Women's Flashcards
describe the hormonal changes in pregnancy
↑ acth = ↑ cortisol + aldosterone
↑ prolactin
↑ T3/4
↑ progesterone - to maintain pregnancy
↑oestrogen - produced by placenta
describe the resproductive system changes in pregnancy
uterus increase in size = hypertrophy/hyperplasia
cervical discharge
hypertrophy of vaginal muscles + vaginal discharge
describe the CVS changes in pregnancy
↑ blood volume
↑ plasma volume
↑ cardiac output/stroke volume/heart rate
↓ peripheral vasc resistance
↓ blood pressure in early/mid pregnancy
varicose veins
peripheral vasodilation = flushing/hot sweats
describe the respiratory changes in pregnancy
increase tidal volume
increase resp rate
describe the renal changes in pregnancy
↑ renal blood flow
↑ GFR
↑ aldosterone = ↑ Na/water retention
↑ protein excretion
LESS urea + creatinine
dilatation of ureters and collecting system = hydonephrosis
describe the haematological changes in pregnancy
↑ RBC
↑ iron/folate/B12/calcium requirements
↑ WBC
↑ ESR/d dimer
↑ ALP (secreted by placenta)
↓haemoglobin concentration
↓ clotting factors/fibrinogen
↓ haemocrit
↓ platelets
↓ albumin (loss thru kidneys)
describe the skin and hair changes in pregnancy
increase pigmentation due to ↑ melanocyte stimulating hormone = linea nigra and melasma
striae gravidarum
pruitus
spider naevi
palmar erythema
postpartum hair loss
describe the GI changes in pregnancy
delayed gastric emptying
cardiac sphincter relaxation (= heart burn)
reduced secretion of CCK from GB
increased risk of gallstones
dyspepsia
slower gut transit time
small bowel = increase nutrient uptake
large bowel = increased water absorption = constipation risk
what is an ovarian cyst and what is the main type
fluid filled sac
functional = common in premenopausal + fluctuate with hormones
= follicular cyst most common but not harmful
= corpus luteum cyst can cause pain/discomfort/delayed menstruation
describe 5 other types of ovarian cysts
- serous cystadenoma = benign
- mucinous cystadenoma = benign but can become huge
- endometrioma = endometriosis lumps of tissue = pain/disrupt ovulation
- dermoid cyst/germ cell tumour = benign, associated with torsion
- sex cord-stromal tumours = rare, can be malignant
what features suggest ovarian cyst malignancy
abdo bloating
reduced appetite
weight loss
urinary symptoms
pain
ascites/lymphadenopathy
describe the investigations and management for a simple/small ovarian cyst
blood test
USS
CT or MRI if unable to see on USS
laparoscopy and fine needle aspirate
premenopausal + simple cyst <5cm on USS = no further
rule out pregnancy + CA125 tumour marker
what is the tumour marker for ovarian cancer and what does a raised marker indicate
CA125
raised = not specific:
endometriosis
fibroids
adenomyosis
pelvic infection
liver disease
pregnancy
what is the risk of malignancy index
RMI = risk of malignant ovarian mass:
1. menopausal status
2. USS findings
3. CA125 level
describe the management for a larger ovarian cyst
5-7cm - refer to gynae and yearly USS
>7cm - MRI or surgical evaluation = laparoscopy/ovarian cystectoomy/oopherctomy
what are the complications of an ovarian cyst
= ACUTE ONSET PAIN
torsion
haemorrhage into the cyst
rupture = bleeding into peritoneum
what is Meig’s syndrome
triad:
1. ovarian fibroma (mass)
2. pleural effusion
3. ascites
= older women
= remove tumour to resolve effusion/ascites
what is early miscarriage vs late miscarriage
spontaneous termination of pregnancy
early = before 12 weeks
late = 12-24 weeks gestation
what is a missed miscarriage
fetus no longer alive but no symptoms
what is a threatened miscarriage
vaginal bleeding with closed cervix and alive foetus
what is an inevitable miscarriage
vaginal bleeding and open cervix (finger into internal os)
what is an incomplete miscarriage vs complete miscarriage
incomplete = retained products of conception remain in uterus = may need medical/surgical management for miscarriage
complete = full miscarriage, no products left in uterus
what is an anembryonic pregnancy
gestational sac present but no embryo
how is a miscarriage diagnosed
transvaginal USS
1. mean gestational sac diameter (should be >25mm before pole)
2. fetal pole and crown-rump length (should be >7mm before heartbeat)
3. fetal heartbeat = pregnancy considered viable