repro revision Flashcards
4 phases of menstrual cycle
menstruation
follicular
ovulation
luteal
how is the menstrual cycle controlled by feedback systems??
level of oestrogen = negative / positive feedback of HPO axis
3 phases of ovarian cycle and what happens
follicular - theca (produce androgens) and granuloma (inhibin) cells, FSH production inhibited by oestrogen and inhibin
ovulation - LH surge after 12 hrs, day 14, after maturation of dominant follicle and ruptures, releasing oocyte
luteal - lasts for 14 days, formation of corpus luteum,
progesterone production
gold standard investigation for suspected endometriosis ??
laparoscopy
adenomyosis - definitive tx??
hysterectomy
occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus (myometrium)
Basically, ‘endometriosis but with the extra tissue being in the uterine wall only’
Can treat with hormonal therapy (eg, Mirena coil), tranexamic and mefanamic acid, uterine artery embolisation (fertility-sparing), or ablation/hysterectomy.
what meds can be used to reduce the size of fibroids before surgery??
GnRH
OR
ulipristal acetate for fibroids ≥3cm in diameter
USE OF Mefenamic acid VS Tranexamic acid
Mefenamic acid - to relieve the dysmenorrhoea. usually 2nd line after using IUS
3rd line - Tranexamic acid is used for heavy menstrual bleeding, rather than dysmenorrhoea (painful bleeding).
VIN
how long to turn into cancer??
Vulval intraepithelial neoplasia
pre-cancerous condition, will usually take over 10 yrs to turn into cancer
Lymph from the gonads drains to which lymph node group??
lumbar (caval/aortic)
para-aortic nodes
______ signals corpus luteum to secrete progesterone
hCG
what happens when you forget to take a pill (COCP)?? do you need any emergency contraception ??
- fine if missed in middle of wk
- if 1 pill has been missed and it is 48-72 hrs since the last pill in the current pack, or is 24-48 hrs late starting the new pack, MISSED PILL NEEDS TO BE TAKEN ASAP
- remaining pills continued at usual time
- if 2 pills have been missed, take most recent one. Barrier contraception until 7 consecutive pills are taken
emergency contraception not required unless pills were missed earlier or in last wk of previous pack
if COCP, implant, IUS, injection is started after day 5, need to use contraception for at least 1 week
IUD = immediately fine, no contraception needed
POP = 2 days
patient has menorrhagia with small subserosal fibroids. what is an appropriate form of contraception??
- IUS
- IF PATIENT DOES NOT WANT IUS, THEN MAYBE POP
IUS
IUD
IUS coil - up to 5 yrs, making menstrual periods lighter and shorter
invasive - risk of perforation, ectopic pregnancy
IUD - up to 10 yrs, making menstrual periods heavier and irregular
invasive - PID, perforation
Most likely embryonic explanation for 2 uteri
incomplete fusion of paramesonephric duct
in males, which structure develops to form the vas deferens (ductus deferens)?
mesonephric duct
in females, which structure develops to form the superior portion of the vagina ??
paramesonephric duct
how long do male lice live on average ??
22 days (3 wks)
what structures relax in pregnancy that may cause pelvic pain??
pelvic inlet
first sacral segment, ilium, and the pubis
what is a complete hydatidiform mole at risk of turning into? compared w partial moles
choriocarcinoma
Best contraception for 46 yr old, BMI of 42, smokes 20 a day, history of PID. Has multiple fibroid uterus including intramural and submucous fibroids
what is contraindicated in this?
POP
Difficult to fit Mirena w fibroid uterus.
COCP contraindicated in smoking and high BMI and aged above 40
vertex
area of foetal skull:
anterior and posterior fontanelle
and
parietal eminences
occipitofrontal diameter and biparietal
occipitofrontal - longer than wider
distance of the foetal head from the ischial spines is called the ________
station
negative number = the baby head is above the ischial spines
positive number = baby head is positive
placenta accreta vs placenta praevia vs placental abruption
accreta = attached to myometrium due to defective decidua basalis, previous C SECTIONS
praevia = vaginal painless bleeding, 3rd trimester
abruption = placenta separates from the uterus
PPH
-primary postpartum haemorrhage
-emergency
-4Ts causes, trauma, tissue, thrombin, tone
normal value for NT
<3.5mm
assessing the amount of fluid in neck of foetus
screening for Down’s
11+0 weeks and 13+6 weeks = combined test
bloods and USS
US = NT
Bloods = PAPP-A, aFP, beta-hCG
2ND STAGE OF SCREENING = 15-16 WEEKS, add in inhibin and oestriol
in downs, what are the levels of PAPP-A, aFP, beta-hCG and NT??
PAPP-A and aFP are low
beta hcg and nt are increased
when are foetal anomaly scans done??
18-20 weeks
20 week scan for every woman
when is SFH measured??
from 24 weeks
when is anti-d offered if neg?? 1st and 2nd dose
28 weeks
34 weeks
what test can be done to check the right dose for anti-d sensitizing event by quantifying fetal red blood cells in mother’s blood??
to have maximal effect, when should anti-d be given by??
KLEIHAUER
within 72 hrs
2 main diagnostic tests for fetal abnormality?? when can they be done??
CVS - between 11 and 13+6 wks
amniocentesis - after 15 wks
NIPT - screening test (NOT diagnostic)
non-invasive prenatal test
more sensitive and specific than other screening tests
reduces the risk of miscarriage
chorionicity is most determined by ________ using the shape and thickness of membrane
when is this done?? and why is this important??
USS
11 - 13+6 weeks
to pick up early signs of TTTS
what is the mode of delivery for MCMA?? mode of delivery for BREECH BABIES
C-section due to higher risk for cord entanglement
C-section or ECV
3 types of breech presentation, which one is the most risky??
complete breech - legs folded at bottom
footling breech - one or both feet point down
frank breech - both legs UP
FOOTLING - cord prolapse
IN FOETAL HYPOXIA, umbilical artery __________ its resistance
MCA __________ its resistance
definition of stillbirth and causes
baby born with no signs of life at or after 28 weeks gestation
labour complications, maternal infections and disorders, FGR
hypertensive disorders of pregnancy - 3
pre-existing hypertension
gestational hypertension
pre-eclampsia
gestational hypertension develops after 20 wks but does not involve proteinuria/oedema unlike pre-eclampsia
what happens if pre-eclampsia is not controlled ??
develop into eclampsia = characterised by grand Mal seizures
gestational diabetes
polyhydramnios
glycosuria
PPROM
pre-term prelabour rupture of membranes
if the latent period between rupture of membranes to onset of painful contractions is greater than 4hrs
hydrops fetalis - what is this a late sign of ??
placental praevia and vasa praevia
infections in pregnancy
_____ is the leading direct cause of maternal death??
what is the leading indirect cause of maternal death??
SGA - has an estimated weight or abdo circumference below the _____ centile
10th
large for dates fetus has an estimated fetal weight to be greater than the _____ centile
what substance would you give for inducing labour ?
prostaglandin
pregnant woman has confirmed DVT and suspected PE. Tx?
start low molecular weight heparin in suspected PE
CTPA and V/Q scan = confirm or rule out the presence of a thrombus
1ST LINE AND 2ND LINE for management of hypertensive disorders in pregnancy.
- Labetalol (do NOT use in asthmatics)
- Nifedipine
mx for severe pre-eclampsia, she has presented with moderate hypertension and also has symptoms of headache and vomiting
IV magnesium sulphate and plan
immediate delivery
most common cause of antepartum haemorrhage??
second most common cause??
- placental rupture
- placental praevia
prolonged labour - diagnosis
when cervical dilatation is of less than 2cm in 4 hours during active labour
labour 3 stages
1 stage is divided into latent and active, latent = up to 4cm
active = 4-10cm
2nd = full dilatation to delivery (passive/active stage)
3rd = time between delivery of foetus and delivery of placenta and membranes (active/physiological mx)
active - need to use drugs
in a nulliparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs??
in a multiparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs??
2
1
what are the 7 steps of the mechanism of labour??
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
caput succedaneum
cephalohaematoma
subgaleal haemorrhage
present at birth
develops several hrs after birth
at delivery and may progress rapidly
pros and cons of operative vaginal delivery vs C-section
vag = shorter stay and quicker recovery
neonatal trauma, facial nerve palsy, postpartum haemorrhage, shoulder dystocia
C-section = no injury to cervix or tears
haemorrhage, TTN, risk of uterine rupture, venous thromboembolism
IOL - most commonly used method of assessment?
what are the methods of inducing labour??
Bishop’s score
> 6 = most likely to predict labour
artificial rupture of membrane
drugs
mechanical - balloon catheter
CEFM
continuous electronic fetal monitoring
associated w increased level of intervention without much improvement in low risk women, so usually for people with risk factors
DR C BRAVADAO mnemonic - for interpreting CTGs
amniotic fluid embolism
CPR in pregnant woman
uterine neoplasia / cancer
endometrial carcinoma
endometrial sarcoma
carcinosarcoma
endometrial hyperplasia
myometrium abnormalities
ovarian neoplasms/cancer
benign tumours pathology
functional cysts
endometrioma
polycystic ovaries
theca lutein cyst
serous cystadenoma
mucinous cystadenoma
fibroma
sertoli/leydig
mature teratoma
malignant tumours
epithelial
mucinous
endometrioid
clear cell
sex cord
germ cell
cervical neoplasia
