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MSRA > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Antenatal care: Treatments

Nausea and vomiting:

Vitamins:

A

ginger and acupuncture of P6 (by wrist)
Promethazine

Vitamin D

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2
Q

Signs and symptoms:

Ectopic pregnancy

Placental abruption

Placenta praevia

Vasa praevia

A

6-8 weeks of amenorrhoea with lower abdominal pain.
Shoulder tip pain and cervical excitation.

Constant lower abdominal pain, women more shocked than expected. Tender tense uterus, normal lie and and presentation, fetal heart distressed

Vaginal bleeding, no pain, non-tender uterus, lie and presentation may be abnormal

Rupture of membranes followed by immediate vaginal bleeding. Foetal bradycardia classically seen

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3
Q

Breast feeding contraindications:

Antibiotics:
Psychiatric drugs
NSAIDs
Misc:

A

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Lithium, benzodiazepines, clozapine

Aspirin

Carbimazole, methotrexate, sulfonylureas, amiodarone

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4
Q

Which medication may be used to suppress lactation?

A

Cabergoline

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5
Q

Management of breech presentations:

Absolute contraindications to ECV:

A

If <36 weeks: most turn spontaneously
If still breach at 36 weeks -> ECV offered from 36 weeks for nulliparous women and 37 weeks in multiparous women.

When C-section required
Antepartum haemorrhage within last 7 days
Major uterine abnormality
ruptured membranes
multiple pregnancy

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6
Q

C sections: Categories and timings

A

Cat 1: delivery of baby should occur within 30 minutes of making decision

Cat 2: delivery within 75 minutes

Cat 3: Delivery is required but mother and baby are stable

Cat 4: elective caesarean

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7
Q

Treatment of chickenpox exposure in pregnancy:
when given?

Treatment of chickenpox infection:

A

post-exposure prophylaxis:
Oral Aciclovir at any stage of pregnancy
Day 7 to 14 following exposure

Oral Aciclovir provided woman is >20 weeks and she presents wihtin 24 hours of on-set of rash

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8
Q

Eclampsia:
Seen after how many weeks gestation?

Signs/symptoms

Treatment

If respiratory depression:

A

20

Pregnancy-induced hypertension, proteinuria

Magnesium sulphate

Calcium gluconate

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9
Q

Side effects in pregnancy: AEDs
Sodium valproate
Carbamazepine
Phenytoin
Lamotrigine

A

Associated with neural tube defects

Least teratogenic of older AEDs

Associated with cleft palate

low rate of congenital malformations - may be increased in pregnancy

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10
Q

Gestational diabetes:

Test of choice:

Diagnostic threshold BMs

Treatment:

If declining insulin

A

OGTT performed as soon as possible after booking and again at 24-28 weeks

Fasting glucose > 5.6
2 hour glucose > 7.8
Think (5,6,7,8)

If fasting glucose <7, diet and exercise advice should be offered.
If glucose targets not met within 1-2 weeks add metformin
if still not met or fasting glucose >7 at diagnosis : add insulin

Glibenclamide should be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets but decline insulin

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11
Q

Group B streptococcus
Risk factors:

Management

Who should it be offered to:

A

prolonged rupture of membranes
previous sibling GBS infection
Maternal pyrexia - secondary to chorioamnionitis

Intrapartum antibiotic prophylaxis (IAP) benzylpenicillin

Women with previous baby with GBS
Women with a pyrexia of >38 during labour

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12
Q

Postpartum haemorrhage

Blood loss greater than:

4Ts

Treatment:

A

500mls

Tone (uterine atony in majority of cases), Trauma, Tissue, Thrombin

ABC -> mechanical (palpate uterine fundus) -> IV oxytocin, ergometrine IV or IM, carboprost IM (unless asthmatic) -> misoprostol SL -> Surgical (intrauterine balloon tamponade) -> B-lynch suture, ligation of uterine arteries or internal iliacs

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13
Q

COCP: UKMEC 4

A

> 35 y/o and smoking /15/day
migraine with aura
history of VTE/stoke/IHD or thrombogenic mutation
breastfeeding <6weeks postpartum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
APL

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14
Q

Contraception: MoA

COCP
POP
Desogestrel only pill
Injectable contraceptive
Implant
IUD
IUS

A

COCP: Inhibits ovulation

POP: Thickens cervical mucous

Desogestrel only pill: inhibits ovulation AND thickens cervical mucous

Injectable contraceptive: inhibits ovulation AND thickens cervical mucous

Implant: inhibits ovulation AND thickens cervical mucous

IUD: Decreases sperm motility and survival

IUS: Prevents endometrial proliferation AND thickens cervical mucous

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15
Q

Emergency contraception MoA:

Levonorgestrel
Ulipristal
IUD

A

Inhibits ovulation

Inhibits ovulation

Toxic to sperm and ovum and inhibits implantation

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16
Q

What should all pregnant women at risk of pre-eclampsia take
When?

Hypertension in pregnancy numbers:

Management:
If asthmatic

A

Aspirin 75 mg
From 12 weeks until birth of the baby

> 140/90 or increase from booking of > 30/15 mmhg

Labetalol
Nifedipine and hydralazine

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17
Q

Induction of labour methods (6)

Which method to induce labour (Bishops score)

Main complication of induction of labour:

A

Membrane sweep
Vaginal prostaglandin E2
Oral Prostaglandin E1
Maternal oxytocin infusion
Amniotomy
Cervical ripening balloon

If Bishops <6 - Vaginal PGE2 or oral misoprostol
If Bishops > 6 amniotomy and IV oxytocin infusion

Uterine hyperstimulation - prolonged and frequent contractions
Manage by removing PGE2 and stopping oxytocin infusion

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18
Q

Intrahepatic cholestasis of pregnancy management:

A

Induction of labour at 37-38 weeks (not evidence based)
Urseodeoxycholic acid
Vit K supplementation

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19
Q

Secondary PPH timescale:
Causes

A

24 hours - 12 weeks
Retained placental tissue or endometritis

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20
Q

Anaemia pregnancy:
When screened:
Cut-offs:
Management:
How long shold treatment continue for post-correction?

A

Booking visit (8-10 weeks) and 28 weeks
1TM - <110
2TM - <105
3 TM < 100

Ferrous fumarate or sulphate -> Should be continued for 3 months post-correction

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21
Q

Obese women in pregnancy management
Folic acid dose:
Screening for which diseases
Delivery precautions based on BMI?

A

Folic acid 5 mg (rather than 400mcg)
Gestational diabetes screening with OGTT at 24-28 weeks
If BMI > 35 patient should give birth in consultant led unit
If BMI > 40 antenatal consultation with obstetric anaesthetist

22
Q

Preterm prelabour rupture of membranes
How to confirm:

Management:

A

Sterile speculum examination looking for pooling of amniotic fluid - NO digital exam (risk of infection)
Test fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor binding protein 1
US may also be useful

Admission
Erythromycin for 10 days
Antenatal corticosteroids
Consider delivery at 34 weeks

23
Q

Most common cause of puerperal pyrexia:

Other causes:

Management

A

Endometritis

UTI, Wound infection, mastitis, VTE

If endometritis suspected pt. should be referred for IV antibiotics (clindamycin and gentamicin)

24
Q

When to give anti-D immunoglobulin

Tests:
Coombs and Keihauer

Symptoms in affected foetus:

Treatment:

A

Delivery of a rhesus positive infant
Any ToP
Miscarriage if greater <12 weeks
Ectopic pregnancy (if managed medically with methotrexate, anti-D not required)
Antepartum haemorrhage
Amniocentesis CVS, foetal blood sampling
Abdominal trauma

All babies born to Rh -ve mother should have cord blood taken at delivery
Coombs test: direct antiglobulin - will demonstrate antibodies on RBCs of baby
Kleihauer test: Add acid to maternal blood, fetal cells resistant

Oedematous
Jaundice, hepatosplenomegaly, heart failure, kernicterus

25
Q

Rheumatoid arthritis in pregnancy:
Which drugs are not safe and when should they be stopped:

Which drugs are considered safe?

NSAIDS?

A

Methotrexate - at least 6 months prior to conception
Leflunomide

Sulphasalazine and hydroxychloroquine

Low dose corticosteroids may be used in pregnancy to control symptoms

NSAIDS may be used until 32 weeks buy after this time should be withdrawn due to risk of early closure of ductus arteriosus

26
Q

Manoeuvre for shoulder dystocia:

complications of shoulder dystocia

A

McRoberts

Maternal: PPH, perineal tears
Foetus: Brachial plexus injury, neonatal death

27
Q

Investigations for amenorrhoea

A

Exclude pregnancy - HCG
Gonadotrophins - low levels suggest hypothalamic cause where as raised levels suggest ovarian problem
Prolactin
Androgen levels (may be raised in PCOS)
Oestradiol

28
Q

Androgen insensitivity syndrome
Biologically which gender appearing as which gender?

A

46XY (MALE) with female phenotype

29
Q
A
29
Q

Cervical cancer:
HPV risk types
Other risk factors

A

16,18,33

Smoking, HIV, early first intercourse, many sexual partners, high parity, COCP

29
Q

Ectopic pregnancy management:

<35mm, unruptured, asymptomatic, no foetal heart beat, hCG <1000

<35mm, no foetal heartbeat, hCG <1500

> 35mm, can be ruptured, pain, foetal heartbeat hCG >5000

A

Expectant management - monitoring

Medical management - methotrexate

Surgical management - Salpingectomy if no other risk factors for infertility. Salpingotomy if risk factors

30
Q

Cancer which occurs largely due to unopposed oestrogen

Risk factors:
Protective factors:

Investigations:
Management:

A

Endometrial cancer

Early menarche, late menopause, nulliparity, obesity, DM, HNPCC

Smoking, COCP, multiparity

First line investigation is TVUS -> Hysteroscopy with endometrial biopsy

Surgery -> Progrestogen therapy considered if frail, old women not fit for surgery

31
Q

Endometriosis
Investigation:
management:

A

Laparoscopy

NSAIDs/paracetamol -> COCP/progestogens -> referral to secondary care for GnRH analogues, surgery

32
Q

Menorrhagia:

1) what is management dependent on:

2) Management:

3) Medication which can be used in short term only to rapidly stop heavy bleeding:

A

1) Need for contraception

2) No contraception: Mefanamic acid or tranexamic acid started on first day of period

2) Requires contraception: IUS (first line)
COCP

3) Norethisterone

33
Q

Current or past breast cancer
Any-oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

Are all contraindications for which drug therapy

A

HRT

34
Q

1) Medical management of miscarriage:
2) When should patients be offered pregnancy test after this:

3) Surgical management of miscarriage

A

1) Oral Mifepristone -> 48 hours -> PO, PV, SL Misoprostol (strong myometrial contractions)
If bleeding has not started within 48 hours of misoprostol treatment contact healthcare professional

2) 3 weeks from ToP

3) 2 options -> vacuum aspiration (suction curettage) or surgical management in theatre

35
Q

Ovarian cysts
1) Most common type of physiological cyst:

2) Most common benign ovarian tumour in women <30

3) Most common benign epithelial tumour

4) Second most common benign epithelial tumour which if ruptures may cause psuedomyxoma peritonei

A

1) Follicular cyst

2) Dermoid cysts

3) Serous cystadenoma

4) Mucinous

36
Q

Commonest cause of pelvic inflammatory disease

First line treatment for suspected PID:

A

Chlamydia trachomatis

IM ceftriaxone followed by 14 days of doxycycline and metronidazole

37
Q

1) Name of criteria for diagnosis of PCOS:

2) Management of hirsutism in PCOS

3) Management of infertility in PCOS

A

1) Rotterdam criteria

2) COCP -> topical eflornithine if not responding

3) lose weight -> ongoing debate - Clomifene and/or metformin (contesteD)

38
Q

1) Increase in gonadotrophins with menopausal symptoms in a female less than 40 y/o

2) Treatment:

3) Until what age

A

1) Premature ovarian failure

2) HRT

3) 51 (average age of menopause

39
Q

1) Management of menorrhagia secondary to fibroids

2) Treatment to shrink fibroids

A

1) IUS (only if uterine cavity NOT distorted), NSAIDS (mefanamic acid), Tranexamic acid, COCP, Progestogens

2) Medical - GnRH agonists - may reduce the size of the fibroid
Surgical - myomectomy, hysteroscopic endometrial ablation

40
Q

1) Management of vaginal candidiasis

2) If recurrent

A

1) Oral fluconazole as single dose (first-line) -> Clotrimazole pessary (if oral therapy contraindicated)

2) Once confirmed - induction maintenance regime Fluconazole for 3 doses (3 day intervals) then oral fluconazole for 6 months (weekly)

41
Q

Vaginal discharge:

1) Cottage cheese discharge, vulvitis itch

2) Offensive yellow/green frothy discharge, vulvovaginitis, strawberry cervix

3) Offensive thin white/grey fishy discharge

A

1) Candida

2) Trichomonas vaginalis

3) Bacterial vaginosis

42
Q

Hyperemesis, vaginal bleeding in first or early second trimester.
Large for dates, non-tender uterus

HcG level?

2-3% go on to develop:

A

Molar pregnancy

Elevated (very high)

Choriocarcinoma

43
Q

Contraception in epilepsy:
UKMEC 1

A

Phenytoin, carbamazepine, Topiramate: Depo-provera, IUD, IUS

Lamotrigine: POP, implant, depo-provera, IUD, IUS

In essence, IUD, IUS, depo-provera appear to be safest bets for epilepsy meds.

COCP tends to be UKMEC3 - less appt.

44
Q

1) Most effective form of contraception

2) Mechanism:

3) secondary mechanism

4) Additional contraception required if:

5) Main side effect:

A

Implant

Inhibits ovulation

Thickens cervical mucous

Not inserted on day 1-5 of a woman’s menstrual cycle

Irregular/heavy bleeding

45
Q

Injectable contraceptives:

1) Mechanism
2) How often does it need injected?
3) Adverse effects

A

Inhibits ovulation

Every 12 weeks (can be given up to 14 weeks without additional precautions

Irregular bleeding, weight gain, increased risk of osteoporosis, delay in fertility

46
Q

Implantable contraceptives:
1) IUD mechanism
2) IUS mechanism
3) IUD/IUS may be depended on after:

A

Prevention of fertilisation by decreasing sperm motility and survival

Prevents endometrial proliferation and causes mucous thickening

IUD instantly, IUS after 7 days

47
Q

Post-partum, after how many days should a female re-start contraception?

POP - when may it be started?

COCP - when may it be started?

Length of time after child-birth in which IUD/IUS may be inserted

A

21 days (3 weeks)

Anytime, additional contraception required for 2 days.

Absolutely contraindicated if breast feeding and <6 weeks
Should not be used in the first 3 weeks post-partum due to risk of VTE

Within 48 hours or after 4 weeks

48
Q

Lactational amenorrhoea method
How long is it effective for?
what are the conditions

A

amenorrhoeic, exclusively breast feeding and <6 months post-partum

49
Q

Progestogen only pill:

Most common side effect:

Immediate protection if started:

If not started in this time, how long should condoms be used for?

Missed pills: how long constitutes missed?
if > X hours late -> extra precautions?

Buffer zone for missed pill with Cerazette (desogestrel) ?

A

Irregular vaginal bleeding
Within 5 days of cycle
2 days (2 days to become active)

> 3 hours

Take as soon as possible. Condoms until pill taking has been re-established for 48 hours

12 hours

MSRA (8 decks)

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