Women's Health Flashcards
1
Q
What can reduced fetal movements indicate?
A
Fetal distress
2
Q
How are reduced fetal movements used to compensate for fetal distress?
A
Used to reduce oxygen consumption in response to chronic hypoxia
3
Q
When should the first fetal movements occur?
A
Between 18-20 weeks gestation
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
5
Q
Why is posture a risk factor for decreased fetal movement?
A
More prominent when lying down and less so when standing up
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
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
8
Q
Why is medication a risk factor for decreased fetal movement?
A
Alcohol and sedative medications (opiates or benzodiazepines) can temporarily cause it
9
Q
Why is fetal position a risk factor for decreased fetal movement?
A
Anterior fetal position means movements are less noticeable
10
Q
Why is body habitus a risk factor for decreased fetal movement?
A
Obese patients are less likely to feel movements
11
Q
Why is amniotic fluid volume a risk factor for decreased fetal movement?
A
Both oligohydramnios and polyhydramnios can cause reduced fetal movements
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
13
Q
What is oligohydramnios?
A
Decreased amniotic fluid
14
Q
What is polyhydramnios
A
Too much amniotic fluid
15
Q
How are fetal movements investigated?
A
Usually based on maternal perception
Can be assessed with a doppler ultrasound or ultrasonography
16
Q
What is the most common problem of the progesterone only pill?
A
Irregular vaginal bleeding
17
Q
How often should you take the progesterone only pill?
A
Same time everyday with no breaks
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
19
Q
When are pregnant women screened for anaemia?
A
- The booking visit (8-10 weeks)
- 28 weeks
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
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
22
Q
What scale is used to screen for postnatal depression?
A
The Edinburgh Postnatal Depression Scale
23
Q
What are the 3 most common post partum mental health problems?
A
- Baby blues
- Postnatal depression
- Puerperal psychosis
24
Q
When does ‘baby-blues’ typically occur?
A
3-7 days following birth
25
How does 'baby-blues' present?
Anxiety, tearful and irritable
26
Management for baby blues?
Reassurance and support, the health visitor has a key role
27
When does postnatal depression typically occur?
Within a month but peaks at 3 months
28
How does postnatal depression present?
Features similar to depression
29
Management for postnatal depression?
- Reassurance and support
- Cognitive behavioural therapy can be beneficial
- Certain SSRI's like sertraline and paroxetine
30
Why is paroxetine useful when breast feeing?
Because of the low milk/plasma ratio
31
When does puerperal psychosis typically present?
Within the first 2-3 weeks following birth
32
How does puerperal psychosis present?
- Severe mood swings (similar to bipolar)
- Disordered perception (e.g auditory hallucinations)
33
Management of puerperal psychosis?
- Admission to hospital (mother and baby unit)
- Antipsychotics, mood stabilisers or antidepressants
- Electroconvulsive therapy
34
What is menorrhagia?
Heavy menstrual bleeding
35
Investigations for heavy menstrual bleeding
- Full blood count
- Transvaginal ultrasound
36
What is the management for heavy menstrual bleeding (no contraception)
Mefenamic acid or tranexamic acid on first day of period
37
What is the management for heavy menstrual bleeding (contraception)
- Intrauterine system (minera) is first line
- Combined oral contraceptive pill
- Long acting progesterones
38
Definition of endometrial hyperplasia
An abnormal proliferation of the endometrium in excess of whats normal during the menstrual cycle
39
Types of endometrial hyperplasia
- Typical
- Atypical
40
Presentation of endometrial hyperplasia
Abnormal vaginal bleeding
41
Management of typical endometrial hyperplasia
- High dose progesterones with repeat sampling in 3-4 months
- Levonorgestrel intrauterine system
42
Management of atypical endometrial hyperplasia
Hysterectomy
43
What are the 3 main categories of ovulatory disorders?
- Hypogonadotropic hypogonadal anovulation
- Normogonadotropic normoestrogenic anovulation
- hypergonadotropic hypoestrogenic anovulation
44
First line treatment for infertility in polycystic ovarian syndrome?
Exercise and weight loss
45
What is the first line medical treatment for infertility in PCOS?
Letrozole
46
Letrozole - MOA?
- Aromatase inhibitor
- Reduces negative feedback caused by oestrogens to the pituitary gland
- This increases FSH production
47
Letrozole - Side effects
- Fatigue
- Dizziness
48
What is clomiphene citrate
A PCOS infertility treatment
49
Clomiphene citrate - MOA?
- Selective oestrogen receptor modulator
- Works in hypothalamus to block negative feedback of oestrogens
- Increases GnRH = Increase in FSH and LH
50
Clomiphene citrate - Side effects
- Hot flushes
- Abdominal distension and pain
- Nausea and vomiting
51
What is ovarian hyperstimulation syndrome?
A potential side effect of ovulation induction
52
Pathophysiology of ovarian hyperstimulation syndrome
- Ovarian enlargement occurs and cystic spaces form
- The capillaries increase in permeability so fluid shifts from intravascular to extravascular space
53
Complications of ovarian hyperstimulation syndrome
- Hypovolaemic shock
- Acute renal failure
- Venous or arterial thromboembolism
54
Management of ovarian hyperstimulation syndrome
- Fluid and electrolyte replacement
- Anticoagulation therapy
- Abdominal ascitic paracentesis
- Pregnancy termination to prevent hormonal imbalances
55
Risk factors for gestational diabetes?
- 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
Gestational diabetes investigation
Oral glucose tolerance test
- if previous gestational diabetes test should be done at booking
57
Diagnostic threshold for gestational diabetes
- Fasting glucose > 5.6mmol/L
- 2 hour glucose > 7.8mmol/L
58
Management of gestational diabetes
- 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
What is levonorgestrel
'Morning after pill' (emergency contraception)
60
Dose and indications of levonorgestrel
Must be taken within 72 hours - single dose of 1.5mg
(doubled for a weight over 70kg or bmi over >26)
61
What is Ulipristal?
Emergency contraception - EllaOne
62
Ulipristal - MOA
- Selective progesterone receptor modulator
- Inhibits ovulation
63
Dose and indications of Ulipristal
Taken no later than 120 hours after - Oral dose of 30mg
64
When can contraception be taken after using ulipristal?
Contraception should be restarted 5 days after as it can effect the effectiveness
65
What screening tests should be done for downs syndrome
- Nuchal translucency measurement
- Serum B-HCG
- Pregnancy associated plasma protein A
66
When should screening for downs syndrome be done?
between 11 - 13+6 weeks
67
What results of screening suggest downs syndrome
- Raised HCG
- Decreased PAPP-A
- Thickened nuchal translucency
68
Which 3 chromosomal abnormalities do we screen for?
Down's syndrome - Trisomy 21
Edward syndrome - Trisomy 18
Patau syndrome - Trisomy 13
69
What is fetal varicella syndrome
- When the mother gets chickenpox during pregnancy and it can pass to the foetus
70
Management of chickenpox exposure in pregnancy
- 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
What is hrHPV
High risk strains of human papillomavirus
72
Management of negative hrHPV
RETURN TO NORMAL RECALL UNLESS:
- On the test of cure pathway (6 months after treatment)
- Follow ups
73
Management of positive hrHPV
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
What is mastitis?
Inflammation of the breast tissue that may involve an infection
75
First line treatment for mastitis
Flucloxacillin for 10-14 days
Breast feeding should continue during treatment
76
Complications of mastitis
May develop into a breast abscess
This would require incision and drainage
77
What is engorgement?
Your breasts can become overly full
- Always affects both breasts
78
Symptoms of engorgement
- Pain in both breasts
- Pain or discomfort before a feed
- Milk tends to not flow well
- Breasts may appear red
- Fever
79
Complications of engorgement
- Blocked milk ducts
- Mastitis
- Difficulties breast feeding
80
Treatment for engorgement
- Hand expression of milk
- Warm compress
- Feeding more regularly
81
What is Raynaud's disease of the nipple?
Blanching and cyanosis of the nipple
- Causes pain during and immediately after breast feeding
82
Treatment for Raynaud's disease of the nipple
- Minimise exposure to cold
- Warm compress after feeding
- Avoid caffeine and stop smoking
83
Urinary incontinence risk factors
- Advancing age
- Previous pregnancy and childbirth
- High body mass index
- Hysterectomy
- Family history
84
What are the different classifications of urinary incontinence
- Overactive bladder/urge incontinence
- Stress incontinence
- Mixed incontinence
- Overflow incontinence
- Functional incontinence
85
What is urge incontinence?
- Detrusor overactivity
- Urge to urinate followed by uncontrollable leakage
86
What is stress incontinence?
Leaking small amounts when coughing or laughing
87
What is mixed incontinence?
Both urge and stress
88
What is overflow incontinence?
Due to bladder outlet obstruction (prostate enlargement)
89
What is functional incontinence?
- Comorbid physical conditions impair ability to get to the toilet in time
- Causes inclue dementia, sedating mediation or injury/illness
90
Investigations for urinary incontinence
- Bladder diaries completed for a minimum of 3 days
- Vaginal examination (excludes pelvic organ prolapse)
- Urine dipstick and culture
- Urodynamic studies
91
Urge incontinence management
- Bladder retraining
- Bladder stabilising drugs (antimuscarinics)
- Mirabegron (beta 3 agnoist) may be used if concern of anticholinergic side effects in frail elderly patients
92
Stress incontinence management
- Pelvic floor muscle training
- Surgical procedures
- Duloxetine (noradrenaline and serotonin reuptake inhibitor)
93
What is umbilical cord prolapse?
When the umbilical cord descends ahead of the presenting part of the foetus
94
Complications of umbilical cord prolapse
Can lead to compression of the cord or cord spasm
- Cause foetal hypoxia
95
Risk factors for cord prolapse
- Prematurity
- Multiparity
- Polyhydrammios
- Twin pregnancy
- Cephalopelvic disproportion
- Abnormal presentations
96
When do 50% of cord prolapses occur?
Artificial rupture of the membranes
97
Management of cord prolapse
- 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
What is shoulder dystocia?
The head has been delivered but the shoulder is stuck behind the mothers pubic symphysis
99
What is shoulder dystocia a complication of?
Vaginal cephalic delivery
100
Key risk factors
- Foetal macrosomia
- High maternal body mass index
- Diabetes mellitus
- Prolonged labour
101
Shoulder dystocia management
McRoberts manoeuvre
102
What is the McRoberts manoeuvre?
- Flexion and abduction of maternal hips, mothers thighs towards her abdomen
- This increases relative anterior-posterior angle of the pelvis
103
Complications of shoulder dystocia
Maternal - postpartum haemorrhage & perineal tears
Foetal - brachial plexus injury & neonatal death
104
Differential diagnosis for jaundice in pregnancy
- Intrahepatic cholestasis of pregnancy
- Acute fatty liver of pregnancy
- Gilberts syndrome (may be exacerbated)
- Dubin-Johnson syndrome (may be exacerbated)
- HELLP syndrome
104
Features of intrahepatic cholestasis of pregnancy
- pruritus, palms and soles
- No rash
- Raised bilirubin
105
Management of intrahepatic cholestasis of pregnancy
- Ursodeoxycholic acid (symptom relief)
- Weekly liver function tests
- Induction at 37 weeks
106
Complications of intrahepatic cholestasis of pregnancy
Increased rate of stillbirth
107
When might acute fatty liver of pregnancy occur?
In the third trimester or immediately following delivery
108
Features of acute fatty liver of pregnancy
- Abdominal pain
- N&V
- Headache
- Jaundice
- Hypoglycaemia
- If severe may result in pre eclampsia
109
Investigations for acute fatty liver of pregnancy
- Raised ALT
110
Management of acute fatty liver of pregnancy
- Supportive care
111
What does HELLP syndrome stand for
- Haemolysis
- Elevated Liver enzymes
- Low Platelets
112
What is the triad of presentation in pre-eclampsia
- New onset hypertension
- Proteinuria
- Oedema
113
Definition of pre-eclampsia
- 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
Potential consequences of pre-eclampsia
- eclampsia
- other neurological complications (altered mental state, stroke, severe headaches)
- Fetal complications
- Intrauterine growth retardation
- Prematurity
- Liver involvement
- Haemorrhage
- Cardiac failure
115
Prevention of pre eclampsia
- Take aspirin 75-150mg daily from 12 weeks gestation until birth if
- >1 high risk factor
- > 2 moderate risk factors
116
Management of pre-eclampsia
- Oral labetalol (nifedipine if asthmatic)
117
What is postpartum haemorrhage defined as
- The blood loss of > 500mls
118
Management for primary postpartum haemorrhage
- ABC including 2 peripheral cannulae
- IV syntocinon (oxytonin)
- IM carboprost (prostaglandin analogue)
- Surgical options may need to be considered
119
What is placenta praevia
A placenta lying wholly or partly in the lower uterine segment
120
Risk factors for placenta praevia
- Multiparity
- Multiple pregnancy
- Embryos more likely to implant on a lower segment scar from previous c-section
121
Features of placenta praevia
- No pain
- Uterus not tender
- Lie and presentation may be abnormal
- Fetal heart normal
- Small bleeds before large
122
Diagnosis of placenta praevia
- Digital vaginal examination should NOT be performed
- Often picked up on a 20 week scan
- Transvaginal ultrasound is recommended
