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Phase 3A Medicine > Women’s Health > Flashcards

Women’s Health Flashcards

1
Q

High risk factors for pre-eclampsia?

A

Prev HTN in preg
CKD
Autoimmune condition
Diabetes
Chronic HTN

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2
Q

Moderate risk factors for pre-eclampsia?

A

First preg
40+
Preg interval of 10+yrs
BMI 35+
Fam hx
Multiple pregnancies

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3
Q

Preventative against pre-eclampsia?

A

150mg Aspirin daily until delivery from 12 weeks.

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4
Q

Define Gravidity (G)

A

Sum of all pregnancies
Incl. miscarriages and stillbirths

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5
Q

Define Parity (P)

A

Total number of deliveries over 24w
Still birth/IUFD/Neonatal death -1

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6
Q

What is the latent first stage of labour?

A

Cervix 0-4cm, 0.5cm per hr
Irregular contractions

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7
Q

What is the established first stage of labour?

A

4-10cm dilation of cervix
1cm/hr
Regular contractions

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8
Q

What is the first stage of labour?

A

From the onset of labour until cervix effacing and dilating up to 10cm.
Mucoid plug (show)
Can last up to 2-3 days

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9
Q

What is the second stage of labour?

A

From full dilatation to birth of foetus- pushing!

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10
Q

What is the third stage of labour?

A

Birth of foetus to the expulsion of placenta and membranes

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11
Q

What is the role of oxytocin in labour?

A

Surge at onset of labour will contract uterus

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12
Q

What is the role of prolactin in labour?

A

Stimulates process of milk production in the mammary glands

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13
Q

What is the role of oestrogen in labour?

A

Surge at onset of labour prohibits progesterone to prepare smooth muscles for labour

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14
Q

What is the role of prostaglandins in labour?

A

Aids cervical ripening

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15
Q

What is the role of beta-endorphins in labour?

A

Natural pain relief

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16
Q

What is the role of adrenaline in labour?

A

Released when birth is imminent to give the mother energy to give birth

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17
Q

What is the name of the position of the foetus when its head first?

A

Cephalic

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18
Q

What is the name of the position of the foetus when its feet first?

A

Breech

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19
Q

What is effacement?

A

AKA ripening- thinning of the cervix in labour

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20
Q

What is OP?

A

Occiput posterior- baby is ‘back-to-back’ with mum

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21
Q

How much amniotic fluid is there on average at term?

A

500-800mls

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22
Q

Name some holistic and non-invasive forms of analgesia for labour?

A

Water immersion
Aromatherapy
Massage
Entonox (gas and air)
Paracetamol
Codeine

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23
Q

What is an epidural made up of?

A

Buvacaine and fentanyl

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24
Q

Who does gynae look after?

A

Women up to 20 weeks gestation

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25
Q

History of pelvic PAIN- associated symps to ask about in gynae?

A

PV bleeding
Change in discharge
Dyspareunia
LUTS
Change in bowel habit
Cyclical- endometriosis
Non-cyclical- PID/ectopic

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26
Q

Pregnant woman vaginal bleeding- key questions to ask?

A

LMP and EDD
Quantify- number of pads/tampons (heavy= >1hr)
Pain?
Associated trauma?
Fever/malaise?
USS results?
Abnormal bleeding- PCB
PMH

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27
Q

Hx heavy menstrual bleeding- questions to ask?

A

Period history-length/freq/quantify
IMB? PCB?
Pain, LUTS, bowels
Contraception?
Anaemia symps

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28
Q

Gynae hx fertility questions?

A

How long trying for?
Sexually active?
Prev. pregnancies?
Pre-existing health conditions
Medications
Menstrual history
Fam hx
Social hx- smoking/diet

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29
Q

What is stress incontinence?

A

Leakage of urine when coughing/exercising (increased intra-abdominal pressure)

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30
Q

What is urge incontinence?

A

Overactive bladder, unable to control urge to urinate

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31
Q

What is an ectopic pregnancy?

A

Fertilised egg implants outside of the uterus

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32
Q

Symptoms of ectopic pregnancy?

A

PV bleeding
One sided abdo pain
Shoulder tip pain
Dizziness
Asymptomatic

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33
Q

How do you diagnose an ectopic pregnancy?

A

USS- mass moving separately to uterus
-hCG >1500 if not found in uterus red flag ectopic

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34
Q

Where are most ectopic pregnancies located?

A

90% Fallopian tubes

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35
Q

How to manage an ectopic pregnancy?

A

Expectant- watchful wait
Medical- methotrexate
Surgical removal
Depends on stability/pain/size of foetus (<35mm)

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36
Q

What drug given to medically manage ectopic?

A

Methotrexate
RULE OUT INTRAUTERINE FIRST
No pregnancy for 3 months after

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37
Q

What is a salpingectomy?

A

Surgery to remove Fallopian tubes

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38
Q

Types of miscarriage?

A

Complete: PV bleeding, empty uterus on USS, follow up hCG >50% 48 hrs
Incomplete: echoes on USS. <35mm tissue- expectant, medical, LA surgery
>35mm tissue- GS surgery
Delayed: Dx on scan- 2 sonographers- management on size

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39
Q

How does ovarian torsion present?

A

Severe ‘twisting’ unilateral abdo pain
Nausea and vomiting
Non-specific

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40
Q

What is a molar pregancy?

A

Gestational trophoblastic disease- tumour develops instead of embryo
Small risk of carcinoma
Surgically managed

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41
Q

How does pelvic inflammatory disease present?

A

Pelvic pain
Dyspareunia- deep
Post-coital bleeding
Dysuria
Inter-menstrual bleeding
Change to vaginal discharge

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42
Q

Risk factors for PID?

A

Unprotected sex
Multiple sexual partners
IUS/IUD (4-6w after insertion)

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43
Q

How to treat PID?

A

IM 1g ceftriaxone single dose FOLLOWED BY
PO 100mg doxycycline PLUS 400mg metronidazole BD for 14d

44
Q

Symptoms of PCOS?

A

Excess body hair- hirsutism
Irregular/no periods
Acne
Weight gain
Hair thinning
Infertility

45
Q

What cannula is used on obstetric patients?

A

Minimum GREY cannula (16 gauge)

46
Q

What is an APH?

A

Antepartum haemorrhage- bleeding from anywhere in the genital tract after 24w

47
Q

Causes of APH?

A

Low lying placenta (praevia)
Placenta accreta (invasive)
Vasa praevia (low fetal vessels)
Minor/major abruption
Infection

48
Q

Management of placenta praevia?

A

Dx at 20w anomaly scan, rescan at 32w
If remains <20mm from os= elective caesarean
Watch pain/bleeding, avoid sex, admit if recurrent bleeds

49
Q

Management of vasa praevia?

A

Close observation- caesarean as if SROM -> catastrophic foetal bleed
60% foetal mortality

50
Q

Management of placenta accreta?

A

Elective CS at 36-37w
Consent for poss hysterectomy
V high risk to maternal life

51
Q

Management of placental abruption?

A

CS or vaginal delivery ASAP

52
Q

Key sign of placental abruption?

A

Woody-hard, tense uterus
Vaginal bleeding, abdo pain

53
Q

Complications of APH?

A

Premature labour
Acute tubular necrosis
Disseminated Intravascular coagulation
PPH
ITU admission
ARDS
Foetal morbidity/mortality

54
Q

What is pre-eclampsia?

A

Hypertension, proteinuria and at least one of:
Severe headache
Visual disturbances
Papilloedma
Clonus
Liver tenderness
Abnormal liver enzymes

55
Q

Treatment of pre-eclampsia?

A

Hypertensive: labetalol, nifedipine, methyldopa
Blood tests, MgSO4, monitor urine output, delivery

56
Q

What is eclampsia?

A

Onset of seizures in a woman with pre-eclampsia

57
Q

Treatment of eclampsia?

A

IV MgSO4 4g over 5 mins, IV infusion of 1g/hr over 24 hrs

58
Q

Risk factors for maternal sepsis?

A

Obesity
Diabetes
Hx Group B strep
Impaired immunity/immunosuppressed
Anaemia
Vaginal discharge
Prolonged SROM
Hx pelvic infection
Group A strep close contacts

59
Q

Risk factors for cord prolapse?

A

Premature ROM
Polyhydramnios
Long umbilical cord
Foetal malpresentation
Multiparity

60
Q

Management of cord prolapse?

A

Emergency buzzer
Infuse fluid into bladder
Tredelenberg position
^^ To alleviate pressure on cord
Prepare for delivery CS

61
Q

What is shoulder dystocia?

A

Failure of anterior shoulder of foetus to pass under pubis after delivery of head

62
Q

Risk factors for shoulder dystocia?

A

Maternal diabetes
Macrosomia
Prev shoulder dystocia
Disproportion between M v F (small mother v large baby)
Postmaturity
Maternal obesity
Prolonged 1st/2nd stage labour

63
Q

Management of shoulder dystocia?

A

HELPERR(R)
-call for Help
-evaluate for Episiotomy (cut perineum)
-Legs in McRoberts- knee to shoulder
-suprapubic Pressure
-Enter pelvis
-Rotational manoeuvres
-Remove posterior arm
-Replace head- Zavanelli - baby unlikely to survive

64
Q

What are the 4 T’s of PPH?

A

Tissue- placenta complete?
Tone- uterus contracted?
Trauma- look for tears
Thrombin- check clotting

65
Q

Risk factors for PPH?

A

Big baby
Nulliparity or grand multiparity
Multiple pregnancy
Prolonged labour
Maternal Pyrexia
Operative delivery
Prev PPH
Shoulder dystocia

66
Q

Management of PPH?

A

Most often tone so give uterotonics
Surgical- last line hysterectomy

67
Q

What 3 P’s influence the progression of labour?

A
  • Power (uterine contractions)
  • Passenger (size, presentation, position of fetus)
  • Passage (shape/size pelvis and soft tissue)
68
Q

What is considered a delay in the first stage of labour?

A
  • Less than 2cm dilation in 4 hours
  • Slowing in progress of multiparous woman
69
Q

What is considered a delay in the second stage of labour?

A

Over
- 2 hrs in nulliparous woman
- 1 hr in multiparous woman

70
Q

What did the Abortion Act 1991 amend?

A

Changed latest gestation from 28 w to 24 w

71
Q

What are the two medications used in termination of pregnancy?

A

Mifepristone (anti-progesterone)
Misoprostol (prostaglandin analogue- stimulate uterine contractions) 1-2 days later

72
Q

What is risk of Rubella transmission to fetus <12 weeks?

A

90% with high likelihood of defects

73
Q

What are neonatal manifestations of rubella infection?

A

Deafness, cardiac- pulmonary stenosis, patent ductus arteriosus, retinopathy, cataracts, learning disabilities, thrombocytopaenia, DM, thyroiditis

74
Q

Risk of cytomegalovirus transmission in 1st/2nd trimester?

A

30-40%

75
Q

What are the conditions for a termination of pregnancy?

A

Before 24 weeks, if continuing pregnancy involves greater risk to the physical or mental health of the woman or existing children in the family.

Anytime if risk to woman’s life, grave permanent injury to mental or physical health or substantial risk child will be seriously handicapped.

76
Q

Two legal requirements to perform an abortion?

A

Two registered doctors must sign.
Carried out by a registered medical practitioner in an approved premise.

77
Q

What is stress incontinence caused by?

A

Sphincter weakness

78
Q

Cause of overactive bladder?

A

Detrusor overactivity (muscle in bladder)

79
Q

Triggers of stress incontinence?

A

Cough, laugh, lifting, exercise, walking/running esp downhill, intercourse, stumble/choking/vomiting

80
Q

Features of overactive bladder?

A

Urgency, frequency, nocturia, enuresis (wet bed), key in door, handwash, intercourse

81
Q

Types of catheters

A

Indwelling: suprapubic or urethral
Can be bag or flip flow
CISC- Clean Intermittant self catheterisation

82
Q

At what points do pregnant women have routine imaging?

A

12 week- dating scan and nuchal thickness
20 week- anomaly scan (gender)
- early and additional scans if clinically indicated

83
Q

What does the 12 week scan involve?

A

Heart beat to assess viability
Crown- rump length to date the pregnancy
Number of fetuses
Nuchal translucency (normal thickness)

84
Q

What does the 20 week scan involve?

A

Detect abnormality scan - detailed whole body
Assess nature of abnormality- viable or not
Extent of the abnormality- referral to specialist
Assess placenta and its location

85
Q

What happens if abnormality detected at 20w?

A

Referred to a fetal maternal scan
Counselling by qualified staff
Additional investigations- blood test, amniocentesis, further US, MRI

86
Q

What does amniocentesis collect?

A

Fetal exfoliated cells, transudates, fetal urine, and lung secretions.
Can check if fetus has genetic or chromosomal abnormalities

87
Q

What pathogen causes Chlamydia?

A

Chalmydia trachomatis
Obligate gram negative baterium

88
Q

Risk factors of chlamydia?

A

Age <25
Sexual partner positive
Recent change in sexual partner
Co-infection with another STI
Non-barrier contraception or lack of consistent use of barrier contraception

89
Q

What proportion of chlamydia infections are asymptomatic?

A

70% women, 50% men

90
Q

Symptoms of chlamydia in women?

A

WOMEN
Dysuria
Abnormal vaginal discharge
Intermenstrual or postcoital bleeding
Deep dyspareunia
Lower abdominal pain
Cervicitis +/- contact bleeding
Mucopurulent endocervical discharge
Pelvic tenderness
Cervical excitation

91
Q

Management of chlamydia?

A

1st: Doxycycline 100mg twice daily for 7 days
2nd or pregnant: Azithromycin 1g single dose

92
Q

Management for Herpes Simplex virus?

A

1st: Acyclovir 400mg orally three times daily for 7-10 days
Paracetamol, topical lidocaine 2%, vaseline, salt water cleanse

93
Q

Symptoms of herpes simplex virus?

A

Ulcers or blistering lesions affecting the genital area
Neuropathic type pain (tingling, burning or shooting)
Flu-like symptoms (e.g. fatigue and headaches)
Dysuria (painful urination)
Inguinal lymphadenopathy

94
Q

What pathogen causes gonorrhea?

A

Neisseria gonorrhoeae
Gram-negative diplococcus bacteria

95
Q

Symptoms of gonorrhea?

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain/ testicular pain

96
Q

Management of gonorrhoea?

A

IM ceftriaxone 1g

97
Q

If UC/UG neg and symphylis/HIV neg- what to consider?

A

Mycoplasma genitalium

98
Q

Treatment for Mycoplasma genitalium?

A

Doxycycline 100mg twice daily for 7 days then;
Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)

99
Q

Symptoms of trichomoniasis?

A

Vaginal discharge (frothy, yellow green, foul fishy smell)
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)

100
Q

Treatment of trichomoniasis?

A

Metronidazole 2g orally single dose

101
Q

Symptoms of primary syphilis?

A

Painless genital ulcer- chancre
Local lymphadenopathy

102
Q

Symptoms of secondary syphilis?

A

Typically after chancre is resolved
Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions

103
Q

Symptoms of neurosyphilis?

A

Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment

104
Q

Pathogen causing syphilis?

A

Treponema pallidum

105
Q

Treatment of standard syphilis?

A

Deep IM benzathine benzylpenicillin

106
Q

Triad of sexually acquired reactive arthiritis?

A

Conjunctivitis, arthiritis, urethritis

Phase 3A Medicine (5 decks)

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