Repro Other Flashcards
Ectopic pregnancy vs miscarriage symptoms
Ectopic: pain mainly, dull ache, sharp stabbing
Miscarriage: mainly bleeding rather than pain, experience period cramp pain
What needs to be assessed to gauge whether someone requires a scan for TOP
(7)
- pain/ bleeding?
- <16yrs
- does patient want a scan
-IUD/IUS in situ? - hx of PID/ chlamydia
- hx of ectopic pregnancy
- known tubal disease/previous sterillisation
- unsure of LMP
what type of ovarian tumours are more common in women under 40
Germ cell tumours
what type of cancer are most endometrial carcinomas
adenocarcinomas
what is the inheritance of lynch syndrome and what kind of uterine cancer does it cause
autosomal dominant
endometrial carcinoma TYPE 2
ixfor tumours caused by lynch syndrome
immunohistochemistry staining of tumour for mismatch repair proteins
microsatellite instability (characteristic of defective mismatch pair)
TP53 mutation associated with which cancer
endometrial carcinoma type 2
type 1 or type 2 endometrial carcinoma: which is more agressive
Type 2, spreads along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease
the presence of … gives carcinosarcoma the worst prognosis
rhabdomyosarcomatous
endometroid and mucinous adenocarcinoma are what type of endometrial cancer
type 1
type 2 endometrial cancer: what type of cancers
serous and clear cell carcinoma
what is the causative organism for syphilis
give type of organism too
treponema pallidum I - spirochete
which strains of hpv associated with cervical cancer
HPV 16 and 18
Which strains of HPV associated with genital warts
HPV 6 and 11
contraindications to HRT
hx of breast cancer/ endometrial cancer
CHD, TIA, stroke
active liver disease
unexplained vaginal bleeding
how does the combined oral contraceptive supress fertility.
progesterone & oestrogen together have a negative effect on HPG axis (negative feedback)
this prevents the LH surge from occurring= oocyte is not released (prevents ovulation)
type 1 vs type 2 vasa praevia
type 1:Type I when the vessel is connected to a velamentous umbilical cord
Type II when it connects the placenta with a succenturiate or accessory lobe.
cholestatic LFTS vs Hepatic
cholestatic: greater ratio of ALP:ALT
hepatic: higher ratio of ALT: ALP
what contraceptive is most associated with weight gain
injectable
Contraceptives - time until effective (if not first day period):IUD
instant
Contraceptives - time until effective (if not first day period): pop
2 days
what Contraceptives take 7 days to be effective (if not first day period)
coc, injection, implant, ius
when should methotrexate be stopped before conception in both dad / mum
both partners must stop 6 months before conception
placenta increta vs placenta accreta vs placent perceta
abnormal placentation,
placenta accreta: chorionic villi attach to myometrium but do not deeply invade it
placenta increta: chorionic villi invade myometrium but not deep enough to reach perimetrium
(increta deeper)
perceta: invades perimetrium
what is the role of oestrogen regarding menstrual cycle
thins cervical mucus
thickens endometrium (hyperplasia)
what is the role of progesterone regarding the menstrual cycle
thickens cervical mucus
increases gland secretion
increases blood flow to uterus
thickens and maintains endometrium
what does progesterone medication end in
strel
eg. levonogestrel
COC: if 1 missed pill
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
(it doesn’t matter when in the cycle)
COC: if 2 or more missed pills in week one of cycle
take last missed pill & continue on as normal
condoms/no sex till taken 7 pills over7 days in a row
emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
COC: if 2 or more missed pills in week 2 of cycle
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
*no need for emergency contraception
COC: if 2 or more missed pills in week 3 of cycle
what days are week three
days 15-21
start a new pack the next day; thus omitting the pill free interval
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
miscarriage types
threatened
inevitable
incomplete
complete
missed
when can a miscarriage occur
<24 weeks
(otherwise its a stillbirth)
when does gestational hypertension occur
> 20 weeks
when in pregnancy timeline does hyperemesis gravidarum occur
before 20 weeks
what age is a risk factor for infertility
> 35
first degree tear (after labour) involves…
Tear limited to the superficial perineal skin or vaginal mucosa only
second degree tear (labour) involves
Tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)
third degree tear (labour)
3a: <50% of the thickness external anal sphincter is torn
3b: >50% of the thickness of the external anal sphincter is torn, but internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact
4th degree tear (labour) involves
Perineal skin, muscle, anal sphincter and anal mucosa are torn
what are some drugs that should be avoided during breastfeeding
some abx (not penicillins but)
psychiatric drugs: lithium, benzodiazepines,clozapine
aspirin
carbimazole
methotrexate
amiodarone
what babies in utero are at higher risk of folic deficiency
them/partner has hx of Neural Tube Defects
mother taking antiepileptic drugs/ has coeliac/ has thalassemia trait
woman is obese (bmi >/=30)
pregnant women are screened for anaemia at 8-10 weeks & 28 weeks. what are their haemoglobin cut offs for intervention
First trimester < 110 g/L
Second/third trimester < 105 g/L
Postpartum < 100 g/L
what day does ovulation occur on
day 14 (for a 28 day cycle)
or
14 days before start of next cycle
HRT and cancer
oestrogen only inc risk of endometrial cancer
adding progesterone mitigates that risk
oestrogen slightly inc risk of breast cancer. adding progesterone further inc risk of breast cancer (prog worse for breasts than oestrogen)
oestrogen only and hrt both slightly inc risk of ovarian cancer
what cancer does the combined oral contraceptive pill increase the risk of
breast and cervical cancer
what cancer is the combined oral contraceptive pill protective against
ovarian and endometrial cancer
fundal height- when/ where palpate
20 weeks palpable at umbillicus
36 weeks palpable at xiphoid sternum
risk factors for abruption
ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
mcroberts manouevre position
(for shoulder dystocia)
supine with both hips fully felxed and abducted
high risk factors for pre-eclampsia
hypertensive disease previous pregnancy
CKD
autoimmune disease eg. SLE or APP syndrome
t1 or t2 diabetes
chronic hypertension
moderate risk factors pre-eclampsia
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
BMI 35 or more at first visit
FHx of pre-eclampsia
multiple pregnancy- as in twins
When is miscarriage a potential diagnosis
Before 24 weeks !!!!!
most common causative organism for pelvic inflammatory disease
chlamydia trochamitis
what is diagnostic of a miscarriage on ultrasound
us showing no cardiac activity and crown-rump length is greater than 7mm or gestational sack is greater than 25mm
