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MSRA- Imo > Women's Health > Flashcards

Women's Health Flashcards

1
Q

COCP mode of action

A

Inhibits ovulation

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2
Q

Progesterone Only Pill (POP)

A

Thickens cervical mucous

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3
Q

Desogestrel- only

A

Primary- inhibits ovulation
Also thickens cervical mucous

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4
Q

Injectable contraceptive (medroxyprogesterone acetate)

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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5
Q

Implantable contraceptive (etonogestrel)

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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6
Q

Intrauterine contraceptive device

A

Decreases sperm motility and survival

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7
Q

Intrauterine system (mirena)

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

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8
Q

Levonogestrel

A

Inhibits ovulation

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9
Q

Ulipristal

A

Inhibits ovulation

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10
Q

IUD as emergency contraception

A

Toxic to sperm and ovum

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11
Q

What are UKMEC 3

(7 of them!)

A

> 35 and smoking less than 15 a day
-BMI >35
-Family history of thromboembolic disease in 1st degree relative <45
-Controlled hypertension
-Immobility eg wheelchair use
-Carrier of BRACA-1 or BRACA-2
-Current Gallbladder disease

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12
Q

What are UKMEC 4 conditions?

(9 of them!)

A
  • > 35y/o and smoking >15 a day
    -Migraine with aura
    -History of thromboembolic disease or thrombogenic mutation
    -history of stroke or IHD
    -Breast feeding <6 weeks postpartum
    -Uncontrolled hypertension
    -current breast cancer
    -major surgery with prolonged immobilisation
    -positive antiphospholipid antibodies
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13
Q

When do you refer a woman earlier for breast cancer screening if she only has one 1st or 2nd degree relative with a history of breast ca?

A

-age of diagnosis < 40 years
-bilateral breast cancer
-male breast cancer
-ovarian cancer
-Jewish ancestry
-sarcoma in a relative younger than age 45 years
-glioma or childhood adrenal cortical carcinomas
-complicated patterns of multiple cancers at a young age
paternal history of breast cancer

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14
Q

What are considered ‘moderate’ risk factors for pre-eclampsia?

A

-Age >40
-First pregnancy
-Pregnancy interval of >/= 10yrs
-BMI of 35 or more
-Family history of pre-eclampsia
-Multiple pregnancy

Need to have two risk factors to be started on aspirin 75mg from 12 weeks

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15
Q

What are considered high risk factors for pre-eclampsia?

A

Hypertensive disease during prev pregnancy
CKD
Autoimmune disorder
Type 1 or 2 diabetes
Chronic hypertension

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16
Q

What obstetric drugs are contraindicated in pre-eclampsia?

A

Syntometrine
Ergometrine

(Both drugs are associated with hypertension)

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17
Q

When do you start insulin straight away in GDM?

A

If fasting glucose >7

Or if fasting glucose between 6-6.9, but evidence of complications ef hydraminos or macrosmia

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18
Q

What are risk factors for GDM? When is OGGT offered?

A

Women with;
-BMI >30
-Previous macrosmic infant
-First degree relative with DM
-Previous GDM
-From a country where DM common (south asia, middle eastern etc)

Offer OGTT at 24-28 weeks
For women who have had GDM before, offer it straight away and then again at 24-28 weeks

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19
Q

What is stepwise management of GDM?

A

If fasting glucose <7, offer diet and lifestyle modifications for 2 weeks, if targets not met, commence metformin.

Targets:
Fasting glucose 5.3
1hr after meals 7.8
2hrs after meals 6.4

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20
Q

What BP reading in pre-eclampsia means women should be admitted?

A

> 160/110

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21
Q

Features of severe pre-eclampsia?

A

-BP >160/110
-Proteinuria
-Headache
-Visual disturbance
-Papilloedema
-RUQ pain/epigastric pain
-Hyperreflexia
-PLT count <100

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22
Q

What is the triad for vasa previa?

A

Rupture of membranes
Painless PV bleeding
Fetal bradycardia

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23
Q

What is Kleihauer test?

A

Determines proportion of fetal RBCs present in maternal blood and therefore the calculation of amount of anti-D required for any sensitisation

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24
Q

What does rhesus isoimmunisation/sensitisation mean?

A

A rhesus negative mother with a rhesus positive baby

(The mum produces IgG antibodies which will affect future pregnancies)

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25
Q

How do you prevent rhesus sensitisation?

What can you do if sensitisation has already occured?

A

Give Anti-D doses, one at 28 weeks and the other at 34 weeks gestation

No point in giving Anti-D!

26
Q

What counts as a ‘sensitising event’ in the woman?

A

-Delivery of Rh positive infant
-APH
-Miscarriage
-TOP
-Invasive pregnancy testing (amniocentesis)
-Ectopic pregnancy
-Abdominal trauma
-External cephalic version

If an event occurs in 2nd or 3rd trimester, give a larger dose of anti-D and use Kleihauer test to determine amount

27
Q

What can haemolytic disease of the newborn look like?

A

Occurs when sensitisation in the mother has happened and not been detected;

Hydrops fetalis
Intrauterine detah
Kernicterus
Heart failure
Jaundice, anaemia and hepatosplenomegaly

Baby needs transfusions and UV therapy

28
Q

When do you give steroids in labour?

A

If labour <35 weeks

28
Q

Management of PPROM

A

Give erythromycin for 10 days
Do not perform digital vaginal examination
Aim delivery at 34/40, risk of chorioamnionitis in Mum

28
Q

When do you give magnesium sulphate in labour?

A

Typically <30 weeks, can be given up to <34 weeks
Prevents CP

29
Q

What is difference of PPROM and PROM?

A

PPROM is preterm premature rupture of membranes;
-ROM <37 weeks
-Need 10 days of erythromycin
-Deliver right away if any signs of chorioamnionitis, otherwise wait until 34/40

PROM is premature rupture of membranes, in >37 weeks. ‘Waters breaking’ before onset of labour, most women will start to labour within 2hrs, if not need IOL by 48hrs to reduce risk of infection (this is prolonged ROM)

30
Q

Who gets tested for GBS?

A

Routine testing not recommended
Only test women who have had previous GBS pregnancy, offer test at 35-37 weeks or IAP

31
Q

Who gets IV benpen during labour?

A

-Women positive for GBS
-Women with a pyrexia during labour
-Women in preterm labour regardless of GBS status
-Offered to women with a prevoius early to late onset GBS in baby

32
Q

What is oligohydraminos?
When is it usually seen

A

Insufficient liqor (<2cm, below 5th centile)
-Renal abnormalities- Potter’s disease, renal agenesis
-Premature rupture of membranes
-Pre-Eclampsia
-Twin- twin transfusion (MCMA twins)
-IUGR and post term pregnancies

33
Q

What is polyhydraminos?

A

Excessive liqor (>95th centile)
-Idiopathic
-fetal GI tract anomalies (duodenal or oesophageal atresia)
-Congenital infection
-Fetal polyuria (diabetes and twin-twin transfusion)

34
Q

What is potter sequence?

A

Bilateral renal agenesis of baby plus pulmonary hypoplasia, cause of oligohydraminos

35
Q

What are the stages of labour?

A

Stage 1: onset of true to labour to full cervical dilation
Stage 2: Active pushing with contractions until baby is born
Stage 3: Delivery of placenta

36
Q

What are the series of movements the foetus makes down through pelvis?

A

-Engagement
-Descent
-Flexion
-Internal rotation of fetal shoulder
-Extension
-Resitution (head externally rotates)
-External rotation
-Expulsion

37
Q

What is scoring system used for Induction of labour

A

Bishops score

38
Q

What makes up the Bishops score?

A

Cervical position
Cervical consistency
Cervical length
Cervical dilatation
Fetal station

<5 means labour unlikely to occur on its own
>7 suggests labour will begin spontaneously

39
Q

What are the contraindications to induction of labour?

A

Cephalopelvic disproportion
Malpresentation
Fetal distress
Placenta and vasa previa
Cord prolapse

40
Q

IOL if Bishop score is >6?
IOL if Bisoph score is </= 6

A

If >6: Jump straight to aminotomy (ARM) and IV oxytocin

If </= 6: Can do a membrane sweep and give pessary of prostaglandins or oral misoprostol

41
Q

What is counted as a prolonged deceleration vs fetal bradycardia?

A

Prolonged deceleration is lasting >2mins
Bradycardia is lasting >3mins (needs urgent delivery)

42
Q

What are the grades of perineal tears?

A

Grade 1- superficial damage
Grade 2- injury to perineal muscle, not involving anal sphincter
Grade 3a- <50% EAS thickness torn
Grade 3b >50% of EAS thickness torn
Grade 3c Internal anal sphincter is torn
Grade 4 Injury to perineum involving anal sphincter complex and rectal mucosa

43
Q

How do you manage 3rd and 4th degree tears?

A

Need repair under epidural and GA
Give antibiotic prophylaxis for 10 days

44
Q

What should you think about in patient who has had ARM and suddenly becomes unresponsive?

A

Amniotic fluid embolism

45
Q

What is medical condition means a contraindication to using Ulipristal

A

Asthma

46
Q

Management of shoulder dystocia?

A

H call for help
E valuate for episiotomy
L egs in mcroberts manoeuvre
P ressure on the suprapubic area and apply steady traction to the fetal head
E nter menoeuvres- internally rotate the fetal shoulders
R emove posterior arm
R oll the patient on all 4s

47
Q

Risk factors for cord prolapse

A

Breech presentation
Polyhydraminos
ARM
Unengaged presenting part
Prematurity and low birth weight
Abnormal lie

48
Q

Management of cord prolapse

A

-Push presenting part of fetus back into uterus
-If cord is past level of introitus, minimial handling- keep cord warm and moist
-Patient on all 4s or in left. lateral position
-Retrofill the bladder with normal saline as lifts pressure off

49
Q

When do you offer external cephalic version?

A

If breech presentation can offer from 36 weeks in nulliparous women
If multiparous at from 37 weeks

50
Q

When is ECV contraindicated?

A

Contraindicated in
-where caesarean delivery is required
-antepartum haemorrhage within the last 7 days
-abnormal cardiotocography
-major uterine anomaly
-ruptured membranes
-multiple pregnancy

51
Q

What is secondary PPH typically due to? (From 24hrs-12 weeks post partum)

A

Endometritis or retained placental tissue

52
Q

Management of Primary PPH?

A

Bimanual compression
Empty the bladder
IV oxytocin
IM/IV ergometrine (unless HTN)
Carboprost IM (unless asthmatic)
Misprostol sublingual

Balloon tamponade is best surgical option

53
Q

What organism most commonly causes mastitis?
Tx?

A

Staph aureus
Tx with flucloxacillin

54
Q

What should you consider if ‘dark red mass’ suddenly appears postpartum with bleeding and abdominal pain?

A

Inverted uterus

-Immediately replace- push through cervix
-Transfuse 4-6units
-Tocolytic drugs
-If manual and medical replacement fails, for laparotomy

55
Q

Tx of BV if allergic to metronidazole?

A

Topical clindamycin

56
Q

Treatment of hyperthyroidism in pregnancy?
Tx of hypothyroidism?

A

-Carbimazole from 2nd trimester
-PTU from before conception and during 1st trimester
Avoid carbimazole in 1st Trimester

Hypo increase levothyroxine by 25-50mcg

57
Q

Most common cause of hyperthyroidism in pregnancy?

A

Graves disease (accounts for 85%)

58
Q
A

MSRA- Imo (10 decks)

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