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Women's Health > Women's health > Flashcards

Women's health Flashcards

1
Q

Mode of action of contraceptives

A

-COCP: inhibits ovulation
-Progesterone only: thickens cervical mucus
-Desogestrel-only pill: inhibits ovulation
-Injectable: inhibits ovulation
-Implant: inhibits ovulation
-ICD: decreases sperm motility and survival
-IUS (levonorgestrel): prevents endometrial proliferations

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2
Q

Mode of action for emergency contraception

A

-Levonorgestrel: inhibits ovulation
-Ulipristal (Ella): inhibits ovulation
-IUD: toxic to sperm

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3
Q

Urgent C Section catagories

A

Category 1: Immediate threat to the life of the woman or fetus. The procedure should be performed within 30 minutes.
Category 2: there is maternal or fetal compromise which is not immediately life-threatening. Delivery should be planned as soon as possible, and within 60-75 minutes.
Category 3: delivery is required, but mother and baby are stable
Category 4: elective

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4
Q

Contraindication to Vaginal birth after Caesarean (VBAC)

A

previous uterine rupture or classical caesarean scar (longitudinal incision in the upper segment of the uterus)

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5
Q

Ectopic pregnancy investigation + Mx

A

Investigation: transvaginal ultrasound
Management:
Medical: <35mm, no heartbeat, no sig. pain- Methotextrate (only if patient is willing to attend follow up)
Surgical: >35mm, pain, ruptured, visible heartbeat, hCG >5,000IU/L, Salpingectomy (first line)
- Salpingotomy should be considered for women with risk factors for infertility such as contralateral tube damage around 1 in 5 women who undergo a salpingotomy require further treatment (methotrexate and/or a salpingectomy)

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6
Q

Causes of folic acid deficiency

A

Phenytoin
Methotextrate
Pregnancy
Alcohol Xs

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7
Q

Consequences of folic acid deficiency in pregnancy

A

-macrocytic, megaloblastic anaemia (hypersegmented neurtophils, low Hb, high MCV)
-Neural tube defects

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8
Q

Prevention of neural tube defects protocol

A
  • all women take 400mcg folic acid until 12th week
    -women at high risk take 5mg of folic acid from before conception to 12 weeks
    High risk criteria:
    -partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
    -the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
    -woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
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9
Q

Food to avoid in pregnancy

A

-listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
-salmonella: avoid raw or partially cooked eggs and meat, especially poultry

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10
Q

Rare complication of uterine fibroids

A

polycythaemia secondary to autonomous production of erythropoietin

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11
Q

Mx of menorrhagia secondary to fibroids

A

levonorgestrel intrauterine system (LNG-IUS)
useful if the woman also requires contraception
cannot be used if there is distortion of the uterine cavity

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12
Q

Treatment to remove/shrink uterine fibroids

A

Medical: GnRH agonist (but menopause like symptoms) + loss of bone mineral density
Surgical: myomectomy

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13
Q

Forms of ovulation induction

A

-For PCOS women (weight loss)
-Letrozole: increases FSH production

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14
Q

Hypogonadism

A

Lack of sex hormones oestrogen and testosterone

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15
Q

Sheehan’s syndrome

A

post-partum pituitary necrosis due to significant blood loss in delivery
Sx: difficulty breastfeeding, amenorrhoea, hypothyroidism, hypogylcaemia
Tx: hormone replacement e.g. oestrogen, cortisol, thyroid

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16
Q

Turner’s syndrome

A

45XO
Sx: short stature, shield chest and widely spaced nipples
webbed neck
bicuspid aortic valve/coarctation of aorta
primary amenorrhoea
Lymphoedema

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17
Q

Von Willebrand disease

A

-most common inherited bleeding disorder (autosomal dominant)

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18
Q

Oestrogen side effects

A

Nausea +bloating
Breast swelling/tenderness
Headaches
Leg Cramps

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19
Q

Progesterone side effects

A

Mood swings
Bloating
Fluid retention
Weight gain
Acne/greasy skin

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20
Q

Causes of primary postpartum haemorrhage

A

PPH (4 Ts)

  1. Tone (uterine atony)
  2. Trauma (e.g perineal tear)
  3. Tissue (retained placenta)
  4. Thrombin (clotting/bleeding disorder)
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21
Q

PPH management

A

A-E approach
-Two peripheral cannulae (14 gauge)
-lie flat
-group and save
-crystalloid infusion
Mechanical: rub fundus and catheterise
Medical: IV oxytocin, IV ergometrine (unless HTN Hx), IM carboprost
Surgical: intrauterine balloon tamponade

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22
Q

Breastfeeding drug contraindications

A

-antibiotics: ciprofloxacin, tetracycline
-psychiatric: lithium, benzodiazepines
-aspirin
-carbimazole
-methotrexate
-amiodarone

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23
Q

Mastitis Mx

A

Flucloxacillin and analgesic

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24
Q

Quadruple tests for: Down’s, Edward’s, Neural tube defects

A

Down’s: low alpha, low oestriol, high hCG high inhibin A
Edward’s: low alpha, low oestriol, low hCG normal inhibin A
Neural: high alpha, normal oestriol, normal hCG normal inhibin

25
Q

PMS mangement

A
  • regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
    -COCP
    -SSRI
26
Q

COCP UKMEC guidance

A

UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk

3:
>35 less than 15 cigarettes
BMI >35
Immobility e.g. wheelchair use
BRAC 1/2 carrier

4:
>35 +>15 cigarettes/day
VTE, stroke, IHD Hx
Breast feeding <6 weeks post-partum
positive anti-phospholipid antibodies e.g. SLE
Major surgery with immobility
Migraine with aura

27
Q

Meigs’ syndrome

A

Fibroma + ascites + pleural effusion

28
Q

Pre-eclampsia Dx

A

new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction

29
Q

Uterine fibroids in pregnancy

A

growth of pre-existing fibroids due to oestrogen, low-grade fever, pain and vomiting

30
Q

implant pros/cons

A

Pros: highly effective: failure rate 0.07/100 women-years - it is the most effective form of contraception
long-acting: lasts 3 years
doesn’t contain oestrogen so can be used if past history of thromboembolism, migraine etc
can be inserted immediately following a termination of pregnancy
Cons: additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman’s menstrual cycle
irregular/heavy bleeding is the main problem: this is sometimes managed using a co-prescription of the combined oral contraceptive pill. It should be remembered to do a speculum exam/STI check if the bleeding continues

31
Q

Pregnancy induced HTN Mx

A

1st line: Oral labetalol
2nd line: oral nifedipine

32
Q

What is the most important aetiological factor causing cervical cancer?

A

Human papillomavirus infection (particularly 16,18 & 33)

33
Q

chickenpox exposure in pregnancy Mx

A

maternal blood should be urgently checked for varicella antibodies
oral aciclovir given at day 7 to day 14 after exposure, not immediately

34
Q

hormones and cancer risk

A

HRT: progesterone increases breast cancer risk
Unopposed oestrogen: endometrial cancer

35
Q

IUS insertion after vaginal delivery

A

IUS up to 48 hours after delivery or after 4 weeks

36
Q

Postmenopausal bleeding causes

A

-Vaginal atrophy
-HRT
-endometrial hyperplasia/ cancer
-cervical cancer
-ovarian cancer
Women >55 with postmenopausal bleed should get 2ww US for endometrial cancer

37
Q

Potter sequence

A

cause of oligohydramnios (vilateral renal agenesis and pulmonary hypoplasia)

38
Q

Preterm pre-labour rupture of membranes abx

A

Oral erythromycin 10 days

39
Q

gestational diabetes diagnosis threshold

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

-If fasting<7 trial diet/exercise if not met in two weeks start metformin
-If still not met add short-actin insulin
-If >7 at diagnosis start insulin

40
Q

Trophoblastic Disease

A

The growth of abnormal trophoblast cells in the uterus after conception, rather than the development of a healthy fetus. The predominant type of gestational trophoblastic disease is a hydatidiform mole.

41
Q

How soon after emergency contraception can you start COCP

A

Immediately
-Levonorgestrel MOA stop ovulation and prevent implantation

5 days post ulipristal acetate inhibits ovulation

42
Q

Turner’s syndrome Ix

A

Increased FSH/LH

43
Q

Low FSH, LH and 10 day progestin challenge, does not induce a withdrawal bleed.

A

hypothalamic dysfunction

44
Q

Menopause confirmation test

A

FSH

45
Q

Tocolytics

A

Mx for preventing labour induction by slowing uterine contractions e.g. indomethacin, salbutamol, terbutaline

46
Q

High-risk factors for pre-eclampsia

A

-hypertensive disease in a previous pregnancy
-chronic kidney disease
-autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
-type 1 or type 2 diabetes
-chronic hypertension
Take low dose aspirin for first trimester

47
Q

how soon postpartum do you require contraception?

A

21 days

48
Q

Types of miscarriage

A

-Threatened: painless bleed, os closed
-Missed/delayed: no expulsion, closed os
-Inevitable: heavy bleeding, open os
-Incomplete: pain, bleeding open os

49
Q

Placenta praevia Mx

A

Scan at 32 weeks
Elective caesarean for grade III/IV at 37-38 weeks
Emergency c section is woman gos into labour

50
Q

Types of incontinence

A

A) Urge incontinence - urgency/frequency/wake up at night

B)overflow incontinence - poor stream/incomplete emptying

C) stress incontinence - leak when cough

D) functional incontinence - physical disability prevent from urinate (eg.wheelchair/bedridden)

E) mixed incontinence - (UI + SI)

51
Q

Ix suspected PPROM: no fluid in posterior vaginal vault

A

Perform IGF binding protein-1 testing

52
Q

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency?

A

uterine fibroids

53
Q

For how long is the COCP contraindicated in breastfeeding women?

A

6 weeks

54
Q

Recurrent vaginal candidiasis

A

Order HbA1c to rule of diabetes

55
Q

HELLP syndrome

A

Haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

56
Q

Pre-eclampsia Mx

A

Labetalol → Largely Used, Lung disease caution (asthma)
Nifedipine → Narrow airways (asthma) friendly
Magnesium Sulfate → Seizure Prevention and neuroprotection

57
Q

Ultrasound pelvic findings

A

Whirlpool sign- ovarian torsion
Hyperechoic mass- fibroid
Snow storm- complete hydatidiform mole

58
Q

PCOS infertility mx

A

Clomifene

Women's Health (2 decks)

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