Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 5 > Repro 6 > Flashcards

Repro 6 Flashcards

1
Q

PCOS: outline

A
  • Affects 5-20% of women of reproductive age
  • Both Hyperinsulinaemia and high levels of luteinizing hormone are seen
  • Overlap with metabolic disorders
  • Hyperandrogenism; oligomenorrhoea, hirsutism and acne
  • Characterised by Hyperandrogenism, Ovulation disorder and polycystic ovarian morphology
  • Complications: infertility, metabolic syndrome, T2D, cardiovascular disease, Hypertension, OSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of PCOS

A
  • Subfertility and infertility
  • Menstrual disturbances: oligomenorrhoea and amenorrhoea
  • Hirsutism, acne (due to hyperandrogenism)
  • Obesity
  • Acanthosis nigricans (due to insulin resistance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PCOS investigations

A
  1. Pelvic ultrasound: multiple cysts on the ovaries
  2. Baseline investigations: FSH, LH, prolactin, TSH, testosterone and sex hormone binding globulin
  3. Classical feature- raised LH:FSH ratio (>2)
  4. Raised oestrogen
  5. Prolactin may be normal or mildly elevated
  6. Testosterone may be normal or mildly elevated
  7. SHBG is normal to low
  8. Check for impaired glucose tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rotterdam criteria: diagnosis of PCOS

A
  • Can be made if 2 of the following 3 are present:
  • Infrequent or no ovulation (usually manifested as infrequent or no menstruation)
  • Clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
  • Polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PCOS: conservative treatment

A
  1. Weight reduction if appropriate, exercise, smoking cessation
  2. COCP; regulate periods and protect against endometrial cancer
  3. Co-pyrindrol: reduces Hirsutism and promotes regular menstruating
  4. Metformin: regulate menstruation, reducing hirsutism and acne
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PCOS: Hirsutism and acne treatment

A
  1. First line: COCP
  2. If don’t respond to COCP then topical eflornithine may be tried
  3. Spironolactone, flutasamid and finasteride can be used under specialist supervision
  4. Acnes: retinoids, topical antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PCOS: infertility treatment

A
  1. Weight reduction if appropriate
  2. Metformin, clomiphene or a combination can be used to stimulate ovulation particularly if obese
  3. Fertility treatment using GnRH analogues
  4. Ovarian drilling: second line, damages the hormone producing cells of the ovary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Postpartum haemorrhage

A

Some bleeding from the genital tract following the 3rd stage of labour routinely occurs, up to 500mls is normal.

Any blood loss greater than this constitutes a postpartum haemorrhage. PPH can be primary (from the time of birth, up to 24 hours after) or secondary (after 24 hours and up to six weeks following birth).

Blood loss >1000mls is considered a major obstetric haemorrage and therefore the relevant major haemorrhage protocol should be employed. <1000 is minor PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The 4 main causes of PPH: the 4 ‘T’s’

A
  • TONE – Uterine Atony (the uterus is unable to contract to arrest bleeding – this is the most common cause)
  • TISSUE – Retained products such as placenta or membranes.
  • TRAUMA – To external genitalia, vaginal wall, cervix or uterus.
  • THROMBIN – Coagulopathies (either pre existing or caused by heavy bleeding).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for primary PPH include

A
  • Previous PPH, BMI >35
  • Prolonged labour, previous PPH
  • Pre-eclampsia, Induction of labour, instrumental labur
  • Increased maternal age, multiple pregnancy
  • Polyhydramnios
  • Emergency Caesarean section
  • Placenta praevia, placenta accreta
  • Macrosomia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PPH: preventative measures

A
  • Treating anaemiaduring the antenatal period
  • Giving birth with anempty bladder(a full bladder reduces uterine contraction)
  • Active management of the third stage(withintramuscular oxytocinin the third stage)
  • Intravenous tranexamic acidcan be used during caesarean section (in the third stage) in higher-risk patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PPH management

A
  • ABC approach: two peripheral cannulas, lie the woman flat. Bloods including group and save. Commence warmed crystalloid infusion. Warmed IV fluid and blood resuscitation
  • In severe cases activate the major haemorrhage protocol
  • If clotting abnormalities fresh frozen plasma
  • In secondary PPH; US for retained products and swabs for infection
  • Mechanical: palpate the uterine fundus and sub it to stimulate contraction. Catheterisation to prevent bladder distension and monitor urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PPH: medical management

A
  • IV oxytocin: slow IV injection followed by an IV infusion
  • Ergometrine slow IV or IM (unless there is a history of hypertension)
  • Carboprost IM (unless there is a history of asthma)
  • Misoprostol sublingual
  • Tranexamic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PPH: surgical management

A
  • Surgical options are only done when medical options fail
  • An intrauterine balloon tamponade is the first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
  • Other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
  • If severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Secondary PPH

A

Secondary PPH occurs between 24 hours - 6 weeks. It is typically due to retained placental tissue or endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Secondary PPH: Ix and management

A
  • US for retained products
  • Endocevical and high vaginal swab
  • Surgical evaluation for retained products
  • Antibiotics for infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Prevention of pre-eclampsia

A

Prevention of hypertension: consider aspirin 150mg at night daily if 1 high or 2 moderate risk factors. Start before 16 weeks and continue through pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pre-eclampsia: high risk factors

A
  • Hypertensive disease during a previous pregnancy
  • Chronic kidney disease
  • Autoimmune disease such as SLE or APLS
  • Type 1 or type 2 diabetes
  • Chronic hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pre-eclampsia: moderate risk factors

A
  • First pregnancy
  • Age ≥40
  • Pregnancy interval of more than 10 years
  • Booking BMI ≥35
  • Family history of pre-eclampsia
  • Multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gestational hypertension and chronic hypertension

A

Gestational hypertension: new hypertension in pregnancy presenting at >20 weeks without significant proteinuria

Chronic hypertension: high blood pressure that predates pregnancy or is diagnosed before 20 weeks gestation

21
Q

Gestational hypertension overview

A
  • Hypertension (as defined above) occurring in the second half of pregnancy (i.e. after 20 weeks)
  • No proteinuria, no oedema
  • Occurs in around 5-7% of pregnancies
  • Resolves following birth (typically after one month). Women with PIH are at increased risk of future pre-eclampsia or hypertension later in life
22
Q

Management of chronic and gestational hypertension

A
  • Stop ACEi and ARB’s and switch to labetalol
  • If labetalol not tolerated offer methyldopa and nifedipine
  • Aim for <135/85
  • Admit if BP >160/110
  • Regular urinalysis and BP measurements
  • May have planned early birth if complications occur, BP returns to normal after birth
  • After birth switch antihypertensive to Elanopril or Amlodipine (if black)
23
Q

Hypertension in pregnancy is usually defined as

A
  • systolic > 140 mmHg or diastolic > 90 mmHg
  • or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
24
Q

Premenstrual syndrome

A

The emotional and physical symptoms that women experience in the luteal phase of the normal menstrual cycle. Occurs in the days prior to menstruating but resolve once menstruation begins. Doesn’t occur prior to puberty, pregnancy or after the menopause. Can have severe PMS also known as premenstrual dysmorphic disorder (PMDD)

25
Q

Premenstrual syndrome symptoms

A
  • Emotional: anxiety, stress, fatigue, mood swings
  • Physical: bloating, breast pain, fatigue, sleep problems, difficulty concentrating, changes in appetite
26
Q

Premenstrual symptoms management

A
  • Lifestyle: eat frequent, small, balanced meals rich in complex carbohydrates, stress reduction, CBT
  • Moderate symptoms: new generation COCP i.e. Yasmin
  • Severe symptoms: SSRI, can be taken continuously or just doing the luteal phase i.e. day 15-28 of the menstrual cycle
  • Severe: Danazol (breast pain), transdermal oestrogen, GnRH analogue to induce menopause
27
Q

Diagnosing premenstrual syndrome

A
  • Keep a symptom diary for at least two menstrual cycles
  • GNRH analogue can be used by specialists to halt the menstrual cycle and see if symptoms resolve
28
Q

Maternal sepsis: definition and risk factors

A

Leading cause of maternal death in the UK. Two main causes in pregnancy are chorioamnionitis and a UTI

Risk Factors
- Pre-existing: obesity, diabetes, impaired immunity (i.e. on immunosupressants), BME groups, hypertension, low socio-economic status, anaemia, hx of PID, hx of GBS infection, ‘Flu season
- From presentation: vaginal discharge, recent procedure (i.e. amniocentesis, cervical cerclage) PROM, in contact with individuals with GAS infection or influenza

29
Q

Maternal sepsis: clinical features

A
  • One or more of the following: pyrexia, hypothermia, tachycardia, tachypnoea, hypoxia, hypotension, oliguria, impaired consciousness, failure to respond to treatment
  • Note that genital tract sepsis may present with constant severe abdominal pain and tenderness unrelieved by usual analgesia
30
Q

Antepartum sepsis: organisms, source, investigations, complications

A

Common organisms: = Group A Beta-haemolytic Streptococcus, E.coli, Influenza

Common sources of AN Sepsis= Chorioamnionitis, Urinary tract

Investigations: Urine dipstick and culture, high vaginal swab, sputum culture

Complications= Preterm labour, preterm delivery (for maternal well being), fetal death, maternal death

31
Q

Postpartum sepsis

A

Risk factors: same as for AN risk factors plus: prolonged ROM, multiple VEs, vaginal trauma, c-section, wound haematoma, retained products of conception, MROP/other instrumentation of genital tract.

32
Q

Postpartum sepsis: clinical feastures

A

same as for AN clinical features +

  • Mastitis: breast pain, tenderness, “wedge shaped” erythema, palpable abscess
  • Endometritis: pain, offensive discharge, bleeding (commonest cause of secondary PPH)
  • Wound Site: pain, tenderness, erythema, discharge from wound, collection
33
Q

Postpartum sepsis: organisms and sources

A

Organisms: Main cause is group A beta-hemolytic streptococci (GAS). Others: E.coli, S.Aureus, S.Pneumoniae, MRSA, Influenza

Sources
- Genital tract and uterus causing endometritis
- Mastitis
- UTI
- Pneumonia
- Skin/soft tissue

34
Q

Postpartum sepsis: management

A
  • See Antenatal (AN) Sepsis for Sepsis 6.
  • Sepsis is an emergency, and should be managed as such.
  • Use a maternity specific Early warning score (“MEWS”) chart – allows for early recognition of deterioration.
  • Get early senior involvement. Consider HDU/ITU involvement.
  • Consider drainage of collection/abscess if applicable.

Occurs within 6 weeks of giving birth.

35
Q

Chorioamnionitis

A
  • A potentially life-threatening condition to both mother and foetus and is a medical emergency.
  • It is the result of an ascending bacterial infection of the amniotic sac and fluid. The major risk factor is PROM (can still occur when the membranes are still intact) which expose the normally sterile environment of the uterus to potential pathogens.
  • Prompt delivery of the foetus (via cesarean section if necessary) and administration of intravenous antibiotics is done

Diagnosed clinically but confirm with blood tests and cultures

36
Q

Chorioamnionitis symptoms

A
  • Fever
  • Mother or fetus has rapid heartbeat
  • Tender or painful uterus
  • Abdo pain
  • Vaginal discharge with an unpleasant smell or unusual colour
  • Sweating
37
Q

Chorioamnionitis complications

A
  • Infection in the pelvic region and abdomen
  • Endometriotis
  • Blood clots in the pelvis or lungs
  • Sepsis
  • Newborn complications: sepsis, meningitis, pneumonia
38
Q

Risk factors for chorioamniotis

A
  • Premature labour
  • Water breaks more than 24 hours before delivery
  • Long labour
  • Vaginal infection or STI
  • Most common organism: Group B strep, E.coli and anaerobic bacteria
  • Frequent vaginal exams after your water breaks
  • Internal fetus or uterine monitoring
39
Q

Chorioamnionitis management

A
  • Indication for hospital admission and delivery
  • IV broad spectrum abx as part of sepsis 6
  • Monitor mother and fetus for complications
  • May need early delivery
40
Q

Mastitis treatment

A
  • The first-line management of mastitis is to continue breastfeeding. May need manual expression, warm compress and analgesia
  • Antibiotics if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection’.
  • The first-line antibiotic is flucloxacillin for 10-14 days, the most common organism causing infective mastitis is Staphylococcus aureus. Breastfeeding or expressing should continue during treatment.
  • In non-lactating women prescribe co-amoxiclav, if penicillin allergic prescribe erythromycin or clarithromycin and metronidazole
41
Q

Mastitis categories

A
  • Lactational (puerperal): occurs during breastfeeding, the most common organism is Staphylococcus aureus. Happens due to milk stasis because of reduced breastfeeding. Tends to occur early and in first time mums
  • Non-lactational: occurs in non-lactating women of any age. The infection is usually mixed, the commonest organisms are staph aureus, enterococci, and anaerobic bacteria.
  • Granulomatous: a rare breast infection which occurs in women with diabetes mellites, autoimmune diseases and sarcoidosis.
42
Q

Mastitis risk factors

A
  • Changes in feeding regime
  • Introduction of bottle feeding
  • Poor attachment of the infant to the breast
  • Maternal stress and fatigue
  • Inverted nipple, nipple piercing, skin conditions like eczema, diabetes, immunosuppression
43
Q

Mastitis: symptoms, complications, investigations

A

Symptoms: erythema of the breast, swelling of the breast, painful breast, fever and general malaise

Complication: abscess needing incision and drainage

Investigations: US

44
Q

Termination of pregnancy: legality

A
  • two registered medical practitioners must sign a legal document (in an emergency only one is needed)
  • only a registered medical practitioner can perform an abortion, which must be in a NHS hospital or licensed premise
45
Q

The method used to terminate pregnancy depending upon gestation

A
  • Mifepristone (Progesterone antagonist) followed 48 hours later by prostaglandin analogue (Misoprostol) to stimulate uterine contractions. Can be done at home <10 weeks. Pregnancy test after 2 weeks
  • Surgical dilation and suction of uterine contents
  • Surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
  • Surgical procedures may use misoprostol +/- mifepristone
  • Choice between medical and surgical terminations up to week 24 but after 9 weeks medical abortions are rare
46
Q

When can abortion be done and anti-D prophylaxis

A

When can an abortion be done= When its before 24 weeks and involved greater risk to the physical or mental health of the women or existing children of the family

Anti-D prophylaxis should be given to women who are rhesus D negative and are having an abortion after 10 weeks gestation

47
Q

An abortion can be performed at any time during the pregnancy if:

A
  • Continuing the pregnancy is likely to risk the life of the woman
  • Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
  • There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
48
Q

Post abortion care

A

may experience vaginal bleeding and abdominal cramps up to 2 weeks after the procedure. A urine test is performed 3 weeks after the abortion to confirm its complete

49
Q
A

Year 5 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions