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Medicine > Women's Health > Flashcards

Women's Health Flashcards

0
Q

What are the subdivisions of the first stage of labour?

A

Latent stage - from beginning of contractions to cervical effacement (~4cm dilated)
Active stage - cervical effacement to full dilation

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1
Q

When does the first stage of labour start and finish?

A

Onset of labour till the cervix is fully dilated

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2
Q

What is cervical effacement?

A

Thinning and stretching of cervix

The internal os and cervical canal is incorporated into uterus

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3
Q

Ideally, how quickly does the cervix want to dilate?

A

1cm per hour

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4
Q

When does the second stage of labour begin and end?

A

Begins when cervix is fully dilated

Ends when baby is delivered

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5
Q

What are the subdivisions of the second stage of labour and describe them?

A

Propulsive phase - fully dilated to head at pelvic floor

Exclusive phase - irresistible desire to ‘bear down/push’ to delivery of baby

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6
Q

What happens in the third stage of labour?

A

Expulsion of placenta and membranes

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7
Q

How long should the second stage of labour last?

A

<2 hours if no epidural

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8
Q

How long should the third stage of labour last?

A

<30 minutes

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9
Q

What is cervical dilation?

A

Increased diameter of the external os

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10
Q

What is operculum (‘show’)?

A

Blood stained mucous discharge (the plug of mucous from the cervical canal)
Occurs in 2/3 pregnancy in early labour

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11
Q

What is ‘waters breaking’?

A

Rupture of the membranes

75% occur after cervix is >9cm dilated

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12
Q

What is the difference in the cervix between a nulliparous and multiparous woman?

A

Nulliparous have a more tubular cervix

Multiparous have a more open/expanded cervix

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13
Q

What problems might you get in a primigravid mother?

A

Inefficient uterine contraction
Prolonged labour
Risk of cephalopelvic disproportion and foetal trauma

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14
Q

What is a risk in multigravid mother that has previously had a NVD?

A

Risk of uterine rupture

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15
Q

In which primigravid women is inefficient uterine contraction more common?

A 
Very young (teenagers)
Older (>40)
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16
Q

What rate of contractions can cause foetal distress?

A

More than 5 contractions in 10 minutes

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17
Q

What is caput?

A

Oedema of the scalp due to pressure of the head against the rim of the cervix

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18
Q

What is moulding?

A

Overlapping of the vault bones, altering the shape of the skull so the engaging diameters become shorter

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19
Q

What is engagement?

A

Descent of the biparietal diameter through the pelvic brim

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20
Q

When is the head of the foetus engaged?

A

When it is at the level of the ischial spines (not more than 2/5ths can be felt abdominally)

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21
Q

What is the lie of the baby?

A

Relation of the long axis of the foetus to that of the mother
Can be longitudinal, oblique or transverse

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22
Q

What is presentation?

A

The part of the foetus that is in the lower pole of the uterus
Can be cephalic, vertex or breech

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23
Q

What is the attitude of the foetus?

A

Posture of the foetus’ head

Can be flexion, deflexion or extension

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24
Q

What is meant by the position of the foetus?

A

Relationship of the presenting part of the foetus to the mother

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25
Q

What is the denominator?

A

Describes the position of the baby with respect to the mothers pelvis.
Eg left occipito posterior, right occipito lateral, direct occipito anterior

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26
Q

What is the normal denominator of the foetus?

A

Direct occipito anterior

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27
Q

What is the station of the foetus?

A

Relationship of the head to the ischial spines

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28
Q

What is fifths palpable per abdomen?

A

On examination, the amount of the head felt above the pubic symphysis and is expressed in fifths

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29
Q

What are the five steps of the mechanism of a normal birth?

A 
Engagement and descent
Flexion
Internal rotation
Extension
External rotation
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30
Q

What is syntocinon?

A

Synthetic oxytocin

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31
Q

What is oxytocin important in?

A

Effacement and stimulating uterine contraction

Neuromodulator of brain

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32
Q

What is syntocinon used for?

A

Inefficient uterine contractions

Postpartum haemorrhage

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33
Q

What does oxytocin cause?

A

Short rhythmic contractions

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34
Q

What is ergometrine used to treat?

A

Postpartum haemorrhage

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35
Q

What does ergometrine cause?

A

Tetanic contractions (prolonged spasms)

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36
Q

How quickly does ergometrine act?

A

IV - 40 seconds

IM - 6 minutes

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37
Q

What are the main side effects of ergometrine?

A

Nausea
Vomiting
Hypertension

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38
Q

What is syntometrine?

A

Combination of syntocinon (10iu) and ergometrine (500mcg)

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39
Q

What is syntometrine used for?

A

Active management of the third stage of labour - speeds up delivery of placenta to reduce blood loss

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40
Q

Give an example of a prostaglandin E2 analogue and when would you use it.

A

Dinoprostone - induce labour

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41
Q

What does prostaglandin E2 do in labour?

A

Ripens and effaces cervix

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42
Q

What is gravidity?

A

The number of times a woman has been pregnant

43
Q

What is parity?

A

The number of times a woman has given birth to a foetus with a gestational age of 24 weeks or more (regardless of alive or stillbirth)

44
Q

What is a risk in giving syntocinon?

A

Cause rupture of uterus (less likely in primigravid)

45
Q

What does meconium signify?

A

That the foetus may be in distress

46
Q

When is the triple test for Down’s syndrome conducted?

A

Between 15 and 20 weeks

47
Q

What is measured in the triple test?

A

Alpha-feta protein
Beta-hCG
Unconjugated oestradiol

48
Q

What tends to happen to pre-existing conditions during pregnancy?

A

1/3 improve
1/3 stay the same
1/3 deteriorate

49
Q

What does hypertension during pregnancy predispose to?

A

Pre-eclampsia

50
Q

When can pre-eclampsia develop?

A

Anytime after 20 weeks, usually in the last trimester (after 26 weeks)

51
Q

What are the characteristic clinical features of pre-eclampsia?

A

Hypertension
Proteinuria
With/without oedema

52
Q

When might a woman develop gestational hypertension?

A

Anytime after 20 weeks

53
Q

What is a complete molar pregnancy?

A

An egg with no genetic information is fertilised by a sperm and grows to become a lump of tissue, not a foetus

54
Q

What is a partial molar pregnancy?

A

An egg with no genetic information is fertilised by 2 sperm, and the placenta develops to become the molar growth

55
Q

Why do molar pregnancies need to be evacuated quickly?

A

They can develop into choriocarcinomas

56
Q

What is spontaneous miscarriage?

A

Spontaneous loss of pregnancy prior to viability (before 23 weeks and 6 days)

57
Q

When do the majority of miscarriages occur?

A

First trimester (upto 12 weeks)

58
Q

What is the cause of the majority of first-trimester miscarriages?

A

Chromosomal abnormalities

59
Q

What is a threatened miscarriage?

A

Bleeding in early pregnancy

60
Q

What is an incomplete miscarriage?

A

The products of conception remain in the uterus

61
Q

What is a silent miscarriage?

A

The embryo or foetus has died but a miscarriage has not yet occurred

62
Q

How many miscarriages must you have to be considered to have recurrent miscarriages?

A

Three consecutive

63
Q

What medical management is there for a miscarriage?

A

Mifepristone with misoprostol (prostaglandin)

64
Q

How would an ectopic pregnancy present?

A

Pain
5-8 weeks amenorrhea
Scanty brown vaginal bleeding
Tenderness

65
Q

What are the clinical features of a miscarriage?

A

PV spotting
Pain
Hyperemesis

66
Q

What can cause subfertility?

A 
Ovulation disorder
Sperm dysfunction
Tubal disease
Endometriosis
Coital failure
Uterine abnormalities
67
Q

What do ovulatory disorders tend to involve?

A

Hypothalamic-pituitary-ovarian axis

68
Q

Name some hypothalamic causes of ovulation disorders.

A

Eating disorder
Stress
Excessive exercise
Underweight

69
Q

What are some ovarian causes of ovulatory disorders?

A

Polycystic ovarian syndrome

Primary ovarian failure

70
Q

What classified PCOS?

A

Having 2 of the following criteria:
Hyperandrogenism
Oligo-ovulation/anovulation
Polycystic ovaries of ultrasound

71
Q

What is the treatment of ovulatory disorders that cause subfertility?

A

Ovulation induction, mainly by oestrogen anatgonists or gonadotropins

72
Q

What are the risks of ovulation induction?

A

Multiple pregnancies, eg twins

73
Q

What can cause sperm dysfunction that leads to subfertility?

A

Primary failure, eg failure of sperm production

Obstruction, eg congenital

74
Q

What are the fertility treatments for sperm dysfunction?

A

Intrauterine insemination
Donor insemination
IVF

75
Q

What can causes tubal disease leading to subfertility?

A

Infection
Inflammation
Trauma/Post op
Sterilisation

76
Q

What infections can causes tubal disease?

A

Chlamydia

Gonorrhoea

77
Q

What is the main inflammatory cause of tubal disease?

A

Endometriosis

78
Q

What are the treatment options for subfertility caused by tubal disease?

A

Tubal surgery
Ablation of endometriosis
IVF

79
Q

What are uterine fibroids?

A

Benign growth of smooth muscle of uterus

80
Q

What are the different types of fibroids?

A

Subserosal fibroids
Intramural fibroids
Submucosal fibroids

81
Q

What symptoms occur with fibroids?

A

Menorrhagia
Dyspareunia
Urinary frequency and urgency
May suffer miscarriages

82
Q

What are the treatments for fibroids?

A

Medication for symptoms, eg. NSAIDs, OCP

Surgery, eg. myomectomy (remove fibroid), hysterectomy

83
Q

What is an ovarian cyst?

A

Collection of fluid surrounded by a thin wall within an ovary

84
Q

What can ovarian cysts be sub classified into?

A

Epithelial
Stromal cell tumours
Germ cell tumours
Mixed/metastatic

85
Q

In reference to a gynaecological history, what is kappa?

A

The number of days she bleeds over the cycle length, eg. k=6/28

86
Q

For menorrhagia, what is it important to know?

A

Kappa
Last smear (when and results)
Parity
Contraceptive use (which one)

87
Q

What is the difference between primary and secondary dysmenorrhea?

A

Primary - not associated with an organic disease or psychological cause
Secondary - linked with a cause, eg endometriosis, PID

88
Q

What are the most common causes of menorrhagia?

A

Dysfunctional uterine bleeding

Fibroids

89
Q

What would make a diagnosis of dysfunctional uterine bleeding more likely than fibroids in menorrhagia?

A

A normal sized painless uterus on examination

90
Q

How does tranexamic acid treat menorrhagia?

A

An antifibrinolytic that you take during menstrual cycle.

Reduces blood loss by approx 50%

91
Q

Do oral progestogens have a role in the treatment of menorrhagia?

A

No - not in regular menorrhagia

92
Q

What is mefenamic acid and how is it useful in menorrhagia?

A

An NSAID

Good to reduce heavy bleeding and dysmenorrhea

93
Q

What can mefenamic acid be used in conjunction with?

A

Tranexamic acid

94
Q

What are the effects of the combined oral contraceptive pill in menorrhagia?

A

Reduce bold loss by 20-30%

Improves dysmenorrhea

95
Q

What are the effects of the (mirena) coil in treatment of menorrhagia?

A

Reduce blood loss by up to 90%

At 1 year, 30% are amenorrhoeic

96
Q

What is the treatment for menorrhagia patients who are very anaemic and bleeding continuously?

A

GnRH agonist or high dose progestogen to achieve amenorrhoea quickly

97
Q

When are surgical options applicable to menorrhagia?

A

When patient is sure family is complete and there is failure of medical treatment

98
Q

What are the three types of HRT?

A

Oestrogen only
Sequential HRT (14 days oestrogen, followed by 14 days O & P)
Continuous O & P

99
Q

Which patients are applicable for oestrogen only HRT?

A

Have had hysterectomy

100
Q

Which patients are applicable for sequential HRT?

A

Still have uterus and are in peri-menopause

101
Q

Which patients are applicable for continuous combined HRT (O & P)?

A

Patients who are at least 1 year after menopause

102
Q

What are the advantages of HRT?

A

Elimination of hot flushes, night sweats and vaginal dryness

Protects against osteoporosis

103
Q

What are the disadvantages of HRT?

A

Small increase in breast cancer and VTE

104
Q

What is classified as post-menopausal bleeding?

A

Vaginal bleeding more than 12 months after LMP

105
Q

What are uterine fibroids also known as?

A

Uterine leiomyomas

Medicine (19 decks)

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