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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
How do you prevent rhesus sensitisation? What can you do if sensitisation has already occured?
Give Anti-D doses, one at 28 weeks and the other at 34 weeks gestation No point in giving Anti-D!
26
What counts as a 'sensitising event' in the woman?
-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
What can haemolytic disease of the newborn look like?
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
When do you give steroids in labour?
If labour <35 weeks
28
Management of PPROM
Give erythromycin for 10 days Do not perform digital vaginal examination Aim delivery at 34/40, risk of chorioamnionitis in Mum
28
When do you give magnesium sulphate in labour?
Typically <30 weeks, can be given up to <34 weeks Prevents CP
29
What is difference of PPROM and PROM?
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
Who gets tested for GBS?
Routine testing not recommended Only test women who have had previous GBS pregnancy, offer test at 35-37 weeks or IAP
31
Who gets IV benpen during labour?
-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
What is oligohydraminos? When is it usually seen
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
What is polyhydraminos?
Excessive liqor (>95th centile) -Idiopathic -fetal GI tract anomalies (duodenal or oesophageal atresia) -Congenital infection -Fetal polyuria (diabetes and twin-twin transfusion)
34
What is potter sequence?
Bilateral renal agenesis of baby plus pulmonary hypoplasia, cause of oligohydraminos
35
What are the stages of labour?
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
What are the series of movements the foetus makes down through pelvis?
-Engagement -Descent -Flexion -Internal rotation of fetal shoulder -Extension -Resitution (head externally rotates) -External rotation -Expulsion
37
What is scoring system used for Induction of labour
Bishops score
38
What makes up the Bishops score?
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
What are the contraindications to induction of labour?
Cephalopelvic disproportion Malpresentation Fetal distress Placenta and vasa previa Cord prolapse
40
IOL if Bishop score is >6? IOL if Bisoph score is
If >6: Jump straight to aminotomy (ARM) and IV oxytocin If
41
What is counted as a prolonged deceleration vs fetal bradycardia?
Prolonged deceleration is lasting >2mins Bradycardia is lasting >3mins (needs urgent delivery)
42
What are the grades of perineal tears?
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
How do you manage 3rd and 4th degree tears?
Need repair under epidural and GA Give antibiotic prophylaxis for 10 days
44
What should you think about in patient who has had ARM and suddenly becomes unresponsive?
Amniotic fluid embolism
45
What is medical condition means a contraindication to using Ulipristal
Asthma
46
Management of shoulder dystocia?
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
Risk factors for cord prolapse
Breech presentation Polyhydraminos **ARM** Unengaged presenting part Prematurity and low birth weight Abnormal lie
48
Management of cord prolapse
-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
When do you offer external cephalic version?
If breech presentation can offer from 36 weeks in nulliparous women If multiparous at from 37 weeks
50
When is ECV contraindicated?
Contraindicated in -where caesarean delivery is required -antepartum haemorrhage within the last 7 days -abnormal cardiotocography -major uterine anomaly -ruptured membranes -multiple pregnancy
51
What is secondary PPH typically due to? (From 24hrs-12 weeks post partum)
Endometritis or retained placental tissue
52
Management of Primary PPH?
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
What organism most commonly causes mastitis? Tx?
Staph aureus Tx with flucloxacillin
54
What should you consider if 'dark red mass' suddenly appears postpartum with bleeding and abdominal pain?
Inverted uterus -Immediately replace- push through cervix -Transfuse 4-6units -Tocolytic drugs -If manual and medical replacement fails, for laparotomy
55
Tx of BV if allergic to metronidazole?
Topical clindamycin
56
Treatment of hyperthyroidism in pregnancy? Tx of hypothyroidism?
-Carbimazole from 2nd trimester -PTU from before conception and during 1st trimester Avoid carbimazole in 1st Trimester Hypo increase levothyroxine by 25-50mcg
57
Most common cause of hyperthyroidism in pregnancy?
Graves disease (accounts for 85%)
58

MSRA- Imo (10 decks)

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