Women's Health Flashcards
Chicken pox >20 weeks
Oral Acyclovir or VZIG
<20 weeks and not immune to Varicella
VZIG
Risk for Hyperemesis
Twin pregnancy
Draggy and heavy uterus
Urogenital prolapse
Cervical excitation causes
PID and Ectopic pregnancy
> 8 Bishops score
Vaginal birth likely
<6 Bishops score
Vaginal birth unlikely and needs induction
Chocolate cyst
Endometriotic cyst
Most common ovarian cancer
Serous Carcinoma
Simple cysts in young woman
follicular or corpus luteal
Bladder palpable after urination
urinary overflow
Signs of labor
Regular and painful uterine contractions, shedding mucos plus, ROM, shortening and dilation of cervix
Stages of Labor Stage 1:
onset of true labor to when cervix is fully dilated
10-16 hours in primigravida
latent phase: 0-3 cm dilation
Active phase: 3-10 cm
Stage 2 labor
From full dilation to delivery of fetus
Passive second stage: absence of pushing
Active second stage: maternal pushing
> 1 hour- ventouse extraction, forceps or C section
Stage 3
from delivery of fetus to when the placenta and membrane have completely delivered
Management of GBS
intrapartum Antibiotics such as Benzylpenicillin
Breech babies at or after 36 weeks
USS at 6 weeks
Reduce size of fibroid using
GNRH analogues
Mefenamic Acid
treat dysmenorrhea and Heavy menstrual bleeding
transxamic Acid
Menorrhagia and excessive blood loss
Antiphospholipid syndrome
Recurrent miscarriage;
Snow-storm appearance of uterus and abnormally large uterus and high hCG
Hydatiform mole
Most common cause of post-coital bleeding
Cervical Ectropion
Location of most ectopic pregnancy
Ampulla of Fallopian tube
Cocaine use is associated with (pregnancy)
Placental abruption
What ovarian tumour is related to Endometrial Hyperplasia
Granulosa cell tumour
Investigation of choice in Ectopic pregnancy
TVUS
Medical management of Miscarriage
Misoprostol
Known Previa going to labour prior to elective C-section
conduct an emergency c section
Spirometry in IPF- FEV1, FEV1/FVC and TLCO
FEV1 increased or normal
FEV1/FVC decreased
FVC decreased
Week when External cephalic version can be performed
36 week
37 if multiparous
Red degeneration
Fibroid degeneration during pregnancy, Low grade fever, pain, and vomiting
Managed with rest and analgesia, resolves in 4-7 days
Risks associated with Abruption
Maternal age, Multiparity and Advanced age
What is a galactocele
Women recently stopped breastfeeding; occlusion of a lactiferous duct; cystic lesion formed
1st line for management of Fibroids <3 cm
Levonorgestrel IUS
Breast tumour less then 4 cm
Wide local excision
Best imaging to diagnose Adenomyosis
MRI pelvis
Gold standard diagnosis for placenta previa
TVUS
Management of Post parturition Hemorrhage
1st line: IV syntocinon (oxytocin) or IV ergometrine
2nd line: carboprost
Surgical management: Intrauterine balloon tamponade - Uterine Atony is the cause
Pre-eclampsia Features
Eclampsia, fetal complications - IGR, prematurity, liver enzymes elevated, hemorrhage and cardiac failure
Ovarian torsion is associated with what sign on USS
Whirlpool sign
high risk pregnancy management
Aspirin 150mg daily from 12 week
High blood sugar in pregnancy
Fasting = 5.6 and 2 Hour =7.8
Placenta Accreta
Abnormal adherence by placental villi
Increta
Chorionic villi invade the myometrium
Pancreta
chorionic villi penetrate the uterine serosa and other organs such as bladder
Perineal tears
1st degree: vaginal mucosa torn
2nd degree: perineal muscles torn
3rd degree: Anal sphincter torn
4th degree: Rectum torn
Snowstrom Appearance on USS
Hyadtiform mole/ molar pregnancy
Investigation for miscarriage
TVUS
management of simple ovarian cysts
If asymptomatic - NO action
>5 cm - surgery; CA-125
Early pregnancy, smoking, spotting, Pain
Ectopic pregnancy
C-section is a risk factor for what pain causing 3rd trimester condition
Placenta Praevia
Most common cause of post-partum hemorrhage
Uterine Atony
4 Ts tone tissue trauma and thrombin
Cord prolapse
Push the head and not the cord
Immediate C-section
string on pearls on USS
PCOS
Abnormal smear and abnormal cytology
Colposcopy
Most common symptom associated with fibroids
Heavy menstrual bleeding/ Menorrhagia
Oligomenorrhia + Subfertility + Hirstuism + USS - beads on string
PCOS
Ectropion is commonest cause of
Post-coital bleeding
Most significant risk of vaginal birth after C-section
Uterine Rupture
Placenta praevia going for preterm birth
Emergency C-section ASAP!!!
Eclampsia treat with
MGSO4 (immediate) + C-section
Oligohydraminos cause
poor functional fetal kidneys
Polyhydraminos Cause
duodenal atresia and maternal diabetes
Thin and unilocular cyst is linked to
Simple cysts
Surfactant lung disease risk factors
Male sex; diabetic mother, C-section and 2nd premature twin
Investigation of PROM
Speculum exam
Hyperreflexia is an important symptom of
Pre-eclampsia
When should Vitamin K be given in epilepsy in a pregnant woman
36 week onwards
Carries a risk of hemorrhagic disease of the newborn
HIV is screened at booking scan - True or false
True
Combined test for Downs
Nuchal translucency, HCG, PAPP-A
Triple test for downs
Combined + AFP + oestriol and inhibin A
Quadruple
HCG, estriol, AFP, Inhibin A
Pulmonary hypertension, hypoxia, amniotic fluid and fetal matter in maternal lungs, collapse, respiratory distress, central cyanosis, DIC
Amniotic fluid embolism
10-13 weeks antenatal timetable
Booking scan- Advice, smoking, alcohol, folic acid, Bloods, rhesus status, HIV test, syphilis, Hepatitis screen.
Dating scan - USS
Down’s Screening
18-20 weeks antenatal timetable
Anomaly scan
24 weeks antenatal timetable
SFH measure
28 weeks
Anti-D for rhesus negative mothers
GTT
36 weeks
identify presentation
Risk for preterm labor
Acute illness, low BMI, Multiple pregnancy, polyhydraminos, PROM, cervical surgery, smoking, uterine abnormality
Management of shoulder dystocia
Episiotomy, Mcrobert’s, suprapubic pressure, internal rotation
Miscarriage and antiD
RH-ve mother and >12 weeks gestation
Surgical treatment of ectopic
Laparoscopic salpingectomy of affected tube
salpingostom if contralateral tube is absent or damaged
Laparotomy if unstable
1st trimester surgical Termination
Vaccum aspiration
2nd trimester termination
dilatation and evacuation
Endometrial cancer risks
Obesity, tamoxifen, HRT, increased estrogen, Lynch syndrome
Dysmenorrhea, deep dyspareunia, chronic pelvic pain, and ovulation pain; subfertility, dyschezia
Endometriosis
Menorrhagia causes
Fibroids, coagulopathy, pelvic cancers
Treatment of fibroids
Submucosal: trans-cervical resection
Intramural and subserosal: myomectomy
Hysterectomy
uterine artery embolization
PPH management
Oxytocin
Main lymph drainage of ovary
Para-aortic nodes
Mittelschmerz
mild suprapbic pain due to ovulation; subsides in 1-2 days
When should a referral made for no fetal movements in pregnancy
24 weeks
Management of Atrophic vaginitis
Moisturiser, water based lubricant and topical estrogen therapy
Most common site for Ectopic pregnancy
Ampulla in Fallopian tube
Why does ectopic pregnancy cause Shoulder tip pain
Ruptured contents in the abdomen causes irritation of the diaphragm
Risks for an ectopic pregnancy
Previous ectopic; IUD use, chronic inflammation, tubule surgery, progesterone only pill and IVF
Investigations in Ectopic pregnancy
First line: beta HCG and urinalysis
Gold standard: Transvaginal USS
Viable pregnancy in ectopic
HCG will double every 48 hours
What are the indications for expectant management in ectopic
Size <35mm Unruptured Asymptomatic and no heart beat Serum bHCG <1000 Compatible with another intrauterine pregnancy
Indication for medical management with Methotrexate in ectopic pregnancy
Size <35 mm Unruptured No pain No fetal heart beat <1500 hcg
Surgical management of ectopic by Laparoscopic or laparotomy - indications
Size >35 mm Ruptured Pain Visible fetal heartbeat >1500 hCG
Endometrioma in ovary is called
Chocolate cysts
Chronic pain, dysmenorrhea, deep dyspareunia, sub-fertility
Endometriosis
Gold standard diagnosis for endometriosis
Laparoscopic surgery
Management of endometriosis
NSAIDs/ paracetamol - 1st line
COCP or progestrins such as medroxyprogesterone acetate
Fertility priority
GNRH analogues
Laparoscopic excision and laser treatment
When does red degeneration of a fibroid occur
During pregnancy
Menorrhagia, iron deficiency, cramping abdominal pains and menstruation, subfertility, polycythemia
Fibroids
Diagnosis of fibroids
transvaginal USS
Medical and surgical treatment of fibroids
Progesterone tablets, GnRH analogues
Surgical: Myomectomy, hysteroscopic endometrial ablation, uterine artery embolization
Management of menorrhagia secondary to fibroids
Levonorgestrel Intrauterine system - IUS
NSAIDs such as Mefenamic acid, tranexamic acid, COCP
Bleeding from a closed cervical, does not result in a miscarriage
Threatened miscarriage
Bleeding from an open cervix, abdominal cramps, uterine contents visible during pelvic examination, heavy bleeding
Inevitable miscarriage
Open cervix, passing of uterine contents, Not all products are yet expelled and the OS is open and bleeding
Incomplete miscarriage
Uterine cavity is empty
Complete miscarriage
No symptoms of expulsion, fetus is not viable
Missed miscarriage
Diagnosis of miscarriage
TVUS
Pelvic exam
HCG levels
Treatment of missed, incomplete and inevitable miscarriage
Vaginal Misoprostol
vacuum aspiration or suction curettage
Dilation, curettage and uterine aspiration
Expectant miscarriage management
Wait and watch - 7 to 14 days
High risk patients: Coagulopathy, later first trimester
Previous adverse events and infection
Commonest type of ovarian cyst
Follicular cyst
These cysts are only seen during pregnancy
Theca lutein cysts
Most common ovarian tumour in young women (under 30)
Dermoid cysts (likely to cause torsion)
Most common benign epithelial tumour
Serous cystadenoma
Which cyst on rupture can cause pseudomyxoma peritonei
Mucinous cystadenoma
Diagnosis of ovarian cysts
Abdominal USS, MRI, CA-125, histology USS guided
> 5 cm ovarian cyst
Laparoscopically removed
What is the ratio of LH and FSH in PCOS
LH > FSH 2:1
Decreased SHBG, Raised free testosterone; insulin resistance, raised testosterone and Estrogen
PCOS
Diagnosis of PCOS
Anovulation (primary)
Hyperandrogenism
PC ovary >12 on TVUS
What is an endometrial complication of PCOS
Endometrial hyperplasia
Acanthosis nigricans
Skin patches related to PCOS
Management of PCOS
OCPs and Co-cyprindiol
Topical eflornithine
Fertility - Clomiphene and met Forman
Ovarian drilling - surgical
Prevention of Anemia in pregnancy
60 mg iron and 400 mcg folic acid until 12 weeks
5 mg if high risk pregnancy - NTD, SCD
Descent of umblical cord through cervix along with or past the presenting part in PROM
Cord prolapse
Risks of cord prolapse
Artificial ROM, breech position, polyhydramnios, congenital anomalies and previous cord prolapse
Management of cord prolapse
push the head not the cord
Bladder filling
exaggerated Sims position
C-section if not dilated
Placental hormones that can relate to gestational diabetes
Growth hormone, CRH, Placental lactogen
Risks for GD
Increased maternal age, obesity, previous macrosomia, FH, PCOS, South asian
GD screening occurs at
24 to 28 weeks
> 7 mmol/L fasting glucose (normally 5.6)
Insulin should be started
Pre-existing diabetes
High risk preganancy and treat with folic acid 5 mg, glycemic control and 20 w anomaly scan
What vitamin is recommended in AEDs taking mothers babies
Vitamin K
LFTs in Obstretic cholestasis
High bilirubin, ALT, AST and bile acids - 10-100 times
Management of obstretic cholestasis
Ursodeoxycholic acid
Vitamin K
37 week induction of labour
when placenta lies near the OS
Placenta Previa
Risk factors for previa
Endometrial scarring - Previous C-section, increased parity and prior Curettage, smoking, multiple gestation and high altitude
Painless PV bleeding, shock, non-tender uterus,
Previa
Accreta
abnormal placental implantation into the uterus by placental villi
Increta
Chorionic villi invade the myometrium
Percreta
Involves uterine serosa and other organs
Diagnosis of Previa and other placental abnormality
Tranvaginal USS
MRI- Accreta
Management of previa
repeat USS at 34 weejs
at 37 week C-section
Painful 3rd trimester bleeding, tender tense uterus, coagulation problems, Anuria, pre-eclampsia
Placental abruption
confirmation of placental abruption diagnosis
USS - retroplacental blood clot or collection
<36 weeks and alive fetus in abruption
Distress- c-section
no distress- steroids
> 36 weeks in abruption
Distress- C-section
no distress- vaginal induction
Fetus dead in abruption
Vaginal delivery
Commonest cause of PPH
Uterine atony
Risk factors to PPH
previous PPH, prolonged labour, pre-eclampsia, increased age, polyhydramnios, placental abnormalities such as previa and accreta
Management of PPH
Oxytocin aka syntocin Syntometrine: oxytocin + Ergot drugs Uterine massage Surgical: intrauterine balloon tamponade - uterine atony B- lynch suture
Secondary PPH occurs
between 24 hours to 12 weeks
Triad of pre-eclampsia
Hypertension + proteinuria + oedema
HELLP syndrome
Hemolysis, elevated liver enzymes and low platelets
Risk reduction in pregnancy - hypertension
> 1 high risk factor or >2 moderate risks - Aspirin 75 to 150 mg daily from 12 weeks until the birth
Medications in Gestational hypertension
Labetalol 1st line
Nifedipine is asthmatic
Antibiotics that can be used in Pregnancy
Trimethoprim cant be used in 1st trimester
Amoxicillin and nitrofurantoin
do not use nitrofurantoin in last trimester
treat for 7 days
What is the classic feature of vasa previa
Fetal bradycardia
Risk factor for vasa previa
placenta previa, multiple pregnancy, iVF
Screen for VCI
vasa previa - velamentous insertion of the cord; no wharton’s jelly
Treat dysmenorrhea
Nsaids such as mefenamic acid
COCP 2nd line
Whirlpool sign
Torsion
how mant visits in first pregnancy
10 antenatal visits
How many in non-first pregnancy
7 antenatal visits
18-21 weeks what happens in antenatal time period
Anomaly scan
first dise of anti-D prophylaxis
28 weeks
2nd dose of anti-d
34 week s
Offer external cephalic version
36 week s
latent phase of stage 1
0-3 cm dilation
active phase of stage 1
3-10 cm dilation
