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Phase 3a > Women’s Health > Flashcards

Women’s Health Flashcards

1
Q

Interpreting CTG

A

DRCBRAVADO
Define Risk
Contraction
Baseline Rate
Accelerations
Variability
Deceleration
Overall

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2
Q

Define and describe the different types of decelerations

A
  1. Early - Relative to contraction the deceleration is early. Normal because baby head is squeezed triggering vagal stimulation.
  2. Late - Pathological
  3. Variable - Cord compression. Cord is 2 arteries and 1 vein. When compressed vein compresses first and then arteries. When pressure released arteries rebound and then vein. The down and up nature of the graph depicts this.
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3
Q

Define antepartum haemorrhage (APH)

A
  1. Vaginal bleeding
  2. Between 24w and birth
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4
Q

Ix for APH

A
  1. Abdo exam
  2. Speculum exam
  3. Bloods
    • Group + save
    • Crossmatch
    • Coag screen
    • Kleihauer test (in Rh-ve women)
  4. USS (exclude placenta praevia)
  5. CTG
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5
Q

Management of APH

A
  1. Obtain IV access
  2. Monitor for concealed haemorrhage
  3. Antenatal corticosteroids between 24-34w of gestation if risk of preterm birth
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6
Q

What is a booking appt

A
  1. Comprehensive health assessment
  2. Before 10w gestation
  3. Identify women who require additional support
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7
Q

Ix in booking appt

A
  1. Comprehensive histories of:
    • Medical
    • Psychiatric
    • Surgical
    • Obs + gynae
    • Social
  2. Height, weight, BMI
  3. Urinalysis
  4. BP
  5. Full bloods
  6. Test for sickle cell and thalassaemia
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8
Q

Indications for elective c-section

A
  1. Previous c-section
  2. Symptomatic after previous perineal tear
  3. Placenta praevia
  4. Vasa praevia
  5. Multiple pregnancy
  6. Uncontrolled HIV
  7. Cervical cancer
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9
Q

Indications for emergency c-section

A
  1. Category 1 - Immediate threat to life of mother and baby. Decision to delivery time = 30 mins
  2. Category 2 - No imminent threat to life but required urgently due to compromise of mother or baby. Decision to delivery = 75 mins
  3. Category 3 - Delivery required but mother and baby stable
  4. Category 4 - Elective c -section
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10
Q

Define breech presentation

A

Fetal position where buttocks or feet are near cervix and head near fundus

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11
Q

Management of breech presentation

A
  1. External Cephalic Version (ECV) at 36w for primiparous
  2. ECV at 37w for multiparous
  3. C-section
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12
Q

State absolute contraindications to ECV

A
  1. C-section already indicated
  2. APH within last 7d
  3. Non-reassuring CTG
  4. Major uterine abnormality
  5. Placental abruption or placenta praevia
  6. Ruptured membranes
  7. Multiple pregnancy
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13
Q

Define chorioamnionitis

A
  1. Bacterial infection
  2. Affects membranes surrounding fetus
    • Amniotic sac
    • Amniotic fluid within uterus
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14
Q

Sx of chorioamnionitis

A
  1. Fever
  2. Abdo pain
  3. Offensive vaginal discharge
  4. Preterm rupture of membranes
  5. Maternal + foetal tachycardia
  6. Uterine tenderness
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15
Q

Management of chorioamnionitis

A
  1. IV broad spec Abx
  2. early delivery if necessary
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16
Q

State the complications of diabetes in pregnancy

A
  1. Macrosomia
    • unusually large birthweight (>4kg)
    • Increase risk of shoulder dystocia
  2. Pre-term delivery
    • may lead to respiratory distress syndrome
  3. Hypoglycaemia in baby
    • Due to continued high foetal insulin levels even after birth
  4. Increased risk of T2DM later in life
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17
Q

Sx of Down’s

A
  1. Facial features
    • Upward-slanting palpebral fissures
    • Protruding tongue
    • Small low set ears
  2. Short stature
  3. Learning difficulties
  4. Congenital heart defects
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18
Q

Ix for Down’s screening

A

Screening test between 10w and 14w for:
- Trisomy 13
- Trisomy 18
- Trisomy 21

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19
Q

Summarise Down’s screening

A
  1. Combined test
    • Nuchal translucency using USS
    • PAPP-A hormone (reduced)
    • beta-hCG (raised)
  2. Triple test if woman presents post 13w
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20
Q

Define pre-eclampsia

A
  1. Placental condition
  2. Affects pregnant women from 20w
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21
Q

Sx of pre-eclampsia

A
  1. Hypetension
  2. Proteinuria
  3. Peripheral oedema
  4. Severe headache
  5. Drowsiness
  6. Visual disturbances
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22
Q

State the maternal complications in pre-eclampsia

A
  1. Eclampsia
    • Seizure due to cerebrovascular vasospasm
  2. Organ failure
  3. Disseminated intravascular coagulation (DIC)
  4. HELLP syndrome (Haemolysis (H), elevated liver enzymes (EL), low platelets (LP))
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23
Q

State foetal complications of pre-eclampsia

A
  1. Intrauterine growth restriction
  2. Pre-term delivery
  3. Placental abruption
  4. Neonatal hypoxia
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24
Q

Ix for pre-eclampsia

A
  1. BP measurement
  2. Urinalysis (confirm proteinuria)
  3. Bloods
    • Kidney function
    • Liver function
    • Clotting status
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25
Q

Management of pre-eclampsia

A
  1. Aspirin as prophylaxis
    • 12w to birth for women with 1x high risk factor or 2 or more moderate risk factors
  2. Anti-hypertensive
    • Labetalol
  3. Magnesium sulphate prophylaxis for eclamptic seizures
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26
Q

Define ectopic pregnancy

A

embryo implanting and growing outside the uterine cavity

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27
Q

Sx of ectopic pregnancy

A
  1. Pelvic pain - may be unilateral ipsilateral to ectopic
  2. Shoulder tip pain - if ectopic bleeds, blood irritates diaphragm -> shoulder top pain
  3. Abnormal vaginal bleeding
  4. Haemodynamic instability
  5. Cervical tenderness (Chandelier’s sign)
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28
Q

Ix for ectopic pregnancy

A
  1. Pregnancy test to confirm
  2. Transvaginal USS to locate
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29
Q

Management of ectopic pregnancy

A
  1. Conservative management
    • For minimal to no Sx
    • Close follow-up with repeat B-hCG; if do not decrease -> active management
  2. Medical management
    • One off dose of methotrexate
    • Criteria for methotrexate:
      • Low hCG level
      • Ability to attend follow up
      • Adherence to avoiding pregnancy for a period post treatment
    • If initial dose fails, 2nd dose or surgical
  3. Surgical management
    • Salpingectomy
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30
Q

Summarise management of epilepsy pre-pregnancy

A
  1. Aim for lowest effective dose monotherapy
  2. Levetiracetam and lamotrigine safest options
  3. AVOID SODIUM VALPROATE
  4. If no fits in last 2y - consider stopping all meds
  5. 5mg/day folic acid from pre conception -> end of 1st trimester
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31
Q

Summarise management of epilepsy in antenatal pregnancy

A
  1. Monitor plasma anti-epileptic drug levels regularly
  2. Foetus monitor throughout pregnancy
  3. Vit K therapy from 36w due to reduced foetal clotting factor production
  4. If seizures during labour -> benzos asap to terminate seizures avoid maternal and foetal hypoxia
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32
Q

Define fibroids

A

benign smooth muscle tumours originating from myometrium of uterus

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33
Q

Sx of fibroids

A
  1. Often asymptotic
  2. Menstrual dysfunction
  3. Infertility if large
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34
Q

Ddx for fibroids

A
  1. Endometrial polyps
    • Irregular menstrual bleeding + spotting
  2. Endometriosis
    • Dysmenorrhea
    • Deep dyspareunia (painful sex)
    • Chronic pelvic pain
    • Infertility
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35
Q

Ix for fibroids

A
  1. Trans-vaginal USS
  2. Biopsy
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36
Q

Management of fibroids

A
  1. Non surgical
    • NSAIDs
    • Anti-fibrinolytics
    • COCP
    • Mirena coil
  2. Surgical
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37
Q

Define 1st stage of labour

A
  • Regular uterine contractions -> cervix dilated to 10cm
    • further divided into:
      • Latent phase: 0-3 cm
      • Active phase: 3 - 10 cm
    • Dilation rate: 1cm/2h primiparous, 1cm/1h multiparous
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38
Q

Sx of 1st stage of labour

A
  1. Regular, painful contractions
  2. Progressive cervical dilation
  3. Blood stained mucus called ‘show’
  4. Rupture of membranes
  5. Descent if foetal head into pelvis
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39
Q

Ddx for 1st stage of labour

A
  1. Braxton Hicks contractions
    • Irregular, non-progressive contractions
    • Do not result in cervical dilation
  2. Preterm labour
    • <37w gestation
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40
Q

Define genital candidiasis (yeast infection)

A
  1. Inflammation of vagina + vulva
  2. Candida Albicans
  3. Recurrent: 4 or more symptomatic episodes / year + 2 episodes confirmed
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41
Q

Rf for Candida infection

A
  1. Pregnancy
  2. Abx use
  3. Immunosupression
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42
Q

Sx of candida infections

A
  1. Women
    • Itching
    • White curdy discharge
    • Sour milk odour
  2. Men
    • Soreness
    • Pruritis
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43
Q

Ddx of candida infection

A
  1. Bacterial vaginosis
    • Greyish white
    • Fishy odour
    • Absence of significant inflammation
  2. Trochomoniasis
    • Yellow-green frothy discharge
    • Dysuria
    • Itching
  3. Chlamydia/ gonorrhoea
    • Pelvic pain + bleeding
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44
Q

Tx of candida infection

A
  1. Oral (-azoles)
    • Fluconazole
  2. Intravaginal
    • Clotrimazole pessary
  3. Vulval
    • Topical clotrimazole cream
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45
Q

Define gestational Diabetes mellitus (GDM)

A
  1. Glucose intolerance
  2. Fasting blood glucose > 5.6 mmol/L
  3. 2h plasma > 7.8 mmol/L
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46
Q

Rf for GDM

A
  1. High 2TDM prevalence ethnic backgrounds
  2. PMH of GDM
  3. Prior delivery of macroscopic babies (>4.5kg)
  4. Maternal obesity (BMI > 30)
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47
Q

Sx of GDM

A
  • Usually no noticeable Sx
    • Some may experience:
      • Polyuria
      • Thirst
      • Fatigue
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48
Q

Foetal complication of GDM

A
  1. Macrosomia (>4kg)
    • Increased risk of shoulder dystopia, birth injuries, emergency c-section
  2. Sacral agenesis
  3. Neonatal hypoglycaemia due to high insulin
  4. Baby developing T2DM
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49
Q

Maternal complication of GDM

A
  • Increased risk of hypertension and pre-eclampsia
    • T2DM
    • GDM in subsequent pregnancies
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50
Q

Tx of GDM

A
  1. Lifestyle changes
    • If target not met within 2w, offer metofrmin
  2. If fasting glucose >7mmol/L insulin therapy
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51
Q

Define GBS

A
  1. Group B Strep infection
  2. Bacterium carried asymptomatically in GU tract for ~25% pregnant women
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52
Q

Sx of GBS in newborn

A
  1. Sepsis
  2. Pneumonia
  3. Meningitis
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53
Q

Tx of GBS

A

Intrapartum Abx prophylaxis: IV Penicillin during labour and delivery

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54
Q

Define HELLP syndrome

A
  1. Complication of pregnancy characterised by:
    • Haemolysis (H)
    • Elevated liver enzymes (EL)
    • Low platelets (LP)
  2. Manifests in 3rd trimester
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55
Q

Sx of HELLP syndrome

A
  1. Headache
  2. N+V
  3. Epigastric pain
  4. RUQ pain
  5. Blurred vision
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56
Q

Complications of HELLP syndrome

A
  1. Maternal complications
    • Organ failure
    • Placental abruption
  2. Foetal complications
    • Intrauterine growth restriction
    • Preterm delivery
    • Neonatal hypoxia
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57
Q

Define Haemolytic Disease of Newborn (HDN)

A
  1. Immunological condition
  2. Rh- negative mother sensitised to Rh+ RBCs of baby in utero
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58
Q

Sx of HDN

A
  1. Hydrops foetalis
    • Appears as foetal oedema in at least 2 compartments on antenatal USS
  2. Yellow amniotic fluid due to excess bilirubin
  3. Neonatal jaundice
  4. Foetal anaemia
  5. Hepatomegaly or splenomegaly
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59
Q

Ddx of HDN

A
  1. G6PD deficiency
    • Same Sx but EPISODIC
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60
Q

Ix of HDN

A
  1. Direct Antiglobulin Test (DAT)
  2. USS to detect foetal oedema
  3. LFTs
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61
Q

Tx of HDN

A
  1. Intrauterine transfusions if severe anaemia in foetus
  2. Early delivery if severe
62
Q

Define Tocolytics

A
  • Drugs used to suppress contractions and therefore labour
  • Used in pre term labour
63
Q

State indications for induction of labour

A
  1. Post date: >41w gestation
  2. Preterm pre labour rupture of membranes
  3. Intrauterine foetal death
  4. Abnormal CTG
  5. Maternal conditions like pre-eclampsia
64
Q

State contraindications to labour induction

A
  1. Previous vertical incision during c-section
  2. Multiple lower uterine segment C-sections
  3. Transmissible infections
  4. Placenta previa
  5. Vasa previa
65
Q

How is labour induced?

A
  1. Membrane sweep
    • Insert gloved finger into external os
    • Separate membrane from cervix
  2. Vaginal prostaglandins (PGE2)
    • Used to ripen cervix and induce contractions
  3. Amniotomy
    • Artificial rupture of membranes
  4. Balloon catheter
    • Mechanically dilate cervix
66
Q

What is the Kleihauer test?

A
  • Diagnostic procedure
  • Quantify volume of foetal Hb present in maternal circulation
67
Q

Define vasa praevia

A
  • Unprotected foetal vessels run close to/across internal cervical os
  • Makes them prone to rupture during membrane rupture
  • Can result in foetal haemorrhage
68
Q

Sx of vasa praevia

A

Triad of:
1. Painless vaginal bleeding
2. Rupture of membranes
3. Foetal bradycardia

69
Q

Ddx of vasa praevia

A
  1. Placenta praevia
    • NO foetal bradycardia or death
  2. Abruptio placentae
    • abdo pain
    • Uterine tenderness and rigidity
70
Q

Ix for vasa praevia

A

Transabdominal/transvaginal ultrasonography

71
Q

Tx of vasa praevia

A

C-section prior to rupture of membranes

72
Q

Sastra the types of foetal presentations

A
  1. Cephalic
    • Baby’s head palpable at base of abdomen
  2. Breech
    • Buttocks or feet palpable at base of abdomen
    • Shoulder
    • Shoulder, arm or trunk palpable at base of abdomen
73
Q

What are twin pregnancies classified by?

A
  1. Zygosity
    • Number of zygotes
  2. Chorionicity
    • Outer sac
  3. Amnionicity
    • Inner sac
74
Q

Summarise monozygotic pregnancy

A
  1. Identical twins
  2. Depending on stage at which split occurs:
    • Dichorionic + diamniotic (2 different sacs)
    • Monochorionic + diamniotic (same outer sac, different inner sacs)
75
Q

State the 1st line tocolytic agent

A

Nifedipine

76
Q

Contraindications for tocolysis

A
  1. Gestation >34w
  2. Cervical dilation >4cm
77
Q

Define the 3rd stage of labour

A
  1. Stage between delivery of foetus and delivery of placenta + foetal membranes
  2. 30-90 mins naturally or 5-10 mins with oxytocin
78
Q

Sx of 3rd stage of labour

A
  1. Gush of blood from vagina
  2. Lengthening of umbilical cord
  3. Ascension of uterus in abdomen
79
Q

State the supplements recommended in pregnancy

A
  1. Folic acid 400 mcg/day
    • Pre term -> 12w gestation
  2. Vit D 10 mcg (400 units)/day
    • Throughout pregnancy and breastfeeding
80
Q

Define Spina bifida

A
  1. Neural tube defect
  2. Incomplete development of spinal column
  3. Herniation of the spinal cord
81
Q

State the 3 types of Spina bifida

A
  1. Spina bifida occulta
    • Incomplete fusion of vertebrae
    • NO herniation of spinal cord
  2. Meningocele
    • Incomplete fusion of vertebrae
    • WITH herniation of meningeal sac containing CSF
  3. Myelomeningocele
    • Incomplete fusion of vertebrae
    • WITH herniation of meningeal sac containing CSF AND spinal cord
82
Q

Define shoulder dystocia

A
  1. Type of obstructed labour
  2. Following delivery of foetal head, anterior shoulder impacted behind maternal pubic symphysis
83
Q

Define the 2nd stage of labour

A

Stage from desire to push to repositioning of foetus in prep for birth

84
Q

State Rf for PPH

A
  1. Previous PPH
  2. BMI >35
  3. Multi pregnancy
  4. Parity >4
  5. Macrosomia
85
Q

Define rhesus isoimmunisation

A
  1. Rh- mother with Rh+ baby
  2. If any foetal RBCs enter maternal circulation, mother form anti-D antibodies
  3. Maternal anti-D antibodies can cross placenta in subsequent pregnancies for future Rh+ baby
    • Cause Rh haemolytic disease
86
Q

What are sensitisation events?

A

Rh+ foetal blood crossing placenta into maternal circulation

87
Q

State complications of anti-D sensitisation

A

Incompatibility in pregnancy + haemolysis in future pregnancies

88
Q

Tx for rhesus isoimmunisation

A
  • Anti-D antibodies given to:
    • patients who have experienced sensitising events
  • All non-sensitised Rh- mothers at 28w
  • Anti-D antibodies prophylaxis only
89
Q

Management of pre term labour (before 37w)

A
  1. Corticosteroids - accelerate foetal lung maturation
  2. IV Abx if risk or history of GBS - Penicillin if no allergy
  3. Tocolytic agents (Nifedipine) to delay labour
90
Q

Define pregnancy of unknown origin

A

+ve pregnancy test but no signs of intrauterine or extrauterine pregnancy on transvaginal USS

91
Q

Aetiology of pregnancy of unknown origin

A
  1. Early viable or failing intrauterine pregnancy
  2. Complete miscarriage
  3. Ectopic pregnancy
92
Q

Sx of pre labour rupture of membranes at term (PROM)

A
  1. Foul smelling or greenish amniotic fluid
  2. Maternal fever
  3. Reduced foetal movements
93
Q

Tx of PROM at term

A

Induce labour if doesn’t commence spontaneously within 24h of PROM

94
Q

Define PPH

A

Loss of at least 500mL of blood within first 24h of delivery

95
Q

Risk factors for PPH

A
  1. Previous PPH
  2. BMI > 35
  3. Multiple pregnancy
  4. Parity > 4
96
Q

Tx of PPH

A
  1. ABCDE
  2. Consider major haemorrhage protocol
  3. 2x large bore cannulas
  4. MEDICAL: Oxytocin, tranexamic acid
  5. SURGICAL: Intrauterine balloon tamponade, B-lynch suture
97
Q

Define polyhydramnios

A

Excess amniotic fluid

98
Q

Sx of polyhydramnios

A
  1. Tense/large uterus
  2. Difficulty feeling foetal parts on palpation
99
Q

Complications of polyhydramnios

A
  1. Maternal resp compromise due to increased pressure on diaphragm
  2. Inreased risk of UTI due to increased pressure on urinary system
  3. Worsening reflux, constipation, oedema and sretch marks
100
Q

Define placental abruption

A
  1. Premature separation of placenta from uterine wall during pregnancy
  2. -> maternal haemorrhage
101
Q

Sx of placental abruption

A
  1. Abdo pain
  2. Woody uterus
  3. Contractions
  4. Vaginal bleeding (some cases can be concealed -> no bleed)
  5. Reduced foetal movement + abnormal CTG
102
Q

Risk factors of placental abruption

A
  1. Trauma
  2. Pre-eclampsia or hypertension
  3. Multiparity
  4. Polyhdramnios
  5. Substance abuse during pregnancy (smoking and cocaine)
103
Q

Tx of placental abruption

A
  1. ABCDE
  2. Emergency delivery if maternal and/or foetal compromise detected
  3. Induction of labour preferred no foetal or maternal compromise
  4. GIVE ANTI-D WITHIN 72H OF ONSET IF MOTHER RH-
104
Q

Define placenta praevia

A

Low lying placenta that may cover cervix

105
Q

Sx of placenta praevia

A
  1. Painless bright red vaginal bleeding after 24w
  2. Malpresentation of foetus
106
Q

Ix for placental praevia

A
  1. Painless bleeding after 13w -> transvaginal USS to exclude PP
  2. No routine screening in low risk in UK
107
Q

Tx of PP

A
  1. Bleeding with unknown placental position
    • ABCDE
    • Urgent transvaginal USS if stable
    • Immediate c-section if uncontrolled bleeding
  2. Bleeding with known placenta praevia
    • ABCDE
    • Emergency C-section if not stabilised
    • Corticosteroids if between 24-34w (risk of preterm labour
108
Q

Define the types of perineal tears

A
  1. 1st degree
    • Limited to the superficial perineal skin or vaginal mucosa
  2. 2nd degree
    • Extends to perineal muscle and fascia BUT anal sphincter intact (episiotomy classified as 2nd degree)
  3. 3rd degree
    • 3a: <50% of the thickness of the external anal sphincter is torn
    • 3b: >50% of the thickness of external anal sphincter torn but internal sphincter intact
    • 3c: External and internal anal sphincter torn but anal mucosa intact
  4. 4th degree
    • Perineal skin, muscle, anal sphincter and anal mucosa torn
109
Q

State pathogens that cause Pelvic Inflammatory Disease (PID)

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhoeae
110
Q

Define oligohydramnios

A

Lower than normal volume of amniotic fluid

111
Q

Sx of aligohydroamnios

A
  1. Lack of space -> foetal compression
    • Clubbed feet
    • Facial deformity
    • Congenital hip dysplasia
  2. Lack of amniotic fluid
    • Pulmonary hypoplasia
112
Q

Sx of obstetric cholestasis

A
  1. After 24w
  2. Accumulation of bile acids
  3. Pruritus
  4. RUQ pain
  5. Jaundice
  6. Loss of appetite
113
Q

Tx for obstetric cholestasis

A
  1. Chlorphenamine + Vit K
  2. Early delivery planning
  3. Off - license use of UDCA
114
Q

State Naegele’s rule

A

(1st day of LMP + 1y7d)-3m = EDD
(Expected Date of Delivery)

115
Q

Define molar pregnancy

A
  1. Gestational trophoblastic disease
  2. Imbalance of paternal and maternal chromosomes
116
Q

Sx of molar pregnancy

A
  1. Vaginal bleeding
  2. Nausea
  3. Hyperemesis gravidarum (severe vomiting before 20w)
117
Q

State the 4 types of miscarriage

A
  1. Threatened miscarriage
  2. Inevitable miscarriage
  3. Complete miscarriage
  4. Missed miscarriage
118
Q

Define threatened miscarriage

A
  1. Mild Sx of bleeding
  2. Foetus retained within uterus as cervical os is closed
119
Q

Inevitable miscarriage

A
  1. Heavy bleeding + pain
  2. Foetus intrauterine but cervical os open
120
Q

Complete miscarriage

A
  1. Intrauterine pregnancy that has fully miscarried
  2. All products of conception expelled
  3. Uterus empty + cervical os closed
121
Q

Missed miscarriage

A
  1. Uterus contains foetal tissue
  2. Foetus no longer alive
  3. Missed due to asymptotic + closed cervical os
122
Q

Tx for miscarriage

A

MEDICAL
1. Missed miscarriage:
- 200mg mifepristone
- 48h later 800 mcg misoprostol (vaginal, oral or sublingual)
2. Incomplete miscarriage:
- 600-800 mcg misoprostol (vaginal, oral or sublingual)
SURGICAL
1. Manual vacuum aspiration under local
2. Surgical management under general

123
Q

Define meconium

A
  1. Initial faeces passed by newborn
  2. Sometimes expelled into amniotic fluid before birth
    -> meconium stained liquor
124
Q

Define meconium aspiration syndrome

A

Passage of meconium into foetal lungs
-> blockage + inflammation

125
Q

Sx of meconium aspiration syndrome

A
  1. Meconium stained liquor during rupture of membranes or birth
    • greenish/yellowish
  2. Green staining of infant’s skin, nail beds or umbilical cord
  3. Resp distress in newborn
  4. Crackles on ausc. of foetal lungs
126
Q

Tx of meconium aspiration syndrome

A
  1. Gentle suction mouth + nose
  2. Abx
  3. Transfer to neonatal ICU
127
Q

Outline cervical screening

A
  1. All women 25-64
  2. Sample taken and tested for HPV
  3. 24-49 every 3y
  4. 50-64 every 5y
  5. Identify pre - cancerous dyskaryotic cells
128
Q

State outcome of +ve HPV test during cervical screening

A

Referred for cytological testing
-> +ve = colposcopy referral
-> -ve = Repeat HPV in 12m then 24m if still +ve. If remains +ve then -> colposcopy

129
Q

What type of cancer cell is cervical cancer?

A

SCC

130
Q

Sx of cervical cancer

A
  1. Vaginal discharge
  2. Bleeding
  3. Vaginal discomfort
  4. Urinary/bowel habit changes
  5. Suprapubic pain
131
Q

Ix for cervical cancer

A
  1. Speculum
  2. Bloods
    • FBC (anaemia)
    • LFTs (liver involvement)
    • U&Es (renal involvement)
  3. CT for staging
  4. Colposcopy
132
Q

Tx of cervical cancer

A

Maintain fertility
1. Small cancers
- conisation with free margins
2. Radical trachelectomy
- Removal of cervix, upper vagina and pelvic lymph nodes
NOT maintaining fertility
1. Laparoscopic hysterectomy + lymphadenectomy
2. Invasive, infiltrating and early metastatic cancer
- Wertheim’s hysterectomy
- Removal of uterus, primary tumour, pelvic lymph nodes, upper 1/3 of vagina

133
Q

General principle of female contraception

A
  1. Thickening of cervical mucus
  2. Thin the endometrial lining
  3. Prevent ovulation (COCP)
134
Q

Contraindication for contraception

A
  1. Known pregnancy
  2. HYT SBP >160 or DBP >100
  3. Smoker with >15 cigarettes age>35
  4. IHD
  5. Stroke/ vasc disease
135
Q

Management of dysmenorrhoea

A
  1. Tranexamic acid
  2. Contraception
136
Q

Summarise emergency contraception

A
  1. Levonorgestrel (Levonelle)
    • Within 72h
    • Prevent ovulation + implantation (ellaOne)
  2. Ulipristal acetate
    • Within 120h
    • Prevent ovulation
  3. Copper IUD (ParaGard)
    • Within 120h
    • Prevemy implantation
137
Q

Define endometriosis

A

Growth of endometrial tissues outside the uterine cavity

138
Q

Sx of endometriosis

A
  1. Dysmenorrhoea
  2. Dyspareunia (pain during intercourse)
  3. Subfertility
139
Q

Dx of endometriosis

A

Diagnostic laparoscopy

140
Q

Tx of endometriosis

A
  1. Analgesia
  2. HRT: COCP (unsuitable if endometriosis causing infertility)
  3. Ablation or excision of lesions
141
Q

Define fibroids

A
  1. Benign tumours of myometrium of uterus
  2. Common in women >30
142
Q

Sx of fibroids

A
  1. Menstrual dysfunction
  2. Infertility
143
Q

Dx of fibroids

A

Transvaginal USS

144
Q

Define vaginal prolapse

A
  1. Displacement of pelvic structures from normal position
  2. Towards or through vaginal opening
145
Q

Tx of vaginal prolapse

A
  1. Pelvic floor exercises
  2. Pessary
  3. Surgical intervention
146
Q

Sx of ovarian cyst rupture

A
  1. Can be asymptomatic
  2. Acute unilateral pain
  3. Bloating + early satiety
147
Q

Ddx for ovarian cyst rupture

A
  1. Ovarian torsion
    • Sudden severe pain
    • N+V
  2. Ectopic pregnancy
    • Abdo pain
    • Amenorrhea
    • Vaginal bleeding
  3. Appendicitis
    • Navel -> RLQ pain
    • Loss of appetite
    • N+V
148
Q

Sx of ovarian torsion

A
  1. Sudden onset abdo pain
  2. N+V
  3. Palpable adnexal mass
149
Q

Tx of ovarian torsion

A

Surgical
- Detorsion
- Salpingo-oophorectomy if ovary necrosed

150
Q

Sx of PCOS

A
  1. Oligomenorrhoea
  2. Hirsutism (male pattern hair growth)
  3. Acne
  4. Subfertility
151
Q

Tx of PCOS

A
  1. Medical (not planning pregnancy)
    • COCP
    • Co-cyprindol
    • Metformin
  2. Medical (wishing to conceive)
    • Clomiphene
    • Metformin

Phase 3a (5 decks)

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