Women's Health Flashcards
When can pts restart their pill after taking levonorgestrel?
Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for emergency contraception
How does imperforate hymen present?
At puberty, girls usually do not have any problems from an imperforate hymen until they start their period. The imperforate hymen blocks the blood from flowing out. As the blood backs up the vagina, it causes: Mass or fullness in the lower part of the belly (from the buildup of blood that can’t come out)
When is the POP effective?
2/7 after taking, unless taken on first day of period
How do we treat eclampsia?
Mag Sulph first line
Levonorgestrel must be taken within x hours of UPSI
Levonorgestrel must be taken within 72 hours of UPSI
How frequent is cervical cancer screening?
Cervical cancer screening
25-49 years: 3-yearly
50-64 years: 5-yearly
What should we do with chickenpox exposure in pregnancy?
first step is to check varicella zoster immunoglobulins (unless had before/had vaccine). If -ve, antivirals are given 7-14/7 afterwards
What is the gold standard ix for endometriosis? First line?
Laparotomy
1st line = TVUS
Which medicine for nausea can causes EPSEs?
Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects
What are EPSEs?
tremor
How can we treat vasomotor symptoms like flushing in the menopause?
SSRI e.g. fluoxetine
Why does the Mirena lead to light bleeding/amenorrhoea?
This is because the Mirena intrauterine system (IUS) releases a small amount of the hormone levonorgestrel into the uterus. This hormone has multiple effects, one of which is to thin the lining of the uterus which reduces menstrual flow and can lead to amenorrhoea in some women. Initially, this may cause irregular spotting or light bleeding but over time (usually within 3-6 months), periods tend to become lighter and less painful, and some women stop having periods altogether.
What is chorioamnionitis?
Chorioamnionitis is an infection of the amniotic fluid and fetal membranes, usually caused by ascending bacterial infection from the vagina and cervix.
How does chorioamnionitis present?
The patient’s presentation with PPROM, abdominal pain, uterine contractions, ‘flu-like symptoms’, fever, and foul-smelling discharge are all characteristic features of chorioamnionitis.
How does candida present?
The patient’s symptoms of a curd-like white vaginal discharge and pain during sexual intercourse are indicative of candidal vulvovaginitis, commonly caused by Candida albicans. This condition is characterised by pruritus, dyspareunia (painful sexual intercourse), and a thick, white ‘cottage cheese’ like discharge.
When do we test for coagulation disorders with heavy menstrual bleeding?
Testing for coagulation disorders (for example, von Willebrand’s disease) should be considered in women who have had heavy menstrual bleeding since menarche and have personal or family history suggesting a coagulation disorder.
When are we concerned about BP in pregnancy?
Above 160.80mmHg and proteinuria
What is the most common inherited bleeding disorder?
Von Willebrand’s Disease
How do we investigate for VWD?
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
How do we manage urge incontinence if bladder training is unsuccessful?
Muscarinic antagonist e.g. Tolterodine = ‘told her to hold it in!’
Others include oxybutynin and solifenacin
When do you feel a firm, woody uterus?
Placental abruption
What is Sheehan’s syndrome?
Sheehan’s syndrome (otherwise known as postpartum hypopituitarism) is a reduction in the function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth.
How does hypopituitarism present?
Amenorrhoea, problems with milk production and hypothyroidism
How must we manage a pt with placenta praevia who has just gone into labour in the community?
If a woman with known placenta praevia goes into labour (with or without bleeding), an emergency caesarean section should be performed
How does the COCP impact breast milk production?
Significantly reduces it, so is contraindicated in breast feeding mothers
When must levonorgestrel be taken?
Within 72H of UPSI
What conditions is premature menopause associated with?
Premature menopause is associated with increased all cause mortality including increased risk of osteoporosis and cardiovascular disease
When do women need contraception post-partum?
21 days
What abx prophylaxis do we give in PPROM?
10 days erythromycin should be given to all women with PPROM
How does ectopic pregnancy present?
amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain suggesting peritoneal bleeding
What is HELPP syndrome?
HELLP syndrome is a severe form of pre-eclampsia whose features include: Haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).
How do we treat atrophic vaginitis?
Treatment is with vaginal lubricants and moisturisers, if these do not help then topical oestrogen cream can be used.
How does atrophic vaginitis present?
Atrophic vaginitis often occurs in women who are post-menopausal women. It presents with vaginal dryness, dyspareunia and occasional spotting. On examination the vagina may appear pale and dry.
Give a RF for cervical cancer
Human papillomavirus infection (particularly 16,18 & 33) is by far the most important risk factor
Give the main adverse effect of the nexplanon implant.
Irregular menstrual bleeding. The Nexplanon implant, which contains the progestin etonogestrel, mainly functions by inhibiting ovulation. However, it also alters the endometrium and cervical mucus, which can lead to changes in menstrual bleeding patterns. According to UK guidelines, up to 1 in 5 women may experience amenorrhoea after a year of use, while others may have frequent or prolonged bleeding.
Where do you see cervical exitation?
Cervical excitation is found in both pelvic inflammatory disease and ectopic pregnancy.
How do we suppress lactation?
Cabergoline - dopamine receptor agonist which inhibits prolactin production causing suppression of lactation
How do we reduce occurrence of pre-eclampsia in women at high risk of developing it?
There is A level data showing that low-dose aspirin started at 12-14 weeks’ gestation is more effective than placebo at reducing occurrence of pre-eclampsia in women at high risk, reducing perinatal mortality and reducing the risk of babies being born small for gestational age
What is placenta praevia?
Placenta praevia refers to a pathological positioning of the placenta in the lower segment of the uterus, either wholly or partly. If the placenta overlies the internal cervical os then this is classed as ‘major praevia’, whereas in ‘minor’ or ‘partial’ praevia it does not. Bleeding from the placenta can occur spontaneously, as a result of trauma, or at the onset of labour as the cervix opens.
What is used first-line for infertility for a pt with PCOS?
Infertility in PCOS - clomifene is typically used first-line
What is Asherman’s syndrome?
Asherman’s syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would.
When can the copper IUD be given as contraception?
The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later
What is a molar pregnancy?
Molar pregnancy is a form of gestational trophoblastic disease. In a normal pregnancy, half of the chromosomes come from the father and half come from the mother. Molar pregnancies may be partial or complete.
What is the difference between a complete and incomplete hydatidiform mole.
A complete hydatidiform mole has a 46 XX or 46 XY karyotype with all of the genetic material deriving from the father. This is most commonly due to abnormal fertilisation of an empty ovum. A partial hydatidiform mole has a karyotype of 69 XXX or 69 XXY and contains both maternal and paternal chromosomes.
How do we manage uterine atony?
Bimanual uterine compression
IV oxytocin
IM carboprost
What is the most common cause of early onset sepsis in the neonate?
The most likely pathogen is Group B Strep which is a common commensal of the female genital tract.
What are the most common causes of late onset sepsis in the neonate?
Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.
When can we use instrumental delivery?
When the cervix is fully dilated
How do we manage stress incontinence in pts who don’t respond to pelvic floor muscle exercises.
Duloxetine may be used in patients with stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention
What antibiotic is ceftriaxone? Can it be given with breast feeding?
Ceftriaxone is a third-generation cephalosporin antibiotic which is considered safe for use in breastfeeding mothers according to the British National Formulary (BNF). It has a low oral bioavailability, and therefore minimal amounts would be absorbed by the infant through breast milk.
Can we give Mirena as emergency contraception?
No
Give the RFs for placental abruption
Risk factors for ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
What does unopposed oestrogen increase the risk of?
Endometrial ca
When can oestrogen not be given by itself as HRT?
If the woman has a womb
What does progesterone in HRT increase the risk of?
Breast ca, VTE
What is the most common cause of post-coital bleeding
Cervical ectropion
How do we treat infertility in PCOS?
Clomifene first line, metformin second line
When can Down’s screening be performed?
Down’s syndrome screening including the nuchal scan is done at 11-13+6 weeks
If the patient requests the screening later in the pregnancy, either the triple or quadruple test should be offered between 15 and 20 weeks.
Give a disadvantage of using depo-provera.
Depo Provera is the main injectable contraceptive used in the UK*. It contains medroxyprogesterone acetate 150mg. It is given via in intramuscular injection every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions**
The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.
Disadvantages include the fact that the injection cannot be reversed once given. There is also a potential delayed return to fertility (maybe up to 12 months)
When is ECV offered?
ECV should be offered from 36 weeks if the baby is still breech.
If the lady was multiparous ECV would be offered from 37 weeks.
What is dilation and curettage used for?
This procedure involves dilating the cervix and scraping or suctioning tissue from the lining of the uterus. It’s typically used to diagnose or treat conditions such as heavy bleeding or to clear the uterine lining after a miscarriage or abortion
What are sometimes referred to as chocolate cysts because of their external appearance?
Endometriotic cyst
Which is the most common ovarian cancer?
Serous carcinoma
What are follicular cysts?
Follicular cysts
commonest type of ovarian cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles
How do we treat nausea in hyperemesis gravidarum?
Cyclizine is correct. This patient has a likely diagnosis of hyperemesis gravidarum given the presentation of nausea and vomiting in association with pregnancy. The recommended initial anti-emetic agent of choice is an antihistamine such as cyclizine.
Why do we take a serum progesterone?
Serum progesterone is taken to confirm ovulation in patients who are struggling to conceive.
When do we take a serum progesterone level?
It should be taken 7 days before the next expected period to coincide with ovulation. For a typical 28 day cycle, this is done on day 21.
What is first-line in primary dysmenorrhoea?
NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
combined oral contraceptive pills are used second line
Give three causes of secondary dysmenorrhoea
Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids
What is oligohydramnios?
In oligohydramnios there is reduced amniotic fluid. Definitions vary but include less than 500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile.
What makes up the amniotic fluid?
Foetal urine
When do we offer the MMR vaccine in pregnancy?
If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination in the post-natal period
What does the COCP protect against?
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
cOc - prOtective against Ovarian and endOmetrial cancer.
Why do we give aspirin in pts with diabetes in pregnancy?
Patients with diabetes (type 1 and 2) should take aspirin 75mg daily from 12 weeks gestation to reduce the risk of pre-eclampsia. They are also at higher risk of neural tube defects, therefore should take the higher dose of folic acid, 5mg daily, whilst trying to conceive until 12 weeks gestation. Pregnant women who have risk factors such as this should be referred at booking to Consultant lead antenatal care.
What is mefenamic acid?
NSAIDs such as mefenamic acid are the first line treatment for primary dysmenorrhoea
When is VBAC contraindicated?
Planned vaginal birth after caesarean (VBAC) is contraindicated in patients with previous vertical (classical) caesarean scars, previous episodes of uterine rupture and patients with other contraindications to vaginal birth (e.g. placenta praevia). Women with two or more previous caesarean sections may be offered VBAC.
What is seen on the combined test in Down’s syndrome?
In Down’s the papa leaves (the others are high)
Thickened nuchal translucency, increased B-HCG, reduced PAPP-A
What is the first-line mx of shoulder dystocia?
Shoulder dystocia: McRoberts manoeuvre (hyperflexion of the maternal legs) is the first management approach, then episiotomy if unsuccessful
How does nexplanon prevent pregnancy/
Inhibition of ovulation. Nexplanon, also known as the etonogestrel contraceptive implant, primarily works by inhibiting ovulation. The progestogen component in Nexplanon suppresses the mid-cycle surge in luteinising hormone (LH), preventing the release of an egg from the ovaries. This is its primary method of contraception.
