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Women's Health > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What can reduced fetal movements indicate?

A

Fetal distress

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2
Q

How are reduced fetal movements used to compensate for fetal distress?

A

Used to reduce oxygen consumption in response to chronic hypoxia

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3
Q

When should the first fetal movements occur?

A

Between 18-20 weeks gestation

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4
Q

Name 5 risk factors for reduced fetal movement

A
  • Posture
  • Distraction
  • Placental position
  • Medication
  • Fetal position
  • Body habitus
  • Amniotic fluid volume
  • Fetal size
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5
Q

Why is posture a risk factor for decreased fetal movement?

A

More prominent when lying down and less so when standing up

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6
Q

Why is distraction a risk factor for decreased fetal movement?

A

When a woman is busy the fetal movements can be less prominent

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7
Q

Why is placental position a risk factor for decreased fetal movement?

A

A patient with anterior placentas prior to 28 weeks gestation may have less awareness for feal movement

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8
Q

Why is medication a risk factor for decreased fetal movement?

A

Alcohol and sedative medications (opiates or benzodiazepines) can temporarily cause it

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9
Q

Why is fetal position a risk factor for decreased fetal movement?

A

Anterior fetal position means movements are less noticeable

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10
Q

Why is body habitus a risk factor for decreased fetal movement?

A

Obese patients are less likely to feel movements

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11
Q

Why is amniotic fluid volume a risk factor for decreased fetal movement?

A

Both oligohydramnios and polyhydramnios can cause reduced fetal movements

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12
Q

Why is fetal size a risk factor for decreased fetal movement?

A

Up to 29% of women presenting with reduced fetal movements have a small gestational age fetus

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13
Q

What is oligohydramnios?

A

Decreased amniotic fluid

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14
Q

What is polyhydramnios

A

Too much amniotic fluid

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15
Q

How are fetal movements investigated?

A

Usually based on maternal perception

Can be assessed with a doppler ultrasound or ultrasonography

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16
Q

What is the most common problem of the progesterone only pill?

A

Irregular vaginal bleeding

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17
Q

How often should you take the progesterone only pill?

A

Same time everyday with no breaks

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18
Q

How long until you are protected from the progesterone only pill?

A

If commenced up to and including day 5 of the cycle it provides immediate protection

Otherwise additional contraception should be used for the first 2 days

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19
Q

When are pregnant women screened for anaemia?

A
  • The booking visit (8-10 weeks)
  • 28 weeks
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20
Q

What are the NICE cutoffs for oral iron therapy in pregnant women?

A
  • First trimester < 110g/L
  • Second/Third trimester < 105g/L
  • Postpartum < 100g/L
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21
Q

What is the management for anaemia in pregnancy

A
  • Oral ferrous sulfate or ferrous fumararte
  • Treatment continued for 3 months after iron deficiency is replenished
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22
Q

What scale is used to screen for postnatal depression?

A

The Edinburgh Postnatal Depression Scale

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23
Q

What are the 3 most common post partum mental health problems?

A
  • Baby blues
  • Postnatal depression
  • Puerperal psychosis
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24
Q

When does ‘baby-blues’ typically occur?

A

3-7 days following birth

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25
Q

How does ‘baby-blues’ present?

A

Anxiety, tearful and irritable

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26
Q

Management for baby blues?

A

Reassurance and support, the health visitor has a key role

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27
Q

When does postnatal depression typically occur?

A

Within a month but peaks at 3 months

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28
Q

How does postnatal depression present?

A

Features similar to depression

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29
Q

Management for postnatal depression?

A
  • Reassurance and support
  • Cognitive behavioural therapy can be beneficial
  • Certain SSRI’s like sertraline and paroxetine
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30
Q

Why is paroxetine useful when breast feeing?

A

Because of the low milk/plasma ratio

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31
Q

When does puerperal psychosis typically present?

A

Within the first 2-3 weeks following birth

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32
Q

How does puerperal psychosis present?

A
  • Severe mood swings (similar to bipolar)
  • Disordered perception (e.g auditory hallucinations)
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33
Q

Management of puerperal psychosis?

A
  • Admission to hospital (mother and baby unit)
  • Antipsychotics, mood stabilisers or antidepressants
  • Electroconvulsive therapy
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34
Q

What is menorrhagia?

A

Heavy menstrual bleeding

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35
Q

Investigations for heavy menstrual bleeding

A
  • Full blood count
  • Transvaginal ultrasound
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36
Q

What is the management for heavy menstrual bleeding (no contraception)

A

Mefenamic acid or tranexamic acid on first day of period

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37
Q

What is the management for heavy menstrual bleeding (contraception)

A
  • Intrauterine system (minera) is first line
  • Combined oral contraceptive pill
  • Long acting progesterones
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38
Q

Definition of endometrial hyperplasia

A

An abnormal proliferation of the endometrium in excess of whats normal during the menstrual cycle

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39
Q

Types of endometrial hyperplasia

A
  • Typical
  • Atypical
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40
Q

Presentation of endometrial hyperplasia

A

Abnormal vaginal bleeding

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41
Q

Management of typical endometrial hyperplasia

A
  • High dose progesterones with repeat sampling in 3-4 months
  • Levonorgestrel intrauterine system
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42
Q

Management of atypical endometrial hyperplasia

A

Hysterectomy

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43
Q

What are the 3 main categories of ovulatory disorders?

A
  • Hypogonadotropic hypogonadal anovulation
  • Normogonadotropic normoestrogenic anovulation
  • hypergonadotropic hypoestrogenic anovulation
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44
Q

First line treatment for infertility in polycystic ovarian syndrome?

A

Exercise and weight loss

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45
Q

What is the first line medical treatment for infertility in PCOS?

A

Letrozole

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46
Q

Letrozole - MOA?

A
  • Aromatase inhibitor
  • Reduces negative feedback caused by oestrogens to the pituitary gland
  • This increases FSH production
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47
Q

Letrozole - Side effects

A
  • Fatigue
  • Dizziness
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48
Q

What is clomiphene citrate

A

A PCOS infertility treatment

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49
Q

Clomiphene citrate - MOA?

A
  • Selective oestrogen receptor modulator
  • Works in hypothalamus to block negative feedback of oestrogens
  • Increases GnRH = Increase in FSH and LH
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50
Q

Clomiphene citrate - Side effects

A
  • Hot flushes
  • Abdominal distension and pain
  • Nausea and vomiting
51
Q

What is ovarian hyperstimulation syndrome?

A

A potential side effect of ovulation induction

52
Q

Pathophysiology of ovarian hyperstimulation syndrome

A
  • Ovarian enlargement occurs and cystic spaces form
  • The capillaries increase in permeability so fluid shifts from intravascular to extravascular space
53
Q

Complications of ovarian hyperstimulation syndrome

A
  • Hypovolaemic shock
  • Acute renal failure
  • Venous or arterial thromboembolism
54
Q

Management of ovarian hyperstimulation syndrome

A
  • Fluid and electrolyte replacement
  • Anticoagulation therapy
  • Abdominal ascitic paracentesis
  • Pregnancy termination to prevent hormonal imbalances
55
Q

Risk factors for gestational diabetes?

A
  • BMI > 30kg/m2
  • Previous macrosomic baby weighing 4.5kg or above
  • Previous gestational diabetes
  • First degree relative with diabetes
  • Family origin with a high prevalence of diabetes
56
Q

Gestational diabetes investigation

A

Oral glucose tolerance test
- if previous gestational diabetes test should be done at booking

57
Q

Diagnostic threshold for gestational diabetes

A
  • Fasting glucose > 5.6mmol/L
  • 2 hour glucose > 7.8mmol/L
58
Q

Management of gestational diabetes

A
  • Diet and exercise
  • If targets not met from exercise add metformin
  • If targets still not met then add short acting insulin as well
    GLIBENCLAMIDE - if cannot tolerate metformin
59
Q

What is levonorgestrel

A

‘Morning after pill’ (emergency contraception)

60
Q

Dose and indications of levonorgestrel

A

Must be taken within 72 hours - single dose of 1.5mg

(doubled for a weight over 70kg or bmi over >26)

61
Q

What is Ulipristal?

A

Emergency contraception - EllaOne

62
Q

Ulipristal - MOA

A
  • Selective progesterone receptor modulator
  • Inhibits ovulation
63
Q

Dose and indications of Ulipristal

A

Taken no later than 120 hours after - Oral dose of 30mg

64
Q

When can contraception be taken after using ulipristal?

A

Contraception should be restarted 5 days after as it can effect the effectiveness

65
Q

What screening tests should be done for downs syndrome

A
  • Nuchal translucency measurement
  • Serum B-HCG
  • Pregnancy associated plasma protein A
66
Q

When should screening for downs syndrome be done?

A

between 11 - 13+6 weeks

67
Q

What results of screening suggest downs syndrome

A
  • Raised HCG
  • Decreased PAPP-A
  • Thickened nuchal translucency
68
Q

Which 3 chromosomal abnormalities do we screen for?

A

Down’s syndrome - Trisomy 21
Edward syndrome - Trisomy 18
Patau syndrome - Trisomy 13

69
Q

What is fetal varicella syndrome

A
  • When the mother gets chickenpox during pregnancy and it can pass to the foetus
70
Q

Management of chickenpox exposure in pregnancy

A
  • If less than 20 weeks gestation and not immune then she should have varicella-zoster immunoglobulin
  • If greater than 20 weeks gestation then varicella-zoster immunoglobulin or antivirals should be given
71
Q

What is hrHPV

A

High risk strains of human papillomavirus

72
Q

Management of negative hrHPV

A

RETURN TO NORMAL RECALL UNLESS:
- On the test of cure pathway (6 months after treatment)
- Follow ups

73
Q

Management of positive hrHPV

A

SAMPLES EXAMINED CYTOLOGICALLY
- If cytology is abnormal then colposcopy
- If cytology is normal then test is repeated in 12 months
- If now negative return to normal recall

74
Q

What is mastitis?

A

Inflammation of the breast tissue that may involve an infection

75
Q

First line treatment for mastitis

A

Flucloxacillin for 10-14 days
Breast feeding should continue during treatment

76
Q

Complications of mastitis

A

May develop into a breast abscess
This would require incision and drainage

77
Q

What is engorgement?

A

Your breasts can become overly full
- Always affects both breasts

78
Q

Symptoms of engorgement

A
  • Pain in both breasts
  • Pain or discomfort before a feed
  • Milk tends to not flow well
  • Breasts may appear red
  • Fever
79
Q

Complications of engorgement

A
  • Blocked milk ducts
  • Mastitis
  • Difficulties breast feeding
80
Q

Treatment for engorgement

A
  • Hand expression of milk
  • Warm compress
  • Feeding more regularly
81
Q

What is Raynaud’s disease of the nipple?

A

Blanching and cyanosis of the nipple
- Causes pain during and immediately after breast feeding

82
Q

Treatment for Raynaud’s disease of the nipple

A
  • Minimise exposure to cold
  • Warm compress after feeding
  • Avoid caffeine and stop smoking
83
Q

Urinary incontinence risk factors

A
  • Advancing age
  • Previous pregnancy and childbirth
  • High body mass index
  • Hysterectomy
  • Family history
84
Q

What are the different classifications of urinary incontinence

A
  • Overactive bladder/urge incontinence
  • Stress incontinence
  • Mixed incontinence
  • Overflow incontinence
  • Functional incontinence
85
Q

What is urge incontinence?

A
  • Detrusor overactivity
  • Urge to urinate followed by uncontrollable leakage
86
Q

What is stress incontinence?

A

Leaking small amounts when coughing or laughing

87
Q

What is mixed incontinence?

A

Both urge and stress

88
Q

What is overflow incontinence?

A

Due to bladder outlet obstruction (prostate enlargement)

89
Q

What is functional incontinence?

A
  • Comorbid physical conditions impair ability to get to the toilet in time
  • Causes inclue dementia, sedating mediation or injury/illness
90
Q

Investigations for urinary incontinence

A
  • Bladder diaries completed for a minimum of 3 days
  • Vaginal examination (excludes pelvic organ prolapse)
  • Urine dipstick and culture
  • Urodynamic studies
91
Q

Urge incontinence management

A
  • Bladder retraining
  • Bladder stabilising drugs (antimuscarinics)
  • Mirabegron (beta 3 agnoist) may be used if concern of anticholinergic side effects in frail elderly patients
92
Q

Stress incontinence management

A
  • Pelvic floor muscle training
  • Surgical procedures
  • Duloxetine (noradrenaline and serotonin reuptake inhibitor)
93
Q

What is umbilical cord prolapse?

A

When the umbilical cord descends ahead of the presenting part of the foetus

94
Q

Complications of umbilical cord prolapse

A

Can lead to compression of the cord or cord spasm
- Cause foetal hypoxia

95
Q

Risk factors for cord prolapse

A
  • Prematurity
  • Multiparity
  • Polyhydrammios
  • Twin pregnancy
  • Cephalopelvic disproportion
  • Abnormal presentations
96
Q

When do 50% of cord prolapses occur?

A

Artificial rupture of the membranes

97
Q

Management of cord prolapse

A
  • Presenting part of the foetus pushed back into uterus
  • Minimal handling of the cord and kept warm to avoid vasospasm
  • Patient on all 4s
  • Tocolytics to reduce uterine contractions
  • C section is first line
98
Q

What is shoulder dystocia?

A

The head has been delivered but the shoulder is stuck behind the mothers pubic symphysis

99
Q

What is shoulder dystocia a complication of?

A

Vaginal cephalic delivery

100
Q

Key risk factors

A
  • Foetal macrosomia
  • High maternal body mass index
  • Diabetes mellitus
  • Prolonged labour
101
Q

Shoulder dystocia management

A

McRoberts manoeuvre

102
Q

What is the McRoberts manoeuvre?

A
  • Flexion and abduction of maternal hips, mothers thighs towards her abdomen
  • This increases relative anterior-posterior angle of the pelvis
103
Q

Complications of shoulder dystocia

A

Maternal - postpartum haemorrhage & perineal tears
Foetal - brachial plexus injury & neonatal death

104
Q

Differential diagnosis for jaundice in pregnancy

A
  • Intrahepatic cholestasis of pregnancy
  • Acute fatty liver of pregnancy
  • Gilberts syndrome (may be exacerbated)
  • Dubin-Johnson syndrome (may be exacerbated)
  • HELLP syndrome
104
Q

Features of intrahepatic cholestasis of pregnancy

A
  • pruritus, palms and soles
  • No rash
  • Raised bilirubin
105
Q

Management of intrahepatic cholestasis of pregnancy

A
  • Ursodeoxycholic acid (symptom relief)
  • Weekly liver function tests
  • Induction at 37 weeks
106
Q

Complications of intrahepatic cholestasis of pregnancy

A

Increased rate of stillbirth

107
Q

When might acute fatty liver of pregnancy occur?

A

In the third trimester or immediately following delivery

108
Q

Features of acute fatty liver of pregnancy

A
  • Abdominal pain
  • N&V
  • Headache
  • Jaundice
  • Hypoglycaemia
  • If severe may result in pre eclampsia
109
Q

Investigations for acute fatty liver of pregnancy

A
  • Raised ALT
110
Q

Management of acute fatty liver of pregnancy

A
  • Supportive care
111
Q

What does HELLP syndrome stand for

A
  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets
112
Q

What is the triad of presentation in pre-eclampsia

A
  • New onset hypertension
  • Proteinuria
  • Oedema
113
Q

Definition of pre-eclampsia

A
  • New onset blood pressure >140/90 mmHg after 20 weeks of pregnancy and ONE of the following
  • Proteinuria
  • Other organ involvement e.g renal insufficiency, liver or neurological
114
Q

Potential consequences of pre-eclampsia

A
  • eclampsia
    • other neurological complications (altered mental state, stroke, severe headaches)
  • Fetal complications
    • Intrauterine growth retardation
    • Prematurity
  • Liver involvement
  • Haemorrhage
  • Cardiac failure
115
Q

Prevention of pre eclampsia

A
  • Take aspirin 75-150mg daily from 12 weeks gestation until birth if
    • > 1 high risk factor
    • > 2 moderate risk factors
116
Q

Management of pre-eclampsia

A
  • Oral labetalol (nifedipine if asthmatic)
117
Q

What is postpartum haemorrhage defined as

A
  • The blood loss of > 500mls
118
Q

Management for primary postpartum haemorrhage

A
  • ABC including 2 peripheral cannulae
  • IV syntocinon (oxytonin)
  • IM carboprost (prostaglandin analogue)
  • Surgical options may need to be considered
119
Q

What is placenta praevia

A

A placenta lying wholly or partly in the lower uterine segment

120
Q

Risk factors for placenta praevia

A
  • Multiparity
  • Multiple pregnancy
  • Embryos more likely to implant on a lower segment scar from previous c-section
121
Q

Features of placenta praevia

A
  • No pain
  • Uterus not tender
  • Lie and presentation may be abnormal
  • Fetal heart normal
  • Small bleeds before large
122
Q

Diagnosis of placenta praevia

A
  • Digital vaginal examination should NOT be performed
  • Often picked up on a 20 week scan
  • Transvaginal ultrasound is recommended

Women's Health (1 decks)

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