IUS, endom ablation, hysterectomy
non HRT for vasomotor symptoms 5
fluoxetine 20mg OD citalopram 20mg OD velefaxine 37.5mg BD clonidine - lots of SE vaginal dryness - lubricant/moisturiser
HRT for vasomotor symptoms
oral or transdermal combined
HRT for no uterus
oral or transfermal oestrogen only
premenopausal
steroid and HRT or COC
HRT for mood
oraltrandmeral
urogenital atrophy
topical oestrogen
vaginal dryness
moisturise, lubricant, topical oestrgent
sexual dysf
testosterone - off licence
benefits of HRT
decreased risk of fragility fracture, decreased risk of bowel cancer, muscle strength and mass
risks of HRT
VTE oral >trandermal
increased risk in breast cancer
CHD and stroke in oestrogen and progesterone combined
prolapse risk factors
increased age, obesity, increased number of vaginal deliveries, increased abdominal pressure
anterior aka
what is it
cystocele
bladder drops into anterior vagina
middle aka
apical/enterocele
herniation of pouch of douglas into vagina
posterior aka
rectocele
prolapse of rectum into posterior vagina walls
uterine prolapse levels
in vagina
at interoitus
outside vagina
procidenta
ix for prolapse
abd exam
biman exam - cough, speculum
POPQ
0 no prolapse 1 >1cm above hymen -ve 2 within 1cm -ve 3 1-2cm below +ve 4 exercion
treatment of prolapse conservative and non
avoid heavy lifting lose weight vaginal oestrogen - if atrophy pessary -surgery
risks of pessary
can fall out
bleeding
erosion -> fistula
conception - what is started
FA 0.4mg daily for up to 3months into pregnancy
if BMI>30 5mg
booking is when
what is checked
8-12 weeks
scan
blood group, FBC, syphilis, Hep B/C, HIV, VDRLA, haemoglobinopathies, rubella, random BG, urinalysis, BP
anomaly scan
18-21w
visits
monthly visits till 28 weeks
fortnightly visits till 36w
weekly visits from 36>
growth scan when
what is checked and why
28 weeks
abd circumferance IUGR
femur length weight
head circumference IUGR
anti D
28 and 34 weeks or all at 28w
vaccines offered to pregnant woman
pertussis from 16-32w
flu every year from oct-march
assessment of fatal growth
fatal growth chart
normal metal heart baseline
variability
acceleration? decelerations?
120-160
>5bpm
accelerations present. no decel
early decel happen when
part of what
why are they happening
same time as contraction
normal labour
head and orbital compressed during second stage
variable decel - why variable
why
when are they pathological
variable in depth and timing to contraction
umbilical cord compression
pathological if deep and prolonged and other CTG features present
late decel when
why
action
after contractions
fetal hypoxia, fetal distress
fetal blood sample. deliver
biophysical USS - what is assessed and numbers
movement, tone, breathing , liquor vol
8-10 satisfactory, 4-6 repeat, 0-2 deliver
umbilical artery doppler
20-24 weeks
screening for PET
