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Human Development > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Pre-eclampsia definition

A

New hypertension in pregnancy (after 20 weeks gestation) with end-organ dysfunction, notably with proteinuria

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2
Q

Pre-eclampsia triad

A

Hypertension
Proteinuria
Oedema

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3
Q

Eclampsia definition

A

Seizures as a result of pre-eclampsia

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4
Q

Pre-eclampsia high risk factors

A

Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune condition
Diabetes
Chronic kidney disease

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5
Q

Pre-eclampsia moderate risk factors

A

Older than 40
BMI >35
>10 years since pregnancy
Multiple pregnancy
First pregnancy
Family Hx of pre-eclampsia

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6
Q

Pre-eclampsia preventative medication & indication

A

Aspirin from 12 weeks
1 high risk factor
>1 moderate risk factor

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7
Q

Pre-eclampsia NICE definition and symptoms

A

Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (this is due to liver swelling)
Oedema
Reduced urine output
Brisk reflexes

NICE guidelines state diagnosis with bp >140/90 (only need diastolic or systolic)

PLUS any of proteinuria, organ dysfunction, placental dysfunction

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8
Q

Pre-eclampsia medical management

A

Labetolol = first-line
Nifedipine = second-line
IV hydralazine
IV magnesium sulfate (during labour & in 24hrs after)
Fluid restriction

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9
Q

HELLP syndrome definition

A

Combination of features occurring due to pre-eclampsia/eclampsia

Haemolysis
Elevated Liver enzymes
Low Platelets

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10
Q

Premature ovarian insufficiency definition & biochem presentation

A

Menopause under the age of 40 (amenhorrea for 1 year; high FSH at 2 samples >4 weeks apart)

High LH/FSH
Low oestradiol

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11
Q

Premature ovarian insufficiency management

A

HRT until usual age of menopause (reduces cardiovascular, osteoporosis, cognitive, and psychological risks ass. w/ premature menopause)

Traditional HRT (increased risk of VTE, give transdermally)
Combined oral contraceptive pill

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12
Q

Placental abruption definition

A

Placenta separates from wall of uterus during pregnancy

Significant cause of antepartum haemorrhage

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13
Q

Placental abruption risk factors

A

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use

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14
Q

Placental abruption presentation

A

Sudden onset severe abdo pain (continuous)
Vaginal bleeding
Shock (hypotension & tachycardia)
CTG showing fetal distress
Woody abdomen on palpation

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15
Q

Concealed abruption definition

A

Placental abruption when cervical os remains closed, with bleeding contained within uterine cavity

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16
Q

Fertility investigations

A

BMI
Chlamydia
Semen analysis
Rubella immunity (mother)
Female hormonal testing

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17
Q

Management of anovulation

A

Weight loss
Clomifene
Letrozole
Gonadotrophins
Metformin

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18
Q

Female hormone testing details

A

Serum LH and FSH on day 2 to 5 of the cycle
Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).
Anti-Mullerian hormone
Thyroid function tests when symptoms are suggestive
Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

High FSH suggests poor ovarian reserve
High LH suggests PCOS
Rise in progesterone on day 21 indicates that ovulation has occurred

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19
Q

Stages of labour

A

First stage - from onset of labour (true contractions) to 10cm dilation
Second stage - from 10com dilation to delivery of baby
Third stage - from delivery of baby to delivery of placenta

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20
Q

Stages of first stage of labour/what happens

A

Cervical dilation and effacement, loss of mucus plug

Latent phase - 0-3cm dilation & irregular contractions
Active phase - 3-7cm dilation & regular contractions
Transition phase -7-10cm dilation & strong, regular contractions

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21
Q

Braxton-Hicks contractions

A

Occasional irregular contractions of the uterus
Usually during second and third trimester
Not true contractions

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22
Q

Diagnosing onset of labour

A

Show (mucus plug)
Rupture of membranes
Dilating cervix
Regular, painful contractions

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23
Q

Prematurity definition

A

Birth before 37 weeks gestation

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24
Q

Non-viabilty definition

A

Babies below 23 weeks gestation

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25
Q

Management of preterm labour

A

Fetal monitoring
Nifedipine (blocks Ca ion channels to prevent smooth muscle contraction)
Atosiban (oxytocin receptor agonist, use when nifedipine contraindicated)
Maternal corticosteroids (<35 weeks, helps develop fetal lungs)
IV magnesium sulphate
Delayed cord clamping

26
Q

Signs of magnesium toxicity

A

Reduced respiratory rate
Reduced blood pressure
Absent reflexes

27
Q

Induction of labour - beneficial situations

A

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

28
Q

Options for induction of labour

A

Membrane sweep - insert finger to cervix to stimulate onset of labour
Vaginal prostaglandin E2
Cervical ripening balloon (silicone balloon inserted into cervix and gently inflated to dilate)
Artificial rupture of membranes with oxytocin (only if prostaglandins can’t be used/haven’t worked)
Oral mifepristone & misoprostol where intrauterine foetal death has occurred

29
Q

Uterine hyperstimulation definition

A

Main complication of induction of labour with vaginal prostaglandins

Contraction of uterus is prolonged and frequent, causing foetal distress & compromise

IU contractions >2 mins duration
>5 contractions every 10 minutes

30
Q

Uterine hyperstimulation complications

A

Foetal compromise w/ hypoxia and acidosis
Emergency c-section
Uterine rupture

31
Q

Management of uterine hyperstimulation

A

Removing vaginal prostaglandins/stopping oxytocin
Tocolysis w terbutaline

32
Q

Sepsis 6

A

Three tests:

Blood lactate level
Blood cultures
Urine output

Three treatments:

Oxygen to maintain sats 94-98%
Broad-spectrum antibiotics
IV fluids

33
Q

Ectopic pregnancy definition

A

Pregnancy implanted outside the uterus, most commonly the fallopian tube

34
Q

Ectopic pregnancy risk factors

A

Prev ectopic preg
Prev pelvic inflammatory disease
Prev surgery
IU devices
Older age
Smoking

35
Q

Ectopic pregnancy presentation

A

Missed period
Constant lower abdo pain in R/L iliac fossa
Vaginal bleeding
Lower abdo/pelvic tenderness
Cervical motion tenderness

36
Q

Ectopic pregnancy ultrasound findings

A

Gestational mass in fallopian tube
Blob/bagel/tubal ring sign (mass with empty gestational sac)
Empty uterus/fluid in uterus

37
Q

Ectopic pregnancy management options

A

Expectant management (await natural termination)
Medical management (methotrexate)
Surgical management (salpingectomy/salpingotomy)

38
Q

Ectopic pregnancy expectant management criteria

A

Follow up needed
Unruptured ectopic
Adnexal mass <35mm
No visible heartbeat
No significant pain
HCG <1,500 IU/L

39
Q

Ectopic pregnancy medical management criteria

A

Follow up needed
Unruptured ectopic
Adnexal mass <35mm
No visible heartbeat
No significant pain
HCG <5,000 IU/L
Confirmed absence of IU pregnancy

Should not get pregnant for 3 months following

40
Q

Ectopic pregnancy surgical managements

A

Laparoscopic salpingectomy - general anaesthetic & key-hole surgery to remove affected fallopian tube

Laparoscopic salpingotomy - avoids removing whole tube e.g. for women who have a risk of infertility if tube is removed

Anti-rhesus D prophylaxis given to rhesus negative women

41
Q

PCOS definition & key features

A

Polycystic ovarian syndrome is a common condition causing metabolic and reproductive problems in women

Key features:

Anovulation - lack of ovulation
Oligoovulation - irregular, infrequent ovulation
Amenorrhoea - lack of periods
Oligomenhorrhoea - irregular, infrequent periods
Hyperandrogenism - effects of high levels of androgens (i.e. male sex hormones)
Hirtuism (male pattern facial hair growth)
Insulin resistance - lack of response to hormone insulin

42
Q

Rotterdam criteria

A

Used for making a diagnosis of PCOS

Anovulation/oligoovulation (presents a missed or irregular periods)
Hyperandrogenism (hirsutism and acne)
Polycystic ovaries on ultrasound

43
Q

PCOS presentation

A

Oligomenorrhoea or amenorrhoea
Infertility
Obesity (in about 70% of patients with PCOS)
Hirsutism
Acne
Hair loss in a male pattern

44
Q

PCOS complications

A

Insulin resistance and diabetes
Acanthosis nigricans
Cardiovascular disease
Hypercholesterolaemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiety
Sexual problems

45
Q

Differential diagnoses of hirsutism

A

PCOS
Medications e.g. testosterone, corticosteroids, ciclosporin
Androgen secreting tumours
Cushing’s syndrome
Congenital adrenal hyperplasia

46
Q

Mechanism of insulin resistance in PCOS

A

Insulin promotes release of androgens from ovaries & adrenal glands
Higher levels of insulin result in higher levels of androgens
Insulin also suppresses sex hormone-binding globulin production by the liver, which normally binds to androgens and suppresses their functions
Reduced SHBG further promotes hyperandrogenism in PCOS
High insulin levels contribute to halting development of the follicles in the ovaries, leading to partially developed follicles and anovulation

47
Q

Blood tests for PCOS/results

A

Testosterone
SHBG
LH
FSH
Prolactin (may be mildly elevated)
TSH

Would see:

High LH
High LH:FSH ratio
High testosterone
High insulin
Normal or raised oestrogen

48
Q

PCOS investigations

A

Pelvic ultrasound
Transvaginal ultrasound

May see follicles around the edge of ovary, giving appearance of a string of pearls
Diagnostic criteria = >=12 developing follicles in one ovary, or ovarian vol of >10cm^3

Also 2-hr 75g oral glucose tol test

49
Q

General PCOS management

A

Weight loss
Low glycaemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)

50
Q

PCOS managing risk of endometrial cancer/mechanism of increased risk

A

Loss of progesterone due to amen/anovulation leads to loss of uterine shedding and continued proliferation due to oestrogen, increasing risk of endometrial cancer

Mirena coil gives continual endometrial protection
Cyclical progestogens or combined oral contraceptive pill allow for withdrawal bleed every 3-4 months

51
Q

PCOS managing hirsutism

A

Co-cyprindiol (combined oral contraceptive) which has anti-androgenic effects, but increases risk of VTE - only take for 3 months at once
Topical eflornithine
Electrolysis
Laser hair removal
Spironolactone
Finasteride
Flutamide
Cyproterone acetate

52
Q

Monitoring whilst on magnesium sulphate

A

urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment

respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression

53
Q

Placenta praevia definition

A

a placenta lying wholly or partly in the lower uterine segment

54
Q

Placenta praevia presentation

A

Painless vaginal bleeding, ranging from spotting to life threatening haemorrhage
Mean initiation of bleeding is 30 weeks

shock in proportion to visible loss
no pain
uterus not tender
lie and presentation may be abnormal
fetal heart usually normal
coagulation problems rare
small bleeds before large

55
Q

Placenta praevia differential diagnoses

A

Placental abruption - usually painful, with a woody abdomen on examination
Miscarriage - often accompanied by cramp-lie pain, and is more common in 1st/2nd trimester (3rd is more common for placenta praevia). Cervical os may be open, and products of conception may be lost
Placenta accreta - placenta invades too deeply into uterine wall. Ultrasound used to differentiate

56
Q

Placenta praevia investigations

A

Ultrasound

Full blood count
Blood type and cross match for surgery
Fetal cardiotocography
Biochem to rule out pre-eclampsia

57
Q

Placenta praevia management

A

If serious haemorrhage, ABCDE
corticosteroids where gestational age <34 weeks
Tocolytics to delay age
Anti-D prophylaxis to rhesus negative mothers

C-section usually arranged

58
Q

Perineal tears classification

A

first degree
superficial damage with no muscle involvement
do not require any repair

second degree
injury to the perineal muscle, but not involving the anal sphincter
require suturing on the ward by a suitably experienced midwife or clinician

third degree
injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
require repair in theatre by a suitably trained clinician

fourth degree
injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
require repair in theatre by a suitably trained clinician

59
Q

When to refer for lack of foetal movements

A

If fetal movements have not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit

60
Q

Indications for high dose folic acid

A

Take MORE Folic acid (5mg) if:
M- Metabolic disease (diabetes or Coeliac)
O- Obesity
R- Relative or personal Hx of NTDs
E- Epilepsy (taking antiepileptic medications)

+ Sickle Cell and Thalassaemia

61
Q

Pre-term rupture of membranes management

A

admission
regular observations to ensure chorioamnionitis is not developing
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
delivery should be considered at 34 weeks of gestation - there is a trade-off between an increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses

62
Q

Placenta praevia grading

A

I - placenta reaches lower segment but not the internal os
II - placenta reaches internal os but doesn’t cover it
III - placenta covers the internal os before dilation but not when dilated
IV (‘major’) - placenta completely covers the internal os

Human Development (4 decks)

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